There are links between violence and aggression and staff sickness absence, turnover and lost productivity, according to a report on the NHS.
The NHS has to do more to protect staff from violence, according to the National Audit Office. Head of the National Audit Office, Sir John Bourn said: ‘It is unacceptable that the very people who are trying to help the sick and injured are themselves subject to violence and aggression on a daily basis. Apart from the immediate impact on the individuals concerned, the experience or threat of violence causes increased stress and sickness absence, lowers staff morale and drives individuals out of the health sector at a time of serious staff shortages. Good progress has been made through the zero tolerance zone campaign, launched in October 1999, but the NHS needs to demonstrate clear improvement in incident follow up, staff training and partnerships with other public agencies." A report, A Safer Place to Work: Protecting NHS Hospital and Ambulance Staff from Violence and Aggression, said around 95,500 incidents were reported in 2001-02. Only a fifth of NHS trusts met the Department of Health’s national improvement target of a 20 per cent reduction in such incidents by April 2002.
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Mixed success
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The report says the NHS (Europe’s largest employer) has embraced the ‘zero tolerance’ campaign, but ‘there has been mixed success in encouraging staff to report incidents. Wide variations in reporting standards, different definitions and continued under-reporting, make it impossible to say conclusively how far the increase in reported violence reflects an actual increase in incidents, or measure how trusts, individually and overall, are performing. There also remains a high and varied level of under-reporting of incidents (which we estimate is around 39 per cent).’ The NAO says there is little or no data on the financial impact of violence and aggression onthe NHS but, based on their estimates of the cost of work-related accidents, the NAO puts the direct cost at at least œ69m a year. Staff may not report incidents for fear it reflects badly on their ability to handle situations; or they may feel reporting will not make a difference. The NAO says it found a lack of consistency in the way that NHS trusts manage the consequences of violence and aggression, including the support provided to victims. The report admitted the need for a balance between security, being patient-friendly and hospitals doing their job. The report said: ‘Security measures vary across trusts, for example the
use of CCTV (92 per cent of trusts), panic alarm systems (85 per cent of trusts) and having security staff (40 per cent of trusts) and or a police presence (20 per cent of trusts).’About one in four ambulance trusts said they were using or testing CCTV in their emergency vehicles. The NAO however adds that there is limited scientific evidence of the effectiveness of these measures. When introducing new measures, the report says, trusts need to identify clearly the risks they intend to address and evaluate their impact. Hospitals do appear keen to spend on security. Besides NHS trusts carrying out their own spending on security, the Department of Health, under the Improving Working Lives Initiative, part of the Human Resources Performance Framework has set aside œ1.5m for security initiatives over three years, to be match-funded by trusts. In the first year, 2001-2, trusts put in œ4.9m of bids. Examples include CCTV at Birmingham Heartlands and Solihull Hospitals NHS Trust (featured in our Septembe 2002 issue). Some of the Department of Health’s £150m Accident and Emergency Modernisation programme has gone on security, such as CCTV and personal alarms for staff. Some factors seem to be out of Security’s hands, however. The report found: Over half the NHS trusts
in our survey of accident and emergency departments see the reduction of waiting times as essential if levels of aggression are to be reduced.’
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Among case studies praising good practice are Surrey Police’s work with five hospital trusts, including CCTV at Ashford and St Peters’ Hospital. Blackburn, Hyndburn and Ribble Valley NHS Trust’s security manager has sent 155 warning letters after incidents. The trust has funded a sub-police station next to its accident and emergency department, and seen a fall in incidents. Car parking profits go on security upgrades. A warning letter approach, according to its users, does bring home to perpetrators that violence will not be tolerated. Prosecutions however are rare, and even then a sentence is, in the report’s words ‘often perceived to be light’. The NAO gives a January 2003 example: a patient who assaulted a nurse at the Lakes Hospital Colchester, was fined œ100 with œ150 compensation by Colchester magistrates for punching a nurse in the head and face. Hospitals reported these obstacles: slow police response; police removing violent individuals from NHS premises, only to let them go; police reluctant to press charges, particularly if the offender was mentally ill; police see accident and emergency as not seen as a public place and therefore not a priority; staff are often reluctant to act as witnesses. Nursing organisations, for example, have called ‘zero tolerance’ into question, given a lack of prosecutions. Hence in October 2002 the Government updated the managers’ guide to stopping violence against NHS staff but could only repeat pleas to hospitals to report and act on incidents, and restate that health authorities have a statutory duty to look after staff, and should work with police and other partners under the Crime and Disorder Act.
