This puts a question to the claim that NHS could be a safe place to work. Although National Audit Office data can be claimed to be authentic, it should be noted that there may be considerable and persistent under-reporting, even up to the extent of 39%. There are no standards of reporting, and hence there would be wide variations in underreporting (White, 2003) and hence wrong estimation of the problem.
In order to tackle the violence against NHS staff, consequently, there would be need for clear-cut delineation of the problem, which would indicate the incidence, prevalence, situations, and solutions (Cole, 2003). A significant violence has been defined by the Health and Safety executive to be an incident of assault to the staff that results into the staff being off work for more than three days. Although in 2002, the campaign of zero tolerance resulted in reduction of such incidents by 20% only in five trusts; the target now is a 30% reduction from the previous value. In contrast, the reports suggest higher incidence rates, and some of this rise has been ascribed to better reporting and heightened awareness. However, it has been also contended that higher workload of nurses, greater expectations of the patients and families, accentuated frustrations for prolonged waiting times, and acute intentions to express themselves on the parts of the patients may also be involved in higher violent assault rates to the staff, which in some cases now are even 31 assaults per 1000 staff per month with fingers being pointed at mental health and Accident and Emergency (White, 2003).
In order to have a structured approach to tackle the problem of violence against NHS staff, the need of the hour is a methodological approach to understand the problem, and grounded on that, management strategies can be taken up to reduce such incidences. The first step thus would be to know all the facets of the problem and to study the cause and effect relationships. For example, it has been reported that in the Accident and Emergency most of the incidences of violent assaults are related to drug and alcohol (Vanderslott, 1998). Therefore, this is a risk factor in that work scenario. A risk assessment and management approach and policy to reduce such violent events would thus appear plausible. This is not enough since the contents of such assessments have been reported to be extremely variable. Staff and security personnel need to be trained, but the assessment of training needs becomes a difficult issue due to this variability, despite the fact that the quality of delivery is extremely important for the service providers. For many personnel such as doctors and other ancillary staff training is difficult for paucity of time and resources. Lastly, the standards of identification and recording of the events need to be improved along with the attitude of the staff towards violence, who should not take violence as a necessary evil related to the type of work they do. This may lead to the desired situation of clear unambiguous