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An accident is defined as an undesirable or unfortunate event that occurs unintentionally and usually results in harm, injury, damage or loss. If you have had an accident or are injured at work, see our guidance on accidents at work and personal injury.

Asbestos was used extensively in the construction and refurbishment of hospital buildings up until the late 1990s. Exposure to even very small amounts of asbestos can lead to cancer and a total ban on the use and import of all asbestos was introduced in 1999 in the UK. However, asbestos is not a problem of the past. Despite being banned from use, many buildings that were constructed before 2000 still contain asbestos-containing materials.

Our guidance on asbestos provides information about the risks and management of asbestos in the workplace.

Sometimes you may be asked to temporarily cover work elsewhere due to staffing shortages or other reasons.

If you are being redeployed in this way, please read our guide on redeployment and unsustainable pressures about your rights and your employer’s responsibilities, to ensure this is done safely. 

Treating people in inappropriate spaces is unsafe, undignified and unacceptable. There may also be increased health and safety risks for nursing staff including work related stress, sharps injuries, musculoskeletal injuries and an increase in violence and aggression from patients and their families due to long waits or a perception of undignified care.

Please read our guidance for members around corridor care and what you can do to raise your concerns.

What are DEEEs?

DEEEs contain a complex mixture of gases, vapours, liquid aerosols and particulate substances, which are the products of combustion. The main chemical constituents of DEEEs include carbon monoxide, carbon dioxide, nitrogen, oxides of nitrogen and various hydrocarbons.

Smoke from diesel engines may be blue, black or white. If a vehicle is emitting blue or black smoke, it should be taken out of use for maintenance, as the smoke emissions identify serious problems with the engine. Table 2 in the Health and Safety Executive (HSE) guidance document  identifies such emissions as representing a high exposure risk.

The major source of workplace exposure to DEEEs is from heavy vehicles that use diesel fuel, such as buses and lorries. Concerns have been raised in hospital settings about fumes from ambulances when queuing outside accident and emergency departments. The potential exists for these fumes to gather in indoor enclosed areas if they are near open windows or external air supply vents into buildings and foyers.

Are there health risks associated with DEEEs?

Information for employees

Your employer should provide you with specific information on DEEEs, which includes communicating the findings of risk assessments, and should cover:  

• hazards associated with diesel fumes 
• control measures they are putting in place to prevent/reduce exposure 
• how to report concerns.

If you have any concerns about how DEEEs are being managed in your workplace:

• raise your concern with your line manager 
• contact your ¹úÄÚ¾«Æ·ÒÁÈ˾þþþø¾ Representative and ask for their help and support  
• contact us if you would like further support and advice.

If you believe you are being exposed or have been exposed to DEEEs, complete and submit an incident report.

Further information is available from the HSE: 

A hazardous substance is a material or substance with one or more hazardous properties that can cause harm to a person either directly or indirectly.

For example, you may work directly with hazardous substances when administering specific drugs/medicines, and during the cleaning and disinfecting of surfaces and equipment. You may also be exposed indirectly during processes that create or release a hazardous substance e.g. surgical smoke.

It is easy to think of a hazardous substance as something which comes in a bottle or container and has warning signs on the label. However, that is not always the case and hazardous substances are present in a variety of forms including:

• liquids
• dust
• vapour
• fumes
• mists
• gas
• biological agents (e.g. bacteria, viruses, parasites). 

Hazardous substances may enter the body in several different ways and the form of the hazardous substances influences this. It is also possible for a substance to enter the body in more than one way.

• acute - an immediate reaction which may occur after one exposure or multiple exposures (e.g. skin irritation), or
• chronic - meaning it may take months or years to appear and is a result of repeated small exposures (e.g. exposure to hazardous medicinal products like chemotherapy drugs or anaesthetic gases). 

COSHH risk assessments

The Control of Substances Hazardous to Health 2002 Regulations (COSHH) and the Control of Substances Regulations (Northern Ireland) 2003 place a legal duty on employers to ensure exposure/potential exposure to hazardous substances in the workplace is prevented - or where this is not possible - adequately controlled. 

Employers should evaluate the risk from hazardous substances by the undertaking of a COSHH risk assessment, including:

• how, when and where the substance is used
• who is likely to be exposed
• the potential to cause harm
• the frequency of exposure, and
• the level of exposure.

The assessment should also include activities such as maintenance and cleaning, as well as emergency situations. 

The risk assessment should be carried out before the commencement of any work involving hazardous substances and in consultation with staff and/or their representatives, such a trade union representative.

The risk assessment should take into account substances which are:

• brought into the workplace* and handled, stored and used (e.g. disinfectants)
• produced or emitted (e.g. as gas, fumes, vapour dust etc) by a process or an activity, or as a result of an accident or incident
• used for, or arising from, maintenance, cleaning and repair work
• produced at the end of any process (e.g. wastes, residues, scrap etc)
• produced from activities carried out by another employer’s employees in the workplace (e.g. contractor).

(*This should also include any hazardous substances handled, stored and used, or which employees may be exposed to outside of the employer’s site/buildings (e.g. in community settings).)

Exposure in health and social care

In health and social care, some of the hazardous substance you may be exposed to in the workplace include:

• biological agents from exposure to blood, bodily fluids and airborne viruses (e.g. COVID-19, RSV, flu and fungi such as aspergillus (black mould)
• surgical smoke from electrocautery, lasers and ultrasonic devices, which may contain chemicals and biological agents
• hazardous medicinal products (e.g. medicines such as cytotoxic drugs)
• anaesthetic gases (e.g. nitrous oxide (Entonox))
• chemicals like chlorine-based cleaning products.

Hazardous substances can enter the body by:

• inhalation
• ingestion
• injection (for example, sharps or needlestick injuries)
• absorption through the skin or eyes.

Employers are required to implement control measures to protect you from exposure to hazardous substances. There should be a series of controls implemented and the risk assessment process will consider:

• eliminating the substance (e.g. changing the process or activity)
• using a less harmful substance or a different form of the substance
• altering working procedures or processes
• engineering controls, such as enclosed systems or local exhaust ventilation
• where risk remains after other control measures have been implemented, the use of personal protective equipment (PPE)
• providing information on the risk assessment and safe system of work to you
• monitoring controls to ensure they are effective - which may include air or surface monitoring and/or health surveillance.

Risk assessments must be recorded in writing where there are five or more employees. It is a good practice to do so anyway.

Labelling

Hazardous substances that are manufactured should have product labels which help identify the hazards associated with the substance. These will be in the form of a pictogram in the shape of a diamond with a distinctive red border and white background.

A safety data sheet (SDS) provides key information which can assist the COSHH assessment process including the hazard classification, exposure controls, workplace exposure limits, handling and storage and emergency measures. SDSs can be requested from suppliers or many are available online. However, it should be noted that not all substances have a SDS.

Under health and safety legislation, employers have a legal duty to ensure suitable and sufficient risk assessments are carried out and adequate control measures are put in place to reduce the risk of harm to staff and patients, so far as is reasonably practicable.

This includes ensuring nursing staff are provided with adequate personal protective equipment (PPE) to protect them from infectious diseases and prevent the spread of infection to others. The following ¹úÄÚ¾«Æ·ÒÁÈ˾þþþø¾ guidance should be helpful:

Respiratory risk assessment toolkit

Infection prevention and control

PPE at work

The principles outlined in the ‘hazardous substances’ section above also apply to infectious diseases/pathogens, as the Control of Substances Hazardous to Health Regulations (COSHH) apply to biological agents.

Lone workers are those who work by themselves without close or direct supervision. Our guidance on prioritising personal safety outlines your employer's responsibilities to protect lone working community staff, as well as the steps you can take to raise and escalate your concerns.

Please see our advice guide on moving and handling for information about using correct techniques, plus employer and employee obligations.

What is RAAC?

RAAC is a lightweight precast concrete material, which due to the autoclaving process results in the formation of air bubbles in the material. It was widely used in the construction of public and municipal buildings throughout the 1950s to the mid-1990s because it's cheap, lightweight and provides good thermal insulation. As a building material there are several structural deficiencies associated with RAAC which the Building Research Establishment has previously raised concerns about. These include cracking, excessive displacements and durability. It was primarily used in roof panels but was also used in walls and flooring systems. It can be hidden behind ceiling tiles or panels and coatings, so can be difficult to identify.

Hospitals and other health and social care buildings built or refurbished between the 1950s and mid-1990s are highly likely to contain RAAC.

Risks from RAAC

RAAC is weaker than traditional concrete and has a lifespan of approximately 30 years, after which it starts to deteriorate. RAAC planks can develop hairline fractures leading to collapse of the structure.  As RAAC is porous, water can seep through the structure causing further weakness and damage. The states that RAAC is 'now life-expired. It is liable to collapse with little or no notice'.

RAAC is generally not visible, i.e. it is behind walls, above ceilings and so on therefore it is likely that asbestos will also be present in buildings constructed prior to 2000. Employers must consider this risk and plan work appropriately to avoid disturbing or damaging asbestos.

As RAAC cracking may result in water ingress, there's a risk of water damage or damp areas in buildings, which are ideal conditions for mould to grow. Staff are at risk of breathing in spores which may cause or exacerbate respiratory issues or illness. In addition, mould and spores may impact on effective infection prevention and control. 

Action to address concerns

Employers have a duty under the Health and Safety at Work, etc Act 1974 and the Health and Safety at Work (Northern Ireland) Order 1978 to provide a safe working environment. 

There is a need for immediate action by employers to identify if RAAC is present in their buildings. If RAAC is suspected or confirmed, competent professionals, e.g. a structural engineer, should assess the immediate risk of harm. Where necessary, employers will need to put in place action plans for remedial work and temporary measures to reduce any risk of harm to staff and patients.

If you have concerns about your workplace, speak to your ¹úÄÚ¾«Æ·ÒÁÈ˾þþþø¾ representative who can ask:

• about the current status of any investigation and remedial work
• whether there are any risks you should be aware of
• what they are doing to protect you
• how they are keeping staff up to date.

You can also report any concerns about the buildings you work in to your manager and complete an incident report form. If you don't know who your ¹úÄÚ¾«Æ·ÒÁÈ˾þþþø¾ representative is, please contact us.

Further information

¹úÄÚ¾«Æ·ÒÁÈ˾þþþø¾ news story: Crumbling concrete: nursing staff must be briefed and properly protected

England:

Northern Ireland:

Scotland:

Hazardous substances can sometimes enter the body by injection; these are usually called sharps or needlestick injuries.

Please read our guidance in the 'hazardous substances' section above and in our publication on sharps safety for more information.

Staffing levels can be a health and safety issue, particularly due to the current unsustainable pressures in the workplace and the increased demands placed on staff. Our guidance on staffing levels advises on:

• employer responsibilities
• staffing levels
• reporting staffing incidents
• raising concerns.

You can also see the ¹úÄÚ¾«Æ·ÒÁÈ˾þþþø¾â€™s Nursing Workforce Standards. These apply across the UK to set the standard for nursing support in all settings, and include guidance for all staff and standard checklists to help identify areas of staffing improvement in your workplace.

Unsafe staffing levels can also lead to work-related stress. Please read our guidance on managing stress for more information.

If you are concerned about staffing levels where you work, contact us.

Your employer has a duty of care to you as an employee and should not put you at risk. If you are unable to get to your normal place of work, our guidance on travel disruption and getting to work explains the health and safety risks you should consider.

Incidents of violence and abuse can impact on both your mental and physical health. Employers have a legal duty to protect employees from violence at work by undertaking a risk assessment and acting on it.

You can read about your employer's obligations and what to do if you are assaulted in our violence in the workplace guidance. This includes:

• what to do if you are assaulted at work
• an explanation of your employer's duties
• third party sexual harassment and sexual assault.

Contact us for advice and support if you are concerned. 

Stress is not an illness, but it can make you ill. Employers have a legal duty to protect employees from stress at work by doing a risk assessment and acting on it. The risk assessment should be carried out in consultation with staff and/or their representatives, such a trade union representative.

It may be necessary to make a formal complaint in writing if work-related stress continues, and this could include the effects of unsustainable pressures in the workplace causing stress.

See our range of managing stress resources with guidance and information to support members, managers and ¹úÄÚ¾«Æ·ÒÁÈ˾þþþø¾ representatives. 

Working in extremes of temperature can lead to heat exhaustion and heatstroke. As heat is a hazard, workplace temperature should be factored into activity and area risk assessments for nursing staff, including those working in the community. In addition, increased temperatures should be considered in individual risk assessments for nursing staff with health conditions which may be exacerbated by heat. Heat should also be considered in pregnancy risk assessments.

Read our guide on working in hot weather for how your employer should take steps to protect staff when working in elevated temperatures. This includes providing access to drinking water, relaxing uniform policy, ensuring breaks are taken and controlling the temperature as far as is reasonably practicable

Working time regulations apply across the UK with the aim of ensuring standards of health and safety in the workplace. Our working time and breaks guide will help explain your rights in relation to:

• the definition of working time
• breaks, daily and weekly rest
• on-call work, and
• night shifts.

The global pandemic highlighted significant levels of concern about health and safety issues from members, staff, media and political commentators. These concerns focused on risks relating to:

• the provision of adequate Personal Protective Equipment (PPE)
• the interpretation and application of national guidance 
• assessment and management of risk to BAME and other vulnerable staff groups
• RIDDOR reporting by organisations and how we challenge non-compliance.

Much learning has been taken from this, however risks to the health, safety and wellbeing of staff and patients persist in many forms.

Reporting is key

In health and social care, reporting health and safety concerns is vital to protect patients, staff, and visitors from potential harm. Timely reporting helps identify risks early, ensures compliance with safety regulations, and supports a culture of accountability and continuous improvement in patient care and staff safety. A lack of incident reporting impacts on an organisational risk management process and organisational learning. 

Furthermore, staff who fail to, or delay reporting incidents locally and risk undermining any personal injury claims, industrial injury disablement benefits or Death in Service claims.

Raising concerns in the first instance

Our raising concerns toolkit is intended to show members and representatives the process in which the ¹úÄÚ¾«Æ·ÒÁÈ˾þþþø¾ supports raising concerns. This advice applies to all members who work in the NHS, independent sector and social care.

If you have any workplace health and safety concerns, follow your employer’s health and safety policy and contact us for advice as needed. The ¹úÄÚ¾«Æ·ÒÁÈ˾þþþø¾ can support further discussion and escalation of the concerns with your employer. Where they do not reach a satisfactory outcome, the ¹úÄÚ¾«Æ·ÒÁÈ˾þþþø¾ will consider whether further escalation to the relevant enforcement authority is required. 

What do I do next?

If your concerns are not addressed satisfactorily with the support of your ¹úÄÚ¾«Æ·ÒÁÈ˾þþþø¾ representative, the below model letters can be copied and sent to the relevant Health and Safety Executive office address at the top of the template. 

Template for England, Scotland and Wales

Template for Northern Ireland

In cases of fire safety, concerns can be escalated to your local fire and rescue service. Find out which service you should contact in , ,  and .

If you have not yet received support from your local ¹úÄÚ¾«Æ·ÒÁÈ˾þþþø¾ representative, please contact us.