Deputy Head, NHS Security Management Service, London, UK
The pressured, busy environment of a hospital is unlikely to top a list of workplaces with an obvious need for lone worker security measures. Yet the NHS Lone Worker Service, one of a number of pro-security initiatives implemented by the NHS Security Management Service (NHS SMS), has won the Safer Workplace category of the National Personal Safety Awards 2010, demonstrating that even staff based in large, busy workplaces may – whether regularly or occasionally – find themselves in vulnerable situations working alone. The awards celebrate the work being done across the UK to keep people safe from violence and aggression and recognise best practice in the field across all sectors, and are made by the Suzy Lamplugh Trust, the UK’s national charity for personal safety.
The Safer Workplace award is given to the employer that has done the most to improve personal safety awareness among staff. So the winning of this award provides strong evidence, it would seem, not only of the significance of personal safety provision for hospital personnel, but also of a growing acceptance of this fact outside as well as within the health service.
The NHS Lone Worker Service, centrally negotiated and managed by the NHS SMS, has only been in existence since summer 2009, but it already gives nearly 30,000 NHS lone workers a means of discretely raising an alert if they feel at risk. These alerts are monitored by operators who can summon help from the emergency services as required. Crucially, the alerts are also recorded and the audio can be retained, if appropriate, for use as evidence of verbal and physical abuse in criminal proceedings.
Increase in abusive behaviour
Abusive behaviour towards NHS staff generally – let alone those made more vulnerable by working alone – is not as rare as might be expected. Earlier this year, a patient who was verbally abusive to staff while attending A&E departments across England with faked illnesses – costing the NHS tens of thousands of pounds in wasted care – was given a three-year criminal antisocial behaviour order and the possibility of a five-year prison sentence if he breaches it.
Aside from the resources drained by this one patient were the effects of his abusive behaviour on the staff present. These consequences are, of course, less easy to quantify than the financial losses incurred, but they are equally damaging to the health service in general terms as well as to the individuals directly affected.
Security in the health service affects all of us – whether we work in the NHS, receive treatment from it or simply take for granted that its resources are there if we need them. Not only do verbal assaults such as these reduce morale and cause staff absences – thereby further adding to their financial impact – but they can also lead to more serious physical assaults.
In 2009–10, there were 56,718 reported physical assaults against NHS staff in England and addressing this is a priority area of action for the NHS SMS. A division of the NHS Business Services Authority, the NHS SMS was set up in 2003 to handle policy and operational guidance relating to the management of security within the NHS in England.
There are, of course, many security issues in such a vast organisation, and protecting staff from assaults and abuse is a particular area of concern. All those who work so hard to deliver patient care have the right to do so without fear of violence or other abuse. The NHS SMS is clear that such behaviour must not be tolerated and has implemented various measures to ensure that all NHS bodies tackle it effectively.
Many of these measures are applicable across the NHS generally. For example, in April 2004, the NHS SMS developed a national syllabus for conflict resolution training aimed at all front-line NHS staff. In terms of tackling violence against staff, this is a key preventative measure.
The aim of the training is to equip members of staff to respond appropriately where their work may expose them to situations that could become volatile and confrontational and potentially result in abuse or violence. The syllabus was developed in association with the British Medical Association, the Royal College of Nursing and UNISON, the public services union. Figures show that more than 428,000 staff have been trained so far.
More recently, the organisation welcomed the revisions made to the sixth edition of the Code for Crown Prosecutors, which underscores the public interest in prosecuting all those who attack health workers. After input from the NHS SMS, the code’s definition of staff who serve the public was broadened to include ‘members of the emergency services’ and ‘health or social welfare professionals’. This bolsters the efforts of the NHS SMS’s in-house Legal Protection Unit, which works with the police and Crown Prosecution Service to increase the prosecution rate of those who assault NHS staff.
Risks of working alone
While it is not known how many of the reported physical assaults on NHS staff were attacks on lone workers, it is widely recognised that these staff face significantly increased risks. Without the immediate support of colleagues if an incident does occur, they may also be unable to escape easily from a threatening situation – if they are conducting a home visit, for example. Specific provisions to address these risks are needed, therefore, in addition to more widely applicable security measures.
The NHS SMS defines lone working as any situation in which someone works without a colleague nearby, or when someone is working out of sight or earshot of another colleague. This could be outside of a hospital or similar environment or internally, where staff care for patients or service users on their own. Other common examples of lone workers in the NHS are community or outreach workers.
Lone working may be a constituent part of a person’s usual job or could occur infrequently, as and when circumstances dictate. Lone working is not unique to any particular staff group, working environment or time of day, so a security measure developed in response this need had to have wide application.
In 2007, funding was announced for a project to procure just such a lone worker solution for the NHS. The requirement was for a device that could be activated discretely in a potentially violent or intimidating situation and which could summon help – from a nominated escalation point or from the emergency services if necessary. The device also needed to have the potential to provide evidence for any subsequent prosecutions.
Its procurement was conducted by the NHS SMS and the commercial unit of the NHS Business Services Authority on behalf of the Department of Health, which introduced a framework agreement for NHS Lone Worker Services. The preferred supplier, Reliance Secure Task Management, and the NHS SMS’s lone worker team have delivered over 30,000 subscriptions under this agreement.
The partnership approach brought considerable benefits for the NHS:
- Central funding to subsidise the cost to trusts for the first 30,000 devices helped launch this service locally
- Central procurement reduced the overall cost
- Partnership working and central management of the supplier and contracts reduced the administrative burden on trusts.
More than 200 trusts have signed contracts under this framework and the lone worker service is working well across England – not only enhancing the safety of lone workers specifically, but also contributing to safeguarding people and property across the service. Each lone worker who subscribes to the service receives a device, the network coverage most appropriate to their working environment, training, a help-desk facility and the services of an alarm-receiving centre with experienced operators who monitor the alarms raised by the devices.
The lone worker device is not intended to be used only as an alarm in threatening situations; it should also be used as part of normal preparations for lone working. By recording an ‘amber alert’ – a short message about their location and how long they expect to be there – a lone worker can maximise the efficiency of an emergency response should one be needed. Their message will be retained by the alarm-receiving centre and listened to if the individual subsequently raises a ‘red alert’ because they feel at risk. A red alert creates an open voice call to an operator who will monitor the audio from the device, assess the situation and notify the relevant NHS body’s escalation points and/or the emergency services as required.
An aid to prosecution
Recordings are stored securely and are then used as required for the purposes of criminal, civil or local sanctions against alleged offenders. Within the NHS trust, only the Local Security Management Specialist (LSMS) – trained in areas such as evidence-gathering, witness interviewing and preparation of case files, and responsible for investigating security incidents along with the police – can access the audio recordings and must do so in line with agreed standard procedures.
The first NHS lone worker devices went live in summer 2009. In the last 12 months, there have been over 200 genuine red alerts, and more than 20 of these have initiated a response from the emergency services. One case is pending prosecution and the audio recording has been used as evidence.
All the genuine red alerts are monitored by the NHS SMS and details of follow-up action is recorded centrally to ensure that each one is dealt with appropriately, according to agreed procedures. For example, the police are contacted in scenarios such as the following:
- If the operator can determine that an assault is taking place
- If the operator believes that an assault is likely to happen
- If the user sounds distressed
- If the user requests police attendance.
A survey undertaken by Reliance Secure Task Management in conjunction with the NHS SMS to gauge usage and satisfaction levels and identify areas for improvement has also provided examples of how the device is being used and the impact it has on staff’s feelings of safety at work. The data, which is statistically reliable due to the high survey response rate, revealed that 45% of respondents use their lone worker device once a week or less, and 28% use it more than five times a week.
High user satisfaction
Overall, the survey provides some excellent feedback, particularly on the levels of satisfaction with all aspects of the Reliance help-desk facility and the response to red alerts. Only eight per cent of respondents have needed to use the red alert function. Of these, 84% are ‘very satisfied’ with the response they received. Sixty-four per cent are either ‘very satisfied’ (24%) or ‘quite satisfied’ (40%) with the NHS Lone Worker Service overall.
The information supporting the initial roll-out and implementation of the service was also felt to be useful: 97% of respondents said they received sufficient information to make them fully aware of the lone worker device and service, and 32% were aware of how to obtain refresher training if required.
The next task for the NHS SMS in terms of communication is to relay as widely as possible the benefits of using the device more frequently. Many of these benefits were referred to in the free-text comments section of the survey, and included:
- Feeling safer and more confident
- The device’s ease of use
- The reassurance of someone being able to listen in to an incident and take prompt action
- The fact that the device provides evidence that can be used in court and can log an individual’s whereabouts
- The constant cover and fast response provided in response to alerts.
As part of the Lone Worker Service, monthly meetings are held, involving staff from NHS trusts, Reliance Secure Task Management account managers and representatives from the NHS SMS, to discuss usage, satisfaction and ways to improve the service. Monthly usage reports allow trusts to monitor users and ensure that the devices are being used in accordance with the training provided and in line with risk assessments.
These meetings are valuable in ensuring that all contractual requirements are adhered to and that service users have regular opportunities to review how the service is functioning locally. The NHS SMS is keen to make sure that all trusts and their lone working staff are entirely comfortable with their use of the device to ensure that they receive the best possible service from it. This means, in practice, that NHS staff who find themselves in a challenging or dangerous situation have the confidence to activate the device to summon help whenever required.