They bite, they hit, they spit: patients assault staff at Nottingham hospital

<span>Queen’s Medical Centre A&E deputy charge nurse Hanna Freer. </span><span>Photograph: Christopher Thomond/The Guardian</span>
Queen’s Medical Centre A&E deputy charge nurse Hanna Freer. Photograph: Christopher Thomond/The Guardian

“I’ve seen patients take swings at doctors because they’re not happy with the time it’s taken or the doctor’s diagnosis. I’ve seen fire extinguishers set off and thrown at people, computers lifted and thrown across the emergency department and people run out of cubicles and punch other patients – people they don’t know – for no reason.”

Roger Webb, a security supervisor at the Queen’s Medical Centre hospital in Nottingham, is recalling some of the more unsavoury incidents he has witnessed in the course of his work.

“I’ve been struck in the groin, had scratches all over my arms where people have dug their nails in. I’ve been bitten and I’ve been spat at while trying to deal with situations. The spitting is the most depressing of those, though, because it’s so contemptuous and so horrible. And legally it’s assault.”

The abuse faced by staff at his hospital is more often verbal than physical, he adds. “I’ve had personal insults like being called short, stumpy, fat and four-eyed. I’ve also been called a male escort. I don’t know how they got hold of that information!” he laughs at that unlikely jibe.

Hannah Freer, a deputy charge nurse in the hospital’s A&E, is among the many frontline staff who have been on the receiving end of a marked increase in hostility and aggression.

“My husband used to be a pub landlord,” she says. “But we reckon that I’ve had more ABH [actual bodily harm] than he ever had.

“I’ve had a man threaten to follow me home and firebomb my house. Luckily, he got arrested. It does happen predominantly to females. There’s a lot of sexual comments as well – I’ve had someone prosecuted for what he said to me – and sexual advances, including a lot of grabbing.

“And you get verbal abuse, like ‘You’re useless’, ‘I’m going to get you sacked’ and ‘I pay your wages.’ If I’m working as a triage nurse in A&E I might bring someone in and say, ‘I’m Hannah, one of the nurses. What’s brought you into hospital today?’ And they say, ‘I’ve not come to see a fucking nurse. I’ve come to see a doctor.’

“There’s so much verbal abuse that you can sort of shrug it off as ‘another mouthful – that wasn’t that much’.”

Related: Survey shows high levels of abuse of UK doctors by patients

Like staff across the NHS, those at the QMC have seen a rise in abusive, threatening and intimidatory behaviour by patients and their relatives in recent years. In 2021-22, Nottingham University hospitals (NUH), the NHS trust that runs the QMC and its sister City hospital, recorded 1,237 incidents of aggression, violence and harassment. But it had many more – 1,806 – during the following year, 2022-23.

Last year brought another increase. In the six months between April to September alone, NUH recorded another 1,167 incidents, leaving 2023-24 likely to be the worst ever on record.

Staff have been hit, spat at, threatened, verbally abused and racially abused during this roll call of unpleasant incidents. Racially aggravated harassment has increased notably.

Some of the incidents have led to perpetrators being charged and convicted. Worryingly, in a growing number of cases, the patient has been responsible for several incidents while receiving one single episode of care.

Care delays are the main trigger for abuse at the QMC. But such incidents also arise when staff are treating drunks, rival gangs, people who are high on drugs and those with mental health problems.

Sometimes homeless people who have come into A&E for some much-needed warmth become difficult when they are asked to leave once a doctor has decided they need no treatment.

This rising tide of abuse is an NHS-wide phenomenon. Matthew Trainer, the chief executive of the Barking, Havering and Redbridge university trust in London, recently warned that violence and aggression against hospital staff is “going through the roof just now”.

Historically, A&E staff, paramedics and mental health staff have borne the brunt of such behaviour. But Trainer reported that at his trust, ultrasound technicians were suffering abuse, sometimes from groups of people, when undertaking pregnancy scans and that staff on frailty wards, where most of the patients are older people, had been targeted too.

The London ambulance service disclosed recently that a 39% year-on-year jump in violence against its staff meant that incidents are now experienced by an average of two crew members a day.

The Royal College of Nursing fears that unprecedented levels of aggression against nurses are prompting some to quit, compounding the health service’s already chronic shortage of nurses. And 85% of GPs have received verbal abuse, as have 65% of hospital doctors and 70% of dentists, according to a recent survey by the medical defence organisation MDDUS.

QMC staff are concerned but also perplexed by the surge in nastiness they are seeing. “People come in and just start abusing staff. I have no idea why people think they can do that”, says Glynn Osborne, a manager in the NUH security team.

“People come in to see a nurse or a doctor, to be helped. But to then attack the person that’s looking after you, it doesn’t make any sense.”

When hospital services reopened to patients after Covid, “people just had this perception they could come here and attack the staff, shout and swear at them, hit them and get away with it”, he adds.

These days, patients are quicker to get frustrated by delays in their care, Freer added. Many arrive at A&E expecting to have a scan, blood test or other investigation, and to get it immediately, because a GP or the NHS 111 telephone advice service have told them they will get that, she said. But A&E staff may well decide on a different course of action, leaving patients frustrated.

She adds: “A lot of people come in the hope that they’re going to get a diagnosis, because they’ve been struggling to see their GP or are in limbo because while they’ve been referred, they’ve not seen a specialist yet.

“They hope we’re going to give them an answer and we can’t necessarily do that, because A&E staff deal with medical emergencies, not long-term conditions. You can understand why people get frustrated and lash out at us.”

Others think turning up at A&E will cut the time – sometimes months – that patients can wait to see a hospital specialist. However, again, Freer and her colleagues cannot do that. A lack of public understanding that at A&E “we can’t cure everything, we can’t diagnose everything and we can’t fix everything” is a key reason for the growing hostility, she believes.

NUH has taken steps to deal with this spike in hostility and support affected staff. Since last April, abusive patients have received a yellow or red card. The latter means they are banned from being treated by NUH, explains Gilbert George, its director of governance. There is CCTV in many areas.

“No excuse for abuse” posters around the hospital ask that staff are treated with respect. And dozens of staff now use bodyworn cameras to record confrontations with unruly patients. The trust’s in-house psychologists help staff process the trauma they have encountered.

Webb’s key tasks are to defuse threatening situations and protect staff. “I take the heat off whoever’s been abused,” he said. He talks calmly to the protagonist and explains that things are taking time because the doctors and nurses are very busy. He may make them a cup of tea or go and get the person an update on their care. But he worries that his stab vest makes him look too “intimidating” for situations that need careful handling.

Sometimes de-escalation proves impossible, however. Occasionally NUH security staff have to call the police, who come quickly. Some patients have been taken to court and convicted, sometimes thanks to footage from the bodyworn cameras.

Freer, who carries an attack alarm in case she needs help, believes that some people attending A&E are less patient, less understanding and more self-centred now than before.

“Sometimes when you explain that their wait is because we’ve got lots of critically unwell patients, the person will come back to you and say, ‘I don’t care about anybody else.’ That’s really hard to take.”