NHS staff regularly face abuse and violence, and work unpaid overtime to keep services running, a survey shows.
Despite unpaid overtime and abuse, staff are fairly satisfied, the survey says
A quarter of staff were abused or harassed by patients in the last year, with 14% being physically attacked, the Healthcare Commission said.
The numbers subjected to any form of abuse rose to 37% when attacks by colleagues were included.
More than half of the 217,000 respondents also said they had worked unpaid overtime.
Some 12% said the extra unpaid hours accounted for more than six hours on average.
The most common reason given for working unpaid overtime was to ensure patients received the best possible care.
However, the staff quizzed, which included doctors, nurses and non-clinical staff, said they were fairly satisfied with their job, with only 9% wanting to leave the NHS.
The findings in these areas were broadly similar to the watchdog's survey last year.
But the survey, which was completed by 60% of NHS staff last autumn, also found more staff were undergoing training and being offered flexible working.
There has also been a decrease in the numbers suffering work-related stress from 39% to 36%.
Healthcare Commission chief executive Anna Walker said she was disappointed no improvements had been made in the danger staff faced.
"It is clear from this survey that NHS staff remain committed to providing good patient care and helping their colleagues.
"Staff are generally satisfied with their work, and there are welcomed increases in the number of staff receiving training and appraisals.
27% have faced harassment or abuse from patients, rising to 37% when attacks from colleagues are included.
55% work unpaid overtime, with 12% clocking up more than six hours a week on average.
93% have received some form of training
83% said their employer had offered them flexible working, with the most common being job sharing, reduced hours and flexi time.
"However, it is worrying that little has changed with regards to the harassment and violence towards NHS staff."
Karen Jennings, head of health at public sector union Unison, said more action was needed to reduce the attacks against staff.
"Although there are no dramatic changes from last year's survey, it's very disturbing to see that the levels of violence and harassment.
"We fully support zero tolerance in NHS trusts, but we would like to see violent offenders prosecuted and facing tougher penalties in the courts. "We need to make it clear that violence against health workers will not be tolerated and offenders will have the book thrown at them."
Health Secretary John Reid admitted improvements were needed, but he also said the positive results should be recognised.
"The Healthcare Commission survey shows that the vast majority of NHS staff are happy at work.
"The government is committed to helping the NHS become an employer of choice and improving working conditions in order to recruit the best staff."
NHS staff figures
Meanwhile, figures released by the Department of Health show the number of staff working in the NHS now tops 1.3m - up 48,000 on last year.
An extra 8,000 doctors, 11,200 more nurses and 3,000 more allied health professionals were recruited last year, according to the annual NHS workforce statistics for England.
In total there are now 117,000 doctors and 397,500 nurses working in the NHS.
However, less than half the NHS workforce is made up of qualified clinical staff. Last year the NHS recruited 2,400 new managers, bringing the total to 37,700.
Shadow Health Secretary Andrew Lansley said the number of administrators had risen at double the rate of doctors and nurses in recent years and three times the rate since Labour came to power.
"The NHS needs more doctors and nurses - it needs less bureaucracy."
And Liberal Democrat health spokesman Paul Burstow added: "We cannot allow so many hardworking NHS staff to face violence and harassment while they try to do their jobs."