The nature of the business

The government’s recent announcement that £97 million will be allocated to tackle high levels of violence against health service staff is a timely reminder that crime is a major threat to people and property across the NHS.
    
Statistics show that acts of violence against NHS staff are so common that nurses are second only to police officers in the level of risk they face on a day-to-day basis. Hospitals need to address the problem by means of a risk assessment to establish the need for security measures and training.
    
Risks will vary by location and the nature of the employee’s job. A & E departments, for example, tend to have the highest levels of risk. Drugs, alcohol and frustration over waiting times are major contributors to risk.
    
The latest funding will enable more training in how to defuse dangerous situations, as well as providing satellite-linked communication devices for front-line staff and isolated workers.
                         
The risk of violence often results from the particular nature of the job but hospitals have always been vulnerable to crime of all kinds. The typical presence of large numbers of people coming and going is a central factor because it is often difficult to control access and identify trespassers.
    
Greater risk
This combines with several other factors, such as the possession of large amounts of property attractive to thieves and often emotionally charged conditions, to enhance the risks to people and property. The total impact of these circumstances is impossible to quantify, since a lot of crime in hospitals goes unreported. The fact that much hospital property is disposable and not always easily accounted for is one reason for this.  
    
Some general figures are available. It has been estimated that crime costs the NHS more than £1 million every week and the employees union, Unison, has said that almost nine out of ten health service staff worry about violence at work.
    
Lone workers making home visits are also vulnerable, indicating the need to extend security planning beyond the immediate hospital environment. Several hospitals have reported that seemingly mundane items such as linen are frequent objects of theft that account for large cumulative losses.
    
Risks extend beyond the walls to include offences in the hospital grounds, such as the theft of or from vehicles in car parks, which presents risks to staff, patients and visitors – particularly female drivers parking at night. Such a widespread and varied problem calls for a holistic response, involving the intelligent use of security procedures, manpower and technology.

A unique set-up
All hospitals have unique characteristics that demand unique security solutions. Identifying these conditions is the first element of risk assessment because doing so defines the scale of the problem and highlights the need to address specific issues. Even though it is difficult to generalise, the following key principles are widely applicable:
    
The number of entrances and exits in day-to-day use should be kept to a minimum, subject to expert advice about any safety implications, such as the need for emergency egress. Unless free public access is required, such as for hospital visiting, doors should be locked to prevent casual entry. Access control systems should be provided for use by authorised members of staff.
    
CCTV cameras should be used to provide comprehensive surveillance of key areas within the site. Depending on the location, they may be monitored by on-site security staff or remotely via an alarm receiving station. In all cases, they may be linked to a recording device to deter and provide evidence for later investigation of events. The advent of digital camera technology and video-over-IP protocols has both reduced the cost of this type of protection and enabled a wide range of new possibilities for communicating high quality visual images over unlimited distances. Cameras and door release/intercom systems should be considered to check visitors before they are admitted to protected areas.
    
Security teams should be employed whenever large-scale public access is a feature. A security presence is a key factor, both in deterring crime and reassuring staff and visitors. The involvement of well trained and equipped security officers is also central to the effective operation of all protective systems, such as by monitoring and responding to fire and intruder alarms and specialised equipment such as baby-tagging systems in maternity units.
    
The effective use of precautions such as alarms and CCTV surveillance can also control revenue costs by reducing the number of security staff required. A number of NHS Trusts have implemented successful combinations of manpower and technology, including a 700-camera surveillance system at St James’s Hospital in Leeds.
    
Protect isolated premises and high-risk locations by fitting an intruder alarm, linked to a remote alarm receiving centre with priority access to the local police control room and/or the in-house security room. Combine intruder alarms with ‘panic buttons’ in sensitive locations to generate a response in case of emergency such as robbery or assault.
    
Remember that security considerations can extend off-site. BSIA members have been at the forefront of developing new technology in this area, including communications systems that allow lone workers to discreetly call for assistance if they are endangered.

Research and planning
Research and planning are at the heart of good security. Studies have shown a marked statistical relationship between the prevalence of crime and different physical situations, such as transit areas connecting different destinations within a hospital. One survey showed that nearly 80 per cent of thefts took place in such areas, as opposed to ‘cul-de-sacs’ or departments where access was controlled. Although it is impossible to eliminate circulation areas in a hospital environment, it is clear that a careful survey can ensure that access control, surveillance and security manpower resources are deployed in a well-targeted and cost-effective way.
    
Another example of the relationship between crime and the environment applies to the security of places where known risks exist. These include accident and emergency departments where assaults on staff are most common, cashier’s departments and dispensaries, where there is a risk of robbery and burglary, and special risk areas such as maternity units, which need to counter the possibility of infant abduction.
    
Given adequate physical security and the availability of staff who are trained to respond, modern security technology can provide highly effective protection for these areas. Access control systems, intruder alarms and panic buttons with remote monitoring enormously reduce the risks of ‘walk-in’ theft and undetected burglary or robbery, whilst portable panic buttons can help both to protect and reassure individual members of staff. Electronic tagging systems can greatly reduce the risks of undetected infant abduction.  
    
The use of lone worker devices by individuals who work either alone or in areas of risk should also be a consideration as these devices can be used to sumum assistance if required or provide reassurance to staff that help is at hand when required.
    
In each of these aspects of hospital security, the key issue is professional on-site advice about the identification and reduction of risk. Effective security solutions almost always need to be tailored to individual buildings and circumstances. This is true of security manpower services, in-house training and security technology alike. The interface between manned security services and technology is critical, since the means to detect problems must obviously go hand-in-hand with the ability to respond to them.
    
Always take professional advice before making decisions about security. BSIA member companies will provide expert guidance and no-obligation quotations free of charge.

About BSIA
The British Security Industry Association (BSIA) is the professional trade association of the UK security industry. Its members produce over 70 per cent of the country’s security products and services to strict quality standards. For further information, visit www.bsia.co.uk. The BSIA operates a local rate help line, open during normal business hours on 0845 389 3889.