Violence and aggression against NHS staff

If you are assaulted, threatened or abused at work in the NHS, report it through your trust’s incident reporting system as soon as you can, and call the police if a crime has been committed. Your employer has a legal duty to assess and reduce the risk of violence, and assaulting an NHS worker who is providing healthcare is treated as an aggravating factor in sentencing under the Assaults on Emergency Workers (Offences) Act 2018. You should be offered support afterwards, including occupational health and counselling, and time off if you need it.

What counts as violence and aggression

NHS policies use a wide definition. It covers physical assault, and also:

• threats of violence, in person, by phone or online
• verbal abuse, shouting and swearing directed at staff
• racist, sexist, homophobic or other discriminatory abuse
• sexual harassment and sexual assault
• spitting, intimidating behaviour and damage to property

Some aggression comes from patients whose behaviour is caused by illness, such as dementia, delirium, a brain injury or a mental health crisis. That changes how it is managed and whether a crime has been committed, but it still needs reporting. Staff injured by a patient who lacked capacity are just as entitled to support.

How to report

Report every incident through your trust’s incident reporting system, often Datix or a similar tool, even if you were not hurt and even if it feels routine. Include:

• what happened, when and where
• who was involved, including witnesses
• any injury, and any first aid or treatment given
• whether police or security were called

Tell your line manager too. If a crime has been committed, call the police or ask security to do so. You can report to the police yourself without your manager’s permission.

Your employer must also report some incidents to the Health and Safety Executive under RIDDOR, such as assaults that lead to certain injuries or to a worker being off work for a set period. Your trust’s health and safety team handles this.

The law on assaulting NHS staff

The Assaults on Emergency Workers (Offences) Act 2018 covers people providing NHS health services, including doctors, nurses, paramedics, healthcare assistants, porters and reception staff, as well as police, fire and prison staff. It applies whether the worker is paid or unpaid. The Act created a specific offence of assault on an emergency worker with a higher maximum sentence than common assault, and it makes the victim’s status as an emergency worker an aggravating factor for other offences, such as actual bodily harm.

Trusts usually have a security or local security management specialist who can help you work with the police and support a prosecution.

What your employer should do

Your employer has duties under the Health and Safety at Work etc. Act 1974 and the risk assessment regulations to assess the risk of violence and put controls in place. In NHS settings that typically means:

• risk assessments for wards, emergency departments, community visits and reception areas
• alert markers on records for people with a history of violence, shared with staff who need to know
• staffing, layout and alarms planned with the risk in mind
• conflict resolution and, where needed, restraint training
• lone working arrangements for community staff, covered in lone working
• body-worn cameras in some ambulance and hospital settings
• a review after each serious incident to see what should change

NHS England has a violence prevention and reduction standard that trusts are expected to follow, with a board-level lead responsible for it. From 30 October 2026 the Employment Rights Act 2025 also places a duty on employers not to permit harassment of their staff by third parties, which includes patients and visitors.

Support after an incident

Afterwards you should get a check-in from your manager, a chance to talk about what happened and, if you want it, an occupational health or psychological support referral. Most trusts have staff wellbeing services and an employee assistance programme. Our guide to staff wellbeing support in the NHS lists what is commonly on offer.

If you are injured and need time off, your normal NHS sick pay applies. Agenda for Change also has an injury allowance for staff on reduced pay because of an injury or illness wholly or mainly attributable to their NHS work. Ask HR whether it applies.

If you think nothing is being done

If incidents keep happening and nothing changes, raise it through your manager, your union safety rep and your trust’s health and safety committee. You can also speak to a Freedom to Speak Up guardian. A persistent failure to manage risks to staff is a health and safety issue and, in some cases, a whistleblowing matter. See health and safety rights.

The annual NHS Staff Survey asks staff about violence, harassment and abuse from patients, relatives and the public, and trusts publish their results. If you are thinking of moving, it is a useful way to compare trusts.