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Security and Violence Risk for Healthcare Workers in High-Risk Settings

Security Intelligence

Security and Violence Risk for Healthcare Workers in High-Risk Settings

72,000+ physical assaults on NHS staff in 2022/23. Community nurses, A&E clinicians, and GP practices face specific violence risks requiring lone worker protocols and site security measures.

7 min 7 May 2026

Written by James Whitfield — Senior Security Consultant

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Violence against healthcare workers is one of the most prevalent occupational hazards in the UK, affecting community nurses, A&E staff, GP practice teams, and mental health outreach workers at a rate and volume that most other industries would regard as an immediate operational crisis. Within the NHS, it is managed as a persistent background condition.

James Whitfield, Senior Security Consultant, works with NHS Trusts, primary care networks, and private healthcare organisations on security risk management for healthcare settings. The consistent finding is that the physical security of NHS facilities and the lone worker safety management of community healthcare teams are under-resourced relative to the documented incident rate – and that the gap between policy commitment and operational implementation is wide.

The incident profile

NHS England’s 2022/23 data records approximately 72,000 physical assaults on NHS staff in England in a 12-month period. The NHS Staff Survey 2024 indicates that approximately 15% of NHS staff reported experiencing physical violence from patients, relatives, or the public in the preceding 12 months. This places healthcare alongside education and social care among the highest-assault-rate occupational sectors in the UK.

The Assaults on Emergency Workers (Offences) Act 2018 created a specific aggravated offence for assaults on emergency workers, including NHS staff, with an enhanced sentencing framework. In practice, prosecution rates for these assaults remain low relative to incident volumes – both because staff under-report incidents and because police and prosecution resources are not consistently applied to what is a high-volume, low-visibility category of offence.

The highest-frequency environment is the A&E department, followed by acute inpatient wards (particularly psychiatric and alcohol/substance misuse wards) and community mental health outreach settings. GP surgeries, while lower-frequency, host patients with documented threatening behaviour histories and have limited physical security infrastructure.

A&E department security

The combination of extended waiting times, acute patient presentations, and the physical openness of a typical A&E waiting area creates the conditions for a high incidence of violent incidents. Alcohol and substance-related presentations – concentrated during evenings and weekends – are systematically correlated with assault risk.

A number of NHS Trusts have introduced SIA Door Supervisor-licensed staff at A&E entrances. This model was adopted in Scotland earlier than in England and has been evaluated in several individual Trust programmes. The Door Supervisor presence provides a visible deterrent, a first-contact de-escalation resource, and a managed access point without the clinical staff needing to manage confrontation at the entrance.

The baseline physical security requirements for A&E departments include: monitored CCTV with coverage of all waiting areas and corridors; panic alarms within reach of all clinical staff at reception and triage points; a clear duress alarm protocol with a defined response (security attendance within defined seconds from alarm); access control between the waiting area and the clinical treatment area; and a police direct-line contact for acute incidents where arrest is warranted.

Community lone worker safety

Community nurses, mental health outreach workers, and community mental health team (CMHT) staff conduct home visits to patients with a range of presentations, some of whom have documented histories of violence or current risk indicators. The Suzy Lamplugh Trust’s National Lone Worker Safety Survey consistently identifies healthcare as one of the sectors with the highest percentage of lone workers who have experienced threatening or violent incidents in a 12-month period.

The NHSCFA and NHS Security Management guidance requires NHS organisations to implement a lone worker safety programme for community staff. In practice, the components of an effective programme are: access to a patient violence risk flag before a visit is booked (so that a community nurse knows before travelling to an address that the patient has a documented history of threatening behaviour, and can take appropriate precautions or decline the solo visit); a structured check-in protocol with a team base or control function; a lone worker device or application with monitored escalation; and a clear escalation path when a situation develops.

The lone worker device is the lowest-cost and most consistently underused element. The NHS has procured lone worker solutions including SafeZone, Peoplesafe, and StaySafe across various Trusts. The gap is typically not in procurement but in use: staff do not consistently activate monitoring before a visit, the check-in protocol is not consistently followed, and the organisational culture has not made lone worker safety management a standard professional practice rather than an optional administrative step.

GP surgery security

GP surgeries are not low-risk environments. They serve populations that include patients with significant mental health comorbidities, substance dependence, and – in some urban areas – connections to criminal networks. A GP surgery in a high-demand urban catchment sees hundreds of patients per week across a team of clinical and administrative staff.

The site-specific risk assessment for a GP surgery should include: the incident history of the specific practice over the preceding three years; the characteristics of the patient population; the physical layout of the premises (is there a clear separation between the waiting area and the clinical consultation rooms; are there uncontrolled access points to the staff area); and the availability and tested functionality of panic alarms.

CCTV is a basic requirement in any high-footfall healthcare premises. Access control – a door lock between the waiting area and the clinical corridor, operated by reception staff – is the most effective single physical security measure for managing patient intrusion into staff areas.

For the lone worker safety framework applicable to community healthcare workers, the Suzy Lamplugh Trust national guidance and the NHSCFA Security Management Framework provide the organisational baseline. For the broader lone worker security context across high-risk urban settings, see our lone worker security in high-risk cities guide. For the physical security standards applicable to private hospitals and private medical clinics where higher-risk patients may be seen, see our security for private hospitals and clinics guide.

Sources:

NHS England: NHS Staff Survey 2024. March 2025. NHS Counter Fraud Authority (NHSCFA): Security Management Standards for NHS Bodies. 2024. Assaults on Emergency Workers (Offences) Act 2018. HMSO. Health and Safety at Work Act 1974, Section 2. HMSO. NHS Code of Practice for the Security Management of NHS-Funded Care. 2003 (updated 2024). Suzy Lamplugh Trust: National Lone Worker Safety Survey 2024. NHS Protect: Violence Against NHS Staff – Policy and Guidance. 2024. Management of Health and Safety at Work Regulations 1999. HMSO. NHSCFA: Incident Reporting Culture in NHS Security Management. 2024. WHO/ILO: Global Programme on Occupational Health for Health Workers. 2024.

James Whitfield is a Senior Security Consultant with experience in public venue security, lone worker safety management, and security programme design for healthcare and public sector organisations.

Summary

Key takeaways

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72,000+ physical assaults on NHS staff per year represents a systemic occupational hazard, not exceptional incidents

The volume of physical assaults on NHS staff in England is among the highest of any occupational group. This is a systemic risk that requires a systemic security response -- not individual staff resilience, but organisational risk assessment, site security measures, and incident reporting infrastructure.

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Community healthcare lone workers require a structured safety management system, not just a mobile phone

A check-in protocol, access to patient violence risk flags before visits, a lone worker device with monitored escalation, and a defined response path for elevated-risk situations are all required elements of a community lone worker safety programme. A personal mobile phone without these supporting systems is not sufficient.

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The Assaults on Emergency Workers Act 2018 aggravated offence is inconsistently applied

The Act doubled the maximum sentence for assaults on emergency workers including NHS staff. In practice, the sentencing enhancement is applied inconsistently and prosecution rates remain low. The Act is a symbolic and practical tool, but its protective effect depends on enforcement quality.

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Under-reporting of violence against healthcare staff systematically understates the risk

Healthcare staff under-report violence incidents for multiple documented reasons. Risk assessments based on reported incidents underestimate the actual frequency and severity distribution. Improving incident reporting culture -- through simpler reporting processes, visible follow-up action, and leadership commitment -- is a precondition for accurate risk assessment.

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GP surgery security requires a site-specific risk assessment and physical security measures

GP surgeries are not low-risk environments. They host patients with a wide range of presentations, including those with documented histories of threatening behaviour. A site-specific risk assessment, access-controlled clinical areas, panic alarms linked to a monitored response, and CCTV are proportionate measures for any GP surgery in a high-demand urban area.

FAQ

Frequently Asked Questions

NHS England’s annual NHS Staff Survey and the NHS Security Management Service (NHS SMS) data record physical assaults and non-physical incidents against NHS staff. The 2022/23 NHS People Plan data recorded approximately 72,000 physical assaults on NHS staff in England in the 12-month period. This figure includes assaults in A&E departments (the highest-frequency environment), inpatient wards, and community settings. The NHS Staff Survey 2024 records that approximately 15% of NHS staff reported experiencing physical violence from patients, relatives, or members of the public in the previous 12 months – a figure that has been relatively stable over the preceding five years, indicating that the absolute volume has grown with the NHS workforce but the rate has not significantly declined. The NHS Counter Fraud Authority (NHSCFA) is responsible for security management policy across NHS-funded care.

Healthcare workers are protected by the general framework of the Health and Safety at Work Act 1974 (Section 2, employer duty to provide a safe working environment) and the Management of Health and Safety at Work Regulations 1999 (risk assessment obligation). There is no specific healthcare violence regulation, but the NHS Code of Practice for the Security Management of NHS-funded care, issued by the Secretary of State under the NHS Reform and Health Care Professions Act 2002, establishes specific obligations for NHS bodies. The Assaults on Emergency Workers (Offences) Act 2018 created a specific aggravated offence for assaults on emergency workers, including NHS staff, with an enhanced sentencing framework – typically doubling the maximum sentence for the underlying assault offence. In practice, however, the sentencing enhancement is applied inconsistently, and prosecution rates for assaults on healthcare staff remain low relative to the volume of incidents. The Protection from Harassment Act 1997 applies where patterns of threatening behaviour are directed at a specific healthcare worker over time.

Community nurses, mental health outreach workers, and social care professionals who conduct home visits face a lone worker risk profile that is structurally similar to that of lone workers in other high-risk sectors: they are geographically dispersed, they visit addresses where they have limited ability to control the environment, and they have limited immediate support capability if a situation deteriorates. The specific additional risk in healthcare is that the clinical context may involve patients with documented histories of violence, substance dependence, or acute mental health presentations that elevate the assault risk beyond a general lone worker scenario. The risk assessment and management steps for community healthcare lone workers include: patient violence risk flagging in the clinical records system and a defined access to that flag before visits are scheduled; a structured check-in protocol with the team base; a lone worker device or application (SafeZone, Peoplesafe, StaySafe, or NHS-procured equivalents) with escalation capability; a defined escalation path to the community mental health team or police if a patient presents with elevated risk indicators; and a post-incident reporting protocol that records incidents in a way that feeds into the organisational risk assessment.

A&E departments are the highest-frequency environment for violence against NHS staff. The combination of long waits, acute distress, alcohol and substance presentations, and the physical layout of a typical A&E (large, open waiting area with frequent patient and visitor movement) creates a high-risk environment. Some NHS Trusts have deployed SIA Door Supervisor-licensed staff at A&E entrances as a deterrent and management presence. The legal basis for this is the Private Security Industry Act 2001 (which requires SIA licensing for Door Supervisors in licensed premises) and the NHS Trust’s powers to manage access to its facilities. SIA Door Supervisors at an NHS A&E are not employed as security officers under the NHS Security Management framework but as contracted or in-house licensed staff managed by the Trust’s security or facilities function. The effectiveness of this approach in reducing violence is documented in individual NHS Trust evaluation reports; no national dataset exists across all Trusts that have deployed this model. In addition to door supervision, fixed CCTV with monitored coverage of waiting areas, regular security patrols by NHS security staff, and a clear process for de-escalation and police call in acute incidents are the standard complement.

The NHS Zero Tolerance policy on violence and aggression was introduced in 1999 and updated periodically since. Under the policy, NHS organisations must: investigate all incidents of violence and aggression; support staff in pursuing a prosecution where there is sufficient evidence; consider whether to notify the police of all physical assaults regardless of severity; and provide support and follow-up to staff who have been assaulted. In practice, the consistent application of the Zero Tolerance policy across NHS trusts has been uneven. Staff often do not report incidents because they believe the response will be inadequate, because they are concerned about the patient relationship, or because the reporting process is administratively burdensome. Under-reporting means that organisational risk assessments based on reported incidents are systematically underestimates of the actual incident rate. The NHSCFA has issued guidance on improving incident reporting culture as a prerequisite for effective security risk management.
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