There has long been an acknowledgment by ministers and NHS leaders that violence against staff by patients was an issue that needed addressing, with a strategy to tackle it announced nearly five years ago.
The health service’s 2019 long-term plan included a pilot for the use of body-worn cameras by paramedics in a bid to “de-escalate” situations. The following year the Crown Prosecution Service announced an agreement with the police and NHS England to “secure swift prosecutions” of those who assault staff, and the maximum penalty for assaulting emergency workers, including doctors and nurses, was also doubled to two years.
Despite these measures, there have been internal disagreements within NHS England about the best approach to the problem, which affected almost 15% of staff last year, according to the latest national survey of the health service workforce.
The Guardian understands that senior managers in NHS England told staff in its violence prevention and reduction (VPR) team last April that prosecutions of those who assaulted healthcare workers and dismissals of abusive staff should be a last resort. Instead, the focus should be on improving the culture of the NHS and staff wellbeing.
It is also understood that managers cautioned against using the term “zero tolerance” because they said it did not take into account that some people who abuse NHS staff might lack capacity, an apparent reference to mentally ill patients.
A number of staff in NHS England’s violence prevention and reduction team warned that moving away from prosecution was dangerous, the Guardian understands, given the risk posed by violent and sexual offenders. A spokesperson from NHS England denied there had been any change in approach and stressed police were responsible for the prosecution of any perpetrators.
The Guardian has been told the VPR team, which used to number 12 in 2021, will be cut to two next year under a major restructure of NHS England.
It is also understood that the VPR team no longer provides advice and support to Operation Cavell, an initiative first set up in Sussex in 2016 to increase convictions of people who assault frontline healthcare staff, which is also being piloted by police forces and NHS trusts in London, Hampshire and Wiltshire.
Although the scheme still exists, an NHS England insider said the operation had been deprioritised, because of a feeling among senior management that the focus on prosecution was unhelpful.
A three-month pilot scheme of Operation Cavell in five London boroughs, Lambeth, Southwark, Bromley, Croydon and Sutton, between October 2020 and January 2021, recorded an increase in charges, according to a CPS press release.
But none of the Operation Cavell pilots in England have since published further data on prosecution or convictions rates. Penelope Gibbs, director of Transform Justice, said their research on violence against healthcare staff and the police, which examined the project, found that there was no evidence that harsher sanctions deter assaults on emergency workers.
A presentation on Operation Cavell in Sussex, first given in 2018, highlighted a range of problems that initially prevented it from working, including disagreements between police and NHS staff over how to handle incidents of abuse by mentally ill patients.
Supt Richard Bates, Sussex police’s lead on Operation Cavell, said reliable data on its impact was not available. He added that the scheme was not just about increasing prosecutions, and the force had helped Sussex partnership NHS foundation trust develop informal responses to low-level incidents, including warning letters and acceptable behaviour contracts.
An NHS England spokesperson said it was already reviewing how it supported the health service to tackle sexual misconduct in the workplace. He added: “This work does not include any formal role in Operation Cavell. But NHS England continues to work with the government and other partners to ensure the NHS is a safe space for staff and patients; local services must not tolerate sexual misconduct, violence, harassment, or abuse – it is totally unacceptable.”
Additional reporting by Anna Bawden
