Criminal Justice and Immigration Bill

I shall make a considered and lengthy response to this set of amendments—for which I apologise in advance—not least because we are sympathetic to the issues which lie behind them. I particularly thank noble Lords who have recognised and congratulated the Government on bringing forward the provisions from Clause 170 onwards which more generally address the issue. I am grateful for the support we have received. We are conscious that we are struggling with an issue that poses a particular difficulty—an issue which the noble Baroness, Lady Hanham, touched on. I shall work through our observations on this group of amendments in that context. This is not an easy issue to resolve. We had some of this debate before when we discussed amendments to the corporate manslaughter legislation—legislation which is somewhat parallel—which addressed the offence of obstructing a police officer in the course of his or her duty. It was a very useful debate and on that occasion we extended the law to offer further protection to emergency workers, which was helpful and constructive. That debate was very much in the same vein, as it is a difficult issue. I turn first to Amendments Nos. 163 and 164. The application of the offence of causing nuisance or disturbance to hospital settings only is a targeted response to a specific problem. Some 78 per cent of respondents to the 2006 Department of Health consultation on tackling nuisance and disturbance behaviour on NHS healthcare premises supported the introduction of an offence to deal with this behaviour, and most respondents felt that the acute hospital setting is where such behaviour is most prevalent. I think that that is probably right. It is important, however, to understand that the practical benefit to NHS staff is in Clause 171—to which noble Lords referred—where they are provided with a power to remove a person suspected of committing this offence. Although the offence is the basis for this power, on its own it does not have the intended impact, which is to enable NHS staff to deal with an incident of nuisance or disturbance behaviour immediately. Simply extending these provisions, which are specifically designed for hospitals, to the wider NHS is both unjustifiable and would make them unfit for purpose as it would assume the problem exists in the same way in other healthcare settings as it does in hospitals, and that the correct method to deal with nuisance or disturbance behaviour in these settings is to remove the person from the premises. I do not consider that the problem is identical in other healthcare settings or that the solution to deal with the problem in other healthcare settings should be the same. As I believe the noble Lord, Lord Thomas of Gresford, said, evidence presented by the BMA in January this year highlighted the problem of violent behaviour against doctors outside the hospital setting; namely, in GP surgeries. For the purpose of this study, violent behaviour is defined as physical assault as well as verbal aggression or abuse and threats or harassment. The latter could be classed as nuisance or disturbance behaviour under these provisions. However, 94 per cent of GPs state that violent behaviour is committed mostly by patients rather than family, relatives, friends or companions at whom these provisions are aimed. That is usually the case in an A&E hospital setting where families, relatives or friends are likely to cause the problem and the aggression. In the GP surgery, the situation is rather different. I think that the noble Lord, Lord Thomas of Gresford, referred to likely causes of the problem in the GP surgery, for example issues to do with medication or a disagreement over treatment. So, the causes of the problem are very different in that setting. As I say, this is different from the hospital setting which, by its nature in being open to the general public 24 hours a day and spread over a large area, has nuisance or disturbance behaviour committed by non-patients on a regular basis. Of course, none of this is acceptable and that is why we seek to legislate in a particular way. This supports the view that the offence is not suitable for non-hospital premises as patients cannot commit an offence under Clause 170 as their need for medical advice, treatment or care may be greater and more important than the need to remove them from the premises because of their low-level nuisance or disturbance behaviour. We believe that further research needs to be undertaken on nuisance or disturbance behaviour in other healthcare settings, and how this can best be dealt with, before a solution that is fit for purpose can be devised. Without further investigation and consultation on the nature and extent of the problem having taken place, it would not be appropriate to attempt to deal with the problem by extending a solution that has been designed specifically for hospital settings to other healthcare settings, when the settings and the problem itself are different in nature. As far as the power to remove in Clause 171 is concerned, most hospitals have full-time security staff and CCTV coverage to protect staff from those causing a nuisance or disturbance and to deter potential offenders. Under these proposals, trained security staff could assist in exercising the power to remove a person from hospital premises should they commit the offence. Not all GP practices, dental surgeries, nursing homes or hospices have such security services available to them. Therefore, enabling the offence to be committed on such premises would prove problematic as there would be no guarantee that a correctly trained person would be available to remove an offender from the premises, using reasonable force if necessary. Applying these proposals to the wider NHS would therefore ironically put the safety of such NHS staff at risk. Applying the offence to ambulances or vehicles used by NHS staff in connection with work to attend a patient’s home would be impractical due to the mobile nature of such vehicles and the potential for offenders to be removed from the vehicle to a place that leaves them vulnerable; for example, at the side of a road. Furthermore, fully trained security staff would not necessarily be available to remove offenders from the ambulance or NHS staff vehicles, by force if necessary, so exercising the power would again put ambulance staff and other NHS staff at risk. The Government recognise the risk to NHS staff working outside hospital settings and believe that all healthcare staff deserve to work in an environment that is safe and secure. The NHS Security Management Service has introduced conflict resolution training for all front-line staff and has trained over 250,000 staff to date. Local security management specialists have been placed in every healthcare body to oversee security issues and to take forward reports of nuisance or disturbance behaviour and more serious offences such as assault. Guidance has also been issued by the NHS Security Management Service on the better protection of members of staff who work alone—as raised by the noble Baroness, Lady Finlay of Llandaff—and a long-term communications programme is under way to encourage reporting of abuse and violent behaviour against NHS staff in the primary care setting. The latter will help to identify the nature and scale of the problem in primary care and help work towards a suitable and more effective solution. Amendment No. 165 seeks to supplement Amendments Nos. 163 and 164 by extending the definition of ““NHS staff member”” to include staff working in NHS settings outside hospital premises. I have already dealt with the reasons why it would be inappropriate to extend the application of this offence and the power of removal to NHS premises other than hospital premises. Amendment No. 165 is unnecessary, as the current definition of ““NHS staff member”” in Clause 170(4)(c) already covers persons other than those employed directly by the hospital in which an offence might be committed. Indeed, the current definition covers persons who are employed by a relevant English NHS body or are otherwise working for it, whether as or on behalf of a contractor, as a volunteer, or otherwise. The relevant English NHS body can be an NHS trust, including a mental health trust, primary care trust or an NHS foundation trust. This broad definition means that a range of NHS staff could have a nuisance or disturbance caused to them which may constitute an offence under Clause 170(1), whether they are employed directly by the hospital, by a primary care NHS organisation, or even as a contractor or volunteer. There is broad coverage. If the NHS staff member in question is on NHS hospital premises in connection with his or her work, he or she will be protected by these provisions. For example, an offence could be committed against a GP if they were visiting the hospital to see a patient or on business-related matters. This is because they are employed or contracted to work for a relevant English NHS body—a primary care trust—and are thus an ““NHS staff member”” for the purpose of these provisions. Amendment No. 166 creates a new offence of causing ““physical or mental harm”” to an NHS healthcare worker who attends a patient in their own home. We do not consider the introduction of such an offence necessary or appropriate. Such an offence is unnecessary, as the causing of physical harm to the NHS healthcare worker would already constitute assault or another criminal offence against the person under current legislation. If a healthcare worker was caused physical harm in a patient’s home, the appropriate course of action would be to call the police to deal with the situation using their powers under existing legislation. It is unclear what is meant in Amendment No. 166 by the causing of ““mental harm”” to an NHS worker and how one could measure or prove that mental harm was being caused as an incident occurred so as to enable the police to respond to an incident, or to consider that an offence had been committed. On that basis, I do not consider that the introduction of an offence of causing ““mental harm”” to an NHS healthcare worker who attends a patient’s home would be appropriate. However, we recognise that there is a risk to NHS staff members who work in the community, in particular those who attend the homes of patients to provide treatment, care and advice. In 2005, the NHS Security Management Service issued guidance to lone workers entitled Not Alone: A Guide for the Better Protection of Lone Workers in the NHS. This offers practical advice to such staff on protecting themselves against potentially hostile and/or violent situations when attending a patient’s home in connection with their work. As I have already mentioned, conflict resolution training is available to all front-line staff. Finally, a long-term communications programme is now under way to encourage better reporting of abuse and violent behaviour against NHS staff in a community setting. This will help to identify the nature and scale of the problem for lone workers, and help us to work towards a suitable and effective long-term solution. In summary, we are sympathetic to the spirit behind this amendment. The solution that is sought, which is to extend the provisions for NHS premises in the way that they are set out in Clause 170, would not necessarily be effective. A lot more thought, consultation and discussion with other potentially affected NHS staff would be required before we could move in that general direction. We need to think about specific remedies and measures that are more appropriate to deal with the problems sometimes caused, primarily by patients in the GP setting. That is where the real core of this particular problem, identified by the noble Baroness, exists. For those reasons we continue to seek solutions in the longer term. We are grateful to noble Lords who supported Clause 170 and the consequent sections. I invite the noble Lord and the noble Baroness to withdraw their amendments.