My Lords, I thank the noble Baroness, Lady Donaghy, for sponsoring this Bill, and am pleased to contribute to the debate today, taking the welfare of our public service staff seriously.
I understand that in Committee the definition of emergency worker has been extended from its original remit to include all NHS workers and support staff and to prisoner custody officers. The Royal College of Nursing highlights that nursing is an occupational group with a high risk of experiencing work-related violence, which can occur across a variety of settings: emergency departments, prisons, mental health units and the community. The literature tells us that there are 200 attacks on NHS staff daily, and 23 assaults on prison officers every day. However, in reality, as others have said, the figures are likely to be far in excess of those reported.
Others have rightly highlighted the role of alcohol in violence against NHS staff, particularly in the other place, and against paramedics and accident and emergency staff. I would like to expand the discussion to consider drugs—in particular, synthetic cannabinoids, commonly
called Spice or Mamba. Following the Psychoactive Substances Act, which outlawed so-called legal highs, the numbers of people using Spice throughout the UK appear to have dropped. However, this is not the case in prisons, where the problem continues to intensify and has been described in media reports as endemic.
Many nurses, doctors and other healthcare professionals provide input into prisons, which are increasingly becoming challenging environments in which to work. One psychiatrist I have spoken to, who has worked in both prisons and mental health hospitals, told me of the devastating effects Spice intoxication can have on those who consume it. Many prisoners use Spice for the first time on entering prison. She described a number of cases in which young men who had consumed Spice behaved bizarrely, including throwing themselves on to the netting, assaulted staff and even committed self-harm. Some young men developed psychotic symptoms related to Spice—that is to say, experiencing hallucinations and having paranoid beliefs. These can last for weeks at a time. The physical effects can be frightening; seizures, collapses and vomiting are all common emergency situations that clinical staff are asked to respond to in prison. Staff who are the first responders—often prison officers, nurses and GPs—have been the victim of serious assaults, which often do not lead to prosecution. Staff are also breathing in toxic fumes, and there are numerous examples in the media highlighting staff themselves becoming unwell due to secondary inhalation of smoke.
The Royal College of Nursing highlighted its concerns just last month by writing to Michael Spurr, the chief executive officer of HM Prison and Probation Service, calling on prison bosses to do more to protect nurses and other health workers, whose health is put at risk each day from both direct and indirect effects of the drug. In April, nursing staff were pulled out of Holme House prison due to the risks posed by Spice inhalation. Spice is comparatively cheap in the prison system and is available as a chemical that can be sprayed on to letters and pictures sent via the post. There are still difficulties in detecting it without specially trained sniffer dogs, and standard drug testing does not necessarily pick up all strains.
A holistic approach is needed. In addition to legislating for penalties for those who assault emergency workers, which this Bill sets out, focus also needs to be on recovery-oriented and integrated substance misuse services to young people and prisoners, coupled with support on release. It is vital that criminal sanctions go hand in hand with violence prevention. There must be robust systems for screening and violence reduction. It should be incorporated into training and development; staff should be equipped with the skills and confidence to de-escalate situations where violence may occur and know how to break away if an incident regrettably happens and they need to protect themselves.
What happens after a violent event to staff in terms of reporting incidents of violence and the support given to victims of violence in these situations? As others have mentioned, assaults are underreported, and there are many reasons for this. Research has indicated that there are many barriers to reporting,
including high workload and little time, frequent occurrence of violent events, and ethical conflicts about reporting a patient.
Worryingly, there is also evidence that staff are concerned about a blame culture in which they will be seen as provoking the violence and an endemic view that violence is “just part of the job”. Employers’ responsibility to support employees in such circumstances cannot be overemphasised. I am fully supportive of the Bill, but also ask whether a better long-term solution would be to have mental health services accessible to many of the perpetrators much more quickly. We should recognise that we do not even hold waiting lists for most mental health problems.
This Bill is about respect for emergency workers and this is highly commendable. However, I want to emphasise that, in a climate where the UK is calling out for health professionals and we are struggling to recruit and retain staff, there needs to be adequate training and robust support for NHS staff and other emergency workers when an incident occurs. Do the Government plan to introduce a duty on the employer to assist employees who are going to give evidence in court against their assailants, which is often a time of anxiety for victims? Why are they so often left on their own, with only union support? I am also concerned that, should an assault occur, assailants should be held responsible for their actions and not be able to lay blame on service inadequacies by saying that they were not appropriately dealt with and thus not accountable for their actions. Will the Government re-emphasise to the Department of Health that there is a duty on employers to ensure that staff have the relevant CPD to prevent aggression; to provide safe environments for those who they care for; and to provide support for staff when violence occurs, having first taken every possible preventative measure?
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