NHS violence soars despite trusts’ zero tolerance policy

workers are still experiencing alarming amounts of violent incidents and
attacks, even though a zero tolerance campaign has been running. By Quentin

violence against NHS staff is soaring, despite the Department of Health’s (DoH)
zero tolerance campaign.

figures are alarming – in the past two years, the level of reported violence
and aggression against NHS staff has increased by 13 per cent.

total, there were 95,501 reported cases of violence or aggression against
healthcare workers, according to a study by the National Audit Office (NAO).

the NAO report, A Safer Place to Work: Protecting NHS Hospital and Ambulance
Staff from Violence and Aggression, estimates the actual figure could be far
higher, as many staff still don’t report attacks.

increase comes despite the DoH’s zero tolerance campaign which began in 1999,
designed to ensure that violence or threats of violence by patients or other
members of the public towards NHS staff is not simply accepted as ‘part of the
job’, and offenders are prosecuted.

a fifth of trusts managed to meet the DoH’s improvement target of a 20 per cent
reduction of violence or aggression towards healthcare staff by April 2002.

John Bourn, head of the NAO, believes good progress has been made to improve
the safety of NHS staff, despite the increase in reported incidents.

he admits that more needs to be done, particularly on risk assessments, staff
training and the way reported incidents are followed up by employers.

also calls for the establishment of effective partnerships between the NHS and
other public agencies, such as the police.

is unacceptable that the very people who are trying to help the sick and
injured are themselves subject to violence and aggression on a daily
basis," Bourn said.

from the immediate impact on the individuals concerned, the experience or
threat of violence causes increased stress and sickness absence, lowers staff
morale and drives individuals out of the health sector at a time when we are
experiencing serious staff shortages."

stopping abuse makes financial sense. The NAO estimates the direct cost is
likely to be at least £69m a year, excluding staff replacement costs and the human
costs, such as stress, low morale, lost productivity and high staff turnover,
which are known to be substantial.

HR professionals at the coalface, the choice is simple, according to Mike
Griffin, HR director at Kings College Hospital NHS Trust.

trust has successfully turned staff security around over the past five years by
making a major investment in physical security, such as CCTV monitoring, and by
putting an emphasis on recruiting and training high-quality security staff.

hospital was very accessible and that posed a threat to individuals, their
property, and the hospital’s property," he said. Security staff can now be
summoned quickly, and the service is highly regarded by workers.

said that besides a policy of zero tolerance, investment is crucial.
"Staff needed to learn to be intolerant of bad behaviour. We have now
successfully challenged that. We encourage clinical staff to report incidents,
and have adopted policies supporting that and communicated them to staff."

said if the trust had not invested in security and the safety of its employees,
the hospital would have experienced increased staff turnover and its services
would have suffered.

Royal College of Nursing (RCN) believes the NAO figures show more still needs
to be done to protect healthcare workers, particularly in the way managers
respond to reports of violence.

RCN’s own research shows that in 2001-2002, one in three nurses experienced
some form of harassment or assault by their patients. It finds that nurses are
reluctant to report violence, because they do not feel confident action will be
taken by their managers or police.

RCN is calling for improved support from managers and for a more consistent
approach to be taken by the Crown Prosecution Service towards prosecuting

Brewer, RCN employment relations adviser, said HR must play a crucial role in
reducing attacks and harassment.

should be very involved in the health and safety side of things, liaising with
risk management, and establishing structures so that incidents can be dealt
with immediately.

will have to liaise with occupational health and counselling services, and
monitor staff after they have reported an incident," she said.

believes proper counselling facilities can keep healthcare workers in the

NAO report shows that nurses are up to four times as likely as other employees
to experience violence at work.

Chandler, national officer in Unison’s health group, said: "Every incident
should be reported and, where necessary, lead to prosecution. NHS staff are
dedicated to caring for the public. All they are asking is that the public
cares for them."


Mid Essex hospital services NHS trust

Groves, director of workforce development at Mid Essex Hospital Services NHS
Trust, said he is not surprised that the figures have increased, because staff
are now more aware of the importance of reporting incidents.

he said, industries that have encouraged increased reporting have, over time,
seen a decrease in serious incidents.

trust has been working hard to improve the way it ensures staff safety. It has
introduced a system where patients are given a ‘yellow card’, warning them if
they misbehave, and a ‘red card’ barring them from treatment if they continue.

members are given training on how to de-escalate violent patients and visitors,
and are taught controlled restraint.

two-day course in emotional intelligence has also been developed, in
conjunction with psychologists, that teaches staff to identify if someone is
about to ‘turn nasty’.

needs to provide a clear policy, proper training, and invest in its training
resource on teaching about behaviour," he said.

College of Nursing membership survey 2002

More than a half of all nurses working in mental health had been harassed or
assaulted by patients in the 12 months prior to the survey. Half of those in
learning disabilities nursing and 45 per cent of those in adult general nursing
have also experienced it

Nurses working nights (47 per cent) or three-shift rotations (48 per cent) are
more exposed to harassment than others

Fifty-three per cent of men have been harassed or assaulted by patients in the
12 months period prior to the survey compared to 38 per cent of women. This is
related to a con-centration of male nurses in fields where harassment is more

Royal College of Nursing

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