'We have the right to care safely' UHDB launches new warning system to prevent and take action on intentional abuse towards NHS staff
''All I ever wanted was to be a nurse and care for and look after people… Now I feel I have to be on my guard all the time at work, I feel I need to have eyes and ears everywhere because the presence and threat of violence is with all staff, at every single shift.'' - Megan, Senior Sister, Emergency Department (ED).
Abuse towards NHS staff is rising nationally and at UHDB, the NHS staff survey highlighted that one in four people have experienced physical violence from patients, relatives or members of the public while at work. Last year (2024-2025), more than 2,600 incidents of violent and aggressive behaviour were reported by our staff.
This is unacceptable, NHS staff have the right to work with dignity, respect and safety without the fear of abuse while providing essential patient care and services. Violence and aggression can be bullying, harassment, physical violence, racial, sexual, physical or verbal abuse.
We are taking action to protect our staff from intentional violent and aggressive incidents because we have the right to care safely.
Our staff have the right to care safety so we have put in place a new sanctions standard, which is a set of safety measures that clearly details the action we will take against individuals who intentionally abuse our staff, which can include a written warning or in severe cases, excluding people from Trust premises and withholding non-emergency treatment.
Megan shared the impact that increasing violence in the workplace has had on her and her colleagues, "This doesn't just affect one staff member, it affects the whole entire team, it affects everyone on shift that day and in the days after, it affects patients and visitors around them who see and overhear violence and aggression towards staff."
A wide range of Trust internal and external groups have contributed to the new approach to ensure it is fair, proportionate and reasonable and does not impact patient safety and essential care.
The sanctions are also only in place for intentional violence and aggression, and the warning system does not apply to vulnerable people in our care.
We know there are vulnerable patients in our care who do not mean us harm and have complex health challenges that can result in aggressive behaviour they are not at fault for. The new sanctions standard will not impact these patients and are aimed at stopping those who intentionally abuse our staff.
Tina, Senior Sister from Anna Ward at Samuel Johnson Community Hospital said, "We understand that there are patients who have no capacity or insight into their behaviour, and we support these patients in a different way, to understand their needs and deescalate any violent behaviour.
"I still encourage my staff to seek support in these instances, so we can debrief after any incidents, signposting colleagues to the correct areas for physical and mental wellbeing support if they feel they would benefit from that."
What are the new sanctions standards?
The standards are guidelines that set out how UHDB will manage incidents of abuse towards staff, balancing this with our priority to deliver care to our communities. The sanctions include an escalation process that investigation teams can use to manage and respond to extreme behaviour incidents and includes and a yellow and red card warning system:
- Informal verbal warning - A verbal conversation will happen to inform individuals they have breached the unacceptable behaviour criteria.
- Formal verbal warning - A recorded verbal warning will be raised on our incident system and alert will be placed on the patient's care records.
- Yellow card: written warning - The warning system will be triggered where a formal written warning will be sent to the patient and their GP which will be recorded on our incident system and an alert placed on patient care records. The investigating team will also have a discussion with various stakeholders to review the incidents, learnings and appropriate action
- Red card: right to withhold care - If a patient continues to exhibit violent and abusive behaviour, a Trust panel will consider all incidents, manage and assess risk to staff and patients, and assess whether the behaviour should result in excluding the patient from the premises and withholding non-emergency treatment. A letter will also be sent to the patient and GP.
John Frazer, Head of Health and Safety, said "Working in nursing, medicine or in allied health professional roles, is often cited as a 'calling' rather than a job, and we totally understand the passion that working for an organisation such as the NHS can inspire in people. At UHDB, we fundamentally believe everyone has 'the right to care safely' however that should not come at the cost of the health, safety and wellbeing of our staff.
The Violence and Prevention Reduction Lead and our key stakeholders have worked to bring in new support measures at UHDB to ensure that in the few extreme cases of V&A, our staff are protected, they have clear pathways of support and those that continue to act violently will be managed with using a clear set of sanctions so they understand that unacceptable behaviours whatever form they manifest as, will be dealt with."
John continued, "Our hope is that we never have to use these sanctions, or at best we use them sparingly but if required, we will offer the unequivocal support to our staff in the face of any unacceptable behaviours to enable them to have the right to care safely and work in a safe working environment whatever their function at UHDB."
Empowering our colleagues on knowing what to do when an incident happens is crucial to making sure they get access to the right support. The Trust has a robust reporting system called DARSE which stands for Detect, Act, Report, Support and Evaluate, providing colleagues with the clear steps to follow to support themselves or fellow colleagues after physical or verbal incidents take place.
We have the right to care safely communication campaign
Our new warning system has been launched along with a new communication campaign called 'We have the right to care safely' which is live in our 'hot spot' areas for violent and aggressive incidents, raising awareness about the impact of this on staff and UHDB's clear stance that we will take action to protect staff.
