SMS/VASV2/03/07/02
Tackling violence against staff
Explanatory notes for reporting procedures introduced
by Secretary of State Directions in November 2003
(updated June 2009)
Protecting your NHS
Contents
Introduction The NHS SMS establishment and strategy
3
Requirements of the legal framework
6
Physical assault – the definition
The national incident reporting system
The Security Management Director
The Local Security Management Specialist
The Legal Protection Unit
Reporting
11
Why report?
What to report
How to report
How the Legal Protection Unit can help you
17
Healthcare delivery sector issues
19
Mental health and learning disability sector
Primary care sector
Ambulance sector
Acute sector
NHS SMS support
25
The Case Management Team
The ASMS and the NHS SMS Central Unit
National physical assault data collection findings
Other NHS SMS initiatives around tackling violence
28
Frequently asked questions
30
Annex A
Physical assault reporting form
32
Annex B
Directions to NHS bodies on measures to
deal with violence against NHS staff
34
Annex C
Directions to NHS bodies on security
management measures 2004
37
Annex D
NHS SMS contact details
41
Annex E
Confidentiality and data protection
42
© THE NHS SM
1.
Introduction
The NHS SMS establishment and strategy
1.1
The Security Management Service (SMS) is part of the Counter Fraud
and Security Management Service (CFSMS), which is an independent
division of the NHS Business Services Authority.
1.2
The NHS SMS was originally launched in April 2003 with a remit
encompassing all policy and operational responsibility for the
management of security in the NHS (Statutory Instrument 3039/2002).
The remit is broad but can be defined as protecting people and
property, so that the highest standards of clinical care can be made
available to patients.
1.3
Before April 2003, security management work fell to various parts of
the Department of Health and the NHS, or was not addressed at all.
For the first time, security management has been brought under the
direction of one central organisation within the NHS tasked with raising
the standards and professionalism of this area of work and ensuring
that it is being undertaken consistently across the NHS.
1.4
Between April and June 2003, the NHS SMS conducted a series of
fact-finding visits to health bodies to see and experience what the
problems were and to explore how they could be addressed and
prioritised. The identified problems included:
•
inconsistent standards of security management work
•
inconsistent standards of training for those in security-related roles
•
lack of nationally consistent guidance
•
lack of application of, or compliance with, guidance
•
limited awareness of the consequences of poor security, in both
human and financial terms
•
inconsistent reporting and lack of coordination, at both national and
local levels.
1.5
The National Audit Office (NAO) report A Safer Place to Work:
Protecting NHS Hospital and Ambulance Staff from Violence and
3
Aggression 1 , published in March 2003, had also identified a number of
problems around the reporting of violent incidents. Before November
2003, there were more than 20 definitions of ‘assault’ in use across the
NHS for reporting violence and aggression. This inconsistency meant
that little meaningful analysis of incident reports could take place
nationally.
1.6
Responses to incidents by both the relevant health body and the police
also varied across the NHS, as did the feedback given to the person
assaulted. The recommendations of the NAO report, in short, were that
clear and unambiguous reporting cultures and systems should be
developed, in parallel with consistent and comprehensive mechanisms
for pursing prosecutions.
1.7
The priority areas identified during the fact-finding visits have been the
focus of the early work of the NHS SMS and continue to be priorities.
They are:
•
tackling physical and non-physical assaults on NHS staff
•
ensuring the security of property and assets
•
ensuring the security of drugs, prescription forms and hazardous
materials
•
1.8
ensuring the security of maternity and paediatric wards.
The 2003 fact-finding visits culminated in the launch of the strategy A
Professional Approach to Managing Security in the NHS 2 in December
2003. The strategy puts into context the NHS SMS’s approach to
ensuring that an environment that is properly secure is delivered for
those working in and using the NHS.
1.9
The strategy outlines the legal framework, created by Secretary of
State Directions (annexes B and C), within which security management
work takes place. This framework enables a structure to be developed,
ensuring that security work is delivered by local staff and systems but
1
2
www.nao.org.uk/publications/nao_reports/02-03/0203527.pdf
www.cfsms.nhs.uk/doc/sms.general/sms.strategy.pdf
4
to consistently high national standards across the NHS, using a
common approach, language and skills.
1.10
The highest priority area for security management work remains
tackling violence against staff. Work in this area is already underway,
not only to ensure that robust systems are in place to minimise the risk
of incidents occurring in the first place, but also to enable clear action
to be taken against assailants.
5
2
Requirements of the legal framework
2.1
In November 2003, the Secretary of State for Health issued Directions
to NHS bodies on measures to deal with violence against NHS staff
(annex B). Further Directions to NHS bodies on security management
measures (annex C) were issued in March 2004. Directions are
secondary legislation, enacted through powers conferred under the
National Health Service Act 1977 which required the introduction of the
following measures:
•
a national definition of physical assault 3
•
a national incident reporting system, for recording physical
assaults, to be operated and monitored by the NHS SMS. Direction
5 (d) specifies that ‘the details of the incident are recorded in
accordance with the NHS body’s recording system’
•
a nominated Security Management Director (SMD) at board level
in all health bodies, with overall responsibility for security
management work and leading work to tackle violence against staff
•
a network of highly trained and professionally accredited Local
Security Management Specialists (LSMSs) across the NHS,
established by the NHS SMS, to lead local security management
work, initially concentrating on investigation of cases of physical
assault, particularly where the police are not taking action. Until
LSMSs are trained, accredited and in place within each health body,
NHS SMS case management staff continue to manage these cases
•
a national definition of non-physical assault 4
•
creation of a Legal Protection Unit (LPU) to work with health
bodies and provide them with advice on cost-effective methods of
pursuing a wide range of sanctions against offenders.
3
‘The intentional application of force against the person of another without lawful justification, resulting
in physical injury or personal discomfort’ – Eisner v. Maxwell 1951, Kaye v. Robinson 1991
4
‘The use of inappropriate words or behaviour causing distress and/or constituting harassment’ –
www.cfsms.nhs.uk/doc/sms.general/non.physical.assault.notes.pdf
6
Physical assault – the definition
2.2
The Directions introduced a common, legally-based definition of
physical assault:
The intentional application of force against the person of another
without lawful justification, resulting in physical injury or personal
discomfort. 5
2.3
This definition was designed to apply specifically to the NHS, to replace
any other definition previously in use across the NHS and to allow
health bodies to be clear about which incidents they need to report.
Consistent reporting enables consistent action to be taken across the
NHS. It is important to note that, whilst the definition is there to clarify
what constitutes physical assault for reporting purposes, any
subsequent legal action is a decision for the investigative body i.e. the
police and the Crown Prosecution Service (CPS) and in some cases
the NHS SMS and LPU.
National incident reporting system to record physical assaults
2.4
The NHS SMS’s introduction of the physical assault reporting system
(PARS) has enabled it to collate accurate information on the level of
violence in the NHS.
2.5
In addition, PARS enables the NHS SMS to monitor and track cases
from report to conclusion, ensuring that necessary and appropriate
action is taken in every case, whether investigated by the police or the
LSMS.
2.6
The case monitoring system ensures that each case has the best
possible outcome for both the person assaulted and the health body. It
will also allow the NHS SMS to learn more about the problem so that
appropriate preventative action can be considered, both locally and
5
The legal definition of an assault is more wide-ranging and the police and other bodies may refer to a
physical assault as a battery or an assault by beating etc.
7
nationally. This is particularly important where sanctions may not be an
appropriate option.
The Security Management Director (SMD)
2.7
The SMD, in conjunction with the LSMS, must facilitate the continual
development of a pro-security culture among staff and NHS
professionals.
2.8
Building on work already underway, the SMD should continue to raise
awareness of security issues, encouraging staff and professionals to
report all violent incidents. Staff should feel confident and reassured
that they will be supported throughout the process, and that everything
possible is being done by the health body to deter and prevent such
incidents occurring.
2.9
When an incident has taken place, the SMD must ensure a thorough,
fair and professional investigation is undertaken, and that offenders are
dealt with appropriately.
2.10
The SMD is responsible for ensuring compliance with the Directions in
respect of the reporting procedures. Where a fully trained LSMS is not
yet in post, the SMD will ensure adequate arrangements are in place to
initiate and conclude an appropriate and sufficient response to the
incident, and that the NHS SMS is kept fully informed.
2.11
When immediate or urgent advice is needed in respect of a physical
assault, the SMD can contact the NHS SMS by telephone, as detailed
in annex D. It is important to note that any report made by telephone
must include the required information contained at annex A and should
be followed up by a completed PARS form. In addition, the SMD should
liaise with the NHS SMS Area Security Management Specialist (ASMS)
responsible for the health body concerned as soon as possible.
2.12
The SMD should refer all other information requests, as well as
requests for advice on policy and operational matters, including non8
urgent physical assault incidents, to the ASMS. This is covered in more
detail in section 6.5.
2.13
The SMD must ensure that full cooperation is given to the police and
the NHS SMS in respect of an investigation and any subsequent
action, including ensuring access to personnel, premises and records,
whether electronic or otherwise, which are considered relevant to the
investigation.
2.14
The SMD must also ensure that the information is captured on the
health body’s incident reporting system in accordance with health and
safety legislation and that those physical assaults which result in the
absence of a staff member for three or more days are reported in
accordance with the Reporting of Injuries, Diseases and Dangerous
Occurrences Regulations 1995 (RIDDOR).
2.15
The SMD must ensure that the person assaulted is kept informed of the
progress and outcome of the case and should arrange for
acknowledgement to be sent to them at the earliest opportunity. The
acknowledgement should state what action is being taken and should
offer support, such as counselling or referral to an occupational health
practitioner.
9
The Local Security Management Specialist (LSMS)
2.16
Since April 2004, following the issue of Secretary of State Directions on
security management 6 , health bodies have been required to nominate
suitable people to undergo training by the NHS CFSMS training
service, to enable them to perform the function of LSMS effectively.
2.17
Each health body is therefore required to nominate an LSMS to carry
out security management functions that are required by Directions and
outlined in the NHS SMS’s security management strategy.
2.18
Sample LSMS role descriptions, tailored specifically for each
healthcare delivery setting, are available on the NHS SMS website 7 .
2.19
Once fully trained and accredited, the LSMS will have full access to the
NHS Security Management Manual.
2.20
All security incidents and, in particular, violent incidents, should be
reported to the heath body’s LSMS. The LSMS, as the lead on security
matters and, in particular, physical assaults, should make sure that
local systems are in place to ensure that they receive details of all
incidents and report them to the NHS SMS.
The Legal Protection Unit (LPU)
2.21
The Legal Protection Unit is part of the NHS SMS. The unit is staffed
by a specialist team of legal case officers, all of whom are experienced
in public sector legal work.
2.22
The initial focus of the LPU is to work with health bodies, the police and
the Crown Prosecution Service (CPS) to increase the prosecution rate
of individuals who assault NHS staff and professionals.
6
www.cfsms.nhs.uk/doc/sms.general/lsms.nomination.pdf
7
www.cfsms.nhs.uk/pubs/sms.gen.pubs.html
10
3
Reporting
Why report?
3.1
In order for the NHS to achieve its goal of reducing violence within all
healthcare delivery settings, it is essential that the nature and scale of
the problem is properly identified and recorded.
3.2
It is essential that health bodies and, subsequently, the NHS SMS, are
made aware of all incidents of physical assault and that staff are
supported and encouraged to report appropriately.
3.3
Staff may feel intimidated by the criminal justice system and by the
thought of having to confront the assailant in court. Health bodies
should ensure that all staff are made aware of all support services
available to them and emphasise that they will be given the full backing
of their organisation and the NHS SMS in the reporting and any
subsequent prosecution of physical assaults.
3.4
The reluctance of the individual assaulted to pursue the matter is in
many cases understandable; however, it is important to view matters
from a wider perspective. The concerns of other staff and patients have
to be considered, as does the effect of not pursuing an incident on the
overall aim of creating an environment where no physical assaults will
be tolerated. If a physical assault is not reported, this may leave the
next member of staff who deals with the visitor or cares for the patient
vulnerable to an even more severe attack.
3.5
Anecdotal evidence suggests that some trusts are reluctant to report
incidents to the police. Staff should be made aware of the LPU and that
the NHS SMS can bring private prosecutions with the assistance of the
individual(s) and the health body. However, this service should not be
seen as a replacement for the police or CPS and can, in most cases,
only be undertaken if the police or CPS have been notified of an
incident but have not responded in a satisfactory manner.
11
3.6
As staff become more aware of the reporting procedures and are
assured that consistent and appropriate action will be taken against
those who assault them, confidence in the system will grow and a
culture where violence is not accepted as part of the job will be
achieved.
3.7
It is important to inform staff that failure to report an assault to the
police could adversely affect any claim they might make for
compensation under the Criminal Injuries Compensation Authority
Scheme.
What to report
3.8
Directions state that all incidents of physical assault must be
reported to the NHS SMS, as well as to the police. This means all
incidents in which NHS staff or individuals contracted to work for the
NHS are physically assaulted.
All incidents of physical assault on staff, including those that may have
been due to the patient’s mental or other clinical condition 8 , should be
reported to the NHS SMS. Other than in exceptional cases 9 , all
occasions when a patient, service user or member of the public makes
any unnecessary, unwarranted or uninvited physical contact with an
NHS staff member should be regarded as an intentional act of assault.
Some of these contacts may be directly due to the incapacity of the
individual at the time, and although they may not have been aware of
the consequences or impact of their actions, they still intended to inflict
pain or injury on the member of staff. Being under the influence of
alcohol or recreational drugs will not, in most cases, be accepted as a
defence to an assault. Such cases should be reported.
3.9
It is very difficult to provide a comprehensive description of all types of
incident that are covered under this policy. Guidance on the types of
8
These types of incident may be referred to locally as ‘unintentional’ or ‘clinical’ assaults
9
Exceptional cases may include patients recovering from anaesthesia or suffering from severe head
trauma
12
incident which fall within the scope of the physical assault definition is
given below:
•
The assault must be on a member of NHS staff10 . NHS staff means
directly employed staff AND contracted staff and professionals,
providing services or goods to the health body.
•
Physical contact must have been made, not just an attempt.
Examples include punches, slaps, kicks, head butts, scratches,
nips, hair being pulled and strikes by weapons.
•
Physical contact also means when items (weapons, objects and
liquids (including spittle)) thrown hit a member of staff.
3.10
Incidents which do not constitute physical assault but which fall into
the scope of the NHS SMS non-physical assault guidance are detailed
in paragraph 1.10 of the NHS SMS’s Non-Physical Assault Explanatory
Notes 11 .
3.11
The LPU can offer advice on non-physical assault cases, which, in
some instances, can be more serious than those defined as physical
assault.
3.12
Some examples of the types of incident which have been reported and
their outcomes are given below:
3.12.1 Incident 1
The incident took place on a mental health ward managed by a primary
care trust. The male assailant, detained under the Mental Health Act
Section 37/41, wished to undertake an unscheduled activity at short
10
Patient-on-patient and staff-on-staff assaults or bullying do not fall within the NHS SMS’s current
remit. Investigations into staff-on-staff physical assaults should be led by the trust's human resources
department, which will decide whether to utilise the skills of the accredited LSMS in the process. These
assaults must, however, be recorded and reported to the NHS SMS in line with the definition. Excluding
such assaults would potentially condone inappropriate behaviour in the workplace.
11
www.cfsms.nhs.uk/doc/sms.general/non.physical.assault.notes.pdf
13
notice, which could not be arranged. He then became agitated and
struck the male clinical support worker on the side of the head. This
resulted in a possible concussion, with the victim taking two days’ sick
leave.
The assailant was found guilty of common assault, given a six-month
conditional discharge and ordered to pay £100 compensation to the
victim. His status under the Mental Health Act remained unchanged.
3.12.2 Incident 2
The assailant was being brought in by ambulance staff, apparently
unconscious. On the way into the Accident and Emergency department
(A&E), he became aggressive and refused treatment. He was being
escorted from the premises when he picked up a plastic maintenance
barrier and struck a nurse on his back, threw punches and spat at him.
The assailant was found guilty of common assault, sentenced to a
community rehabilitation order and ordered to pay £75 compensation.
3.12.3 Incident 3
A female healthcare assistant was assaulted in A&E, as she helped a
female patient onto a bedpan. The patient started to shout, punch and
kick, kicking the healthcare assistant on the side of her face.
She was convicted of common assault and sentenced to 30 days’
imprisonment (suspended for 12 months). In addition, she was ordered
to undertake 200 hours’ unpaid community work and pay the victim
£150 compensation and £80 court costs.
3.12.4 Incident 4
On an acute hospital ward, a female patient had become verbally
aggressive to staff, accusing them of stealing her money. The patient
discharged herself but then refused to leave the ward. Police and
14
security staff attended and the patient agreed to leave the ward. She
then accused security staff of manhandling her, which they had not.
The patient became physically aggressive and abusive, attempting to
strike the staff member, eventually making contact and striking her in
the chest. Verbal abuse continued and the patient threatened to return
to the ward and “get” the staff member.
The assailant was given a six-month community punishment order and
ordered to pay £75 compensation to the victim and £34 costs.
3.13
It is important to report incidents in which the violence may seem
minor, and incidents which are deemed to be clinically induced, as
these can often escalate into more serious behaviour. By reporting
these incidents, a profile or case history can be built, which is not only
vital for future legal action but also enables the NHS SMS to determine
whether an individual is assaulting staff on a regular basis in different
parts of the health service. Without such a profile, both staff safety and
the potential for future legal action may be jeopardised.
3.14
The LSMS will ascertain whether or not the police are pursuing the
case, if this has not already been established. If the police are pursuing
the case, the LSMS will ensure the NHS SMS is kept informed of the
progress.
3.15
Should the police and CPS decide not to pursue a case, the NHS SMS
LPU will, in conjunction with the health body and the person assaulted,
consider what action can be taken, in line with the memorandum of
understanding between the CPS and the NHS SMS 12 .
How to report
3.16
After a physical assault on a member of NHS staff, the physical assault
reporting system (PARS) form (annex A) 13 should be fully completed
12
www.cfsms.nhs.uk/doc/sms.agreements/mou_sms_cps.pdf
13
www.cfsms.nhs.uk/doc/sms.general/pars.form.doc
15
and sent to the health body’s accredited and trained LSMS, in
accordance with the instructions provided with the form.
3.17
The LSMS should forward a copy of the PARS report to the NHS SMS
as soon as practicable following the assault and, in any case, within
five working days of the receipt of the report.
3.18
While reporting systems are being enhanced and refined, some
flexibility in the reporting method may be agreed in consultation with
the NHS SMS. However, the report to the NHS SMS is essential to
enable a thorough understanding of the problems of violence in all
healthcare delivery environments and to ensure an appropriate
response and support for the victim.
3.19
The Data Protection Act 1998 makes provision for the disclosure of
information, including patients’ personal details, for the purposes of
prevention and detection of crime and legal proceedings. Further
information on the Data Protection Act can be found at annex E.
16
4.
How the Legal Protection Unit can help you
4.1.
If the police or CPS have decided not to pursue a case, the LPU will
consider any matter referred through the ASMS, as detailed in section
4.7, for re-submission to the police/CPS, or for private prosecution by
the LPU where appropriate.
4.2.
General advice and assistance may also be given on matters that are
being investigated by the police or prosecuted by the CPS.
4.3.
In addition to criminal prosecution, the LPU will consider whether the
civil court process may provide additional or alternative avenues for
dealing with assailants (e.g. injunctions, claims for damages, AntiSocial Behaviour Orders etc).
4.4.
In ALL cases of physical assault, the health body’s SMD should
consider whether the matter is appropriate for referral to the LPU for
consideration of criminal or civil court action or for advice on alternative
remedies.
4.5.
There are many instances in which a referral would be appropriate.
These may include cases where:
•
the police have not attended
•
the police have attended but have decided not to investigate
•
a caution or conditional caution has been issued
•
the police have investigated but have decided not to take the matter
any further
•
the police have suggested a civil remedy is sought
•
the CPS has decided not to take any action after the matter was
referred by the police.
4.6.
If an individual member of staff wishes to pursue a case, they should
initially approach the health body’s LSMS. The LSMS will consult with
the trust’s SMD before contacting the NHS SMS.
17
4.7.
Referrals of specific cases to the LPU should be made by an
accredited LSMS, via the ASMS. The ASMS will be able to advise
whether the matter is suitable for referral to the LPU and what
information or documents are required. The ASMS is always the first
point of contact.
4.8.
Health bodies can make general legal enquiries in relation to physical
assaults, non-physical assaults and any other issues relating to
security management work, either in writing to:
Legal Protection Unit, Weston House, 246 High Holborn, London
WC1V 7EX
or by email to: lpu@cfsms.gsi.gov.uk.
18
5
Healthcare delivery sector issues
Mental health and learning disability sector
5.1
The NHS SMS recognises the higher frequency of physical assaults in
the mental health environment, but remains convinced that all assaults
must be reported to the NHS SMS for the reasons outlined above. This
will also ensure appropriate legal action can be taken, where
necessary, which can result in arrangements being made for the
patient to be treated in the most secure environment for their own
safety and for the protection of staff.
5.2
Directions state that the police must be contacted in all cases of
physical assault. The NHS SMS recognises that this may have serious
implications for mental health and learning disability trusts, for example,
where the numbers of incidents are higher than in other healthcare
settings. While it is important that all incidents of physical assault are
reported to the NHS SMS, paragraph 4.2.1 of annex 2 of the Directions
allows the decision about whether or not to contact the police to be
made locally. In reaching this decision, the following criteria should be
applied:
Following an alleged physical assault on a member of staff, the police
should be contacted immediately by the person assaulted, their
manager or relevant colleague. The exception is in those cases where
the SMD in the health body, having consulted with relevant staff and
obtained clinical advice, has reached the conclusion that the assault
was not intentional and that the patient did not know what he was
doing, or did not know what he was doing was wrong, owing to the
nature of his medical illness, mental ill health or severe learning
disability or the medication administered to treat such a condition. The
view of the person assaulted should also be sought in each incident.
5.3
While this means that there are instances when the police will not be
called, the presence of a mental illness, for example, should not
automatically be used as a reason not to report the assault to the
19
police. The presence of a mental illness is one of the factors taken into
account when considering prosecution, but it is not the only factor.
Each case should be judged on its own merit. Expert clinical opinion
should be sought at the earliest opportunity, supported by an initial
capacity statement attesting to the assailant’s state of health at the
time. It is important to note that decisions on intent and subsequent
legal action rest with the investigative body and ultimately with the
courts, not with the health body. The fact that a person may have a
mental illness is insufficient in itself to afford a complete defence. The
question is one of law, and it is to be determined by the presiding judge
or magistrate.
5.4
If the matter is reported to the police, they should be given basic
information about the assailant’s clinical condition, if this could be seen
as a factor relevant to the assault taking place.
The LPU undertook a recent prosecution of an individual who had
physically assaulted a nurse. The assault had been reported to the
police, in accordance with Secretary of State Directions, and the police,
in turn, obtained a witness statement from the consultant treating the
assailant. The police considered the report to be biased towards the
assailant and felt it did not assist the victim. On this basis, the police
decided not to pursue a prosecution.
When the matter was referred to the LPU for consideration, it was
decided that the consultant’s statement showed no such bias. A further
detailed witness statement was sought from the consultant and led to
the successful prosecution of the assailant.
5.5
Irrespective of whether a particular physical assault falls into the
categories described above and may not have to be reported to the
police, all cases of physical assault must be reported to the NHS
SMS using a PARS form, as described in sections 3.16 and 3.17.
20
Primary care sector
5.6
During 2005, the NHS SMS conducted additional fact-finding visits,
focusing on primary care and community healthcare settings.
Stakeholders analysed their security issues and collectively identified
the following areas of concern:
•
violence in the workplace
•
assaults, physical and verbal, on healthcare staff and patients
•
security of premises
•
patients/carers with challenging behaviour, or on alcohol or drugs
•
domiciliary visits to inhospitable areas (weapons/dangerous
dogs/illegal drug taking)
•
risks of lone working, including home visits/out-of-hours visits
•
lack of support from police and other local services/failure by
management to involve police
5.7
•
issues on information-sharing by professionals
•
no data being collected nationally
•
inadequate communication systems for summoning help
•
lack of support and follow-up after incidents
•
inadequate risk assessment and information about the patient
•
complicated reporting systems
•
security of drugs and prescription forms in surgeries
•
security of GPs’ cars, which are targeted for possible drug contents.
Progress has been made by most primary care health bodies in
reporting incidents of violence against their directly-employed staff. It is
recognised that there is a need to work more closely with primary care
trusts and professional representative bodies to ensure that all
incidents are reported and that the benefits of existing work are made
available to all those working in and delivering NHS services
throughout primary care and community healthcare.
5.8
To that effect, an agreement was signed in October 2005 between the
NHS SMS and a number of primary care NHS professional
21
representative bodies. Working Together – the Way Forward 14 set out
the way in which the NHS SMS and the primary care representative
bodies would work together in tackling violence and aggression in NHS
primary care and community healthcare services.
5.9
Since 1 April 2004, SMDs of primary care trusts have been required to
ensure that appropriate systems are in place to receive reports of
physical assault from community pharmacists within their geographical
remit and to forward these reports to the NHS SMS as appropriate.
5.10
LSMSs in primary care settings, while carrying out security
management functions within the health body, need to be aware of
their responsibilities towards all those contracted to provide services to
the health body (such as GPs, dentists and pharmacists). This should
reflect the remit and responsibility of the NHS SMS, which covers all
who provide NHS care, whether directly employed or contracted.
14
www.cfsms.nhs.uk/doc/sms.agreements/primary.care.charter.pdf
22
Ambulance sector
5.11
Occasionally, ambulance and paramedic staff are assaulted and no
assailant details are known. The assailant may have absconded before
the police attend or the police may have removed the alleged assailant
before their true identity is established. All such cases should still be
reported to the police and the NHS SMS, giving a thorough description
of the assailant and the nature of the assault, as well as descriptions of
any associates present at the time of the incident. It may still be
possible to trace the individual concerned by other means, such as
using CCTV images, and bring charges if appropriate.
5.12
Ambulance and paramedic staff must attend to individuals suffering
from mental illness, learning disabilities, dementia, and intoxication,
often in extremely traumatic and stressful circumstances. As is the
case in mental health environments, the NHS SMS remains convinced
that all assaults must be reported to the NHS SMS, for the reasons
outlined in paragraph 5.3. This will also ensure appropriate legal action
can be taken where necessary.
23
Acute sector
5.13
The acute sector offers a wide variety and combination of healthcare
services. Large acute trusts often provide a 24-hour A&E service and a
variety of specialist services such as paediatric, maternity, mental
health and cancer care. Each of these specialist services presents its
own particular issues in terms of patient profile and security
considerations. In addition to this, the acute sector provides long-term
care which may require repeat attendance, as in the case of renal
dialysis units. In the acute environment, violent attacks are carried out
not only by patients but also by their friends, parents and other
relatives. Violence against staff where long-term care is provided is a
particular problem; violent attacks are more likely to recur as patients
have to attend frequently for treatment.
5.14
NHS staff working in all areas of healthcare delivery in the acute sector
must attend to individuals suffering from mental illness, learning
disabilities, dementia and intoxication, often in extremely traumatic and
stressful circumstances. As is the case in mental health environments,
the NHS SMS remains convinced that all assaults must be reported to
the NHS SMS, for the reasons outlined above. This will also ensure
appropriate legal action can be taken where necessary.
24
6.
NHS SMS support
The Case Management Team
6.1
Upon receipt of a PARS report, the Case Management Team will
contact the LSMS, as soon as practicable, acknowledging receipt of the
report and ensuring that appropriate action is being taken.
6.2
The Case Management Team is responsible for ensuring that the
details of the physical assault contained on the PARS form (annex A)
are entered on the NHS SMS case management system and regularly
updated with progress and outcomes.
6.3
Where an LSMS is not in post, the Case Management Team will follow
up the incident with the person submitting the report and/or the SMD of
the health body. In addition, this will require liaison with police forces,
courts, the NHS SMS LPU and the victim.
6.4
Once the appointed LSMS in a health body is fully trained and
accredited, they will take responsibility for the role previously carried
out by the case management team.
The ASMS and the NHS SMS Central Unit
6.5
At a local and regional level, the LSMSs are supported in their work by
a team of NHS SMS Area Security Management Specialists (ASMSs).
The ASMSs provide the operational link between the ever-expanding
LSMS network and the NHS SMS. The ASMSs take the lead on
developing the LSMS structure, creating a pro-security culture,
identifying and disseminating best practice and offering advice and
support on investigations and sanctions work. The ASMSs ensure
operational work informs and drives revision of national policy,
procedures and systems.
6.6
At a national level, the NHS SMS Central Unit offers guidance and
support for security management work, ensuring that lessons learned
25
from security incidents and breaches can be reflected in preventative
measures and policy development or revision.
National physical assault data collection findings
6.7
In May 2005, the NHS SMS requested data from all NHS trusts
covered by Secretary of State Directions, plus Foundation Trusts,
concerning the number of physical assaults on NHS staff and
professionals in the 2004–05 financial year.
6.8
A 100% response rate for reported violent incidents 15 was received
from health bodies, allowing the NHS SMS to measure accurately the
true nature and scale of the reported problem.
6.9
A validation exercise was undertaken and 170 trusts were visited, to
ensure the accuracy of the reported figures. This involved the
examination of the original incident reports held by each trust.
Thousands of reports were painstakingly examined for accuracy. The
data was independently verified as being accurate to within ±1.5%.
6.10
A total of 60,385 physical assaults were reported in the period 1 April
2004 to 31 March 2005 16 . They are broken down as follows:
•
Mental Health Trusts 17
43,097
•
Acute and Foundation Trusts
10,758
•
Ambulance Trusts
1,333
•
PCTs
5,192
•
Special Health Authorities
5
15
While all health bodies provided their data on recorded incidents, it is not accurate to conclude that all
physical assaults were reported.
16
www.cfsms.nhs.uk/doc/sms.general/2004-05.volence.against.nhs.staff.per1000.pdf
17
Nineteen PCTs are designated as providing a mental health service; these figures are included in the
mental health statistics and not the PCT figures.
26
6.11
These figures provided the first accurate baseline that the NHS can use
to put in place guidance and other measures to increase further the
safety and security of its staff.
6.12
A further data request took place in 2006 for the reporting period 1 April
2005 to 31 March 2006 18 . A total of 58,695 physical assaults were
reported in the period and are broken down as follows:
6.13
•
Mental Health Trusts
41,345
•
Acute and Foundation Trusts
11,100
•
Ambulance Trusts
1,104
•
PCTs
5,145
•
Special Health Authorities
1
A validation exercise was again undertaken in which 146 trusts were
visited to ensure the accuracy of the reported figures. As before, this
involved the examination of the original incident reports held by each
trust. The data was independently verified as being accurate to within
±1.2%.
6.14
Overall, these figures represent a reduction in the number of physical
assaults of 1,690, or 2.8%.
6.15
With respect to the reported incidents from PCTs, it is likely that the
figures do not accurately reflect the nature and scale of these incidents.
Work is in progress to increase reporting by primary care professionals
and staff, as evidence suggests these figures are understated 19 .
18
www.cfsms.nhs.uk/doc/sms.general/2005-06_violence_against_NHS_staff_per1000.pdf
19
This conclusion is drawn from the results of a pilot study undertaken in PCTs in four geographic areas
(Hillingdon PCT, Central Liverpool PCT, S&E Dorset PCT and North Kirklees PCT) to encourage
reporting within primary care. These findings and subsequent anecdotal evidence suggested there was
underreporting of physical assault incidents.
27
7
Other NHS SMS initiatives around tackling violence
7.1
A key preventative measure in tackling violence, in addition to the
proactive and reactive measures described above, is the development
of a national syllabus for conflict resolution training (CRT) for all
frontline staff and professionals working in the NHS. The syllabus is
delivered in the form of a one-day training course in non-physical
intervention methods, including communication techniques, cultural
awareness and de-escalation techniques. The aim is to equip staff with
the skills necessary for de-escalating potentially violent situations.
Further guidance on the syllabus can be found on the NHS SMS
website. 20 Alternatively, the training team can be contacted on
ConflictResolution@cfsms.gsi.gov.uk.
7.2
On 19 October 2005, the NHS SMS launched a national training
programme for mental health and learning disability services, in nonphysical interventions for prevention and management of violence 21 .
The programme identifies 10 key learning aims and provides trainers
with the resources necessary to ensure the aims are achieved. The
resources include a tutors’ manual, course slides and a participants’
workbook. The syllabus does not set out to alter current good practice
but aims to establish a uniform standard.
7.3
On 19 January 2007, the NHS SMS launched a new set of standards to
ensure that training for ambulance workers in the prevention and
management of violence and aggression is of a consistently high
quality wherever it is delivered. These were the first training standards
of their kind in non-physical conflict resolution techniques for
ambulance personnel, and have been developed following consultation
with major stakeholders, including the Ambulance Service Association,
UNISON, independent experts and ambulance trusts. They provide
ambulance staff with the skills, knowledge and confidence to recognise,
prevent and manage potentially violent situations safely and effectively,
20
www.cfsms.nhs.uk/training/crt.html
21
The training syllabus has been subject to consultation by all relevant stakeholders, including service
user and staff representatives, and sets a standard for training that aims to promote a safe and
therapeutic service for all.
28
to avoid situations escalating and minimise risks to staff, patients and
others
7.4
The aim is to equip staff with the skills necessary in these highly
complex and specialised fields to – confidently and lawfully – prevent,
de-escalate, control and manage violent or potentially violent situations.
The NHS SMS is addressing the need for quality assurance to
guarantee consistently high standards across the NHS and the
regulation of training providers.
Further information on the NHS SMS can be obtained by emailing
securitymanagement@cfsms.gsi.gov.uk
www.cfsms.nhs.uk.
29
or
by
visiting
8
Frequently asked questions
Why have these reporting systems been introduced? Most health
bodies already have robust systems in place.
The existing NHS Counter Fraud Service became part of the new NHS
Counter Fraud and Security Management Service in April 2003, when it
assumed the added remit of security management in the NHS. The
NHS SMS was created, at the request of Ministers, in response to the
inconsistency of approach in dealing with this problem, taking action
against offenders and reducing the number of violent incidents against
staff and professionals. The NHS SMS is aware of existing good
practice in terms of reporting and recording incidents. However,
standardised, consistent and comprehensive reporting systems are
required across the NHS, to enable reliable action to be taken where
necessary and appropriate.
Will this not create an additional bureaucratic burden – especially
on mental health trusts, where physical assaults are very
common?
The physical assault reporting system will reduce the burden on health
bodies in the medium to long term. The NHS SMS is working with risk
management software providers to develop direct links to the NHS
SMS case management system. The NHS SMS will continue to use
technology to ensure better analysis and the provision of better quality
information. In addition, for non-physical incidents, the use of a
standard definition will allow greater reporting locally.
What is being done to address matters with the police and
prosecuting authorities?
In order that the police and the NHS can be clear about what they can
expect of each other in terms of security management matters and, in
particular, tackling violence against NHS staff, the NHS SMS has
30
recently developed and signed a memorandum of understanding (MoU)
with the Association of Chief Police Officers (ACPO) 22 .
In addition, on 1 November 2006, the NHS SMS agreed and signed an
MoU with the CPS 23 to ensure that there is effective prosecution of
cases involving violence and abuse against any member of NHS staff.
What are the longer-term arrangements?
The NHS SMS is charged with driving up the standards of security
management across the NHS. Although the NHS SMS is not
responsible for day-to-day operational management of security within
health bodies – this remains the responsibility of the Board, the Chief
Executive and the Executive Security Management Director (SMD) – it
has created the strategic approach and legal framework within which
security management work will be carried out. The NHS SMS will
provide professional training for those leading this work, and guidance
and support to ensure that outcomes are delivered locally to high
standards.
22
23
www.cfsms.nhs.uk/doc/sms.agreements/mou.sms.acpo.pdf
www.cfsms.nhs.uk/doc/sms.agreements/mou_sms_cps.pdf
31
ANNEX A
REPORT OF A PHYSICAL
ASSAULT ON NHS STAFF
Your
reference
Is this incident linked to
another PARS report?
PARS reference
This form is to be used for the reporting of all physical assaults against NHS staff and professionals that fall within the
single definition of physical assault as detailed in Secretary of State Directions on tackling violence issued in Nov 2003.
The definition is: ‘The intentional application of force against the person of another
without lawful justification, resulting in physical injury or personal discomfort’.
Name of trust:
Contact tel. number:
LSMS of trust (or SMD if no LSMS in post)
Address of trust:
IMPORTANT – MUST BE COMPLETED
Based on appropriate clinical advice, is this assault considered likely to have been unintentional, as the
assailant did not know what they were doing or did not know that what they were doing was wrong due to
medical illness, mental ill health, a severe learning disability or treatment administered?
Incident date (dd/mm/yy)
YES
NO
Incident time (hh:mm)
Did the assault occur during the restraint of the assailant for reasons not connected with this assault?
(e.g. to administer medication)
YES
NO
Site address where assault took
place (full address including
postcode)
Specific location of assault within the site
(e.g. Ward 1, A&E, patients’ kitchen, etc)
PERSON ASSAULTED
Contact address:
Last name
First name
Employment title
Date of birth (dd/mm/yy)
Male
Work tel.
Female
Other tel.
Injuries sustained
Treatment received
Does the victim wish to pursue the matter via the police or NHS SMS Legal Protection Unit?
Yes
No
ALLEGED ASSAILANT
Contact address (if known):
Last name
First name
Date of birth (dd/mm/yy)
NHS number (if known)
Female
Male
Patient
Visitor
Staff member
Other
INCIDENT DETAILS – enter detail of the incident and circumstances of the assault
Possibly
motivated by (9)
Police
attendance
details
(Use this section if a
report was made to
the police after the
incident occurred)
Race
Religion
Gender
Disability
Unprovoked
Were the police called to attend this incident?
Yes
No
Are the police actively pursing this matter?
Yes
No
Yes
No
Has the matter been concluded?
Other
If YES, complete
A below
If YES, complete
B below
Name(s) of officers attending:
A
Shoulder numbers of officer(s)
Force/Constabulary of police officer(s):
Police station of officer(s) dealing:
What sanction, if any, was applied?
B
Please detail the date and location of the sanction
(i.e. Coventry Magistrates’ Court, 01 September 2005)
Is the investigation into this incident now complete and
no further action required by the trust, police or the NHS SMS?
Yes
No
Details of person completing this form
Contact address:
Name
Job title
LSMS ID number
Tel. 1
Tel. 2
Additional information
To detail any additional victims, any known witnesses or other useful information, please use an additional sheet
The form must be sent to the NHS SMS, either electronically to pars@cfsms.gsi.gov.uk or
to PARS, NHS SMS, 8th Floor, Coventry Point, Market Way, Coventry CV1 1EA
This form is to be used to report all physical assaults against NHS staff and professionals to the NHS Security Management Service (NHS
SMS)
All information reported to the NHS SMS will be treated in the strictest confidence. No further disclosure shall be made without the
informed consent of those concerned.
ANNEX B
NATIONAL HEALTH SERVICE ACT 1977
Directions to NHS bodies on measures to deal with violence against NHS staff
2003 (amended 2006)
The Secretary of State for Health, in exercise of the powers conferred by sections
16D, 17 and 126(4)of the National Health Service Act 1977 and of all other powers
enabling him in that behalf, hereby makes the following Directions: Application, commencement and interpretation
1.
(1) Subject to sub-paragraph (4), these Directions apply to all NHS bodies in
England and come into force on 21st November 2003.
(2) In these Directions –
“CFSMS” means the Counter Fraud and Security Management Service”
established as a Special Health Authority ( 1 );
“nominated director” means the executive director nominated to be responsible
for security management matters as provided in paragraph 2;
“NHS body” means a Primary Care Trust, an NHS Trust and those Special
Health Authorities listed in paragraph (3);
“NHS staff” means any person who is employed by or engaged to provide
services to an NHS body.
(3) The Special Health Authorities referred to in the definition of “NHS body”
in paragraph (1) are the Counter Fraud and Security Management Service, the
Mental Health Act Commission( 2 ), the National Blood Authority ( 3 ), the
National Treatment Agency ( 4 ), the Retained Organs Commission ( 5 ) and the
Prescription Pricing Authority ( 6 ).
(4) In the application of these Directions to the CFSMS, paragraph 2(b), 3(b)
and 4(c) shall not apply.
Nominated Director
2. Each NHS body must (a) nominate one of its executive directors to take responsibility for security
management matters, including in particular responsibility for measures to
deal with violence towards NHS staff; and
(1) See the Counter Fraud and Security Management Service (Establishment and Constitution) Order
2002, S.I 2002/3039,
(2) S.I. 1983/892.
(3) S.I. 1993/585.
(4) S.I. 2001/713.
(5) S.I. 2001/743.
(6) S.I. 1990/1718.
34
(b) In accordance with Annex 1 to these Directions inform the CFSMS of
the name and contact details of the executive director so nominated.
Monitoring and compliance
3. Each NHS body must (a) monitor and ensure compliance with these Directions and in particular
ensure that all NHS staff are informed of the content of these Directions
and what is required of them to ensure compliance;
(b) take into account any other guidance or advice on measures to deal with
violence against NHS staff which may be issued by CFSMS ( 7 ).
Physical assault
4.
In the event of physical assault on a member of NHS staff as described in
Annex 2, the nominated director must ensure that the instructions contained in
paragraph 4 of Annex 2 are complied with, that is to say he must put in place
effective arrangements to ensure that in all cases (a) he is informed of the incident;
(b) the police are contacted immediately either by the person assaulted or by
an appropriate manager or colleague and that full co-operation is given to the
police in any investigation;
(c) the CFSMS is informed of the incident and that full co-operation is given
to it in any investigation or subsequent action which it considers appropriate;
(d) the details are recorded in accordance with the NHS body’s incident
reporting system; and
(e) the victim of the assault is informed of the investigation’s progress and
offered such support as is necessary or desirable in the circumstances.
Non physical assault
5. In the event of non-physical assault on a member of NHS staff as described in
Annex 3, the nominated director must ensure that the instructions contained in
paragraph 4 of Annex 3 are complied with, that is to say he must put in place
effective arrangements to ensure that (a) he is informed of the incident;
(b) in appropriate cases, assessed by reference to their nature and seriousness,
the police are contacted as soon as reasonably practicable and that full cooperation is given to the police in any subsequent investigation;
(7) See HSC 2000/001”Tackling violence toward GPs and their staff” and HSC 2001/18, “Withholding
treatment for violent and abusive patients in NHS trusts”.
35
(c) in any case where the police decide not to prosecute, the NHS body
considers what action, if any, it should take, and in particular considers
whether private prosecution or civil proceedings would be appropriate;
(d) the details of the incident are recorded in accordance with the NHS
body’s recording system; and
(e) the victim of the incident is informed of the progress of any investigation
and is offered such support as is necessary or desirable in the circumstances.
Signed by authority of the Secretary of State for Health
Date:
Senior Civil Servant
36
ANNEX C
NATIONAL HEALTH SERVICE ENGLAND
Directions to NHS Bodies on Security Management Measures 2004 (amended
2006)
The Secretary of State for Health, in exercise of the powers conferred upon him by
sections 16D, 17 and 126(4) of the National Health Service Act 1977( 1 ) and of all
other powers enabling him in that behalf, hereby gives the following Directions:
Application, commencement and interpretation
1.—(1) These Directions apply to NHS bodies in England and shall come into force
on 25 March 2004.
(2) In these Directions—
“the CFSMS” means the Counter Fraud and Security Management Service ( 2 );
“LSMS” means a Local Security Management Specialist appointed in accordance
with direction 5;
“NHS body” means a Strategic Health Authority, Special Health Authority,
Primary Care Trust or NHS trust;
“NHS body’s staff” means any person who is employed by or engaged to provide
services to, an NHS body; and
“Security Management Executive Director” means the person designated under
direction 4(1) (a).
General
2.—(1) Each NHS body must promote and protect the security of people engaged in
activities for the purposes of the health service functions of that body, its property
and its information in accordance with these Directions and having regard to any
other guidance or advice issued by the CFSMS.
(2) Each NHS body must require its Chief Executive and Security Management
Executive Director to monitor and ensure compliance with these Directions.
Co-operation with the Counter Fraud Security Management Service
3.—(1) Each NHS body must co-operate with the CFSMS to enable the CFSMS
efficiently and effectively to carry out its functions in relation to security
(1)
1977 c.49; section 16D was substituted by section 12(1) of the Health Act 1999 (c.8) (“the
1999 Act”) and amended by sections 1(3) and 3(1) and (2) of, and paragraphs 1 and 6(a) of Part 1 of
Schedule 1 to, the National Health Service Reform and Health Care Professions Act 2002 (c.17) (“the
2002 Act”); section 17 was substituted by section 12(1) of the 1999 Act and amended by section 1(3)
of, and paragraphs 1 and 7 of Part 1 of Schedule 1 to, the 2002 Act and section 67(1) of, and
paragraphs 5(1) and (3) of Part 1 of Schedule 5 to, the Health and Social Care Act 2001 (c.15) (“the
2001 Act”); section 126(4) was amended by section 65(2) of the National Health Service and
Community Care Act 1990 (c.19), by paragraph 37(6) of Schedule 4 to the 1999 Act and by paragraph
5(13)(b) of Part 1 of Schedule 5 to the 2001 Act. The functions of the Secretary of State under these
provisions are, so far as exercisable in relation to Wales, transferred to the National Assembly for
Wales by article 2(a) of the National Assembly for Wales (Transfer of Functions) Order 1999, S.I.
1999/672, as amended by section 66(5) of the 1999 Act.
A Special Health Authority established by the Counter Fraud and Security Management
(2)
Service (Establishment and Constitution) Order 2002 S.I. 2002/3039 (“the Order”).
37
management( 3 ) and in particular each NHS body must, subject to the following
paragraphs of this direction—
(a) enable the CFSMS to have access to its premises;
(b) put in place arrangements which will enable the CFSMS to interview, as
appropriate, the NHS body’s staff for the purpose of carrying out its security
management functions; and
(c) supply such information including files and other data (whether in electronic
or manual form) as the CFSMS may require for the purpose of carrying out its
security management functions.
(2) In the case of information required under paragraph (1)(c) in connection with
the CFSMS’ responsibility for quality inspection and risk assessment in relation to
security, an NHS body must respond to any request from the CFSMS as soon as is
reasonably practicable.
(3) In the case of any other information required under paragraph (1)(c), an NHS
body must respond to a request as soon as is reasonably practicable and in any event
within seven days from the date the request was made.
(4) Nothing in paragraph 1(b) contravenes any right a member of staff may
otherwise have to refuse to be interviewed.
(5) Nothing in paragraph 1(c) or direction 7(h) obliges or permits an NHS body to
supply information which is prohibited from disclosure by or under any enactment,
rule of law or ruling of a court of competent jurisdiction or is protected by the
common law.
Board level responsibility
4.—(1) Within six weeks of the date on which these Directions come into force
each NHS body must designate a person—
(a) to take responsibility for security management matters; in the case of an NHS
trust he is to be one of the trust’s executive directors and in the case of an
NHS body other than an NHS trust, he is to be one of that body’s officer
members; and
(b) to promote security management measures; in the case of an NHS trust he is
to be one of the trust’s non-executive directors and in the case of an NHS
body other than an NHS trust, he is to be one of that body’s non-officer
members.
(2) A further designation must be made within 3 months of the date on which an
NHS body learns that there is to be a vacancy for a person referred to in paragraph
(1)(a) or (1)(b).
(3) The names of the persons designated under paragraphs (1) or (2) must be
notified to the CFSMS together with the information specified in the Annex to these
Directions within 7 days of the designation.
(4) Each NHS body must ensure that the persons designated under paragraphs (1)
or (2) receive security management training recommended by the CFSMS.
(3)
For the functions of the CFSMS in relation to security management see article 3 of the Order
and direction 2(a), (b), (d) and (f) to (h) of the Directions to the Counter Fraud and Security
Management Service 2003.
38
Local Security Management Specialists
5.—(1) Each NHS body must nominate at least one person that it proposes to
appoint as the body’s LSMS within three months of the date on which these
Directions come into force.
(2) The name of the nominee must be notified to the CFSMS together with the
information specified in the Annex to these Directions within 7 days of the
nomination.
(3) Before making a nomination each NHS body must take into account any
guidance issued by the CFSMS on the suitability criteria for a LSMS.
(4) After a nominee has—
(a) been approved by the CFSMS as a person suitable for appointment, and
(b) successfully completed any training required by the CFSMS,
the NHS body may appoint the person as its LSMS.
(5) An NHS body’s LSMS must report directly to that NHS body’s Designated
Security Management Executive Director.
(6) A LSMS must not undertake responsibility for, or be in any way engaged in,
the counter fraud activities of any NHS body.
(7) A further nomination must be made within 3 months of the date on which an
NHS body learns that there is to be a vacancy for an LSMS.
(8) The procedures in paragraphs (2) to (5) also apply to a person nominated
under paragraph (7).
General responsibilities of NHS bodies
6. Each NHS body must ensure that it has effective arrangements in place to
ensure that—
(a) breaches of security and weaknesses in security related systems are reported
as soon as practicable to—
(i) the NHS body’s LSMS, and
(ii) where appropriate, and having regard to relevant CFSMS guidance, the
CFSMS and to the NHS body’s audit committee, auditors and risk
management committee;
(b) any confidentiality of information relevant to the investigation of breaches of
security is protected; and
(c) where possible, it recovers money lost through breaches of security.
Responsibilities of NHS bodies in relation to Local Security Management
Specialists
7. Each NHS body must—
(a) require that its LSMS and its Security Management Executive Director
complete, within one month of the beginning of the financial year, a written
work plan for the LSMS’ projected work for that financial year;
(b) enable its LSMS to attend the NHS body’s risk management committee and
audit committee meetings;
(c) require its LSMS to provide a written report, at least once in every financial
year, summarising the LSMS’ work for that year;
(d) send copies of the work plan mentioned in paragraph (a) and the report
mentioned in paragraph (c) to the CFSMS;
39
(e) require its LSMS to keep full and accurate records of any breaches, or
suspected breaches of, security;
(f) require its LSMS to report to the CFSMS any weaknesses in security related
systems of the NHS body or other matters which the LSMS considers may
have implications for security management in the NHS;
(g) ensure that its LSMS has all necessary support including access to the CFSMS
secure intranet site to enable him efficiently and effectively to carry out his
responsibilities;
(h) subject to any contractual or legal constraint, require all of its staff to cooperate with the LSMS and in particular that those responsible for human
resources, disclose information which arises in connection with any matters
(including disciplinary matters) which may have implications for the
investigation, prevention or detection of breaches of security;
(i) enable its LSMS to receive training recommended by the CFSMS;
(j) require its LSMS, its employees and any persons whose services are provided
to the NHS body in connection with security management work, to take into
account guidance and advice which may be issued by the CFSMS on media
handling of security management matters;
(k) enable its LSMS to participate in activities in which the CFSMS is engaged,
relating to national security management measures, where he is requested to
do so by the CFSMS ;
(l) enable its LSMS to work in conditions of sufficient security and privacy to
protect the confidentiality of his work; and
(m) enable the LSMS generally to perform his functions effectively, efficiently
and promptly.
Signed by authority of the Secretary of State
2004
A member of the Senior Civil Service
Department of Health
40
ANNEX D
NHS SMS contact details
General enquiries
or telephone
securitymanagement@cfsms.gsi.gov.uk
020 7895 4500
Legal Protection Unit
lpu@cfsms.gsi.gov.uk
Website
www.cfsms.nhs.uk
For contact details of your Security Management Director (SMD) or
Local Security Management Specialist (LSMS), enquire at the health body
where you are employed or to which you are contracted.
41
ANNEX E
Confidentiality and data protection – executive summary
In November 2003, the Secretary of State issued Directions to NHS bodies
on the measures they should take to deal with violence against NHS staff
and professionals. Pursuant to these Directions, each NHS body must
nominate one of its executive directors to take responsibility for measures
to deal with violence against staff. In order to discharge its responsibilities,
the NHS SMS has established a physical assault reporting system (PARS)
which includes a computer database.
A difficulty has arisen because some health bodies, directors and NHS
staff are refusing to pass on relevant and necessary information about
incidents of violence to the NHS SMS. It is being suggested by those who
should, but refuse to, pass on this information that to do so would
contravene the Data Protection Act or would otherwise be a breach of
confidence. The guidance below is relevant to this concern:
Confidentiality
The right to confidentiality is not absolute and it can be waived or
overridden in a number of circumstances – e.g.:
•
If a patient has expressly or implicitly consented to information
being disclosed – e.g. when a victim makes a witness statement
and details the injuries suffered.
•
Regardless of consent, it can be overridden by primary or
secondary legislation – e.g. Directions, The Public Health (Control
of Disease) Act 1984, etc.
•
Again, regardless of consent, if disclosure is in the public interest,
the duty of confidence can be overridden.
The NHS, as an employer, owes a duty to its employees to take
appropriate steps to keep the working environment safe. Employees have
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a similar duty. The duties of employer and employee to comply with
measures designed to prevent or investigate workplace violence are
enshrined in health and safety legislation. An incident not reported and
dealt with appropriately may lead to escalation of the behaviour and further
harm to staff.
Disclosure can be justified as being in the public interest in the
investigation of crime and the prosecution of offenders. The right of a
patient to keep his or her medical records private does not extend to the
right to prevent relevant and necessary details of an assault he or she has
committed being passed to the relevant authorities. The doctor/patient
confidentiality regime is to encourage a patient to be frank with their doctor
and so receive the best treatment, and not to enable them to commit
assaults without recourse for the victim. Details of the assailant’s medical
condition/treatment would only be required if they are relevant – i.e. they
may have influenced the patient’s behaviour in some way.
The appropriate offence with which an assailant is charged is selected, in
large part, according to the extent of the injuries suffered by the person
assaulted. Details of the injuries and subsequent medical treatment are
required for this purpose. The balance would be correctly struck if there
were no more disclosure of the patient records than was necessary for the
proper investigation of the assault.
Disclosure can also be ordered by the courts. The courts have wideranging powers to order disclosure of any material, except where it is
protected by legal professional privilege etc. No such privilege exists,
however, regarding communications between a patient and his or her
doctor or other healthcare worker. Any potential breach of confidentiality
should be pointed out to the judge, who will then weigh up the arguments
made for and against disclosure and make the final decision.
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The Data Protection Act 1998 (DPA)
Exemptions from certain provisions of the DPA have been created for a
variety of purposes and the main ones appear in part IV of the act. Each of
the exemptions authorises non-compliance with various parts of the act’s
provisions. For NHS SMS purposes, the most likely exemptions would
come under the following categories:
•
the investigation of crime
•
the apprehension or prosecution of offenders
•
if the disclosure is required by or under any enactment (i.e.
Secretary of State for Health’s Directions)
•
by rule of law or by order of the court
•
in connection with legal proceedings (including prospective legal
proceedings)
•
for the purpose of obtaining legal advice
•
if the exemption is otherwise necessary for the purposes of
establishing, exercising or defending legal rights.
The Office of the Information Commissioner is the body responsible for
enforcing the DPA. Guidance on the use and disclosure of health data,
published by this body, makes specific reference to the duty of
confidentiality and the DPA and, in both instances, states that disclosure of
medical information would most likely be justified in the event of an assault
on a member of staff.
In summary, it is the view of the NHS SMS, supported by detailed legal
advice and the guidance of the Information Commissioner, that disclosure
of the personal details and relevant medical information of those involved
in assaults against NHS staff is a justifiable breach of confidentiality,
required by law and covered by various exemptions to the DPA.
The complete guidance document on confidentiality can be obtained by
contacting the Legal Protection Unit at Weston House, 246 High Holborn,
London WC1V 7EX or by emailing lpu@cfsms.gsi.gov.uk.
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