LONE WORKER GUIDANCE

Author(s) name job title(s) / Barbara George, HR Business Partner
Approved by / NHS NCL Joint Partnership Group
Approved on / 11.05.2012

This guidance applies to all staff employed by NHS Islington working in the NHS North Central London Cluster which incorporates the Primary Care Trusts (PCTs) known as NHS Barnet, NHS Camden, NHS Enfield, NHS Haringey and NHS Islington.

Contents

Page No.

1. Introduction 3

2. Scope 3

3. Who this guidance applies to3

4. Definitions used in this guidance 3

5. Recommendations for independent contractors3

6. Roles and responsibilities 3

7. Framework for managing lone working 5 - 11

Risk management 5

Identification of Risks5

Assessment of Risks6

Managing Risk6

Review6

Before a lone working situation 6

Buddy System7

Escalation Process8

Technology8

Risk Assessment9

Escorting Patients9

Lone working and vehicles9

In the event of an incident10

8.Training10

9. Monitoring compliance 11

Appendices

Appendix 1 – Checklist for managers12

Appendix 2 – Site based risk assessment checklist14

Appendix 3 – Home visiting risk assessment 15

Appendix 4 – NHS Islington risk assessment tool19

Appendix 5 – Good practice for home visiting 21

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 NHS Islington 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 NHS Islington who may occasionally or regularly work on their own, wherever they are working.

4.Definitions used in this guidance

Lone working:The NHS SMS define 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 NHS Islington.

6.Roles and responsibilities

NHS North Central London

  • NHS NCL has a legal duty to ensure the health, safety and welfare of their employees. NCL is ultimately responsible for ensuring effective implementation of this guidance.

Chief Executive

  • The Chief Executive is ultimately responsible for all aspects of health and safety within NHS NCL London including lone working.

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.

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:
  • Name/address/home phone number
  • Description and photograph of worker
  • Mobile phone and/or pager number
  • Contact details of the next of kin
  • Itinerary of visits
  • Expected time of finish
  • Car registration, colour, make, model
  • 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 Risk Manager 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 local induction of new staff.
  • Ensure staff are aware not to put themselves in danger.
  • Ensure incidents are reported in line with NHS Islington guidance. Including for example to the police. Ensure incidents are investigated and risk assessments are reviewed following incidents.
  • Follow any incidents ensure staff are offered relevant support from managers, occupational 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 NHS Islington 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.
  • Plan visits andensure 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.
  • Travelling between environments/settings.
  • Wearing uniforms.

7.3Assessment 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.

NHS Islington’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.
  • 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 stopsthe 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 overThe lone worker must ensure they keep the buddy updated regarding any delays etc to avoid unnecessary escalation.

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 includes:

  • 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.

Practical use of other devices includes:

  • 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 an 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
  • 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 NHS Islington 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 at Stephenson House. 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 through RIDDOR 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 NHS NCL Governance Team.

8. Training

Training will be delivered to all lone workers in line with the Trust Training Needs Analysis.

Security training, including managing violence and aggression, is part of the NHS Islington 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.

9Monitoring compliance

Monitoring will be via the Governance Team at Stephenson House.

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?