Attacks on NHS Staff

Gavin Robinson Excerpts

Monday 27th February 2017 Westminster Hall

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

It is an honour to serve under your chairmanship, Mr Gray. As many people in the Chamber know, I spent 33 years working in the NHS, and I have been on the receiving end, as other Members may have been.

I remember a particular incident in a breast cancer clinic. I was warned by the nurses before I went into the room that the husband was very angry, not at anything I had done but at something on the way that had upset him. That is often the situation. It is not necessarily someone who would normally be violent or worked up. They are frightened for the person they love. That can be in A&E, where they have been sitting for hours and people are going past them, or it can be in the situation I had. What I had was a man about 6 inches from my face with both fists clenched. Because the staff knew about it, they were not seeing anyone else and had their ears at the door. The problem for me was that I could not afford to fall out with this man, because the pale woman sitting in a chair had breast cancer, and I knew I would have to work with the two of them afterwards.

The challenge of de-escalating such situations is enormous. NHS staff can become very good at it, but if they are under time pressure—we have seen that this winter in accident and emergency—it can pour petrol on the flames. Someone is saying, “Excuse me! Excuse me! Can I speak to you? My wife is ill,”—or “my child is ill”—and people are running past all the time. Eventually, a gasket blows. It is not always someone with tattoos of “love” and “hate” or whatever, making it obvious that they are trouble; it can be someone who is frightened. To de-escalate that requires training, support and back-up. More than anything else, it requires time, so that when we spot that something like that emerging, we can put the time into that person to explain their situation and what will happen next and to look at what they are worried about. If everyone is rushing to someone who is more ill, that situation will spiral out of control.

The hon. Member for Hertsmere (Oliver Dowden) mentioned people who work on their own and providing them with lone-worker devices. I agree with that. However, the hon. Member for Halifax (Holly Lynch) talked about someone responding to 999 calls in an ambulance on their own, which is probably not altogether appropriate. In particular, if we have a patient in the community who has been noted as being violent or aggressive in the past, social care workers and others should not be sent to that person by themselves.

In my health board, we have a service where someone who keeps being violent or aggressive in primary care is removed from that practice. Specialist primary care has been developed to provide care for people who have anger issues or violence issues so that care can be given in a protected way, not—we keep hearing about the seven-day NHS—by a female GP at half-past 7 at night when there is hardly anyone left in the practice. Some of the issues need to be thought about in advance. We need to think about how we set up the system and how we organise things in particular so we do not always end up with a kettle whistling shrilly, which is what we have seen over the past winter.

It is quite difficult to get accurate or comparative data. In England data are gathered through NHS Protect. It sends a bad message that a consultation is starting this Wednesday at the end of its contract—it is due to finish at the end of March—with NHS staff none the wiser as to who will protect them or collect the data. That is a terrible message to send out in the face of such escalating numbers across NHS England. In Scotland we have Datix information, which is the same as we use for any non-standard occurrence in a hospital or medical situation.

Members have mentioned the Emergency Workers (Scotland) Act 2005, which was updated in 2008 to ensure that it extended to all community workers—GPs, mental health workers, social workers, social careworkers and people assisting them—and many of the points made by the hon. Member for Halifax about her ten-minute rule Bill are covered by that Scottish Act.

That Act did not of itself bring the numbers down; as in England, they were climbing. The turnaround seems to have been five years ago in 2011-12, and part of that was because we, too, started to have practically a zero-tolerance campaign. People who walked into accident and emergency saw posters that said, “This is not acceptable behaviour and it will not be accepted.” It was easier to do that when we could say, “This was so important that we made a separate piece of legislation to protect all emergency careworkers.” The Act includes coastguards and lifeboat volunteers at the Royal National Lifeboat Institution—they are all covered in Scotland. That is a really important message to send out for a zero-tolerance campaign.

In the past five years our numbers have decreased by 10% and the number of violent offences taken forward by the police and prosecuted has decreased by more than a quarter. It does therefore appear to be having an effect, although the numbers are still shockingly high and something that we should not see.

In response to the Government’s comment about a new charge being unnecessary because it is covered by the offence of assault, we must remember that people in other businesses, and even in other public services, can bar someone and walk away. A healthcare worker cannot walk away. We have a duty of care no matter how aggressive, no matter how rude and no matter no violent someone is being, particularly if they are ill.

The hon. Member for Heywood and Middleton (Liz McInnes) mentioned that she would not support an automatic custodial sentence because many of these people have mental health issues. However, the NHS Protect data show that even when we exclude people with a medical cause or medical excuse for violence, ambulance staff report half of the assaults on them, but the acute sector—that includes acute wards and A&E— and mental health sector report fewer than 5% of all assaults. Creating an offence can encourage people to report.

[Gavin Robinson (Belfast East) (DUP)]

That is an important point, because part of the prosecutorial decision is whether prosecution would be in the public interest. The Crown Prosecution Service published some useful guidance three years ago about how many cases perpetrated by someone struggling with mental health issues were discontinued, or not advanced, on the basis that to pursue them would be against the public interest; so that criterion already exists. While the 5% figure represents what could be reported, prosecutors often decide not to pursue a matter on the basis I have set out. That does not go against the strong argument for a stand-alone offence.

[Dr Whitford]

The NHS Protect data clearly separate out the assaults with no medical cause, and then focus on what percentage of those are reported. The number is remarkably low.

The data that we are capturing in Datix, which shows high numbers in Scotland as well as in England, include verbal assaults and racist comments. Sadly, with some of the reaction after the EU referendum last year, we have seen horrific reports of people from the EU who work here—and make up a significant proportion of medical and nursing staff—being racially abused by the people they look after. As every Member of the House has tried to do in debates since the referendum, we must send out the message that that is unacceptable. An Act relating specifically to all types of emergency worker, both in the community and in hospital, would send a strong message and would have an effect. The fact that staff cannot turn away must be taken into account.

Just because a patient has a mental health issue, a learning disability or, particularly, dementia, it is not any less distressing for a member of staff to be punched in the face, have their glasses broken, or be cut or scratched deeply by someone’s nails. That comes back to how situations are managed. It should be possible, as soon as any incident occurs—or any perception arises of a patient beginning to develop violent tendencies—for a social careworker not to be sent in alone to deliver personal care to them; planning for the patient’s care should be done in a responsible way by the team, for both the patient and the staff member.

--- Later in debate ---

[Gavin Robinson]

rose—

[Dr Whitford]

rose—

[Mr Gyimah]

I will give way to the hon. Gentleman.

[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.