this week

Health secretary Alan Milburn promised another crackdown on violence in the NHS this week, pledging that he 'will stand fullsquare behind trusts who take tough action to protect staff '.

He told the third annual human resources in the NHS conference in Birmingham that persistently violent patients could run the risk of being refused treatment.

Mr Milburn referred to the scheme being piloted at the Royal London Hospital where patients who are violent, use offensive sexual behaviour or are verbally threatening get yellow warning cards. Repeat offenders get a red card and could be banned from up to a year, though excluded patients can ask for treatment elsewhere. Prime minister Tony Blair was also at the Royal London to endorse the initiative.

Mr Milburn told the conference that many trusts are already taking action to tackle violence and there had been investment in CCTV and personal security.

Withholding treatment 'should only ever be a last resort and must be subject to stringent safeguards', he said.

He promised further guidance, plus 'new targeted resources - which I hope that trusts themselves will match'.

The initiative is one of many since 1997, the most significant being the zero-tolerance campaign, launched in 1999. But HSJ understands that the campaign's original target to reduce violence by 30 per cent by 2003 has now been pushed back to 2004.

Many trusts contacted by HSJ have yet to establish the baseline against which their success or failure in tackling violence against staff can be judged, with a number reporting steep rises in violent incidents. At Grampian University Hospital trust in Aberdeen, for example, there were 1,892 physical and verbal attacks in 2000, compared to 720 the previous year.

John Sinclair, management of aggression adviser at the trust, said most staff 'do not feel they want to go down the lines of prosecution'. Enabling trusts to take criminal cases against offenders, rather then having to rely on victims to do so would make a big difference, he said.

Health unions have broadly welcomed the red and yellow card scheme, with Unison general secretary Dave Prentis describing it as a 'fresh and innovative' approach.

Royal College of Nursing senior employment relations adviser Sheelagh Brewer said: 'Nurses will be very reluctant to stop treating a patient - but if a patient is being . . .

aggressive, they can't deliver highquality care. This announcement gives nurses permission to say 'no' to violence at work. '

Mr Milburn told the conference that local modernisation reviews being carried out will lead to three-year action plans setting out the changes and investment required to deliver the NHS plan.

Royal medical colleges, unions and other organisations will be urged to encourage their members to take part in devising 'local plans for local communities'.

Mr Milburn told delegates that£100m of 'bureaucracy savings' generated by the abolition of health authorities would be spent on childcare. He also announced an additional£10m this year for Independent Learning Accounts for NHS staff without professional qualifications and£20m for training for staff with qualifications to continue with professional development.

See feature in recruitment and retention HSJ special repor t, 5 July.