Guidelines for the Provision of Staff Welfare and Support following a Distressing Incident

1 Guidelines for the Provision of Staff Welfare and Support following a Distressing Incident These guidelines describe the support available to staff following a distressing incident. The guidelines focus in particular on incidents of violence and aggression, but may also be helpful following other types of distressing incident. Key Words: Version: Adopted by: Date adopted: Name of originator/author: Staff welfare, Support, Violence, Aggression, Debrief Final v4 Quality Assurance Committee TBC Claire Armitage, Lead Nurse Steve Walls, LSMS Name of responsible committee: Date issued for publication: Healthy Organisation Group March 2014 Review date: March 2017 Expiry date: March 2018 Target audience: All staff Type of Policy Clinical (tick appropriate box) Risk Management Standards if applicable: State Relevant CQC Standards: 10 and 14 Non Clinical

2 CONTRIBUTION LIST Key individuals involved in developing the document: Name Designation Steve Walls Local Security Management Specialist Neil Loach Occupational Health Nurse Samantha Roost Health and Safety Advisor Maureen Bailey Health and Safety Administrator Key individuals involved in the document review, March 2014 Name Designation Claire Armitage Lead Nurse, Adult Mental Heath Steve Walls Local Security Management Specialist Val Dawson Union representative Michelle Churchard Smith Lead Nurse, Learning Disability Service Lynne Moore Practice Development Nurse, Learning Disability Service Circulated to the following individuals for comments Name or Group Members of the Health and Safety Committee Dr Heather Dipple, Clinical Director Adult Mental Health Services Dr Arinash Hiremath, Clinical Director, Learning Disability Services Dr Noel O Kelly, Clinical Director, Community Health Services Dr Abbay Rathore, Clinical Director, Families Young People and Children s Services Dr Satheesh Kumar, Medical Director Paul Miller, Chief Operating Officer Teresa Smith, Acting Divisional Director, AMHS and LDS Rachel Bilsborough, Divisional Director, CHS Helen Thompson, Divisional Director, FYPC Adrian Childs, Chief Nurse Michelle Churchard, Lead Nurse LDS Neil Hemstock, Lead Nurse FYPC Kathy Feltham, Lead Nurse MHSOP Jude Smith, Head of Nursing, CHS Vicky McDonnell, Patient Safety Lead Vyv Wilkins, Equality Officer Jackie Wilkinson, Trust Safeguarding Lead Jacquie Burden, Clinical Governance Lead, AMHS Heather Darlow, Clinical Governance Lead, CHS Nikki Crust, Clinical Governance Lead, FYPC Police liaison (via LSMS) Richard Apps, Risk Assurance Lead Chaplaincy Department Prevention and Management of Aggression Team

3 Contents Equality Statement and Due Regard 6 1 Introduction 6 2 Purpose of the Guidelines 7 3 General Notes and roles and responsibilities 8 4 Services which can provide support 10 4.1 AMICA Counselling Services 10 4.2 Local Security Management Specialist 10 4.3 Health and Safety Team 11 4.4 Department of Spiritual and Pastoral Care 12 4.5 Human Resources 13 4.6 The Prevention and Management of Aggression Team 14 4.7 Occupational Health Department 14 4.8 Risk Assurance Department 15 4.9 Union Representation 16 4.10 Anti-Bullying and Harassment Support Service 16 4.11 Further Support 17 5 Debrief 17 6 Whistleblowing Policy 18 7 Criminal Injury and Reporting to the Police 18 8 Compensation 19 9 Monitoring arrangements 19 Appendices Appendix 1 Support after an incident your at a glance guide (staff poster) Appendix 2 Debrief tool Appendix 3 Staff welfare and support following an incident at work (staff leaflet) Appendix 4 Coping after incidents (staff leaflet) Appendix 5 Due regard screening template

4 Version Control and Summary of Changes Version Date Comments number (description change and amendments) V1 December 2012 New document V2 November 2013 V3 January 2014 V4 March 2014 Reviewed document first draft Reviewed document second draft Reviewed document final draft All LPT Policies can be provided in large print or Braille formats, if requested, and an interpreting service is available to individuals of different nationalities who require them. Did you print this document yourself? Please be advised that the Trust discourages the retention of hard copies of policies and can only guarantee that the policy on the Trust website is the most up-to-date version. For further information contact: Local Security Management Specialist (LSMS) 0116 295 3016

5 Definitions that apply to this document Physical Assault Non- Physical Assault Due Regard Debrief The intentional application of force to the person of another, without lawful justification, resulting in physical injury or personal discomfort. The use of inappropriate words or behaviour causing distress and/or constituting harassment. Having due regard for advancing equality involves: Removing or minimising disadvantages suffered by people due to their protected characteristics. Taking steps to meet the needs of people from protected groups where these are different from the needs of other people. Encouraging people from protected groups to participate in public life or in other activities where their participation is disproportionately low. The term debrief can understood to mean to question formally and systematically in order to obtain useful information. Psychological debriefing can involve a supportive opportunity to reflect on the incident, identify learning and future actions.

6 Equality Statement and Due Regard Leicestershire Partnership NHS Trust (LPT) aims to design and implement policy documents that meet the diverse needs of our service, population and workforce, ensuring that none are placed at a disadvantage over others. It takes into account the provisions of the Equality Act 2010 and advances equal opportunities for all. This document has been assessed to ensure that no one receives less favourable treatment on the protected characteristics of their age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex (gender) or sexual orientation. In carrying out its functions, LPT must have due regard to the different needs of different protected equality groups in their area. This applies to all the activities for which LPT is responsible, including policy development, review and implementation. The Trusts commitment to equality means that this document has been screened in relation to paying due regard to the Public Sector Equality Duty as set out in the Equality Act 2010 to eliminate unlawful discrimination, harassment, victimisation; advance equality of opportunity and foster good relations. Please refer to Appendix 5 Due Regard screening template for further details. 1 Introduction These guidelines describe the support available to staff following a distressing incident. The guidelines focus in particular on incidents of violence and aggression, but may also be helpful following other types of distressing incident. It should be recognised that the majority of service users and patients are not violent and should not be perceived as such. The causes of violence and aggression within our healthcare settings are often complex and can be attributed to many factors. However, it is recognised that there may be instances when employees and service users may be faced with potentially violent or aggressive incidents. It is nationally recognised that there is a high risk of violence and aggression within NHS settings, and that within Learning Disabilities and Mental Health Services, this risk may be increased where the number of incidents is over two and a half times the average for all Trusts (NHS Protect 2012). The Trust board acknowledges that all of its employees who work within or outside Trust premises are potential targets of violent behaviour, and within certain service areas this can be a frequent occurrence. There should be systems in place within all areas to ensure a range of options of post-incident support and review. This will be in line with the recommendations of the LSMS and MAPA Trainers. The Trust wishes to ensure staff that following a violent or aggressive incident all staff members will receive full support from the organisation.

7 2 Purpose of the Guidelines The Trust wishes to ensure that following a distressing, violent or aggressive incident all members of staff receive full support. The principles and resources within this document may be helpful following a wide range of incidents. It is recognised that within many areas the support provided at ward or department level is commendable. There are many ways of providing support, which may happen regularly between peers and also be provided by the local management team. For example, peer support must happen during locally arranged debriefing or supervision sessions. It is also recognised that many control methods have been implemented in order to reduce the risk of injury as a result of violence and aggression. For example, conducting: Violence & Aggression Risk Assessment Prevention and Management of Aggression environmental risk assessments Clinical risk assessments of all patients that may pose a risk of violence. Clinical Supervision Prevention and Management of Aggression training courses. Regular reviewing and monitoring of incidents. It is also recognised that individuals require support in various ways and that no two people s needs are the same. Therefore the guidance will provide information concerning support available within the Leicestershire Partnership Trust, and will ensure that all staff have the opportunity to access these services. The aim of the document is to ensure that in the event of a violent or aggressive incident managers and staff are aware of: The support systems available The specific role support systems provide The debriefing process, and how and when it may be used Criminal injury and reporting to the Police and has been developed to support the following Trust policies: Prevention and Management of Aggression Policy http://www.leicspart.nhs.uk/library/preventionandmanagementofaggre ssionpolicyfeb2013.pdf Incident Reporting Policy http://www.leicspart.nhs.uk/library/incidentreportingpolicy_final_marc h2013.pdf

8 Supporting Staff Involved in Incidents, Investigations, Complaints and Claims http://www.leicspart.nhs.uk/library/supportingstaffinvolvedinincidentsp olicyasat31jan13.pdf 3 General Notes and roles and responsibilities It is important to recognise that the guidelines are an addition to the Leicestershire Partnership NHS Trust Policies and Procedures. It must also be noted that it is Trust Policy to report all accidents and incidents, which includes violence and aggression. Please note: in cases where multiple teams are involved, a lead person must be identified to ensure that all staff involved are contacted and informed of the incident and appropriate actions are taken. Roles and responsibilities Immediately following the incident: Identify an appropriate team member to take the lead on ensuring the wellbeing of involved staff. This could be the nurse in charge, a colleague from a neighbouring team, the on-call manager or coordinator as appropriate. The lead team member will assess the immediate need for medical or psychological support. The lead team member will check out how the affected employee will travel home if needed, who will be at home to support them and what medical follow up they can access. The lead team member will ensure that staff are identified to provide clinical cover as required to relieve affected staff, and that an eirf is completed and appropriate managers are informed. In the days following the incident: The line manager will consider offering appropriate information and leaflets on coping after an incident and the sources of support available. The line manager will offer an opportunity for debrief, reflection and further support once the employee and other involved staff have had the time to adjust. The line manager will consider any support the employee will need to get back to, or remain, at work for example, change of duties or base, further training and support. In the months following the incident: The senior manager will ensure that all involved staff are kept informed of any investigation or other proceedings (for example inquest or court

9 hearings etc.) and provide any input and training required to support them through the process. The senior manager will ensure that all involved staff receive feedback following the incident investigation. The following at a glance guide is provided as appendix one:

10 4 Services which can provide support The guidelines will provide details of Trust-wide services listed below, which are able to provide support to staff and managers following an incident. Some of the services are confidential while others will be used in accordance with management procedures. AMICA Counselling Services Local Security Management Specialist Health, Safety and Security Team Department of Spiritual and Pastoral Care Human Resources Prevention and Management of Aggression Team Occupational Health Risk Management Union Representation Anti-Bullying and Harassment Support Service 4.1 AMICA Counselling Services Dealing with aggressive incidents within the workplace is stressful, the AMICA Staff Counselling and Psychological Support service offers support to all Leicestershire Partnership staff. How can they help following an incident? If you have experienced an aggressive incident within the workplace, you can contact the Amica service 365 days per year, via the confidential telephone counselling line. The line gives you direct access to a qualified and experienced counsellor. If you would rather attend face-to-face counselling or a psychological debrief, please call the same number to access an appointment. Contact Details: AMICA is available everyday between 8.30am and 8.30pm. You can phone AMICA Confidential telephone counselling Service on: Tel: (0116) 254 4388. 4.2 Local Security Management Specialist At Leicestershire Partnership NHS Trust we want to ensure that our staff can work and our patients receive treatment in an environment that is safe and secure. The Trust has two LSMSs, Steve Walls and Bob Lovegrove, who work to ensure that the Leicestershire Partnership Trust is a safe and secure place in

11 which to work and receive treatment. To achieve this, all members of staff need to support this work, by reporting any security concerns they may have, and any incidents that occur. The LSMS is the expert on all matters of security management. They ensure that security policies, guidance and procedures are in line with the national standards set by the NHS Security Management Service. As well as training and supporting LSMSs, the NHS Protect has overall responsibility for the security of NHS staff, property and assets in England. This includes protecting NHS staff from violence and abuse and ensuring the security of NHS property, facilities, equipment and other resources. This is a huge responsibility in an organisation the size of the NHS, which is why we need LSMSs to take forward this work at a local level. The Role of LSMS On a day-to-day basis, LSMSs develop local solutions and provide expert advice in relation to a wide range of security issues. They work to deter and prevent security incidents, as well as to investigate and take the necessary actions when incidents do occur. Their role is to: Ensure local security management arrangements meet national standards Continually improve and develop local security provisions and policy Tackle violence against NHS staff Protect NHS property and assets Ensure the security of drugs, prescription forms and hazardous materials Protect vulnerable high-risk areas such as maternity and paediatric units. Contact Details: Steve Walls can be contacted on 0116 2953016 or 0771 7881602 or by email Steve.walls@leicspart.nhs.uk Bob Lovegrove can be contacted on 0116 225 6116 or 07920 711764 4.3 Health and Safety Team The Health and Safety Team provide impartial advice and support on all matters relating to health and safety and promote a culture whereby health and safety management is an integral to all. How can they help following an incident? The Health and Safety Team will:

12 Provide initial advice to the member of staff or staffs and/or manager(s) following an incident in respect of reporting procedures Give specialist advice if the incident requires reporting to the Health and Safety Executive (HSE) if reportable under the Reporting of Injuries Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR) Assist in collating information, obtaining witness statements where appropriate Investigate incidents Assist and advice in reviewing risk assessment(s) and the environment in order to ensure appropriate control measures are in place and implemented Contact Details: The Health and Safety Team can be contacted on:- 0116 2950988 or by e-mail healthandsafety@leicspart.nhs.uk 4.4 Department of Spiritual and Pastoral Care The mission of the Department of Spiritual and Pastoral Care is to contribute to an environment where service users, carers and staff are able to value one another s humanity and spirituality, whether expressed in religious or other terms, so that concern for the whole person pervades every aspect of healthcare. Aims To recognise and provide for the spiritual needs of service users, carers and staff of all religious traditions and of none. To provide regular opportunities for worship within the in-patient units. To contribute to good practice, and help explore/clarify ethical issues To contribute to the development of cohesive and effective teamwork in local NHS settings To contribute a spiritual element to the development of policy and good practice at regional and national levels. To foster links with local faith communities and encourage their involvement in appropriate ways. Chaplains are available to all who use the LPT healthcare services Chaplains visit the in-patient units regularly and are also active in the community setting. Supporting staff For healthcare staff in any context, work can be both rewarding and stressful. Sometimes staff members might feel they are struggling, and need someone with whom they can offload and share their experiences in confidence. Chaplains can provide pastoral and spiritual support for staff if requested.

13 Contact Details: To contact a Chaplain, in the first instance, call the Department office at Lakeside House on 0116 295 7569 In case of difficulty or out of hours: Call the main switchboard 0116 225 6000 and ask for the on-call chaplain 4.5 Human Resources The Human Resources Team provide advice to managers and staff. They will advise and assist managers on the application of the Trust s ill Health procedure to ensure employees are fully and appropriately supported. How can they help following an incident? They can provide advice regarding the access of the most appropriate channels of support such as AMICA Counselling Services and the Occupational Health Department. They can provide timely advice and support regarding aspects of terms and conditions of service, which may be effected as a result of the incident. An example could be application for Temporary Injury Allowance. Temporary Injury Benefit Allowance Individuals on certificated sick leave on account of an injury sustained by a violent or aggressive incident at work may be eligible for a Temporary Injury Allowance (TIA). This allowance is paid by your employer and tops up your income (i.e. pay, NHS Pension and certain Social Security Benefits) to 85% of the average pay you were getting immediately before your pay was reduced because of the injury. TIA is not payable if your income is more than 85% of your average pay and it stops when you return to work. Contact Details: Further information is available by contacting your local HR Advisor. 4.6 The Prevention and Management of Aggression Team and SCIP Team Teams primarily provide a training service in order to provide a greater awareness in dealing with individuals that challenge the service. The teams also advise on management of challenging incidents, risk assessments and ways to help manage difficult situations.

14 How can they help following an incident of Violence and Aggression? Both teams provide different levels of training dependant on the staff group and the environment in which they work. The levels are: Personal Safety Training relevant to all staff groups Disengagement Skills Training relevant to clinical and other staff following a risk assessment Physical Intervention Skills relevant to clinical staff in higher risk areas More details of the above courses can be found within the Trust training prospectus or by contacting the team. On request the teams will also visit areas, providing support and guidance concerning difficult situations i.e. challenging clients. The aim is to reduce the risk to the clients and also members of staff. The team can also work with managers, team and individuals by reviewing incidents, providing advice on measures to reduce the level of risk and identifying support mechanisms and structures. Contact Details: Prevention and Management of Aggression Team: Bracken Centre Glenfield Hospital Site Leicester LE3 9DZ Tel: (0116) 225 5739 E-mail: ian.thomas@leicspart.nhs.uk or joseph.zulu@leicspart.nhs.uk For Learning Disability Teams, contact Lynne Moore Tel: (0116) 225 5206 E-mail: lynne.moore@leicspart.nhs.uk. 4.7 Occupational Health Department The Occupational Health Services provides confidential and impartial advice on all aspects of the relationship between work and health. This will include health screening, immunisation, and ergonomic advice, advice for work related injuries, health education and counselling. The team consists of Occupational Health Physicians and Occupational Health Nurse Advisors and specialist Nurse Practitioners.

15 How can they help following an incident? Occupational health services are available for staff, who have suffered a physical or verbal assault in relation to work duties. The team will offer a listening service to all staff and provide additional support when necessary. This may include an assessment from the occupational health nurse or physician.the department may liaise with the knowledge of the assaulted employee with the GP and any specialist involved. A referral for physiotherapy funded by Leicestershire Partnership NHS Trust can be made where appropriate to assist in optimising support for the employee. Following assessment the occupational physician or nurse may recommend a suitable return to work programme to the line manager and/or Human Resources to assist a successful return to work at an agreed time. This might include temporary modification of working hours and/or duties and follow up in the occupational health department if appropriate. It is advised that staff be referred by their Manager or may self refer for specialist advice and support regarding related health and work issues. Contact Details: Tel: (0116) 225 5431 Baldwin Lodge Glenfield Hospital Site Groby Road Leicester LE3 9QP 4.8 Risk Assurance Department The team comprises a Head of Risk Assurance, Risk Co-ordinator and Risk Assurance System Support. The team provides advice and guidance for a variety of risk management issues, and co-ordinate the process for assessing risk i.e. Risk Register. A central database is maintained for accidents / incidents and near misses. Regular anonymised statistical reports are provided for managers and various committees How can they help following an incident? They can provide: Initial advice to staff and/or managers following an incident in respect of reporting procedures. Incident investigation where appropriate.

16 Post incident advice to include the reviewing of risk assessment in order to ensure appropriate preventative / control measures are implemented. Contact Details: Head of Risk Assurance 0116 295 7657 Risk Co-ordinator 0116 295 5801 Risk Assurance System Support 0116 295 7523 4.9 Anti-Bullying and Harassment Support Service The Trust Anti-Bullying and Harassment Support Service (ABHSS) has been developed to support staff who believe that they are being subjected to workplace bullying or harassment. Anti-Bullying and Harassment Advisors are members of staff who have volunteered to signpost individuals to existing support mechanisms which are outlined in more detail on the Trust ABHSS website. Anyone accessing this service will be referred to an on call Advisor to discuss in the strictest confidence the issue/s that have caused them to contact the service. In most case the Advisor is likely to be the first person to whom someone experiencing harassment will talk. The service aims to ensure each and every client contacting the service will be able to talk in confidence and be advised of the possible options. Contact details: Helpline 07557190581 Confidential reporting via nobullying@leicpart.nhs.uk or Dedicated ABHSS webpage on esource 4.10 Union Representation The Trust ensures that Staff Side representation is available by working jointly with the relevant unions. Staff Side Union members represent members both as individuals and collectively to ensure staff are treated fairly and reasonably. Staff Side representatives work closely with the managers striving to ensure a safe working environment. How can they help following an incident? A union will generally be able to: Support and represent individuals through any investigation processes. Provide free legal advice and representation. Provide advice on injury schemes and general benefits.

17 Represent staff interests via the policy-making process and review violence and aggressive incidents within health and safety committees. Contact Details: Please contact your Union Representative or Chair of Staff Side Representatives on 0116 2957176. 4.11 Further Support There may be an occasion when you still feel the need for more support or have concerns about the way in which a particular violent or aggressive situation is dealt with. In this instance you are advised to discuss the issue with your line manager. If you feel you are unable to do this other ways of raising these concerns are: Telephone the Staff Hotline (0116) 295 2425 Any comments or suggestions you may have will be noted and passed on to an appropriate director. A response will be promptly directed to you. Staff Ombudsman (0116) 246 3482 The role of the Staff Ombudsman is to offer confidential advice and support to staff who have concerns about issues relating to patient care but who feel, for whatever reason, that formal management channels and procedures are either not open to them or have been exhausted. 5 Debrief A debrief can be described as an opportunity for staff who have been involved in an incident to reflect on what has happened, identify a way forward and be offered support. Following an incident, there is often a pull to do something, however, the evidence for debriefing is mixed and in some cases a debrief can be harmful. Staff often ask for a debrief session, but it must be acknowledged that not everyone will feel comfortable with this and the debrief must be optional. The tool provided in appendix two has been designed to help team members to facilitate a debrief for colleagues after an incident. The tool is based on the 6Cs - values which all NHS staff are encouraged to embrace (care, compassion, competence, communication, courage and commitment). The tool aims to provide a structure for the debrief process and some ideas for discussion points. The document will also provide a record of the debrief and highlight any ongoing actions that have been identified.

18 The debriefer must let participants know that their emotional response is an expected part of the adjustment process to the experience of trauma, and mild symptoms are likely to subside over the coming weeks. Offer the leaflet Coping after incidents (appendix four). After four weeks, anyone still experiencing symptoms should be advised to seek further support, for example via their GP, occupational health or Amica. Note: A training pack for staff who are likely to be offering debriefs has been prepared to support the implementation of this tool. Please contact your divisional lead nurse or the Trust Lead for Patient Safety if you would like a copy of the pack. 6 Whistle Blowing Policy Staff may be worried about raising issues or prefer to keep their concerns to themselves. They might feel raising the issue will be disloyal to colleagues, managers or to the organisation. They may fear the consequences of possibly speaking to the wrong person or raising the issue in a wrong way. The policy exists in order to support staff if they feel they need to raise a genuine concern. You will not risk losing your job or any form of retribution as a result or raising your concern. Providing you are acting in good faith it will not matter if you were mistaken. It is recognised that, sometimes, a member of staff may prefer to raise a concern in confidence under this policy and this wish will be respected. The Whistle Blowing Policy is available to all areas. 7 Criminal Injury and Reporting to the Police Any person within the Trust who has been threatened or assaulted has a right to report the incident(s) to the police. It is advisable to talk this over with somebody first, preferably with a senior member of staff within your department or the Local Security Management Specialist. The police may take a statement from you and should let you know if somebody has been arrested, cautioned or charged. When the police charge somebody they pass on the evidence to the Crown Prosecution Service, who then decide whether to take the case to court. In any instance that involves a patient under the care of the Trust there needs to be an investigation into the mental wellbeing of the offender. This will be obtained by an opinion of the person responsible for the care of the patient (usually a Consultant/Psychiatrist). Contact Detail: When reporting an incident call the contact management centre on 101. Local Officers can be called for advice, however it is advised to call on the above non-emergency number following a discussion with a senior member of staff. Details of local Police contacts will be available in your area.

19 8 Compensation As a victim of violence you may be eligible for criminal injuries compensation. The process for this is the Criminal Injuries Compensation Scheme. This is a government-funded scheme and aims at supporting persons who have been subject to a violent incident. The responsibility for deciding and to make a claim is yours. It does not matter whether the defender has been caught or charged, you may still have the right to claim for compensation. There are, however, rules which determine whether or not you are eligible to receive any compensation. Again it is advisable to discuss this with a senior member of staff within your department or the Local Security Management Specialist, who will be able to advise and support you on this matter. 9 Monitoring arrangements A field will be added to the eirf so that when staff report a violent incident, they are asked to record if a debrief takes place. This will then be monitored in the quarterly patient safety report as the number of debriefing sessions compared with the number of violent incidents and SIs. A letter is sent out to staff by the Health and Safety Team, and this acts as a mechanism for ensuring that staff are aware of available support.