Monday 27 February 2017
[James Gray in the Chair]
Attacks on NHS Staff
I beg to move,
That this House has considered e-petition 176138 relating to attacks on NHS medical staff.
It is a pleasure to make these introductory remarks under your chairmanship, Mr Gray. The petition highlights the rising problem of attacks on NHS staff, an issue with which I am very familiar from my constituency work. Indeed, local GPs recently raised it with me in my surgery in Radlett. I pay tribute to listeners of London’s LBC radio, who backed this petition as part of the Guard our Emergency Medical Services—GEMS—campaign. Their support for the petition helped to push the number of signatures well over 100,000, which the Petitions Committee usually takes as a benchmark for triggering a debate in this place. I also thank the Royal College of Nursing and the many other representative organisations that have contacted me to highlight the scale of the problem. It is clear that the petition has struck a chord with the public and hon. Members.
The raw facts speak for themselves: there were more than 70,000 recorded assaults on NHS staff in England in 2016—an increase from nearly 68,000 in 2015 and 60,000 in 2004. In the NHS trust serving my constituency, there were more than 1,000 recorded assaults last year. A recent RCN members’ survey found that 56% of nurses had experienced physical or verbal abuse from patients, and a further 63% had experienced abuse from relatives of patients or members of the public.
Those statistics tell only one side of the story. Since I agreed to lead this debate on behalf of the Petitions Committee, I have been inundated with examples of the scale of the problem. I will cite just a few, which were compiled by 38 Degrees. An NHS staff nurse said that in her
“20 year nursing career I have been spat at, punched, kicked, verbally abused…and even had a cardiac monitor thrown at my head!”
Another said that she works
“in an A&E department as a staff nurse. On a daily basis I see some sort of aggression whether this is physical or verbal towards staff. I can’t recall a day that has gone by where we’ve not had to have security or the Police in the department.”
Perhaps more worrying is evidence given to the Petitions Committee by the Royal College of Nursing, which suggests that some female nurses fear that they are seen as “fair game” for sexual assault. I am sure hon. Members find that appalling.
This problem does not just affect NHS staff working in hospitals and GP surgeries. Concerns have been raised about the safety of lone NHS workers—for example, nurses visiting care homes. Such violence against NHS workers is clearly completely unacceptable, and all Members of the House agree that we must not stand for it. This debate is an opportunity to highlight the problem and send a clear signal from this House that it cannot be tolerated. It is also an opportunity to consider measures to tackle it.
The petition calls for higher legal provision and protection to be extended to NHS staff, making it a specific offence to assault them. As the petition makes clear, that protection is already afforded to police officers under section 89 of the Police Act 1996, and my research indicates that it is also a specific offence to assault prison and immigration officers. It is also an offence to assault doctors, nurses and midwives in Scotland. I raised that point with the Prime Minister at Prime Minister’s questions, and I know from both the response I received subsequently from her and the Government’s response to the petition that they take this problem seriously.
I understand that the current position is that, first, to ensure that prosecutions are brought forward once a charge has been made, the code for Crown prosecutors makes it clear that a prosecution is more likely if the offence has been committed against someone who was serving the public at the time, which includes NHS workers. Secondly, at the sentencing stage, the fact that an offence was committed against a person working in the public sector is an aggravating factor, which means that it is considered as adding to the seriousness of the offence, thereby meriting a longer sentence within the maximum penalty available. In addition, current sentencing practice indicates that custody is used as a starting point for assaults on public servants.
Although what the hon. Gentleman said about aggravating factors, which are set by the Sentencing Council, is important, the argument for having a specific offence rests on the fact that medical staff often deal with people in stressful and sensitive situations, so they deserve a better level of protection equal to that afforded to police officers.
The right hon. Gentleman makes an apposite point, which I was just about to come on to.
I welcome the progress that has been made as a result of the petition. I understand that the Government have committed to updating the protocol on tackling violence in the health system, which will involve the police and the Crown Prosecution Service, and I would be grateful if the Minister could update us on that in his concluding remarks. Like the right hon. Gentleman, I urge the Government to keep an open mind about creating a new specific offence.
My hon. Friend is making an excellent speech on a subject that is close to many of our hearts. I pay tribute to all those who work in the NHS and do a wonderful job. I wish to raise an issue that my police and crime commissioner raised with me, which affects all those who work in the emergency services—that of spit guards. The PCC has written to the Home Office to ask it to research this issue further and to hold a public consultation. What is my hon. Friend’s view on how we can stop people spitting on people, which is just as much of an assault as thumping someone? Perhaps the Minister will inform us how far down the road we are on that issue.
My hon. Friend is absolutely right, and hopefully this debate will provide the opportunity not just to discuss a specific new criminal offence but to look at preventive measures. Certainly, spitting at NHS staff is completely unacceptable, and any measures we can take to prevent it would be most welcome. Like him, I would be grateful to hear the Minister’s reflections on that point.
Returning to the argument about why we need a specific offence, I understand the Government’s point that existing measures already prioritise prosecuting and sentencing assaults on NHS workers. All assaults are unacceptable, but the fact that we have created specific offences for police, immigration and prison officers, but not one for NHS workers, might amount to a discrepancy. It is important that we send the strongest possible signal from this place that such assaults are unacceptable, and creating a specific offence is one way to do that.
It is important to stress that a new law is not a panacea. This debate provides an opportunity for a wider examination of safety issues surrounding NHS workers. I have a number of issues to raise, and I would be grateful if the Minister addressed them in his remarks. Concerns have been that only about 10% of physical assaults result in criminal sanctions. I would be grateful if the Minister could confirm whether the Government’s promised review of the protocol will look at how that low level of prosecution can be addressed. In addition, the consultation that the Petitions Committee held on this debate suggests that there is scope for more effectively training security staff at NHS facilities in how to deal with violent behaviour to ensure that difficult situations do not escalate.
Further work can be done on preventive measures. My hon. Friend the Member for South Dorset (Richard Drax) mentioned spit guards. Other possibilities mentioned to me include the provision of lone-worker alarms for NHS staff visiting care homes on their own and better designed environments that make it harder for violent offences to be committed. There is, however, concern about the future of NHS Protect, so will the Minister provide some clarity on that?
A wider question concerns changing attitudes towards NHS staff. The Petitions Committee received evidence that some people have an entitlement attitude—“We’ve paid our taxes”—which is sometimes used to justify aggressive behaviour towards NHS staff. That needs to be stamped out. I rarely cite Wales as a good example of NHS practice, but it has had a campaign on zero tolerance of violence against NHS staff, which I believe has worked well. Perhaps that is something else the Minister will consider.
I am conscious that other Members wish to speak in the debate, so I will conclude. I hope that the NHS staff listening to the debate will be reassured by the seriousness with which Parliament treats the issue of violence against NHS workers. I hope that the debate will provide an opportunity to consider what further measures we may take to protect nurses, doctors, paramedics and all other NHS staff, to whom we all owe a tremendous debt of gratitude.
It is a pleasure to serve under your chairmanship, Mr Gray. I am grateful to the hon. Member for Hertsmere (Oliver Dowden) for his introduction to the debate, which is on an important issue about which I feel very strongly as an ex-employee of the NHS and a former workplace trade union rep in the NHS.
Hospitals, clinics and health centres, by their nature as public buildings, have to be open to everyone. That brings particular security risks to the staff who work in them. Risks are also encountered by community staff who visit people in their homes. Those risks were clearly explained to the Petitions Committee in its meeting with the safety reps from the Royal College of Nursing. Better liaison and sharing of information between the police and the NHS regarding people who present a risk are clearly needed.
Although I appreciate the spirit of the petition and am sure that no one would argue that our NHS staff do not deserve to be protected while going about their work, there is a degree of confusion over what the petition aims to achieve. First, some clarity is required. The petition should cover all NHS staff, not only medical staff. After working in the NHS for many years, I realise that “doctors and nurses” is used as shorthand for all NHS staff, but given that there are about 400 different job roles in the NHS, it must be made clear that our concerns are for all NHS staff. Among many others, the porters, the cleaners, the healthcare assistants, the allied health professionals and the many volunteers are the unsung heroes of our NHS.
Secondly, the Government’s response to the petition stated:
“The fact that the victim is providing a service to the public is listed as an aggravating factor in sentencing guidelines”.
Therefore, is there a need to toughen up the law? Most people would say that there is in order to send out a clear message that to attack any member of NHS staff is totally unacceptable.
I am listening to the hon. Lady closely, and she is making an excellent speech. Should the Government consider an automatic prison term, with the period of detention obviously depending on the circumstances of the assault?
I will go on to talk about the special circumstances in which NHS staff work, which include working with patients with mental health issues, so I cannot agree with the hon. Gentleman on a blanket prison sentence. One size does not fit all, I am afraid, and I will expand on that later. However, I thank him for his intervention.
Scotland has a law to protect NHS medical staff. According to the House of Commons Library, that law seems to have reduced the incidence of assaults on staff, although the number is still unacceptably high.
Thirdly, many assaults on staff are committed by patients who have mental health issues such as dementia. The accounts given by the RCN safety reps highlight the problems in dealing with those patients, such as whether they are capable of realising the harm that they have caused. That goes some way towards explaining my response to the hon. Member for South Dorset (Richard Drax). There also seems to be a feeling, certainly among the RCN reps, that the police are rather too ready to dismiss cases in which the assailant has mental health problems. That subject deserves further exploration and I hope the Minister will comment on it.
My constituency is served by the Pennine Acute Hospitals NHS Trust, in which the number of cases of physical violence against staff by patients has, unfortunately, gone up from 169 in 2014-15 to 240 cases in 2015-16. The trust had been doing good work on training staff in conflict resolution and had managed to bring the figure down from 251 assaults in 2012-13. Sadly, reported assaults appear to be on the rise again. A spokeswoman for the trust informed me that the most recent rise was due to increased awareness and reporting, but I remain slightly unconvinced of that. I am informed that many staff are still reluctant to report assaults because they do not feel that any action will be taken as a result. The RCN safety reps highlight that the onus on staff to report attacks can act as an obstacle to reporting, so employers should provide more help and support to staff in such situations.
Assaults do not happen only when staff are on duty. There have been many incidents of assaults and muggings of staff at Pennine when they are in hospital car parks. In my days at Pennine, I can clearly remember that a member of staff suffered a serious assault—she was stabbed —when returning to her car after a shift on the Rochdale site. Fortunately, she survived that serious assault. We must make it clear that assaults on NHS staff are unacceptable at all times, not just when they are on duty.
This weekend it was announced that the Government are calling for a complete smoking ban on all English hospital sites. That is very laudable, but who will police it? In my experience of the NHS, a member of staff telling a patient or visitor that they cannot smoke in a particular area is likely to lead to a flurry of verbal abuse. I therefore hope that if the Government are serious about the move, they back it up with funding for trained security staff and do not simply expect already hard-pressed and stressed NHS staff to take on yet more responsibility for enforcement.
Where do we go from here? Without doubt, this is a serious issue and action on it has the support of a great deal of the public, including 161 of my constituents. Undeniably, our NHS staff are under a great deal of pressure at the moment, with long waiting lists, patients waiting on trolleys in corridors and staff having to deal with angry relatives as a result. The Government’s handling of the NHS appears to be creating a perfect storm of unrest and discontent among patients and relatives, which is likely to exacerbate tension and ill feeling. The Government must take some responsibility for that.
In summing up, I return to the Government response to the petition. It states:
“A protocol to tackle violence and anti-social behaviour in the NHS by shared actions between the Police, Crown Prosecution Service and NHS Protect was signed in 2011”,
which, importantly, sets out steps
“to improve victim and witness support. This protocol is currently being updated”.
This debate is therefore very timely. It is my hope that what is said in this Chamber today will be taken note of and fed into that update to ensure that our wonderful and dedicated NHS staff are afforded the highest standards of safety while they go about their daily, and nightly, duties to us, the British public.
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.
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.
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.
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?
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.
I am not a lawyer, but in response to the hon. Member for Cheltenham (Alex Chalk), although it is quite true that someone could get a life sentence, most judges use a scale that depends on the seriousness of the crime. As far as I am concerned, six months is too low to be a deterrent for such crimes, whether they are committed against national health service workers, policemen or public service workers. The sentence should be higher, and judges can be guided on that—the scales can actually be altered.
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.
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.
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.
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.
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.
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.
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.
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.
It is a pleasure to serve under your chairmanship, Mr Gray. I congratulate the hon. Member for Hertsmere (Oliver Dowden) on the eloquent and powerful way he introduced the debate on behalf of not only the Petitions Committee but the more than 115,000 people who signed this extremely important petition. He took us through some of the many figures and gave us a clear overview of the issue. I also found some of the stories he told us compelling, such as that of the NHS worker who had been spat on, punched, kicked and verbally abused, and the other who said they could not recall a day going by without police or security being called to their department. Such personal tales add weight to the plethora of figures, which I will repeat, to some extent.
The hon. Member for Hertsmere correctly identified the fact that sentencing guidelines acknowledge that it is an aggravating factor when assaults are made on public servants in the course of their duty. It is right that that is so, but the general thrust of his speech was that the Government should consider a specific offence, and he identified the fact that there is such a specific offence for other public sector servants as a discrepancy. Clearly, the speeches today suggest support for tackling that discrepancy.
It is to the credit of my hon. Friend the Member for Halifax (Holly Lynch) that, despite the many demands on her time, she took a considerable period of her own time to shadow many frontline public servants in her constituency. It is telling that her experiences led her to introduce her ten-minute rule Bill. I congratulate her on her work on that Bill to make it an offence to assault emergency workers. It is due for Second Reading on 24 March. I hope the Government will find time to support it, although I think my hon. Friend was realistic enough to acknowledge that it may not make it and become legislation. However, that does not mean the campaign will end there. She clearly set out some of the ways in which current legislation falls short and why she believes her Bill should make it on to the statute book. I hope the Minister will be encouraging about it.
The Scottish National party spokesperson, the hon. Member for Central Ayrshire (Dr Whitford), clearly set out, from her own experience, the immense challenge that healthcare professionals face in balancing the need to give patients the right advice against the need to de-escalate highly charged situations. It is interesting that she said it was not only legislation that led to improvement in Scotland; it was also the sending out of a clear message that there would be zero tolerance of assaults on staff. I think that is something that we can all agree on and do our bit to deliver.
As always, it was a pleasure to hear from my hon. Friend the Member for Heywood and Middleton (Liz McInnes), who brings many years of experience of working in the NHS. As she rightly said, many assaults are occasioned by patients with mental health issues, and she made the important point that those factors make it difficult to come up with a blanket sentencing policy. We certainly need to reflect upon how we balance those sensitive issues with the need to send out a clear and strong message, as most hon. Members have said. She also made a pertinent point about the risks that NHS staff will face in enforcing a blanket no-smoking policy. I think we can all envisage the difficulties that asking our frontline staff to enforce that will bring.
I am pleased that we had time to hear from the hon. Member for Cheltenham (Alex Chalk). He made the important point that NHS staff need to see us taking this seriously, and that we need to follow that through with resources. There is an awful lot we can do that does not require the statute book. I will return to that later.
We are all rightly proud of everyone who works in the NHS—not only the doctors and nurses, but the midwives, porters, healthcare assistants, cleaners, receptionists, care workers, paramedics and many others who make up our national health service. None of us could have missed the many troubling reports over recent months about the pressure that the health service is under. I have said it many times before, but I do not think this is something we can ever say too much: each and every Member of the House recognises and values the incredible commitment our health service staff give to their job. I have no doubt that the current difficulties that we have all heard about would be even more significant were our wonderful staff not continually prepared to go the extra mile.
The petition relates specifically to NHS medical staff. If I was to make one slight amendment to it—this was also suggested by my hon. Friend the Member for Heywood and Middleton—I would broaden its definition to include non-medical NHS frontline staff. Like many Members from across the House, I have heard worrying reports of attacks not only on medical staff but on reception staff in both hospitals and primary care settings. We need to take firm action on that. All our frontline NHS staff are public servants. They work long hours, often in very difficult circumstances, and they help and treat our loved ones as if they were their own. They are the reason why we are so proud of our health service, and they deserve our respect, admiration and gratitude.
However, it is not enough for us to simply state our support for NHS staff in these debates; as the hon. Member for Cheltenham said, we have to demonstrate it in a meaningful way. Those staff dedicate their lives to caring for us, so it is right that we should also care for them. Sadly, the warm words that we hear are not always reflected in reality. The truth is that NHS staff are working longer hours in a system facing much greater pressure, they are being paid less in real terms and, most worryingly of all, as the subject of the debate shows, they are more and more likely to be attacked while simply doing their job. The impact of attacks on individual members of staff cannot be overstated. Violence and aggression can leave staff traumatised both emotionally and physically. Many need to have a significant amount of time off work, and sadly some have to leave their profession altogether.
I draw hon. Members’ attention to one example I was given of a 35-year-old ambulance technician from Cornwall, who was punched in the face while at work by a drunk and aggressive woman. She sustained a broken jaw. She has had at least 12 surgical procedures since and is still suffering from symptoms. She had a titanium jaw implant put back in in September 2016, but has had to have two further procedures since and cannot open her mouth wider than finger width at the moment. She was attacked in 2006; that is more than a decade of agony and suffering. We owe it to people like her—and everyone else who has been attacked while just doing their job—to stand up and send a message: that attacks on NHS staff are contemptible and we will do everything in our power to stop them.
While the incredible human cost is all too apparent from such examples and others we have heard today, we should also be mindful that, in addition to the individual impact on staff and their families, those incidents have a significant financial impact as well. The Royal College of Nursing reports that the estimated cost to the NHS of healthcare-related violence exceeds £69 million a year, which is equivalent to the salaries of an additional 4,500 nurses.
We have heard from hon. Members about the indisputable rise in attacks, but it is also important to note that the increasing likelihood of attacks on staff is not a long-term, gradual rise, but seems to have increased markedly for the worse over the past six years. Looking back at some of the figures we have heard, a decade ago, in 2005-06, there were 43 attacks per 1,000 staff, while in 2009-10, it was at a similar level of 44 attacks per 1,000 staff. However, as we have heard, by 2011-12 there were 47 attacks per 1,000 staff, which rose again to 53 attacks per 1,000 staff by 2015-16.
As alarming as those figures are, they may actually understate the position. As we heard from the hon. Member for Hertsmere, a Royal College of Nursing survey found that 56% of its members had experienced physical or verbal abuse from patients, with 63% experiencing that from relatives of patients or members of the public. The most recent figures show that there are 193 physical assaults on NHS staff each and every day. When we hear figures like that and of some of the experiences of staff, it is no wonder that every day someone is called to the department. Will the Minister indicate whether he feels there is any particular reason for such a significant increase in recent years? Is he also prepared to undertake a candid and detailed look at the reasons behind that rise and to report back to the House in the near future?
Much of the focus has been on attacks in accident and emergency, but as hon. Members have said, it is clear that assaults occur in every part of the NHS—hospitals, pharmacies, GP surgeries and in the community. One such example I was told about was of an occupational therapist working in Ipswich who was conducting a relaxation therapy session with a service user. We would expect that to be a fairly calm environment, but suddenly and without warning, the service user grabbed the therapist and attempted to strangle her, during which time she fell unconscious. The attacker has now been charged with attempted murder.
That example demonstrates that the risk of physical assault is higher for staff working alone; indeed, the figure for lone workers suffering injury is about 9% higher. Another example is of a paramedic in the East of England Ambulance Service NHS Trust who was instructed to attend a call alone. During the visit, she was physically attacked with a claw hammer. The assailant attempted to strike her on the head, but the paramedic managed to deflect the blow, sustaining serious injuries to her right hand in the process. We do not know what would have happened had she attended with someone else, but there is at least a reasonable chance that, had she not been alone, the attack would not have occurred.
The Minister will also be aware that, along with the medical factors that we have discussed today, such as mental health issues and substance abuse, the acute shortage of staff across departments and lengthening waiting times has been cited as a common factor behind many assaults. I appreciate that he is not a Health Minister, but I would welcome any comments on what the Government are doing to ensure safe staffing levels in the NHS, and that lone working is kept to a minimum. Having considered the rise in attacks and their impact, the Opposition support new, specific criminal sanctions for assaults on NHS staff. I am prepared to give an undertaking that we will assist the Government in ensuring that any legislation of that nature receives a swift passage through Parliament and on to the statute book. I would appreciate it if the Minister could indicate whether the Government have any plans to bring forward such a Bill in Government time.
While we support the introduction of new criminal sanctions, the creation of a new offence alone is not a panacea, as the hon. Member for Hertsmere said. He suggested many improvements that could be introduced alongside new legislation, including lone-worker alarms, well-designed environments and conflict resolution training, all of which have been called for by the Royal College of Nursing. Again, I would be grateful if the Minister indicated what steps the Government are taking to follow up such initiatives. Until such legislation is introduced, we need to use all the tools available to improve safety. I know that NHS staff find it to be a particular injustice that just 10% of assaults not related to a medical condition result in criminal sanctions. I would welcome the Minister’s comments on why he believes that figure is so low and whether any steps can be taken to increase it.
I would like to press the Minister on the worrying reports about the future of NHS Protect, which other Members have mentioned. Various media reports have suggested that the security and violence function will cease to exist on 31 March 2017. That would be a retrograde step and would send out totally the wrong message about the value of NHS staff and our commitment to protecting them. Can the Minister confirm today whether the Government will be making any changes to the vital role of NHS Protect?
In conclusion, there is no doubt that the NHS is one of the country’s greatest assets and that the people who work within it are by far the single most important component of its success. If we want to ensure that that asset continues to be a source of great pride for the people of this country, we have to value the staff who work within it, respect them and, above all, protect them.
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.
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.
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.
Can the Minister clarify why prison officers and immigration officers warrant that extra protection, but healthcare workers looking after patients do not?
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.
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?
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.
I will give way to the hon. Gentleman.
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.
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.
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.”
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.
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.
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.
Thank you again for your chairmanship, Mr Gray. I thank all hon. Members for their contributions. I hope that everyone agrees that this has been a useful debate not only in drawing out the powerful experiences of NHS workers suffering assaults, but in getting greater clarity about the extent to which a new offence is needed and what that offence might look like.
I thank the Minister for his constructive engagement. I hope that this is the beginning of a process. A lot has been said about zero tolerance. Certainly the experience with drink-driving was that we managed to move from a situation in which drink-driving was commonplace to one in which it was completely socially unacceptable. We need to go along a similar path with assaults on NHS workers.
Question put and agreed to.
That this House has considered e-petition 176138 relating to attacks on NHS medical staff.