Zero Tolerance Policy 1
Zero Tolerance Policy Policy ref no: CCG 024/15 Author (inc job Kat Tucker, Complaints and FOI Manager title) Date Approved 30 th June 2015 Approved by Bristol CCG Governing Body Date of next June 2017 review How is policy to Via Bristol CCG Website be disseminated Check list for Governing Body/approving committee Has an Equality Impact Assessment been Yes completed? Has legal advice been sought? No Have training issues been addressed? Yes Are there financial issues and have they None identified. been addressed? How will implementation be monitored Via incident reports to the Quality and Governance Committee. How will the policy be shared with: Following Governing Body approval this Staff? policy will be published on the Bristol CCG Patients? website. Public? Are there linked policies and procedures? Bullying and Harassment Policy Persistent Communications Policy 2
Contents 1 Introduction...4 2 Purpose and Scope...4 3 Duties and Responsibilities...4 3.1 Governing Body Responsibility...4 3.2 Director Responsibilities...5 3.3 Line Manager Responsibilities...5 3.4 All Staff...6 4 Explanations of Terms Used...6 5 Risk Assessments...7 6 Management of Violence, Aggression and Abuse...7 6.1 Process for staff following violent or abusive behaviour...7 6.2 Actions following violent or abusive behaviour...8 7 Training Requirements...8 8 Equality Impact Assessment...9 9 Monitoring Compliance and Effectiveness...9 3
1 Introduction Bristol Clinical Commissioning Group believes that any act of aggression, violence or intimidation, both physical and non-physical from any member of staff, patient, visitor or member of the public is unacceptable. The CCG is committed to the creation of a culture and environment where employees may undertake their duties without fear of abuse or violence. As an organisation, we are committed to introducing measures, through the Zero Tolerance Policy and relevant guidelines, to reduce risk and to have procedures in place that will enable staff to manage appropriately an aggressive or violent situation should it arise. 2 Purpose and Scope The objective of this document is to set out how Bristol Clinical Commissioning Group will fulfil its statutory duty to ensure, as far as is reasonably practicable, the health and safety and welfare of staff and others, in respect of managing the risks associated with violence and aggression. The policy applies to all employees, whether directly or indirectly employed by Bristol Clinical Commissioning Group and in particular deals with the issue of violence, aggression and abuse against a member of its staff by a member of the public. This policy can be implemented even if the incident occurs outside of working hours or outside of CCG property as long as it relates to the member of staff s CCG role. If a member of staff feels that they are experiencing any violence, aggression or abuse by another member of staff, they should refer to the CCG s Bullying and Harassment Policy. All employees have a common law duty of care to co-operate with their employer to comply with the CCG s policy and follow their service, departmental and local procedures governing violence, aggression and abuse and abide by any risk assessment. No-one can guarantee that violence can be completely eradicated in any environment, however through the appropriate application of robust systems, the risk of incidents occurring in the first place can be minimised and where incidents occur, clear actions can be taken against assailants. 3 Duties and Responsibilities 3.1 Governing Body Responsibility The Governing Body has overall responsibility to ensure that policies, procedures, systems and environments are in place that reduce the risk of violence and aggression. Bristol Clinical Commissioning Group will ensure that: 4
Appropriate and adequate security arrangements are in place based on Risk Assessment. Staff are appropriately trained to ensure they are competent to provide high quality care and deal with members of the public in a sensitive and courteous manner. Arrangements are in place which are clear and understood by all staff on how to deal with situations where patients or visitors act in an unacceptable or violent manner. Support is provided where a member of staff has been the victim of an assault or attack by a patient or visitor. Provide safe working conditions for staff. 3.2 Director Responsibilities Directors will: Ensure that they and all persons reporting to them are aware and undertake their responsibilities under the Zero Tolerance Policy and other related policies and are adequately trained to enable its successful implementation. Advise the Director with responsibility for Health and Safety or the Corporate Secretary where additional support or legal advice is required. Give prompt and appropriate attention to matters brought to their attention. Ensure proactive and reactive reporting to the Corporate Secretary of any compliance issues, incidents and any investigations undertaken. 3.3 Line Manager Responsibilities Line Managers are responsible for ensuring their staff receive all necessary training, instruction and information and that any incidents of violence or aggression are properly recorded and records maintained. They must: Ensure that where incidents of violence or aggression occur that these are promptly reported via an incident form to the Corporate Secretary. Incident forms can be found as an appendix to the Incident Reporting Policy on the CCG S:/. Ensure that all significant incidents receive investigation into root causes and that these are reported to the Corporate Secretary. Organise the department, section or workplace so that operations or work carried out results in minimal risk of violence or aggression. Carry out risk assessments and reduce the risks identified. Ensure that all staff are aware of zero tolerance procedures. 5
Ensure that staff are provided with full support following any violent incident, including referral to Occupational Health and support for access to counselling if required. Act upon any information regarding violence or aggression received and provide feedback to the staff about these actions. 3.4 All Staff Have an awareness of the triggers of conflict in their own area, and to try to minimize the impact of these. Identifying his/her own high-risk situations and agreeing action plans with line managers. Undertake identified training in conflict management skills. Highlight environmental issues that may increase risk of violence. Individual employees have a responsibility to take all practicable steps not to place themselves, colleagues, or members of the public at risk and to communicate known problems as and when they become aware of them. Employees have an obligation to comply with Bristol Clinical Commissioning Groups Incident Reporting Policy and Risk Management Strategy. This includes the completion of incident reporting forms after each incident. Employees are required to identify, to their managers, situations, which they believe to be potentially hazardous. All employees should be aware of how their behaviour might be perceived by others and ensure that they do not behave in a way that is aggressive or violent. 4 Explanations of Terms Used Violence The CCG defines acts of violence as: Any incident where staff are abused, threatened or assaulted in circumstances related to their work, involving an explicit or implicit challenge to their safety, wellbeing or health. This is a very broad definition of violence, however it is important to acknowledge that violence can be either physical or non-physical and the two must be distinguished and recorded as different from one another Physical Assault the intentional or unintentional application of force to the person by another, without lawful justification, resulting in physical injury or personal discomfort Non-Physical Assault The use of inappropriate words or behaviour causing distress and/or constituting harassment 6
Risk Assessment Risk Assessment is process of identifying what hazards exist in the workplace and how likely it is that they will cause harm to employees and others. It is the first step in deciding what prevention or control measures need to be taken to protect staff from harm. 5 Risk Assessments When dealing with a known or suspected violent or abusive individual, under no circumstances should staff see such people on their own. They should seek advice from their Line Manager before face-to face meetings are arranged. Whenever there is a reasonably foreseeable risk of violence, line managers must ensure that risk assessments are completed. All risk assessments relating to violence and aggression should be added to the directorate risk register and must be reviewed on a 6 monthly basis by the relevant manager or when there is a change in circumstances. In making a risk assessment the following may indicate that there is a risk of violence: Dealing with intoxicated or distressed members of the public. Dealing with members of the public suffering from mental illness or stress. Dealing with members of the public who are confused/disorientated/suicidal/ have a known criminal history High risk areas such as contentious issues or complaints or staff working alone. Tasks where money, drugs or other valuables may be targeted for theft. When withholding or withdrawing a service. Irregular situations such as where persons known to be potentially violent are referred to other disciplines, services or Trusts. The list shown above is not exhaustive and manager must take care to assess all possible personal security risks within their responsibility. Police assistance should be sought where the presence of drugs or weapons has been detected or to deal with violence or threatened/suspected violence. Where an individual s behaviour may be affected by their mental health the use of an advocate should be considered. 6 Management of Violence, Aggression and Abuse 6.1 Process for staff following violent or abusive behaviour All instances of actual or threatened violence and aggression must be reported in accordance with Bristol Clinical Commissioning Group s Incident Reporting Policy (this can be found on Bristol Clinical Commissioning Group s website). Incident 7
reporting will be used to ensure that other members of staff benefit from shared experiences and that training is realistic and relevant. All staff who are subjected to violent or abusive behaviour should report such incidents to their line manager with whom referring the matter to the Police will be considered. Incidents of violence and aggression can have a detrimental effect on the victim out of proportion to the scale seen by outsiders. Managers are to ensure that staff are properly cared for and debriefed immediately, or as soon as is reasonably practicable after each such incident. Even those staff not directly involved can be subject to anxiousness and concern. It is important that all staff are informed as soon as possible of the basic details of the incident and any counter measures planned. Counselling is available in strict confidence to all staff by calling 0117 9002181 or email counselling@swcsu.nhs.uk Further information regarding the Counselling service and occupation Health can be found by contacting the HR Department. In any case where a member of staff feels that an individual has behaved in an unprofessional or inappropriate manner, the relevant Line Manager must be informed of the occurrence and an Incident Form completed. 6.2 Actions following violent or abusive behaviour Where a patient, relative or member of the public is alleged to have carried out an act of violence, abuse or aggression then the CCG reserves the right to respond to the alleged incident, as deemed necessary in light of the circumstances. The level of response will be dependent upon the seriousness of the incident and the outcome of any investigation. The potential responses or actions available to the CCG include: Verbal warnings Recommendation to use advocacy services. Written warnings from the Chief Accountable Officer Warning flag applied to patients notes Withdrawal of services. Involvement of the police Involvement of the Local Security Manager. Criminal prosecution Civil Prosecution. 7 Training Requirements All new staff are required to attend the mandatory induction programme and given relevant information. In addition all staff will undergo specific conflict resolution training, as per the statutory and mandatory training passport. The training will focus on defusing and managing aggressive and potentially volatile situations. 8
8 Equality Impact Assessment Due to the nature of this policy, it could potentially impact protected groups, specifically those suffering with Mental Ill Health who may be communicating with the organisation inappropriately due to their current Mental Health. There have been a few recorded instances where the individual has been living with a mental health illness and this has had to be taken into consideration when implementing the policy. These issues are mitigated by the recommendation to review each individual case on the specific circumstances taking into account any disability or cultural issues which may be influencing the individual s behaviour. There is also a recommendation within the policy to utilise advocacy where appropriate to support members of the public to raise concerns in an appropriate manner. The impact of this policy will be monitored on a quarterly basis and reported to the Quality and Governance Committee via the Incident Report. Any additional/required actions will be taken and reported back to the committee. 9 Monitoring Compliance and Effectiveness The Corporate Secretary will ensure that a Zero Tolerance Register is established as part of the monitoring arrangements. Reports concerning the number of incidents reported will also be used to monitor elements of this policy. This will also be monitored with evaluation of the effectiveness of training programmes. Bristol Clinical Commissioning Group Incident Reporting Procedure will provide baseline information on the number, nature and location of incidents of violence and aggression, to assist in the identification of root cause analysis and implementation of control measures. 9