As if working in the NHS isn’t hard enough, the number of reported incidents classed under the umbrella of violence, aggression or abuse towards NHS staff has risen.
The Health and Safety Executive (2021) says violence at work is any incident ‘where an employee is abused, threatened or assaulted in circumstances relating to their work’. Violence can impact people differently, but can result in a lack of confidence, anxiety, sickness, increased alcohol intake and, at its most serious, post-traumatic stress disorder.
In my own Trust, reports of violence used to come mainly from the emergency departments, but now reports come from many different specialties. Reflections from my colleagues include that there is an increase in patients with challenging complexities, and that the COVID-19 visiting restrictions are having an ongoing impact, giving rise to stress among the public, which can translate into difficult behaviours. Worryingly, the extent of the true impact of such behaviours is unlikely to be known because many staff regularly either do not report incidents and ‘normalise’ poor behaviours, or report an incident as ‘no harm’ regardless of any psychological impact on them.
According to NHS England/NHS Improvement (2020), 569 000 NHS employees across 300 separate organisations responded to the 2020 NHS Staff Survey. NHS England/NHS Improvement states that too many still experience unacceptable abuse from patients and the public. It reports that more than one in four staff (28.5%) said they had experienced harassment, bullying or abuse from patients, relatives or members of the public, with almost one in seven staff (14.9%) experiencing physical violence. Almost 40 000 of those who responded (7.2%) said they had faced discrimination from patients over the past year—up from 5.8% in 2015. With racism reported as the most common form of discrimination, 2019 also saw the highest levels of reported sexism and intolerance of religion and sexuality.
The Nuffield Trust (2021) examined staff and patient experiences of violence in the NHS. It reminds us of the rights and responsibilities of patients, the public and staff to ensure the NHS operates fairly and effectively. It also states that patients and the public have the right to be cared for in a safe and secure environment, and have the responsibility to treat staff and other patients with respect.
The Nuffield Trust states that health and social care employees have had a consistently higher risk of violence at work than other occupational groups in recent years, with incidents likely to be under-reported due to a lack of confidence in the reporting process or an acceptance that it is part of the job.
The NHS Staff Survey asked respondents whether the last time they experienced physical violence at work it had been formally reported, either by themselves or by a colleague (Nuffield Trust, 2021). Between 2015 and 2020, the percentage of respondents who said that the last incident was reported fluctuated between 72% and 74%. Staff in mental health and learning disability trusts were the most likely to have reported incidents, with 91% of respondents in 2020 saying that the last incident of violence had been reported. This compares to 68% of staff in acute trusts. Between 2015 and 2020, the percentage of staff who said that either they or a colleague had reported it the last time they experienced violence remained roughly constant for all trust types except ambulance trusts (increasing from 66% to 74%) (Nuffield Trust, 2021).
So, what are the options for improving this worrying picture? NHS England/NHS Improvement (2021a) has launched the Violence Prevention and Reduction Standard, with an accompanying implementation programme called the ‘Violence prevention and safety programme’. The aim of the programme is to create cultures in which NHS colleagues feel supported, safe and secure at work. The programme aims to support NHS organisations to create compassionate workplace cultures, through the prevention of and response to incidents where staff feel threatened, vulnerable, unsafe, or where they are assaulted at work.
The standard delivers a risk-based framework that supports a safe and secure working environment for NHS staff, safeguarding them against abuse, aggression, and violence. The new programme includes case studies looking at topics such as introducing the wearing of body cameras for staff. This is an area that my Trust is progressing—as well as a relaunch of our revised policy and communications campaign.
Also welcome is a renewed level of confidence that action can be taken, following the introduction of changes since April under the new NHS England/NHS Improvement Standard Contract rules (2021b). NHS services will be able to protect staff by barring from non-emergency care any patient or visitor who inflicts discriminatory or harassing behaviour on staff. Previously, individual NHS organisations could only refuse services to patients if they were aggressive or violent.