NHS Staff Survey Results 2025: What They Really Reveal About Violence Against Staff

The NHS staff survey results published in March 2026 come from the largest workforce survey in the world - over 766,000 NHS staff in England responded, across all 206 NHS trusts. And on staff safety, the findings are stark: physical violence against NHS staff is at its highest level in three years, harassment and abuse remain stubbornly high, and the staff facing the greatest risk are the least likely to see incidents addressed.

Most coverage of the survey has stopped at the headline "one in seven" figure. That number is real, but on its own it flattens what the data actually shows - which groups of staff carry the risk, how the picture is changing, and where the genuine leverage points are for NHS organisations that want to respond with more than a zero-tolerance poster. This article works through the full picture.

At a glance: the 2025 NHS staff survey results on violence and abuse

The headline NHS staff survey results - and the trend behind them

The survey found 14.5% of staff had experienced at least one incident of physical violence from patients, service users, their relatives or other members of the public - up from 14.38% in the 2024 survey and the highest figure since 2022. This is the second consecutive year the number has risen.

That direction of travel matters more than the level. A rising trend across two years, in the same period that NHS trusts disclosed nearly 300,000 recorded incidents of physical violence in three years (a Guardian investigation published shortly before the survey), points to a problem that is worsening despite a decade of zero-tolerance campaigning.

Harassment, bullying and abuse from patients and the public sits at around one in four staff - a level essentially unchanged since 2021, and described in this year's results as the highest in three years. The Royal College of Nursing's general secretary, Professor Nicola Ranger, called the overall picture "a national emergency for staff safety."

Who carries the risk: the staff group breakdown

Averages hide more than they reveal here, and this is where most commentary on the survey - including from other training providers - has been thin.

Nurses and midwives. Of the 219,563 nurses and midwives who responded, 22.6% experienced at least one incident of physical violence - more than one in five, and the highest since 2022. Thirty-five per cent experienced harassment, bullying or abuse from patients or the public, 11.4% experienced unwanted sexual behaviour, and 13.8% reported discrimination from patients - with race cited as the grounds in almost two-thirds of those cases.

Ambulance staff. The ambulance sector remains the most dangerous place in the NHS to go to work. Roughly half of ambulance staff reported harassment, bullying or abuse from the public in the 2025 survey, and 31% - nearly one in three - reported unwanted sexual behaviour, the highest of any sector. This continues a pattern the Association of Ambulance Chief Executives has been raising the alarm about for years: the previous year's survey found 38% of frontline ambulance staff had been physically attacked, AACE's own data recorded around 22,500 incidents of violence, aggression and abuse in a single year - an all-time high - and female ambulance staff are three times more likely than the NHS average to be assaulted at work.

Doctors. The BMJ's analysis of the survey found nearly one in six resident doctors had been physically attacked, alongside what it described as "toxic" and persistent racism.

Black and minority ethnic staff. One in five Black and minority ethnic staff reported abuse, bullying or harassment from patients or the public - four times the rate reported by white colleagues. One in seven faced similar behaviour from colleagues or managers, double the white staff rate.

The pattern is consistent: risk concentrates on frontline, patient-facing, predominantly female staff groups, and it compounds for minority ethnic staff. Any organisational response that treats "NHS staff" as a single population will miss where the harm actually sits.

The reporting gap: the finding almost everyone missed

Perhaps the most operationally important finding in the survey is not about incidents at all - it's about what happens afterwards.

Around three-quarters of staff (75.4%) said they would report physical violence. But barely half said they would report harassment or abuse. And while just over 60% of staff said they feel safe to speak up about concerns, only 47.6% were confident their organisation would actually address them.

Read those numbers together and the message is uncomfortable: a quarter of physical assaults and roughly half of abuse never enters an incident system at all - which means every trust's internal violence data understates the problem, and any board relying on incident reports alone is working from a flattering picture. The RCN's Professor Ranger was blunt about the consequence: staff have "falling confidence... that employers will do anything about it," and what's needed "isn't more talk of 'zero tolerance'" but "a culture of transparency and accountability, where staff are empowered to speak up and employers take action and are seen to take action."

This gap between experiencing and reporting is where training, culture and systems meet - and it's addressable, which is more than can be said for many of the survey's grimmer findings.

Why is violence against NHS staff rising?

The honest answer is that no single cause explains it, but the survey itself points at the conditions. Thirty-five per cent of staff describe their work as emotionally exhausting, 30% report burnout, and over 42% feel worn out at the end of a shift. Staff managing heavy workloads in crowded departments, with patients and relatives frustrated by long waits, are operating in exactly the conditions where situations escalate - and where a tired, stretched member of staff has the least capacity to catch escalation early.

The RCN has explicitly urged ministers to "recognise and address the link between under-resourced services, waiting times and rising violence against staff." The King's Fund's chief executive, Sarah Woolnough, put the principle plainly: "You can't run a health service on hostility... Just as the public have a right to free healthcare, NHS staff have the right to work without fear and abuse."

None of that lets individual organisations off the hook, though - because the same survey shows wide variation between trusts facing similar pressures. Demand is a national problem; how prepared and supported staff feel is substantially a local one.

Zero tolerance isn't a strategy. What actually works?

The phrase "zero tolerance" has been on NHS posters since 1999. The 2025 survey - with violence at a three-year high - is a fairly definitive verdict on posters as a control measure.

What the evidence and the survey's own findings point towards instead:

Skills before slogans. Staff who can recognise escalation early - the change in tone, posture, pacing - and who have practised de-escalation under realistic conditions resolve more situations before they become incidents. This is trainable, and it degrades without reinforcement: a single induction session years ago does not survive contact with a Friday night ED.

Training matched to actual risk. A ward nurse, a call handler, a paramedic entering a stranger's home alone and a security team supporting an ED face categorically different risks. The survey's staff-group breakdown makes the case by itself: training that isn't differentiated by role and setting is training for an average employee who doesn't exist.

Closing the reporting gap. If half of abuse goes unreported, the fastest data improvement available to any trust is making reporting worth staff's time - simpler systems, visible follow-up, and feedback loops that show staff what happened as a result. Reporting rates are also a training outcome: staff who understand what counts as a reportable incident, and why the record matters, report more.

Post-incident support as standard. The survey's burnout figures and its violence figures are not separate stories. Staff who are supported after an incident recover confidence; staff who are not carry the incident into every subsequent difficult interaction.

What should trust and department leads do with the 2025 results?

Every NHS organisation receives its own benchmarked results alongside the national data. Five practical uses for them:

1. Compare your violence and abuse figures against your benchmark group - not the national average. A mental health trust or ambulance service comparing itself to the all-NHS figure is flattering itself.
2. Look at your reporting confidence scores next to your incident data. If survey-reported experience is high but recorded incidents are low, you don't have a safe organisation - you have a reporting problem.
3. Break results down by staff group and directorate to find where risk concentrates, and check whether your training provision maps to it - or whether the highest-risk teams are receiving the same generic package as everyone else.
4. Ask when frontline teams last received conflict management or de-escalation training that reflected their current role and environment - not their induction.
5. Track the trend, not the snapshot. One year's figure is noise; the direction over three years is the signal your board should be seeing.

Where Stand2 fits

Stand2 has been delivering conflict management, de-escalation and physical intervention training inside the NHS for over two decades - including to London Ambulance Service since 2010 and West Midlands Ambulance Service since 2003, the sector this survey confirms as the most exposed in the health service. That work spans exactly the spectrum the survey describes: frontline de-escalation and personal safety skills, through to advanced physical intervention and clinical holding for teams where physical risk is a foreseeable part of the role - including understanding exactly when restraint is legally justified, which is where many teams' confidence gaps actually sit.

Our programmes are built around prevention before intervention, least restrictive practice, and legally defensible decision-making - and they're differentiated by role and risk, because the survey's own data shows a one-size-fits-all course is training for nobody in particular. If your trust's 2025 results have raised questions about whether your current provision matches your actual risk profile, that's a conversation we have with NHS organisations every week - starting with what your data shows, not with a course catalogue.

NHS staff survey results: frequently asked questions

What is the NHS Staff Survey?

It's the annual survey of all NHS staff in England - the largest workforce survey in the world. The 2025 edition was conducted between September and November 2025, received over 766,000 responses across all 206 NHS trusts, and was published in March 2026.

What did the 2025 survey find about physical violence?

14.5% of staff - about one in seven - experienced at least one incident of physical violence from patients, service users, relatives or the public in the previous 12 months. That's the highest level since 2022 and the second consecutive annual rise.

Which NHS staff face the most violence?

Frontline, patient-facing groups. More than one in five nurses and midwives (22.6%) experienced physical violence, ambulance staff report the highest levels of public abuse and unwanted sexual behaviour of any sector, and nearly one in six resident doctors were physically attacked.

How much violence against NHS staff goes unreported?

Around a quarter of staff say they would not report physical violence, and nearly half would not report harassment or abuse - meaning official incident figures substantially understate the real level.

Does "zero tolerance" reduce violence against NHS staff?

Not on its own. Zero-tolerance messaging has been NHS policy since 1999, yet violence is at a three-year high. The survey points instead towards staff capability, reporting culture, and visible organisational follow-up as the levers that change outcomes.

Where can I see my own trust's results?

Organisation-level results are published alongside the national data on the NHS Staff Survey website, benchmarked against comparable organisations.

Sources referenced:

• NHS Staff Survey Co-ordination Centre, National results
• The Guardian, Hundreds of thousands of NHS staff in England attacked and harassed, survey shows
• Nursing in Practice, Attacks and abuse against nurses 'a national emergency'
• Open Access Government, Bullying, violence, and burnout: What the 2025 NHS Staff Survey reveals
• The BMJ, NHS staff survey: Nearly one in six resident doctors physically attacked
• Association of Ambulance Chief Executives, AACE calls for further interventions as violent incidents against ambulance staff reach 22,500 a year
• AACE, Protecting our people: confronting violence against the ambulance workforce
• NHS England, Violence prevention and reduction programme

This article is based on the published results of the 2025 NHS Staff Survey and reporting on it at the time of writing. Figures are quoted from the sources above, which should be consulted for the underlying data.