The importance of risk assessment

Where members of staff are assaulted and injured by a psychiatric patient, they are often likely to seek compensation from their employer. Andrew Parsons looks at a recent case of this type and sets out the steps authorities can take to avoid a successful claim.

Many working in the psychiatric field will be familiar with incidents of patient assaults on staff. Where injuries arise these are often subject to a claim for compensation against the employer. However, a recent case – Desai v North Essex Partnership NHS Foundation Trust (March 2011) Central London County Court – has demonstrated the sort of steps that a hospital authority needs to take to avoid liability.

Facts

The Claimant healthcare assistant was assaulted by a patient allegedly causing physical injuries and post traumatic stress disorder. The patient suffered from Huntington’s Chorea with symptoms including early onset dementia. He had been demonstrating increasing aggression and violence and had previously attempted to assault staff, leading to the need to use restraint.

On arrival at the hospital a risk assessment had been undertaken and a care plan had been put in place including arrangements for regular future assessments, the provision of three staff when he was agitated and 1:1 care, to be reviewed as necessary.

The hospital had a clinical risk management protocol to provide guidance for the approach required.

On the day of the incident the patient suddenly attacked the healthcare assistant, punching and head butting her. She alleged that the staffing levels at the time were inadequate, that she had been given inadequate training, and that the risk assessment had not been properly undertaken. She also alleged that the patient should have been transferred to an alternative unit.

The hospital was able to demonstrate that the healthcare assistant had attended a “break away” course for dealing with violent patients and that although the initial care plan had suggested a minimum of three staff where required when the patient became agitated, his behaviour had improved and this had been reassessed. More importantly, they were able to demonstrate that the patient’s needs were reviewed every morning and that staffing levels were increased where necessary. A formal risk assessment was undertaken each day.

The hospital also argued that the presence of a nurse at the time would not have prevented the assault because it was commenced without any warning and there would have been no opportunity to intervene to prevent it.

Court decision

The Judge held that the hospital had taken the appropriate reasonable steps. There was no evidence of a failure to implement the care plan and although the staffing levels had been reduced from the original 1:1 ratio, this had not been done in a way that was negligent. The level of observation was a matter for the ward manager to decide and he had properly applied his judgment to this issue as a result of the daily risk assessment. Nothing could have prevented the sudden attack. The claim was therefore unsuccessful.

Comment

Incidents of this sort are common. This case underlines the need to ensure that full and proper risk assessments and care plans are put in place, and confirms that if appropriate steps are taken, a successful claim may be avoided.

Although the actual requirements will depend on the facts of any particular case, clearly the essential important elements were:

1. A full and detailed initial risk assessment.
2. A detailed care plan based upon that risk assessment.
3. The provision of sufficient and increased numbers of staff when there were indications that greater numbers were needed.
4. A daily review of risk.
5. Provision of appropriate training.
6. Clear records to demonstrate compliance with the above, including documenting the daily risk assessment.

None of this will be new to those managing acute psychiatric units but nevertheless the case demonstrates the sort of steps that the courts will expect to have been undertaken if a claim is to be defended.

Andrew Parsons is a partner at RadcliffesLeBrasseur. He can be contacted at This email address is being protected from spambots. You need JavaScript enabled to view it..