Health and Safety Executive Report - Notification of Contravention
Meeting: Trust Board – Public Meeting
Date: 9 July 2025
Report Title: Health and Safety Executive - Notification of Contravention
Agenda Item: PUB25/07/3.2
Author: Martin Judd (Head of Health, Safety and Security)
Lead Director: Simon Chase (Chief Paramedic and Director of Quality)
Purpose:
- Discussion/Review
- Information/Noting
Assurance: Reasonable
Link to CQC domain:
- Caring
- Responsive
- Effective
- Well-led
- Safe
Link to EEAST’s Strategic Mission:
- Patient Mission
- Partnership Mission
- People Mission
- Productivity Mission
Link to Strategic Risk:
- SR1 Demand and Capacity
- SR2 Quality Governance
- SR8 Staff Retention
- SR9 Organisational Development
Equality Impact Assessment: No negative impact identified
Previously considered by: Trust Board (May 2025), Health and Safety Executive relationship team (June 2025)
Purpose: As the national regulator for workplace health and safety, the HSE has statutory powers which allow them to enforce health and safety regulations to prevent work related deaths, injury and ill health.
In fulfilling their role, the HSE can and will often send inspectors to a business or site to ensure that all regulations are being adhered to correctly and where concerns are raised or issues identified, they have the power to act which can include issuing appropriate notices.
A Notice of Contravention is a notice served on you by the HSE to explain that they suspect or have seen something that is against Health and Safety legislation.
The HSE have asked EEAST to explain what we are going to do regarding the Material Breaches and to provide evidence as soon as possible which explains how we will put things right.
Recommendation: The Trust Board is asked to review and discuss the current position of the actions undertaken by the Trust since the Notice of Contravention was received.
Executive Summary:
Following an announced visit to the Trust and interviews with staff in September 2024. EEAST received a Notice of Contravention from the Health and Safety Executive (HSE) in April 2025 relating to Material Breaches of the management of work-related stress.
The HSE is of the opinion that EEAST have breached the Management of Health and Safety at Work Regulations 1999 – specifically Regulations 3, 4 and 5:
Regulation 3 Suitable and sufficient risk assessment of risks to health and safety of employees at work.
Regulation 4 Any preventative and protective measures will use the principles specified in the regulations (avoid, adapt, instruct, priority to collective measures).
Regulation 5 Appropriate arrangements for the effective planning, organisation, control, monitoring and review of the preventative and protective measures taking into account the nature of activities and the size of undertaking.
EEAST have actively engaged with the HSE and have a series of arranged relationship meetings to discuss current and improved practices to ensure the safety of our people. Due to this being a new area for HSE, the partnership approach is for EEAST to be the ‘trail blazers’ and the HSE will work with the Trust to identify ‘good practice’ for the Management of Work-Related Stress within the Ambulance Service Sector.
The Trust have successfully submitted the new look risk assessments to the HSE in line with the first timeframe of 01 July 2025 and is currently awaiting feedback as to submission.
Introduction / Background
Employers have a legal duty to protect workers by assessing the risk from causes of work-related stress and acting upon their findings. HSE defines stress as “the adverse reaction people have to excessive pressure or other types of demands placed on them”.
The Management of Health and Safety at Work Regulations 1999 require EEAST to implement appropriate arrangements for the effective planning, organisation, control, monitoring and review of preventive and protective measures.
The measures should be identified through suitable and sufficient assessment of the risks to the health and safety of the Trust’s employees.
The evidence presented by the HSE:
1. EEAST Stress Risk Assessment does not identify key risks and controls
- Data not used correctly, eg. staff absence, exit interviews, staff surveys
- Risk assessment was too generic – assessments of different staff groups
- Controls in place not linked to the key stressors identified
2. The arrangements/measures in place for managing stress are ineffective
- Managers are not enabled/encouraged to support staff resulting in lack of contact between frontline managers and their team members
- Bullying culture identified in some areas
- Some employees were unaware of policies/arrangements including stress policy and absence policy or unable to access easily
- Mentoring systems for new starters was considered ineffective
3. Existing stress management measures are not effectively monitored and reviewed
- Was not clear what would trigger a review of the stress risk assessment
- Centralised rostering had been introduced at EEAST, but the stress risk assessment had not been reviewed to account for this
To comply with the Management regulations, the HSE have highlighted areas we need to take remedial actions. There are eight points to which we need to respond:
| HSE Action | EEAST | RAG | Progress/Complete | |
|---|---|---|---|---|
| 1 | Introduce measures to enable staff to complete shifts/work on time and monitor to ensure that these are being implemented effectively HSE Requested Due Date: 01/10/25 | Implementing • Engagement with System Partners to reduce delays at Acutes/GOs, etc. • Use of Taxis, etc. at end of shift • Team Based Working Update/Review • ESOP – End of Shift • ESOP – Deployment Guidelines | RED | HO45 accepted by all hospitals within Trust footprint, team based working programme has commenced and monitored through Trust Portfolio Board, Chief Operations Officer Appointment is focusing on end of shift through Big Conversation. |
| 2 | Develop appropriate protocols to protect staff from exposure to abuse, through all means including phone calls or face to face engagement with patients. HSE Requested Due Date: 01/10/25 | Implementing • SOP-001 Responding to V&A Patients • ESOP055 Dealing with Abusive Callers • Patient Threat Assessment • V&A Letters to Patients • Face to Face CM Training (Operational) • Virtual CM Training (EOC Staff) • Wellbeing Support to EEAST Staff • BWCs (Each Operational Vehicle) • Re-circulate ESOP055 (EOC Staff) Update/Review • VPR Strategic Plan • POL056 V&A Policy | GREEN | Roll out of new BWC to vehicle issue is underway, SOPs updated and Health and Wellbeing Services under peer review from TASC. |
| 3 | Through collaboration, develop systems for managing competence to meet demands, through ensuring people undertake mandatory training and are developed under structured supervision. HSE Requested Due Date: 01/10/25 | Implementing • Sector Clinical Leads • Named Team Leaders & LOMs (Time to Lead Programme) • 1:1s & Appraisals/Development Update/Review • Clinical Mentoring Programme • Sustained training performance. | AMBER | Statutory training remains at >90% since February 2025, staff circle introduced to streamline appraisal and TTL programme merging with TBW going forward. |
| 4 | Design and implement (supported by training) appropriate line management and clinical supervision systems to ensure all staff have a designated line manager, have regular 1:1s and line managers can support staff and respond to concerns so the causes of work-related stress can be managed with a proactive, preventative approach. HSE Requested Due Date: 01/10/25 | Implementing • Increased Teams Leaders/LOMs (Time to Lead Programme) • Named Team Leaders & LOMs • Management of Stress Training to Operational Management (Wellbeing) • Team Based Working Update/Review • TPB programme group established and review of merging TTL with TBW | AMBER | TTL programme merging with TBW going forward. |
| 5 | Develop and make arrangements to implement and monitor policies and procedures that set out values and standards of behaviour to ensure all employees are not subjected to unacceptable behaviours in their workplace. HSE Requested Due Date: 01/10/25 | Implementing • Freedom to Speak Up Process Update/Review • Grievance Policy • ER Case Management • Disciplinary Process | AMBER | Big Conversation is reviewing dignity at work and grievance combination to support informal resolution approach. |
| 6 | Make arrangements for direct communication and engagement between frontline staff and senior leaders to ensure a first-hand understanding of how procedures and high-level decisions impact frontline staff, to demonstrate commitment to managing work-related stress more effectively and to develop trust. HSE Requested Due Date: 01/10/25 | Implementing • Recently updated Managing Stress at Work Policy • Named Team Leaders & LOMs • Team Based Working • EOC Supervision • LOMs/HALOs are Operational Update/Review • Big Conversation agreed action plan | AMBER | Big Conversation plan has identified 6 key areas to support with Exec SROs |
| 7 | Make arrangements to monitor the measures that you implement to ensure that they are appropriate and effective and act as soon as possible if they are not effective, rather than wait for a scheduled review. HSE Requested Due Date: 01/10/25 | Implementing • Recently updated Managing Stress at Work Policy • WRS Data to be shared/discussed at Health & Safety Working Group • Organisational Change to include Health & Safety to ensure Risk Assessments can be updated Update/Review • Trust Board oversight commenced • HSE relationship meetings commenc | AMBER | Arrangement now active with HSE to help create workable plan to provide best practice guidance to staff at EEAST and share with UK ambulance services. |
| 8 | Suitable and sufficient assessment of the risks associated with work-related stress should be carried out, identifying the key risks at all organisational levels and deciding who might be harmed and how HSE Requested Due Date: 01/07/25 | RA-HSS-071 (WRS Operational Staff) RA-HSS-079 (WRS EOC Staff) RA-HSS-080 (WRS Ambulance Station based roles) Risk Assessments and associated hazards have been identified using: • The EEAST 2024 NHS Staff Survey • Sickness/Absence data associated to Anxiety, Stress & Depression • Occupational Health data • Wellbeing Department Training programme developed in line with EEAST Management for managing Work-Related Stress • Engagement with different Staff Groups across the Trust. • Union Health and Safety Leads | BLUE | Completed. Sent to HSE |
Note: Action 8 had a submission date of 1 July 2025. This was sent to the HSE on 24 June 2025.
Key Issues / Risks
- EEAST cannot directly control delays with our system partners.
- The Health and Safety Executive has been invited to the National Ambulance Risk and Safety Forum (Sub-group of QIGARD) chaired by the Head of Health, Safety and Security at EEAST) to discuss outcome of inspections and to work with the Ambulance Service to create best practice across the industry. Currently, it is unclear of the HSE wishes to engage nationally.
How does this report link with EEAST’s vision, purpose and values?
People Mission: this report provides remedial actions to support our people. The reduction of staff sickness because of Work-Related Stress will increase productivity.
Summary
Following the Notice of Contravention from the Health and Safety Executive (HSE), EEAST have been open and honest with Staff Groups and have openly engaged with the HSE with regular meetings to discuss current processes to manage Work-Related Stress and the potential implementation of new process to adequately ensure the safety of our staff.
