It is right to draw attention to the physical, verbal, racial and sexual violence and abuse experienced by ever increasing numbers of NHS staff in the course of their work (Editorial, 19 January). These threats to NHS staff safety are experienced both physically – in wards, departments and GP practices across the country – and virtually, as staff are filmed and photographed without their consent, and humiliated or abused on social media.
The data on the sharp and continuing increase in violence and abuse rightly creates headlines. Beneath it are complex lives and rapid shifts in societal and behavioural norms. This complexity means that there is no neat solution to the growing problem of violence and abuse towards NHS staff.
The patient with dementia who hits and kicks the healthcare assistant who is trying to provide them with personal care will not be deterred by police intervention or exclusion. These patients may be better supported, and violence averted, with care environments and routines designed for them, and through a national mandatory training framework on de-escalation skills for NHS staff.
There is certainly a place for consistent enforcement intervention. Operation Cavell – a partnership between healthcare, local police services and the Crown Prosecution Service to prevent and reduce assaults against emergency workers – should be rolled out nationally. The NHS should develop a national exclusion framework for patients with mental capacity who abuse or assault staff.
The Assaults on Emergency Workers (Offences) Act 2018 should be strengthened to include online abuse and racist abuse. The NHS is here for all and it must be safe for all – patients and staff alike.
Kate Jarman
Milton Keynes University Hospital NHS Foundation Trust
Recent suggestions that the NHS sexual safety charter has failed underline a long-standing problem: many NHS staff do not feel safe reporting sexual misconduct within their own NHS trust (Charter to tackle sexual harassment across NHS in England has failed, say unions, 18 January).
Research by the Working Party on Sexual Misconduct in Surgery (WPSMS), culminating in the Breaking the Silence report, found that staff are reluctant to report incidents when perpetrators hold positions of power or when confidence in local processes is low.
The charter signals good intentions and sets expectations, but it cannot drive cultural change unless credible reporting mechanisms are implemented – systems that staff can trust, that provide consistency across NHS trusts, and that collect reliable data. Seventy-six percent of NHS trusts have introduced trust-level anonymous reporting, according to NHS England.
Yet individuals affected by sexual misconduct consistently tell us that fear of reprisal remains a significant barrier to reporting, particularly when reporting processes are controlled locally. Without a trusted reporting mechanism, sexual misconduct remains underreported, harmful behaviour goes unchecked, and organisations are unable to recognise or address the scale of the problem.
If the NHS is serious about tackling sexual misconduct, establishing a national, independent, anonymous reporting mechanism must be an urgent priority – something the Royal College of Surgeons of England and WPSMS have repeatedly called for. Without it, the real extent of sexual misconduct in NHS trusts will continue to sit below the radar, and any efforts to create a safer workplace will inevitably fall short.
Prof Vivien Lees
Senior vice-president, Royal College of Surgeons of England
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