Verbal and physical abuse against staff in hospitals has risen to such levels that hospitals are now adopting radical measures to stem the rising tide.
A recent TV programme, 'Casualty Cops', documented life at King's College Hospital where staff endured 9,000 attacks last year in the A&E department – despite a £3 million security investment in the last three years.
Other hospitals like Guys in London and Royal Berkshire & Battle Hospitals Trust have sought closer partnerships with the police, even to the extent of hiring beat officers to patrol the hospital grounds, and maintain exclusion policies for persistent offenders.
Now the Royal London NHS Trust is following suit with its own Zero Tolerance strategy. Involving Tower Hamlets police and the Crown Prosecution Service (CPS), protection extends to both patients and visitors alike. Two police officers are assigned to the Trust to maintain closer links with staff and on-site security.
Separately, the Trust has also produced a red and yellow card exclusion policy to deal with violent patients, and a more robust policy to manage aggression and violence within its three-year security strategy.
Reporting lines
Spearheading the Zero Tolerance strategy is Joe Greenan, security manager of Barts and the London NHS Trust which covers three sites – the Royal London Hospital, St Bartholomews and the London Chest Hospital in Bethnal Green.
Greenan heads up a team of four security managers and 30 on-site contract security personnel provided by First Security (Guards).
In 1999, the hospital recorded 650 incidents of violence against staff, of which 18 resulted in injury. But the figures measure only a small percentage of the actual problem. The hospital is now piloting an incident form which is expected to increase reporting levels. If there is any decrease in violence, it's going to be difficult – if not impossible – to attribute what that reduction is. Realistically, Greenan aims to compare them with the 1999 data.
That way, by 2001 he should be in a better position to see what progress the hospital has made.
The strategy has also called for a more sophisticated IT package which helps to analyse the incidents more closely, and identify the most vulnerable areas. Like all hospitals, though, it's the A&E Department which takes the most number of hits.
Says Greenan: "We've got a number of situational measures in A&E, combining the most sophisticated CCTV cameras in the Trust with panic alarms. If the panic alarm is pressed, the operator is to call security back-up, while at the same time dialling 999 to summon police. I also have a security manager on-site 24 hours a day who is able to respond to incidents of violence, to make sure the team is co-ordinated and to co-ordinate our efforts with the police."
After any incident, Greenan also maintains the database and follows up action with the police. By writing his own reports on the incident, and maintaining a close working relationship with police at Bethnal Green to exchange information, Greenan also collates the results of what happens to the perpetrator.
However, in line with Data Protection restrictions, some of the information that the police can release is only available to the victim. As a result, Greenan's strategy is based around writing to the victim, and asking to be kept informed of police action.
Three-pronged strategy
It's a strategy that's been embraced both by the inspector of operations at Bethnal Green police station – David Harris – and the branch crown prosecutor at Tower Hamlets, David Atkins.
Both Harris and Atkins attend quarterly meetings with Greenan, and have participated in moves to increase detection rates and speed up prosecution.
The hospital has also assumed responsibility for collecting medical evidence (often from doctors who are contracted to the hospital) following any violent incident and passing it on to the police, who can then take the inquiry forward and pass files to the CPS.
So far, one case has been passed on to the CPS where two employees were seriously assaulted, and there was some criminal damage on hospital property. One employee received superficial injuries, but the other received bite wounds.
The case stands as an excellent test of the tri-pact agreement between the hospital, the police and the CPS, and has now reached sentencing stage.
"The Crown Prosecutors' Code of Practice makes specific reference to any offence against a person serving the public," adds Greenan. "It also assists us to have closer liaison with the hospital regarding evidence, because you have to present the details of the injury so that the person who has committed those injuries is properly sentenced, and so that the person who has received those injuries receives the just level of compensation."
Off the streets
Why, though, is violence in hospitals increasing, and what can security managers do to alleviate the situation?
According to Inspector David Harris, the problem results from a shift in peoples' attitudes to hospital staff. "Attitudes towards staff who traditionally would have been respected have become less respectful," states Greenan. "There seems to be more alcohol and drug abuse which affects people's reactions, and because of the alcohol, it brings them into the A&E Department as well, so it acts as a double-edged sword. They're in here more, and they're more troublesome and violent."
Last year, there were 105,000 attendances at the A&E Department. The area the hospital lies in also attracts its own problems. Some 30% of the population in Tower Hamlets and Hackney is ethnic. Traditionally, it is also one of the most poverty-stricken boroughs in London, with the three worst wards – all of which are served by Royal London. There is also a high level of homelessness, with much of the population being refugees.
But now there is a new phenomenon of violence spilling out from the streets into hospitals, says Inspector Harris. "In my experience, it used to be that if someone was assaulted by a gang, when that person went to hospital, the gang wouldn't follow. Now we have regular instances – with the amount of gang violence in this area – where the gang will come into the hospital and look for the victim."
Apart from drugs, alcohol and gang violence, clearly there are other triggers for violence too. Says Greenan: "We deal with people in very traumatic circumstances. Waiting times can be a trigger for violence, and as part of the NHS controls assurance, we are looking at ways in which we can reduce our waiting times. There is a lot being done on the clinical side as well which directly helps us to manage aggression and violence within the Trust."
Dealing with violence
The red and yellow card system is now a firm procedure aimed at dealing with violent patients – and, if necessary, banning them from the site. While the hospital has a duty of care to treat injured patients, it is now taking positive action to remove persistent offenders once the treatment is over, if necessary with security escorts. Patients are then referred to their GP to make alternative care arrangements.
Greenan has successfully applied for £319,000 from the Government's budget for CCTV, and is currently upgrading all the cameras in the car parks with improved street lighting. At the same time, the hospital's 132-strong network of CCTV cameras is being matrixed to allow operation from one keyboard. If a staff member is assaulted, it's easier to call incidents on screen and progressively follow them through to be able to provide the police with better CCTV evidence which can then lead to prosecution.
Working closely with the hospital security staff, police are also trying to improve response times to incidents. Inspector Harris states that a positive arrest policy is in place where there is enough evidence to support it, and police also maintain a positive attitude to having the necessary staff to collate the evidence and pass it on to the CPS.
Says Greenan: "A Zero Tolerance target is by definition a Zero Tolerance initiative. It's going to take time and a number of measures to reduce it. These are tough targets, but we are actively looking to meet them."
Making a case for NHS police?
Chris Doherty, security manager at King's College Hospital, has sparked a debate on establishing an NHS Police Force to deal with hospital violence. He suggests that the NHS should benefit from its own force in line with other forces which lie outside standard geographic boundaries, such as the British Transport Police (BTP), the Ministry of Defence Police and local authority parks police.
In an open letter to health service officials, Doherty states: "While we are keen to prevent criminal activity in parks and on trains, we appear to be disinclined to provide similar levels of support and protection to NHS staff. The BTP has 96 police stations providing a service for 100,000 staff, responding to 5,000 violent crimes in 1998/99.
"The NHS has 950,000 staff, 65,000 violent incidents against staff in the same year and no police. The time has surely come to provide nurses, doctors and healthcare workers with an equivalent level of safety to that enjoyed by railway staff."
Doherty continues that security acts as a quasi police service which relieves the police of the need to respond to minor disruptions. He says: "In terms of national policing priorities, surely hitting a nurse should rate more highly than speeding roller blades in the park!"
Forcing the issue
That said, with the Met remaining some 2,000 officers short, police resources are severely stretched. Tower Hamlets' Inspector David Harris says: "There is a strong relationship between what happens in hospitals and on the streets. We should police all areas in the same way. If there is a separate police service for the NHS, where would they take people they arrest, and who deals with complaints?"
Joe Greenan, security manager at Royal London NHS Trust, said that while the idea is fantastic in concept, he is more inclined to support Ken Livingstone's proposals to scrutinise the £2 billion police budget, cut overall costs and establish a police presence in hospitals.
"I believe that by tapping into these proposals a police presence in our hospitals could be funded without Trusts having to purchase extra policing under the Police and Magistrates' Courts Act," states Greenan. "Agreement on the duties of the police on hospital sites could then be developedto allow officers to act on their own professional judgement in partnership with security officers."
Source
SMT
