LONE WORKER GUIDANCE 1 SUMMARY 2 RESPONSIBLE PERSON: 3 ACCOUNTABLE DIRECTOR: 4 APPLIES TO: Guidance for lone workers Sarah Price - Chief Officer Sarah Price - Chief Officer All employees 5 GROUPS/ INDIVIDUALS WHO HAVE OVERSEEN THE DEVELOPMENT OF THIS POLICY: 6 GROUPS WHICH WERE CONSULTED AND HAVE GIVEN APPROVAL: Barbara George - HR Business Partner (NCL) Eleanor Davies-HR Business Partner (HCCG) Joint Partnership Group CCG Governing Body 7 EQUALITY IMPACT ANALYSIS COMPLETED: Policy Screened TBC Template completed TBC 8 RATIFYING COMMITTEE(S) & DATE OF FINAL APPROVAL: 9 VERSION: 10 AVAILABLE ON: NHS NCL Joint Partnership Group 11.05.2012 Officially adopted by Haringey CCG Governing Body (date) 2. Intranet Website 11 RELATED DOCUMENTS: 12 DISSEMINATED TO: 13 DATE OF IMPLEMENTATION: 14 DATE OF NEXT FORMAL REVIEW: All staff 1 st April 2013 31 st March 2015 LONE WORKER GUIDANCE Page 1 of 20
DOCUMENT CONTROL Date Version Action Amendments 11 th May 2012 1.0 Policy first implemented N/A 1 st April 2013 2.0 Policy amended Changes made to reflect new employing body- Haringey CCG. LONE WORKER GUIDANCE Page 2 of 20
Contents Page No. 1. Introduction 3 2. Scope 3 3. Who this guidance applies to 3 4. Definitions used in this guidance 3 5. Recommendations for independent contractors 3 6. Roles and responsibilities 3 7. Framework for managing lone working 5-11 Risk management 5 Identification of Risks 5 Assessment of Risks 6 Managing Risk 6 Review 6 Before a lone working situation 6 Buddy System 7 Escalation Process 8 Technology 8 Risk Assessment 9 Escorting Patients 9 Lone working and vehicles 9 In the event of an incident 10 8. Training 10 9. Monitoring compliance 11 Appendices Appendix 1 Checklist for managers 12 Appendix 2 Site based risk assessment checklist 14 Appendix 3 Home visiting risk assessment 15 Appendix 4 Haringey CCG risk assessment tool 19 Appendix 5 Good practice for home visiting 21 LONE WORKER GUIDANCE Page 3 of 20
1. Introduction This guidance is designed to ensure the safety of lone workers and staff who sometimes work alone by minimising risk and taking appropriate measures. The overall aim of the guidance is to provide a framework for assessing and managing risks associated with lone working to ensure the safety of Haringey CCG staff. 2. Scope Lone working is not always planned and can occur in a variety of settings. For example you may work alone: in an otherwise unoccupied, or an isolated part of a building; moving between buildings; in a clinic setting; at a reception or in a patient s home. This guidance covers all lone working whether planned or unplanned, and where ever it may occur. Please note this guidance is not intended to cover staff working at home. 3. Who this guidance applies to The guidance applies to all staff employed by Haringey CCG who may occasionally or regularly work on their own, wherever they are working. 4. Definitions used in this guidance Lone working: The NHS Security Management Service (SMS) defines lone working as: any situation or location in which someone works without a colleague nearby; or when someone is working out of sight or earshot of another colleague. 5. Recommendations for independent contractors It is recommended that independent contractors manage lone workers in accordance with this guidance. Independent contractors are bound by the statutory obligations outlined in the introduction in the same way as Haringey CCG. 6. Roles and responsibilities Haringey CCG Haringey CCG has a legal duty to ensure the health, safety and welfare of their employees. Haringey CCG is ultimately responsible for ensuring effective implementation of this guidance. Chief Executive The Chief Officer is ultimately responsible for all aspects of health and safety within Haringey CCG. Responsible Directors Ensuring that any moderate and high risks reported to them within their service areas are managed effectively and where appropriate incorporated within the risk register. LONE WORKER GUIDANCE Page 4 of 20
Line Managers, Service Managers and Heads of Service Identify who lone workers are within the service. Ensure that the following information is known regarding staff who undertake lone working: o Name/address/home phone number o Description and photograph of worker o Mobile phone and/or pager number o Contact details of the next of kin o Itinerary of visits o Expected time of finish o Car registration, colour, make, model o Anything other information deemed relevant for tracking a person Ensure that this guidance is disseminated to relevant staff, implemented in their area, and that staff are protected appropriately before undertaking lone working. Ensure sufficient risk assessment is undertaken with appropriate others (e.g. LSMS, risk manager). Appropriate measures following. Regular review of risk assessment. Ensure risk assessments and agreed safe systems of working are documented and communicated. Report any moderate and high risks to the Head of Integrated Governance and relevant Director. Ensure lone workers are provided with sufficient information, training and supervision before entering a lone working situation. Ensure staff receive relevant training and that records are kept of that training, including Haringey CCG s local induction of new staff. Ensure staff are aware not to put themselves in danger. Ensure incidents are reported in line with Haringey CCG guidance. Ensure incidents are investigated and risk assessments are reviewed following incidents. Follow up any incidents and ensure staff are offered relevant support from managers, occupational health and Oasis. Appendix 2 provides a checklist for managers to assist with implementing the responsibilities outlined. All staff Must take responsibility for their own safety and cooperate with Haringey CCG regarding health and safety requirements. This includes attending training; reporting incidents; working in line with relevant policies and undertaking or assisting with risk assessments. Consider risks of day to day working practices ongoing and ensure concerns are raised with line management. LONE WORKER GUIDANCE Page 5 of 20
Plan visits and ensure necessary action or risk assessment is completed beforehand. Request information regarding risks before working in a new area or with a new patient. Tell your manager if your work plans change. Do not put self at risk if a situation arises that is unfamiliar or unsafe. Withdraw and seek further advice. Do not undertake any activity you have not received training in which you consider may prove injurious to yourself. In the event of an incident (even it is minor) ensure an incident form is completed and that this is reported to your manager. Utilise appropriate technology and attend relevant training regarding the use of technology. 7. Framework for managing lone working This section outlines the process for managing lone working including: Risk management Before a lone working situation During a lone working situation What to do in the event of an incident 7.1 Risk management Good structured risk assessment process will enable informed and rational decision making for managing risks and ensuring actions are proportionate. Every team with regular or occasional lone workers must carry out a risk assessment to identify risks to workers and make decisions about how to manage those risks. It is the responsibility of service managers to ensure risks assessments are carried out, documented and regularly reviewed. 7.2 Identification of risks To identify possible risks the following should be considered (this is not intended to be exhaustive): Groups exposed to lone working risk. Working conditions for example poor lighting, isolated areas, hazards. Work activities being undertaken such as carrying drug prescription forms. Delivering unwelcome information. Risks of violence associated with patients due to drug or alcohol misuse. Carrying equipment that is a target for theft. Capability to work alone e.g. level of experience, pregnant. LONE WORKER GUIDANCE Page 6 of 20
Travelling between environments/settings. Wearing uniforms. 7.3 Assessment of risks The risk assessment should include the following: Identification of the type of risk and staff groups affected. The likelihood of occurrence and impact on individuals and resources (such as service delivery and finance). The adequacy of the agreed controls to minimise the risks. An overall risk rating to determine the severity of the risk. Risk rating = Impact x Likelihood. What action is needed to reduce the risk further. Agreed timescales for reviewing the risk assessment. Haringey CCG s generic risk assessment tool is included in appendix 5. This can be used to determine an overall risk rating for identified risks by combining the likelihood of the risk occurring with the impact it would have. Further risk assessment tools tailored for particular lone working situations are included in appendix 3 (site based) and 4 (home visiting). These are suggested formats and can be adapted to use locally. 7.4 Managing risk Following risk assessment, team leaders and service managers must agree and document actions for minimising the identified risks. Advice should be sought as necessary from appropriate managers, for example the Governance Team. The agreed actions should then be communicated with relevant staff across the team to ensure all staff are aware of recommended protection advice. Moderate and high risks must be reported to the responsible director and risk manager for inclusion on and monitoring via the corporate risk register. 7.5 Review Risk assessments should be reviewed on a six monthly basis initially, and thereafter at least annually. Risk assessments should also be reviewed following reported incidents and concerns. Review of moderate and high risks will take place more frequently as deemed appropriate. 7.6 Before a lone working situation Before undertaking any activity with involves lone working the following good practice guidelines should be considered and followed as appropriate. The risk management process outlined in section 10.1 should be used to identify appropriate actions for particular activities. Check any known documentation that may indicate existing risks associated with the activity. Patients on the Violent Patient Scheme should be communicated with staff, and home visits may not be appropriate to such patients. LONE WORKER GUIDANCE Page 7 of 20
Patient s records should be marked with known violence. If lone workers do not have access to electronic records or systems other ways of recording and sharing such information should be considered. Information sharing of known risks across different settings (for example health and social care) should be facilitated. Identify low risk lone working that is deemed acceptable. Identify high risk areas where lone working is not deemed acceptable and alternative arrangements have been made, such as staff attending in pairs. Someone should always be aware of a lone workers movements and whereabouts. Consider what technology and emergency equipment may be useful (such as a mobile phone, personal alarm, torch etc). A written log should be kept of all visits being undertaken. The use of a buddy system. An escalation process should be agreed to manage any problems that arise. Ensure you and/or your staff have had appropriate training. Be aware of any cultural issues before entering a lone working situation. When working on site out of normal hours the following good practice guidance should also be considered and followed as appropriate: Inform your line manager how long you will be staying and ensure any security staff in the building are aware. Clarify arrangements for leaving the building or area. Such as returning keys and notifying reception or security. Consider locking yourself in. Keep several lights on, not just your office. Ensure you can make outside calls and ensure you know where panic alarms are. Specific guidance on good practice for managing home visiting is included in appendix 6. 7.7 Buddy system The buddy system involves identification of a point of contact for the period you are working alone. This person should be aware of the movements, known breaks or rest periods and contact details (including next of kin) of the lone worker. If communication stops the buddy should attempt to make contact and follow appropriate escalation when necessary (if contact still cannot be made after reasonable timescales). Arrangements should be made if the buddy needs to leave before the lone work activity is over. The lone worker must ensure they keep the buddy updated regarding any delays etc to avoid unnecessary escalation. LONE WORKER GUIDANCE Page 8 of 20
7.8 Escalation process It is essential that an escalation process is agreed before a lone working situation and use of a buddy system to ensure escalation is implemented appropriately. Based on the seriousness of the situation and the discretion of the caller the process may include escalation to: Line manager Head of Department Executive Director Nominated bleep holder out of hours Police 7.9Technology The purpose of using technology is to enhance protection. It will not however prevent all incidents or make people invincible. It should therefore always be used in conjunction with other measures to reduce the risk. Technology can be useful as a deterrent, distraction of an assailant or to summon assistance. The following technology should be considered and applied as deemed appropriate following risk assessment: Internal alert systems activated by panic alarms, provided there are robust systems for responding to the alarms. Internal alert systems activated from portable panic attack devices. Fixed panic buttons linked to a switch board. These can also be linked to the police if deemed necessary. Mobile human resource safety devices and systems that are operated using mobile technology or handsets. Personal attack alarms. CCTV Mobiles. Although it is important to ensure they are charged, emergency contacts are included on a speed dial and they are never left unattended. It is also important to remember that using a mobile may escalate an aggressive situation. Code words or phrases could be agreed to alert colleagues to a threat and the appropriate required response, such as calling the police. Practical advice for the use of a personal alarm: Remember this is primarily for distraction, check them regularly particularly before a lone situation. Checking the batteries regularly. Use them pointed towards the assailant. Remember there is no certainty of assistance but distraction may allow time for you to remove yourself from the situation. They are better for use outdoors than indoors. LONE WORKER GUIDANCE Page 9 of 20
Practical use of other devices: Ensure you and/or your staff are trained to use the device. Maintain the device regularly, change batteries etc. Use code words. Keep them nearby. Be familiar with the expected response. 7.11 Risk assessment Risk assessment is a continual process and during a lone working visit staff should: Be alert to warning signs such as body language, animals, influence of drugs. Ask patients to secure animals as unexpected behaviour may frighten them. Remove yourself from the situation if there is felt to be a risk of harm. Do not put yourself in danger. Place yourself in a position for escape, don t stand in corners etc. Be aware of all entrances and exits. Be aware of positioning of items that could be used as a weapon. Judge best possible course of action. Utilise appropriate physical security measures such as panic buttons. Operate door locks. Remain calm. 7.12 Escorting patients Before escorting patients anywhere the following should be considered: Physical and mental state of the patient Experience of staff to manage patient during escort Type of transport required Seat patients in the back Pull over if conflict arises 7.13 Lone working and vehicles When travelling alone the following good practice guidelines should be followed as appropriate: Ensure vehicles have adequate fuel Don t leave items visible in vehicles such as drugs and bags Get keys ready for your vehicle before leaving premises Check inside and outside of the car Lock all doors whilst inside Park close to the location in well lit areas LONE WORKER GUIDANCE Page 10 of 20
Contact your manager or buddy if you breakdown, ensure your hazard lights on and lock your doors Don t display signs such as doctor on call Don t leave items with personal details in the car When using taxis use a reputable one or one with contract with trust Do not use a minicab Book taxis in advance as far as possible Do not give personal information to the driver On foot avoid known areas of risk Carry items safely so as not to advertise what you are carrying Stay in well lit areas and avoid isolated pathways Relinquish property if challenged Report to the police and Haringey CCG any theft incidents Obtain a timetable for your route if using public transport Wait for transport in well lit areas Be vigilant Sit near the driver in aisle seats Familiarise yourself with relevant safety procedures Avoid upper decks and empty compartments Alert the driver if threatened 7.14 In the event of an incident All incidents relating to lone working must be reported to the Governance Team. Formally reporting incidents will assist with any further action required including legal action. In line with the incident reporting guidance any incidents resulting in a member of staff being off work for more than 3 days must be reported by the relevant line manager. Line managers should also ensure staff are referred to occupational health and/or the Staff Welfare Service for further support as necessary. Advice and incident forms are available from the Haringey CCG Governance Team. 8. Training Training will be delivered to all lone workers in line with the Trust s Training Needs Analysis. Security training, including managing violence and aggression, is part of the Haringey CCG mandatory training needs analysis and it is required that all staff attend. Training is given at corporate induction and relevant policies and local procedures incorporated as part of the local service induction. 9 Monitoring compliance Monitoring will be via the Governance Team. LONE WORKER GUIDANCE Page 11 of 20
Appendix 1 Checklist for managers Are your staff: 1) Issued with all relevant policies and procedures relating to lone working staff? 2) Trained in appropriate strategies for the prevention and management of violence (in particular, have they received conflict resolution training)? 3) Given all information about the potential risks for aggression and violence in relation to patients/service users and the appropriate measures needed to control these risks? 4) Issued with appropriate safety equipment and the procedures for maintaining such equipment? 5) Trained to be able to confidently use a device and familiar with the support service systems in place before being issued with it? 6) Aware of how to report an incident and of the need to report all incidents when they occur? 7) Issued with the necessary contacts for post-incident support? Are they: 8) aware of the importance of doing proper planning before a visit, being aware of the risks and doing all they can to ensure their own safety in advance of a visit? 9) Aware of the importance of leaving an itinerary of movements with their line manager and/or appropriate colleagues? 10) Aware of the need to keep in regular contact with appropriate colleagues and, where relevant, their nominated buddy? 11) Aware of the need to carry out continual dynamic risk assessments during a visit and take an appropriate course of action? 12) Aware of how to obtain support and advice from management in and outside of normal working hours? 13) Aware that they should never put themselves or colleagues in any danger and if they feel threatened should withdraw immediately? Do they: 14) Appreciate the organisation s commitment to and support for the protection of lone workers and the measures that have been put in place to protect them? 15) Appreciate that they have their own responsibilities for their own safety? 16) Appreciate the circumstances under which visits should be terminated? 17) Appreciate the requirements for reporting incidents of aggression and violence? 18) Understand the support made available to lone workers by the trust, especially post-incident support and the mechanism to access such support? LONE WORKER GUIDANCE Page 12 of 20
Appendix 2 - SITE BASED RISK ASSESSMENT CHECKLIST Staff Details: Date: Completed by: 1. Are there any staff who work in isolation (i.e. alone in a building or part of a building), in people s homes or who travel as part of their job? - if No do not proceed any further 2. Is there a written statement that sets out lone working systems and procedures for these staff? 3. Has the lone working statement been communicated to all staff working in the area? 4. Are lone working procedures covered as part of induction for new staff? 5. Does the lone working statement include arrangements for (where applicable): a) Risk assessing new patients for safety risks to staff? b) Staff checking in & out with base during the day? c) Ensuring staff whereabouts are known/traceable? d) Access to and appropriate use of mobile phones and/or other communications devices? e) Making staff aware of incident reporting requirements? f) Access to out-of-hours management support for staff? g) Emergency procedures for staff thought to be missing? h) Requirements for recording car registration numbers? i) Sharing information about known risks with other staff/services/agencies? j) Guidelines on not leaving property (CCG or personal) in vehicles wherever possible (such as patient notes, equipment, drugs, medicine bags, etc)? N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 6. Is the lone working statement reviewed and updated each year as applicable? LONE WORKER GUIDANCE Page 13 of 20
Appendix 3 Home Visiting Risk Assessment Part 1 Note: The following questions are not intended to be exhaustive and can be tailored to suit individual services and / or patient groups. HOME VISITING RISK ASSESSMENT Date Completed Completed By Job Title External Environment Is the home in an isolated area? Can you access the home by public transport? Details of public transport (bus, train etc) Brief description of property (e.g. flat, apartment, house) Are there parking facilities close by? Are there parking restrictions? How is the property accessed from street level? If there is a lift, is it in good working order? What level/floor is the home/flat on? Is there adequate lighting? Is the home in an area with known risks? Direct access Concealed entrance Stairs Lift Other observations regarding the local environment Overall External Environment Profile Green = no known risk factors Yellow = some elements of concern (e.g. access via alleyways); Red = serious potential risks (e.g. flat in known high risk estate) Internal Environment Is the property in a safe state of repair? e.g. steep stairs, holes in the floor, electrical hazards, visible damp, sanitation issues, etc Are there any infection control issues? Green Yellow Red If Yes, please describe LONE WORKER GUIDANCE Page 14 of 20
Are there any manual handling issues caused by the environment? If Yes, please describe Are there any weapons or similar clues to violence in the home? Other observations regarding internal environment Overall Internal Environment Profile Green = no known risk factors Yellow = some elements of concern (e.g. cleanliness) Red = serious potential risks (e.g. known weapons in the home) Patient / Family / Carers / Neighbours Does the patient or carer have a history of mental health problems? Does the patient live alone? Is the patient or carer or anyone known to live at the property likely to be drunk or on drugs? Does the patient or carer or anyone known to live at the property have a history of violent behaviour? Does the patient or carer face high level of stress? Does the patient or carer perceive you as a threat? (for children services to their child) Does the patient or carer have an unrealistic expectation of what you can offer? Does the patient or carer have any fears, prejudices or grievances that may make one individual or group of workers more vulnerable? Is the patient or carer showing signs of atypical excitement or passivity? Is the patient or carer showing signs of rapid mood swings? Is the patient or carer showing signs of over sensitivity to suggestions or advice? Are there friends, family or neighbours present that may pose a threat to your safety? Has the patient or carer got a history of carrying a weapon? Additional comments regarding patients, family, carers and neighbours Overall Patient/Family/Friend Profile Green = no known risk factors Yellow = some elements of concern Green Yellow Red Y/N/Unknown Green Yellow Red Red = serious potential risks Pets LONE WORKER GUIDANCE Page 15 of 20
Does the patient have any pets? If yes, indicate type of animal? Is there a need to exercise caution with the pet? Overall Pet Risk Profile Green = no known risk factors Yellow = some elements of concern (e.g. poorly controlled pet) Green Yellow Red Red = serious potential risks (e.g. pet has history of attacking staff) Part 2 HOME VISITING RISK ASSESSMENT Date Completed Completed By Job Title Overall home visit risk rating All Green = Green 1 Yellow = Yellow 1 Red = Red Actions agreed to minimise identified risks Green = no action required Yellow = decide on appropriate actions, as per guidance in the guidance (e.g. buddy system, equipment) Red = decide on appropriate actions, as per guidance in the guidance (e.g. visiting in pairs, make alternative arrangements to provide healthcare, such as in a clinic environment) Client s name: Address: Signature: Date: LONE WORKER GUIDANCE Page 16 of 20
Appendix 4 Haringey CCG Risk Assessment Tool LONE WORKER GUIDANCE Page 17 of 20
LONE WORKER GUIDANCE Page 18 of 20
Appendix 5 Good practice for home visiting It is important to note that statistics show there is a very low incidence of attacks on staff carrying out home visits. Common sense and raised awareness of potentially difficult situations reduce the risk even further. Preparing for a visit Prior to visiting an unknown service user/carer, gather as much information as possible. Likely sources are GPs, social workers, discharge planners, colleagues, carers, the referrer etc. Ensure that you know what the check in system, or other procedures to protect you, is in your team. If there is any doubt or an element of risk surrounding a visit ask someone to accompany you. If this is not possible, cancel your visit and contact your manager. Ensure that there is enough fuel in the car to carry out that journey. When carrying a personal alarm and/or mobile phone regularly check the serviceability of personal alarm. Do not carry excessive amounts of money or valuables, unless essential CCG property. Be discreet when handling money; do not count it whilst walking along the street. During a visit Keep doors locked when driving, especially in towns or when stopping at traffic lights. Park the vehicle, if used, in a safe place under a street light, especially at night. Avoiding parking in a cul-de-sac, but if needs must, ensure vehicle is pointing out of a dead end street. Use the quickest and safest route, not a dark lonely alley. When parking your car, avoid unauthorised parking areas. Do not leave nursing bags, medications, handbags, wallets, service user records, items of equipment etc. on view. Lock them in a boot or glove compartment. You are recommended not to use nurse on-call stickers as this draws attention to the car and a possible opportunistic break in for syringes etc. When visiting high-rise flats be especially mindful of stairways and lifts, especially those that are unlit at night. When arriving at a patients/clients home assess the situation as you approach to determine if anything is unusual or if anything makes you feel uneasy. Do not enter if you have any doubts make an excuse not to go in. If the person answering the door gives you cause for concern, for example they appear drunk, or if the patient is aggressive, or if a potentially aggressive relative is present do not enter. If you are unsure you should withdraw immediately from the area and inform your line manager, document findings in notes and complete an incident report form. Stand well clear of the doorway after ringing or knocking, and stand side on to the doorway to present a smaller target. Show identity badges. Check the identity of the person you are visiting by asking a question which requires them to tell you who they are do not ask are you Mr. Jones?. Check as you go in how the front door locks. Do not allow the patient to lock door with a key. Take only what you need into the house. LONE WORKER GUIDANCE Page 19 of 20
Remain aware of the environment. Look for an escape route in case problems arise. Follow the patient into the house, remaining between them and the door as much as possible. Ask for any animals, i.e. dog, to be put in another room. Remain alert. Watch for changes in mood, movements or expression. If you feel at risk leave immediately Care should be taken when establishing relationships with people as an over familiar or affectionate response might be misinterpreted. If during the course of the visit you begin to feel uneasy or uncomfortable with the situation, withdraw at once with as much tact as possible, report the incident immediately to your line manager and await further advice. At the end of a visit Check in with supervisors, control point or buddy at the end of your journey, especially if going straight home from the last call or making a home visit that is likely to continue after normal hours. Ensure key is in hand before approaching car. Walk around the back of the car to check all sides and park on the correct side. Check back seat of car before getting in. Home visiting in pairs If the risk assessment indicates that visits in pairs is required then in advance of the visit agree a clear plan of action in case an aggressive or violent incident appears likely. You should discuss and agree how you would indicate to each other that you are in danger and need assistance. As with lone visiting do not enter the house if you feel the situation is not safe. A clear exit strategy needs to be agreed. A mobile phone should be available on such occasions. Report any difficulties to your manager. Complete an incident report form as soon as practicable. Under no circumstances compromise your safety. If you feel unsafe at any point remove yourself from the situation. LONE WORKER GUIDANCE Page 20 of 20