General Note

NHS Fife acknowledges and agrees with the importance of regular and timely review of policy statements and aims to review policies within the timescales set out. New policies will be subject to a review date of no more than 1 year from the date of first issue.

Reviewed policies will have a review date set that is relevant to the content (advised by the author) but will be no longer than 3 years.

If a policy is past its review date, then the content will remain extant until such time as the policy review is complete and the new version published, or if national policy or legislative changes are made.

1. FUNCTION

1.1 That NHS Fife staff are able to perform their duties without fear of abuse or violent acts.

1.2 That staff do not consider that violence is to be an acceptable part of their employment.

1.3 This policy will enable NHS Fife to meet its obligation to protect staff where reasonably practicable.

1.4 That staff are given appropriate post incident support.

1.5 NHS Fife defines an incident of violence and aggression as:

“Any incident in which a member of staff or person working on behalf of NHS Fife is verbally abused, threatened or physically assaulted by a patient, member of the public, or another member of staff in circumstances relating to his or her employment”.

(Pin Policies, Managing Health at Work, Protecting against violence and aggression at work)

2. LOCATION

2.1 This policy forms an integral part of NHS Fife's Health and Safety Strategy and is applicable in all locations where NHS Fife staff encounter violence and aggression in connection with their working duties or activities.

2.2 It covers all staff, including temporary staff, agency staff, contractors, volunteers, students and those on work experience and applies in conjunction with any specific local guidance for managing violence and aggression in the workplace.

3. RESPONSIBILITY

3.1 The Chief Executive is responsible for:

• Ensuring that there are arrangements for identifying, evaluating and managing risks associated with violence and aggression at work.
• Providing resources for putting the policy into practice.
• Ensuring there are arrangements for monitoring incidents of violence and aggression in the workplace.
• Ensuring that the NHS Fife Board reviews the effectiveness of the policy.

3.2 Senior and Line Managers are responsible for:

• Ensuring that all staff are aware of this policy, understand its content and local procedures.
• Ensuring that their areas of responsibility are risk assessed with regular reviews carried out.
• Ensuring care plans for patients displaying aggressive or violent behaviour are in place and up to date.
• Ensuring that any area of high risk is staffed by individuals who have undertaken appropriate training.
• Ensuring procedures, safeguards and safe systems of work are put into practice to eliminate or reduce the likelihood of violence and aggression.
• Ensuring, where necessary, procedures restricting and preventing access to treatment or withdrawing treatment or services are implemented appropriately.
• Ensuring that staff groups and individuals identified as being at risk are given appropriate training instruction and supervision.
• Ensuring that staff groups and individuals are given information and guidance on organisational policies and procedures designed for working safely.
• Ensuring that support is given to staff involved in any incident of violence and aggression.
• Monitoring the effectiveness of preventative measures through reporting, investigating and recording of all incidents.

3.3 All staff are responsible for:

• Taking reasonable care of themselves and other people who may be affected by their actions
• Following policies and procedures designed for safe working
• Reporting all incidents involving verbal abuse, threats and physical assault through the DATIX Incident reporting system
• Undertaking training designed to meet the requirements of the violence and aggression at work policy
• Reporting any hazards they identify within their work environment and any concerns about potentially violent situations
• Sharing information on individuals who pose a risk of violence and aggression against health professionals.

 3.4 The Violence and Aggression Reduction Advisor is responsible for:

• Providing advice and guidance to managers and staff on strategies to help reduce violence and aggression
• Where required giving advice and guidance to line managers during incident investigation
• Providing training for staff in the prevention and management of violence and aggression. The advisor can be contacted through the Health and Safety Services Team.
• Improving organisational confidence by providing informed feedback to staff who have been victims of violence and aggression.
• Developing a range of communication bulletins informing staff of initiatives to promote well being

4. OPERATIONAL SYSTEM

4.1 Managing Incidents

4.1.1 Departmental procedures must be in place which provides guidance for staff on managing violent or aggressive incidents and associated emergency situations. (Appendix 1 Sample Emergency Procedure) 

4.2 Use of Reasonable Force

4.2.1 NHS Fife acknowledges that there may be circumstances where it will be necessary for staff to use reasonable force to protect themselves and patients, or to contain an incident to ensure a safe environment for all persons concerned. 

Where the use of reasonable force is assessed as necessary the following requirements must be met:

• the minimum amount of force will be used.
• by the minimum numbers of staff.
• for the minimum amount of time.

4.2.2 Other than during emergency situations restrictive holding techniques and other forms of restraint measures should be encompassed within patient care plans. All care plans will take into account any equality and diversity considerations in relation to the patient.

4.2.3 For guidance on the use of force please refer to:

• The Human Rights Act 1998.
• Guidance from Nursing and Midwifery Council, The Code.
• Mental Welfare Commission for Scotland; Rights, Risks and Limits to Freedom.
• Policy for Rapid Tranquillisation in Adult Patients (M1-G2-MH).

4.3 Staff Support

4.3.1 NHS Fife will ensure that all staff who are victims of violence or assault, or who have required to use reasonable force, to safely carry out their duties will have access to support. 

4.3.2 Managers are responsible for making sure that a debriefing session is carried out as soon as possible after incidents with all the staff involved. Where staff require time off work to receive medical attention, legal advice, or counselling support this will be provided.

4.4 Reporting and Recording

4.4.1 In accordance with the NHS Fife Adverse Events Policy (GP/I9), all incidents must be reported through the NHS Fife DATIX Web System. If more than one individual is directly affected by an incident, a separate report must be completed for each.

4.4.2 All investigations and further reporting must also be in accordance with the NHS Fife Adverse Events Policy (GP/I9), the recording of hate incidents and where necessary Health and Safety Executive RIDDOR reporting requirements.

4.4.3 Local statistics and incident reports will be reviewed through clinical governance, and management meetings, in order to monitor the effectiveness of this policy and associated local procedures and protocols.

4.5 Involving Police Scotland

4.5.1 NHS Fife is committed to protecting staff from violence and aggression. Staff and managers will be supported in reporting incidents to the police where appropriate and through any subsequent investigation process. A decision not to contact Police Scotland due to a clinical reason relating to the condition of a patient will be determined by following:

• A local area procedure or protocol which has been agreed and implemented prior to an incident occurring.
• By the senior or line manager after consultation with the staff involved.

Please Note: None of the above points remove a staff member’s right, as a victim of crime to contact Police Scotland and to report the incident.

4.5.2 It is the role of the Procurator Fiscal to assess the evidence submitted by Police Scotland and to decide if criminal proceedings are to be initiated. Senior and line managers must ensure that staff have ongoing support throughout the process and assistance may be obtained from Police Liaison, contact information available via the Staff Resilience Lead. Additional support is also available to staff through staff side representatives, trade unions or other professional organisations.

4.6 Restricting or preventing access to treatment or withdrawal of treatment or services. 

4.6.1 NHS Fife reserves the right to prevent a patient accessing treatment or to withdraw treatment and services, where the patient's aggressive or violent behaviour impacts on or is a threat to:

• The safety of a staff member.
• Another patient or visitor.
• NHS Fife property.

(See Appendix 2 Guidance for Restricting or Preventing Access to Treatment, or Withdrawal of Treatment and Services)

4.7 Emergency Treatment

4.7.1 Where a patient is under 16, mentally ill, cannot be held responsible for their actions or requires emergency treatment arrangements and behaviour management measures must be considered to safely allow the patient access to treatment.

4.7.2 Each case will be considered individually, and all staff will be given information specifying the action they should take in response to varying levels of risk. Refer to local procedures and patient care plans.

4.8 Compensation

4.8.1 The Criminal Injuries Compensation Authority provides a system of compensation for any blameless victim of a violent crime, provided the victim has reported the crime to Police Scotland. Under this Authority staff can make a claim for personal injury resulting from an assault. Guidance on eligibility and advice on making a claim is available from their website.

4.8.2 If a staff member loses earnings as a result of an incident they can make a claim to the NHS Injury Benefits Scheme. Reference Information and advice on this scheme is available from Human Resources.

4.8.3 If a staff member suffers loss or damage to personal property as a result of an assault, they can make a claim for compensation. Information and advice on this is available from Human Resources.

4.9 Monitoring and reviewing

4.9.1 Unless there are emerging issues this document will be subject to three yearly review and the consultative process will include the Area Partnership Forum (APF), NHS Fife Health and Safety Management Group, Trade Unions, Professional Organisations and Health and Safety representatives.

The review process will include:

• collecting and monitoring all reported incidents.
• Local Health and Safety Committees conducting quarterly reviews of incident statistics and improvement safety measures.
• If necessary, matters will be presented to the Executive Directors Group to be ratified.

Once ratified, the revised document will be disseminated throughout the organisation by the attending members.

5. RISK MANAGEMENT

5.1 Assessing risk from violence and aggression. 

5.1.1 Risk must be assessed in all work areas and will involve identifying situations where there are potential risks of violence and aggression. It should identify who will be affected and how, and what control measures are needed to eliminate or reduce the risk to the lowest level. The risk assessment should be recorded, shared and accessible. The following details should be recorded:

• The extent and nature of the risks
• The factors that contribute to the risk including job content, work environment and any history of violence an individual may have previously demonstrated
• How risk can be eliminated or reduced.

5.1.2 The risk assessments will be reviewed and updated annually or sooner if circumstances change. 

5.1.3 Every patient who has a history of aggression or violence will have a suitable management plan that identifies the risks and states the action to be taken to minimise them.

5.2 Staff Information, Instruction and Training

5.2.1 NHS Fife has an obligation to provide training. Managers are responsible for ensuring that staff receive appropriate training and have access to regular refresher training. All training will be provided by NHS Fife recognised instructors. Details of training interventions are available from TURAS Learn.

5.2.2 NHS Fife will provide training to give staff the skills needed to help prevent and manage violence and aggression. This training is mandatory and appropriate levels of training for staff should be identified through local risk assessment and training needs analysis. Training and advice can be accessed through:

• Health and Safety Services Team
• Violence and Aggression Advisor
• Health and Safety Advisor / Trainer
• In Mental Health and In Learning Disability
• Physical Interventions Trainer
• Reducing Restrictive Interventions Advisor
• NHS Fife Learning and Development
• NHS Fife Violence and Aggression TURAS module

6. RELATED DOCUMENTS (*Includes Forms/Monitoring documents used)

• NHS Fife Health & Safety Policy Statement
• NHS Fife Pledge against Violence and Aggression
• NHS Fife Lone Worker Procedure (GP/L6)
• Guidance on Management of Risks Associated with Lone Working
• NHS Fife Wide Patient Supervision Policy (FWP-PSP-01)

 7. REFERENCES

• Health & Safety at Work Act 1974
• Mental Health (Care and Treatment) (Scotland) Act 2003
• Adults with Incapacity (Scotland) Act 2000
• The Children and Young People (Scotland) Act 2014
• The Management of Health and Safety at Work Regulations 1999
• Scottish Parliament; Emergency Workers (Scotland) Act 2005
• Mental Welfare Commission for Scotland; Rights, Risks and Limits to Freedom, Edinburgh, 2021
• The Royal College of Nursing; Violence in the workplace / advice guides
• Nursing and Midwifery Council; The Code: Professional standards of behaviour for nurses and midwives
• NHS Scotland Partnership Information Network; Managing Health at Work Guideline 6 Protection against violence and aggression at work
• Health and Safety Executive; RIDDOR- Reporting of Injuries Diseases and Dangerous Occurrences Regulations 2013
• Criminal Injuries Compensation Authority; Apply for compensation for a criminal injury
• NHS Business Service Authority; NHS Injury Benefits Scheme