A Guardian investigation into violence and sexual harm by patients against NHS staff has revealed tens of thousands of alleged incidents reported over the past three years.Here is what we know from the findings.The Health and Safety Executive (HSE) defines work-related violence as “any incident in which a person is abused, threatened or assaulted in circumstances relating to their work”.Under the Assaults on Emergency Workers (Offences) Act from 2018 anyone who attacks an emergency worker could face a maximum two-year prison sentence.An assault may include pushing, shoving or spitting, as well as fear of an attack.

Judges also have to give longer sentences for more serious offences, such as GBH or sexual assault, if the victim was an emergency worker.NHS trusts in England recorded at least 295,711 alleged incidents of physical violence and aggression by patients against staff in England between 2022 and 2025, the Guardian has found.Responses to freedom of information (FoI) requests from 212 trusts showed the number of incidents reported by staff rose sharply over the three years, 91,175 in 2022-23 to 104,079 in 2024-25.This is equivalent to about 285 cases reported daily in the most recent year.As some trusts have yet to provide figures for all types of violence and aggression, the overall numbers are likely to be substantially higher.

Furthermore, managers and frontline staff told the Guardian that the number of incidents officially recorded by trusts significantly underestimated the scale of the problem.The results of the latest annual NHS staff survey also suggests the number of incidents recorded should be far higher.Of the 744,358 workers who responded, one in seven said they experienced physical violence from patients, their relatives or other members of the public.Given the NHS in England employs about 1.5 million people, this would equate to 215,700 staff in 2024 alone.

As staff may experience abuse from several patients, or be abused by the same patient several times, it is not unreasonable to estimate that the true amount of violence and aggression could well exceed a million incidents per year.Mental health and learning disability trusts recorded the highest numbers of violent incidents, reflecting the complex needs of their patients, which can be difficult to manage.The trust that recorded the highest number of physical assaults by patients against staff was Cumbria Northumberland Tyne and Wear NHS foundation trust, with 17,793 alleged incidents over three years.The HSE raised concerns with the trust in early 2024 that it wasn’t doing enough to protect staff from violent patients at its Mitford Unit at Northgate Hospital, which cares for autistic adults.The trust’s chief operating officer said: “We have seen a reduction in moderate and high levels of harm across our violence and aggression related incidents and continue to ensure our safety and learning systems work well to learn and implement any areas of improvement.

”Mersey Care NHS foundation trust, another large mental health trust, recorded 22,918 incidents of violence and aggression by patients against staff over three years, including physical assaults, attempted assaults and verbal abuse.A trust spokesman said: “As a trust we consistently report approximately 6,500 incidents per month on average, with around 80% of these incidents being categorised as no harm or low harm.”Most trusts only disclosed physical assaults by patients against staff.Some trusts also included attempted assaults and violent threats.Where trusts provided a breakdown of all types of violence and aggression, actual assaults were usually the most commonly reported incidents.

For example, Bradford District NHS trust recorded 783 physical assaults, 348 attempted assaults and 364 incidents of aggressive behaviour, such as threats of violence.The Guardian’s initial FoI requests did not ask trusts whether assaults involved weapons or caused injuries, although a minority of trusts did disclose this information.For example, University Hospitals Birmingham NHS foundation trust reported that 871 of the 1,981 incidents recorded over three years involved injuries to staff.North West ambulance trust reported that weapons were used in 75 out of 983 alleged physical assaults by patients on staff.Violent and aggressive incidents are the third largest cause of injuries reported by the health and social care sector, according to the HSE.

Three-quarters of trusts do not record whether attacks on staff were deliberate or unintentional, for example because of a patient lacking insight into their behaviour as a result of conditions such as dementia, delirium or mental health problems.Of the 54 trusts that did provide a breakdown in their responses, 7,438 incidents were recorded as deliberate acts of violence, compared with 7,094 recorded as unintentional.The split varied widely by type of NHS trust.Most incidents recorded by mental health trusts were classified as unintentional, while ambulance trusts recorded the vast majority as deliberate.Other trusts do record whether patients have a medical condition that might impact their behaviour.

But they said they could not determine whether the patient lacked capacity at the time they were violent or abusive to staff without checking the case file.NHS trusts also recorded a total of 49,946 claims of sexual misconduct and sexual violence over 2022-23 to 2024-25.This figure covers a spectrum of allegations, from abusive remarks to rape, including those perpetrated by and against patients, staff and visitors.This represents a significant rise compared with a previous investigation by the Guardian and the British Medical Journal, which found more than 35,606 sexual allegations were recorded between 2017 and 2022.More than 47% (23, 754) of alleged sexual harm incidents reported over the past three years concerned patients allegedly abusing staff.

Additionally, there were 7,494 reported incidents of patients sexually abusing other patients, 1,769 allegations of staff abusing patients and 1,252 cases of staff abusing other staff from 2022-23 to 2024-25.Experts said these figures significantly underestimated the true level of sexual harm.In the latest NHS staff survey, one in 12 workers said they experienced unwanted sexual behaviour, including offensive comments, touching and assault, in the past 12 months.Of those, 8.8% reported sexual harassment and abuse from patients, relatives or members of the public, which equates to 132,300 staff across the entire NHS workforce.

Meanwhile, 3.7% of respondents said they had been the targeted by colleagues and other staff, which equates to 54,900 incidents throughout the health service.A Liverpool John Moores University report put the annual cost of violence, harassment and abuse towards NHS staff in England in 2020-2022 at £1.4bn.This included the costs of staff sickness and higher turnover, diminished productivity, and treatments for physical injuries and mental distress.

NHS England, which oversees trusts and other NHS organisations in England, introduced a violence prevention and reduction standard in 2020, which provided guidance on risk assessments and violence control measures.NHS England also introduced a sexual safety charter in 2023, under which all NHS trusts committed to working to eradicate sexual harassment and abuse in the workplace.The charter requires NHS trusts to improve their recording of sexual harm incidents against staff.The Department of Health and Social Care added that NHS trusts have been told they must strengthen training for staff on recognising and investigating sexual misconduct and ensure police are engaged swiftly and appropriately in serious cases.Rachel Harrison, the national secretary of the GMB union, said the rising number of incidents of abuse of healthcare staff was “a mark of shame upon our nation”.

She added: “No one should have to put up with being spat at, bitten, punched, even sexually assaulted at work – especially not those who are trying to help us.”The Royal College of Nursing (RCN) has warned that the high prevalence of abuse could mean that many NHS trusts are in breach of the Health and Safety Act for failing to provide a safe working environment.Both the RCN and the British Medical Association (BMA) have also raised concerns that trusts are failing to meet their legal duties to prevent sexual harassment under the Worker Protection Act.They noted that even stronger duties on employers to prevent sexual harassment are due to come into force under the Employment Rights Act.