Protecting your staff

Violence against NHS staff undoubtedly makes for dramatic headlines, sociological debate and political manoeuvring and one-upmanship. But beyond the posturing and the academic arguments, what can practically and effectively be done in order to stem this rising problem?

Empowering staff
No-one can disagree that there is a very real need for response, when faced with figures that show that in 2005 alone, 60,385 NHS staff were physically assaulted (ref: NHS Security Management Service and the Association of Chief Police Officers). Furthermore, few can argue that one fundamental solution to this issue, is to empower NHS staff, with the knowledge, confidence and skills to proactively defuse abusive and aggressive behaviour before situations escalate and descend into violence. Staff training is therefore a prerequisite - but to whom can the NHS turn in order to provide such guidance and support? More importantly, how may the NHS be assured that any training provider can adequately satisfy and fulfil its unique challenges?

1. Shared values
It is surely imperative that any organisation that seeks to train the NHS in such a sensitive arena as behaviour management, must embody a philosophy that is wholly compatible with healthcare provision. In practical terms, this means finding a training provider who espouses a person-centred approach to crisis prevention and intervention training, and who recognises, above all else, the need to ensure all individuals’ care, safety and welfare.However, in real terms, such training is not always sought. Indeed, some of the physical intervention techniques that are currently used by healthcare workers, can be excessive, extreme and in certain circumstances, dangerous to the point whereby a service user’s life may be seriously endangered. It is perhaps for this reason, that many within the NHS are now moving away from the more invasive and pain-based restraint strategies of old, and seeking training solutions that do not compromise the commitment to therapeutic care. Thus, whilst the NHS must clearly maintain robust strategies in order to respond to the type of abuse perpetuated by the individual predisposed towards anti-social behaviour, it must be remembered that many of the assaults against NHS staff are a result of illness, disability, addiction, fear or anxiety. In such circumstances, the NHS has a clear moral duty to act in accord with its primary mandate - to extend care and help to those in need. In summary therefore, it is proposed that the NHS has explicit responsibility to seek intervention training solutions that value, respect, and ensure the security of, staff as well as service users and all others.

2. Longevity and credibility
More obviously, when choosing a training provider, the NHS should seek to identify an organisation that is well-established. Thus, any provider should be able to readily demonstrate a proven history of training services, supported by qualified and credible references, endorsements and/or research that specifically speak to the success of the provider’s training within a healthcare environment.

3. Formal recognition
A training provider must also be suitably accredited. Specifically, any training programme that seeks to minimise abuse and assault against NHS staff must be fully compliant with the National Syllabus for Conflict Resolution Training as issued by the NHS Counter Fraud and Security Management Service. Moreover, the provider’s staff should have attended the Conflict Resolution National Syllabus Seminar. It would also be preferable if a training provider was recognised by the Institute of Conflict Management (ICM), in order to attest that its programme is in accord with the Health and Safety Executive’s National Occupational Standards on the management of workplace violence. Equally, in order to support service users with learning difficulties, autism or emotional behaviour disturbances, a training provider should have formal accreditation from the British Institute of Learning Disabilities (BILD).

4. Implementation tools
A training provider should also be equipped to aid the NHS in its implementation of crisis prevention and intervention strategies - above and beyond teaching its core course content - in order to ensure the long-term effectiveness and sustainability of the training. This may include offering a Needs Analysis prior to the scheduling of any on-site training, in order to ensure that only the most appropriate staff attend the sessions, and that the programme will be suitably adapted to the particular concerns and idiosyncrasies of the commissioning NHS body. Additional implementation support may involve the supply of Audit Tools, which may facilitate the monitoring of crisis prevention initiatives post-training, and thus identify shifts in staff attitudes and confidence, together with changes in both the need for, and the intensity of, physical interventions.

5. On-going support
Finally, it is essential that both providers and NHS alike, recognise the need not to view crisis prevention and intervention training as a one-time event, but instead, as an integral part of an on-going process. Thus, it is recommended that prior to the commissioning of any training provider, the NHS must ascertain what will be subsequently available as extended support. This will include any options for on-going consultation and refresher training, together with opportunities for continuing professional development of staff. The possibility for supply of resource materials to stimulate and further encourage staff, should also be evaluated. Ultimately, such support will ensure that the strategies taught within a training programme are not simply forgotten or distorted in the weeks and months following a training session, but that the theories and practical applications live on, and most importantly, that standards are maintained.

In conclusion, and despite the very urgent need for crisis prevention and intervention training within the NHS at present, it is advised that commissioners and budget holders take time to make a considered judgement prior to appointing a training provider, in order to ensure that the strategies and philosophies that will be tutored in this most difficult area, are wholly compatible, stable, credible and holistic. After all, this training could save lives.

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