"Withholding treatment
Separate guidance on withholding treatment, 'Withholding treatment from
violent and abusive patients in NHS Trusts', has been issued under cover of
Health Service Circular 2001/18 as part of the NHS zero tolerance zone
campaign.

The withholding of NHS treatment from violent and abusive patients will
always be a last resort, but it is an option available to managers and staff
working in all trusts (except for mental health settings as patients
detained under the Mental Health Act 1998 cannot be discharged for
harassment). ...Healthcare workers need to work within the requirements of
the Human Rights Act 1998. They will take care to ensure that the refusal of
treatment is done in a way that does not amount to an infringement of the
patient's other Convention rights, for example, Articles 2 (right to life)
and 3 (right not to be subjected to degrading treatment or punishment).
Doctors may obtain further guidance on the impact of the Act on medical
decision-making from the British Medical Association (BMA).
>>> http://www.nhs.uk/zerotolerance/dealing/procedures.htm

This whole guide is useful, Stephen

* * * * * * * * * * * * * * * * * * * * * * * * * *
Stephen James,  Head of Partnerships and Diversity, Ealing Primary Care
Trust, 1 Armstrong Way, Southall, Middlesex UB2 4SA. Tel: 020 8893 0318.
Fax: 020 8893 0398. email: [log in to unmask]

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-----Original Message-----
From: Sarah Corlett [mailto:[log in to unmask]]
Sent: Friday, November 12, 2004 9:45 AM
To: [log in to unmask]
Subject: Re: refusal to be treated by a member of staff on the grounds
of race


Greetings
I largely agree with Stephen but i think a Trust taking the sort of
avoidance action he describes is risky as it suggests the organisation
does not have adequate procedures in place (although I agree staff must
be protected where necessary).  Perhaps people remember the recent case
of Rosie Purves who was eventually compensated by her employers who were
found to be  complicit with parents' racist demands that she not take
care of their child.
http://www.guardian.co.uk/race/story/0,11374,1219135,00.html
This has set a legal precedent and any other member of staff could
reasonably expect to win in similar circumstances.  To me it shows that
at the very least it is sensible risk management for a Trust to have an
explicit policy which it publicises to patients and carers as well as
staff that racist behaviour towards staff or other patients etc is both
unacceptable and illegal and what steps they will take if it happens.

People may worry that this might lead to an impasse where there could
be some sort of ultimatum leading to at least the threat of withdrawal
of treatment which is very difficult for most NHS staff to contemplate
as many are so dedicated they would rather put up with abuse than turn
someone away.  I think this scenario is highly unlikely as when senior
staff take a firm line and back up their staff (up to the Chief Exec
speaking to the patient if necessary) and people know what is expected
of them most will behave. On the other hand a Trust may also decide that
this could be a final sanction.  It might well fit within policies about
zero tolerance for violent or otherwise abusive patients.

I think the case illustrates the law quite well. The Trust is liable
under the RR(A)A to ensure staff do not suffer discrimination
irrespective of its source.  This needs pre-emptive to put systems in
place to both minimise risk and take prompt action should something
occur.  Also under the Act, as I am sure I do not need to spell out to
this audience, an organisation is required to consult on its measures to
reduce discrimination and promote equality, and to demonstrate that its
policies are working by regular monitoring and publishing findings.

By the way I have just found out that our PCT policies are not clear
enough to cover this so will have to address!
Have a good weekend people
Sarah

Sarah Corlett
Consultant in Public Health
Lambeth Primary Care Trust
1 Lower Marsh
London, SE1 7NT
Tel: 020 7716 7097
em: [log in to unmask]


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