Guidance on Manual Handling in Physiotherapy (4th edition)

Professional and legal framework

• Physiotherapists owe a duty of care to their patients, colleagues and employers. This includes treatment involving manual handling, delegation of treatment, and the provision of manual handling guidance, advice and education.
• Health and safety legislation provides a framework that can assist the physiotherapist through the process of risk assessment and risk management. Recording the process and the outcome of patient-specific risk assessment is an essential part of the physiotherapist’s commitment to patient care.
• The law recognises that it would not be reasonably practicable to eliminate all potentially hazardous work. In considering the reasonable practicability of avoidance, the utility – or potential benefit – of the act (in this case, treatment involving manual handling) is one factor to be considered. Utility alone is not a sufficient rationale to proceed with hazardous manual handling interventions regardless of risk. There is an absolute requirement to assess the risk arising, and reduce it so far as it is reasonably practicable.
• Balancing the potential benefits (utility) to patients arising from physiotherapy interventions involving manual handling with the potential risks to themselves, the patient and colleagues, as well as family and other unqualified workers, is central to physiotherapy practice.
• Employers (including physiotherapist employers eg owners or directors of private physiotherapy practices) have a duty to provide physiotherapists with a safe system of work and to provide appropriate health and safety-related training.

Risk management in treatment handling

• When treatment programmes are devised that involve manual handling, physiotherapists must assess that part of their work which is potentially hazardous and reduce the risks so far as is reasonably practicable. This must be recorded.
• Staff working in different specialisms will have differing skills. However, all physiotherapists will need relevant updating in manual handling throughout their career.
• Training must include relevant rehabilitation strategies, with especial reference to those to whom the rehabilitation process may be delegated.
• Physiotherapists must not use or condone unsafe systems of work. The use of additional suitably trained staff or equipment may need to be considered.
• Treatment goals must be realistic and achievable within available resources, or may need to be reconsidered.

Delegation, guidance and advice

• A physiotherapist may be an ideal person to contribute to the handling plan for a patient. Before acting to influence the handling of a patient by another, the physiotherapist must be clear in their mind whether their intention is to delegate or to offer guidance to assist in the decision-making process.
• All physiotherapists must be indemnified for their work and must be confident that they are working within their personal scope of practice.
• When undertaking handling, or delegating a handling task, the physiotherapist should ensure they are up-to-date with current good practice. They should understand that they remain accountable for their decision to delegate a task to another person, and should also consider who has managerial responsibility for that person.

Education and continuing professional development (CPD)

• Undergraduate physiotherapists should experience discrete manual handling training as part of their studies, both within their Higher Education Institution and on therapeutic placement within a problemsolving environment.
• Chartered physiotherapists should be aware that their physiotherapeutic skills and knowledge only confer proficiency in manual handling and should not promote themselves as a manual handling expert prior to additional, specific training in manual handling.
• Graduate physiotherapists should continue to develop skills, knowledge and experience within manual handling situations as an integral part of their CPD.
• All manual handling courses provided to chartered physiotherapists shall be provided by competent persons and contain certain common core elements.
• Physiotherapy assistants and technical instructors should receive appropriate manual handling training before handling patients.
• All levels of staff should receive regular updates on manual handling from a competent person.
• Chartered physiotherapists who accept responsibility for training others in manual handling, for example as back care advisers, must understand the obligations and responsibilities of this role.

Key Issues with regards to purchasers, commissioners and service planners

• The role of the purchaser (or commissioner) is to ensure that health services are planned and delivered in a way that meets the interests of patients and taxpayers rather than health care providers. The role of the provider is to deliver the agreed health care services. For Scotland, Wales or Northern Ireland, services are planned by health boards.
• Manual handling services are regarded as provider services. They may be purchased privately or commissioned as part of a service, for example, within an acute trust, one of the quality key performance indicators (KPIs) may relate to manual handling.