England has been in the grip of far-right riots, in the previous week, following the horrible murders of three young girls. These riots were stoked by racist lies, mostly online, but fizzled out when confronted by large and peaceful counter protests. So many people were threatened and injured in these riots, so many people have had their businesses and livelihoods destroyed, and many NHS staff were also the victims of these riots.
Two Filipino nurses were attacked in Sunderland. They were sharing a taxi to work. GP Practices and other healthcare clinics closed early, during the riots, to enable staff to get home safely. NHS staff have received threatening messages, clinics have closed early because staff feared being trapped in themby rioters, staff were afraid to use public transport and were not going onhome visits. So many NHS staff were affected by these riots, directly and indirectly. So many NHS staff were feeling very afraid by these riots, and afraid clinicians don’t deliver the best care, and that isn’t their fault.
The new Health Secretary Wes Streeting, in response to this, said: “I will not tolerate, under any circumstances, NHS or social care staff in any health or care setting being subjected to intimidation, harassment or racist abuse.
“We have a zero tolerance policy in the NHS and we'll take a zero tolerance approach in social care too.
“People who are abusing NHS staff can be turned away, and should be turned away, if that is the way that they are treating our staff."
But Wes Streeting wasn’t right, there is no specific NHS zero tolerance policy to violence against staff. Many NHS trusts have zero tolerance policies but NHS England does not have one. In 2018, the then Health Secretary, Matt Hancock, announced the Stronger protection from violence for NHS staff policy. This announced a “violence reduction strategy”, which included:
- NHS to work with the police and Crown Prosecution Service to get prosecutions in the “quickest and most efficient way”.
- the Care Quality Commission (CQC), as part of their inspections, to monitor the level of violence against staff in a trust.
- training for staff to deal with violence.
- prompt support for staff.
What this didn’t contain was a zero tolerance to violence against NHS staff policy.
In 2020, NHS England released Violence prevention and reduction standard, which stated that it was part of an NHS employer’s duty of care to protect staff against violence and abuse at work, but this didn’t contain a zero tolerance policy either.
The Royal College of Nursing (RCN) summarised what NHS staff are allowed to do if they are faced with a violent and/or abusive patient. The nurse (or other NHS clinician) can refuse to treat a patient who is threatening or being violent. But care cannot be automatically withdrawn from the patient, it should be delivered while the patient’s violence is “managed”. Any violent situation must be discussed with the clinician’s manager and assessed. The clinician’s employer has a duty to the clinician but also has a duty to provide care to the patient, even if they are violent to healthcare staff. But an employer cannot dismiss or discipline a clinician for refusing to treat a violent patient. The emphasis is on managing the patient’s violence and ensuring the patient still receives care.
The Nursing and Midwifery Council (NMC), the nursing regulator in Britain (Find a discussion of their duties here), on 9th August, sent an email to all professionals on their register, about the current riots. They first reminded readers that, under the NMC’s Code of Conduct, “that professionals should prioritise people and put the interests of people needing or using health and care services first.” If faced with a violent patient, a nurse “should escalate your concerns as soon as possible. Your health and safety at work is your employer’s responsibility.” The NMC’s language is clumsy but their point is clear, nurses should put the patient first. If they are faced with a violent and/or abusive patient, they should still be treated and later “escalated” for management to decide what to do. There was no mention, nor any discussion, of a zero tolerance policy.
While I worked as a nurse, I was the recipient of violence and abuse from patients and/or their relatives, far too many times, and even more times I supported colleagues who had been the victims of violence and/or abuse at work, especially racist abuse. Only one time was I supported by a manager. As a ward nurse, a patient’s relative had threatened me with a knife. He also threatened a porter. My manager called the police and had the relative arrested for his actions, she also had the patient discharged that day too because he encouraged the attacks. But this was the exception. I have watched managers bend-over backwards to accommodate abusive patients. When I worked as a District Nurse, we had a patient who had physically and racially abused so many nurses that the whole team refused to visit her. Senior management repeatedly put pressure on us to visit her and they went out of their way to arrange a plan so she would get the care she wanted. She suffered no repercussions for her behavior. Senior managers seemed to be far more afraid of violent patients complaining about not getting the care they want, then about the effect of violence and abuse against staff.
I still see that attitude in the current policy about violent patients. NHS staff have to find a way to treat abuse patients. There is still no zero tolerance to violent patients. Would this be tolerated in other professions? If a constituent was violent and abusive towards an MP, would the MP bend over backwards to meet that constituent’s demands?
There are 75,000 physical and verbal attacks on NHS staff each year yet only 2.4% of these assaults ended with the attacker being cautioned or charged bythe police, let alone found guilty by the courts. This 2.4% could be an over estimation because only half of trusts responded to this survey. How is this zero tolerance of anything?
Punch a nurse and you’ll probably get away with it, scot-free.
Drew
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