STAFF at Hereford County Hospital are getting tough with abusive patients and visitors.

Many have been subjected to inexcusable behaviour while they were helping to make people better - often, but not always, because the abuser had too much to drink.

Hereford Hospitals Trust has decided to re-launch its policy of zero tolerance for violence and aggression, wherever it happens in the hospital.

And it copied a system from the football world, giving offenders a yellow warning the first time and a red one for a repeat performance.

They don't actually hand out yellow and red cards - the warnings are sent as letters to their homes. After the first warning, culprits are told not to return to the hospital again unless they need urgent treatment.

It has not yet been necessary to issue a red card but more than 10 people have received the yellow warning and there have been prosecutions.

Abuse happens in different parts of the hospital at different times but often in the A&E department later in the evening.

Staff get sworn at, some are racially abused and there are cases of pushing and shoving and general abusive behaviour.

Lead nurse Paula Heath and staff nurse Heather Pardo-Matthew have experienced it.

They say they welcome the yellow and red card system, praising it as a proactive step taken by the trust to support them and people using the department.

They accept that attending a hospital can be stressful, especially in A&E, but the staff's priority is to give patients the care they need. If they, the police and ambulance staff have to respond to a few disruptive individuals, there is less time to treat others.

The nurses hope the community will support them and would be happy to receive comments and ideas from the public "so that together, we can make the A&E department at the County Hospital a safe place to be".

Those who make the decision about warning abusers do not do so lightly. People who act in an intolerable manner are warned at the time their behaviour is not acceptable.

The incident is then reviewed by the appropriate Matron and the hospital's security officer and if further action is necessary, a written warning is then sent to the individual and to their GP.

But the hospital means business and wants to cut out violence and free staff from the fear of being abused at work. It does happen, it causes distress and there are cases of staff having to take time off from their jobs.

Is the yellow and red warning tactic working? There are hopeful signs that it will because the hospital has already received letters of apology from some of those who have been told to behave themselves in future.