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Harassment and assault are commonplace for over a third of nurses in the NHS. Demetrios Matheou reports on how UNISON is calling for tough penalties for anyone found guilty of assaulting staff
The health frontline
According to the British Crime Survey, around one in three nurses have
experienced some form of harassment or assault by their patients in the
course of their careers.
The same survey suggests that nurses are second only to security personnel
in the likelihood of their being assaulted at work.
Between 2001-2002 violence and aggression directed at NHS staff in general
accounted for a massive 40% of all health and safety issues reported to
the National Audit Office.
And UNISON’s own annual membership survey in the health sector showed
a rise in the number of staff reporting incidents of violence from 34%
in 2000 to 41% in 2001.
These disturbing facts provide the background to a concerted new effort
to stamp out the abuse of NHS staff, which has been highlighted by a new
report by the audit office.
UNISON, which represents over 460,000 health workers, is chief amongst
those calling for appropriate action to protect health workers –
not least tougher penalties for those found guilty of attacking them.
'A safer place to work: protecting NHS hospital and ambulance staff from
violence and aggression' examines the extent and impact of violence and
aggression within the NHS, and evaluates the effectiveness of the actions
taken by the Department of Health and the NHS trusts to combat these problems.
The report identifies nurses and other NHS staff who have direct interaction
with the public – for example, ambulance and accident and emergency
staff, and staff who work in acute mental health units – as having
a higher risk of exposure to violence and aggression.
In particular, the average number of incidents for NHS mental health and
learning disability trusts is almost two and a half times the average
for all trusts – despite evidence that staff working in mental health
units are much less likely to report verbal abuse.
The audit office suggests that attempts to combat these problems over
the past three years have largely failed.
In October 1999 two initiatives were launched in October 1999 to address
the growing concerns.
- The 'NHS zero tolerance zone' campaign was aimed at increasing staff awareness of the need to report violent incidents, while informing the public that violence against NHS staff would be stamped out.
- 'Working Together, securing a quality workforce for the NHS', required NHS trusts and health authorities to have systems in place for recording incidents, and set targets for reducing violence and aggression by 20% by 2001 and 30% by 2003.
However, two national surveys subsequent to those initiatives identified
the scale of the problem. A 2000-2001 survey identified 84,214 reported
incidents of violence or aggression, an increase of 30% over 1998-1999
The survey for 2001-2002 revealed 95,501, a further 13% increase. Only
a fifth of NHS trusts met the Working Together target for 2002.
Reasons given for the increase include increased hospital activity, higher
patient expectations and frustrations due to increased waiting times;
as well as improvements in reporting of incidents.
A number of research projects have demonstrated clear links between violence
and aggression, and staff sickness absence, turnover and loss productivity.
The audit office reports that whilst all NHS trusts “have embraced
the values set out in the campaign”, they have been inconsistent
in turning words into action.
- Many trusts fail to provide staff with the training needed to deal
with violence and aggression
- Many trusts fail to offer counseling to those members of staff who
have been attacked
- Many trusts fail to pursue criminal prosecutions or to support staff wishing to pursue civil actions
- Security measures vary across trusts
It is also suggests that often members of staff do not report violent
incidents against them, because they fear that this may be viewed as a
reflection of their own inability to manage difficult situations. Staff
also believe that no action will be taken or that the NHS trust is unlikely
to give them adequate support.
In the light of the audit office report, health minister John Hutton has
stepped up the zero tolerance campaign, urging trusts to take tougher
action.
"The safety of staff working in the NHS is paramount,” he said.
“We are already working with the NHS and stakeholders to ensure that
violence against staff is stamped out. We need to correct the historic
under-reporting by NHS staff of incidents of violent behaviour.”
Hutton has announced a nationwide poster campaign to raise awareness amongst
general practice staff and to spell out to patients in family doctor surgeries
that violent behaviour will not be tolerated. The posters carry a clear
warning that violent and abusive patients will be reported to the police,
may be subsequently prosecuted and may be struck off a GP's list.
Also, from 1 April the new Counter Fraud and Security Management Service
(CFSMS) Special Health Authority (SHA) will take over lead responsibility
for tackling violence against NHS staff.
From 2004, as part of their accreditation process, security specialists
in health bodies will receive training in law enforcement techniques,
such as interviewing and taking statements from witnesses.
Karen Jennings, UNISON's head of health, said: "The NAO report shows
encouraging signs that the Zero Tolerance campaign is working. It is raising
awareness among staff, managers and the public that it is simply not acceptable
for NHS staff to work in fear. But clearly there is still a lot of work
to be done to further reduce the risk of violence to staff.”
UNISON wants to see an improvement in risk assessments, training, and
in the partnerships between the trusts and other public agencies such
as the police force. The union is also calling for tough penalties for
anyone found guilty of assaulting staff.
Contact the article's author Demetrios Matheou
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