Political Propaganda or Political Imperative? An Inquiry into the Legacy of the NHS Zero Tolerance Campaign for Forensic Mental Health Nurses

  • Caroline Ruth Brookes

Student thesis: Doctoral ThesisDoctor of Philosophy


The government response to high levels of patient violence and aggression towards NHS staff
was the introduction of the NHS Zero Tolerance Campaign in 1999. The aim was to reinforce
to the public that violence towards NHS staff was unacceptable, and clear working
relationships with the Police and prosecution services were to be established.
This study explores the impact of the NHS Zero Tolerance Campaign and its subsequent
iterations to understand if the political attempts to reduce patient violence and aggression in a
Forensic Low Secure Hospital have succeeded. Moreover, have the attempts been made as
a matter of necessity, or have they merely been rhetoric to garner favour with the public that
they are managing a situation which receives regular media attention are also considered in
the study.
Research Methodology
For this qualitative small-scale study, I followed a Heideggarian-Gadamerian philosophy of a
hermeneutic phenomenology theoretical framework and applied Structuration Theory as the
conceptual framework. This facilitated listening to the voices of Forensic Mental Health Nurses
working in the Hospital through a series of research conversations. Following transcription of
the conversations, I was enabled to become an active participant in the interpretive process
by joining my voice with theirs, together with a circle of reading and reflective writing, to reveal
deep understandings of their experiences.
Several major understandings emerged, underpinned by insights into the world of the Forensic
Mental Health Nurses. These included understanding their experiences of patient physical
aggression and verbal abuse and the changes in training and response to patient aggression
since Zero Tolerance Campaign. The relationship with the Police and Crown Prosecution
Service in preventing and responding to patient violence was also revealed, together with the
impact the environment had on patients.
Fusion of Horizons
Drawing together the understandings and insights with my own experiences enabled
interpretation. This revealed what it is like being a Forensic Mental Health Nurse working in a
Low Secure Hospital, caring for some of the most mentally unwell individuals. What was
strongly evidenced was a working environment of fear and conflict within which they continued
to provide the best care they are able, putting the patients’ needs before their own.
Interestingly, there was lack of political awareness in relation to the nursing profession and
the impact on their roles as subsequent politicians introduced measures to tackle patient
violence. This was seen as management driven rather than government initiatives and
directives and often viewed with cynicism.
Recommendations and Conclusion
The key recommendation is the need to address the lack of political awareness in nurse
education as it was clear that the research Conversationalists felt unable to effect change that
they viewed as being driven my Senior Management rather than the Government. There is
still a lack of protection from the Police and their understanding of mental health remains poor.
The Crown Prosecution Service continue to rarely progresses the prosecution of patients
detained in the Low Secure Hospital.
The Low Secure Hospital is not a prison, patients can be responsible for their aggression and
justice does not have to stop at the doors. Nurses are entitled to state protection and politicians
need to listen to the Forensic Mental Health Nurses but, to do so, there needs to be a strong
nurse voice.
Date of Award2023
Original languageEnglish
Awarding Institution
  • Coventry University
SupervisorGill Cressey (Supervisor), Adrian Hancock (Supervisor) & Rob James (Supervisor)

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