Campaign to beat violence on the wards

The Government will not tolerate any abuse of NHS staff, writes Alex Watson

The sight of a traffic warden being abused by an irate car owner is such a common occurrence that it scarcely warrants comment. You would not, however, expect to see a nurse receiving the same treatment. Yet there are around 65,000 violent incidents perpetrated against NHS staff each year and hospitals are increasingly unsafe places in which to work.

A survey carried out by the Royal College of Nursing (RCN) and Nursing Times magazine last year found nearly half the 950 nurses questioned had been physically attacked in the last year and 85 per cent had been verbally abused. More than 80 per cent said aggressive incidents had increased since they had joined the profession. Those particularly at risk are nurses, ambulance and Accident & Emergency staff, and carers of psychologically disturbed patients.

Anxious to tackle this, the Government has launched a Zero Tolerance Zone campaign, to underline to the public that violence against staff working in the NHS is unacceptable. The Government is determined to make it clear to all hospital staff that violence and intimidation will not be tolerated and is being dealt with. Speaking at its launch last month, Health Minister John Denham outlined the human cost of violence in hospitals: "The threat of violence causes fear and anxiety. Physical attack causes serious injury. Other patients suffer. Scarce resources for patient care are wasted. Violence and the threat of violence puts people off working in the NHS and makes others give up."

The financial cost of violence to the NHS is also considerable, and includes sick pay for time off work and the additional cost of temporary cover; fees for legal action; counselling; loss of experience and the cost of training if staff leave.

Sheelagh Brewer, the RCN's employment relations adviser, explains: "Some staff are going to work feeling worried that it's going to be another day of abuse from patients or their relatives. When you have experienced aggression it stays with you for a long time and affects how you do your job."

Although it is a particular problem in hospitals, violence towards staff applies throughout the public sector. As well as the caring professions, teachers are particularly at risk, as are social workers and environmental health workers who may be closing down offices or threatening to. Sarah Simpson, training director at The Suzy Lamplugh Trust, the national charity for personal safety, claims the public sector has the highest levels of risk, as people see it as providing a service they have a right to. There are, Ms Simpson believes, various reasons for the increase in violence. She says: "We live in a much more stressful society, where things like getting stuck in a traffic jam create stresses that you pass on to the next person you see. More people believe they have rights, and many just feel violence is a way of getting attention."

Employers have duties with respect to the management of work- related violent incidents, framed both by national and European health and safety legislation and by their common law duty of care. The problem is that in many organisations, policies either don't exist or are ignored. Ms Brewer argues that the majority of hospitals do have safety policies, but they have realised that more needs to be done to communicate these to staff. She says: "Many organisations are doing good work around policy, but too often it sits forgotten in a file somewhere. Employers need to roll it out and let staff know everything is being done to protect them at work."

The vital factor for an effective safety policy for staff is teamwork and getting everybody to make strategies together. The Suzy Lamplugh Trust runs awareness-raising sessions for a number of NHS trusts, and Ms Simpson believes that by directly involving employees in forming strategies for violent incidents at work, they become far more confident at dealing with it. She stresses that few violent incidents are unpreventable, so staff can greatly reduce the chance of them happening if they are trained to deal with people and situations.

The health service has drawn parallels from the aviation industry, which has been faced with developing strategies to deal with increasing numbers of air rage attacks on cabin staff. The Government's recognition of the problem helped bring in new legislation against disruptive behaviour on airlines in September, and has helped demonstrate to airline employees that any violence they are subjected to will not be tolerated.

The Zero Tolerance Zone campaign promises to be similarly effective in letting hospital staff know that their managers will take a strong line if they are subjected to violence. By sending out the message that violence does not have to be tolerated, that it is a criminal offence and that offenders will be sentenced properly, hospitals will help to give staff the confidence they need to carry out their work. Other organisations, it is hoped, will learn from this model.