Abuse of NHS staff by patients and the public is at its highest level in three years. Here is what hospital trusts are doing to prevent it and to look after the people who experience it.
One in seven NHS staff in England experienced physical violence from patients, service users, relatives or the public last year. The 2025 NHS Staff Survey put the figure at 14.5%, with 25.3% reporting harassment, bullying or abuse. For nurses and midwives the numbers rise to 22.6% and 35.0%. Professor Nicola Ranger, General Secretary and Chief Executive of the Royal College of Nursing, said: “This is a national emergency for staff safety and it should profoundly shock us all.”
Coming on top of high levels of burnout across the workforce, these figures are pushing trusts to treat abuse as a risk to plan for rather than part of the job.
Putting someone in charge of violence reduction
The starting point for many trusts is NHS England’s Violence Prevention and Reduction Standard, published in January 2021. It sets out a risk-based framework that asks organisations to assess where staff are most exposed and to review their controls regularly.
In practice that often means a named lead. Sherwood Forest Hospitals, for example, has a Professional Lead for Security Management and Violence Reduction, Wesley Burton. Having one person accountable makes it easier to join up security, estates, clinical teams and HR. It also gives incident data a clear owner, and those figures are only useful when staff report every event, including verbal abuse.
Training staff to de-escalate
Most trusts now offer conflict resolution and de-escalation training, and many add alerts to patient records where there is a known history of aggression. Public messaging plays a part too. The #WorkWithoutFear campaign, developed by NHS England with the Association of Ambulance Chief Executives, uses real stories from crews to ask people to treat them with respect.
Consider a hypothetical example. A ward admits a patient whose record shows two previous incidents. Before the first night shift, the nurse in charge, the security team and the patient’s consultant agree on a short plan: who attends first if the patient becomes distressed, which room offers a quieter space and when to call for support. Nobody improvises at 3am and the patient gets a calmer, more consistent response.
Cameras in emergency departments and security teams
Emergency departments see the highest volume of incidents. Barts Health reported over 100 incidents of violence and abuse in a single month across the trust, including 49 physical assaults, with its emergency departments recording the most. Róisín O’Doherty, Emergency Department matron at Newham Hospital, said: “Our staff work relentlessly to care for patients with compassion, often whilst managing disruptive and abusive behaviour.”
Several trusts now issue body cameras to security officers and emergency department staff, worn openly on the uniform and switched on only when an incident is under way, with the person told before recording starts. At Sherwood Forest, every security officer at King’s Mill and Newark hospitals wears one.
Safeguards matter as much as the kit. Belfast Health and Social Care Trust has consulted on a six-month pilot in the adult emergency departments at the Royal Victoria and Mater hospitals. Under the proposal only trained volunteers would wear cameras. Devices would never be hidden or used during personal care or in private areas. Footage would be deleted automatically unless an investigation needs it.
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The evidence calls for realistic expectations. RAND Europe’s evaluation of the ambulance service trial for NHS England found staff views were mostly positive but that cameras “do not necessarily de-escalate situations on their own”. Good communication and a supportive culture were just as important.
Supporting staff after an incident
Prevention will never stop every incident, so aftercare matters. Good practice includes a prompt debrief, time away from the floor when someone needs it, quick access to occupational health and psychological support and practical help with police statements. A manager who checks in a week later shows the organisation takes it seriously.
This links closely to a preventative approach to staff wellbeing. People who feel supported after a frightening shift are more likely to report the next incident and to stay in post.
| Measure | Purpose | What makes it work |
|---|---|---|
| Violence reduction lead | Owns the risk and the data | Authority to coordinate security, estates and clinical teams |
| De-escalation training | Calms situations early | Regular refreshers and shared care plans |
| Body cameras | Deterrence and evidence | Volunteers, overt use and strict privacy rules |
| Post-incident support | Recovery and retention | Fast access and follow-up from managers |
What makes the difference
No single measure solves the problem. The trusts making progress combine visible leadership, consistent reporting and staff involvement in choosing what to introduce. When frontline workers help shape the response and see action after they speak up, they are more likely to trust the system and keep using it.
