NHS lessons for social care on tackling violence

The NHS has introduced a series of national measures to tackle violence against staff. Daniel Lombard asks whether these could provide a blueprint for social care

The NHS has introduced a series of national measures to tackle violence against staff. Daniel Lombard asks whether these could provide a blueprint for social care

Health and social care staff share many of the same risks when they start work each day.

Both groups work with vulnerable patients and service users who could turn aggressive at any moment, leading to thousands of abusive incidents and injuries each year.

But measures taken to protect workers differ vastly between the sectors. In 2003, the then health secretary John Reid announced a national strategy aimed at reducing the number of assaults on NHS staff in England, including a national incident reporting system for recording physical assaults (see box).

Annual figures showing the number of physical assaults in each trust are published on the NHS security management service website – in 2008-09 there were 54,700 reported physical assaults against NHS staff in England, a reduction of 1,200 compared to 2007-08.

Steady decline

In addition, the Care Quality Commission’s annual NHS staff survey shows abuse rates have experienced a steady decline: the proportion of staff reporting physical attacks by patients has decreased from 15% in 2003 to 11% in 2009, while staff reporting bullying, harassment and abuse by patients has fallen from 28% in 2003 to 21% in 2009.

The government’s response to the issue in social care pales by comparison. Only local reporting systems exist, making national analysis of the problem difficult, although employers must report incidents leading to staff absence of more than three days to the Health and Safety Executive.

Guidance from Skills for Care on combating violence against adult social care staff is due to be officially launched later this year, but unions say this is not enough and are campaigning for extra funding and a greater national focus.

Unison recently published a 10-point blueprint aimed at combating the abuse and attacks faced by its 300,000 members in social care. Chief among its proposals is a national system of monitoring violent incidents.

However, Local Government Employers and the Association of Directors of Adult Social Services both reject the plan, and instead call on local authorities to improve their responses to risks in their local areas and put proper interventions in place.

Steve Sumner, national health and safety policy advisor for LGE, told Community Care: “The NHS may have their own system but they are a small sector compared to local government.”

The problem is compounded by the diversity of the adult social care workforce in England – from a total of 1.5 million workers, around one million work in the independent sector and just 220,000 are employed by councils.

Nevertheless, Sumner’s comments provoked a swift rebuff from Helga Pile, national officer for social care at Unison.

“To say that it is easier for the NHS because it is a small sector makes no sense – it is the largest employer in Europe,” she says.

Pile also rejects the LGE’s objections to a national system on the grounds that there are major differences in the way that incidents are recorded locally.

“This is exactly why it’s vital to bring in standardised reporting,” she says.

“Unless this happens, the differences in reporting will be an easy excuse to do nothing.”

Lone working on risky visits

Unison also wants to ban lone working on risky visits; a greater focus on employers’ responses to incidents in inspections; closer relations between police and employers; and better police and ambulance back-up for mental health admissions.

The NHS systems are not perfect, however, according to healthcare unions. The number of healthcare workers suffering physical assaults “is still unacceptable”, says Kim Sunley, senior employment relations adviser at the Royal College of Nursing.

Issues yet to be resolved include: a lack of data about attacks on specific types of workers; local security management specialists holding a number of other roles; and “gross” under-reporting of incidents. “The annual figures may just be the tip of the iceberg,” she says.

The RCN, like Unison, believes more national initiatives such as a standardised reporting system would benefit the social care sector.

For Sunley, the Department of Health’s personalisation agenda, which calls on local authorities and NHS trusts to work together more closely in delivering care, is one more factor strengthening the case.

“With the integration of some health and social care services there is a need to ensure that staff working alongside each other in potentially violent situations are afforded the same protection.”

National initiatives to tackle violence in the NHS

Department of Health’s 2003 initiatives:

• National incident reporting system for recording physical assaults

• A consistent local reporting system for non-physical incidents

• Launch of the NHS Security Management Service to oversee protection of NHS staff and property in England

• Dedicated professionals, known as “local security management specialists”, within each NHS trust to lead on day-to-day work to tackle violence against staff – now in place in 90% of health bodies

Since then, the following have been introduced:

• Annual CQC staff survey collating figures on assaults and abuse against staff

• National syllabus for conflict resolution training aimed at all frontline NHS staff

• Launch of a Legal Protection Unit, which pushes for legal action against perpetrators who attack staff

Related articles

Read more about violence against social workers

Employers reject call for national violent incident register

Mental health staff at risk through ambulance delays

External information

NHS Security Management Service

Care Quality Commission