This is the third in a series of interim reports on the FOI responses from NHS Trusts received to date

To review the previous report Click Here

The focus of this report is the responses received to question 3  – Autonomy of Security Officers to conduct removals of persons from NHS Premises.


Introduction:

On 26th July 2021 AEGIS Protective Services sent security related Freedom of Information (FOI) requests to 194 NHS Trusts in England.

The Freedom of Information Requests asked:

  1. Does the NHS Trust contract a private security company to provide Security Officers to work onsite, or employ an ‘in house’ team of Security Officers, or both?
  2. Please provide a copy of the most recent ‘training needs analysis’ conducted at the Trust for a Security Officer role or, explain why there isn’t one.
  3. Do Security Officers have autonomy to remove people from the Trust’s premises i.e. without seeking advice from clinical staff as to whether or not the person to be removed requires medical advice, treatment or care?
  4. Are Security Officer training deficiencies that are known to exist listed on the NHS Trust’s Risk Register?

This 3rd Interim report addresses the responses received to Question 3 above.

Question #3: Autonomy of Security Officers to remove people from NHS premises

Our Question #3 asked: “Do Security Officers have autonomy to remove people from the Trust’s premises i.e. without seeking advice from clinical staff as to whether or not the person to be removed requires medical advice, treatment or care?”

Below are some examples of the FOI responses we received:

“No, our contracted do not have the authority to remove patients. They have very little to do with patients. If a removal is required, the police are asked for support.”

“Medical advice would always be sought before removing a patient from the premises; however visitors may be removed from the premises depending on the reason without seeking medical advice.”

“With the Emergency Department and Ward areas security staff refer to clinical leads before escorting from site. For simple trespass and anti-social behaviour they have the autonomy to escort from site.”

In most cases, security officers are guided by trust staff before removing people from a trust site.”

“Yes, using a dynamic risk assessment, i.e. youths misusing the Trust’s premises would not require seeking advice from clinical staff, however someone with a visible injury, looking confused, in hospital clothing etc. etc. would require advice from clinical staff.”

“Yes but, driven by clinical decisions.”

“Security staff will take the advice of clinical staff if a person displays signs that they need medical treatment.”

“Where the person is a patient or anyone seeking treatment, the Security Officers will always take advice from the clinical teams before removing that person. However, where the person is a visitor who is not on hospital premises for treatment for themselves, the Security Officers do have autonomy to remove that individual, as a last resort.”

“If the person was in a clinical area, advice would generally be sought from clinical staff.  If the person to be removed was not a patient and in the hospital grounds, advice would not need to be sought from clinical staff first.”

“Security work to regularly reviewed Trust policies which reference the Criminal Justice and Immigration Act 2008.  s119 1 (a), (b) and (c) of the Act references offences of causing nuisance or disturbance on NHS premises and s120 references the removal of a person causing nuisance or disturbance.”

“Our security staff do not remove people from the Trust premises. If there is a public order matter, we hand this to the police.”

“Any escorts/removals from site for persons requiring medical attention, treatment or care are requested by clinical staff. Security have autonomy to remove homeless or rough sleepers from site and anyone who causes a nuisance/disturbance who is on-site for reasons other than medical attention.”

“This would be dependent on the individual incident and is covered under Training and Trust policies.”

“Possibly if it is not a patient.”

“Security officers have discretion to remove persons from site, however if there are any obvious clinical/medical concerns/issues then clinical advice is sought.”

“In some cases yes, they remove people from site such as visitors. When the people are patients the security team follow clinical guidance.”

“For any patients being removed this will always be on direction of the clinical staff who grant authority.  For all other persons, the security team have autonomy to remove (e.g. homeless) and will use their discretion if site managers and senior managers may need to be contacted prior to removal.”

“Security staff will generally consult with the clinical team/site team before removing anyone from site and will follow Section 118/119 of the Criminal Justice and Immigration Act.”

“We are paediatric Trust and so would never remove a young person in our care. However should this be a parent or visitor to the Trust, the security team do have autonomy to remove should it be needed.”

“Yes, all our officers are trained to deal with persons committing crime such as public order, assault, or damage to property this is often assisted with by the police. Security staff are all trained to SIA level Door supervisor and, as part of their SIA Training, they have to take out physical intervention training which also provides the legal side of their role. Part of this Is the use of Section 119 and 120 of the Criminal justice and immigration act which does mean that they have to confirm with an on-duty clinician that advice care or treatment has been provided or is not needed so that the person can be suitably asked to leave or removed. Often in these situations police will be called to ensure that any refusals are assisted by police.”

“All Trust Security Operatives operate within a framework. I unable to answer the above question due to the various different circumstances and incidents that occur, and they all require a different response depending on the circumstance.”

“Officers would always consult a clinical member of staff before removing a patient or person from site as they are not medically trained and would not be able to assess if an individual required medical treatment. The exception would be an intruder or trespasser where they would be asked to leave and police contact would be made if the individual was violent or aggressive.”

Yes, for staff and visitors. No patient would be removed without the appropriate clinical team engagement.”

“I am advised that staff do not have the autonomy to remove staff if it is clinically related.  If the person is a patient, then security does not have the autonomy to remove the patient without seeking clinical advice; removal of a patient from the premises will be a clinically lead decision. If the person on site is a visitor, or a member of the public and displaying violent/aggressive/ disruptive behaviour then clinical advice is not needed (as they are not a patient).”

“This would depend on the type of incident. For example, if whilst undertaking a patrol a group of youths are hanging around a building, they would be asked to move on, if they become aggressive or refuse, we would have the autonomy to remove them from the premises. If the incident involves an inpatient, someone undergoing treatment or is awaiting treatment, then we do not have the autonomy to remove from the site until we have spoken to the clinical teams to ensure we have that agreement, as we, like clinical teams have a duty of care to uphold at all times.”

About Question #3

Question #3 was designed to elicit whether NHS Trusts recognised the danger of Security Officers potentially removing a person from NHS premises against their will who either requires medical advice, treatment or care, or is in some way vulnerable and removal would endanger their physical or mental health.

It would obviously be unethical – and a breach of duty of care – to remove a person from NHS Premises if the person requires medical advice, treatment or care or, if removal would endanger the person’s physical or mental health.

Judging from the FOI responses received, most NHS Trusts appear to be aware that patients should not be removed from the premises without authorisation from clinical staff. However, more than a few indicated that Security Officers were permitted to remove ‘visitors’ without referral to clinical staff. Examples included: groups of youths loitering, vagrants, intruders and trespassers.

This is unwise.

Since Security Officers are likely to lack the requisite clinical knowledge and skills to make such assessments, they should not be permitted autonomy to remove any person from the premises without reference to clinical staff.

The thing is, while a need for medical advice, treatment or care may be fairly obvious in some situations (such as a bleeding wound), other situations may be less clear and complex.

For example, a head injury or a diabetic hypoglycaemic attack can result in behaviour that can easily be mistaken for drunkenness.

Also, it is well known that some people with mental health difficulties or substance misuse problems will visit Hospitals giving a false impression that they are not seeking help when in fact they are, and this could result in a Security Officer not recognising a person’s underlying medical needs.

It may also be unethical and unreasonable to remove a visitor who is accompanying a dependent to the hospital if the Trust cannot make appropriate arrangements to care for the interests of the dependent. Such complex situations should not be left to be resolved by Security Officers working independently of clinical staff.

Then, there is the issue of vagrants (homeless people).

For a variety of reasons, vagrants can be attracted to hospital settings. One of those reasons is because hospitals afford sanctuary from inclement weather. Homeless people are recognised as a ‘vulnerable group’ and Security Officers should be prevented from taking responsibility for deciding whether or not it would be the right thing to do to remove them back into the inclement weather.

To eliminate the risk, NHS Trusts should have a Standard Operating Procedure (SOP) requiring Security Officers to always get confirmation from clinical staff before removing any person from the premises.

It’s worth remembering here that, in the event of an untoward/adverse outcome (e.g. sudden death) following expulsion from NHS premises, the subsequent Serious Incident Investigation will inevitably examine the processes and procedures that should reasonably be expected to be in place to protect against predictable and avoidable harm happening. This will include the instructions, training and level of supervision given to the Security Officers. An absence of suitable ‘protective protocols’ can mean liability (and culpability) is easily and quickly established, on the basis of ‘res ipsa loquitor’ – the facts speak for themselves.

Calling Police to assist with removal of a Trespasser

Several NHS Trusts mentioned in their FOI Responses that police would be called to assist in the event that anyone needed to be removed from their premises.

However, Police Officers do not have a legal duty to assist Security Officers or other NHS staff to eject a ‘trespasser’ unless a Breach of the Peace (i.e. violence) has occurred or is likely to occur.

Yes, if the circumstances are truly exceptional, a Police Officer may render assistance to eject a trespasser from NHS premises in the absence of an actual or threatened Breach of the Peace, but if they do then in law they will not be acting as a Police Officer but as a private person acting as a ‘servant’ of the NHS Trust for that special purpose. Significantly, no offence of assaulting, resisting or wilfully obstructing an Officer in the execution of their duty can arise and when acting as a private person the Officers would not be insured by the Commissioner of Police.

So, there are powerful legal reasons, why Police are no longer as willing as they used to be to engage in ‘trespasser removal processes’ at NHS Trust premises.

Here’s another heart wrenching reason. The video shows Police action (19/08/2019) to remove Dr Rashid Abbasi from his daughter’s hospital bedside at the request of an NHS Trust.

(Full footage)

(Sky News Clip)

The upshot is that, now if Police are called to trespass situations, their instructions will be to simply stand by to prevent a Breach of the Peace and leave any pushing or shoving to NHS Staff/Security.

So, NHS Trusts that currently rely on the Police to effect removals of trespassers from NHS Trust premises should review the efficacy of their arrangements.

Note: One of the Joint Protocol Commitments agreed in the Memorandum of Understanding (MOU) on the Police Use of Restraint in Mental Health & Learning Disability Settings was: Staffing in both health and policing to be able to discharge their respective legal responsibilities.

S.119/120 CJIA 2008

More than a few NHS Trusts referred to s.119 and s.120 CJIA 2008 in their FOI Responses.

Section 119 of the Criminal Justice and Immigration Act 2008 (‘CJIA 2008’) created a new criminal offence of causing a nuisance or disturbance on NHS premises.

Section 120 CJIA 2008 provides legal authority to Police and ‘authorised’ members of NHS staff (including security Officers) to physically remove a person suspected of committing an offence under s.119 CJIA 2008 who refuses to leave when asked to do so.

It is a very useful piece of legislation, designed specifically for use in Hospital settings.

One advantage it brings is that, whereas Police do not have a legal duty to attend trespasser situations, they do have a duty to attend if a crime is either in progress or has been committed and the suspect is still in the vicinity.  This means NHS Staff can legitimately call for Police support to deal with nuisance or disturbance behaviour – and any associated physical removal that is necessary.

Another benefit of the CJIA legislation is the safeguards designed to protect against anyone who has a need for medical advice, treatment or care being forcibly removed from NHS Premises. These safeguards are embedded into the training that ‘authorised officers’ should receive (See s.121 below), along with a decision-making model to follow when determining whether there is reason to believe that a person requires medical advice, treatment or care, or that removal would endanger the person’s physical or mental health.

Ideally, of course, similar ‘safeguards’ should be in place for any removals, whether carried out under the Law on Trespass or the Provisions of s120 CJIA 2008.

S.121 CJIA 2008

This is important.

S.121 CJIA 2008 requires English NHS bodies, when exercising functions under, or in connection with S.120 CJIA 2008, to have regard to guidance about the powers, published by the Secretary of State (and for Welsh NHS bodies, guidance published by the Welsh Ministers.)

The Guidance provided for English NHS Trusts:

Note: Section 4.3 of the Guidance addresses the necessary training requirements for Authorised Officers and Appropriate Officers.

Is your Security Team’s CJIA Training up-to-date?

CJIA 2008 Training Pack

AEGIS has produced a Training Pack of white label (unbranded) training materials, including a video, PowerPoint presentation and Course Handouts, that will enable you to deliver CJIA Training to Authorised Officers and Appropriate Officers at your NHS Trust.

Learn More

If you’d like to read more about the powers to deal with nuisance and disturbance behaviour on NHS Premises, click on the image below.

Nuisance and disturbance behaviour on NHS Premises