In a recent case, two companies were fined a combined total of more than £400,000 after staff working at a South Wales mental health hospital were subjected to violent attacks by patients.

Over a three-year period between 2014 and 2017, there were incidents of violence and aggression towards both care staff and patients, resulting in serious injuries, including loss of consciousness and permanent scarring. Due to the frequency and severity of incidents, concerns were formally raised by senior management of the hospital in November 2016 to Priory Central Services Limited, which was responsible for the provision of training and equipment and the employment of staff. Priory Central Services Limited failed to take prompt and appropriate action to rectify the deficiencies and incidents were allowed to continue.

An investigation by the Health and Safety Executive (HSE) found there were no suitable and sufficient risk assessments carried out and the equipment and environment was not fit to diffuse violent situations. Staff were not provided with adequate information or training to cope with patients with aggressive traits.

The investigation also found staff were not given the appropriate personal protective equipment, including bite resistant clothing and personal safety alarms.

There were no post incident de-brief sessions carried out with staff involved or even when individuals return from sick leave following an injury. No investigations were carried out of incidents to establish what had happened to identify lessons learnt despite repeated serious and significant injuries being caused.

The companies were fined at a sentencing hearing on 26 July 2023 after entering guilty pleas at an earlier date for failing to manage risks to care staff and patients from violence and aggression.

Parkcare Homes (No.2) Limited pleaded guilty to breaching Sections 2(1) and 3(1) of the Health and Safety at Work etc. Act 1974. Priory Central Services Limited pleaded guilty to breaching Section 3(1) of the Health and Safety at Work etc. Act 1974.

Parkcare Homes (No.2) Limited was fined £363,000 and ordered to pay £43,656 in costs. Priory Central Services Limited was fined £40,000 and ordered to pay £21,828 in costs.

After the hearing HSE Principal Inspector, Anne Marie Orrells, said:

“Priory is a leading independent provider of mental healthcare and adult social care in the UK. It is a long-established company and despite repeated warnings about systemic failures it failed to prevent its staff being injured. Care providers should have adequate arrangements to effectively plan and organise preventative measures to prevent violence towards staff and other patients.”

The case highlights that health and social care employees should not accept incidents of violent or aggressive behaviour as a normal part of the job. They have a right to expect a safe and secure workplace.

Violent and aggressive incidents are the third biggest cause of injuries reported under RIDDOR from the health and social care sector, but the problem is not exclusive to that sector alone.

The HSE defines work-related violence as "any incident in which a person is abused, threatened or assaulted in circumstances relating to their work". This can include verbal abuse or threats, including face to face, online and via telephone and physical attacks.

This might include violence from members of the public, customers, clients, patients, service users and students towards a person at work. But for violence to be work-related, it must be in connection with the work activity. For example, the following situations would not be included in this definition:

• Personal disputes between workers and other people, such as family members.
• Violence between people not at work, such as customers or service users.

For employers, violence can lead to increased staff sickness, poor morale and a damaged reputation, making it difficult to recruit and keep staff. It can also mean extra cost, with higher insurance premiums and compensation payments.

What the law says
Health and safety law applies to risks from work-related violence, just as it does to other risks from work. The main pieces of relevant legislation are provided below.

Health and Safety at Work etc. Act
This Act places a legal duty on employers to ensure, so far as reasonably practicable, the health, safety, and welfare of workers. This includes protecting them from work-related violence.

Management of Health and Safety at Work Regulations
These Regulations require employers to assess the health and safety risks to workers, including the risk of work-related violence.

Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR)
Under these Regulations, employers, certain self-employed people and those in control of work premises must report certain workplace injuries, dangerous occurrences and occupational diseases to HSE.

Identifying the risks
As an employer, you must carry out a risk assessment to identify significant risks to your workers and implement effective control measures. This includes how to prevent and manage violence.

The first step in your risk assessment is to identify the hazards. A hazard is anything that can cause harm to people.

This can include both verbal and online abuse, and physical assault to your workers.

There are number of ways to identify your hazards, but here are some tips:

• Ask your workers about their experiences and what they think – this can be done through supervisors, managers or safety representatives, or through a survey.
• Look around at your workplace, including how people work and their working environment.
• Look back at your incident records on work-related violence.
• There may be a known pattern of violence linked to certain work situations (professional organisations and trade unions may have useful information).

Once you have assessed the risk of violence in your workplace, and where you cannot remove it, you must put the right controls in place to protect your workers.

You should reduce the risks so far as ‘reasonably practicable’. This means balancing the level of risk against the measures needed to control the real risk in terms of money, time or trouble.

The following are examples of controls.

Your workplace
The design of your workplace can increase the risk of violence happening to your workers. Think about:

• Space and layout, for example ensuring good visibility throughout your workplace and providing good lighting to remove blind spots and ensure workers and others can be seen.
• Places where tension could grow, for example implementing a suitable queuing system.
• Security measures, like CCTV, trained security personnel, body-worn cameras, alarm systems, building security – they can act as a deterrent but also provide evidence for the police to convict offenders.
• Carefully worded signage and visual displays as these can remind people to respect each other and not abuse workers.

The work you do
How jobs are designed or carried out may increase the risk of violence to your workers. Here are some examples of control measures:

• Have good communication between you and your workers.
• Work closely with others, like the police, local authorities, local community groups and other organisations in the same sector.
• Raise awareness with the public to target specific forms of violence, for example in the local community or through national campaigns.
• Consider how workers engage with the public and what might trigger people to act aggressively – you could manage expectations with clear information about delays or problems.
• Manage loneworking by making arrangements to keep in touch with people who work away from their base, for example using mobile phones and personal alarms.
• Ensure you have adequate staffing levels to manage violence and respond to incidents.

Training
Training can be used to prevent and manage violence. It can provide workers with appropriate skills to reduce or diffuse potential incidents.

Training should be available to everyone working for you who may be at risk, including cleaners and maintenance workers. This also applies to temporary or agency workers.

However, you must ensure the level of training provided to workers reflects the specific needs of the work activities identified in your risk assessment.

Basic training in the principles of managing violence often includes:

• Identifying underlying and immediate causes.
• Understanding that it should not be accepted as part of the job.
• Recognising warning signs, such as body language.
• Relevant interpersonal skills, such as verbal and non-verbal communication skills.
• Details of working practices and control measures.
• Incident reporting procedures.

You might need to include additional training, such as physical intervention techniques, if there is a serious risk of physical aggression towards your workers.

Training needs should be monitored and reviewed regularly and training courses evaluated for their effectiveness. You should carry out refresher training periodically to ensure workers’ skills are kept up to date.