Some trust managers still do not believe that they can reduce the risk of workplace violence, according to the latest report from the Health and Safety Executive.
All 42 trusts visited as part of the HSE's management inspections programme for 1998-99 were aware of violence as a significant issue, but inspectors found wide variation in how it was tackled and the effectiveness of control measures. Despite guidance on violence from the Health and Safety Advisory Committee and the NHS Executive, 'some managers do not seem to accept that the risk could be managed'.
Chris Taylor, head of the HSE's health services unit, said trusts that attempted to tackle violence, often didn't go far enough. 'They accept that violence is a problem and they will try to do something - like provide one training course - but trusts need to adopt a more comprehensive strategy.'
Without a more structured and coordinated approach, trusts will be unable to meet NHS Executive targets for reductions in violence, the report warns.
It concludes that trusts' progress on health and safety is too slow. Mr Taylor said boards need to say: 'Where are we now and where should we be?'
The NHS Executive launched a new programme of controls assurance last month with 18 standards. One covers generic risk management. The rest cover specific areas, such as infection control, health and safety, fire safety, transport or record management.
Stuart Emslie, head of the NHS Executive's controls assurance team, has been touring conferences assuring managers that the standards, which pull together 120 statutes and 300 pieces of guidance and documents, should provide a handy check-list for boards.
Trusts will have to assess themselves against the standards by next March and then produce statements on how they will implement the requirements by July.
But Mr Emslie and NHS finance director Colin Reeves have insisted that the initial assurance - to be signed and included in annual reports from next year - should present chief executives with few problems.
Mr Taylor said trusts that had been following its guidance should be well on the way to achieving the standards already.
But he added: 'Controls assurance should drive standards up, but the danger is that trusts will have so much to do that they will focus on clinical governance and not worry about health and safety.
'A number of trust managers have pointed out to us that they are overwhelmed by initiatives.'
For the first time since the inspections programme began three years ago, the HSE has summarised its findings in a letter which is being sent to trust chief executives throughout the UK.
It highlights 'serious concern' about trusts' continuing failure to protect patients from scalding, and 'disappointment' that glutaraldehyde (a disinfectant which causes asthma in staff ) has not been replaced by a safer alternative.
Between April 1998 and March 1999, eight trusts were prosecuted, seven as a result of accidents to either staff or patients.