Frequently Asked Questions about conflict resolution training

What is conflict resolution training?

Conflict resolution training (CRT) is a means of providing employees of NHS organisations and providers of NHS services with the skills to spot signs of a potentially violent incident before it escalates. It teaches them how to defuse, prevent and manage an incident without the use of physical restraint. We believe that these skills are a safe and more ethical way to prevent an incident of violence. Physical restraint must be the last resort.

Why is there a particular version of CRT for the NHS?

By its very nature NHS work involves a particularly high level of personal interaction with the public, much of it at close quarters. There are many pressures surrounding the provision of treatment that could result in conflict.

Do you recommend a minimum or maximum number of delegates to a CRT course?

The delivery of CRT benefits from the interaction between the trainer and the delegates and between the delegates themselves. To ensure that this is the case, while also ensuring that the trainer can establish that learning is effective, NHS Protect recommended groups of no less than 12 delegates and no more than 20.

How long should be spent delivering the core learning aims and outcomes?

Based on NHS Protect experience it is recommended that the CRT curriculum requires five hours of contact time to be effective; and this approach is supported by the Health and Safety Executive. 

Can the minimum delivery time be split up into sessions?

We do not recommend this because the learning aims and outcomes benefit from being delivered together. Separating them will increase the length of the training as delegates will need to be refreshed about previous elements before resuming the course. Splitting the sessions up would also lead to delegates being part-trained between delivery and therefore vulnerable during the interim period. This would create a risk to organisations from a liability perspective during those interim periods.

What are the minimum qualifications required to deliver CRT?

NHS Protect recommended that trainers delivering of CRT should have a formal training qualification, although it does not recommend specific courses or suppliers.

How will I know if the CRT that my staff have received is effective?

It is not enough to merely deliver appropriate risk-based CRT to frontline NHS staff, it is crucial that the training is effective and addresses the identified risks. Organisations are expected to monitor, review and evaluate their CRT to ensure that it effective and make improvements to it where appropriate.

How will I know whether a person requires CRT or not?

There is such a wide range of organisation types, settings and job roles in the NHS that there is no simple way of defining whether a post requires CRT or not and what level of training should be delivered. It is the employer’s responsibility to ensure that individuals and roles are risk-assessed in relation to violence and aggression and this will determine whether CRT is required and to what level.

Who should provide the CRT?

NHS organisations and providers of NHS services can train their staff via in-house trainers or, if appropriate, via private contractors. Those delivering the training should adhere to the NHS Protect guidance to ensure that the appropriate standard of training is achieved.

Should there be refresher CRT?

Yes. The frequency of refresher CRT will be determined by local needs, although NHS Protect recommended that, in the interests of retention of knowledge and personal safety, refresher training should take place no more than three years after delivery of the previous training.

Can CRT be delivered by e-learning?

E-learning may be appropriate to support the delivery of knowledge aspects of CRT but should not be a substitute for the recommended contact time. It is important to be mindful that IT literacy is not an essential requirement for some staff groups requiring CRT.

Can CRT be delivered using a work book?

As with e-learning, a work book can be a useful support in the delivery of knowledge aspects of CRT but should not be a substitute for the recommended contact time.

Can CRT be delivered as part of a broader training day including other training?

CRT can be delivered as a stand alone course, although there are benefits to conflict resolution being integrated into a more holistic approach to communication, customer care and engagement with service users, as these are all transferable skills.

CRT consists of a set of learning outcomes to be delivered to minimum standards. Where these outcomes are also covered by other training, this may be delivered at the same time as CRT, if it can be demonstrated that this can be done without compromising on the quality of training delivery.

For example, it may be that CRT is incorporated as part of a series of training courses based around the Skills for Health UK Core Skills Training Framework.

How is CRT mandated? Will NHS organisations and providers of NHS services be forced to deliver this?

The Health and Safety Act 1974 requires a safe working environment and adequate facilities including appropriate training. Also outcome 14D of the Care Quality Commission’s Essential Standards of Quality and Safety requires staff to have a safe working environment where risks of violence, harassment and bullying are assessed and minimised. Under the NHS Standard Contract, among other things, providers of NHS services were required to adhere to NHS Protect’s security management requirements and standard 3.1 specifically addresses CRT.

Could an overall risk rating for conflict for each organisation be determined, in order to define what approach for CRT is needed?

NHS organisations and providers of NHS services may vary considerably according to factors such as location and demographics. Therefore, prescribing what is appropriate for the roles in each organisation is best done by those who know the most about their organisation, i.e. at a local level.

An overall risk rating for an organisation would not determine who might be harmed and using such a general approach may result in people receiving training that they do not need it or in training not being received by those who need it. The number of reported incidents of violence should not determine whether there is a need for CRT because the number of incidents has no bearing on the risk to staff.

What evidence is there to show that CRT provides benefits?

NHS Protect’s CRT survey found that the vast majority of delegates felt that the training would help them to identify potential conflict situations (95.1%) and manage such incidents more effectively (96.4%). Furthermore, staff said that they felt safer and more secure at work following CRT. Twelve months after receiving the training, 67% of NHS staff surveyed said their working environment felt safer and more secure from violence.

This compares to 47% of NHS staff surveyed before receipt of the training. It is a similar picture in respect of verbal abuse. After CRT, 56% of NHS staff surveyed felt safer from verbal abuse at work, compared to only 43% before the training. In some cases, staff feeling safer and more secure at work will mean the difference between staff leaving the NHS or not. Improved retention of staff will mean better patient care.

How do I know if the training has been effective?

The Conflict resolution training curriculum has now been developed which focuses on learning aims and outcomes. NHS Protect’s expectation was that the training has to achieve positive outcomes and so organisations are expected to monitor, review and evaluate their CRT to ensure that it is effective and make improvements to it where appropriate. All of this has been designed to move away from output-focussed training that sought to merely achieve a ‘tick in the box’.

Will new employees be made to re-do the training when they change jobs?

In cases where new employees have already received CRT from other NHS providers or commissioners, their prior learning may be counted if the training has followed NHS Protect guidance. In such cases a risk assessment should be made of the employee’s present needs before determining whether their prior learning is sufficient for their new role.