One in seven NHS staff (14.38%) experienced physical violence from a patient, relative or member of the public in 2024, according to the 2024 NHS Staff Survey. That figure is up from 13.88% the year prior, the highest rate since the pandemic years, and it comes from the largest response in twenty-years, with over 744,000 staff taking part. The usual response is to call for more training. The real question isn’t how much training staff get, it’s where in the escalation cycle that training is aimed – most of it lands at the point of crisis, long after the moment to prevent one has passed.
Where the numbers point
A&E is the clearest case. Freedom of Information requests sent by the Royal College of Nursing to 89 trusts found 4,054 recorded incidents of physical violence against emergency department staff in 2024, compared with 2,093 in 2019 – nearly double in five years. Over the same period, waits of more than 12 hours in A&E rose more than twenty-fold. The RCN named lengthy waits, corridor care and chronic understaffing as the primary drivers.
Ambulance services show the same pattern from a different angle. Nuffield Trust analysis found that 31% of ambulance staff experienced at least one violent incident in 2024. The Association of Ambulance Chief Executives names alcohol, drugs and mental health crisis as the leading triggers.
No training provider can shorten an A&E wait or resource an ambulance shift, and no programme is ever going to fix that. What training can actually affect is how early the moment of intervention happens, and what’s in place for the staff member once it’s over.
The distinction that actually matters
Most conflict-resolution training is built around the moment an incident is already happening – a fixed set of phrases and physical positions to deploy once someone is escalated. That kind of training has a ceiling, because by the time it’s needed, the environment has already played its part: the four-hour wait, the packed corridor, the crisis nobody flagged early. Reactivity can only ever manage what’s already in motion.
The stronger model – the one behind BILD ACT and RRN-aligned training – treats prevention as a sequence. It trains staff to recognise the early signs specific to their own setting, before a situation reaches the point where de-escalation phrases are the only tool left; it builds understanding of how a particular environment produces these points of tension, so teams can spot the pattern coming rather than just responding to it.
Under-reported violence is common in the NHS partly because staff come to see it as normal – part of the job, not worth logging. Training that only ever arms someone for the moment of crisis does nothing to change that culture. Training that starts earlier, and follows through afterwards, does.
Getting the timing right
Timian delivers BILD ACT certified positive behaviour management training to education, health and social care organisations. If your organisation wants to talk about how your teams are trained to recognise risk early and support staff after an incident, speak to our team about how we can help.
