13 May 2019
E-mail: [FYI request #10100 email]
Dear Ms Lehnhard, Official Information Act (1982) Request
I write in response to your Official Information Act request, received by us on 15 April 2019. You
requested the following information:
• The total number of assaults against nurses by members of the public from 2013-2018.
• How many assaults against nurses by members of the public, broken down by each year from
Counties Manukau DHB responds to a number of requests for information on this topic each year. Like
other state sector agencies, we now proactively publish responses to Official Information Act requests
in a searchable matter on our website.
We believe these several of these responses will address your question, and ask that you review them
(best search term is ‘harm to staff
’), and contact us if you still require additional information.
Before answering your questions, the following may also provide you with useful context.
CM Health services provide health services to in excess of 569,400 people residing in South Auckland,
both in hospital and community settings. Obviously, many of these people are acutely unwell and/or in
distress when they require care and that can result in behaviours that our staff members need to
manage and respond to.
We employ over 7,000 staff, and are constantly working to create a safe work environment. We are clear
that it is unacceptable for anyone to experience violence and abuse while working in or receiving care
from our services.
Our Incident Reporting system is intended to enable DHB staff to report on any incidents in their
workplace, and to have these fully investigated and resolved. However, this can mean there can be
issues with data ‘uniformity’ and interpretation, and we cannot always directly extract information
across all incidents logged. Given the differences in reporting systems, and in the DHB sizes and services,
comparisons between DHBs can also be misleading.
Counties Manukau District Health Board
19 Lambie Drive, Manukau, Auckland 2104 | Private Bag 94052, Manukau, Auckland 2241
T: 09 276 0000 | cmdhb.org.nz
Each incident is counted as a unique file, and we use coding themes to guide the allocation of incidents,
along with narrative text that provides extended details, but this is not as easily coded. While there are
‘nominated’ codes for types of incidents reported, these may not always be consistently interpreted by
everyone. In addition, there will be a range in the severity of incidents within the same code group.
When an incident is logged, details of victim and perpetrator are only in the text descriptions, and may
not identify the qualification of the staff member, or their role. Due to the way that incidents are logged,
it is not possible to accurately discern from the statistical fields, just assaults on staff members and
whether that staff member was a Nurse, and to identify if the perpetrator was a patient, a visitor or a
member of the public (although, this is generally clear from the textual description). Incidents can
involve more than one type of violence and one incident may be reported by multiple people.
With the above caveats, we can provide the total number of incidents related to violence or aggression
that have occurred at Counties Manukau DHB during the years requested.
• Annual total number of reported violent incidents calendar years 2013 – 2018
The following totals include all
violent incidents reported at CMDHB, regardless of whether the victim
was a staff member, patient or visitor, and regardless of whether the perpetrator was a patient, visitor
or member of public.
The following Specific Incident Types are included in these numbers:
o assault - physical
o assault - sexual
o assault - verbal/ gesture
o behaviour - aggressive/ threatening
o behaviour - violent
o hit/ bitten/ scratched by person
We note that this data shows reported incidents per annum since 2015, but accept that will not be the
totality of the cases where staff deal with aggression or verbal abuse. The incident type
“hit/bitten/scratched by person” is typically used for incidents where the victim was unintentionally hit,
bitten or scratched.
We have also provided the data above by totals of each type of assault/ behaviours, noting that some
incidents included more than one type of behaviour.
• Type or nature of all reported incidents calendar years 2013 - 2018:
Specific Incident Type
assault - sexual
behaviour - violent
hit/ bitten/ scratched by person
assault - verbal/gesture
behaviour - aggressive/ threatening
assault - physical
Accurately determining the role/ profession of a victim, and isolating those cases for the period you have
specified would require a manual review of all of the incidents. This would be a substantial piece of
research, and collation, as the data fields would need to be confirmed. We have considered if this can
be achieved, however, the work involved for five years of reports would compromise other operation
priorities for the DHB. We are therefore declining this element of your request, under the Act - Section
18f – substantial collation and research. We believe it is important that the DHB focus on the
investigation of incidents as they occur, and of system-wide changes to reduce the number of instances.
We acknowledge that there has been an increase in reported incidents of violence (including physical
and verbal) toward staff, but believe this is due to a range of factors, including increasing staff awareness
of the importance of formally reporting all types of incidents (both against staff and patients), rather
than simply an increase in incidents of physical violence, as we deliver services to more people each
Different services in our system will have different numbers of incidents, and have different resources
available and clinical skill levels to deal with these types of situations, that can affect reporting. We
provide all staff with opportunities for training to learn risk assessment, de-escalation and effective
communication techniques that aim to reduce the number of such incidents, and the adverse impacts
that can result.
All incident reports are automatically sent to managers for investigation and follow–up. If appropriate,
we will support individuals to debrief, access additional health and/or counselling services if desired,
and to work with NZ Police, if they pursue investigations.
During 2018, the Emergency Department at Middlemore Hospital starting use of a “code Orange”
reporting system, which enables rapid flagging of situations that may require additional assistance/
• Intimidating or manipulative behaviour from patient, whaanau or visitors
• Aggressive/ intoxicated or suicidal patient or visitor
• Event or behaviour in which staff feels uncomfortable or compromised
• Unwelcome visitors
• Patients, whaanau or visitors refusing to be sensitive to, or respect the rights of others to privacy,
extremely stressed patient, whanau or visitors
We have implemented a range of service-specific initiatives in clinical areas of greatest need, including
the Emergency Department, Mental Health, and with our security and orderly staff, to further enhance
our staff’s ability to report, debrief and prevent issues of violence against staff and/or patients. These
initiatives include use of CCTV, personal alarms, input from specialist staff, and enhanced training. In
addition, we continue to use social media and other messaging with our wider Counties Manukau
community about living our CM Health values, and treating others with respect.
I trust this information satisfactorily answers your query. If you are not satisfied with this response you
are entitled to seek a review of the response by the Ombudsman under section 28(3) of the Official
Please note that this response or an edited version of this may be published on the Counties Manukau
Fepulea’i Margie Apa Chief Executive