The 2014/15 figures for assaults on NHS staff were published yesterday and they show 67,864 assaults overall, right across our NHS. This involved 1,861 assaults on paramedics – my brothers and sisters in green – and 45,220 assaults within the mental health sector, which is 66% of the total, down from 70% in years gone by. You can read the NHS Protect spreadsheet if you want a lot more data to consume or a very detailed look at your area.
Assaults on NHS mental health staff has always been a difficult subject: no-one thinks that getting assaulted is ‘part of the job’ but we also know that when people are in extreme distress and fearful, an assaultative reaction to circumstances can be at least understandable, if not a direct manifestation of their particular condition. So the NHS identifying which cases should be reported to the police is difficult enough: we know that only about 1 in 8 of the assaults recorded by the NHS are subsequently reported to the police. Officers then knowing how to investigate them and determine an appropriate outcome has also proved problematic – I still hear anecdoates from MH professionals that when they report matters to the police, the response is mixed. Some officers still believe you cannot arrest and / or prosecute someone who is detained in hospital under the MHA – well, you absolutely can! … and that you have to have complicated discussions with psychiatrists about ‘capacity’ before they can start doing anyting – you absolutely don’t!
But there is confusion in the NHS as well – and you’ll have to look at the detailed spreadsheet to see this for yourself. The NHS recording mechanisms ask staff to indicate whether there were “medical factors” involved in the assault – I’m not aware of whether this is specifically defined or whether such a judgement is given tby the victim or by the doctor in charge of that patient’s care. Either way, the outcome is interesting –
- Oxleas NHS Trust in London and Nottinghamshire Healthcare Trust believe that none of the assaults that occured within their trust involved any medical factors – NONE of them.
- West London Mental Health Trust and Cheshire and Wirral Partnership Trust believe that all of their assaults involved such factors – absolutely ALL of them.
Now I’m not a medical doctor, as you know – but I suspect that neither of these can be correct! And as a police officer I can say that this can have implications for the appropriate legal response to any allegation because it will either affect the police / CPS assessment of the evidence; or the assessment of whether it is in the public interest to prosecute. Imagine the response officer or the hospital liaison officer taking a report and asking about whether there were any clinical issues affecting the incident or whether “medical factors” were involved? The answer is important: in Oxleas and Nottinghamshire, it’s easier for the officer: they can confidentally tell their supervisor and the CPS that the professionals involved have negated the possibility of a clinical factors playing any role. But the officer in West London and Cheshire can’t do that, can they?
So it begs the question: if clinical issues affected the incident, how did they affect the incident? Does it affect the so-called ‘capacity’ question (which is incidentally, the wrong question to ask but I’ve covered that elsewhere) or does it affect how we might weigh the public interest? What exactly does “medical factors” mean for this patient and victim?!
I’ll leave the point there – you can (re-)read other BLOGS on here if you’re interested in other things that could be said about all this and you can peruse the spreadsheet to your satisfaction … now who doesn’t love a good spreadsheet?!
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