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Criminal Justice and Immigration Bill

My Lords, I record my gratitude to the noble Baroness, Lady Finlay, for again tabling this amendment, which gives us the opportunity to rehearse some of the issues. I am also grateful to the noble Lord, Lord Thomas of Gresford, for his contributions. We are agreed that there is a problem with nuisance and disturbance on NHS premises but we are not agreed about how best to deal with it in different settings and circumstances and what is practicable in those different circumstances. These provisions are limited to NHS hospital premises. Amendment No. 110 seeks to extend the definition of ““NHS premises”” in Clause 118 to cover registered hospices and specialist palliative care units. Amendment No. 110A seeks to extend the definition of ““NHS premises”” to the wider National Health Service in general. As I said, we acknowledge that there is a problem of physical violence against NHS staff who work in healthcare settings outside hospitals, including in hospices. I also acknowledge the need for the Government to work even harder to deal with these problems. However, I owe it to the House to explain how and why we designed these provisions specifically for hospitals to deal with the unique problems that they face. Given that these proposals are designed for the hospital setting, I am not convinced that simply extending the provision to other National Health Service premises, including hospices, palliative care units and general practitioner premises, would meet the protection needs of the staff involved. In Committee, I and others referred to research undertaken by the Department of Health in 2006 which indicated that the problem of nuisance or disturbance behaviour, which does not include physical violence, was a particular problem in hospital premises and was largely caused by friends, family members or relatives of patients rather than patients themselves. We have all experienced this in one form or another, particularly in A&E units on Friday and Saturday nights. These provisions have been designed to tackle the problem on NHS hospital premises identified in that 2006 research and will do so in two crucial ways. First, the offence cannot be committed by patients or those seeking medical advice, treatment or care, but rather people who are present on NHS hospital premises and are not seeking treatment, but who cause a nuisance and disturbance. Secondly, the provisions include a power in Clause 119 to remove people reasonably suspected of committing, or having committed, an offence under Clause 118. It is crucial that trained security staff should be able to remove people causing a nuisance before the behaviour escalates towards violence. NHS hospital staff have faced problems in the past when they have had to wait for police to arrive before action can be taken. For that reason, numbers of trained security staff have been increased over recent years. Exercising the power to remove a person reasonably suspected of committing or having committed an offence under Clause 118 will require the support of fully trained security staff, which hospitals generally have available on a 24-hour basis. Without the assistance of security officers, NHS staff could place themselves at serious risk by seeking to exercise the power to remove. I do not think that anyone in the House wants to see that happen. In Committee, I brought to the attention of noble Lords evidence presented in 2008 by the British Medical Association, to which I think the noble Lord, Lord Thomas of Gresford, referred this evening, that 94 per cent of GPs had reported experiencing violence committed by patients. That indicates that the problem of nuisance and disturbance behaviour outside the hospital environment is different and may need separate solutions to meet the very real need of NHS workers for a safe working environment in healthcare settings in the community. The BMA report defined violence as physical and non-physical acts against doctors, so further research needs to be conducted to examine whether the problem is one of mainly physical violence, or of the type of non-physical, anti-social behaviour covered by these provisions. I assure the House that the NHS Security Management Service is working to identify the nature and scale of the problem of nuisance and disturbance behaviour against NHS staff outside hospital premises, and it will take a leading role in developing solutions that are appropriate to the needs of our ever-evolving health service. While I do not believe that extending these provisions to all NHS premises including hospices—where I recognise that there could be a problem—and specialist palliative care units is appropriate, I can offer some limited reassurance to the House about the effect of the existing provisions. In Committee, the noble and learned Baroness, Lady Butler-Sloss, rightly alluded to the fact that hospices could be covered by these provisions if they are located within the grounds of an NHS hospital. This also applies to any building or vehicle associated with the hospital and it would include specialist palliative care units, so there is some breadth to the provision. Using hospices as an example, if an NHS or privately owned or funded hospice was located within the physical boundaries of an NHS hospital, then NHS staff attending such buildings or departments in connection with their work would be covered by these provisions. The reasoning behind that lies again in the power that we are giving to NHS staff to remove those reasonably suspected of committing or having committed the new offence. As I have suggested, exercising the power to remove safely will require the support of fully trained security staff, which hospitals generally have available on the 24-hour basis that I referred to earlier. Hospices located within the grounds of the hospital may be able to draw on those resources to deal with a person suspected of committing an offence. However, there is no guarantee that such resources would be widely available to deal with a person committing a nuisance or disturbance in a hospice, specialist palliative care unit or any other NHS body located in the community. The noble Baroness, Lady Finlay, pointed out in Committee that some hospices employ security staff on-site at night. The noble Baroness reminded me of that earlier today. From my personal understanding of these issues, I would support that point. However, in these cases, that could mean that incidents of nuisance or disturbance behaviour could not be dealt with under these provisions at any other time of the day. I am not satisfied that the provision of security staff in hospices, specialist palliative care units or any other NHS body providing healthcare in the community is widespread. Therefore it would be inappropriate to extend these clauses, which are tailored to the needs of hospitals, to healthcare facilities that could not use them as they are intended to be used. I hope that my commitment that further work will be undertaken to deal with the problems of violence and anti-social behaviour faced by NHS staff outside the hospital setting will be appreciated and that we can work together to secure a solution over time. I am grateful to noble Lords who have again brought this matter to the fore, because we accept that it is an issue. I hope that, having heard my explanation, noble Lords will withdraw their amendments. I shall respond to a couple interesting issues that emerged. The noble Lord, Lord Thomas of Gresford, accepts here that prevention is important, but perhaps he does not accept it regarding other aspects of the way in which we seek to use, for instance, violent offender orders. His acceptance of prevention here but not there is an important point. I thought that his point about notices being displayed being tied to the amendment was not as well thought through as it might have been. In my experience—and, I am sure, that of the noble Lord’s—most GPs’ surgeries make it clear that unacceptable behaviour of a violent or abusive nature will not be tolerated and that people should not behave in a disorderly way. That is absolutely right. My experience, and probably that of other noble Lords, is that staff in surgeries will seek to rely on the help and support of the police service in calling its attention to any difficulties that they experience. They rely on the police to make a critical intervention and we should rely on that, because that is exactly what the police service is there for. I accept that there is an issue. We think that further work is required. We need to tailor more precisely the sorts of powers and duties that might be required in other settings and how those settings work, particularly in relation to the needs of palliative care units and hospices. I am grateful to the noble Baroness and I thank her for bringing the amendment, but I do not think that these amendments will greatly assist us in resolving some of the real problems regarding this issue.