Violence in the NHS (Hansard, 16 July 2002)

§ Lord Clement-Jones
asked Her Majesty's Government:
Whether they are taking sufficient action to tackle violence in the National Health Service.

§ The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath)
My Lords, action has been taken to tackle the problem of violence as part of the NHS zero-tolerance zone 1090 campaign. For the first time ever, that includes central funding to support a large number of local initiatives being introduced to protect staff.

§ Lord Clement-Jones
My Lords, I thank the Minister for that reply. The Government have talked tough on violence in the NHS for years now, but the latest survey from the Department of Health shows a rise from 65,000 to 85,000 violent incidents during the past two years. How will the department reduce violent incidents by 30 per cent during the next year, as its target states? Is it riot time to ensure that violent patients are banned from National Health Service treatment and prosecuted?

§ Lord Hunt of Kings Heath
My Lords, prosecutions have taken place. There are many examples of good practice. We have a policy on withholding treatment. I cite the example of Bart's and The London NHS Trust, which produced a policy on withdrawal of treatment from violent patients in September 2000. That has been an effective deterrent.
As for the baseline survey, of course the number increased. The original survey was incomplete because it lacked robust data requirements. The baseline figure of 85,000 reported incidents is for 2000–01. We are now beginning to measure the most recent financial year; we shall continue to measure. The target of 30 per cent is for financial year 2003–04.

Baroness Sharpies
My Lords, can the Minister tell us how many charges have been brought against those violent people?

§ Lord Hunt of Kings Heath
No, my Lords. that information is not held centrally, nor is it held by the Crown Prosecution Service. But there are recent examples of prosecutions. For instance, in the East Anglian Ambulance NHS Trust area, a man was sent to prison for four months for threatening paramedics with a crossbow and a replica gun. There are other examples of successful prosecutions. The key is getting across the message that we shall not tolerate violent action against our staff.

§ Baroness Masham of Ilton
My Lords, does the Minister agree that not only staff but patients need protection? There have been several cases of rape. Does he agree that it may be worth considering breathalysing disruptive and disorderly people on National Health Service premises for drugs and alcohol?

§ Lord Hunt of Kings Heath
My Lords, I am not sure about breathalysing, but I certainly agree with the noble Baroness that members of the publicpatients—have been the victims of violent assaults on NHS premises. That makes it important that the NHS has effective policies in place at local level to protect patients. Many of the measures that are being taken, including the introduction of closed-circuit television and the use of swipe cards in selected areas will have a protective effect for both patients and staff. At the 1091 same time, we are stepping up staff training so that they can deal with those difficult situations and, we hope, defuse what can otherwise become extremely nasty incidents.

§ Lord Walton of Detchant
My Lords, can the Minister tell us what proportion of those violent offences occur at weekends compared to other parts of the week? Anecdotally, it appears that many of those are alcohol-related incidents on Friday, Saturday and Sunday evenings. Would it not be wise for the Government to recommend that a higher number of security guards be available at times when those incidents are likely to take place?

§ Lord Hunt of Kings Heath
My Lords, clearly, the experience of each individual NHS trust is different, but I certainly agree with the noble Lord that many accident and emergency departments face especial problems in the late hours of the weekends and the early hours of Saturday and Sunday mornings. As for the use of security officers, I agree that a proper security policy in each trust would consider the number of incidents and match the presence of security personnel and other staff to ensure that sufficient people are present to deal with such incidents. My impression is that from almost a standing position several years ago, the NHS has become much more fully geared-up to deal with those issues.

§ Viscount Falkland
My Lords, were not the previous two supplementary questions an attempt to get the Minister to remark on alcohol and other substances? Is it not unusual for people in this country to become violent unless they are mentally unstable, have been taking either alcohol or other drugs or, possibly, have just got out of their motor car? If we removed all such cases from the incidence of violence in hospitals, would there be any violence left?

§ Lord Hunt of Kings Heath
My Lords, I am afraid that the extensive research that I have undertaken—which is of course available—does not help to answer that question. We do not know the causes of each of those 85,000 recorded incidents of violence. The noble Viscount is absolutely right: substance misuse and alcohol are a cause of many incidents. Sometimes, where there has been a violent incident in the community—whether or not caused by drink—the trouble can follow injured people into the casualty department and NHS staff have to pick up the pieces.
In common with many other sectors of society, members of the public in hospitals are less patient than they used to be. Staff often have to deal with incidents of rage. We need to give out a clear message to the public that we will not tolerate such incidents in future. The zero-tolerance campaign is beginning to work. The example of Bart's and other hospitals, which have withheld treatment, shows that we are taking the matter seriously.

§ Lord Stoddart of Swindon
My Lords, does the Minister agree that the continued use of mixed-sex 1092 wards increases the chance of attacks—especially on women? Will the promise completely to phase out such wards by the end of 2002 be kept? When we speak of single-sex wards, we mean real single-sex wards, not merely partitions and curtains.

§ Lord Hunt of Kings Heath
My Lords, the noble Lord has raised the question of mixed-sex wards on several occasions. I agree that they add to problems of security and violence, as well as being disliked by many patients in normal situations. We are well on the way to meeting that target.

§ Earl Howe
My Lords, did the Minister read the balanced and responsible press release issued by the British Medical Association last November, which supported the zero-tolerance policy but also pointed out the ethical and practical difficulties for doctors in withdrawing treatment from violent patients? Does he accept that there may be genuine medical reasons why a patient may behave violently or abusively? Does not that present an ethical dilemma for the staff involved?

§ Lord Hunt of Kings Heath
My Lords, I do not always associate the BMA with balanced press releases, but there is always hope. Yes, of course we must accept that there are ethical dimensions to the withholding of treatment. But we have discussed that carefully with representatives of the National Health Service. Life-saving treatment will always be available.
I mentioned the example of the approach taken at Bart's. There, they have introduced a policy of withdrawal of treatment from violent patients, known as the yellow and red card scheme. The use of yellow cards has a deterrent effect, and, although the trust has issued 12 yellow cards, it has proved necessary to issue only one red card.
There is a balance to be struck, and there is an ethical dimension. However, if we are to get over to the public the fact that such incidents will not be tolerated, we must show that we mean business.