Nurses and other health service workers, particularly those in front line services such as casualty departments, face a constant threat of violence.

Criticised for being too slow to react to their concerns, hospitals and the government are now making efforts to counter the danger.

The problem was highlighted in August last year when four nurses were attacked at West Middlesex Hospital, London, prompting protests calling for more security.

Staff demanded round-the-clock security guards in A&E and around the hospital site.

The threat to GPs is also now being understood and a secure surgery has been opened in a police station in Southampton.

Zero tolerance

The Department of Health has launched a zero tolerance campaign to combat violence against NHS staff.

The initiative is backed by the Lord Chancellor who has asked magistrates to take a firm line with people who attack health workers.

Posters have gone up in hospitals and GP surgeries showing the types of weapons used against staff - including knives, bottles and syringes - and urging the public not to stand by when attacks happen.

Launching the campaign in October last year, health minister John Denham said: "It is unacceptable that caring NHS staff can be rewarded with intimidation and violence.

"The cost of violence against staff is great. Victims can suffer physical and psychological pain. Confidence can be irrevocably dented and stress levels rise."

'One-in-two assaulted'

A Royal College of Nursing survey showed one-in-two nurses had been subjected to physical violence or serious verbal assault during their careers.

Hospital trusts are now obliged to record the numbers of attacks on staff, improve reporting methods to help police catch offenders and reduce violence by 30% by 2003.

Accident and emergency departments are being redesigned to make them safer for staff and hospitals are being encouraged to install better lighting and closed circuit television (CCTV) cameras and hire security guards.

University College Hospital, London, is one hospital leading the way - at least two security guards are on duty round-the-clock in A&E, CCTV has been fitted and staff have been issued with personal attack alarms.