Trauma 2003 - Violence to Public Service Workers report

Contents

1.0 Executive Summary *
2.0 Introduction *
3.0 Campaign Objectives *
4.0 Research Partners *
THE RESEARCH *
5.0 Definitions, Scope and Methods *
6.0 The Legal Context *
7.0 Survey Results *
8.0 Managerial responses *
9.0 Additional Information *
10.0 Conclusions & Recommendations *

1.0 Executive Summary

In October 2002 UNISON adopted a six-point action plan for Zero Tolerance of Violence in the NHS. The aim now is to extend these principals throughout Scottish public services.

Almost exactly half of the survey respondents indicated that they went to work in fear of some form of violent incident.

According to this survey men are more worried about violence than women. This is despite the fact that sexual harassment and related assaults are a major element within those incidents that take place.

Questionnaire respondents reported 238 specific violent incidents which led to injuries. Of these, 34 were described as assaults leading to major injuries requiring medical assistance over and above first aid.

If threats and verbal abuse are included, then at least half of the sample had personally experienced some form of attack in the previous 12 months.

When applied to the overall UNISON membership in Scotland, this questionnaire suggests that something in the region of 50-70,000 UNISON members in the Scottish public services were victims of a verbal abuse or physical attack at work in the last year.

On a national level, if the UNISON membership is typical of public sector workers generally then, with over 400,000 employees in health, education and social work in Scotland, the frequency of verbal abuse and physical attacks must be in excess of 100,000 per year.

Thirty four people indicated that they had received a major injury in the last twelve months. Four of this group reported two major injuries.

Just under one 10% said they had received a minor injury in the last year. The total number of recorded injuries was 242.

Nearly two thirds of those experiencing minor injuries (64%) said they received no assistance from their employer in the aftermath of the assault.

Eighty-three people said they had been threatened with a weapon. Of those, around half reported multiple incidents including two people who said they had lost count of the number of such incidents.

The total number of cases where use of some form of weapon was threatened was 135. The weapons referred to included: stones, bricks, planks of wood, hot drinks, chairs, walking frames, knives, snooker cues, hammers, bottles, cigarettes and airguns.

At 49.5%, threats or verbal abuse is the type of incident that is most prevalent in Scotland with almost half of the survey experiencing such incidents at some time in the last year.

Excluding those people who said verbal abuse was simply a daily event, the aggregate number of incidents where staff received threats or verbal abuse was 2018.

Twenty six UNISON members reported racial harassment by members of the public, each person reporting at least one incident. Four people reported multiple incidents and the aggregate number of incidents reported by this group was 48.

Fifty seven people (5%) said they had been sexually harassed by members of the public. But this level of reporting doubles to over 12% if we look at the level of sexual harassment among women.

Of those who said they were sexually harassed, nearly three-quarters said they received no assistance from their employers after the incident.

Most worryingly, in the course of the research, UNISON became aware of several serious sexual assaults. We intend to draw this matter to the attention of the Scottish Executive in the hope that an effective response can be encouraged.

Twenty-four people (2%) reported sectarian harassment. Of the 24 respondents, four said such incidents were too common to identify separately.

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2.0 Introduction

UNISON members deliver essential public services 365 days of every year. Across Scotland UNISON members save lives, build communities, support families, protect vulnerable people, care for children and much more. But increasingly this essential work is being done in the face of a threat — the threat of violent attacks.

UNISON takes the view that this type of behaviour is unacceptable in any context, but it is particularly unacceptable that valued public services workers should have to face this threat in the course of their employment. For this reason UNISON's health and safety committee is running its high profile campaign for Zero Tolerance — zero tolerance of violence at work.

UNISON activists are worried that growing levels of violence indicate that, in some quarters, violence against people in the public service has come to be viewed as an unavoidable part of the job. The Zero Tolerance Campaign rejects that view.

Through this research, and the work of the campaign, UNISON aims to expose the scale of the problem our members face, give a voice to those who tolerate unrecorded violence, and build a campaign through which UNISON members receive the support and protection they deserve. No one should be asked to work for less.

In launching the initial findings of this research UNISON is extremely grateful to Guardian Angels. The existence of this company and the service it provides only serves to highlight the fact that there are innovative ways to tackle violence, reduce harm and give comfort and security to people working with the fear of violence.

We look forward to building this campaign with the help of our sponsors and using this research to plot the reduction in incidents of violence as the Zero Tolerance message takes hold across Scottish Public Services.

Millie Somerville
Chair, Scottish Health & Safety Committee

Jim Devine
Scottish Organiser

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3.0 Campaign Objectives

The role of this research is to expose the problem as it is today, and to set up a process by which UNISON can use future research to track progress towards the aim of Zero Tolerance.

In October 2002 UNISON adopted a six-point action plan for the NHS. The aim now is to extend these principals through Scottish public services. The six-point plan is as follows:

Employers and trade unions should adopt a joint Staff Charter, reminding the public that it is not part of a public service worker's job to be physically or verbally abused at work.

There should be nation-wide adherence to standard definitions, recording and follow up of violent and potentially violent incidents, including verbal abuse, for all public service workers.

Widespread use of agreed best practice in training courses on the management of violent or potentially violent incidents.

The introduction of a 'yellow and red card' warning system for members of the public who constantly abuse staff. These warnings could lead to the banning of individuals from premises if they persistently physically or verbally abuse staff.

Clients, patients, tenants and relatives who physically abuse staff must be automatically charged and prosecuted by the Procurator Fiscal.

Every public service worker in Scotland must recognise that, in addition to employer duties, every staff member has a duty to ensure their own safety and the safety of their colleagues, to use the reporting system for every incident, and accept that a culture of zero tolerance is essential.

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4.0 Research Partners

Health and safety is a top priority for UNISON. Last year more than one million injuries and 258 deaths were reported in the workplace. 24.3million working days were lost and over 27,000 people were forced to give up work due to injury. Since 1999 UNISON has won over £40 million in compensation for members involved in work-related personal injury cases.

In a recent survey most UNISON members identified health and safety as the most important workplace issue for them. So, as the largest public service union UNISON is at the forefront of campaigns on issues such as stress at work and violence in the workplace.

In Scotland, UNISON's Health & Safety work is organised through a lay elected Scottish Committee, a Senior Regional Officer, UK headquarters staff and a network of branch Health & Safety Reps.

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Guardian Angel

Guardian Angel is the market leading mobile phone based personal security service. Available across all of the United Kingdom and the Republic of Ireland, Guardian Angel already provides peace of mind to over ten thousand users in professions ranging from community nursing and social care to Domestic services and Government departments.

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Research Consultants

The survey and data analysis was conducted by Rachel Harris and Kushtrim Ibrani. The research partners would like to acknowledge their contribution and thank them for their enthusiastic work.

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THE RESEARCH

5.0 Definitions, Scope and Methods

The campaign aims to promote zero tolerance of all violence against staff. This is based on a definition of violence that includes threats, verbal abuse and harassment as well as actual attacks and injury tostaff by clients and members of the public.

This report is based on two primary sources. First a short questionnaire was distributed to all branches in UNISON Scotland. This distribution covered branches in the following sectors: health, local government, public utilities, the community and voluntary sector, higher and further education and other miscellaneous branches.

In the twelve-section questionnaire UNISON members were asked 27 questions regarding their experience or perception of violence at work. In addition to numeric answers indicating the frequency of different incidents, members were asked a series of yes or no questions in relation to their work situation. These answers are used to provide the statistical data used in this report.

Finally in the questionnaire, members of the union were given the opportunity to expand in more detail on issues relating to violence at work. This qualitative data was then supplemented by information received through a series of short semi-structured interviews.

These qualitative responses have been used to inform the interpretation placed on the statistics and exerts from the interviews have been dispersed through the body of the report to illustrate the views and perceptions of those who supported the research.

Obviously UNISON would like to re-state its thanks to those members who took part in the research, many of whom had to re-visit painful memories of specific incidents in order to participate in the project.

The profile of participants is set out at figure 1 (below). While the dominance of health and local government does reflect the composition of the union's membership, there are some notable deviations. First, the returns from health exceed those from local government despite the fact that local government is the larger membership area. Second, there is a disproportionate response from individual subgroups such as A&E staff.

What this underlines is that, although large, the survey sample is a sub sample of the overall UNISON membership and is not necessarily a direct reflection of the experience of the membership as a whole.

The key point here is that the participants are self-selecting and therefore those who encounter violence are probably more likely to participate in the process than those who have no comment to make.

The result is that, although there is a considerable volume of data, there would probably be a slight tendency towards over-reporting if this data was extrapolated to cover the whole population of UNISON members.

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6.0 The Legal Context

Criminal law and workplace violence

All the elements of UNISON's definition of violence are covered by the criminal law. In addition to assaults and aggravated assaults, the use of threats and verbal abuse would also constitute a criminal offence in most cases.

The enforcement of the criminal law is a matter between the state and the alleged perpetrator. However, it is important that employers recognise the importance of reporting incidents to the police.

In an employment context, employers have a duty to take such steps as are reasonably practicable in order to protect the health and safety of employees. Where a failure to involve the police contributes to an injury sustained by a member of staff then it is possible that the employer may be viewed as negligently contributing to the increased risk of injury.

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Self defence in the face of violent attack

Where an employee is involved in a violent incident there is a risk that they become the focus of police attention if their assailant sustains an injury.

However, staff can use reasonable force to protect themselves or other people where they have a reasonable belief that an assault is about to take place.

The Protection Against Harassment Act

Every employee has a right to be free from harassment. The law states that a person must not pursue a course of conduct which amounts to harassment of another. Even if the perpetrator does not intend to harass an employee, it is deemed to be unlawful if a reasonable person would view the behaviour as harassment.

Risk assessments & safety management

Under European law there are various steps that employers must take to manage the threat of violence. Central to these is the risk assessment which is designed to identify the circumstances when violence may occur. Employers then have a legal duty to take steps to address the threat identified in the risk assessment.

The scope for personal injury claims

Employers are liable for damages when they are negligent in failing to take reasonable steps to prevent injury at work. Even though some violence is unpredictable, employers are obliged to take steps to reduce the risk of attack, and to reduce the harm that occurs when attacks take place.

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The employees' right to stop working

Where an employee perceives an immediate risk to their health or safety they have the right to stop working in order to remove themselves from the risk of injury.

Any worker who has a reasonable belief that they are in imminent danger of attack should take the necessary steps to make themselves safe. This is a clear legal right.

Asserting safety rights

Many employees are worried that they will be disciplined or dismissed if they stop working without permission or assert their safety rights in some other way.

However, it is unlawful to dismiss a worker, or to subject them to any other detriment, where the reason for that action is the fact that the employee asserted their safety rights.

Race Relations Amendment Act

All the main public service employers now have a duty to eliminate discrimination and promote race equality. Under the new law there are a series of general and specific duties which employers must follow. Any failure to record, monitor and actively address instances of racial harassment and violence against staff would be a in breach of these duties.

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Legal Summary

This legal overview provides a useful reference point for the following analysis of the problem public service workers face. It is clear that employees have a variety of rights that are designed to protect them from violence at work. UNISON's quest for zero tolerance clearly has a strong legal foundation, the question is whether current practice meets this required standard of care.

7.0 Survey Results

Profile of Participants

The questionnaires were circulated through UNISON branches. 1212 people returned information to UNISON. It is safe to assume therefore that the overwhelming majority of participants are UNISON members employed in the Scottish Public Services.

However, some of the questionnaires do give additional information on the profile of the sample population. In a small but noticeable number of cases the respondents indicate that while not UNISON members, they felt strongly about the issue and wanted to submit their evidence for consideration.

Given that the intention behind the report is to improve the safety and well being of all public service employees including UNISON members, there was no reason to exclude non-UNISON members from the project.

Figure 1 below sets out the sectors from which responses were returned.

Figure 1: Questionnaire Responses by Industrial Sector

There are two particularly significant features in the data on returns by industrial sector. First, the proportion of returns from health service members is disproportionately large when compared with health service members as a proportion of UNISON members overall.

If we assume that health service members are not more efficient at the completion and return of forms, the data appears to suggest that they are more highly motivated when given the chance to comment on the threat of violence at work. As with all such studies it is dangerous to make firm conclusions without further research but it would appear that violence at work is a source of greater concern in the health sector than other areas of the union.

This possible finding is supported by the second feature of the industry data. That is the significant over-representation of accident and emergency staff in the sample. It is safe to assume that staff in A&E are regularly exposed to violence at work and this number of responses supports the hypothesis that high levels of return from any sector indicate that these are hot spots where fear of violence is heightened.

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Fear of violence

Before going on to ask about the detail of actual incidents, UNISON asked its members whether they worried about violence at work. Almost exactly half of the 1200 respondents indicated that they went to work in fear of some form of violent incident.

The basis of that fear is something we will go on to examine below, but some important questions arise at this stage?

• What is causing this widespread fear?
• Is fear of attack based on a history and culture of violence or is it an unsubstantiated state of mind that has taken root in the public services?
• Even if there are a limited number of previous incidents, is the lack of protection and effective policy leaving people exposed in a way that leaves them worried and anxious?
• Who holds this fear? Are they men or women? Where do they work? Have they been attacked before?
• The ultimate question for this report is: "What can be done to reduce attacks and the fear of attack?"

Fear of violence was particularly high in the following areas: accident & emergency (86%), council housing (73%), and primary & secondary education (75%). This is particularly significant. It would be a remarkable survey that found that A&E staffs were anything other than worried about violence. However, it is perhaps surprising that education and housing staff also dominate the list of those staff who work in fear of attack.

Reports from the teaching unions indicate that violence by pupils against teachers is a growing problem. This survey suggests that support staff in education also have a growing fear of violence.

The breakdown by gender is particularly significant. According to this survey men are more worried about violence than women. This is despite that fact that sexual harassment and related assaults are a major element within those incidents that take place.

Of those men who commented on fear of violence, 64% said they were worried about attacks at work. The equivalent figure for women was 56%.

Various factors may explain this. For example men may be employed in posts that are exposed to greater risk. Service users may be more likely to attack men rather than women, or men may be less skilled at defusing violent situations. But all of this requires further research.

Perhaps logically the fear of assault was most closely connected to recent experience of violence. Of those who had recently received a minor injury, fear of violence was 83%. The very real nature of the risk employees face is reinforced by the fact that training and awareness of safety measures has little impact on fear of violence among those who have previously been attacked.

In the final analysis, worry about violence is one step removed from the focus of this report. One might assume that if actual incidents are reduced then levels of anxiety might reduce in a corresponding fashion.

However, there will be some workplaces such as an A&E where a degree of violence may be endemic. Some people might argue that in such cases a residual fear of unpredictable violence may be a necessary element of self defence. However, UNISON submits that this is dangerously close to a culture where managers abdicate responsibility for managing risks and hazards while violence and fear become an accepted part of the job.

UNISON calls for further work on the extent and nature of fear among certain key occupational groups.

The aim should be a culture where fear is replaced by an informed awareness among staff of the risks they face at work.

This should be complimented by more consistent adherence to effective systems within which the risk of violence is managed in a context where awareness of risks and knowledge of appropriate systems are deployed in order to avert incidents and reduce harm.

This study should seek to assess the extent to which staff in hazardous occupations are working with a controlled awareness of risk in an environment where risk is managed.

This is the method by which fear of attack should be reduced.

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Frequency of attacks

Questionnaire respondents reported 242 specific violent incidents at work over the last year. Of these, 34 were described as assaults leading to major injuries requiring medical assistance over and above first aid. This excludes countless number of instances of threatening or abusive language.

If threats and verbal abuse are included, then at least half of the sample had personally experienced some form of attack in the previous 12 months.

In the section on survey methods we pointed out that the self-selection of survey participants does suggest that those with a view on violence at work are more likely to participate in the research and this creates a slight tendency towards over reporting.

However, bearing that caveat in mind, when applied to the overall UNISON membership in Scotland, this questionnaire suggests that something in the region of 50-60,000 UNISON members in the Scottish public services were victims of a verbal or physical attack at work in the last year. Attacks that left the majority of UNISON members worried about the prospects of a violent attack at work.

On a national level, if the UNISON membership is typical of public sector workers generally then, with over 400,000 employees in health, education and social work in Scotland the frequency of verbal and physical attacks must be well in excess of 100,000.

Perhaps the most worrying feature of the study was the way many members failed to record the number of incidents they had experienced. In doing so many adapted the questionnaire and wrote in phrases such as "daily event" "too many to recall" in the box where they were asked to provide the number of incidents.

It is clear that for many staff in Scottish Public services, threats, abuse, assault and the fear of such incidents have become a permanent and regular feature of their working lives.

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Nature of attacks

Incidents resulting in major injuries

For the purposes of this survey, a major injury was defined as requiring medical assistance. Thirty people indicated that they had received a major injury in the last twelve months, four of whom had been attacked and injured twice. The aggregate number of serious injuries was therefore 34.

The evidence suggests that most of those with serious injuries were women.

Of those who received major injuries, the majority were aware of existing measures intended to address violence. Similarly, the people who received major injuries were more likely than not to have received training on existing measures in the workplace.

Although the numbers are small, this does tend to indicate that, despite the existence of workplace measures to tackle violence, and training in those measures, the steps taken are not adequate to prevent assault and major injury.

While the majority of people who received major injuries (67%) said they received help after the incident, it might be reasonable to assume that all employees who received a major injury at work would receive assistance from their employer in the aftermath of the incident.

Incidents leading to minor injuries

For the purposes of the survey minor injuries were defined as those requiring first aid. Just under one in ten of the people who answered this question said they had received such an injury. In addition to comments such as "weekly occurrence, or "too many to mention" the total number of recorded incidents was 208.

According to this survey, women and men are at equal risk of minor injury when working in the public services. Nearly two thirds of those hurt received their injury despite the fact that they said they were aware of the measures intended to protect them from assault, and they had been trained in the observance of those measures.

Nearly two thirds of those experiencing minor injuries (64%) said they received no assistance from their employer in the aftermath of the assault.

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Staff who have been threatened with weapons

Eighty-three people said they had been threatened with a weapon — 7% of those who answered the question. Of those, around half reported multiple incidents including two people who said they had lost count of the number of incidents.

The total number of cases where use of some form of weapon was threatened was 135. The weapons referred to included the following: stones, bricks, planks of wood, hot drinks, chairs, walking frames, knives, snooker cues, hammers, bottles, cigarettes and airguns.

Women and men face an equal risk of such an incident according to this survey. And, of those who were threatened with a weapon, 57% said they received no assistance from their employer after the incident.

Just over half of those who were threatened had received training on how to deal with violent situations.

Threats or verbal abuse

At 49.5% this is the type of incident that is most prevalent in Scotland. With almost half of the survey experiencing such incidents at some time, 235 people reported multiple incidents by indicating a specific number, while a further 183 said that the there were two many incidents to recall a specific number.

Excluding those people who said verbal abuse was simply a daily event, the aggregate number of incidents where staff received threats or verbal abuse was 2018.

This is the type of incident that prompted the most additional comments from UNISON members who said that violence had become an endemic feature of work in the public services.

People reporting threats and verbal abuse were particularly evident in the following areas: the health service (62%), A&E (96%), council miscellaneous (67%) and the voluntary sector (64%).

Of those who experienced threats or verbal abuse in the last 12 months, two-thirds said they had received no help or assistance from their employer after the incident.

Of those who experienced threats or verbal abuse, 43% were not aware of measures to deal with violence and half had not received relevant training.

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Racial harassment

Twenty six UNISON members reported racial harassment by members of the public, each person reporting at least one incident. Four people reported multiple incidents and the aggregate number of incidents reported by this group was 48. The incidents tended to occur in either social work services or in the health service.

Bisha was a council official who, when conducting a piece of routine work for the council, became surrounded by an angry mob. Later a community councillor complained about the work Bisha was doing and threatened to "punch the paki's lights out". The council said that the use of racist language and threats of violence were unacceptable. But, when challenged by the community councillor, the council then withdrew its remarks and gave a written apology for any offence caused.

Shortly after this Bisha was the subject of a racist assault while working alone in the community. He was moved to another job for reasons of safety, but his new work duties involved working with a council tenant who had painted a Nazi swastika across the living room window of his council home. The council took the view that they were unable to remove the racist graffiti and some time later Bisha was involved in racist incident in with that tenant.

After a series of similar events Bisha eventually went absent on sick leave before eventually resigning from the council. Throughout the time when Bisha was exposed to racist violence no risk assessment was conducted and no effective action was taken. With UNISON's help Bisha achieved a comprehensive settlement.

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One person who reported racial harassment said that lone-working was a regular occurrence and a particular problem. There were numerous incidents at this office, all reports were recorded but nothing had been done by management to rectify the problem.

Another person described "countless" instances of threatening and abusive behaviour, some of it racial harassment and some of it sexual. Her principal concern was the recognition of this problem because racial, sexual, and sectarian incidents were not recorded separately. If this practice is widespread then it suggests there may be a problem with the under-reporting of aggravated or serious incidents within official data.

The concerns of this UNISON member are well founded. Within the new duty to eliminate discrimination, employers need to record details of incidents which indicate that additional measures are required to combat racism. This is an area in which action is required.

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Sexual Harassment

Fifty seven people (5%) said they had been sexually harassed by members of the public. But this level of reporting doubles to over 12% if we look at the level of sexual harassment among women.

Four respondents said that harassment was so common that they could not quantify the number of incidents.

It is very alarming to note that over one in ten of women working in the public services report that they were sexually harassed in the last twelve months.

Over two thirds of those who were sexually harassed said they were aware of the relevant measures to combat violence and had received training in their use. This must cast serious doubt on the efficacy of existing policies if harassment persists despite the widespread observance of policy and practice by staff in the frontline.

Of those who said they were sexually harassed, nearly three-quarters said they received no assistance from their employers after the incident.

Most worryingly, in the course of the research, UNISON became aware of several serious sexual assaults. For obvious reasons we have elected not to give specific detail of these incidents in this report, not least because it is still possible that criminal charges may be brought. The relevance for this study is that these incidents highlight the potential seriousness of workplace violence. We intend to draw this matter to the attention of the Scottish Executive in the hope that an effective response can be encouraged.

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Sectarian harassment

Twenty-four people (2%) reported sectarian harassment with some people reporting being harassed because they had Irish accents without choosing to label this as sectarian abuse. Of the 24 respondents, four said such incidents were too common to identify separately. Of the remaining 20, 16 experienced single incidents while four people made multiple reports giving an aggregate frequency of 30 incidents per year.

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8.0 Managerial responses

In the survey UNISON members were asked whether they thought their managers took the issue of violence seriously. While over 78% said that managers did take the issue seriously, that still leaves a significant minority — around one in five — who have lost confidence in the willingness of managers to combat violence at work.

Training

The majority of UNISON members have received no training on how to deal with violence at work. Only 38% of members said training was provided.

With the exception of housing and social work there is virtually no evidence of training on this issue anywhere outside the health service. In housing 46% of staff had access to training and the equivalent figure for social work staff was 44%.

Outside A&E the position in the health service is only marginally better at 49%, while 73% of A&E staff had access to training.

Given the number of people who report being worried about violence, the fact that the majority of UNISON members say they don't have access to training is a significant problem.

One possible explanation for the variation in training levels is that this resource is targeted at those areas where the risk of violence is greatest. Bearing in mind that the average participation rate is 38%, the following groups have a high level involvement in training: victims with major injuries (83%), A&E staff (73%), victims of sexual harassment (68%), victims of racial harassment (63%).

However, there are at least three weaknesses in this assumption that training is effectively targeted. There is nothing in the research data to indicate whether the training was in place before these reported incidents, or whether the training was instigated in response to serious incidents.

Secondly, even if the training was in place before the incidents, the continuing prevalence of violence does cast doubt on the efficacy of the measures upon which the training is based.

Finally, Only 55% of those threatened with weapons, and 33% of those facing sectarian attacks said they had access to training.

All of this suggests that employers should not assume that the variation in training levels can be attributed to the effective targeting of training provision. Training is a key element of an effective response to violence and existing training strategies must be reviewed.

The greatest apparent benefit of training is that workers become aware of measures in place to protect their safety. When asked about measures that had been adopted to improve staff safety, only half the respondents thought such steps had been taken. Looking at the group who had never been trained, knowledge of workplace measures drops to 38%. However, where training has been used, awareness of preventative measures rises to 70%.

In another example, example, 44% of people who had not been on training did not know how to report an injury received during an violent incident. Yet ignorance of reporting procedures drops to below 10% when we look at the group who have been trained. The clear implication is that training makes a significant difference, in those places where it occurs.

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Staff awareness of policies and existing measures

Whether staff are aware of policies and procedures is, perhaps, closely related to training arrangements. However, the research data on staff awareness reveals more than just where training is, and is not provided.

Interestingly, 70% of respondents knew their employer had a policy which covered issues relating to violence. Just under 50% of the group also knew of measures that were introduced in response to the risk of violence at work.

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9.0 Additional Information

Many of the participants took the time to make additional comments. Some gave detailed descriptions of recent incidents while others listed measures they would like to see introduced. The following are some common themes that emerged in this section of the data.

Bullying

Although the survey we very specifically about violence toward staff from members of the public, many participants took the opportunity to complain about specific cases of bullying. These cases are now being investigated by UNISON officers where contact details were provided.

Good practice

It should be noted that a small, but identifiable, group said that while there was some violence from time to time, all appropriate measures were in place and reviewed from time to time and the residual level of aggression was something respondents felt able to deal with. It is also safe to assume that there is a further group of UNISON members who share that positive experience but were sufficiently content that they did not feel the need to report the good practice they experience.

Lone working

The survey questionnaire made no specific reference to Lone Working. Clearly on reflection, this was an unfortunate omission. The frequency and depth of the comments on this issue indicate that it is a major factor that contributes to the risk of violence and the heightened fear of attack.

The evidence from our members is that staff cuts under the Executive's policy of "Best Value Reviews" has led to an increase in the frequency of lone working.

Necessary safety measures are not in place. For example, in 1999 the Executive instructed trusts to issue all community nurses with mobile phones linked to a comprehensive safety system. This direction has been ignored in large parts of the NHS.

Further work is clearly needed in this field and, while this will be an immediate campaign priority for UNISON, the union calls on the Scottish Executive to take the lead on this area of work. (See recommendations)

UNISON therefore calls on the Executive to commission independent research to identify:

• The circumstances in which lone working arises.
• The occupations ad industries where lone workers are particularly at risk.
• The extent to which lone working has increased in recent years, especially since the introduction of best value.
• The essential and desirable components of an effective policy on lone working.
• And the prevalence of lone working policies in the Scottish public services.

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10.0 Conclusions & Recommendations

Conclusions

In research terms this is a comparatively brief snap shot of the position in Scottish public services. The evidence gathered is sufficient to support the following general conclusions:

• Verbal and physical attacks are a common feature of work in the pubic services.
• UNISON members have described a fearsome arsenal of weapons and objects which they have faced during the last year.
• Recent attacks include racial and sexual assaults, sectarian attacks and some have resulted in major injuries.
• While most managers are believed to be taking the issue seriously, around a quarter of public services workers have lost confidence in the their managers commitment to safety.
• Exactly half of public service staff work in fear of violent attacks.
• Obvious measures such as risk assessments, safety policies and training are not used universally as they should be.
• Critically, some staff report that they are not forewarned of known risks where clients have a history of violence.
• UNISON members describe the deliberate under-reporting of violent incidence and a culture where reporting and record keeping are discouraged.
• Worst of all, although not asked to address this question specifically, numerous workers took the chance to state their belief that violence had come to be viewed as an accepted part of the job.

Much of what has been reported to UNISON is clearly illegal. Every employer should have an up to date risk assessment within which risks and hazards such as violent attacks are recorded. Every employer should have information for staff which, so far as is reasonably possible, indicates to them the circumstances in which violence is known to occur, the elements of the job that are particularly vulnerable, the names and descriptions of clients who are known aggressors.

There should be policies and procedures on how to deal with specific threats and the general risk of violence. All necessary equipment should be in place, from screens and cameras to personal alarms and mobile phones.

Credit must be given to those employers and manager who have followed these legal obligations. But the Scottish Executive is obliged to take steps to identify those workplaces where staff are being placed at risk.

This is not a moral obligation. This is a clear legal obligation. It's a legal duty in the sense that UNISON can, and will sue, where our embers are injured. But, there is an overriding legal obligation on the Government to ensure that the rules are being followed.

The levels of harm and fear uncovered by this survey suggests that public service managers are not being instructed or resourced to take the steps that are required by law. In UNISON's campaign for Zero Tolerance of Violence there is also Zero Tolerance of organisations and agencies that fail to address the risk of violence and fail to support and protect public service workers. The evidence of good practice recorded in this study demonstrates what can be done. This standard must be the target for all, and not just some, of Scotland's public service employers.

Recommendations

Given the evidence in this report it would miss the point to conclude with a list of recommended steps for employers in each and every service sector. Lack of information on protective measures is not the issue.

Good health and safety is not a checklist, it is an ongoing process within which risk is observed, assessed and tackled. The problem identified by this report is a systemic problem.

• Levels of violence are high
• People have become accustomed to an atmosphere of aggression and violence.
• Fear is a common element of life in the public services.
• Reporting is unreliable and risk assessment is patchy.
• The response to risk is unclear and training is uncommon.

The specific use of CCTV, alarms, mobiles self defence etc will only become apparent once the management of health and safety improves. Solutions will vary from workplace to workplace, but the common need across the country appears to be the acceptance that violence can be effectively managed as a health and safety issue.

UNISON therefore recommends:

• A national initiative across the public sector with the aim of achieving a step change in the quality of health and safety management.
• A clear government message to employers and staff that the personal safety of employees is paramount and overrides other factors such as efficiency, the needs of the service, or indeed the needs of the client.
• Key indicators should be identified to enable better government monitoring of compliance with the EU Directive on the management of health and safety.
• In addition to data on assaults, we need data on the extent to which risk assessments, personal safety policies, training and related measures are being used to get to grips with violence against staff.
• In the auditing and monitoring of safety management in Scotland, closer links need to be built between the police, the Health and Safety Executive and public service employers.
• There must a national review on the use, and implications, of the practice of lone working right across the public sector.
• Public sector staff are demoralised when known offenders are not prosecuted effectively. The criminal justice system must offer better protection to staff in the Scottish public services.
• And, most importantly, every service user in every school, hospital, college, housing office or other public premises must be left in no doubt —

Public service staff will not work in fear of violent attack and offenders will reported to the police.

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