Preventing and reducing violence against staff

NHS staff should be adequately protected and assault should never be considered as part of the job. This is particularly vital in an environment where workloads and waiting times in the NHS are rising, and staff are under greater pressure, leading to the risk that patients are more likely to take out their frustration on those providing a public service.

Location: UK
Audience: All doctors
Updated: Monday 4 January 2021
NHS Structure Article Illustration

How is violence defined?

The Health and Safety Executive (HSE) defines violence at work as "any incident in which an employee is abused, threatened or assaulted in circumstances relating to their work." This can include verbal abuse or threats as well as physical attacks.

Violence can impact people in different ways. The consequences can range from lack of confidence, anxiety to absenteeism, increased use of alcohol and PTSD.


Prevalence of violence

Last year nearly 15% of NHS staff experienced physical violence from patients, their relatives or the public.

A BMA survey in January 2020 found that:

  • 43% of 602 doctors were concerned about physical violence and verbal abuse from patients in the workplace
  • 32% of 602 doctors believed that incidents of violence or verbal abuse had increased in the past year
  • 43% of 644 doctors have witnessed physical violence or verbal abuse directed at colleagues and other staff groups
  • issues thought to be factors in the incident(s) of physical violence or verbal abuse included dissatisfaction with the service provided (60%), health related/personal problems (54%), and intoxication (30%).


What obligations does my employers have to prevent violence?

The legal requirements for employers set out by HSE include the following:

  • Employers have a legal duty to ensure, so far as it is reasonably practicable, the health, safety and welfare at work of their employees.
  • Employers must consider risks to employees (including the risk of reasonably foreseeable violence); decide how significant these risks are; decide what to do to prevent or control the risks; and develop a clear management plan to achieve this.
  • Employers must notify their enforcing authority in the event of an accident at work to any employee resulting in death, specified injury, or incapacity for normal work for seven or more days. This includes any act of non-consensual physical violence done to a person at work.
  • Employers must inform, and consult with, employees in good time on matters relating to their health and safety.


Reducing and responding to violence at work

HSE guidance sets out the steps employers should take to reduce the risk of work-related violence health and care settings.

Actions for employers

  • Put in place a violence reduction policy and share this with all staff
  • Ensure adequate staffing levels
  • Undertake risk assessments (of the workplace and staff) and implement the mitigation strategies. Consider space/layout, staff security etc.
  • Develop a culture where staff don’t endure violence or see it as ‘part of the job’
  • Provide de-escalation training for staff
  • Design the work environment to reduce the risk of violence
  • Consult with trade unions as well as service users/carers on the development of violence reduction strategies/processes
  • Encourage staff to report all violence incidents and know how to do this
  • Following an incident, bring staff together for debriefing to discuss what happened
  • Ensure staff are supported during the reporting process
  • Have systems in place for recording/exchanging info about patients (handover briefings)
  • Ensure staff have access to physical and mental health support
  • Collect/monitor data on incidents

Actions for doctors

  • Be aware of your employer’s violence reduction policy and take up any training
  • Report incidences to your manager and fill out an incident reporting form
  • Report any incidences involving physical attack or serious cases of threatening or verbal abuse to the police, including any details about when it happened, who was involved and any other relevant
  • Take up wellbeing support offers and encourage colleagues to do the same
  • Suggest additional measures to managers which might help to prevent and manage the risk of violence 


Violence prevention and reduction standard

All commissioners and providers of NHS-funded services operating under the NHS Standard Contract must provide Board assurance bi-annually that they have met the standard.

The standards set out the following:

  • The trusts’ violence prevention and reduction policy is developed based on comprehensive risk assessments and sets out specific objectives, performance measures and mitigation requirements.
  • The policy is maintained and updated annually with senior management oversight and approval.
  • The violence prevention and reduction strategy and policy are communicated to all staff, including incident reporting mechanisms.
  • A comprehensive risk assessment (workforce and workplace) is undertaken to consider the associated factors (i.e. protected characteristics) of violence within the organisation. The outputs from the risk assessments informs the mitigation strategies and operational processes.
  • A designated Executive Level Violence prevention and reduction Lead should ensure that appropriate financial resources are available to support the organisations delivery of violence prevention and reduction programme, the appropriate level of resourcing will be determined locally.
  • A designated Operational Violence prevention and reduction Lead should be formally accountable for the design, maintenance, documentation and improvement of the organisational violence prevention and reduction systems and processes.
  • The violence prevention and reduction process, plans and systematic approach is reviewed, updated, and undertaken in consultation with trade union & safety representatives.
  • Proposed corrective and preventative actions are assessed and implemented in a timely fashion.
  • Any lessons learned are captured and considered by the organisation and subsequent changes are made to the violence prevention and reduction policy.


What is the BMA doing?

  • We have lobbied for increasing the maximum penalty for common assault against emergency workers.
  • Work in partnership through the Social Partnership Forum to support the development of a violence reduction strategy.