Committee of Public Accounts

Press Notice No. 39 of Session 2002-03, dated 23 July 2003


Mr Edward Leigh MP, Chairman of the Committee of Public Accounts, said today it was shocking that nurses and other care workers were subject to high levels of violence and aggression, and urged the Department of Health and the NHS to reverse the rising trend.

Mr Leigh was speaking as the Committee published its 39th Report of this Session, which examined the effectiveness of the Department for Health's strategies for dealing with violence and aggression, and NHS Trust's arrangements for preventing or reducing incidents and supporting staff who experience violence and aggression. Reported incidents of violence and aggression against NHS staff are high and rising, with over 95,000 reported incidents in 2001-02. Nurses and care workers are at a higher risk of violence and aggression than most other workers. The impact on staff is immediate, in terms of injury and distress, and longer term with increases in stress, sickness absence, lower morale and productivity, and problems in retention and recruitment.

The Committee found that while there has been progress in encouraging reporting, there remains a significant level of under-reporting; many NHS Trusts are not using the standard definition promulgated by the Department; and the information collected by the Department does not differentiate between the types and severity of incidents. These factors limit the Department's understanding of the problem, and make it difficult to say how far the increase reflects an actual increase in incidents or to measure how well trusts individually and overall are performing. The next phase of the Department's zero tolerance zone campaign should set out the reporting requirements which Trusts should apply.

Trusts have developed a range of measures to deter patients and visitors from becoming violent or aggressive, but there are no evaluations of the effectiveness of these deterrents and dissemination of information on effective measures is limited. Trusts are also carrying out risk assessments but the coverage varies, there are deficiencies in the skills of staff undertaking the assessments, and there is a lack of evidence as to the effectiveness of measure taken to counter risks. The Department should review the measures applied by Trusts, identify those which have been effective, and publicise these measures through their zero tolerance website and advisory material.

The Department has been active in promoting partnership working with the police and Crown Prosecution service. While many Trusts have developed good relationships with these bodies, there is scope for further improvements, in response times and in pressing charges. The new Counter Fraud and Security Management Service is planning to develop a concordat with the Association of Chief Police Officers. NHS Trusts also need to take a consistent approach in reviewing all serious incidents, in the provision of support to staff and in feedback to staff on outcomes.

Mr Leigh said today:

"It is shocking that nurses and other NHS staff, who care for others, should be subject to such high, and rising, levels of violence and aggression. The Department for Health and the NHS have improved awareness and reporting, and developed a range of measures to deter potential attackers. But this is not enough; I want to see them reverse the rising trend in the number of incidents. The Department must sort out its reporting arrangements so it knows how well Trusts are performing. And there is an urgent need to identify which approaches are most effective in preventing violence."

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