A recent study involving nearly 500 nurses and social care workers makes for worrying reading - 46% of those surveyed had faced both physical and verbal abuse while at work. This is an unacceptable lived experience for any workforce, let alone one still recovering from the fear and uncertainty of the pandemic and stretched to capacity.

As more people leave the sector and search for better work environments, we look at what employers can do to reduce the risk of harm. 

There are essentially two ways for care providers to address this issue through their policies/procedures and documentation and then following through to make sure these are reflected in their culture.

What policies/documentation/procedures should you have in place?
HR policies (Dignity at work/Anti-bullying, etc.) often address how staff must behave towards one another or towards customers. But it is critical that they, or other specific policies, outline the behaviours that staff can expect from service users, their families, or other supporters. If behaviours dip below those outlined in the policy, then it must be clear how staff can raise this and how their employer will respond to address the situation. 

Currently, there is nothing under the Equality Act 2010 to automatically protect workers from any third-party harassment (arising from a protected characteristic) so these policies are key to making sure the right behaviours are communicated and individuals are held accountable.   

• Contractual provision 

Your contracts are a record of the legal relationship between you and your customers, but they also set the tone for how you will engage with one another, what your customers can expect from your workers and how your customers are to conduct themselves. Whilst abuse is largely a relational issue, it is important to have the right contractual tools available to you in the event you need to step back, re-organise or potentially terminate that relationship. Your terms and conditions should ideally reflect the staggered process you will follow whilst recognising the severity of the issue. The documents should make it clear which behaviours fall outside the ‘acceptable norm’ and will result in remedial action by you.

• Risk assessments 

Where there is any risk of violence and aggression, whether that be from clients or their families, risk assessments are key to minimising (and ideally eliminating) the risk of harm. It may be appropriate to have both general and individual risk assessments. The latter is specific to the client and should address their mental, emotional, and physical condition and how their condition may manifest itself. 

The risk assessment is insufficient without control measures. What are the practical steps that can be taken to reduce the risk? That may be ensuring training or changing the working environment to create an open and light environment. For key information on this, do see further information from the HSE.

• Record keeping 

Record keeping is an essential piece of the puzzle. Last month, the Local Government and Social Care Ombudsman issued guidance for care providers on good record keeping. The ombudsman’s guide is in response to them identifying that lack of efficient record keeping was often a factor in things going wrong. It can, as they pointed out, have serious consequences for service users. 

That’s not the whole picture - good record-keeping can also help protect staff. If accurate incident reports are logged promptly by staff, the issues can be addressed early and with all the necessary information. This can then help iron out issues and highlight weaknesses in the care provision so protecting staff from more serious incidents or complaints, and even abuse, that may occur if a problem is swept under the carpet and/or left unresolved. They should also be regularly reviewed alongside the risk assessment to ensure these remain fit for purpose and you can build on lessons learned.

• Complaints policy

An effective complaints policy for both clients and staff is key. The policy should be accessible and not hidden. Whilst providers would not want to 'invite' complaints, addressing issues early and efficiently through a complaints procedure can avoid unnecessary escalations and outbursts arising from frustrations at issues not being addressed.

What’s so key about culture?
Policies, documentation, and procedures, however, are of little use if they are not supported by a culture which protects its staff, does not tolerate any abuse in the workplace and provides an environment where staff feel able to speak out and speak up. 

Creating this culture may look like a number of things - having a specific member of staff who deals with complaints and is available and willing to address them; offering a counselling service or support to staff who have been affected by more serious cases of abuse; assuring staff that all incidents will be addressed in a timely measured way and knee jerk, blaming reactions will be avoided. This culture will be strengthened every time a member of staff feels heard and feels action will be taken where necessary for their wellbeing and safety.    

It may seem an extra pressure and resource to provide when margins are thin, and resources stretched. However, the alternative could be more staff leaving as they get to a place where their treatment becomes unbearable. 

Please do contact Matt Wort or Emma Watt if you would like further information on these issues.