Dr Richard Dune

17-02-2023

What is the role of the Health and Safety Executive?

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Understanding the HSE’s influence across workplaces, including the health and social care sector

In Great Britain, health and safety laws apply to all work environments and public spaces. Whether in a factory, farm, offshore platform, care home, hospital, or classroom, the same principles apply: risks must be identified, controlled, and reduced.

But who enforces this? Who ensures employers comply with safety legislation, and how are failures addressed?

That responsibility lies with the Health and Safety Executive (HSE), Britain’s national regulator for workplace health, safety, and welfare. In this blog, Dr Richard Dune explores the evolving role and responsibilities of the HSE, how it works with other regulators, and what organisations across sectors, especially in health and social care, must understand to stay compliant, safe, and resilient.

What Is the Health and Safety Executive?

The Health and Safety Executive (HSE) is an independent regulator operating under the Department for Work and Pensions (DWP). Its statutory role is to prevent work-related death, injury, and ill health, and it does so by combining enforcement powers with education, guidance, and strategic engagement.

Established by the Health and Safety at Work etc. Act 1974, the HSE absorbed several earlier inspectorates, including the Factory Inspectorate and the Railway Inspectorate (later transferred to the Office of Rail and Road).

Today, the HSE remains the cornerstone of health and safety enforcement across England, Scotland, and Wales, covering over 1.5 million businesses and over 30 million workers.

The Legal and strategic foundation

The HSE’s regulatory powers come primarily from the Health and Safety at Work etc. Act 1974, but its authority extends to enforcing over 200 pieces of secondary legislation, such as:

• Management of Health and Safety at Work Regulations 1999
• Manual Handling Operations Regulations 1992
• Control of Substances Hazardous to Health (COSHH) 2002
• Provision and Use of Work Equipment Regulations (PUWER) 1998
• Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) 2013.

The underpinning principle of British health and safety law is that:

“Those who create risks are best placed to manage them.”

The HSE ensures that dutyholders, employers, service providers, and sometimes employees, understand, assess, and control these risks appropriately.

HSE’s core responsibilities

The HSE operates with a clear mission: “to protect people and places”. Its key responsibilities include:

• Regulation and enforcement
• Advice and guidance
• Targeted inspections and investigations
• Licensing and permissioning.

Regulation and enforcement

The HSE performs crucial regulatory and enforcement duties to ensure compliance with health and safety legislation, which includes:

• Enforcing compliance with health and safety laws
• Investigating breaches, incidents, and complaints
• Serving Improvement or Prohibition Notices
• Prosecuting where legal duties have been violated.

Advice and guidance

The HSE provides comprehensive advice and guidance to assist employers, workers, and the wider public in understanding and meeting safety standards, such as:

• Providing accessible information for employers, workers, and the public
• Issuing safety alerts and sector-specific guidance
• Hosting online tools and templates for risk assessments and reporting.

Targeted inspections and investigations

Proactive inspections and thorough investigations are central to the HSE's approach to identifying and addressing safety issues, including:

• Conducting proactive inspections based on risk profiles
• Investigating incidents that meet RIDDOR and internal selection criteria.

Licensing and permissioning

In high-hazard industries, the HSE plays a key role in controlling activities through a robust licensing and permissioning framework, which involves:

• Operating control regimes in major hazard industries, such as chemicals, nuclear, and offshore oil.
• Issuing licences for activities such as the use of explosives and asbestos work.

Influence and engagement

Beyond direct enforcement, the HSE actively works to shape positive safety cultures and public awareness, through efforts such as:

• Influencing industry culture, behaviours, and attitudes
• Running national safety campaigns (e.g. stress, manual handling, fire risks).

HSE and the health and social care sector

While the Care Quality Commission (CQC), Ofsted, and professional bodies such as the General Medical Council (GMC) and the Nursing and Midwifery Council (NMC) regulate clinical quality, care standards, and professional practice, the HSE focuses on workplace safety and risk management.

Its responsibilities in health and social care settings include:

• Ensuring the safety of staff, including nurses, carers, therapists, and support workers
• Safeguarding residents, patients, visitors, and contractors from non-clinical harm
• Enforcing legal duties under the Health and Safety at Work etc. Act 1974 and supporting regulations
• Promoting systemic safety governance in environments where vulnerable people receive care.

This remit applies across settings such as:

• NHS and independent hospitals
• Residential care homes and nursing homes
• Domiciliary care services
• GP and dental surgeries
• Day centres and supported living
• Mental health units.

Providers are expected to embed robust health and safety procedures into their governance structures, not as an afterthought, but as an integral part of their operational priorities.

What triggers an HSE investigation?

The HSE investigates serious non-clinical safety incidents that result in:

• Death or life-altering injury
• Significant breaches of safety law
• Systemic failures in organisational risk management.

An incident must also meet one of two additional criteria:

• It is reportable under RIDDOR (e.g. fatal falls, scalding, manual handling injuries); or
• The harm was caused by failure to comply with established safety standards, such as a national safety alert, internal policy, or industry-recognised good practice.

Examples of incidents the HSE may investigate include:

• A resident dies from a fall due to an unmaintained stairlift
• A care worker suffers a spinal injury while lifting a service user without training
• Fire from faulty electrics causes injury or evacuation
• Inadequate PPE or COSHH controls lead to infection or illness.

What the HSE will not investigate

• Incidents caused by clinical judgement or treatment errors
• Concerns related to hydration, nutrition, or care planning
• Disputes over diagnosis or prescribing
• Any matter better handled by another regulator (e.g. CQC, CIW, GMC, NMC, HCPC).

In such cases, the HSE defers to the most appropriate body, ensuring that enforcement and improvement efforts are proportionate and targeted.

Working with other regulators

The HSE collaborates closely with other health and social care regulators to ensure a coordinated approach to regulation. This includes formal Memoranda of Understanding (MoUs) and liaison agreements that outline referral mechanisms and data-sharing protocols.

In England

• Care Quality Commission (CQC) - Responsible for monitoring and inspecting care services. The HSE and CQC collaborate on incident reviews involving workplace safety and safeguarding.
• Ofsted - Where environmental risks affect children’s settings, the HSE may support Ofsted investigations.

In Scotland

• Healthcare Improvement Scotland (HIS) - Oversees healthcare quality; HSE intervenes on physical risks in hospital environments.
• Care Inspectorate - Focuses on care provision; HSE addresses equipment, staffing, safety, and hazardous substances.
• Mental Welfare Commission (MWC) - Coordinates on risks in mental health and learning disability settings.

In Wales

• Healthcare Inspectorate Wales (HIW) and Care Inspectorate Wales (CIW) - Inspect care quality and safety; collaborate with HSE on environmental and occupational safety concerns.
• Local authorities - Enforce environmental health law; work with HSE on shared investigations.

Fire safety and the HSE

The HSE regulates process fire risks, such as those caused by:

• Flammable substances (e.g. alcohol-based hand gels, gas cylinders)
• Electrical systems or appliances
• Faulty equipment that is stored or used incorrectly.

However, general fire precautions, such as escape routes, fire exits, signage, fire alarm testing, and evacuation drills, fall under the Regulatory Reform (Fire Safety) Order 2005, which is enforced by the local Fire and Rescue Service (FRS).

The tragic Rosepark Care Home fire in 2004, in which 14 elderly residents died, demonstrated the need for joint enforcement. Following that event, multi-agency coordination between the HSE, fire authorities, and care regulators became a model for future response and prevention.

Common health and safety failures in care settings

During inspections and investigations, the HSE often finds the following issues in health and social care:

• Incomplete or generic risk assessments, not tailored to the environment or task
• Inadequate staff training, especially in manual handling, fire safety, and COSHH
• Poor equipment maintenance (e.g. hoists, wheelchairs, bed rails)
• Unsafe storage of hazardous substances (e.g. cleaning chemicals, oxygen cylinders)
• Failure to report serious incidents under RIDDOR
• Weak infection prevention and control, particularly in shared spaces
• Lack of fire drills and emergency planning.

These failings are often systemic, reflecting poor leadership, fragmented responsibilities, or inadequate board-level oversight.

HSE priorities for 2025–2030

In its current strategy and business plan, the HSE outlines enforcement and engagement priorities for the care sector, including:

Manual handling injury reduction

Reducing musculoskeletal injuries among staff through better equipment, training, and supervision.

Workplace mental health

Ensuring employers identify and mitigate risks of work-related stress, fatigue, and burnout, especially in high-pressure care environments.

Fire safety in high-dependency residential settings

Improving fire risk assessments, escape planning, staff training, and building maintenance.

Safe use of technology

Focusing on risks linked to care equipment (hoists, alarms), digital devices, and data systems used in care delivery.

Safe staffing and supervision

The HSE recognises that under-staffing or inadequate supervision can contribute to avoidable harm. This includes:

• Increased physical strain on carers, leading to manual handling injuries
• Higher risk of mistakes due to fatigue or lack of breaks
• Poorly managed lone working in domiciliary care Delayed emergency response or lapses in supervision in residential settings.

Organisations must ensure they have sufficient staffing levels, particularly during nights, weekends, and holiday periods, and that supervision is structured, documented, and risk-based.

Integration with digital safety and data protection

While data protection is primarily enforced by the Information Commissioner’s Office (ICO), the HSE remains interested in the physical implications of digital care delivery, including:

• Staff are required to use unfamiliar electronic records without training
• Risks introduced by poor ergonomics or screen overuse
• Alarms or alert systems that do not integrate with manual response protocols
• Failures in digital monitoring systems for high-risk residents (e.g. fall detection).

Organisations are encouraged to conduct digital risk assessments as part of their health and safety governance.

Embedding HSE standards into organisational governance

For health and social care providers, meeting HSE expectations isn’t just about passing inspections; it’s about integrating risk management into day-to-day operations. Key recommendations include:

Clear and accessible policies

Every care setting must have a health and safety policy tailored to its environment. These should be:

• Regularly reviewed
• Accessible to all staff
• Reinforced through training and leadership.

Competent people and named roles

Employers must appoint competent persons to oversee safety; this may be a health and safety officer, registered manager, or board lead. Their responsibilities must be clearly defined and supported.

Continuous training and supervision

Mandatory training should cover:

• Manual handling
• Fire safety and evacuation
• Infection prevention and control
• COSHH
• RIDDOR and incident reporting
• Stress management and mental health.

Refresher training must be scheduled and recorded.

Regular risk assessments and audits

Dynamic risk assessments should be conducted for:

• Individual residents or service users
• Workplace tasks and equipment
• Environmental factors (e.g. layout, temperature, hygiene).

Findings should be acted on and monitored over time.

Effective incident reporting and learning

An incident must be seen as a learning opportunity. Organisations should have systems that enable:

• Prompt reporting
• Root cause analysis
• RIDDOR compliance
• Sharing of lessons across teams
• Tracking of improvement plans.

Sector-specific challenges and responses

Different care settings face unique health and safety challenges, requiring tailored responses and strategies.

Residential care homes

• Challenges - Staffing, ageing infrastructure, fire safety, medication security
• Response - Regular environmental checks, fire risk reassessments, and equipment logs.

Domiciliary care agencies

• Challenges - Lone working, fatigue, time pressures
• Response - Lone working policies, GPS check-in/out systems, mental health support.

Mental health units

• Challenges - Self-harm risk, physical restraint, ligature points
• Response - Specialised risk assessments, restraint training, and incident debriefing.

NHS and independent hospitals

• Challenges - High patient throughput, complex care, multidisciplinary teams
• Response - Integrated incident reporting systems, floor-specific audits, shift briefings.

What employers must do to stay compliant

The HSE expects all employers to take a proactive, proportionate, and transparent approach to health and safety. In the care sector, this means:

• Having a named health and safety lead at the executive level
• Including health and safety in Quality Assurance and Governance frameworks
• Reporting incidents under RIDDOR within prescribed timeframes
• Cooperating with other regulators and following up on inspection findings
• Demonstrating a culture of continuous improvement through audits and reviews.

Innovation, technology and the future of regulation

The HSE has recognised that innovation brings both new solutions and new risks. In response, it is:

• Developing guidance on Artificial Intelligence (AI) in workplaces
• Reviewing implications of wearables, remote monitoring, and robotics
• Engaging with digital-first service providers to ensure ergonomics, data handling, and human oversight are not compromised by technological adoption.

Health and social care providers investing in tech solutions must strike a balance between achieving efficiency gains, reducing risk, ensuring training, and ensuring regulatory compliance.

Responding to criticism and public perceptions

The HSE has faced its share of criticism, often accused of promoting a “nanny state” or contributing to “compensation culture.” In reality:

• Many so-called “health and safety bans”, e.g. children playing conkers, banning birthday candles, were misreported
• The HSE addressed these concerns with its “Myth of the Month” campaign (2007–2010)
• The HSE maintains that most of its work is focused on serious harm prevention, not minor inconveniences or public misconceptions.

HSE has worked to demystify regulation and assure the public that health and safety laws are practical, proportionate, and evidence-based.

Who regulates the regulators?

As an executive non-departmental public body, the HSE is:

• Accountable to Parliament through the Department for Work and Pensions (DWP)
• Subject to oversight via annual reports, strategic plans, and public scrutiny
• Required to demonstrate value for money, proportionality in enforcement, and outcomes in line with the national strategy.

The HSE works closely with:

• The Professional Standards Authority (PSA)
• Office for Product Safety and Standards (OPSS)
• Environmental regulators (e.g. Environment Agency, SEPA)
• UK Health Security Agency (UKHSA) for biohazards and pandemic response.

How the HSE supports dutyholders

The HSE’s role extends beyond enforcement; it plays a vital part in education, prevention, and engagement. Recognising that most employers want to comply but may lack resources or clarity, the HSE equips them with the tools and support necessary to manage risks effectively and proportionately.

Here are key ways the HSE supports dutyholders:

Free access to guidance and legal resources

The HSE’s website is a comprehensive portal offering:

• Up-to-date legislation and guidance covering every primary industry
• Step-by-step templates for risk assessments, policy development, and incident reporting
• Downloadable documents on topics like COSHH, PUWER, and workplace stress
• Approved Codes of Practice (ACOPs) that interpret the law and clarify what compliance looks like in practice.

This guidance helps providers meet both their statutory duties and best practice standards, whether they’re SMEs or large care groups.

Practical tools and calculators

To encourage continuous improvement, the HSE has developed several interactive tools, including:

• The Manual Handling Assessment Charts (MAC tool)
• The ART Tool for assessing repetitive tasks
• The Stress Management Standards Indicator Tool, which helps employers address psychological risk factors
• RIDDOR decision trees to determine reportability
• The COSHH e-tool for evaluating exposure to hazardous substances.

These tools enable care providers and other employers to identify risks early, assign responsibility, and evidence decision-making.

Sector-specific campaigns and case studies

The HSE uses real-world case studies and national campaigns to raise awareness of sector-specific risks. In health and social care, this includes:

• “Safe handling in care homes” - promoting correct manual handling techniques
• “Helping GB work well” - focusing on building a safety culture across sectors
• Spotlight on stress and fatigue in domiciliary and residential care
• Case studies of enforcement actions which provide learning without the consequences.

These resources can be used in staff inductions, refresher training, and governance reports.

‘When an inspector calls’ and inspection checklists

The HSE publishes a guide titled “When an inspector calls”, helping providers:

• Understand the purpose and scope of an HSE visit
• Prepare required documentation, e.g. training logs, risk assessments
• Know what questions inspectors may ask staff and managers
• Avoid common pitfalls that result in enforcement notices.

This transparency demystifies inspections and encourages a partnership approach to compliance.

The OSHCR - Occupational Safety and Health Consultants Register

For organisations requiring external support, the Occupational Safety and Health Consultants Register (OSHCR) lists verified consultants who meet professional standards. These experts can assist with:

• Creating bespoke health and safety frameworks
• Conducting independent audits
• Investigating near misses or recurring incidents
• Advising on complex or multi-site risks.

This empowers providers to access trusted advice without engaging unqualified consultants.

Final thoughts - The Health and Safety Executive’s lasting value

The Health and Safety Executive is more than an inspectorate. It is a national safeguard that quietly but powerfully protects millions of people across thousands of workplaces, every single day.

Its role in health and social care is not to duplicate clinical regulation but to ensure that the environments in which care is delivered are safe, well-managed, and legally compliant. By regulating employers rather than clinical decisions, the HSE ensures that both workers and service users are protected from preventable harm.

In the years ahead, as the care sector navigates complex challenges such as digital transformation, workforce shortages, and increasing demand, the HSE’s oversight will continue to evolve. But its core mission, to prevent death, injury, and ill health, remains as vital as ever.

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Last updated on 03-07-2025