Safe approach to handling racist abuse

RACIST abuse directed towards NHS staff by patients remains a serious problem.

A recent ITV report found that recorded racist attacks against NHS staff increased from 589 in 2013 to 1,448 last year – a 145 per cent jump. The report also featured a moving interview with senior surgeon Mr Radhakrishna Shanbhag who has worked in the NHS for more than 20 years. He described how one of the patients on his waiting list requested a ‘white’ doctor carry out his operation and how this gave him cause to reconsider his position in the NHS.

The report sparked much debate, as healthcare staff may feel that adhering to such requests is the simplest solution, despite believing it only rewards bad behaviour. Are you expected to carry on treating a patient despite feeling abused and threatened? Can you refuse to treat such patients or have them transferred or removed from your list? What if there is no alternative doctor/dentist available?

It’s important to remember that there are a range of potential appropriate responses, dependent on the seriousness of the matter and level of offence caused. For example, you may have a patient who appears to be reasonable and non-threatening but still asks for an ‘English-speaking’ or ‘non-foreign’ doctor. Such a request may not require an immediate reaction from you and perhaps finding an opportunity to highlight how the patient’s behaviour is inconsiderate will be enough to make them think again.

Any formal steps taken to warn a patient in regard to such comments should be clearly communicated in a letter. Should such behaviour persist you can then escalate matters and potentially remove them from your practice list.

Situations where a patient is demonstrating clear abusive and threatening racist language or behaviour should not be tolerated. Such behaviour may understandably result in a breakdown of trust between you and the patient, therefore compromising your professional relationship with them. Our advice would always be to keep yourself safe – and if at any point you feel threatened take appropriate steps. In extreme circumstances this may even include calling for police assistance.

The GMC offers guidance on ending your professional relationship with a patient who has been “been violent, threatening or abusive to you or a colleague”. The guidance states that you should first warn the patient and explore alternatives. It further advises:

If you decide to end your professional relationship with a patient you must:

a) make sure the patient is told of your decision to end the professional relationship, and your reasons for doing so; where practical, the patient should be told in writing

b) follow relevant guidance and regulations

c) record your decision to end the professional relationship – information recorded in the patient’s records must be factual and objective, and should not include anything that could unfairly prejudice the patient’s future treatment

d) make sure arrangements are made promptly for the continuing care of the patient, and you must pass on the patient’s records without delay

e) be prepared to justify your decision.

GDC standards also remind dentists that: "Before you end a professional relationship with a patient, you must be satisfied that your decision is fair and you must be able to justify your decision".

In delivering care, where any delay could result in undue harm to a patient, MDDUS advises that you prioritise urgent care needs first before taking any action to transfer care to another doctor or dentist.

Your organisation or practice should have a policy in place which sets out its expectations of patients’ behaviour towards staff. It should highlight that any kind of racial abuse towards staff is unacceptable, and within this policy there should be clear guidance on how these situations will be handled. Employers are required, under the Equality Act 2010, to protect their staff from discrimination relating to race, gender, religion or other protected characteristics.

In response to the ITV report, Matt Hancock, Secretary of State for Health and Social Care, wrote to all NHS staff in England stating: "If a patient asks to be treated by a white doctor, the answer is 'no'. Your management must and will always back you up. We are very proud that everyone in the UK is entitled to healthcare at the point of delivery, according to need not ability to pay. No one is entitled to choose the colour of the skin of the person giving that healthcare.

"We all need to act to ensure racism in our NHS is eradicated. It is not the responsibility of those who suffer racist abuse to challenge it alone."

ACTION POINTS

• Avoid reacting out of anger or upset and take the time to assess the situation before taking action.
• Consider whether a warning to the patient would be deemed enough to deter them from further abusive behaviour. If you or a colleague feels threatened in any way you may need to take immediate action such as phoning the police and having the patient (of family member/carer) removed from the premises.
• For employers, ensure you are complying with the Equality Act 2010 and have clear policies and procedures in place that protect your staff from abuse of any kind.

Kay Louise Grant is a risk adviser at MDDUS