Policing patients

'Doctors and nurses should blow the whistle on New Labour's plans to give yellow and red cards to violent patients.'

Dr Michael Fitzpatrick

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Topics Politics

Health secretary Alan Milburn’s plan to ban violent and abusive patients from hospitals is a typical New Labour initiative. A gesture of concern for hospital staff that costs little, it does nothing to improve the quality of care while further poisoning relations between health workers and the public.

Under Milburn’s ‘zero tolerance’ policy, patients who ‘commit acts of violence, make an offensive or sexual gesture, or use threatening or abusive language’ will receive a ‘yellow card’. A second offence will result in a ‘red card’ exclusion from treatment (1). Tony Blair gave prime ministerial approval to the new scheme in a visit to an east London A&E department yesterday (18 June). ‘I was really shocked when I first read about it’, said Blair. ‘You always think that people treat nurses well. It is just amazing, isn’t it, when you are looking after people and caring for them?’

The selection of the issue of violent patients as the focus of one of the first health service initiatives of the newly returned Labour government is highly symbolic. After an election campaign in which promises to improve the NHS were a prominent theme, this initiative offers merely to appoint a new form of policeman to patrol the queue of angry and frustrated patients in the squalid casualty waiting rooms.

Milburn’s initiative implies that violence is a major and growing problem in hospitals – but where is the evidence for this? There have always been problems with Saturday night drunks and the occasional distraught or disturbed patient. If violent incidents have become more common, which I doubt, could it be because people are being kept waiting for longer and longer and are often treated brusquely – if not contemptuously – by hospital staff?

Though the government is committed to an ‘evidence-based’ health policy, where is the evidence that giving out yellow and red cards will improve patients’ behaviour? It is, of course, much cheaper to provide self-defence training for staff, to install closed-circuit television cameras and panic buttons (all measures included in Milburn’s comprehensive policy) than it would be to employ more doctors and nurses to reduce the queues and to improve A&E facilities.

The government conflates acts of violence, which occur occasionally, with offensive language, which is no doubt heard quite often in hospitals. Hospital staff are entitled to be protected against assault by patients. Such conduct is already proscribed by law and should be dealt with through the criminal justice system.
But in dealing with patients who are angry and abusive, hospital staff have always exercised discretion. Experienced doctors and nurses know that illness causes fear and anxiety and causes some people to behave badly. They also know how to defuse difficult situations, often by ignoring provocative behaviour and getting on with the job. The fatuous rhetoric of ‘zero tolerance’ substitutes a policy of rigid policing for the commonsensical flexibility with which hospital workers have always dealt with difficult patients.

It is immediately obvious that Milburn’s policy is unworkable in practice. Who is to be the referee? Will the cards be transferable from one hospital to another? Will there be an appeals procedure? What will happen if a ban is challenged in court? This scheme is all New Labour spin, a public relations stunt that does nothing to protect hospital staff while reinforcing the image of the A&E department as a zone of trench warfare between health service workers and their patients.

It is deeply regrettable that Milburn’s zero tolerance initiative has been widely approved by representatives of hospital staff, from the British Medical Association and the Royal College of Nursing to unions like Unison. In their current state of demoralisation and introspection, such organisations have inflated the issue of violent patients as a key aspect of their claims for greater public recognition and sympathy.

It is a measure of the breakdown of professionalism and the ethic of public service that NHS workers now seem to be more concerned about protecting themselves from their patients than they are about improving patient care. Instead of making common cause with patients to demand more resources for the NHS – and to resist government policies that are making the problems of the NHS even worse – health service workers are allowing the government to intensify conflicts between them and the public.

Instead of welcoming referees into hospitals, health service workers should blow the whistle on Tony Blair’s health service stunts and kick Alan Milburn’s proposals into touch.

Dr Michael Fitzpatrick is the author of MMR and Autism, Routledge, 2004 (buy this book from Amazon (UK) or Amazon (USA)); and The Tyranny of Health: Doctors and the Regulation of Lifestyle, Routledge, 2000 (buy this book from Amazon UK or Amazon USA). He is also a contributor to Alternative Medicine: Should We Swallow It? Hodder Murray, 2002 (buy this book from Amazon (UK) or Amazon (USA)).

Read on:

Second opinion, by Dr Michael Fitzpatrick

Are you the one in four?, by Josie Appleton

(1) Violent patients face ban, BBC Online, 18 June 2001

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Topics Politics

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