As head of training and quality at the NHS Counter Fraud and Security Management Service (CFSMS) Richard Rippin manages what’s arguably the biggest UK security-related training: in conflict resolution, given to all front-line National Health staff, plus refreshers. He goes over his work with Mark Rowe.
Richard has a public sector fraud background, having worked in the DWP (Department of Work and Pensions) and local authorities. “Then I was in the Law Society, in their education and training department, looking after the regulation of people seeking to become a solicitor.” That meant assessing professional competence; and accreditation for specialisms such as family lawyer. Hence the two sides to his experience; going after fraud, and what you could call the classroom stuff, of training people (and trainers) and assessing how well they do. Plenty of people have one of those sides; not so many have both. The CFSMS finds it quite difficult to recruit trainers, Richard reports, who have the knowledge – and with that the credibility – whether of being a security manager or fraud investigator; and the ability to stand in front of security or non-security staff and train them. It’s more than giving a presentation. You cannot very well bring in a general teacher, and expect them to understand the intricacies of security management, or countering fraud, skills that take years to gain from scratch. Hence the trainers the NHS does have are generally former DWP or HMRC investigators, or security management specialists from the National Health, who have already had something to do with the CFSMS.
The conflict resolution training – that health trusts have to give to their front-line staff, plus refresher training after three years – has gone to about 700,000 people so far. Part of Richard’s job is managing the quality assurance. Because what’s the point of doing it all (and the cost of the trainers and the staff being paid for being trained in works time – and someone has to do their job meanwhile) if it’s not done well, or even if it is delivered well, the trainees don’t rate it? Hence quality assurance work, first for the counter-fraud side, then security management. How do you assess security? It’s extremely challenging, but can be achieved with support from the NHS SMS, Richard says. Take security management. Is there a pro-security culture? What’s the protection of staff and assets like? What of redress and sanctions? How do the counter-fraud or security managers themselves measure their work, the outcomes – ‘because that’s the hard thing to do; to come to a conclusion, what’s the impact of the work they do’. On that score, you can count incidents of violence, or disturbance and nuisance, ‘but it’s also staff perception. You the security manager may think, and have the stats to prove, that you are clearing up cases and reported cases are falling; but what is the use of that if staff feel less safe, less comfortable at work?
Turning to conflict resolution training, and assessing how effective it is: staff perception is part of the equation – but not all of it. What if staff – community nurses, ambulance crews, let’s say – feel really happy about the training, but it’s flawed, or badly taught? And so when that comfortable-feeling nurse or ambulance-man next encounters aggression, it doesn’t work? Because hospitals like workplaces have conflict between staff and ‘customers’, with the added stress on both sides of sometimes life and death worries and decisions. The national syllabus for conflict resolution training dates back about seven years now, with a specific module for ‘mental health settings’, to use the NHS phrase. To be brief, a mental health patient may lash out at a nurse, but not out of malice, purely because of their mental illness. Some of the conflict management training, the CFSMS has given for trusts; the CFSMS has trained trainers to deliver the training for trusts; or the private sector has provided the training. In other words, what Richard calls a ‘mixed economy’. Since April, the CFSMS has removed itself from this training, as it’s developing what Richards calls a ‘quality assurance programme’. The CFSMS could not very well have marked its own trainers. The quality assurance, then, seeks to check among other things that trainers are keeping to the national syllabus; and that the front-line staff are gaining from the training. People giving or taking courses towards SIA badge applications may recognise some of the things the CFSMS looks for: the conflict resolution training is recommended to be five hours; if a trust is getting through it in two, is that because they’re doing a good job, or because that’s cheaper? What are the class sizes? If some of the learning by computer and some face to face (‘blended learning’, in the jargon), does it get the syllabus through to people? The syllabus itself is under review; can people deal with conflict better as a result? That is, can front-line staff stop aggression and verbal abuse escalating to a punch in the face? As Richard says, it’s a massive job of work, ‘because everything we have got suggests that conflict resolution training does have an impact on behaviour, and does make people feel safer and more able to deal with incidents, and stop them from escalating further, if delivered correctly’.
A thread running through Richard’s talk is how the CFSMS has to understand the octopus-like NHS: a nationwide, forever-changing organisation with its own lingo that can look bewildering to the outsider; and the CFSMS has to plug into the wider world of crime prevention and justice, whether putting its case to the Security Industry Authority, Care Quality Commission (the new health and social care regulator for England), police, the Audit Commission, National Fraud Authority; the list goes on.
Take the law, part of the larger Criminal Justice and Immigration Act 2008, giving the NHS since last year the power to remove people making a nuisance on healthcare premises. The CFSMS is offering training, for the NHS manager (whether from security or a staff nurse or clinician in charge of A&E) authorised to assess the person making the nuisance, and for the security guard authorised to remove the person. As featured in our November 2009 issue, the aim is to deal with low-level stuff that might not count as a crime – smoking on hospital premises, shouting, being noisy. But it bothers other patients and may work in A&E for instance harder. So what to do? What if conflict resolution, trying to calm someone, doesn’t work? This new law means that if an ‘authorised officer’ assesses the situation, and directs the guard to remove someone, not leaving the premises is then an offence under the Act. The manager doing the assessing has to take into account a possibly bewildering number of factors, some not visible or present. What if the person shouting is suffering from the stress of waiting for urgent treatment for their child? Any mental health problems? Or learning difficulties? Is the person making a disturbance truly having trouble in expressing themselves, or are they throwing a wobbly to get seen next? Again, here is the need for balance, between security and giving care; hospitals after all are there to help people, not turn people in need away. This power hasn’t been widely taken up yet.
To give some background on the CFSMS; in fact the counter-fraud and security management halves are kept separate. The hundreds of NHS trusts have to employ a counter-fraud specialist and a security management specialist – and not the same person, though they may be contracted in, or shared with another trust. One thing on Richard’s plate is the likely upcoming badging by the SIA of investigators. That was laid down in the original 2001 Act that led to the regulator’s launch in 2003, but licences for investigators have been postponed ever since, forever seeming to be two or so years in the future. If an NHS security manager or counter-fraud manager does licensable work for another NHS trust, will they need to apply for the investigator badge? The CFSMS is working to show that it has the investigation side covered, so that it can be exempted. To get exempted, or at least to be able to ask for it, the CFSMS has to show its ‘currency of learning’; that its investigators are already of the standard the SIA is looking for, and the CFSMS at least matches the Criminal Records Bureau and other background checks the SIA will require of applicants. So whether you feel this is another case of the SIA regime reducing licensable activity to a multiple-choice lowest common denominator, or setting minimum standards so that everyone knows where they stand, the CFSMS faces the wider world. Similarly the CFSMS was part of a National Fraud Authority working group on fraud in the private sector, that reported in the spring. But to turn inwards again, the NHS as a £100 billion a year organisation is at risk from fraud: from the everyday – staff fiddling their timesheets, or taking equipment out of the back door – to the multi-million procurement fraud. Some frauds may be NHS-specific, such as doctors and dentists claiming for work they don’t do, some recognisable in any other workplace, like false expenses claims. What to do? Richard points to that requirement for each trust to have the counter-fraud specialist; someone is responsible, and accountable. The CFSMS aim here is to offer guidance – if fraud X is happening in several places, it might be going on elsewhere – and with its regional operational teams, take on frauds that cross NHS trust borders; often higher-value and more complicated. The CFSMS seeks to promote an anti-fraud culture, to raise awareness of fraud among the mass of honest, non-security staff; to close loopholes, to ‘fraud-proof’ policies and procedures; to deter staff from trying to do fraud. So, to return to the start; the NHS counter-fraud or security manager has to know their way around the block.
