Theodore Dalrymple

Rough treatment

Assaults on hospital staff are a telling symptom of our national condition

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If anyone needed persuading of the deep moral disarray of modern British society, the latest figures on assaults against National Health Service staff should be more than sufficient to convince him. It is not so much their overall number — though 57,830 in a year seems quite a lot to me — that is alarming, as the variation in the way with which they are dealt. The predominant response is, as you would expect, feeble, vacillating, lazy and cowardly: or, if you prefer, forgiving.

I mean no criticism of NHS Protect, the horribly named agency that collected the figures, when I say that these figures raise far more questions than they answer. They do, however, illuminate the general state of confusion in our country much as a flash of lightning illuminates a dark landscape at night.

The number of assaults increased by only 1,112 over the previous 12 months, or 1.96 per cent: not dramatic, but no doubt better than the GDP.

For statistical purposes, assaults on NHS staff are divided into two main categories: those that ‘involve medical factors’ and those that do not. The latter declined to 18,060, or by 19 per cent, compared with the previous year (22,381); but unfortunately the corollary is that the British are becoming more violent under the influence of illness, because assaults that ‘involve medical factors’ increased by 5,433, or 15.8 per cent.

Why this should be so is not explained. It is, of course, much more likely that the increase is the result of a change in classificatory fashion rather than in the underlying reality, because the two categories are highly elastic, to say the least, and of little intrinsic validity.

Just how elastic can be gauged from an examination of the variation in the figures between the individual NHS trusts. Why, for example, should none of the 90 assaults in Barnet have ‘involved medical factors’ but 71 of 72 in Ashford have done so? Why should only five of 57 assaults at the Whittington Hospital have involved medical factors, but 166 of 199 in Derby? There would be some variation if the categories were real or natural ones, but not a variation as great as this.

Just as great was the variation in the number of people prosecuted by the various trusts. One might have supposed, or at least hoped, that all people who assaulted NHS staff without medical extenuation would be prosecuted, not because the staff of the NHS are morally perfect and deserving of special protection, but because if people are prepared to assault them in a public place in front of many trustworthy witnesses, their conduct in other circumstances requires little effort to imagine. But although the numbers of people prosecuted who assaulted without medical extenuation increased by almost 24 per cent over the previous year, the absolute number was only 1,397, that is to say 7.7 per cent, or one in 13. Given the nature of the sentences frequently handed down (one in eight convicted robbers or burglars goes to prison, for example), one might as well put up a notice saying ‘Assault a member of staff today! You have nothing to lose!’

In some hospitals, however, practically every patient who committed assault without medical extenuation was prosecuted: for example Guy’s procured ‘criminal sanctions’ (not further explained) against 68 of 77 such patients, and Central Manchester 52 of 53. Dartford, however, successfully prosecuted none of 71 and Doncaster none of 79. So if you feel like assaulting a member of the NHS staff, go to Dartford or Doncaster.

There are many possible explanations for this variation. Hospitals might not agree as to what an assault is: some might record the merest unsolicited physical contact, others only violence that caused actual injury. The police in one area might be willing to arrest and unwilling in another; the Crown Prosecution Service likewise might pursue cases in one place but not another. Magistrates might vary in the willingness to convict, and in their severity or leniency. But different hospital policies seem the most likely explanation.

Overall, there were roughly four assaults per 100 NHS staff, though for clinical staff the number must be higher, say five. Not surprisingly, perhaps, the psychiatric services bore the brunt of the attacks, 39,321 of the 57,830 total. The staff of the inaptly named 2gether NHS Foundation Trust (how the managers must have congratulated themselves on their wit in giving the trust this name!) were assaulted at a rate of 41.4 per 100 per year. Of 740 assaults, 666 were deemed to have ‘no medical factors’ — but not a single one of the 666 resulted in a conviction. Perhaps the trust should have been named in honour of Polly Toynbee.

It is not the case that that assaults ‘involving medical factors’ are not ipso facto punishable by law. The staff of the Calderstones Partnership NHS Trust were subjected to 677 assaults (a rate of 44.5 per 100 workers), every one of which was held to ‘involve medical factors’. Yet 32 of the perpetrators received criminal sanctions. However, of 12,081 assaults on mental health staff deemed to ‘involve no medical factors’, at most 459 resulted in criminal sanctions, that is 3.8 per cent.

No one, I suppose, would want a completely uniform, centrally dictated or inflexible response to assaults on NHS staff. There really are medical conditions that exculpate assault. As Hippocrates said a long time ago, life is short and judgment is difficult. And where judgment is exercised, consistency is impossible.

Nevertheless, these figures demonstrate that our society — or at least its administrative class — does not have the most minimal agreement as to what properly constitutes individual responsibility, or how to react to behaviour that at least 99 per cent of the population would regard as reprehensible or downright criminal. The official class lacks all conviction, and the rabble has nothing to fear.

With economic implosion a distinct possibility, and a society that does not have the confidence to deal even with a drunken lout in casualty, the auguries are not good.