In July 2013, NHS Protect updated Guidance to NHS Trusts on staff training to deal with violence

Below is a summary of the new requirements.


Conflict Resolution Training – The NHS Syllabus

The new CRT Guidance reaffirmed that s3.1 of the NHS Standard Contract general conditions, requires NHS organisations to supply all frontline NHS Staff* with Conflict Resolution Training (CRT) in accordance with NHS Protect guidance.

*The NHS SMS define ‘NHS Staff’ as anyone who is employed by or engaged to provide services to an NHS body and ‘frontline’ NHS staff as being those whose work brings them into contact with members of the public which may expose them to situations that may become volatile and confrontational, resulting in violence and abuse.

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Click on the image to view the document.

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The CRT Guidance  also emphasised that risk of occurrence (and causes) of aggressive behaviour vary across healthcare settings and that, in order to meet statutory Health & Safety obligations, staff working in higher risk roles will need to be provided with further training, in addition to basic CRT (e.g. Assault Avoidance and Breakaway Skills for A&E Staff.)

NHS Protect recommends that all frontline NHS staff undergo a CRT risk assessment to determine the risks being faced and identify training needs.

Risk of violence can be determined by factors such as:

  • Situational – accident and emergency unit, mental health trusts, learning and disability services, community based nursing services, maternity services and the ambulance sector.
  • Clinical conditions – renal units, head injury units, mental health and learning disabilities and dementia.
  • Lone working – “By the very nature of their work, Lone Workers need to be provided with additional support, management and training to deal with increased risks ….” (Quote from Not Alone – A guide for the better protection of lone workers in the NHS.)


Clinically Related Challenging Behaviour

The CRT Guidance from NHS Protect also highlighted the need for NHS organisations to raise awareness about Clinically Related Challenging Behaviour (CRCB).

According to NHS Protect, 79% of reported physical assaults against NHS staff in England in 2012-13 were classed as ‘Unintentional’ due to clinical factors.

NHS Protect now require that all staff interacting directly with patients receive both CRT and CRCB Awareness training.

NHS organisations and providers of NHS services can choose to include CRCB Awareness training as part of a combined course with CRT or incorporate it as part of other training initiatives, such as those addressing staff training needs around dementia.

NHS Protect guidance on Prevention & Management of CRCB, published Dec 2013, provides a model for training in this area.

Refresher CRT

The purpose of Refresher CRT is to refresh and consolidate delegates’ prior CRT learning and where applicable to update it.

The new CRT Guidance from NHS Protect acknowledges that the frequency of Refresher CRT will be determined by local needs but confirmed that it should take place no more than three years after the previous training.


Dementia Training

Objective 13 of the National Dementia Strategy is: ‘An informed and effective workforce for people with dementia’ and one of the four goals of the Commissioning for Quality and Innovation (CQUIN) framework for 2013/14 was for acute services providers to:

  • Incentivise the identification of patients with dementia and other causes of cognitive impairment alongside their other medical conditions
  • To prompt appropriate referral and follow up after they leave hospital; and
  • To ensure that hospitals deliver high quality care to people with dementia and support their carers.

In order to meet the CQUIN requirement and qualify to receive the government funding, hospitals must have a named lead clinician for dementia and an appropriate staff training programme.

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