Violence and Aggression

Sep 25, 2023

Sadly the statistics for violence and aggression against health and social care workers continues to rise despite training and increased awareness across these sectors.

This blog provides information and asks are you doing all you can to ensure you avoid becoming one of these statistics?

The actual statistics are thought to be lower due to under reporting of incidents that some staff feels are minor or irrelevant. (See HSE statement below).

Early recognition and reporting are being encouraged – could that minor complaint have been an early warning sign of aggression or violence to follow?

The NHS violence prevention and reduction programme aims to support our NHS people with organisations and systems to embed a culture where our NHS colleagues feel supported, safe and secure at work.

In May 2023 the tabloids stated that incidents of violence against staff at one NHS Trust had doubled between 2020 and 2021 and increased again between 2021 and 2022 by almost 18%.

This was despite violence reduction and safety measures being implemented in January 2022 at the Trust and various initiatives being put in place nationally.

In one Trust the escalation of their stats led to the launch of a No Excuse for Abuse campaign.

‘Any incident in which a person is abused, threatened or assaulted in circumstances relating to their work’ is the definition used by the HSE for workplace violence. They mandate that  – “If there is a risk of violence and aggression, or challenging behaviour, you must assess the risks This process will help you: identify hazards; evaluate risks; and, implement, monitor and review measures to reduce the risk.”

They also state that the main risk in health cand social care is the verbal abuse or physical assault of an employee or other person.

There is a high level of under-reporting of incidents of violence and aggression within the health and social care sector, as many accept it as part of the job.

In their report in March 2023, they found that “employees involved in the following activities are at increased risk of violence and aggressive behaviour:

  • working alone.
  • working after normal working hours.
  • working and travelling in the community.
  • handling valuables or medication.
  • providing or withholding a service.
  • exercising authority.
  • working with people who are emotionally or mentally unstable.
  • working with people who are under the influence of drink or drugs.
  • working with people under stress.

It is important to consider all groups of employees that might be affected. Ancillary staff such as cleaners or caterers, and bank or agency staff are often overlooked.”

The key findings and areas that were recommended for review due to the risks from workplace violence and musculoskeletal disorders (MSDs) in the NHS were: –

  • risk assessment
  • training
  • roles and responsibilities
  • monitoring and review

They found that whilst things may have been recognised and procedures put in place they are often not monitored or reviewed to ensure that they work in practice or remain effective.

The HSE state the main drivers which can lead to violent or aggressive behaviour and create a risk include:

  • inherent aggression or mental instability.
  • impatience (due to waiting, lack of information or boredom).
  • frustration (due to lack of information or boredom).
  • anxiety (lack of choice, lack of space).
  • resentment (lack of rights).
  • alcohol and drugs; and,
  • poor design of premises.

The considerations to be made as part of the risk assessment are: –

1. Implementing control measures

Provide signage and communication that is clear for service users to avoid frustration from the outset. Respond appropriately to incidents and record them appropriately. Consider how staff engage with people. People can get annoyed if information is not available or they feel as if they are being ignored. Manage new patients or service users – check you have the right information at referral regarding violent behaviour and share it at induction with staff.

2. Personal Communication Devices

The provision of personal communication devices may form part of several reasonably practicable control measures to help manage the risk. These include telephones, mobile phones, radios, automatic warning devices and emergency alarms.

3. The workplace

The physical environment may affect the likelihood of violent incidents, and the ease at which people can respond to them. You must ensure the work environment is as safe and secure as possible to reduce the risk of violence and aggression. How can you get out quickly if needed? Is an alarm required?

4. Lone working – Community workers

Lone workers can face additional risks. Assess risks thoroughly and ensure your lone working policy/processes are clear and robust. Undertake relevant checks wherever possible and before the decision to visit is made.

  • Is there information regarding previous visits available from the referrer (if there is one)
  • Is there any past history of violence (person receiving care or relatives).
  • Are any of the drivers previously listed likely to exist?
  • Would it be worth gathering recent medical and personal history before the visit?

If there is not enough information to make a suitable assessment, or there are any concerns should the initial visit be made alone? Take a chaperone and state this in advance or the visit.

5. Training

Training in the prevention and management of violence/aggression can provide employees with appropriate skills to reduce or diffuse potential incidents. If you are working alone this training can be accessed on-line and is advisable.

We suggest a focus is placed on reporting all violent and aggressive incidents and that a proactive approach is taken to this incident reporting however small.  By tracking and then monitoring this, trends can be spotted sooner, and actions taken to attempt to reduce and where possible eliminate the risk.


NHS England V and A Prevention

Bolton NHS No Excuse for Abuse

HSE Violence in Health and Social Care

If you have any questions, we would love to hear from you.

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