Attacks on NHS Staff

Alex Chalk Excerpts

Monday 27th February 2017 Westminster Hall

[Holly Lynch (Halifax) (Lab)]

May I join colleagues in saying what a pleasure it is to serve under your chairmanship, Mr Gray? I hope that right hon. and hon. colleagues from across the House are familiar with my “Protect the Protectors” campaign, and I am truly grateful to the many who have lent it their support. As part of that campaign, I have lobbied for protections that would cover all emergency service workers and NHS staff. I will outline what needs to change and how we should go about it.

My campaign started last summer after I spent a Friday evening in August on patrol in my constituency with West Yorkshire police. I joined PC Craig Gallant, who was single crewed and responding to 999 calls. When a routine stop quickly turned nasty, I was so concerned for his safety that I rang 999 myself to stress just how urgently he needed back-up. Thankfully, other officers arrived at the scene shortly afterwards to help manage the situation. Although, amazingly, no injuries were sustained on that occasion, I saw the dangers for myself and understood just how vulnerable all emergency service workers are, especially when they are out on their own.

Since being elected in May 2015, I have spent time shadowing all the frontline services in my constituency to understand the work they do and the pressures they are under, and to inform my work here on their behalf, but I confess that I am also the daughter of a retired police sergeant and a nurse. [Hon. Members: “Hear, hear!”] Thanks very much. Both my parents were subject to abuse in their roles as public servants, so I feel very strongly about this issue. I have done shifts with the emergency services—the police, the fire and rescue service, and paramedics—and spent time with doctors and nurses in A&E. I also spent a Friday night with out-of-hours mental health services and I will spend a day with the local search and rescue team in the next few weeks. May I take this opportunity once again to pay tribute to the work that they all do? Behind their uniforms, they are incredibly brave and dedicated individuals who, regrettably, face risks almost daily that they simply should not have to face.

Our emergency services and NHS staff routinely go above and beyond their duties to keep the public safe, and the law must convey in the strongest possible terms how unacceptable it is for someone to set out deliberately to injure or assault an emergency responder or NHS worker. As we have already heard, NHS Protect figures show that there were 70,555 assaults on NHS staff last year—a significant increase on the year before. A report published just before Christmas by Yorkshire ambulance service revealed that its staff face violence and aggression weekly. There was a 50% increase in reported incidents of verbal and physical attacks on staff, with 606 incidents reported in 2015-16. Richard Bentley, a paramedic in Leeds, told the BBC that he had faced three serious assaults in five years. He had been bitten, head-butted and threatened with a knife.

I sought to do something about that unacceptable violence directed at our most dedicated public servants by drafting a ten-minute rule Bill, which I presented in the Chamber earlier this month. The Crime (Assaults on Emergency Services Staff) Bill would extend protections to all emergency service workers and—crucially in relation to this debate—would cover paramedics, doctors and nurses.

The petition, which was launched on 22 December by LBC presenter Nick Ferrari—I commend Mr Ferrari and LBC for their role in this campaign—calls on the Government to make it

“a specific criminal offence to attack any member of NHS Medical Staff.”

However, in consultation with several bodies representing all the emergency services workers with whom I have spent time, I agreed that it would make sense to seek to amend existing legislation to make assaulting an emergency service worker or NHS worker an aggravating factor in existing criminal charges, for several reasons.

[Alex Chalk (Cheltenham) (Con)]

The hon. Lady is making a powerful speech. It goes without saying that assaults on NHS staff are appalling, but does she agree that our NHS staff want to know that any changes will make a meaningful difference to their safety and to enforcement? Given that the maximum penalty for assault of a police constable is six months, which is the same as the maximum penalty for common assault, I query whether a change in offence would actually make a difference. The key is enforcement. People want to know that if they are attacked, the police will come around, make arrests and throw the book at the people who did it.

[Holly Lynch]

I will come on to some of the problems that we identified with the stand-alone assault police charge, which led us to seek to amend existing legislation. The hon. Gentleman makes an interesting point, which I will come on to in more detail.

The petition states that for

“twenty years it has been a specific offence to attack a Police officer conducting their duties”

and refers to section 89 of the Police Act 1996, which deals with assault police charges. However, although that section sets a precedent for making assaulting a particular sector of public servants a stand-alone offence, it was precisely because of that legislation’s shortcomings that we sought to do things differently and more comprehensively.

Assault police charges are summary only, so are triable only in a magistrates court. As the hon. Gentleman rightly says, the maximum custodial sentence for even the most serious assault police charges under section 89 —so-called category 1 offences—is 24 weeks, with offenders more likely to receive a fine or community order. Even if someone is given a custodial sentence for a category 1 offence, the sentencing guidelines for section 89 offences propose three questions:

“Has the custody threshold been passed?…if so, is it unavoidable that a custodial sentence be imposed?…if so, can that sentence be suspended?”

To me, none of that reinforces the seriousness of the crime or, more crucially, acts as a deterrent. I have seen examples of repeat offenders who, due to the problems with the assault police charge, have effectively collected suspended sentences. I share that information simply to explain why I have arrived at my proposals, which I believe would make our emergency services and NHS workers safer in their roles.

My Bill would make offences including malicious wounding, grievous or actual bodily harm and common assault aggravated offences when perpetrated against a police constable, firefighter, doctor, paramedic or nurse in the execution of his or her duty or, significantly, against someone assisting such persons in the execution of their duty. It would therefore cover NHS staff more broadly, which my hon. Friend the Member for Heywood and Middleton (Liz McInnes) mentioned. The Bill would ensure that tougher sentences were available to the judiciary when sentencing someone convicted of assaulting an emergency responder or NHS worker. As I said, the sentences handed down to offenders convicted of such acts must reflect the seriousness of the crime and, more crucially, serve as a tough deterrent to dissuade others from even considering committing such violence towards NHS workers in the first place.

[Alex Chalk]

The hon. Lady makes a really interesting point, but the maximum penalty for causing grievous bodily harm with intent is life imprisonment in any event, and judges have sufficient sentencing powers to reflect the gravity of the aggravating factor of the attack having been on a public servant. Given that judges already have certain sentencing latitude, how would she change things?

[Holly Lynch]

I welcome the hon. Gentleman’s intervention. It is perhaps just an issue of clarity and the weight that comes with such uniformed service roles. Perhaps the problem is as simple as someone who is particularly angry and comes into an A&E department and lashes out at an NHS worker, not understanding that deterrent. We must explore how to ensure that that deterrent is understood by people who arrive at A&E departments.

--- Later in debate ---

[Alex Chalk (Cheltenham) (Con)]

It is a great pleasure to serve under your chairmanship, Mr Gray. I congratulate my hon. Friend the Member for Hertsmere (Oliver Dowden) on securing the debate and the hon. Member for Central Ayrshire (Dr Whitford), who made a powerful speech. The starting point, although it is perhaps obvious, bears emphasis. Assaults on NHS staff are appalling and people watching the debate will find it astonishing that they are so prevalent. The hon. Lady seemed to suggest that they are an occupational hazard, and that fact is as serious as it is appalling. Everyone in the House, as well as people beyond this Chamber, will share my consternation.

Another point that is obvious but bears emphasis is that the law must come down hard on people whose conduct is so despicable. However, it is important that the debate should not lead NHS staff, including those in Cheltenham general hospital in my constituency, to feel that what is proposed is mere window dressing. I imagine that they would want what I certainly want on their behalf: concrete action to improve enforcement and, picking up on a point made just now, to create a culture of zero tolerance. There may be any number of offences on the statute book, but without the resources to investigate them and the will to prosecute them, they are of no more than academic interest. We should focus resolutely on creating measures that will make a meaningful difference and inculcate the culture of zero tolerance.

I mention that because, as I said earlier, the offence of assaulting a police constable carries a maximum of six months in prison. That is the same as for common assault. I remind hon. Members that common assault is a battery where the harm that is caused is merely “transient or trifling”. If it is more serious than that, it becomes assault occasioning actual bodily harm, with a maximum penalty of five years. That can apply to a police officer or a person in the street, in the normal way. However, in my time in practice, when I was prosecuting offences of assault PC, the message that often came back from police officers was: “Our concern is that this offence is not taken seriously enough or prosecuted enough.” It was not so much that a defendant had been prosecuted for assault PC rather than for common assault; the question was whether assaults on police officers were taken seriously by being investigated and by charges being brought. It is the same in the case that we are considering. We must be clear: if we create a further offence, will it mean that the people in A&E think there is a better chance of securing justice? Shiny new legislation will not in itself achieve that. What is needed is the will and resources to make it happen.

That is the simple point that I wanted to make. Those who go out of their way to work in our public services, and who, notwithstanding the fact that they are abused, assaulted and jeered at, come back to show compassion, need to know that law and order are on their side. By all means let us consider creating another offence if that is what we want, but it should not be a fig leaf for the fact that there is something more important: when a member of staff in A&E has cause to make a complaint to the police that she has been spat at or abused, the police should turn up, arrest the individual and throw the book at them. As the hon. Member for Heywood and Middleton (Liz McInnes) said, ultimately the sentence must be a matter for the court, and in a fair society we would not have things any other way, and nothing we do here should diminish that key priority of enforcement.

--- Later in debate ---

[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.