National security

HD, Feb 2005 by Van Der Bijl, Nick

Nick Van Der Bijl says that the NHS has taken its time to wake up to the present risks facing trusts and take action, and some obstacles remain.

For decades after its birth in 1948 the National Health Service clung onto the Home Office assessment that for some reason, patients, staff and visitors alike seem to believe that because hospitals are caring places, they are somehow immune to the effects of local crime and the ills of society.

However by the 1990s, there were signs that the lack of adequate security throughout the Healthcare sector was beginning to be recognised as an issue that needed to be addressed. When in 1993 former NHS Confederation chief executive Sir David Nicholls reported on the state of security, commenting that "hospitals are supermarkets without tills" it was clear that the situation could not continue. The inquiries after the Beverley Allitt affair, the events at the Bristol Royal Infirmary and the murders committed by Harold Shipman have done much to expose the frailties in the clinical fraternity. Although Nicholls was referring principally to crime, it also rather proved that employing second-rate security officers or buying a cheap CCTV is a far cry from investing the time and resources needed to protect patients and staff, assets and information, while maintaining the reputation of the NHS.

The establishment in 1997 of the Counter Fraud Service (CFS) by the then new secretary of State for Health Frank Dobson, was an important move to tackle the fraud and corruption known to exist throughout health services. Between 1999 and 2003 the impact of the CFS and benefit to the NHS is £478m back from those engaged in fraud. A primary care trust chief executive has served a jail sentence for claiming £40,000 in fraudulent travel expenses; a consultant who wrongly convinced NHS patients to pay for private treatment has been dismissed, and a dentist has had to repay the NHS £1.15m. Achieving a 97% successful prosecution rate, the CFS is performing better than any other protection agency in the UK including the Police Service and the Serious Fraud Office. There can be no question that the CFS has made significant inroads into protecting public money.

In a separate effort in the past few years, the National Association for Healthcare security (NAHS) which represents NHS security management - was lobbying Lord Hunt of Kings Heath, the Minister for Health, to raise the security profile of the NHS. This would entail a close examination of the protection of people, property, equipment and resources from loss, damage and interference across the service. The National Audit Office then produced 'A Safer Place to Work - Protecting NHS Hospital and Ambulance Staff from Violence and Aggression', which again highlighted security weaknesses throughout the NHS. On 1 January 2003, the CFS was expanded into the Counter Fraud and security Management Service (CFSMS), under the NHS (England) Statutory Instrument 2002 No 3040', with a mission "To provide the best protection for its patients, staff, professionals and property". As a Special Health Body, its remit was the development of "policy and operational responsibility for the management of security in the NHS". The strategy that emerged superseded those developed by NHS Estates and is described in Α Professional Approach to Managing security in the NHS'' (available on the CFSMS website'). However a dilemma has emerged - while fraud concentrates principally on sections of the 1968 Theft Act, corporate security management is multifunctional in order to defend the organisation from crime and breaches of corporate security. Two powerful directives from the secretary of State for Health quickly followed. The first of these, published on 20 November 2003, included detailed measures to Tackle Violence against Staff and Professionals who Work or Provide Services to the NHS'3 including:

* The establishment of the legal Protection Unit to help with legal advice and to increase the prosecution rates of assaults.

* The introduction of electronic Physical Assault Reporting Systems (PARS) as the first step in wider reporting.

* The appointment of an executive director in every health body to lead initiatives to tackle violence.

* The publication of a National Syllabus on Conflict Resolution Training for the NHS.

APPOINTING A LOCAL SECURITY MANAGEMENT SPECIALIST

The publication of the 'secretary of State of Health Direction on NHS Security Management Measures'4 on 24 March 2004 was a clear acknowledgement, at ministerial level, that healthcare security can no longer be overlooked. It stated that every health body must:

* Appoint a non-executive director or non-officer to promote security management. The take-up is understood to be slow.

* Appoint a board level representative to take responsibility for security management issues. At trust level, this must be an executive director, and is typically the director of facilities.

* Appoint a local security management specialist (LSMS). A job description and person specification was issued by the CFSMS in June 2004. This is a trust appointment.