Physical violence and verbal abuse against NHS staff rose by a fifth in 12 months, according to a study published today.
Hospital trusts are recording more than 500 incidents a year despite increased security measures, including closed circuit television and more security guards.
The journal Health Service Report said only a fifth of trusts it surveyed believed they would meet government targets for a 20% reduction in workplace violence between 1998 and April this year. A third expected to hit the 30% fall by April 2003.
The study's author, Adam Geldman, accepted that staff were encouraged far more than they once were to report incidents, but insisted: "This is a shocking finding. There is no doubt that many frontline NHS staff continue to face a serious risk of being physically assaulted and/or seriously verbally abused while serving the public."
Mr Geldman said his survey of 45 trusts suggested that reported cases had risen from an average of 419 in 1999 to 511 last year.
However, the rise in attacks might be because hospitals were encouraging staff to report complaints more.
One trust said that complaints about violence had quadrupled since it revised its reporting procedures.
The present levels of violence were "a blight on the NHS", said Mr Geldman, although there was strong evidence that many trusts were now responding to government calls to stamp it out.
Carol Bannister, occupational health adviser with the Royal College of Nursing, said: "At least trusts have begun to take some action, although it is also clear that targets, particularly for this year, are not going to be met.
"I am not sure we have seen enough cases of trusts taking serious assaults to court or passing them on to the police."
A government study in 1998 estimated that there were 65,000 violent incidents every year against NHS staff and the Department of Health is to reassess the size of the problem.
It has also warned patients in its new public guide to the NHS that it will not tolerate violence or racial, sexual and verbal harassment from patients or relatives.
An advertising campaign by the London ambulance service warns that people convicted of attacking staff will face imprisonment.
However, a spokeswoman for the Department of Health said that Mr Geldman's survey was quite small and some trusts had managed "huge reductions".
She argued that it was unfair to compare individual trusts' performance against national targets. "We take violence against NHS staff extremely seriously," she added.
