Work-related violence, harassment, and aggression (VHA) is a common issue impacting healthcare workers across the health and social care sector. Due to the nature of these services, certain categories of healthcare workers are at increased risk of exposure to VHA incidents. These events can lead to a range of outcomes, from short-term mild effects to long-term effects, severe physical and psychological harm.

Beyond their personal impact on staff, VHA incidents can have organisational consequences, including increased absenteeism, reduced staff morale, and diminished quality of care and service delivery. Additionally, such incidents may give rise to claims, which carry financial implications through both direct and indirect costs. However, with targeted interventions and proactive risk management, the likelihood and impact of these claims can be significantly reduced.

Violence, harassment and aggression (VHA) - a snapshot across the health and social care sector

In line with its risk management mandate to share learning from incidents and claims with State authorities, the State Claims Agency’s Enterprise Risk Management Unit has examined work-related VHA claims and incidents, managed under the General Indemnity Scheme, during the period 2019 – 2023, across the health and social care sector.^*

Key data during the period 2015 – 2019 across the health and social care sector

• Claim volume: 381 VHA claims were received arising from incidents which occurred between 2019-2023 (on average, 76 claims are received annually).
• Claim’ cost: The cost of a VHA claim ranged between €255 and €143,000. This includes damages, legal costs and expert costs. The median cost of a VHA claim was €32,000, and the median damages were €27,000.
• Location: The majority (66%) of VHA claims were received from the community sector, mainly within disability and mental health services. 27% of VHA claims were received from the acute hospital sector.
• Incident type: Incidents and claims mainly related to physical assaults/harassment.
• Injury type: The primary injuries resulting from VHA incidents and claims were soft tissue injuries, pain/discomfort, and cut/laceration/graze/scratch.
• Injured party: Claims were primarily taken by healthcare assistants (33%), nurses/midwives (21%) and psychiatric healthcare workers (11%). Incidents involving healthcare assistants account for 19% of reported incidents, suggesting a level of underreporting by this category of person.
• Age: In 65% of VHA incidents, the injured parties were under 45 years of age. Considering the age profile of the workforce, it can be concluded that younger healthcare workers were more at risk of VHA.
• Incident review: Less than 1% of VHA incidents had reviews completed on NIMS, the National Incident Management System, in accordance with the HSE’s Incident Management Framework.

Key learnings and recommendations for the health and social care sector to mitigate VHA risks

1. Incidents and claims activity is more prevalent in the community and voluntary community sector. The majority of VHA claims and incidents are concentrated in the community sector, with highest activity observed in the disability and mental health sectors. Given this distribution, risk management programmes that specifically target the community sector are likely to have the greatest impact in reducing both the frequency and severity of VHA incidents and associated claims.
2. Specific groups of healthcare workers are at a higher risk of experiencing VHA in the workplace. VHA claims and incidents predominantly involve healthcare assistants, nurses/midwives, and psychiatric nurses. Health and social care services should consider all healthcare worker groups at risk of VHA when conducting risk assessments and developing care plans. This includes not only clinical staff but also other care staff such as healthcare assistants, agency staff, temporary workers, contractors, and work placement students.
3. Physical assaults are the most frequently reported type of incident and the most common basis for claims. Specific training must be implemented to help staff exposed to VHA incidents in the workplace. This training should include information on recognising warning signs and using de-escalation techniques. Based on a risk assessment, using the Work Positive CI (WPCI) framework, healthcare workers should receive support through employee assistance programmes and critical incident support programmes, as appropriate.
4. While the culture of incident reporting is improving, there is room to strengthen the review of incidents to align with national policy. While the incident reporting culture remains strong, most incidents reported are not formally reviewed in line with the HSE’s Incident Management Framework, and lessons learned are not consistently captured on NIMS. There is an opportunity for the HSE and health and social care services to strengthen incident review practices and ensure they are practical and appropriate for reviews associated with healthcare worker incidents.
5. While NIMS remains a crucial data source, challenges remain in ensuring data accuracy and capturing lessons learned. The current NIMS Healthcare Incident Review Screen requires an update to support more effective reviews of incidents involving healthcare workers. This may involve tailoring of the review screen to better capture contributing factors and outcomes specific to healthcare worker-related incidents. Enhancing this functionality would improve the quality of reviews and support more meaningful learning from healthcare worker incidents.

If you are a State authority in the health and social care sector and require further assistance or support, or would like to request a copy of the report, please contact our Enterprise Risk Management Unit at stateclaims@ntma.ie.

*Note: Health and social care sector in this report includes the Health Services Executive (HSE) (acute, community and emergency services) and agencies funded under Section 38 of the Health Act 2004.