Violence at work is not part of the job

See the scale without creating stigma

The national figures describe workforce experience, not the intent or culpability of people receiving care. They also cover physical violence from people supported, while HSE's wider definition of work-related violence includes threats and abuse from any relevant source. Providers therefore need both person-centred and organisation-wide views: what is happening for a particular person, and where patterns are emerging across shifts, teams, locations and activities.

DHSC found lower care work-related quality-of-life scores among respondents who experienced violence, harassment, abuse or bullying. In its longitudinal analysis, earlier experience or witnessing of these events was associated with a greater likelihood of changing employer or leaving adult social care. That is an association, not proof of causation, but it makes violence prevention part of retention and continuity as well as health and safety.

Person-centred care and worker safety are not rival objectives. Repeated distress is evidence that the care environment is not working well for either person.

Risk assessment starts before the injury

HSE says employers must assess significant risks and implement effective controls; completing a form is not itself a control. Its health and social care guidance distinguishes generic assessment of work, environment, lone working and training from individual assessment where a person may present a risk. For someone receiving care, that assessment should be part of care planning and regularly reviewed.

The person-specific review should consider mental, emotional and physical condition, medicines, alcohol or drugs, stress, previous behaviour and whether the person perceives others as a threat. Staff exposed to the risk need to know triggers and preventive measures. HSE highlights additional care when a person is newly admitted, when new or agency workers are involved, or when mental or physical state, medication, behaviour or mood changes. A bruise is therefore not the beginning of the assessment; it may be evidence that an earlier signal was missed.

Staffing and familiarity are control measures

HSE says staffing should reflect the level of foreseeable risk and managers must have enough suitably trained staff to cope with foreseeable violence. Headcount alone is insufficient. Deployment may need to reflect the time of day, activity, experience, familiarity with the person, de-escalation skill and ability to summon help. If a care plan says two workers are needed for a particular intervention while the rota repeatedly makes the second worker unavailable, the written control is not operating.

Agency workers can be competent and still lack the person-specific knowledge that makes an encounter safe: communication preferences, early warning signs, known triggers and approaches that reduce distress. That information must survive beyond the memory of permanent staff. Handover, care records and induction need to turn it into usable instruction without using labels that stigmatise the person.

Lone work changes the consequence

HSE identifies lone workers as potentially more vulnerable because nearby support is absent. For home visits, it says potential violence should be assessed in advance using referral information, relevant intelligence from other agencies, past history and recent medical and personal history. Where information is insufficient, controls may include a different meeting place, two workers, an escort or communication and alarm arrangements.

A device is only part of the system. Providers need reliable visit and location information, agreed check-in and overdue-visit procedures, a response owner and permission for a worker to withdraw when they feel unsafe. HSE is explicit that communication devices alone do not prevent incidents. Technology cannot repair a package commissioned for lone work when the current assessment requires another model.

A report is the start of learning

Among survey respondents who had experienced physical violence, 77% said they reported the most recent incident themselves and 12% said a colleague reported it; the categories can overlap and should not be added. HSE says employers should support workers, record and report incidents, then review whether additional controls are required. It identifies fear of blame, complicated systems and the belief that nothing will happen as reasons people stay silent.

The useful question is what changed after the report. Did the care plan, staffing, environment, clinical input or handover change? Did leaders examine repeated events by person, time, task, worker and location? Was the worker offered proportionate physical and psychological support before returning to the same situation? Reporting volume without evidence of action measures exposure, not learning.

Keep statutory reporting and insurance in their proper place

Not every violent incident is reportable under RIDDOR. HSE says a work-related act of violence must be reported when it results in death, a specified injury, or a physical injury that prevents a worker carrying out normal duties for more than seven consecutive days. Work-related injuries causing more than three days' incapacity must be recorded even where they do not cross the reporting threshold. Internal care, safeguarding, HR, police and CQC processes answer different questions; completing one does not automatically complete another.

Most employers in Great Britain must hold Employers' Liability insurance for at least £5 million with an authorised insurer, subject to exemptions. That requirement does not make every incident a claim, decide liability or show that health-and-safety duties were met. Insurance may transfer some financial consequence; it cannot assess risk, staff a shift, train a worker or support someone after an assault. Provider-specific cover and claims questions belong with an appropriately authorised insurer or intermediary and, where needed, legal advisers.