A pilot scheme intended to reduce assaults on NHS employees by improving accident and emergency waiting areas is a vital first step in making sure staff feel safe and protected at work, says Noel Walsh.

In November the NHS made two important announcements in their fight to tackle violence against staff. Three hospitals in Chesterfield, Southampton and London announced that they are taking part in a new initiative backed by the Design Council to improve A&E waiting areas to help reduce incidents of assault and abuse.

Designers selected by the Design Council have produced low budget panels designed to inform patients about how the A&E departments work; their priorities, systems and anticipated waiting times. The overall cost is expected to be modest at around £60,000 and will go hand in hand with further refurbishments to improve the A&E environment to include changes to lighting and seating.

November also saw the announcement by NHS Protect of an agreement between the Association of Chief Police Officers, Crown Prosecution Service and NHS to promote effective working between the three bodies.

Although the NHS reported a 24 per cent increase in criminal sanctions following cases of assault for 2010-2011, in reality the figures remains small with only 1,397 prosecutions as against in excess of 59,000 reported incidents. The agreement, it is hoped, will deliver a clear message that violence and abuse will not be tolerated.

These initiatives follow a six-year period during which the reported number of assaults on NHS staff has remained static at around 60,000 per annum. Apart from the impact on individual staff and moral within the NHS as a whole, violence eats away valuable NHS resources. The total cost of tackling violence is an estimated £69m per year when taking into account the cost of security, preventative measures and staff absence associated with assaults and abuse.

It has been long recognised in all sectors where violence is a daily risk to staff, that effective measure can reduce the number of incidents. At the heart of good risk management are measures to prevent customers or patients becoming frustrated and agitated. The first step is to identify the problem, where, when and why violence occurs.

The best source of information is to ask staff and ensure that they report all incidents. Next, consider what effective steps can be introduced. Staff should be trained on the correct methods of communication, how to de-escalate a situation should it arise and how to call for help.

Introduce appropriate security, policies and strategies to include zero tolerance and take enforcement action against perpetrators. It is fair to say that the NHS has invested heavily in staff training and anti- violence campaigns however the statistics reveal that further new initiatives are called for.

Design has long been recognised as an important tool for tackling violence. There are perhaps three aspects: making the customer or patient comfortable, keeping them well informed and where necessary, provide protection to staff such as the installation of screens.

The NHS’s initiative to create a more customer friendly design for A&E follows similar initiative in other sectors. In transport for instance, gone are the old fashioned bus stations replaced by clean, comfortable stations, well lit with clear visibility. The emphasis is on informing passengers on when they can expect their train, tram or bus to arrive.

If a delay is likely then provide an explanation even if it amounts to the “wrong type of snow on the track”. Similar approaches have been adopted in job centres which aim to provide a commercial retail environment for customers and staff which are both informative and encourage one to one conversations.

Gone are the harsh lights, uncomfortable seating, long delays, lack of information and protective screens which acted as a barrier to good communication.

NHS statistics reveal that 69 per cent of assaults are often medically related, however even this “hard core” of violence and abuse can be reduced by introducing appropriate measures. Research has shown that design features such as colour can make a difference. A particular shade of pink has been proven to have a moderating effect on feelings of anger and aggression. Is this the end for the NHS blue? Perhaps not, but all aspects of design are to be considered.

It is hoped that with the introduction of the new designs that assaults on staff within the A&E departments can be reduced by 11 per cent. Time will tell but undoubtedly these initiatives are moves in the right direction in the constant challenge to protect NHS staff.