A Guardian call-out to NHS staff in England to share their experiences of violence in hospitals has revealed that doctors, nurses, paramedics and managers are being overwhelmed by a torrent of physical assaults and sexual abuse by patients.
Most respondents said they had little faith in the NHS to tackle the scale and severity of this abuse, which included being attacked with weapons, including knives and chairs. Many staff felt there was no point in reporting physical or sexual harm because perpetrators faced no real comeback from the NHS or the police.
Chloe, 29, a resident doctor in an acute medical unit at a London hospital, said she had frequently dealt with abuse and threats since completing her training just over a year ago. “Patients have told me to fuck off, and that they’ll ‘sue the shit out of me’,” she said. Male patients have also sexually harassed her during intimate treatments, she added. “I’ve had lots of men implying that I enjoy it or that I want to have a look [at their genitals]. One guy who grabbed my arm as I was putting the catheter in kept telling me ‘Oh, you’re so beautiful’. It was very uncomfortable.”
Chloe said she often felt unable to remove herself from hostile situations because of staff shortages and concerns about leaving other patients at risk of harm. On one night shift, when she was the only doctor for 40-50 patients, she said a female patient stormed into a staff room and threatened her. “She was screaming ‘why haven’t you fucking come to see me? You should kill yourself’ I had to move a chair between us. Luckily, a nurse came and distracted her and she stormed back to her room. I’ve been lucky not to be physically assaulted but it’s so common. Two colleagues were severely assaulted by patients just outside the emergency department the other day.”
Emily, a charge nurse from England, said A&E staff faced daily violence and sexual harm from patients and their relatives. “Nurses have been spat at, pushed, and punched,” she added, saying colleagues had left the NHS or gone on prolonged sick leave after suffering injuries and trauma. She said a particularly worrying development since the pandemic was the increasing number of younger patients, aged 14 to 25, bringing knives and other weapons into her hospital: “This happens once a month. That is utterly terrifying when you’ve got a very overcrowded A&E department. Someone could do catastrophic harm in a matter of minutes.”
Like Chloe, Emily said sexual harassment by patients was common. She recounted two separate incidents in her emergency department where men, seemingly waiting for treatment, deliberately ejaculated on nurses. Neither man had mental health or medical issues that might mitigate their behaviour, she added.
Although the two men were prosecuted, Emily said there were usually no consequences for abusive patients. Her trust issues warnings and treatment bans but, in practice, there is “nothing to stop them coming back a few hours later or booking into A&E under an alias”. Together with the sheer volume of abuse and rising demand for treatment, this means staff report only a small minority of abusive incidents. “When you’re managing too many patients, you are only going to report the tip of the iceberg,” added Emily.
John, a risk manager in a large northern teaching hospital, said dealing with the rise in patient hostility was hampered by staff shortages, budget cuts and police inaction. “People have found that you can act in a threatening way to get what you want and there won’t be any comeback,” he said, adding that at least two staff a week were treated in A&E after attacks by patients.
“Fifteen years ago, it wouldn’t have been appropriate to stand in A&E swearing and hitting people,” he said, noting that many perpetrators were mentally well patients aggressively demanding treatment. “If you did, you’d be arrested and you wouldn’t get care. Whereas now the police aren’t coming, you’re not going to be arrested, and you actually get care faster, so staff can get you out of the department. We took down the poster saying there was zero tolerance to violence and aggression. The argument was that we can’t say that because there isn’t. No one’s getting prosecuted.”
He and several other staff highlighted the challenges caused by admitting mentally unwell teenagers who were waiting for specialist psychiatric treatment. “We have a child patient and they are assaulting every staff member that comes near them,” said John. “Last week, three of our nurses were in A&E. One had been strangled, one had been hit in the face with a table. The other one had been punched and had their eyes gouged. It’s horrific, the level of violence. But the police won’t touch it because patients are medically unwell, so they won’t have them in the cells. They’ll just bring them back to A&E.”
Other staff said a lack of beds for mentally ill adults and people with dementia contributed to the increase in violent incidents. George, 59, a former consultant at a teaching hospital in northern England, said he experienced two potentially life altering assaults in the months before he retired two years ago. Both incidents involved mentally ill adults who were being treated on medical wards because no specialist care beds were free. “The first was a patient who managed to obtain a knife from the staff kitchen,” he said. “He told a male nurse that he was going to kill me, and attempted to attack me but the nurse disarmed him.”
Weeks later, another patient, who was on a medical ward despite being known to be psychotic, attacked him from behind and punched him in the head. “He wrestled me to the floor and kicked me,” said the former doctor. “He had already assaulted three or four nurses before that happened. He was a danger to everybody, including the other patients. It was only after this incident that he was sectioned under the Mental Health Act.”
Adam, a paramedic from the south-west of England, agreed that the difficulty of accessing mental health services was a major factor behind a huge increase in violence and aggression toward ambulance crews since the pandemic. Although he and his colleagues were now equipped with bodyworn cameras, this did not deter attacks, he added. “I’ve been grabbed, I’ve been strangled,” he said. “I’ve had knives pulled on me in the back of ambulances.”
His ambulance service regularly has to deal with aggressive patients who ring 999 whenever they are in crisis. “Some of these people are phoning 100-200 times within a six-month period,” he said, adding that these patients had warning markers in their medical records but police often refused to deal with them because their mental health problems were deemed to be an ambulance matter. “That’s exposing staff to an increased level of violence and aggression, as having the police there is generally a deterrent,” he said.
Adam said that even when the police did respond to reports of assault, they often did not take action because it was not in the public interest to prosecute vulnerable patients. “They’ve basically been let off,” he said. “Even though they’ve assaulted us and damaged equipment on the ambulance.”
