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You’ll never work alone

Ensuring the safety of lone workers

What do NHS lone workers need to protect them? Robust risk assessments? Effective policies? Reliable communications? Effective emergency procedures? Safety training? The answer is all of them, says Simon Whitehorn

NHS staff face a wide range of risks to their safety and efforts have been made to address the level of violence they face. This includes those contracted to the NHS, such as security officers.

Particular attention has been focussed on the safety of lone workers. In 2007, the then health secretary Alan Johnson announced that to give greater protection, personal safety alarms would be issued “to those NHS staff who need them, as part of a £97 million boost to the NHS security budget”.

This was a repeat of a pledge in 2005 that NHS community staff would each be given an alarm. These announcements and the increased emphasis on security in the NHS are to be welcomed as they acknowledge that threats to NHS staff exist and provide a focus for efforts to address them.

Sadly, however, the boost to the NHS security budget did not amount to increased funding, merely re-prioritisation of existing budgets and it has taken two years since Mr Johnson’s speech for the first of 30,000 lone worker safety devices to be issued to NHS staff.

The HSE define lone workers as those working “by themselves without close or direct supervision”. As with any risk, employers have a responsibility to assess the risk arising from their activities, reduce it and manage the residual risk. The NHS Litigation Authority requires trusts to take measures to protect lone workers by having a policy in place and actively monitoring its implementation and effectiveness. Both these bodies refer to the NHS Security Management Service lone worker guidance and expect trusts to take it into consideration in their efforts to protect lone workers.

The HSE’s guidance identifies measures employers should undertake to assess the risks and control measures relating to lone working, including assessing if the risks can be safely controlled by one person; if the worker has a medical condition whether they work safely alone; what training staff require and whether lone workers are competent to deal with circumstances that are new, unusual or beyond the scope of training; and what methods of supervision will be used.

Lone workers’ health and safety may be compromised by a number of factors including access and egress, machinery, environmental factors, violence and factors specific to the worker namely age, disability, pregnancy or limited knowledge of English causing difficulties in communication. Whilst these factors need to be managed, most emphasis on protecting lone workers is often focussed on the risk of violence.

The relationship between occupation and risk of assault at work has been well documented but exposure to violence at work depends not only on occupation but the circumstances and situations in which a person performs their job. Working alone does not automatically imply a higher risk of violence but it can increase the vulnerability of workers.

A wide range of NHS staff undertake lone working in healthcare premises and in the community. Paramedics, CPNs, receptionists, midwives, OTs, porters, engineers and phlebotomists amongst others may all be lone workers

Policies
It is often not in the production but the application of policies where problems become evident. Common challenges to the effectiveness of a lone worker policy are:

Inaccurate contact details and descriptions/photographs of staff and details of vehicles.
While itinerary tracking systems may be in place, their application is not audited by supervisory staff.
Failure of staff to comply with regular reporting of location, often citing ‘Big Brother’ surveillance concerns. This implies a lack of recognition that they have a responsibility to comply with policies and procedures.
Out of hours weaknesses, with staff acknowledging that lone workers could be unaccounted for until the following morning or until a family member reports absence.
An assumption that police would be called to search for missing staff. Accurate information is needed before mounting a search and missing staff may not be regarded as a priority for several hours.
Failure to use standardised forms to log lone worker activity, with details often scribbled on a notepad or a wipe clean board, if recorded at all.
Supervision

The supervision of lone workers may be conducted in a number of ways. Periodic visits and regular contact by supervisory staff are the most effective. Automatic warning devices which operate if signals are not received (known as “man-down” systems) or other devices designed to raise an alarm in an emergency offer a technical solution. The final layer of supervision is making checks to ensure a lone worker has returned to their place of work or home.

Communication

Mobile phones are a useful asset but reception problems exist in both urban and rural areas, a factor that should be included in the risk assessment process and for which the policy should take account.

The lone worker devices identified earlier are a reassuring tool but usually utilise mobile phone technology with the problems identified above and are dependent on staff overcoming their “Big Brother” concerns and recording their locations prior to every visit.

Often overlooked when considering communication is the communication of risk relating to individuals and environments.

Risk assessment, recording & information sharing

In community settings where there is known or unquantified risk, two health workers should visit together. Ideally, lone workers should not enter any premises ‘blind’ after an initial visit. Before any visit, contact should be made with other professionals engaged with the individual to be visited to ascertain:

Pertinent history including medication and mental health concerns
Risks presented by relatives, carers, neighbours or associates.
Presence of animals.
Environmental hazards.
Record of complaints.
Layout of premises, parking areas, access and egress points.
Mobile phone “blackspots”.
Information gathered before and during a visit should be recorded and shared with team members and other agencies, utilising warning markers on care records and incidents should be analysed to identify lessons learnt.

Training

Trusts have a duty to ensure that employees are given the necessary information, instruction, training and supervision to enable them to recognise hazards and appreciate the risks involved with working alone.

Personal safety training courses covering safe working practices, spatial awareness and travel safety, including the use of public transport and private vehicles are essential. Other elements that should be included are communication procedures such as pre-programming telephone numbers, the use of planned calls to lone workers during visits and code words or phrases to signal an emergency. Emergency procedures should also be included and basic first aid may already be part of mandatory training.

Some trusts include breakaway techniques to assist staff escape from an assailant. Despite evidence that staff do not retain the detail of specific breakaway techniques most will remember simple themes and concepts and evaluate breakaway training positively.

Conclusions

Although lone worker policies are workable strategic documents, their application is often intermittent. It is essential that managers establish clear procedures to ensure safe working practises and then actively ensure they are being applied. This may mean checks of records and observation of lone worker activities. Equally, staff have a duty to apply lone working procedures for their own and colleagues safety. Policies are only ever effective if compliance with them is monitored.

Continuous intelligence gathering should be carried out to ensure that when lone workers visit a premise, they are in possession of the latest risks.

A committee such as health and safety or risk management should review reports of all incidents involving lone workers.

Finally, the most trusted procedures are often those devised and implemented by small, close knit teams and those where managers proactively apply policies and monitor them to ensure that they are effective.

References:

BBC (2010), Full text of health SecretaryAlan Johnson’s speech to the Labour party Conference. http://news.bbc.co.uk/1/hi/uk_politics/7012265.stm Accessed on 9 January 2010

Budd, T. (1999) Violence at work: findings from the British Crime Survey. Home Office Occasional Paper. London: Home Office

Chappell, D. & Di Martino, V. (2000) Violence at Work. Geneva: International Labour Organisation

Health & Safety Executive (2009) Working Alone Health & safety guidance on the risks of lone working. http://www.hse.gov.uk/pubns/indg73.pdf

Simon Whitehorn is security management specialist for Birmingham & Solihull Mental Health NHS Foundation Trust and National Association for Healthcare Security

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