Management of Violence and Aggression · 2019-10-03 · Management of Violence and Aggression Policy Contents Pages 1.0 Strategy 2.0 Introduction 3.0 Duties and Responsibilities 4.0

Source: Security Manager Status: Approved Page 1 of 32 Issue date: March 2017 Review date: March 2020 Document ref: PP(17)082

Document ref. no: PP(17)082 Trust Policy and Procedure Management of Violence and Aggression Policy

Contents Pages

1.0 Strategy

2.0 Introduction

3.0 Duties and Responsibilities

4.0 Review

5.0 Monitoring

6.0 Policy Storage

7.0 Prevention / Management

8.0 Lone Working

9.0 Training

10.0 Physical Assault

11.0 Non-Physical Assault

12.0 Range of Legal Sanctions

13.0 Support

2

2 - 3

3 - 5

5

5 - 6

6

6 - 7

7 - 8

8 - 9

9 - 11

11 - 12

13 - 14

14

Appendix A – Generic Ward / Department Risk Assessment 16 - 18

Appendix B – Physical Assault Flow Chart 19

Appendix C – Zero Tolerance Panel-Policy and Procedure 20 - 29

Appendix D – Non-Physical Assault Flow Chart 30

Appendix E – The Use of Warning Markers 31 - 32

For use in: West Suffolk Hospital

For use by: All Staff

For use for: Management of Violence and Aggression

Document owner: Health and Safety Committee

Status: Approved


1.0 STRATEGY All security work will be approved and ratified via the West Suffolk NHS Foundation Trust’s (WSFT) Governance framework, (See Appendix A). A member of the Executive Board will be responsible for overseeing, providing strategic management and support for all security management work, within the WSFT. The organisation will ensure that those working in security management have all the necessary support to enable them to carry out their role efficiently, effectively and promptly. The WSFT will allocate appropriate resources and investment to security management in line with its identified risks. The WSFT will employ a qualified person to undertake the full range of security management work (LSMS). This person will be trained and accredited by the appropriate professional accreditation board. The LSMS will report annually to the Trust board on how it has met the standards set by NHS Protect in relation to security management, and its local priorities’ as identified in its work plan 2.0 INTRODUCTION Everyone has a duty to behave in an acceptable and appropriate manner; staff has a right to work, as patients have a right to be treated, in an environment that is safe and secure. The West Suffolk NHS Foundation Trust has a statutory obligation to ensure as is reasonably practicable, a safe and secure environment for its staff. Violent, abusive behaviour and criminal acts will not be tolerated. The risks of violence to staff must be assessed and where possible action will be taken, to protect staff, patients and visitors. 2.1 Policy Aim This policy is designed to ensure that staff working in healthcare are provided with an environment that is safe and secure and that minimises the risk of violence and aggression. This is in line with the requirements of the Health and Safety Executive (HSE) HSG65, the key elements of successful health and safety management; in relation to managing the risk of violence and aggression. This policy has been introduced in the context of the mandatory requirement to report all cases of physical and non-physical assaults to WSFT staff. It details the avenues that are available for staff, and the Trust alike, to seek legal redress. The legal definitions of physical and non-physical assault will be explained, along with detailed guidance on how to deal with incidents involving violence, abuse, threats, intimidation, harassment and other inappropriate behaviours. The policy will also clearly define the duties of the Security Management Director (SMD) and the Local Security Management Specialist (LSMS) in supporting Trust staff to avoid, deal with, and manage, violent and abusive persons. 2.2 Scope and Application This policy applies to all full-time and part-time employees of the Trust; all patients (inpatients and out patients), including children and young people. In addition contractors or sub-contractors who provide services to the Trust (including agency / bank staff - clinical and non-clinical), students / trainees, volunteers, clinical attachments, and all other staff on placement within the Trust. In addition this policy will also extend to patients relatives and visitors.


Under the Health and Safety at Work Act etc 1974, the Management of Health and Safety at Work Regulations 1999 and Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 employers have a duty to ensure the health, safety and welfare of their staff and all physical and non-physical assaults should be reported directly to them. This function will be performed by the LSMS on behalf of the West Suffolk NHS Foundation Trust. The use of this policy will apply to the specific requirements of the statutory requirements of Health and Safety legislation. Therefore, this policy bolsters the Trust’s existing legal duties to protect staff, as far as reasonably practicable, from the effects of violence and aggression in the workplace. This policy document seeks to provide guidance to all staff working at West Suffolk NHS Trust, based on both the existing Health and Safety legislation and the more recent national and legal frameworks for tackling physical and non-physical assaults. This additional legal framework was introduced in November 2003, under the direction of the Secretary of State for Health. This policy supersedes the previous NHS Zero Tolerance Campaign and the Trust’s Violence and Aggression policy in light of these directions. 3.0 DUTIES AND RESPONSIBILITIES As the named accountable officer, the Chief Executive has the ultimate responsibility for ensuring compliance with the Health and Safety at Work Act etc 1974 and the Management of Health and Safety at Work Regulations 1999.

3.1 Health and Safety Committee Responsibilities The Health and Safety Committee has the responsibility:

1) To ensure that the organisation has an approved documented process for managing the

risks associated with the safety of staff, patients and others, the physical security of the premises and assets.

2) To ensure that all security related action plans, that arise from risk assessments are

submitted to the Health and Safety Committee to ensure that they are monitored, reviewed and actioned.

3) For receipt of written and verbal updates from the LSMS. 4) To provide an organisational overview of the implementation of the Security, Management

of Violence and Aggression and Lone Working policies. 5) To provide assurance of the implementation of the above policies to the Corporate Risk

Committee. 6) The Health and Safety Committee will be responsible to the organisation for monitoring

compliance with all of the above.


3.2. Accredited Security management specialist (ASMS) Responsibilities The Accredited Security Management Specialist (ASMS) will report directly to the Security Management Director. In addition ASMS will work under the auspices of the Health and Safety Committee; quarterly reports, and annual reports for the committee’s consideration. The purpose of these reports is to provide detail of security incidents and breaches; update the Health and Safety Committee on security prevention activity. To submit risk assessments and action plans for consideration as part of the prevention strategy.

The ASMS will produce a report to the Trust’s SMD every three months and an annual report on security management work. 3.3. All Department / Ward Managers All department / ward managers are responsible for ensuring that risk assessments are undertaken, local policies and procedures are introduced; safe systems of work are adopted; training is available and provided; health and safety and security training records are maintained; ensuring statutory health and safety requirements and compliance; incident reporting; effective communication and support for staff who may face violence and aggression. 3.4 All Heads of Department, Managers and Supervisors All heads of department, managers and supervisors are responsible for the safety of their staff and patients, in particular for ensuring compliance with this policy. They are to ensure that risk assessments have been undertaken and risks identified are managed and that positive practical support is given to staff involved in incidents. In addition they must ensure that staff receive appropriate training e.g. conflict resolution training (CRT) and where appropriate, breakaway and lone working instruction. 3.5 Every Member of Staff Every member of staff has a general duty of care for his or her own health, safety and that of immediate colleagues, patients and visitors. They are required to comply with the relevant policies, adhere to management plans to reduce the risks of violence and to report any potential and actual incidents that may affect safety, in line with the Trust’s incident reporting policy PP(**)105. All front line staff are required to attend mandatory training such as CRT. 3.6. Restrictive Physical Intervention (RPI) Team Responsibilities The Trust has adopted an innovative approach to deal with specific incidents of violence and aggression. They have trained and developed a specific team to undertake Restrictive Physical Intervention (RPI). This recognises that the attendance of a security or police officer at a patient bedside may exacerbate a potentially violent incident. The purpose of the RPI team is to provide support to staff when they are nursing clinically confused patients who become violent and aggressive. The RPI team can be employed to achieve a number of different outcomes (please see policy PP(**) 220 e.g.

To prevent a patient causing themselves or others physical harm.

To break away or disengage from dangerous or harmful physical contact initiated by a patient without inflicting pain or injury.

To separate an individual from a possible “trigger”.

To protect a patient from a dangerous situation for example, a busy road.


The RPI team, which is available 24/7, can be requested via the Trust’s emergency number 2222; it is important to clearly state who you are, where you are and what the problem is. Switchboard staff will then relay the details to the team who will immediately attend and provide assistance. 3.7 The Zero Tolerance Panel This policy sets out clearly the responsibilities of senior managers within the Trust to maintain a safe and secure environment for its staff. This includes a process by which any evidence of physical or non-physical violence or aggression can be highlighted, reported and appropriately managed. Responsibility for identifying incidents (physical or non-physical) that need to be reviewed rests with the West Suffolk’s appointed LSMS. As part of this process a Zero Tolerance Panel (ZT Panel see Appendix C for terms of reference) is formulated from representatives within the Trust. The Panel is scheduled to meet every second and fourth Tuesday of every month, however emergency meetings can be convened when necessary. 1. Reviews security incidents presented by the LSMS. 2. Considers evidence including statements from all parties involved in the incident. 3. Agrees an action plan taking account of all mitigating factors. 4. Monitors success of action plans agreed. 5. Monitors themes and trends and identify areas of learning within the organisation. 6. Supports the LSMS in provision of information to the Health and Safety Committee.

4.0 REVIEW The Trust LSMS and the Health and Safety Committee will review this policy every two years. Earlier review may be required in response to exceptional circumstances, organisational change or relevant changes in legislation or guidance. 5.0 MONITORING This policy will be monitored using the following tools: 1) All wards and departments will be required to have a security risk assessment in place.

This will be monitored by the LSMS and the Risk Office “Work Place Inspections”. 2) All incidents of violence and aggression will be reported to the ZT panel and where

necessary, appropriate action to be taken. To be monitored by the Health and Safety Committee, with the expectation, of a year on year reduction in incidents resulting in harm.

3) The Health and Safety Committee will monitor and ensure, with the support of the Trust

Board that CRT and Break Away Training is 100% compliant for all appropriate staff. 6.0 POLICY STORAGE This policy will be stored on the WSFT Intranet and the Facilities Department shared drive.


7.0 PREVENTION / MANAGEMENT 7.1 Identifying Risk In conjunction with the Trust’s Health, Safety and Welfare policy PP(**)018, managers of all departments are required to carry out risk assessments, which should be reviewed at least annually. Certain areas in the Trust are subject to higher levels of violent and abusive incidents, but all wards and departments should be assessed with a view to identifying, managing and minimising risk. The risk assessment should be carried out in conjunction with the staff in the department to ensure that all potential and actual risks are captured. The hazards identified in the assessment should be scored using the Trust’s risk assessment procedures to establish both the impact of the hazard and its likelihood of recurrence. The risk assessment should cover aspects such as the type of work, training and competency of staff, supervision and communication of problems, emergency situations and contingencies. The LSMS has produced a generic risk assessment (appendix A) to guide in risk assessing the management of violence and aggression. An action plan should be created in order of risk priority and implemented. Any problems in implementation or outstanding risks must be brought to the attention of the LSMS, Trust’s Risk Office or the Health and Safety Committee. The completed risk assessment and required actions should be communicated to all staff in the area, and all assessments must be captured on the Datix Risk Register. Staff new to the area should be informed of risks at local induction. Any changes in practice should be monitored to ensure that they are both being adhered to and also adequately control the risks identified. 7.2 ‘Clinical Condition’ Where clinical opinion indicates that the aggression / assault was unlikely to have been intentional as the assailant did not know that what they had done was wrong due to a medical illness and or confused state of mind, mental ill health, a severe learning disability or as a result of treatment administered. 7.3 Assaults The majority of assaults within the WSFT Trust occur due to one of the above ‘clinical conditions’. When nursing communicating with confused, dementia patients the following guidelines will help to reduce the risk of assaults against staff;

Caring: be aware that the patient is not in surroundings that they recognise or feel at ease in and are therefore likely to be scared and anxious. Should the patient be hard of hearing or have poor sight, it is advisable to approach them with caution, making sure that they are aware that someone is approaching and about to enter their personal space.

When nursing aggressive patients it is important, to control your natural defence mechanisms and not assume an antagonistic demeanour that may exacerbate a potentially violent situation.


People with dementia understand far more than they are given credit for. Take care what is said in their presence and do not exclude them from conversations or decisions. Exclusion of any kind can produce anger.

Look behind the illness and understand that there is a potentially frightened person who

needs to feel secure, respected and cherished.

Managing: on a day-to-day basis it is important to ensure that the patients’ immediate environment is free from clutter, thus allowing the nursing / medical team to move freely around the bed area and maintain, if necessary, a safety buffer zone. This can be achieved by removing all unnecessary equipment, crockery items, and anything else that may be used as a weapon. Should the patient require a drip stand, it is advisable to use the type that can be screwed to the base of the bed.

Routine: establishing, a familiar, order to the patients’ day, may help to reduce the risk of violent / aggressive outbursts. If possible, consult the family / care home and try to organise the patients’ day with a routine that they feel comfortable with, it is important that specific actions are repetitively employed.

Should it be deemed, safe to do so, perhaps a Trust Volunteer could read a newspaper or book to them.

Talk to the Family / Care Home: when caring for a patient who has been displaying violent tendencies, talk to the family and or the care home and explain the problem, with a view to obtaining tacit consent for the administration of a sedative.

Consider: what drugs the patient is already on and what the first choice of sedative should be, historically “Haloperidol” is used however this may not be in the patient’s best interests. After the initial rapid response, the “Hard Hit” (Quick acting and potent sedative) approach should be reviewed, consult with Pharmacy and ask their advice.

Detox patients: this category of patient may present in a very agitated and violent manner; early consultation with the Trusts Alcohol Liver Disease Specialty Nurse will enable staff to manage the nursing of detox patients.

8.0 LONE WORKING Managers of staff working alone, on site / off site or making home visits need to ensure that a risk assessment is carried out and captured on the Datix risk register, and where possible sensible precautions are taken to minimise risk. Staff should be fully briefed on patients and procedures such as logging of home visits, movement plans; regular contact with colleagues and / or reporting back to base should be in place, together with contingency plans for providing assistance. All Lone Working staff must have Conflict Resolution Training and furthermore, lone working may mean that there are additional difficulties in obtaining assistance in the event of an incident such as accidents or vehicle breakdowns. For detailed advice please refer to the Lone Working Policy PP(**)134.


9.0 TRAINING There are a number of considerations that managers should make when determining the training needs analysis for their area of responsibility regarding training for management of violence and aggression. The following training options are available. 9.1 Conflict Resolution Training Staff, particularly front line staff should attend the National Syllabus in Conflict Resolution training. This is the largest training programme ever undertaken in the NHS and its aim is to ensure that all frontline staff receive high quality, consistent training in Conflict Resolution. The training, which is mandatory, has been developed by NHS Protect in conjunction with the British Medical Association, Royal College of Nursing and UNISON. This measure has been introduced as per the Secetary of State directions issued in November 2003.

The half-day course has been designed for all frontline NHS staff whose work brings them into contact with patients, relatives and members of the public. Their work may expose them to situations that may become volatile and confrontational, resulting in violence and abuse. The course consists of non-physical intervention techniques on managing and de-escalating potentially violent incidents within the work environment.

Managers are to ensure that all staff who have regular and consistent contact with members of the public, patients and visitors, attend this mandatory training. Courses can be booked via the Facilities Directorate (ext 3669). At the end of the course, delegates will be able to:

Describe common causes of conflict

Describe the two forms of communication

Give examples of how communication can breakdown

Explain three examples of communication models that can assist in conflict resolution

Describe patterns of behaviour they may encounter during different interactions

Give examples of the different warning and danger signs

Give examples of impact factors

Describe the use of distance when dealing with conflict

Explain the use of 'reasonable force' as it applies to conflict resolution

Describe different methods for dealing with possible conflict situations

Give examples of appropriate options that can be used to deal with conflict situations. 9.2 Breakaway Training Staff in those areas where there is a high number of physical assault incidents can attend training in breakaway techniques in addition to the Conflict Resolution Training.

By the end of the course the students should be able to:

Explain the importance of 360º awareness, effective stance and movement

Demonstrate basic breakaway techniques

Understand the importance of post incident procedures

Demonstrate fundamental self-defence principles

Apply learned skills in appropriate training scenarios State relevant policy and use of force legislation and medical implications of techniques;

Self-defence or defence of another may be used providing no more force is used than is reasonable to repel an attack, such force is lawful and no crime is committed.’


9.3 Mandatory Training Refresher Conflict resolution refresher training is required every three years.

9.4 RPI Team Training (and Update) Safer Physical intervention techniques are a skilled hands-on method of physical restraint involving trained designated healthcare professionals to prevent individuals from harming themselves, endangering others or seriously compromising the therapeutic environment. Its purpose is to safely immobilise or restrict the individual involved. What will the team look like? The Trust’s RPI team will comprise of bleep holders to form a rapid response unit, which will operate 24/7 (24 hours and seven days per week. The team will consist of a minimum of three persons. All nominated members will be trained in conflict resolution, breakaway skills and restrictive physical intervention techniques. Refresher training will take place every six months and is mandatory for the team members. The team should be chosen (when possible) to best meet the needs of the service user / situation and should be appropriate to the age, size and gender of the service user. The team members, who are all volunteers, will be drawn from the all staff groups / individuals within the Trust.

10.0 PHYSICAL ASSAULT 10.1 What is a Physical Assault? Physical assaults on NHS staff are now defined as: "The intentional application of force to the person of another without lawful justification, resulting in physical injury or personal discomfort.” This definition replaces any other definition that may currently be in use within the NHS for reports of physical assault, with the exception of requirements under Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR). 10.2 What Do I Do When a Physical Assault Has Occurred? As soon as practicable - following an incident of physical assault, first ensuring that everyone involved is now safe (assistance can be obtained urgently by calling 2222) - the matter should be reported by the person assaulted, to their manager or colleague and the police, except in those cases where a ‘confused clinical condition’ exists. Each incident must be considered on a case-by-case basis in light of all the available facts. Where the police are involved and attend an incident, every effort should be made to ascertain if the police intend to take action against the assailant, along with obtaining the details of the police officers involved so that these can be passed onto the LSMS to assist in their role in monitoring the progress of such cases. The staff members’ Line Manager / Head of Department will arrange support as necessary. (Please see Support, section 13.0 page 14 - 15).


10.3 How Do I Report a Physical Assault? Firstly, report the incident to your manager or senior member of staff, on duty and the Police (Informing the Police is only mandatory when the assailant is deemed to be not in a clinically induced confused state). An incident report form must be completed on the DATIX on-line incident reporting system. Note: Physical assaults where a clinical condition exists are not precluded from the reporting process. It is important, when completing the incident report to include the assailant’s details e.g. CRN, DOB, ethnicity, full name and address. The victims (member of staff) name, DOB, banding and ethnicity must also be recorded on the incident report. Reporting to the Health and Safety Executive (HSE) physical assaults that result in a staff member being absent or unable to undertake their normal duties for seven or more days, a serious injury or fatality in accordance with RIDDOR. The Risk Office will ensure that a RIDDOR report is completed based on the data on the Trust incident report form. 10.4 What Will Happen When I Have Reported the Physical Assault? The LSMS will arrange for an acknowledgement to be sent to the person assaulted so they know that the incident will be investigated. Reports of physical assault received by the LSMS can typically be divided amongst three categories:

Those which are being pursued by the police and requiring monitoring by the LSMS;

Those which require investigation by the LSMS.

Those assaults, following a preliminary investigation by the LSMS, where the Security Management Director (SMD) and Medical Director have deemed that the assault was as a result of the assailant’s ‘clinical condition’ and that pursuing a sanction would be inappropriate.

The LSMS will contact the police, to ascertain what action they intend to take. Where the police are continuing action, the LSMS will arrange to be kept appraised of progress and outcome. A Flowchart for actions to be taken, when a physical assault has taken place can be seen in Appendix B. Where the police decline to investigate the incident, the LSMS will consider investigating further to see whether or not a private prosecution or other action, such as an Anti-Social Behaviour Order (ASBO) or civil injunction is necessary. The LSMS will make reasonable attempts to interview the person suspected of the assault, to allow them to answer or provide explanations about their alleged actions. The LSMS will invite the person to an interview, which will be carried out in accordance with the Police and Criminal Evidence Act (PACE) 1984. When an investigation is concluded, and it is considered that there is sufficient evidence to support a prosecution, the matter will be referred to the Legal Protection Unit (LPU) of the NHS SMS for further action as appropriate. Irrespective of whether a sanction is pursued or not, the Chief Operating Officer and LSMS, in conjunction with the Trust’s “Zero Tolerance Panel” (see Appendix C for Zero Tolerance Panel Terms of Reference) will always consider whether further action such as “warning letters” about future conduct should be sent. Where it is particularly serious or repeated in nature and staff, patient and public safety could be at risk, the Chief Operating Officer should consider whether withholding of treatment is appropriate.


Please see ‘Range of Legal Sanctions’ 12.0. 11.0 NON-PHYSICAL ASSAULT 11.1 What is a Non-Physical Assault? Non-Physical assaults on NHS staff are now defined as: “The use of inappropriate words or behaviour causing distress and / or constituting harassment”. This definition replaces any other definition that may currently be in use within the NHS for reports of non-physical assault. It is difficult to provide a comprehensive description of all types of incidents, which are covered under this non-physical assault policy. However, examples of the types of behaviour covered by this policy are summarised below, although the list is not exhaustive:

Offensive language, verbal abuse and swearing which prevents staff from doing their job or makes them feel unsafe;

Loud and intrusive conversation;

Unwanted or abusive remarks;

Negative, malicious or stereotypical comments;

Invasion of personal space;

Brandishing of objects or weapons;

Near misses i.e. unsuccessful physical assaults;

Offensive gestures;

Threats or risk of serious injury to a member of staff, fellow patients or visitors;

Bullying, victimisation or intimidation; (Staff on staff bullying does not fall into the remit of this policy. Human Resources will deal with any such issues via the Disciplinary route).

Stalking;

Alcohol or drug fuelled abuse;

Unreasonable behaviour and non-cooperation such as repeated disregard of hospital visiting hours; or any of the above, which is linked to destruction of or damage to property.

Unwanted conduct related to a protected characteristic under the Equality Act 2010 (i.e. age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion and belief, sex and sexual orientation). Such harassment is considered unlawful discrimination under the Act.

It is important to remember that such behaviour can be either in person, by telephone, letter or e-mail or other form of communication such as graffiti on NHS property. 11.2 What Do I Do When a Non-Physical Assault has Occurred? Taking action is appropriate where non-physical assault or abusive behaviour is likely to:

Prejudice the health and safety of staff involved in providing the care or treatment; or lead the member of staff providing care to believe that he / she is no longer able to undertake his / her duties properly as a result of fearing for their safety; or

Prejudice any benefit the patient might receive from the care or treatment; or

Prejudice the safety of other patients; or


Result in damage to property inflicted by the patient, relative, visitor or as a result of containing their behaviour.

Police assistance can be summoned urgently by calling 2222. The following is a list of possible aggravating factors, which should be considered when deciding to report an incident to the police. It is by no means exhaustive: The clinical condition of the assailant should be considered as part of the decision making process.

The effect on the victim and / or others present;

The assailant’s behaviour is motivated by hostility towards a particular group or individual on the grounds of race, religious belief (or lack of), nationality, gender, sexual orientation, age, disability or political affiliation;

A weapon, or object capable of being used as a weapon, is brandished or used to damage property;

The incident was an attempted, incomplete or unsuccessful physical assault;

The incident involves action by more than one assailant

The incident is not the first to involve the same assailant(s)

There is an indication that a particular member of staff or department / section is being targeted;

There is serious concern that any threats made will be carried out;

There is a concern that the individual’s behaviour may deteriorate. 11.3 How Do I Report a Non-Physical Assault? You must notify your manager of the incident. They will help you complete a Datix incident report form, which should detail what has happened, and noting the behaviour of the offender and what they said or did, including, if known, full name, address and date of birth. This form should be completed using the DATIX on-line incident reporting system. There will be a copy of this sent to the LSMS for further investigation. (Appendix D)

In Patients / Visitors: an incident of non-physical assault, involving an inpatient, (During normal working hours) should be reported, immediately, to your Line Manager and the LSMS. Out of hours, should be reported to the most senior person present in your department and, depending on the severity of the assault, the Police.

11.4 What Will Happen When I Have Reported the Non-Physical Assault? A thorough investigation of the incident will form the basis for any subsequent action. An investigation is essential in order to ensure that contributing factors are identified, which will ensure that lessons are learnt and vital information utilised for risk assessment purposes and preventative action. However, where appropriate, evidence gathered will also ensure that appropriate sanctions are sought. It is important that each case is judged on its own merits. The sections overleaf outline a range of options that can be taken in order to effectively tackle non-physical assaults, depending on severity of the incident and aggravating factors. The ‘clinical condition’ of the assailant will always be considered. For support following an incident, please see Support, Section 13. 12.0 RANGE OF LEGAL SANCTIONS


A wide range of measures can be taken by the Trust depending on the severity of the Physical and Non-Physical assault. These sanctions may assist in the management of unacceptable behaviour by seeking to reduce the risks and demonstrate acceptable standards of behaviour, these may include:

Verbal Warnings

Written Warnings

Withholding treatment

Civil Injunctions and Anti-Social Behaviour Orders

Criminal Prosecution

Police issuing of Penalty Notice for Disorder (PND) 12.1 Verbal Warnings When dealing with some incidents of a minor nature, it may be appropriate for the LSMS to speak to the transgressor and issue a verbal warning. This type of warning can be tailored, by the LSMS to suit each occasion, and subsequently recorded. 12.2 Zero Tolerance Panel All incidents of violence and aggression will be investigated by the Trust’s LSMS and then referred to the Trust’s Zero Tolerance Panel for appropriate action, e.g. warning letters, alert / markers placed on patient’s notes or the recommendation of withdrawal of treatment. Letters will be signed off by the Chief Operating Officer. 12.3 Withholding of Treatment The withholding of treatment raises a number of ethical as well as clinical issues for clinicians and managers. However, there is a clear indication that they act as a deterrent to potentially violent and aggressive patients and visitors and ensure that those who work hard to deliver quality patient care and services can do so in a safe environment. The decision to withhold treatment should only be applied where appropriate and always as a last resort. Any decision to withhold treatment must be based on a proper clinical assessment and the advice of the patient’s consultant or senior member of the medical team on a case-by-case basis. Under no circumstances should it be inferred or implied to a patient that treatment may be withheld without appropriate consultation taking place. The withholding of treatment should always be seen as a last resort. Before withholding of treatment is considered, that is, as a first step towards dealing with abusive behaviour, it is recommended that a verbal warning be given. If this fails, a formal written warning should be considered. Failure to comply may then lead to the withholding of treatment. The decision to withhold treatment should be issued to the patient by the Chief Operating Officer, and must be copied to the patient’s consultant, GP, adjoining Trusts and the Police. The letter or written warning should:

Explain the reasons why withholding of treatment is being considered (including relevant information, dates and times of incidents);

Explain that the behaviour demonstrated is unacceptable;

Explain that appropriate sanctions will apply to violent or abusive patients;


Give details of the mechanism for seeking a review of the issue by writing a letter to the Chief Operating Officer; and.

Explain that the patient’s GP and consultant will be sent a copy of the letter. This letter must state: (Appendix C)

The reason why treatment is being withheld (including specific information, dates and times of incidents);

The period of the exclusion (the period of exclusion should normally not exceed 24 months, after which the decision must be reviewed);

Details of the mechanism for seeking a review of a decision to withhold treatment by writing a letter of appeal to the Chief Operating Officer;

The action that the health body intends to take if an excluded individual returns to health body premises for any reason other than a medical emergency;

Each case is judged on its own merits to ensure that the need to protect and ensure the safety of staff is properly balanced against the need to provide health care to individuals; and

That their GP and consultant will be notified in writing of the decision. 12.4 Consideration of Appeals against Sanctions The Chief Operating Officer on a case-by-case basis will consider appeals against sanctions. 13.0 SUPPORT 13.1 Needs In the event of a serious incident, the quality of support to the victim and those associated with it is crucially important in restoring wellbeing. It is important that while attention is being paid to the perpetrator the needs of the victim are not overlooked. The nature of the support required will be a reflection of the seriousness of the incident and the experience of the victim. If the member of staff is too shaky to travel home by normal arrangements, then arrangements should be made to send them home by taxi or accompanied by a colleague. 13.2 Medical Support Victims of physical assault requiring medical attention should be referred to the Occupational Health Department or, if a serious trauma or out of hours, Accident and Emergency. Wherever possible, a colleague should accompany the victim. 13.3 Emotional Support Unless the victim cannot work, it is probably more helpful for the member of staff to remain at work among colleagues than to be sent home. However, the wishes of the victim must be respected. The immediate and continuing interest in the member of staff’s wellbeing by colleagues and managers is very important, together with the opportunity for them to talk through the incident. Managers and colleagues can be most helpful by being available to listen. The support required will not only be in the immediate aftermath of an incident, but may also continue for some time after the event. The Occupational Health Department will be able to offer assistance and support when necessary.


Author(s): Darren Cooksey- Local Security Management Specialist

Other contributors: NHS Protect

Approval and endorsements: Health and Safety Committee

Consultation: Health and Safety Committee

Issue no: 7

File name: Facilities Shared Drive

Supersedes: PP(14)082

Equality assessed: Yes

Implementation: Distributed to all Managers; Published on the Intranet

Monitoring: To be reviewed annually or when policy or a change in the law dictates.

Other relevant policies / documents and references:

Security policy Lone Worker policy Child Abduction protocol Armed Response protocol Zero Tolerance Policy Bomb Alert / Warning protocol Restrictive Physical Intervention Policy Health, Safety and Welfare Policy Incident Policy and Procedure Risk Assessment Policy and Procedure

Additional information: None

Appendix A Appendix E


Local Activity ref: Security 10 Trust Risk Register Number: 578 (To be added by the Assessor when allocated by Risk Office) Directorate/Service: Facilities Dept/Ward/Other: Security Site: West Suffolk Hospital Address: Hardwick Lane, BSE

Original Assessment Date: 28

th February 2011

Dates on which reviews have taken place: March 2014 Date of next review: March 2015 Name of Assessor: Jim Pretty Signature of Assessor: …………………………..

Please ensure all sections of form are complete before sending to the Risk Office. Description of the task/activity/issue:

Generic - Management of Violence and Aggression Frequency of task/activity: Daily Please identify category of people affected: Staff / Patients / Visitors / Contractors Estimate of number of people affected by hazard: 100+

Hazards identified: 1) Clinically confused patient physically assaults a member of staff / other patients and or visitors and relatives

Definition; Where clinical condition indicates that the aggression assault was unlikely to have been intentional as the assailant did not know that what they had done was wrong due to a medical illness (including confusion), mental ill health, a severe learning disability or as a result of treatment administered”.

2) Non confused patient, relative or visitor attacks a member(s) of staff.

Definition: Physical Assault;” The intentional application of force to the person of another without lawful justification, resulting in physical injury or personal discomfort”.

3) Non Physical Assault.

Definition: ”The use of inappropriate words or behaviour causing distress and / or constituting harassment”.

4) Cluttered corridors hindering person obstructing escape route from violent individual. 5) Poor layout of consultation/office/meeting rooms having the potential to hinder escape route from violent individual or from alerting others to the incident.

Significant consequences: 1) Physical injury to staff member (or other person) resulting in minor injury to over 7 day absence from work (RIDDOR), or major injury (RIDDOR). Musculoskeletal injury to back, shoulder, wrist etc resulting in possible over 7 day injury (RIDDOR). Psychological impact resulting in over 3-day absence from work (RIDDOR). Stress to other patients/staff/visitors witnessing the incident.

2) Physical injury to staff member (or other person) resulting in minor injury to over 7 day absence from work (RIDDOR), or major injury (RIDDOR). Musculoskeletal injury to back, shoulder, wrist etc resulting in possible over 7 day injury (RIDDOR). Psychological impact resulting in over 7-day absence from work (RIDDOR). Stress to other patients/staff/visitors witnessing the incident. 3) Psychological impact resulting in over 7-day absence from work (RIDDOR). Stress to other patients/staff/visitors witnessing the incident. Distress to member of staff, patient visitor. 4) Potential for slip, trip or fall accident, leading to time off work, over 7 day injury reportable under RIDDOR. Musculoskeletal injury to back, shoulder, wrist etc resulting in possible over 7 day injury (RIDDOR). 5) Potential for slip, trip or fall accident, leading to time off work, over 7 day injury reportable under RIDDOR. Musculoskeletal injury to back, shoulder, wrist etc resulting in possible over 7 day injury (RIDDOR).

Risk Assessment Form



6) Damage to Trust property by violent individual (s)

7) Armed patients, visitors and or relatives. 8) The abduction of Children / Babies from the Trust

Calculate the Risk Rating without controls in place (please see scoring matrix on following page): L (Likelihood) X C (Consequence) = Weekly x Moderate = Amber

Physical injury to staff member (or other person) resulting in minor injury to over 7 day absence from work (RIDDOR), or major injury (RIDDOR). Musculoskeletal injury to back, shoulder, wrist etc resulting in possible over 7 day injury (RIDDOR). Psychological impact resulting in over 7-day absence from work (RIDDOR). Stress to other patients/staff/visitors witnessing the incident. 6) Cost of repairing/replacing the fabric of the building or items of furniture/equipment. 7) Potential for a fatality to occur. Physical injury to staff member (or other person) resulting in minor injury to over 7 day absence from work (RIDDOR), or major injury (RIDDOR). Musculoskeletal injury to back, shoulder, wrist etc resulting in possible over 7 day injury (RIDDOR). Psychological impact resulting in over 7-day absence from work (RIDDOR). Stress to other patients/staff/visitors witnessing the incident 8) Psychological impact resulting in over 7-day absence from work (RIDDOR). Stress to other patients/staff/visitors witnessing the incident. All of the above:

Litigation

Media interest

Delay in services

What controls are in place and used to reduce the risk: 1) Management of Violence and Aggression PP(**)082.

2) Conflict Resolution Training. 3) Break Away Training. 4) Security Awareness training. 5) Restrictive Physical Intervention team (RPI), to assist with clinically confused patients. 6) Panic Buttons in high risk areas. 7) Clear Signage regarding Zero Tolerance as a deterrent against anti-social behaviour. 8) 2222 system to alert Police and/or Rapid Response Team. 9) Trust Incident Reporting system to record all incidents of violence or aggression thus providing useful data when planning anti-violence and aggression strategies. 10) Every incident of violence or aggression investigated by Local Security Management Specialist (LSMS). 11) Zero Tolerance panel convened by LSMS. Panel identifies problem with a view to putting measures in place to prevent reoccurrence e.g. recommend: extra training for staff, change of layout of physical environment, putting an



‘alert’ on the Patient Administration System (PAS) and/or individual’s health records to inform staff of past behaviour, issuing warnings to transgressors, withdrawing all but life saving treatment, restricting visiting access. 12) CFSMS Legal Protection Unit that will assist NHS Trusts, to prosecute aggressor through Courts if Police do not do so. WSFT Trust will support individual members of staff to pursue private prosecution against the aggressor. 13) Support to injured / distressed staff through Occupational Health Department. 14) Lone Working policy, device, training. 15) Armed Response procedure. 16) Child/ Baby abduction procedure. 17) CCTV cameras. Recalculate the Risk Rating with existing controls in place: L X C =Weekly x Moderate = Amber Are the existing controls listed above satisfactory? YES If No, complete the following:

Describe the key risk(s) to be addressed:

Description of additional controls required (actions being taken) to reduce the risk

Cost

Lead

Completion date

Recalculate the Risk Rating with the additional control measures in place: L X C = …. x …. = …..

Please send an amended risk assessment to the Risk Office when additional controls have been implemented so the Trust’s Risk Register can be updated. Signature of responsible Manager as determined by Risk Rating score (please use guide on next page): Green: ........................................................ Amber: ....................................................... Red: .................................................... Risk Assessment Form Version 6 (January 2010) Location: Intranet/Trust Info/Forms/General Forms/Risk Assessment Form

Appendix B Appendix E


Policy Flowchart

PHYSICAL ASSAULT “The intentional application of force to the person of another without lawful justification, resulting

in physical injury or personal discomfort”.

NO YES

Each incident must be considered on a case-by-case basis in light of

all the available facts

Was it because of a Clinical Condition? ‘Clinical condition’ – where clinical opinion indicates that the assault was unlikely to have been intentional as the assailant did not know

that what they had done was wrong due to a medical illness (including confusion), mental ill health, a severe learning disability or

as a result of treatment administered

Make the area safe Emergency Call to Police on 999

and LSMS on 2222

It would be unsuitable to summon the Police if the assault was due to the patient’s clinical condition – However you may

require RPI assistance to prevent further attacks, create a safe environment or to restore law and order; the Team may

be contacted via 2222 Staff to receive support and / or

treatment as required. Manager to arrange support / treatment Physical assaults where a clinical condition

exists are not precluded from the reporting process

Where the Police are involved and attend an incident, every effort should be made to ascertain if the Police intend to take

action against the assailant, along with obtaining the details of the Police Officers involved so that these can be passed onto

the LSMS

As soon as is practically possible following the incident, complete incident report. Form to be sent to the Risk Office as well as the Local Security

Management Specialist (within 48 hours). To be completed by staff member and / or manager

SIRS form to be completed by LSMS. Acknowledgement letter sent to staff

member by the LSMS

Investigation process commences

Zero Tolerance Panel meets to discuss options

Legend Symbol Description Decision Note Action

Appendix C

Source: Facilities Status: Approved Page 20 of 32 Issue date: March 2014 Review date: March 2015 Document ref: PP(14)082

University of Cambridge Associate Teaching Hospital

ZERO TOLERANCE PANEL – POLICY AND PROCEDURE (Addendum to Policy PP (13) 082)

REVISED NOVEMBER 2013

P O L I C Y

1. DEFINITIONS The Health & Safety Executive definition of Violence in the work place; “Any

incident in which a person is abused, threatened or assaulted in circumstances relating to their work. This can include verbal abuse or threats as well as physical attacks”.

NHS Protect definition of Violence & Aggression

1) Physical assault-“the intentional application of force to the person of another without lawful justification, resulting in physical injury or personal discomfort.”

2) Non-Physical assault-“the use of inappropriate words or behaviour causing distress and/or constituting harassment.”

2. WEST SUFFOLK NHS FOUNDATION TRUST

(a) General Policy The West Suffolk NHS Foundation Trust has a Policy for the Management of

Violence and Aggression – PP (**) 082. This policy sets outs clearly the responsibilities of senior managers within the

Trust to maintain a safe and secure environment for its staff. This includes a process by which any evidence of physical or non-physical

violence or aggression can be highlighted, reported and appropriately managed. Responsibility for identifying the incidents (physical or non-physical) that need to

be reviewed rests with the West Suffolk Hospital’s Security Advisor (LSMS). (b) Zero Tolerance Panel As part of this process a Zero Tolerance Panel (ZT Panel) is formulated from

representatives within the Trust.

Appendix C


Constitution of Panel The Panel membership will comprise

Facilities Administration Manager (Chair)

Senior Matron

PALS Manager

Occupational Health Representative

Risk Office Representative

LSMS

Alcohol & Liver Disease Nurse Specialist.

Information Governance Officer

In attendance: Nominated Secretarial/Clerical Assistant from Facilities *(who will also assist LSMS with agenda papers and circulation of minutes, etc.)

Members of the Panel may nominate appropriate substitutes to attend the Panel

in their absence; the substitutes’ names to be notified to the above * prior to the meeting.

A quorum of three must be in attendance to enable the meeting to proceed. The Panel is scheduled to meet fortnightly; should there be no incidents to

present to the Panel the Panel members will be notified. Emergency meetings can be convened when necessary as long as the required

minimum quorum of three can be met.

The Terms of Reference for this Panel are: 1. To review security incidents presented by the LSMS. 2. To consider evidence including statements from all parties involved in the

incident. 3. Agree an action plan taking account of all mitigating factors. 4. Monitor success of action plans agreed. 5. Monitor themes and trends and identify areas of learning within the

organisation. 6. Support the LSMS in provision of information to the Health and Safety

Committee.

The procedure to be followed by the Zero Tolerance Panel is attached (Appendix C).

Appendix C Appendix C



ZERO TOLERANCE PANEL PROCEDURE 1. The Trust Security Advisor / LSMS will investigate all incidents of violence and

aggression and where a patient or associate of the patient is considered an immediate risk to staff, other patients and visitors; the LSMS will place a temporary alert on the patients’ records/electronic system.

The LSMS having received the Incident report will follow the process outlined in

Appendix 5. He will discuss the content with the member of staff promptly and obtain further statements as necessary. This information will be presented to the Zero Tolerance Panel Chair for confirmation of whether or not to proceed.

2. The LSMS will promptly write to the alleged aggressor; informing him/her that a Trust

incident report has been raised. What the allegation is and request a statement or verbal explanation of their involvement (Appendix 1)

3. Upon completion of the investigation and allowing a two week response time, the LSMS

will write to the alleged aggressor and inform him/her that the investigation has been completed and of the date of the ZT Panel meeting with an invitation to attend (Appendix 2).

4. Depending on the timing of the incident, the Panel which convenes the second and

fourth Thursday every month will be advised by the LSMS of:

Incidents currently under investigation (brief resume)

Incidents for which investigation have been completed (detailed discussion taking into account of all statements received)

If alleged aggressor attends, this case to be considered first. 5. In line with the Trust’s Zero Tolerance Policy PP(13)082 and the NHS Protect

guidelines; the Panel can recommend the following sanctions (subject to the agreed authorisation levels within the Trust):

Decide whether to confirm the temporary alert or remove it. and/or

The placement of a zero tolerance warning marker on the individuals (s) electronic and paper records. All markers whether electronic or paper will be placed in accordance with the NHS Protects Guidance “procedures for placing a risk of violence marker on electronic and paper records” April 2010.

Verbal warning (Head of Department/Matron/LSMS).

Appendix C


Acknowledge of Responsibilities Agreements (ARAs) (LSMS/Head of Department/Matron).

Written Warnings (Chief Operating Officer) (Appendix 3).Withholding Treatment (Chief Operating Officer) (Appendix 4).

Civil Injunctions & Anti-Social Behaviour orders (SMD/LSMS/LPU/Police).

Criminal Prosecution (Police/CPS/LPU).

6. The Panel (via the LSMS) will ensure that the patient or associate person is informed of their decision and of any imposed sanctions.

7. The Panel will consider the following four areas:

1. Current Risks to patients, staff and the Trust. 2. General information; number of staff involved in the incident, staff on duty in the

area and other staff in the incident perimeter. 3. Level of training received by staff involved in the incident. 4. Recommendations and actions.

8. The Panel will review, in the light of new information and as a matter of course on a

six-monthly basis all existing alerts and instruct the removal of all those markers no longer a risk of violence.

9. The Panel (via the LSMS) will inform the person that the marker has been removed. 10. The WSFT Chief Operating Officer will approve and sign off all letters and action

plans recommended by the Panel. 11. Appeals: All appeals will be referred to the Chief Operating Officer who will appoint a

panel of General Managers from the Trust to adjudicate the appeal. N. B. Scope of the NHS Violent Patient Marker Scheme (Zero Tolerance Alert) A marker may be considered regardless of whether the act or acts of violence were intentional or not. The use of the marker is to reduce the risk of further incidents by enabling staff to consider and implement measures to reduce risk and increase protection. A marker does not just apply to patients who may abuse staff but also where the abuser is an associate of the patient e.g. partner, guardian, relative and friend. The marker and any associated information such as warnings, exclusions, action plans and handling advice should be available to all internal clinical and non-clinical NHS staff.

Appendix C



APPENDIX 1 Date Our Ref: ZT/JP [Insert name and address here]

Security Department Hardwick Lane

Bury St Edmunds Suffolk

IP33 2QZ

Tel: 01284 713000 Fax: 01284 701993

www.WSFT.nhs.uk

Dear As a result of your visit to the West Suffolk Hospital’s name of ward/dept on date, members of staff felt it necessary to raise an incident report. The incident report alleges that you import content of incident report. The West Suffolk NHS Foundation Trust operates a zero tolerance policy and all incidents of this nature are investigated by the Trust’s Zero Tolerance Panel. It is my responsibility to carry out this investigation and if appropriate present the facts to the Panel who will then decide on any action that may be required. As of today’s date …………………. I have commenced my investigation and in order that a fair and balanced view is presented to the Panel, it is essential that I have a statement from you regarding your recollection of the incident. Please include any factors that may have caused the alleged incident and how you may have felt at the time. Should you not wish to make a statement and would prefer to talk about the alleged incident, I can be reached on the above telephone number. Upon completion of the investigation I shall write and inform you of the Panel’s meeting date and should you wish to attend I will talk you through the process and answer any questions that you may have. I look forward to hearing from you. Yours sincerely James Pretty LSMS Security Manager

http://www.wsh.nhs.uk/

Appendix C



APPENDIX 2 Date Our Ref: ZT/JP [Insert name and address here]

Security Department Hardwick Lane


IP33 2QZ

Tel: 01284 713000 Fax: 01284 701993

www.WSFT.nhs.uk

Dear Further to my letter of date I have now completed my investigation into the alleged incident on the date in the department / ward.

The Zero Tolerance Panel will convene on date and time to discuss this incident. I have your verbal / written statement / do not have any statement from you regarding the

incident. However you are welcome to attend the investigation hearing and represent yourself.

* Should you wish to do so please call me on the above telephone number so that I can give

you further details of where the Panel will meet and what format the enquiry will take. I will of course notify you of the Panel’s decision in due course.

Yours sincerely

James Pretty LSMS Security Manager * or It has been agreed that there are no issues to be discussed and the incident will not need to be reviewed by the Zero Tolerance Panel. Thank you for providing your statement / account of the incident.


Appendix C



APPENDIX 3 Today’s date Our Ref: ZT/JG/JP/HL Name and address of aggressor

Facilities Directorate Hardwick Lane


IP33 2QZ

Tel: 01284 713000 Fax: 01284 713875

www.WSFT.nhs.uk

Dear Name

I am writing further to your attendance in the department on date when you behaved in a manner that could have been interpreted as frightening and intimidating for the members of staff in this area. As a result of your behaviour during your visit, the Police were called and members of staff considered it necessary to complete a Trust incident form with regards to your behaviour. Behaviour such as this is unacceptable and will not be tolerated. This Trust is firmly of the view that all those who work in or provide services to the NHS have the right to do so without fear or violence or abuse. The Trust has a Zero Tolerance policy with regard to violent and/or aggressive behaviour towards staff and the Zero Tolerance Panel meets twice a month to discuss cases where staff have felt that their safety was compromised. I am formally notifying you that the aforementioned Panel, who met on date of ZT Panel meeting, has agreed that your medical records and the hospital computer system will both be annotated with a Zero Tolerance alert. This will ensure that staff are aware of the previous occasion when your behaviour was considered to be unacceptable. Retention of this letter on your healthcare record will be reviewed in 12 months’ time. In the meantime, this information may also be passed to other healthcare bodies, Local Authorities, Social Services, Probation Services, HM Prison Service, the Police or any other public body in the interests of public safety if deemed appropriate. In the event of you exhibiting any similar behaviour in the future the Panel may decide to withhold all further care and treatment from you, with the exception of in a life-threatening situation. This action can be taken and is in line with national guidance for dealing with violent and aggressive acts against NHS staff. If you consider that your alleged behaviour has been misrepresented or that the action is unwarranted, please contact Mr Jim Pretty, Local Security Management Specialist, on 01284 713000. Yours sincerely Jon Green Chief Operating Officer cc Health Records Department, West Suffolk Hospital NHS Trust, Hardwick Lane, Bury St

Edmunds, Suffolk, IP33 2QZ GP: Name and address of patient’s GP


Appendix C



APPENDIX 4 Today’s date Our Ref: ZT/JG/JP/HL Name and address of aggressor

Facilities Directorate Hardwick Lane


IP33 2QZ

Tel: 01284 713000 Fax: 01284 713875 www.WSFT.nhs.uk

Dear Name I write further to the incident on date on location at West Suffolk Hospital. On that date you physically assaulted a member of the department staff at the hospital, whilst they were trying to treat you. The Trust does not tolerate violent and/or aggressive behaviour towards its staff. The Trust’s staff are entitled to work in a safe environment without fear of violence and aggression. Because of the severity of the incident on date, I am writing to inform you that the Trust has decided to exclude you from its premises. The period of this exclusion is twelve months and comes into effect from the date of this letter. This means that you will not be allowed to attend West Suffolk Hospital to receive treatment unless it is life saving treatment. If you attend the hospital premises for any other form of treatment, which is not life saving treatment; you will be asked to leave by the Trust’s staff. If you refuse to leave the staff are instructed to call the Police and ask for your removal. In considering withholding treatment West Suffolk Hospital considers cases on their individual merits to ensure that the need to protect staff is balanced against the need to provide health care to individuals. If you consider that your alleged behaviour has been misrepresented or that the action is unwarranted, please contact Mr Jim Pretty, Local Security Management Specialist, on 01284 713000, who will review this decision in light of your account of the incident. Further copies of this letter will be sent to your General Practitioner and placed on your healthcare records. Details of this letter will be recorded on the West Suffolk HISS record system. Retention of this letter on your healthcare record will be reviewed in 12 months time. In the meantime, this information may also be passed to other healthcare bodies, Local Authorities, Social Services, Probation Services, HM Prison Service, the Police or any other public body if it is deemed to be in the interest of public safety. In the meantime, I would reiterate that you are only allowed to attend the premises of West Suffolk Hospital for life saving treatment. If you attend the Trust’s premises for any other purpose you will be trespassing and the Trust will ask the Police to remove you. Yours sincerely Jon Green Chief Operating Officer


Appendix C

Source: Facilities Status: Approved Page 28 of 32 Issue date: March 2014 Valid until date: March 2015 Document ref: PP(14)082

cc Suffolk Constabulary Security Management Specialist, Addenbrookes Hospital Security Management Specialist, Ipswich Hospital NHS Security Management Service GP: Name and address of patient’s GP

Appendix C

Source: Facilities Status: Approved Page 29 of 32 Issue date: March 2014 Review date: March 2015 Document ref: PP (14)082

APPENDIX 5

Zero Tolerance Process

Complaint against Patient/Member of the Public

Complaint about a patient/member of the public received from member of staff (triggered by Incident Report Form).

Member of staff interviewed by LSMS and supporting statements sought. Decision by member of staff whether they want the complaint to be taken forward to Panel (consent

signed on LSMS Incident Investigation Report).

Panel chair and the LSMS consider the complaint and if the decision is to take it forward, the LSMS writes to the alleged aggressor informing them that there has been a complaint raised. Providing the supporting information (summary statements and reference to the

policy and where to find it); and asking if they would wish to respond; and also setting out the process that will be followed.

Panel decides on action to be taken based on evidence provided. Member of staff and patient/member of public notified of decision.

Review date of any actions to be taken also agreed.

LSMS carries out the investigation and upon completion writes to the alleged aggressor. Alleged aggressor is informed that the investigation is completed and when the case will be heard by the ZT Panel. In addition they will be invited to attends and represent their

version of the event

Appendix D


NON-PHYSICAL ASSAULT

“The use of inappropriate words or behaviour causing distress and / or constituting harassment”

Examples: Offensive language, verbal abuse and swearing which prevent staff from doing their job or makes them feel unsafe; Unwanted or abusive remarks; Negative, malicious or stereotypical

Comments; Invasion of personal space; Brandishing of objects or weapons; Offensive gestures;

Legend

Symbol Description

Action

Each incident must be considered on a case-by-case basis in light of all the available facts. For example,

did the incident occur because of a ‘clinical condition?’

Manager must be notified

Restrictive Physical Intervention Team and LSMS (Police if necessary) to be summoned via

2222

Staff to receive support as required.

Manager to assist

As soon as is practically possible following the incident, complete incident report form. The form should be sent to the Risk Office as well as the Local

Security Management Specialist (within 48 hours). To be completed by staff member and / or manager

Where the Police are involved and attend an incident, every effort should be made to ascertain if the Police intend to take action against the assailant, along with obtaining the

details of the Police Officers involved so that these can be passed onto the LSMS

Investigation process commences

Incident and appropriate action to be taken. Zero Tolerance Panel meets to discuss options.

Appendix E


THE USE OF WARNING MARKERS Warning markers that are placed on patients’ medical records will be used very carefully and will contain the reasons for identifying individuals as being potentially violent, aggressive or abusive. They are likely to record information relating to:

The apparent mental stability of an individual; or

Any threatening actions, incidents or behaviour they have or are alleged to have committed.

Compliance with the Data Protection Act 1998 (The Act) The first data protection principle requires that the processing must be fair and lawful. This means that a decision to put a marker on an individual’s file must be based on a specific incident or expression of clearly identifiable concern by professional, rather than general opinions about the individual. The individual will pose a genuine risk and the decision will be based on objective and clearly defined criteria and a line with a clear and established policy and review procedure. The criteria will take into account the need to accurately record any incident. For consistency a nominated person (LSMS) & V&A Panel will be responsible for making the decision to place such a marker upon an individual’s record. Decisions will be reviewed regularly and when making said decision the following would be taken into account:

The nature of the threat;

The degree of violence / aggression / abuse used or threatened; and

Whether or not the incident indicates a credible risk of violence to the staff.

For the processing to be fair, the individuals who have been identified as being in a category that requires a “Warning Marker” will be written to, as soon as possible after the decision has been made to place a warning on their record. The letter will contain the following information:

The nature of the threat or incident that led to the marker:

That their records will show the marker;

Who this information may be passed on to; and

When the marker will be removed / or review its status. “The Act” gives individuals the right to make a subject access request, in most cases, it will be revealed that there is a warning marker in place (in the majority of cases the individual concerned will have been written to and informed of the action). However this decision will be taken on a case-by-case basis, and consideration given to any other individuals (third parties) that may be included in the in formation. There may be rare cases when there will be a need to consider whether:

Revealing the existence of the marker;

Revealing the information in the marker; or

What the individual may infer from the existence of the marker;

Appendix E


May actually cause serious harm to the physical or mental health or condition of that individual. In these cases specialist advice from a health and data protection professional will be sought (WSFT Information Governance Officer). Requests from individuals to stop processing their personal information Section 10 of The Act gives individuals the right to require that the Trust stops processing their personal information if this is likely to cause them substantial and unwarranted damage or distress, Should the Trust receive a section 10 notice, relating to a warning marker and the Trust is of the opinion that it remains in place, it may. Ultimately have to justify creating the marker in court. Passing the information to other organisations This action will be justified where there is good reason to do so e.g. to alert them to the potential risk to their staff. In these cases the focus will be on justification rather than being unfair. This action will be considered on a case-by-case basis where there is a credible risk that an unlawful act, such as an assault, will occur. The information will be passed to a senior member of the organisation. Should the information be passed on the individual will be informed unless there may be a serious risk to the individual or a third party. If the marker is reviewed and it is decided to change or remove it all alerted organisations must be informed. Retention The Act requires that personal information will not be kept longer than is necessary. Warning markers must not be kept longer than is necessary; they must be removed when there is no longer a threat. This will be part of the standard review procedure. The retention period is likely to depend on the following criteria:

The original level or threat of violence / aggression / abuse;

How long it was;

The previous and subsequent behaviour of the individual; and

Whether or not any incident was likely to have been a “one-off”. For example, where the individual was suffering an unusual amount of stress due to a particular set of circumstances.

Security All files containing an indication that an individual is potentially violent, aggressive or abusive must be retained securely. Access to said files must be restricted to authorised personnel. Staff Training Staff will be trained to use the system and procedures relating to warning markers. They will be aware of:

Their duty to report all violent, abusive and aggressive incidents or professional expressions of concern about real or potential violence;

The name of the person they will report the incidents to; and

The nominated person / panel who makes the decisions about markers

Documents

Management of Violence and Aggression · 2019-10-03 · Management of Violence and Aggression Policy Contents Pages 1.0 Strategy 2.0 Introduction 3.0 Duties and Responsibilities 4.0