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Not alone: safety issues for lone workers

Ann de Vere
Corporate Affairs Manager
NHS Security Management Service

Assaults on nursing staff are a serious problem affecting every NHS body in the country. The NHS Security Management Service (SMS) has already introduced a range of initiatives aimed at tackling assaults against NHS staff and we are finally seeing success. During 2004/05, there was a 15-fold increase in the number of prosecutions over 2002/03, and in November 2005 we saw the first-ever private prosecution by the NHS, against an individual who assaulted a community nurse who was trying to treat his partner. The individual was found guilty, sentenced to a 12-month conditional discharge and ordered to pay compensation and costs.
Most people think of staff working in A&E departments or acute mental health settings as those who are most likely to face assault, but as illustrated by the case mentioned above, NHS primary care lone workers face similar problems. Community and district nurses, health visitors, outreach workers and many others work alone with patients, relatives and members of the public in their own homes.
Solutions to the explicit risks faced by lone workers needed to be identified quickly. Employing more security staff and better CCTV at clinics and surgeries is expensive and not effective when protecting lone workers because they usually work away from other colleagues so cannot call for help or retreat to a staff-only area for safety. Any guidance or advice had to include the best practical and theoretical
protection measures.
In March 2004, the SMS published Not Alone - a guide for the better protection of NHS lone workers.(1) The guidance states: "It is essential that all staff feel safe and secure, so that they can undertake and perform their duties free from fear and in the full knowledge that ... effective action can be taken, should they find themselves in a threatening environment and need help." This is the foundation for our work to tackle violence and abuse. Staff should be protected and feel safe from harm, but should an incident occur, they need to be aware that the toughest possible action will be taken against the offender - as was seen in November 2005.
We believe it is important for NHS lone workers to take responsibility for their safety, but they must be supported by management and given the tools to do so. Training staff is an essential part of this process. By April 2008, all frontline NHS staff in England will be trained in conflict resolution. This means every community nurse and health visitor will have the tools to defuse and manage a potentially violent incident, or prevent one from occurring.
The SMS also looked at a range of devices that aim to provide an additional layer of protection for lone workers. Technologies that are currently available or being developed, and which can help as a deterrent or enable responses to an incident, include:

  • Internal alarms, activated by "panic buttons" either in treatment rooms or carried by personnel.
  • Panic buttons linked to police stations.
  • Mobile technology based on the cellular mobile systems of GSM or GPRS networks.
  • Mobile attack alarms that emit a loud, high-pitched noise on activation.

The SMS considered this range and decided to trial the Identicom device across 22 health bodies across the NHS.(2) A discreet device, it uses the mobile phone network to record evidence of violence or abuse, and can help locate the position of a lone worker if an alert is raised. The results were favourable, and because of the work of the SMS the device is now available through a government contract. The rates represent good value for money and are part of a package that enables NHS workers to get the best use out of the device. It is worn like an ordinary ID card holder, into which a standard ID card can be inserted. It uses mobile phone technology to allow a lone worker to record information about their expected whereabouts during the day. The lone worker is encouraged to leave information concerning any risks that may be present or perceived. For example, a health visitor attending a patient's home may feel uncomfortable about a group of youths who are congregating nearby. All this information may simply be recorded by way of a short voice message. This information is stored at the response centre until it is superseded by a new voice message or an alert is triggered.
Devices such as this enable the lone worker to share any situation with a third person as soon as they feel threatened or uncomfortable without alarming the potential aggressor or exacerbating a possible aggressive situation. The lone worker does not have to wait until abuse or assault has taken place before they raise an alert - they are encouraged to raise an alert as soon as they feel their safety may be compromised. Alerts are received at a central response centre, where highly skilled and trained operatives listen to events that are taking place and employ appropriate escalation procedures, such as alerting the emergency services or staff managers. Training on how to operate Identicom is available as part of the whole package and is delivered by NHS SMS trainers.
Staff who have experience of the device have already noted that it has improved their confidence and feeling of safety. One trial participant said: "I feel safe when visiting new patients, or even walking to their front door. I can't believe the difference it's made."
If you regularly work on your own, the advice of the SMS is to bring this technology to the attention of management. In conjunction with management, nurses will need to undertake a risk assessment to determine whether such a tool will help protect you and your colleagues. But no technology is sufficient on its own. It must be utilised in conjunction with a comprehensive and well-implemented lone worker policy, which is focused on enabling lone workers to perceive and manage their work in the context of the specific risks.
Risk assessments should be made before any home visit. Lone workers should try to find out whether the patient or their family are potentially violent, and make a decision on whether a home visit is the best option. On a visit, they should also make sure that they can escape easily, should it become necessary. They need to assess their location - for example, know the nearest exit and not position themselves in the corner of the room. Teamwork and good communication within client groups and the community are vital. However, staff must ensure confidentiality is maintained while sharing any known risks regarding a patient's care with others.
NHS departments with lone workers should also consider using the "buddy system". The buddy system means that one person will be nominated as a contact for the lone worker and will be fully aware of the lone worker's activities for that day. The lone worker should contact the buddy at agreed times each day. If this doesn't happen it is the responsibility of the buddy to contact them immediately and take action if required.
This comprehensive approach to protect lone workers, incorporating solutions such as those described above, can be achieved through the new structure for security that is being implemented throughout the NHS in England. By June 2006, security issues in every health body will be led by the new Local Security Management Specialist (LSMS). The role is intended to provide a complete overview of security issues, including creating a pro-security culture, deterrence and prevention of offences, detection and investigation where assaults take place, and a thorough process of review and learning.(3) Equally important is the implementation of conflict resolution training, personal safety training and specific training in the use of technology provided by NHS SMS trainers who are experts in these fields.(4)
For further information on training opportunities visit or contact the NHS SMS at


  1. NHS CFSMS. Not alone - a guide for the better protection of lone workers in the NHS. Available from
  2. NHS CFSMS. Lone worker device - NHS national trial evaluation report. Available from
  3. NHS CFSMS. A professional approach to managing security in the NHS. Available at
  4. NHS CFSMS. Conflict resolution training guidance. Available from

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