Are efforts to protect NHS staff from violent and abusive patients working?
Hutchins was banned from using the NHS in a landmark case
A 53-year-old man this week became the first person to be banned from using the NHS.
In a landmark case, Norman Hutchins was told he could no longer visit or call any hospital or clinic in Britain.
Magistrates in York made the order after hearing how Hutchins had been abusive towards NHS staff more than 40 times during the past five months, in hospitals as far apart as Devon and Dundee.
The case marks a new stage in the fight against abusive and violent patients.
Ministers have been pledging to stamp out violence in the NHS since the mid 1990s.
Six years ago, they ordered trusts to take steps to reduce violent incidents against staff by 20% by 2001 and by 30% by 2003. Both targets were missed.
In 1998, there were 65,000 reported abusive or violent incidents against NHS staff. By 2001, that had increased to 84,273. Last year, the figure was 116,000.
The increases were put down to improvements in the way information is collected.
Nevertheless, a report by the National Audit Office (NAO), published last year, suggested the true figure may be even higher.
Violence in the NHS
There were 118,000 reported incidents in 2003
Nurses are four times more likely to be assaulted than other staff
One in six NHS staff have been attacked
Violence is estimated to cost the NHS at least £69m each year
It estimated that two in five incidents go unreported, with doctors particularly reluctant to report.
The report revealed that nurses are four times more likely to be physically or verbally assaulted compared with other NHS staff. Those working in mental health units are most at risk.
The NAO estimates that violence against staff costs the NHS at least £69m each year.
The government has tried to tackle the problem.
In 1999, it launched a poster campaign warning that the NHS would take a "zero tolerance" approach to violence against staff.
In 2000, it urged managers to do more to protect staff from violent patients.
In the same year, it issued new sentencing guidelines to magistrates urging them to get tough with people who attacked NHS staff.
In 2001, ministers ordered hospitals and clinics to deny treatment to people who verbally or physically abused staff.
Money was also made available to pay for new CCTV systems, personal alarms and training for staff in some hospitals and clinics.
In 2002, they sent fresh guidelines to managers outlining some of the steps they could take to protect staff.
Lack of action
Last year's report from the NAO praised many of those measures. However, it criticised the failure to take action against the thousands of offenders.
A recent survey by the Royal College of Nursing (RCN) suggested that action is taken in just one out of every five cases reported.
Figures from the Department of Health show that just 50 people were prosecuted last year for attacking NHS staff.
"The number of prosecutions has been very disappointing," says Sheelagh Brewer, a senior employment relations advisor at the RCN.
Surveys suggest one in six NHS staff has been attacked by patients
"We are hoping that the decision to transfer responsibility for tackling violence to the new NHS Security Management Service (SMS) will result in increased prosecutions."
The NHS Security Management System was given responsibility for tackling violence in the health service in April 2003.
It is setting up a new system for collecting information on violence, which should give a more accurate picture of how many NHS staff are attacked each year.
It has established a new legal protection unit to work with the police and Crown Prosecution Service to try to increase the number of prosecutions.
"We hope to make the number of prosecutions more proportionate to the number of serious incidents," says a spokesman.
The agency is also training local NHS staff to improve security, deal with violent patients and to investigate cases.
It is testing a state-of-the-art ID card with an in-built panic button, which staff can press if they feel threatened. Mobile technology enables security to pinpoint their exact location if they are in trouble.
However, others believe much tougher action is needed.
The trade union Unison, which represents over 250,000 NHS workers, has been pressing the government to go even further.
It wants assaults on NHS staff to be regarded in the same light as an assault on a police officer.
"Everyone knows that if you attack a police constable then they will throw the book at you," says a spokeswoman.
"We want the same for NHS workers. We are still not getting through to people. We need to have a tougher deterrent."