(Section 3b of the NHS Constitution)
What this means in practice
Patients have a right to be treated with respect and dignity in all their dealings with the NHS, but it is also important that they (and anyone who might accompany them) treat staff
providing NHS services and other patients with respect and consideration in return. NHS staff should be able to work, and other patients be treated, without fear of being subjected to violence or abuse, nuisance or disturbance.
It is difficult to provide care to a patient if they are behaving violently and abusively. It is
therefore in the interests of their own care, the safety, wellbeing and effectiveness of staff and the care of other patients that individuals do not act abusively and violently when seeking to access NHS services.
Prosecution
NHS Protect provides standards for the NHS on protecting staff from violence.12 These standards include steps to prevent violence against staff whenever possible and detail the actions available to the NHS, including prosecution of offenders where violence does occur.
NHS Protect works with local organisations to help them take appropriate action, and with clinical experts and other stakeholders to promote the safety and security of NHS staff.13
12 NHS Protect leads work to identify and tackle crime across the health service. The aim is to protect NHS staff and resources from activities that would otherwise undermine their effectiveness and their ability to meet the needs of patients and professionals. For further information, please see www.nhsbsa.nhs.uk/protect.aspx
13 For example, an online Design Council toolkit for reducing violence and aggression in Accident and Emergency units while providing efficient and informed service for patients is available at www.designcouncil.org.uk/AEtoolkit/
Responsibility
“Please treat NHS staff and other patients with respect and recognise that violence, or the causing of nuisance or disturbance on NHS premises, could result in prosecution.
You should recognise that abusive and
violent behaviour could result in you being refused access to NHS services.”
(Section 3b of the NHS Constitution)
What this means in practice
Patients have a right to be treated with respect and dignity in all their dealings with the NHS, but it is also important that they (and anyone who might accompany them) treat staff
providing NHS services and other patients with respect and consideration in return. NHS staff should be able to work, and other patients be treated, without fear of being subjected to violence or abuse, nuisance or disturbance.
It is difficult to provide care to a patient if they are behaving violently and abusively. It is
therefore in the interests of their own care, the safety, wellbeing and effectiveness of staff and the care of other patients that individuals do not act abusively and violently when seeking to access NHS services.
Prosecution
NHS Protect provides standards for the NHS on protecting staff from violence.12 These standards include steps to prevent violence against staff whenever possible and detail the actions available to the NHS, including prosecution of offenders where violence does occur.
NHS Protect works with local organisations to help them take appropriate action, and with clinical experts and other stakeholders to promote the safety and security of NHS staff.13
12 NHS Protect leads work to identify and tackle crime across the health service. The aim is to protect NHS staff and resources from activities that would otherwise undermine their effectiveness and their ability to meet the needs of patients and professionals. For further information, please see www.nhsbsa.nhs.uk/protect.aspx
13 For example, an online Design Council toolkit for reducing violence and aggression in Accident and Emergency units while providing efficient and informed service for patients is available at www.designcouncil.org.uk/AEtoolkit/
The NHS is encouraged to work with local police forces to deal with anyone who is aggressive and abusive to staff. Assaulting a member of staff or another patient is a serious criminal offence which can carry a prison sentence of up to life imprisonment depending on the severity of the assault. A joint working agreement has been signed by NHS Protect with the Association of Chief Police Officers and the Crown Prosecution Service to facilitate effective prosecution action against those who assault NHS staff. The fact that an offence has been committed against a person serving the public is considered an aggravating factor.
Provisions under the Criminal Justice and Immigration Act 2008 give NHS hospitals the power to remove from hospital premises individuals not in need of treatment and causing a nuisance or disturbance. If they refuse to leave without a reasonable excuse, they may be prosecuted.
Those found guilty of the offence may be liable to a fine of up to £1,000. Where this nuisance or disturbance is persistent and disruptive, NHS bodies can also work in partnership with other authorities to seek Anti Social Behaviour Orders to place restrictions on an individual’s ability to enter NHS premises.
Alcohol and drugs
Hospital security staff can also be given powers, through the Community Safety Accreditation Scheme, to issue Penalty Notices for Disorder to those individuals whose behaviour is likely to cause harassment, alarm or distress. Those staff can also take action against the consumption of alcohol in a designated public place. Some hospitals have also found it effective to place police officers in A&Es. This could be funded through the late night levy which enables councils to collect a contribution from late-opening licensed premises towards the cost of policing.
Committing an offence while under the influence of alcohol or drugs is a factor that can increase the seriousness for the purposes of sentencing.14
Denial of access to any NHS services
Providers of NHS services will have their own policies, which will seek to balance the interests of the patient, other patients and staff. These should reflect that violent and abusive patients can only be denied access to NHS services if it is clinically appropriate to do so, with
consideration given to the possibility that the patient may have a severe or life-threatening condition that requires immediate attention. The processes and clinical assessment needed to establish this will depend on the services sought and the circumstances. In most circumstances the patient is to be assessed by an appropriate medical practitioner or suitably qualified person before any decision to refuse access is taken.15 All decisions should be based upon an
assessment of what a patient’s reasonable requirements are in the light of their behaviour and in any given set of circumstances, and should only be made by a senior team member. Where urgent treatment is required, services may need to be provided in a manner that can safely and appropriately manage violent and abusive behaviour.
14 Sentencing Council Assault Definitive Guideline 2011.
15 Requirements may differ in some circumstances, such as where patients are seeking dental or pharmacy services.
Some medical conditions or other underlying reasons may cause patients to exhibit disturbed, violent or abusive behaviours. If the patient has a disability, and their impairment is causing or contributing to the violent and abusive behaviour, ‘reasonable adjustments’ should be made in accordance with Equality Act 2010 to ensure that the medical condition is identified and treated.
There is no obligation on staff providing NHS services to refuse access to NHS services for patients who are violent and abusive.16 Decisions must be taken as to what is reasonable in any given circumstances, including considering how to protect the health and safety of staff.
If a decision is made to refuse access to any NHS services, the patient should be given information about the appropriate way of challenging this decision.
16 However, NHS staff may not be able to provide treatment if they feel in serious and imminent danger as a result of any violence or abuse from either the patient(s) they are trying to treat or others in the vicinity.
Some medical conditions or other underlying reasons may cause patients to exhibit disturbed, violent or abusive behaviours. If the patient has a disability, and their impairment is causing or contributing to the violent and abusive behaviour, ‘reasonable adjustments’ should be made in accordance with Equality Act 2010 to ensure that the medical condition is identified and treated.
There is no obligation on staff providing NHS services to refuse access to NHS services for patients who are violent and abusive.16 Decisions must be taken as to what is reasonable in any given circumstances, including considering how to protect the health and safety of staff.
If a decision is made to refuse access to any NHS services, the patient should be given information about the appropriate way of challenging this decision.
16 However, NHS staff may not be able to provide treatment if they feel in serious and imminent danger as a result of any violence or abuse from either the patient(s) they are trying to treat or others in the vicinity.
Responsibility