Taming the antisocial minority

The NHS will come across a number of challenges during 2008 relating to security of people, property and assets. These are not only the ongoing issues of protecting these vital resources so the NHS can better protect the public’s heath – they are also to consolidate improvements that have been made and ensure that the approaches that have started to take effect are followed through.
    
Managing security in the NHS is not just about physical measures such as CCTV, security guards or bulletproof glass. These might be the most visible aspects of security in the NHS, but before any measures can be implemented, the basic purpose of the health service has to be considered.
    
The NHS exists to treat patients on the basis of need and, as such, needs to be as open and accessible as possible. NHS staff cannot treat patients from behind a barricade or locked doors. This means that protecting staff, property and assets has to be carefully considered, as patients in need should not be denied access to healthcare.

Antisocial behaviour
As in all areas of healthcare, it is better to prevent issues occurring than attempt to affect a cure after they have happened. The NHS Security Management Service (SMS) therefore appeals to people who use the NHS to opt out of being part of the antisocial minority. The NHS has always been a caring organisation, committed to helping people. This has sometimes fostered the misapprehension that NHS staff can be verbally abused, threatened, shoved or spat on – never mind seriously assaulted – without consequences.
    
The NHS SMS has been working with NHS health bodies to help them try to create a culture in their local populations where assaulting NHS staff or damaging property is unacceptable. In September 2007, the NHS SMS supported NHS Security Awareness Month throughout the health service. This was run in conjunction with NHS trusts and PCTs in England.
    
A range of methods, such as media relations, internal communications, presentations and poster campaigns, were used to inform staff, patients and the public. The messages were that antisocial behaviour harms staff morale, bleeds off NHS resources and can ultimately harm patient care. The aim was to make people think of the consequences of antisocial behaviour to the staff, to the health service in general and to their own healthcare – and consequently think twice about behaving in that way.

Building a culture
Building a culture within the NHS is every bit as important as building one among local communities. It is vital that NHS staff believe that they are entitled to work in an environment that is free from violence and aggression. The NHS SMS is determined to combat the feeling held by some NHS workers that facing violence and abuse is simply part of working in healthcare. This can mean that staff do not report abuse when it takes place, do not seek out training to help them prevent and manage abuse, and do not encourage their colleagues to press for measures to prevent violence.
    
The NHS SMS is committed to ensuring that members of staff do not regard violence as part of the job. It is therefore essential that staff know that they should report incidents to their health body wherever appropriate.
    
It is up to the NHS SMS and local security managers to ensure that staff know how to report, who to report to, and what action can be taken. It is also essential that staff are given feedback on the results of any reports they make. If staff are not informed of action that has been taken against offenders (or even why no further action can be taken) they are likely to feel that their reports have not been taken seriously and do not matter.
    
The NHS SMS has been working to implement a network of trained and accredited local security management specialists (LSMSs) in every health body in England. These employees will have a key role to play in the work to develop security in the NHS. They will be pivotal in creating a culture, both within and outside the NHS, where violence is unacceptable, and everyone is aware how seriously it is taken.
    
The NHS SMS wanted to ensure that every health body had a skilled security manager ‘on the ground’ who would have the authority to oversee all security issues in the health body. The advantage of this approach is that these specialists have access to all the best practice emanating from the NHS SMS, while also being attuned to the pressures faced by local staff on a daily basis. It will be their role to emphasise that while the NHS faces unique issues, it is largely a very safe place to work.

Security management
A further challenge is to see that the NHS Security Management strategy, which was begun in 2003, is fully implemented throughout the NHS. This means ensuring that every health body has a local security management specialist in place, a director at board level with overall responsibility for security management and a non-executive director with a specific remit for security. This ensures that security is taken seriously in the senior management of every health body in England, and also that every health body has the skills and expertise to deal with specific local pressures.
    
The LSMS also acts as the ‘face’ of security in each health body and is a recognisable single point of contact for staff reporting incidents and police officers investigating them. This has already meant improvements in reporting and streamlining processes for reporting and liaising with outside agencies.
    
The NHS SMS is able to ‘plug in’ to this local structure with the regional and national structure that has been set up to support local managers. This includes Area Security Management Specialists who each cover a region in England and are the first point of contact for LSMSs. Quarterly forums are held for each region where all LSMSs in that area can meet, discuss developments in the profession, share best practice and be updated on relevant national issues.
    
At the centre of the process is the NHS Security Management Service itself, developing guidance for local specialists, policy for health bodies and establishing links with other agencies to improve joint working. Examples of this are the Memorandums of Understanding with the Association of Chief Police Officers (ACPO) and the Crown Prosecution Service (CPS). These are designed to ensure that the NHS, the police and the CPS have the same dedication to investigating and prosecuting people who assault NHS staff.

Making real changes
Of course, it is not sufficient to create a culture of awareness in security issues; real changes that make staff safer are necessary. The true measure of these changes can already be seen in the fact that the number of physical assaults against NHS staff in England has gone down for the last two years. This is against the backdrop of a large number of assaults – over 55,000 in England in 2006/07. This is clearly unacceptable and the NHS SMS is determined to tackle this. However, the fact that a reduction of around 5,000 has been seen over two years shows that the approach that has been established is bearing fruit, and fewer staff are being assaulted as a result.
    
The NHS SMS has put in place the elements of a strategy that promises to have real and lasting benefits for the safety and security of NHS staff, property and assets. The chief challenge in 2008 will be to make sure that this work continues unabated and pressure on the antisocial minority is not only maintained, but also increased.