Progress on violence against NHS employees is just the starting point

NHS employers need to take action to address high levels of violence, harassment and bullying that are still prevalent in the health service,
the Healthcare Commission has warned.

The government health inspectorate’s annual survey, which questioned 209,000 NHS workers, revealed that only half the staff who had reported being victimised were confident that their employer would take action to ensure attacks did not happen again.

However, the 2005 survey, released last week, showed that levels of violence reported by staff had fallen slightly. More than one in four (26%) staff said they had encountered bullying, harassment or abuse from patients or their relatives, compared to 27% in 2004. Of the respondents, 12% of staff said they had experienced physical violence from patients or their relatives; down from 14% in 2004.

Fewer victims
The proportion of staff who had been victims of abuse from their colleagues also fell from 16% to 15%. This included a very slight drop in the percentage of staff who were physically attacked by colleagues, although the number remained around 1% of cases.

Anna Walker, Healthcare Commission chief executive, said it was encouraging to see the number of reported incidents falling, but that more needed to be done.

“NHS trusts must continue to work hard in addressing this very concerning issue to ensure that this positive start becomes a sustained trend,” she said.

Jim Gee, chief executive of the NHS Security Management Service, which is in charge of promoting staff safety, said he was very pleased with the figures.

“We are also determined to create a pro-security culture within the health service, where more staff report incidents, so that tough action can be taken,” he said.

“Instead of viewing it as just part of the job, NHS staff are now more confident in reporting incidents of violence,” added Gee.

Training plans from health bodies in England show that by the end of March 2006, one in three (250,000) frontline NHS staff will have been trained in conflict resolution. All 750,000 frontline staff are supposed to receive the training by March 2008.

The Healthcare Commission also highlighted fears about the lack of staff receiving an appraisal in the past 12 months.

In the 2005 survey, 60% of staff had an appraisal – down on 2004, but the same proportion as in 2003. The report said this was of particular concern because the number of staff who said their appraisal was well structured fell from 38% in 2004 to 32%.

Steve Barnett, director of NHS Employers, said he expected the proportion of staff receiving a proper appraisal to improve significantly in the year ahead, as annual appraisals were integral to the Agenda for Change pay structure.

Training was highlighted as another problem area by the report, with 79% reporting difficulty in accessing training beyond basic mandatory requirements.

NHS staff in numbers



  • 26% encountered bullying, harassment or abuse from patients or patients’ relatives
  • 15% were victims of abuse from their colleagues
  • 60% of staff had an appraisal
  • 32% said appraisal was well structured
  • 36% suffered from stress related to work
  • 7% experienced some sort of discrimination
  • 52% received training, learning or development in infection control
  • 73% took advantage of flexible working arrangements

Source: The National Survey of NHS Staff 2005, the Healthcare Commission


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