Managing security in the NHS

Security is not only a clinical issue, but is one that can have a significant impact on the delivery of healthcare. Security can have implications for staff, property and assets. The sound management of security can save money, protect valuable equipment, increase staff morale and productivity and improve recruitment and retention.
    
The NHS Security Management Service (NHS SMS) was set up in 2003 to take responsibility for security in the NHS. Since then, the NHS SMS has implemented a national structure for security management in England, produced guidance and policy to protect NHS staff and assets, begun the largest training programme in NHS history and created a new profession of security management specialists.

Protecting your staff
It is every employer’s responsibility under health and safety law to provide a safe working environment for all employees. This includes doing as much as possible to protect staff from violence and abuse. Keeping staff safe from abuse, however, is not always easy in a health service that is committed to being open and accessible. Healthcare staff will always come into contact with patients and the public on a regular basis. They cannot deliver healthcare from behind a barricade so measures to protect them have to take a broader view of how protection can be achieved.
    
The establishment of the NHS SMS was the first part of this process. Prior to 2003, no organisation had a national overview of security in the NHS. Security fell across different disciplines such as risk or estates management, which also limited what could be achieved.
    
Furthermore, prior to 2003 it was difficult to ascertain the extent of security related issues in the NHS, particularly the number of physical assaults against staff. Statistics collected before 2003 did not distinguish between different types of security-related incident and definitions varied throughout the NHS. When the NHS SMS was set up it introduced legally-based definitions of physical and non-physical assault, so with any future statistics the results would be clear. The NHS SMS then set up the Physical Assault Reporting System to ensure that reports were made promptly and that the necessary responses could be made.
    
The most important task, however, was and is to ensure that there is a professional approach to security management throughout the NHS in England. To achieve this two things need to be in place: a national structure to organise security management and a new profession to carry it out. The structure would ensure that security management was represented at board level in every health body, and that the work was overseen by a trained expert. The creation of a new profession would ensure that security management could be carried out to a consistently high standard throughout the NHS.
    
From 2003, every health body in England was required to nominate a Local Security Management Specialist (LSMS) who was to be trained and accredited by the NHS Security Management Service. The NHS SMS set about finding the best examples of security management in the NHS and making that knowledge available to all health bodies.
    
Local Security Management Specialists are trained to develop local solutions to security issues and provide a single point of contact for staff and the police. They have the authority to oversee all areas of work in the NHS that relate to security, and also have the training to implement changes.
    
In addition, all LSMSs in each region meet with representatives of the NHS SMS four times a year to discuss security issues and developments within the field. This ensures that each LSMS has the backing of a burgeoning profession and that best practice in the field is developed rapidly.
    
Each health body was also required to nominate a director and non-executive director to have overall responsibility for security management in the health body, to complement the LSMS role and ensure that the LSMS has all the necessary support to tackle violence, abuse, theft or damage to property.

Prosecuting offenders
A problem that demanded immediate action when the NHS SMS was set up was the low number of prosecutions. In 2002-3 only 51 people were prosecuted for assaulting NHS staff. This was quite clearly disproportionate to the number of assaults, but with the ability to receive reports of incidents in a timely fashion the NHS SMS could start to contribute to increasing the number of criminal sanctions against offenders for attacks on NHS staff.
    
As part of their training, new LSMSs learn how to liaise with the police, interview witnesses, protect crime scenes and generally improve the chances of evidence being available to support a police prosecution. In addition, the NHS Security Management Service’s Legal Protection Unit (LPU) has undertaken much pioneering work to ensure that prosecution is emphasised. This has included taking forward prosecutions in cases where the police or CPS have not progressed the case, collaborating with other agencies to bring asbos and injunctions, and most importantly, providing cost effective and objective legal advice to health bodies.

Staff abuse
The NHS SMS felt that it was even more important to prevent incidents, and give staff the skills to prevent and manage violence and abuse. The Conflict Resolution Training syllabus was designed to help NHS staff avoid conflict and manage the factors that lead to violence. There was a great deal of good practice available but because there were previously no national standards, training was not available to the same quality across England.
    
Therefore, the largest ever national training exercise in the 56-year history of the NHS began in 2004, with the bold aim to help 750,000 frontline staff deal with violence and abuse in the course of their work. The one-day Conflict Resolution Training course covers how to recognise potentially violent situations, verbal and non-verbal communication skills, i.e. body language, cultural awareness and many other factors that can influence safety.
    
Conflict Resolution Training should be made available by each health body to all NHS frontline staff including doctors, nurses, paramedics and receptionists, and all those who come in to regular contact with the public in the course of their jobs.
    
Legislation currently progressing through Parliament includes new powers for NHS trusts. These new powers mean that health bodies will be able to remove those not requiring treatment and who are causing a nuisance or disturbance - behaviour which, if unaddressed, may escalate into assault or abuse. In addition, in September 2007 the Health Secretary announced an additional £97 million to support security management in the NHS.
    
Awareness is higher than ever, and the government has demonstrated a commitment to security in the NHS, which is greater than it has ever been. The foundation is set for a future NHS in which staff and patients can be confident in their safety and security.