Hospitals to use good design to cut crime

Crime against NHS staff 'could be reduced with good design'

Three hospitals in England are to try to reduce the levels of crime in their A&E departments through the use of better design.

Guy's and St Thomas' in London, Chesterfield Royal Hospital and Southampton University Hospitals NHS Trust will take part in a project involving designers and architects working alongside NHS staff and patients.

Together, the teams in each hospital will try to find design solutions to make their casualty departments a safer environment.

The designers will be selected via a competition, set by the Design Council.

An NHS staff survey in 2009 found 11% of staff had experienced physical violence from patients or their families in the previous year.

Figures for 2008-09 show 150 physical assaults on health care staff occurred nationally per day, a total of 56,718 physical assaults in England.

Staff absence as a result of violence and aggression from patients is estimated to cost the NHS around £69m each year.

Pressure cooker

As a complex, high pressure department, A&E can be one of the most difficult areas in which to handle such incidents.

Fiona Hoskins, divisional head of nursing for A&E at Southampton General Hospital said that the emergency department was "a bit of a pressure cooker."

She said that in A&E there were particular demands on both staff and patients.

"Patients are in an unfamiliar environment, they don't know what's going on - they see nurses call patients and get impatient for their turn, but they don't understand that we have to see people according to their need."

Designers will be invited to submit a proposal showing how their designs could reduce aggression and violence against staff.

The solutions will include changes to interior design such changing the layout or bringing in new furniture, changing how information is given to patients and redesigning clinical and non-clinical services and systems.

At the Birmingham Heartlands Hospital the A&E was redesigned between 2003 and 2005.

Crime in the department was reduced significantly. In 2002, around 13 aggressive incidents were reported each month. This dropped to five a month in 2005 after the redesign.

Changes to the department included relocating the reception desk to face the patient entrance so that visitors could see it as they entered the department; replacing walls with transparent screens and improving signage for patients so that they knew where to find A&E.

These changes improved the "natural surveillance" within the department - people could see and be seen more easily, as well reducing tension because people could find their way around.

However the changes were complemented by staff training and extra CCTV and access controls.

Professor Matthew Cooke, national clinical director for urgent and emergency care at the Department of Health said that design could make a significant difference within the NHS: "Verbal abuse is a daily occurrence and unfortunately physical violence against staff is not rare."

He said that better design would reduce aggression and violence, and that the project would make work safer for staff and enable them to provide better care for patients.