What is violence?

The Health and Safety Executive (HSE) says violence at work is "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. It can result in lack of confidence, anxiety to not turning up to work, increased use of alcohol and PTSD.

NHS violence statistics

Last year nearly 15% of NHS staff had 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 at work
• 32% of 602 doctors believed that incidents of violence or verbal abuse had increased in the past year
• 43% of 644 doctors saw physical violence or verbal abuse towards colleagues
• issues thought to be factors in the incident(s) of physical violence or verbal abuse included discontent with the service provided (60%), health related or personal problems (54%), and being drunk (30%).

How NHS trusts should be stopping abuse

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

• Employers have a legal duty to ensure, so far as reasonable, the health, safety and welfare at work of their staff.
• Employers must look for risks to staff (including the potential risk of violence); decide how significant these risks are; decide what to do to prevent or control the risks; and develop a clear plan to achieve this.
• Employers must notify their enforcing authority in the event of an accident at work to any employee resulting in death 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 their health and safety.

How to reduce violence

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

Actions for employers

• Put in place a violence reduction policy and share this with all staff.
• Make sure there are enough staff.
• Do risk assessments (of the workplace and staff) and put solutions in place. Consider space, layout and staff security.
• Make work a place where staff don’t have to put up with violence or see it as ‘part of the job’.
• Teach staff how to react to or calm down those who are being abusive.
• Design the work environment to reduce the risk of violence.
• Talk with trade unions and patients about making violence reduction strategies and processes.
• Encourage staff to report all violence incidents and know how to do this.
• After an incident, bring staff together for debriefing to discuss what happened.
• Ensure staff are supported when reporting an incident.
• Have handover briefings for recording and exchanging information about patients.
• Ensure staff have access to physical and mental health support.
• Collect and monitor data on incidents.

Actions for doctors

• Read your employer’s violence reduction policy and do any training.
• Report incidents to your manager and fill out an incident reporting form.
• Report physical attacks or serious cases of threatening or verbal abuse to the police, including any details about when it happened and who.
• Take up wellbeing support offers and encourage colleagues to do the same.
• Suggest measures to managers which might help to prevent violence. 

Violence prevention and reduction standards

All NHS-funded services under the NHS Standard Contract must declare to the board twice a year that they have met the standard.

The standards set out:

• The trust’s violence prevention and reduction policy is developed based on risk assessments and sets out objectives, performance measures and requirements to reduce violence.
• The policy is updated annually with senior management oversight.
• The strategy and policy are communicated to all staff, including how to report incidents.
• A risk assessment (staff and workplace) is done to consider other factors (for example, protected characteristics) of violence. This will inform any prevention plans.
• An executive level violence prevention lead should ensure that financial resources are available, the appropriate amount will be decided locally.
• An operational violence prevention lead should be accountable for the design, maintenance, documentation and improvement of the strategy and policy.
• The violence prevention process and approach is reviewed and updated with trade union and safety reps.
• Any proposed actions are assessed and done in a timely fashion.
• Any lessons learned are considered by the organisation and changes made to the policy.

What is the BMA doing?

• We have lobbied for increasing the maximum penalty for common assault against emergency workers.
• We have worked in partnership through the social partnership forum to support the development of a strategy.