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The Parliamentary Under-Secretary of State for Justice (Mr Sam Gyimah)
I am pleased to serve under your chairmanship, Mr Gray. I thank my hon. Friend the Member for Hertsmere (Oliver Dowden) for introducing this debate and all hon. Members who have spoken. I also extend my thanks to LBC for its campaign on the assault of NHS staff, which has raised awareness of the issue.
I will start with where we all agree with the petition: any attack on NHS staff is completely unacceptable. More than 1 million people earn their living in the NHS. They are committed to providing health services and work incredibly hard in a high-pressure environment. They should not expect or experience aggression or violence at work. Patients and members of the public should respect NHS staff and must not be abusive or violent towards them. I will begin by looking at what we can do to ensure that assaults on NHS staff are dealt with seriously, much in the vein of what my hon. Friend the Member for Cheltenham (Alex Chalk) said. I will focus on prevention, better law enforcement and prosecution.
As with any kind of crime, the best and most important solution to violence against NHS staff is to prevent it from being committed in the first place, through measures to protect staff and by managing potentially risky situations before they escalate. Employers in the NHS are responsible for assessing the risk of violence to their staff, taking action to address those through prevention work and pursuing legal action when assaults do occur.
The NHS has introduced a range of measures to combat workplace violence, such as conflict resolution training and guidelines for lone workers. Again, as with any other crime, if NHS staff are attacked, the next solution is effective law enforcement. The NHS is working with the police and the Crown Prosecution Service to ensure that even low-level violence is treated seriously and that offences are prosecuted. Rigorous enforcement of the current law sends a strong message about the unacceptability of violence and makes staff feel safer and more confident to do their job.
What effective law enforcement means in the large and complex situation of the NHS is encapsulated in the joint working agreement on tackling violence and antisocial behaviour in the NHS between the police, the Crown Prosecution Service and the NHS, signed in 2011. It sets out steps to improve the protection of NHS staff; strengthen the investigation and prosecution process by improving the quality of the information exchanged; and improve victim and witness support. That protocol is currently being updated—for instance, to include aide-mémoires for the police, the CPS and NHS staff. The revised version is due to be in place in the coming months.
There is, frankly, a lot more we need to know about the circumstances of attacks. We have heard a number of examples in this debate, but what we do not know about all of those is, for example, whether the person was actually prosecuted. Are we talking about cases where someone’s elderly grandmother with dementia wakes up confused and lashes out against an NHS worker? We need to do a lot more work on what is going on. Centrally, we do not know who the assailants were in all cases, whether they were patients or members of the public or, if they were patients, what they were suffering from and what was happening to them at the time of the incident.
To delve into that further, I would like to extend an offer to convene a meeting between my hon. Friend the Member for Hertsmere, my right hon. Friend the Minister for Policing and the Fire Service, the Solicitor General and Lord O’Shaughnessy, the Parliamentary Under-Secretary of State for Health. We can then explore how to better build the evidence base.
I will now look at the appropriate law enforcement response in more detail. First, there should be no hesitation in involving the police as needed. To support that, the joint working agreement or protocol sets out guidance and best practice on contact and liaison between NHS staff and the police, incident reporting, the police response to incidents, investigations and victim-witness communication. Before we look at having a specific law, we need to ensure that the protocol is working as effectively as it should.
The next stage of the law enforcement solution to attacks on NHS staff in the criminal justice process is prosecution. At that point, and throughout the process, there is a particular emphasis on the seriousness of assaults on workers serving the public, including in the NHS. All cases referred by the police to the CPS are considered under the code for Crown prosecutors. Under that code, prosecutors must first be satisfied that there is sufficient evidence to provide a realistic prospect of conviction. If there is, prosecutors must then consider whether a prosecution is required in the public interest. The relevant section of the code for Crown prosecutors says:
“A prosecution is…more likely if the offence has been committed against a victim who was at the time a person serving the public.”
The protocol states:
“In all cases, the fact that an offence has been committed against a person serving the public will be considered an aggravating factor. There is a strong public interest in maintaining the effective provision of healthcare services and the CPS should always consider whether the individual incident has further aggravating features that may influence a decision on disposal.”
If the evidence is there and the code is satisfied, the CPS will prosecute.
When an offender is convicted, sentencing guidelines specify that an offence committed against those working in the public sector or providing a service to the public is an aggravating factor. Courts have a statutory duty to follow those guidelines and, as such, offenders who assault someone providing a service to the public could face a higher sentence than that imposed for assaults committed in different circumstances. In response to the petition, I have been in touch with the Director of Public Prosecutions to ensure that where these cases appear before the courts, the status of a frontline public sector worker is clearly drawn to the court’s attention as an aggravating factor.
Alex Chalk
May I thank the Minister for what he said about bringing that fact to the court’s attention? A victim impact statement can be provided to indicate the impact that a crime has had on the victim. It is critical the court understands front and centre that if the victim is a public servant, the court must treat the case more seriously and punish more severely as a result.
Mr Gyimah
My hon. Friend makes a forceful point. That is precisely what the engagement with the Director of Public Prosecutions is meant to achieve, and I would like to involve my hon. Friend the Member for Hertsmere in those discussions.
Prevention and effective law enforcement, through collaboration between the NHS, the police and the CPS, are the best solutions to the problem of attacks on NHS staff. This debate is about a specific criminal offence. As has been mentioned, there are already comprehensive provisions in criminal law for dealing with a wide range of attacks and assaults. The relevant offences include common assault; assault occasioning actual bodily harm, where the injuries are more than superficial; wounding or inflicting grievous bodily harm; and wounding or causing GBH with intent. All those offences cover every victim, whatever their occupation. Depending on the particular offence and the seriousness of the criminal conduct, the penalties available to the courts range from a maximum of six months’ imprisonment, a fine or both for common assault, through a maximum of five years for ABH or GBH, to a maximum of life imprisonment for wounding or causing GBH with intent.
Given the current offences framework and sentencing guidance, which make provision for an increase in sentence to be considered where an assault victim is a public sector worker, I am not persuaded that there is a need to create a specific offence for this group of workers. Of course, as my hon. Friend the Member for Hertsmere pointed out, some specific offences of assault apply to particular occupation groups, such as police officers. As the Minister responsible for prisons, I am aware of the specific offence of assault against prison officers.
Dr Philippa Whitford
Can the Minister clarify why prison officers and immigration officers warrant that extra protection, but healthcare workers looking after patients do not?
Mr Gyimah
That is a very good question. The first point I would make is that even in the case of prison officers, where there is a specific offence, the most important thing is better law enforcement. The fact that a specific offence exists does not on its own lead to an increase in prosecutions. What is needed is the better law enforcement that I have outlined. There is also a wider point. It is recognised that, by the very nature of the roles that have been mentioned, the individuals working in them are likely to be assaulted in the course of their duties. That is why the law provides specific protection. The law currently makes a distinction between those occupations and others serving the public, although, as I have said, if there is an attack against someone serving the public, that is treated, and should be treated, as an aggravating factor in law.
Dr Whitford
I thank the Minister for giving way again. Does he not accept that 70,500 attacks on NHS staff means that they, too, face the likelihood of being assaulted at work?
Mr Gyimah
The evidence clearly suggests so, but let me come on to my other point and the point about Scotland, which the hon. Lady mentioned. All the occupation-specific offences have the same maximum sentence—six months’ imprisonment, a fine or both—as common assault. As I have already said, where the offending behaviour is more serious, more serious offences and penalties are available. Having the specific offence does not change the sentence that someone can receive.
Gavin Robinson
The first step that the Minister mentioned, with the Director of Public Prosecutions, is an important one, but has he carried out any analysis with the Lord Chief Justice to see how much greater the penalty is for someone found guilty of common assault on someone in a particular occupation? Does he think that there would be benefit in saying, in the round with this type of offence, that although the penalty would have been three or four months, because of the aggravating factor of the victim’s occupation, there will be an additional penalty that is clearly spelt out by the courts, so that the factors that will deter a person from attacking someone whom we want to protect are clearly defined and outlined? If such analysis has not been conducted, I suggest that it should be.
Mr Gyimah
As I said earlier in my speech, a piece of work does need to be done on who is doing the assaulting and what has happened. I gave the simple example of a grandparent suffering from dementia who wakes up confused and lashes out. It is not as simple as saying that they have assaulted a member of staff in the NHS and therefore they should go to court, be convicted and get a long sentence. The key point, when people make this argument, is the belief that the creation of a new offence of assaults on health workers would deter such attacks and so offer better protection for NHS workers or result in more prosecutions than occur under current legislation.
Mr Gyimah
I would like to develop my point. I am aware that in Scotland there is a specific offence of assaulting health workers on hospital premises. Sadly, however, the number of assaults on NHS staff in Scotland has continued to grow since the legislation was introduced. In 2010, the Scottish Government stated:
“There is no clear evidence that the 2005 Act has been a success in acting as a deterrent.”
Mr Gyimah
I need to develop my argument. The Scottish legislation raises a number of other points, some of which I have touched on. Would the offence, as in Scotland, apply only to attacks on NHS staff on hospital premises? There are many other NHS locations. Would it apply to attacks by patients or also to attacks by visitors and family members? How would “NHS staff” be defined? Many people work in the NHS without being employed by it. Would the offence apply only when staff were on duty, or when they had left the premises and were at a bus stop outside the hospital? However those questions were resolved, every specific circumstance applying to a new offence would be an additional element for the prosecution to prove, over and above a charge of common assault.
Dr Whitford
I thank the Minister for giving way again. I wanted to intervene again to point out that in 2008, the maximum sentence for the offence in Scotland was changed to 12 months’ imprisonment and/or a £10,000 fine, so it is not exactly the same as for other common assaults. The protection is not just for staff in hospitals. The 2005 Act already covered blue-light workers, their assistants and particular classes of people, and in the 2008 renewal of the Act, it was extended to all, including volunteers and assistants, so it is not just about hospital staff. As I said in my speech, it includes lifeboat, coastguard, ambulance and fire service workers—all emergency workers.
Mr Gyimah
The hon. Lady’s question points to precisely that definitional issue. As we have gone through the debate, the definition of “NHS worker” has expanded with each speech we have heard.
I will bring my comments to a close where I began. Any attack on NHS workers is unacceptable. It is right that the House is debating this issue today, and right that LBC raised it. I would like to pursue, with my hon. Friend the Member for Hertsmere, a way of ensuring that the joint working agreement actually works; that we have the right evidence to understand what precisely is happening; and that, where what we are discussing should be treated as an aggravating factor by the CPS and the courts, that is indeed happening. I strongly believe that, as my hon. Friend the Member for Cheltenham said, we need to act urgently to ensure that the law, as it stands, is implemented properly, so that NHS staff are protected. That is the best way to ensure that they can go to work and not have to suffer some of the violence that they have suffered.