Prof Nicola Ranger, the general secretary of the Royal College of Nursing (RCN), is right to describe the rising level of violence directed at NHS staff in England as an emergency. Freedom of information requests by the Guardian have uncovered a sharp increase in the number of reported attacks in hospitals, with an average of 285 each day in 2024-25. Some of the details shared with our reporters were horrifying. One A&E nurse said that she sees weapons brandished on a monthly basis, and described two incidents in which male patients deliberately ejaculated on nurses while waiting for treatment. A consultant – now retired – said that he had been violently assaulted twice within a period of weeks.
The increase in racist incidents is also gravely concerning. Because the UK’s health workforce is so diverse, and interacts constantly with the public, its members are highly exposed to rising anti-migrant sentiment. In November the health secretary, Wes Streeting, expressed shock at the impact on the NHS of resurgent “1970s-, 1980s-style racism”.
But deeds as well as words will be needed if a disturbing pattern of aggression against frontline workers – which is also affecting teachers and others – is to be turned back. Existing duties on employers to prevent sexual harassment, including by their own staff, are being strengthened in the Employment Rights Act. But tackling abuse and violence in healthcare is a difficult task, with managers facing tough decisions about whether to treat people who threaten or insult. Such incidents harm institutions as well as individuals. Whole departments face consequences when victims need time off to recover, or when a ward is closed to provide a secure environment for a violent patient.
Last year patient satisfaction fell to a record low, with 59% of people questioned describing themselves as dissatisfied. But while frustration at an overstretched health system may be understandable, and some allowances can be made for patients who are mentally unwell, the current levels of hostility and violence are a disgrace. A workforce that becomes inured to such behaviour is likely to experience falling morale and provide a worse overall service. Already there is alarming evidence of recruitment being affected. Between April and September last year there was a sharp drop in the number of nurses and midwives from abroad joining UK registers, compared with the year before. There are also growing fears that the NHS sexual safety charter, which was supposed to improve recording of sexual misconduct, is not being followed.
Even if it were possible, a return to old‑fashioned deference towards doctors and other senior professionals would not be desirable. Rigid hierarchies and dynamics whereby members of the public and junior workers are infantilised and dominated cause terrible problems, with profound costs for patients. But a situation in which people feel entitled to abuse service providers, or bully their way to the front of A&E queues, is also highly damaging.
While the NHS is a particularly challenging setting in which to confront such behaviour, these problems are not unique to the health service. Reduced trust in institutions and heightened suspicion of experts are widely observed societal trends that many public-facing organisations are grappling with. Mr Streeting must empower staff to uphold standards and boundaries. Police also have a role in ensuring that violent offenders are dealt with. The social contract of which the NHS is such a powerful symbol is stretched and frayed, but it can be mended.
