Security Management Practice Guidance Note Version Issued ...…Issue 1- Aug 2019 Issue 2 – Oct 2019 Planned Review June 2022 SM-PGN 02 Part of CNTW(O)21-Security Management Author/Designation

Security Management Practice Guidance Note

Lone Working V04

Version Issued

Issue 1- Aug 2019 Issue 2 – Oct 2019

Planned Review

June 2022

SM-PGN 02

Part of CNTW(O)21-Security

Management

Author/Designation Tony Gray – Head of Safety, Security and Resilience

Responsible

Officer /

Designation

Gary O’Hare – Executive Director of Nursing & Chief

Operating Officer

Section Description Page No:

1 Introduction 1

2 Legal framework and guidance 1

3 Legal requirements on all service providers for the implementation and use of Lone Worker Systems

1

4 Responsibilities for all practice guidance notes 2

5 Responsibilities for this practice guidance note 2

6 Head of Service/Line managers 2

7 Induction 2

8 Instruction/Training 3

9 Supervision 4

10 Definitions 4

11 Development of local protocols 4

12 Risk assessment 4

13 First contacts 5

14 Staff working in the community or peoples homes 5

15 Home visiting 6

16 Locating staff 6

17 Staff working in health centres/clinic and GP practices 7

18 Staff who have to travel as part of their working day 7

19 Severe weather conditions 7

20 Limit the risk of breakdown 8

21 If you are involved in a road traffic accident 8

22 Personal safety in your car 8

23 Safety on public transport or in taxis 9

24 Personal safety on foot 9

25 Staff who work in isolated areas of a hospital site 10

SM-PGN 02

26 Staff who work alone in confined spaces 10

27 Staff who see patients by themselves in a hospital setting 10

28 Staff who work at home unsupported 11

29 Audit 11

30 Training and awareness 11

Appendices – listed separately

Appendix 1 Lone Working Checklist – Home visiting/Working in community

Appendix 2 Lone Working Checklist - Clinics, Health Centres and GP Practices

Appendix 3 Working in hospital setting in isolated locations

Appendix 4 Staff Personal Details Form

SM-PGN 02

Cumbria Northumberland, Tyne and Wear NHS Foundation Trust SM-PGN-02 – Lone Working – V04-Iss 2 – Oct 19 Part of CNTW(O)21 - Security Management Policy

1

1. INTRODUCTION

1.1 Cumbria Northumberland, Tyne and Wear NHS Foundation Trust, (the Trust) provides a range of mental health, learning disability, neuro-rehabilitation and substance misuse services for a population of approximately 1.4 million. Services are provided in a variety of locations: in hospitals, health centres, schools, clinics, community homes, stand alone units / centres and in peoples own homes. Health and social care services are regularly provided by ‘lone workers’, Lone working, this is often appropriate for the most part and a rewarding experience for staff. There is however risks associated with rare occurrences that all lone workers must be prepared for.

1.2 The Trust will ensure, so far as is reasonably practicable, that employees

(including students on placement) who are required to work alone or unsupervised for significant periods of time are protected from risks to their health and safety. Measures will also be adopted to protect anyone else affected by lone working.

1.3 Lone working exposes employees and others to certain hazards. The Trust's intention is either to entirely remove the risks from these hazards or, to reduce them to an acceptable level.

1.4 This Practice Guidance Note (PGN) is written to cover all lone workers whether they are clinical or non-clinical staff.

2. LEGAL FRAMEWORK AND GUIDANCE 2.1 The provision of lone working systems is controlled by a number of statutes,

regulations and guidance documents.

The Health & Safety at Work etc. Act 1974

The Management of Health & Safety at Work Regulations (as amended) 1999

Safety for Trainees in Psychiatry-Royal College of Psychiatrists.

Working Alone in Safety – Health & Safety Executive. 3. LEGAL REQUIREMENTS ON ALL SERVICE PROVIDERS FOR THE

IMPLEMENTATION AND USE OF LONE WORKER SYSTEMS

3.1 Health and Safety legislation currently in force does not prohibit lone working, except in a few specific circumstances e.g. working in confined spaces. For the purposes of this practice guidance note reference should be made to the Estates Department local policy for confined spaces / permit to work systems.

3.2 The Trust has a general duty under Section 2(1) of the Health and Safety at Work etc. Act, 1974, to ensure so far as is reasonably practicable the health, safety and welfare at work of employees.

3.3 The Management of Health and Safety at Work Regulations 1999 (as amended) requires that work activities are risk assessed. The risk assessment needs to consider options to eliminate or control a hazard in order to reduce the level of

SM-PGN 02


2

risk to as low as is reasonably practicable. The assessment should consider the suitability of the member of staff to undertake lone worker duties which may include pregnancy at work or other health related issues. Checklists to aid risk assessment are attached as Appendices 1, 2 and 3.

3.4 This Practice Guidance Note is based on organisational responsibilities and as such will dictate the controls in place within generic situations. It is important to consider local arrangements specific to each service within the risk assessment.

4. RESPONSIBILITIES FOR ALL PRACTICE GUIDANCE NOTES 4.1 The key responsibilities for all Practice Guidance Notes are identified within the

Security Management Policy. 5. RESPONSIBILITIES FOR THIS PRACTICE GUIDANCE NOTE 5.1 Local Security Management Specialists (LSMS) 5.2 The LSMS will update this PGN in line with updated guidance being issued by

the Security Management Service, as part of the annual review. 5.3 The LSMS will produce quarterly and annual reports of all security related

information for all Trustwide groups as appropriate. 5.4 The LSMS will give advice and information to staff regarding lone worker issues. 6. HEADS OF SERVICE / LINE MANAGERS 6.1 Will ensure as part of the risk assessment process that the information included

in this PGN is considered when developing local systems for lone working. 6.2 Will ensure that any incidents relating to lone working are reported through the

normal Trust reporting mechanisms. 6.3 Will ensure that a thorough investigation is carried out into any incidents relating

to lone working. 6.4 Staff will be supplied with the necessary information to enable them to carry out

their duties safely. 7. INDUCTION

7.1 All staff on joining the Trust or significantly changing their role will attend corporate induction training as detailed in the Trust Induction Policy.

7.2 All staff, including students, will have local workplace induction that will identify the potential risks the job may entail and any controls that the risk assessment has identified, as a minimum, local arrangements for lone workers

7.3 Records will be kept of all local inductions that take place and monitored centrally by Human Resources. This will include induction records for nursing students whilst on placement.

SM-PGN 02


3

7.4 The induction will include the Trust’s incident reporting processes and policies

that support this. 7.5 The risk assessment will identify the employees who spend a lot of their time

alone and who face a risk from violence and aggression by either a patient or related family member or a member of the public.

7.6 Managers must ensure:-

Local Protocols are established as both a framework for personal safety as well as a reporting mechanism for physical attacks. The Local Security Management Specialists (LSMS) can assist with this.

Local Protocols need to be established as both a framework for the safe use of mobile communication devices as well as a reporting mechanism for lost, stolen or damaged mobile communication devices – See CNTW(O)58 – Issue and use of Mobile Communication Devices.

7.7 When these two protocols are considered together, the employee is much better

placed to know their limitations within their work environment and should any incident happen then they will also know the next course of action to take.

7.8 As part of the local protocol for reporting physical attacks, staff should complete

as much information as possible will help to identify corrective action. 8. INSTRUCTION/TRAINING

8.1 Instruction and training is crucial for all groups of staff that work alone and for

those who manage them. 8.2 The instruction and training must be relevant to the nature of the work

undertaken. 8.3 Where a training need is identified through either a risk assessment process or

following an incident that further instruction / training is required the line manager shall make arrangements for this and will gain advice from the Local Security Management Specialists and/or Trust lead for the Management of Violence and Aggression.

8.4 Instruction and Training can bring about:

A reduction in the number of serious incidents.

A reduction in the severity of incidents.

A reduction in the psychological effects of incidents.

An improved response to incidents.

An improvement in staff morale.

8.5 Instruction and Training programmes will be centrally co-ordinated and recorded

and aimed at key staff across the organisation based on risk assessment.

SM-PGN 02


4

Training will meet the standards of the SMS conflict resolution or SMS Safer Therapeutic Services and contain information within this policy.

9. SUPERVISION

9.1 Line managers have a responsibility to provide management supervision and where appropriate clinical supervision inline with Trust supervision policy, and should be available to provide advice and guidance.

9.2 Where issues arise that cannot be dealt with by the line management team then

advice should be sought from the individuals listed in 8.3 of this practice guidance note

10. DEFINITIONS

10.1 The Health & Safety Executive defines Lone Working as: - “Those who work by themselves without close or direct supervision”.

The Trust has a number of different lone workers who will face different risks as

part of their daily routine, these are as follows:-

Staff working in the community or peoples homes

Staff who work alone in confined spaces or where there may be physical, chemical or environmental hazards

Staff working in Health Centres / Clinics / GP Practices

Staff who have to travel as part of their working day

Staff who work in isolated areas of a hospital site

Staff who work alone in confined spaces

Staff who see patients by themselves.

Staff who work at home unsupported.

Staff on escort duty. 11. DEVELOPMENT OF LOCAL PROTOCOLS

11.1 No two lone workers will face the same hazards or risks as they go about their daily work routine, however there are some simple principles that can and must be built into local protocols, and should be issued to all employees as well as new and temporary workers, such as locums, agency staff and students on placement.

12. RISK ASSESSMENT

12.1 An initial risk assessment must be carried out following the Health & Safety Executives 5 point plan (see Appendices 1, 2 & 3). The findings of the assessment must be shared with all staff exposed to the hazard / risk. This practice guidance note has been structured to help managers identify risks with specific types of lone workers defined in section 10.

SM-PGN 02


5

13. FIRST CONTACTS 13.1 Consideration should be given to first contacts with Service Users, these being

arranged at staffed premises where appropriate and, where possible, to having two clinicians carry out this first contact to allow an appropriate assessment to be completed.

14. STAFF WORKING IN THE COMMUNITY OR PEOPLES HOMES 14.1 The Trust has invested in the Reliance Lone Working System to protect lone

workers , who work in community settings, and those staff who use this system should also read the Reliance Protect – Lone Working System – Practice Guidance Note – SM –PGN-09.

14.2 Trust employees referring a service user to another service will be responsible

for highlighting whether or not there is a history of aggression or violence and if this was actual or potential. This will be documented in the referral and / or notes.

14.3 Any professional, other member of staff and family / carers likely to come into

contact with the service user must be informed. 14.4 The potential risk of violence should be assessed before any home visit. 14.5 Useful information required by staff member prior to any visit to a patient’s home

will include:-

Name

Address (clear direction to location of residence)

Access to transport / car parking (consider time of day to visit)

Date of birth

Telephone number

Known to services - list

How access to the house can be obtained e.g. key to house and isolation of resident, if known

GP name

Diagnosis

Reason for referral

Specific nursing referral

Assessment of individuals may need to be with a chaperone to avoid risk of allegation of impropriety.

Indication of need for staff to visit in pairs

Any perceived or previous problems e.g. patient/relative aggression/known causes of aggression

Aggressive pets

Information from other agencies, such as Police and Social Services

Past history of violence

SM-PGN 02


6

Recent medical and personal history including information on: Behaviour, mood, medication and aggressive outbursts.

Any other information relevant e.g. excessive weight of patient

Other occupants in house

Visits requested with little or scant information should be dealt with as a high risk visit

15. HOME VISITING 15.1 The following should be considered when home visiting:-

Staff should carry and show identification at all times.

As much information as possible should be ascertained prior to making a visit.

If a visit is planned to a known high-risk service user, the manager and the multi-disciplinary team should be made aware in order that appropriate action is taken.

Any service user with a history of aggression or violence whether actual or potential will be discussed with the team leader / service manager and the multi-disciplinary team and a strategy for care will be formulated. This may include offering a clinic appointment as opposed to a home visit or by making an accompanied visit to the home. If any aggression or violence is threatened, the staff member should leave the situation if they feel at risk.

Any unplanned, out of hours visit in which information on the service user is scant should be managed with caution and subject to dynamic risk assessment, where information is gathered mentally as the situation develops.

Staff should assess the risk to carers and any children involved and determine appropriate action.

If staff identify an emergency situation in a patients home then they should contact the appropriate emergency service as soon as possible, do not put yourself at unnecessary risk.

If at any stage the staff member is faced with a situation in which they feel threatened they should either activate a lone worker device if issued (see 16.4) or return to base and inform their manager.

16. LOCATING STAFF 16.1 All staff working in the community and/or making home visits should leave an

itinerary for their day. This should provide information on where visits are to be made that day and approximate time of arrival / departure as minimum information. Clear systems should be detailed in the local protocol for lone working / risk assessment documents as to the action if someone:

Does not return from home visits.

Does not contact the department after their last visit.

Contacts the department with concerns about a visit.

SM-PGN 02


7

16.2 If white boards are to be used to maintain a register, these need to be managed

and updated on a regular basis, and one member of staff should have responsibility to manage the board and take appropriate actions.

16.3 Team Managers should have a record of all staff’s, including students, personal

information as listed on the Staff Personal Details Form as listed at Appendix 4. 16.4 There are a variety of locating devices available which use mobile phone

technology and these systems can be used to further enhance lone worker protocols. The use of these systems must be suitably managed to ensure their effectiveness and reliability. When considering the use of location devices, as part of a lone worker protocol, advice should be sought from the Trusts Local Security Management Specialists. Further advice on the use of these devices can be found in practice guidance note SM-PGN-09 Lone Worker Protection Systems.

17. STAFF WORKING IN HEALTH CENTRES/CLINICS/GP PRACTICES 17.1 Some staff will, as part of their working day, work out of Health Centres / Clinics

and GP Practices. Whilst they may well be supported by staff within their work area, they may still be isolated and staff should ensure:

All the principles of working in the community and home visits as listed above are adopted.

In addition staff should ensure the manager of the building is aware that the staff member has arrived or is leaving.

Any local protocols for the security of the building are adopted.

Staff understand the use of and have access to any alarms that are issued as part of the protocols.

Staff may be required to report incidents more than once through the Trust’s process and through other agencies systems to inform the appropriate management team.

18. STAFF WHO HAVE TO TRAVEL AS PART OF THEIR WORKING DAY 18.1 Any staff who travel as part of their working day should include the information

highlighted in sections 19 – 24 in their risk assessment. 18.2 This may include community workers, but can include managers who travel from

site to site due to the complexities and size of the organisation. 18.3 Consideration should also be made to staff attending training / education both

locally and nationally. 19. SEVERE WEATHER CONDITIONS 19.1 If weather conditions are severe and roads are unsafe, do not put yourself at

unnecessary risk. Staff must communicate with their manager and co-workers to inform them that they are going on a visit, where, how long, what route etc.

SM-PGN 02


8

20. LIMIT THE RISK OF BREAKDOWN

20.1 By carrying out regular servicing on your motor vehicle you will limit the risk of breaking down. If you use your car for work purposes ensure, where possible, that it is safe and that you have appropriate breakdown cover.

20.2 If you do breakdown

Turn on your hazard warning lights, and summon assistance as appropriate

Try to assess whether it is safer to stay in your car, or to get out. Take account of how isolated you are and the time of day. Staff should get out of the vehicle if they break down on a motorway and move to a safe place away from the car.

If you stay inside, sit in the passenger seat to give the impression you are not alone

Display a “help” notice if you stay in the car

Keep your doors locked and the window open no more than 1. 5 inches, if someone stops to offer help, ask them to telephone the police

If you leave the car, lock it and note its location, if you have a personal alarm, take it and keep it in your hand. If it is dark or getting dark take a torch

If you have a warning triangle, place it in the direction of on-coming traffic, 30 metres from your car and on the same side of the road

21. IF YOU ARE INVOLVED IN A ROAD TRAFFIC ACCIDENT

Do not leave the scene if someone is injured until the Police have arrived.

Never admit liability

If you are concerned for your safety, do not get out of your car, open the window slightly and talk through the gap.

If possible contact someone or ask someone else to phone for you, tell someone what has happened and where you are.

Exchange insurance details with the other parties; ensure you have the other vehicle index number.

Complete an incident form (IR1) on return to base. 22. PERSONAL SAFETY IN YOUR CAR

Keep your car in good working order, report any faults and ensure it is serviced regularly

Always ensure you have enough fuel for your journey, there and back.

Carry details of the breakdown/rescue organisations in the vehicle

SM-PGN 02


9

Plan your route before setting off, when you have the choice use main roads

Adopt the same principles for alerting your line management of your whereabouts as for 14.1 above.

Have the directions and maps in the car so you do not have to stop to ask

Do not have valuables visible in the car when driving.

Stay in the car as much as you can. Keep the doors locked and windows closed, especially in towns where you will be stopping at junctions

Keep handbags, briefcases and mobile phones out of reach of open windows

in case of snatch thieves

When you leave the car, lock personal belongings in the boot, not on display

Lock your car, even if you are only going to pay for petrol on a garage forecourt

When parking in daylight, consider what the area will be like in the dark

At night, park in a place which is well lit and if possible busy. Try to avoid multi-storey car parks or areas where you and your vehicle are not clearly visible

Before you get into the car, check the back seat, keep a torch handy for this

If you see an incident or accident, or someone tries to flag you down, don’t stop; however assistance should be summoned from the emergency services as soon as possible but only when it is safe to do so.

If a car pulls up in front of you and you have to stop, keep the engine running

If you think you are being followed, try to alert other drivers with your lights and horn. Keep driving until you reach a busy area with lots of people about or a police/fire or ambulance station or even a garage.

23. SAFETY ON PUBLIC TRANSPORT OR IN TAXIS

Wait for transport at a busy stop or station that is well lit.

Ensure you have a timetable for the mode of transport and route.

Sit next to the driver if possible.

Be aware of safety procedures and the location of alarms.

Avoid empty carriages.

If threatened by other passengers, inform the driver / guard.

Book taxis in advance using the Trust’s formal system (for business use Taxis only).

Go to a recognised taxi rank to hail a taxi and only use registered and easy to identify hackney carriages.

Sit in the back of the taxi, behind the passenger seat. When escorting a service user ensure they are seated in that position.

Be aware of child locks and central locking within taxis.

SM-PGN 02


10

24. PERSONAL SAFETY ON FOOT

You are more likely to escape danger wearing clothes you can move in easily and shoes that are comfortable, walking quickly is usually safer than trying to run

Valuables, such as wallets should be kept in an inside pocket and secured, or use a body belt or “bum bag”, try to keep both hands free.

To carry things, use a small bag slung across your body under a jacket or coat, or a shoulder bag with a short strap and secure fastenings, make sure it sits close to your body with the fastening innermost.

Carry in your pocket the telephone number to stop all your cheque cards, some change or a travel card, and your keys.

Whenever possible, avoid walking alone at night.

Keep to busy, well lit roads.

Do not take short cuts, unless you know they are as safe as the longer route

Avoid poorly lit or little used underpasses. 25. STAFF WHO WORK IN ISOLATED AREAS OF A HOSPITAL SITE 25.1 Staff who work on main hospital sites should ensure they know what local

procedures are in place for security, and how to call on these in case of emergency.

25.2 If working out of hours at night or at weekends and in isolation, the environment

in which you work should be secure, with at least a lockable door between the member of staff and the exterior to the building.

25.3 If the individual is working in a unit attached to an in-patient setting, the member

of staff should make the nurse in charge aware of what time they are expecting to work until. Checks should take place from the nurse in charge.

25.4 The member of staff should have access to a personal attack alarm; preferably

one linked to the staff attack alarm system. Personal attack alarms can be requested from the Trusts’ Local Security Management Specialists.

26. STAFF WHO WORK ALONE IN CONFINED SPACES 26.1 Staff should not work alone in confined spaces. Estates working procedures will

identify preventative and protective measures such as a permit to work system where confined work has to take place.

26.2 It will be the specific responsibility of the Estates Department to oversee this

work.

SM-PGN 02


11

27. STAFF WHO SEE PATIENTS BY THEMSELVES IN A HOSPITAL SETTING 27.1 A majority of standards to be achieved when seeing patients one to one in a care

setting, will be the same as that of a home environment. The risk assessment should take into account the support mechanisms for staff on a hospital site. Managers responsible for areas covered by personal attack alarms should ensure local response protocols are in place.

Staff who see patients by themselves should be aware of the standards adopted in the Royal College of Psychiatrists – Council Report CR118, namely:

Interview rooms if possible should have two points of entry / exit.

Interview rooms should have anti-barricade doors.

Interview rooms should have vision panels in the doors.

Interview rooms should have minimal furniture.

Interview rooms should not have a number of items that could be used as weapons.

The interview room should not be able to be locked from the inside without staff able to override from the outside.

Staff who use interview rooms should be equipped with an alarm system or staff issued with attack alarms.

28. STAFF WHO WORK AT HOME UNSUPPORTED 28.1 With the increasing trend for more non-operational staff to work from home, the

legislation still classes this type of work as lone working, if they are required by their employer to work from home.

28.2 In these instances it is necessary to have written formal agreements with the

immediate line manager and the conditions applied for working at home. 28.3 The principles of this policy still apply, but it is recognised that the support

mechanism for this lone worker will generally be the emergency services in the first instance for any emergency or dangerous situation.

28.4 This guidance is to be read in conjunction with the Trust’s Guide to Tele /

Remote Working Policy. 29. AUDIT 29.1 The effectiveness of this Practice Guidance Note will be reviewed on an annual

basis by the Trust-Wide Security Management Group. 29.2 The Practice Guidance Note will be updated to reflect changes as required by the

Security Management Service. 29.3 Any incidents relating to Lone Working issues will be reported to the Local

Security Management Specialist and advice given as per each individual case.

SM-PGN 02


12

29.4 An annual audit of the systems adopted in local areas must be carried out by the

Team / Department Managers. 30. TRAINING AND AWARENESS 30.1 All staff should be made aware of the content of this practice guidance note.

Documents

Security Management Practice Guidance Note Version Issued ...…Issue 1- Aug 2019 Issue 2 – Oct 2019 Planned Review June 2022 SM-PGN 02 Part of CNTW(O)21-Security Management Author/Designation