How trivial incivility is linked to criminal injury

According to the Department of Health, there were 84,273 reported incidents of violent or abusive behaviour by patients within the National Health Service during the year 2000-01. The number of such incidents reported in 1998-9 was approximately 65,000. Although the two figures are not directly comparable, because they were gathered using different criteria, no one nowadays would find it implausible or unlikely that there had been so large a real a rise in the incidence of violence and abuse towards NHS staff and property. It also is probable that many, and perhaps most, instances of such conduct still went unreported.

What is in any case indisputable is that the atmosphere in our hospitals has changed beyond all recognition over the past two or three decades. When I qualified as a doctor, just over a quarter of a century ago, none of the hospitals in which I had ever worked as a medical student employed security staff. There were hospital porters, of course, but there was no one deputed to protect staff from attack or property from malicious damage. It was literally unthinkable that doctors and nurses should be attacked in the course of their work, and receive anything other than the very occasional minor drunken abuse on a Saturday night. The hospital in which I now work not only has a force of uniformed security men trained in unarmed combat, but a police station on site. This did not deter one of our patients recently from attacking and injuring a young female doctor who was trying to attend to him in the accident and emergency department. She did not press charges for fear of retaliation when she left the hospital at night. A recent edition of the BMA News (June 15, 2002) remarked on the adoption by ambulance staff of flak jackets as part of their uniform.

The Department of Health document that gives the latest statistics for violent and abusive behaviour by patients in the NHS points out, with propagandistic pride, that 'new money' has been devoted to tackling the problem. This money will be used, inter alia, for fitting central locking devices to ambulances, purchasing personal alarms for staff, training staff in self-defence, installing closed-circuit television in hospitals and swipe-card locks to doors to wards and other areas. Henceforth a knowledge of karate will be as important to a doctor as a knowledge of pharmacology; and in the process, hospitals will have changed from being silent sanctuaries from the hurly-burly of life to being armed camps under permanent siege from the barbarians.

Of course, it is still true that the vast majority of people do not behave in an aggressive fashion in hospital or in their doctor's surgery. It would be tempting to suppose, therefore, that the population of patients can be divided neatly into two: the great majority who behave 'normally', and the small minority who behave badly.