The Health and Safety Executive is in the process of inspecting NHS organisations to ensure they are meeting statutory requirements regarding protecting staff and others.
Violence and aggression
HSE inspections are being focused on areas of high risk where violence and aggression are seen as significant issues.
The best path to a successful inspection is to be on top of your obligations at all times, not just when an inspection is due.
- create a strategy
- continually assess the risks
- remain vigilant and proactive
1 – Delegate
Nominate someone at director level who has overall responsibility for managing violence and aggression in the trust. They will require an experienced deputy (violence and aggression manager) to provide the hands-on support, skills, knowledge and experience of managing violence and aggression.
If you need external support, IKON has significant experience of providing risk-assessed training needs analysis. We already carry out this role with a significant number of NHS clients. Prior to engagement, one of our senior team will discuss your specific requirements and provide advice and recommendations.Following engagement, we offer feedback and ongoing support to all our clients. The process will also need the support of an internal committee to oversee the process and to build support across the organisation on an ongoing basis.
2 – Plan
Plan your violence and aggression policy and share the plans with staff. This will help staff know how you plan to manage it and reassure them about your commitment.
Your violence and violence and aggression policy should clearly state who is responsible for what, when and how.
The policy should be as simple as possible so that everyone can understand and comply with it. You may need to enhance the basic policy with a security, lone worker and restraint/rapid tranquilisation policy depending on your trust’s services and local requirements.
You should ensure staff have access to these policies and where necessary training or information on the relevant procedures to enable a fast, confident response to any situation.
IKON has significant experience around violence and aggression policies and procedures. We analyse our client’s policies and procedures and ensure they are incorporated into our training programmes to bring relevance for the delegates. Over the years we have consulted, advised and even written policies for our clients.
3 – Assess
Risk assessments should be carried out according to staff role and locations. Departments should have a nominated person to carry out risk assessments, which should be collated and coordinated by the violence and aggression manager.
Risk assessments highlight what is being controlled adequately and what is not. It’s about identifying sensible measures to control the risks adequately.
The law does not expect you to remove all risks, but it does expect you to protect people by putting in place relevant measures to control those risks, providing they are reasonably practical.
In our experience, Trusts can have poor inspection outcomes because they have not carried out effective risk assessments or have not fulfilled their obligations regarding the identified control measures. A training need is recognised to reduce the risk but not carried out or maintained adequately.
IKON recommends a tailored program based on your risk assessments, incident reports, policies and procedures and staff feedback/experience. We can help and advise on your risk assessment and training needs analysis to ensure compliance and improved staff safety.
4 – Act
When you have established all the risks (if any) within the workplace, it is important to act on them accordingly and take the relevant steps to reduce the risks.
Inform your colleagues of any changes to the plan/policy and their requirements. If you have a response or security team, ensure people know how and when to access their help.
Provide training and information, you must provide clear instructions, information, and adequate training, so that everyone understands how they can work safely and keep safe. If there is a restraint policy, then relevant staff will need relevant training.
IKON can provide posters and documents to help bring these requirements to the attention of staff. We have also provided support at staff forums, violence and aggression committee meetings and delivered workshops to provide guidance to teams.
5 – Report and review
It is essential that all incidents are reported, no matter how trivial they may seem.
Reporting forms the basis of assessing the prevalence of violent episodes. When an incident is reported, strategies to modify behaviour can be developed.
Reporting the incident and recording the facts to the appropriate person e.g. supervisor or police is imperative to prevent this happening to others or yourself in the future.
The more you report incidents the easier it is to identify risks. Do not give up reporting even if it appears that no action is being taken. If fewer incidents are reported than occurred your employer may not take the situation seriously.
You should also report near misses and non-physical assaults. Often low-level aggression is a precursor to higher-level aggression. Near miss reporting can help to identify trends and triggers and enable changes to practice to avoid future escalation.
In effect if there are no reports there are no incidents.
Post-incident reviews are a critical process of the incident lifecycle. Your teams can’t improve without retrospective, blameless analysis of incident response and remediation. Teams can improve their ability to manage violence and aggression by recording incident details to enable post-incident reviews that improve the experience for people.
Analysis is only one part of the post-incident review process. But understanding the shortcomings of your policies and procedures, alongside an understanding of your team’s response leads to a more holistic process for continuous improvement.