What social care can learn from the NHS’s system for recording and tackling violence

The number of people prosecuted for assault on NHS staff is rising rapidly year on year thanks to NHS Protect, its national system for recording incidents. Max Daly looks at what social care could take away from this approach.

Guidance is produced for NHS staff (Caiaimage/Rex, posed by models)

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Social care workers face far greater risks of abuse and violence than the average employee. Research by Community Care suggests more than two-thirds have been subjected to physical assaults, with anything from fists and knives to chairs and dangerous dogs. Yet, despite their vulnerability, Britain’s vast army of care workers have little of the protection afforded to their counterparts on the public sector frontline. While care staff must rely on a patchy network of protection and the whims of local employers, NHS employees are shielded by a national system with a long track record of monitoring and confronting violence against staff.

Take Sheffield-based care worker Michael Greaves, for example, who was cut on his arm by a service user with autism and obsessive compulsive disorder in August 2010 while helping the man to prepare his lunch. Investigations by specialist workplace injury lawyers at Irwin Mitchell revealed that an incident report by his employers, Mears Care Ltd, found that there was no risk assessment or training given to care workers, despite the man previously showing aggressive behaviour.


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It is no surprise, then, that observers in the social care sector are increasingly looking across at the NHS’s anti-violence model as the way forward.

In 2003, the then-health secretary John Reid announced the formation of 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. NHS staff deemed most at risk were issued with personal GPS alarms designed to look like ordinary NHS identity cards, which enabled them to call for emergency assistance in dangerous situations.

Now run by NHS Protect, an arm of the NHS’s Business Services Authority, the £11m system produces national standards, policies and guidance to assist NHS organisations in developing local strategies to prevent violence against its workers. A countrywide network of local and regional security management specialists (SMS’s) provide NHS organisations with support, advice and guidance on crime prevention.

Each year, the NHS collects information from all NHS organisations and providers on physical assaults. By gathering intelligence and data on abuse, harassment and violence across England, it is able to identify trends and react accordingly.

While the number of physical assaults on NHS staff, between 50,000 and 60,000 a year, has remained static over the last decade, the number of victims reporting attacks is steadily rising, with 73% of staff saying they opted to report an attack in 2011 compared to 71% in 2009.   

“Until we set up the system of reporting we had little idea of the size of the problem,” says Richard Hampton, head of local support and development services for NHS Protect. “Now we have a better idea, although we know this is not the full extent of it. However, rather than accepting violence, people are reporting it. The concept that someone attacking you us part of job is being challenged.”

NHS Protect uses the data it gathers to shape its anti-violence policies. For example, it found that of the 59,744 physical assaults on NHS staff last year, more than three quarters of the perpetrators either had mental health problems or learning disabilities. This prompted NHS Protect to develop a piece of guidance for staff on how to manage and prevent violence when working with people with challenging behavior.  

NHS Protect has issued guidelines on dealing with dangerous dogs, conflict resolution training, what to use hi-tech personal alarms for and anti-social behavior. Over 40,000 healthcare staff in England now use the Lone Worker Service, launched in 2009 to protect staff working alone in potentially dangerous situations. In 2010, NHS Protect launched new guidance on the use of “markers” on patients’ care records, in order to alert staff to the risk of physical violence or aggression from certain patients.

Its Legal Protection Unit (LPU) offers free paralegal advice to health bodies, particularly on the sanctions available against those who assault, harass and abuse NHS staff and in chasing down private prosecutions against perpetrators of violence. As a result, the number of people prosecuted for assault on NHS staff is rising rapidly year on year.

The system also operates at a regional level. In July this year, NHS Protect coordinated the signing of a new service level agreement (SLA) between four police forces and the West Midlands Crown Prosecution Service, to help protect NHS staff in the Midlands from violent and antisocial behavior. The SLA aims to improve information exchange and lines of communication, in particular between the police and NHS, in order to tackle and prosecute violent acts on NHS premises.

Barriers to adopting this approach in social care

In 2010, Unison published a 10-point blueprint, including a proposal for a national system of monitoring violent incidents, aimed at combating the abuse and attacks faced by its 300,000 members in social care. However, the Local Government Association and the Association of Directors of Adult Social Services knocked back the plan, arguing the care sector was too large and disparate for such a system. They instead called on local authorities to improve their responses to risks in their local areas.

While campaigners for an NHS Protect style system admit that the social care sector is far more diverse than the NHS, with the vast majority of its workers employed not by councils but by the notoriously difficult-to-police independent sector, they are confident these barriers can be overcome.

“A national recording system will be more complex to deliver, but we believe if there is a will to do it then it can be done,” says Helga Pile, Unison’s national officer for social care. “It needs to extend to the providers that local authorities commission and this can be tackled, like the NHS do, through contract compliance.”

Indeed, NHS Protect ensures that all contracts between commissioners and providers contain elements that require them to provide services in line with the NHS’s duty to protect staff, to gather data on crime and to provide a framework where people have access to the most effective guidance and support.

Pile says the key value in the NHS system is consistency. “In our experience if it’s down to individual employers, then the way information is gathered is not consistent, and you need the data to reveal the trends.

“For example, our members were anecdotally reporting an upsurge in violence against them whenever a very negative case about social workers appeared in the media. But with no system of reporting violent incidents, we had no way of knowing if this is true and therefore no way of preparing for it.”

As NHS Protect has shown, a system can drive best practice purely in terms of its data. While refusing to be drawn on whether an increasingly localized social care sector should adopt an NHS Protect style system on dealing with violence, Hampton told Community Care: “Unless you know what the nature and scale of the problem is, how are you going to address the problem in a strategic and proportional way. But the bottom line is this: nobody should go to work and expect that they can be assaulted and nothing done about it.”

Find out the results of and reaction to our latest national survey on violence against social care staff

How to protect yourself

Watch our video guide to dealing with hostile behaviour at work (part of last year’s special report)

Read Unison’s revised and updated guide to dealing with violence

Find out more about the benefits of Unison membership for social care staff

More from Community Care

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