VIOLENCE IN HEALTH AND SOCIAL CARE WEBINAR Andrew Hynes Solicitor 1 Legal and Risk Services Companies House, Cardiff 22 February 2019 1
THE ELEPHANT IN THE ROOM The combination of an ageing population and increased longevity means that the size of the hospital and care population is increasing as is the average age of the patients. Older patients will tend to present more frequently with cognitive impairment in addition to their medical issues. This demographic will lead to increasing incidents of violence and aggression against staff in general medical wards as well as in mental health settings. 2 The management of the impact of this developing reality is a key challenge for all Health Organisations. 2
VIOLENCE AND AGGRESSION CIVIL CLAIMS – TREND ANALYSIS All Wales Sample Health Board 153 150 154 152 140 136 140 145 134 145 125 105 78 21 22 22 21 19 21 22 17 15 11 16 12 13 Apr 12 to Oct 12 to Apr 13 to Oct 13 to Apr 14 to Oct 14 to Apr 15 to Oct 15 to Apr 16 to Oct 16 to Apr 17 to Oct 17 to Apr 18 to Sep 12 Mar 13 Sep 13 Mar 14 Sep 14 Mar 15 Sep 15 Mar 16 Sep 16 Mar 17 Sep 17 Mar 18 Sep 18 The writer has defended the NHS since 1998. V&A Claims have doubled since 2012 They are now more prevalent than patient manual handling claims (36) Claims are the tip of the iceberg 3 Estimate that less than 50% of patient or staff assaults are reported Estimate 5% of incidents end up in criminal or civil courts 3
CAPTURE The Central Importance of the Incident Report Form The Incident Report Form takes the position of a conductor within a symphony. The Incident Report Form is the trigger for all other matters. All objectives very much depend upon whether or not the Incident Report Form is filled in. (See Diagram) They are certainly achieved more easily when one is 4 done.
CAPTURE Central Importance of Incident Form Prevention Emotional Air Goes to Health & Safety Dept. Employee has Statistical analysis communicated and Occupational Health identifies trends been listened to Goes to OH. for effective Risk Management Correlation between system of work and injury? Departmental Manager can assist to identify Estates trends. Make a case for Department extra resources Environment INCIDENT repairs FORM Human Resources & Payroll Corroborates incident for benefits purposes – Sick Pay Procureme nt Department Defective equipment Proper Investigations Key prompts Medical Support What happened? Litigation Dept Prompts referral to A & E Proper Investigation or other medical treatment provides vital prompted witnesses rehab evidence RIDDOR report to HSE 5
CASE STUDY Actual case study of Appeal in Violence and Aggression Case Before His Honour Judge Bidder QC “JUDGEMENT” 6
RISK INTEGRATION In relation to prosecution and civil cases Investigation Topic – Civil case Key Investigation subject areas uncover the root Employer v Employee of the problem Negligence/ Breach of Statutory Duty Facts Corroborated Generic Risk Assessment Unescorted leave – decision reached by MDT Specific Risk Assessment Final decision on unescorted leave Environmental Risk Assessment Imports control measures met as CCTV at entrance Placement of Patient Voluntary patient with ongoing requirement for treatment Training of all staff Not pleaded as a breach of duty - Staff male /female ratio considered Contributory Negligence Claimant’s conduct not criticised – needs to be more than inadvertence Equipment Provided Breathalyser not relevant to violent reaction Vicarious Liability Not a factual finding that staff assisting didn't follow training Hidden organisation costs are huge The issues are equivalent or overlap -Management Time -Divisive nature of proceedings -Loss of new staff PREVENTION is more likely if duty of care is met -Disintegration of teams -Morale DEFENCE is more likely if duty of care is met -Falling standards of care 7 7
RISK INTEGRATION In relation to prosecution and civil cases Criminal Case against Investigation Topic – Criminal Case against Health Key Investigation subject areas Perpetrator/Patient for Organisation Corporate uncover the root of the problem assault Manslaughter Fines under H&S Offences Act Facts Generic Risk Assessment Specific Risk Assessment Environmental Risk Assessment Placement of Patient Training of all staff Contributory Negligence Equipment Provided Vicarious Liability Hidden organisation costs are huge The issues are equivalent or overlap -Management Time -Divisive nature of proceedings PREVENTION is more likely if duty of care is met -Loss of new staff -Disintegration of teams DEFENCE is more likely if duty of care is met -Morale 8 8 -Falling standards of care
How to Manage Unintentional Violence in Healthcare 9
Scan QR code using mobile device to take you to the webpage 10
Full agreement is available at http://www.nwssp.wales.nhs.uk/nhs-wales-anti-violence-collaborative 11
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