Knowing the risks

The Health and Safety Executive’s definition of work-related
violence is “any incident in which a person is abused, threatened
or assaulted in circumstances relating to their work”.

In social care risk is particularly high for lone workers, such as
home carers, outreach workers and personal assistants funded by
direct payments.

In a joint report by the HSE and the Home Office, care workers came
third in a table of those most at risk of assault, after security
staff and nurses.¹ So how do employers protect them?
What statutory duties and guidance are out there? And are they
abiding by them?

The Health and Safety at Work Act 1974 places a legal duty on
employers to ensure, so far as is reasonably practicable, the
health, safety and welfare at work of their employees.²
Although this is a mandatory duty, it is very general, says Ann
Harrington, policy adviser at the HSE’s health directorate. The
Management of Health and Safety at Work Regulations 1999 clarify
the situation, giving employers a legal duty to assess risk to
employees and take appropriate measures to reduce risk and monitor
and review the situation.

Employers also have a legal duty to report physical acts of
violence to staff that cause them to be off work for three days or
more to the HSE or the local authority, depending on which carries
out the health and safety inspection, under the Reporting of
Injuries, Diseases and Dangerous Occurrences Regulations
1995.

Four social workers were killed in the line of duty during the
1980s. These were followed by the deaths of Katie Sullivan in 1992,
voluntary worker Jonathan Newby in 1993 and Jenny Morrison in 1998.
It was Morrison’s death that prompted Community Care‘s No
Fear campaign to reduce violence and stress in social work.

Following hard on the heels of the No Fear campaign, the government
launched the National Task Force on Violence against Social Care
Staff in 1999. Its remit included producing strategies to reduce
violence, as well as a national action plan with recommendations
and timescales.³ Have things improved for staff since
then?

One task force recommendation was that every employer establishes
its own baseline data on the number of violent incidents affecting
workers by March 2002. It is too soon to know whether this has been
done effectively, but the overall target is for these figures to be
reduced by 25 per cent in three years.

However, Unison’s NOP survey six months ago asked local authority
social workers if their employer had produced new guidelines on
violence in the past 12 months. Forty per cent said yes. Owen
Davies, Unison’s senior national officer for local government, is
inclined to take this as good news. “It means they have updated or
changed their policy in the past 12 months, which is a result of
the task force.

“The important thing is that employers have to be accountable,” he
says. “They need thorough and appropriate risk assessment
procedures. They must work out safe systems of working -Êyou
don’t do this by giving staff counselling after they have been
beaten up -Êso, for example, they must decide whether workers
go in double-handed to a situation or carry a phone with an alarm
facility.

“It is prevention not cure and risk assessment is the word for
prevention when it comes to social care.”

Other task force recommendations now in place will also protect
lone staff. The new General Social Care Council code of practice
includes an employers’ safety standard. The National Care Standards
Commission inspects employers against this standard. The Social
Services Inspectorate includes the standard in its annual
performance assessment of all social services departments.

Employers had to undertake an audit of their organisation’s ability
to deal with violence and abuse, carry out a training needs
analysis for their workforce and prepare an action plan. Again,
through performance assessment framework, the SSI monitored their
progress and the latest information is that, by October 2001, 79
per cent of councils had made a good start with about a quarter
completing more or all of the tasks.

And training organisation Topss has contributed to the national
occupation standards on managing work-related violence produced by
the National Training Organisation for Employment.

Chris Davies, social services director in Somerset and chairperson
of the task force, is convinced that the situation has undoubtedly
improved for staff: “What we don’t know is the impact that it has
made on the ground level across the country, but that will emerge
through the performance assessment process.”

Part of the problem is the lack of information on the scale of the
problem. National Institute for Social Work workforce studies in
1997 found that about half of male staff and a third of female
staff had been physically attacked in their present job. More than
two-thirds of staff working with adults with severe learning
difficulties had been attacked and half of the staff working with
children and adolescents had been attacked.

“Everybody can tell you that there’s violence, what they can’t tell
you is the total nature, prevalence rates and the best way of
dealing with it,” says Lesley Rimmer, chief executive of the United
Kingdom Home Care Association.

Home carers are one of the largest groups of lone workers in the
social care workforce. About 60 per cent of domiciliary care is
provided by the independent sector, where organisations may be
small and have little ready access to human resources or health and
safety specialists. The UKHCA has sent all national task force
documentation to its members.

There are two types of violence within social care: deliberate
violence that comes from people being knowingly physically,
verbally or emotionally abusive; and violence from those who do not
know what they are doing, such as a confused older person or
someone with mental health problems.

Within a residential home it is easy to monitor this violence and
assess the cause – for example, the medication or environment could
be wrong, says Carolyn Gratton, UKHCA’s director of training and
development. Monitoring in domiciliary care, which takes place in
clients’ own homes, is not so straightforward.

“Training will help because some instances of violence can be
avoided by carers knowing how to handle the situation,” says
Gratton. “Unless they understand what causes the violence they
don’t know how their behaviour aggravates or minimises it. Is it
because they are upset because it is the anniversary of a loved
one’s death? Are they frightened or in pain and cannot express it?
When you understand the reasoning behind it then you can decide
which is the best way of managing it.”

Withdrawing care is the most drastic step an employer can take, but
sometimes a relationship breaks down irretrievably and it is the
only way to protect your staff.

One home care manager withdrew care from three clients – one who
hit staff with his walking stick, a disabled woman who pushed a
carer breaking her ribs, and another client who verbally abused a
carer who was gay.

Gratton says: “We need a survey to know the exact size of the
problem and the causes. We need to analyse why it’s happening and
then we need to train people to cope.” 

For more information go to www.doh.gov.uk/violencetaskforce  

¹ Tracey Budd, Violence at
Work: Findings from the British Crime Survey, HMSO, 1999

3 Department of Health, Report and National Action Plan of the
National Task Force on Violence against Social Care Staff,
HMSO, 2000