The recent brunch briefing of the National Association for Healthcare Security (NAHS) ‘Dealing with Challenging Behaviour in Healthcare’ was the occasion for the presentation of the certificate of Chartered Security Professional (CSyP) status to the association chairman, Peter Finch the first to receive the certificate in the NHS. Back at his office in Birmingham he spoke to Mark Rowe about how and why he sought the chartered standard, and of healthcare security matters arising from the conference.
Why do it?
Why put yourself through the paperwork for CSyP, and the interview with two senior figures in UK security management? Peter Finch, sitting behind his desk in his first floor office at City Hospital Birmingham, spoke of how ‘to become a chartered security professional is to be at the height of your profession’. He described it as a matter of professional credibility – among other security people. And added credibility in his workplace, which since Professional Security last visited in 2011 has new customer care promises. ‘Where everyone matters’ said the coffee cup I was given – with coffee in, from one of the facilities staff. While I waited, two young nurses came into the building to have their photographs taken for their ID cards. I had arrived on site early, just off Birmingham city centre, and had walked through the main building. It was mid-morning. Staff of all sorts walked about their business – pushing beds or wheelchairs, men in white overalls with paint on. I walked a quarter of a mile along the main hospital spine as far as the front of the hospital, to a Costa Coffee bar with canteen-style plastic seats and tables, before A&E (accident and emergency). Like many city hospitals, it’s like a small town, with paper shop, places to eat, people of all ages and shapes and all manner of business. As in many other A&Es (and indeed towns), the scene on a weekday is quite unlike a Friday or Saturday night. Then, wounded drunks may come (and their friends may tag along) only to continue the dispute from the night-club that brought them to hospital. The August 2011 rioting saw looting in Birmingham as in other city centres. The three men who were hit by a car and killed in Winson Green were taken to the City Hospital A&E some 300m away. To sum up, the hospital – the same as other hospitals in other cities – is part of its city and cannot barricade itself as a rule. And the hospital needs security – indeed Peter Finch begins by speaking of the function of a hospital: to give healthcare. If nurses and doctors are hurt, or threatened, they cannot care of patients. Nor can healthcare workers do their jobs if their equipment is stolen or damaged.
A chartered professional
To return, then to the CSyP; like the Certified Protection Professional qualification from ASIS (Peter’s certificate, dating from 2009, is on his office wall) gives credibility among your security peers. Besides, in a hospital, as Peter adds, ‘I am working with healthcare professionals, who are qualified to the highest degree. A chartered security professional is on a par,’ with a chartered accountant, or a solicitor or engineer. That word ‘chartered’ is something the hospital consultant or other healthcare and management professionals can relate to even if they do not know the details of ‘chartered security professional’. “It shows that you are working at a strategic level, and that you have a wide range of skills and personal qualities.” I asked if there was an element of personal pride in your work. Peter answered in terms of being passionate about his work, ensuring the safety of the staff, protecting the Trust’s property and giving the security officers the right tools for the job, ‘whether equipment, training, processes, whatever. But you can only really do that, you can only demonstrate that you are doing the best for your guys, if you are prepared to show that you are prepared to lead from the top, and develop yourself.’ As an aside, to show that CSyP isn’t only for the academically-inclined who have gained a master’s degree in security management (or who have through the vocational courses offered by the Security Institute), Peter left school after O levels, joining the Royal Air Force Police as an airman, and was then commissioned as a RAF Provost Officer specialising in security. He’s been at City Hospital for 13 years, so as a security manager he sits at ‘the top tables’ of Trust committees. “Having this [CSyP] certification is another one of those sort of tools in the armoury to help persuade or influence people that what I am saying is the right thing, that they are talking to someone who has credibility among his peers.” He thanked Security Institute General Manager Di Thomas for encouraging him to apply for the CSyP, and spoke of how honoured he was that Lord Carlile, long-time institute patron, presented the certificate (pictured), on the 29th floor of Guy’s Hospital, offering spectacular views of London.
Challenging behaviour
The day’s subject was ‘challenging behaviour’. Host was Guy’s and St Thomas’ Head of Security Jayne B King; among attenders were Richard Hampton, the head of local support and development services at NHS Protect, the National Health’s central security and anti-fraud body; and his deputy, Nick Martin, who took over from Sue Frith, having been NHS Protect’s West Midlands area man; and NHS Protect’s policy lead for violence, Andrew Masterman. On the basis that anything NHS-wide has to be the largest in the country, simply because the NHS is the largest organization in Europe, the training for NHS clinical and non-security staff in conflict resolution was arguably the largest UK security training work of the 2000s, larger even than the bulge of training for the original SIA licence applications. Just as nurses and porters may find themselves the victim of assault, so a hospital’s security officers are the first responders to assaults or flash-points, particularly because police response times, armed or otherwise – or any response at all – are becoming longer. That’s not new; and it’s true for similar public or semi-public buildings large enough to have security staff – universities, business parks, shopping malls. But to return to Peter Finch: “We need to make sure that our security officers are equipped to do the job that in many cases the police have undertaken. The sort of things my guys are doing – obviously, includes physical intervention. Security officers should not be undertaking physical intervention unless they have also received, and are regularly refreshed on, basic life support skills. It’s absolutely critical.” As he adds, “if the restrained person goes into a heart attack, you have to know what to do – waiting four or five minutes for a medic to arrive is too long. Next year, Peter is looking at body-worn CCTV for his officers, pointing to reduced violence and aggression where body-worn cameras have been used. And, given slow police response – ‘four hours is the longest it’s taken for a triple-nine to get here’ – he’s looking at his officers having handcuffs, to better restrain some offenders and free up his officers. He gives a case of when, after shots were fired at the front of the hospital (it stands on the main Dudley Road) armed police response came 40 minutes later, and then only a drive-past. “That’s where we are at now. With our security officers as our first responders, they have got to be able to deal with some of these challenging issues, from the minute they occur.” That could be a fire; what then for bed-bound patients? Or what’s termed in the field of civil protection as a ‘mass casualty event’, when the hospital might plan to receive up to 500 people. If those injured are contaminated from a ‘dirty bomb’ – or are suspected of being – you want to avoid even more problems by those casualties ‘self-presenting’, walking into the hospital and maybe contaminating others, including the nurses who then may be knocked out, or fear that they are in danger. A hospital or part of it may have to go into ‘lock-down’; Security will have to know what parts of a hospital to lock-down, and how quickly. The risks change, whether to do with terror or the longer-term changes in the UK population, which is gradually ageing and presenting new challenges with large numbers of dementia sufferers. Quite apart from security officers maybe needing to learn a new technique, refresher training may be required by a regulator, the Care Quality Commission (CQC) or the NHS Litigation Authority. Refresher training, as Peter says, is not easy to manage but nevertheless essential. While assaults against NHS staff are most likely under-reported (as in some other workplaces) it might be news to non-healthcare specialists that the number of ‘clinical’ assaults has become greater than the non-clinical. In other words, people who pinch, punch, bite or scratch or lash out may be ‘clinical’ – because they may be confused through dementia, or have learning difficulties for example, and are clearly not well and don’t know that what they are doing is wrong. Whereas, ‘non-clinical’ are the otherwise able-bodied who lose their temper through drink, or get angry when waiting for treatment, or for treatment in A&E for a relative or friend. And we can expect more people to show signs of dementia. If someone with dementia pulls a nurse’s hair, they may not know they are doing it, or know that it is wrong. How then to reduce violence and aggression, and still give quality care to patients – because the NHS is there to care, not (if avoidable) slap cuffs on people and bring in the police and courts? “The ultimate aim from my perspective,” Peter says, “would be to absolutely minimise physical intervention by security officers, because in the vast majority of cases it shouldn’t be needed. But we have got a lot to do to achieve that in terms of changing culture and processes and educating our hospital staff more about communication and the needs of dementia sufferers.”
Dementia and security
Dementia is a security issue not only in hospitals, Peter adds: “It’s something the wider security industry and, in fact, business as a whole, needs to start to understand, because dementia sufferers are out there in the community; they only come to a hospital when they are physically ill and need treatment.” If someone in a shopping centre seems a little slow, or confused, they still need to be treated with respect. Peter hailed the presentation at the NAHS conference by Karen Clayton of FIND, a company selling signage and household goods made with dementia sufferers in mind. If colours, designs and signs are tailored to reassure and not confuse dementia sufferers, fewer slips and falls, and fewer cases of violence and aggression will follow, is the argument supported by evidence from Stirling University. The company offers doors (or rather door-sized stickers that you can place over the front of the door), letterboxes, toilet seats, in primary colours, typically red. If better signage to a toilet means that a dementia sufferer can reach the toilet in good time, that can mean less incontinence, greater dignity for the patient and maybe less cause for a confused person to hit out. As for design, security managers may be familiar with ‘designing out crime’, CPTED (crime prevention through environmental design) and, from the police, architectural liaison officers. But that’s largely for the outdoors – water features or prickly bushes to keep vehicle bombs or intruders at bay, or well-clipped hedges to give better fields of vision, to promote ‘natural surveillance’ and deny hiding places for intruders. But Peter is suggesting design to make dementia sufferers less anxious and frustrated, and hence give confused people less cause to become aggressive. Much of this applies to care homes, but could work in A&E and on wards: such as paler colours on the walls, and dimmer lights, to make people feel calmer and making the environment feel more like home. While brightly coloured plates, bowls and cups help dementia sufferers identify food and drink which aids hydration and nutrition.
First responders
Whatever the incident – a theft, assault, an alarm – Security is the first responder, the fourth (or fifth) emergency service; the glue, or part of it, that keeps the hospital together, so that the clinical people can do the job they are there for. Quite often Security are there, in the night, for example, when snow falls or ice is forming. Security staff on duty can call out the snow and ice teams, to salt paths. Meanwhile Security can shovel snow from the most pressing parts of the estate, such as the front of A&E until the snow and ice team arrive . If someone’s coming to A&E with a broken arm, having slipped, it’s no good if that person slips again and breaks something else at the hospital entrance. (That could give the anxious well-wishers accompanying the person cause to get angry, on a day when the hospital is presumably already stretched.) Security can do simple things, while walking around, such as checking salt buckets are filled; checking doors are shut, to keep heat in (saving money); turning car park lighting off at night, if all the cars have gone. Little things that are however measurable and show that Security is part of a wider team, and seen as adding value and not merely seen as a cost pressure to the organisation. This is something – Security as an aid to sustainability – that Peter has been keen to promote lately.
Officers, not guards
“I am really pleased to say that all of my security officers are undertaking a security apprenticeship with Telford College.” Once that’s passed, they can go on to foundation level degrees in security management if they choose to. He believes that in-house security officers ought to be SIA-licenced but understands that’s easier said than done; his supervisers are CCTV operator and door superviser-badged, and all officers are door-badged. The team leaders are taking Institute of Leadership and Management level five NVQ courses. “Every one of my security officers is qualified as an ‘Authorised Officer’ under the Criminal Justice and Immigration Act to remove people causing a nuisance or disturbance. They are also trained in-house as a fire response team leader, so they can control an in-house response to a fire; until the arrival of the fire brigade or a qualified senior manager, and then provide support … the days of a security officer being an old man wearing a flat cap with a flask sitting at a gate are well behind us.” Likewise, Peter hates the phrase ‘security guard’ rather than ‘security officer’: “They aren’t guards; it just implies they are just guarding something … I cringe when I hear the word guard.”
About the CSyP
The Security Institute and the Worshipful Company of Security Professionals developed the register for security people; those on the register are known as Chartered Security Professional, CSyP for short. You have to prove you know your job, and show you have leadership and commitment; and either have a degree-level qualification in security (or a non-security subject and a vocational qualification such as the CPP from ASIS) or, you have to write a paper of at least 4000 words, besides the other hurdles (so many years of operational experience, and an interview with two reviewers). The most recent gainer of chartered status are Chris Lawrence, of engineering consultancy TPS Consult, part of Carillion. Once a CSyP you have to comply with a code of conduct, hold professional indemnity insurance (either individually or via their employer), and undertake Continuous Professional Development each year. Visit www.security-institute.org.
