Hospital Pharmacist
Vol 9 No 9 p278
October 2002

Review of circulars and official publications
by Alex Bower, MRPharmS

The Department of Health (DoH) issued the document, "Dealing with harassment by National Health Service users" in September. The document says: "there is no place for harassment of any kind in the NHS and it will not be tolerated. NHS staff should be treated fairly and consistently, and with dignity and respect wherever they work". According to the document, NHS employers (and that includes hospital pharmacy managers) have a statutory duty of care to ensure the health and safety at work of all employees. This includes a duty to protect against harassment as far as is practical.

The guidance explains how to recognise harassment, what can be done to prevent it, and the steps which can be taken to address harassment in the workplace. Defining what constitutes harassment is not straightforward. The document considers that behaviour can harass if it is "unwanted, unreasonable and offensive," or if it "creates fear, demoralisation and humiliation, and a hostile or ineffective working environment". Harassment can be by verbal abuse, written abuse, physical abuse, intimidation, or by displays of offensive material.

It will be appreciated that a decision on whether or not a situation can be classed as harassment will need to be judged on the specific situation and the view of an individual. Each individual will have a different level at which they will deem that they have been harassed and each case will, therefore, need to be judged on its own merits at the time. Staff who are harassed or bullied are advised by the report to complete an incident report form and, in violent cases, advised that the matter should be reported to the police.

Hospital pharmacy managers who have not done so already should take the opportunity to devise a strategy for preventing harassment at work. This will involve conducting a risk audit to identify the risks followed by the development of local policies for dealing with harassment situations. Arrangements should be in place to support those who have been subjected to harassment, and awareness training should be provided for all pharmacy staff. Access to counselling services may be appropriate in some cases.

The document says that systems should be in place to report, record and monitor all incidents, and records should be regularly evaluated to establish any patterns of behaviour for which appropriate action might be taken. A policy statement that makes it clear to patients and the public that harassment of pharmacy staff will not be tolerated should be published, says the report. This should be done as part of a general trust initiative, but could be a specific pharmacy policy that is prominently displayed in the outpatient area.

Hospital pharmacy staff have many direct contacts with patients and health care professionals. They are exposed to the risk of harassment on a daily basis, but there is little evidence of the extent to which this occurs, or the seriousness of any harassment in practice. There is no standard system for recording cases of harassment in hospital pharmacy departments. Hospital pharmacy managers might wish to debate the need for standard reporting procedures aimed at assessing the risk in practice to pharmacy staff.

A range of "Improvement leaders' guides" from the NHS Modernisation Agency has appeared over the summer months. The guides summarise current learning and thinking. They contain practical advice and are presented as tools to support improvements in patient care. The following guides have been published to date:

• Process mapping analysis and redesign

• Matching capacity and demand

• Measurement for improvement

• Sustainability and spread

• Involving patients and carers

• Managing the human dimensions of change

• Further reading list

A guide on "Setting up a collaborative programme" is expected to follow shortly. The titles are self-explanatory, with the exception of "Sustainability and spread," where some clarification of the topic might be helpful. "Sustainability" refers to situations where new ways of working, including attitudes, become the norm. "Spread" refers to an active sharing process and adoption across the health care system.

Much of the content of the guides will be familiar to hospital pharmacists, but it is helpful to have them available as anaide-memoire and checklist when involved in work in a specific area. The guides, which are succinct and easily readable, are commended to hospital pharmacy managers on this basis.

The guides are available here.

"Remedies for success: A strategy for pharmacy in Wales — a consultation document" was published by the Welsh Assembly Government in September. Comments are invited by 31 December 2002. This is a weighty document — 70 pages in total. The document will be of interest to any hospital pharmacy manager, not just those in Wales, who wishes to check out their thinking about the key issues for future developments in pharmacy services. Much of what appears will be well known but the document will serve as a useful checklist of the key opportunities for developing the pharmaceutical contribution to patient care. An abbreviated version or consultation by section might have avoided the risk that readers will not give due attention to all the contents. The process of consultation has been simplified, however, by the inclusion of a pull-out section but, even so, this still runs to 50 questions over eight pages.

The focus in the strategy is on treating patients as individuals. The strategy envisages that technological and supply chain changes will allow services to develop "direct to the patient," thus missing out the community pharmacy, and that hospital pharmacy might provide emergency pharmaceutical care on a 24-hour basis. These potential changes may be of concern to some community pharmacists, but the strategy is to be commended for pointing out likely developments that may be of benefit to patients. Growth in automated dispensing and the development of the Doctorate in Pharmacy (ie, PharmD) are seen as likely developments.

The consultative document provides a comprehensive oversight of likely future developments. The outcome of the consultation, and the content of the final strategy, will be eagerly awaited.

The document can be found here (PDF 285K).

  * PDF files on PJ Online require Acrobat Reader 4 or later.

Mr Bower is a consultant pharmacist