Violence prevention and reduction

The Violence Prevention and Reduction Programme aims to support NHS organisations and systems to embed a culture where our NHS colleagues feel supported, safe and secure at work.

The NHS Long Term Plan, NHS People Plan and NHS People Promise demonstrate a commitment to support the health and wellbeing of NHS colleagues, recognising the negative impact that poor staff health and wellbeing can have on patient care. More recently, the NHS EDI improvement plan further demonstrates our commitment to supporting the NHS workforce.

Violence and abuse toward NHS colleagues is one of the many factors that can have a devastating and lasting impact on health and wellbeing.

The 2024 NHS Staff Survey outlined that:

  • 14.38% of NHS staff who completed the survey have experienced at least one incident of physical violence from patients, service users, relatives or other members of the public in the last 12 months. This is a 0.5% increase from the 2023 results (13.88%)
  • 0.78% of NHS staff who completed the survey have experienced at least one incident of physical violence from managers in the last 12 months. This is an 0.6% increase from the 2023 results (0.72%)
  • 1.89% of NHS staff who completed the survey have experienced at least one incident of physical violence from other colleagues in the last 12 months. This is a 0.16% increase from the 2023 results (1.73%)
  • 25.08% of NHS staff who completed the survey experienced at least one incident of harassment, bullying or abuse in the last 12 months from patients/service users, their relatives or other members of the public which is lower than the previous years. This is a 0.26% decrease from the 2023 results (25.34%)

“The vast majority of patients and the public show nothing but respect and thanks for the skilled care they receive, but the unacceptable actions of a small minority have a massive impact on the professional and personal lives of our  colleagues.”

Amanda Pritchard, NHS England Chief Executive (February 2022)

Updated NHS violence prevention and reduction standard

The NHS violence prevention and reduction (VPR) standard has been updated, and developed in partnership with the Social Partnership Forum, integrated care systems and NHS organisations who were early adopters of the standard.

It complements existing health and safety legislation and supports NHS organisations to address violence against NHS staff. It delivers a risk-based framework that supports a safe and secure working environment for NHS staff, safeguarding them against violence and abuse. It now includes a new red, amber, green (RAG) rating that helps organisations identify areas to action and measures progress over time.

Use of the VPR standard will be a key step for organisations to evidence their commitment to reducing violence and abuse against our workforce, supporting their health and wellbeing in line with the ‘we are safe and healthy’ element of the NHS People Promise, reducing absenteeism and ultimately improving staff experience, retention and patient care.

The expectation is that all organisations will use the new standard which has been designed and developed to seamlessly transfer any existing workplans that used the 2021 version of the standard by your next work plan review.

Using the NHS VPR standard in primary care

We encourage using the VPR standard as a framework – the new high level assessment and improvement action plan has been created to support this. Elements of the standard can be incorporated into pre-existing strategies and policies, including mitigating the risk of violence, incident reporting and post-incident support offers.

Within all 4 sectors of primary care, it is acknowledged that the structure is very different from secondary care and the way in which it is able to introduce and embed the VPR standard may be different from the way in which other parts of the NHS use the VPR standard.

Understanding the impact of violence on our workforce

NHS England is working in collaboration with a number of key partners and organisations to better understand the nature, extent and impact of work-based violence, harassment and abuse to NHS staff across all healthcare settings, as well as identifying examples of good practice that can inform future interventions.

In 2022/23 we commissioned Liverpool John Moores University (LJMU) to examine work-based violence, harassment and abuse towards NHS staff in England and the costs associated.

Colleagues can access the following resources by visiting the links below: (all resources via the LJMU website unless otherwise stated)

We encourage strategic leaders across the NHS to refer to these resources to help inform their approaches and activity towards the violence prevention and reduction agenda, in line with the refreshed VPR Standard.

Supporting the education and training of NHS staff

NHS England expects all parts of the NHS to commit to preventing and reducing the risk of violence towards staff and support health and wellbeing in line with the ‘We are safe and healthy’ NHS People Promise.

This in turn will improve staff experience, retention, and ultimately patient care. NHS England is committed to supporting colleagues in violence prevention, security management roles and those who work in ‘at risk’ environments, to feel upskilled and able to do their job to the best of their abilities.

NHS England in collaboration with the Royal Society for Public Health (RSPH) have developed an eLearning course, titled ‘An Introduction to Violence Prevention and Reduction’.

This course is for staff working in health and care settings who have a role in reducing and preventing violence against our staff, or for those who are working in ‘at risk’ environments.

It was developed based on an identified training need for staff and was piloted with staff across England who found the course “enjoyable” and “useful” and 88% of whom would recommend it to a colleague or friend.

Over 1 hour, trainees will:

  • identify the key policy and legislative drivers for violence prevention and reduction in healthcare settings
  • understand and describe the individual, situational and environmental factors that can cause violence
  • describe how using public health and trauma informed approaches can prevent violence at individual and community level
  • explore a range of best practice approaches that can be used by individuals, teams, and organisations to minimise the risk or impact of violence

The course is free and open to all NHS and social care staff either using their work email address or personal email address via the NHS Learning Hub. Trainees can download a certificate at the end too.

In addition to this, an accredited educational pathway has been developed and made available, consisting of several qualifications ranging from Level 3 to Level 7.

This education pathway focuses on the public health approach of understanding the root causes of violence and abuse, before then taking appropriate steps to prevent and reduce violence against our staff.

The pathway supports attendees to move away from a zero tolerance approach and consider why incidents are occurring, for example due to individual-specific factors (such as trauma and distress) and structural, environmental, and societal factors (such as the impact of health inequalities).

The pathway has been developed and delivered by two key educational partners:

  • The Royal Society for Public Health – delivering the Level 3 and Level 4 training
  • Liverpool John Moore’s University – delivering the Level 7 training

A limited number of places were funded across 2023-2025 by NHS England for colleagues who are based in roles considered to be exposed to a high level of risk to violence and abuse. These include, but are not limited to, areas such as:

  • acute care
  • specialist secondary care
  • mental health
  • ambulance trusts

If you would like to find out more about RSPH’s educational pathway, you can visit RSPH | Violence Prevention and Reduction (VPR) Education Pathway or contact VPRPathway@rsph.org.uk.
If you’d like to find out more about LJMU’s Level 7 course, please visit CPD Violence Prevention, Reduction and Public Health | CPD course | Liverpool John Moores University or contact courses@ljmu.ac.uk.

Working with the ambulance sector

Piloting bodyworn cameras in ambulance trusts

NHS England has provided £8.4 million to all 11 ambulance services for the procurement and evaluation of a three-year body worn camera trial. Alongside this dedicated funding, an independent partner has completed an evaluation of the rollout.

This will help determine if body worn cameras can help to reduce violence against NHS ambulance staff and provide learning for other sectors around the implementation and operation of these cameras in NHS services.

Violence prevention and reduction hub

NHS England has commissioned the Association of Ambulance Chief Executives (AACE) to deliver a new Violence Prevention and Reduction Hub, specifically designed for NHS ambulance services.

Initially funded for 2 years until May 2024, and extended to March 2025, work on a series of workstreams to support the ambulance sector’s efforts to improve staff safety is underway. These include:

  • Data and information: Share best practice, expertise, and information about all aspects of violence prevention and reduction across the ambulance sector.
  • Education: Promote new and innovative ways to extend skills and knowledge across the sector to help combat the challenges of violence and abuse.
  • Collaboration: Facilitate a culture of collaborative working through several key workstreams assisting and supporting the ambulance sector, providing a consistent process when managing violence and aggression.

To learn more about this work on the Association of Ambulance Chief Executives website.

Work without fear – communications campaign

#WorkWithoutFear has been developed in collaboration with the Association of Ambulance Chief Executives (AACE), as a national communications campaign in response to the rising levels of verbal and physical violence against NHS ambulance personnel working in emergency operations centres (EOC) and on the frontline when caring for patients.

The key objective is to portray ordinary people doing an extraordinary job and highlight the profound impact that violence and abuse can have on the everyday lives of ambulance staff and encourage the minority to have respect for the people who are trying to help them, their friends, and families when they need it most.

Launched in February 2022, phase 2 began in July 2024, featuring assets which have been developed using real-life stories from staff in NHS ambulance trusts in England.

“It is horrific that in just one year, thousands of our hardworking ambulance staff have experienced unacceptable violence and abuse at work.

“Ambulance staff are already under huge pressure delivering urgent care to patients and they have a right to feel safe when they come to work.

“We know there is more to be done right across the NHS to ensure staff are protected and Work Without Fear is an important campaign which will highlight the horrendous impact this is having on the ambulance workforce and hopefully help towards preventing such violence from happening.”

Amanda Pritchard, NHS England Chief Executive

To find out more, hear real life stories from ambulance colleagues and how you can support the campaign, visit the Association of Ambulance Chief Executives website.

Further resources and useful links