Jayne King

Head of Security & Site Services

Guy’s & St Thomas’ NHS Foundation Trust

Chair

National Association for Healthcare Security (NAHS)

Security in Healthcare

• Context

• Role of NAHS

• In house V’s Contracted out

• Are SIA licences applicable?

Who are our people

• 2nd career for managers and Security Officers?

or

• Make it a 1st career choice, addressing career pathways and/or apprenticeships

• Is the pool drying up?

Training

• Sector specific?

• Acute

• Community units

• Mental Health

• Ambulance

Conflict

Resolution

Training

Course

Training

Need

Skills

Gap

Conflict

Resolution

for

Managers

Course

3 Year Refresher Year 1 Year 2 Year 3

Conflict

Resolution

Junior

Refresher

Course

Skills Fade

Senior

Staff

Nurse

Ward

Manager

Senior

Staff

Nurse

Control &

Restraint

Training

Course

Conflict

Resolution

Training

Course

Day

1

Day

2

Security Officer Training

Yearly Refresher

Training

Ethos &

Syllabus

Do no

harm

Early

Intervention

Physical Intervention

a last resort

Inclusive Problem

Solving

Risk Assessment

& Management

Human Behaviour /

Attitude

Positive

Interactions

De-escalation

Skills

Practical Safety

Techniques

The Contract

• Procurement of Security services in the NHS

• Understanding the market/adjust?

• Working with stakeholders (internal & external)

What do we do - Specialist role

• Violence - 1100 incidents per year - approx 170 incidents of physical violence however approx 135 of those are patients whose clinical condition may be a factor.

• Teach conflict resolution to frontline staff - definition front line (NHS Protect) any staff that may contact with patient or visitor

• Theft - every hospital has this issue.

• Safeguarding issues - vulnerable persons, elderly, dementia, mental health, children

• VIPs ( anyone who may be subject to press intrusion, high risk prominent prisoners)

• Location attracts a wealth of high profile visitors, PM’s/Ministers, Royal family

• Major Incident.

• Site Issues (facilities role)

• Crime prevention adviser (CPDA) New builds (Evelina, CTC) ongoing project works

• Domestic violence issues work closely with DV team

Defining violence, abuse or challenging behaviour

• Violence is defined as the intentional application of force to a person of another, without lawful justification, resulting in physical injury or personnel discomfort

• Abuse is defined as the inappropriate use of words or behaviour causing distress, alarm and or constituting harassment

• Challenging behaviour is defined as any non-verbal, verbal or physical behaviour which makes it difficult to deliver good care safely

The majority of the incidents we see are related to Challenging behaviour

Very unwell aggressive patient broke IV pole in half

7 days of Violence and Aggression in ED

Aggressive alcoholic patient sleeping in ED entrance

refused to leave

Patient very verbally aggressive to nurse calling her ‘fucking bitch’ and

threatening to slap her

Patient in waiting area been discharged but refusing to

leave

Patient left department and then jumped 13 feet off a wall

Patient with self-harm punched security guard in the face, pushed over the

nurse and consultant

Patient started shouting aggressively because waiting

time was too long

High risk mental health patient trying to leave -restrained

Patient was throwing punches, punched the doctor once then punched the nurse in the

chest.

Confused elderly man lashing out hitting security with his

walking stick

Aggressive patient who had self-harm cut his wrists

attempting to leave dept

Patient punched Dr then put his hands round Drs neck

Patient shouted ‘fuck you’ then hit nurse and security guard

Patient threatening to kill nurses family and follow her

home after work

Patient became very aggressive and shouting to nurse that she was 'a cunt'

and a 'motherfucker'

Patient deliberately pulled out cannula spraying blood

everywhere

Patient stated ‘wait till Monday comes and you find out what

happens to you'

Examples of medical causes for patients becoming violent or aggressive

• Head injury

• Hypoxia (low oxygen levels)

• Hypoglycaemia (low blood sugar)

• Shock (sepsis, hypovolaemia, anaphylactic, cardiac)

• Stroke

• Neurological disorders

• Seizures

• Intracranial infections (infection in the brain)

• Encephalitis (swelling of the brain)

• Hyponatraemia (low sodium levels)

• Drugs and alcohol

• Mental health problems

• Many other medical problems

It’s not just about our staff...

The scene from an incident on

one of our wards recently at 3am

Why do we have a problem

• Increase in drug & alcohol abuse

• Increase in the number of mental health patients in crisis

• Staff hesitant to take action, giving the patient or family a second chance

• Delay in identifying a problem, leading to crisis

• Staff accepting its part of the job

• Difficulty in trying to identify cause - ? Clinical

• Not always agreement or support amongst the MDT

• Staff don’t always stick to the plan

• Lack of confidence & courage, staff hesitant to report and press charges

• Our behaviours

How do we support our staff?

Instil a culture that accepts it is not part of the job

Give staff the skills & confidence to

identify a potential or actual

deteriorating situation

Staff respond with confidence and are supported by their managers and the Trust

Our aim is to ensure staff feel they can do their job without the fear of violence and aggression towards themselves and their patients.

Networks

• Private and public sector partnerships (SBBW, LB Security Forum, Security Commonwealth, etc)

• The Security Industry - common goals and links.

• Best Practice – what can we learn from each other

• Is there/should there be a strategy?

Ambulances

Injury in the night-time economy requires:

Scene Management to:

– Ensure there is room for crews to work

– Direct people away from scene, inside or outside

– Protect the safety of ambulance crews

Looking ahead

• Going forward

• fit for the future

• long term strategy

CQC Inspection 2016

Emergency Department

Areas of outstanding practice-

‘The role of the security team in the Emergency Department was embedded into the day to day working of the department. The team was multi-lingual and trained in effective de-escalation techniques and demonstrated outstanding empathy to patients.’

Q&A