FEAR of attack is a hidden culture in the NHS, where caring staff suffer in silence at the hands of the patients they try to help. Many incidents go unreported.

A VICIOUS attack on staff nurse Paul Tubby, came like a bolt of the blue.

One moment he was helping a patient back to her hospital bed, the next she was screaming torrents of abuse and raining blows on his slight frame.

"She was much bigger than me," said Paul today as he recalled the incident a year ago – just one of a shocking eight attacks in his 12-year career. He has also seen countless patients attack colleagues, sometimes by trying to strangle them.

Paul was working an extra shift when the patient, aged about 30, turned violent.

He said: "I'm not sure what was wrong with her but she had suffered some kind of life crisis and had psychiatric tendencies. She had been behaving bizarrely, shouting inappropriately, so she had been moved to a side room for her own privacy and dignity.

"She had walked out into the ward several times, where she would stand and stare at you. I said 'would you like to go back to your room for a cup of tea?' and she turned and walked off.

"But she went to the other end of the ward where there was a bay of six other patients, full of visiting relatives. She started displaying inappropriate behaviour again, so I immediately went after her with a colleague. We tried to persuade her to come back.

"I turned to one side so I didn't invade her space, and a uniformed policeman who was sitting with another patient, caught my eye. As that happened, she punched me in the back, and hit me on the back of my head several times.

"I span round and she punched me in the face, scratched my nose. I was able to step back and grab her arm.

"The policeman grabbed her other arm and she kicked out. We physically propelled her into the side room using our shoulders against hers. She was shouting obscenities all the time, and calling us rapists. A doctor was called, and for her own safety she was sedated, and she calmed down after the assault.

"The whole incident lasted about 20 minutes. The attack on me lasted ten to 15 seconds, and in that time, I'm told by colleagues I was hit seven to ten times. It was full-on aggression.

"I was left with a blinding headache, scratched nose, bruised head and shin and had to be checked at A&E for infections like HIV. The other staff were mostly junior or agency nurses, and it was traumatising for them too."

The case was investigated by the police, but the patient was never prosecuted because her intention could not be proved, due to her medical state. It was not the first attack on Paul, and he suspects it won't be the last.

He said: "I've also been head-butted several times, had equipment thrown at me, been badly scratched – and I've seen it happen to others many, many times. I've also heard of patients trying to strangle nurses by pinning them up against a wall with their hands round their necks.

"It leaves you shaken and upset, looking out for signs of aggression in patients, but you go on to give them all the best quality of care."

He said: "The general public's perception is that violence happens in A&E, when young lads are drunk or on drugs. The reality is that most attacks happen in A&E, but there are also confused elderly people who think you are trying to burgle their house who lash out.

"Many don't even realise what they are doing, and it can be completely out of character. Their relatives tell them later, and they are so apologetic.

"You have to rate it differently when the person's medical condition is the cause, and common sense will hopefully prevail, but if people are deliberately kicking off at doctors and nurses because they are an easy target, they will be prosecuted.

"People also see Casualty on television every week, and think violence is normal. They think nothing is going to happen to them if they do it too.

"We do appreciate the frustrations of people in a queue, or who have had a long wait. Some may feel they are not being looked after because they haven't been seen by a doctor yet, but the doctor may have 90 other people to see first. Somebody has to be first, and somebody has to be last - but nobody should have to be subjected to abuse."

Although the official rate of incidents at Ipswich Hospital is 200 a year, Paul, who is also a UNISON chairman and union convenor, said: "That's conservative. You can add another nought to the end to get the true figure.

"A snapshot survey last year showed 60 incidents in one month, between A&E and the Medical Assessment Unit – much more than had been previously thought. The majority were verbal assaults. There is also a growing tendency for female patients to be violent."

But many go unreported, and Paul said: "It's like domestic violence – a hidden culture where people don't speak up for fear they won't be believed, or just accept violence as part of their job."

Hospital management supported Paul and offered counselling, and he urged anyone in the same situation to report it.

He said: "Every instance where a member of staff feels intimidated, should be reported, whether it's by patients, their relatives, or other members of staff.

"We should not have to put up with any form of abuse."

Paul added: "But Ipswich Hospital is not full of violence. There are incidences, but people are not running amok. The general public can come here and feel safe. To my knowledge, there has never been a member of the public assaulted here."