Why is report writing so important in NHS Healthcare?

Written by Pat Lane, IKON Trainer

‘Violence and Aggression toward NHS staff, and in society in general, is not new.’ Controversial statement? Or a statement of fact?  

We tend to view history through rose-tinted spectacles, a view of an ideal world of red telephone boxes, bobbies on bicycles, everyone leaving their front doors open, and endless summers.  

Sadly, there has always been a level of violence in society. Still, with the advent of satellite communications and social media, we are now much more aware of what is happening around us. 

The 2021 NHS Staff Survey https://www.nhsstaffsurveys.com/results/national-results/ of which there were nearly 600,000 responses from 220 NHS trusts, found that: 

• 14.3% of NHS staff have experienced at least one incident of physical violence from patients, service users, relatives or other members of the public in the last 12 months. In the ambulance sector, our paramedics have experienced a much higher volume of abuse (31.4%). 

• The impact on staff is significant, with violent attacks contributing to 46.8% of staff feeling unwell as a result of work-related stress in the last 12 months, with 31.1% said thinking about leaving the organisation. 

Amanda Pritchard, NHS Chief Executive said in February 2022: 

‘The vast majority of patients and the public show nothing but respect and thanks for the skilled care they receive, but the unacceptable actions of a small minority have a massive impact on the professional and personal lives of our colleagues.’

One positive result is that most people find violence and aggression toward our NHS staff unacceptable, and moves have been afoot for several years to deal with this issue, both in prevention and in the follow-up within the Criminal Justice system.   

Nationally, the NHS has now introduced the Violence Prevention & Reduction Standard in an effort to make the working lives of our NHS staff safer:

Approach  

The violence prevention and reduction standard employ the Plan, Do, Check, Act (PDCA, also known as the Deming Cycle) approach, an iterative four-step management method to validate, control and achieve continuous improvement of processes.

Plan   

The NHS organisation must review their current status against the violence prevention and reduction standard and identify its future requirements to understand what needs to be completed and how, who will be responsible for what, and what measures will be used to judge success. This phase includes developing or updating strategies, policies and plans to deliver the aims.

Do  

The NHS organisation must:

• Assess and manage risks
• Organise and implement processes and communicate plans to and involve NHS staff and key stakeholders in their delivery
• Provide adequate resources and training.

Check 

The NHS organisation must ensure that the plans are implemented successfully, assess how well the risks are controlled, and determine if the aims have been achieved via audit measures. The NHS organisation should routinely assess gaps and ensure swift corrective action as part of the process. Credible, accurate and unambiguous data will assist in checking incidents of violence that have fallen.   

Act  

The NHS organisations must review their performance to enable the senior management team to direct and inform changes to policies or plans in response to any localised lessons learnt and incident data collected in respect of violence prevention and reduction. The NHS organisation should share critical findings with internal and external stakeholders.

Compliance assessment 

The process mentioned above is for NHS organisations to consider when completing the violence prevention and reduction assessment. It ensures that responses to the evaluation are valid, and any required organisational actions are endorsed at the senior management level in consultation with key stakeholders via the designated internal governance routes. The evidence showing whether the criteria have been met for each indicator should be made available to essential stakeholders.   

Why is incident reporting important? 

Reporting incidents encourages a positive safety culture within an NHS Trust and can lead to staff feeling supported. NHS organisations with a high level of incident reporting are more likely to learn and subsequently increase safety for people using their services, staff and visitors. 

The incident reporting process enables an NHS Trust to identify, manage, communicate and analyse risks identified as a result of incidents. It is a systematic approach to firstly ensure that those affected by the incident are supported in a timely and effective way and secondly to evaluate what has gone wrong and learn from past events to ensure steps are taken to minimise recurrences.  

It may identify a training need and lead to the development and improvement of procedures, an increase in staffing numbers, new safety equipment? and even structural changes to improve safety and security across the NHS.  

If incidents go unreported, then the trust and managers of those departments cannot analyse specific incident themes and trends or implement any required changes, increasing the chance of a similar incident occurring again; this could leave both staff and patients at risk.  

An important aspect of reporting may also be overlooked; the evidential value it brings; providing an official record of the incident may enable this to be referred to and considered in executing criminal proceedings against individuals. 

The latest figures from the Crime Survey for England and Wales (CSEW) for the year ending March 2020 indicated an estimated 688,000 incidents of violence at work in 2019/20. This represents an average risk rate of assaults and threats at work across all occupations of 1.4%.   

This risk is heightened for health and social care staff. Compared to the all-occupation risk rate of 1.4%, health and social care associate professionals and health professional staff are calculated to have a rate of 3.9% and 3.3%, respectively.   

Physical harm is not the only consequence of violence and aggression; the anticipation of, as well as the actual exposure to, violence and aggression can significantly impact mental health, leading to work-related stress, anxiety and depression.  

Most incidents of work-related third-party violence and aggression result in no or minor injury, are not reported to the police and do not meet the criteria for reporting under Reporting of Injuries, Diseases and Dangerous Occurrences Regulations RIDDOR. It is, therefore, likely that the risk is more prevalent than the available statistics show. 

In April of this year (2022) Sky News published information from a Freedom of Information Request they had sent out to 150 NHS Trusts  

76 Trusts responded, recording 72,174 assaults on staff between January 2018 and December 1, 2021. So, we can probably estimate in the region of double that figure. And that is just those that were reported.  

Only 23 of the Trusts provided the complete information required (number of assaults, number of police referrals and criminal justice outcome).  

There was a Criminal Justice outcome (charge or caution) in just 458 cases.  

We understand this will partly be due to the patient’s lack of capacity at the time and the lack of credible evidence to take things further.    

NHS Security Departments are expected to deal with complex and sometimes dangerous situations.  

A frustration often raised by the Local Security Management Specialists and some senior clinical staff are around the reporting standards after incidents have occurred. Not just on DATIX and other E-Systems across the NHS but also in follow-up statements for incidents that may end up in a court of law.  

In conclusion: 

In 2021-2022 the HSE completed 20 NHS visits. These visits aimed to assess how effectively NHS Trusts and Boards manage the risk to their employees from third-party violence and aggression. The findings from all visits will enable a fuller understanding of the successes and challenges faced by the NHS in managing these risks.   

At IKON Training, we would advocate raising the standards of reporting further awareness around the law; Trust Policies, as well as Department of Health and Restraint Reduction Network guidance. Every individual has the right to feel safe and confident in the workplace, and this critical skill will help to make a positive impact. 

Written by Pat Lane, IKON Trainer

Updated June, original blog dated Oct 2022.