Incident Reporting and RIDDOR

When something goes wrong in care — a fall, a medication error, a scald, an aggression incident, equipment failing — the response follows one sequence: person first (make safe, treat, reassure), then honesty (tell the people who need to know, including the person and family where the duty of candour applies), then record (facts, promptly), then learning (why did this happen, what stops it happening again).

The reporting map confuses people mainly because different regulators watch different populations. HSE, via RIDDOR, watches work-related harm to workers and members of the public. CQC watches harm to people receiving care from registered services in England, through statutory notifications. Many incidents also touch safeguarding (the local authority) and the duty of candour (owed to the person and family). Rather than memorising every permutation, use a decision aid — this site includes a RIDDOR walkthrough — and when genuinely unsure, ask, then report; late is worse than asking.

Underneath the rules sits culture. Services where reporting is rewarded find their problems early and small. Services where reporting is punished find their problems in coroners' courts. Every manager builds one of those two services, one reaction at a time.

• RIDDOR 2013: the responsible person (employer) must report: work-related deaths; specified injuries to workers (most fractures excluding fingers/thumbs/toes, amputations, sight loss, crush injuries to head/torso, serious burns, scalping, unconsciousness from head injury/asphyxia, enclosed-space incidents); over-7-day incapacitation (report within 15 days); listed occupational diseases; dangerous occurrences (including lifting equipment failure); and deaths/hospital-treated injuries of non-workers from work activity. Over-3-day injuries are recorded, not reported.
• CQC (Registration) Regulations 2009 (regs 16 and 18): registered providers notify CQC of deaths, serious injuries, abuse allegations, police incidents, deprivation of liberty applications/outcomes and events disrupting the service — without delay.
• Enforcement split (England, since 2015): for people receiving care from registered providers, CQC leads on safety of care; RIDDOR duties continue for workers and others.
• Regulation 20 — duty of candour: for notifiable safety incidents, tell the person/family promptly, give a true account, apologise, and follow up in writing.
• Regulation 17: incident records and their analysis are part of good governance.
• Social Security (Claims and Payments) Regulations: the humble accident book, kept for RIDDOR and employee rights purposes.

CQC cross-references ruthlessly: incident logs against notifications sent, daily notes against incident forms, safeguarding referrals against abuse allegations in records. Gaps — the fall in the notes that never became an incident form, the fracture never notified — are governance findings in themselves. Beyond compliance, CQC looks for analysis: trends by time, place, person and staff pattern; actions that changed something; duty of candour evidenced with dates and letters; and staff who say, when asked, that reporting is easy and expected.

• Make one internal form catch everything (accident, incident, near miss, behaviour, medication) with prompts for the follow-on duties: RIDDOR? CQC? Safeguarding? Candour? Family informed? GP informed?
• Write factually and immediately: times, places, quotes, injuries described and body-mapped, observations, actions. "Found on floor beside bed at 06:40, alert, laceration 2cm left eyebrow" — not "had a fall, seems fine".
• Never pre-judge causes in the report ("tripped over slippers" when nobody saw it happen) — describe, then investigate.
• Time-stamp the duties: RIDDOR without delay/10 days/15 days per category; CQC "without delay" (same working day as a rule of thumb); candour conversations promptly with the written follow-up.
• Close the loop visibly: weekly incident review, monthly trends to the team ("falls up at nights on Unit 2 — here's what we're changing"), and thanks to reporters by name where they consent.
• Treat near misses as headline news: the hoist strap that looked wrong, the tablets found on the floor, the visitor who wandered into the sluice. Cheap lessons — collect them.

Example 1. A care worker slips on a wet corridor and fractures her wrist. The provider treats and supports her, records it, reports RIDDOR (specified injury) without delay, and investigates: the cleaning cupboard's wet floor signs had walked. Signs are replaced and clipped to each trolley, and mopping moves to after breakfast, not during. HSE never visits; the report and the fix stand ready anyway.

Example 2. A resident is found with a skin tear and blood on the bed rail. The senior's checklist thinking fires in order: first aid and reassurance; incident form; bed rail risk assessment reviewed (padding fitted); CQC notification considered against the injury threshold and sent; family called the same morning with an honest account and apology; GP visit arranged; daily notes cross-referenced. Five duties, one incident, no drama — because the sequence was rehearsed before it was needed.