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April 04, 2006

Doctors and Nurses in the NHS are facing unprecedented levels of violence from their patients - Unrealistic promises by politicians are to blame, argues NHS doctor

Posted by Fred Hansen

Doctors, nurses and other health care professionals are facing unprecedented levels of violence from patients. NHS doctor Fred Hansen argues that this is a result of unrealistic public expectations of what the NHS can deliver. These expectations have been created by the extravagant promises of politicians. When the NHS does not live up to these expectations, patients can understandably become frustrated. A proportion of frustrated patients sadly turn to violence.

There are probably few health care systems in the world where violence is as common as in the NHS. It's telling that on entering any NHS premises you will nearly always be welcomed by a sign indicating "zero tolerance" of violence and a ubiquitous campaign poster showing an injured doctor with a bruised eye.

In a surgery in East London where I have done some locum shifts, the staff have put five iron bars in front of the reception hatch. For any incoming patient at first glance the receptionist appears completely behind bars. In another surgery in Leicester, where violence occurred on a daily basis, the GP installed bullet-proof glass as a precaution.

In most doctors' consulting rooms the eye catches a notice - signed by the local Primary Care Trust - saying something like:

We are currently working in partnership to secure safety and security for yourselves and our staff.
Violence, including verbal abuse, against health care professionals is widespread in the NHS and is on the rise. The Department of Health reported 65,000 incidents of abusive or violent attacks against NHS staff in 1998, 84,273 in 2001 and 116,000 in 2003. The figure for 2004 is estimated at about 200,000 according to a survey by the Commission for Health Improvement. But even these soaring figures may be too low, as a result of underreporting. The National Audit Office suggested in another report published in 2004 that as many as two in five incidents go unreported.

According to the journal Family Practice, in 2004 about two-thirds of receptionists in a survey of 50 practices in Leeds had been verbally abused on the telephone, or indeed face-to-face. More representative data is reported from Scotland, where it is estimated that every hour of the day on average two NHS staff are subject to physical or verbal attacks. Most exposed to such abuse are nurses and midwives, according to the first ever Occupational Health and Safety survey of its kind. Issued in the summer of 2004 it exemplifies a new trend of awareness:

About 150 occupational injuries were sustained per 1,000 staff in 2002/03, a rise of 14.9 % on 2001, with almost 60% resulting from violence and aggression.
This rise of violence occurred only during the 1990's and has already caused problems with the recruitment of GPs in some rough inner city areas. It has also triggered the launch of a nationwide "zero tolerance" government campaign which started in 2000. But according to surveys this has had no measurable impact on the level of abuse. Today at least in big cities almost all surgeries I have seen are fitted with emergency buttons for doctors. They are hidden under the doctor's desk and he or she is supposed to press them if a patient turns violent or the situation otherwise escalates. Doctors are now also offered special training to protect themselves and their colleagues from assault.

Why is all this happening? Well, in my view it has a lot to do with frustrations about the NHS. Unrealistic government promises have created unrealistic public expectations. When the NHS fails to live up to the inflated promises of politicians, patients get frustrated. In my experience, rude behaviour and violence occur when people make demands upon the NHS which it cannot deliver or which it would not be appropriate to deliver through a tax funded system. As long as GPs comply with all the demands of their patients they may not encounter violence - but if they take an opposite view or disagree with the patient then the situation can escalate.

The NHS strips patients of consumer power. This produces frustrated patients. In their frustration a proportion of patients sadly turn to violence.

Fred Hansen is a doctor working in the NHS.


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"We are currently working in partnership to secure safety and security for yourselves and our staff."

There must be an inverse relationship between the prevalence of this kind of sign and the civility of a particular setting. If safety and security were secured, there would be no need for a sign proclaims that "we" are "working in partnership" (with whom exactly) to attain it.

Posted by: Seamus Sweeney at April 4, 2006 09:11 PM
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It is not politicians who are to blame. Everyone knows they tell lies. It is all part of the return to thuggery, noticeable on any bus or train or street on any day, among our citizens. Spitting, abuse, violence; the British are returning to their pre-Victorian habits, remarked upon by so many foreign visitors to these isles in the 18th century, of habitual drunkenness and violence.
And I don't think patients lack "consumer power" as you put it. There has never been a time when they had so much power over their doctor. Armed with half digested notes from the internet on their complaint, and the sure knowedge that an ambulance chaser will sue the health authority for millions if they do not get their "rights", they have never before been so powerful. No longer does "doctor know best". It's a case of "I know what's best for me, and I want it now, no matter what the cost".
I do sympathise. I no longer go to my GP, because I can't make myself heard over the torrents of abuse heaped on the receptionist by those who have been kept waiting more than five minutes.
I know that you are all men of peace and healing, but why not fight back? Refuse to treat them. Detain them and call the police. Hit back. It's not frustration that makes them like this. It's knowing they get away with it.

Posted by: Christopher Peachment at April 6, 2006 04:01 PM
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