As the latest stats show a three-year high in attacks on NHS staff, Alex Jay, CEO of Little Green Button, asks why the resources, technology, and training available to workers vary so much across trusts, outlining what’s needed to fix the fragmentation.
For most, the phrase “postcode lottery” in the NHS cuts straight to the fact that where you live can still determine the care you get, from which treatments are offered to how long you wait.
But what if that same unevenness is also bleeding into staff safety?
According to the latest NHS Staff Survey, almost one in seven staff (14 per cent) reported being physically attacked by patients or the public in 2025 – the highest level in three years. Reports of unwanted sexual behaviour have also risen, reaching nearly one in three for ambulance workers alone.
These statistics are concerning in themselves, but the variation across trusts is equally striking. Some trusts report significantly higher-than-average violence rates – more than 5,000 cases over 2022-2025 – while others report far lower figures, or operate with different reporting cultures, with some recording fewer than 10 cases over the same period.
Some of these differences can be expected to a degree; a busy A&E in a dense urban area will inevitably see more flashpoints than a small community setting. But the unevenness appears to extend beyond case mix alone.
Variation in resources, technology and training
Most in the healthcare sector will be familiar with the Violence Prevention and Reduction (VPR) Standard, which sets expectations for investment in prevention through training, reporting systems, and safety measures. In practice, implementation remains uneven.
The standard itself exists because trusts were not applying prevention consistently and a framework was needed to “apply a focused approach more consistently”. Yet still we’re seeing uneven protection across the UK, with some trusts and agencies investing in improved security protocols, staff training, and safety technology, and others not.
As an example, following a trial at Fairfield General Hospital in Bury last year, four hospitals in Greater Manchester have introduced body-worn cameras, with the stated aim of creating “a safer, more respectful environment so we can focus on delivering the best possible care to those who need us”, according to Julie Newton, a lead nurse in Fairfield’s Emergency Department.
Elsewhere, similar technologies are less widely available, limiting opportunities to de-escalate incidents earlier, improve reporting, or provide reassurance to staff.
What is the cost?
When discussing these variances, it’s also important to talk about how the cost of inaction is not just measured in harm, but in churn.
Budgets are undoubtedly under strain and may well be limiting investment in a huge range of tools and infrastructure specifically designed to keep staff safe. However, two points are worth noting.
First, some preventative measures can be implemented at relatively low cost — in some cases, around £30 per person per year. Second, the costs associated with turnover, absence, and compensation are typically higher than the costs of prevention.
Estimates from the CIPD suggest replacing a staff member costs, on average, £6,125. The Health and Safety Executive indicates that work-related injuries leading to absences of seven days or more can cost around £7,500 per case, while compensation awards for workplace assault range from £1,000 to over £25,000.
Cumulatively, these costs are material. One report found that the NHS paid £20.7 million in staff assault claims over the past five years, across 1,017 cases since 2019.
What can be done?
Despite the financial argument being a strong one, there is still clearly a patchwork approach to risk, with protections varying across geographies and organisations. But what’s interesting here is there’s no “South is worst, North is best” regional inequality pattern; high-violence trusts are scattered across England, as are safer-performing trusts. Variation is clearly hyper-local and driven by local decisions, not just population or funding factors.
This points less to a gap in policy design and more to inconsistency in implementation and prioritisation. The existing national standard applies across all trusts; the issue is the degree to which it is enacted.
What’s needed, therefore, is not another framework, but follow-through. A clearly enforced baseline for staff protection – one that ensures adherence to existing standards and investment in fit-for-purpose technology – would go further than any new guidance.
The emphasis on being “fit for purpose” is key here. The answer is not to simply invest in tech. Panic alarms, body-worn cameras, and reporting tools can all make a huge difference, but they need to be tested and effective, but only where they are properly specified, tested, and embedded in practice.
Because tick-boxing or treating prevention as negotiable will only see the NHS continue this trust-by-trust staff safety lottery.
Find out more about Little Green Button here.