Analysis

Fall in staff assaults is recorded but acute care attacks on the rise

The number of reported physical assaults against all NHS staff in England in 2014/15 has fallen slightly on the previous year – down from 68,683 in 2013/14 to 67,864.

Picture credit: John Behets

This is a welcome drop given that in 2013/14 physical assaults on NHS staff in England reached their highest since national data began in 2004/05.

But the figures, collected by NHS Protect which provides guidance on security in the NHS, show it is not all good news. Attacks on nurses and other acute care staff in England have risen in the past year, with 19,167 physical assaults in 2014/15, compared with 17,900 in the previous year.

NHS Protect head of external engagement and services Richard Hampton says staff who are victims of violence should be encouraged to report it so ‘appropriate action’ is taken.

He says the 2014 NHS staff survey indicated that about 34% of incidents of violence are not reported, suggesting the actual number of incidents is much higher. ‘While it is encouraging to see the total figure going in the right direction, there is no room for complacency after this small reduction in reported assaults,’ he explains

While assaults in mental health settings fell from 47,184 to 45,220, mental health organisations continue to have the highest number of assaults per 1,000 staff (see box below).

Health bodies with the most assaults in 2014/15
Name of trust (all mental health) Declared total staff Assaults per 1,000 staff 2014/15 Assaults per 1,000 staff 2013/14
Calderstones Partnership NHS Foundation Trust 1,039 1,352 1,098
Coventry and Warwickshire Partnership NHS Trust 4,129 703 517
Northumberland Tyne and Wear NHS Foundation Trust 5,959 600 516
Rotherham, Doncaster and South Humber NHS Foundation Trust 3,653 342 282
Bradford District Care Trust 2,956 339 308
(NHS Protect 2015)

Mr Hampton explains that a partnership protocol is due to be launched by NHS Protect, the National Police Chiefs’ Council and the Crown Prosecution Service to protect staff in NHS mental health settings by taking appropriate cases forward for prosecution.

In May last year, the National Institute for Health and Care Excellence (NICE) published guidance on helping NHS staff to deal with violence and aggression from patients. The guidance states that providers should train staff in recognising early signs of agitation and anger, as well as using techniques for distraction and calming. It also says physical restraint should only be used as a last resort.

Assaults on NHS staff by sector (2014/15)
Sector Total Assaults Assaults involving medical factors Assaults per 1,000 staff
Mental health 45,200 35,338 187
Ambulance 1,861 551 44
Acute 19,167 14,152 21
Primary care 1,616 1,281 19
(NHS Protect 2015)

RCN professional lead for mental health Ian Hulatt welcomes the reduction in assaults in mental health settings, particularly given the backdrop of challenges with nurse recruitment and a shortage of hospital beds. But he warns against complacency.

‘As people are looking at reducing restrictive interventions such as seclusion and restraint as well as responding to NICE guidance, I hope these figures will fall further,’ he says.

Lack of training

However, Restraint Reduction Network chair and mental health nurse Joy Duxbury, says too often restraint is still used as a first line of defence.

‘Nurses we meet tell us they do not like restraining patients, primarily because they lack the necessary training in how to do it safely,’ she explains. ‘This actually causes more injuries and recordings of assaults because nurses get forced into trying to restrain a patient when they don’t know what they are doing.’

Professor Duxbury explains that it is important nurses have enough time to ‘forge bonds’ with the patients they treat. ‘Then when the time comes to treat them, patients are often much calmer,’ she adds.

At Calderstones Partnership NHS Foundation Trust in Lancashire, which had the highest number of assaults, the figures for reported attacks are higher than the number of staff employed, with 1,352 and 1,039 respectively. The assaults per 1,000 staff have also risen on the previous year’s figure of 1,098. More than 96% of assaults on staff at the trust involved medical factors, including mental health conditions, personality disorder and autism spectrum conditions.

The trust supports adults in low and medium security settings, and many patients present with extremes of serious, challenging or offending behaviour.

Trust executive director of nursing and quality John Smith says support and training for staff is vital. ‘We work hard to ensure they are proficient in delivering positive behaviour support and ensuring they can apply secondary and tertiary strategies when needed.’

In November last year, a risk management and incident reporting system was introduced to make it easier to analyse incidents and put processes in place to reduce future occurrences.

Coventry and Warwickshire Partnership NHS Trust, which provides specialist mental health and learning disability services had the second highest number of assaults per 1,000 staff. Director of nursing and quality Tracey Wrench attributes the rise in its figures to improved staff reporting, adding: ‘We report every incident that constitutes an assault, from grabbing someone to a really serious physical assault.’

The trust is currently implementing a Safe Wards programme which involves a range of interventions to positively influence behaviour on wards, such as designing friendly, calming wards and using calm down methods when treating patients.

Terry Ferns, a London-based nurse academic who teaches conflict resolution and tackling violence, says that assaults on staff tend to rise in line with austerity measures and staffing shortages. However, he says nurses can take measures to protect themselves at work.

Dr Ferns says having a friendly and empathetic manner is important. ‘If you come across as a caring person you are less likely to be assaulted than staff who do not appear as compassionate,’ he explains.

RCN senior employment relations adviser Kim Sunley says: ‘Organisations should look at where the hotspots are to allow time to learn from incidents and put in place local solutions’.

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