Emergency departments record the highest rate of work-related violence in the NHS. The risk assessment is required under the Health and Safety at Work etc. Act 1974, the Management of Health and Safety at Work Regulations 1999 and — for NHS providers — the NHS Violence Prevention and Reduction (VPR) Standard, which became mandatory in 2021. The assessment must address the three populations who present a foreseeable risk (intoxicated patients, mental-health-crisis presentations, frustrated relatives during long waits), the environmental controls (sight-lines, lone-working, panic alarms, lockdown), the staff training programme (de-escalation, Promoting Safer and Therapeutic Services / PSTS, breakaway), and the post-incident response (Datix, occupational health, criminal referral under the Assaults on Emergency Workers (Offences) Act 2018).
HSWA 1974 s.2 imposes the employer duty to staff; s.3 imposes the duty to non-employees who may be affected, which includes other patients and visitors who could be hurt during an incident. MHSWR 1999 reg 3 mandates the risk assessment. For NHS providers, the NHS Violence Prevention and Reduction Standard (2021, updated periodically) is contractually mandated through the NHS Standard Contract and is what CQC and the trust's NEDs will ask to see evidence against. The Assaults on Emergency Workers (Offences) Act 2018 sits behind the assessment as the criminal-justice route for incidents that meet the threshold.
The assessment must also reference the trust's lone working policy, the security incident reporting route (Datix / IR1), and the local police single-point-of-contact (SPOC) for NHS-related crime.
Intoxicated patients (alcohol, recreational drugs, novel psychoactive substances) present an unpredictable physical-violence risk and benefit from controlled environment, security presence, and clear pathways to medical clearance. Mental-health-crisis presentations require a different response — Section 136 suite or equivalent quiet room, dedicated mental health liaison, restrictive intervention only as last resort and only by trained staff under the Mental Capacity Act 2005 / Mental Health Act 1983 framework. Frustrated relatives and patients during long waits present a verbal-and-low-level-physical risk that is reduced primarily by communication (real-time wait-time displays, regular updates by named staff, food and drink, and clear escalation to a senior nurse or duty manager).
The assessment names the specific controls for each population. A single 'staff trained in de-escalation' bullet point is not enough.
The assessment names the physical security features: triage window security glass, controlled access to clinical areas (electronic door release, swipe / fob), CCTV coverage with named monitoring point, panic alarm coverage (every consultation room, every triage point, every cubicle), the security officer staffing model (24/7 or on-call), and the lockdown procedure for a major incident.
Lone working is a specific risk for staff in resus, cubicles after hours, the minor injuries stream and the mental-health assessment area. The assessment names the lone-worker device (Skyguard / Reliance / equivalent), the response protocol when activated, and the dynamic risk-assessment training for staff entering a cubicle alone with an unknown patient.
Staff training is named explicitly: PSTS (Promoting Safer and Therapeutic Services) for clinical staff; conflict-resolution training (CRT) for reception and triage; restrictive-intervention training only for staff in the mental-health response team. Frequency and refresher cycles are named, with the training register cross-referenced.
Post-incident response covers: immediate management (security, medical attention, separation), Datix / IR1 within 24 h, occupational health referral, peer-support / TRiM referral, criminal-justice referral via the SPOC under the Assaults on Emergency Workers (Offences) Act 2018, and case-by-case decisions on prosecution-led ASBOs / community protection notices. The assessment names the trust's lessons-learned route — typically a quarterly violence-and-aggression review at the divisional governance meeting.
The numbered sections a reviewer expects to see, in order.
ED name, named clinical lead, named security lead, VPR Standard self-assessment score and date.
Intoxication, mental-health crisis, long-wait frustration — specific controls and pathways for each.
Triage security glass, controlled access, CCTV coverage, panic alarm coverage, security staffing model.
Lone-worker device specification, response protocol, dynamic risk-assessment training, cubicle-entry procedure for unknown patients.
Section 136 suite or equivalent, MH liaison cover, restrictive-intervention-trained team, MCA / MHA decision framework.
Real-time wait-time display, named senior-of-the-day briefings, food / drink provision, escalation route.
PSTS, CRT, breakaway, restrictive intervention — frequency, refresher cycle, training register cross-reference.
Immediate management, Datix / IR1, occupational health, TRiM / peer support, criminal-justice referral via police SPOC.
Quarterly review at divisional governance meeting; lessons-learned route into the trust VPR Standard self-assessment update.
Why a risk assessment gets sent back — these are the patterns we see most often.
The legal framework this risk assessment operates inside. Links go to the official source.
1974 c.37
Employer duty under s.2 to staff and s.3 to non-employees affected.
SI 1999/3242
Regulation 3 — the explicit duty to assess work-related violence as a workplace hazard.
NHS VPR Standard (2021)
Contractually mandated standard for NHS providers via the NHS Standard Contract.
2018 c.23
Criminal-justice route for assaults on staff in the course of duty.
1983 c.20
Statutory framework for detention and treatment of patients in mental health crisis; Section 136 covers police-route detention to ED.
HSE sector guidance
Sector-specific guidance on risk assessment, training and reporting.
Yes for NHS providers — it is mandated through the NHS Standard Contract and is reported on annually. Independent hospitals are not directly bound but typically adopt it as good practice and to satisfy CQC's well-led domain.
A dedicated room (sometimes in an ED, sometimes co-located with mental health services) used for the assessment of a patient detained by police under s.136 of the Mental Health Act 1983. The risk assessment must name the suite if one is on site, the alternative pathway if not, and the named mental-health practitioner cover.
The on-shift senior nurse / consultant in coordination with the security team. The assessment should name the decision-making authority and the trust's SPOC with the local police force. Calling the police does not preclude continuing clinical care — the two run in parallel.
Not legally required, but increasingly part of the VPR Standard self-assessment for high-risk departments. Where deployed, the assessment must cover GDPR / UK Data Protection Act 2018 (footage retention, subject access, sharing with police) and staff training on activation criteria.
Annually as a minimum, and after any significant incident (a RIDDOR-reportable injury to staff, a serious untoward incident, a coroner's PFD report), or after any change to the physical environment, staffing model or pathway. The VPR Standard self-assessment update is the natural review trigger.
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