1. PROTECTING LONE WORKERS
“Working alone increases the vulnerability of workers (Chappell & Di Martino, 2000.)”

2. Definition of Lone Working
…..any situation or location in which someone works without a colleague nearby; or when someone is working out of sight or earshot of another colleague.
Source: NHS Security Management Service ‘Not Alone’ (2005)

3. Background to RCN lone worker survey
Key Findings
You’re Not Alone Campaign
National Action
Local Action

4. RCN Lone worker survey - background to survey
March 2005: John Reid
“NHS staff who work on their own in the community will have their very own guardian angel in the form of a high-tech protection device”
“I am determined to do everything within my power to stop NHS staff suffering from violence and abuse”
“Up to 100,000 staff work alone in the NHS every day and thanks to this device they will have the knowledge that help is only a button away.”

5. “Guardian Angel” Device
ID card holder
Lanyard or ID card holder
24 hour monitoring
Amber/Red alerts
Voice channel
Signal strength/battery charge
“The NHS Security Management Service has successfully completed trials of the Identicom device.  NHS staff said they felt safer and more at ease in their working environment when using this device.”

6. RCN LONE WORKER SURVEY 3010 members across UK; 996 completed
85% spent more than a quarter of their time working alone
53% work outside “office” hours
66% stated that employer did not know whereabouts or only “sometimes”
78.8% said employer had details of car
82.4% said employer had policy but 17% not provided with it

7. RCN LONE WORKER SURVEY 38% rarely or never carried out risk assessment
72% never rarely or only sometimes received all the information needed about the visit
Over three quarters felt very or quite safe at work but one third sometimes felt unsafe while working alone

8. RCN LONE WORKER SURVEY
52% said they thought the risk of violence/abuse had increased over last two years
Mobile phone most common safety equipment – often employee’s own
3.5% had Identicom
Nearly one fifth had not received conflict management training. Almost half had not received any training in last two years

9. RCN Survey Number of Incidents
Verbal
Physical
Number of incidents
1893 96
Number of incidents reported
883
(44.6% of total verbal incidents) 83
(86.5% of total physical incidents)
Number of incidents reported to police 30
(1.6% of total verbal incidents) 12
(12.5% of total physical incidents)
Number of racial incidents 49
(2.6% of total verbal incidents) 27
(28.1% of total physical incidents)
Number of sexual incidents
128
(6.8% of total verbal incidents)

10. Comparisons with HCC Annual Staff Survey 2006
Sector
Experienced physical assaults
Knew how to report
Who reported physical assault
MH/LD
22%
88%
87%
PCT 6%
86%
66%
Acute
11%
79%
56%

11. Demographics
Physical incidents as great in rural workers as urban and suburban
Urban workers experienced the highest levels of verbal abuse
Female workers reported feeling less safe than males
Male workers experienced higher levels of physical assaults
Young workers more likely to experience physical assaults
Older workers rarely felt unsafe and most likely to have a number of safety systems in place

12. Findings in four countries
Northern Ireland highest rates of weekend lone working and least likely to state that their employer had a specific lone working policy
Scottish and Welsh respondents more likely to feel ‘very safe’ whilst lone working
Northern Ireland highest rates of verbal assaults
Scotland and England highest rates of physical assaults
Welsh respondents most optimistic over employers awareness of risks and support available

13. “Attending a remote farmhouse, rural location recently, I was threatened verbally by a patient's husband that 'he would be behind the door with a gun if he was ever in a bad mood'...This experience has greatly affected my feelings for my career as a district nurse,” district nurse, North East England.
“I was assaulted and subjected to high levels of aggression and threats to kill us on a home visit with a social worker in 2000, where there were child protection concerns and serious enduring mental illness in the mother. The social worker sustained a serious injury and we were both traumatised for months and ever since,” health visitor, Merseyside.

14. You’re Not Alone Campaign
FIVE POINT PLAN:
Risk assessment
Prevention: technology
Policy
Training
Support from employer

15. National Action General secretary letter to MPs, Ann Keen.
Lobbying at party conferences
Also to PCTs: CEOs, HR, Nursing Directors
Meeting with NHSE

16. Labour Party Conference Alan Johnson annouced £97 million boost to tackle violence against NHS staff:
£29 million on 30, 000 safety alarms devices for lone workers
Remaining £68 million on training; additional LSMS; more funding for prosecutions and a centralised reporting system

17. Five Point Plan “Risk Assessments”
Who is at risk? At risk activities, environmental risk factors, risks associated with client groups and physical capacity of lone worker
Sharing information between service providers. Is there an agreement or process? Patient markers?
Dynamic risk assessment – there and then. Are lone workers able to and supported if they walk away from a visit if they feel unsafe?

18. Five Point Plan “Risk Assessments”
Community Visits:
Prevention of violence within community and domiciliary settings relies heavily on the professional competence of staff, but additional measures can be taken. These can include detailed plans of staff movements, periodic reporting in, procedures for assessment of potential or actual risk from clients, provision of information on patient risk and ‘high-risk’ geographical areas and extra security
measures for visiting high-risk areas.
NHS Scotland Zero Tolerance Campaign Pack at

19. Five Point Plan “Prevention”
Implement safe systems of work e.g. doubling up; re-siting care; informal or formal contract with patient/relative; animals; modes of transport; appropriate means of raising the alarm; supervision; log book/board.

20. Five Point Plan “Policy”
Jointly agreed
Arrangements; responsibilities; systems in place to monitor and review arrangements.
Policy covers arrangements for violent individuals
Policy made living document and lone workers made aware of it and their responsibilities.

21. Five Point Plan “Training”
Lone working procedures; conflict management/resolution (de-escalation), personal safety/awareness, disengagement techniques, reporting incidents, use of devices.
Include managers
Relevant
Refreshed
Competent trainers
“For training in the management of violence and aggression to be effective all training must be delivered by knowledgeable and credible trainers.” (ALL WALES NHS VIOLENCE AND AGGRESSION TRAINING PASSPORT AND INFORMATION SCHEME)

22. Five Point Plan “Training”
HSE research on training on violence :
Generally training is having positive but limited short term benefits
At worse can be damaging
Not just tick-box must be part of wider organisational objective
Regulation of V&A training
Trainer Competencies
National Guidance
Support and development of trainers
Organisational learning key
HSE research reports RR440 Violence and aggression management training for trainers and managers and RR495 Violence management training: The development of effective trainers in the delivery of violence management training in healthcare settings (

23. Five Point Plan “Support”
Immediate post incident support
Support of line management key
Support = action
Report and Investigation
Feedback/information

24. Next Steps Action in four countries
How are the devices going to be allocated?
Independent sector
Policy and strategy behind devices - five point plan
Lone workers at permanent bases
Roll out RCN Violence Risk Assessment Tool
Reporting incidents – what can we do to encourage reporting?