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Stamping out aggression

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New statistics highlight the need for government and employers to tackle violence and aggression against HCAs by patients, reports Louise Hunt

Two-thirds of healthcare assistants have experienced or witnessed violence and aggression by patients in the last year – and 11% have been threatened with a weapon.

These findings came from a national survey into HCAs’ working lives, taken by UNISON in July. The union surveyed 10,000 HCAs and received almost 1,400 responses, giving it data on the levels of violence they experienced for the first time.

The findings came as no surprise to Gail Adams, UNISON head of nursing. ‘We have seen a significant increase in the number of healthcare assistants who have experienced some form of violence or aggression. The numbers being threatened with a weapon is also much higher than we anticipated and that’s the most worrying aspect,’ she says.

‘Routinely our HCA members talk about receiving verbal violence, threats and intimidation. The problem is that staff get so used to people swearing and don’t challenge that behaviour.’

The very real risks to HCAs were illustrated by the violent murder of HCA Mamade Chattun by a patient at a south London mental health trust in 2005. UNISON says government and employers must take the issue more seriously.

While HCAs do not necessarily experience more violence than other groups, Ms Adams believes they may be at greater risk because they receive less training on self-protection by avoiding confrontation. The threat is compounded by the extension of HCA roles, which sees them increasingly working in isolation, such as in community settings.

‘We have certainly heard from HCAs asking for advice because they are working in community settings that the police have defined as “no-go” areas,’ Ms Adams says.

The union is working with the NHS Counter Fraud and Security Management Service to develop guidance for lone working. It also wants HCAs to receive personal safety training on a par with that given to nurses.

‘Nurses know how anger manifests anatomically, for example, when a patient goes red in the face or is spitting, and can assess whether it’s safe to intervene,’ says Ms Adams. ‘Part of the solution for us is to ensure HCAs have access to training, including knowledge of what happens physiologically to patients, how to distinguish between a medical condition and aggression and techniques to understand when or not to intervene.’

However, despite government pledges to give all NHS staff access to training, HCAs say they get little if any. UNISON branches work with staff to address these issues locally, and this feeds into national work helping organisations to manage violence and aggression. It also provides support for some individual legal claims.

Ms Adams says HCAs can help to address the situation by reporting even the most minor incidents. ‘They often think they won’t be taken seriously and then it becomes a vicious cycle because there isn’t the data to take action,’ she says. ‘Staff should take their personal safety seriously, irrespective of frequency or level of incidence.’

Staff should always fill in incident reports and get their organisations to medically assess perpetrators immediately, as many court cases collapse without evidence of a patient’s capacity for aggression.

And NHS organisations must take the matter more seriously, says Ms Adams. ‘They need to ensure there is adequate staffing, such as in dementia settings, and risk needs to be identified in care plans.’

She says staff safety policies vary across the NHS. ‘Some are brilliant,’ she says. ‘The London Ambulance Service, for example, ensures staff get psychological support and mental health trusts tend to have more robust risk assessments but these practices are not so good in the acute sector.

‘We hope the survey will be a catalyst for change and will raise the issue with healthcare assistants so they can push for better practice in their organisations.’

HCA survey findings

  • Two-thirds experienced or witnessed violence and aggression in the last year

  • Among those who experienced V&A 77% received verbal abuse – 60% said it was threatening, 35% experienced violence not requiring medical attention, 18% needed medical attention and 11% were threatened with a weapon

  • 80% working in mental healthcare experienced V&A in the last year. Twice as many were threatened or required medical attention than in other settings

  • 54% of HCAs said staffing levels on wards were inadequate


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