Managing nuisance behaviour on NHS Wales premises

It is widely acknowledged that NHS staff are amongst those most likely to face violence and aggression during the course of their employment. 

All NHS bodies recognise their duty to provide a safe and secure environment for all staff, service users and visitors. Within their health and safety obligations and the strategic ambition of A healthier Wales: long term plan for health and social care the NHS seeks to become an exemplar employer in respect of the health and wellbeing of its workforce. NHS bodies have local violence and aggression policies outlining their agreed approach to preventing and responding to such instances towards their workforce. 

The vision of the AVC is to support NHS Wales and Emergency Services organisations to reduce and manage violence and aggression incidents. Facilitating collaboration with Criminal Justice Service partners, NHS Wales bodies, Emergency Services organisations, staff associations and Welsh Government, the AVC promotes violence reduction strategies and communication with service users. The AVC also supports partners to comply with the directions contained in the Anti-violence collaborative obligatory responses document (WHC/2024/0 24).

This guidance relates to the offence of causing nuisance or disturbance on NHS premises in Wales introduced by section 119 of the Criminal Justice and Immigration Act 2008 (referred to in this guidance as “the Act”). It also provides NHS bodies in Wales and their authorised officers with important information to support them in their use of the power to remove persons causing nuisance or disturbance contained within section 120 of the Act.

It should be remembered that the use of the power of removal should be integrated within existing strategies for the security and safety of NHS staff. The underlying principle is one of prevention of nuisance or disturbance situations before they arise, or when they do arise, de-escalation of the situation using non-physical methods wherever possible.

When incidents of nuisance and disturbance do occur on NHS premises in Wales, NHS bodies may consider it to be more appropriate to deal with those situations in line with their current policies and using their existing training. However, where it is necessary to remove a person causing a nuisance or disturbance using the powers in section 120 of the Act, this document provides some guidance as to best practice, with the aim of producing a safe environment for all those who work in or use NHS services.

This guidance does not provide specific advice to NHS bodies in relation to prosecuting a person for committing the offence under section 119 of the Act. NHS bodies, in cooperation with the police and Crown Prosecution Service, are responsible for leading on the investigation and subsequent considerations of prosecution in line with local policies and procedures.

The relevant sections of the Act for the purposes of this guidance are sections 119, 120 and 121. A copy of these provisions as at the date of this guidance is contained at Appendix A, and a full copy of the Act can be found online.

This guidance is relevant only in so far as sections 119 to 121 of the Act applies to the NHS in Wales. This guidance does not apply to the NHS in England. References in this guidance to an ‘NHS staff member’ are to be taken to mean a staff member of a relevant Welsh NHS body or a person otherwise working for such a body. Also, references in this guidance to ‘NHS premises’ are to be taken to mean NHS premises in Wales. Each of these terms are summarised in further detail in this guidance and defined by the relevant provisions of the Act. 

This guidance will discuss the following:

• the application of sections 119, 120 and 121 of the Act
• selection of appropriate NHS Wales staff to exercise the power of removal
• training provision for selected staff
• record keeping, recording and monitoring
• public awareness and media exposure

There are 2 key provisions in the Act relating to nuisance and disturbance behaviour on NHS premises; the first is section 119 of the Act and the second is section 120 of the Act.

Section 119: Offence of Causing a Nuisance or Disturbance

Section 119 establishes the offence of causing a nuisance or disturbance on NHS premises. A person commits this offence if all of the following are satisfied: 

1. the person causes, without reasonable excuse and while on NHS premises, a nuisance or disturbance to an NHS staff member who is working there or is otherwise there in connection with their work, and
2. the person refuses, without reasonable excuse, to leave the NHS premises when asked to do so by a constable or an NHS staff member, and
3. the person is not on the NHS premises for the purpose of obtaining medical advice, treatment or care for himself or herself

For the purposes of section 119, a person ceases to be on NHS premises for the purpose of obtaining medical advice, treatment or care for himself or herself once the person has received the advice, treatment or care. Further, a person is not on NHS premises for the purpose of obtaining medical advice, treatment or care for himself or herself if the person has been refused the advice, treatment or care during the last 8 hours. 

Section 120: Power to remove person causing nuisance or disturbance

Section 120 gives constables and authorised officers the power to remove a person reasonably suspected of committing an offence on the NHS premises concerned under section 119. Authorised officers can also authorise an appropriate NHS staff member to remove a person in these circumstances. Who can be an authorised officer and appropriate member of staff will be discussed later in this guidance.

A person may be removed under section 120 of the Act using reasonable force if necessary, but an authorised officer cannot remove a person, or authorise another person to do so, if the authorised officer has reason to believe that:

• (a) the person to be removed requires medical advice, treatment or care for himself or herself

  or 

• (b) removal of the person would endanger the person’s physical or mental health

What is nuisance or disturbance?

Anti-social behaviour on NHS premises includes nuisance, anything causing inconvenience or annoyance, and disturbance meaning disruption of peaceful behaviour. This may include, but is not limited to:

Intimidation and aggression

• intimidating behaviour or gestures
• verbal abuse or use of foul language

Obstruction and interference

• physically obstructing corridors, doorways, or thoroughfares
• preventing or impeding staff from carrying out their duties
• failing to comply with reasonable requests to stop disruptive or dangerous activity
• refusing to leave NHS premises on completion of medical advice, treatment and care and causing a nuisance and disturbance when asked to do so
• failing to comply with reasonable requests to stop disruptive or dangerous activity

Disruption of services and environment

• interrupting services being delivered
• creating excessive noise in waiting areas, wards and other areas of the NHS premises
• playing loud music on NHS premises (for example, via mobile devices)
• being loud or obnoxious in shared spaces

Disregard for Rules and Etiquette

• ignoring or breaching visiting hours or limits on visitor numbers
• smoking on NHS premises
• use or possession of alcohol or drugs
• inconsiderate or obstructive parking

The Act does not provide a definition of what constitutes a "nuisance" or "disturbance" to an NHS staff member, and the courts would be the ultimate arbiter in deciding whether there is a nuisance or disturbance in the circumstances of each case. 

The explanatory notes to the Act confirms that a nuisance or disturbance can include any form of non-physical behaviour which breaches the peace, such as verbal aggression or intimidating gestures towards NHS staff. 

Physical violence or assault against NHS staff, patients, or visitors is covered by other criminal offences, and should normally be dealt with under the appropriate legislation. For further guidance, refer to the AVC Obligatory Responses to Violence Document, which has been endorsed by all 4 Welsh Police Services. These services are committed to supporting NHS Wales colleagues in responding to criminal behaviour.

Is there a reasonable excuse to cause a nuisance or disturbance? 

The Act does not provide a standard definition as to what constitutes reasonable excuse for the purposes of section 119 of the Act. It will therefore be for the courts to consider the circumstances under which the potential offence was committed when deciding what is reasonable excuse.

It is however important that consideration is given to legitimate reasons a person may have for causing a nuisance or disturbance on NHS premises. If a person has a reasonable excuse, they cannot commit an offence under section 119 of the Act and therefore cannot be considered for removal from the premises using the powers under section 120 of the Act.

For example, someone who has just received distressing news about a loved one may struggle to regulate their behaviour, and an emotional outburst in such a context may be understandable in certain circumstances.

In some cases, disruptive behaviour may stem from a mental health condition or learning disability, and if an offence has been committed consideration must be had around whether the condition caused the behaviour in question.

Persons causing a nuisance or disturbance while under the influence of drugs or alcohol will not be able to use this as a reasonable excuse for their behaviour.

Authorised officers should always be objective in their decision-making and take into account the person’s physical or mental state when deciding if they should be removed from the premises using these powers.

What are NHS premises?

The legislation applies to behaviour exhibited on ‘NHS premises’. The Act, at Section 119(4), defines NHS premises separately for England and Wales. With regards to Wales, the Act describes NHS premises as meaning “Welsh NHS premises”, being as follows: 

• any hospital vested in, or managed by, a relevant Welsh NHS body (“a relevant Welsh NHS body” is defined by the Act to mean:
  • a National Health Service trust, all or most of whose hospitals, establishments and facilities are situated in Wales
  • a Local Health Board
• any building or other structure, or vehicle, associated with the hospital and situated on hospital grounds (whether or not vested in, or managed by, a relevant Welsh NHS body)
• the hospital grounds (being land in the vicinity of a hospital and associated with it)

Hospital

The term ‘hospital’ is not defined by the Act but is generally interpreted to mean secondary care facilities that provide acute services. This may extend to facilities such as mental health hospitals, dental hospitals, community hospitals, walk-in centres, and polyclinics, depending on whether the Welsh NHS body deems the facility to fit the definition of "hospital". Additionally, certain buildings or structures, including GP surgeries or other primary care settings located on hospital grounds and associated with a hospital, may also be included in this definition.

It is important to note that the determination of whether a particular facility constitutes a "hospital" for the purposes of the Act is ultimately a matter for judicial interpretation. The Courts retain the authority to determine the meaning of statutory terms in the context of individual cases.

Some NHS premises may be spread across multiple sites or be separated across different locations. Provided the premises in question are situated on ’hospital grounds’ as defined in section 119 of the Act (that is, land in the vicinity of a hospital and associated with it), they will still fall within the definition of NHS premises and will be covered by these provisions.

Vehicles

The term ‘NHS premises’ covers all vehicles, including ambulances, patient transport services and taxis, which are managed by or associated with the hospital and situated on land in the vicinity of a hospital and associated with the hospital.

What is excluded

The definition of NHS premises does not include healthcare premises of the following types, unless they are located within the hospital grounds:

• GP surgeries
• dental practices or surgeries
• pharmacies
• hospices
• private ambulance providers

Who is an NHS staff member?

In relation to the NHS in Wales, an NHS staff member is defined by the Act as being a person employed by a relevant Welsh NHS body (see above for the definition of “a relevant Welsh NHS body”) or otherwise working for it, whether as or on behalf of a contractor, as a volunteer or otherwise. 

Note that the definition of an NHS staff member includes contractors and volunteers working for the relevant Welsh NHS body. It is therefore not limited to clinical staff and could include others, such as those working for the relevant Welsh NHS Body in managerial, clerical, facilities and housekeeping positions.

The offence in section 119 of the Act relates to the causing of a nuisance or disturbance to an NHS staff member who is working at NHS premises or is otherwise there in connection with work. It follows that the offence could take place when NHS staff members are arriving at or leaving the NHS premises in which they work at the beginning or end of their working day or shift.

Refusal to leave premises

To satisfy the second element of the offence at section 119 of the Act, a person causing (without reasonable excuse and while on NHS premises) a nuisance or disturbance to an NHS staff member must refuse, without reasonable excuse, to leave the premises when asked to do so by an NHS staff member or a police constable. The NHS staff member requesting the offending person to leave does not have to be the same NHS staff member subjected to the relevant nuisance or disturbance.

It is recommended that the instruction to leave the premises should be accompanied by a warning that a refusal to leave may result in removal under the powers of the Act. The relevant Welsh NHS body should make every effort to ensure the request to leave has been understood by the person being asked to leave.

Is there a reasonable excuse to refuse to leave the premises? 

A reasonable excuse for refusing to leave the premises can be different from a reasonable excuse for committing a nuisance or disturbance. What is reasonable in such cases is not defined by the Act and will of course depend on the circumstances. NHS staff members should assess the circumstances of each case in a reasonable and proportionate manner to determine whether the person has a reasonable excuse for refusing to leave the premises. 

For example, a person may have a reasonable excuse for refusing to leave if they are accompanying a child or dependent to the hospital and leaving the premises would result in that child or dependent being alone. Similarly, a person may be a carer for a patient in the hospital, and leaving the premises would leave this patient alone or vulnerable. However, it may be that an individual may be considered for removal if alternative care arrangements have been put in place, as appropriate.

Persons who cannot commit this offence

The offence in section 119 of the Act does not apply to individuals who are on NHS premises for the purpose of obtaining medical advice, treatment, or care for themselves. Therefore, individuals who meet this criterion cannot commit the offence in section 119. This would apply, for example, to patients registered with the hospital for clinical or medical assessment, including those with scheduled appointments, or those presenting at an Emergency Department.

However, by virtue of section 119(3) of the Act, a person is to be regarded as not being on the NHS premises for the purpose of obtaining medical, advice, treatment or care, and hence could commit the offence, in the following circumstances:

• once the person has received the advice, treatment or care which they were on the NHS premises to obtain
• if the person who is seeking medical advice, treatment or care has been refused such advice, treatment or care within the last 8 hours

Careful assessment of the situation and of the circumstances of the person suspected of causing a nuisance or disturbance will therefore be essential in all cases. 

Reasonable suspicion that a person is committing or has committed an offence under Section 119 of the Act, and the power of removal

If a constable or authorised officer reasonably suspects that a person is committing or has committed an offence under section 119 of the Act, the constable or authorised officer may remove the person from the NHS premises using the power of removal in section 120(1) of the Act (in the case of a constable) and section 120(2) of the Act (in the case of an authorised officer). 

In such cases, the authorised officer is also able to authorise an appropriate NHS staff member to remove the person and further guidance on this is contained at section 4 of this guidance.

Who is a ‘constable’ and ‘authorised officer’ for the purposes of section 120 of the Act can be briefly summarised as follows:

• A constable is not defined in the Act but should be taken to mean a Police Officer or a volunteer Police Officer (known as a Special Constable). Special Constables have the same powers and perform the same role as a full-time Police Officer, but on a part-time basis.
• A constable does not include a Police Community Support Officers (PCSOs) as they do not share all of the same powers and are not required to be attested by making a declaration in a prescribed form before a justice of the peace in the force area concerned. PCSOs, therefore, do not have the power to remove a person suspected of committing an offence under section 119 of the Act. However, a PCSO could use their own powers to require the name and address of someone suspected of committing an offence under the Act.
• Police forces may consider implementing a Memorandum of Understanding to endorse a PCSO acting as an authorised officer.
• An authorised officer is defined in section 120(5) of the Act as any NHS staff member who has been authorised by a relevant Welsh NHS body to exercise the power conferred by section 120 of the Act. It is recommended that these persons receive appropriate training delivered by the AVC before being authorised to exercise this power. More information on the roles and responsibilities of authorised officers is provided below in this guidance.

In practice, the authorised officer may not be present at the time the nuisance or disturbance is caused and may have to be contacted by NHS staff to attend the incident. In such cases, the authorised officer would have to verify what has taken place by asking NHS staff and other witnesses present during the incident before he or she can reasonably suspect a person of committing an offence under section 119 of the Act. 

If an NHS staff member believes a person is causing a nuisance or disturbance to them and that the person should be removed from the premises, the NHS staff member should contact the authorised officer immediately to assess whether the person is suspected of committing the offence and could be considered for removal. 

It is important for NHS staff members to consider the dynamics of a situation before using the powers provided under section 120 of the Act, and to take a proportionate approach at all times. For example, there will be situations where persons on NHS premises are upset and therefore potentially at a greater risk of demonstrating unpredictable behaviour, such as in the following scenarios: 

• if an authorised officer deems that the failings of the organisations have been a significant contributing factor to the individual’s behaviour
• if an individual is a relative of a deceased or unwell patient, and receives distressing news relating to their loved one
• if the individual is a parent who is anxious about the condition of their child

Should a person be removed?

Authorised officers are advised to follow the established procedure outlined during the recommended AVC training when assessing if an individual has committed an offence under section 119 of the Act and is eligible for removal from the premises. This approach is intended to ensure that legislative safeguards are followed and that individuals are not improperly removed. 

Below are some of the practical issues the authorised officer may need to consider when making their assessment. It should be noted that this is not an exhaustive list and may be followed in a different order. 

• is the nuisance behaviour ongoing?
• has the offending person been told to stop their behaviour?
• are the other more serious offences to consider? For example, have they assaulted anyone?
• is the person experiencing a medical emergency?
• do they have a reasonable excuse for their behaviour?
• what is the impact of their behaviour? 

Under section 120(4) of the Act there are important legal safeguards that restrict when an authorised officer may remove a person from NHS premises or authorise another person to do so. These arise where the authorised officer has reason to believe that: 

• (a) the person to be removed requires medical advice, treatment, or care for himself or herself

     or

• (b) removal of the person would endanger the person’s physical or mental health

These safeguards are in place to ensure that removal powers are exercised proportionately, and with full regard to the health, dignity, and safety of individuals on NHS premises. They are particularly relevant in situations involving patients, carers, or visitors who may be in distress, confused, or experiencing a health crisis.

This guidance is intended to support relevant NHS bodies and authorised officers in exercising the powers of removal under section 120 of the Criminal Justice and Immigration Act 2008, including when dealing with individuals who may be vulnerable due to mental health issues. The guidance does not provide direction to the police, as guidance under section 121(1) of the Act is issued only to relevant NHS bodies and authorised officers. While the guidance outlines the legislative framework, further practical detail on exercising the right of removal, particularly in circumstances involving vulnerable individuals, will be provided through recommended AVC training.

Safe removal of a person suspected of committing the offence

There may be risks involved in removing from a premises a person who is reasonably suspected of committing or having committed an offence under section 119 of the Act. Therefore, before considering using the power of removal, an authorised officer should undertake an assessment of the potential risks.

Just by way of example, consideration should be given to factors such as: 

• the current demeanour of the individual concerned
• the location of the incident
• whether other staff members are in the vicinity
• impact factors such as sex, size, age and any known behavioural issues, for example, whether the offending person known to be particularly aggressive
• whether the police been called, and whether it would be better to wait for them to deal with the situation 

When deciding to remove a person from the premises, the authorised officer should consider their own safety, the safety of NHS staff authorised by them to remove the person, and the safety of the person being removed, of other patients and visitors around them.

As part of the risk assessment process, if it is considered that removing the individual will place the individual at risk of harm to themselves (for example, being placed in a deserted bus shelter late at night), or else place others involved in their removal at risk of harm (for example, by using a taxi driver contracted by the hospital) then this should be avoided.

Before attempting removal, it is recommended that the person to be removed is advised that reasonable force may be lawfully used if it is considered necessary, but that the person is not under arrest at this point. Any removal should be proportionate to any risks perceived.

What is ‘reasonable force’?

Reasonable force should only be used as a last resort if non-physical methods prove unsuccessful in removing the person from the premises. There is no legal definition of what is ‘reasonable’ when considering using force to remove a person, and this will depend on the

circumstances of the particular case. However, the degree of force used should be necessary, proportionate and justifiable in the circumstances.

Authorised officers and appropriate staff members should be in receipt of relevant training provided by their employer, which describes in detail what could be considered ‘reasonable’ force and training in the practical application of removing someone from premises. 

If the authorised officer decides that reasonable force is necessary to remove a person, they should ensure the degree of force used by the authorised NHS staff is appropriate and absolutely no more than necessary, and that it is in line with the physical intervention training of the authorised NHS staff carrying out the removal. Staff using reasonable force should consider the safety of all those involved in the incident. 

For example, if the person to be removed has a medical condition (but they are not on the NHS premises to receive advice, treatment or care for this condition), then removing them using reasonable force may not be appropriate as this may cause them harm.

If, during removal, the person their behaviour escalates to more serious offences such as assault, the police should be called immediately. Further, if the person being removed becomes physically injured by the methods used to remove them, appropriate medical advice should be sought immediately. In both of these circumstances, the authorising officer should record the incident, including obtaining written statements from those involved, and these records should form part of a post-incident review.

The procedure for the authorising of authorised officers is not laid out in the Act, but it is recommended that authorisation of officers is made in writing by a person at board level in the Welsh NHS body. They should have assurance as part of this process that the authorised officers and appropriate NHS staff are suitably trained and competent to carry out their roles.

The role of the authorised officer is an important one, carrying significant responsibility. It is recommended, therefore, that the authorised officer is someone in a managerial position who has decision-making responsibility attached to their current job description. Decision making responsibility can cover decisions relating to a person’s health or decisions relating to the operations or running of the organisation in which they work. 

The authorised officer may, for example, be a clinician or an NHS manager. Suitable roles may be, but are not limited to: 

• Charge Nurse
• Senior Nurse or Matron
• Duty Site or Bed Manager
• Senior Midwife
• Registrar or Consultant Doctor
• Operations manager
• Clinical site manager
• Security officer 

The Welsh NHS body should ensure that there is sufficient provision of authorised officers, taking into account the size of the hospital and the need for 24-hour cover. NHS bodies should ensure authorised officers attend a relevant training programme (details of this are contained below).

NHS staff members should be aware of who their authorised officers are and how to contact them. Welsh NHS bodies should ensure that a list of authorised officers is made available to staff along with the times at which they can be contacted.

The selection of appropriate NHS staff

Authorised officers will need to satisfy themselves that the NHS staff members they authorise to carry out the removal of a person under section 120(2)(b) of the Act are suitably trained, in line with the requirements set out above.

If possible, it is recommended that authorised officers draw on the services of security officers in NHS premises and authorise these members of staff to assist in removing persons from the premises when incidents occur. 

Where NHS Wales bodies have access to security staff, this is generally on a 24-hour, 365-day basis. It may therefore be considered that such staff members are appropriate for this role. 

However, where NHS Wales bodies do not have security staff, or do not have security staff as a constant presence on their premises, consideration should be given to nominating an appropriate alternative. This should be persons whose job role regularly includes the use of conflict resolution and physical intervention skills.

It is recommended that the Welsh NHS Body ensures all relevant departments are given an up to date list of authorised officers and appropriate NHS staff as a matter of course.

Training requirements

Authorised officers

For authorised officers to fulfil their duties, there is an expectation they have undertaken appropriate training delivered by the AVC. It is recommended that authorised officers undertake training in areas including but not necessarily limited to the following: 

• understanding Sections 119 to 120 of the Act
• how to assess whether a person has committed an offence
• how to safely remove a person from NHS premises and what would constitute reasonable force
• health and safety matters (including risk assessments)
• diversity awareness
• mental health awareness
• de-escalation factors
• Violence and Aggression Welsh Passport Training: Managing violent behaviour training
• how to authorise appropriate NHS staff members to assist with removal
• effectively recording the event

Appropriate NHS Wales staff members

There is also an expectation that the appropriate NHS staff members authorised by the authorised officers to remove a person from NHS premises undertake training in areas including, but not necessarily limited to, the following: 

• understanding of Sections 119 to 120 of Act
• how to safely remove a person from the premises and what would constitute reasonable force
• health and safety matters (including risk assessments)
• physical intervention & de-escalation techniques
• diversity awareness
• mental health awareness
• de-escalation 

It is important that NHS bodies making provision to use the power of removal ensure that authorised officers and appropriate NHS staff undertake refresher training as appropriate.

Datix-Cymru report

All authorised officers must ensure all authorised officers ensure that a comprehensive Datix-Cymru Violence and Aggression incident report is submitted at the earliest opportunity following any incident that falls under Section 119 or Section 120 of the Act. This requirement applies equally and independently to incidents under either section, and must be reported using the Datix Cymru system. This should include a full description of the event, actions taken and the rationale for such actions.

The appropriate member of staff as designated by the NHS Wales Body should on receipt of the Datix-Cymru report ensure the head of the relevant Health & Safety Department has sight of the report. They should also keep records of such reports to help each NHS Wales Body track the number and locations of incidents.

Accurate reporting within the Datix-Cymru system is mandatory for both internal governance and external accountability. It ensures that incident data is reliably captured and can be used to inform reports, support investigations, and contribute to legal proceedings where necessary. 

To facilitate this process, all staff will be provided with a comprehensive user guide, along with a S119 or 20 incident report template. These resources are designed to support the correct and consistent uploading of incidents to Datix Cymru, thereby strengthening the quality of evidence available for prosecutions and other formal reviews.

NHS Wales bodies should ensure the public are aware of the offence of causing a nuisance or disturbance to an NHS staff member on NHS premises and of the power that authorised NHS staff have to remove people suspected of committing this offence. 

This may be done through patient information leaflets as well as on websites of the NHS body. Appropriate signage can act as a deterrent as well as a communication tool for explaining the powers to members of the public. Signage should be displayed in a number of areas in NHS hospitals as the offence can be committed anywhere on the premises.

While this guidance has been produced to help illustrate how sections 119 to 121 of the Act work, it should be read in conjunction with the relevant legislation. This guidance should not be taken as an authoritative statement or interpretation of the law, as only the courts have this power. Every effort has been made to ensure that this guidance is as helpful as possible, but it is ultimately the responsibility of NHS bodies and their staff to ensure compliance with their legal obligations, including those set out in the wider legislative framework (including but not limited to obligations in equalities, human rights and health and safety laws). 

Appendix A

Sections 119, 120 and 121 in full (available at legislation.gov.uk)

119 Offence of causing nuisance or disturbance on NHS premises

(1) A person commits an offence if:

• (a) the person causes, without reasonable excuse and while on NHS premises, a nuisance or disturbance to an NHS staff member who is working there or is otherwise there in connection with work,
• (b) the person refuses, without reasonable excuse, to leave the NHS premises when asked to do so by a constable or an NHS staff member, and
• (c) the person is not on the NHS premises for the purpose of obtaining medical advice, treatment or care for himself or herself. 

(2) A person who commits an offence under this section is liable on summary conviction to a fine not exceeding level 3 on the standard scale.

(3) For the purposes of this section:

• (a) a person ceases to be on NHS premises for the purpose of obtaining medical advice, treatment or care for himself or herself once the person has received the advice, treatment or care, and
• (b) a person is not on NHS premises for the purpose of obtaining medical advice, treatment or care for himself or herself if the person has been refused the advice, treatment or care during the last 8 hours. 

(4) In this section:

• “English NHS premises” means:
  • any hospital vested in, or managed by, a relevant English NHS body,
  • any building or other structure, or vehicle, associated with the hospital and situated on hospital grounds (whether or not vested in, or managed by, a relevant English NHS body), and
  • the hospital grounds,
• “hospital grounds” means land in the vicinity of a hospital and associated with it
• “NHS premises” means English NHS premises or Welsh NHS premises
• “NHS staff member” means a person employed by a relevant English NHS body, or a relevant Welsh NHS body, or otherwise working for such a body (whether as or on behalf of a contractor, as a volunteer or otherwise),
• “relevant English NHS body” means:
  • (a) a National Health Service trust (see section 25 of the National Health Service Act 2006 (c. 41)), all or most of whose hospitals, establishments and facilities are situated in England,
  • (b) an NHS foundation trust (see section 30 of that Act), (c)
• “Relevant Welsh NHS body” means:
  • (a) a National Health Service trust (see section 18 of the National Health Service (Wales) Act 2006 (c. 42), all or most of whose hospitals, establishments and facilities are situated in Wales, or
  • (b) a Local Health Board (see section 11 of that Act),
• “vehicle” includes an air ambulance
• “Welsh NHS premises” means:
  • (a)any hospital vested in, or managed by, a relevant Welsh NHS body,
  • (b)any building or other structure, or vehicle, associated with the hospital and situated on hospital grounds (whether or not vested in, or managed by, a relevant Welsh NHS body), and (c) the hospital grounds.

120 Power to remove person causing nuisance or disturbance

 (1) The appropriate national authority may from time to time prepare and publish guidance to relevant NHS bodies and authorised officers about the powers in section 120.

(2) Such guidance may, in particular, relate to:

• the authorisation by relevant NHS bodies of authorised officers
• the authorisation by authorised officers of appropriate NHS staff members to remove persons under section 120
• training requirements for authorised officers and persons authorised by them to remove persons under section 120
• matters that may be relevant to a consideration by authorised officers for the purposes of section 120 of whether offences are being, or have been, committed under section 119
• matters to be taken into account by authorised officers in deciding whether there is reason to believe that a person requires medical advice, treatment or care for himself or herself or that the removal of a person would endanger the person's physical or mental health
• the procedure to be followed by authorised officers or persons authorised by them before using the power of removal in section 120
• the degree of force that it may be appropriate for authorised officers or persons authorised by them to use in particular circumstances
• arrangements for ensuring that persons on NHS premises are aware of the offence in section 119 and the powers of removal in section 120
• the keeping of records

(3) Before publishing guidance under this section, the appropriate national authority must consult such persons as the authority considers appropriate.

(4) A relevant NHS body and an authorised officer must, when exercising functions under, or in connection with, section 120, have regard to any guidance published by the appropriate national authority under this section. 

(5) In this section:

• appropriate national authority” means:
  • (a) in relation to a relevant English NHS body and authorised officers in respect of English NHS premises, means the Secretary of State, and
  • (b) in relation to a relevant Welsh NHS body and authorised officers in respect of Welsh NHS premises, means the Welsh Ministers
• “appropriate NHS staff member” and “authorised officer” have the same meaning as in section 120
• “relevant NHS body” means a relevant English NHS body or a relevant Welsh NHS body

(6) Terms defined in section 119 have the same meaning in this section as in that section.