Introduction

Purpose of the Violence prevention and reduction (VPR) standard

It is a legal requirement under health and safety legislation, that NHS employers must ensure that all staff feel safe, supported and empowered to report incidents of violence and abuse and feel confident that action will be taken to keep them and others safe. This aligns with the NHS People Promise ‘we are safe and healthy’.

This updated edition of the violence prevention and reduction standard supports organisations to take action to prevent and reduce violence and abuse against staff. It achieves this by supporting NHS organisations to assess themselves against a series of evidence-based indicators spanning the following seven domains.

1. leadership and accountability
2. governance and assurance
3. collaboration
4. data
5. workforce
6. interventions
7. evaluation

This assessment can then be used to develop, implement, and evaluate a continual VPR improvement plan.

Update to the standard

The first Violence Prevention Reduction (VPR) Standard was published in December 2020. Since then, the Social Partnership Forum (SPF) and NHS England have worked in partnership to co-design this second edition of the VPR Standard. This has been enabled by extensive evaluation, feedback, and co-design with integrated care system leaders and VPR experts, to ensure that this revised edition of the standard is usable and transferable across as many healthcare organisations as possible. The Social Partnership Forum recommends employers to consult with local trade unions on implementation of this second edition of the standard.

What is work-related violence?

The Health and Safety Executive (HSE) defines work related violence as:

“Any incident in which a person is abused, threatened or assaulted in circumstances relating to their work. This can include verbal abuse or threats as well as physical attacks.” (Violence and aggression at work – guidance for employers)

Impact of violence in the workplace

Violence in the workplace is a significant issue. The HSE states that:

 “Work-related violence can have an impact on both you and your workers, including those who may witness an incident. It can cause injury, stress and mental health conditions, disability or death. There can be physical harm, but serious or persistent verbal abuse or threats can also have a serious effect on a worker’s mental health.”

Over one in four people (25%) completing the 2023 NHS Staff Survey have experienced at least one incident of harassment, bullying or abuse from patients or other members of the public in the past year. Almost one in six (14%) have experienced an incident of physical violence that year.

Furthermore, colleagues from minority ethnic backgrounds and disabled staff are more likely to experience violence at work. The NHS equality, diversity and inclusion improvement plan includes actions organisations should deliver to “create an environment that eliminates the conditions in which bullying, discrimination, harassment and physical violence at work occur”.

Violence and abuse can have a devastating and lasting impact on health and wellbeing. The NHS long term workforce plan and the NHS people promise recognise the negative impact poor health and wellbeing has on staff and on patient care. Yet, creating cultures where colleagues feel safe and supported can lead to higher retention, lower sickness absence rates, enhanced employee experience, and subsequent improvement to patient experience and outcomes. 

Public health, proactive and preventative approach

There is growing recognition that violence is preventable. If we understand what is causing and influencing violence, we can put initiatives in place that tackle and reduce violence at its root cause. Taking this public health and trauma informed approach to preventing and reducing violence against colleagues is supported by evidence and experience, aligning with advice of key organisations such as the Home Office, Health and Safety Executive and the World Health Organization.

This approach focuses on understanding the causes and consequences of violence so we can address the risk factors that increase the likelihood that an individual will experience violence or exhibit violent behaviour. This includes defining and monitoring the issue, identifying why violence occurs, developing and testing approaches, and supporting widespread adoption of effective initiatives.

Legislation and regulations

All employers have a duty of care and legal responsibilities to protect staff from threats and violence at work. The legislative framework covering violence at work is the Health and Safety at Work Act 1974, which places a legal duty on employers to ensure, so far as reasonably practicable, the health, safety and welfare of workers. This includes protecting them from work-related violence. The Act is underpinned by regulations, including:

• Management of Health and Safety at Work Regulations, 1999
• Reporting of Injuries, Diseases and Dangerous Occurrences Regulations, 2013
• Safety Representatives and Safety Committees Regulations, 1977
• Health and Safety (Consultation with Employees) Regulations, 1996
• The Serious Violence Duty within the Police, Crime, Sentencing and Courts Act, 2022

It is the responsibility of individual healthcare organisations, providers and primary care employers to meet their obligations under the Health and Safety at Work Act 1974. If in doubt, organisations should seek legal advice about their responsibilities.

The VPR standard promotes the importance of and consideration around equality and outlines responsibilities under the Public Sector Equality Duty (2011). This includes the needs of diverse groups in order to eliminate discrimination, advance equality of opportunity, access and foster good relations between different groups.

The standard outlines organisations’ duties under the Equality Act 2010. It encourages organisations to analyse local data and identify which members or groups within their workforce have been affected by violence and abuse, including those with protected characteristics, and use this data to inform local policy and equality and health inequalities impact assessments (EHIAs) to prevent and reduce violence and abuse towards staff.

When using the violence prevention and reduction standard to develop effective approaches to violence reduction, organisations are also encouraged to align their activity with the NHS sexual safety charter assurance framework.

Which organisations should implement the standard?

All integrated care boards and providers of NHS-funded services who are operating under the NHS Standard Contract or primary care contracts should implement the standard. Organisations and systems that employ voluntary sector and social care staff alongside NHS staff are encouraged to implement the standard to support and protect all employees. 

Implementing the standard

Summary of implementation steps

When implementing the standard, it is recommended to follow these improvement steps as part of a continuous improvement cycle.

Step 1: Initial benchmarking and assessment

• Conduct an initial assessment against the key indicators of the VPR standard.
• Gather evidence and examples to support the assessment of findings. Use both quantitative and qualitative sources of data to support assessment.
• Use Red, Amber, Green (RAG) rating to categorise each indicator based on assessment.
• Create an improvement action plan based on the areas that require improvement.
• Gain board level (or equivalent senior leadership team) sponsorship of the action plan and have clear governance routes to escalate issues and achievements.

Step 2: Regular reviews and continuous improvement

• Determine ownership and establish timeframes for addressing any identified actions within the action plan as part of a governance framework.
• Establish a continuous improvement process to review progress against the standard.
• Continue to capture qualitative and quantitative data to demonstrate performance against the action plan.
• Schedule regular reviews of progress, ideally twice a year, and keep the board engaged.

Step 3: Promotion of good practice

• Identify areas of good practice within the organisation.
• Share these across partners within your integrated care system and wider networks.
• Encourage sharing of successful interventions, solutions and control measures.

Assessment against the indicators

The standard comprises 43 indicators across seven domains, including:

1. leadership and accountability
2. governance and assurance
3. collaboration
4. data
5. workforce
6. interventions
7. evaluation

Each indicator has a numerical reference to help track progress, and there is space for explanatory notes and considerations to help you to evaluate progress against each indicator. 

This updated version of the standard uses Red, Amber and Green (RAG) ratings to support the measurement of progress against each indicator and understand where further interventions or actions are needed.

It is important to evidence progress against each indicator to justify the rating. If an indicator has been rated as amber or red, improvements should be put in place and documented as part of an improvement action plan.

If an indicator has been marked as green, consideration can also be given for how this might be an example of good practice that can be shared across the NHS.

Using local data to benchmark performance and progress

When assessing and rating each of the indicators, local data can be analysed to identify where colleagues have been affected by violence and abuse, including consideration toward minority groups and protected characteristics. This data can inform an action plan and local policies to prevent and reduce violence and abuse towards staff.  

When looking at local data to understand performance or progress, the following illustrate several examples that can be considered. Ensure compliance with UK GDPR and the Data Protection Act 2018 when collecting and analysing data.

Stakeholder engagement

Engage with internal and external stakeholders to support data collection. Co-designing an action plan with stakeholders and staff to address improvements will also ensure they feel included and supported as part of the improvements identified.

Undertaking a stakeholder mapping exercise will enable you to identify stakeholders who can contribute to the initial and subsequent assessments or reviews of progress against the standard. Stakeholders could include:

• staff within the organisation
• staff networks
• local health and safety committee and/or Social Partnership Forums (SPF)
• elected safety representatives
• chief people officers and health and wellbeing guardians within the organisation and integrate care system
• partners such as local authorities and local statutory Community Safety Partnerships
• violence reduction units (where in place)
• the police
• patient and public engagement functions

Reviewing progress against the standard

An initial benchmarking assessment against the standard should be carried out by a dedicated violence prevention and reduction lead, or, by an individual with responsibility for violence prevention or staff safety as part of their role. They should engage with elected safety representatives and the organisation’s Health and Safety Committee, and work collaboratively with relevant teams to complete it, for example, HR / workforce, health and safety, and risk management. Executive and senior management colleagues (or equivalents) should be engaged from the start with ongoing senior sponsorship.

After the initial benchmarking is completed and action plan put in place, progress should be regularly reviewed, ideally at least twice a year, or as part of any contract reviews, using a continuous improvement process. Also ensure that any green indicators remain green. This will provide assurance at Board, or the appropriate senior leadership governance level. Where any risks or concerns are identified, these should be shared with executives or senior leadership teams to agree next steps, ownership and timeframes for any corresponding actions. 

Good practice should be shared across the integrated care system and wider networks. Interventions, solutions and control measures that work well in one area can often be replicated or adapted in others.

Leadership, accountability and governance

Evidence demonstrates that good leadership is vital to creating and sustaining a positive culture around violence prevention and reduction. Your VPR action plan should set out who is responsible for overseeing violence prevention and reduction, including both senior leaders and operational teams.

Developing a violence prevention and reduction policy and strategy and associated action plan relies on collective leadership, where colleagues at all levels are empowered to act as individuals and as part of teams.

Having an effective governance structure will help you review progress and stay accountable, as well as helping to unblock barriers and identify and mitigate risks. Your action plan and any related VPR policy and strategy should set out governance arrangements for how you will:

• develop and sustain strong working relationships with partners
• ensure that decisions are taken at the right level
• provide clear system-minded reasons for decisions
• establish clear lines of accountability for decisions
• check that decisions and improvements are being delivered.

Board and senior level accountability

Board level leaders (or the equivalent organisational senior leadership team) should take ownership of the outcomes and actions arising from the assessment against the standard. This can be in line with The insightful provider board.

The organisational health and wellbeing guardian or equivalent health and wellbeing senior leader should also take a role in holding the board and senior leaders to account for understanding and taking action to reduce violence against staff, in line with their role in championing the overall staff health and wellbeing agenda.

Using the standard across primary care and smaller healthcare organisations

The refresh of this standard acknowledges the need to support smaller healthcare organisations including primary care to reduce violence in the workplace. Whilst there may not be a formal violence prevention lead, leaders across these organisations are encouraged to explore the standard and how they may use the indicators to create actions that can reduce violence in the workplace appropriate to their local context. To make taking action more manageable, actions and improvements can feed into existing local strategies, plans and policies, rather than creating a formal VPR action plan.

The violence prevention and reduction standard assessment

Download a Word version of the violence prevention and reduction standard assessment. 

Publication reference: PRN00202