Nurses/care workers - Social workers/personal care staff

Work-related violence case studies

West Lothian Council serves around 160 000 people in rural and urban areas of West Lothian. The Council employs approximately 7700, including 700-1000 lone workers, mainly classed as mobile workers. Council employees carry out a wide range of jobs and may be required to work alone. They include social workers, personal care staff, housing officers, environmental health officers (EHOs), building control officers (BCOs), special school teachers, joiners, plumbers, refuse workers and gardeners.

This study focuses mainly on the Council's social workers, personal care employees, and environmental health officers. They do various lone working duties:

• There are approximately 240 personal care staff whose main activities include visiting the homes of people to help them wash and dress. Their working hours range between 7.30 am and 10.30 pm.
• Social workers' activities include talking to people who feel unable to cope and more difficult tasks such as removing children from homes where they may be in danger, or where care is inadequate. Social workers often carry out these tasks at the person's home.
• EHOs visit restaurants to check standards of hygiene and buildings, and to investigate complaints of noise disturbances. This often means working late in the evening.

Key risks

• Staff are often required to work at all hours, including late at night.
• EHOs may have to close down a restaurant because of poor hygiene standards. This may mean that a business loses money and it can lead to aggressive and abusive behaviour towards the EHO.
• Social workers may have to take children away from their home. This is often a highly intense and emotional experience for parents, children, and social workers.
• Personal care staff are often on foot and have regular patterns of visits. This may make them more vulnerable targets for assault.
  

Examples of incidents

• Care workers have experienced verbal abuse, including sexual harassment.
• Personal care staff have been mistaken for health visitors carrying drugs and have been attacked.

Successful measures

The Council uses a combination of measures for each of their employee groups.

Training and information

Training: courses are run either by the police or trainers from the Suzy Lamplugh Trust - or a combination of both. Managers or staff can both raise the need for training.

Key aims of training:

• Avoiding potentially violent situations.
• Encouraging confidence and the use of care and common sense.
• Developing coping methods.
• Minimising risk - eg parking cars facing the road to enable quick escape.

Training points:

• Be aware of your surroundings.
• Do not sit down.
• Do not spread any belongings or papers out.
• If you feel at risk, make an excuse to leave.

Audits and reviews: the Council conducts audits, feasibility studies, pilots and reviews of the measures to ensure they are working effectively. If they are not, then steps are taken to improve them.

'Personal Safety at Work' policy and guidance note: all employees receive this. Included is advice to managers about their responsibility for joint risk assessments with employees.

Incident reporting: this helps to establish what the problems are so as to develop appropriate prevention measures. It also raises the profile of violence prevention. There is a problem of under-reporting but the Council is developing a simple flow chart so that people know what to do and how to report different types of incidents. It is hoped this will increase reporting. A benchmark level of violent incidents can be set to help evaluate measures and monitor incident trends.

Work environment and equipment

Charters explaining standards: charters are placed on the walls of Council buildings to promote the Council's policy and to deter violence. They state clearly the standards that clients can expect of the Council, and those expected of clients.

A mobile phone lone worker system: employees can programme a number into the phone, and leave a message detailing a visit and the time it will take. The message goes to a central computer. If the employee has not called in to cancel the system after the stated time, the computer alerts someone in reception who tries to contact the employee, then the line manager, and eventually the police, if there is no response. The phone also has a panic button for emergency use. This links directly to reception and allows the receptionist to listen into a conversation. The employee uses code words in the conversation to alert reception to organise assistance if needed.

Personal alarm loan system: staff who work after 4 pm can borrow a personal alarm. The alarm comes with a card detailing when and how to use it, eg if attacked from behind it can be used in someone's ear to disorientate the attacker and give the employee a few extra seconds to get away. All social workers and EHOs are issued with personal alarms.

Job design

Flagging system: social workers have a system of flagging up potentially violent people and are able to recommend who should or should not visit those people - eg, not females/males/ lone workers, etc. Usually two social workers will visit people flagged by this system.

Police accompanying employees: the police accompany some EHOs attending potentially violent locations, where repeated and extreme threats have been made to them.

Using alternative staff: employees who have been previously threatened may request another employee to visit in their place.

Risk assessments: these can be joint risk assessments with input from the police, employees and the trade unions.

Other measures

Doubling-up at night: the Council is conducting a feasibility study to assess whether it is possible for all personal care employees to go out with another employee at night.

24-hour reception: the Council is considering a 24-hour reception to receive emergency calls.

Less successful measures

Some measures are sometimes less successful, or have disadvantages:

Self-defence training: staff sometimes request this but the Council does not encourage it because it conveys the wrong message. This can lead to an escalation in the violence or put both the client and employee at more risk of injury. It also requires regular practice and refresher training.

High-tech phones: employees were keen to buy high-tech phones but these had functions which were not necessary for work purposes. More 'basic' phones were judged to be more suitable.

Mobile phones: these are rarely useful when someone is being physically attacked.

The lone worker mobile phone system: this requires a 24-hour reception.

The benefits and the costs

• There is reduced stress among staff.
• Staff retention is higher.
• The Council has a good reputation and is perceived as an attractive place to work - a good employer which invests in employees' safety and welfare.
• The Council is considering whether 'doubling-up' might result in work being completed in less time and therefore at no extra cost.
• The lone worker mobile phone system is expensive but it means that employees feel more confident and are happier in their work.