POLICY FOR LONE WORKING

POLICY FOR LONE WORKING Document Summary To state the Hospice at Home Carlisle and North Lakeland Policy for ensuring, as far as reasonably practicable, the health, safety and welfare of staff who work alone. This is the final version of this document and all other versions must be destroyed. Policy Category Document Number Risk, Fire, Health, Safety and Welfare POL/H&S/01 Date Ratified 29 April 2015 Date Implemented 29 April 2015 Next Review Date April 2016 Accountable Individual Policy Author/ Authors Policy Source (s) Chief Executive Chief Executive Head of Non-Clinical Services Trustee NHS Policy Existing Hospice at Home Policy

TABLE OF CONTENTS 1. Scope 3 2. Introduction 3 3. Statement of Intent.... 3 4. Definitions 3 5. Duties and Responsibilities.4 6. Arrangement for Management of Lone Working.. 4 7. Safe Systems of Working 5 8. Organisational Overview of Risk.. 5 9. Reporting and Investigation of Incidents. 5 10. Training 5 11. Monitoring and Review.5 12. References/Bibliography...6 13. Related Policy/Procedures 6 Appendix 1 Risk Assessment & Safe Systems of Work for Lone Working Appendix 2 Risk Assessment Form Appendix 3 Developing a Lone Worker Emergency Response Procedure Appendix 4 Good Practice Guidelines for the Management of Lone Working Lone Working Policy/Version 1 2 Ref: POL/H&S/01

1. SCOPE This policy will apply to all staff working within Hospice at Home Carlisle and North Lakeland (Hospice at Home), including full-time and part-time clinical and non-clinical staff and Volunteers (the staff). Hospice at Home also has responsibility for visitors, contractors and self-employed people whom it may engage. Further detailed guidance on arrangements for the management of risks associated with violence and aggression can be found in the Prevention and Management of Violence and Aggression Policy. 2. INTRODUCTION Under the general provisions of the Health and Safety at Work Act 1974, and the specific requirements of the Management of Health and Safety at Work Regulations 1999 (as amended), employers or others must assess risks to employees or others, who may be affected by work of Hospice at Home. Whilst the work activities of lone workers should not be significantly more hazardous than activities of other staff working in groups, the risk to lone workers are considered to be greater due to the potential consequences if an adverse incident were to occur. It is for these reasons that risks associated with lone working must be assessed and managed in order to comply with the legislation mentioned above. 3. STATEMENT OF INTENT Hospice at Home will:- Implement arrangements to assess and manage work activities undertaken by lone workers. Minimise risks to lone workers health, safety and welfare as far as reasonably practicable. 4. DEFINITIONS 4.1 Lone Worker A person, who works by him/herself without close or direct supervision in any environment where there are no other workers present available to respond quickly and effectively to unusual occurrences and or emergencies. 4. 2 Lone Working A person is classed as working alone, if the definition in 4.1 applies for any significant period of time, whilst the lone worker is engaged in the business of Hospice at Home. The definition of a significant period will be determined by the level of risk posed by the activity. Lone Working Policy/Version 1 3 Ref: POL/H&S/01

5. DUTIES AND RESPONSIBILITIES Hospice at Home must identify all lone workers as defined by this Policy. Safe working systems must be devised and implemented in relation to lone working to avoid or minimise risk where necessary. It is the responsibility of the managers to ensure;- This policy is implemented within their area An operational framework is in place and documented for ensuring the health, safety and welfare of lone workers Where staff within their remit undertake lone working, that risk assessments for lone working are documented and safe systems of work are implemented, including follow-up procedures should a lone worker become unaccounted for All lone workers are aware of and understand lone working procedures All untoward incidents involving lone workers are reported using Hospice at Home s established incident reporting policy and procedures It is the responsibility of all staff to ensure that they:- Understand the lone working procedure in operation in their area and implement the procedure when they work alone Follow health and safety procedures Do not take unnecessary risk when working alone Always seek and follow advice where a perception of risk exists Share information with colleagues and other agencies relating to potential risks to other lone workers Bring to the attention of their manager any issues they consider relevant that may affect their safety or welfare whilst lone working in order that appropriate measures can be implemented to minimise risks 6. ARRANGEMENTS FOR MANAGEMENT OF LONE WORKING 6.1 Risk Assessment Risk assessments for lone working must be undertaken, documented and reviewed and should consider the nature of the lone working activities being undertaken as well as the environments where lone working is being undertaken. Lone Working Policy/Version 1 4 Ref: POL/H&S/01

Guidance on how to complete risk assessment forms for lone working can be found at Appendix 1. For Risk Assessment form see Appendix 2. 7. SAFE SYSTEMS OF WORKING Safe systems of work are the control measures identified and implemented within risk assessments for the management of significant risks. Managers must ensure a safe system of work for lone working is implemented that is appropriate to their team/department s circumstances and that is practical to implement. The safe system of work will also incorporate follow up actions to be taken in the event of there being concerns for the welfare of a lone worker (Appendix 3) 8. ORGANISATIONAL OVERVIEW OF RISK Hospice at Home will implement the Policy for Service Delivery Health and Safety Risk Assessment to take account of all risks, including risks associated with lone working. 9. REPORTING AND INVESTIGATION OF INCIDENTS All incidents and near misses involving lone workers must be reported and investigated in accordance with Hospice at Home s Incident and Serious Untoward Incident and Near Miss Reporting Policy. 10. TRAINING Hospice at Home will deliver training that relates to lone working as appropriate. 11. MONITORING AND REVIEW The table below outlines Hospice at Home s monitoring arrangements for this policy / document. Aspect of compliance or effectiveness being monitored Arrangements for ensuring the safety of lone workers Monitoring method Review of sample lone worker s risk assessments and arrangement for safe practice Individual responsible for the monitoring Manager responsible for discrete service provision Frequency of the monitoring activity Annual Committee which will receive the findings/monitoring report Health and Safety Committee Lone Working Policy/Version 1 5 Ref: POL/H&S/01

11. REFERENCES / BIBLIOGRAPHY HSE 2005, Working Alone in Safety, INDG73 (Rev), HSE Books, Sudbury, Suffolk HSE 2007, Management of Health and Safety at Work Regulations, L21, HSE Books, Sudbury, Suffolk NHS Security Management Service 2003, A Professional Approach to Managing Security in the NHS, Counter Fraud & Security Management Services, www.cfsms.nhs.uk NHS Security Management Service, 2007, Tackling Violence against NHS Staff, www.cfsms.nhs.uk 12. RELATED POLICY / PROCEDURES Policy for Prevention and Management of Violence and Aggression Incident and Serious Untoward Incident and Near Miss reporting Policy Lone Working Policy/Version 1 6 Ref: POL/H&S/01

APPENDIX 1 - RISK ASSESSMENT & SAFE SYSTEMS OF WORK FOR LONE WORKING A. Risk Assessments for Lone Working/ 1-1 Appointments Risk assessments for lone working should consider potential exposure to violence and aggression risks, as well as other risks associated with the work activities being undertaken (for example driving) and the environment in which the appointment is to be held. It is essential that risks associated with lone worker appointments are considered prior to undertaking the appointment As part of that assessment process consideration must be given to the following:- History/knowledge of the individual - are there any issues that give cause for concern for working alone with the individual or at their address (e.g. family, friends, pets) If there is no prior knowledge of the individual, e.g. on initial referral, consider arranging an alternative venue or not conducting the meeting alone. Location of the meeting/interview room proximity to colleagues/other staff who may be able to hear if voices are raised. Facilities within the room is there a panic alarm and/or telephone within the room and where are they situated in relation to where the lone worker will be sitting? Furniture/equipment within the room what are the layout/design/seating arrangements in the room? Will the lone worker sit closest to the door in line with good practice? Is there any unnecessary furniture/equipment in the room that could be used as potential weapons/barricades? Is there a procedure to follow, if the lone worker becomes concerned for their safety/welfare during the meeting and if so, what is that procedure. B. Components of A safe system of work for lone working:- A safe system of work for lone working should consider the following aspects of the assessment and management of lone working tasks and the assessment of the suitability of the work activity being undertaken by a lone worker: for example whether or not to conduct a home visit to an unknown service user who may be potentially violent. Reference to individual service users clinical risk assessments for signs or indications of potential violence/ aggression risks or other risks to the personal safety of the lone worker. Tracking arrangements for staff working out in the community or at places away from their usual work base. In particular:- Lone Working Policy/Version 1 7 Ref: POL/H&S/01

Where they are going When they expect to return Whom they are visiting (if appropriate) How they can be contacted whilst on the visit Use of personal alarms, mobile phones or other security devices/alarm systems (if provided / available). The use of buddy systems. Communication with colleagues. Procedure for visiting/contacting unknown service users. Arrangements for joint visits/interviews. Last out procedure (for units which close at the end of a working day). Consideration of whether the lone worker should have access to a first aid kit/equipment. Consideration of whether lone working should be undertaken at night. Action plan if a lone worker cannot be accounted for or if an incident occurs, including:- How long after the lone worker becomes unaccounted for should colleagues start locating their whereabouts What process should be followed to try to trace the lone worker Who should be notified, if the lone worker cannot be accounted for (e.g. on call managers) How long after the lone worker cannot be located should the police be contacted What information can be provided to the police (e.g. description of the lone worker, vehicle they were travelling in, route they would be likely to have taken, calls made). Maintenance of current information regarding lone workers (e.g. vehicle model and registration) Instruction of all lone workers in the implementation of the lone worker procedure. Instruction of all lone workers in the management of violence and aggression whilst lone working. Lone Working Policy/Version 1 8 Ref: POL/H&S/01

C. Communication An essential element of any safe system of work is good communication. It is therefore vital that lone workers ensure they communicate their whereabouts to a colleague in the office base (or other designated contact) and that all information regarding the lone worker, for example vehicle registration, is kept up to date. In clinical settings it is essential staff discuss their service users at Multi- Disciplinary Team meetings (or other similar forum) and, in particular, they should raise issues of safety. It is also expected that safety and risk issues presented by a patient are raised and discussed at each clinical assessment review. D. Buddy Systems Buddy Systems can be described as formal arrangements between colleagues who look out for each other to make sure the lone worker has completed their lone working tasks safely. It usually involves a telephone call, or other means of contact, by the lone worker to their buddy when the lone worker has finished their duties. If the buddy does not receive contact by the agreed time, the buddy will try to contact the lone worker to enquire about their safety/whereabouts. If contact cannot be made, the follow-up procedures for the lone worker should be implemented. E. Conducting 1-1 Meetings / Interviews It is acknowledged that many lone workers within Hospice at Home meet patients/clients in 1-1 interview type situations, usually in rooms not managed by Hospice at Home, such as in GP surgeries. In these situations staff are considered to be lone workers. When conducting 1-1 interviews with a service user or other person (whilst lone working) it is important to be aware of all cultural, ethnic and sexual orientation issues that may be relevant to the service user. Whilst it is good practice for interview rooms to be fitted with panic alarm, it is acknowledged that it is not always possible or practical. In these situations it is vital that the assessment procedures described above are thoroughly undertaken and, if/where there is significant concern, the meeting should be arranged at an alternative venue or with more than one member of staff or volunteer present. Time spent in such locations may be relatively short or may be all day. In these situations there should be an arrangement for the lone worker to be in contact with colleagues at some point in order that a check may be made on their welfare. This could be perhaps at the start and end of the working day. F. Lone working at night / out of hours All lone worker visits undertaken at night or out of hours must first be risk assessed for suitability to be undertaken by a lone worker and appropriate control measures described above must be implemented. Lone Working Policy/Version 1 9 Ref: POL/H&S/01

Such visits should be undertaken only when there is support available to the lone worker, i.e. a system (on call mobile) to establish whether the lone worker has returned safely from the appointment / visit. G. Responding To Lone Worker Emergency Situations The nature of the response will depend on the environment the lone working is taking place in and/or the nature of the work being undertaken. The nature of the response will also depend on what staffing resources, equipment, facilities and information are available to the people responding to the emergency. The response to a lone worker emergency situation must be understood by all persons implementing the emergency response procedure. Please refer to Appendix 3 for details of what should be incorporated into an emergency response procedure. Lone Working Policy/Version 1 10 Ref: POL/H&S/01

APPENDIX 2 RISK ASSESSMENT FORM HOSPICE AT HOME, CARLISLE AND NORTH LAKELAND RISK potential outcome or effect of hazard PERSONS AFFECTED Staff, Patients, Other FREQUENCY OF EXPOSURE How often is/are the person(s) exposed to the hazard RISK GRADING Assume NO control measures in place Infrequently Weekly Constantly Annually Daily Monthly Likelihood Consequence x Risk Grading = Hourly EXISTING CONTROL MEASURES What is being done already to reduce the likelihood of harm, damage or loss occurring 1-3 very low 4-6 medium 8-12 moderate 15-25 very high RISK GRADING TAKING INTO ACCOUNT EXISTING CONTROL MEASURES Likelihood x Consequence = Risk Grading Likelihood: Consequence: x Risk Grading: = DOES THE CAUSE OF THIS RISK ISSUE, OR DO ITS EFFECTS, EXTEND BEYOND THE REMIT OF YOUR TEAM? 1-3 very low 4-6 medium 8-12 moderate 15-25 very high YES NO Likelihood: 1=Rare: may occur only in exceptional circumstances; 2=Unlikely: may occur at some time; 3=Possible: will occur from time to time; 4=Likely: will occur at some time in the near future; 5=Almost certain: will occur at any time and recur frequently. Consequence: 1=Insignificant: no obvious harm, costs up to 1k, no significant effect on quality of care; 2=Minor: first aid injury, no permanent damage, no lost time, costs up to 10k, noticeable effect on quality of care; 3=Moderate: sprain, strain, burn, may require medical attention, lost time, temporary incapacity, costs up to 50k, significant effect on quality of care; 4=Major: loss of limb, fracture, crushing, RIDDOR reportable, exposure to toxins, permanent incapacity, major disruption to service, costs up to 250k, patient care significantly impaired; 5=Catastrophic: fatality, multiple casualties, loss of service, costs over 250k, patient care impossible. Lone Working Policy/Version 1 11 Ref: POL/H&S/01

APPENDIX 3 - DEVELOPING A LONE WORKER EMERGENCY RESPONSE PROCEDURE The lone working systems must incorporate a procedure for following up on the welfare of the lone worker should they become unaccounted for. All personal information about lone workers held in support of a lone working system must be kept up to date. Emergency / Follow-up procedures should include the following:- A. Timescales for following up the lone worker after they become unaccounted for Timescales for follow up for unaccounted lone workers may vary depending on the location and nature of the lone worker s appointment. For example, a lone worker visiting somebody with a high risk potential for violence or aggression should be followed up immediately, whereas a lone worker on a low-risk appointment, driving on roads known to be affected by traffic delays may be allowed a longer timescale before being followed up. Each department operating a lone working system must agree a protocol as to how long it will allow for high risk visits, and for other visits and then implement an appropriate follow up system. A suggestion for this is to display on a white board (or other readily accessible reference tool) the expected return time and also whether a visit is high risk (e.g. entry written in red pen), so that colleagues/buddies can check at a glance whether the lone worker has returned/made contact on time. B. Process to be followed to try to trace the individual The process for following up the lone worker needs to be agreed. Again this will depend on the nature of the visit; on the place(s) being visited and on whether the visit is deemed to be a high risk visit. The first step is to try to make direct contact with the lone worker concerned via their mobile phone (or, if the lone worker is in another area of the building/premises, to visit that area to check they are still there and all is well). If contact cannot be made at that time, the protocol needs to be followed as to how many times contact is attempted and as to the timescales between each attempt, before escalating the situation to the next level. This will differ according to the assessed level of risk, with less time being allowed between follow-up attempts for high risk visits. Lone Working Policy/Version 1 12 Ref: POL/H&S/01

An example of this could be where the lone worker fails to make contact at the expected time. After the initial timescale agreed for follow up, say 20 minutes, an attempt is made to contact the lone worker by mobile at their place of work. Following a further unsuccessful attempt further action must be taken. At this stage it needs to be decided how to start trying to track the lone worker. This may involve working through the lone worker s appointments for the day and making contact with each one or, if there is the likelihood the person may have returned home (say at the end of the working day) and simply forgotten to make contact, to try to contact them at home. During the time these tracing steps are being made, attempts should still be made to contact the lone worker directly. C. Who should be notified if the lone worker cannot be accounted for (e.g. on call managers, relatives?) At some stage during this process, usually after several attempts have been made to contact the lone worker without success, the colleague needs to notify the manager (if not already involved) of the missing lone worker. At some stage the on-call manager will also need to be notified of the situation. The police may also need to be contacted. Decisions as to when to notify the oncall manager and the police should be based upon the risk level of the visit, i.e. whether it was a high risk visit. Agreement needs to be reached as to how long, after the lone worker becomes unaccounted for, notification to the on-call manager, police and relatives should occur. Discussions need to take place with each individual lone worker as to how they feel about contact being made with relatives/home contacts and after what duration of being missing this should be done. D. Contacting the Police When contacting the police as much information as possible needs to be provided about the lone worker, their last known whereabouts, routes/places they were known to be travelling to, people they were due to meet etc. Descriptions of and information about the lone worker including the vehicle they were traveling in, are also essential to the police to assist them to trace the person quickly. Once contact is made with the police, it cannot, however, be assumed that Hospice at Home s responsibility for tracing the lone worker is at an end. Attempts must continue to be made with the lone worker and with their relative/home contact, until they are located. Lone Working Policy/Version 1 13 Ref: POL/H&S/01

APPENDIX 4 - GOOD PRACTICE GUIDANCE FOR THE MANAGEMENT OF LONE WORKING A. Lone Workers Undertaking Community / Home Visits In the community where lone workers need to remain watchful for their own safety. The following guidance notes provide advice that contributes towards a positive safety culture. B. Planning the visit Lone workers should use their discretion concerning a suitable venue to see the service user. They should take into account history, current mental state and whether or not the service user is known to Hospice at Home. In the event of a service-user not being known to Hospice at Home, the lone worker should discuss the service-user with other staff, who may know the service-user. In the case of new service-users, the referring agency should be contacted. If for any reason when planning a visit, Lone worker has any doubts about the risk of violence or about other issue potentially affecting the safety of a lone worker, consideration should be given to: - A joint visit. The service-user being seen in a setting, which offers greater safeguards, e.g. outpatient department, GP practice, hospital building. Police support (please note, police can offer support if there is a significant risk of violence occurring and should be called only in emergency situations or where there is evidence to support the potential for violence). Starting and finishing the visit from the base. If the visit is to take place in any premises other than the service-user s home, the lone worker must get permission from staff at the premises in question to use the building and provide information for them to ensure the safety of their staff, e.g. receptionists. Lone workers should organise appointments so that the staff at the premises know the purpose of the meeting. If the lone worker is concerned about any risk issues or feels uncomfortable about a visit they should consult their line manager prior to taking action. C. Undertaking the Visit Lone workers should familiarise themselves with the area where the visit is being made, e.g. how to get there, where to park and access to public transport. Lone Working Policy/Version 1 14 Ref: POL/H&S/01

Lone workers must comply with local procedures and inform staff of actions to be taken when carrying out lone visits throughout and beyond the normal working day, also carrying a functioning mobile phone and an identification badge provided by Hospice at Home. Lone workers should assess the situation as they arrive and be prepared to abandon the visit if they have cause for concern as to their safety. Lone workers should stand clear and sideward of the door, after ringing the doorbell or knocking at the door, assess the manner of the person answering the door and not enter in the event of any concerns. In the service-users home a lone worker should be aware of exits, the serviceuser s mental state, of the presence of any potential weapons, of other individuals and animals, of the layout of the furniture in the room and of where to position themselves, which if possible should be nearest the exit door, ensuring the pathways to the exit are not blocked. D. After a visit Wherever practical a lone worker should ensure that all parties are satisfied with the outcome of the visit, making sure that if there are any problems or unresolved issues, everyone knows what will happen next. E. Initial contacts On initial contacts lone workers should collect as much information as possible regarding the person referred and his/her circumstances in order that an initial assessment of risk may be made. Sources of information might include referrer, medical/nursing notes and information from other professionals. An assessment of risk should be made using the clinical risk assessment form (see Appendix 2), which identifies past and current information as to: Harm/aggression to others, specific people or groups of people Self-neglect or general ill health Alcohol and/or drug misuse Association with family or others who pose a risk Location (e.g. isolated or prone to vandalism at certain times) Good communication is essential. Lone workers should be clear about the purpose of their visit (e.g. to assess for the provision of a service), ensuring the person they are to meet knows who the Lone worker is and the purpose of the meeting. Lone Working Policy/Version 1 15 Ref: POL/H&S/01

Initial contacts should be made in a supportive environment: Location (e.g. team base, Social Services office, GP Practice) Time (e.g. when other staff are available to give support, if required) Initial contacts with people at locations, the support of other staff is unavailable should not be undertaken, unless justified by a risk assessment. Initial contacts should be formally arranged and not made on-chance, unless a rationale and plans are agreed with the Line Manager. All lone workers must carry authorised identification and offer it as proof of identity, when making a visit Lone workers should arrange to report back to a team member or the Line Manager after an initial contact to ensure any necessary follow up action is taken. F. General (applies to all appointments - clinical & non-clinical) Travelling by Car A lone worker should: Make sure the car is adequately maintained and fuelled to avoid breakdown. Allow enough time for each journey. Not leave items visible in the car, lock valuables or other items in the boot before starting the journey. Not display on-call stickers or anything else, which may identify the vehicle as belonging to a health-care worker. Try to park as near as possible to the appointment address, if possible in areas which allow the car to be driven away without hindrance. As far as possible, avoid areas that are unlit and /or isolated. Be aware of local places that may serve as a place of safety (such as local shops). Lone Working Policy/Version 1 16 Ref: POL/H&S/01

Travelling by Bus A lone worker should: Use a bus stop known to be usually busy and well lit. Try to alight at a bus stop nearest to the destination, so reducing time spent walking in unfamiliar locations. Know the departure and arrival times and try to let someone at the destination know the expected arrival time with a view to meeting you at the destination bus-stop. Sit close to the driver. If someone starts up a conversation, be pleasant and confident, but don t give away personal information such as where you live or work. Travelling by Train A lone worker should: Wait on a well-lit section of the platform, close to the exit or where there are other people around. Stations may now have CCTV cameras and staff, who are trained to deal with emergencies. Try to sit in a busy carriage and keep any bags and personal belongings close by. If a lone worker feels uncomfortable, should switch seats, carriages or even consider getting off the train and catching the next one, though only if the station concerned is manned and there are people on the platform. Know where the location of the emergency button or cord is situated on the train or any help points if possible, at the station. Travelling by Taxi A lone worker should: Carry the phone number of a known taxi or mini cab firm, and whenever booking a taxi ask the firm for the driver s name and the type of car they will be driving. Try to book the taxi for the return journey, before setting out, giving their name, and, when the driver arrives make sure they know the name under which the booking was made. If a booking for a taxi has to be made in a public place, it should be done quietly, where people are unlikely to overhear personal details. If possible, share a taxi with a friend and have your money ready and keys handy at the end of the journey, so that there is no delay in entry to home or workplace. In the event of feeling uneasy in a taxi, when in a busy and known place ask the driver to stop and exit the taxi. Lone Working Policy/Version 1 17 Ref: POL/H&S/01

Travelling on Foot A lone worker should: Be aware of their surroundings; know where they are going and how they are going to get there. Wherever possible, avoid carrying valuable items or equipment in a clearly visible manner. Mobile Telephones Mobile phones are considered to be an item of safety equipment in the context of lone working. Everyone conducting lone working should be provided with, or have available to them, a mobile phone. Phones with shared access should be considered only if it can be guaranteed a mobile phone will always be available to the lone worker. Pay as you go phones should not be considered acceptable, as there is a risk of credit running out during a series of visits. Lone workers using mobile phones within the community should familiarize themselves with locations and places where mobile phone reception is poor or a signal may be able to be unobtainable. Additional safety measures should always be considered before visiting such an area. Communication with Colleagues All lone workers must ensure colleagues are made aware of their whereabouts for the duration of the time for lone working. Information relating to destination, arrival time, return time, and the person/people whom the lone worker is meeting must be available to staff at the team base in order that appropriate steps can be taken to follow up the lone worker should they become unaccounted for. Lone workers must inform colleagues promptly in the event of any changes to plans, e.g. if return time changes. Lone workers must make contact with their buddy/colleagues at the end of their period of lone working and/or at agreed times to ensure their welfare is monitored appropriately. Lone Working Policy/Version 1 18 Ref: POL/H&S/01