Defence strategy

Hospital staff are increasingly facing violence and abuse from the public. Ross
Wigham looks at a training initiative designed to help keep staff safe

I did a shift myself on a Friday evening and it was pretty extreme. A major
brawl had broken out in the town centre. Those involved ended up at the same
hospital and the fight started again, despite their injuries."

No, this is not an episode from the latest TV drama, but a glimpse into
United Bristol Healthcare NHS Trust, which runs nine city-centre hospitals and
suffered 66 violent episodes last year. Security is hugely important.

The speaker, Des Green, head of security for the trust’s hospitals in
Bristol, went back to the floor to understand the stark realities of working in
casualty. "I had to restrain people who were already injured, until the
police arrived," he recalls. "It’s very difficult because you not
only have to protect staff and the public, but also people who are already
injured and bleeding heavily."

Green was appointed after the trust had been served with a health and safety
notice which stated that the problem was becoming dangerous and seriously
damaging staff morale.

Specialist training formed the central component of a new £200,000 security
programme including CCTV, protective equipment, personal alarms and improved
liaison with police. It centres on tailor-made training to help the trust’s 11
security staff deal with threats and learn sophisticated conflict-management

"They were providing a viable response but needed more training. We
wanted to ensure security staff were operating professionally and were
compliant with Home Office rules and standards, using proper techniques,"
says Green.

The security officers have been issued with handcuffs, individually tailored
body armour, slash-proof gloves and the trust is now considering issuing riot
shields. Using the equipment properly and within legal guidelines required
extensive training, with staff receiving regular updates every three months.

"Training was absolutely crucial. We needed to equip them with the
right tools so they didn’t get hurt while restraining people or going about
their duties," explains Green.

Staff also have to be taught their legal limitations and protocol
surrounding violent incidents. Green explains that because of the nature of the
job, staff have to perform an almost quasi-policing role. Naturally staff must
be aware of the law.

"We have to study the legal aspects around when staff have the
authority to use force, reports and procedural rules. We also try to instil
restraint and the need for a cool head because it’s crucial security staff
don’t over-react to an incident" he adds.

Courses are provided by a specialist training firm made up of ex-police
officers (which cannot be named). Training culminates in practical and written
exams to check competency. This is backed with continuous on-the-job training
and ongoing checks to ensure constant development. It also teaches staff the
correct way to reporting incidents, collect evidence, and submit written

Training also has to stand up to scrutiny if anything does go wrong, so
Green logs every level of development. "If we ever have to appear in court
I can bring out all the training records to show what we do and how we do

Green says the training scheme has proved so fundamental to the running of
the hospital that the security department in now going through ISO
accreditation. "I would recommend the training to others and in fact I’m
hoping to establish this trust as a centre of excellence for security."

The security team had expected some adverse reaction from other hospital
staff and patients but concerns that the appearance of uniformed guards would
create a daunting atmosphere on the wards have proved to be unfounded.

In fact, the trust’s HR director Anne Couts has received positive feedback
from staff who say they feel safer and have less concerns about security.
"Patients and staff at the hospitals see that security has visibly
improved. Security in the NHS has traditionally been low key but I’m sure other
trusts will follow us," she says.

Proper restraint

Training is similar to police techniques, involving classroom
theory and practical learning where staff practice on crash mats.

"The main thing we focus on is the use of Home
Office-approved restraining techniques. Specifically, we teach methods such as
arm locks and holding grips," says Green.

At the outset the team went back to basics and initial training
was completed within two weeks. This was supplemented with regular updates,
building up level by level.

"You have to get the basics right to be able to progress,
but all the training was done in full kit for realism.

"All body armour is tailor-made for the individual so it
is important to get it right," says Green.

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