Health and safety concerns

If you have had an accident or are injured at work, see our guidance on accidents at work and personal injury.

Asbestos was used 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. 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. 

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, various hydrocarbons and more.

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 'Control of diesel engine exhaust emissions in the workplace (HSG187)' 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, for example, 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 RCN 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: COSHH SR14

A hazardous substance has the potential to cause serious harm to your health. Some substances can cause asthma or other diseases, including cancer. Many can damage the skin, and some can cause serious long-term damage to the lungs. The effect can be immediate, such as dizziness or stinging eyes, or can take many years to develop, such as lung disease. Many of the long-term or chronic effects cannot be cured once they develop.

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.

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:

• infectious pathogens
• medicines such as cytotoxic drugs or nitrous oxide (Entonox)
• chlorine-based cleaning products.

Hazardous substances can enter the body by:

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

Control measures could include:

• eliminating the need to use the substance
• using a less harmful substance
• altering working procedures
• engineering controls, such as local exhaust ventilation
• where risk remains after other control measures have been implemented, the use of personal protective equipment (PPE).

If you have any concerns regarding hazardous substances in your workplace, raise your concerns with your manager immediately. 

Guidance can be found on the Health and Safety Executive (HSE) website, RCN Sharps Safety Tools of the Trade, and the NHS Staff Council Guidance on the safe use of chlorine-based disinfectant chemicals in the NHS. 

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 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 is 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 Health and Safety Executive (HSE) state that RAAC is “now life-expired. It is liable to collapse with little or no notice”.

As RAAC is generally not visible, i.e. it is behind walls, above ceilings, etc, 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 to provide a safe working environment. 

There's a need for immediate action by employers to identify if RAAC is present. 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 RCN Rep 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.

Further Information

RCN news story: Crumbling concrete: nursing staff must be briefed and properly protected

England:

Reinforced autoclaved aerated concrete (RAAC) in hospitals: management information - Gov.uk
Reinforced autoclaved aerated concrete (RAAC) - NHS England

Northern Ireland:

Safety Notice: RAAC Planks - Department of Health Northern Ireland

Scotland:

Safety Action Notice - NHS National Services Scotland
Reinforced Autoclaved Aerated Concrete (RAAC) Discovery Survey Programme - List of Properties

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 RCN’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.

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 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 reps. 

Read our guide on working in hot weather for how your employer should take steps to protect staff when working in elevated temperatures.

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:

• what is working time?
• breaks, daily and weekly rest
• on-call work
• night shifts.