Tackling violence in the NHS

The problem is increasing and your help is needed to help combat it

Staff, including medical students, working in the NHS go to work to care for others. They do not go to work to be victims of violence. No one has the right, whatever the circumstances, to abuse, intimidate, harass, or injure NHS staff and then expect the same staff to respond with their usual care and compassion. However, in recent years there has been an increase in the number of violent incidents against NHS staff. A survey of NHS trusts in England carried out in 1998­9 found that, on average, there were seven violent incidents recorded each month per 1000 staff. That is equivalent to approximately 65 000 violent incidents against NHS trust staff each year.

There is a significant cost arising from such violence. Some victims suffer physical or psychological pain or both. Confidence can be irrevocably dented, while stress levels rise. That is why the government and the NHS is determined to tackle this problem and to ensure that staff who spend their lives caring for others are not rewarded with intimidation and violence.

The government has set national improvement targets for reducing the incidence of violence against staff by 20% by 2001 and 30% by 2003. The NHS Zero Tolerance Zone Campaign is part of this strategy. It was set up in 1999 to tackle the problems of violence against staff working in the NHS. It defines violence as "any incident where staff are abused, threatened or assaulted in circumstances related to their work, involving an explicit or implicit challenge to their safety, well being or health." This includes both verbal and physical abuse.

The two aims of the campaign are, firstly, to tell the public that violence against staff working in the NHS is unacceptable and that the government is determined to stamp it out and, secondly, to get the message over to staff that violence and intimidation towards them is unacceptable and are being tackled. The campaign covers only England, but Scotland, Wales, and Northern Ireland should have their own initiatives up and running soon. Any trust can access the campaign material even though it may not have a specific policy on violence.

The campaign provides a strategic approach to tackling violence against staff. This approach recognises that the NHS cannot solve the problem on its own. Healthcare environments are integral to the communities in which they serve. Fostering good relationships within the community and, in particular, with the police is therefore important in reducing violence against staff.

There is no single solution to preventing violence against staff. The zero tolerance approach requires NHS employers to start with a thorough assessment of the risks. Local prevention strategies should then take into account a range of factors, including the environment in which staff work for example, walking along long, lonely corridors at night, and whether they can raise the alarm for help. Most hospitals now have CCTV cameras and some staff in busy emergency departments carry alarm devices.

Personal safety awareness training and knowing how to deal with the frustration and aggression of patients, family, and friends is also important. Where approriate such training should be made available to medical students. You should not be in situations that make you feel unsafe. If you are, however, you need to know how to deal with them. The level and type of training depends on the degree of risk that individual staff face. Many NHS trusts provide three levels of training: general awareness, the management of violence (including break­free techniques), and, for certain employees, instruction in control and restraint techniques. Precise training needs should be informed by the risk assessment process.

Every NHS employee has a role to play in tackling the problem of violence. Managers must ensure they properly assess the risks to staff and put in place local prevention strategies as described above. However, there is no point in having a safer working policy if few people know about it, so it should be widely circulated, read, and understood by all members of staff, including medical students. Equally, individual members of staff must ensure that they report all incidents of violence and abuse. This is essential if the risk assessment process is to accurately reflect the true level of violence directed at staff. Accurate reporting of incidents also provides the police with the information they need to charge offenders.

Finally, the zero tolerance approach also means that when violent incidents do occur, staff should receive appropriate support and practical assistance. Above all, no one should feel that they have to cope alone with violence, that it is part of the job, or that they do not have the support of their managers or colleagues. Aggression, violence, and threatening behaviour have no place in the NHS and should not be tolerated.

Simon Bennett, organiser of the NHS Zero Tolerance Campaign, NHS Executive, Department of Health, Leeds
Email: Simon.bennett@doh.gsi.gov.uk

As part of the campaign, the Department of Health has issued several guidance documents to help NHS managers and staff to tackle violence. You can access these documents by visiting the zero tolerance website on www.nhs.uk/zerotolerance, which includes a newsletter providing regular updates on the campaign

studentBMJ 2001;09:261-304 August ISSN 0966-6494

1. Health Service Report Issue 29, winter 2000­1,1­24.