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Management of Violence and Aggression Policy – HSC029

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Table of Contents Management of Violence and Aggression Policy – HSC029 ................................................................... 1

Why we need this Policy ..................................................................................................................... 3

What the Policy is trying to do ............................................................................................................ 3

Which stakeholders have been involved in the creation of this Policy .............................................. 4

Any required definitions/explanations ............................................................................................... 4

Key duties ............................................................................................................................................ 5

Chief Executive ........................................................................................................................ 5

The Security Management Director ........................................................................................ 5

Local Security Management Specialist (LSMS) ....................................................................... 6

NHFT Managers ....................................................................................................................... 6

Trust Employees ...................................................................................................................... 6

Security Personnel .................................................................................................................. 7

Policy detail ......................................................................................................................................... 8

Preventing and Minimising the Likelihood of Violence & Aggression .................................... 8

Incident Reporting ................................................................................................................ 11

Sanctions and Redress .......................................................................................................... 12

The NHS Protect Legal Protection Unit (LPU) ....................................................................... 14

Training requirements associated with this Policy ........................................................................... 14

Mandatory Training .............................................................................................................. 14

Specific Training not covered by Mandatory Training .......................................................... 14

How this Policy will be monitored for compliance and effectiveness .............................................. 14

For further information ..................................................................................................................... 15

Equality considerations ..................................................................................................................... 15

Reference Guide ............................................................................................................................... 15

Document control details ................................................................................................................. 16

APPENDIX 1 – STATUTORY RESPONSIBILITIES .................................................................................. 17

APPENDIX 2 - CREATING A SAFE ENVIRONMENT.............................................................................. 19

APPENDIX 3 PRISON PROCEDURES……………………………………………………………………………………………..20

APPENDIX 4 – WHAT TO DO IF YOU ARE ASSAULTED ....................................................................... 20

APPENDIX 5 - NHS PROTECT WARNING LETTER TEMPLATE ............................................................. 22

APPENDIX 6 - RESTRICTIONS ON VISITING LETTER TEMPLATE ......................................................... 23

APPENDIX 7- EXCLUSION FROM PREMISES LETTER TEMPLATE ........................................................ 24

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Why we need this Policy

This policy outlines Northamptonshire Healthcare NHS Foundation Trust’s (NHFT) approach to the

deterrence, prevention and management of Violence and Aggression against staff by patients,

visitors, relatives and the public in general. It is acknowledged that whilst there is an increased risk

of aggression and violence against healthcare staff, this risk can be greatly reduced by effective

communication, effective risk assessment (see section 6.11), prevention planning, service user

involvement and learning from incidents. Although the Trust does not accept that violence and

aggression is ‘part of the job’ it is essential to acknowledge that past experiences and current

symptoms may influence the behaviour of our service users.

What the Policy is trying to do

The purpose of this policy is to ensure that staff working in healthcare are provided with a safe environment that minimizes the risk of violence and aggression. This risk can be reduced by a commitment to the five core values of NHFT (PRIDE), provision of a supportive and caring environment and the implementation of a violence reduction model. Models of violence reduction which incorporate primary, secondary and tertiary prevention strategies have been shown to reduce the incidence of violence and aggression and this therefore, is the framework used within NHFT. The main legislation governing the management of violence and aggression towards staff in NHS establishments are contained in, but not limited to The Health and Safety at Work Act 1974 (HASWA), Management of Health & Safety at Work Regulations 1999 (MHSW), and Secretary of State Directions to NHS Bodies on measures to deal with violence against NHS staff. NHS Protect guidance “A Professional Approach to Managing Security in the NHS” is considered best practice in relation to security management and is enforceable by the Health and Safety Executive. This policy requires managers to formally assess the safety needs of their employees and put in place local control strategies commensurate with the risk. Compliance is measured by the NHS Protect Standards for Providers; an annual submission is required detailing how the Trust meets the Standards and this may be audited by NHS Protect. In order to deal with Violence and Aggression effectively, it is vital that all incidents are reported and formally recorded. Any resulting action taken by NHFT will vary according to individual circumstances. This may range from immediate removal and arrest of offenders by the police, to the issuing of formal or informal warnings, and in extreme cases exclusion from Trust Premises for offenders who are not patients. The Trust emphasises that Violence and Aggression will not be tolerated or accepted and NHFT will pursue such sanctions for patients who commit acts of violence and aggression against staff when they are deemed to have capacity to do so. The Trust will use all appropriate opportunities to inform the public and patients about its policy regarding violence and aggression to staff; this will include placing posters in public areas, inserting notices in publications and using the media.

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NHFT recognizes the need to support staff at all times. This support may be in the form of training, supervision or advice, and may include guidance and aftercare as necessary. NHFT acknowledges the right of any individual to take legal action in the case of an act of violence at work.

Which stakeholders have been involved in the creation of this Policy

Prevention and Management of Violence and Aggression Group

Health, Safety and Risk Group

Trust Policy Board

Any required definitions/explanations

Violence & Aggression at Work

“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” (HSE)

Physical Assault

“The intentional application of force to the person of another without lawful justification resulting in physical injury or discomfort”. (NHS Protect)

Please note - this applies to all incidents involving physical contact with staff by patients, including incidents deemed as being clinically-related. “Any incident where staff are abused, threatened or assaulted in circumstances related to their work, involving an explicit or implicit challenge to their safety, well being or health". (HSE)

Non-Physical Assault

The NHS has defined non-physical assaults as “The use of inappropriate words or behaviour causing distress and/or constituting harassment”.

Violent and Aggressive Actions

May include the following (NB – this list is not exhaustive):

Physical contact in the form of hitting, kicking, punching, scratching, biting, slapping, pinching, spitting, head-butting and strangulation.

Incidents where reckless behaviour results in physical harm to others.

Incidents where attempts are made to cause physical harm to others and fail.

Sexual assault.

Use of weapons.

Throwing of furniture and objects.

Slamming and punching of doors.

Damage to property – smashing windows, objects.

Threatening comments and verbal abuse including racist or sexist language.

Non-verbal aggression – waving fingers, fists, invasion of body space, stalking.

Hostage taking.

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Stalking.

Alcohol or drug fuelled abuse.

Effects of assault

The effects of non-physical and physical assault are wide ranging. As well as the more evident impacts of a physical assault, such as visible bruise or injury, there may often be non-evident, longer-lasting impacts such as emotional and psychological trauma.

Self Defence

In the event of a violent / aggressive incident, all staff have the common law right of self defence (the minimum action and/or force necessary to remove themselves from a situation presenting imminent or present harm to their personal safety).

Physical Intervention / Restraint

Physical intervention/restraint refers to the use of force to restrict movement or mobility, or the use of force to disengage from dangerous or harmful physical contact initiated by a patient/client. Physical intervention/restraint differs from manual guidance or physical prompting in so far as it implies the use of force against resistance.

NHFT

Northamptonshire Healthcare Foundation Trust

Key duties

Chief Executive

Has overall responsibility for the provision of appropriate policies and procedures for all aspects of Health and Safety at work. The duty of implementing these policies is delegated to the Board of Directors.

The Security Management Director

The SMD is the nominated executive with the responsibility for security management; in NHFT this is the Finance Director. The SMD will lead and communicate at board level on strategies to tackle violence against staff. This will assist the Trust in meeting its responsibility for the health and safety of staff. The SMD will work with the nominated Non Executive Director (NED) to:

Be responsible for the introduction, operation, monitoring and evaluation of this policy to ensure comprehensive, fair and consistent application throughout the Trust.

Facilitate the continual development of a pro-security culture among staff and NHS professionals.

Raise awareness of security issues and encourage staff and professionals to report all incidents, following the Trust Incident Reporting Procedure.

Ensure that full co-operation is given to the LSMS, the Police, the Legal Protection Unit (LPU) and the Area Security Management Specialist (ASMS) in respect of an investigation and any subsequent action, including ensuring access to personnel, premises and records, whether electronic or otherwise, which are considered relevant to the investigation.

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Local Security Management Specialist (LSMS)

A key priority area of work for the LSMS is preventing and managing violence and aggression, in conjunction with Trust policies and in accordance with Secretary of State Directives (see Appendix 1). The LSMS will:

Act as the lead for all security matters

Ensure that all incidents of violence and aggression are reported immediately on the Trust integrated risk management system (Datixweb), and if necessary, to the police

Review and if necessary act upon all reported incidents of violence and aggression.

Develop an annual written plan of work in consultation with the SMD and ASMS and submit an annual report detailing how this was met

Submit annual Violence and Aggression statistics to NHS Protect

Produce Quarterly security reports which include analysis of incidents of Violence and Aggression, and an annual report.

Attend the Security and Personal Safety Committee and the Health and Safety Committee

Act as a single point of contact for the witness service and support staff who are called to court as witnesses

Manage the provision and operation of lone worker protection devices and provide security advice to members of staff as required

Liaise with the police and pursue sanctions and redress where appropriate

NHFT Managers

Line managers should liaise with the LSMS and the Risk Management Department to develop local departmental policies to protect staff from violence and aggression which are tailored to their needs. This should include risk assessments; Promoting Safer and Therapeutic Services (PSTS) for clinical frontline staff within Mental Health and Learning Disability inpatient services and Conflict Resolution Training (CRT) training for other clinical and non-clinical frontline staff; Breakaway and Physical Intervention training where applicable; and the reporting of incidents. Managers must ensure that staff work within these guidelines. If a member of staff has been involved in an incident of violence and aggression, their manager must ensure that it has been reported on the Integrated Risk Management System (Datixweb). They must ensure that the incident is reviewed, either as part of a patient’s care plan or as a standalone incident, and an action plan put in place to reduce the risk of further incidents. The member of staff involved must be supported and offered access to occupational health and counselling if required.

Trust Employees

Staff have a responsibility to make themselves aware of the violence and aggression policies and procedures locally within their directorate. Staff must report all incidents of violence and aggression, they also have a responsibility for contributing to a safe and secure environment and creating and maintaining a pro-security culture. Under the Health and Safety at Work Act 1974, employees have a duty to take reasonable care for the health and safety of themselves and others affected by their acts or omissions. This responsibility therefore, also includes an awareness of the risks to visitors to the area from any aggressive / violent behaviour and staff must weigh these risks when facilitating visits and act accordingly. This action may include terminating the visit and or chaperoning visitors – individual ward / unit policies should be referenced for further guidance on

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visiting. Staff working on Mental Health and Learning Disability inpatient wards must meet the mandatory training requirements with regard to Physical Intervention training as detailed in the CLP060 Policy on the Use of Physical Interventions. It is important to note that staff cannot continue to work in an environment that puts themselves and their colleagues at uncontrollable risk.

Security Personnel

Where contracted security personnel are on site, they are responsible for complying with Trust and local policies and procedures.

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Policy detail

Preventing and Minimising the Likelihood of Violence & Aggression

Successful primary prevention of aggression / violence (addressing root causes) requires action from

all levels in the organisation (service users, staff, teams managers and Trust Board) as effective

leadership and high morale have been associated with reduced levels of conflict in the workplace. It

is also essential that the issue of violence prevention, management and reduction is ‘owned’ at the

highest level of the organisation as it requires commitment and resources to be focussed and

effective.

Examples of primary prevention include the following: therapeutic engagement and collaboration

with service users, the use of advanced statements, accurate risk assessment (see section 6.1.1),

clear communication and a culture of respect and understanding. Staff and service user engagement

is a key factor all levels (primary, secondary and tertiary).

Secondary prevention (early intervention to prevent escalation) refers to the use of de-escalation

skills and techniques and is therefore, heavily reliant upon the communication skills and positive

attitude of staff.

Tertiary prevention seeks to learn lessons from incidents of violence and aggression therefore it is

expected that in clinical settings care plans, post incident and seclusion reviews are used to this end.

Staff/Team Debriefing, Service User Learning, Accountability, System Evaluation and Root cause

analysis (organisational and not just individual patterns of behaviour) are all key components of

tertiary prevention.

In order to learn lessons and to deal with Violence and Aggression effectively, it is vital that all

incidents are reported and formally recorded. Any resulting action taken by NHFT will vary according

to individual circumstances. This may range from immediate removal and arrest of offenders by the

police, to the issuing of formal or informal warnings, and in extreme cases exclusion from Trust

Premises for offenders who are not patients. The Trust emphasises that Violence and Aggression will

not be tolerated or accepted and NHFT will pursue such sanctions for patients who commit acts of

violence and aggression against staff when they are deemed to have capacity to do so. The Trust will

use all appropriate opportunities to inform the public and patients about its policy regarding

violence and aggression to staff; this will include placing posters in public areas, inserting notices in

publications and using the media.

NHFT recognizes the need to support staff, service users and visitors at all times. This support may

be in the form of training, supervision or advice, and may include guidance and aftercare as

necessary through Occupational Health and our Trust Psychologist. NHFT acknowledges the right of

any individual to take legal action in the case of an act of violence at work.

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The main legislation governing the management of violence and aggression towards staff in NHS

establishments are contained in, but not limited to The Health and Safety at Work Act 1974

(HASWA), Management of Health & Safety at Work Regulations 1999 (MHSW), and Secretary of

State Directions to NHS Bodies on measures to deal with violence against NHS staff. NHS Protect

guidance “A Professional Approach to Managing Security in the NHS” is considered best practice in

relation to security management and is enforceable by the Health and Safety Executive. This policy

requires managers to formally assess the safety needs of their employees and put in place local

control strategies commensurate with the risk.

Risk Assessment

There are two approaches to the risk of violence and aggression: individual risk assessment

and physical risk assessment. CLP021 Working with Risk Policy details the process of

individual clinical risk assessment to minimize the risk of violent and aggressive behaviour.

HSC004 Security Policy concerns the process of physical risk assessment which includes

measures to prevent and minimise the risks of violence and aggression towards staff.

Guidance on creating a safe environment is attached (Appendix 2).

How NHFT carries out Risk Assessments for the Prevention and Management of Violence

and Aggression

The Security Policy HSC004 details how physical risk assessments are carried out. The risk

assessment includes sections on reducing aggression and staff safety (including lone

working).

Timescales for the review of Risk Assessments and how Action Plans are developed and

followed up

The LSMS (or representative) will make a biennial audit of physical security and provide

recommendations to the local manager as well as identifying violence and aggression risks to

put on the directorate risk register. The process of developing, following up and monitoring

action plans is detailed in the Security Policy HSC004. The LSMS will also make interim risk

assessments in response to incidents or at the request of local managers; any actions

recommended as a result will be recorded on an action plan.

Protection of Staff

The Trust must provide a safe environment for staff and patients; this will be achieved by training,

Personal Protective Equipment (PPE) and Risk Assessment, and will be supported by local

procedures.

Protection of Lone Workers

It is recognized that lone workers face increased risks of violence and aggression due to the

circumstances in which they work, without the support of colleagues in an uncontrolled

environment. The Trust has a separate policy: HSC006 Lone Working, which must be

referenced in conjunction with this policy.

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Protection of NHFT Staff Working in Prisons

Prisons present a very different environment to hospitals/healthcare centres and staff have

to operate within the prison management regime. A supplementary guidance for the safety

of NHFT staff working in prisons is attached at Appendix 3.

Training

It is mandatory for all Trust staff who have patient contact to complete mandatory training in either

Promoting Safe and Therapeutic Services (PSTS) which includes Clinically Related Challenging

Behaviour (CRCB) or Conflict Resolution Training (CRT) with additional CRCB training where

appropriate. A Training Needs Analysis is set out in the Physical Interventions Policy CLP060.

Attack Alarms

Attack alarms/personal alarms are used by staff to summon help when they are in a difficult

situation. Alarms must be supported by a robust response procedure. Attack alarms may be used

on inpatient wards, in prison environments and in smaller clinics and may be a fixed and hardwired

button, a mobile unit with detectors hardwired in the building, a portable noise maker or a

computer alert. Staff are responsible for checking portable alarms are working before they use

them, managers need to ensure written instructions for testing the alarms are available to and

followed by all staff.

All staff working on mental health inpatient wards must be provided with and wear an attack alarm

(unless they are escorted such as a maintenance contractor). The alarms at the Welland Centre and

Berrywood Hospital are provided and maintained by the PFI but staff are responsible for testing and

reporting faults. Staff working in community hospitals and clinics should align the type of alarm to

the level of risk and provide a suitable response. Where staff are working with another organisation,

for example a GP practice, they must be treated as part of that team. Likewise, staff from other

agencies will be expected to comply with NHFT local procedures.

Trend Analysis

Incidents reported on the integrated risk management system DatixWeb are reviewed at regular

intervals to provide information and trend analysis to managers. Managers should investigate

clusters and identify the root cause of incidents and ensure this is fed back into care plans and local

procedures.

Staffing

Managers who are setting staffing levels need to ensure that there are always adequate numbers of

appropriately trained staff to cope with the risk presented from violent or aggressive behaviour.

Security personnel

Any security personnel, whether they are employed directly by the Trust or are a contracted

provider, are present as a deterrent and to participate in incidents involving members of the public.

They are not permitted to be involved in clinical restraint or to be given responsibility for patient

safety.

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Detection of violence / aggression risks

Where applicable, ePEX/Systm1 must be checked before meeting with a patient or their family to

see if a warning marker has been placed there. All reasonable efforts will be made by Trust staff to

obtain information from other agencies known to be involved with individual patients to ensure as

far as possible all appropriate background information is available prior to an initial assessment/visit

with a new patient.

When meeting with a new patient or one with known risks, the location must be chosen with care to

ensure that assistance is readily available and staff have the ability to withdraw. It is important that

meetings are not held within access controlled areas.

Personal Safety

Detailed personal safety guidance is available on the Security page of the Trust intranet.

Incident Reporting

Incidents must be reported in line with the Trust’s Incident Policy CRM002. All incidents must be

reported on the Trust’s integrated risk management system: DatixWeb, whether they are related to

a clinical condition or not.

Staff do not have to accept physical or non-physical abuse including verbal abuse and may request

alternative duties which do not involve contact with the abuser. Managers are obliged to make

arrangements which are not detrimental to the staff concerned and provide support to staff

including referral to occupational health and the psychology department if appropriate. The Trust’s

Policy on Restrictive Policy CLP060 details the support, reconciliation and review measures which

follow an incident where physical interventions are used. The review must include a successive

clinical risk assessment and may advocate an interim security risk assessment by the LSMS.

All staff who have been assaulted have the right to report the assault to the police and will be

supported by the Trust if they do so. Physical assaults by patients must be reported to the police

unless the assailant’s clinical condition is such that the assault was clearly unintentional and the

member of staff affected does not wish to report the incident. The Police Response for NHFT Policy

CLP022 gives full details of the process and the LSMS will give advice and support. This includes

liaising with the Witness Care Unit, providing a pre-trial briefing and accompanying any members of

staff who have been called as witnesses to Court. A flowchart is available for easy reference (see

Appendix 4). The prosecution of assaultive individuals should not be viewed as a punitive response

as there is evidence to suggest that it can reduce the frequency of such behaviour, improves staff

morale, improves the accuracy of risk assessments and ultimately the appropriate placement of high

risk individuals (Clark et al 2012).

The person assaulted or their manager should report the incident to the police as soon as possible,

either as an emergency on 999 if assistance is required immediately or as an incident on 101. They

should note the incident number and if given, the crime number. This will be required when

reporting the incident on DatixWeb and in any further communication with the police. If the police

require a written statement, the member of staff affected may request the presence of the LSMS or

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their manager.

Non-physical assault

Examples of the kind of behaviour which constitutes Non-Physical Assault:

Offensive language, verbal abuse and swearing which prevents 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

Near misses (unsuccessful physical assaults)

Offensive gestures

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

Bullying, victimization or intimidation

Stalking

Alcohol or drug-fuelled abuse

Unreasonable behaviour and non-co-operation such as repeated disregard of hospital

visiting hours

Non-physical abuse can take place in person or by telephone, letter, email, fax or text, or other form of communication such as graffiti on NHS property.

Staff may choose whether to report verbal abuse to the police, depending on how it has affected them and whether they believe it to be intentional. Any threats must be reported to the police whether the person affected believes they are credible or not

Hate crime Hate Crime must always be reported to the police. Verbal Abuse will constitute a hate crime if the very nature of the language used falls into one of the following categories: a Racist, Religious or Faith Incident (Hate Crime) is defined as any incident which is perceived as such by the victim or any other person; a Homophobic Incident (Hate Crime) is defined as any incident which is perceived to be homophobic by the victim or any other person; a Disablist Incident (Hate Crime) is defined as any incident which is perceived to be disablist by the victim or any other person and includes those having occurred as a result of a persons actual or perceived disability or impairment. It includes both physical impairment and mental health problems.

Physical assaults All physical assaults by visitors to the Trust must be reported to the police. Physical assaults by patients should be reported to the police unless the assailant’s clinical condition is such that the assault was clearly unintentional and the member of staff affected does not wish to report the incident.

Sanctions and Redress

NHFT will not withdraw mental health or learning disability services from a patient who has been violent and aggressive; these incidents will be reviewed as part of their care plan. However, if a physical assault is not the result of a clinical condition and the patient is deemed to have capacity the Trust will press charges. The Trust has zero tolerance of acts of violence and aggression by visitors.

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The following behaviour is unacceptable on Trust property:

Violence

Any behaviour constituting harassment

Threats or threatening or intimidating behaviour

Wilful damage to NHFT property or staff property

Bringing restricted materials onto the wards

Illicit drug dealing and supplying

Offensive sexual gestures or behaviours

Malicious allegations relating to members of staff, other patients or visitors

Derogatory, racial or sexual remarks

Discrimination and victimisation including third parties

Threatening or abusive language involving excessive swearing or raised voice

Hate crime A range of measures can be taken by the Trust depending on the severity of the assault which may assist in the management of unacceptable behaviour:

Criminal prosecution

Civil injunctions

Verbal reprimand (given by the police)

Written warning / restrictions on visiting / exclusion from NHFT premises

Alternative arrangements for care

o Written warning / restrictions on visiting / exclusion from NHFT premises

In certain circumstances a formal written warning can be issued by the LSMS (Appendix 4). In order for a letter to be issued, the following steps must be followed:

An incident of unacceptable behaviour needs to have occurred.

The person committing the offence must be told their behaviour is unacceptable and asked to desist, unless confronting this behaviour has personal safety implications for staff or patients.

The incident and intercession/reason for not interceding must be recorded on DatixWeb.

The manager must believe the incident is likely to reoccur.

The LSMS must be notified and a warning letter requested by the modern matron. This must be approved by the head of service.

If this warning is not heeded, the recipient of the warning letter may be asked to leave Trust property by the staff in charge or, if this action has personal safety implications for staff or patients, by a security officer or by the police. The incident must be recorded on DatixWeb and the LSMS notified. The LSMS must then consult with the ward manager/modern matron and head of service to decide if a Restrictions on Visiting letter (Appendix 5) or Letter of Exclusion (Appendix 6) is appropriate. The letter must be authorised by the Head of Service (Restriction) or Chief Executive/Security Management Director (Exclusion) before sending out. The LSMS must keep a record of all letters sent out and provide details in the annual security report.

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The NHS Protect Legal Protection Unit (LPU)

The LPU works closely with providers to safeguard NHS staff from violent and disruptive individuals. They can provide legal advice on issues such as appropriate sanctions and redress and will draft letters and agreements on request. Where appropriate, the LPU will work with providers to prosecute individuals who have assaulted or abused members of NHS staff in cases that have not been progressed by the police or the CPS.

Training requirements associated with this Policy

Mandatory Training

Training required to fulfil this policy will be provided in accordance with the Trust’s Training

Needs Analysis. Management of training will be in accordance with the Trust’s Statutory and

Mandatory Training Policy HR025.

Specific Training not covered by Mandatory Training

NHFT has a requirement under Secretary of State Directions 2003 to have an accredited Local Security Management Specialist (LSMS) in post.

How this Policy will be monitored for compliance and effectiveness The table below outlines the Trusts’ monitoring arrangements for this document. The Trust reserves

the right to commission additional work or change the monitoring arrangements to meet

organisational needs. Where a lack of compliance is found, the identified group, committee or

individual will identify required actions, allocate responsible leads, target completion dates and

ensure an assurance report is represented showing how any gaps have been addressed.

Aspect of compliance or effectiveness being monitored

Method of monitoring

Individual responsible for the monitoring

Monitoring frequency

Group or committee who receive the findings or report

Group or committee or individual responsible for completing any actions

Duties To be addressed by the monitoring activities below.

Requirement to carry out risk assessments for the prevention and management of violence and aggression

Physical Security Schedule

Security Manager LSMS

Quarterly Health and Safety Risk Committee

Security Manager LSMS

Requirement to develop and follow up action plans as a result of risk assessments

Action Plan Monitoring Schedule

Security Manager LSMS

Quarterly Health and Safety Risk Committee

Local manager of the property assessed.

Requirement to monitor the completion of recommended action plans

Action Plan Monitoring Schedule

Security Manager LSMS

Quarterly Health and Safety Risk Committee

Local manager of the property assessed.

Requirement to monitor risk assessments for non-clinical violence and

DatixWeb Risk Register

Security Manager LSMS

Quarterly Health and Safety Risk Committee

Security Manager LSMS

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aggression

Requirement to monitor reports of incidents of violence and aggression

Analysis report of data from DatixWeb

Security Manager LSMS

Quarterly Prevention and Management of Violence and Aggression Group

Security Manager LSMS

If there is mandatory training associated with this document state the mandatory training here

Training will be monitored in line with the Statutory and Mandatory Training Policy.

For further information

Please contact the Security Manager LSMS.

Equality considerations

The Trust has a duty under the Equality Act and the Public Sector Equality Duty to assess the impact

of Policy changes for different groups within the community. In particular, the Trust is required to

assess the impact (both positive and negative) for a number of ‘protected characteristics’ including:

Age;

Disability;

Gender reassignment;

Marriage and civil partnership;

Race;

Religion or belief;

Sexual orientation;

Pregnancy and maternity; and

Other excluded groups and/or those with multiple and social deprivation (for example

carers, transient communities, ex-offenders, asylum seekers, sex-workers and homeless

people).

The author has considered the impact on these groups of the adoption of this Policy and

incorporated into the overarching health and safety equality analysis

Reference Guide

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Department of Health, 2003, “Directions to NHS Bodies on Measures to Deal with Violence Against NHS Staff”, www.nhsbsa.nhs.uk Department of Health, 2004, “Directions to NHS Bodies on Security Management Measures”, www.nhsbsa.nhs.uk Department of Health, 2006, “Directions to NHS Bodies on Measures to Deal with Violence Against NHS Staff (Amendment) Directions 2006”, www.nhsbsa.nhs.uk

Document control details

Author: Security Manager LSMS

Approved by and date: Trust Policy Board 10.01.2017

Responsible Committee: Health, Safety and Risk Committee

Any other linked Policies: CRM001 Risk Management Strategy CRM002 - Incident Policy CLP007 - Seclusion Policy CLP021 - Working with Risk Policy CLP022 - Policy for Police Intervention for Staff and Service Users in Mental Health In-Patient Areas CLP060 - Restrictive Physical Interventions Policy HSC001 - Health and Safety Policy HSC002 - Policy and Guidance for the Use of Risk Registers HSC004 - Security Policy HSC006 - Lone Working Policy HR016 - Bullying and Harassment Policy and Procedure HR025 - Statutory and Mandatory Training Policy

Policy number: HSC029

Version control: 5.0

Version No.

Date Ratified/ Amended

Date of Implementation

Next Review Date

Reason for Change (eg. full rewrite,

amendment to reflect new legislation, updated flowchart, minor amendments, etc.)

5.0 10.01.2017 10.01.2017 10.01.2020 New governance of trust policies template.

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APPENDIX 1 – STATUTORY RESPONSIBILITIES

The NHS SMS, part of the NHS Counter Fraud and Security Management Service, was established in April 2003 with statutory responsibility for the management of security within the NHS (Statutory Instrument 3039/2002). These delegated responsibilities are exercised on behalf of the Secretary of State for Health, through the issuing of Secretary of State Directions. For foundation trusts, these arrangements are replicated under schedule 13 of the standard NHS contract. In 2003, the NHS SMS launched a national strategy for managing security in the NHS: A professional approach to managing security within the NHS (2003). NHS bodies have responsibilities to meet the requirements of Secretary of State Directions (Directions to health bodies on measures to deal with violence against NHS staff and Directions to health bodies on security management measures, 2003 and 2004 respectively and as amended 2006). For foundation trusts, the same responsibilities apply under schedule 13 of the standard NHS contract. Directions outline the responsibilities of NHS bodies to manage security and provide a safe and secure environment for staff, patients and visitors. These responsibilities include protecting NHS staff from violence and aggression. They include important security management definitions of physical and non-physical assault and state how NHS bodies should report incidents. They explain that NHS bodies must nominate a Security Management Director (SMD) to manage security and represent security management work at executive board level. A non-executive director (or the equivalent person in foundation trusts) must be in place to support, scrutinise and, where appropriate, challenge the SMD and/or executive board on issues relating to security management where appropriate to do so. SMDs have overall responsibility for the nomination and appointment of a Local Security Management Specialist (LSMS). The LSMS is required to undergo professional accreditation training to ensure security management work, including work to tackle violence and aggression, is being undertaken to the highest standard locally. In 2013 NHS Protect introduced Standards for Providers, 31 Standards which all providers have to work towards in order to meet the conditions of the NHS Standard Contract. Providers must complete a self review tool (SRT) describing how they meet the standards based on the 4 core principles of Strategic Governance, Involve and Inform, Prevent and Deter, and Hold to Account. Providers will then be audited by NHS Protect periodically. The Health and Safety Executive The Health and Safety Executive (HSE) is responsible for the encouragement, regulation and enforcement of workplace health, safety and welfare, underpinned by the Health and Safety at Work etc Act 1974. Employers have responsibilities under the Health and Safety at Work etc Act 1974 to ensure, as far as is reasonably practicable, the health, safety and welfare of employees at work. Employers must have a written health and safety policy setting out their arrangements for managing health and safety risks.

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The Management of Health and Safety at Work Regulations 1999 require employers to assess risks to employees and non-employees and make arrangements for effective planning, organisation, control, monitoring and review of health and safety risks. Where appropriate, employers must assess the risks of violence to employees and, if necessary, put in place control measures to protect them. Employers need to ensure that suitable provisions are in place to monitor and assess how effective they are in controlling the risks and these need to be able to be demonstrated to the HSE. Effective health and safety management requires board-level commitment. Employers should ensure that they seek competent advice where needed to assist them in complying with these statutory duties. The HSE and NHS SMS have signed an agreement to ensure the closer working of the two organisations, including better communication and liaison, information sharing, referrals of concerns and joint visits on violence and abuse issues, which have wider implications on the health, safety and welfare of staff. The Care Quality Commission The Care Quality Commission (CQC) was established under the Health and Social Care Act 2008 as the independent regulator for health and adult social care in England. Under this Act, the Regulated Activities Regulations 2010 outlines the types of service that must be registered with the CQC and the Registration Requirements Regulations 2009 outlines what service providers have to do to become registered. Since January 2010, NHS providers have been required to register against a new set of outcomes/standards regarding the safety and quality of services. Since April 2010, all NHS trusts, including PCTs, have been required to be registered. From October 2010, all adult social service providers and independent healthcare providers must be registered. It is illegal for an NHS provider to operate without being registered with the CQC. The CQC has issued guidance on compliance: Essential standards of quality and safety. This outlines the outcomes/standards providers need to meet to achieve compliance with the registration requirements. This guidance includes essential standards of quality and safety and requires that staff are supported by the NHS provider to undertake their work in a safe working environment where risk of violence is minimised. Providers are not legally bound to meet these standards, however if they follow alternative arrangements, they should still be able to demonstrate that they have taken account of the standards when judging compliance with the regulations. As part of registration, the CQC will develop a Quality and Risk Profile (QRP) for each provider to assess where the risks lie and which may prompt further regulatory activity, such as inspection. The CQC will continue to check and monitor service providers to ensure that they continue to meet the essential quality and safety standards, including preventing violence against staff. Where a provider is not complying, the CQC will take further action such as making further enquiries to the provider or partner organisations and making a site visit. If the non - compliance is serious or previous action plans have not been completed, the CQC will take proportionate enforcement action. This could include warning notices, imposition or variation of conditions, suspension of registration to provide certain services, fines, prosecution or cancellation of registration.

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APPENDIX 2 - CREATING A SAFE ENVIRONMENT

1. Reduce stress Environmental issues are potential causes of violent and aggressive behaviour. The following actions can reduce stress and therefore reduce the risk of violent and aggressive behaviour.

Clear directions

Convenient car parking

Signposts

A friendly greeting

Access to toilet facilities

Provision of drinking water

Clean and comfortable surroundings

Provision of informative and entertaining literature

Good timekeeping

Keep patients informed if appointments are delayed 2. Protect staff Simple precautions can be taken to reduce the risk and effects of violence and aggression when meeting patients and their families:

Research. Check to see if there are any warning markers and ask if there is anything you should be aware of. For example, risks from family members, anniversaries of significant events.

Arrange the meeting room so that there is nothing between you and the door.

Have access to a personal alarm and check that a response protocol is in place with sufficient staff available.

Ensure that access control measures are in place to contain any incidents. All staff must ensure their mandatory training is up to date, particularly Promoting Safer and Therapeutic Services / Conflict Resolution Training and the required level of Physical Intervention.

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APPENDIX 3 – PRISON PROCEDURES GUIDANCE FOR NHFT STAFF WORKING IN PRISONS

Training

All staff must complete the NHFT staff induction training before commencing their employment at the prison. They also need to complete a local NHFT induction on site and return the form to Learning and Development as directed by the policy.

All staff must complete mandatory CRT training as directed in the Mandatory Training Policy.

The Prison Service (check terminology) will provide an induction for staff at each individual prison; this must include Breakaway or appropriate equivalent, jail craft, key handling, information sharing, use of PPE including radios and attack alarms, use of rooms.

Staff Safety

Every prison is different therefore healthcare staff need to keep written procedures specific to their location.

As a minimum requirement:

Staff must not enter areas where prisoners are present without the knowledge of the prison officers.

Staff must not work 1:1 in a room without access to an alarm or radio. If this is unavoidable the door must be kept open and appropriate* support with access to an alarm must be within calling distance and inside any barriers.

*Appropriate support must be defined by risk assessment; for example, a co-worker may be appropriate if the prisoner is not mobile whereas most fit prisoners would necessitate a prison officer to be present.

Staff should keep written instructions on how to operate and check alarms/radios. It is the staff’s responsibility to check the equipment they are using is in working order before entering areas where prisoners may be present.

The prison must provide written details of their alarm response procedure and staff must be familiar with them.

If staff are asked to work in a room they believe is unsuitable (for example, no alarm, unsafe layout, difficult access) they must ask for a prison officer to accompany them. If this is not provided they must have the confidence to refuse to work there and be supported by NHFT management.

Information relating to risks to staff must be shared between services.

Monitoring and Evaluation

Prison healthcare areas are included on the schedule for bi-annual security assessments to be carried out by the Trust’s Health, Safety and Security Officer on behalf of the LSMS. This will include a review of the written attack alarm procedures and verbal checks with both management and staff.

Induction and CRT training will be monitored by Learning and Development

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APPENDIX 4 – WHAT TO DO IF YOU ARE ASSAULTED

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APPENDIX 5 - NHS PROTECT WARNING LETTER TEMPLATE

Dear WARNING LETTER I am the Local Security Management Specialist for the insert name of trust I have overall responsibility for security issues and part of my role is to deal with incidents of violent, threatening or abusive behaviour directed at trust staff and patients. It has come to my attention that… Insert summary of behaviour complained of 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 of violence or abuse. Such behaviour also Insert details of effect of behaviour on patient… If applicable, insert details of possible criminal offences/harassment warning You are warned that your future conduct will be monitored and if there is a repetition of your unacceptable behaviour, consideration will be given to taking one or more of the following actions: (to be adjusted as appropriate)

Asking you to sign an agreement regulating your behaviour.

Placing restrictions on your attendance at attend our premises as a visitor

Excluding you from insert name of premises

The matter will be reported to the police with a view to this health body supporting a criminal prosecution by the Crown Prosecution Service.

The matter will be reported to the NHS Security Management Service Legal Protection Unit with a view to this health body supporting criminal or civil proceedings or other sanctions. Any legal costs incurred will be sought from yourself.

Consideration will be given to obtaining a civil injunction in the appropriate terms. Any legal costs incurred will be sought from yourself.

If you consider that your alleged behaviour has been misrepresented or that this action is unwarranted, please contact in writing < insert details of local complaints procedure> who will review this decision in the light of your account of the incident(s). A copy of this letter has been issued to and Advise who has been notified (trust staff/G.P./Consultant/police) and whether records have been marked and if so when this will be reviewed. Yours sincerely,

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APPENDIX 6- RESTRICTIONS ON VISITING LETTER TEMPLATE

Dear Restrictions on visiting I am the Local Security Management Specialist for the insert name of trust I have overall responsibility for security issues and part of my role is to deal with incidents of violent, threatening or abusive behaviour directed at trust staff. I have received a number of reports in which it is alleged that you have, Insert summary of behaviour complained of 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 of violence or abuse. Such behaviour also Insert details of effect of behaviour If applicable, insert details of possible criminal offences/harassment warning This has been made clear to you in <insert details of previous oral warnings/correspondence/ meetings>. A copy of this health body’s policy on violence against staff is/are enclosed for your attention. Due to your behaviour you will only be allowed to visit XX ward in accordance with the following instructions (amend as appropriate)-

You will telephone xxxxxxxx and ask to speak to xxxxxxx before you intend to visit

You may only visit between xxxx and xxxx

You must leave XX ward at the end of the visiting time

You are prohibited from bringing any of the following items on to the ward……. If when you visit in the future there is any further unacceptable behaviour, you will be asked to leave the ward immediately and security staff will be asked to remove you if you refuse to leave. You are warned that your future conduct will be monitored and if there is a repetition of your unacceptable behaviour, consideration will be given to taking one or more of the following actions: (to be adjusted as appropriate)

Asking you to sign an agreement regulating your behaviour.

Excluding you from insert name of premises completely

The matter may be reported to the police with a view to this health body supporting a criminal prosecution by the Crown Prosecution Service.

The matter may be reported to the NHS Security Management Service Legal Protection Unit with a view to this health body supporting criminal or civil proceedings or other sanctions. Any legal costs incurred will be sought from yourself.

Consideration will be given to obtaining a court order preventing you from attending our premises. Any legal costs incurred will be sought from yourself.

If you consider that your alleged behaviour has been misrepresented or that this action is unwarranted, please contact in writing < insert details of local complaints procedure> who will review this decision in the light of your account of the incident(s). A copy of this letter has been issued to and Advise who has been notified (trust staff/Consultant/police) and when this decision will be reviewed.

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APPENDIX 7 - EXCLUSION FROM PREMISES LETTER TEMPLATE Dear Exclusion from premises I am the Local Security Management Specialist for the insert name of trust I have overall responsibility for security issues and part of my role is to deal with incidents of violent, threatening or abusive behaviour directed at trust staff. I have received a number of reports in which it is alleged that you have, Insert summary of behaviour complained of 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 of violence or abuse. Such behaviour also Insert details of effect of behaviour If applicable, insert details of possible criminal offences/harassment warning This has been made clear to you in <insert details of previous oral warnings/correspondence/ meetings>. A copy of this health body’s policy(ies) on violence against staff/the withholding of treatment from patients is/are enclosed for your attention. Due to your behaviour permission for you to attend (insert details of premises/site covered, and refer to map if available) has been withdrawn. (If the person has no reason to attend the premises in question the following can be omitted) You will therefore only be permitted to attend these premises in the following circumstances (amend as appropriate)

to attend (or to accompany a member of your immediate family), at a pre-arranged appointment,

to attend for non medical purposes any meeting previously arranged in writing. If you attend our premises without a legitimate reason in the future, you will be asked to leave immediately and security staff will be asked to remove you if you refuse to leave. You are warned that your future conduct will be monitored and if there is a repetition of your unacceptable behaviour, consideration will be given to taking one or more of the following actions: (to be adjusted as appropriate)

The matter may be reported to the police with a view to this health body supporting a criminal prosecution by the Crown Prosecution Service.

The matter may be reported to the NHS Security Management Service Legal Protection Unit with a view to this health body supporting criminal or civil proceedings or other sanctions. Any legal costs incurred will be sought from yourself.

Consideration will be given to obtaining a court order preventing you from attending our premises. Any legal costs incurred will be sought from yourself.

If you consider that your alleged behaviour has been misrepresented or that this action is unwarranted, please contact in writing < insert details of local complaints procedure> who will review this decision in the light of your account of the incident(s). A copy of this letter has been issued to and Advise who has been notified (trust staff/G.P./Consultant/police) and when this decision will be reviewed. Yours sincerely,