lone working policy - porthosp.nhs.uk...for the document author and others involved in the process...

Title of Policy: Lone Worker Policy Version: 7 Issue Date: 06 November 2019 Review Date: 05 November 2021 (unless requirements change) of 21

LONE WORKING POLICY

Version 7

Name of responsible (ratifying) committee Health and Safety

Date ratified 11 September 2019

Document Manager (job title) Health, Safety & Wellbeing Manger

Date issued 06 November 2019

Review date 05 November 2021

Electronic location Health and Safety

Related Procedural Documents -

Key Words (to aid with searching) Lone Worker Personal safety; Violence to staff; Staff welfare; Security; Hazards; Risk assessment; Working environment; Forms; Health service staff

Version Tracking Version Date Ratified Brief Summary of Changes Author

7 11.09.2019 Policy re-write J.Michael

6.1 12.03.2019 Extension to review date, updated Trust standards -

6 02.11.2016 No changes J Cattle


CONTENTS

QUICK REFERENCE GUIDE ............................................................................................................. 3 1. INTRODUCTION ......................................................................................................................... 4

2. PURPOSE ................................................................................................................................... 4

3. SCOPE ........................................................................................................................................ 4

4. DEFINITIONS .............................................................................................................................. 4

5. DUTIES AND RESPONSIBILITIES .............................................................................................. 5

6. PROCESS ................................................................................................................................... 7

7. TRAINING REQUIREMENTS .................................................................................................... 17

8. REFERENCES AND ASSOCIATED DOCUMENTATION .......................................................... 17

9. EQUALITY IMPACT STATEMENT ............................................................................................ 18

10. MONITORING COMPLIANCE WITH PROCEDURAL DOCUMENTS ....................................... 19

EQUALITY IMPACT SCREENING TOOL ......................................................................................... 20


QUICK REFERENCE GUIDE This policy must be followed in full when developing or reviewing and amending Trust procedural documents. For quick reference the guide below is a summary of actions required. This does not negate the need for the document author and others involved in the process to be aware of and follow the detail of this policy. The quick reference can take the form of a list or a flow chart, if the latter would more easily explain the key issues within the body of the document

Identify if you have lone workers within the team/care group/division

Ensure that appropriate risk assessments are undertaken

Develop and implement control measures

Test control measures to ensure they work effectively

Ensure that all incidents are reported via DATIX


1. INTRODUCTION Portsmouth Hospitals NHS Trust are committed to ensuring the safety of its employees who are exposed to risks arising from lone working activities both within and away from a recognised workplace or base. The Trust has a statutory duty under the Health and Safety at Work Act 1974 and the Management of Health and Safety at Work Regulations 1999 to identify work hazards, assess the risks involved and implement suitable and sufficient measures to avoid or control the risks, which includes the risks associated with lone working.

2. PURPOSE Therefore, the aim of the policy and the guidelines is to eliminate the potential risks associated with lone working and where this is not possible, the risks will be minimised to the lowest possible level so far as is reasonably practicable.

3. SCOPE This document applies to all directly and indirectly employed staff within Portsmouth Hospitals NHS Trust and other persons working within the organisation in line with the Trust’s Equal Opportunities Document. This document is also recommended to Independent Contractors as good practice. The policy is specifically aimed at those employees whose work is intended to be carried out unaccompanied or without immediate access to another person for assistance; this mainly includes Trust employees who tend to work alone, which includes employees working from home and who visit patients. ‘In the event of an infection outbreak, flu pandemic or major incident, the Trust recognises that it may not be possible to adhere to all aspects of this document. In such circumstances, staff should take advice from their manager and all possible action must be taken to maintain ongoing patient and staff safety’

4. DEFINITIONS Lone Working

• Any situation or location in which someone works without a colleague nearby; or when someone is working out of sight or earshot of another colleague.

• Those who work by themselves without close or direct supervision.

Dynamic Risk Assessment:

“the continuous assessment of risk in the rapidly changing circumstances of an operational incident, in order to implement the control measures necessary to ensure an acceptable level of safety”


5. DUTIES AND RESPONSIBILITIES The Chief Executive The Chief Executive Officer has a legal duty to ensure the health, safety and welfare of those employees who work for the organisation including the protection of lone workers. The Security Management Director (SMD) has overall responsibility for operational aspects. Security Management Director: • Is responsible for ensuring that appropriate security management provisions are made within the NHS organisation to protect lone working staff • Should ensure that measures to protect lone workers complies with all relevant health and safety legislation. • Has overall responsibility for the protection of lone workers by gaining assurance that policies, procedures and systems to protect lone workers are implemented • Has responsibility for raising the profile of security management work at board level and getting their support and backing for important security management strategies and initiatives Accredited Security Management Specialist (ASMS): • Will assist the Trust Health & safety Adviser to update policies and procedures for the safety of lone workers • Advises the organisation on systems, processes and procedures to improve personal safety of lone workers and make sure that proper preventative measures are in place • Advises the organisation on appropriate and proportionate physical security, technology and support systems that improves personal safety of lone workers and ensures it meets the needs of the organisation and lone worker • Plays an active part in assisting managers identifying hazards, assessment and management of risks. Advises on the proper security provisions needed to mitigate the risks and protect lone workers. • In the event of an incident, the ASMS will carry out a review and where necessary liaise with the police should any further action be required. • Should be involved in any post incident root cause analysis, working with managers to identify any shortcomings and learn from them, ensuring that appropriate measures are taken to negate or mitigate future failings. Service/Team Managers: • Are to identify all staff who are lone workers, based on recognised definitions, (see section 2) • Will ensure that this policy and all other relevant policies and procedures are disseminated to staff


• Must ensure that a proper risk assessment is conducted (in consultation with the relevant personnel) to ensure that all risks from lone working are identified and that proper control measures have been introduced to minimise, or mitigate the risks before staff enter a lone working situation • Should forward copies of all local lone working procedures to the ASMS for quality assurance and audit purposes • Will ensure that lone workers are provided with sufficient information, training, instruction and supervision before entering a lone worker situation • Will ensure physical measures are put in place and appropriate technology is made available to ensure the safety of lone workers • Ensure that staff have received conflict resolution training. Ensure staff have received device training provided by the service supplier in the event of being issued with lone worker devices • Will ensure that all the relevant staff undertake regular reviews of hazards and associated risks to make sure that all measures are effective and continue to meet the requirements of the lone worker • Where a security incident has occurred, must make sure that the employee completes an incident reporting form as soon as possible. This will be reviewed by the ASMS • Where someone has been assaulted, must ensure that the individual is properly de-briefed, undergoes a physical assessment, any injuries are documented and they receive access to appropriate post incident support and report it to the police • Will ensure that following an incident, a risk assessment is carried out as soon as possible and immediate control measures are put in place. This is prior to a formalised review of lessons learnt following an incident. Lone working staff members: • Have a responsibility to do all they can to ensure their own safety and that of their colleagues and follow the local service procedure. This is in line with current health and safety legislation • Will undertake all relevant training including conflict resolution training and (where applicable) device specific training before entering a lone worker situation • Are to seek advice from their line manager, action guidance, procedures and instruction to avoid putting themselves or their colleagues at risk • Will conduct proper planning prior to a visit and utilise continual dynamic risk assessment during a visit. Understand they should never put themselves or their colleagues at risk and if they feel at risk they should withdraw immediately and seek further advice or assistance • Are to properly utilise all appropriate technology which has been provided for their own personal safety, ensure that they attend training in the use of such technology and associated support services, where provided • Must report all incidents even where they consider it to be a minor incident, including ‘near misses’ to enable appropriate follow up action to be taken


6. PROCESS Identification of risks The identification of risks relies on using all available information in relation to lone working to

ensure that the risk of future incidents can be minimised. This includes learning from operational experience of previous incidents and involving feedback from all staff and stakeholders. It is therefore essential that staff are encouraged to report identified risks to managers, as well as ‘near misses’, so that a risk assessment can be carried out, appropriate action taken and control measures put in place.

Identification of risk for lone workers The risk identification process should be carried out to identify the risks to lone workers and

any others who may be affected by their work. This information is needed to make decisions on how to manage those risks and ensure that the action taken is proportionate. Arrangements also need to be made to monitor and review the findings.1

This risk identification should consider:

• lone working staff groups exposed to risk • working conditions: normal, abnormal and hazardous conditions, such as dangerous

steps, unhygienic or isolated conditions, poor lighting • particular work activities that might present a risk to lone workers, such as prescribers

carrying prescription forms and medicines on their person, particularly controlled drugs • staff delivering unwelcome information or bad news: whether they have received suitable

and sufficient training to deliver sensitive or bad news and de-escalate potentially violent situations

• the possibility of an increased risk of violence from patients/service users due to alcohol

abuse, or drug misuse in relation to their clinical condition or response to treatment, and the risk of violence from their carers or relatives

• the lone worker wearing uniforms when visiting certain patients/service users • working in or travelling between certain environments or settings • lone workers carrying equipment that makes them a target for theft or makes them less

able to protect themselves • evaluation of capability to undertake lone working – for example, being inexperienced or

pregnant, or having a disability.

Risk Assessment The key to risk assessment is to identify hazards, understand how and why incidents occur in

lone working situations and learn from that understanding to make improvements to controls

1 See Management of Health and Safety at Work Regulations 1999


and systems to reduce the risk to the employee. To achieve this, the following factors should be considered and documented2:

• type of incident risk (e.g. physical assault/theft of property or equipment) • frequency/likelihood of incident occurring and having an impact on individuals, resources

and delivery of patient care • severity of the incident: cost to the healthcare organisation in human and financial terms • confidence that the necessary control measures are in place or improvements are being

made • the level of concern and rated risk • what action needs to be taken to ensure that improvements are made and risks reduced.

Managing Risk Managers are required to implement measures to manage, control and mitigate risks to lone

workers. The levels of follow-up action should be proportionate to the level of concern highlighted in the risk assessment.

These measures should be specific, commensurate with the risk identified, and realistic. Any associated costs need to be included not only in terms of resources and purchasing equipment but also staffing, training and expertise.

Measures might include removing weaknesses or failures that have allowed these incidents to

take place (procedural, systematic or technological), and identifying further training needs of staff in relation to the prevention and management of violence, or other training such as correctly identifying and operating the relevant technology.

Before a lone worker home visit Where it is practicable3, a log of known risks should be kept by the department. This should

record the location and details of patients/service users/other people that may be visited by staff, where a risk may be present. This log should be kept securely and the information should be accurate and reviewed regularly. It should be available to lone workers to inspect ahead of any visit they make. Consideration should be given to requiring, as part of a lone worker’s job description that they inform their manager or buddy if they have to make a visit to an address or person on that log.

Information Sharing

As part of the risk management processes outlined above, information concerning risks of

individuals and addresses should, where legally permissible, be communicated internally to all relevant staff who may work with the same patients/service users.

Members of any one family may be users of a number of the community services provided by

the Trust and sharing information between services is essential if the safety of all staff involved is to be maintained.

2 For further information, see the Health and Safety Executive’s Five Steps to Risk Assessment: http://www.hse.gov.uk/risk/fivesteps.htm 3 If staff work from a variety of locations, a written log may be difficult to implement and maintain. Where this is in place, consideration should be given to placing it in a secure location that is only accessible to managers and lone workers – for example, on the trust intranet or by setting up a group calendar in MS Outlook®


Service/Team managers are to notify other services of high-risk patients/clients, using the most appropriate means (i.e. e-mail) when information needs to be cascaded as quickly as possible.

Wherever possible and legally permissible, the healthcare organisation should also share

information on known risks of addresses and associated individuals externally, within the health, social care and other public sectors. This should include social care services, the ambulance service, patient transport services and primary care where applicable. Communication could also be facilitated through existing participation in crime and disorder partnerships, community groups and other health-care organisation forums, and liaison with the police.

Low-Risk Activities

There may be certain scenarios and activities that can be classified through a risk

assessment as low-risk – for example, staff undertaking office work during normal daytime hours. Staff in this situation may be authorised to work alone without the agreement of their line manager. However, risk assessments need to consider not only safety while at work during normal office hours, but also issues of location and timing relating to personal safety (e.g. someone leaving an empty building, alone, at night).

High-Risk Activities If there is a history of violence and/or the patient/service user, other friends/relatives who may

be present or the location is considered high-risk, the lone worker must be accompanied by at least one colleague. . Consideration should be given to whether the patient/service user should be treated away from their home, at a neutral location such as a clinic, or within a secure environment.

Scheduling Visits Before visiting a location or patient/service user that is a known risk, colleagues who may

have worked alone in the same situation previously should be contacted. This aids communication and informs the action taken to minimise the risks.

If there are known risks associated with a particular location or patient/service user, lone

workers should consider, in consultation with their manager, rescheduling the visit so they can be accompanied by another member of staff.. As part of the risk assessment process, consideration should also be given to whether they should, and can, be treated by attending a clinic or hospital.

If practical, the time of day and day of the week for visits should be varied when visits are

frequent. If a lone worker has been given personal equipment, such as a mobile phone or a lone worker

device, this is safety protective personal equipment supplied in support of providing a safe working environment as required by health and safety legislation. All due care should be taken by the lone worker to maintain the equipment in good working order and ensure it is fully charged and ready to use (see section 3.7).

Emergency Equipment As part of the planning process, the emergency equipment that may be required should be

assessed. This might include a torch, map of the local area, telephone numbers for emergencies (including local police and ambulance service), a first aid kit, etc.

Lone Worker Movements


Lone workers should always ensure that someone else (a manager or appropriate colleague)

is aware of their movements. This means providing them with the address of where they will be working, details of the people they will be working with or visiting, telephone numbers if known and expected arrival and departure times.

Lone workers should leave a written visiting log, containing a diary of visits, with a manager

and colleague(s). This information must be kept confidential. Details can be left on a whiteboard or similar, if it is in a secure office to which neither patients/service users nor members of the public have access and is not overlooked through windows.

Arrangements should be in place to ensure that if a colleague with whom details have been

left leaves work, they will pass the details to another colleague who will check that the lone worker arrives back at their office/base or has safely completed their duties. For office-based staff, if details have been left on a whiteboard, they must not be erased until it has been confirmed that the lone worker has returned safely or completed their duties for that day.

Details of vehicles used by lone workers should also be left with a manager or colleague, for

example, registration number, make, model and colour. Procedures should also be in place to ensure that the lone worker is in regular contact with

their manager or relevant colleague, particularly if they are delayed or have to cancel an appointment.

Where there is genuine concern, as a result of a lone worker failing to attend a visit or an

arranged meeting within an agreed time, or to make contact as agreed, the manager should use the information provided in the log to locate them and ascertain whether they turned up for previous appointments that day. Depending on the circumstances and whether contact through normal means (mobile phone, pager, etc) can be made, the manager or colleague should involve the police, if necessary (see escalation process in 3.2.5.10).

If it is thought that the lone worker may be at risk, it is important that matters are dealt with

quickly, after considering all the available facts. If police involvement is needed, they should be given full access to information held and personnel who may hold it, if that information might help trace the lone worker and provide a fuller assessment of any risks they may be facing.

It is crucial that contact arrangements, once in place, are adhered to. Many such procedures

fail simply because staff members forget to make the necessary call when they finish their shift. The result is unnecessary escalation and expense, which undermines the integrity of the process.

“The Buddy System” It is essential that lone workers keep in contact with colleagues and ensure that they make

another colleague aware of their movements. This can be done by implementing management procedures such as the ‘buddy system’.

To operate the buddy system, an organisation must ensure that a lone worker nominates a buddy. This is a person who is their nominated contact for the period in which they will be working alone.

The nominated buddy will: • be fully aware of the movements of the lone worker • have all necessary contact details for the lone worker, including next of kin


• have details of the lone worker’s known breaks or rest periods • attempt to contact the lone worker if they do not contact the buddy as agreed • follow the agreed local escalation procedures for alerting their senior manager and/or

the police if the lone worker cannot be contacted or if they fail to contact their buddy within agreed and reasonable timescales.

The following are essential to the effective operation of the buddy system:

• the buddy must be made aware that they have been nominated and what the

procedures and requirement for this role are • contingency arrangements should be in place for someone else to take over the role of

the buddy in case the nominated person is unavailable, for example if the lone working situation extends past the end of the nominated person’s normal working day or shift, if the shift varies, or if the nominated person is away on annual leave or off sick.

Escalation Process All services must operate an escalation procedure, outlining who should be notified if a lone

worker cannot be contacted or if they fail to contact the relevant individual within agreed or reasonable timescales. The escalation process should include risk assessment and identification of contact points at appropriate stages, including a line manager, senior manager and, ultimately, the police. Any individual nominated as an escalation point should be fully aware of their role and its responsibilities.

Manage Behaviour - Cultural Sensitivity

Staff members must be aware of cultural and gender issues before entering a lone worker

situation, to avoid the possibility of escalating a situation. Whilst In a Lone Working Situation The situation with the greatest potential for adverse risk, is when in a lone working situation,

be that in the community or at a health site. There are several strategies that should be employed to reduce exposure to such risks.

Dynamic Risk Assessment The importance of dynamic assessment is that it enables lone workers to anticipate and

recognise the early warning signs of suspected risks and enables safe early interventions to minimise or negate the risk to themselves and others. It recognises that situations change rapidly as do associated risks and that dynamic risk assessment should be an ongoing process.

Dynamic risk assessments should be conducted as necessary in the circumstances in place

at the time. The process involves: • The assessment of risk in dynamic situations is undertaken before, during and after a

home visit, potentially hazardous appointment or working period. • The benefits of proceeding with a task must be weighed carefully against the adverse risk

posed to the lone worker


• What sets DRA apart from systematic risk assessment is that it is applied in situations that are:

- unpredictable/unforeseen risks - the risk environment rapidly changes - allows individual to make a risk judgement - provides personnel with a consistent approach to assessing risk

Recognising warning signs This section should explain the importance of lone workers being able to recognise the

warning signs, including if anyone present is under the influence alcohol, drugs, confused, animals present etc. Being aware of warning signs enables action to be taken, including a decision to continue to work or withdraw as appropriate.

Under no circumstances should a lone worker put themselves, their colleagues, other patients

or service users in any danger. Management of a violent or abusive incident All incidents of violent and/or abusive behaviour should be handled in accordance with the

procedures set out in the Management of Violence, Aggression and Abuse against Staff policies.

Dealing with animals Staff must consider the potential risks posed by household pets when conducting home visits.

Considerations will of course involve safety, allergies and infection control. Where animals are present and the staff member is concerned for any of the above reasons,

a polite request should be made for the animal to be placed in a different room. If the resident/owner is not content with this request and has had the clinical and personal safety issues explained in a calm manner, if appropriate the visit should be abandoned and reported in accordance with the risk reporting policy.

Escorting patients/service users Those services that have occasion to escort service users are to ensure that they risk assess

each service user and individual occurrence. They should consider: • The physical and mental state of the patient and whether they are capable of being

transported. • The level of staff experience, their qualifications and the number of staff needed to

manage the patient. • The type of transport to be used (e.g. ambulance, patient transport service, contracted taxi

service or lone worker’s vehicle). • Physical safety measures during the escorting process should be outlined. Lone workers

should not escort a patient if there are any doubts about their own safety. • What is the process if conflict arises? This should follow local procedures, which may

involve calling the police, their manager, a colleague or buddy.


• Appropriate planning and provision should be made for the safe return of a lone worker to

a familiar place, once the patient has been dropped off. Lone working and lease/private vehicles Lone working staff should ensure that they know where they are going, plan their route and

always carry a map. When working in evenings/nights staff members should ensure that they park in a well lit

area, as close to the patient’s door as possible, facing in the direction in which they will leave. If an area is known to be unsafe a decision will need to be made by the line manager and

staff member on the safety of the visit and an appropriate plan implemented. Staff members in uniform should keep their uniform out of sight as much as possible and

keep any equipment locked safely in your boot as this may make them a target. All personal belongings are to be kept out of sight.

Staff members should carry their car keys in their hand when leaving the premises, in order to

avoid looking for them outside, which could compromise personal safety. The inside of the car and area around the car should be checked for possible intruders before

entering. Once inside the car, all doors should be locked, especially when travelling at slow speed, at

traffic lights or known danger areas. Lone Workers should not unlock or wind car windows down to talk to people they do not

know, even if they may be in distress or requiring help; they should stop in a safe place as soon as practicable and call the emergency services as appropriate.

Staff should not display signs such as ‘nurse on call’ as this may encourage thieves to break

into the vehicle. The Health and Safety Executive’s safe driver programmes advise that lone workers should

reverse into car parking spaces so that, if attacked, the door acts as a barrier. If followed, or if in doubt as to whether they are being followed, lone workers should drive to

the nearest police station or manned lit building such as a petrol station, to request assistance.

If a lone worker uses their own vehicle, this should be considered as part of the lone working

assessment outlining and precautions that need to be taken when driving, parking and returning to vehicles.

Lone working and taxis The Trust does not advocate the use of taxis or private hire vehicles for use by lone workers.

Where there is an operational requirement for such transport to be used, lone workers are only to use reputable licensed companies and they should book in advance. Private hire cabs should not be used, other than licensed or registered hackney carriages.

Staff members should avoid displaying uniform or equipment which would identify them as

health workers. They should ensure that they remain in possession of all equipment and records and they do not leave any in the vehicle on exiting it.


Lone working and travelling by foot Where staff need to make part of their journey by foot they should always endeavour to use

well lit paths and pavements. They should avoid unoccupied/populated areas and should ensure that their colleagues are aware of the route being taken prior to the journey.

Staff members need to be aware of the areas that they are working in and plan their journey

accordingly. Uniforms should be covered up and equipment and other items should be kept to a minimum. In the event of a situation where a staff members has concern for their safety they should head for the nearest public area (Shop, Petrol Station, Police station etc) If possible look out for street CCTV cameras and try and remain in view of these.

Lone working and public transport Where it is necessary to utilise public transport, staff members should prepare for their

journey by ensuring they know the routes and times of buses/trains etc. They should stick to using larger stations and bus stops in busy areas.

Following an incident Reporting All staff members and their line managers are required to report all incidents of physical, non-

physical assault, theft, and damage to NHS property to the Risk Department & ASMS, using the Trust incident Reporting System at the earliest opportunity. This will enable the ASMS to conduct an investigation and to ensure that all appropriate cases of physical assault are reported to the police as soon as possible for appropriate action to be taken.

Staff should be supported and encouraged to report an incident to the ASMS using the

approved system, in the knowledge that it will be investigated and appropriate action taken. Staff should also report near misses that could have resulted in a serious incident.

This will also ensure that any lessons learned can be fed back into risk management

processes to make sure similar incidents do not recur. It also means that further preventive measures can be developed, sanctions taken (where appropriate) and increased publicity generated, creating a strong deterrent effect.

If an incident causes more than three consecutive days’ absence from work, there is also a

legal requirement for it to be reported to the Health and Safety Executive under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) 1995. This must be done in addition to reporting all physical assaults to the ASMS and line managers should contact the Trust’s Health and Safety Advisor immediately they become aware of the change in RIDDOR status.

Post-incident support Incidents that occur in lone working situations, whether they involve assaults on staff, theft or

criminal damage to NHS property, have a direct impact on both the human and financial resources allocated to the NHS to deliver high-quality patient care.

Line Managers are to ensure that any lone worker, who becomes the victim of a crime, is fully

supported and referred to the Trust’s Occupational Health Service and the counselling service where required. The ASMS will confirm that this action has been taken during their enquiries.

If assaulted, the individual will also need to undergo a physical assessment and receive

treatment for any injuries, so they are well enough to return to work. Post-incident action


Following an incident or threat in a lone working situation, the ASMS should make sure that

there are effective arrangements to ensure that incidents and risks are reported and dealt with in accordance with the national frameworks for tackling violence and security management work.

If the incident involves a physical assault on a staff member, it must be reported to and

reviewed by the ASMS. Where appropriate, it should also be reported to the police as soon as possible, the ASMS is available to provide advice on the appropriateness of this where uncertainty exists.

If the incident involves a non-physical assault, such as verbal abuse, it must be reported, and

staff should be fully supported by both their line manager and the ASMS. In some cases it may be possible to take action against a verbally abusive individual.

For all incidents, irrespective of whether the police may be pursuing a case against offenders,

the ASMS should be involved in any Root Cause Analysis of the incident. For incidents where violence is not a factor, such as theft or criminal damage, line managers

are to ensure that staff report these to the police, where appropriate, and through the incident reporting system. Reporting has a significant effect, as it will determine the actions and investigation undertaken by the ASMS. The investigation will establish, where possible, who the offenders are and whether there are any trends or patterns that can be identified to prevent a recurrence and determine the actions required to control and reduce the risk. Such information can also be used to inform action that needs be taken to enhance security/staff safety and allow for solutions to be developed for specific problems.

Post-incident review Post-incident review will enable all available information to be used to ensure that lessons can

be learned and the risk of future incidents minimised. The key to post-incident review, risk assessment and follow-up action is an understanding of how and why incidents occur in lone working situations and being able learn from that understanding. In order to achieve this, the following factors should be considered: • type of incident (for example, physical assault/theft of property or equipment) • severity of incident • likelihood of incident recurring • cost to healthcare organisation (human and financial) • individuals and staff groups involved • weaknesses or failures that have allowed these incidents to take place (for example,

procedural, systematic or technological) • training needs analysis of staff, in relation to the prevention and management of violence,

the correct use and operation of lone worker protection technology or other relevant training

• review of measures in place to manage and reduce identified risks • review of the effectiveness of support measures for the staff involved • technology in place to protect lone workers.


Sanctions There are a range of sanctions that can be taken against individuals (or groups) who abuse

NHS staff and professionals, or who steal or inflict damage on its property. These range from criminal prosecutions and Criminal Behaviour Orders to civil injunctions. There are also a series of administrative sanctions that can be considered where appropriate. Managers should consult with the ASMS to ascertain the most appropriate sanctions. The victims’ wishes should always be of paramount importance.

Technological Responses to Lone Worker Risk

Introduction Technology should not be seen as a complete solutio n in itself . Consideration must be

given to the legal and ethical implications of its use, as well as to its limitations. Technology, however, can play an important part in helping to protect lone workers, as part of

a robust risk assessment process. This section provides advice to help manage expectations in relation to this. It is clear that technology can only be effective if it works alongside: • a rigorous risk assessment process for managers and staff • clear and robust management policies and procedures that put in place measures to

address identified and potential risks and to deal with incidents when they occur • managers and staff accepting responsibility for and supporting the need to operate

systems, procedures and technology provided for their protection • the sharing of information from within and outside the NHS on identified and potential risks • support and proportionate response from the police and technology support services

when a lone worker device is activated • the provision of good-quality conflict resolution training to help staff prevent and manage

violent situations • device-specific lone worker safety training including scenarios that reflect the fact that lone

workers have been issued with a device and that support services are in place.

The requirement for technology should result from risk assessments, pre-or post-incident reviews and analysis of relevant reports and operational information. It is essential that Service Managers contact the ASMS, prior to procurement to ensure that the technology and training is appropriate and fit for purpose. Where such devices are issued, the ASMS and Service Managers should ensure that it is used appropriately, effectively and that it is proportionate to the problem it is intended to address.

Lone working devices It is essential to recognise that lone worker devices will not prevent incidents from occurring.

They will not make people invincible, nor should they be used in a way that could be seen to intimidate, harass or coerce someone. However, if used correctly in conjunction with robust procedures, they will enhance the protection of lone workers. Lone workers should still exercise caution even if equipped with such devices and continue to use the dynamic risk assessment process. Finally, lone workers should remember that a device will only be useful if checked regularly, properly maintained and kept fully charged.


The use of such devices can send a strong deterrent message to potential offenders. They may also improve the feeling of confidence amongst NHS staff, helping to reduce the fear of crime. However, physical security measures in the absence of appropriate policies, procedures, and training to prevent and manage violence may create a false sense of security. It is therefore important to ensure that robust policies and procedures are available to work in conjunction with such devices.

If a lone worker protection device is misused frequently or maliciously, the matter should be

referred to the system administrator or the ASMS for investigation.. Where lone worker devices are issued, staff members are to be fully trained in their use prior

to deployment. Practical suggestions on the use of a mobile phone Lone workers will inevitably carry mobile phones and they should always check the signal

strength before entering a lone working situation. A mobile phone should never be relied on as the only means of communication. Lone workers should tell their manager or a colleague about any visit in advance, including its location and nature, and when they expect to arrive and leave. Afterwards, they should let their manager or colleague know that they are safe.

If provided, a mobile phone should always be kept as fully charged as possible. The lone worker should ensure they can use the mobile phone properly, by familiarising

themselves with the handset and instruction manual. Emergency contacts should be kept on speed dial. The phone should be kept nearby and never left unattended. Lone workers should be sensitive to the fact that using a mobile phone could escalate an

aggressive situation. In some circumstances, agreed ‘code’ words or phrases should be used to help lone workers

convey the nature of the threat to their managers or colleagues so that they can provide the appropriate response, such as involving the police. The decision to use code words or phrases should give due consideration to the ability of a member of staff to recall and use them in a highly stressful situation.

A mobile phone could also be a target for thieves. Care should be taken to use it as discreetly

as possible, while remaining aware of risks and keeping it within reach at all times.

Staff members are reminded that it is against the law to use a mobile phone whilst driving

7. TRAINING REQUIREMENTS Managers should ensure that all staff that Lone work have received guidance and training training in the following:

• Conflict Resolution • Lone Working Safety • Department lone working procedures and guidelines • Use of any lone worker devices where applicable

8. REFERENCES AND ASSOCIATED DOCUMENTATION


Procedural documents must be evidence-based and referenced, wherever possible. References could include any associated national policies, standards, guidelines, Acts of Parliaments. References and associated documents must be checked when reviewing an existing procedural document, to ensure they are still current and relevant. The following referencing format must be used: An Organisation-Wide Policy for the Development and Management of Procedural Documents: NHSLA, May 2007. www.nhsla.com/Publications/

9. EQUALITY IMPACT STATEMENT Portsmouth Hospitals NHS Trust is committed to ensuring that, as far as is reasonably practicable, the way we provide services to the public and the way we treat our staff reflects their individual needs and does not discriminate against individuals or groups on any grounds. This policy has been assessed accordingly All policies must include this standard equality impact statement. However, when sending for ratification and publication, this must be accompanied by the full equality screening assessment tool. The assessment tool can be found on the Trust Intranet -> Policies -> Policy Documentation Our values are the core of what Portsmouth Hospitals NHS Trust is and what we cherish. They are beliefs that manifest in the behaviours our employees display in the workplace. Our Values were developed after listening to our staff. They bring the Trust closer to its vision to be the best hospital, providing the best care by the best people and ensure that our patients are at the centre of all we do. We are committed to promoting a culture founded on these values which form the ‘heart’ of our Trust:

Working together for patients Working together with compassion Working together as one team Working together always improving

This policy should be read and implemented with the Trust Values in mind at all times.


10. MONITORING COMPLIANCE WITH PROCEDURAL DOCUMENTS

This document will be monitored to ensure it is effective and to assure compliance.

The effectiveness in practice of all procedural documents should be routinely monitored (audited) to ensure the document objectives are being achieved. The process for how the monitoring will be performed should be included in the procedural document, using the template above.

The details of the monitoring to be considered include:

• The aspects of the procedural document to be monitored: identify standards or key

performance indicators (KPIs); • The lead for ensuring the audit is undertaken • The tool to be used for monitoring e.g. spot checks, observation audit, data collection; • Frequency of the monitoring e.g. quarterly, annually; • The reporting arrangements i.e. the committee or group who will be responsible for

receiving the results and taking action as required. In most circumstances this will be the committee which ratified the document. The template for the policy audit report can be found on the Trust Intranet Trust Intranet -> Policies -> Policy Documentation

• The lead(s) for acting on any recommendations necessary. • recommendations necessary.

Minimum requirement to be

monitored

Lead Tool Frequency of Report of Compliance

Reporting arrangements Lead(s) for acting on Recommendations

Lone working risk assessments

ASMS Yearly Policy audit report to:

• H&S committee

Divisional H&S leads

Lone Working procedures

ASMS Yearly Policy audit report to:

• H&S committee

Divisional H&S leads

Incidents relating to lone working

ASMS/H&S Advisor

DATIX Policy audit report to:

• Divisional H&S leads


EQUALITY IMPACT SCREENING TOOL To be completed and attached to any procedural docu ment when submitted to

the appropriate committee for consideration and app roval for service and policy changes/amendments.

Stage 1 - Screening

Title of Procedural Document: Lone Working

Date of Assessment November 2019 Responsible

Department

Name of person completing assessment

Jenny Michael Job Title H,S & W Manager

Does the policy/function affect one group less or m ore favourably than another on the basis of :

Yes/No Comments

• Age N

• Disability N

• Gender reassignment N

• Pregnancy and Maternity N

• Race N

• Sex N

• Religion or Belief N

• Sexual Orientation N

• Marriage and Civil Partnership N

If the answer to all of the above questions is NO, the EIA is complete. If YES, a full impact assessment is required: go on to stage 2, page 2

More Information can be found be following the link below

www.legislation.gov.uk/ukpga/2010/15/contents


Stage 2 – Full Impact Assessment

What is the impact Level of Impact

Mitigating Actions (what needs to be done to minimise /

remove the impact)

Responsible Officer

Monitoring of Actions

The monitoring of actions to mitigate any impact will be undertaken at the appropriate level

Specialty Procedural Document: Specialty Governance Committee

Clinical Service Centre Procedural Document: Clinical Service Centre Governance Committee

Corporate Procedural Document: Relevant Corporate Committee

All actions will be further monitored as part of reporting schedule to the Equality and Diversity Committee