Violence in healthcare settings doesn’t only affect staff. Here’s what organisations need to understand – and do

When healthcare organisations think about workplace violence, the focus is almost always on staff being assaulted by patients or members of the public. That focus is right and important - the data on violence against NHS staff is alarming and the duty of care to protect them is clear.

But there is a dimension of violence in healthcare settings that receives far less attention.

Patients are also at risk - from other patients. And the staff responsible for managing environments where vulnerable people with complex, unpredictable, and sometimes dangerous presentations share space have a responsibility that extends in both directions.

Understanding that responsibility, and being genuinely prepared to meet it, is one of the more demanding aspects of healthcare and care management. It is also one of the most important.

The scale of the problem

A 2025 study examining violence against healthcare staff across three dementia wards at Julian Hospital in Norwich found that 55% of respondents experienced verbal aggression from patients almost daily, with 21% facing physical violence at a similar frequency. Clinical support workers - who have the most frequent and direct patient contact - were among the most vulnerable.

Those figures are consistent with a wider body of evidence. Research published in NPR's health coverage in 2024 described verbal, physical, and sexual aggression among dementia patients in long-term care facilities as alarmingly common, with one researcher describing the situation as one of endemic violence. A systematic review and meta-analysis published in 2025 found that 60% of older inpatients with dementia in acute hospital settings displayed one or more behavioural and psychological symptoms - including agitation, aggression, and disinhibition.

The people most at risk from these behaviours are not always staff. They are frequently other patients - elderly, frail, confused, unable to protect themselves, and sharing a ward or care environment with someone whose condition means they cannot always control their own behaviour.

Why this happens - and why it matters for training

The aggression that occurs in dementia wards, acute hospitals, and care home settings is almost never intentional in the way that a street assault is intentional.

A person with dementia who strikes a fellow resident is not acting with malice. They may be frightened. They may be in pain. They may be confused about where they are or who the person next to them is. They may be reacting to a sensory overload they cannot process or communicate. The behaviour is the symptom of an unmet need - and it is the staff in the environment who are responsible for recognising that need before it becomes an incident.

That requires a specific and sophisticated kind of training. Not training that teaches staff to manage conflict in the way a security officer manages conflict - with physical authority and the backing of enforcement powers - but training that helps staff understand the communication behind the behaviour, recognise the early signs of agitation and distress, adapt the environment and their own approach to reduce triggers, and respond safely and proportionately when a situation does become physical.

The Alzheimer's Society is clear that aggressive behaviour in people with dementia is nearly always rooted in an unmet need or an emotional response to a specific trigger - pain, confusion, fear, or frustration - and that the most effective responses are those that address the underlying cause rather than simply managing the surface behaviour.

That understanding has to be built into training. It cannot be assumed.

What risk assessment must cover

Healthcare organisations tend to focus their risk assessments on the risk to staff from patients. That is necessary but insufficient.

A complete risk assessment in any environment where patients with complex or challenging presentations are cared for alongside vulnerable people must also consider the risk those patients may present to one another. That means asking specific questions.

Which patients may present a risk to others - through agitation, confusion, disinhibition, or unpredictable behaviour? Which patients are particularly vulnerable - through frailty, cognitive impairment, communication difficulty, or physical weakness? Are observation levels appropriate to the risk profile of the environment? Is information about known risks and triggers shared effectively between shifts and between teams? Are staff confident and competent to intervene safely and proportionately when a situation develops? Is there a clear escalation procedure and are clinical staff available and responsive when it is needed?

These questions matter because situations in these environments can develop quickly and without warning. A patient who was calm during the morning round may be agitated and unpredictable by the afternoon. A person whose risk profile was low on admission may present very differently after a few days in an unfamiliar environment without normal sleep, routine, or the reassurance of familiar faces.

Risk assessment in healthcare and care settings is not a document that is completed on admission and filed. It is a continuous process. And the staff who carry it out need the skills and confidence to act on what they observe.

What the duty of care actually requires

The Health and Safety at Work Act 1974 places a clear duty on healthcare employers to protect staff from foreseeable risks. But the duty of care in healthcare settings extends further - to the people in care, whose safety is also the organisation's legal and ethical responsibility.

The Care Act 2014, the Mental Capacity Act 2005, and CQC regulatory standards all require providers to demonstrate that they have taken appropriate steps to protect vulnerable people from foreseeable harm - including harm from other people in the same environment. Where that harm occurs, and where it can be shown that the organisation failed to take reasonable precautions, the consequences for registered managers, providers, and commissioning bodies can be significant.

Training is one of the most direct and demonstrable ways organisations meet that obligation. Staff who can recognise risk early, adapt their communication, manage distressed and agitated individuals safely, and intervene proportionately when necessary are staff who protect both themselves and the people in their care.

What good training looks like in acute and care settings

Stand2 delivers conflict management, personal safety, and physical intervention training to NHS trusts, hospitals, care homes, and community healthcare teams across the UK. Our programmes are built around the specific realities of healthcare and care environments - the dynamics of dementia wards, the pressures of emergency departments, the challenges of community-based care where staff work alone and without immediate support.

Our training is principle-led. It helps staff understand why behaviour occurs, not just how to respond to it. That understanding is what allows them to intervene earlier, de-escalate more effectively, and respond proportionately when physical intervention is necessary - in a way that protects the dignity, safety, and rights of everyone involved.

Every physical programme is independently medically reviewed by a consultant in emergency medicine and fully risk assessed by a NEBOSH-qualified practitioner. Our training team includes professionals with direct experience of high-pressure clinical, custodial, and emergency environments. When we talk about what works under pressure, we are drawing on experience that goes well beyond the training room.

Violence in healthcare settings is not inevitable. But managing it requires more than policy, more than goodwill, and more than the assumption that staff will know what to do when it happens.

Preparation is what makes the difference. For staff. And for the patients in their care.

Stand2 delivers specialist conflict management, personal safety, and physical intervention training to NHS trusts, hospitals, care homes, and community healthcare organisations across the UK. Our programmes are AIM accredited, independently medically reviewed, and built around the specific risks and responsibilities of clinical and care environments. To find out more, visit our healthcare sector page or get in touch.