‘Spat at, pushed, punched’: medics tell of soaring levels of violence in hospitals | NHS
A The Guardian’s call for NHS staff in England to share their experiences of violence in hospitals has revealed that doctors, nurses, paramedics and managers are being overwhelmed by a torrent of physical assault and sexual abuse from patients.
Most of those surveyed said they had little confidence in the NHS to tackle the scale and severity of the abuse, which included attacks with weapons including knives and chairs. Many staff felt there was no point in reporting physical or sexual abuse because perpetrators faced no real response from the NHS or police.
Chloe29, a resident doctor in an acute medicine unit at a London hospital, said she had frequently faced abuse and threats since finishing her training just over a year ago. “Patients told me to fuck off and that they would sue me,” she said. Male patients also sexually harassed her during intimate treatments, she added. “I’ve had a lot of men hint that I like it or want to take a look [at their genitals]. A guy who grabbed my arm while I was putting in the catheter kept saying, “Oh, you’re so beautiful.” It was very uncomfortable.
Chloe said she often felt unable to get out of hostile situations due to staff shortages and fear of leaving other patients in danger. During one night shift, when she was the only doctor caring for 40 to 50 patients, she said a patient burst into a staff room and threatened her. “She was screaming, ‘Why the fuck didn’t you come see me? You should kill yourself’. I had to move a chair between us. Luckily a nurse came to distract her and she stormed back to her room. I was lucky not to be physically attacked but it’s so common. Two colleagues were severely attacked by patients just outside the emergency room the other day.”
Emiliea charge nurse from England, said emergency department staff faced violence and sexual abuse on a daily basis from patients and their relatives. “Nurses were spat on, shoved and punched,” she added, saying their colleagues had left the NHS or gone on extended sick leave after suffering injuries and trauma. She said a particularly worrying development since the pandemic was the increasing number of younger patients, aged 14 to 25, bringing knives and other weapons into her hospital: “This happens once a month. It’s quite terrifying when you have a very overcrowded emergency department. Someone could cause catastrophic damage in a matter of minutes.”
Like Chloe, Emily said sexual harassment from patients was common. She recounted two separate incidents in her emergency department in which men, apparently awaiting treatment, deliberately ejaculated on nurses. Neither man had any mental health or medical issues that could mitigate their behavior, she added.
Although both men were prosecuted, Emily said there are usually no consequences for violent patients. His trust issues warnings and bans on treatment but, in practice, “nothing stops them from returning a few hours later or booking into A&E under a pseudonym”. Combined with the sheer volume of abuse and increasing demand for treatment, this means that staff only report a small minority of abusive incidents. “When you manage too many patients, you’re only reporting the tip of the iceberg,” Emily added.
Johnrisk manager at a major northern teaching hospital, said dealing with growing patient hostility was hampered by understaffing, budget cuts and police inaction. “People have discovered that you can act in a threatening way to get what you want and there will be no coming back,” he said, adding that at least two staff members a week were treated in emergency rooms after patient attacks.
“Fifteen years ago, it would not have been appropriate to insult and hit people in emergency rooms,” he said, noting that many of the perpetrators were mentally healthy patients who aggressively sought treatment. “If you did, you would be arrested and you would not receive treatment. Whereas now the police are not coming, you are not going to be arrested, and in fact you will be treated more quickly, so that staff can remove you from the ward. We took down the poster saying there was zero tolerance for violence and assault. The argument was we can’t say that because there isn’t any. No one is being prosecuted.”
He and several other staff members highlighted the challenges of admitting mentally ill adolescents who were awaiting specialized psychiatric treatment. “We have a child patient and they assault every staff member who comes near him,” John said. “Last week, three of our nurses were in the emergency room. One had been strangled, the other had been hit in the face with a table. The other had been punched and had his eyes gouged out. It’s horrible, the level of violence. But the police won’t touch it because the patients are medically ill, so they won’t keep them in the cells. They’ll just take them back to the emergency room.”
Other staff said a lack of beds for mentally ill adults and people with dementia has contributed to the increase in violent incidents. George59, a former consultant at a university hospital in the north of England, said he suffered two potentially life-changing assaults in the months before his retirement two years ago. Both incidents involved mentally ill adults who were being treated in medical wards because no specialist care beds were free. “The first was a patient who managed to get a knife from the staff kitchen,” he said. “He told a nurse he was going to kill me and tried to attack me, but the nurse disarmed him.”
A few weeks later, another patient, who was on a medical ward when he was known to be psychotic, attacked him from behind and punched him in the head. “He tackled me to the ground and kicked me,” the former doctor said. “He had already assaulted three or four nurses before this happened. He was a danger to everyone, including other patients. It was only after this incident that he was brought under the Mental Health Act.”
Adama paramedic from the South West of England, agreed that difficulty accessing mental health services was a major factor behind a huge increase in violence and assaults towards ambulance crews since the pandemic. Even though he and his colleagues were now equipped with body-worn cameras, that did not deter the attacks, he added. “I was grabbed, I was strangled,” he said. “I had knives pulled on me in the back of ambulances.”
Its ambulance service regularly has to deal with aggressive patients who call 999 whenever they are in crisis. “Some of these people call 100 to 200 times over a six-month period,” he said, adding that these patients have warning markers in their medical records, but the police often refuse to deal with them because their mental health problems are considered an ambulance matter. “This exposes staff to an increased level of violence and aggression, as the presence of police on site generally acts as a deterrent,” he said.
Adam said even when police responded to reports of assault, they often took no action because it was not in the public interest to pursue vulnerable patients. “They were basically left behind,” he said. “Even though they attacked us and damaged the ambulance equipment.”
