Having the right procedures in place to deal with the management of patients (and in some cases their relatives) who are abusive, aggressive or threatening is more important than ever. Assaults on NHS staff for 2009/2010 amounted to 56,718 (1). This is clearly of huge concern both from the perspective of those individual staff members personally attacked whilst carrying out their jobs, but also in terms of the time and money which is being diverted from the delivery of healthcare.
From railway operators to housing associations, the term "zero tolerance" is often used to describe the approach to be taken with those who are violent or aggressive to staff. However, coming up with the appropriate response to deal with aggressive patients can be difficult for NHS providers, in light of the fact that zero tolerance can mean a withdrawal of treatment and in some cases, the behaviour itself can be the result of a clinical condition which they are trying to treat.
In October 2011 the Health Service Ombudsman published a report: Listening and Learning: the Ombudsman’s complaint handling by the NHS in 2010-2011. The report highlighted the growing number of complaints arising from decisions by GPs to remove patients from their practice lists. Of all complaints received about GPs from the Ombudsman, 21% related to patient removals, a rise of 6% the previous year. The appropriate way in which to deal with patients who display aggressive behaviour is of course not limited to GP practices. There is also concern that at times GP’s seek to remove patients from their lists when in fact those individuals are vulnerable adults. They may not have in fact met the appropriate thresholds and there has not been an escalation plan or multi- agency working to manage the adult who may be demonstrating challenging behaviours for a variety of reasons, some medical. There is a real variance of the use of the Violent Patient Scheme across the regions. There are also some misunderstandings, for instance that the whole family including the children must go on the scheme if an adult of the family is placed on that scheme.
NHS bodies should already have systems in place for reporting, investigating, and managing violence against staff. These policies should incorporate appropriate escalation policies, processes for reviewing decisions taken and complaints policies. The policies should incorporate relevant guidance, such as that issued by the NHS Security Management Service (SMS), who are responsible for tackling violence against NHS staff. They have issued guidance on placing a violent patient indicator on the electronic records of those who have previously assaulted NHS staff (2). This alerts staff to the possibility of violence in the future so that precautions can be taken.
One of the benefits of the marker scheme is the sharing of information. Individuals can often go to different providers of NHS Care and the marker scheme allows information to be shared, including with those who don’t have access to the electronic marker scheme. There is specific guidance on the way in which the decision making process for placing a marker should be dealt with, including a process for reviewing the decision so that the process can be objective and transparent. This is important because, as the report from the Ombudsman shows, there are likely to be complaints by individuals about the use of the marker scheme. It is also important to ensure that on seeing a marker, staff know what they should do.
The position becomes more complicated when a patient’s aggressive behaviour may be linked to their clinical condition, medication or treatment. There may still be options for action to be taken in respect of their violent behaviour, but if they lack the capacity to understand their actions then this will be more difficult. It is important to ensure that a mental capacity assessment is carried out in relation to violence and aggression. Training on issues such as early intervention, the appropriate use of restraint and physical interventions will also be key. In the case of mental disorder reference should be made to the Code of Practice for the Mental Health Act 1983. This sets out guidance on the assessment, identification and management of violent behaviour.
Also, consideration should be given to proportionate management of the patient. Can arrangements such as therapeutic contracts be of help? In some cases decisions around the management of aggressive behaviour need to be multi-agency based to best understand the reasons behind the patient’s behaviour and that the response and actions required to manage this are proportionate in all the circumstances. This will hopefully avoid patients, who may be vulnerable, being subject to draconian measures.
When NHS providers say they have a zero tolerance approach to abuse of staff, the reality is more complex. This is because the sanctions as well as criminal prosecutions and injunctions, can include hospital exclusions and withdrawal of treatment. The way in which policies and procedures are implemented are important; not just to avoid complaints and further problems by patients who are unhappy with the way in which these matters are handled, but also to ensure the most effective methods are used to try to halt the unacceptable levels of assaults against staff.
As November comes rolling in, the malls will play Christmas songs and commercials on TV get increasingly emotional and family-oriented. This is your cue – the holidays are fast approaching, and pretty soon you’re going to find yourself scrambling to buy presents for each and every one of your friends and family. The problem? You’ve run out of cash!
As November comes rolling in, the malls will only play Christmas songs and commercials on TV get increasingly emotional and family-oriented. This is your cue – the holidays are fast approaching, and pretty soon you’re going to find yourself scrambling to buy presents for each and every one of your friends and family. The problem? You’ve run out of cash!
Christmas is the season of giving, yet, it’s a little difficult to get into the holiday spirit when there isn’t much left for you to give. To avoid this problem, you’ve got to make sure that November is all about your pre-holiday season prepping. Follow these simple tips on saving and planning for the upcoming holidays and you’ll be sure to have a little left to get everyone something nice for Christmas.
Knowing what you spend on and how much you do is essential for making sure you don’t overspend. It’s also a great way to assess whether you can cut down on unnecessary spendings, or if you can find better alternatives to expensive purchases.
Tracking your finances should be done all year round, and ideally at least once a week. The old school way is to collect your receipts and keep a list of the things you buy on a daily basis, then go over all of your spendings in a notebook or a spreadsheet at the end of the week. If this is too tedious for you, you can always download one of many apps available today, which help you track daily and weekly expenses, and even categorize them neatly into ‘food,’ ‘fuel,’ ‘gifts,’ ‘eating out,’ etc.
Many of us have that trait of thinking twice before throwing something out. “Sayang, eh.” we’ll say to ourselves before stuffing a sweater we never use all the way in the back of our closet. While it’s great that we try to avoid throwing away something that’s perfectly useful, it’s also still sayang if we never get to use the item anyway.
Give your home a once over and set aside some of the things that you never or rarely use. Now, allot three boxes for your stuff – things you want to throw away, things you want to donate, and things you want to sell. Throw away the stuff that’s of little or no value, or stuff that’s pretty much falling apart. Donate stuff that can be used or recycled by the less fortunate, but make sure they’re not old enough that they might as well belong in the ‘throw away’ box. Lastly, put up a garage sale or better yet, put up an ad online for some of the stuff that are still in good condition. You’ll be surprised by how much money you can make on stuff you’ve been neglecting all this time!
Similar to your regular budget where you allot a certain amount of your earnings to your essentials, a seasonal budget helps you figure out exactly how much money you’re going to need and spend over the holidays. The simplest way to do this is to make a spreadsheet. Have a budget for Christmas gifts, noche buena food and Christmas party potluck contributions, Christmas decors, donations to your Church and solicitors, aguinaldo’s for all your apo’s and inaanak’s, and even bonuses for your household help. Having even just a ballpark figure of just how much you’ll be spending over the holidays helps you be able to do the next tip, which is…
When you’re setting aside the money to put into your savings account, allot a portion of those savings to your holiday expenses budget. This tip is actually best done at the beginning of the year, so that you have enough savings by December to not have to worry about putting a strain on your finances. But don’t worry, you’ll still be able to save a bit even if you start in November, especially if you take the other tips to heart.
By tracking your expenses, you evaluate in which areas you tend to overspend and which areas can be given an even lower budget to make room for more savings. By selling some stuff you don’t need, you earn a few extra pesos which you can immediately store into your holiday savings. And lastly, by making a seasonal budget, you have a guide as to just how much you need to save by December.
We’re throwing in an extra tip here for people who really want to save as much as they can for the holidays. Use what is called the envelope system. It basically involves divvying up your paycheck into three envelopes – one for food, one for gas, and one for fun. This lets you see exactly how much money you have left from your budget, and it allows you to see what really costs the most. You’ll also be able to see what areas suffer when you overspend on others,like sacrificing a few hundred pesos from the fun envelope to cover food expenses because you’ve exhausted that one.This little method will help you save as much as you can just before the holidays hit.