Managing Health at Work Partnership Information Network (PIN) Guideline

MANAGING HEALTH AT WORK

APPENDIX 6.A
Model policy on violence and aggression at work

1 Policy statement

[Name of organisation] takes extremely seriously the health, safety and welfare of all its staff. It recognises that violence towards staff is unacceptable and that staff have the right to be able to perform their duties without fear of abuse or violent acts. No staff member should consider violence or abuse to be an acceptable part of their employment. The purpose of this policy is to enable [Name of organisation] to meet its obligation to protect staff as far as is reasonably practicable.

2 Scope

This policy applies to all staff, including temporary and agency staff, contractors, volunteers, students and those on work experience. It forms an integrate part of [Name of organisation]'s Health and Safety policy and applies along with specific local guidance for managing violence and aggression in the workplace. The policy applies to all situations in which violence at work may occur arising in connection with the duties and activities of our staff.

3 Definition of violence and aggression

[Name of organisation] defines an incident of violence and aggression as:

'any incident in which a member of staff or person working in [Name of organisation] is verbally abused, threatened or physically assaulted by a patient or member of the public in circumstances relating to his or her employment'.

4 Policy aims

This policy aims to:

• increase staff awareness of issues relating to violence and aggression;

• make sure that the risk of violence and aggression is assessed in a systematic and ongoing way, and that safe systems and methods of work are put in place to reduce the risks as far as is reasonably practicable;

• make sure that appropriate training is available to staff in all areas, that equips them to recognise risk and provides practical advice on preventing and managing violence and aggression;

• make sure that appropriate support is available to staff involved in violent incidents;

• encourage full reporting and recording of all incidents of violence and aggression; and

• reduce the number of incidents and injuries to staff resulting from violence and aggression.

5 Responsibilities

5.1 The Chief Executive is responsible for:

• making sure that there are arrangements for identifying, evaluating and managing risk associated with violence and aggression at work;

• providing resources for putting the policy into practice; and

• making sure that there are arrangements for monitoring incidents of violence and aggression and that the Board regularly reviews the effectiveness of the policy.

5.2 Senior and line managers are responsible for:

• making sure that all staff are aware of the policy;

• making sure that risk assessments are carried out and reviewed regularly;

• putting procedures and safe systems of work into practice which are designed to eliminate or reduce the likelihood of violence and aggression;

• making sure that staff groups and individuals identified as being at risk are given appropriate information, instruction and training (including training at induction, updates and refresher training when necessary);

• making sure that appropriate support is given to staff involved in any incident of violence and aggression; and

• monitoring the effectiveness of preventative measures through an effective system of reporting, investigating and recording incidents.

5.3 All staff are responsible for:

• taking reasonable care of themselves and other people who may be affected by their actions;

• co-operating by following rules and procedures designed for safe working;

• reporting all incidents involving verbal abuse, threats and physical assault;

• taking part in training designed to meet the requirements of the policy; and

• reporting any dangers they identify or any concerns they may have about potentially violent situations or the environment in which they work.

6 Assessing risk

6.1 Risk in all work areas where violence and aggression pose an actual or potential risk to staff must be assessed. The assessment will involve identifying situations where acts of violence and aggression could occur. It should identify who will be affected and how, and what control measures are needed to eliminate or reduce the risk to the lowest level reasonably practicable. A competent person must carry out the risk assessment and it should be recorded and shared with relevant others. The following details should be recorded:

• the extent and nature of the risks;

• the factors that contribute to the risk - including job content and work environment; and

• the safe systems of work to be followed to eliminate or reduce the risks.

6.2 These details should be communicated to staff, and risk assessments reviewed and updated annually, or sooner if circumstances change.

7 Managing incidents

7.1 Departmental procedures must be in place which provide guidance for staff on managing violent or aggressive incidents. This should include details of emergency procedures. All staff must be familiar with these local procedures. In particular, staff must be aware of local procedures for raising the alarm and getting help if an incident occurs.

7.2 Practical guidance for staff in relation to preventing and managing violence and aggression is contained in our booklet Personal Safety: Guidance For Managing Violence At Work.

8 Staff training

8.1 We will provide training to give staff the skills needed to help prevent and manage violence and aggression. Different levels of training will be available and we will provide training which is based on the needs identified through local risk assessment. We will provide specialist training, such as training in control and restraint techniques, for staff working in identified high-risk areas. Staff working in these areas will have to attend the training as part of their job.

8.2 We have an obligation to provide training, and managers are responsible for making sure that staff receive appropriate training and have access to regular refresher training. All training will be provided by accredited instructors, and details are available from our Training and Development Department.

9 Staff support

We will make sure that all staff who are victims of violence or assault will have access to appropriate support. Managers are responsible for making sure that debriefing is carried out as soon as possible after the incident with all the staff involved. Staff may need time off to get medical attention, legal advice, or counselling support. An independent and confidential counselling service is also available through OHS. Managers can refer staff for counselling support or they can refer themselves.

10 Reporting and recording

Staff should report all incidents of violence and aggression (including near misses) to their line manager at the earliest opportunity. Managers should record this on an incident form and investigate the matter. In line with RIDDOR the manager must write to the Health and Safety Executive within ten days of an incident if any staff member is absent from work for more than three days in a row as a result of an act of violence and aggression. To monitor the effectiveness of this policy and associated local protocols, local statistics and incident reports should be reviewed regularly.

11 Involving the police and prosecution

11.1 [Name of organisation] is actively committed to protecting staff from violence and assault and will support criminal proceedings against those who carry out assault. All staff are encouraged to report violent incidents to the police and will be supported by the organisation throughout the process.

11.2 The Procurator Fiscal may decide to take legal action and line managers must make sure that staff have access to ongoing support throughout this process. Other support may also be available to staff through Trade Unions/Professional Organisations.

12 Withholding treatment

12.1 Where a patient's aggressive or violent behaviour impairs a staff member's ability to undertake his/her duties properly, or has become a threat to the safety of a staff member, another patient, or hospital property, [Name of organisation] reserves the right to withhold treatment from the patient.

12.2 If a patient, or someone accompanying a patient, is violent or aggressive, s/he will be told what is considered unacceptable behaviour and its possible consequences. If the behaviour continues, the patient or person accompanying a patient will receive a written warning with details of the policy on withholding treatment, signed by a site manager/Clinical Director or senior nurse, and copied to the patient's GP. The patient's consultant (or senior member of the medical team) will advise the Chief Executive on a decision to withhold treatment on the basis of a clinical assessment. As a last resort, the treatment will be withheld, and the patient will receive a written explanation from the Chief Executive giving the reasons for exclusion, and copied to the patient's GP. Exceptionally, treatment may be withheld immediately. The decision will be recorded in the patient's medical and nursing notes and the patient informed of this. Other local NHS service providers and agencies will be informed of the decision.

12.3 Each case will be considered individually and all staff will be given information specifying the action they should take in response to varying levels of incidents. Allowances will be made for patients who are under 16, mentally ill, who require emergency treatment, or who cannot be held responsible for their actions. The withholding of treatment is limited to a maximum period of 12 months. A patient may appeal against a decision to withhold treatment via the local patient complaints procedure.

13 Compensation

13.1 The Criminal Injuries Compensation Scheme provides a system of compensation for any victim of violent crime. Under this scheme staff can make a claim for personal injury resulting from an assault. Guidance on eligibility and advice on making a claim is available from Human Resources.

13.2 If a staff member loses earnings as a result of an incident they can make a claim to the NHS Injury Benefits Scheme. Information and advice on this scheme is available from Human Resources.

13.3 If a staff member suffers loss or damage to personal property as a result of an assault, they can make a claim for compensation through Human Resources.

14 Monitoring and reviewing

We will monitor and review this policy in partnership to make sure that we are achieving the aims of the policy. We will do this with Trade Unions/Professional Organisations and safety representatives. The review processes will include:

• collecting and monitoring all reported incidents by our Health and Safety Advisor;

• every three months reporting to local Health and Safety committees and the Local Partnership Forum on incident statistics and safety improvement measures which have been introduced;

• every year, reporting to our Health and Safety committee and Risk Management Group on how we are following the policy, the outcomes of risk assessment, and details of training provided;

• every year, reporting to the Board to highlight progress in reducing risk and incidents and making recommendations for the forthcoming year.

APPENDIX 6.B
Risk factors for workplace violence - a sample checklist

1 Workplace

Outside	Yes	No
Is there uncontrolled access to the site?
Is there uncontrolled access to buildings and work areas?
Are bus stops and car parks close to buildings?
Are there appropriate footpaths?
Are areas well lit with good all-round visibility?
Are there areas where people can hide or move unnoticed (for example, trees, shrubbery, waste and storage areas)?
Are signs clear, visible and appropriate?
Is there a security patrol?

Inside	Yes	No
Are there physical barriers to restricted areas?
Are these areas suitably signed?
Can staff make unobstructed 'swift' exits if necessary?
Are existing security installations working and maintained?
Are signs clear, visible and appropriate?
Is the lighting sufficient or are there dark or shaded areas?

Interactive areas - for example, waiting areas	Yes	No
Is there enough space to prevent overcrowding?
Are there private rooms available to deal with sensitive issues?
Are waiting areas separated from other activities?
Do staff have a good view across the area?
Is the layout confrontational?
Is there physical separation for staff - is this confrontational or intimidating?
Is seating comfortable and is there enough?
Is the area noisy (for example, trolleys, banging doors)?
Are there systems to keep patients informed (for example, of delays)?
Are there ways to reduce anxiety or boredom?

Lighting, decoration and furnishings	Yes	No
Is the lighting harsh or glaring?
Are there any potential weapons or missiles (for example, unsecured chairs, pictures, pot plants, crockery)?

2 Work place procedures and organisation

Outside	Yes	No
Are there enough competent staff to deal with any possible violence?
Are there special arrangements for higher-risk staff (for example, young workers, pregnant workers, staff with any disability, new or inexperienced staff)?
Are there procedures for bank staff?
Are there any lone workers?
Are there other precautions in place for lone workers?
Is appropriate information available to staff on potentially violent or aggressive patients or family?
Are emergency arrangements in place?
Do staff have to travel alone?
Do staff have a mobile workplace?
Do staff work in a community-based setting?
Do shift patterns involve working alone or in small numbers?
Do shift patterns involve working late at night or during the early hours of the morning?
Do staff work in a high-crime area?
Do staff handle valuable property or possessions?
Do staff handle materials, including drugs, which are often targets for theft?
Do staff handle complaints?

Communication	Yes	No
Can staff attract the attention of other staff if necessary?
Can staff get immediate support?
Can staff call for help if alone or working off site?
Are systems in place to pass on information on incidents and patients to other affected staff, departments and agencies?

Staff training	Yes	No
Are staff trained and competent to deal with potential violent and aggressive situations?
Are staff facing unusual stress in their personal lives?
Are staff aware of incident forms and how to fill them in?
Are staff so busy that it may be difficult to display a caring attitude?
Do staff have the opportunity to discuss concerns about violence and aggression?

3 Patients, family and friends

Patients, family and friends	Yes	No
Is there the possibility of alcohol or drug abuse?
Are there rowdy or over-anxious groups of people accompanying patients?
Is there the possibility of psychiatric disorders or confused states or behavioural problems?
Is there the possibility of situations which patients or relatives see as threatening?
Are people likely to be unstable or volatile?
Are people likely to be highly stressed or angry?
Are long waiting times involved (for example, in receiving units or clinics)?

APPENDIX 6.C

References

CRAG Working Group On Mental Illness	The Prevention and Management of Aggression:A Good Practice Statement, HMSO, Edinburgh, 1996
HSC, Health Services Advisory Committee	Violence And Aggression To Staff In HealthServices. Guidance On Assessment And Management, HSE Books, London, 1997, ISBN 0717614662
Industrial Relations Services	Stamping Out Violence In The NHS: A Survey OfPolicy Provision, Health Service Report, Vol. 19, Summer, 1998
The NHS Executive	Manager's Guide To Stopping Violence Against Staff Working In The NHS, from 'NHS Zero Tolerance Zone', NHS Executive, London, 1998
The Royal College of Nursing	Dealing With Violence Against Nursing Staff, RCN, London, 1998
The Scottish Executive	Towards A Safer Healthier Workplace, HMSO, Edinburgh, 1999