Past history of violent behaviour is the strongest predictor of future violence.
A news article in the Sunday Telegraph some years ago described a reporter’s experiences while spending a weekend on the road with a London Ambulance Service crew. Amongst descriptions of paramedics being shot and being shot at, about the violence and aggression he witnessed against these staff, the reporter mentioned a very special list, maintained by LAS.
There existed at that time a list of 1400 addresses in the London area which, if the emergency services were called and an ambulance required to attend those addresses, certain precautions were to be taken. The paramedic crew must stop on the way to the location and put on their stab-proof vests. On arrival, they must then await and assure police escort before going into the address.
Now, such a list sounds very interesting. If I was a criminal justice social worker, or a district nurse or a children’s dental health worker for example, I would probably want to know that this list (for example) was being shared with my team…just in case I be asked to visit one of these addresses by myself!
VIOLENCE WARNING MARKERS
Practice differs. One local authority we worked with keeps a definitive record of potentially adverse incidents and marks them on it’s database of service users. They do this probably in line with the NHS’s published guidance on Violence Warning Markers. This guidance published in 2010, makes clear that information pertaining to past and therefore potential future violence by service users can be recorded and shared in certain broad circumstances. However we are also aware of one local authority who ‘burned’ their entire violence warning marker database in response to a perceived legal threat about breach of confidentiality or privacy. Unsurprisingly, when we ask care staff if they would want to work for an organisation that had essentially blinded itself to violence risks, we don’t get many volunteers!
Some disagree with Violence Warning Markers, stating the need for care workers to be non-judgemental, respecting diversity and equality. Of course this is a legitimate aim, however respecting diversity is more appropriate to issues of race, gender, ethnicity. Being non-judgemental is appropriate to issues of lifestyle, relationships, culture and choice. Some even state that warning a care worker about a service users proven history of violence will make them over-cautious and therefore cold towards the client, thereupon bringing even more risk of an incident occurring! These arguments, while well meant, can not stand the scrutiny of one who holds one overriding public interest in their mind: the protection of life. We will return to this issue shortly – first let’s finish addressing the issues of the RCN survey.
RECORDING AND REPORTING ARE CRITICAL TO STAYING SAFE!
More than one in ten physical assaults against lone working staff in the community were being reported to a line manager! The risk here of course is that one persons “shoved out the door of the house” becomes the next person’s punch in the face, becomes the next persons….well, who knows? Certainly, if staff don’t feel the need to report assaults, then there is something very wrong. Firstly, staff should feel the responsibility of protecting their co-workers and others who interact with their clients. If their client has assaulted them, then the client could assault another person and there would seem to be a clear moral duty to warn of the danger. Sometimes though, over years of practice, staff with this keen sense of warning others have it worn down to a blunt edge. They write incident reports, discuss issues with their line managers and await the directives to come back down the chain of responsibility…to no result. Why should they spend the time to write reports when the reports aren’t seen to be actioned?
Another reason for lack of reporting can be that staff become convinced that being assaulted is part of their daily expected workload, and therefore does not warrant special mention in an incident report. Sometimes, we have heard of managers coercing staff not to report certain incidents because of the paperwork generated. Worse still, upon receiving a report of an incident occurring, the manager initiates an interview with the worker about how they must have been at fault for causing the service user to be so aggressive! This will not encourage reporting!
So now we can see, until we are supervising workers adequately, putting safe systems of work in place, recording and sharing information about danger, treating the problem seriously and having adult discussions about risk, then we won’t be able to stop the tragedies from happening.
Care Services wishing to control their exposure to a training omission could explore our Lone Worker training or Breakaway training which might be appropriate for their level of risk and their service type.
Gerard O’Dea is a conflict management, personal safety and physical interventions training consultant. He is the training director for Dynamis, a specialist in personal safety and violence reduction initiatives and the European Adviser for ‘Verbal Defense and Influence’, a global programme which addresses the spectrum of human conflict. www.dynamis.training