Safety & security report - East and North Herts NHS Trust

defAgenda Item: 20TRUST BOARD 30 th MARCH 2011SAFETY AND SECURITY REPORTPURPOSE:PREVIOUSLYCONSIDERED BY:To inform the Board of issues relating to Safety & Security covering theperiod from April 2010 to February 2011The Risk & Quality CommitteeIMPLICATIONS:Objective(s) towhich issue relates:To improve the quality of all aspects of our servicesRisk Issues:Compliance with health, safety & security legislation. Non compliancewith trust policies and procedures.Health, Safety & Security forms part of the trusts statement of internalcontrol. Compliance with HTM 02Financial:HR:Healthcare/National Policy:Legal Issues:Equality Issues:Potential fines and litigationCompliance with mandatory trainingHealth & Safety Executive, Standards for Better Health and futurehealthcare regulation, NHSLA, NHSCFSMS Secretary of State Directions,Criminal Justice and Immigration ActClaims, litigation, prosecutionNone Identified.RECOMMENDATIONSThe RAQC are asked to note the reportDIRECTOR:Director of Nursing / DIPCPRESENTED BY: Acting Director of Nursing / DIPCAUTHOR:Safety & Security Manager/LSMSDATE: March 2011

BackgroundGood safety and security management is essential in order to deliver an environment for thoseto work in or use the Trust that is properly secure and safe so that the highest standard ofclinical care can be made available to patients.AssuranceThe information provided indicates the focus of management activity that the Board would wishto be aware of and assists in the process of giving safety & security assurance to the Board.Health, Safety & Security Management is required to provide assurance for the following:Health & Safety Executive, Care Quality Commission, NHSLA, Environment Agency, Secretaryof State Directions (NHSCFSMS).Following the recent change in executive director accountability, this report will provide a briefoverview of the current position and outline the subjects that will be reported in more detail infuture quarterly reports.The Trust has a duty of care to staff, patients and visitors and is required to comply with anumber of Health and Safety Regulations.Key challenges;Failure to comply with trust policies and procedures represents a risk to the trust.Action; The trust provides corporate health & safety polices and procedures to all departmentsin a Safety & Security Red file. Each department is required to complete departmental riskassessments and file these in the departmental risk assessment file. These files are auditedannually by the Health & Safety Advisor. The results of the 2010 audit are shown below:198 red files audited;125 80% compliant or above65 70%-79% compliant9 below 70%.complianceThese 9 departments have action plans in place and are receiving support to further improvetheir score to achieve compliance.The Safety & Security Red files are also audited by the trusts auditors RSM Tenon; all actionsrequired from their last audit have been completed.Many incidents are unreported which makes accurate analysis difficultAction; The team liaises with Risk Management and the Police and uses training events tohighlight the importance of reporting. all thefts of property reported to Police.A poor security culture increases the incidence of theft of both personal and trustpropertyAction; Ensuring better partnership working with community safety partnership and the localneighbourhood policing teams. A number of security audits have been undertaken with supportfrom Hertfordshire Constabulary.RIDDOR reportable incidents are frequently outside the required 10 day deadline

Action; All RIDDOR reportable incidents have been investigated to ensure lessons have beenlearnt and appropriate measures are in place. All late RIDDOR submissions have beeninvestigated to ensure all staff are aware of the type of incidents that must be reported. Aregular review of all Datix entries is undertaken to identify possible RIDDOR reportableincidents, this allows for early contact with managers to establish if an F2508 is required.The existing manned guarding contract is no longer fit for purpose.The trust is unable to implement the powers of the Criminal Justice and ImmigrationAct or implement a full site lockdown.CCTV is out dated and unable to provide evidential quality images to assist in theprosecution of offendersAction: The existing security contract has been in place for a number of years. The contracthas been managed by the General Services Manager up until January 2011. The contract isnow managed by the Safety and Security Department. A review of the existing arrangementshas been undertaken but no decision made. The Director of Nursing has agreed to revisit thiscontract. There needs to be consideration in respect of increasing the number of hours thatsecurity officers are on site and the skills of those officers. The current contract covers nightsand weekends only. Day time incidents are managed by trust staff which potentially puts theseuntrained staff at risk. Existing security officers are not trained in control and restraint. Havingofficers trained in control and restraint available 24 hours a day would improve the safety andsecurity of all staff, patients and visitors and improve the trusts ability to secure and lockdownthe site should the need arise, an action required to be taken to implement the powers of theCriminal Justice and Immigration Act.Senior nursing staff have recently drafted a policy on control and restraint of patients/ visitorswhich will require trained personnel if this policy is to be implemented.An audit of all access and egress points has been completed and many additional doors havehad locks fitted enabling more exits to be secured in the event of a lockdown. A review ofCCTV will be completed in due course. The trust is non compliant with HTM 02 (A guidance document relating to thetraining required for staff who handle, transport and administer medical gases).Action: The management of medical gases presents a challenge to the trust as theprocurement, storage; transport and administration of medical gases are managed by a largenumber of different departments, across a number of different directorates. A number of risksappear on the risk register relating to maintenance and purchase of equipment for medicalgases in addition to issues relating to training of staff. A decision regarding operationalaccountability is required to ensure medical gases are managed appropriately. Initial training of60 members of staff has taken place during the first week of March and 5 staff have beentrained as medical gas trainers. Arrangements are underway to develop a mandatory trainingprogramme for all staff who handle and administer medical gases.HSE Enforcements/Visits1. Following an incident in June, the HSE visited Lister on July 14 th 2010 to review the safety &security arrangements regarding a patient who absconded from award and then jumped fromthe third storey floor of the Surgicentre.The HSE met with the Matron from A & E / Emergency Medicine, Safety Manager andrepresentatives from both Hertfordshire Foundation Trust and Carillion.The Inspector was satisfied that all parties had taken all reasonable measures to maintain thepatient’s safety and no action or recommendations were made.2. In February, the HSE visited Lister following the notification via RIDDOR of an exposure to ahazardous substance that occurred when a member of staff activated a carbon dioxide systemwhen they accessed the flammables store. We are currently awaiting a letter detailingrecommendations for action. The inspector accepted that issues relating to the training of staffwere implemented immediately after the incident occurred.

RIDDOR reported Manual Handling IncidentsThere are an average of around 30 manual handling related incidents in the Trust per quarter,with a ratio of roughly 2:1 for patient handling related incidents in relation to non-patient (orinanimate load) handling incidents,For example for Oct – Nov:Patient Handling related incidents = 23 & Non-Patient Handling related = 11 for a total numberof 34 reported incidents.For Jan / Feb 2011, the 5 manual handling related RIDDOR reported incidents – 3 patientrelated (staff injury) and 2 inanimate loads related.Current actions:Department managers are contacted to establish possible causes.Trends in RIDDOR reportable incidents relating to manual handling will generally fall either intoone of two categories ‘overexertion’ incidents or ‘cumulative effect’ incidents.In relation to inanimate load handling these are likely to be individual capability / equipment /environment based. All these aspects are covered on mandatory back awareness / loadhandling training with the opportunity for work area specific training being limited.In relation to patient handling, overexertion is often related to situations such as assistingpatients with unpredictable movements or falling, which can lead to inappropriate interventionsby staff in relation to their own safety.In response to this, emphasis is placed on including discussion of current best practiceguideline and some demonstration on annual patient handling training, though full practicaltraining is not possible due to the risk of injury during training for such an unexpected event.Patient handling needs assessment forms include a section to highlight possible unpredictableor uncooperative behaviour. This is often a key risk factor in patient handling incidents. The lastaudit of Patient Handling Needs Assessment documentation in September 2010 showedPatient cooperation was documented as assessed around 80% of the time.In relation to patient handling, cumulative effect is often related to overall workload and mobilitydependency of patients. Details of poor working postures or exact moving & handlingtechniques used are often difficult to fully establish. Potential shortfalls in sufficient equipmentare addressed with mangers and an improved system for the inventory of departmental moving& handling equipment has been devised which will involve closer working with departmentalHandling Co-coordinators and risk assessors.Although there are no significant issues regarding injury in the use of patient hoistingequipment, at times its use is mentioned by staff in a general context to highlight times whenpatient dependency increases in a department in terms of assistance with mobility,Staff IncidentsAnalysis of staff incidents reported and documented on to the Datix Incident Reporting Systemshow that the highest number of staff incidents can be attributed to:Moving and handling of patientsKnocks and bumpsSlips and TripsIncidents by Sub categoryDamage/loss to property 96Moving & Handling Patient Related 79Knock or bump 75Fall whilst walking 57Assault 55Accidental injury 47

Theft 44Moving & Handling No Patient Related 41Drugs missing 35Fire Events/Alarms/Explosions 34Exposure to body fluids 30Inappropriate disposal of sharps 26Verbal abuse 23Suspicious Incident 21Doors locked/unlocked 19Drug spillage/wastage 14Other injury 14Breach of confidentiality 13Hazardous exposure - chemical 13Contact with hot/cold substance/object 9Fainted 8Lone Worker issue 8Other challenging behaviour 8Aggressive behaviour 7Fall from sitting position 6Infectious disease exposure 6Motor Vehicle Accident 6Fall from height 5Hazardous exposure - electrical 5Struck by/knock 5Hazardous exposure - radiation 3Racial Abuse 3Cytotoxic Drug Spillage/Exposure 2Allergic reaction (non specific) 1Fall (non specific) 1Inappropriate behaviour 1Incident - no reported injury 1An analysis of these statistics confirms that patient handling, knocks and bumps and slips, tripsand falls are the most common cause of health & safety injury, whilst loss of property, assaultand theft are the main security related incidents.The results of the staff survey indicate a higher number of incidents of physical assaultoccurring between work colleagues, such incidents appear not to be reported via the AdverseIncident Reporting forms, however when reported they are investigated and action taken asappropriate to the situation.Compensation claims made by staff for injuries incurred in the workplace confirm that patienthandling and slips and trips are the main reason for claims being made.Analysis of loss of property shows many cases of lost identity badges as well as staff personalproperty which has been left unsecure.Regular Security Audits are conducted by the ward constable and PSCOs at both Lister andQEII which is helping to raise staff awareness about the security of their personal and trustproperty.This report does not cover the analysis of incidents within each division as this is monitored atthe directorate performance management meetings and quarterly reports are provided by theclinical risk management department.

Compliance with Secretary of State DirectionsSecretary of State Directions require the Trust to adopt the NHSCFSMS guidance “AProfessional Approach to Managing Security in the NHS.”The aim of the NHS Security Management Service is simple: to protect the NHS so that it canbetter protect the public's health. The NHS Security Management Service was established in2003, creating the NHS Counter Fraud and Security Management Service.The NHS Security Management Service is responsible for the security of NHS staff andproperty in England – the first time a dedicated organisation has had such a remit. Thisincludes:• protecting NHS staff from violence and abuse• taking appropriate action against those who abuse, or attempt to abuse, NHS staff• helping to ensure the security of property, facilities, equipment and other resourcessuch as drugs.The NHS Security Management Service is raising the profile and standards of securitymanagement work in a comprehensive, inclusive and professional manner, working with theDepartment of Health, NHS bodies, NHS professionals, trade unions and other bodies such asthe Health and Safety Executive. All NHS health bodies must nominate a director at board levelto take responsibility for security management, ensuring that security of NHS staff and propertyis considered at the highest levels in each health body. This will, over time, allow more moneyand time to be invested to make real and lasting improvements to protecting NHS staff andNHS property.Putting these improvements into practice at a local level are trained and accredited LocalSecurity Management Specialists (LSMSs) who have taken the lead in security managementwork since April 2004. Each LSMS is the expert in matters of security management in theirhealth body and is responsible for translating the NHS Security ManagementService's guidance, policies and initiatives into good practice locally The NHS SecurityManagement Service is committed to delivering an environment for those who use or work inthe NHS that is properly secure so that the highest possible standard of clinical care can bemade available to patients.The Trust is compliant and has an Accredited Local Security Management Specialist. TheDirector of Nursing has recently been given Executive Director, accountability for Safety &Security and also appointed as Security Management Director. A Non Executive SecurityManagement Director has been appointed as required by the Directions. An annual report fromthe local security management specialist is produced in April and an annual work plansubmitted for the forth coming year. These reports will be included with future reportsConflict Resolution Training (CRT)The Secretary of State directions require the trust to deliver conflict resolution training to allfrontline staff who may have face to face or telephone contact with the public. The trust made acommitment that conflict resolution training would be mandatory for all staff. Conflict resolutiontraining has been delivered in the trust since November 2005. Staff must attend refreshertraining every three years.An annual return on the number of staff trained in CRT is submitted to NHSCFSMS.A new training provider has been appointed to deliver the training from April 1 st 2011

SecurityDamage or loss to property is the highest incident reported which includes staff ID badges andpersonal property which may have been lost or stolen.Assault and Verbal abuse are also reported frequently. All incidents of assault are investigatedand where the assault cannot be explained by medication, mental health or clinical condition,staff are encouraged to press charges and prosecution is sought.The trust has recently been invited to join the community safety partnership “Pub watch”scheme. This scheme operates a ban from one ban from all (licensed premises) policy foranyone who has been prosecuted for violence following the consumption of alcohol. Many ofthe incidents in A & E result from the partners and friends of patients being violent to staff dueto intoxication. The ban may also be applied to the frequent drunken visitors to the departmentprovided they are not in need of medical treatment.During this financial year 2 cases have gone to trial, one resulted in a custodial sentence of 4months for the defendant, the other defendant was found not guilty by the jury.Management of Violence and Aggression:An annual return is submitted for the number of physical assaults that occur in the trust. Thestatistics are used to produce a National Summary.The trust submits an annual return to the NHSCFSMS each year detailing the number ofphysical assaults that have occurred.The table below details the number of incidents submitted and audited amongst the list ofcomparator trusts.ProviderCambridge University Hospitals NHSFoundation TrustNorfolk And Norwich University HospitalNHS Foundation TrustColchester Hospital University NHSFoundation TrustMid Essex Hospital Services NHS TrustWest Hertfordshire Hospitals NHS TrustBasildon and Thurrock University HospitalsNHS Foundation TrustIpswich Hospital NHS TrustJames Paget University Hospitals NHSFoundation TrustPeterborough And Stamford Hospitals NHSFoundation TrustWest Suffolk Hospitals NHS TrustBedford Hospital NHS TrustEast And North Hertfordshire NHS TrustNumber ofphysicalassaultsdeclared2009/10Involvingmedical factorsclinicalAssaults notinvolvingmedicalfactorsDeclaredsanctions107 105 2 1167 164 3 268 59 9 09 3 6 456 55 1 0125 116 9 056 54 2 070 30 40 066 29 37 087 87 0 025 24 1 1141 137 4 2

Luton And Dunstable Hospital NHSFoundation TrustSouthend University Hospital NHSFoundation TrustThe Queen Elizabeth Hospital King's LynnNHS TrustHinchingbrooke Health Care NHS TrustPapworth Hospital NHS Foundation TrustThe Princess Alexandra Hospital NHS Trust50 42 8 067 14 53 075 66 9 442 42 0 020 20 0 059 49 10 3The majority of reported assaults are associated with patients mental health, medication orclinical conditions and no further action is taken against a patient, however where medicalfactors are not involved police are informed and action is taken. The table above shows thephysical assaults reported in 2009/10 and comparative figures for other trusts in the region.Whilst the figures for East & North Hertfordshire Trust appear high, staff reporting is good, asregular conflict resolution training has raised their awareness resulting in improved reporting.In summary, the Department are continuing to support and hold to account, poor performancein terms of audit compliance. Reporting of all adverse incidents continues to be promotedincluding follow up of those that may be RIDDOR reportable to ensure reporting deadline ismet.A training plan is being developed to ensure all relevant staff meet HTM 02 requirements. Adraft specification for manned guarding is being developed. CCTV arrangements are to bereviewed and improved reporting of all security incidents via SIRS (Security Incident ReportingSystem) is being undertaken.