GBH on the NHS Transcript

NB: THIS TRANSCRIPT WAS TYPED FROM A TRANSCRIPTION UNIT RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT: BECAUSE OF THE POSSIBILITY OF MIS-HEARING AND THE DIFFICULTY, IN SOME CASES OF IDENTIFYING INDIVIDUAL SPEAKERS, THE BBC CANNOT VOUCH FOR ITS ACCURACY.

---

PANORAMA
GBH ON THE NHS
RECORDED FROM TRANSMISSION: BBC ONE
DATE: 26:02:07

---

JEREMY VINE: Good evening. I'm Jeremy Vine and this is Panorama Tonight: bruised, battered and beaten by the people they were caring for. Punch bags... all in the line of duty.

TONY BLEETMAN: I've been struck by a man whose arm was in a plaster cast, I've been threatened, I've been spat at.

UNKNOWN MALE: I've had a patient threaten to stub a cigarette out in my eye.

UNKNOWN FEMALE: I've been bitten, slapped.

VINE: We turn the tables on the patients that think they can attack doctors and nurses and get away with it

SHELLEY: Well, do you think that they should continue to treat you given the way you've treated them?

VINE: Well, do you think that they should continue to treat you given the way you've treated them?

VINE: The scandal is, they usually do.

VINE: If you happen to find yourself in Accident & Emergency any time soon, you might want to sit with your back against the wall. Tonight we expose the largely untold story of violence against NHS workers, which, as you're about to see, can turn hospitals into battle zones. Not only that, all too often, the person that starts the trouble doesn't even end up in court. Just watch this.

SHELLEY: Staff nurse Amai Gold used to love her job in Accident and Emergency. The variety made up for long hours and modest pay. But two and a half years ago something happened at work she just wasn't expecting. Amai was treating a diabetic man who'd collapsed. After more than an hour caring for him she tried to give him an injection.

AMAI GOLD: He just knocked the other nurse and two doctors flying, pulled me and the needle with him, towards him, on one way to the trolley, and then literally all the way round the trolley. And as I went round the trolley, I was still trying to, you know, get the syringe off him.. you know. He wouldn't let go. He looked at me, just basically said, "You bitch! You hurt me." And in it went, into my finger, and pulled me down on the bed with him in an arm-lock position.

SHELLEY: He pushed it into your finger?

AMAI: He did. It went straight under my wedding ring.

SHELLEY: The needle caused permanent nerve damage and the attack has kept Amai off work for 6 months in all.

Who'd tolerate violence like that at work? More nurses and doctors than you might think. An estimated 75,000 NHS staff were physically assaulted across the UK last year. That's one attack every 7 minutes.

Over the last nine months, I've spent time at two of the country's busiest city hospitals to see just what their staff have to contend with, all in a day's work. Some of the violence they face has been caught on security cameras.

SHELLEY: Heartlands Hospital, Birmingham. A Saturday morning in A&E and Doctor Steve Linney had just come on shift. He shows me how he tried to calm down a drunk and abusive patient.

SHELLEY: She looks in quite a bad way, oh and she's pointing her finger at you.

STEVE LINNEY: She decided she doesn't particularly like me.. but I'm talking to her in a cooperative manner.. trying to be gentle.. trying to persuade.. as you see there's no threatening behaviour on my part.. and I'm gently ushering her back.

SHELLEY: What's she saying to you, as we can't hear it obviously ?

STEVE: Ehm you wouldn't want to hear it. She's shall we say f-ing and blinding at me.

SHELLEY: Oh my goodness look at that.

STEVE: She makes a grab for a chair (SHELLEY - What's that?) It's a.. It's a plastic chair with metal legs and she's trying to spear me thru the.. there you are that one.. And she's trying to spear me thru the face with the legs..

SHELLEY: Well, that all happened in a split second?

STEVE: I don't normally get caught as I say and I didn't see that coming.

The woman was quickly removed from the hospital and charged with assault. Six months earlier, another doctor in the department had a similar bad experience. This time the patient was sober.

KRIS PARTHASARTHY: I went up to this guy who was sitting in the corridor and eh said, introduced myself, said "I just need to have a look at your foot". I bent over him saying, "if this hurts tell me and I'll stop". Not even a second after touching him there was a sharp punch on the side and I'm thinking what.. why are you doing that.

SHELLEY: He punched you?

KRIS: He just punched me. He just took off and just punched for no obvious reason at all.

SHELLEY: This is the patient - caught on camera - shortly after the attack. Sitting calmly in the corridor having been removed from the treatment room by security.

So what was running through your head, 'cos I mean most normal people would probably want to thump this guy back.

KRIS: Most normal people would and I am a normal human being as well. I mean beside being a doctor first you are a human being. And I was furious, absolutely furious.

SHELLEY: But the violence continued, you can see him here shouting abuse as he is restrained in the corridor. His injured foot seems long forgotten as he throws punches at the security guard. Shortly afterwards, he was arrested and charged with assault.

I've been chatting to different members of staff today and already I've heard about a nurse being reduced to tears by an abusive patient, somebody else being punched in the chest by a patient and another doctor being attacked by a woman with a chair. And this is all in the space of the past week.

Over the last year, 91 physical assaults were formally reported by staff here. That's nearly 8 a month. An improvement on the previous year, but still way too high for the doctor who runs A&E.

TONY BLEETMAN: People that come to emergency departments something bad has happened to them. They are scared, they're anxious, they're in pain or they're sick, and they lose the ability to behave as a normal cultured educated human being. The animal inside them takes over, so part of it we can't blame them. But there remains a hard core of people that we can blame them. They are bad, they are evil and they should behave better.

And this hard core don't care about the staff or sick patients when they kick off.

DR ARNE ROSE

SHELLEY: Tell me how the trouble started.

DR ARNE ROSE: Well I was standing just about here where we are standing now in a normal afternoon shift when I was told by the Sister that there was a fight breaking out in X-Ray, and I could already hear it. One of them got in there, got past the receptionist, grabbed a pair of scissors and then jumped on top of this desk to you know fend the others off. One of the people grabbed one of these fire extinguishers off the wall and tried to throw it after the guy who'd run into the Reception area and there was bedlam.

SHELLEY: It was a fight between two gangs of young men that spilled into the hospital when one of them was brought in for treatment. Frightened patients had to be evacuated as staff risked their own safety to break it up. Two men were later convicted of affray.

SHELLEY: It was a fight between two gangs of young men that spilled into the hospital when one of them was brought in for treatment. Frightened patients had to be evacuated as staff risked their own safety to break it up. Two men were later convicted of affray.

SHELLEY: The hospital has introduced protection for its staff that wouldn't be out of place in a prison. Bullet-proof glass in reception; swipe cards to restrict entry to treatment areas; cameras on every corner; panic buttons and personal alarms for all staff.

Most of the violence is fuelled by drink and drugs. It's 4 o'clock in the morning at Edinburgh's Royal Infirmary. It's been a hectic night and tempers are beginning to get a little frayed in A&E.

SHELLEY: One of the patients starts shouting at the other people who're waiting. Then he loses it and bites an already injured man on the ear. As the man runs off for help, Security try to calm the attacker down?but he's having none of it. Shouting abuse and lunging towards nurses and patients, he's wrestled to the ground by staff and security and later arrested.

SHELLEY: Fending off drunk and abusive patients is just part of the job these days for A&E staff. But they also have to expect the unexpected.

It's just before ten at night and a patient from emergency surgery has been brought down to a recovery room. An ordinary shift for staff nurse Chris Mclaughlin here on the left?until the patient starts to come round.

CHRIS MCLAUGHLIN: I was just going to go into the room and do what I would normally do after somebody had come from theatre, just check their observations basically.

INT: You had come out quite quickly here?

CHRIS: Obviously, all I could think about was trying to keep him in the room he was jumping up and down fists clenched and shouting, swearing, spitting, so I knew that if he could get out what a problem he would actually be. You will see he is coming at us with a bedside table.

INT: Its pretty dramatic.

CHRIS: As you can see the door is kind of bulking away, but there is a few of us managing to hold on to close the door.

INT: It has just come through the glass. You must have been petrified, were you not?

CHRIS: It was very scary, I have to say. At this stage somebody came up with the idea of putting the mattress up against the door, as you can see we have got more mattresses and we have got more staff coming through to try to give us a hand.

SHELLEY: Well, there's a huge number of staff here now.

SHELLEY: The Royal - like every other NHS hospital - says it has Zero Tolerance of attacks on staff. That policy is backed up with a permanent police presence in A&E. But still there were 73 physical assaults reported by staff here last year.

OPERATOR: Is she conscious?

SHELLEY: And the abuse isn't confined to hospitals. GPs, midwives, even emergency call operators are targets.

CALLER: My old man's in hospital. You sort that out first, fat cow, you sort that out first.

OPERATOR: Do you want an ambulance or not ?

CALLER: Yes, I want an ambulance, not for me..fat cow.

SCREAMS

SHELLEY: Life on the NHS frontline these days involves a constant tirade of verbal abuse from patients.

A&E ACTUALITY: Young man You need to walk off.

WOMAN: You need to shut your mouth.

YOUNG MAN: No, you need to shut your mouth.

STAFF NURSE: You need to play sensible. You're going to get yourself nicked.

SHELLEY: All the staff I spoke to said swearing and shouting is so routine that they don't even bother reporting it.

ELIZABETH SHAND: There's never a day goes by that there isn't abuse of some kind.

STEVE LINNEY: The old idea that is was weekends or a Friday phenomenon are gone it's 24/7 now.

DARREN DICKINSON: I would say at least four or five times a week.

SHELLEY: Have you reported much of the abuse you've suffered?

STEVE: Ehm.. the vast majority of it, no.. Because there's no point.

TONY BLEETMAN: They fill out a form, it goes into a black hole so what's the incentive for staff to report it if they perceive that nothing's being done about it apart from compiling official figures.

SHELLEY: Do the official figures tell the real story of what staff are having to put up with?

TONY: I'm absolutely clear that official figures are the very small tip of a very large iceberg.

SHELLEY: Zero Tolerance means NHS staff are encouraged to report any kind of abuse. But actually prosecuting a case takes time and effort. And what's the point if nothing happens afterwards?

SHELLEY: Amai Gold was left permanently disabled by her attacker. He stabbed her with a needle in front of witnesses. She was determined to press charges.

AMAI: The Police dealt with it em.. they did their reports, their investigations. It was then referred to the Crown Prosecution Service who decided to drop the case due to lack of evidence and the fact that it wasn't in the public interest to pursue the case.

SHELLEY: What did you think then when they said it wasn't in the public interest and there wasn't enough evidence to pursue?

AMAI: I just couldn't believe what had happened.

SHELLEY Back on Chris McLaughlin's shift, things have got worse. Much worse. Struggling to cope on their own, he and his colleagues call for reinforcements.

CHRIS MCLAUGHLIN: We are still containing him in the room and the Police Officers are kind of helping us at the moment.. The staff here have got protective masks and stuff on, just because he was kind of spitting and there was a lot of body fluids, blood and stuff

INT: This is obviously not a scene you would expect to see in a hospital.

CHRIS: It is something that is pretty rare that would happen. We have got the riot Police coming in now.

INT: That's just after midnight. So this has been going on for a good couple of hours now.

CHRIS: Basically, yes. We could hear him in the room, but he had put the lights out so we couldn't actually see him. We didn't want to take the mattresses away. He was up and about, being quite abusive, shouting.. As you can see we have kind of taken away the mattresses and put the shields up just so they could get a much better view of what was going on in the room. There was a lot of blood on his leg.

INT: He looks in a bad way at the moment.

SHELLEY: As part of its Zero Tolerance campaign, the Department of Health wants all NHS staff in England to be trained in conflict resolution by next year. But how much protection will it really offer?

TONY BLEETMAN: I've been through the training and to my mind it is very low level and does not confer any practical skills to staff.

SHELLEY: He teaches his staff what to do when things get physical. And he does this in his own free time.

This training is more than what the department of health suggest.. I mean why do you think it's important to teach these extra skills?

TONY: The Department of Health's initiative is a tremendous step forward on what we had before which was precisely nothing.. I applaud the efforts to do something about it. But it's not enough.

SHELLEY: I was surprised at how hands on the training was but it did bring home the reality of what life must be like for staff in A and E if they are actually dealing with that sort of threat that they are expected to deal with at work. It was a bit odd though that the whole thing was run by an A and E consultant.. I'm not sure the public would think that was a very good use of his time.

SHELLEY: The government has invested heavily in protecting health service workers. But no-one could tell Panorama how much GBH on the NHS costs the taxpayer. So we contacted health agencies across the UK and calculated it ourselves. Last year alone we estimate the Health Service spent at least £100 million dealing with violence and abuse. That's money that could have paid for an extra four and a half thousand nurses or more than eight hundred thousand paramedic callouts.

ABUSIVE CALL (999 CALL CENTRE)

OPERATOR: It's the ambulance service. I just need to ask you a couple of questions to update the crew. How old is your nephew.

CALLER: No you can't ask me any questions to update the crew. My nephew's lying in front of me? (both at once) No ! My son's in Iraq. Listen don't f*** about with me?

OPERATOR: Have you finished?

SHELLEY: If Zero Tolerance is not just to be an empty slogan, patients need to know they can't get away with assaulting medical staff. But the prosecution rate is a measly 2%. The government has set up a new Legal Protection Unit specifically to increase the number of prosecutions. And - with its help - two years after the assault, Amai Gold's attacker is finally being brought to court.

SHELLEY: Do you think there can be a satisfactory conclusion to your case? What are you hoping happens?

AMAI: I don't know what is going to happen. Part of me, yes, wants justice and he deserves everything he gets and part of me thinks, you know, OK, we have got this far is he only going to get a slap on the wrists and a £50 fine, you know.

SHELLEY: Do you think some of your colleagues wonder why you are pursuing this so vigorously?

AMAI: Some of them said to me, its part of the job, you know, nothing will come of it, you know. What's the point of going to Court, you know, because the CPS will only throw it out, which did happen in the first step of my case. But I have pursued it, and I have done it for everyone, you know, and for me.

SHELLEY: Amai's gone off, there will be another Court appearance next week and even then it won't be dealt with. I guess that's why a lot of staff just don't even bother pursuing these things as it takes so much time.

SHELLEY: But if Amai's still waiting for justice, what about the two doctors who were assaulted at Heartlands?

Remember the drunken chair-thrower? She pled guilty to assault and she's up in court for sentencing today.

SHELLEY What I'd really like to do when she comes out is see if I can have a chat to her, and actually show her the CCTV footage which I've got on camera.

DOORSTEP

SHELLEY: Do you realise how serious it was? Have you seen the footage? Watch what happens .Look at that. It's pretty bad, isn't it?

MOIRA: Mhmh.

SHELLEY: I mean he says you came really close to actually injuring him badly in the face, that he might have needed surgery if it had, you know, not missed him the way it did. How do you feel about that now?

MOIRA: Bad, I feel awful about it. What else can I say?

SHELLEY: I mean these people do a really difficult job.

MOIRA: I know that. I know that. I understand that. But me head was going... I was having a brainstorm, and I... I've got a lot more issues than that, do you know what I mean?

SHELLEY: She did seem genuinely shocked when she saw what she'd done. I don't think until she saw the pictures she'd actually realised quite how serious it was. But you do wonder why staff have to put up with that sort of behaviour at work.

STEVE LINNEY

SHELLEY: So a twelve month suspended sentence and fifty pounds compensation to you. What do you make of that?

STEVE: Well frankly it's ridiculous. Where is the deterrent? We are talking about having a Zero Tolerance Policy. So we prosecute these people when they perpetrate force against members of the NHS, and then the courts do this for us.

SHELLEY: What about the guy who punched the doctor who was just trying to examine his injured foot? Remember, the man who then let fly at the security guard? He was found guilty of both assault charges.

KRIS PARTHASARTHY

SHELLEY: The man who attacked you got a suspended jail sentence and a fine of fifty pounds. What do you think of that?

KRIS: A suspended jail sentence and a fine of fifty pounds for assaulting NHS staff in the hospital. That's right, OK ? I think that makes me very, very angry.

SHELLEY: I caught up with his attacker at home. I wanted to show him his behaviour on camera.

SHELLEY: Do you regret it at all?

MALE: Well I don't regret it because I didn't do anything wrong.

SHELLEY: Really? That's your position... Even though the doctor says you punched him on the head. Even though the pictures show you assaulting a security guard?.

MALE: Excuse me, excuse me,. He tried to put me on the floor when I had a broken toe. I had no choice, anybody would have acted exactly the same as I did, and that's?..

SHELLEY: I don't think that's true is it, most people don't assault medical staff?

MALE: I didn't?. look, I'm trying to say to you, you're not listening to me, you're not listening to me.

SHELLEY: So no apology then? You're not sorry?

MALE: No I didn't do anything wrong. As far as I'm concerned, I'm in the right.

KRIS PARTHASARTHY

KRIS: I was expecting him to go to jail. It should reflect what the NHS keeps harping about. It says Zero Tolerance, Zero Tolerance. I think it should have Zero Tolerance.

SHELLEY: Hospitals can ban abusive patients though that hasn't happened in this case. But what does Zero Tolerance really mean anyway if withdrawing care for a patient could kill them?

That's the dilemma currently facing the Royal Infirmary of Edinburgh. For three years, staff here have been providing kidney dialysis three times a week for a particularly abusive patient. The treatment keeps him alive.

CAROLINE WHITWORTH

CAROLINE WHITWORTH: His behaviour started off as being mainly incessant complaining often with sort of verbal aggression or intimidatory comments?threatening comments.. The complaints side of things became a real issue. He was accounting for more than 95% of the complaints received by the Renal unit.. one individual..

SHELLEY: But worse, Donald Gibson began terrorising the female staff. They didn't know at first, but he's a convicted rapist.

SHELLEY: Tell me what sort of things he would do that would make staff here feel afraid?

CAROLINE: He would at the end of his dialysis session might hang around the unit.. he might follow nurses out to their cars.. he would often make comments that were perhaps of a sexual nature..

He'd often try and find out little bits of personal information about your home life or something like that.. and then try and use that you know just as a sort of.. you know I know about you.

SHELLEY: And did he threaten staff?

CAROLINE: He did.. on one occasion he threatened to kill one of our nurses.

SHELLEY: The hospital eventually got a Court Order against Donald Gibson, requiring him to behave. But he later kicked a nurse, racially abused a security guard and was sentenced to nine months in jail. He still needs dialysis though.

SHELLEY: This is where Donald Gibson comes for treatment now. A special room has been created just for him at a cost of 12 grand. It's well away from where he used to get his dialysis and used to terrorise the staff there. It has been completely kitted out just for his use and he comes here three times a week shackled to a prison guard and sits here for five hours and then goes straight back to prison. And you can see, the room also a one-way mirror so that staff on the outside can keep an eye on him but he can't intimidate them.

SHELLEY(not in vision): Isn't there a time when you just have to sort of draw the line and say I'm afraid we've given you every chance you.. you do not deserve treatment anymore?

CAROLINE: I don't think that's a line that any of us are prepared to draw.. I think that's something that the courts might one day decide.. There's no precedent for that.. but maybe one day it will happen..

SHELLEY: Donald Gibson's case makes a mockery of Zero Tolerance. He was released from jail recently and - no matter how badly he behaves - he knows the medical staff still have a duty to care for him.

SHELLEY: Donald Gibson? I'd just like to ask you about your behaviour towards the staff in the hospital over the last wee while?

DONALD GIBSON: No comment

SHELLEY: Well, do you think that they should continue to treat you given the way you've treated them? Your behaviour has been extremely threatening

(D.G. - Stop harassing me.) You've threatened to kill (D.G. - Stop harassing me.) Well, you've been harassing staff in the hospital, haven't you?

DONALD GIBSON: Well, that's untrue.

SHELLEY: Well, you've just served a prison sentence for actually assaulting a nurse.

DONALD GIBSON: You do not know the full story.

SHELLEY: Have you no regrets about how you've behaved in the hospital?

DONALD GIBSON: I have, I have actually.

SHELLEY: You have? What do you regret?

DONALD GIBSON: You're upsetting me. I've just come off a dialysis machine, and I'm really upset. Just leave me alone please.

SHELLEY: There's hardly anybody willing to treat you because of what you've done.

DONALD GIBSON: You don't know the full story.

SHELLEY: So a man who threatened and assaulted medical staff continues to receive treatment on the NHS.

Meanwhile, staff nurse Amai Gold has just learned the case against her attacker has collapsed. An expert report says the man's diabetes means he can't be held responsible for assaulting her.

AMAI GOLD: I was the one who nursed that patient. I was the one who cared for him and I was there and it happened to me. To pull me from one side of the trolley to the other, stabbed that needle into me, into an arm lock position and then do it again, you know, he knew what he was doing. It should have gone to a Judge and jury and for the trial to decide, you know, whether he was guilty or not. I can't go on, sorry.

SHELLEY: Two and a half years on, though, Amai isn't giving up. She's now trying to get justice by suing the patient who stabbed her.

SHELLEY: Right, so here we are now quarter to one, it is still going on, quarter to one in the morning. Why are they trying to prize open the door?

CHRIS MCLAUGHLIN: I think basically they decided that they weren't going to be able to talk him down so we had to get into the room to restrain him.

SHELLEY: So you were here throughout this whole incident?

CHRIS MCLAUGHLIN: Yes.

I think that is the Anaesthetists going in to check on him. Some more of them went in. I think at this stage because he had kind of been going on for so long he was kind of lost a lot of blood and stuff. The Police Officers are bringing him out and popping him on the mattress.

SHELLEY: But, you can see there everybody is just straight in, trying to look after him.

CHRIS: Yes, basically and that was our priority afterwards, was to get him sorted.

SHELLEY The patient had mental health problems and was taken elsewhere for treatment.

Chris, meanwhile, had to get to the end of his nightshift.

SHELLEY: This is you, nearly 2 o'clock in the morning.

CHRIS: Yes.

SHELLEY: You must have been really shaken by that?

CHRIS: It has been the most scared I have ever been, and I am sure, well I hope, I will never see anything like that, to that extreme, again.

SHELLEY: Doctors and nurses have a duty to care for their patients. But what about their right to work in safety? In the time you've been watching this film another four NHS staff have been physically assaulted.

JEREMY VINE: Shelley Jofre on the frontline in A&E.

Now we'd love to hear your views on whether you think health-workers should be allowed to refuse to treat certain patients.

And in fact, any stories you've got on the NHS - whether you work in it or you've been a patient there - we would also love to hear. That's it for this week.

If you've been affected by any of the issues in tonight's programme and would like to talk to someone in confidence, call the BBC action line free on 0800 077 077, that's 0800 077 077.