Two national guidance products for adoption across all NHS-funded organisations, co-produced with 120+ frontline staff and safety leads
| Outcomes at a glance |
|---|
| • Two national products developed and submitted to NHS England for formal approval: the Safe Working Practices Guidance and the VPR Data Reporting Framework |
| • Tiered reporting model developed, with a mandatory Tier 1 baseline for all organisations and an optional Tier 2 for deeper local insight where capacity allows |
| • Co-designed with more than 20 interviewees, 100+ survey respondents, and an Expert Coproduction Advisory Group through five structured workshops |
| • Outputs designed for adoption across all NHS-funded organisations in England, complementing the 2026/27 Standard NHS Contract |
The challenge
Violence against NHS staff is systemic. In the 2025 NHS Staff Survey, 14.47% of staff reported at least one incident of physical violence from patients, service users, relatives, or other members of the public in the past 12 months, and 25.25% reported harassment, bullying, or abuse. The estimated cost to the NHS in England was £1.36 billion in 2021/22. These harms affect staff wellbeing and retention, increase sickness absence, and reduce productivity, which ultimately compromises patient care.
The impact is not uniform. Findings from the project’s own stakeholder consultation found that 86% of survey respondents agreed that ethnic minority staff are disproportionately affected by work-based violence, and 81% agreed that female staff are more affected. Staff working nights, in unfamiliar settings, or as lone workers face additional risk. Yet organisations across England respond inconsistently, with different definitions, thresholds, and approaches, making it impossible to benchmark harm, identify patterns of inequality, or learn from effective practice.
The work grew from NHS England’s 2023 Agenda for Change non-pay commitments to tackle violence and aggression. The need it addresses is straightforward: better data linked to practical action. Without consistent national definitions and reporting requirements, the NHS cannot benchmark, compare, or systematically reduce the harm done to its people.
Our approach
From November 2025 to April 2026, TPHC was commissioned by NHS England’s Violence Prevention and Reduction (VPR) team to develop two complementary national products: the Safe Working Practices Guidance and the VPR Data Reporting Framework.
Both outputs were developed using evidence and co-design to balance national consistency with local feasibility. We established an Expert Coproduction Advisory Group (ECAG) of people with lived experience, which shaped successive drafts through five structured workshops supported by written feedback and surveys. We conducted more than 20 stakeholder interviews and gathered over 100 survey responses, and worked through national forums including the Violence Reduction Oversight Group, the NHS Staff Council EDI group, and the RCN Health and Safety Committee. This ensured the outputs reflect different settings, roles, and lived experiences, and that the language and expectations are practical for frontline use.
Visible iteration was central to the process. Feedback from stakeholders led to clearer structure and explicit must/should expectations, additional practical tools and role-specific content in the Safe Working Practices Guidance, and clearer definitions, a ‘No data available’ option, and inclusion of all protected characteristics in Tier 1 within the VPR Data Reporting Framework.
The Safe Working Practices Guidance sets out practical, trauma-informed approaches to prevention, de-escalation, and the safe management of clinically related challenging behaviour, with clear expectations for organisational leaders, line managers, patient-facing staff, and supporting teams. The VPR Data Reporting Framework provides recommended definitions, thresholds, and minimum data requirements to standardise what organisations record and how incident data are used, aligned with existing local reporting systems to minimise duplication.
The impact
In partnership with NHS England, TPHC developed a nationally consistent approach to preventing and responding to violence against NHS staff, bringing together a shared data reporting framework and practical, frontline-focused guidance. Developed through extensive co-design with staff, people with lived experience, and national bodies, the approach reflects the realities of frontline environments while embedding equity from the outset.
The VPR Data Reporting Framework supports more consistent and reliable collection of information on violence and abuse across England. Once adopted, it will enable stronger national oversight, meaningful benchmarking, and shared learning between organisations, helping the NHS identify risks earlier and take more targeted action. By ensuring data captures protected characteristics and other vulnerability indicators such as lone working and repeat perpetrators, it enables organisations to understand patterns of inequality and address them directly.
The Safe Working Practices Guidance provides accessible, trauma-informed tools and priority actions for frontline teams, supporting staff to feel safer, more confident, and better supported in managing challenging situations. Earlier identification and intervention are expected to reduce the frequency and severity of incidents for staff, patients, and services. It promotes reasonable adjustments and tailored controls for staff who may face higher risk, including disabled staff, globally mobile staff, internationally recruited staff, and those working in unfamiliar or isolated settings.
Designed with extensive input from frontline staff and system leaders, both outputs balance the need for national consistency with practical applicability, ensuring organisations at different levels of data maturity can adopt and implement the guidance effectively. The final drafts have been submitted to the NHS England VPR team for formal approval ahead of publication, expected later in 2026.
What our clients say
“This is a comprehensive, high-quality piece of work. Both sets of guidance look excellent and go well beyond what we originally envisaged. Overall, this is a really strong output.”
Wazir Muhammad, National Staff Violence Prevention and Reduction Programme Lead, NHS England
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