Post on 08-Sep-2020
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The Newcastle upon Tyne Hospitals NHS Foundation Trust
Management of Violence and Aggression at Work
Version No: 7.0
Effective From: 29 November 2018
Expiry Date: 29 November 2021
Date Ratified: 16 August 2018
Ratified By: Health and Safety Committee
1. Introduction The Trust is responsible for and committed to providing a safe non-violent/non-threatening environment for all its employees, patients and visitors and will take reasonable steps to secure the health & safety of staff that may be exposed to the risk of aggression, violence or abuse in the workplace. 2. Scope This policy has been drawn up to give employees support and advice, and deals specifically with violence to staff from patients, relatives and visitors. It provides clear guidance to managers of their responsibilities in managing violence at work. Managers may find it helpful to read this policy in conjunction with the Lone Worker policy. This policy does not apply to issues of violence between members of staff. These should be dealt with according to the Dignity and Respect at Work Policy, Equal Opportunities and Diversity Policy or the Trust’s Disciplinary Policy/Procedure as appropriate. 3. Aims and Objectives The Trust believes that any act of violence, aggression or intimidation against any member of staff is unacceptable, whether perpetrated by patients, visitors, service users or staff members. This Policy details the Trust commitment to ensuring that measures are in place to reduce the risk and that there are appropriate procedures in place to enable staff to deal appropriately with violent situations should they arise. 4. Responsibilities 4.1 Trust Board
The Trust Board is ultimately responsible for fulfilling all Health and Safety duties as an employer, including all statute health and safety law requirements.
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4.2 Chief Executive
The Chief Executive has overall responsibility to the Trust Board for ensuring that appropriate and effective health and safety management systems are in place including for the prevention and management of Violence and Aggression.
4.3 Executive Directors
The Executive Team is responsible to the Trust Board for ensuring compliance with this Policy.
4.4 Directorate Managers, Directorate Directors
Directorate Directors are responsible for ensuring that day-to-day activities of the Directorate are conducted in as safe and suitable manner and this policy is effectively and correctly employed within their own Directorate.
Directorate Managers have the ultimate responsibility for all health and safety issues within their Directorate. They must ensure that there is a sound local health and safety function as well as well-developed health and safety awareness and culture within their remit including for the prevention and management of violence and aggression.
4.5 Heads of Department/Managers
Managers should establish local procedural guidelines specific to their own departments. These should draw upon closely related Trust policies e.g. Lone Workers Safety, violent patient marker and exclusion from treatment policies.
Managers should ensure that risk assessments are in place to protect at risk employees, they may appoint a Departmental Risk Assessor to assist in this process.
Managers are responsible for acting on and assessing the outcomes of risk assessments including training, cost and maintenance where necessary to improve the protection of staff. This should be included as part of the Directorate budget setting when compiling budgets plans for approval.
Departmental Heads complete training needs analysis, identifying violence and aggression training requirements for the year ahead. Managers should ensure that staff undertake Conflict Resolution Training, Breakaway or Physical Intervention Training as required by the Mandatory Training Policy and or appropriate as a result of risk assessment, and staff role. As a general standard all staff that have regular verbal or direct contact with
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patients and the public must complete Conflict Resolution Training in accordance with the Mandatory Training Policy.
Risk Assessments should be reviewed if they are no longer considered valid, typically this may result from changes in working practice, staffing, departmental moves/layout changes or other arrangements, post incident and in addition assessments are to be reviewed on an annual basis.
Managers should refer to Section 5 Risk Assessment Process & Requirements below.
4.6 All Staff
All employees have a duty of care to take reasonable care to ensure the safety of themselves, their colleagues, patients and the public at all times. Therefore all members of staff are expected to comply with the Trust Policies and procedures, which are provided for their protection. Employees should also be proactive in helping to reduce the risk of violence occurring in their workplace. Staff must attend training where identified as a requirement under the Mandatory Training Policy or the result of risk assessment. Specifically this may be one or more of the following: conflict resolution, breakaway, Physical Intervention, lone worker training.
4.7 Health & Safety Advisors
The Health & Safety Advisors will provide advice and guidance to managers and employees on violence and aggression reduction methods and assist risk assessors in the identification of risk and training needs analysis.
The Health & Safety Lead will administer the lone worker alerting system in use by staff that operate in the community.
The Health & Safety Advisors will investigate all serious violent & aggressive incidents and analyse violence & aggressive related incident statistics, reporting all serious incidents to the Trust Health & Safety Committee and Trust Security Group.
A Member of the Health and Safety Team will attend the Trust Security group to discuss any outstanding violence or aggression issues.
4.8 Trust Local Security Management Specialist (LSMS)
The LSMS will provide advice and guidance to managers and employees on violence and aggression related initiatives.
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Will advise managers on the application of the withdrawal of treatment policy.
Will establish and maintain links between the Trust, Police.
Chair of the Trust Violent Marker Panel
Is responsible for the Trust wide Security Risk Assessment Programme 5. Definitions of violence at work
Physical Violence - “The intentional application of a force without lawful justification, resulting in physical injury, personal discomfort or loss
Assault - “An assault is committed when a person intentionally or recklessly causes another to apprehend the immediate infliction of unlawful force”
Battery - “A battery is committed when a person intentionally and recklessly applies unlawful force to another”
Serious Assault - “Any assault where the resulting injury causes skin or bone to break, loss of consciousness, internal injury or where any stitching or surgery is necessary.”
Non-Physical Violence - “The use of inappropriate words or behaviour causing distress and/or constituting harassment.”
6. Arrangements to Prevent and Manage Violence and Aggression 6.1 Risk Assessment Process & Requirements
The Trust requires suitable assessment to be made of the risk to employees’ health and safety whilst at work. Risk Assessors are required to consult with staff groups to ensure that all situations are identified where staff are likely to be exposed to violence, evaluate the level of risk involved and identify measures to control the risks.
Staff at Risk of Violence at Work
Identifying possible groups of staff at risk e.g. Assessment Suite, Accident & Emergency. The risk assessment must systematically identify where violence may occur and clearly specify effective control measures/safe working procedures to avoid or reduce the level of risk including the development of action plans where appropriate.
Safe Working Procedures
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Managers should initiate effective safe working procedures, which enable them to be aware of the locations of their staff e.g. lone workers, those working in the community or visiting in the home; where appropriate Managers should put in place written local protocols for shift workers. The risk assessment will identify the necessary precautions required to safeguard staff at risk in their workplace.
Training
The manager should ensure that staff attend training as outlined in the Mandatory Training Policy and that additional support is given when required. Risk Assessment will help identify the appropriate level of training requirements within the Dept / Directorate.
Critical Incident Evaluation
After an incident has occurred Managers and staff should evaluate the event and if necessary modify existing procedures and control measures, ensuring that all staff are aware of any changes. Managers should consider the Exclusion from treatment policy following any incident of aggression and offer support to staff and direct them to Occupational Health counselling services where required.
6.2 Security and Police Support
6.2.1 Security staff are available to attend violent incidents throughout the Trust (with the exception of Community sites). The following telephone numbers should be used for assistance in an emergency:
Security (RVI/FH) 333 Police. 9-999
6.2.2 The Security staff will provide additional support, advice and act as a
presence at an incident as well as applying control and restraining techniques should they be requested by clinical staff. Should patient restraint be required this should be applied with caution, in the presence and under the guidance of clinical staff, taking into consideration the patient’s medical condition in accordance with Restraint Policies.
6.2.3 In the event of the police being required to attend any incident the
Portering/security staff will call them. However there may be urgent situations relating to personal safety where the police should be called as an emergency directly from where the incident is taking place. Employees should dial 9-999.
6.2.4 All security staff must be fully trained and up to date in the applied
techniques of Control & Restraint. Security staff cannot apply physical
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intervention techniques unless they have attended initial or refresher training within the previous 12 months.
6.2.5 The Chair of the Trust Security group will attend the Trust Health and
Safety Committee to provide quarterly Security reports and discuss any outstanding violence and aggression issues.
6.3 Treatment and Support Following an Incident
6.3.1 Any injuries sustained which are assessed as minor, may be treated by a First Aider or Clinical Staff.
6.3.2 Where an employee has sustained a more serious physical injury, as soon
as possible they should be referred to the Accident and Emergency department/Minor Injuries Unit.
6.3.3 It is the Manager’s responsibility to ensure that support and counselling
are provided (if required) for the member of staff involved. All staff involved in a violent and aggressive incident should be offered counselling at the time of the incident. If further counselling is required this can be arranged through the counselling service accessible via Occupational Health.
6.3.4 Following a violent incident; the Manager should make arrangements to
enable the employee to take “time out” from the workplace if required. If after this time normal duties cannot be resumed, suitable alternative duties should be offered. This may be away from their normal duties or work location. This action should be considered by the Department Manager, in conjunction with the Directorate Manager and HR Advisor.
6.3.5 Absence resulting from violence or aggression sustained at work that
requires counselling treatment will be regarded as sickness absence. If the employee concerned is unable to return permanently to their original duties it may be necessary to re-deploy them with guidance from their HR Advisor.
6.3.6 All employees must be given the opportunity to discuss their concerns in
confidence with their Line Manager, their HR Advisor and Trade Union Representative. They should also be encouraged to discuss the incident with their immediate colleagues to help the team consider effective and alternative ways of handling the situation in the future.
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6.4 Reporting Violent Incidents
6.4.1 Any violent or potentially violent incidents must be reported without delay. After dealing with an incident, once the situation is contained, the person in charge of the Department must ensure that staff involved in the incident complete a Datix Web Incident Report Form. (See Reporting Process - Flow chart Appendix 2).
6.4.2 All serious violent incidents where injuries have been sustained will be
dealt with in the same way as accidents at work involving injury as such may be reportable to the Health and Safety Executive under the Reporting of Injuries, Diseases & Dangerous Occurrence Regulations (RIDDOR). The Health and Safety Lead will report violent incidents to the Health & Safety Executive that meet the criteria detailed in the RIDDOR once notified.
6.4.3 All serious Violent Incidents (where physical contact/injury or serious
verbal abuse has occurred) must also be reported immediately to the Health and Safety Lead in the Clinical Governance and Risk Department (CGARD). The person in charge of the department/ward must contact CGARD by telephone as soon as possible following the incident and provide details of the incident as outlined in the Protocol for the Reporting of Violent and Aggressive Incidents to Hospital Staff (Appendix 1).
6.4.4 When an employee is physically assaulted or subjected to serious
threatening behaviour their manager will confirm with the individual concerned whether they wish to have the incident reported to the Police and will act accordingly. Should the incident be of a serious enough nature, a decision to involve the Police may need to be taken even if not supported by the staff involved.
6.5.5 All violent and aggressive incidents will be reviewed, and where
appropriate investigated by the Trust’s Health & Safety Advisors. Suitable preventative action will be taken when required, following investigation by the Trust Health & Safety Advisors.
6.5 Legal Action Following Violence at Work
6.5.1 Staff must report all violent or verbal incidents to their managers at the time they occur, or as soon as possible thereafter.
6.5.2 Should the Police be involved in an incident, and subsequently indicate
that they are charging the assailant through the Common Assault Act, proceedings will be taken through the Crown Prosecution Service. Trust staff will assist and co-operate with the Police as and when required.
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6.5.3 Where the Police have indicated that they will not be charging an assailant, the employee or the Directorate Manager should discuss the incident with the Trust LSMS and they may judge that a Private Prosecution or civil claim should be submitted on behalf of the employee, the Directorate Manager should contact the litigation manager, who will take legal advice from the Trusts solicitors and the NHS Protect Legal Protection Unit to determine whether a Private Prosecution or civil claim is likely to be successful.
6.5.4 Where a Civil Claim is to be pursued the Local Security Management
Specialist (LSMS) in consultation with and the Trust’s solicitors will determine what action will be taken and which department will pursue the case. The costs of any civil action will be incurred by the Trust.
6.5.5 Every employee has a right to pursue his or her own legal action, however
if the Trust after due consideration has decided that legal action would not be instigated, the Trust will not be responsible for any costs incurred.
7. Training
7.1 There are is a range of violence and aggression related training options available for staff that are in daily or regular contact with patients, visitors and the public.
7.2 Conflict Resolution Training is required for all staff identified frontline staff as
detailed in the Mandatory Training Policy related Training Needs Analysis (TNA). Conflict Resolution, Breakaway and Physical Intervention Training is required for all security staff. Training in breakaway and physical intervention techniques for other staff should be considered as part of the risk assessment process.
7.3 Type of Violence & Aggression Training:
Conflict Resolution
Breakaway Techniques Training
Physical Intervention Training 7.4 All staff who under take Breakaway or Physical Intervention Training must attend
annual updates to ensure that their practice is at the required standard. 8. Equality & Diversity The Trust is committed to ensuring that, as far as is reasonably practicable, the way we provide services to the public and the way we treat our staff reflects their individual needs and does not discriminate against individuals or groups on any grounds.
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9. Monitoring Compliance
Standard / process / issue
Monitoring & Audit
Method By Committee Frequency
Completion of Violence and Aggression related risk assessments
Health and Safety Compliance Questionnaire
Health and Safety Advisors
Health and Safety Committee
Quarterly
Monitoring of staff training as outlined in the Mandatory Training Policy
Training Report Staff Development Unit/Training Team
Health and Safety Committee
Quarterly
10. Consultation & Review The policy has been circulated to
H&S
Trust Local Security Management Specialist
Trust Security Management Group
Executive Chief Nurse
Trust Health and Safety Committee
CPG
Staff Development 11. Implementation 12. References
Health and Safety at Work Act 1974
The Management of Health and Safety at Work Regulations 1999
Reporting of Incidents, Diseases and Dangerous Occurrence Regulations 2012
Tackling Violence against Staff, NHS Protect
Meeting needs and reducing distress http://www.nhsprotect.nhs.uk/reducingdistress/
Conflict resolution training: implementing the learning aims and outcomes 2013
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13. Associated Documentation
Health and Safety Operational Policy
Lone Worker Safety Policy
Exclusion from Treatment of Violent or Abusive Patients Policy
Placing a Risk of Violence Alert on Patient Records
Mandatory Training Policy
Author: Health and Safety Lead
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Appendix 1
The Newcastle Upon Tyne Hospitals NHS Foundation Trust Protocol for the Reporting of a Serious Violent Incident to Staff All serious violent & aggressive Incidents must be reported as soon as possible after the event by telephone to the Health and Safety Lead, Clinical Governance and Risk Department (CGARD) on Ext. 21725. Definition of a Serious Violent Incident Where a member of staff or a patient has been serious assault or where considerable damage has been caused following a violent incident and there is considerable loss to the organisation. Incidents forms should still be completed as usual on the DatixWeb system It is the responsibility of the member of staff in charge of the department/ward/team at the time of the incident occurrence to ensure that this information is forwarded to CGARD. If the incident has occurred out of office working hours (overnight or at a weekend) the Patient Services Coordinator (PSC) must be informed. The PSC will inform CGARD the next working day. The following Information will be required when the initial telephone call is made:
Incident number
Name of injured party
Title and grade of injured party and contact details of party
Who is reporting incident and contact details
Hospital
Department/Ward and Specific location
Brief scenario of events and any immediate care/treatment required
Assailant details (If patient include hospital number)
Include any witness details The Health and Safety Lead or PSC should ensure that the staff involved receive the following:
Counselling / support if required
Medical attention as appropriate. Consent should be sought from the injured party to share information with relevant organisations e.g. Police, Department of Health. Following a serious violent incident the Health and Safety Lead will contact the Executive Chief Nurse, who will write to the employee, ensuring that they have received counselling, support and guidance.
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Appendix 2
Trust Violence and Aggression Reporting System Flow chart illustrating the main points of the reporting procedure and any subsequent action that may be taken
Incident Police/Security
Contacted if Required
Reported by person in
charge of Ward/Dept
Local Community Police
Health & Safety
Advisors Incident
Investigation (Where
appropriate)
Immediate First
Aid/Counselling/Support
if required
Complete incident form &
process as normal and
commence initial investigation
Trust Datix System – onward
reporting and data flow
If the incident is significant
Telephone Health and Safety Lead
immediately
(Post Incident)
Trust Health & Safety Committee
Review V & A Statistics
Recommend Proactive
strategies to reduce V & A
(Out of Hours)
Patient Services Coordinator
Serious Incident
Executive Chief Nurse
Correspondence to
injured party
Trust Security Group
1. Assessment Date: 16/08/2018
The Newcastle upon Tyne Hospitals NHS Foundation Trust
Equality Analysis Form A
This form must be completed and attached to any procedural document when submitted to the appropriate committee for consideration and approval.
PART 1
2. Name of policy / strategy / service: _______________ Management of Violence and Aggression at Work Policy
3. Name and designation of Author: Tim White, Health and Safety Lead
4. Names & designations of those involved in the impact analysis screening process: Tim White, Health and Safety Lead ________________________________________________
6. What are the main aims, objectives of the policy, strategy, or service and the intended outcomes? (These can be cut and pasted from your. policy)
To ensure that arrangements are in place to meet the duty of care requirements to prevent and manage violent and aggressive behaviour.
7. Does this policy, strategy, or service have any equality implications? Yes | x | No | |
If No, state reasons and the information used to make this decision, please refer to paragraph 2.3 of the Equality Analysis Guidance before providing reasons: ____________________________________________________________________
5. Is this a: Policy
Strategy
Service
Is this: New Revised x
Who is affected Employees Service Users Wider Community
8. Summary of evidence related to protected characteristics Protected Characteristic Evidence, i.e. What evidence do you have that the
Trust is meeting the needs of people in various protected
Groups
Does evidence/engagement highlight areas of
direct or indirect discrimination? If yes
describe steps to be taken to address (by
whom, completion date and review date) Does the evidence highlight any
areas to advance opportunities or
foster good relations. If yes what
steps will be taken? (by whom,
completion date and review date) Race / Ethnic origin (including
gypsies and travellers) Health and Safety Management encompasses a duty
of care recognised by the Trust to Employees and others.
No N/A
Sex (male/ female) Pregnant Workers Policy and associated risk
assessment recognises the specific risk areas for
those new and expectant mothers
No
One to One specific risk
assessment undertaken already. Religion and Belief Chaplaincy support role in notification and follow up to
incidents of serious violence and aggression against
staff. Chaplaincy support to Stress Group. Incidents where racial behavior has been
demonstrated are escalated to senior management for
investigation.
No N/A
Sexual orientation including
lesbian, gay and bisexual people
Incidents where particular individuals or groups are
targeted are escalated to senior management for
investigation.
No N/A
Age No N/A Disability - learning difficulties,
physical disability, sensory
impairment and mental health.
Consider the needs of carers in
this section
No N/A
Gender Re-assignment No N/A
Marriage and Civil Partnership
N/A No N/A
Maternity / Pregnancy Health and Safety legislation places some restrictions on the risks that new and expectant mothers may be exposed to. To ensure that the reasons for this including legislative requirement are explained when conducting pregnancy related risk assessment. So that assessors are aware of the
No N/A
No
10. Engagement has taken place with people who have protected characteristics and will continue through the Equality Delivery System and the Equality Diversity and Human Rights Group. Please note you may require further engagement in respect of any significant changes to policies, new developments and or changes to service delivery. In such circumstances please contact the Equality and Diversity Lead or the Involvement and Equalities Officer.
Do you require further engagement? Yes | | No | x |
11. Could the policy, strategy or service have a negative impact on human rights? (E.g. the right to respect for private and family life, the right to a fair hearing and the right to education?
No
PART 2
Name: Tim White
Date of
completion:
16/08/18
(If any reader of this procedural document identifies a potential discriminatory impact that has not been identified, please refer to the Policy Author identified above, together with any
suggestions for action required to avoid/reduce the impact.)
drivers for this measure and is not a local Trust imposed restriction.
9. Are there any gaps in the evidence outlined above? If ‘yes’ how will these be rectified?