James Hill
Head of Nursing for Emergency and Acute Medicine
Guy's and St Thomas' NHS Foundation Trust
Westminster Bridge Road
London SE1 7EH

Copies to: Violence and Aggression Working Group in ED at GSTT

Violence against staff in A&E: We Need Dates for Implementation and Who is Responsible

Dear James,

We are the nursing and clinical staff of the Emergency Department, writing together and with the support of our RCN representatives. Violence, aggression and abuse are now part of our ordinary working day. They should not be. What was once regarded as exceptional has become routine, leaving staff feeling unsafe, undervalued and increasingly unable to provide the standard of care our patients deserve.

How we got here

On 15 June 2026, about 25 of us met to talk about what is happening in the department. Colleague after colleague described being sworn at, threatened, spat at or struck, in many cases almost every shift. Several said they were close to breaking point. What came through most strongly was not the violence itself but the years of raising it and seeing nothing change.

We agreed at that meeting to stop raising it one by one and to raise it together. We elected six colleagues to lead this work on our behalf, headed by John Moroney. Following the meeting, an RCN Rep also asked the Trust for its own figures on violence and aggression in the department, and we were collecting written accounts from members of what has happened to them at work.

Since then, there have been useful talks with senior colleagues, the last being:

• 16 September 2026. We discussed setting up a working group on the £2m A&E redesign and other matters.

The Trust has also written to staff setting out its position, and the BBC has since reported on the problem (read the BBC report). The issue is now public.

Where we are now

We welcome the engagement that has taken place and the commitments that have been made. Several of the measures discussed would make a meaningful difference to staff safety. However, discussions do not reduce violence and commitments alone do not make staff safer. What staff need now is clarity about what will happen, who will deliver it, and when.

Without dates and names, colleagues read these promises as good intentions rather than as changes they will see on their next shift. Please close that gap.

We ask you to act now on the following.

1. Body-worn cameras. Ensure that frontline nursing staff have immediate access to functioning body-worn cameras whenever required. Confirm how devices will be maintained, replaced and supported in practice. We note that 20 cameras have been obtained and distributed to senior staff; however, it is our colleagues who work frontline with patients who are most at risk from Violence and Aggression.
2. Security staff. Put more security staff in A&E. These must be extra posts, not staff moved from somewhere else in the Trust.
3. Name badges. Take surnames off our ID badges. Patients use them to find us, and to target us.
4. Zero tolerance. Enforce the policy you already have. That means:
   • Real consequences for people who assault or abuse staff.
   • Follow-up on every reported incident, every time.
   • Telling us what you did about it.
   • Training managers and security staff to apply the policy the same way.
5. Final warnings. Set up a clear final-warning process for verbally abusive patients. Verbal aggression can escalate into violence.
6. What happens after an incident. We need a process we can trust:
   • A simpler, quicker way to report violence, with every report read and acted on promptly.
   • A personal acknowledgement from a senior manager after every incident, spoken directly to the member of staff involved.
   • An offer of support, a debrief and wellbeing help for anyone who suffers or witnesses violence — offered, not waited for.
7. Rewriting the policy. Include clinical staff and our representatives in the review of the Violence at Work policy, before it is finalised, so that frontline nurses and RCN reps shape what it says.
8. Filming. Strengthen the policy on filming and recording. Put up clear signs, enforce them, and step in at once when someone films a member of staff who has not agreed to it.
9. A published plan. Give us an action plan with dates, named leads, and set points at which we can take part and give our views.

We are writing because we want to continue providing excellent care and to do so safely. Violence and aggression should not be accepted as part of working in A&E, and staff should not have to choose between their own safety and caring for patients.

We believe meaningful progress is possible and that several of the measures outlined above could be implemented quickly. The issue is no longer identifying the problem, nor agreeing that action is needed. The issue is delivery.

Staff have heard many of these commitments before. What will rebuild confidence now is not further promises, but a clear plan for implementation, with named leads, timescales and regular updates on progress. Without dates and names, colleagues will continue to see these commitments as good intentions rather than changes they will experience on their next shift.

While our immediate concern is the safety of staff working in A&E, we believe this work could provide a model for tackling violence and aggression across the Trust. We hope the actions taken here can demonstrate how meaningful partnership between staff, trade union representatives and management can deliver safer workplaces throughout GSTT.

For many staff, confidence will be rebuilt only when they see tangible improvements in their working environment and greater protection from violence and aggression. That is why we are asking for dates, names and delivery.

Yours sincerely,

For the nursing and clinical staff of the Emergency Department, Guy's and St Thomas' NHS Foundation Trust, supported by John Moroney, RCN steward and health and safety representative.