Attacks on NHS Staff

Philippa Whitford Excerpts

Monday 27th February 2017 Westminster Hall

[Holly Lynch]

My hon. Friend is right. That is exactly my concern with the assault police charge, which I have explored in detail through my “Protect the Protectors” campaign. The maximum sentence for that charge does not seem to reflect its seriousness. We have to look at all the options available for sentencing.

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

Hon. Members have mentioned that Scotland already has the Emergency Workers (Scotland) Act 2005, under which the maximum sentence for common assault is 12 months and the maximum fine is £10,000. That is about twice the general range in the rest of the UK. In Scotland, serious assaults like some of those that the hon. Lady describes are charged not under that Act but as serious assault, GBH or attempted murder, so the Act is very much for common assault.

[Holly Lynch]

I thank the hon. Lady for that intervention. Again, in assault police charges we found that people were being sentenced under other crimes, which distorted the collection of information on frequency and prevalence of people committing those acts and brought into question the need to have a stand-alone assault police charge, if it is not effective in that regard. I approached the matter by asking what is the best way to sort out some of those charges, and what can we do? In putting together my Bill, it seemed like this was the best option.

One of the other aspects of my ten-minute rule Bill —it has been touched on already—would require someone who spits at or bites an emergency service or NHS professional to provide a blood sample to determine if that professional is at risk of contracting a communicable disease and would require antiviral treatment. If the Government were to adopt my Bill, it would become an offence to refuse, without reasonable excuse, to undergo such tests, much in the same way as it is to refuse a breathalyser test. That could save someone potentially unnecessary and invasive treatments as well as months of uncertainty and anxiety about whether they have contracted a potentially life-changing disease.

That anyone would assault or spit at an NHS worker is an absolute disgrace. The work that they do, often in the toughest of circumstances, should be met only with gratitude and admiration, never with violence. In seeking to protect them and all emergency service workers and NHS staff, my ten-minute rule Bill aimed to send a strong message. However, while it had cross-party support and proceeded unopposed, I am not naive about the nature of ten-minute rule Bills presented by Opposition Back Benchers; nor am I under any illusions about where we are in the parliamentary calendar. I therefore urge all MPs and campaigners to explore every opportunity to take action and bring about the changes we would like to see.

The spirit of my Bill was to say loud and clear that the public and elected representatives as legislators are on the side of NHS workers, and anyone who deliberately seeks to inflict injury on our medical professionals will feel the full and unavoidable force of the law. I wholeheartedly support any and all means of doing just that.

[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.

[James Gray (in the Chair)]

Order. We have plenty of time left, and, slightly unusually, I intend to call one further Back Bencher before the winding-up speech by the Opposition spokesman. I call Alex Chalk.

--- Later in debate ---

[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.

--- Later in debate ---

[Gavin Robinson]

rose—

[Dr Whitford]

rose—

[Mr Gyimah]

I will give way to the hon. Gentleman.

[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.

[Dr Philippa Whitford]

rose—

[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.”

[Dr Whitford]

rose—

[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.