The healthcare profession is filled with lone workers facing risks and hazards aplenty on a daily basis. As latest figures show a sharp rise in attacks on NHS workers and paramedics, LONEALERT’s Sales and Marketing Manager, Mathew Colley, asks: whilst our health workers are looking after us, who is looking out for their safety?
The pressures facing NHS staff are vast and varied. Against a backdrop of crippling budget cuts, staff shortages and increasing patient numbers, no secret has been made of the fact the hardworking professionals at its core are facing unrelenting daily pressures.
Throw into the mix the all-too-real risk of being assaulted or attacked by violent patients or members of the public. And then remember that, much of the time, thousands of these workers are facing these daily hazards whilst working alone.
Is enough being done to keep our health workers safe?
To every right-minded person, the thought of health professionals who dedicate their lives to helping others being attacked whilst doing their job is sickening. However, it is happening in hospitals up and down the country with worrying regularity.
Shocking statistics have revealed that there were 70,555 assaults on NHS staff in 2015-16 - up four per cent from the 67,864 recorded in 2014/15 and a rise of almost 25% from the 56,718 attacks recorded in 2009/10. That works out at almost 200 attacks on medical staff every single day - with latest figures indicating another rise for 2016-17, according to an article reported in the Nursing Times.
According to figures obtained via a Freedom of Information request by the Health Service Journal (HSJ) on behalf of health union Unison, physical assaults on NHS staff increased by nearly 10% last year. The data reveals a worrying leap in attacks on health workers, with the biggest increase seen in the acute sector where assaults were up by 21%. Freedom of Information requests were submitted to all 244 trusts in England, with responses received from 181. The trusts who responded reported a total of 56,435 physical assaults on staff on 2016-17 – a 9.7% increase on the 51,447 reported the previous year. If those figures were extrapolated to cover the whole of the NHS in England, the number of reported violent incidents in 2016-17 is likely to be closer to 75,000.
A survey by the Royal College of Nursing recently found that 56 per cent of nurses had experienced physical or verbal abuse from patients, whilst 63 per cent had experienced abuse from relatives of patients or members of the public. Some hospital trusts consider the threat to their staff so great that dedicated police squads have been brought in to protect workers from assaults and remove potentially volatile patients that refuse to be discharged.
The measures come as latest figures also show a sharp rise of violent assaults on ambulance staff. According to the GMB Union, attacks on ambulance staff has risen by more than a third (34%) in four years, with staff reporting that they had been bitten, stabbed and sexually assaulted.
Ambulance staff were subjected to a total of 14,441 physical assaults between 2012/13 and January this year, the union claimed, with almost three-quarters (72%) of staff affected. A fifth (21%) of the 500 ambulance staff polled by the union had to take sick leave following an attack, and 37% said they had considered leaving their job because of the threat of violence. Almost half (48%) claimed the support offered by their employer was “inadequate”.
It has been claimed that longer waiting times due to understaffed units has created a pressure cooker environment in already highly-charged hospital waiting rooms, increasing the likelihood of attacks on staff, whilst some fear that these worrying statistics are just the tip of the iceberg, with many more incidents going unreported.
Kim Sunley, of the Royal College of Nursing, described it as "an absolutely shocking figure".
You see some horrible physical assaults - people being punched in the face, grabbed by the throat, limbs being broken, chairs being thrown at people.
There's the physical impact of the injury, but also the psychological impact, the long-term effect. People are traumatised.
Where people are frustrated and are having to wait a long time, an environment that isn't fit for purpose so you have trolleys in corridors, it's going to increase tension, it's going to increase frustration and it's a tinderbox atmosphere.
For a time, the security management of the NHS was dealt with by a central body, NHS Protect, which worked to protect NHS staff and resources from crime. But when this was shut down in November, it was seen by many as another hammer blow to the safety of those working in the profession.
The fact that it has reverted its focus to counter-fraud, responsible for leading the fight against corruption, bribery and fraud in the NHS, has led to concerns being voiced from some critics that buildings are being valued more highly than staff safety.
Responding to the closure of the body, UNISON Head of Health, Christina McAnea, said: “It’s going to be harder to gauge the scale of assaults or to prevent them happening in the first place. The NHS must fill this gap as a matter of urgency to show employees’ it takes their safety seriously.”
Many of today’s healthcare professionals will find themselves working alone throughout the day, the majority of which spent working with the general public, often in highly-stressful or emotional circumstances, making their job highly susceptible to change at any given moment.
Being responsible for lone or remote working staff that are not directly supervised brings its own set of risks to the employer / organisation. Some healthcare employers implement a buddy or a sealed envelope system to try and solve their lone working issues. However, buddy systems can always be subject to human error, potentially leaving the lone worker at risk. This is why effective lone worker protection systems are available that are designed to allow healthcare professionals access to easily monitor the status and location of their staff in a streamlined and efficient way whilst also offering organisations a wide range of escalation procedures that will come into effect as soon as an alert is raised so help can be sent should the worst happen.
As it is an employer’s duty to ensure a safe working environment for staff, the responsibility ultimately falls to each individual NHS Trust to take adequate measures to prevent physical abuse and injury to employees. Failure to uphold an employer’s Duty of Care can result in hefty fines, prosecution or, at worst, tragedy. Although lone working does not in itself contravene the law, it does bring with it additional risks. Under the Health and Safety at Work Act 1974 and the Management of Health and Safety at Work Regulations 1999, employers have a legal duty to assess all risks to health and safety, including the risks of lone working. In the current climate, it is now more important than ever that the NHS provides sufficient protection for its employees - including implementing suitable lone working policies and procedures that are backed up with proper communication to all staff and regular training.
The issue of lone working in the UK is one that is continuing its assault on public consciousness due to a number of high profile cases, such as the Ladbrokes worker alone in a betting shop who was murdered by an angry customer or the threat of Euro Star workers striking after a member of staff was allegedly threatened with disciplinary action for refusing to work alone.
But, whilst positive strides are undoubtedly being made, there are still many professions still failing to fully identify the many lone workers among them - and therefore failing to adequately protect them from harm.
As hospitals are generally heavily populated, some struggle with the notion that staff working in them can be considered lone workers. But the truth is that even workers who only spend a small percentage of their time operating in isolated situations face risks and dangers associated with working alone. Their roles are vast and wide-ranging. They may be the paramedic or emergency responder, or the receptionist working alone on a clinic reception area. They could be the community mental health workers, outreach workers, community psychiatric nurses, social workers, carers and occupational therapists out visiting patients in their homes. They could be members of staff who see patients for individual sessions in closed wards or clinics, or the technician working alone in a laboratory out-of-hours. They could be those manning GP practices or community pharmacies single handedly, or security staff guarding NHS buildings alone throughout the night. They could be the pharmacy porter conveying medicines to wards and departments, utilising little-used corridors and walkways where they might not come into contact with any other colleagues. They could be on-call staff required to travel between sites and respond to emergencies.
Similarly, the thousands of clinical staff working behind-the-scenes in locked labs, sometimes with potentially hazardous materials, can be overlooked when thoughts turn to lone working. Whilst the relative calm, sterile environment of a laboratory may not on the surface appear as hazardous as a construction site filled with heavy and noisy machinery, the risks its workers face should not be ignored or underestimated.
This was sadly highlighted tragically when Damian Bowen was asphyxiated whilst working with liquid nitrogen at St Stephens Centre Laboratory, in London, owned by Chelsea & Westminster NHS Trust. He lost his life whilst decanting liquid nitrogen alone, which he was using to freeze blood samples for transport.
Both Chelsea & Westminster NHS Trust and Imperial College London were recently handed hefty fines relating to the 2011 tragedy, which raised the issues of people working alone with dangerous substances as well as procedural failures.
After the hearing, HSE inspector Anne Gloor said: “Liquid nitrogen, rapidly expands as a gas, replacing the oxygen in a room and creating a situation where life cannot be sustained.
Mr Bowen was working alone with liquid nitrogen in a small room without any extraction. If the extraction system had been switched on, Mr Bowen would not have died. There should have been a system in place to prevent the extraction being switched off, a proper system of maintaining the equipment and clear arrangements for preventing lone working with liquid nitrogen.
Since that tragedy, LONEALERT has worked with Imperial College London to implement a robust and tailor-made lone worker solution to prevent anything like this happening again.
With such a broad spectrum of roles, responsibilities and working conditions to consider, what lone working solution works for one won’t necessarily work for all. Therefore it is vital for health trusts to identify their lone workers, understand their working conditions, circumstances and concerns and provide a lone working solution to best suit them.
Personal experience in this sector - including close working with Oxford University Tropical Medicine, University of Birmingham Medical School and Nobles Hospital - means it can be said with certainty that there are solutions available to protect the full spectrum of lone workers in this sector.
From devices that detect individual user behaviour patterns to those with advanced indoor location technology to pinpoint distressed workers to a specific room in a large building, the lone worker protection market is constantly evolving to offer lone workers the very best protection, whatever their working conditions. Even a humble Smartphone can be transformed into a fully intuitive tracking device and alert system whilst other devices are available that send instant panic alerts to a 24/7 alarm-receiving centre, record audio discreetly and respond accordingly. Discreet devices that can be worn on lanyards or or put on keyring could prove to be a vital tool for lone workers to raise the alarm when they are unable to use a mobile phone on shift, such as doctors and nurses.
Considerations must also be made to what point the safety of a worker becomes the responsibility of the employer - once they are on the premises? Once they have checked in to their shift? During their commute to and from work? This issue was highlighted recently when three lone female staff at The Christie, in Manchester, were attacked and mugged just yards from the hospital grounds on the way to and from their shifts. One of the victims was dragged down an alleyway by a man who then snatched her handbag and stole her car. Each had been on their way to or from work when they were targeted.
The Christie already has numerous measures in place to protect staff, including providing security team members to accompany staff travelling alone to their car or public transport when they are working outside of normal working hours, a free fully protected park-and-ride service for all staff as well as providing guidance from the police to staff about how to keep safe during their commute. Bosses have now issued extra safety advice - particularly to lone, female workers who are being targeted - and provided free panic alarms for staff in all departments in a bid to combat the attacks, which have been described as ‘deplorable’.
Trade union, UNISON, has put the protection of staff as its top priority, particularly the issue of lone workers. UNISON has developed a guide called ‘You are not alone’ calling for all trusts to ensure robust lone working procedures are implemented, annually reviewed and communicated effectively to all staff. The guide provides practical advice regarding all aspects of lone working for health workers and employers, including the legal duties and responsibilities of employers, the need for in-depth risk assessments and the importance of comprehensive training to ensure staff are fully aware of how to stay in contact and raise the alarm effectively if needed.
There have also been calls in parliament for lone working to be kept to a minimum in the NHS as a direct response to increasing numbers of attacks on staff. Recently, Justin Madders, a shadow health minister, said that while the focus had been on attacks in accident and emergency, it was clear that assaults occurred in every part of the NHS. During a debate on the issue, he responded specifically to an attack on senior occupational therapist, Hayley Simmons - who was grabbed from behind and throttled until she lost consciousness - which he said demonstrated how the risk of physical assault was higher for staff working alone. He also referred to an East of England Ambulance Service NHS Trust staff member who was physically attacked with a claw hammer after being called out alone.
The Royal College of Nursing is also demanding the government give more protection to nurses. In a survey of 1,000 nurses, it found that 85% spent more than a quarter of their time working alone, but almost three-quarters said they did not always receive all the information they needed about the risks associated with a visit.
More than 6% had been physically assaulted in the last two years, but only 86% of such incidents were reported to managers - compared with 45% of verbal assaults. Two-thirds of the nurses said their employers did not always know their whereabouts when they were working, and almost a fifth had not received any conflict management training.
The RCN says up to 100,000 health care professionals work on their own in the NHS every day, and it is calling on the government to honour its commitment to protect lone workers through funding training and technology.
It suggests technical lone worker protection devices are implemented to monitor the whereabouts of nurses working alone but claims that currently just 3.5% of NHS trusts have invested in them, with many even failing to provide their nurses with a mobile phone.
With the number of verbal and physical attacks on health staff continuing to rise year on year, it is no surprise that so much focus is being thrust onto the safety of those working in the profession and it is pleasing to see that the government is standing up and taking notice with the current discussion of The Assaults on Emergency Services Bill, which would see the law get tougher on those who attack police officers, firefighters, paramedics, nurses and doctors on shift.
But, as a much wiser man than myself famously said: prevention is better than cure.
The number of violent assaults on ambulance staff rose by more than a third (34%) in four years, according to the GMB union, with staff reporting that they had been bitten, stabbed and sexually assaulted.
Ambulance staff were subjected to a total of 14,441 physical assaults between 2012/13 and January this year, the union claimed, with almost three-quarters (72%) of staff affected.
A fifth (21%) of the 500 ambulance staff polled by the union had to take sick leave following an attack, and 37% said they had considered leaving their job because of the threat of violence. https://www.xperthr.co.uk/policies-and-documents/violence-at-work-policy-and-procedure/43483/?cmpid=ILC%7CPROF%7CHRPIO-2013-110-XHR_free_content_links%7Cptod_article&sfid=701w0000000uNMa
Almost half (48%) claimed the support offered by their employer was “inadequate”.
This Friday (27 April) MPs will vote on whether to introduce tougher sentences for people who attack emergency services staff. The Assaults on Emergency Workers (Offences) Bill will introduce a new offence of common assault on an emergency worker and require courts to treat attacks on emergency workers as an aggravating factor.
However, the GMB union criticised the Bill for failing to cover sexual assaults. Between 2012/13 and 2016/17, reported sexual assaults on ambulance staff increased by 211%, it claimed.
The GMB report – In harm’s way: confronting violence against NHS ambulance staff – revealed that attacks on ambulance personnel had a significant impact on workers’ physical and mental health.
One worker claimed they had been “attacked with a samurai sword repeatedly”, while others said they had been kicked, punched, slapped, stabbed, spat on and held at knifepoint.
One worker said: “I have had to have a hysterectomy because of injuries sustained … I have now returned to work but the impact on my life has been immense. I now cannot have children and will have ongoing problems for the rest of my life.” Another explained that they had they had been attacked by a drunk patient in their ambulance: “Found out later patient was Hep C positive; resulting in blood tests for six months. The courts gave him a suspended sentence. It was a horrible six months for my family and I”.
Kevin Brandstatter, GMB NHS national officer, said the risk of violence against ambulance workers was rising as cuts to services increased the number of lone workers. No one should be told that facing violence is just ‘part of the job’. The number of attacks faced by ambulance workers as they try to save lives is beyond unacceptable. “Changing the law will be an important first step as current sentences aren’t providing an adequate deterrent,” he said.
According to figures published earlier this month, physical assaults on NHS staff in England increased by 9.7% last year, compared to 2015/16.
Physical assaults on NHS staff increased by nearly 10% last year, with nurses reporting.
