Analysis

Violence in the NHS: why prevention and psychological care are as important as payouts

The measures needed to protect nursing staff from assaults at work

The measures needed to protect nursing staff from assaults at work

  • Revealed: The personal and financial cost of violence against NHS staff
  • New legal protections for health service employees who are assaulted at work
  • Best practice examples of employers who are tackling the issue – and what to do if you are attacked

Picture: Daniel Mitchell

Nurses and other NHS staff who have been attacked at work have received compensation payouts totalling £20.4 million in England over the past three years.

While compensation may go some way to address the damage of assault, the RCN is urging employers to improve psychological support, and focus on preventing violence in the first place through better staffing and risk assessments.

Figures obtained by Nursing Standard from NHS Resolution for 2015-18 show the £20.4 million reflects 475 successful claims by staff against employers for assaults at work.

Information from employers reveals the appalling nature of these assaults, including hot water being thrown in someone's face, staff being bitten, punched, kicked, attacked with weapons, grabbed by the throat, or kneed in the face.

‘Sometimes nurses feel abandoned’

RCN national officer Kim Sunley says it is likely the higher payouts for assault claims relate to the psychological trauma suffered by staff, as well as any physical injuries.

70,555

assaults against NHS staff were recorded during 2015-16 in England

Source: Ministry of Justice

‘Employers must do more to mitigate trauma after an assault, such as offering counselling support. Sometimes nurses can feel a bit abandoned in the aftermath,’ explains Ms Sunley.

‘It is a shocking amount of money and behind that figure and numbers are people whose lives have been seriously affected.

‘This is money that could be spent on nursing staff, so it is in everybody’s interest to prevent these incidents.’

‘We need to look at data collection – where it is happening, what are the pinch points and triggers?’

Kim Sunley, RCN national officer

Following a year-long review of the mental well-being of NHS staff, Health Education England recently published recommendations for improving post-trauma support. The recommendations include access to a Samaritans-style mental health support service and rapid mental health referrals.

Prevention, not reaction

While Ms Sunley welcomes the focus on greater psychological support in the aftermath of an incident, she says more needs to be done to prevent incidents happening at all.

'We need to go back and look at training, risk assessment, and at data collection – where it is happening, what are the pinch points and triggers?

'If there are a lot incidents in A&E at night, or in a mental health unit, employers can target risk reduction.'

Association with mental ill health

A high proportion of assaults stem from patients with mental health conditions, or dementia. Three quarters of the 53,555 of assaults against NHS staff in England in 2015-16 were attributed to patients' medical conditions, the Ministry of Justice confirmed last year.

Some cases of violence against nurses have been so serious they have led to employers being fined by the Health and Safety Executive.

In one such case, a nurse and a healthcare assistant at a mental health trust were stabbed by a patient with schizoaffective disorder, antisocial personality disorder and a history of violence.

1,544 

assaults against nursing staff working alone, such as district nurses were recorded in England from 2015-17

The Oxleas NHS Foundation Trust pleaded guilty to two charges of failing to ensure health and safety and last December was fined £300,000 at the Old Bailey.

The trust is currently investigating 10 compensation claims by staff assaulted by patients between 2016 and 2018.

Safety improvements

The trust tells Nursing Standard it has a ‘comprehensive programme’ of safety improvements since the 2016 stabbings, including:

  • The It’s Not OK campaign, which provides support for staff, challenges abusive behaviour and takes legal action where necessary. It also involves police liaison.
  • Programmes to look at ways to reduce violence and aggression. Evaluation has shown increasing occupational therapy interventions significantly reduces aggression in inpatients.
  • Shoring up lone working safeguards.
  • Reviewing staffing levels and encouraging staff to record every incident of violence and aggression.

A trust spokesperson says: ‘We held a full investigation at the time into the specific issues on the ward in question and have made a number of changes as a result.

'Since these were implemented, the Care Quality Commission visited the unit in April 2017 and rated services there as good for all areas, including being safe, and outstanding for being responsive.’

Action to encourage reporting

Sussex Partnership NHS Foundation Trust, which looks after people with mental health conditions and learning disabilities, is working with police to tackle violence and antisocial behaviour against staff.

Operation Cavell, named after heroic first world war nurse Edith Cavell, began in 2016.

It aims to encourage reporting, after the trust found only a 'very small number' of incidents of physical and verbal violence against clinical staff resulted in police action.

Under the terms of Operation Cavell, the trust will support in reporting matters to the police, if formal action is warranted.

Support from police

Sussex Police has pledged support NHS staff who report attacks, and to take positive action.

'The safety and well-being of our staff is hugely important to us and any form of violence against a member of NHS staff is unacceptable,' trust chief executive Sam Allen says.

'The partnership raises awareness and an understanding that an assault on a member of our NHS staff is an offence in the same way as if it were a member of the public, and that such behaviour will be reported to the police.'

 

Strengthening legal protections

Of course, compensation is only part of the story.

In 2008, Scotland became the first UK country to make it a specific criminal offence to assault a healthcare worker.

And last November, after campaigning by MPs and health unions, a new law in England and Wales strengthened protection for nurses, police and other emergency workers against violence.

The legislation means that maximum prison sentences for those who assault public sector workers in the course of their duty double from six months to one year.

It will enable judges to consider longer sentences for offences such as grievous bodily harm and sexual assault if the victim is a nurse or other emergency worker.

Ms Sunley adds that this law will ‘go some way’ to sending a determined message that assaults on staff are not acceptable, but employers need to maintain focus on prevention.

Use of data as a prevention tool 

Part of that prevention depends on data pinpointing where and why incidents occur, she says.

180

assaults against NHS staff every day in England

Source: NHS Protect

In the past, the now-defunct NHS Protect collected data on violence against staff. However, at the start of 2017, it was replaced by the NHS Counter Fraud Authority, a new agency that tackles fraud, bribery and corruption in the health service. 

Since this point, no one organisation is collecting data on violence against NHS staff.

‘NHS Protect kept all that data that we still want to see,' adds Ms Sunley.

Although individual employers have taken steps to protect staff, there are some encouraging signs that workplace assaults are being tackled at national level.

Multiple approaches 

Last autumn, England health secretary Matt Hancock promised investment in training, improved data collection on assaults, and psychological support as part of an NHS violence reduction strategy. The strategy also promises swifter prosecution of offenders and other measures to reduce violence, bullying and harassment for staff.

From this year, up to £2 million has been promised in the NHS Long Term Plan for staff training, mental health support for staff and to evaluate a pilot scheme for body-worn cameras for paramedics in England. By 2023-24, a further £8 million has been promised to pilot body-worn cameras more widely across the NHS.

‘It took four years to reach a settlement after my attack’

In March, NHS Employers chief executive Danny Mortimer called for those who attack nurses at work should receive the same swift justice as the spectator who assaulted Aston Villa footballer Jack Grealish.

Mr Grealish was assaulted by a pitch invader at a match in Birmingham in March. The following day his attacker was jailed for 14 weeks.

Nursing Standard readers responded to the story by sharing their experiences and views:

  • ‘This [problem] must be dealt with swiftly and firmly. Staff must know they have backup when assaulted, or will leave the profession in droves, if they aren’t already.’
  • ‘I was assaulted, diagnosed with post-traumatic stress disorder. It took four years to legally settle. This contributed to increased stress and anxiety.’
  • ‘I started my career as a mental health nurse in September 2017 and have been assaulted twice. Once repeatedly punched at back of head whilst by a patient who held me in a head lock. The second time I was punched in the face and received a broken nose by a patient detained under the Mental Health Act. Both had taken illicit drugs but neither charged or prosecuted as police said it wouldn't get passed Crown Prosecution Service as [their] capacity would be questioned… the new law means nothing as they don't get charged.’
  • ‘I was attacked last year. I’m still waiting for any kind of movement on the incident. It’s very discouraging to think it’s okay to be assaulted and racially abused at work.’

 

NHS Employers chief executive Danny Mortimer says: ‘Working with our trade union colleagues, arm’s-length bodies and employers, a plan has been agreed that will commit resources and new guidance to addressing staff experience of violence.

‘As the secretary of state announced in the autumn, this includes the commissioning of the National Institute for Health and Care Excellence to update guidelines on the management of patients whose violent behaviour is a result of their clinical condition or lack of capability.’

A Department of Health and Social Care spokesperson says it is ‘completely unacceptable’ for NHS staff to be subject to aggression or violence.

The spokesperson said the forthcoming workforce implementation plan will consider ways to reduce assault on NHS staff.’


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