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October 12, 2022

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The obstacles to staff safety and wellbeing in the NHS

SHP hears from Roger Ringham, Chair of the National Association for Healthcare Security (NAHS) as he discusses the barriers to safety and wellbeing for NHS staff…

Roger Ringham, Chair of the National Association for Healthcare Security (NAHS)

We know that violence and aggression against NHS staff is a problem. But how big a problem, we can’t be sure. All we can do is make estimates, and judge by our own direct experiences of working in healthcare security.

The reason for that is there has been no comprehensive annual national survey since 2017.

In 2017, NHS Protect which had been collecting fairly reliable and detailed figures once a year, was disbanded. It was replaced by the NHS Counter Fraud Authority, and while the authority’s mission is a vital one, it does not include the same remit for workplace violence reduction or for raising general standards in security management as its predecessor had.

That gap is a problem, and is something that many in the profession, including NAHS, are keen to fix.

No accurate picture
Currently, the best data we have comes from limited sources such as the NHS Staff Survey. This is conducted annually but includes only a few general questions – “have you been subject to, or witnessed violence?” for example – and it is not mandatory. Therefore, it doesn’t give us an accurate picture of how many incidents there are each year across the NHS, or break those incidents down by month, week, or day, or show their severity or type.

What the 2021 survey did tell us was this: 14.3% of the 600,000 respondents said they had experienced at least one incident of physical violence from patients, service users, relatives, or other members of the public in the previous 12 months. A much higher level of abuse was reported in the ambulance sector, with almost a third of paramedics saying they had been subject to violence.

We can supplement this picture with data compiled annually by the Nursing and Midwifery Council, and the Health & Safety Executive. But, while the figures we have are limited in scope, they are still trustworthy sources and confirm what many frontline staff will tell you: that verbal and physical aggression continues to get worse.

Why aggression matters
This matters greatly. I am currently working on a new conflict resolution course for NHS staff and managers, and one of my biggest concerns is the impact of aggression on both individuals and teams. When a front-line health worker is subject to abuse, it not only affects them personally, it can have a negative impact on their close colleagues and as a result lead to lower standards of patient care.

Anecdotal evidence suggests very strongly that aggression has a significant impact on staff absences, on recruitment and on retention. I spent the first 30 years of my career in the police service, and I’ve dealt with some horrible things, but when I spend time with medics and see what they have to cope with, it’s much worse. If the reward for their dedication is to be abused or physically attacked, it’s not surprising if they go sick, or decide they need to change jobs altogether.

When you add to their stress with rising demand for services, staffing shortfalls, and continuing pressure on budgets – all of which we are now seeing – these risks culminate in a self-fulfilling downward spiral.

Just one anecdote from my personal experience shows what can happen when people, and systems, are under too much pressure: a mental healthcare nurse had a knife held to her throat by a patient, the patient escaped, was caught by the police, and eventually returned to the healthcare unit. The nurse wasn’t informed that the suspect had been apprehended, and when she came onto the ward the first person she saw was the man who had attacked her. Understandably, she was badly shaken by this experience. This should not have happened, and her trauma could have been prevented if she’d been warned in advance.

It’s nobody’s fault, but the consequence of a 24/7 conveyor-belt service where a significant turnover of managers can mean key details are not relayed from one shift to another, which can lead to additional challenges.

Looking for answers
So how can we prevent things becoming worse? We need better regulatory oversight, better reporting, and higher benchmarks for security training and education. We also need clearer protocols for dealing with incidents, more effective sharing of best practice – including around technology innovations – and better partnerships with other agencies, most obviously with the police.

These are all topics we’ll be discussing at the NAHS annual conference in November – which this year features an expanded programme of expert speakers.

For regular readers of SHP, I will also be looking at these issues in more detail in a series of quarterly articles on this site.

Watch this space. Until then – keep safe, and keep your people safe.


What makes us susceptible to burnout?

In this episode  of the Safety & Health Podcast, ‘Burnout, stress and being human’, Heather Beach is joined by Stacy Thomson to discuss burnout, perfectionism and how to deal with burnout as an individual, as management and as an organisation.

We provide an insight on how to tackle burnout and why mental health is such a taboo subject, particularly in the workplace.


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Henry Tobin
Henry Tobin
1 year ago

Thanks for a very insightful article Roger. You make some important points. The loss of the former annual recording of violence and aggression data and the national guidance from NHS Protect were both major backward steps, driven by austerity measures. We are seeing a massive increase in verbal abuse and verbal threats, much of it extreme. This is experienced in services that have always had this, but is much more frequent (e.g. in Primary Care). It is also experienced in services where it was almost never seen before, e.g. outpatient services. I believe much of this aggression is driven by… Read more »

Gary Moseley
Gary Moseley
1 year ago

I have 2 daughters working in the NHS who worked through the last 2 years of the covid pandemic. They now have health condition after catching Covid-19 at the workplace and have unfortunately had sickness absence as a consequence of infection. Both have been taken down the disciplinary route. Mental health conditions are on the increase; however, NHS senior management has not acted to ensure support for those staff who continue to suffer. The shameful attitude towards staff health, Safety and welfare is concerning!!!!!