Lone Working Policy

Solent NHS Trust policies can only be considered to be valid and up-to-date if viewed on the intranet.
Please visit the intranet for the latest version.

Health and Safety legislation requires all

employers to provide a safe and secure
environment for their staff. This document
provides guidance and support to managers and
Purpose of Agreement
staff to promote the safety of those who are
lone or remote workers. This document should
be read in conjunction with the Management of
Security and Violence and Aggression Policy.

Document Type X Policy SOP Guideline

Reference Number Solent /Policy/ HS03

Version 2.0

Name of Approving Committees/Groups Policy Steering Group, Assurance Committee

Operational Date September 2018

Document Review Date September 2021
Document Sponsor Director of Finance and Performance

Document Manager Health and Safety Manager

Health and Safety Manager, Local Security
Management Specialist, Learning and
Development, H&S Sub Committee Occupation
Document developed in consultation with
Health and Wellbeing Team, Physical
Intervention Lead , Operational Policy Steering
Group & Assurance Committee
Business Zone> Policies SOPs and Clinical
SolNet Location
Guidance
Website Location FOI Publication Scheme

Keywords (for website/intranet uploading) Lone Worker, Lone Working Device

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Review Log

Version Number Review Name of Ratification Process Reason for

Date reviewer amendments

Amendments Summary
Amend No. Issued Page (s) Subject Action Date
Sep 17 Written Sep 17

Executive Summary

This policy gives comprehensive guidance to ensure staff & management recognise the
procedures to follow for employees whose work is intended to be carried out unaccompanied
or without immediate access to another person for assistance

The policy outlines roles and responsibilities for all staff and describes the arrangements to be
followed to identify and assess risks to the health and safety of employees and how to
identify foreseeable potential hazards. It is recognised that staff provide services in challenging
environments and outside of normal working hours and that this has the potential to put some
staff at risk if they are working alone.

Where the specific work tasks or activities introduce a potential risk the policy outlines the
process that should be followed to clearly establish the action that may need to be taken to
ensure our staff remain safe by eliminating or reducing the risk to the lowest level so far as is
reasonable practicable.

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 Table of Contents –Lone Worker Policy

Item Contents Page

1 INTRODUCTION AND PURPOSE 4

2 SCOPE AND DEFINITION 4

3 PROCESS REQUIREMENT 5

4 ROLES AND RESPONSIBLITIES 6

5 TRAINING 8

6 EQUALITY & DIVERSITY AND MENTAL CAPACITY ACT 9

7 SUCCESS CRITERIA AND MONITORING EFFECTIVENESS 9

8 POLICY REVIEW 9

9 REFERENCES AND LINKS TO RELATED POLICIES 9

10 GLOSSARY 10

Appendixes

11 Appendix A: Lone Working Role Risk Assessment Form 10

12 Appendix B: Guidance on what to consider when completing a Risk Assessment 18

13 Appendix C: Equality Impact Assessment 21

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1. INTRODUCTION & PURPOSE

1.1 Due to the nature of the work within Solent NHS Trust, a significant number of employees are
required to work alone. The Trust recognises the various risks that staff may face and has
considered the actions that should be taken.

1.2 If staff work alone and/or face potentially hostile or abusive situations, it is important to have a
system in place to ensure that an alarm can be raised if assistance is required.

1.3 Health and Safety legislations does not prohibit lone working, but an employee should not be put at
more risk than other people working. An employer has a general duty under Section 2(1) of the
Health & Safety at Work Act 1974, to ensure, so far as is reasonably practicable, the health, safety
and welfare of employee’s whilst at work.

1.4 Health and Safety Legislation requires employers and managers to assess risks to staff whilst lone
working and make arrangements for effective planning, organisation, control, monitoring and
review. This policy deals with generic aspects of management of lone working risks and provides
advice on the efficacy of various actions that may be utilised to reduce these risks.

1.5 Where appropriate, employers must assess the risks of violence to their staff and, if necessary, put
in place actions to protect them.

Refer to Section 3 - Process/ Requirements

This policy should be read in conjunction with the overarching Solent’s Risk Management
Framework.

2. SCOPE & DEFINITIONS

2.1 This policy is specifically aimed at those staff whose work is intended to be carried out
unaccompanied or without immediate access to another person for assistance and applies to *
bank, locum, permanent and fixed term contract employees (including apprentices) who hold a
contract of employment or engagement with the Trust, and secondees (including students),
volunteers (including Associate Hospital Managers), Non-Executive Directors, governors and those
undertaking research working within Solent NHS Trust, in line with Solent NHS Trust’s Equality,
Diversity and Human Rights Policy. It also applies to external contractors, Agency workers, and
other workers who are assigned to Solent NHS Trust.

3. PROCESS/REQUIREMENTS

LONE WORKING ROLE RISK ASSESSMENTS AND PROCEDURAL EVALUATION

General

3.1 Lone Workers can be classified as those who work in any situation or area without other persons
nearby. As a guide if a person called for help and it could not be heard by another member of staff,
then that person would be classed as a lone worker.

3.2 The setting up of safe working arrangements for lone workers is no different to organising the safety
of other staff. The risk which lone workers face should be reduced to the lowest level that is
reasonably practicable.

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 Risk Assessment
3.3 Managers are required to identify and assess risks to the health and safety of employees, who
are lone working. They need to complete a lone working role risk assessments in all areas of work
where working alone poses an actual or potential risk to staff.

3.4 The risk assessment will involve identifying all potential hazards and the risks associated with work
tasks or activities. It will identify who may be affected and how, and the actions which are needed
to eliminate or reduce the risk to the lowest level possible. The risk assessment process will follows
the 5 x 5 risk management matrix agreed as part of Solent NHS Trust Risk Management Framework.

3.5 It is important to recognise that a lone worker risk assessment can be used to cover a whole Service
or for an individual member of staff. The assessment can be completed with support from the local
security management specialist (LSMS) and /or the health and safety manager if required.

Refer to Appendix A- Lone working role risk assessment form and Appendix B- Guidance on what
to consider when completing a Risk Assessment.

3.6 Managers should send the completed lone working risk assessment form to the local security
management specialist and include the recommended action that will be implemented and shared
with all affected staff.

Lone working Staff Dynamic Risk Assessment (DRA)

3.7 The importance of the lone working risk assessment form is that it enables managers to anticipate
and recognise any known hazards and identify actions to be taken. However it is recognised that
situations change rapidly and the associated risks will also change, therefore dynamic risk
assessment should be an on-going process. In this case a new risk assessment including actions
should be completed.

3.8 A Dynamic Risk Assessment (DRA) should be conducted by staff as necessary for the circumstances
in place at the time. What sets DRA apart from the lone working risk assessment is that it is applied
in situations that present unpredictable/unforeseen risks or where the risk environment rapidly
changes. A DRA enables staff to make a risk judgement and provides staff with a consistent
approach to assessing risk.

This type of risk assessment is undertaken when the situation faced by staff has increased the risk
previously assessed to enable them to start working alone. Key details should be recorded on
SystmOne to enable staff to look for any flags prior to visiting.

The process involves:

• The assessment of risk in dynamic situations is undertaken before, during and after a home
visit, potentially hazardous appointment or working period.
• The benefits of proceeding with a task must be weighed carefully against the adverse risk posed
to the lone worker

4. ROLES & RESPONSIBILITIES

4.1 The Chief Executive Officer has overall responsibility for all matters of risk management; this
includes Lone working activities within the Trust. The Chief Executive Officer will also have overall

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 responsibility for ensuring that sufficient resources are provided to enable the policy to be
implemented and to remain effective.

4.2 Line Managers, Associate Directors, Operational Directors and Clinical Directors are responsible
for gaining assurance from service lines that the effectiveness of risk reporting, assessments and
management processes to protect lone workers are implemented and that service line lone working
risk assessments have been completed and monitored

4.3 Local Security Management Specialist (LSMS): will ensure that the Trust has up-to-date policies and
procedures for the safety of lone workers and (in liaison with line managers) ensure that they are
disseminated to all relevant lone working staff. The LSMS will:

• advise the organisation on systems, processes and procedures to improve personal

safety of lone workers and make sure that proper preventative measures are in place
 advise the organisation on appropriate and proportionate physical security, technology
and support systems that improves personal safety of lone workers. Ensure that this is
appropriate, proportionate and meets the needs of the organisation and lone worker
• play an active part in assisting managers with identifying hazards, completion of the
lone working risk assessments and management of risks. They will also advise on the
proper security provisions needed to mitigate the risks and protect lone workers.
 support the training and setting up of users on the Trust recognised approved lone
working technology system (Safeguard)
• be involved in the post incident root cause analysis, working with managers to identify
any shortcomings and learn from them, ensuring that appropriate measures are taken
to negate or mitigate future failings

4.4 Line Managers must establish and supervise safe systems of work (refer to examples at Appendix A
and Appendix B), provide access to appropriate training for their job and ensure, where reasonably
possible, all policies and procedures are observed. The line manager will:

 ensure that this policy and all other relevant policies and procedures are
disseminated to staff
 identify all staff who are lone workers, based on recognised definitions, (see section 2)
• ensure that a proper lone working risk assessment is conducted (in consultation with
the relevant staff) to ensure that all risks from lone working are identified and that
proper control measures have been introduced to minimise, or mitigate the risks
before staff enter a lone working situation
• forward copies of all local lone working risk assessment to the LSMS for quality
assurance and audit purpose
 ensure that staff have received appropriate training identified within the lone working
risk assessment and device training provided by the service supplier in the event of
being issued with lone worker devices
 ensure that lone workers are provided with sufficient information training, instruction
and supervision before entering a lone worker situation
 ensure physical measures are put in place and appropriate technology is made available
to ensure the safety of lone workers
• ensure that all the relevant staff undertake regular reviews of hazards and associated
risks to make sure that all measures are effective and continue to meet the
requirements of the lone worker
 where a security incident has occurred, make sure that the employee completes an
incident reporting form as soon as possible

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  where someone has been assaulted, ensure that the individual is properly de- briefed,
undergoes a physical assessment, any injuries are documented and they receive access
to appropriate post incident support

4.5 ALL staff who are working alone - must ensure they adhere to the Trust policy. It is everyone’s
responsibility to do all they can to ensure their own safety and that of their colleagues whilst lone
working and must ensure the following:

 they should seek advice from their line manager, action guidance, procedures and
instruction to avoid putting themselves or their colleagues at risk
 will conduct proper planning prior to a visit and utilise continual dynamic risk
assessment during a visit. Please note staff should never put themselves or their
colleagues at risk, if they feel at risk they should withdraw immediately and seek
further advice or assistance
 Where provided with a Solent approved Skyguard lone working device staff must
ensure they are trained in how to use the device, note that:
o It must be switched on at the start of each shift
o Devices must be tested a minimum of once a week
o Notify local administrators of any faults or change in personal details
 will undertake all relevant training identified within the lone working risk assessment
and device specific training as applicable
 must report all incidents where safety was compromised including ‘near misses’ to
enable appropriate follow up action to be taken

5. TRAINING

5.1 Training is crucial for all groups of staff who undertake lone working and, it is the line manager’s
responsibility to ensure staff are booked on relevant courses that would enhance staff safety.

5.2 Where staff have been issued with the Trust approved lone working device (Skyguard) training is
obtained via the LSMS and/ or compliance team administration support. Staff that hold one of
these devices must ensure the following:

 The equipment is used in accordance with the training provided and manufacturers
guidance
 It must be switched on at the start of each shift
 Devices must be tested a minimum of once a week

5.3 It is the employee’s responsibility to attend any training specific to them, requested by their
manager.

6. EQUALITY IMPACT ASSESSMENT AND MENTAL CAPACITY

6.1 A thorough and systematic assessment of this policy has been undertaken in accordance with the
Trust’s Policy on Equality and Human Rights.

6.2 The assessment found that the implementation of and compliance with this policy has no impact on
any Trust employee on the grounds of age, disability, gender, race, faith, or sexual orientation.

Equality Impact Assessment- Refer to Appendix C

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7. SUCCESS CRITERIA / MONITORING EFFECTIVENESS

7.1 The effectiveness of this policy will be determined by the analysis of adverse incident reports raised
in response to lone worker safety issues.

7.2 All Service Managers are to provide assurance that local procedures are in place within their services
and to provide copies to the LSMS for audit purposes.

7.3 The LSMS will audit all lone worker procedures received from individual services and teams and
report any shortcomings identified to the Service Manager, will identify any services that haven’t
replied and will report via the Health & Safety Sub-Committee.

Trust approved Lone worker device usage to be monitored appropriately by managers via the
online portal to ensure that non usage of the devices by individual members of their team are
picked up in sufficient time to ensure their safety isn’t compromised and that the lone working risk
assessment remains compliant. Non usage of devices to be addressed directly with the individual
user (s).

8. REVIEW

8.1 This document may be reviewed at any time at the request of either staff side or management, but
will automatically be reviewed 3 years from initial approval and thereafter on a triennial basis unless
organisational changes, legislation, guidance or non-compliance prompt an earlier review.

9. REFERENCES AND LINKS TO OTHER DOCUMENTS

9.1 The Trust acknowledges the following sources of advice and reference:

• The Corporate Manslaughter and Corporate Homicide Act 2007

• Safety Representatives and Safety Committees Regulations
• The Health and Safety (Consultation with Employees) Regulations
• The Management of Health and Safety at Work Regulations
• Health and Safety at Work Act 1974
• Human Rights Act 1998
• Secretary of State Directions ((2003) (2004) both amended in 2006)
• Improving safety for lone workers- A guide for managers, NHS Staff Council
• Working alone - Health and safety guidance on the risks of lone working, HSE
• NHS Security Manual – Chapters 22b & 23
• Risk Management Framework
• Emergency Planning Policy
• Reporting of Adverse Events Policy
• Health & Safety Policy
• Emergency Lockdown Policy
• Management of Security and Violence and Aggression Policy
• Anti-Fraud, Corruption & Bribery Policy
• Freedom to Speak Up Policy

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10. GLOSSARY

• Counter Fraud and Security Management Service (CSFMS)

• Local Security Management Specialist (LSMS)
• Department of Health (DoH)
 Lone Worker: those who work by themselves without close or direct supervision.
 Physical Attack: whether visible injury occurs or not, and includes sexual or racial attack
 Verbal Abuse or Intimidation: where a member of staff or client feels that a threat has been
made.
 Animal Attack: Where an animal is threatening, is used as means to threaten/intimidate staff
conducting Trust duties.
 Criminal damage: the intentional and malicious damage to the home, other property or
vehicles and includes graffiti.
 Arson: the act of deliberately setting fire to property, including buildings and vehicles
 Dynamic Risk Assessment: “the continuous assessment of risk in the rapidly changing
circumstances of an operational incident, in order to implement the control measures
necessary to ensure an acceptable level of safety”

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Appendix A

LONE WORKING ROLE RISK ASSESSMENTS AND PROCEDURAL EVALUATION

Background

This appendix to the Lone Working Procedures should be read in conjunction with the Management of Security and Violence and Aggression Policy and
Procedures. Ensuring that those who work alone or remotely are adequately protected is a priority for the organisation. The NHS Protect Standards for
Providers requires that each organisation assesses the risks to its lone workers, including the risk of violence. It takes steps to avoid or control the risks and
these measures are regularly and soundly monitored, reviewed and evaluated for their effectiveness.

This appendix sets out how:

 Each role should be assessed and summarises the various processes and procedures that can be put in place to reduce and minimise the likelihood of
violence and aggression.
 Processes and procedures are reviewed and evaluated for effectiveness.
 Processes and procedures are shared across teams and the wider organisation to ensure organisational learning and best practice.

Broadly roles fall into 5 categories; however the location and type of service provided may increase the likelihood and consequence of aggression; for
example, while all staff working in mental health wards are likely to be subjected to violence and aggression; those working in a Psychiatric Intensive Care Unit
(PICU) may find that their patients are younger and more physically able and as such the consequences of any assault may be more severe. Each role must
have a role risk assessment conducted to ensure that every action is taken to mitigate the risk of violence and aggression and to keep staff safe.

Process

The risk assessment process follows the 5 x 5 risk management matrix agreed as part of Solent NHS Trust Risk Management Framework.

It is important to recognise that risk assessments may be dynamic and that additional control measures may need to be implemented where a higher risk is
identified; for example a patient or their relative has been identified that poses a specific risk to staff. In documenting risk assessments it is important to
ensure that intelligence is gathered from as may appropriate sources as possible as this may help to inform our response to the given risk. Staff should keep in
mind working closely with other NHS providers, Local Authority teams and care agencies – when sharing information, staff must always follow Information
Governance guidance and best practice to avoid DPA breach.

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In all situations, recommended control measures should be implemented and shared with all affected staff. Managers should make sure that lone working and
buddying procedures are discussed at team meetings to ensure that all staff follow agreed actions. In particular, where “code words” are used managers must
ensure that all staff are familiar with the words used; their purpose and the agreed response.

At least annually, managers should conduct a review to evaluate the effectiveness of the procedure, or procedures adopted. In multi-disciplinary teams, there
may be a blend of processes and procedures. The review must be documented and shared with the team. This review will be assessed as part of the Health,
Safety and Security Improvement Plani.

Role Risk Assessments

 This assessment must be undertaken for any activity deemed to present a

Likelihood
significant risk to employees, patients & visitors. Trivial risks or those
1 2 3 4 5 associated with everyday life do not been to be included, unless they are
Almost compounded by the work activity.
Rare Unlikely Possible Likely
Certain
5 Catastrophic 5 10 15 20 25  The assessment should be reviewed by Line Managers and included within
the Service Line Risk Register where scores are 8 or above.
Severity 4 Major 4 8 12 16 20

3 Moderate 3 6 9 12 15  The hierarchy of controls must be used when considering the Risk Reduction
Plan, i.e. avoid if possible, assess those activities that cannot be avoided,
2 Minor 2 4 6 8 10
reduce the level of risk to the lowest level reasonably practicable
1 Negligible 1 2 3 4 5 ergonomically, by the provision of equipment, information, instruction &
training, signage, etc.

 Very Low = Risk is very well managed; Low = Risk is adequately managed,
although improvements may be possible to reduce the risk further; Moderate
= Risk is NOT adequately managed, a detailed risk reduction plan must be
completed; High = The Risk is NOT managed and could present a significant
risk to SHNS. The activity should be suspended until a detailed assessment
has been undertaken and a Risk Reduction Plan developed and implemented.

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Ratings Action

1-3: Low Risk

Local managers should manage low risks by maintaining routine procedures and taking proportionate action to implement any additional new control
measures to reduce risk where possible. Local Managers must escalate higher levels of risk

4-6: Moderate Risk

Service Managers must ensure that an action plan is identified to reduce risk and entered on local risk register. Managers must escalate higher levels of risk

8-12: High Risk

Senior Management action plan must be specified for high risks. Appropriate management assurance must evidence and control the risk assessment, and
oversee the action plan to reduce the risk. The head of service is generally responsible for this level of risk, ensuring that the risk is placed on divisional and
corporate risk registers. High levels of risk must be escalated to an Associate Director

15-25: Extreme Risk

Executive management is required to ensure immediate action, in line with the context of the risk. Associate Directors will be responsible for this level of risk
and the action plans. However the Executive Director must be over see the progress. The Head of Risk Management and Company Secretary, who will ensure
the risk, is captured Corporate Risk Register as required.

Generic Role Risk Assessments

[Keep in mind that some situations and circumstances may increase the risk to staff members for a specific activity and this must be assessed separately.]
Degree of Additional Actions Residual
Ref Risk Risk
Group Affected Activity Hazard/Risk Existing Control Measures Required to Reduce the
No
L S R Level of Risk L S R

Corporate As per job role Hazard: All Corporate Policies in

particular:
Executive & Challenging patients;
Directors/Service Line service users and external Lone working procedures
Managers/Professional stakeholders
Leads Management of Security,
1.0
Lone working Violence and Aggression
Policy
Travelling from site to site;
risk of breakdown Travel and Subsistence
Policy

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 Degree of Additional Actions Residual
Ref Risk Risk
Group Affected Activity Hazard/Risk Existing Control Measures Required to Reduce the
No
L S R Level of Risk L S R

Risk:
Potential for violence and
aggression

Degree of Residual
Ref Group Risk Additional Actions Required Risk
Activity Hazard/Risk Existing Control Measures
No Affected to Reduce the Level of Risk
L S R L S R

Support – As per job role Hazard: All Corporate Policies in Where appropriate
H&S, Security, particular:
Fire, Estates, Challenging patients;
service users and external Lone working procedures PPE [Lone Worker device]
Facilities,
administrators stakeholders
Management of Security, Robust buddying arrangements]
[his list is not Lone working Violence and Aggression Policy
exhaustive] Training:
Travelling from site to site; Travel and Subsistence Policy Conflict Resolution Training
risk of breakdown (CRT)
Breakaway techniques
2.0
Risk:
Potential for violence and
aggression

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 Degree of Residual
Ref Risk Additional Actions Required Risk
Group Affected Activity Hazard/Risk Existing Control Measures
No to Reduce the Level of Risk
L S R L S R

Clinical/therapy As per job role Hazard: All Corporate Policies in Where appropriate
– clinic based particular:
Challenging patients;
service users and external Lone working procedures PPE [Lone Worker device]
stakeholders Panic Alarms
Management of Security,
Lone working Violence and Aggression Policy
Robust buddying arrangements
Travelling from site to site; Travel and Subsistence Policy including use of code words
3.0
risk of breakdown
Environmental
Risk: controls/potential security
presence
Potential for violence and
aggression Patient history
CRT
Breakaway techniques

Degree of Residual
Ref Risk Additional Actions Required Risk
Group Affected Activity Hazard/Risk Existing Control Measures
No to Reduce the Level of Risk
L S R L S R

Clinical/therapy As per job role Hazard: All Corporate Policies in Educational campaigns
– ward based particular:
Challenging patients;
service users and external Lone working procedures Review of incidents to
stakeholders determine effectiveness of
Management of Security, control measures inclusive of
Lone working Violence and Aggression Policy formal patients written
agreements
Travelling from site to site; Travel and Subsistence Policy
risk of breakdown
Environmental
4.0 Risk: controls/potential security
presence
Potential for violence and
aggression Close proximity of other staff
Patient history including
personalised care plan
Training
CRT/PRISS
Breakaway techniques

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 Degree of Residual
Ref Risk Additional Actions Required Risk
Group Affected Activity Hazard/Risk Existing Control Measures
No to Reduce the Level of Risk
L S R L S R

Clinical/therapy As per job role Hazard: All Corporate Policies in Where appropriate
– community particular:
based Challenging
patients/relatives; service Lone working procedures PPE [Lone Worker device]
users and external
stakeholders Management of Security, Increased staff presence where
Violence and Aggression Policy appropriate
Lone working
Travel and Subsistence Policy Liaison with other supporting
Travelling from site to site; agencies or providers
risk of breakdown Robust buddying arrangements
5.0 Patient history including Review of incidents to
Risk:
personalised care plan determine effectiveness of
Potential for violence and control measures inclusive of
aggression Information sharing formal patients written
Local knowledge of area and agreements
possible risks
Potential of seeing patient in
Training clinic setting
CRT
Breakaway techniques

NOTE: The list of existing control measures and additional actions required is not exhaustive and local arrangements may include further actions.

Signed ………………………………………………….. Signed ………………………………………………

Print Name …………………………………………….. Print Name …………………………………………

(Person Undertaking Inspection) (Manager)

Date completed…………………………………………..

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Risk Assessment Evaluation (where used)

Team Service manager

Location Period under review

Brief summary of patient group and

associated risks

Numbers of incidents of violence Physical assaults Non-physical assaults

and aggression directed at team in
period under review:
Lone Working Process[es]
[Please document all processes and
procedures that are used by the
team.]

Review
Who conducted the review?
[Name of staff member[s]]

When was the review conducted?

How was the review conducted?

Review findings
[Document the number of staff who
were able to be contacted and if they
were where they should have been;
who was unable to be contacted;
escalation processes are appropriate
and all contact details including make
and model of car are accurate.
Where LWDs are in use, review usage
16
as recorded on the web portal.]

Recommendations for improvement

Where risks have been identified Escalated by: Date:

and appropriate mitigation cannot
be identified or implemented - risks
have been documented on
departmental risk register and Action plan in place: Review date:
escalated in accordance with Risk
Management Strategy and Policy.

Review findings and Date shared: Date implemented:

recommendations for improvement
shared with the team and
implemented
Documented in team meeting Date of meeting:
minutes.

Summary

By continually reviewing processes and assessing risks to staff, Solent NHS Trust aims to keep those who work alone or remotely safe. Furthermore our goal is
to work closely with our partnership agencies and organisations to ensure that all intelligence that could be considered during part of the assessment process
is available to support a robust risk assessment process. This is of significant importance when managing patients [or their relatives] where the use of violence
or aggression is a likelihood or certainty.

The organisation has and is willing to invest in technology to support staff; however as is always the case, where public funds are used the organisation must
make sure that the best use is made of any money spent. Where PPE is provided to staff and/or teams, then there will be serious consequences if staff
deliberately misuse or fail to use such equipment and as a consequence put themselves, and potentially others at risk.

Chief Nurse
1 Health, Safety and Security Improvement Plan is the Solent NHS Trust cyclical assessment and audit programme to support safer working procedures in the workplace.

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Appendix B

Guidance on what to consider when completing a risk assessment

Before a lone worker home visit
Where it is practicable, a log of known risks should be kept by the department. This should record the
location and details of patients/service users/other people that may be visited by staff, where a risk may be
present.

This log should be kept securely and the information should be accurate and reviewed regularly. It should be
available to lone workers to inspect ahead of any visit they make.

Information Sharing
Managers should highlight any areas and/or patients that pose a significant risk to staff. Information
concerning risks of individuals and addresses should be communicated internally to all relevant staff who
may work with the same patients/service users.

Scheduling Visits
If there are known risks associated with a particular location or patient/service user, lone workers should
consider, in consultation with their manager, rescheduling the visit so they can be accompanied by another
member of staff.

Emergency Equipment
As part of the planning process, the emergency equipment that may be required should be assessed. This
might include a torch, map of the local area, telephone numbers for emergencies (including local police and
ambulance service), a first aid kit, etc.

Lone Worker Movements

As part of the risk assessment and action taken to reduce risk managers may implement a local system
whereby lone workers ensure that someone else (a manager or appropriate colleague) is aware of their
location and if applicable their visit schedule. Other actions that could be taken include:
 Details of vehicles used by lone workers could also be left with a manager or colleague, for example,
registration number, make, model and colour.
 Procedures could also be in place to ensure that the lone worker is in regular contact with their
manager or relevant colleague, particularly if they are delayed or have to cancel an appointment.

The Buddy System

Where lone working is required staff should ensure they make another colleague aware of their
movements. To operate the buddy system, you must nominate a buddy. This is the person who is the
contact for the period in which they will be working alone.
The nominated buddy will:

 be fully aware of the movements of the lone worker

 have all necessary contact details for the lone worker, including next of kin
 have details of the lone worker’s known breaks or rest periods
 attempt to contact the lone worker if they do not contact the buddy as agreed
 follow the agreed local escalation procedures for alerting their senior manager and/or the
police if the lone worker cannot be contacted or if they fail to contact their buddy within
agreed and reasonable timescales. Contingency arrangements should be in place for
someone else to take over the role of the buddy in case the nominated person is

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 unavailable, for example if the lone working situation extends past the end of the
nominated person’s normal working day or shift, if the shift varies, or if the nominated
person is away on annual leave or off sick.

Escalation Process
Managers should have a local escalation procedure, outlining who should be notified if a lone worker
cannot be contacted or if they fail to contact the relevant individual within agreed or reasonable timescales.
The escalation process should include risk assessment and identification of contact points at appropriate
stages, including a line manager, senior manager and, ultimately, the police.

Dealing with animals

The potential risks posed by household pets when conducting home visits will involve safety, allergies and
infection control. Where animals are present and the staff member is concerned, a polite request should be
made for the animal to be placed in a different room. If the resident/owner is not content with this request
and has had the clinical and personal safety issues explained in a calm manner and if appropriate the visit
should be abandoned and reported in accordance with the risk reporting policy. Where pets are considered
to be a risk this can also be noted in the electronic patient record (EPR).

Lone working and taxis

The Trust does not advocate the use of taxis or private hire vehicles for use by lone workers. Where there is
an operational requirement for such transport to be used, lone workers must only use reputable licensed
companies and they should book in advance. Private hire cabs should not be used, other than licensed or
registered hackney carriages.

Lone working and travelling by foot

Where staff need to take part of their journey by foot they should always endeavour to use well-lit paths
and pavements. They should avoid unoccupied/populated areas and should ensure that their colleagues are
aware of the route being taken prior to the journey.

Staff members need to be aware of the areas that they are working in and plan their journey accordingly.
Uniforms should be covered up and equipment and other items should be kept to a minimum.
In the event of a situation where a staff members has concern for their safety they should head for the
nearest public area (Shop, Petrol Station, Police station etc.)

If possible look out for street CCTV cameras and try and remain in view of these.

Lone working and public transport

Where it is necessary to utilise public transport, staff members should prepare for their journey by ensuring
they know the routes and times of buses/trains etc. They should stick to using larger stations and bus stops
in busy areas.

Lone working devices

It is essential to recognise that lone worker devices will not prevent incidents from occurring. However, if
used correctly in conjunction with robust procedures, they will enhance the protection of lone workers.
Lone workers should still exercise caution even if equipped with such devices and continue to use the risk
assessment process.

Use of a mobile phone

The following information and guidelines should be noted:

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  Lone workers may carry mobile phones and they should always check the signal strength before
entering a lone working situation.
 A mobile phone may be the main form of communication. If entering a known risky area lone
workers should tell their manager or a colleague about any visit in advance, including its location
and nature, and when they expect to arrive and leave. Afterwards, they should let their manager or
colleague know that they are safe.
 If provided, a mobile phone should always be kept as fully charged as possible.
 Emergency contacts may be kept on speed dial.
 The phone should be kept nearby and never left unattended.
 Lone workers should be sensitive to the fact that using a mobile phone could escalate an aggressive
situation.
 In some circumstances, agreed ‘code’ words or phrases should be used to help lone workers convey
the nature of the threat to their managers or colleagues so that they can provide the appropriate
response, such as involving the police. The decision to use code words or phrases should give due
consideration to the ability of a member of staff to recall and use them in a highly stressful
situation.

A mobile phone could also be a target for thieves. Care should be taken to use it as discreetly as possible,
while remaining aware of risks and keeping it within reach at all times.

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Appendix C
Equality Impact Assessment

Step 1 – Scoping; identify the policies aims Answer

1. What are the main aims and objectives of the document? To give all staff comprehensive guidance
on relevant legislation, organisational rules
and good practice so staff can deal
effectively when working with medical
devices. This policy outlines procedures
and guidelines for the systematic
management of medical devices and
equipment throughout the whole medical
devices life cycle.

2. Who will be affected by it? managers and staff who deal with l issues
relating to lone working

3. What are the existing performance indicators/measures Improved management of staff facing lone
for this? What are the outcomes you want to achieve? working situations, challenging behaviour,
reduction in incidents involving lone
workers
4. What information do you already have on the equality - Existing incident report data and usage
impact of this document? data on trust approved f lone working
devices

5. Are there demographic changes or trends locally to be No

considered?

6. What other information do you need? Non identified

Step 2 - Assessing the Impact; consider the data and Yes No Answer
research
(Evidence)

1. Could the document unlawfully discriminate against any 

group?

2. Can any group benefit or be excluded? 

3. Can any group be denied fair & equal access to or 

treatment as a result of this document?

4. Can this actively promote good relations with and 

between different groups?

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5. Have you carried out any consultation  Please see routes of
internally/externally with relevant individual groups? consultation and ratification
process.

6. Have you used a variety of different methods of  Consultation within

consultation/involvement organisation. Please see
above.

Mental Capacity Act implications

7. Will this document require a decision to be made by or 

about a service user? (Refer to the Mental Capacity Act
document for further information)

External considerations

8. What external factors have been considered in the This policy has taken into
development of this policy? consideration all Health and
Safety Executive legislative
management changes that
have taken place

9. Are there any external implications in relation to this No

policy?

10. Which external groups may be affected positively or No

adversely as a consequence of this policy being
implemented?

If there is no negative impact – end the Impact Assessment here.

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