Healthcare workers in Northern Ireland are under constant fear of attack. Will a new campaign go far enough to make their jobs safer? Margaret Canningreports
A campaign to cut attacks on healthcare workers in the North has been welcomed, but some are saying the campaign will be ineffective without legislative change. There were 6,007 attacks on healthcare workers in the North, from ambulance personnel to clerical staff to doctors and nurses, between April 2006 and April this year. Over half were on nurses and out of all the attacks, 1,724 were verbal and 4,283 physical.
The onus is on the worker rather than the hospital or NHS trust to complain to police before a prosecution can be brought.
There are calls for legislation to make it the responsibility of the hospital or trust to prosecute rather than the worker, a possibility being looked at by the North's Department of Health.
In the meantime, the department hopes to bring home the message that attacks are intolerable. Advertisements on radio and bus shelters will get the message to the public while all healthcare workers are being sent a leaflet advising them what to do if attacked - and 'zero tolerance' badges they can wear at work.
Accident and Emergency (A&E) at Belfast City Hospital is one of the North's busiest casualties. Geraldine Byers is the City's lead A&E nurse and has noticed a change in patients' attitude to their carers.
"I suppose when I started there were incidents of abuse but they were more the exception than the rule and usually happened on a Friday or Saturday night.There was a perception it was part and parcel of the job, particularly in A&E."
But now, "people tend to get more aggressive more quickly any time day or night, not just on Friday or Saturday".
She welcomes the department's campaign and vows to wear her zero tolerance badge.
"The campaign will encourage staff to report incidents. People thought before: 'what's the point?' but now it's looked on much more gravely.Staff do get very frustrated because they can't do their job being exposed to that kind of behaviour. . . but their perception has changed and they no longer accept it as being part of the job."
Her hospital also benefits from police patrols under a pilot scheme, which saw episodes of abuse fall by one third and has now been extended until January next year.
But it's not just hospital medics who bear the brunt of patient aggression.
West Belfast GP Dr Michael McKenna wryly refers to himself as "the British Medical Association [ BMA] spokesman for getting beaten up".
He's been attacked three times, including in 2003. He was working for an out-of-hours GP service when a call from an anxious mother whose son was depressed took an unexpected turn.
"I went into the house and quickly realised this man expected things that were unreasonable. When he didn't get what he wanted he took it out on me and my car. Basically, he wanted to be detained [ under the Mental Health Act], but there were no grounds.
"He was initially agitated then kind of lost it. He lifted my briefcase and tried to hit me with it, but his mother intervened.
"Then he went outside, did a dance on the bonnet of my car and kicked the windscreen in. If I wasn't going to lock him up, he wanted to be locked up some other way.
"He had his own expectations and if he didn't get them one way, he would get them another way. People want to have their problems sorted out in the way they expect or they get angry."
He says it's an attitude more prevalent now than when he started in general practice 10 years ago. "It certainly mirrors something in society. People don't really have the time for anything now, and they get increasingly really frustrated with things, rightly or wrongly.
"I didn't do any more out-of-hours work for two or three years," McKenna says. "I didn't feel safe doing it."
McKenna says he's "very much in agreement" with the zero tolerance campaign.
"Attacks happen but I don't think they should be part of the job." He was also attacked when working as a locum GP in 1999. "A drunk came into the surgery demanding a sick line but I refused. He came back in when he was sober and hit me."
McKenna made a complaint and the attacker was prosecuted and sent to prison for six months.
Like McKenna, Alan McKinney, emergency medicine consultant in Altnagelvin Hospital in Derry, sees higher levels of aggression as a reflection of society.
"Nowadays you have air rage, car rage, people ranting in hotel receptions and at staff at checkouts.
"People live on a shorter fuse and lack respect and understanding, and when there's alcohol involved it gets worse."
But having been knocked unconscious himself as a trainee 20 years ago, McKinney says it's not a new problem.
Altnagelvin has had its own zero tolerance for some time and security measures in A&E are under constant review.
Abuse has fallen - "people are realising they're not going to get away with it" - but McKinney is weary of the perpetrator's pet excuse.
"Someone might say they were drunk, but they weren't so drunk that they couldn't stand up and throw a punch at someone. They knew what they were doing.
"The department's involvement in zero tolerance is welcome and it highlights the need for concerted efforts, not just individual members of staff to pursue those villains.
"If a doctor who is alone in A&E is attacked, who looking after the man having the heart attack? And what about the safety of other patients and distressed relatives?We can't allow drunken thugs to run riot holding the whole of A&E to ransom."
In the last few years in Altnagelvin's A&E, he's had various staff knocked unconscious, given a broken nose, a wound requiring stitches and a pregnant nurse punched and kicked.
"All of those went to court and all resulted in sentences but some people might be reluctant to bring police into it . . . they might feel the situation was somehow their own fault or that they are creating a fuss. But as the number of assaults increased, our tolerance decreased.
"I don't think anyone in their right mind would regard going to work as risking getting punched.The vast number of people waiting for treatment don't resort to violence and abhor the idea that people can come in and throw their weight around, thinking it will get them more attention."