A full report on the recent National Association of Healthcare Security conference.
Security officers in hospitals should have at least seven weeks training, David Sowter, National Association of Healthcare Security chairman, told a NAHS conference in Leeds. In a wide-ranging speech he covered the spectrum of the healthcare security sector. The security manager has to take charge of training, investigations, crime prevention, and management of his staff. The ideal healthcare security officer, he said, should be: of smart appearance, enthusiastic, honest, trustworthy, diplomatic, able to work on own initiative, of a calm, sympathetic nature; with a sense of humour and confidence to speak in public; and willing to work any shift at short notice in an emergency. ‘All for £4.50 an hour,’ David Sowter, which drew laughs from the audience. ‘You’re laughing, it’s got to stop. We have got to be thinking on a higher plane.’ His speech went into detail about that higher plane, taking in responses to threats, and the likely future look of healthcare security. He opened by saying that the forthcoming Private Security Industry Authority will make a ‘tremendous difference in the way the public perceives the security industry’. Of noises from the Home Office of an extended police family including special constables and private security guards, he said: ‘Whether we like it or not, we are all going to be part of this extended police family. The police service cannot possible tackle crime on its own. It relies entirely on the support of the public.’ In healthcare terms, that means security depends on staff and others keeping their eyes open.
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A manager’s duties
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David Sowter, a former senior Metropolitan Police officer, joined the Hammersmith NHS Trust in 1991 as security manager. Not all trusts have a security manager, he pointed out, but a trust security manager ought to have direct access to a board member of the trust. David Sowter went through the security manager’s responsibilities: first, to make sure that the Working Time Regulations (1998) are not contravened: ‘If you are employed by the NHS you can only average 48 hours a week over 17 weeks. If you are employed in the private sector and sign a piece of paper, you can work all the hours God sends.’ Security managers should represent the trust on the local crime and disorder partnership – in their own time: ‘We are an important part of the local community; certainly in city hospitals we are an important part of the crime problem.’ He went on to widen the issue of partnership, within the NHS. ‘If we have a situation where you have an acute hospital trust who have developed a good standard of security, they have a professional security manager and a 24-hour control room, it makes sense they are offering their services to the primary care trust who can’t afford to set up a security organisation or even employ a security manager. If you have a 24-hour control room, why isn’t that control room monitoring all the alarms from the satellite buildings that belong to the community and primary care trusts. We are getting better value from the person in the control room if we have decided that is what we need. Whatever fee is paid is going back into the health service for the benefit eventually of patient care because it isn’t hived off to somewhere else.’ To that end, the NAHS is hoping to set up simple specifications if a hospital has to make a contract for, for instance, monitoring services. Also, the security manager should take responsibility for the risk assessment of the public areas of the hospital, and for staff.
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More duties …
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Dealing with crime is a major duty. ‘If you are lucky enough to be operating in an area where the local police service is so well manned that all you have to do is pick up the phone and in five minutes a police officer will be there to deal with and investigate a crime , and because of the lack of crime in the area … well, good luck to you, anybody in that position.’ The audience replied with wry smiles and chuckles. ‘The police in many instances don’t even come, or they say, ‘well, if the victim wants to pursue this, pop into the police station’. That is one way of fiddling crime figures. Most of you have thousands of people you are responsible for. We can’t have a situation where crime is committed and no-one investigates it. The manager has got to supervise that investigation, to make sure all is being done that needs to be done.’ That includes liaising with the manager of the part of the hospital where the crime happened. Sometimes, the security manager has to do the investigation himself – which could involve hand-writing comparison, videotape enhancement, retrieval of data from computers, and examination of paper documents for indentations and alterations. According to the Regulation of Investigatory Powers Act 2000, the trust chief executive is responsible for authorising covert surveillance, and should be asking the security manager for advice. The NAHS has sent to the NHS Executive procedures on covert surveillance. As for the security officer, David Sowter quoted ‘fly on the wall’ television programmes of accident and emergency departments where security officers stand with their arms folded, watching nurses deal with a problem, until fisticuffs start; then security moves in. ‘Why should nurses have the hassle of trying to defuse the aggression” David Sowter asked. ‘The security officer should have the capability and training to deal with it. I assure you after a short time they will be very good at it. They will all have had a bonk on the head at some time, and will see it [defusing aggression] works. They become expert at defusing the situation, getting everything back to normal, letting the nurses carry on with the treatment.’ Other tasks for the security manager include disposing of lost property, providing a property marking service, keeping a high-security key register with pouches and seals for security staff to monitor use of keys. As for suspect packages, David Sowter argued that the security officer should investigate the circumstances of any undamaged suspect package – and not call in the police. He told of an incident at Hammersmith soon after he joined the trust, when a member of staff (issued with a metal detector after a previous incident) got a positive reading on a packet sent through the Royal Mail. The quick-thinking security officer called the police. A constable asked for the room to be evacuated, and windows opened; command of the incident passed upwards to a sergeant and beyond, and ever more of the hospital was evacuated and staff sent home. The day ended in a senior officer taking charge from the hospital gatehouse and stopping traffic, before the bomb squad gave the all-clear. The envelope contained a metal paper clip. David Sowter then agreed with the head of Hammersmith’s radiography department that an undamaged package that had passed through the Royal Mail would be x-rayed on one of the hospital’s own machines.
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And more duties …
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Security staff should strive to reduce fear of crime. On a tour of duty, the security officer should visit every treatment room. Staff will get to know the security officer who in time will be invited to have a piece of cake because it’s someone’s birthday: ‘It’s fine because the staff are talking and the security staff will find out what is going wrong.’ Wanting extra value from the security officer, David Sowter believes that officers should be alert always to health and safety issues such as broken paving stones, unswept stairways and spillages. Such cases should be reported to the appropriate department, and recorded for a follow-up if nothing happens. It’s essential for security staff to make reports before they go off duty – how can a value be put on a security service if staff are not reporting what they are doing’ David Sowter recommended computer software for analysis of staff reports, to be passed to directors in other parts of the hospital. When watching for breaches of internal policies, the security member of staff should talk to the supervisor in the relevant area; and if he is not listened to, the manager should get involved – which is where the ability and confidence to speak in public comes in. As for initiative, security officers have to show it sometimes because you cannot have a policy for everything. David Sowter offered a mission statement: ‘The security officer, providing a reassuring visible presence, and a caring and sensitive security service, will be at the heart of the style of security offered within the NHS.’ He closed by discussing training – not something to forget when drawing up the budget.
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121 hours of training
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To achieve the NAHS security officer certification, the 121 hours of basic tuition should take in first aid; communication and investigative skills; safety and emergency preparedness; the law; and self-defence. Options include CCTV control room and computer procedures.’Thereafter, for at least three months the officers should receive closely supervised on the job training and then refresher and development training indefinitely.’ Managers should take up references, he added. ‘Before you turn them [officers] loose on their own they should have received seven weeks training. You aren’t going to invest in seven weeks training and pay £4.50 an hour because someone is going to offer £4.75 an hour. So you have got to be thinking about the terms and conditions of employment. If he goes to another trust, that’s different, because it’s in the family.’ Can you afford not to train’ David Sowter asked. If security staff exceed or ignore their powers, civil actions for assault and false imprisonment – against the individual or trust – are likely to follow. Finally he asked: ‘Who can remember everything they are taught’ Our security officers aren’t going to carry around in their mind everything we have taught them. So consider getting their procedures on to paper, so controllers can actually turn up the appropriate piece of data and can talk to the operator dealing with it in the field, over the radio.’ From the floor, Rotherham hospital security manager David Beckett asked if SITO was working on healthcare training; David Sowter envisaged the NHS setting the standards of training, and expected that private training companies would pick up the NAHS standard. Another query from the floor spoke of police officers holding back from dangerous situations – namely, a man with a machete trapping a member of staff in a room. The conference heard of a culture in the police whereby officers will stand back, rather than going in as previously, because of risk assessments.
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Kevin Austerberry of the Royal College of Nursing spoke on how the RCN is seeking to make nurses aware of the risks of violence. There is however a ‘deep reluctance’ on the part of all NHS workers to report incidents, not only physical assaults. ‘Maybe it’s part of our culture, and it’s something we should work to change,’ he concluded. From the floor came comments that the government’s policy of zero-tolerance against violence against NHS staff, with targets of reducing incidents by 2003, was impossible to meet. Kevin Austerberry admitted ‘we are doing ourselves no favours’ because investing time in raising staff awareness only led to more reported cases of assaults, not fewer.
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A London pharmacist speaker at the NAHS conference revealed that she had become less naive about drug theft when bringing in a trust-wide policy on drug security.
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A nurse borrows an ampoule of a prescribed drug from a ward – going to a different ward each shift. A patient in accident and emergency tries to load drugs into a plastic carrier bag. An Australian temporary member of a hospital’s staff prescribes himself six months’ worth of birth control before he sets off on a tour of Europe. These are some anecdotes of drug misuse in the NHS outlined at the NAHS Leeds conference. Doctors who are caught stealing drugs are rarely sacked, the conference heard. Anne Jacklin, Chief Pharmacist, Hammersmith Hospitals NHS Trust, stressed that she was not a security professional. But according to the Duthie Report (1988) to the Department of Health, chief pharmacists are responsible for ensuring that safe and secure systems are in place for procurement, storage, dispensing and administration of drugs. In clinical areas, this responsibility is delegated to the lead nurse – and as one of the above examples shows, the ‘trust me – I’m a nurse’ culture is open to abuse. Doctors, pharmacists and nurses alike have routine access to drugs, ‘and in my experience we are a pretty naive bunch of people compared to you guys,’ Anne Jacklin said, ,meaning her security manager audience. Garry Purdy, introducing the speaker, spoke of how society has become an important, if not the most important, social problem: ‘When I started in the police force in Matlock, there were two known drug houses. There are now about 20.’ Hospital staff have regular access to drugs – some 2,500 staff do in the Hammersmith trust, which also has hospitals at Charing Cross and Chelsea. Anne Jacklin reported that the trust has a total of 4,200 staff (including 1,750 nurses, 500 doctors and 130 pharmacy staff in three pharmacies. ‘We formed a drug security review team; we brought together senior people from nursing, medical, pharmacy and security.’ That group, set up in 1995, runs two databases – one of incidents (to identify trends, support investigations, and make sure actions are consistent) and since 1999, a second database for ‘illegal substances’. She admitted that behind the statistics there is probably under-reporting. A peak of incidents in 1998 reached 50 a year. Given that most pharmacists will see one or two incidents a year, how many of those incidents were theft, she asked. A maximum of ten a year, also in 1998. And if incidents are not thefts, what are they’ Answers include suspected thefts and forgeries (for example, the patient adding something to the script). If there is a suspected patient forgery, it is treated as a break in the patient-doctor relationship. Before 1998, the trust did not have a policy of what to do with a patient caught taking illegal drugs on a ward, or bringing in drugs. What were the staff on the spot to do – throw the illegal substances away, or call the police’ When the trust used to call the police to such cases, police did not do much, she said, and bringing in the police caused some upset in the hospital. The trust’s policy today is to alert the police only if there is drug dealing, and drugs are removed and destroyed. Anne Jacklin reported some initial clinician resistance to this policy, and other local trusts have a different policy. Hammersmith did not want a reputation for accepting drugs, because it is not right for patients not on drugs, she added.
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Bad housekeeping’
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One or two instances a month of incorrect stock levels by one tablet may be due to bad record keeping rather than ‘background theft’. The trust decided to get more people involved in drug security, to stress the importance of good house-keeping. Anne Jacklin said she had become less naive about drug theft, because of cases happening under the noses of staff. Nursing and pharmacy staff had examples passed to them in staff training. For example, addicts might siphon off drugs to take onto the wards – even for years; or staff might take pain-killers while on a night shift, rather than go to a GP. In conclusion, thanks to the policy on drugs, staff are reporting their suspicions faster, because they are more security-aware. Staff do not panic when something does go missing. Nor do they laugh so much about the need for a drug security policy, Anne Jacklin said. From the floor, Bristol NHS security manager Nick van der Bijl asked: ‘Bearing in mind we live in a society where drugs are easily available on the street, what are your views on the selective drug testing of staff. Football clubs, the armed forces and private companies insist on drug testing of staff – why not the NHS’ Anne Jacklin’s reply: ‘Because it’s a political football.’ From the floor came the comment that some police forces, too, are introducing drug testing of staff.
