Norfolk and Norwich University Hospital NHS Trust is a large, newly built hospital on the outskirts of Norwich. The Trust employs approximately 4900 staff. Among them, community midwives, dieticians, physiotherapists, social workers, engineers and some administrators carry out their duties alone up to 95 percent of their time.
This case study concentrates on the 64 community midwives in the Trust whose work involves visiting clinics and clients’ homes. They mainly do post-natal work, with some antenatal duties and ‘parent craft’ (teaching parenting skills). They can spend up to two hours with a client whom they typically visit every other day. The midwives cover an area of 1200 square miles including inner city, council estates and rural areas.
A three-stage violence and aggression training programme: all community midwives must attend this training. The main themes of the training include:
Issue of policies, procedures and guidelines: the Trust provides staff with information, including: Guidelines to promote safer working practices in the community; Prevention and management of aggression: Guidelines and reporting procedures; Lone working policy; and Procedure for care of individuals who are violent or abusive.
Incident report form: staff are encouraged to report incidents, no matter how small (eg telephone abuse). This helps to establish what the problems are and to develop appropriate prevention/management measures.
Early warning system: Potential problem areas or problem clients are recorded. Midwives visiting them receive early warnings so joint visits can be arranged if necessary.
Lone worker mobile phone system: Midwives use a mobile phone central message system. They log on to the system when they leave home in the morning and send text messages during the day detailing where they are going and how long they will be. This process continues until the end of the day. If a midwife takes longer than anticipated at a job and does not check in at the expected time, an alert is sent to the midwife’s mobile phone. The midwife then has to send a text to confirm that they are OK. If this does not happen an escalation procedure is put into place whereby the midwife is called every few minutes. Eventually, if the midwife cannot be located the police may be contacted. The mobile phones also have an emergency button.
Personal attack alarms: Staff are provided with personal alarms if they need one.
Other security measures used by hospital staff: these include CCTV and panic alarm buttons. The Trust also employs security staff.
Doubling up: two midwives are now sent to night-time calls, depending on the location and proximity of midwives.
Timing of classes: Adapting the time of parent craft classes so that the caretaker of the health centre is around and can help a midwife should an incident arise.
Risk assessment: all staff and management are encouraged to do risk assessments of their jobs and the situations they encounter.
Keeping the diary system up to date can be difficult because work plans often change significantly during the day.
There are some difficulties with the lone worker mobile phone system:
Confidence: staff feel happier and more confident in their work.
More awareness: staff have greater awareness of potential violence and aggression.
Feeling valued: staff feel more supported and valued by a caring management.
Involvement: staff feel involved because they can contribute views on the systems and the content of training programmes.
Management information: incident reports give a better understanding of the type and scale of incidents so that management can take appropriate action.
Lower staff turnover: has been noted.
Fewer incidents: the Trust has had only a few incidents of violence.