Archived decisions

Contact: David Vallender

1. Summary

1.1 This report summarises:

· progress made on obtaining detailed statistics from Care Managers (Social Workers) relating to incidents of violence and aggression

· progress made on implementing a survey of Care Managers to address their perception of the level of violence and aggression encountered in their job

· progress made on implementing a new incident reporting system for Care Managers

1.2 The outcomes will impact on the delivery of the following Corporate Priorities:

· Hampshire safer and more secure for all - through combating the threat of violence and aggression to staff in Adult Services

· Maximising wellbeing - through initiatives to reassure staff over safety concerns and provide support when incidents occur

2. Background

2.1 At the select committee meeting on 21 July 2008 the potential for violence and aggression towards Adult Services staff was discussed, with particular emphasis upon the risks faced by those employees working as Care Managers.

2.2 A situation was highlighted whereby there was a difficulty obtaining up to date statistics of violence and aggression from Care Managers due to changes in reporting methods and the introduction of a new care management IT system.

2.3 Adult Services were tasked with improving the incident reporting process for Care Managers

and obtaining statistics for the committee to review.

3. Statistics

3.1 Care Managers normally input case notes onto an IT recording system entitled SWIFT. It has been noted that they have become used to including any incidents that occur during a visit within their case notes rather than recording them separately on the departmental Incident Reporting System.

3.2 Coincidentally, the department has been gradually moving all employees onto an IT based incident reporting system that was established first in the operational units that provide in-house care. Care Managers are scheduled to join in with that system starting in January 2009 and ultimately all employees in the department will use it.

3.3 It has proved possible to interrogate SWIFT but only for some limited information gleaned from the notes made by Care Managers. That shows the following results -

3.4 Those results indicate that we need more detail in order to draw any meaningful conclusions but they do give some indication of Care Managers experiences. Unfortunately they do not contain further explanation of the actual experiences and give only a category of incident.

4. Survey

4.1 We wanted to get a better understanding of how Care Managers felt about the threat of violence and aggression in their job as well as getting more details of actual experiences to improve our statistical information.

4.2 A survey was felt to be a quick and easy way to get that data so that it could be properly reviewed and be used to inform future plans.

4.3 Care Managers were sent a survey in November and the results were extracted at the end of December. The survey can be seen in appendix 1.

4.4 The immediate conclusion from the data obtained is that verbal abuse is commonplace and that actual physical assault is a rare occurrence. That is supported by the SWIFT data although the potential for something to occur, i.e. the threat, is clearly felt by staff.

4.5 The quotes obtained from Care Managers indicate a willingness to engage in a more detailed form of incident reporting as well as confirming the emotionally demanding nature of their role and their tendency to accept what happens to them as being part of the job.

5 Violence and Aggression Policy

5.1 There is a corporate policy on violence and aggression which is supplemented by additional departmental guidance in procedure 02/08. The procedure says that the Adult Services department deplores any acts or threats of violence or aggression towards its staff but it also recognises that violent acts can be perpetrated by anyone including service users who may be unable to comprehend or be fully responsible for their actions.

5.2 Adult Services deals with members of the public at a variety of levels including those times when they are facing difficulties which require complex decisions to be made about their welfare and that of their family. Our experience shows that relatives and friends can become involved in threatening behaviour towards staff when the results of care packages, for instance, do not meet their expectations.

5.3 The range of potential exposure to threats of violence and aggression is very wide and we have to take account of many factors when developing policy including government directives and initiatives such as the National Task Force on Violence Against Social Care Staff which helped shape our existing procedure.

5.4 Statistical data is an important element of policy decision making and we recognise the need to gather that data from all staff including Care Managers so that we can plan accordingly.

5.5 The majority of data collected in the recent past has indicated that challenging behaviour from adults suffering from dementia has caused particular concern amongst our staff. New training programmes have subsequently been introduced to address those concerns.

6. Training

6.1 Our departmental procedure was developed in collaboration with our specialist training provider, Maybo, so that we could offer courses that responded to risk assessment outcomes.

6.2 The training programme takes account of the particularly complex variety of threats facing the department and we work in partnership with Maybo to seek solutions using their considerable experience working with other Local Authorities.

6.3 We currently have courses available that cover conflict management and disengagement and can cover a range of staff including Care Managers but we will of course benefit from the additional data we will get from them, out of the IT based reporting system, when designing future programmes.

7. Lone Working

7.1 In the last report on 21 July I mentioned lone working as a potential source of danger, including violence and aggression, for some Adult Services employees including Care Managers.

7.2 Solutions that cover all risks from low level monitoring of lone working staff through to the control of higher levels of risk are now available utilising new technology such as global positioning systems that can track and trace employees.

7.3 Adult Services has made provision in next year's budget to introduce a new lone working monitoring system for high risk staff and we will hold trials early next year.

8. Impact and Implications

8.1 Legal

8.1.1 There are no legal implications attached to the National Task Force implementation or any other actions identified in the report.

8.2 Financial

8.2.1 At this stage work to address areas requiring further implementation can be contained within existing and planned budgets for Adult Services.

8.3 Personnel

8.3.1 No additional staffing requirements have been identified within Adult Services to undertake the work programme.

8.4 Impact Assessment

8.4.1 In compiling this report and the departmental policies referred to, account has been taken of the requirements of the Corporate Equalities Plan and Race Scheme.

9. Conclusion and next steps

9.1 To coordinate incident reporting and ensure that all employees, including Care Managers, are enabled to use the IT based system we have focussed a full time employee upon that task. We have a target to get all employees included by end of March 2009.

9.2 The information and statistics gained from Care Managers will be used to inform future training needs and the design of safe systems of work.

9.3 The health and safety team will work closely with care management teams to ensure that a better understanding of the need for comprehensive and accurate reporting of incidents is established and that we address their concerns raised in the survey.

Appendix 1

Survey of Care Managers to determine the type of incident experienced at work in the last year.

Most staff reported more than one incident with the total being 53.

The types of incidents are as follows

The most common places for incidents to occur are at the workplace 36.8%, in the clients home 34.2% of the time and 9.2% whilst travelling.

The most common causes are clients 35.4%, their relatives or carers 29.2% and the workers themselves 9.2% when slipping or tripping.

Most incidents resulted in no injury 46.9%, bruising 12.5%, a further 28.1% were shocked or distressed and 12.5% sustained physical injuries (2 serious).

81.6% of incidents did not result in any work time being lost and 18.4% did - the 2 most serious injuries both resulted in more than 10 days off work.

Three quarters of all these incidents have not been recorded in accident books at the relevant offices. Fewer than 1 in 3 have seen the IT based incident report system used in Residential homes but most 88% think this is a good idea and 98% say they would use one.

A selection of quotes from Care Managers include the following:

Care M'anagers & Social Workers visit homes which are often dirty and dangerous and they are abused verbally, and sometimes physically. It has never occurred to me to report these incidents: I am fairly certain my colleagues do not report them either.

I have only reported such incidents when I have been physically injured: e.g. when a man with Learning Disabilities hit me when I entered a Day Service unit some years ago.

I think as practitioners we may too readily accept being the victim of verbal abuse from client's and relatives as being a necessary part of the job.

Procedures for recognising the emotional impact of such incidents do not always feel fully integrated into practice, with formal arrangements not always put in place for, for example, de-briefing sessions following traumatic incidents.

Frequently colleagues are subject to swearing and shouting over the phone by clients and their relatives. Accusations regarding motives and professionalism are made to colleagues which can be stressful.

While it is accepted that client's and their families need to "sound off" as result of mental and physical strain, it can be equally stressful for professionals having to deal with such incidents and can cause increased workload as result of colleagues needing to take time out to debrief.

Many incidents are not recorded because they are verbal and team members are unaware of how to report other than on profile notes. It is also difficult to know what to record and remember when, for example, a member of the public arrived at the office making threats or when dealing with an angry client with mental health problems on the telephone.

Visiting dirty homes is a hazard to health

Emotionally demanding - trying to contain clients levels of distress to prevent situation from escalating. Comment whilst describing way injury occurs.

I only recorded the incident where I tripped over the stool. I regard the others as hazards associated with my job, and not accidents.