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In Committee, the Minister told noble Lords:
“It is worth the Government reflecting further on hospices and where they fall in the definition. I am not sure that we can necessarily help, but I will certainly have a closer look at that”.—[Official Report, 10/3/08; col. 1322.]
I appreciate the work that the Minister has undertaken, his detailed letter and for having met me earlier. I am disappointed that the Government have indicated that they will not extend the clause to all hospices, nor to any premises, as in the very neatly drafted amendment tabled by the noble Lord, Lord Thomas of Gresford, where NHS services are provided. I fear that this is going to leave general practitioners and other services vulnerable, as it will leave hospices vulnerable. These are places where aggression is not only from patients who are ill but from relatives, friends and hangers-on and even stray members of the public. Extension through the amendment would not cost any money but would signal a clear commitment to non-tolerance of violent behaviour towards all healthcare workers in the course of performing their NHS duties, particularly as we move towards having more and more services provided out in the community.
It is with the background that I have tabled my amendment—and I fully endorse the amendment grouped with mine, in the name of the noble Lord, Lord Thomas of Gresford. I beg to move.
Lord Thomas of Gresford: My Lords, I shall speak to my amendment. The purpose of this clause is to deal with low-level nuisance and disturbance. Obviously, if a person commits a criminal offence such as threatening behaviour or assault on hospital premises, they can be dealt with there as they can anywhere else. The police can be called, or the security staff can remove them. The key aim of the Government’s legislation is to prevent assaults occurring in the first place by tackling non-physical nuisance and disturbance behaviour before it escalates into greater violence.
The clause is limited to hospital premises, as the noble Baroness, Lady Finlay, has just pointed out. That is not the only place where violence against NHS professionals takes place. In 2003, a survey was carried out by the British Medical Association. It surveyed a large number of UK doctors and found that more than a third of those who responded had received some degree of violence or abuse from patients. So the NHS Security Management Service—SMS—was set up in 2003 to address the management of security within the NHS.
Various measures were introduced, but when the British Medical Association carried out another survey of nearly 600 doctors in October and November of last year, it discovered that a third had experienced some form of violence, including threats and verbal abuse; one in 10 had been physically attacked, including being stabbed, kicked, punched, bitten and spat at; and, of those, one in three received
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I have to say that such a problem did not exist. One would never have thought in the past that doctors, whether in surgery or in hospital, or nursing staff would ever be attacked, not simply by the patients but by the relatives who were with them, which is of course who the Bill is aimed at. Unfortunately, it seems today that that has become prevalent.
The British Medical Association, while firmly supporting the government measures in the Bill, says—quite rightly in our opinion—that does not go far enough. What it seeks and what we seek is to extend that protection, as the amendment says, to,
- “any premises in which medical, surgical or paramedical treatment is provided under arrangements made under the National Health Service Act 2006”.
The argument that was put against this proposal in Committee, and which will no doubt be advanced today, is that hospitals carry security staff, and that they can be summoned to deal with disturbances of this sort. There is a ready-made body of people trained who can deal with disruptive relatives and friends of patients. It would be a protection to GPs in their surgeries and to other medical professionals who are working in NHS premises to have at least the shield of the law around them so that they could require people to, as the Bill says, cease the nuisance so that they can be removed, and, if necessary, so that the police can be called to remove them if they refuse to go in a situation where the intimidation or the nuisance had not escalated into an actual criminal offence where the police could be called anyway.
10 pm
It may be that GP surgeries and other primary care settings do not have the same security services as hospitals. But the fact that there is no security service does not mean that problems do not arise. As I said in Committee, a notice on the wall, to which a disruptive and intimidating relative’s attention could be drawn, is the beginning at least of calming down a difficult situation. We are familiar with notices that say, “If you do this, you are committing a criminal offence”. Why should there not be a similar notice in a doctor’s surgery which would help doctors to point out to people who are causing problems the course to which their conduct will lead? That is the purpose of the amendment. We think that under-reporting would cease and that doctors would be more willing to report nuisance and disturbance if they had the protection of the law. We also think that it would be a framework within which a partnership could be built between surgeries, the people working in them and local police so that the latter could readily be called for assistance.
Viscount Bridgeman: My Lords, I declare an interest as a former chairman of an independent hospice that is wholly contracted to a number of primary care trusts. I echo the remarks of the noble Baroness, Lady Finlay, about hospices, which need to provide particularly sensitive care. Taking up the
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Lord Bassam of Brighton: My Lords, I record my gratitude to the noble Baroness, Lady Finlay, for again tabling this amendment, which gives us the opportunity to rehearse some of the issues. I am also grateful to the noble Lord, Lord Thomas of Gresford, for his contributions. We are agreed that there is a problem with nuisance and disturbance on NHS premises but we are not agreed about how best to deal with it in different settings and circumstances and what is practicable in those different circumstances.
These provisions are limited to NHS hospital premises. Amendment No. 110 seeks to extend the definition of “NHS premises” in Clause 118 to cover registered hospices and specialist palliative care units. Amendment No. 110A seeks to extend the definition of “NHS premises” to the wider National Health Service in general.
As I said, we acknowledge that there is a problem of physical violence against NHS staff who work in healthcare settings outside hospitals, including in hospices. I also acknowledge the need for the Government to work even harder to deal with these problems. However, I owe it to the House to explain how and why we designed these provisions specifically for hospitals to deal with the unique problems that they face. Given that these proposals are designed for the hospital setting, I am not convinced that simply extending the provision to other National Health Service premises, including hospices, palliative care units and general practitioner premises, would meet the protection needs of the staff involved.
In Committee, I and others referred to research undertaken by the Department of Health in 2006 which indicated that the problem of nuisance or disturbance behaviour, which does not include physical violence, was a particular problem in hospital premises and was largely caused by friends, family members or relatives of patients rather than patients themselves. We have all experienced this in one form or another, particularly in A&E units on Friday and Saturday nights.
These provisions have been designed to tackle the problem on NHS hospital premises identified in that 2006 research and will do so in two crucial ways. First, the offence cannot be committed by patients or those seeking medical advice, treatment or care, but rather people who are present on NHS hospital premises and are not seeking treatment, but who cause a nuisance and disturbance. Secondly, the provisions include a power in Clause 119 to remove people reasonably suspected of committing, or having committed, an offence under Clause 118. It is crucial that trained security staff should be able to remove people causing a nuisance before the behaviour escalates towards violence. NHS hospital staff have faced problems in the past when they have had to wait for police to arrive before action can be taken. For that reason, numbers of trained security staff have been increased over recent years.
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Exercising the power to remove a person reasonably suspected of committing or having committed an offence under Clause 118 will require the support of fully trained security staff, which hospitals generally have available on a 24-hour basis. Without the assistance of security officers, NHS staff could place themselves at serious risk by seeking to exercise the power to remove. I do not think that anyone in the House wants to see that happen.
In Committee, I brought to the attention of noble Lords evidence presented in 2008 by the British Medical Association, to which I think the noble Lord, Lord Thomas of Gresford, referred this evening, that 94 per cent of GPs had reported experiencing violence committed by patients. That indicates that the problem of nuisance and disturbance behaviour outside the hospital environment is different and may need separate solutions to meet the very real need of NHS workers for a safe working environment in healthcare settings in the community. The BMA report defined violence as physical and non-physical acts against doctors, so further research needs to be conducted to examine whether the problem is one of mainly physical violence, or of the type of non-physical, anti-social behaviour covered by these provisions.
I assure the House that the NHS Security Management Service is working to identify the nature and scale of the problem of nuisance and disturbance behaviour against NHS staff outside hospital premises, and it will take a leading role in developing solutions that are appropriate to the needs of our ever-evolving health service. While I do not believe that extending these provisions to all NHS premises including hospices—where I recognise that there could be a problem—and specialist palliative care units is appropriate, I can offer some limited reassurance to the House about the effect of the existing provisions.
In Committee, the noble and learned Baroness, Lady Butler-Sloss, rightly alluded to the fact that hospices could be covered by these provisions if they are located within the grounds of an NHS hospital. This also applies to any building or vehicle associated with the hospital and it would include specialist palliative care units, so there is some breadth to the provision. Using hospices as an example, if an NHS or privately owned or funded hospice was located within the physical boundaries of an NHS hospital, then NHS staff attending such buildings or departments in connection with their work would be covered by these provisions.
The reasoning behind that lies again in the power that we are giving to NHS staff to remove those reasonably suspected of committing or having committed the new offence. As I have suggested, exercising the power to remove safely will require the support of fully trained security staff, which hospitals generally have available on the 24-hour basis that I referred to earlier. Hospices located within the grounds of the hospital may be able to draw on those resources to deal with a person suspected of committing an offence. However, there is no guarantee that such resources would be widely available to deal with a person committing
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The noble Baroness, Lady Finlay, pointed out in Committee that some hospices employ security staff on-site at night. The noble Baroness reminded me of that earlier today. From my personal understanding of these issues, I would support that point. However, in these cases, that could mean that incidents of nuisance or disturbance behaviour could not be dealt with under these provisions at any other time of the day. I am not satisfied that the provision of security staff in hospices, specialist palliative care units or any other NHS body providing healthcare in the community is widespread. Therefore it would be inappropriate to extend these clauses, which are tailored to the needs of hospitals, to healthcare facilities that could not use them as they are intended to be used.
I hope that my commitment that further work will be undertaken to deal with the problems of violence and anti-social behaviour faced by NHS staff outside the hospital setting will be appreciated and that we can work together to secure a solution over time. I am grateful to noble Lords who have again brought this matter to the fore, because we accept that it is an issue. I hope that, having heard my explanation, noble Lords will withdraw their amendments.
I shall respond to a couple of interesting issues that emerged. The noble Lord, Lord Thomas of Gresford, accepts here that prevention is important, but perhaps he does not accept it regarding other aspects of the way in which we seek to use, for instance, violent offender orders. His acceptance of prevention here but not there is an important point. I thought that his point about notices being displayed being tied to the amendment was not as well thought through as it might have been. In my experience—and, I am sure, that of the noble Lord—most GPs’ surgeries make it clear that unacceptable behaviour of a violent or abusive nature will not be tolerated and that people should not behave in a disorderly way. That is absolutely right. My experience, and probably that of other noble Lords, is that staff in surgeries will seek to rely on the help and support of the police service in calling its attention to any difficulties that they experience. They rely on the police to make a critical intervention and we should rely on that, because that is exactly what the police service is there for.
I accept that there is an issue. We think that further work is required. We need to tailor more precisely the sorts of powers and duties that might be required in other settings and how those settings work, particularly in relation to the needs of palliative care units and hospices. I am grateful to the noble Baroness and I thank her for bringing the amendment, but I do not think that these amendments will greatly assist us in resolving some of the real problems regarding this issue.
Baroness Finlay of Llandaff: My Lords, I appreciate the response from the Minister; I recognise that this is a pre-assault clause to try to prevent people being hit, targeted and so on. I have reservations because, for
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However, I do not intend tonight to press the amendment, but I want to sound a warning note to the Government. I fear that putting a line around hospitals may be giving mixed messages to NHS staff and to those who accompany patients. I have a concern also that when staff move from one setting to another, they may be confused as to which powers they have or do not have. NHS trusts are providing violence-and-aggression training and are often opening that up to hospice staff as well. It is generally good training and very helpful for staff. Having said that, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Lord Thomas of Gresford moved Amendment No. 110A:
(d) any premises in which medical, surgical or paramedical treatment is provided under arrangements made under the National Health Service Act 2006 (c. 41),”The noble Lord said: My Lords, I propose to press the amendment. It is helpful to go back to Clause 118 to see what the proposed offence is. First, the person commits an offence if he,
- “causes, without reasonable excuse ... a nuisance or disturbance to an NHS staff member who is working there”.
- “the person refuses, without reasonable excuse, to leave ... when asked to do so by a constable or an NHS staff member”.
- “the person is not on the NHS premises for the purpose of obtaining medical advice, treatment or care for himself”.
The noble Lord, Lord Bassam, has recognised that a problem exists in GPs’ surgeries. What is his answer? It is “We are not going to do anything about it”. The relatives of a patient who cause trouble in a GP’s surgery can carry on causing nuisance and trouble. They can be asked to leave and can refuse, according to the noble Lord.
Lord Bassam of Brighton: My Lords, the noble Lord is trying to put in my direction words that he might want to reflect on. I did not say that it was acceptable. I said, as I think that he would accept, that in those circumstances it is entirely right and proper that staff would rely on the support of the police service to make an intervention—a service, of course, that the noble Lord argues we should make more use of in dealing with those who display violence in the community.
Lord Thomas of Gresford: Exactly, my Lords. We are talking about increasing the powers of the police to arrest someone on the basis of a criminal offence—namely, the new criminal offence in this Bill. It would be open to a police officer to arrest somebody for a
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Lord Bassam of Brighton: My Lords, the noble Lord should desist from asserting that that is what I was saying. I did not say that. I said that I was familiar with surgeries that display precisely such notices. I encourage them to do exactly that.
Lord Thomas of Gresford: My Lords, you cannot say at the moment, “If you cause a nuisance and are asked to leave but refuse to do so, you can be arrested and removed”. You cannot say that because it is not possible.
Lord Bassam of Brighton: My Lords, but it is possible if someone is in the business of committing a criminal offence. The noble Lord cannot expect to get away with that allegation.
Lord Thomas of Gresford: My Lords, the Bill provides for a new criminal offence, which is less than the existing criminal offences. If that is not the case, there is no point in having the new offence at all. It relates to disturbance and nuisance that does not currently amount to a criminal offence but which the noble Lord and his Government seek to criminalise in the context of a hospital. It will give the police the power to arrest someone in a hospital but not in a GP surgery. In our submission, that is quite wrong. It does not matter whether you are in a hospital, in hospital grounds or in a hospital ambulance; you are entitled if you work in the NHS to the same level of protection. For that reason, I intend to test the opinion of the House. I beg to move.
10.18 pm
On Question, Whether the said amendment (No. 110A) shall be agreed to?
Their Lordships divided: Contents, 26; Not-Contents, 64.
Addington, L.
Alderdice, L.
Avebury, L.
Bonham-Carter of Yarnbury, B.
Cotter, L.
Falkner of Margravine, B.
Finlay of Llandaff, B.
Harris of Richmond, B. [Teller]
Hylton, L.
Kirkwood of Kirkhope, L.
Lee of Trafford, L.
Linklater of Butterstone, B.
Livsey of Talgarth, L.
Miller of Chilthorne Domer, B.
Nicholson of Winterbourne, B.
Razzall, L.
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Roper, L.
Rowe-Beddoe, L.
Shutt of Greetland, L. [Teller]
Steel of Aikwood, L.
Thomas of Gresford, L.
Tyler, L.
Wallace of Tankerness, L.
Walmsley, B.
Williams of Crosby, B.
Adonis, L.
Andrews, B.
Ashton of Upholland, B. [Lord President.]
Bach, L.
Bassam of Brighton, L.
Berkeley, L.
Bernstein of Craigweil, L.
Bilston, L.
Boyd of Duncansby, L.
Bradley, L.
Bragg, L.
Brett, L.
Brooke of Alverthorpe, L.
Brookman, L.
Corbett of Castle Vale, L.
Davidson of Glen Clova, L.
Davies of Coity, L.
Davies of Oldham, L. [Teller]
Desai, L.
Dixon, L.
Donoughue, L.
D'Souza, B.
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