News

CP safety: expect the unexpected

21 May 2021

Women’s safety has moved into the spotlight recently, and community practitioners – many of whom are female – face particular risks at work. Journalist Radhika Holmström asks how you can stay safe on the job.

The idea of ‘safety at work’ for many employees is often applied to any equipment used and the avoidance of hazards. However, for many women working as community practitioners (CPs), there are other ways to read the phrase. CPs work in community locations, in people’s homes, in places that may be out of the way or badly lit, and with clients and patients who may be hostile. All this adds up to a potentially dangerous situation. And over the past couple of months, the whole issue of women’s safety – on the streets, at home and at work – has come into sharp public focus following the tragic and shocking death of Sarah Everard, who was abducted in March while walking home in London.

Victims of gender

Most of the statistical attention on female safety surrounds what is classified as ‘sexual assault’, while also acknowledging that a huge proportion of sexual assaults go unreported. Figures from the Office for National Statistics (ONS) suggest that men are more likely than women to be the victims of violent crime, except in cases of domestic abuse (ONS, 2020). However, the evidence from women about their experiences demonstrates just why so many women feel unsafe in public. A recent UK-wide survey on sexual harassment found that more than 70% of women in the UK say they have experienced sexual harassment in public (UN Women UK, 2021).

Successive studies bear this picture out. A significant proportion of these assaults take place in public spaces, including on public transport (Mayor of London Office for Policing and Crime [MOPAC] and NHS England, 2016). Younger women, and black and Asian women, are also more likely to be subjected to assaults (MOPAC, 2019).

A vast proportion of these crimes are not reported; they’re accepted as part of daily life. One problem is that organisations define sexual harassment in different ways, so that women often feel that, however uncomfortable or dangerous their experiences, an incident may not count as a crime. The UN Women UK report defines sexual harassment as ‘the continuum of violent practices against women and girls’; and, importantly, this is a wide continuum (see What constitutes sexual harassment?, right).

Risk to healthcare professionals

Healthcare professionals face particular risks – and over the past year the risks have increased. The latest NHS Staff Survey for England shows that 14.5% of staff had experienced at least one incident of physical violence in the past 12 months (NHS and Survey Coordination Centre, 2021). Similar staff surveys in recent years show that 11% had experienced physical violence at work in Wales (GIG Cymru and NHS Wales, 2018), 8% in Scotland – rising to 20% of nursing staff (Scottish Government, 2015) and 14% – rising to 26% of nursing staff – in Northern Ireland (Quality Health Ltd, 2016). Once again, black and Asian staff were more likely to experience such incidents.

No figures were readily available for assaults on CPs specifically, but nurses working in the community face unique problems. Not only are they regularly travelling to and from work, but they are working in different places, with potentially difficult or hostile clients, and they are often working alone. ‘Even if CPs aren’t doing a physical risk assessment, they’re constantly risk-assessing what they encounter,’ says John McLaren, a former practising health visitor and now the employee director (a union role) at NHS Borders and a senior rep for Unite-CPHVA.

‘Most will have at the forefront [of their minds] not their own safety but the safety of those around them. If you think there’s a risk to a child or woman in that environment, it’s going to be further complicated.’ He adds that recent concerns about Covid-19 and PPE have increased the tensions involved.


What constitutes sexual harassment?

  • Being cat-called or wolf-whistled
  • Being stared at
  • Unwelcome touching, body rubbing, or groping
  • In-person comments or jokes
  • Unwelcome sexual advances or requests for sexual favours
  • Being physically followed
  • Indecent exposure
  • Online comments or jokes
  • Sharing of suggestive or indecent content online or in person
  • Being forced into participating in sexual behaviour
  • Having images taken and/or shared without your consent.

UN Women UK, 2021


The law and policies

There is some legislation around violence and assault that specifically protects health workers. In Scotland, the Emergency Workers (Scotland) Act 2005 includes ‘registered medical practitioners’ and ‘registered nurses’ in the categories of people who can invoke this legislation if they are assaulted in the course of their work. In England and Wales, the Assaults on Emergency Workers (Offences) Act 2018 – which is now being extended with longer penalties – covers anyone providing or supporting NHS services. The Northern Ireland Assembly is also considering similar legislation.

The health and safety executive in all four nations has also produced policies to protect the safety of lone workers (in all sectors), with additional policy work aimed at protecting health workers. NHS England published its violence prevention and reduction standard at the beginning of this year, stating that organisations and commissioners should review their work against this twice a year (NHS England, 2021). Some guidance also singles out lone workers: NHS Employers published Improving safety for lone workers: a guide for managers (NHS Employers, 2013) and Improving safety for lone workers: a guide for staff who work alone (NHS Employers, 2018), NHS Wales published its lone worker procedure (GIG Cymru and Public Health Wales, 2018), while NHS Scotland’s health and safety guidelines has a section on lone workers (Scottish Government, 2003).

So overall, there is an overlapping set of documents and policies in this area that give overall guidance, some of it mandatory. Many trusts have also produced their own policies to support lone workers. NHS Glasgow and Clyde, for example, has produced comprehensive guidance, issued staff with electronic alarms, and has risk-assessment policies.

Jacalyn Williams, Unite’s national officer for health, says: ‘Clearly, employers have a duty to carry out risk assessments, address women’s health and safety concerns, and then decide first how the risk can be eliminated, and, if that isn’t possible, minimised or controlled. They should develop an action plan to deal with the risks women face at work, setting out what will be done to keep women safer and healthier, and this should be communicated to women workers so that they know the risks faced, and the steps that will be taken to deal with them.’

Women workers themselves have a part to play in this process, she adds. ‘As part of this, it’s vitally important that they are communicating with the safety representatives and the workplace representatives, because they will know what the specific issues are that this workforce is facing.’

Personal protection

However, in practice, many female CPs and other women do continue to feel unsafe during the course of their work or other daily activities. And some of the standard advice, such as using well-lit routes, may simply not be practicable. Violet Alvarez, senior policy and campaigns officer at the Suzy Lamplugh Trust, suggests using a personal alarm (many health organisations already issue these), and planning some strategies for a quick getaway if necessary. ‘For example, you could say “I’m sorry, I’ve left some paperwork I need in the car”. This could give you time to de-stress before returning, or could allow you to phone from the safety of your car, saying you have been called back to the office and will rearrange the appointment.’

Violet also recommends not going in at all if something seems a bit ‘off’. ‘Conduct your own “dynamic risk assessment” before you enter,’ she says. ‘If the person you expected to meet isn’t there, don’t go in – say you’ll return later or rearrange the appointment. And if you do go in and feel at all uncomfortable, make an excuse and leave. Trust your instincts. If something doesn’t feel right, or you feel unsafe in any way, act on it. It’s better to be over-cautious than under-cautious.’

John says: ‘We [at NHS Borders] do have personal safety training as part of our work, around violence and aggression, so all CPs should be able to at least de-escalate things that are getting difficult – sometimes the safest thing is to withdraw and seek help.

‘We encourage people to think first and foremost about their own safety, and then support them with what they need to do to make it safe for those around them.’ He says safety is on the agenda in a way that it may not have been in the past. ‘We’ve got more risk assessments and more tools to use as practitioners to stay safe and to keep our clients safe.’

To conclude, Janet Taylor, chair of the CPHVA Executive, provides some advice for CPs: ‘Never put yourself in danger; do a risk assessment, and maintain safety at all costs. If you feel you’re threatened or feel at risk, or that this is a house where someone may make you feel at risk, go back and discuss it with your manager. Put safety mechanisms in place. Of course, you can’t rule out the unexpected, but remove yourself and seek help. No member of staff should be in that situation. Never put yourself in danger: not ever.’


Risk factors for lone workers

  • Abnormal and hazardous conditions, such as an isolated work place, poor lighting and so on.
  • Risk to lone worker with medication on their person, particularly controlled drugs.
  • Staff delivering unwelcome information or bad news.
  • Increased risk of violence from service users/clients/patients due to alcohol or drug abuse, drug misuse or non-compliance in relation to their clinical condition or response to treatment, and the risk of violence from their carers, relatives or visitors.
  • Lone worker wearing uniforms, travelling between certain environments or settings and visiting the same destination over a number of occasions especially at the same time.
  • Lone workers carrying equipment that makes them a target for theft or makes them less able to protect themselves.
  • Evaluation of capability to undertake lone working – for example, being inexperienced, pregnant or having a disability.

GIG Cymru and Public Health Wales, 2018


Resources


References

GIG Cymru/NHS Wales. (2018) NHS Wales Staff Survey 2018. See: wales.nhs.uk/sitesplus/documents/866/4.3b%20National%20Staff%20Survey%20Report.pdf (accessed 20 April 2021).   

GIG Cymru and Public Health Wales. (2018) Lone worker procedure. See: phw.nhs.wales/about-us/policies-and-procedures/policies-and-procedures-documents/risk-management-health-and-safety-and-estates-policies/lone-worker-procedure/ (accessed 20 April 2021). 

Mayor of London Office for Policing and Crime. (2019) Violence against women and girls (VAWG). See: https://www.london.gov.uk/sites/default/files/annex_1_-_evidence_pack.pdf (accessed 20 April 2021).  

Mayor of London Office for Policing and Crime and NHS England. (2016) Sexual Violence: the London sexual violence needs assessment 2016. See: https://www.london.gov.uk/sites/default/files/sexual_violence_needs_assessment_report_2016.pdf (accessed 20 April 2021).   

NHS, Survey Coordination Centre. (2021) NHS Staff Survey 2020: national results briefing. See: nhsstaffsurveys.com/Caches/Files/ST20%20national%20briefing%20doc.pdf (accessed 20 April 2021).   

NHS Employers. (2013) Improving safety for lone workers: a guide for managers. See: nhsemployers.org/~/media/Employers/Documents/Retain%20and%20improve/Managers%20guide_Le0882_3.pdf (accessed 20 April 2021).  

NHS Employers. (2018) Improving safety for lone workers a guide for staff who work alone. See: nhsemployers.org/case-studies-and-resources/2018/03/improving-safety-for-lone-workers-a-guide-for-staff-who-work-alone (accessed 20 April 2021).  

NHS England. (2021) Violence prevention and reduction standard. See: england.nhs.uk/publication/violence-prevention-and-reduction-standard/ (accessed 20 April 2021).  

Office for National Statistics. (2021) The nature of violent crime in England and Wales. See: ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/articles/thenatureofviolentcrimeinenglandandwales/yearendingmarch2020#groups-of-people-most-likely-to-be-victims-of-violent-crime (accessed 20 April 2021).   

Quality Health Ltd. (2016) 2015 HSCNI Staff Survey. See: health-ni.gov.uk/sites/default/files/publications/health/staff-survey-regional-report.pdf (accessed 20 April 2021). 

Scottish Government. (2015) NHS Scotland Staff Survey 2015 National Report. See: gov.scot/publications/nhsscotland-staff-survey-2015-national-report/ (accessed 20 April 2021). 

UN Women UK. (2021) Prevalence and reporting of sexual harassment in UK public spaces. See: unwomenuk.org/site/wp-content/uploads/2021/03/APPG-UN-Women_Sexual-Harassment-Report_2021.pdf (accessed 20 April 2021).   

Image Credit | Shutterstock

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