Emergency departments in the UK are grappling with a significant increase in violence, leaving medical staff shaken and patients at risk, according to an emergency medicine physician.
Professor Rob Galloway described a recent night shift where staff were subjected to severe physical assault, including being punched, kicked, and spat at by a patient. This incident, he noted, occurred in a corridor filled with other patients who were horrified and fearful.
Galloway attributed the escalating violence to two primary factors: a critical shortage of mental health beds and a change in how intoxicated and aggressive individuals are handled. Previously, many such individuals were assessed in police stations by trained doctors. However, a decline in the availability of these specialized doctors means that custody assessments are now often performed by less experienced staff, who tend to err on the side of caution and direct individuals to A&E departments, even for minor issues.
"If we only look at the risk to one individual, and ignore the risk to everyone else, we have not made the system safer. We have simply moved the danger into A&E," Galloway stated.
The lack of adequate mental health provision means patients in severe crisis are occupying A&E beds for extended periods. Galloway emphasized that these patients require a calm, specialized environment, which A&E departments are ill-equipped to provide. "A&E is often a terrible place for them – overstimulating, undignified and completely unsuited to the care many of them need," he wrote.
The NHS Staff Survey, published in March, reported that nearly one in seven of over 766,000 respondents experienced physical violence from a patient or member of the public in the previous year, marking the highest rate in three years.
Galloway recalled specific instances of severe violence, including an A&E doctor being repeatedly stabbed and a nurse suffering life-threatening injuries after being attacked with scissors. He stressed that these are not isolated incidents but contribute to an environment where both staff and patients feel increasingly unsafe.
While Galloway's own department has a robust security team and is implementing measures like metal detectors, he noted that security levels vary significantly across the country. He called on the new Secretary of State for Health, Yvette Cooper, to implement national changes.
His proposed solutions include 24-hour visible security staff in all emergency departments, secure entrances with metal detectors, consultation rooms designed for safety with multiple exits, and accessible panic alarms. He also urged a return to police custody doctors and the establishment of separate, specialized facilities for mental health emergencies.
"England had 23,447 NHS mental health beds in 2010-11. By 2024-25, that had fallen to just under 18,000," Galloway noted, highlighting the drastic reduction in available mental health beds. He concluded that when these systemic failures converge, A&E departments become dangerous environments for everyone involved.