It's a fact of society that public service functions were once protected from disrespect and anti-social behaviour by unwritten rules. However, the combination of an ever-more demanding society, the effects of drug-associated crime and the withdrawal of police service response from some public arenas has engendered an increased level of risk. Is enough being done to safeguard against that risk, though?
Any security function aims to detect, prevent, deter, divert and/or protect the host organisation in the most cost-efficient manner, thereby contributing to corporate health, profitability and reputation. Sophisticated security is not always the answer. Very often, prevention is better than a cure, though – with security always being much less expensive than insecurity. A fact worth remembering.

Ultimately, security of any kind must make sense and be supportive of the organisation(s) it's designed to serve. It follows that security planning should be practical and convenient, and never be seen as a hindrance.

Public service functions were once protected from disrespect and anti-social behaviour by a set of unwritten rules. However, of late the combination of an ever-more demanding society, the effects of drug-associated crime and the withdrawal of police service response from designated public areas has produced an increased level of risk. Nowhere is this more apparent than in our hospitals, where anti-social behaviour, crime and weak building design have led to an enhanced danger for patients, staff and property alike.

In the belief that they're immune from such risks, hospital management teams – bless them – have generally been slow to react. Most believe they can rely upon the active support of the police, which is by no means assured (unless one pays for a 'contract' police officer, which some hospital teams have been forced to do at considerable cost). All claim to have seen improvements as a result.

The problem is that members of the public at large – and we include healthcare staff here – are now thoroughly familiar with the presence of security in such places as retail centres, airports and public events, and expect security improvements while they're at work.

Why, then, have hospital managers been slow to respond when it comes to managing the (increased) security risk? One reason has to be the all-too-obvious absence of professional security direction within the Department of Health, at both National Health Service (NHS) Executive and Strategic Health Authority level.

In practice, this has meant little continuity in installing common and safe security systems throughout the health service, and has given rise to a situation where perceptions about healthcare security are no longer challenged.

The NHS must be one of the few organisations in the country where there is no security practitioner at senior level to formulate security policies and procedures, and provide some form of advisory function. The consequence of this apparent weakness is that there's no continuity when it comes to instilling common security themes throughout the NHS.

Hard-pressed security managers, all of whom have better things to be getting on with in an attempt to meet Governmental demands, are expected to develop the complexities of a modern security strategy. There's also no-one to challenge perceptions.

Violent incidents on the rise
Statistics recently unveiled by the Department of Health suggest that there's been a rise of nearly 20,000 violent or abusive incidents to 85,200 since 1998-1999.

While it's accepted that this increase is due to improved reporting and new and different methods of collecting data, no mention has been made of the fact that the healthcare environment is inherently aggressive because of the very nature of hospitals. People are there because they're in pain, have mental health problems, are suffering from post-operation trauma, head damage or pure anxiety. No-one has yet posed the key question: "How many incidents were avoidable?" As such, the conclusion drawn is that the health service is a dangerous place in which to work and be treated.

In terms of avoidable violence, hospitals are probably safer places to be than universities and city centres. Triggered by a justifiable Zero Tolerance campaign several years ago, the Health and Safety Executive – working on a five-figure number of violent and aggressive incidents, and with little knowledge about hospitals – has targeted Trusts to improve upon how they tackle violence and aggression, and have issued several improvement notices. Nothing wrong with that, except for the fact that it smacks of being a knee-jerk reaction based on poorly-assessed information.

The consequence? Hard-pressed security managers are spending time, effort and money addressing the fears abounding over crime and security rather than tackling the identified threats, only one of which is violence and/or aggression.

For example, during the trial of an abductor, a Midlands hospital's management team recently experienced its reputation as a caring organisation coming in for severe criticism from the presiding Judge because of several – avoidable – security failures.

In short, there was no security culture at the hospital in question. The equipment and technology was all there, but it appears that the spirit was weak – resulting in the snatch of an infant by an 18-year-old woman.

A lack of finance
Lack of finance is certainly an issue. Security technology is expensive and, as a public body with heavy political influence, money is first directed at the patient and then on towards the medical and clinical staff. In effect, this means that in the yearly scramble for bids, security often loses out. However, to be fair there have been some notable successes here.

It's interesting to note that, in the Home Office's CCTV competition for funds a couple of years ago, hospitals weren't allowed to apply because schools assumed precedence at a time when hospitals were trying to tackle violence and aggression in the healthcare environment. In charge as they are for public bodies with huge healthcare responsibilities, there's no doubt that hospital management teams could do with some help.

If there are unsung heroes in hospitals, it's the security officers themselves. Often having to play out another role – as a porter or car park attendant (imagine that one!) – they are burdened with the unenviable task of removing aggressive and violent patients and visitors from casualty departments, helping staff with disruptive patients on the wards, searching for missing patients with mental health problems and confronting criminals.

The point is that they have to do so without the resources of protective clothing and 'accoutrements' like handcuffs that are freely available to police officers.

It's interesting, too, to note that these relatively poorly paid officers are often expected to deal with such issues on their own, yet the police would attend the 'scene of crime' in pairs or not at all. The direct consequence is that casualty rates are high, whereas sickness absence rates are low. Retention rates are also usually quite high, which says much for the morale and commitment of the officers themselves. Pity that they don't always receive the credit that's currently offered, particularly by their parent contractor companies (many of whom have only a vague idea of what happens to their officers when stationed on a hospital project simply because their reporting systems are pretty ineffectual).

That said, the bottom line is all right – even if it means that the security officers on site are afforded only cheap, waterproof clothing, or have to carry their radios around because a harness hasn't been provided.

One wonders, too, how many of these active officers have been inoculated against the HIV and Hepatitis viruses...

It's strange that the police service has been slow to even consider that healthcare security officers who interface with the public should have detention powers under the Police Reform Act. There again, chief constables would not be able to 'sell' their own police officers to local hospitals if that were the case. Healthcare security officers would seem to be an obvious choice to be included under such reforms.

Hope on the horizon?
Fortunately, there are glimmers of hope. The National Association for Healthcare Security – membership applications for which are invited from anyone with any form of security responsibility in a hospital (or hospitals) – deserves the 100% representation it ought to have. It continues to influence the direction of healthcare security by virtue of closer links with other security organisations in the NHS. That said, it must adopt the same profile as the Guild of Security Controllers, whose influence in the defence sector is such that nothing happens without its prior knowledge.

The other key factor is controls assurance security. This is an auditing mechanism in which Trusts are expected to meet 12 criteria ranging from accountability through to incident reporting and the compilation of policies and procedures. Introduced about three years ago, it was the first time that Trusts had been expected to review protective security. The problem is that not every Trust has an experienced security practitioner and, consequently, there's a good deal of reinventing of the wheel going on. Alas, not much of the outcome is of a great standard.

While there's no reason why Trusts shouldn't audit themselves, there should be independent auditing teams in place inspecting protective security to ensure that a credible standard has been reached.

In conclusion, with increasing public demand for assured security while at work, itself directly reflected by the high demand for security in most hospitals, there's a real and critical need for positive direction from the top – and soon.

It's high time that a security guru was appointed at both the Department of Health and the Health and Safety Executive.