In our August 2015 print issue we featured the annual Imbert Prize, awarded by the Association of Security Consultants (ASC) for the best security management study dissertation, and some of the finalists. Here we bring you the work of the winner, Peter Finch, on violence in the NHS.
Workplace violence is an industry-wide healthcare problem, is not exclusive to any one healthcare organisation and is a major problem in all healthcare settings in all countries. In the UK, despite the fact that there is a greater risk of violence and verbal abuse being directed to NHS staff than many other professions, there remains a gap in the research that links the role of the Local Security Management Specialist (LSMS) with a reduction of violence against staff. This research evaluates the efficiency and effectiveness of the LSMS in reducing violence in the NHS since their introduction by the NHS Security Management Service (SMS) in 2004. Views of LSMS were sought through an online survey and interviews.
Some reasons in brief
In brief, some reasons why hospitals’ local security managers aren’t as efficient and effective as they could be in reducing violence against staff:
– a national evaluation hasn’t happened on conflict resolution training, begun in 2004 for hundreds of thousands of front line staff, remains ‘fit for purpose’, and only some evaluation has happened at a local level;
– many staff are inclined to accept violence as part of the job and it’s widely under-reported;
– the memorandum of understanding MoU between the police, Crown Prosecution Service and NHS signed in 2011 to reduce violence and antisocial behaviour in the NHS isn’t well known to police at an operational level;
– there is a disconnect between LSMS and NHS Protect;
– and managers are under pressure, with limited resource, time and capacity to do something to reduce violence in the NHS.
Assaults
Assaults against staff have increased marginally from 60,295 incidents in 2004-5 when statistics were first reported to SMS, gradually reducing to 54,758 reported assaults in 2008-9 which then rose to 61,571 assaults reported in 2012-13; against a backdrop of significantly higher numbers of patients being treated. The challenging behaviour of some patients is such that assaults attributed to the medical condition, severe learning disability, mental ill health, or treatment administered to an assailant equated to 48,469 assaults or 78.72pc of the total assaults reported in 2012-13. The challenging behaviour of some patients is such that violence against staff can never be totally eradicated and while progress is slowly being made, more must be done to manage this particular patient group. The marginal increase in assaults against staff may be as a result of more assaults actually taking place or better reporting of incidents by staff or as a result of the higher throughput of patients – the situation is not clear. Despite the gradual increase in assaults three quarters of staff felt the workplace provided safe and secure working against physical assault in 2009 – showing considerable progress in developing a pro-security culture since 2004.
The stats
Two per cent of NHS staff who had been subjected to violent assaults left the NHS as a result. The statistics show that only 11pc of those that could potentially have been prosecuted for violence against NHS staff in 2012-13 received a sanction, and in a third of trusts successful prosecutions are not publicised, which is unlikely to deter others from assaulting NHS staff. Conflict resolution training (CRT), introduced in 2004 for front line staff with direct access to patients and the public, was recognised, although almost 20pc of staff had not undertaken the training in 2010. My research found that since 2007 more than 60pc of trusts have reduced the required face-to-face training time from 5.5 hours – in some cases to 3.5 hours – because of difficulty in releasing staff for training due to workload, other mandatory training commitments or staffing shortages. It is also notable that the gradual reduction in training time commencing in 2007-8 coincided with the gradual increase in assaults against staff between 2007-8 to 2012-13. Strategies to combat workplace violence should include the effective monitoring and reporting of violent or aggressive incidents, undertaking risk assessments and amending patient care plans. Although most trusts undertake a higher level of corporate risk assessment in relation to violence against staff at least annually, in nearly half of trusts ward and departmental risk assessments for violence and aggression against staff and risk assessments for violent or aggressive patients are only sometimes, or are never, documented.
Lack of understanding
Powers to remove persons causing a nuisance and disturbance on hospital premises under the Criminal Justice and Immigration Act 2008 (CJIA) were not widely known by the police or widely used within the NHS with security managers believing this to be a function of the police. There was a lukewarm response from the subject interviewees concerning CJIA. Lack of understanding between NHS Protect and LSMS is such that almost half of LSMS believe that NHS Protect does not understand the realities of the breadth of work by a LSMS at a local level or listens to their concerns about security management work, or acts on them wherever they can. This suggests that there may be a serious dis-connect between the LSMSs, and NHS Protect as the security management policy lead for the NHS.
About the job
Just over half of NHS security managers do not believe that they are resourced to work effectively. More than three-quarters of LSMS are responsible for one or more other roles; almost a third hold more than two other roles, as diverse as car parking, portering, fire, health and safety, general management and nursing. The level of influence that a security manager has within their organisation is seen to depend upon their pay band rather than their communication skills. One interviewee said: “I don’t think you have the same influence when you’re not on the same pay band and on the same level in your role because they [more senior managers] are in charge of their services.” Another said that concerns that have to go through several managers before they reach the board are ‘deleted, diluted or dismissed’. The salary ranges from £21,478 to £47,088 are unexplained in the research and therefore quite surprising, particularly as all LSMS have to ensure the same standards of security are met. However, it may also reflect the need for many ‘specialists’ to undertake extra demanding roles such as health and safety, or car parking.
More hours
Almost two thirds of LSMS have previously been employed in law enforcement, the military, intelligence, emergency management or private security. Almost half of LSMS are working more than their contracted hours to meet deadlines or because they wouldn’t be able to do their job if they didn’t. One said: “We are not just talking about security management. We are talking about senior staff within the NHS. We could argue that it is under-resourced across the NHS, but the fact is that I still have a mortgage to pay.” Almost a fifth of LSMS have been affected by work related stress in the last five years for which they have required time off work. This may be a reflection on a number of factors that can affect stress at work; however, the considerable overtime worked and unmanageable workloads identified by almost a third of LSMS should not be overlooked. Despite the difficulties and barriers experienced by LSMS, clear through the survey and interviews, almost all LSMS would either definitely or probably recommend their job as an NHS career.
Picture by Mark Rowe: Southend General Hospital car park, 2009.
About the writer
While Peter Finch since last year has been Security Manager at the Coventry Building Society, for several years before he was a hospital security specialist, after serving as a Royal Air Force officer of the Provost (Police and Security) Branch; hence this dissertation (supervised by Phil Wood) as part of a Bucks New University masters degree course.
Who’s who in the NHS
Here are the two groups involved with security management in the National Health Service:
– NHS Protect, previously the Counter-Fraud and Security Management Service; launched in 2003 as a central body with a training centre in Coventry. Visit www.nhsbsa.nhs.uk/Protect;
– LSMS – Local Security Management Specialist, the manager in charge of security at a trust such as a hospital.
