Press Release - A Safer Place to Work: Protecting NHS Hospital
and Ambulance Staff from Violence and Aggression
27 March 2003
Head of the National Audit Office, Sir John Bourn, reported to
Parliament today that good progress has been made to improve the
protection from violence given to NHS staff. However he said that
more needs to be done particularly on risk assessment, staff
training, follow up after an incident has been reported, and the
establishment of effective partnerships between the NHS and other
public agencies such as the police.
In the last 2 years the level of reported incidents of violence
and aggression against NHS staff working in acute, mental health
and ambulance Trusts has increased by 13 per cent. Around 95,500
incidents were reported in 2001-02 and only a fifth of Trusts met
the Department’s national improvement target of a 20% reduction by
April 2002.
Better awareness of the need for reporting and more widespread
use of common definitions of what constitutes violence and
aggression have contributed to this reported increase. But many
Trusts consider that increased hospital activity and higher patient
expectations particularly in relation to waiting times, have also
contributed to an increase in the actual levels of violence.
There is little or no data on the financial impact of violence
and aggression but, based on their estimates of the cost of
work-related accidents, the National Audit Office estimate that the
direct cost is likely to be at least £69 million a year. This
excludes staff replacement costs and the human costs, such as
stress, low morale, lost productivity and high staff turnover,
which are known to be substantial.
Nurses and other NHS staff who have direct interaction with the
public (including the ambulance service, accident and emergency
departments and acute mental health units) face the highest risk of
violence and aggression. For example, nurses are up to four times
as likely as other employees to experience an incident and the
average number of reported incidents in mental health and learning
disability Trusts is almost twice the average for all Trusts
despite evidence that staff in mental health units are much less
likely to report incidents. Generally there remains a high level of
underreporting, particularly by doctors, and we estimate that
almost two in five incidents go unreported.
The Department of Health, through its zero tolerance zone
campaign, has been successful in raising awareness of the need for
staff to report and in informing the public that violence against
staff working in the NHS will not be tolerated. The NAO’s survey
found that while all NHS Trusts have embraced the values set out in
the NHS zero tolerance zone campaign, different definitions are
used and there are wide variations in reporting standards and in
the support provided to staff. These factors make it impossible to
say conclusively how far the increase in reported violence reflects
an actual increase in incidents, or measure how individual Trusts
are performing.
Violence and aggression against NHS staff results from a complex
combination of personal and situational reasons including anxiety,
medical or psychological conditions, drugs or alcohol and it is
difficult to predict what could trigger an incident. The NAO found
that many Trusts have generally responded positively with better
use of risk assessments, staff training, and improvements to the
physical environment to make it both more patient-friendly and at
the same time more secure for staff.
However the NAO identified the need for further work in key
areas. While Trusts had improved their reporting procedures over
recent years, two in five incidents still go un-reported and more
needs to be done to ensure that staff understand how and why they
should report incidents and to demonstrate the value of reporting
by ensuring that appropriate action is taken and feedback provided
to staff. A survey by the Royal College of Nursing suggested that
in four out of five cases no action arises from an incident being
reported, and it is clear from the NAO’s work that some Trusts do
not provide adequate support to staff wishing to pursue civil
actions.
The NHS needs to do more to establish partnerships with the
local police, the Crown Prosecution Service, social services and
the media to ensure that there is a clear understanding of
different organisations’ roles leading to a clear and consistent
approach to dealing with violent individuals and incidents in NHS
settings.
Effective staff training is crucial in tackling violence and
aggression. The NAO found that the approach across Trusts is
improving but that doctors, ancillary and support staff are still
not receiving sufficient training. They also highlighted
uncertainties about the quality of courses in the absence of a
system of accrediting course providers and a need for annual
training needs analysis for all clinical and support staff.
While Trusts have implemented various security measures aimed at
combating violence and aggression, such as CCTV and panic alarm
systems, there is limited scientific evidence of the effectiveness
of these measures. When introducing new measures Trusts need to
identify clearly the risks they intended to address and evaluate
their impact.
Sir John said today:
"It is unacceptable that the very people who are trying
to help the sick and injured are themselves subject to violence and
aggression on a daily basis. Apart from the immediate impact on the
individuals concerned, the experience or threat of violence causes
increased stress and sickness absence, lowers staff morale and
drives individuals out of the health sector at a time of serious
staff shortages. Good progress has been made through the zero
tolerance zone campaign, but the NHS needs to demonstrate clear
improvement across Trusts in incident follow up, staff training and
partnerships with other public agencies."
Notes for Editors
- The National Audit Office will publish a companion report on
the management of health and safety risks to staff in April.
- Press notices and reports are available from the date of
publication on the NAO website at www.nao.org.uk
Hard copies can be obtained from The Stationery Office on 0845 702
3474.
- The Comptroller and Auditor General, Sir John Bourn, is the
head of the National Audit Office which employs some 800 staff. He
and the NAO are totally independent of Government. He certifies the
accounts of all Government departments and a wide range of other
public sector bodies; and he has statutory authority to report to
Parliament on the economy, efficiency and effectiveness with which
departments and other bodies have used their resources.
Press Notice 25/03
All enquiries to Keith Davis and Mark Andrews, NAO Press
Office:
Tel: 020 7798 7284/7743
Pager: 07699 783748