A&E is notoriously one of the most challenging working environments in the NHS. The fast pace and high stakes are often accompanied by high staff turnover, and problems recruiting and retaining staff, often leading to over-reliance on locums.

In an environment like this, it’s crucial for A&E departments to keep up to date with ongoing safeguarding training. But with such a transient workforce it’s often difficult for staff to put what into practice what they’ve learned.

All medical staff are required to complete certain training modules every one to three years—depending on the nature of the training—to maintain their registration. But since May 2025, staff no longer have to repeat mandatory training when they move from one NHS organisation to another.

The compulsory training modules include conflict resolution, fire safety, infection prevention control, data security and safeguarding for adults and children. Safeguarding training is often a combination of e-learning and face-to-face work, and every NHS hospital runs safeguarding programmes that include female genital mutilation (FGM), domestic abuse, the Prevent counter-terrorism duty, domestic homicide reviews, and modern slavery and human trafficking.

Hospitals do their best to make this training topical, relevant and interesting to keep people engaged, says Vijay Patel, head of safeguarding at the Social Care Institute for Excellence (SCIE), and a former NHS trust head of safeguarding. But, with safeguarding, training is only one part of the picture; it’s the “spirit on the job” that’s often more effective, he adds.

Domestic abuse is one of the most prevalent safeguarding issues within A&E, affecting one in five people at some point in their lives.

A&E can be a crucial opportunity to reach a survivor of domestic abuse, because it may be one of the rare occasions they are in front of professionals who can help without the perpetrator being present, explains Carrie Bower, practice development consultant trainer at SCIE.

To spot signs of domestic abuse, staff need the space and time to observe the behaviour of the patient and the people accompanying them, and the know-how to create the right setting for the patient to feel safe enough to disclose that they’re being abused, she says.

But, of course, three things most A&E departments lack are space, privacy and time. “You’ve got to strike while the iron is hot – but make the environment safe,” Patel says. This often means having the confidence to think outside the box and find “creative” solutions and ways to speak to the patient alone. Good leadership helps, he adds, especially a supportive safeguarding lead who encourages staff to be curious rather than worrying about being blamed.  

“In the NHS you’re trained to follow processes, and in many cases they work, but not for all, and domestic abuse is especially challenging,” Patel says. Many staff think they need specialist training to handle this, but often skills can be readily transferred from other roles: “It’s the same skillset – being a detective, being curious and communicating well,” he explains.

In an environment like A&E, it’s also important to quickly build a sense of trust with the patient. “It doesn’t have to be physical space—it can be look, feeling or touch, something that tells that person you’re safe,” says Bower. “There are subtle ways of doing it, even in a busy corridor,” she says.

“Some professionals are good at this and some aren’t, some have learnt and some can be taught,” adds Patel. “So it’s good to have role models, to see how other people do it.”

Some experienced staff will also be aware that having these conversations with patients can open up a Pandora’s Box. “Sometimes, the more knowledge staff have, particularly in relation to domestic abuse, the more reluctant they are to ask, because disclosure may increase risk, if there aren’t any specialist services available,” Bower explains. “Many specialist services are funded around particular demographics, with very few services for men and older adults,” she adds.

Most hospitals have “brilliant” safeguarding teams that A&E staff can contact, but they’re often overstretched, says Patel. This is where Independent Domestic Violence Advisors (IDVAs) can help.

Healthcare IDVAs work with some community, hospital and midwifery services. Research shows their presence in hospitals encourages more survivors to ask staff for help. They know and are well connected to local domestic abuse services—important for helping survivors make an informed decision and have confidence in the response. Despite this, IDVAs are thin on the ground in the NHS—a 2021 Safer Lives survey found that only one in ten services had an IDVA based in a healthcare setting.

IDVAs based in hospitals can be particularly helpful in identifying older victims of domestic abuse in A&E departments, Bower adds. “Particularly in later life, someone could have been controlled for a long time by a perpetrator who becomes unwell and needs care and support.

“The power dynamic changes and control can actually intensify as the perpetrator feels they are losing control through their own ill-health”, she adds.

NICE guidelines specify that medical staff should check patients feel safe at home—but mostly in higher risk settings, such as antenatal and postnatal appointments. But Bower argues that practitioners should be reaching out to everyone routinely and asking this—including older people. “There’s a magic age where routine enquiries about domestic abuse start to drop off,” she warns.

A&E also presents a good opportunity for staff to identity young people who are victims of violence. “In major trauma centres, there’s a unique moment where the young person is reachable,” says Sam Sweeney, who manages the ’Redthread’ youth support service for national charity Catch 22. “This is a good opportunity to meet them in that moment of vulnerability, make sure they’re okay and build a relationship with a view to [providing] support post-discharge in the community.”

Redthread delivers training across many trauma and A&E hospitals in London—as well as one in the north of England—supporting young people who are victims of violence, and helping to drive changes within NHS trusts. Redthread training covers various safeguarding issues, including ‘adultification’ and challenging the unconscious bias towards young men. One of its aims is to challenge the assumptions about young people affected by violence and exploitation.

High staff turnover in A&E departments “is a big challenge for us,” says Sweeney. “They often have new influxes of new trainee doctors and nurses, so we will target that group.” This means being proactive with their presence in the hospitals, including joining morning huddles to introduce Redthread’s advisers to new staff.

“Where we have high turnover, it’s about having a good relationships with key clinicians who can advocate for us and champion us. We see real success where they put us at the top of the agenda,” Sweeney says.

But visibility—and ‘easy’ referral routes—only go so far. Identifying young people who are victim to or at serious risk of violence requires professional curiosity, Sweeney says. “This means looking for what might be going on behind the medical presentation. Our training includes adolescent trauma, which helps clinicians to understand how trauma might affect young people’s communication, behaviour and willingness to accept support.” to come. //