This item was published during the term of a previous administration that ended in April 2007
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Violent patients face treatment ban
18/06/2002
Violent patients who make repeated attacks on NHS staff
could be refused treatment under new draft guidance to
improve health and safety in Scotland's hospitals, GP
surgeries and dental practices.
The 'Health at Work' guideline, drawn up by the
Partnership Information Network (PIN) - which includes NHS
professional groups, unions, and representatives from the
Health Department - covers all the major health and safety
issues that could affect staff as part of their day-to-day
work.
For the first time ever, it will give NHS Boards an
'ultimate sanction' to withhold treatment from violent
patients.
Launching the guideline at the 'Safer, Healthier
Workplace Conference' in Dunblane today, Helath Minister
Malcolm Chisholm said:
"No-one should be made ill by the work they do, nor
should they live in fear of attack. Violence and aggression
cannot and will not be tolerated, least of all within the
NHS. That is why - as part of the new 'Health at Work'
guideline - NHS Boards will be given an 'ultimate
sanction', enabling them to withhold treatment from violent
patients.
"This new measure - drawn up by the service for the
service - will not be a panacea for dealing with violent or
abusive behaviour but will take our existing guidance on
protecting against violence and aggression in the
workplace, a significant step further.
"It recognises that persuasion, while often effective,
is not always sufficient to tackle the very small minority
of violent and abusive patients. It will now give Boards an
'ultimate sanction', to be used in exceptional
circumstances, after very careful evaluation and in strict
accordance with steps set out in the guidance.
"It is unfortunate that such a sanction is necessary but
we cannot ignore the reality of what can take place in our
hospitals and health centres. In preparing the guideline we
have been careful to ensure that it will not apply to cases
where a patient in the expert judgement of a clinician, is
not considered competent for their behaviour, for example
where patients are mentally ill. Neither will we refuse
patients, who in expert judgement of the relevant
clinician, require urgent emergency treatment.
"The vast majority of patients have nothing to fear from
this new sanction. Indeed, I believe the public stands
shoulder-to-shoulder with NHS staff against the minority of
thugs whose anti-social behaviour can be a threat to
everyone to whom they come in contact.
"However, I am convinced that the sanction - backed up
by detailed advice for staff - is the right step for us to
take to deter attacks against hard-working staff in our
hospitals and communities. This new guidance will help
staff deal with the individuals who make such violent
attacks and ensure that all NHS staff feel safer and more
secure at work."
PIN Chair Jonathon Best said:
"Staff and Trade Union colleagues have worked extremely
hard to produce a common sense guideline to promote
continued awareness of a safer, healthier workplace. This
guideline continues progress to ensure staff governance is
a major part of any NHS Board local health plan. The
guidelines are produced by the service and consulted on
within the service making them unique in terms of policy
formulation through staff involvement."
Unison health spokesman, Jim Devine, said:
"Unison, which represents the vast majority of health
service workers in Scotland, welcomes this initiative. It
is not part of the health service worker's job to be
verbally and physically abused by an individual who is
neither sick nor psychotic."
James Kennedy, RCN Scottish Secretary, said:
"No NHS staff should see violence as part of their job.
The RCN has long been calling for zero tolerance towards
aggression against staff. We welcome these measures which
make it clear that the NHS won't stand for violence while
ensuring safeguards for patient care."
Dr John Garner, Chairman of the BMA's Scottish Council,
said:
"We welcome the publication of these guidelines for
staff. They provide formal support mechanisms needed to
protect staff from violence in the workplace.
"While clinical staff in the health service will be
aware of health-related underlying causes of aggression in
some patients, those caring for patients need to be able to
do so without fears for their own safety. We hope that the
other areas of health and safety covered in the guidelines
will ensure that Trusts and Health Boards look closely at
the well-being of their staff, and implement the guidelines
to improve their practices."
The PIN guideline, launched for final consultation at
today's conference, follows the first six PIN guidelines
launched in January 2001. The new guideline includes
sections on all the major issues that can affect staff
during their daily work:
- assessing risk
- promoting a healthy organisation, attendance and
employee health and well-being
- promoting safe manual handling
- protecting the health, safety and people working
alone
- protecting against violence and aggression at
work
- the with-holding of treatment from violent and
aggressive patients
- biological and chemical dangers
The guideline reflects the Executive's priorities for
NHSScotland. The SE Health Department will work closely
with other UK Health Departments to maximise all our
efforts in the occupational and health and safety field and
avoid duplication.
In terms of dealing with violent patients, all local
policies on the withholding of treatment should provide as
a minimum:
- a verbal explanation by a member of staff of what
is unacceptable behaviour and the possible consequences
of any further unacceptable behaviour. A copy of the
policy and/or explanatory leaflet on the withholding of
treatment could be given at this stage
- a formal written warning with details of Trust
policy/procedures on the withholding of treatment to be
sent by a site manager/clinical director or senior
nurse, copied to the patient's GP
- as a last resort, a final written explanation of
exclusion from the premises and the withholding of
treatment. This letter, which should be sent by the
Trust Chief Executive, should notify the patient of the
period of the ban and be copied to the patient's
GP.
Under exceptional circumstances, the immediate
withholding of treatment may be made, provided:
the decision to withhold treatment is based on a proper
clinical assessment and the advice of the patient's
consultant or senior member of the medical team (on call
team for out of hours)
it is made clear that the withholding of treatment is
time limited for a period of no more than 12 months
details of the mechanism for seeking a review of the
decision to withhold treatment is given e.g. via local
patient complaints procedures
In terms of violence to staff, the Executive has
recently commissioned £370,000 of practical projects aimed
at increasing awareness and reducing the incidence of
violence and aggression. To help communicate the 'violence
is not acceptable' message to staff and the public, a
combined NHS Fife and OHSAS, the joint Fife/Tayside
Occupational Health and Safety Advisory Service, project is
producing campaign material. If successful, it will be
rolled out as good practice across the rest of NHSScotland
and to GP and dental practices.
To help improve the safety of staff working alone, the
Executive is currently funding a study by Dumfries and
Galloway Acute NHS Trust to evaluate research on available
lone worker personal attack systems for community-based
staff and for the implementation of the preferred
system.
The Executive is also funding West Lothian Healthcare to
evaluate and implement the 'Guardian Angel' lone worker
system, this is movement management security system for
staff working alone and includes a panic button facility
for quick police response. Once these systems have been
properly evaluated, they can be recommended as good
practice to the service.