You are not alone

Conflict managementThe NHS is a vast organisation with a diversity of working environments. Each of these presents its own security risks – from the tension of A&E to the remoteness of out-of-hours and community-based work. Addressing these hazards helps ensure the highest standards of clinical care for patients and the proper protection of NHS staff and property. The organisation committed to achieving this across the health service in England is the NHS Security Management Service (NHS SMS).

A high-level aim of NHS SMS is to ensure that NHS employers meet their legal and ethical responsibilities for providing a safe and secure working environment for all staff, regardless of their roles or responsibilities. Every employer is bound by this duty of care and the NHS, as the UK’s largest, requires a comprehensive approach to fulfilling it.

The NHS SMS’s remit covers all NHS trusts in England, including primary care, acute, mental health and ambulance trusts. It also extends to other NHS areas, such as community pharmacies, dental surgeries, opticians and out-of-hours services. As a result, the NHS SMS’s work to protect staff affects the whole spectrum of NHS workers – both directly employed staff and those who deliver care as contractors.

Protection from violence
Top of the NHS SMS’s priorities in this area is ensuring that all those who work in and for the NHS are protected from violence and abuse – and from the fear of such behaviour – at all times in the course of their duties. This is despite the fact that they may be at greater risk of violence and verbal abuse than many other professionals. Figures released last year show that during 2009-10, there were 56,718 reported assaults against NHS staff working in all care sectors.

Since 2004, the NHS SMS has implemented various measures to promote safer working environments. Underpinning them all is the message that abusive behaviour must not be accepted as “part of the job” in any part of the health service. Until recently, health bodies were required to report all physical assaults on staff to the NHS SMS. In April 2010, this requirement was extended to encompass all security incidents. Underlining this development was the introduction of a new national Security Incident Reporting System (SIRS), which now provides a more accurate picture of the nature and scale of security incidents across the NHS in England.

Also key to the NHS SMS’s work is ensuring that appropriate action is taken against those who assault NHS staff. Its Legal Protection Unit works closely with the police and Crown Prosecution Service to pursue a range of sanctions. More recently, the organisation made a number of recommendations in response to the public consultation on the Code for Crown Prosecutors, successfully arguing that the public interest factors in favour of prosecution should be expanded to ensure that offences against anyone providing NHS services are taken more seriously.

Proactive measures
Clearly, it is essential that there are mechanisms for dealing with the security incidents that occur. But the NHS SMS also works pre-emptively on policies and guidance to reduce the number of incidents.

Another of its proactive measures is the national syllabus for conflict resolution training for frontline NHS staff. Launched in April 2004, it teaches staff to recognise and defuse potentially violent situations. More than 428,000 have been trained already and the syllabus continues to develop, with programmes tailored for mental health and ambulance settings running in parallel.

Given the variety of staff covered by the NHS SMS’s remit, it is important to remember that work-related violence can take place in the community, on the way to and from work and out of hours. As well as requiring employers to ensure, as far as possible, a safe working environment, legislation directs them to address health and safety risks before allowing staff to work alone. For some time, the NHS SMS has worked with NHS trusts to address the specific vulnerabilities of lone workers – a wide variety of staff who work, regularly or occasionally, without access to immediate support from colleagues, security staff or others. It published ‘Not Alone’, a guide for the better protection of lone workers in the NHS in 2004, and recently revised and reissued this guidance to provide further direction on policymaking in this area.

Lone worker solution

While lone workers may not be able to depend on immediate support if a security incident occurs, it is important that these risks are not over-emphasised. Work to minimise them must be based on fact, balancing the need to provide a high standard of care for patients with the responsibility for protecting staff. In 2007, funding was announced for a project to procure just such a lone worker solution for the NHS. The requirement was for an alert system that could be activated discreetly in a potentially violent or intimidating situation and which could summon help – from a nominated escalation point or from the emergency services if necessary. The technology also needed to have the potential to provide evidence for any subsequent prosecutions.

Procurement was conducted by the NHS SMS and the commercial unit of the NHS Business Services Authority on behalf of the Department of Health and a framework agreement for NHS lone worker services introduced in April 2009. This gives subscribers – more than 200 trusts across England so far – dedicated lone worker devices that not only function as an alarm in threatening situations but which should also be used as part of normal preparations for lone working. By recording an ‘amber alert’ – a short message about their location and how long they expect to be there – a lone worker can maximise the efficiency of an emergency response should one be needed. Their message is retained by an alarm receiving centre and listened to if they subsequently raise a ‘red alert’ because they feel at risk. A red alert creates an open voice call to an operator who will assess the situation and notify the relevant NHS body’s escalation points and/or emergency services as required.

Recordings are stored securely and used as required for the purposes of criminal, civil or local sanctions against offenders. Within the trust, only the Local Security Management Specialist – trained in areas such as evidence gathering and witness interviewing, and responsible for investigating security incidents along with the police – can access the recordings, and must do so in line with standard procedures.

The preferred supplier, Reliance Secure Task Management, and the NHS SMS’s lone worker team have delivered more than 30,000 subscriptions under the agreement. In the last 12 months, there have been over 200 genuine red alerts, more than 20 of which have initiated a response from the emergency services. One case is pending prosecution and the audio recording has been used as evidence. All genuine red alerts are monitored by the NHS SMS and details of follow-up action recorded centrally to ensure that each one is dealt with according to agreed procedures.

Long-term advantages
All NHS organisations can recognise the benefits for lone workers but may be slower to acknowledge longer-term advantages of such systems. The NHS Lone Worker Service not only helps staff feel safer and provides a means of summoning assistance if needed; it is also expected to contribute significantly to deterring assaults, as well as providing a means to pursue prosecutions. There is also the potential for reduced costs arising from litigation if trusts can demonstrate they have fulfilled their duty of care to their staff.

In recognition of these comprehensive benefits, the NHS Lone Worker Service won the Safer Workplace category of the National Personal Safety Awards 2010. Given by the Suzy Lamplugh Trust, the UK’s national charity for personal safety, the awards celebrate work across the UK to keep people safe from violence and aggression. As well as highlighting best practice, the award was a useful reminder that even staff based in large, busy workplaces can find themselves in vulnerable lone working situations – something no employer should overlook when conducting risk assessments.

Cost of failure
The NHS, for one, knows the cost of failing to manage such risks. An NHS SMS report on the economic cost of violence against NHS staff for 2007-08 presented the results of an exercise to measure the costs incurred by the health service as a result of violent physical assaults. It considered direct and indirect costs, such as litigation and damages, staff leaving the NHS and anti-violence policing. The exercise suggested that physical violence against NHS employees cost the NHS £60.5 million during the year. It is a sobering figure and one that explains why, especially in the context of shrinking budgets and plans to increase the number of community-based NHS services, organisations are showing a growing interest in lone worker technology.

The NHS Lone Worker Service promotes greater responsibility for staff and its success hinges on user engagement and correct usage. It is important to remember that it is intended for use alongside existing processes and should be viewed as an add-on to regular risk assessments. There are processes to monitor and manage this centrally but NHS trusts must also be proactive to ensure effective usage. A bespoke training package, developed jointly by the NHS SMS and Reliance, is compulsory for all users. This training ensures that staff understand the limitations of the devices as well as the importance of correct and continued use.

This balancing of acknowledged risks and achievable safeguards doesn’t only apply to lone workers but reflects the NHS SMS’s approach to security management more generally. Ensuring that all NHS staff and patients are properly protected means gathering data to assess vulnerabilities and decide where action and resources are best focused. In addition to organisational input, this requires effort at an individual level – whether in terms of reporting incidents, attending training, reading the relevant guidance or making use of appropriate technology. In every area of the NHS, as well as the right to a safe working environment, staff have a responsibility for their own safety, whether they are lone workers or not.

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