Research type 
Year of report 

Summary of findings


A ‘pro security’ culture  

  • The NHS pro-security culture has been strengthened since the 2004 survey, with an increase in recognition of the support provided by employers 
  • Seven in 10 staff - a significant increase on the 2004 findings – agree that their workplace provides a safe and secure working environment against verbal abuse or verbal threats of physical violence from the general public and patients
  • The vast majority of staff – over 9 in 10 – feel secure when they are working alone
  • Among the small proportion who feel less secure, these are most likely to be midwives, security staff and Accident and Emergency (A&E) nurses, as well as those who have been physically assaulted in the workplace in the last 12 months
  • In terms of physical violence, three in four staff agree that their workplace provides a safe and secure working environment against this
  • Those who have attended Conflict Resolution Training (CRT) demonstrate increased awareness of other NHS SMS initiatives, as well as a greater awareness and a more positive attitude towards additional NHS security initiatives
  • One in four staff have attended CRT in the last year, with roughly the same proportion having attended it between one and three years ago
  • As not all roles will have access to CRT, it is perhaps worth considering the other characteristics of non-attendees. Men, staff of an Asian ethnicity and those who have been in their roles for less than a year are all more likely than the overall average to have never attended CRT
  • This is also the case for those in primary care (where CRT is not mandatory among certain professions such as opticians) and mental health organisations (who attend tailored ‘Promoting Safer and Therapeutic Services’ training). This explains why attendance at CRT is significantly higher among those in acute care – more staff in acute care are required to attend this training

Staff awareness of NHS security policies and initiatives 

  • Staff awareness of specific NHS SMS policies and initiatives varies greatly 
  • The NHS SMS initiatives that staff are most aware of include CRT, local reporting procedures (PARS) and local violence/security/lone-worker policies and procedures
  • Awareness of the initiatives benchmarked in the 2004 survey – CRT, Local Security Management Specialist (LSMS) and the Legal Protection Unit (LPU) – have all increased
  • However, while awareness of CRT has increased significantly, awareness of LSMS has increased to a lesser extent
  • Lone worker policies, training and reporting procedures are making staff feel more secure in their place of work  
  • In descending order, CRT, PARS and local violence/security/lone worker policies and procedures are the three initiatives that staff know a lot/a fair amount about

How frontline NHS staff experience violence overall

  • Fewer staff are experiencing verbal abuse and physical assault in the workplace compared to 2004  
  • One in 3 staff say they have been verbally abused or verbally threatened by a patient in the last 12 months, followed by approaching 1 in 5 who say they have been verbally abused or threatened by a member of the public (not a patient)
  • Positively, when compared to the 2004 findings, there has been a significant increase in the proportion who say they have not experienced any types of abuse in the last 12 months, although more have experienced multiple incidents of physical abuse
  • Of those staff who are experiencing abuse, the frequency of verbal abuse experienced remains consistent with the 2004 findings, while the frequency of physical assaults has increased  
  • Among the benchmark staff groups, a notably higher proportion say they have been physically assaulted on 6 to 10 occasions, while significantly fewer say they have been assaulted on 1 occasion
  • Staff are more likely to be adversely affected by incidents of physical (rather than verbal) abuse  
  • The majority of staff – over three in five – say they have not been affected following incidents of verbal abuse or verbal threats of violence. This falls to just fewer than two in five among those staff who have experienced incidents of physical assault
  • Of those who have been affected by verbal abuse or physical assault, around one in four say they have experienced emotional and/or physical distress
  • For those who have experienced physical assault, the second most cited consequence is a short-term physical injury followed by having learned more about personal safety through the NHS

Potential causes, triggers and exacerbating factors 

  • Staff role, demographic characteristics and environmental factors all have an influence on the likelihood that staff will experience a type of abuse  
  • Approaching 4 in 10 (37 per cent) staff say they have experienced verbal abuse or verbal threats in the workplace. However, this is more likely among certain staff groups – particularly those in A&E, security, nursing and complaints roles.  
  • Time of day appears to have an effect on likelihood of abuse occurring, with those staff working both day and night more likely to have experienced verbal abuse compared to those just working during the day
  • Of the 1 in 20 staff who have experienced a physical assault in the workplace, this is most likely to involve staff working in A&E, nursing and security roles, with hospital/inpatient nurses and security staff the two groups that appear to be at particularly high risk
  • Additionally, younger staff aged 16 to 24 and male staff are more likely than average to experience physical assault in the workplace
  • Among those staff who have experienced abuse, the main contributory factors they perceive to be the cause include: 
  • A consequence of the patient’s mental health condition 
  • The person was under the influence of alcohol 
  • The length of time waiting to be seen by a health professional 
  • Problems understanding information or instructions 

Reporting violence 

  • Non-reporting of incidents is an issue for the NHS, with many staff saying that they are used to abuse or abuse is part of their job
  • A significant number of staff are not reporting the incidents of verbal abuse or physical assault that they have experienced (over one in three and one in five respectively)
  • The main reason why staff have not reported all the incidents of verbal abuse in the last 12 months is that they are used to it or consider it part of the job, which indicates that a significant proportion of NHS staff appear to accept verbal abuse as something they are likely to experience in the workplace
  • Additionally, over one in four of non-reporters say they did not report an incident because the situation was resolved or not serious enough 
  • Only a small number of staff are not reporting incidents of physical assault – a reflection of how serious these incidents are generally perceived to be
  • The patient’s clinical condition and sympathy for the patient or their relative are the main reasons for non-reporting. Among those who have not reported an incident, the main reasons are that the incident was a result of the patient’s clinical condition, followed by sympathy for the patient or a relative and the situation was resolved or not serious enough
  • In terms of completing incident reports the majority of staff – over 7 in 10 – say they are very or fairly easy to complete for incidents of verbal abuse and physical assault. Staff tend to be positive about the reporting processes and the action taken to deal with reports for both verbal and physical abuse, but their concern is with reporting outcomes  
  • Two in three agree the NHS takes the appropriate action to deal with reports of physical abuse, while approaching two in three say the NHS takes the appropriate actions to deal with reports of verbal abuse, including threats of physical violence
  • However, significantly fewer staff (less than half) agree that reporting an incident of physical or verbal abuse leads to a satisfactory outcome 
  • Insufficient penalties for the offender and inadequate communication from a manager (one in five for both respectively) are the main reasons cited among staff who disagree that reporting an incident of abuse leads to a satisfactory outcome. ‘Nothing gets done’ is also a top mention

Improving safety 

  • Increased security and a quicker response to incidents are considered to be the priorities for security improvements  
  • It is evident that there is no ‘quick win’ for increasing the perception of safety and security in the workplace among frontline NHS staff, just as there is no immediate solution for tackling the actual levels of verbal abuse and physical assault experienced by staff
  • However, continuous monitoring and improvements to each of the areas covered in this research will no doubt lead to the increased perception among frontline staff groups that they are being effectively supported by their employers in the workplace

Research objectives


The overall aim of this research was to enhance the NHS Security Management Service’s understanding of the ways in which NHS frontline staff experience violence from the public and patients. This is so it is better placed to respond to these challenges with effective and efficient preventive measures. The research captured information about both verbal abuse and verbal threats towards staff, as well as incidents of physical violence.

The specific objectives of this research were to:

  • Provide information about the ways in which NHS frontline staff experience violence from the public and patients
  • Identify causes, triggers and exacerbating factors 
  • Identify effective responses to violence towards NHS frontline staff from members of the public and patients 
  • Assess staff awareness of security policies, procedures and initiatives 
  • Compare the research findings to the baseline survey and identify progress made in establishing a ‘pro-security culture’ 
  • Identify priorities for future work



In 2004, Ipsos MORI carried out a baseline survey to help the NHS Security Management Service understand staff perceptions of workplace safety and incidents of violence, and to allow them to track changes in future surveys.

In 2009 the NHS Security Management Service (SMS) commissioned a follow-up study to assess whether this picture had changed over time. They were keen to measure the progress the service has made over this five-year period in establishing a ‘pro-security culture’.

Quick summary


Research was commissioned to provide a better understanding of the ways in which NHS frontline staff experience violence from the public and patients. A key conclusion was that staff generally feel more secure in the workplace than they did when a similar survey was conducted in 2004. But there is clearly still work to be done, particularly in relation to encouraging staff to report incidents and improving incident outcomes.

Audience Summary








Adults of working age

Social Class






Telephone interviews were conducted among frontline NHS staff groups by Ipsos MORI telephone operations, using CATI (Computer Aided Telephone Interviewing).

Data collection methodology


Sample size



Fieldwork dates


November to December 2009

Agree to publish



Research agency

Ipsos MORI

COI Number