Security and Management of Violence and Aggression Policy

Policy for Security and Management of Violence and Aggression Page 1 of 23

Policy for Security and Management of Violence and Aggression

Solent NHS Trust policies can only be considered to be valid and up-to-date if viewed on the

intranet. Please visit the intranet for the latest version.

Purpose of Agreement To provide guidance over the management of security and violence and aggression within the work place.

Document Type X Policy SOP Guideline

Reference Number Solent NHST/Policy/HS02

Version Version 1

Name of Approving Committees/Groups Assurance Committee Policy Steering Group

Operational Date February 2016

Document Review Date May 2019

Document Sponsors (Job Title) Chief Nurse [SMD]

Document Manager (Job Title) Local Security Management Specialist

Document developed in consultation with H&S Committee

Intranet Location Business Zone / Policies, SOPs and Clinical Guidelines

Website Location Publication Scheme / Policies and Procedures

Keywords (for website/intranet uploading) Security; violence; aggression; risk assessment


Policy for Security and Management of Violence and Aggression

Section 1 – Index of Contents

Page

Overview 3

1. Introduction and purpose 4

2. Scope and definitions 5

2.3 Abbreviations 5

2.4 Violence and Aggression 6

2.5 Work related violence 6

2.6 Clinically related challenging behaviour 6

2.7 Lone Working 6

3. Reporting and Management of Incidents 6

4. Duties/ responsibilities 11

4.1 Chief Executive Officer 11

4.2 Board of Directors 11

4.3 Chief Nurse [SMD] 12

4.4 Head of Health, Safety, Security and Fire 12

4.5 Local Security Management Specialist 12

4.6 Operations Directors/Heads of Service/Departments & Matrons/Specialty Managers

13

4.7 Line Managers 14

4.8 Physical Intervention Lead 15

4.9 Employees 15

4.10 Health & Safety Sub-Committee 15

4.11 Occupational Health 16

4.12 Patients / Visitors 16

4.13 Contractors 16

5. Training 16

5.1 Corporate and local induction 16

5.2 Conflict resolution training 17

5.3 Prevention and management of violence and aggression [PMVA] 17

5.4 Disengagement techniques [breakaway] 17

6. Equality and diversity impact assessment 18

7. Success criteria/Monitoring compliance 18

8 Review 18

9. Reference documents 18

9.1 Legal and regulatory documents 18

9.2 Guidance documents 19

9.3 Local policies and procedures 19

APPENDICES

A1 Glossary 20

A2 Equality and diversity impact assessment 21

A3 Assault incident – flowchart for actions and support 22


OVERVIEW This document sets out the overarching principles and policy for the management of security and violence and aggression with Solent NHS Trust and should be read in conjunction with supporting procedural documents. Each and every staff member has a role to play in keeping our patients, staff and premises secure and for managing violence and aggression in the workplace. Each unit or premises that Solent staff work in or operate from will have specific arrangements in place that staff must be aware of and adhere to. Details of all staffs’ roles and responsibilities are listed in Section 4. All staff should be aware of the Security Management Guidance document and all local procedural documentation. Tackling violence and aggression is a complex issue as there are numerous factors and implications that need to be taken into consideration in reaching decision over an appropriate and balanced approach. The Management of Violence and Aggression Procedure is a guidance document for tackling this issue and most importantly, actions to take to keep staff safe and prevent incidents. Those who work on their own or remotely, should be aware of the Lone Working Procedures and the local arrangements that are in place for their team.


1. INTRODUCTION & PURPOSE

1.1 Solent NHS Trust has a statutory obligation under the Health and Safety at Work Act 1974, to ensure as far as is reasonably practicable, a safe and secure environment for the staff it employs, the health and safety of its service users, visitors, contractors and all persons who visit premises from which the organisation operates.

1.2 The Health & Social Care Act 2012 sets out that all providers of NHS services will be managed via

the standard commissioning contract and this supersedes the Secretary of States Directions on Security Management to NHS Bodies. The contract contains a number of general conditions that relate to security and counter fraud. General Condition 6.1 of the NHS Standard Contract requires all providers to put in

place and maintain appropriate counter fraud and security management arrangements prior to the commencement date of the contract.

General Condition 6.2 requires providers to complete an organisation crime profile

within one month of the commencement date of the contract. General Condition 6.3 requires providers to mitigate any identified risks in line with

NHS Protect guidance.

1.3 The Board of Directors at Solent NHS Trust is committed to provide a safe and secure environment for its patients, staff and visitors and a strategy to eliminate, minimise and control the risk of violence and aggression. Violent or abusive behaviour will not be tolerated and decisive action will be taken to protect individuals. The organisation is mindful that some acts of aggression and violence may be caused by a patients’ illness or condition and in such cases incidents will be managed clinically and with appropriate safety measures. However, where aggression or violence is not caused by a clinical condition the Trust will consider this a Health & Safety / Security Management issue and will take appropriate measures to prevent a recurrence. This may include pursuing criminal sanctions. All service users and visitors have an obligation to behave in an acceptable and appropriate manner. Staff members have a right to work, just as patients have a right to be treated, in an environment that is safe and secure, in line with the Security and Management of Violence and Aggression Strategy.

1.4 The purpose of this policy is to define roles and responsibilities for the effective management of

security in relation to staff, patients/clients, visitors and property; provide additional guidance that should be followed to promote secure and safe premises; support the management of violence and aggression and safety of lone workers and to enable the organisation to proactively and reactively manage security.

1.5 Through robust management procedures the organisation is committed to providing the most

reasonable and practicable means of:

Providing a safe and secure environment for staff, patients and visitors to the premises the organisation operates from.

Protecting life, or preventing bodily injury from malicious criminal activity.

Preventing loss of organisation assets as a result of crime.

Preserving good order on premises from which the organisation operates.

Tackling violence and aggression directed at NHS staff, professionals, staff working on behalf of the NHS and those who use the organisation’s services.

Protecting those who are lone or remote working.


1.6 The Trust recognises that, as an employer, it has a duty of care towards its staff and will take necessary and reasonable steps to ensure their health and safety at all times. It is also acknowledged that all employees have a responsibility for the safety of themselves, their colleagues, patients and service users. Specific procedures applicable to local needs will be developed and implemented within an agreed timescale in consultation with Directors and Staff representatives to address local issues.

1.7 This policy provides overarching principles for security and management of violence and aggression. It should be read in conjunction with the associated procedures and guidance that underpin its principles (see structure chart below):

2. SCOPE & DEFINITIONS

SCOPE 2.1 This document applies to all directly and indirectly employed staff within Solent NHS Trust and

other persons working within the organisation in line with Solent NHS Trust’s Equal Opportunities Document. This document is also recommended to Independent Contractors as good practice.

2.2 Solent NHS Trust is committed to the principles of equality and diversity and will strive to eliminate unlawful discrimination in all its forms. We will strive towards demonstrating fairness and Equal Opportunities for users of services, carers, the wider community and our staff. DEFINITIONS

2.3 The abbreviations used throughout this policy are detailed in the glossary in Appendix 1.

2.4 Violence and aggression - refers to a range of behaviours or actions that can result in harm, hurt or injury to another person, regardless of whether the violence or aggression is physically or verbally expressed, physical harm is sustained or the intention is clear.i Violence - The use of physical force that is intended to hurt or injure another person. (NICE guidelines 25, 2005)

2.5 For the purposes of this policy, the Trust recognises the following definition of work- related

violence:

Security and Management of Violence and Aggression Strategy

Policy for Security and Management of

Violence and Aggression

Security Management Procedures

Managing Violence and Aggression Procedures

Lone Working Procedures

Prison Working Guidance

CCTV Operational Policy

Suspicious Package Response Policy

Management of lone worker devices

Emergency Lockdown Policy

Procedures for withholding treatment or

removal from lists


‘an incident where an individual is abused, threatened or assaulted in circumstances related to their involvement with the Trust, which includes an explicit or implicit challenge to their safety, well-being or health’. (adapted from DOH 2000).

2.6 Clinically related challenging behaviour 2.6.1 It is important to recognise that there is always a cause for clinically related challenging

behaviour, even if it is not evident at the time. An overall approach that looks to prevent distress by identifying, categorising and understanding its reasons should reduce the likelihood of these potentially unforeseen events occurring. The main categories are:

Physical factors

Cognitive factors

Psychological and emotional factors

Environment and social factors.

2.6.2 Challenging behaviour may be a patient’s way of attracting attention if they are unable to verbalise or communicate what is causing them distress or anxiety or have unidentified needs. For further information see Meeting needs and reducing distress (Guidance on the prevention and management of clinically related challenging behaviour in NHS settings). This document has been written in conjunction and endorsed by various colleges of medicine and charities specialising in care and welfare of patients with mental health or learning disabilities.

2.7 Lone (or remote) Working 2.7.1 NHS Protect defines lone working as: any situation or location in which someone works without a

colleague nearby; or when someone is working out of sight or earshot of another colleague. 2.7.2 The Health and Safety Executive (HSE) defines lone workers as: those who work by themselves

without close or direct supervision.

3. REPORTING AND MANAGEMENT OF INCIDENTS

3.1 The organisation’s Incident Reporting Policy must be followed with regards to the reporting and

management of incidents relating to security breaches and also near misses; where a breach has taken place but no harm done, [for example a door which should be secure but is found to be unsecured so unauthorised access may have been achieved, even if there is no evidence to suspect access has taken place].

3.2 In addition to this, security incidents shall be uploaded to the NHS Protect Security Incident Reporting System (SIRS) by the LSMS.

3.3 All incidents that are reported will be graded for severity and will contribute towards actions in

the organisation’s Security Management Strategy and will be included in quarterly and annual reports. The types of incident that constitute a security incident are detailed below. Incidents will be managed in accordance with the guidance set out in the supporting guidance and procedural documents.

3.4 Following review of an incident, alterations or work may be required to premises in order to

prevent recurrence. Works will be categorised as follows:

Level 1 Measures to be taken quickly to improve security; that have minimal expenditure e.g. publicising and adhering to existing instructions – ACTION to be carried out at local level.


Level 2 Measures required to counter an identified threat or weakness requiring resources to rectify e.g. installing a keypad door entry system – ACTION at local level, but may require additional resources.

Level 3 Long term measures required to improve the security of a building e.g. installation of CCTV, intruder or room alarm system, – ACTION at higher level of management and funding will need to be considered against other priorities.

3.5 Fuller Definitions of Incidents and Procedures 3.5.1 The following list includes types of incident that are commonly experienced within the NHS; this

list is not exhaustive and there will be other types of security related incident that must be reported.

3.5.2 Physical assault

i) A physical assault is defined as “the intentional application of force, to the person of another, without lawful justification, causing physical injury or personal discomfort”. (Eisener v. Maxwell 1951, Kaye v. Robinson 1991)

ii) All alleged physical assaults must be reported [see flow chart Appendix 2]:

a) All incidents of physical assaults of staff or contractors must be reported using the incident reporting system, Ulysses Safeguard in line with the Incident Reporting Policy. The Local Security Management Specialist will report these incidents to NHS Protect via SIRS. The LSMS will assist the line manager in completing additional reports for NHS Protect where necessary.

b) The decision of whether the police should be contacted or not, may be made locally. In reaching this decision, the following criteria must be taken into consideration.

iii) Any physical assault which is not considered to be caused by a clinical condition or where

the assailant has knowledge of their actions and intent must be reported to the police, usually as a 999 emergency call, without delay. Whilst the decision on whether to press charges will normally rest with the victim of the assault, the police must always be called in order that immediate actions can be taken to prevent further risk and to secure evidence.

iv) Where it is concluded, by a suitably qualified clinician, that the assault was not intentional

and that the patient did not know what s/he was doing, or did not know what s/he was doing was wrong due to the nature of the medical illness, mental ill health or severe learning disability, or the medication administered to treat such a condition; then it is not normally appropriate to notify the police. The view of the person assaulted should also be sought in each incident.

v) Whilst this means that there are instances where the police do not have to be called, the

presence of a mental illness for example should not automatically be used as a reason not to report the assault to the police. Whilst the presence of a mental illness is one of the factors to be taken when considering a prosecution, it is not the only factor. Each case would be judged on its merit, and it is important to note that decisions on intent and subsequent legal action rest with the investigative body and ultimately, the courts, and not the organisation.

vi) It is important to also bear in mind that the presence of a medical condition should not

preclude appropriate action being taken and it is essential to ensure that there are clear


risk management processes in place for dealing with high risk or mentally ill patients and that these are shared with all relevant staff.

vii) The victim of the incident will be kept fully informed of the progress of any investigation or

action taken and will be offered the full support of the organisation such as debriefing, counselling services or other appropriate support that would be considered necessary or desirable in the circumstances.

viii) Where it is appropriate to report the incident to the police and request that they take

further action, the supporting documentary Police Report as Appendix 7 of the Management of Violence and Aggression Procedures must be filled in and handed to the Police.

3.5.3 Non-physical assaults

i) A non-physical assault is defined as “the use of inappropriate words or behaviour causing distress and/or constituting harassment”. (NHS Protect)

ii) It is important to recognise that non-physical assaults can be just as upsetting as a physical

assault and where staff members are subjected to repeated incidents of abuse this can lead to stress and sickness. Such behaviours may include, but is not limited to gesturing; using abusive language or making personalised comments; inappropriate use of pitch, pace and tone in communication; making racist or defamatory comments; invading personal space or blocking an exit. [See flow chart Appendix 2]:

iii) Non-physical assaults may take place in face to face situations or over the phone; email or

via social media. iv) Social media may be used to post messages about staff. Where postings are considered

derisive and potentially abusive; or where racist comments or threats of violence are made, these may constitute an offence under: • Section 5 of the Public Order Act 1986 • Protection from harassment Act 1997 • Section 127 of the Communications Act 2003 • Section 1 of the Malicious Communications Act 1988

v) Staff should report incidents offensive social media postings using Safeguard and liaise with

the LSMS over whether the posting should be reported to the Police. Most social media platforms operate a Terms of Use Policy, which makes it clear that they will not tolerate 'targeted abuse' or harassment of individuals; such conduct may include: • if the sole purpose of the account is to send abusive messages to others; or • if the report behaviour is one sided or includes threats

vi) Staff may report the abusive/threatening posts to the relevant social media platform, can

be done directly on-line, via an offending post. vii) Although staff may find such behaviour distracting or unsettling; in the vast majority of

cases, patients or visitors recording staff openly or covertly will not be committing any criminal offence.

viii) All non-physical assaults on a member of NHS staff or professional must be reported and

the details recorded in accordance with the Incident Reporting Policy. In appropriate cases, assessed by reference to their nature and seriousness, the police will be contacted as soon as reasonably practicable and full co-operation should be given to the police in any


subsequent investigation. Where the aggressor is a patient or service user, and the incident is to be reported to the Police, the supporting documentary Police Report as Appendix 7 of the Management of Violence and Aggression Procedures must be filled in and handed to the Police to confirm the person has capacity to recognise the consequences of their behaviour.

ix) As with physical assaults, the victim of the incident will be kept fully informed of the

progress of any investigation or action taken and will be offered the full support of the Trust such as debriefing, counselling services or other appropriate support that would be considered necessary or desirable in the circumstances.

3.5.4 Theft (or allegation of theft)

i) Theft is defined as “To dishonestly appropriate the property of another with the intention to

permanently deprive the other of it”. ii) All security related incidents must be reported using the incident reporting process. All

incidents where it is considered likely that a theft has taken place should be reported to the Police using the non-urgent incident reporting number 101 or via the Police website.

iii) Organisation property and assets - organisation property/or assets that have been

considered to have been stolen must be reported through the incident reporting process. Where the loss may impact on the delivery of services, the manager must be advised immediately so that corrective action can be taken.

iv) Patients’ property - All staff should be familiar with departmental instructions relating to

patients’ property and must ensure they are followed accordingly. v) Losses of patient personal belongings should be managed in accordance with the Patient’s

Property Policy. The relevant manager must complete a local investigation and ensure all incidents are reported in line with the Incident Reporting Policy.

vi) Patients and relatives should be advised and encouraged to retain minimal amounts of

money and to keep valuables on their person or request that a relative or friend takes the property home for them.

vii) Alternatively money and/or valuables can be held by the organisation in safekeeping for the

patient. The organisation cannot be held liable for any valuables or money which is not handed in for safe keeping.

viii) Staff property - Losses of staff personal belongings whilst at work will be reported through

the incident reporting procedure. Following consultation with the LSMS the staff member or Manager will inform the Police where a theft is suspected.

ix) Where a member of staff is suspected of the theft of either the organisation’s or patients’

property, any investigation must be conducted in accordance with the Trust disciplinary process or procedures.

x) Staff are also encouraged only to bring the minimum amount of cash or valuables to work

and to ensure that their possessions are stored in a locker; locked drawer or boot of their car and that when vacating any office or department that the area is secured.

3.5.5 Intruders/Unsecured areas


i) These incident types include the presence of suspicious persons on site, individuals found in an area where they have no legitimate right to be, or identifying an area or setting which should be secured but which is found to be open and/or accessible.

ii) All staff are encouraged to challenge persons found to be in areas occupied by the

organisation where they have no legitimate right or reason to be, but only where it is deemed safe to do so. Where appropriate, the Police should be notified – where it is considered a crime is currently taking place, then staff should use 999, or use 101 for non-urgent incident reporting. All such incidents must be reported in line with the Incident Reporting Policy.

iii) Where a lock or means of securing an area fails, for whatever reason, then this must also be

reported to the Estates Helpdesk or other defined process and an incident report completed.

3.5.6 Damage to Property – Criminal Damage and Vandalism

i) The premises from which the organisation operates are owned and managed by the Trust;

NHS Property Services (NHSPS) or other landlords. All incidents that relate to criminal damage or vandalism must be reported to the Estates Helpdesk or the property owner’s established reporting line so that swift action can be taken. However the incident must also be reported locally through Ulysses Safeguard to ensure that such information is captured. Staff may be required to secure an area in order to protect evidence. Where there is evidence of criminal damage and theft and the investigation identifies the offender, the LSMS for NHSPS, or the owner will liaise with local police to enable action to be taken through the Criminal Justice System. Staff may be required to provide witness statements in order to support successful prosecution.

ii) Incidents of accidental damage should also be reported and investigated to establish

whether it was caused by neglect of duty or gross carelessness and identification of any lessons learnt to prevent further incidents. Vehicle or property damage to premises will be reported to ensure that costs can be recovered through the vehicle owner’s insurance where possible.

3.5.7 Fraud

i) The Fraud Act 2006 represents an entirely new way of investigating fraud. It is no longer

necessary to prove a person has been deceived. The focus is now on the dishonest behaviour of the suspect and their intent to make a gain or cause a loss.

ii) The offence of fraud can be committed in three ways;

Fraud by false representation (s.2) – lying about something using any means e.g. by words or actions,

Fraud by failing to disclose (s.3) – not saying something when you have a legal duty to do so: and

Fraud by abuse of a position of organisation (s.4) – abusing a position where there is an expectation to safeguard the financial interests of another person or organisation.

iii) It should be noted that all offences under the Fraud Act 2006 occur where the act or

omission is committed dishonestly and with intent to cause gain or loss. The gain or loss does not have to succeed, so long as the intent is there.


iv) Reporting fraud or corruption - Staff who suspect any fraudulent activity; e.g. knowledge of a colleague or staff member working for another employer or agency whilst on sick leave from the Trust, should refer this to their Manager in the first instance who will then liaise with the Local Counter Fraud Specialist.

3.5.8 Sharing the learning- The LSMS will alert the NHS Protect Area Security Management Specialist of

all incidents that may be part of a trend or may have an impact on other NHS Organisations or providers, for example the theft of Nitrous Oxide, or activity by known members of criminal groups, for example “The Coventry Falcons”. The LSMS will cascade alerts to staff when such groups are known to be operating in the area via the ALERTS process.

4. ROLES & RESPONSIBILITIES 4.1 The Chief Executive Officer has ultimate responsibility for the management of security and safety.

This responsibility includes ensuring the aims and objectives of this policy are met, and ensuring that adequate resources are made available.

4.2 Board of Directors

4.2.1. The organization is led by the Chief Executive Officer and Executive Directors (‘the Executive Team’). The Board and Executive Team are supported by key Committees and working groups as described below.

4.2.2. The organisation is operated through a number of Service Lines, each of which is managed by an

Operations Director who reports directly to one of the two Chief Operating Officers. Each Service Line has internal control processes in place including Clinical Governance Leads and Business Support Leads which report into organisation-wide groups/committees.

4.2.3. The Board of Directors have the responsibility of setting the strategic direction of the Trust and

overseeing the implementation of policies and objectives including those relating to security management. It is the Board of Directors’ responsibility for decision-making on the management of all types of security risks within the organisation including:

Ensuring that the aims and objectives of this policy and associated procedures are met. • Ensuring that adequate resources are made available.

Ensuring that arrangements are in place for the effective management of security and safety issues.

Ensuring that any systems in place for the management of security, violence and aggression and lone working are reviewed by managers and the Board.

• Ensuring the effectiveness of the key personnel listed below in undertaking their security management responsibilities is reviewed as part of the policy review process and the LSMS is satisfied that specified duties are being carried out and any failures to undertake the duties are reported to the relevant line manager for action.

4.2.4 However, certain Directors and managers have a specific role in the strategic management of

security.

4.3 The Chief Nurse

4.3.1 The Chief Nurse is the nominated Security Management Director (SMD) with special responsibility for security management and will lead in promoting a pro-security culture; the safety of lone workers and tackling violence against staff.

4.4 Health, Safety, Fire & Security Manager


4.4.1 The Health, Safety, Fire & Security Manager will work closely with the LSMS and will monitor all

security incidents which are escalated. By exception any on-going risks will be escalated to the Health and Safety Sub-Committee and where appropriate will be added to the Corporate Risk Register and included and managed as part of the Risk Management Strategy and Policy.

4.5 Local Security Management Specialist (LSMS) 4.5.1 The Local Security Management Specialist (LSMS) will be accredited by completion of NHS Protect

Foundation Level Training. The LSMS is responsible for developing a pro-security culture and working environment by supporting and working with Directors / Heads of Service / Departments & Matrons / Specialty Managers and their teams to ensure that a holistic approach to security management is followed to ensure:

All incident reports are reviewed and actioned appropriately, trend analysis is conducted and shared across the organisation to reduce the likelihood of further incidents and that a pro-active approach is taken with regards to security, safety of staff and the management of violence and aggression.

Risk assessments are conducted and that action plans are reviewed and evaluated for effectiveness and lessons learned are shared across the wider organisation.

Incident reports are created and submitted to the NHS Protect Security Incident Reports System (SIRS)

Trend data is monitored to ensure that lessons learnt and best practices are shared across the wider organisation.

Close working relationships are developed with the Crown Prosecution Service and Police Officers to ensure action is taken where prosecution is appropriate.

Liaison with neighbouring LSMS to agree a consistent approach to the tackling of violence and aggression across NHS sites.

Provision of reactive support in the event of any incident (i.e. reporting assaults to the Police where a 999 emergency call was not immediately necessary):

Liaise with the police in relation to incidents of violence to ensure sanctions, where appropriate, are achieved and that assaults and security incidents such as criminal damage or vandalism are investigated. Liaise with and support the LSMS for NHSPS, or landlords’ representatives, in relation to incidents that relate to premises the organisation operates from.

Ensuring that following any incident of violence or aggression, risk assessments have been conducted to establish any actions with regards to the aggressor are taken, for example a warning letter explaining the organisation’s position on violence and aggression to staff.

Liaison with NHS Protect LPU to ensure that appropriate sanctions are applied and suitable warnings issued to offenders.

Reviewing and evaluating any actions for effectiveness.

Reporting defects in maintenance of physical security measures.

Liaison with Essential Training Team and Physical Intervention Lead for the provision of Induction Training and training that relates to managing violence and aggression.

Liaison with Local Security Management Specialists from other NHS organisations within neighbouring organisations / counties

Raising nationally occurring issues that relate to security or provision of services that have been identified to NHS Protect by other organisations, for example the theft of metals or cabling and ensuring that NHS protect alerts are disseminated via the ALERTS process.

4.5.2 The LSMS will work within a professional and ethical framework as set out by NHS Protect, at all

times meeting the six core principles; professionalism; objectivity; fairness; expertise, propriety and vision.


4.5.3 The LSMS will:

• Support service managers with carrying out security reviews of the organisation’s properties, identifying potential problems and assessing any risks that may arise; including the environmental risks that can act as triggers for violent or abusive behaviour.

• Provide advice to managers and staff over security issues. • Develop a strategy and action plan to tackle problems and deliver improvements across

the wider organisation. • Work with the Emergency Planning / Business Continuity Manager to establish the

vulnerability of a department / area and the ability to carry out a lockdown, either; full, partial or progressive where appropriate. The LSMS will assist the Emergency Planning / Business Continuity Manager in raising awareness of lockdown procedures and their importance as part of Business Continuity and Recovery Planning.

• Use expertise to ensure that identified risks are escalated and the implications of such risks considered organisation-wide to provide an organisational overview. Issues will be referred to the Strategic Head of Health & Safety and where appropriate added to the Risk Register.

• Produce an Annual Security Management Report and complete the NHS Protect Self-Review tool and Work Plan for the Board. The specific areas of work for the LSMS are Strategic Governance; Inform and Involve; Prevent and Deter and Hold to Account. The report will cover work undertaken in these areas an update will be provided quarterly/half-yearly.

• Following ratification by the SMD, ensure that the Annual Self-Review Tool and work Plan is completed and forwarded to NHS Protect in line with General Conditions of the NHS Standard Commissioning Contract [Health & Social Care Act 2012].

• Complete the annual NHS Protect Report of Physical Assault [RPA] submission • Lead on national and local initiatives.

4.6 Operations Directors/Clinical Governance Leads/Heads of Service / Departments & Matrons /

Specialty Managers

4.6.1 Operations Directors/Heads of Service / Departments & Matrons / Specialty Managers are accountable for ensuring that:

All managers are aware of their responsibility to participate in risk assessments in conjunction with the LSMS in their area of managerial control, and that those assessments take into account security risks relating to physical security of premises and assets and that environmental issues that may act as triggers to violence and/or aggression are taken into consideration. This will include local risk assessments for staff working off site or in the community.[See Appendix - Security Management Procedures]

Appropriate risk assessments are carried out in each premises/area and where risks are identified they are recorded at least annually and action plans developed to manage the risk[s].

Ensuring that action is taken as a result of risk assessments, that action plans are reviewed and evaluated for effectiveness and that learning is shared across the wider organisation.

Local procedures/contingency plans are drawn up in consultation with affected staff, or their representatives to deal with both foreseeable events and other emergencies, for example security and locking up procedures

Action is taken to protect staff from the effects of violence and aggression; appropriate support is provided following incidents.

Ensuring that appropriate local risk assessments have been carried out to establish the vulnerability of the department/area and the ability to carry out a lockdown, either; full, partial or progressive.

Any training needs identified as a result of risk assessments are actioned appropriately.


The effectiveness of the undertaking of these duties will be monitored and may be documented as part of the organisation appraisal process.

4.7 Line Managers

4.7.1 Line managers are responsible for:

Ensuring that appropriate risk assessments have been carried out to establish the vulnerability of the department with regards to security and of staff coming into contact with patients who may pose a risk of violence and aggression. Where staff are working in premises managed by another organisation, e.g. HM Prison Service; ensuring that any specific measures that relate to the premises/service are shared and adhered to.

Reporting security incidents or breaches (i.e. criminal damage, violence and/or aggression, theft or break in) to the Police in the first instance and/or Local Security Manager (LSMS) in accordance with the Incident Reporting Policy and ensuring that all such incidents are graded for seriousness and investigated accordingly, using the outcome of investigations to update risk assessments, develop action plans; escalated where appropriate and ensuring that action is taken; and that any action is reviewed and evaluated for efficacy.

Ensuring that local procedures are in place for the locking up and security of the site or department and that all staff are familiar with the organisation and/or local procedures that have been adopted for the security of staff, patients and property and that staff in their area are made aware of any risks and consulted on measures to be introduced to minimise them prior to them being put in place.

Providing effective communication and support to those who may face violence and aggression and ensuring lone worker procedures and protocols are in place and followed.

Ensuring that staff are aware of their right to report assaults to the Police and that if an assault is not reported to the Police then the opportunity to make a claim under the Criminal Injuries Compensation Scheme, even if a conviction is not made, will be lost. Within the Prison Service ensuring that incidents of assault are reported to HMPS so that prisoners may be managed under the Prison Adjudication Process.

Ensure appropriate referrals to Occupational Health or Victim Support as a result of exposure to incidents of violence and aggression.

Ensuring that eligible staff attend mandatory training for the management of violence and aggression, including Conflict Resolution Training and that this is followed up by refresher workshops as per the Statutory & Mandatory Training Matrix. Where staff work in premises operated by other organisations, e.g. HM Prison Service that any specific training for that environment is undertaken and kept up to date. All training must be booked through the Essential Training team and attendance/compliance monitored through staff records.

4.8 Physical Intervention Lead

4.8.1. The Physical Intervention Lead will act as a point of contact and support to advise and guide

managers and staff over the appropriate techniques to be employed to tackle specific situations requiring restraint.

4.8.2. The lead will advise the organisation over all training matters relating to the physical restraint of

others and with the team will deliver relevant training and refresher training in PMVA to ensure that staff are suitably skilled to manage situations relating the management of violence and aggression.

4.8.3. The Lead will also be responsible for providing the Board with relevant data relating to the

incidence and use of restraint and any breaches.


4.9 Employees

4.9.1 All employees have responsibility to take reasonable care of their own safety and security, as well as the safety and security of others who may be affected by their acts or omissions, i.e. for the security of their colleagues and visitors. All employees are responsible for:

Ensuring that all security recommendations or provisions that apply to the area of the organisation property/area that they occupy or visit are adhered to including those that relate to lone working, if applicable.

Ensuring that any equipment that they are provided to support their safety and well-being is used in accordance with the manufacturer’s instructions and guidance.

Ensure that they wear an appropriate identification badge when on organisation premises or community visits and lead by example, such as challenging other members of staff or members of the public in relation to a lack of clear identification.

Making themselves and any others who come into their area of work are aware of any potential security risks and the measures that have been put in place to control the risk.

Avoiding situations where they may feel, or be put, at risk.

Reporting any security incidents or breaches to their Line Manager and/or the LSMS in accordance with the Incident Reporting Policy.

Attending training relating to safety and security, including Conflict Resolution Training or PMVA/PRISS

Staff working in premises not operated by the organisation must familiarise themselves with local security controls and ensure that they are adhered to, reporting any issues to their manager.

4.10 Health and Safety Sub-Committee

4.10.1. The Health and Safety Sub-Committee is a sub-committee of the Board and is chaired by the

Chief Nurse [SMD]. 4.10.2. The Committee is responsible for setting strategy and for ensuring that effective systems are in

place to meet legislative and best practice requirements. It advises the Board on the adequacy of controls and assurances in respect of health and safety, and requires action to be taken to address any identified gaps. Issues relating to safety or security will be escalated through the Quality Improvement and Risk Group [QIR] to the Board where relevant.

4.10.3. Service Lines will consider Health & Safety and Security matters as a standing item at

operational meetings and will escalate issues to the Health and Safety Sub-Committee as appropriate.

4.10.4. The Committee will receive the following reports in relation to security:

LSMS Annual [and quarterly] update.

The annual organisation-wide Self Review Tool and Work Plan.

Annual NHS Protect Report of Physical Assaults [RPA] submission.

Security related incidents and trends

4.11 Occupational Health

4.11.1. Occupational Health can provide guidance and support to members of staff affected by incidents, in particular those that relate to workplace violence and aggression. Referrals may be made either directly by the staff member or their line manager.


4.11.2. Occupational Health providers will provide reports and feedback relating to numbers of staff who are referred or self-refer following incidents of violence and aggression. This feedback will be monitored by the Human Resources Department via Service Level Agreement meetings.

4.12 Patients/Visitors

4.12.1 All patients and visitors have obligations under the NHS Constitution to:

“treat staff and other patients with respect and recognise that violence, or the causing of nuisance or disturbance on NHS premises, could result in prosecution. [Patients and visitors] should recognise that abusive and violent behaviour could result in you being refused access to NHS services.” NHS Constitution, 2013.

4.12.2 All patients and visitors are responsible for guarding the safety of their own property unless in the

case of in-patient property that has been lodged with the ward/department for safekeeping and where a suitable receipt has been obtained. Other than for these items, the organisation accepts no responsibility for loss and possible damage of personal possessions brought into its premises or property.

4.13 Contractors

4.13 All contractors or staff working on or behalf of the organisation have a responsibility to take reasonable care of their own safety and security, as well as the safety and security of others who may be affected by their acts or omissions, i.e. for the security of staff, patients and visitors. This will include, but is not limited to the wearing of appropriate identification; securing of areas/departments/premises and ensuring that assets and property of the trust are kept secure.

5 TRAINING

5.1 Solent NHS Trust recognises the importance of appropriate training for staff. For training

requirements and refresher frequencies in relation to this policy subject matter, please refer to

the Training Needs Analysis (TNA) on the intranet.

5.2 Corporate and local induction

5.2.1. All staff will receive corporate and local induction when new to the trust to ensure that they are made familiar with the processes and procedures that are in place to support them in their roles; to enable them to report incidents and support that is available in the event of them being involved in any incident relating to violence or aggression.

5.2.2. Local induction will also highlight any risks that are relevant to their local workplace, including

lone working procedures or risks relating to the patient group that they support.

5.3 Conflict Resolution Training

5.3.1 Conflict Resolution Training and Refresher Training are based on the NHS Protect CRT syllabus and are available for all front line staff and focus on 5 core areas:

To provide a summary of the role of NHS Protect, local anti-crime roles and security

management work in the NHS.

To provide an illustration of what constitutes conflict, how it arises and, using personal

experience, how to be effective in reducing the risk of conflict occurring.

To explore the role of communication in conflict and how to use it effectively.

To outline the procedural, environmental and legal context of violence in the workplace.


Explain what is required of individuals and organisations after a violent incident and the

support available to those involved.

5.3.2 Staff members who are prioritised to attend should attend an initial session and then a refresher

every three years after that, unless following an incident or assessment it is deemed relevant for them to attend more frequently.

5.4 Prevention and Management of Violence and Aggression

5.4.1 This training is for front line Adult Mental Health staff and deals with the prevention and management of violence and aggressive behaviour by using the least restrictive option and focuses on:

De-escalation techniques

Diversion and distraction activity

Developing “Safer Wards”

Lone Working and use of breakaway techniques

Physical restraint training

Ensuring the physical health needs of the individual are monitored post restraint

Use of seclusion; its negative implications; legal aspects and rationale CLS11 Operational

Policies for the Use of Enhanced Care Area Suite

Importance of de-briefing and lesson learned which will involve discussions with the

subject of the incident

Sharing of best practices across the wider organisation

Ensuring the principle of least restrictive practice is adhered to.

5.5 Disengagement techniques [breakaway] 5.5.1. This training is beneficial to those who may find themselves in a situation where a patient or

visitor makes physical contact potentially with the intention of causing harm. The techniques enable a person to effectively “breakaway” but without causing harm or using aggression.

5.5.2. This training will be helpful for those working in ward areas, but not delivering patient care, e.g.

facilities or security staff and for staff working in the community. 5.5.3. Disengagement techniques should also be used in conjunction with conflict resolution training

skills.

6 EQUALITY IMPACT ASSESSMENT AND MENTAL CAPACITY 6.1 A thorough and systematic assessment of this policy has been undertaken in accordance with the

Trust’s Policy on Equality and Human Rights. 6.2 An Equality Impact Assessment has been completed and there are no major concerns relating to

the equality agenda. See Appendix 1.

7 SUCCESS CRITERIA / MONITORING EFFECTIVENESS

7.1 The management of security; violence and aggression will be monitored by the Local Security Management Specialist [LSMS], Directors, Facility Managers, Support Services Managers, Premises Managers, responsible persons both clinical and non-clinical, Safety Representatives, Clinical Risk Manager and the Trust's Health, Safety, Fire & Security Manager.


7.2 To provide assurance to the Board, the LSMS will provide a quarterly report to the Health & Safety

Sub-committee, identified risks and issues will be escalated through the Organisations Risk Register and Quality Improvement & Risk (QIR) group together with proposals and action plans for their mitigation. These documents will be presented to the Board for information and where appropriate approval.

7.3 By nature of the patient groups that the trust provides care for it may be impossible for the

number of incidents to be reduced; however there may be a reduction in the overall severity of incidents and potential injury sustained by staff.

7.4 The criterion for determining the success of the policy and associated procedures will be

determined by:

Reviewing the annual Staff Survey to establish whether there has been reduction in staffs perception of incidents of violence and aggression in the workplace

Where sanctions have been applied, there has been an improvement [reduction] in aggressive behaviour directed at staff and incidents

8 REVIEW

8.1 This document may be reviewed at any time at the request of either at staff side or management,

but will automatically be reviewed three years after initial approval and thereafter on a triennial basis unless organisational changes, legislation, guidance or non-compliance prompt an earlier review.

9 REFERENCES

9.1 Legislation & Regulatory references:

The Health & Safety at Work Act 1974

Safety Representatives and Safety Committees Regulations 1977 (a),

The Health and Safety (Consultation with Employees) Regulations 1996 (b), The Corporate

Manslaughter and Corporate Homicide Act 2007

The Secretary of State for Health’s Directions (2003)

NHS Standards for Providers

Criminal Injury Compensation Scheme: http://www.justice.gov.uk/victims-and-witnesses/cica .

9.2 Guidance Documents

Violence against staff, 2014, NHS Employers (web resource)

http://www.nhsemployers.org/Aboutus/Publications/Documents/Violenceagainststaff.pdf

Directions to NHS bodies on measures to deal with violence against NHS staff 2003 (Amendment)

Directions, 2006, NHS Protect

Directions to NHS bodies on measures to deal with violence against NHS staff, 2003, NHS Protect

NHS Protect Guidance for Applying Sanctions

http://www.nhsbsa.nhs.uk/i/SecurityManagement/Unacceptable_Behaviour_applying_NHS_adm

inistrative_sanctions_Final_LOCKED.pdf

NHS Protect Guidance on warning letters -

http://www.nhsbsa.nhs.uk/Documents/SecurityManagement/Unacceptable behaviour_-

_Guidance_on_warning_letters_and_other_written_communications_Final.pdf

NHS Protect – Not Alone – Lone Working Guidance

http://www.nhsbsa.nhs.uk/Documents/SecurityManagement/Lone_Working_Guidance_final.pdf

https://web.nhs.net/OWA/redir.aspx?C=FrnNmMRyY0S4Tb0YB2yB_NMBbG4xPtFIHYQaccSdg3LouWjOLlqFc1Ru4DRZbEseJpW03b8Zyws.&URL=https%3a%2f%2fweb.nhs.net%2fOWA%2fredir.aspx%3fC%3d0eTwBIT-JU2NHMlWI1r_EGYAg1IzbdBIpH7-eNquxcyCq6ghHdvpGUh9lIAZEBP_h7TqcODZR-Q.%26URL%3dhttp%253a%252f%252fwww.justice.gov.uk%252fvictims-and-witnesses%252fcica

http://www.nhsemployers.org/Aboutus/Publications/Documents/Violenceagainststaff.pdf

http://www.nhsbsa.nhs.uk/i/SecurityManagement/Unacceptable_Behaviour_applying_NHS_administrative_sanctions_Final_LOCKED.pdf

http://www.nhsbsa.nhs.uk/i/SecurityManagement/Unacceptable_Behaviour_applying_NHS_administrative_sanctions_Final_LOCKED.pdf

http://www.nhsbsa.nhs.uk/Documents/SecurityManagement/Unacceptable%20behaviour_-_Guidance_on_warning_letters_and_other_written_communications_Final.pdf

http://www.nhsbsa.nhs.uk/Documents/SecurityManagement/Unacceptable%20behaviour_-_Guidance_on_warning_letters_and_other_written_communications_Final.pdf

http://www.nhsbsa.nhs.uk/Documents/SecurityManagement/Lone_Working_Guidance_final.pdf


NHS Protect: Meeting Needs and reducing distress. Published February 2014

http://www.nhsprotect.nhs.uk/reducingdistress

Violence and aggression: short-term management in mental health, health and community

settings. NICE Guideline Published 28 May 2015 www.nice.org.uk/guidance/ng10

Violence at work- a guide for employers Health & Safety Executive, 2014

http://www.hse.gov.uk/pubns/indg69.pdf

Violence in health and social care, Health & Safety Executive, 2014 (web resource)

http://www.hse.gov.uk/healthservices/violence/

Standards for Providers 2014 – 15 – Security Management: NHS Protect March 2014

http://www.nhsbsa.nhs.uk/3577.aspx

9.3 Solent NHS Local Policies & Procedures

Lone Working Procedures

Management of Violence and Aggression Procedures

Security Management Procedures

Incident Reporting Policy SIRI Policy Risk Management Strategy and Guidance CLS11 Operational Policies for the Use of Enhanced Care Area Suite [Use of seclusion] Health & Safety Policy

http://www.nhsprotect.nhs.uk/reducingdistress

http://www.nice.org.uk/guidance/ng10

https://web.nhs.net/OWA/redir.aspx?C=FrnNmMRyY0S4Tb0YB2yB_NMBbG4xPtFIHYQaccSdg3LouWjOLlqFc1Ru4DRZbEseJpW03b8Zyws.&URL=http%3a%2f%2fwww.hse.gov.uk%2fpubns%2findg69.pdf

https://web.nhs.net/OWA/redir.aspx?C=FrnNmMRyY0S4Tb0YB2yB_NMBbG4xPtFIHYQaccSdg3LouWjOLlqFc1Ru4DRZbEseJpW03b8Zyws.&URL=http%3a%2f%2fwww.hse.gov.uk%2fhealthservices%2fviolence%2f

https://web.nhs.net/OWA/redir.aspx?C=FrnNmMRyY0S4Tb0YB2yB_NMBbG4xPtFIHYQaccSdg3LouWjOLlqFc1Ru4DRZbEseJpW03b8Zyws.&URL=http%3a%2f%2fwww.nhsbsa.nhs.uk%2f3577.aspx


Appendix 1 Glossary of terms

ASMS – NHS Protect Area Security Management Specialist CBRN – Chemical, Biological, Radioactive, Nuclear (usually used to describe particular types of attack or prevention from attack).

CCTV – Closed Circuit Television CRT – Conflict Resolution Training LPU – NHS Protect Legal Protection Unit LSMS –Local Security Management Specialist NICE – National Institute for Health and Care Excellence NHSPS – NHS Property Services SABs/SAMs – Safety Alert Bulletin/Safety Alert Message

SIRS – Security Incident Reporting System (NHS Protect) SMD – Security Management Director

PMVA – Prevention and Management of Violence and Aggression training


Appendix 2 Equality Impact Assessment

Step 1 – Scoping; identify the policies aims Answer

1. What are the main aims and objectives of the document?

To provide guidance to managers and staff over the management of all issues relating to security and violence and aggression.

2. Who will be affected by it?

All staff

3. What are the existing performance indicators/measures for this? What are the outcomes you want to achieve?

Reduction in loss, improved management of challenging behaviour, reduction in severity of incidents of aggression directed at staff.

4. What information do you already have on the equality impact of this document?

Existing incident report data.

5. Are there demographic changes or trends locally to be considered?

No

6. What other information do you need?

None

Step 2 - Assessing the Impact; consider the data and research

Yes No Answer (Evidence)

1. Could the document unlawfully against any group?

No

2. Can any group benefit or be excluded? No

3. Can any group be denied fair & equal access to or treatment as a result of this document?

No

4. Can this actively promote good relations with and between different groups?

No

5. Have you carried out any consultation internally/externally with relevant individual groups?

Yes

6. Have you used a variety of different methods of consultation/involvement

No

Mental Capacity Act implications Yes In determining whether sanction is appropriate

7. Will this document require a decision to be made by or about a service user? (Refer to the Mental Capacity Act document for further information)

Yes See above

If there is no negative impact – end the Impact Assessment here.

Step 3 - Recommendations and Action Plans

Answer

1. Is the impact low, medium or high?

2. What action/modification needs to be taken to minimise or eliminate the negative impact?

3. Are there likely to be different outcomes with any modifications? Explain these?

Step 4- Implementation, Monitoring and Review Answer

1. What are the implementation and monitoring arrangements, including timescales?

2. Who within the Department/Team will be responsible for


monitoring and regular review of the document?

Step 5 - Publishing the Results

Answer

How will the results of this assessment be published and where? (It is essential that there is documented evidence of why decisions were made).

**Retain a copy and also include as an appendix to the document**


Appendix 3

Incident occurs

Provide local 1st aid or

other medical assistance if required

Make sure staff member[s] and others, including all patients [and aggressor,

where applicable] are safe Report incident on Ulysses Safeguard

Record staff members who were affected as “victims” & complete SIRS section for each staff member involved

Non-physical Assault – No physical contact made

Does aggressor have a clinical illness/condition that may have

contributed to the incident?

Physical Assault - Physical contact is

made

Report incident to Police either using 999 if urgent assistance is required or 101

Complete both parts of MOVA Procedures Appendix 7 –

Incident report for Police – this will inform police over appropriateness of action, including arrest and CPS action

Yes No Follow MOVA Procedures Appendix 6 for follow up

support and actions

Risk assess and review medication and treatment

plan – keep in mind appropriate sharing of

information to keep staff and others safe

Liaise with Service Manager and Local Security Management Specialist over

actions which may include: 1. A meeting to discuss

behaviour 2. Drafting a letter regarding

behaviour 3. Drafting of a behaviour

agreement 4. Withdrawal of care – last resort

and may have legal implications and input from CCG