Safety first

Lone working is simply part of the job for many frontline healthcare staff, but year upon year there are still tens of thousands of assaults on these UK employees.

Safeguarding a workforce that by its very nature puts its patients’ health at the top of the agenda is of course, deeply complex, but the Institution of Occupational Safety and Health (IOSH) encourages simple, effective and non-alarmist measures that make a difference to the safety of lone workers in this sector.

Figures suggest there are around 690,000 healthcare professionals employed nationwide, and according to official NHS statistics, 56,718 of its staff were violently attacked in 2009/10. Although it is hard to pinpoint how many of these were lone worker-related incidents, it is common knowledge that these employees do face an increased risk, owing to the fact that by their very definition, they work by themselves without close or direct supervision.

Types of lone work
Lone workers cover a diverse cross section of healthcare employees; some work on their own within an organisation’s buildings, some at home alone, others on the road in a variety of locations. Their roles include community midwives, social and care workers, paramedics and emergency responders, security staff, counsellors, maintenance workers, and even nurses or doctors on shifts or home visits.

Community-based healthcare staff face perhaps the widest variety of risks; the biggest being a social one, of abuse or attack, owing to the fact many work with individuals with specialist and diverse needs. In fact, the NHS employs an estimated 200,000 to 250,000 community-based staff, all of whom are guided under the healthcare system’s lone working policy.

Generally though, it is employees who have close contact with the general public that are subject to the most risk. It can be the nature of their work that presents the most risk; for example, encountering drug or alcohol use, working at height, or alone in a workshop. Late nights and early mornings can also be a factor, as can working in high crime or isolated locations.

The law
Organisations must think about and deal with any health and safety risks that their line of work creates – that includes mitigating dangers of lone working. Employers have a duty to protect their lone workers. But where good health and safety measures are in place and an organisation sticks to the line of the law, employees have a duty to protect themselves and heed the advice they’re given.

Under the 1974 Health and Safety at Work Act, employers are responsible for the health, safety and welfare of their entire workforce. Not only that, they must protect the health and safety of those affected by their work activities, such as the self-employed and visitors including contractors.

In each lone working situation that a healthcare organisation places its employees in, the Management of Health and Safety at Work Regulations 1999 says they must investigate significant hazards and assess the risk of working within those circumstances. They must put in place procedures – physical and mental – to control or completely avoid those risks. Where the risk is too great, lone working simply shouldn’t happen.

Reducing the risks
It is important that the steps organisations put in place to safeguard their workforce are kept under constant review. This will mean that they are changed and improved to reflect the experiences of those frontline healthcare workers that face potential incidents on a daily basis.

Lone workers need to be provided with extra support to mitigate the risks they face. They need to be empowered through training to make sure they are equipped with the know-how and responsibility for their own safety and security.

The best way for an employer to ensure there is organisation-wide consistency over lone working is to develop a policy that managers can integrate into their workforce. Both regular and occasional lone workers should be looked after, so that everyone is aware of the techniques they can employ to protect personal safety.

Group training is an ideal way to share and learn from experiences of this type of work, helping people pool suggestions on the measures that can help to overcome problems. After all, good communication is the most important aspect of looking after lone workers.

Prevention rather than cure
When the correct policies are in place and regular training is given on how these policies apply to people’s real-life experiences, this means incidents are much less likely to happen.

Learning from experience is one of the best ways of avoiding problems in the future, so organisations should not just report incidents and file them away – they should be used to improve lone working policy to avoid similar problems in the future. Encouraging a risk and incident reporting culture is important, and the perspective of other stakeholders who witnessed or dealt with incidents should provide key information for report and strategy in the future.

Prior to a lone worker stepping out in their job, a company needs to take a step back from their tasks and find out what areas of their work will need more finely tuned health and safety considerations and procedures. Risk assessments perform that role.

In fact, dynamic risk assessments are the most important lesson companies have to learn in finding out how to best protect their lone workers. These should assess whether the conditions they’ll be working in are normal or abnormal, and whether they are hazardous – both in terms of the groups of people they face, and the physical conditions of the area such as hygiene and lighting. Lone workers in the healthcare sector might have to refuse appointments, give medication or give bad news – all of which can spark emotional reactions that they will need to be trained to diffuse. Those who work with alcohol or drug users, and patients with mental or personality disorders also face specific risks that need careful procedures and training in place to be able to deal with them.

Certain types of equipment will require assessment, as well as the lone worker’s ability to prevent that equipment from being stolen or mishandled, such as medication. They will also need to carry equipment to help them in unpredictable situations, such as a torch, map of the local area, telephone numbers for emergencies including local police, first aid kits, or mobile phone chargers. Whether a lone worker is disabled, pregnant, or inexperienced will also need taking into consideration to find out their physical capability of dealing with abuse or attack.

Practical solutions
There is an array of solutions to the risks that lone working presents. Some of them are physical, such as providing employees with mobile phones, panic alarms, or even light body armour in accident and emergency departments, but others are psychological and learnt methods that both prevent and calm heated situations.

IOSH believes that communication plays a key role in protecting lone workers. If managers and colleagues are aware of where their fellow employee is, and they keep in regular contact and are able to make contact if an emergency arises, the risk of harm is dramatically reduced. As previously mentioned, robust risk assessments will also help to mitigate risks by providing systems that will cope with potential or actual attack or abuse.     IOSH recommends appointing a ‘personal safety’ champion to ensure lone working is managed proactively in an organisation.

‘Buddy’ systems are useful as they enable a lone worker to keep in regular touch with another employee based back at head office, or another location. This buddy will know the places, times and people that their colleague is coming into contact with and will be able to raise the alarm if an expected call is missed.

If none of these measures are in place, at the very least, others in the organisation should always be aware of a lone worker’s movements, with a full address of where they will be, the details of the person they are visiting or working with, telephone numbers, and times they expect to be at that location.

For those employees who make visits to homes or other places alone, they should ideally make contact each side of the visit. Risk assessments should establish whether the visit presents a chance of harm to the lone worker, and if this is the case, the employer should try to arrange someone to accompany them, or pre-arrange a call during the appointment.

If there is a history of violence where the appointment is being held, or the patient or service is considered high risk, the lone worker should have a colleague, security officer, or in extreme cases, a police officer with them. Visits of this type are best in a neutral location or within a secure environment.

Safety devices
There are several safety systems that allow these lone workers to quickly alert colleagues if they need help, but their level of complexity and reactivity will depend on the risk that person is exposed to. IOSH does urge companies to adopt sensible control measures that don’t unnecessarily alarm – they must be practical and proportionate. Technology shouldn’t be used on its own, or as a substitute for proper training and techniques. It’s an added layer of protection that adds value and can make the difference in a worst case scenario.

The simplest of safety devices come in the form of speed dial buttons on mobile phones, panic buttons that link to base or the police, as well as others that link a user’s whereabouts to their PC and shared e-mail calendar. The simple panic alarm, which sets off a loud noise, is also an effective method.

Other more technical applications might provide automated GPS tracking that can show a user’s movements. There are those that require people to regularly log in to show they are safe, starting a chain reaction of emergency procedures if they don’t.

It’s important that organisations understand that these devices are important, but they don’t make lone workers invincible, nor do they mean they won’t be abused or attacked. What they achieve is enhanced protection, either as a deterrent, or to assist in investigations as evidence.

Lone work within the healthcare sector will more often than not involve driving a company or self-owned vehicle. Advice might seem intuitive for employees in this area, but so often, it is the simple things that get missed because they seem insignificant and easy to carry out at any point during or after working hours. IOSH urges people not to overlook the more obvious precautions.

The aftermath
If an incident does happen, staff and employers need to understand the importance of reporting. Not only will this help to improve their lone worker policies of the future, but on a national level it will inform RIDDOR statistics and other figure-based evidence of incident rates.

Organisations need to have a system in place that cares for those employees who have been a victim of an abusive or violent incident. This might include debriefing or counseling services, post-trauma support, peer support, psychological support and access to a trade union representative.

The key to prevention of abuse or attack of lone healthcare workers is instilling in them the confidence to refuse to go into a situation where they feel their safety or the safety of others could be compromised. Intuitively, they will know what risks are not worth taking, and a common sense approach is needed to safety in this context. Dynamic risk assessment skills should help individuals make informed decisions while they are doing their jobs and will help to protect them. This pragmatic approach will also balance with the standard of care that patients and service users do need in order to get better.  

For more information
www.iosh.co.uk