The Yorkshire Ripper caused terror in the 1970s across the Yorkshire region sadly attacking numerous women and killing several. Many of his attacks in Bradford occurred in the Lumb Lane area of the city and this was quickly associated with the killings in West Yorkshire.

The TV programme Band of Gold which was shown between 1995-7 highlighted this part of Bradford again, and showed it as a seedy red light district. The local residents from the area decided they had simply had enough of this bad reputation and they decided to make a stand. They teamed up by getting together and protested by joining hands and forcing the prostitutes and the pimps out of their neighbourhood. This pushed the red light district to the Thorton Road part of the city which is next to the University of Bradford and it has been there every since.

More recently the self-proclaimed “Crossbow Cannibal” Stephen Griffiths was a student at the University of Bradford and he had a house just off Thornton Road which means he has been walking these streets every single day for many years. One prostitute was reported as saying she saw him every single day. Why is this important I hear you ask? Because all of the victims of the latest murders in Bradford were likely to have known Mr Griffiths personally because they saw him every day. They knew him, or at the very least, they will of known of him.

A scary fact is more than half (60%) of women are attacked by men they already know – not a complete stranger.

In my opinion the guy that attacked these ladies probably lived amongst them.

Good personal safety is being aware of people you know as well as the complete strangers.

Attack Rituals

If we look at attack rituals, an attacker is almost always likely to have his blood full of adrenaline. The murderer, or attacker, attacks people for a reason and usually it’s because they get a buzz out of it.

So if you see someone you know and they are behaving just slightly differently this can often be a key clue because it’s not congruent. Now I am not saying that everyone who acts a little differently is going to attack you but it should ring some alarm bells in your head.

If someone is going to attack they are either going to use the ambush technique, or they are going to use the talking distance attack, because it has to take place at talking distance. The attacker needs to get close, so they can either run and ambush or they come and talk to you nicely but they won’t be acting like they normally do.

If I was to guess I would say that these terrible series of Bradford murders were probably talking distance attacks and the girls probably recognised their attacker and felt pretty comfortable in his company. In fact, one newspaper article I read said the accused, Stephen Griffiths, was acting in a very different way on the day of the final murder – in other words he looked a bit shifty!

There are three elements to look out for:

• Body language
• Tonality
• Words

If the other person seems excited or nervous, or both, there will be a incongruency between their body language, tone and words. In other words they may be saying one thing but their body language and tonality would be saying another because of this extra excitement.

Psychopaths like to kill people because there is a feeling of being important and more in control – they enjoy this kind of domination. They don’t understand empathy and often they simply do it to get a chemical reaction in their blood.

So if your proposed attacker wants to get close, he will try and talk to you and he will have increased levels of adrenaline. This is why some people appear “shifty” as there body language is saying something completely different to their words.

I know this advice may sound simple and it is but it could save your life. I would recommend you trust your instincts even with people you know.

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With this in mind I thought it would be a worthwhile exercise to go through a few ways not to restrain someone.

Restraint techniques have to be professionally taught in a certain way to help prevent death from positional asphyxia. A case which illustrated this was a clubber who sadly died in Bradford.

When any person, door supervisors, authority or organisation considers restraining someone they must be aware of the dangers of positional asphyxia as it’s a known killer. Wikipedia describes positional asphyxia as:

A form of asphyxia which occurs when someone’s position prevents them from breathing adequately. A small but significant number of people die suddenly and without apparent reason during restraint by police, prison officers and health care staff. Positional asphyxia may be a factor in some of these deaths.

It is mainly caused by someone’s lack of ability to breathe, which could be acerbated by the position they are put in when being restrained. For instance, if you restrain someone around the neck that can increase the risk, so can putting extra pressure on the chest as that can restrict the person’s breathing.

Often there is more than one person involved in restraining someone, sometimes if can be by holding them to the floor and another person separately holding them around the neck.

There are a number of factors that can increase the chance of positional asphyxia and these include the following:

1. Someone being pinned down on the floor. Most people will move the person as quickly as possible and get them into the recovery position swiftly

2. Putting weight on a person’s back as this is going to restrict the person’s breathing.

3. Being held around the neck as this also heavily restricts breathing

4. Obesity – a person’s own body weight can restrict breathing

5. Alcohol and drug use

If all of these factors occur at the same time, the chance of positional asphyxia is heavily multiplied.

People suffering from this condition often can’t breathe and they are gasping for air, then they begin to panic and they need even more oxygen to compensate and it becomes a bit of a viscous circle. It’s a bit like a bower constrictor snake slowly strangulating them of oxygen.

There is a common misconception that if someone is talking, they must be breathing, but it has been proved that people can talk even if they can’t breathe. It is an indicator that they are OK but not necessarily true.

In our training at GoodSense we use wrist locks on arms because when the attacker pushes against you and your restraint they put their own pressure on their wrist. The worst that can happen is you can break their wrist but if you sit on them to restrain them you could actually kill them.

In other words as a training organisation we teach holds that reduce the risk of positional asphyxia. We are also designed to work within the manual handling regulations so the person doing the restraining is much less likely to injure themselves as well during the process.

I have enclosed a video which is a good example of the sort of wrist lock we would use but when we do it we would use two people locking each individual wrist. However, we would initially use an escort or holding position first but only if the subject was compliant. If they were non-compliant we would use a wrist lock as shown in the video. You wouldn’t use this type of hold on a child as you could easily break their wrist but you would do it on an adult.

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To be honest it is a tool that can help with training but it’s not the magic bullet that will solve all of your training problems. However, that said it can help save money, time, resources and of course the environment – so it does have some genuine benefits.

I have pulled together a list of pros and cons of e-learning and listed them below, I have also borrowed some great points from the e-learning Guru, have a read and see what you think:

Pros

1. You can get a lot of material background and guidance into documents which people can read in their own time. Materials that will help a delegate hit the ground running when they come on a blended solution training course. They already have background knowledge and this is far better than starting from scratch.
2. It’s cost effective to use it.
3. Learning times reduced, an average of 40 to 60 percent, as found by Brandon Hall (Web-based Training Cookbook, 1997, p. 108).
4. Increased retention and application to the job averages an increase of 25 percent over traditional methods, according to an independent study by J.D. Fletcher (Multimedia Review, Spring 1991, pp.33-42).
5. You can buy several different courses in bulk.
6. It’s environmentally friendly.
7. It comes within a learning management system.
8. Proof of completion and certification, essential elements of training initiatives, can be automated. So the delegate can print off their own certificates if they so wish– again environmentally friendly.
9. Flexibility – the delegate can choose their own place and time to train.
10. The delegate can go into far more detail – by simply clicking on links in the copy.
11. The end of each section often has a quiz to test the delegate’s knowledge and understanding.
12. It saves on backfill costs (which are hidden and hardly ever measured within the public sector). This is when someone has to be paid where the other person goes off site to do the training.
13. The delegate can stop in the middle of the training and pick it up when they want.
14. Self-pacing for slow or quick learners reduces the stress of training and increases the delegates satisfaction.
15. It can be more engaging as it using a variety of methods to capture the imagination of the delegate.

Cons

1. Organisational mindset – there can be reluctance in some organisations to embrace new training methods.
2. Not having the necessary IT kit that can do the job (our courses use flash for instance – so not having flash on your computer could cause problems).
3. People not being organised or motivated to get the job completed when using e-learning they are doing it at their own pace, so it could take forever.
4. It isn’t accredited and there is no industry standard.
5. There is usually an up-front investment required, so budgets and cash flows often need to be negotiated to accommodate this.
6. Technology skill levels of the learners – if they can’t use a computer this will cause the trainer real issues.
7. Portability of training has become a strength of e-learning with the proliferation of network linking points, notebook computers, PDAs, and mobile phones, but still does not rival that of printed workbooks or reference material.
8. Reduced social and cultural interaction can be a drawback. The impersonality, suppression of communication mechanisms such as body language, and elimination of peer-to-peer learning that are part of this potential disadvantage are lessening with advances in communications technologies.
9. You can’t really learn self defence techniques using a computer. Practical application is far better in my opinion.

If e-learning is used in a blended approach, it will prepare the student by building up their general knowledge and guidance around the subject. If the delegate understands the statistics and industry issues etc, we can then take them through much more advanced strategies. This will give them a much higher level of training and give the employer a higher skilled individual.

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One female officer was stabbed in the back and two male colleagues suffered arm and face injuries in the attack at Frankland Prison, Co Durham, on Saturday.

The Category A prison has seen a number of assaults on staff in recent years and in 2008, HM Inspectorate of Prisons raised concerns over levels of violence.

The most recent attack took place just after 9am when the officers, who are all in their early thirties, opened the door to a cell.

One of the officers was thought to have been slashed in the face after rugby-tackling the inmate, while another was said to have suffered a potentially life-threatening arterial bleed.

The key information here is that the officer rugby tackled the inmate, as this shows that people still use this when fighting or restraining people. The best fighting system for dealing with rugby tackles is the Spear system. Both the Gracie and Spear systems have very similar defences against rugby tackles this called sprawling.

If the sprawl hasn’t worked you will be usually be dragged to the floor and you use a technique called The Gracie Guard, which is where you bear hug with your hands, and grab the attacker between your legs and pull them in them tight. If you use this technique you are not going to let the attacker get any power in their punches. When your body is under extreme pressure or stressed (when your heart beat goes above 220 bpm) you can’t use your minor motor skills because you are shaking and your fight or flight kicks in. However, the techniques I have just described work whether you are stressed or not because you are using your legs.

NHS staff that work in prisons are the responsibility of the NHS – which results in their training to be very mixed. The training for these brave team members has to be realistic and practical.

I believe that the people doing these types of jobs should be trained in the latest techniques including how to get out of tackles and locks etc. Although these officers do receive adequate training I personally feel that self defence training in our prisons could be vastly improved. If I was recommending training for them, I would suggest a six-week Gracie or Spear program at the very minimum – not just having a few short lectures on self defence because it’s simply not enough. These are people’s lives we are dealing with here.

I was at an event recently with experts in the UK and not one instructor mentioned the relevance of dealing with a Rugby Tackle but I have seen it happen in attacks.

I have included a video which shows a prison attacker getting attacked and it is pretty shocking. Training can save lives – watch the video and judge for yourself.

The enclosed video clearly shows me the significance of the Gracie system because in that they pull the attacker into the body which stops them having the leverage to punch you. The Gracie defence for this was clearly shown in the post that I did earlier in the year on police training.

Both this post and my previous one clearly demonstrate the importance of good quality training, it should never be a tick box exercise as it could save their lives.

In my opinion, this training needs to be something that is regular and intensive that shares the latest self defence techniques, fear psychology, anti-ambush methods and looking at how to analyse and deal with attack rituals.

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Apparently, when he came to her house he found the patio door of the semi-detached house in Nottingham smashed to pieces. So he grabbed a kitchen knife from a drawer nearby to protect himself and then he was attacked by a 14-year-old burglar, who was brandishing a blade. In the struggle the youngster, who hasn’t been named for legal reasons, was stabbed twice in the leg and then was chased off the property by Roberts. The second burglar Mr Juett, was upstairs checking a bedroom. He then rushed down the stairs to confront Mr Roberts. In the fight Mr Roberts sadly stabbed the teenager in the shoulder which severed one his major arteries resulting in the burglar’s death.

The 14 year old accomplice told the police that Mr Roberts had chased him outside and then stabbed him outside of the property this was key to the investigation. The fact that he said it happened outside and then Mr Roberts went back into the house armed with a knife to get the other burglar is the reason Mr Roberts was acquitted.

Mr Roberts on the other hand, was clear with the police he said he stabbed both burglars in the house as self defence, it was the other burglar that had said he had chased him out.

The idea to prosecute Mr Roberts is interesting and it all stemmed from the stabbing outside in the criminals statement. This is because the prosecution said he could have called the police rather than going after them in vengeance or retaliation. By definition this isn’t self defence and it is clearly breaking the law.

However, the 14-year old changed his story and admitted when was re-interviewed by the police. He then told them he had been waiting for the other burglar outside the house which matched Mr Roberts statement. In other words Mr Roberts never actually went outside of the property. This in the eyes of the law shows he was simply protecting his home in self defence not retaliation. He was simply frightened and outgunned and did what most people would do pick something up to protect themselves.

The Independent’s article reported:

In a press conference immediately following the hearing, it emerged some police officers did not want the case to be brought against Roberts.

His mother Jacqueline McKenzie-Johnson, 47, said the law now needed to be clarified.

At present home-owners are not allowed to use "unreasonable force" but there have been calls for it to be strengthened so that only "grossly disproportionate force" would warrant prosecution.

She said: "There’s a need for clarification on ‘reasonable force’. I particularly believe that when you are faced with an intruder in your own home, the expectation that you behave reasonably doesn’t seem to fit.

"There are number of things that have had a bearing and I am sure that the General Election had something to do with it. Also, the overwhelming support we have had from the public may have influenced the decision as well as the fact there was no evidence."

In the eyes of the law you are allowed to protect your property, including the garden, but once you go off your property you should phone the police as this could then be seen as overly aggressive. This event apparently actually all happened inside the property. So it is seen as reasonable for Mr Roberts to have picked up a kitchen knife, when he had two armed burglars in his house. The intent was simply to defend himself and his mother’s home.

The law doesn’t need changing

The laws are there to protect us, personally I don’t feel the law actually does need clarifying. The general public just need to understand the law better. The mistake here was from the police and forensics in my opinion. If they had interviewed the younger burglar earlier they could have got the true story from him. I don’t know what the reason was why they didn’t sort this side of the investigation out immediately. Because once they got to the truth it all became clear and the charges were dropped.

Questions that need answering

My questions are these:

1. Why did it take the police to get so long to the truth?
2. Should the police take witness statements from known criminals with the same amount of validity as an innocent man protecting his mother’s home?
3. If all of these events did take place in the house why didn’t the forensic evidence either back up Mr Roberts’s story and negate the 14-year olds story?

As you can see there are more questions than answers here but the law is clear if you are scared for your life you can protect yourself in your own property. However, you simply can’t chase someone down the street with a machete and attack them and expect to get away with it as that would never be seen as reasonable.

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When people on the telephone call you and come across all angry and frustrated, it isn’t always because they are actually cross. Sometimes these are just mis-read signals by people and you need to be careful in making assumptions quickly, especially when using the telephone.

For instance, if the call is to the NHS, the caller might be frightened as they are trying to get some important test results to determine whether they have cancer or not. So it may be that they are simply on edge and frightened, not angry. However, the person on the other end of the telephone (NHS) might pick up the wrong signals.

The caller that has got the problem, knows that they have a problem, but the person on the other end of the telephone doesn’t understand it. If this happens (and it often does) it means there is very little rapport, if none at all, and the caller might start to come in with one or two different types of aggression depending on their state.

I have identified two types of aggression as either:

1. a: aggressive – they are venting anger but they are prepared to negotiate
2. A: Aggressive and not prepared to negotiate at all

As with many things I talk about in conflict resolution, this is all about building rapport because you have to build trust with the caller first before resolving anything.

Building Rapport – a: aggressive

On the telephone rapport is based on 84% tonality. In other words your attitude comes across in the tone of your voice. People are going to make their minds up quickly mainly based on your voice tonality. Your voice tonality is made up your volume, speed, pitch and your Timbre (the quality).

So if you start to match the voice tonality of the person on the other end, you are more likely to build some rapport with them. The easiest way to do this is to match the tempo/speed of their voice. Don’t match their aggression, just the speed! By doing this you are sub-consciously saying “I am like you. You can trust me because I am like you”. This is because the person we trust the most in the world is ourselves.

Just by doing this they will be far likelier to be receptive to your questioning or problem solving skills because they now have some level of trust in you. They are much more likely to take on your advice and take their time rather than simply ranting down the line at you.

If you can sort their problem you should do it quickly and SMART.

• S – Specific (Get to the route of the problem)
• M – Measureable (I will get back to you by 2pm this afternoon – did I get back to you)
• A – Alternatives (Giving the person different alternatives – refund, deduct money next month etc)
• R – Realistic (we will reimburse you etc)
• T – Time (I will get back to you by XXX – If you get back to them they will trust you because most people don’t get back)

Taking action with A: Aggression (not prepared to listen)

This is the most difficult person to deal with, you need some kind of pattern interruption by coming in at a slightly different angle. Now to do this you need to have their name and phone number before you do anything.

When you have all of their details, you tell them you won’t be able to help them whilst they are behaving like that.

My quick tips to deal with A: Aggression

1. You say the following quickly and bluntly:“I am not prepared to accept that behaviour”
2. You then hang up on them.
3. You then ring them back in about 15 mins with a new fresh tone offering to help.

You do this because it interrupts their pattern of anger. They didn’t expect you to put the phone down on them initially and they certainly didn’t expect you to ring them back. You can now offer them a gift – by solving their original problem.

Now they should like you a bit more because you have called them back and hopefully they are now a little a rather than a Capital A. They also know you will put the phone down on them if they get too aggressive. You have set the rules of the call. The 15-minute rule also doesn’t give them enough time to write a ranting email or letter of complaint, so you should have covered all bases.

I am not saying this works with every irate customer but these are good rules to go by.

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If you watch the video clip which I have included in this post, you can see the background to the event. In other words what was going on before this particular event actually took place. In the video you can see members of the public being aggressive and surging towards the police. They are moving towards the police aggressively and the police are clearly vastly outnumbered, which could cause them to fear for their lives.

Then Miss Fisher approaches Sgt Smellie in an aggressive manor and he uses what we call clearance strike to push her back and out of his way. You can see he uses the back of his hand – he didn’t use his fist or his baton.

After the strike, she then moves towards him again, in possible retaliation and she seems to have items in both hands. From the video you can’t tell what she has in her hands. They could be anything.

So Sgt Smellie honestly believed he was under attack and consequently under Section 3 of the Criminal Law Act was fully entitled to use reasonable force to protect himself. You can see on the video he drops his body level so he can strike Miss Fisher’s legs, rather than a strike at head height, which could have caused severe head injuries. Because he takes this approach he is demonstrating a measured response which shows he is trying to use reasonable force.

He only uses two strikes, he bends his knees and strikes twice. They are not life threatening blows but you have to remember he also didn’t know if she had a weapon or not. She had already been warned both verbally and with the clearance strike. It is my understanding that the CPS weren’t even interested in the clearance strike, they were only interested in the use of the baton, but the judge decided it was reasonable force and threw it out.

The IPCC still might sanction the police officer in some way. However, the police officer could theoretically sue the police for removing his human rights, Article Two is the human’s right to life. He could say you have taken away my right to defend myself.

The circumstances of the case were extremely public and I believe the Government had to be seen to be doing something but the judge just threw it out. It shouldn’t have gone to court in the first place. The problem is many people simply don’t know how these laws work and they cause confusion.

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In Switzerland they used the strategy that I think we should all use when it comes to conflict resolution.

The Swiss came from a very low base of no training and no conflict resolution solution at all, so they went from nothing to one of the best solutions in Europe by following these simple steps.

This particular case study they cited was on a local hospital where they surveyed a large number of people 1,500, in fact it was everybody in the hospital that they interviewed either directly or indirectly.

The interviewers asked them what caused the conflict, what time did it happen and where did occur? They even asked them to clarify which age groups were more likely to cause trouble. Their findings identified that on the whole it was caused by the young and elderly and bizarrely not the middle aged.

They also asked the interviewees what the patient was doing when the conflict occurred.

All of the data was collated and they worked out an exact picture of everything. Then when they knew everything about the conflicts they brought in some experts on conflict resolution to teach the latest models/strategy techniques to groups of staff.

Once they had taught the staff some techniques they then brought in professional actors and made the staff their new found techniques on an actor who was given a very specific role based on the research which was identified earlier.

In other words they reproduced the actual events, in the actual locations, to teach the staff on the job. They also video recorded the staff practising these techniques with the actor and then played the videos back to a panel and then the panel coached the individual trainee on how to improve on what they were already doing correctly.

Once they had completed this process they would teach them more models and gave them more difficult role plays to do. If they taught method A against scenario B and they would then mix it up and make it more difficult. 

They are going to feedback on what the impact of this style of coaching has achieved very soon. However, I know this will work because they use similar strategies in the pharmaceutical industry, this is what we had to do years ago on our training course. It works and in that case it made a massive difference in our ability to sell to people. All of the best companies are using these types of strategies because it forces you to raise your game and learn quickly

To be honest this is far less painful than getting attacked whilst working on the job in the NHS. I think the NHS should trial this in one hospital and test and measure it and evaluate it against the sickness./absenteeism levels. This style of training maybe costly at the outset but it could save our country billions.

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I think many people whether male or female often take the view that it won’t happen to them but sadly it can and does happen. Many public sector workers have to actually go into people’s homes and attacks can occur here too.

So here are my seven simple tips on personal safety:

1. Always tell someone (who you trust and you know is reliable) where you are going. If you can’t do that write it in a diary somewhere. If an attacker knows you and knows people know you are with them they are much less likely to attack.
2. Always carry a personal alarm – I think this is a very good idea. Most people think that an alarm is to raise awareness and get people to come to your rescue. An alarm is actually there to stop someone in the tracks because the attacker will have an attack ritual (plan). The alarm is to try and distract and break that ritual and put them off. The good thing is it may well alarm someone nearby indirectly too. Also if you use it close to the ear of the attacker that can have a very large impact. When buying an alarm what people need to realise is decibels are measured exponentially meaning that 138 decibels can be several times louder 100 decibels. Personally I would recommend a key ring gas personal alarm with a minimum of at least 138 decibels like this one. I would also recommend using a UV attack defence spray.  The spray emits thick slimy goo and stains the face and leaving a UV Tracer which can act as the ultimate device for defending yourself. It works on two fronts firstly it temporarily blinds someone and secondly it leaves the trace of UV behind. It’s half the size of a deodorant, so can easily fit into a handbag. If you spray someone in the face and it stays – it takes around 48hrs to get rid of the colour but the UV is still present. To see how effective it is check out the video I have embedded in this post.
3. Always try to meet other people in places where CCTV is present. For instance I networked at Harrogate International Centre yesterday and I was seen by about 30 cameras all day. People are far less likely to commit a crime if they are on camera.
4. Make sure your privacy settings on social networks like Facebook are set to their highest settings and be wary of people you have never heard of you approaching you on them.
5. Have a mag-light touch for your car, is a good idea to check who is in the vehicle before you get into it. There have been cases where people lay in wait in the back seat of a person’s vehicle. If you have a mag-light torch it could also double up nicely as a weapon if needs be.
6. Make sure you are a member of the AA or RAC, personally I think this is quite important. Because if you breakdown – you can call them quickly rather than standing by the roadside trying to call people over.
7. Always try to know your way into a building and always have an escape route planned, even if it involves jumping out a first floor window. I have taught my boys how to get out of our family home if there is a fire – instead of facing a fire. Be prepared, it is always.

I am not saying these small steps will save your life or that you have to be worried you are going to be attacked. What I am saying is you can be aware and have an alarm to help you if a situation like this occurs. I mean an alarm costs £19.99 and could save your life to me that makes (pardon the pun) good sense.

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“The NHS Security Management Service (SMS) has welcomed the revisions to the sixth edition of the Code for Crown Prosecutors, which highlights the public interest in prosecuting all those who attack health workers. The NHS Security Management Service (NHS SMS) – a division of the NHS Business Services Authority (NHSBSA) – was set up in 2003 to handle policy and operational guidance relating to the management of security within the NHS in England.

“Issued by the Crown Prosecution Service (CPS), the latest edition of the Code for Crown Prosecutors gives guidance to prosecutors on the general principles to be applied when making decisions about prosecutions. Previously, the Code gave limited specific examples of victims of offences who ’served the public’ – citing the police, prison officers and nurses. These examples have been broadened to specifically include ‘members of the emergency services’ and ‘a health or social welfare professional,’ among others.

This is really good new for both the NHS as a whole and my company as one of it’s accredited training providers. This is what we all wanted to hear; we want people to take aggressive acts against hard working NHS staff members seriously. Now that they are finally considering taking them more seriously it’s about creating some real momentum and making lots of noise about the issue.

Any attacks on a working member of the NHS is disgusting and the fact that people get away with it is even worse. This is about managers saying enough is enough, it’s also about the police taking a harder line with the offenders.

Furthermore, it’s about security managers in the NHS putting the right training and resources in place to avoid the situations altogether. What I am saying is all of this is about cultural change! Whether this is our course delegates, NHS staff managers and policy and security managers.

The CPS needs to realise this is impacting of what it is like to work in the NHS on a day to day basis. It needs to be a much safer and tidier place. The money is in the NHS (£100bn) but its because of inefficiencies that it isn’t used effectively). Did you know sickness in the NHS is 50% higher than the private sector?

In my opinion if you reduce violence and aggression in the NHS and you will reduce sickness and overall improve productivity. How is that for a cutback? You don’t have to cut staff this summer Mr Brown/Cameron – how about taking a tougher line with assaults on NHS staff. The knock on effect of all of this is the patient is more likely to actually get some treatment if the staff are at work and happy in their work.

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