RIDDOR is the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013. HSE's guide to RIDDOR describes it as the law that requires employers, and other people in charge of work premises, to report and keep records of work-related fatalities, work-related injuries, diagnosed cases of reportable occupational diseases and certain dangerous occurrences. The report goes to the enforcing authority, which is either HSE or the local authority.
Home care raises questions that a factory or an office does not. The work happens in someone else's home, the people most at risk of injury are often the people being supported, and many incidents are also something CQC or the local authority needs to hear about. HSE publishes an information sheet written for this sector, Reporting injuries, diseases and dangerous occurrences in health and social care (HSIS1). Most of this guide follows it.
RIDDOR 2013 applies in Great Britain. Northern Ireland has its own regulations, the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (Northern Ireland) 1997, enforced by HSENI or the local council, as set out on HSENI's accident reporting page.
Who has to report
RIDDOR puts the duty on the responsible person. HSE's page on who should report says that an employer must report work-related deaths, and certain work-related injuries, cases of disease and near misses involving its employees, wherever they are working. That covers a carer hurt in a client's home just as much as one hurt in the office.
For people who are not at work, the test is different. Regulation 3 makes the responsible person for a non-worker the person in control of the premises. HSIS1 deals with the home care case directly. Its table of responsible persons says that for a death or hospital injury to a person not at work, such as a patient, volunteer or visitor, the responsible person is the person in control of the premises or, in domestic premises, the employer in control of the work activity. For a care visit in someone's own home, that is normally the agency.
HSIS1 also says that agencies supplying workers should make sure responsibility for reporting is clearly assigned, based on the facts of the employment relationship. If you use self-employed carers or supply staff to another provider, write down who reports what before an incident happens.
What has to be reported
HSIS1 lists what is reportable when it arises out of or in connection with work. For a home care agency, the categories that come up most are these.
| What happened | Who it happened to | Reportable when |
|---|---|---|
| Death | Anyone, at work or not | It was caused by an accident arising out of or in connection with work |
| Specified injury | A carer or other worker | It is on the list in regulation 4, such as most fractures |
| Over-seven-day injury | A carer or other worker | They are away from work, or cannot do their normal duties, for more than seven consecutive days |
| Injury to a non-worker | The person supported, a relative or a visitor | They are taken from the place of the accident directly to hospital for treatment |
| Occupational disease | A carer or other worker | A doctor tells you in writing that they have a reportable disease linked to their work |
| Dangerous occurrence | Nobody needs to be hurt | It is a listed near miss, such as a hoist collapsing |
Specified injuries to workers
Regulation 4 lists the specified injuries. They include any bone fracture diagnosed by a doctor other than to a finger, thumb or toe, amputations, injuries likely to cause permanent loss or reduction of sight, crush injuries to the head or torso, serious burns, scalping requiring hospital treatment, and loss of consciousness caused by a head injury or asphyxia.
Over-seven-day injuries
Regulation 4(2) applies where a worker is incapacitated for routine work for more than seven consecutive days because of an injury from a work-related accident. HSIS1 says the seven days do not include the day of the accident but do include weekends and rest days.
Over-three-day injuries are not reported, but they must be recorded. Regulation 12 requires a record of any work-related injury that keeps a person off routine work for more than three consecutive days.
Violence to carers
HSIS1 says acts of non-consensual violence to a person at work that result in death, a specified injury or more than seven days' incapacity are reportable. An injury caused by a colleague during a dispute about a personal matter, or by a relative or friend visiting about a domestic matter, is not.
Diseases and sharps
A disease is reportable when a registered medical practitioner tells you in writing that an employee has a disease listed in RIDDOR and does work linked to it. HSIS1 gives a care assistant splashed in the face with a service user's bodily fluids who becomes hepatitis B positive as a reportable example. Influenza that cannot reliably be linked to work, because it is common in the community, is given as a case that is not reportable.
For sharps, HSIS1 says an injury is reportable as a dangerous occurrence where the sharp is known to be contaminated with a blood-borne virus such as hepatitis B, hepatitis C or HIV. It is reportable as a disease if a blood-borne virus is acquired that way, and as an over-seven-day injury if the injury itself is severe enough. A community nurse's needlestick injury where the source cannot be traced and no infection follows is not reportable. HSE also says you do not have to name the injured person on a blood-borne virus report, although you may be asked for the name if it investigates.
Work-related stress is not reportable as occupational ill health, HSIS1 says, even with a medical certificate, because it does not come from a single definable incident.
Falls and injuries to the people you support
This is where most of the uncertainty sits. HSE's page on RIDDOR in health and social care says there is often uncertainty about incidents that involve members of the public, such as residents in a care home.
Regulation 5 applies when a person not at work suffers an injury as a result of a work-related accident and is taken from the site of the accident to a hospital for treatment. HSIS1 adds that examinations and diagnostic tests do not count as treatment.
The question is whether the accident arose out of or in connection with the work. HSE's RIDDOR explained page says reportability does not depend on finding blame, and that an accident may still be reportable even where no law was broken and no one was clearly at fault. HSIS1 says a fall is reportable when it arose out of or in connection with a work activity, including where equipment, or how and where the work was carried out, organised or supervised, was involved.
HSIS1's examples translate directly to home care:
- Reportable. A service user falls out of bed, is injured and taken to hospital, and the assessment had identified the need for bedrails, but they or other preventative measures had not been provided.
- Reportable. A service user needs hospital treatment after sliding through a sling while being hoisted from a chair, and the wrong-sized sling was used.
- Reportable. A service user who could understand and follow advice is left alone on the toilet for dignity, gets up and falls, and the carer had left them out of earshot without a call bell they could use, when the care plan said they needed assistance or supervision.
- Not reportable. A service user falls out of bed and is taken to hospital, and a detailed assessment in the care plan had found that fall protection was not needed.
- Not reportable. A service user is found on the floor, no one saw it happen, there is no obvious work-related contributing factor, and the care plan assessment found fall protection was not needed.
HSIS1 says you may need to look at the person's care plan to decide what care was assessed as appropriate, and to ask those responsible for the plan if it is still unclear. That makes the risk assessment and the record of what the carer actually did part of the reporting decision. It also lists a patient or visitor injured by violence from another patient, and deliberate self-harm, as not reportable under RIDDOR.
HSIS1 also notes that an incident that is not reportable is still covered by the Health and Safety at Work etc. Act 1974. HSE's page on who regulates health and social care says that where another regulator has patient or service user safety in its remit and the powers to secure justice, HSE will not in general investigate, and lists the kinds of incident it would. For a registered home care agency in England, that other regulator is usually CQC.
Dangerous occurrences
A dangerous occurrence is a listed near miss with the potential to do significant harm, reportable even if nobody is hurt. HSIS1's health and social care examples include a patient hoist that collapses or overturns, even when the person in it is not injured. It says the failure of a lifting sling during a lift does not need to be reported, because failures of lifting accessories are not dangerous occurrences. The full list is in Schedule 2 of the regulations.
Deadlines
HSIS1 sets out the timescales:
- A reportable death, specified injury or dangerous occurrence must be notified to the enforcing authority without delay, and reported within 10 days of the incident.
- An over-seven-day injury must be reported within 15 days of the incident.
- A disease must be reported as soon as a registered medical practitioner tells you in writing that your employee has a reportable work-related disease.
- Where an employee dies within one year of a specified injury, the employer must tell the enforcing authority in writing, whether or not the original injury was reported.
HSE advises reporting as soon as possible even where a longer timescale applies.
How to report
HSE's page on how to make a RIDDOR report says the responsible person should complete the appropriate online RIDDOR form. There are separate forms for an injury, a dangerous occurrence and a case of disease. For fatal accidents and specified injuries to workers only, HSE says you can also phone 0345 300 9923. Every incident can be reported online.
HSE's coding guidance for the sector says all health and social care incidents should be recorded under the main industry "Government administrative functions, Education, Health". For incidents in a service user's own home, it says the activity depends on the work being done, and gives a home carer injured helping someone out of bed as "Non-residential social work / Elderly, disabled". The same coding is used when the person injured is the service user rather than the carer. It also warns against coding care in a person's own home as "Accommodation".
HSIS1 says that failing to report a reportable incident is a criminal offence and may lead to prosecution, and that reporting is not an admission of liability.
Records you must keep
Regulation 12 requires a record of every reportable incident and diagnosis, and of every over-three-day injury, kept for at least three years. HSE's page on records says that if you do not keep a copy of the online form, the record must include the date and method of reporting, the date, time and place of the event, personal details of those involved, and a brief description of the event or disease. It adds that information in a RIDDOR report is not passed to your insurer, so you need to tell them separately if they need to know.
RIDDOR is not your CQC notification
HSIS1 says the reporting requirements of other regulators are separate from and distinct from the duty under RIDDOR. One fall can lead to three reports:
- a RIDDOR report to HSE, if the work contributed and the person went to hospital for treatment
- a statutory notification to CQC, if the injury meets the serious injury test in CQC's regulations
- a safeguarding concern to the local authority, if neglect or abuse may be involved
Where something has gone wrong in the person's care, the duty of candour may also apply. Each has its own test, and sending one does not complete the others.
A short checklist for the office
- Name who decides whether an incident is RIDDOR reportable, and who covers when they are away
- Write down who reports for self-employed or supplied staff
- Ask carers to report any injury to themselves and any fall or injury to a client the same day
- Check the care plan and risk assessment before deciding whether a client's injury arose from the work
- Count absence days from the day after the accident, including weekends and rest days
- Save the RIDDOR reference and a copy of the form with the incident
- Decide separately whether CQC, the local authority or the person's family also need to be told
- Keep records for at least three years
Where homecareOS fits
The decision to report, and the report itself, belong to the agency. In homecareOS, an incident is recorded in the compliance area, where follow-up actions are assigned and safeguarding referrals are tracked against it, so the record of what happened sits alongside the care plan and risk assessment that the reportability question depends on. homecareOS does not send RIDDOR reports to HSE and does not decide whether an incident is reportable. Use HSE's online forms for that.
Sources
- Reporting injuries, diseases and dangerous occurrences in health and social care (HSIS1 rev4), Health and Safety Executive, for who reports, the deadlines, the health and social care examples, sharps, stress, dangerous occurrences, record keeping and the relationship with other regulators.
- RIDDOR in health and social care, Health and Safety Executive, for how to code incidents in a service user's own home.
- RIDDOR explained, Health and Safety Executive, for what RIDDOR is, what counts as an accident, and the point that reportability does not depend on blame.
- Who should report under RIDDOR and How to make a RIDDOR report, Health and Safety Executive, for employers' duties, agency workers, the online forms and the telephone service.
- What records do I need to keep?, Health and Safety Executive, for the content of records and the point about insurers.
- Who regulates health and social care, Health and Safety Executive, for when HSE investigates incidents involving service users.
- Regulation 3, regulation 4, regulation 5 and regulation 12, Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013, for the responsible person, specified and over-seven-day injuries, injuries to non-workers, and records.
- Accident reporting, Health and Safety Executive for Northern Ireland, for the separate Northern Ireland regulations.
- Compliance features, for how homecareOS records incidents and follow-up actions. That page describes the product.