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Violence rules my A&E ward Armed patients have my staff fearing for their lives

I've seen everything. (Guy Smallman/Getty Images)

I've seen everything. (Guy Smallman/Getty Images)


October 27, 2022   4 mins

I’ve seen everything on my A&E ward: from staff, police officers and members of the public being punched to full-on brawls breaking out. Even visibly pregnant staff are not immune to aggression. And that’s just in a fortnight: people don’t realise how dangerous it is to work in a hospital. As a consultant in a Midlands A&E department, I routinely receive reports that staff have been harangued, spat at, racially abused or physically assaulted. One staff survey reported that 14.3% of workers experienced at least one act of physical violence in 2021 — that’s an average of 200 assaults a day. For paramedics, it’s even worse: 31.4% of those interviewed said they have experienced violent attacks.

The correlation between alcohol and violence is well-known, and something we contend with on a daily basis in A&E. Handling drunk patients, and their often-volatile friends, is one of the job’s less pleasant challenges. Their perceptions of common decency are warped, their ability to communicate impaired, their behaviour unpredictable. Anger can quickly descend into violence. And when you mix the sick and frail with the intoxicated or inebriated, you create a morbid cocktail.

But it’s not for me to judge my patients’ transgressions or “lifestyle choices”. Whether they are drunk or stoned or high, incurred an injury in a car chase, or fell ill from swallowing a handful of drugs before they were arrested — all this is immaterial from a medic’s point of view, and must not pollute any assessment. There’s one A&E department nearby that saved the lives of two separate patients who had been brought in by the police with serious injuries sustained from fighting. Both were later charged with murder.

Even though I’m pretty accustomed to the risks now, there are still times when I genuinely fear for my own safety. On one occasion, a local criminal with a history of mental health problems confronted me. He had a habit of loudly threatening to commit suicide if he didn’t get to skip the queue — a threat which we had no reason to think was genuine, and which therefore got him nowhere with the staff on duty. When he accosted me, I could see that he was on the verge of hitting me, so I called the police and had him removed. He was twice my size and had that crazed look in his eyes; who knew what he would do? After all, if he didn’t take a swing at me, there’s every chance he could attack a member of my team. Or what if he decided to wait for me in the shadows of the staff car park? I wouldn’t be the first, or last, female doctor to be intimidated on her way home.

And then there are the patients who show up in A&E with weapons. Last week, a police pursuit in Rochdale ended when the suspect’s car collided with another vehicle. Officers detained the man and took him to Fairfield Hospital in Bury for treatment, only to find that he was carrying a gun. According to the Manchester Evening News, “police confirmed that there was never any risk to the public, and the weapon was recovered safely” — a statement that strikes me as, at best, nonsense and, at worst, evidence of a potentially sackable offence. If police officers had properly searched him, they would have found the gun, instead of allowing it onto hospital premises and putting countless lives in harm’s way.

It was not an isolated incident. Last year, a clinician in a nearby hospital stumbled across a concealed weapon on a patient who had been brought in by police. Apparently, all hell broke loose. The officer guarding the suspect hit the panic button on his radio, and a team of armed police descended on the patient’s cubicle — much to the distress, no doubt, of other patients.

And it’s worth remembering that untrained, illicit firearms users are as much a risk to themselves as the public. A colleague once treated a young man who had received a gunshot wound to a rather delicate part of his anatomy after a firearm he’d concealed in the waistband of his jeans accidentally went off. (One of the patient’s testicles was rendered redundant.)

But even if external forces and authorities are responsible for bringing potential violence to A&E, the conditions within hospitals serve as a catalyst. Long waiting times, overcrowding, stressed-out patients and relatives, staff shortages: all these factors mean tempers run high. As one nurse who is preparing to strike over pay and conditions told me earlier this week: “Part of our campaign is about safe staffing on wards. The ratio of nurses to patients is out of kilter. This is often why people become aggressive in A&E: because they can’t get seen as we’re so short-staffed.” Nurses feel that they are expected to put up with abusive behaviour because, according to a recent survey, it ​was seen as “just part of the job”. Some described it as “normal” because of the frequency of incidents.

Nurses aren’t the only ones who need better pay and treatment in order to keep patients safe. A&E departments in areas that see a lot of crime also need security staff who are capable of quickly deescalating potentially violent situations. Some hospitals already have this: men with special forces beards, who dress in combat trousers and tactical vests; they look like they are about to carry out a dawn raid with the SAS, not direct Mavis to the disabled parking bay. But these guards are the exception. Those who guard the nation’s emergency departments tend to earn disastrously low wages — and, as the NHS well knows, poor pay attracts poorly trained, unmotivated staff.

These failures trickle down. It shouldn’t need spelling out, but it does: when clinical staff are distracted, abused or assaulted, our capacity to deal with patients is limited, and our departments become less effective. According to The Lancet: “Violence costs the NHS ÂŁ2.9 billion a year. Indirect costs are much greater, including loss of psychological and social function to the individual, diminished community cohesion, and loss of economic productivity.”

Until the public and the Government realise the immediate, future and generational cost of violence, not just to the healthcare system but to society as a whole, I fear Britain will be paying off a debt it can ill-afford. In the meantime, my staff will continue to look over their shoulders, knowing full well that more tragedies are inevitable.


Dr Emma Jones is an A&E consultant based in the Midlands.


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Philip Stott
Philip Stott
1 year ago

‘Our NHS’ continues to hoover up billions of pounds, yet still continues to perform worse outcomes for pretty much every condition than our continental cousins.
Yet doctors like Emma still plead for more cash.
It’s surely time that we realised that our funding model is broken, and that we need to look to an insurance based solution, whereby there is an element of cost associated with turning up to the GP or hospital, even if only nominal.

Last edited 1 year ago by Philip Stott
CHARLES STANHOPE
CHARLES STANHOPE
1 year ago
Reply to  Philip Stott

Exactly, well said, but currently such criticism is blasphemy and the system will have to BREAK before any such reform is even possible.

Richard Baker
Richard Baker
1 year ago
Reply to  Philip Stott

I agree. I’m a consultant in the NHS. The model of funding is at fault. It is a socialist experiment that disincentivises increased productivity and promotes gradual deterioration. However, until enough of the public start saying this to give the politicians the courage to try something new, nothing will change.

Jonathan Nash
Jonathan Nash
1 year ago
Reply to  Richard Baker

Agreed. In scale and organisation it is an old-style Soviet centrally planned economy, and we know how that worked out: shortages of toilet rolls and surpluses of gherkins!

John Solomon
John Solomon
1 year ago
Reply to  Jonathan Nash

I am very tempted to lower the tone and say that depending on where you put the gherkins you might not need the toilet rolls……………
OK, the temptation was too great. Mea culpa.

Jacqueline Burns
Jacqueline Burns
1 year ago
Reply to  John Solomon

Hahaha. Thanks for that. It has cheered me up no end!

Paul Walsh
Paul Walsh
1 year ago
Reply to  Richard Baker

Did you use the words politicians and courage in the same sentence?

Aphrodite Rises
Aphrodite Rises
1 year ago
Reply to  Philip Stott

Many years ago, I heard from a very high up member of the medical profession that the problems of the NHS were so deep rooted they could only be effectively addressed by dismantling the NHS and starting again. More funding was pointless as the money would just be absorbed with no real improvement.

Richard Baker
Richard Baker
1 year ago

Again, as an NHS consultant I agree. After many years as a consultant I now believe the NHS is an obstacle to better healthcare. The current model of everything free, funded by the (dwindling?) proportion of the population that are self-sufficient is unsustainable.

chris Barton
chris Barton
1 year ago
Reply to  Philip Stott

It will be the thing that ultimately bankrupts our country.

Christopher Barclay
Christopher Barclay
1 year ago
Reply to  Philip Stott

You propose that patients with severe injuries or even unconscious patients should produce a credit card that hasn’t been maxed out before receiving life-saving treatment? That doesn’t happen in the US. The refusal to treat someone is likely to lead to more violence.
The law could be changed to remove the obligation of medical staff to treat violent patients. This though would not solve the problem of violence or threats of violence from people accompanying the patient. Would you deny an unconscious or barely conscious patient treatment because of the behaviour of others? It’s hard to morally justify that.
Looking at the funding of the NHS may be necessary for an optimal service. However, the suggestion that society should pay more for medical treatment if that society is becoming more violent is entirely reasonable. You fail to consider why there are such shortages of front-line staff if the NHS is receiving so much money.

Jeremy Bray
Jeremy Bray
1 year ago

It is true that when I was detained in my local hospital to check out a chest pain I felt I had entered a dystopian world where a high proportion of those around me were obviously drunk or drugged and mentally impaired and vast amounts of police time were wasted trying to calm these individuals that I suspect previously would have been detained in a police cell or removed to a psychiatric hospital.

While one is inclined to ask exactly what violence and what costs were being measured by the Lancelet there can be little doubt that large amounts of violence and vandalism generally is allowed to go unchecked in society in general and not just in hospitals. It is all part of the “bad” men and women are victims narrative that prevents effective action to favour the decent citizens over the violent narcissistic thugs and vandals.

Claire D
Claire D
1 year ago
Reply to  Jeremy Bray

“It is all part of the “bad” men and women are victims narrative . . .”

I think that that narrative – ‘compassion’ seemingly – may just be the superficial, virtue signalling cover. The real reason is they do not care; providing big business is happy, employees continue to work and our society limps along unthreateningly, they do not care. There is no evidence that I can see to the contrary except words and statements, so far.

Last edited 1 year ago by Claire D
Jonathan Nash
Jonathan Nash
1 year ago
Reply to  Jeremy Bray

“it’s not for me to judge my patients’ transgressions or “lifestyle choices”. “
Let me then: as the Duke of Wellington would have said, they are the scum of the earth.

Kathleen Stern
Kathleen Stern
1 year ago
Reply to  Jeremy Bray

So,if the justice system did its job effectively,instead of the softly softly approach to violent,dangerous people, the problem might be lessened. Still,reform of this antiquated system is still vital. The Dutch system seems to work well.

AC Harper
AC Harper
1 year ago

I know, let’s clear out a lot of the dead wood in the NHS and use the money saved to offer servicers more wisely.
Yes, it seems like heresy. But many people will tell you of instances of indifferent nurses chatting at the ward desk while patients lay waiting for attention. Of hospital pharmacies that take hours to dispense medicines prescribed a few floors above. Of porters pushing trollies of paper patient histories around. And goodness knows how much administration is just generating paper for internal purposes, not health care.
And as for the drunks and violent people in A&E fit some ‘cubicles’ with mesh cages and only treat the patients when they calm down.

John Solomon
John Solomon
1 year ago
Reply to  AC Harper

A geniune question : do you think that these people would work harder and be more diligent if they got paid more?

Jacqueline Burns
Jacqueline Burns
1 year ago
Reply to  John Solomon

It would help if they were willing to do the job they are already paid to do!

AC Harper
AC Harper
1 year ago
Reply to  John Solomon

No. There are many good people working for the NHS and many poor people. They have all reached an accommodation with the Spanish Practices and more money wouldn’t have much effect.
If you went to any large hospital and (carefully) asked who the slackers were you would get a list. Manage (carefully) the slackers out of the system – then reward those remaining with extra holidays or better shifts or other recognition. Then repeat the process on an annual basis.

Jeremy Bray
Jeremy Bray
1 year ago
Reply to  John Solomon

I am not sure the author is suggesting more money would transform the attitude but rather that it might attract qualified nurses etc who might otherwise prefer to remain abroad or doing some other better paid activity or even in idleness if their husband or the state can subsidise them. In other words more money would translate into more nurses to triage the patients so less infuriated patients.

The problem is that more money is likely to result in more diversity officers and general office staff but not many more nurses. Unfortunately no one is going to sack the diversity officers and surplus admin staff to employ more nurses which would be the sensible thing to do, despite the only diversity issue in the NHS being that the traditional white native population is underrepresented and no one is concerned about that.

Richard Baker
Richard Baker
1 year ago
Reply to  John Solomon

I work hard in the NHS already, but if I was paid per appointment, per operation etc, maybe I’d be motivated to work harder still. But that only works if the porter taking patients to theatre is also similarly incentivised. In the socialist dystopia that is the NHS, everybody must be paid the same


John Solomon
John Solomon
1 year ago
Reply to  Richard Baker

Working hard is not the point : you are supposed to be working optimally. If you got paid to work ‘harder’ there is a danger that you would start to cut corners to make more. The danger, particularly in the public sector is that management set bad targets and get worse results.

Laurence Siegel
Laurence Siegel
1 year ago
Reply to  John Solomon

No, as any damn fool knows, if you offer more money you will get a more skilled and more diligent class of people. Your question is a red herring and presumes that you are stuck forever with the people you have. You’re not.

John Solomon
John Solomon
1 year ago

I hope you are being sarcastic. If you pay staff who are in situ more, they don’t vanish overnight. Eventually they might be replaced, but it would take years. Pay peanuts, get monkeys, certainly, but if you pay more peanuts, for the foreseeable future you just get fat monkeys.

Malcolm Knott
Malcolm Knott
1 year ago
Reply to  AC Harper

I have waited 20 minutes at the window of a hospital pharmacy after handing in my prescription when I was the only patient in the department. The pharmacist busied herself with other tasks until she finally found the energy to take my prescription off the shelf just in front of me. When I asked her why that had taken twenty minutes she was nonplussed. For her, I wasn’t actually a person, just a unit of work.

Andrew Wise
Andrew Wise
1 year ago
Reply to  Malcolm Knott

For her, I wasn’t actually a person, just a unit of work.

The transformation from patient to customer to unit of work is complete … lol 🙂

Dougie Undersub
Dougie Undersub
1 year ago

It’s awful that you have to contend with this, Emma. Sadly, we have decades of hard evidence that increased NHS funding doesn’t lead to better outcomes.
Have you suggested to the hospital management that the Diversity Officer/Security Guard ratio needs to be adjusted?

Andrew Wise
Andrew Wise
1 year ago

A few more diversity managers will fix the problem 🙂

Danny Edwinson
Danny Edwinson
1 year ago

The basis norms of society are in a state of breakdown. Medical staff are assaulted, drugs are openly sold and consumed in daylight in parks, selfish people drive motorised vehicles on pavements – I witnessed a seriously injured person receiving emergency aid several days ago after such an incident. All of this is occurring during a time where people still have relative economic comfort. I fear for what happens when food, fuel, medicines and more become far more scarce.

Sam Hill
Sam Hill
1 year ago
Reply to  Danny Edwinson

Indeed – this seems to me the key point. The author says, ‘But it’s not for me to judge my patients’ transgressions or “lifestyle choices”.’ That may be true to the extent of her as a jobbing medical professional. But it’s not true of society at large. What we have done over the past couple of decades is effectively desensitise ourselves to a normalised degeneracy. What is played out in hospitals seems to me to be symptom not cause.
We can and should argue about why ideas like ‘compassion’ and ‘tolerance’ got hijacked and morphed into what has become a social free-for-all. But we can and should form value judgments on lifestyle choices including those that have implications for a free-at-the-point-of-use healthcare service. What the author seems to me to be talking about is degeneracy and the free for all entering her workplace.
The doctor may have no place passing judgments on those she treats as a medical professional but that does not extend to my mind to her as a member of society at large. We should end the degeneracy as the way of ending what this article talks about.
Of course there isn’t a nice clean and easy line in this. Is not being vaccinated degeneracy? I would say that there is a qualitative difference between drunken violence and refusal of a quasi coerced medical procedure. a difficult one.

John Davies
John Davies
1 year ago
Reply to  Danny Edwinson

2 yrs ago I was in hospital, the guy in the next bed was constantly on his phones loudly doing drug deals day & night, I complained to the staff who said they were too scared to report him as he knew where they lived !! So when he dozed off, a few of the walking wounded grabbed his stash & phones (& threw them down the sluice) while others pulled out his drains & catheter !!! A little later … he discharged himself.

Aaron James
Aaron James
1 year ago

The crime is very scary. But what is coming is scarier.

The Sorros DA’s in USA do not prosecute crime so it burgeons like weeds in an unkempt lawn, and will ultimately take it over.. The Liberal systems let the criminals walk… now why would that be? Same in UK, rap sheets a mile long.

Do you believe it is that Liberal Left are so nice they cannot bring themselves to punish those who prey on the weak?

It is to bring in the Social Credit score. To put facial recognition to the 50 million CCTVs that are everywhere, add in gait recognition, retina scans, finger prints, GPS tracking of everyone, and who they are with – then the CBDC (Central Bank Digital Currency) – instead of a bank your phone holds an account direct with the Central Bank – and your phone is used for every transaction, in and out of the account – what, where, when and with whom.

This cultivating of crime and anti-social behavior by the Government, encouraging it, may as well say creating it, is the surveillance State ‘Foot in the Door’. Who could not be for this tech being used for good? For making you safe? For protecting Grannies…..

Winston, lead character, 1984, published 1949……

”The voice came from an oblong metal plaque like a dulled mirror which formed part of the surface of the right-hand wall. . . The instrument (the telescreen, it was called) could be dimmed, but there was no way of shutting it off completely.”

”The telescreen received and transmitted simultaneously. Any sound that Winston made, above the level of a very low whisper, would be picked up by it; moreover, so long as he remained within the field of vision which the metal plaque commanded, he could be seen as well as heard. There was of course no way of knowing whether you were being watched at any given moment.”

Haha, but that was 73 years ago – now you would know you are being watched at every given moment…….

There is more to this ubiquitous crime than criminals……

John Wilkes
John Wilkes
1 year ago
Reply to  Aaron James

Interesting example of paranoia. Who, please, are the ‘Liberal Left’? Specifics, please, not meaningless terms parroted from twitter or shock jocks. Where is the evidence that they – whoever ‘they’ are – are interested in bringing in a ‘Social Credit’ scheme? Presumably, the writer is referring to the current Chinese government’s attempt to control its people, which itself will probably collapse under its own weight. Does the writer have the faintest idea of just how much the technology would cost and the manpower it would consume? Mentioning George Soros is another giveaway. I don’t agree with his views on Israel, or his having shorted my country’s currency, but to suggest he is an ally of an Orwellian superstate is nonsense when one looks at his initiatives and the organisations he supports.

Michael James
Michael James
1 year ago

Don’t expect anything to improve. People have already begun to solve the NHS problem for themselves by going private. Eventually that will become the norm and the unreformable, ever more expensive NHS will be there only for the poor.

Guy Pigache
Guy Pigache
1 year ago
Reply to  Michael James

There is no private A&E. The NHS has a monopoly.

John Solomon
John Solomon
1 year ago

“Nurses aren’t the only ones who need better pay and treatment in order to keep patients safe.”
Sorry to be picky, but isn’t that a non-sequitur? To keep patients safe, you need ability, training, resources and equipment – not better pay. Unless, of course, you take that view that “because I am not paid enough I am not going to do my best.” Being under-valued and demotivated is not an excuse for slacking.

MJ Reid
MJ Reid
1 year ago

Surely it is not better pay that nurses and other hospital staff need, but better training in how to keep safe. Why is the only solution put forward “throw money into salaries”? Training to spot the signs that someone might be carrying a weapon and how to deal with that appropriately seems a better solution than simply giving people more take home money and leaving them without the appropriate tools for the job.

Linda Hutchinson
Linda Hutchinson
1 year ago
Reply to  MJ Reid

From what I can gather the median wage of a trained nurse is cÂŁ35.5k, not a massive salery, by any means, but a decent one.

Ruud van Man
Ruud van Man
1 year ago

Aren’t the Diversity and Inclusion Managers meant to smooth over these social conflicts?

Andrew Wise
Andrew Wise
1 year ago

A relative on mine spent a year working in an American ‘Emergency Room’ in a violent part of Miami – she was working in the ‘State Hospital’ not a private hospital and often commented how polite the patients were in contrast to the UK counterparts.
Her theory was that the patients knew they were in the last chance saloon, so one else would offer them healthcare so they had better be polite.
In the UK we create this expectation of rights with no obligations – especially around healthcare – and that’s at the root of many of our problems.

Malcolm Knott
Malcolm Knott
1 year ago

I am mild-mannered and do not carry weapons. But you can understand how, after waiting some hours with my wife in acute discomfort and being told two or three times by an unsmiling, unsympathetic person absorbed in her all-important paperwork behind a high counter, ‘I can’t say when she will be seen’ [implication: don’t pester, go and sit down and wait until you’re sent for] I struggled not to betray my irritation.

Last edited 1 year ago by Malcolm Knott
Vici C
Vici C
1 year ago

The NHS could be underfunded or not. What struck me about this article was the level of violence and thuggery in our society. There are no morals left in this country. “Just be kind” doesn’t cut it. Spare the rod and spoil the child.

Nicholas Rynn
Nicholas Rynn
1 year ago

What a pity it was only one testicle the thug with a gun shot off.

chris Barton
chris Barton
1 year ago

The NHS will never work. It has to be dismantled.

Last edited 1 year ago by chris Barton
Dan Steele
Dan Steele
1 year ago

“one act of physical violence” over 7 man-years? With many patients experiencing the nasty side of drug abuse? How is that not the experience of every bartender, on a monthly basis.
Suck it up, lady. This excuse for “I want more stuff” isn’t going to fly.

Last edited 1 year ago by Dan Steele
Alan Hawkes
Alan Hawkes
1 year ago

A great deal of comment on the funding system of the NHS, but little on the situation described. I’m prepared to believe that a better funding system would feed through to reduce violence in A&E, but I don’t think that we should ask the staff in A&E to accept violence and abuse as part of their working life while we debate financial structures. A&E departments should be made secure and that requires action from the Police and the Courts.

Daniel Lee
Daniel Lee
1 year ago

*The mere presence of a firearm poses no actual threat to anyone. It’s a piece of metal and sometimes plastic with no inherent agency of its own. You’re welcome.

Jeremy Bray
Jeremy Bray
1 year ago
Reply to  Daniel Lee

I agree that the presence of a firearm is a potential threat rather than actual threat in itself but in the UK we are keen to keep potential threats away from public places as much as possible. I know the US philosophic preference is to uphold the right of everyone to be armed if they wish and shoot it out if one of the gun holders turns out to be a short tempered violent lunatic who wants to turn the potential threat into an actual threat but that isn’t the way in the UK. As a result we tend to regard possession of an illegal firearm as a threat without the fine philosophic distinction you rightly draw.