Under attack

Source: NHE May/June 2018

One attack against an NHS worker is one too many. But unfortunately, the trend in recent years has been alarmingly upwards, with no part of the NHS seemingly immune, writes Sara Gorton, UNISON head of health.

UNISON – the biggest health union – has been so concerned about the growing levels of violence that it recently commissioned research to find out the true scale of incidents across the NHS.

The shocking finds revealed that there were over 75,000 reported assaults against NHS staff in 2016-17. That’s the equivalent of 200 every single day, an increase of almost 10% on the previous year.

When NHS Protect was scrapped last year, UNISON was keen to ensure its remit for staff safety and the collection of national data on violent assaults was not lost.

But the organisation that replaced it – the NHS Counter Fraud Authority – only does what its name suggests. The remit for the safety of staff has simply been dropped.

Our research suggests that this has been a huge mistake. The biggest increase in violent assaults was in the acute sector, with reported attacks on health workers in hospitals with an A&E department up by a massive 21.5%. There were 18,720 assaults in these trusts in 2016-17, compared to 15,551 the previous year.

The safety of healthcare assistants, nurses, porters, receptionists and all those NHS staff who face potential violence within their jobs – while caring for patients and trying to save lives – must be paramount.

But since the demise of NHS Protect, the collection of data on assaults, or about the criminal or civil sanctions that take place following incidents, is simply not happening in anything like a robust or consistent manner. Our concern is that if NHS organisations are not mandated to collect this important data, they’re likely to stop doing so altogether.

But trusts cannot see how well, or how badly, they’re performing on staff safety if there are no figures to compare theirs to.

Staff and patient safety must be a priority within the NHS. We cannot have a situation where it’s acceptable for staff to feel that regular assaults are ‘just part of the job.’ In some trusts, particularly ambulance services, there is a downward trend in people reporting verbal abuse. NHS staff mustn’t become desensitised to violence or verbal abuse.

People who are trained to care for patients often don’t think to put their own safety above helping an individual. Staff already don’t report every incident where they are shoved, pushed or prodded – otherwise they would struggle to find the time to care for patients.

So more has to be done to stop these assaults in the first place, but there is not a one-size-fits-all approach that can be adopted by every part of the NHS. Of course, it’s not going to be possible to prevent every assault, but there are ways to make staff feel safer and reduce assaults without harming patients’ trust or care.

There must be a national body dedicated to the safety of  staff which has the authority  to insist trusts provide the necessary data,  so that employers can use a robust evidence base to adapt working conditions and create less stressful environments.

The conversation around this issue needs to be much bigger – from discussions around adult nurse training, so the mental health of those attending hospitals with physical needs is not overlooked, to redesigning A&E departments and repainting corridors in more calming colour ways.

There are many trusts around the country doing great work to make their workplaces better and safer for staff.

Some mental health trusts have seen a significant drop in physical assaults by focusing on what has sparked each violent incident and dealing with the root cause, such as introducing more activities to reduce boredom and frustration among people who use the services or moving rotas to make sure someone familiar will always be on shift. Some acute trusts have even made a difference by redesigning the environment and  looking at how quickly patients are initially seen in A&E.

But there is currently nowhere they can share best practice or swap ideas about new ways of working.

And no-one is there to insist this must be a priority for all NHS organisations. This is where the government needs to step in.

Finances and performance

One of the most worrying findings from our research was the strong correlation between trusts that have higher deficits and those where violent assaults have increased significantly. In workplaces that are struggling financially, there are likely to be staff shortages and longer waiting times for patients; this leads to pressures on patient services and increased stress for individuals. Reduced funding also means a reduction in what training can be given to staff – knowing what to do to defuse a potentially violent situation can make all the difference.

The data collected also suggests that, last year, NHS trusts struggling to meet their performance targets were likely to fare particularly badly too. Trusts who treated 90% or fewer of their patients within 18 weeks of referral saw an average increase in reported assaults of 36.2% in 2016-17 (6,982, up 1,857 on the previous year).

This is unlikely to surprise anyone working in the NHS. If staff are always working at 120% of their capacity, they have less time to approach a volatile situation calmly and patiently. When patients are faced with increasingly fragmented services and rarely see the same member of staff twice, this can lead to frustration or fear, which in turn increases the likelihood of an aggressive incident.

Staff need time to report incidents when they occur. They should not be made to feel that there isn’t ever enough time to do so. They must feel supported and reassured that appropriate action will be taken, either when they report an attack or when they withdraw from a dangerous situation to protect themselves or colleagues.

Ministers can’t keep hoping that if they look the other way for long enough, the problem of violent attacks against staff is simply going to disappear. It’s time they stepped up and showed staff that they’re on their side.


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