I have just finished a night shift in A&E – and am writing this now still feeling sick about what I saw.

Not because the night was filled with cardiac arrests, dying patients or terrified families. After 25 years in emergency medicine, I have seen all that many times before and I’ve learned to accept it as part of a job.

But I am shocked and sickened because I saw staff being punched in the face, kicked and spat at in one of the most frightening and ferocious assaults I’ve ever witnessed from a patient.

And it happened in a corridor full of patients horrified by what they saw, many lying on trolleys and unable simply to move away from the violence and fearful they, too, would be hurt.

Worse still, the patient who attacked our staff should never have been in our department in the first place; he was only there because he was waiting for a mental health bed.

Hospitals are supposed to be places of safety, not places where frightened patients watch staff being attacked and who are themselves at risk.

Yet violence in A&E is happening in hospitals up and down the country. It’s a national crisis that needs to be addressed urgently – but I fear it will take the awful death of a medical professional or a patient before the powers-that-be wake up to this.

And this could happen sooner rather than later unless something changes.

Violence in A&E is not new. But the violence now feels worse and the risks greater than ever before.

There are two reasons for this: a lack of mental health beds; and because the violence from drugged and intoxicated patients that used to be managed in police stations now seems to be managed much more frequently in A&E departments.

The true scale of the problem remains hidden – for while hospital trusts record large numbers of incidents of verbal abuse, threats and violence towards staff every year, many staff do not formally report what happens to them.

But have a look at the latest annual anonymous NHS Staff Survey, published in March, for a true picture of the shocking state we’re in.

More than 766,000 staff responded, with almost one in seven reporting they had experienced physical violence from a patient or member of the public during the previous year, the highest rate for three years.

One difference is what happens to people who are intoxicated with drugs or alcohol but also showing threatening behaviour.

Of course, if they have a medical problem they need to be in A&E. But that is very different from what happens so often, and the police having to bring someone to A&E ‘for observations’ simply because they are intoxicated, violent and aggressive.

In the past, many detainees were assessed in police stations by doctors – usually GPs with specialist training. They could treat minor injuries, decide whether someone was safe to remain in custody, or send them, escorted by police, to hospital if they genuinely needed it. That decision balanced the needs of the individual with the safety of NHS staff and the wider public.

That system has changed. Fewer GPs are employed to do this work – experienced doctors cost more than the other clinicians increasingly being used instead.

As a result, custody assessments are now often carried out by less experienced staff, including nurses, who may not have the same training, experience or authority to make complex judgments about whether a detainee can safely remain in custody.

Understandably, they err on the side of caution and send them to hospital. Someone who is intoxicated and violent and has only a minor wound might previously have been treated or monitored in custody. Now, they are more likely to end up with us in A&E.

I understand why. No one wants someone to become ill in a cell.

But if we only look at the risk to one individual, and ignore the risk to everyone else, we have not made the system safer. We have simply moved the danger into A&E.

The second issue affecting the safety of our A&E departments is the increasingly obvious inadequacy of mental health provision.

Patients in severe mental health crisis are staying for days and days in A&E because of a lack of mental health assessment suites or inpatient beds. They arrive in an already overcrowded department, often distressed, intoxicated or agitated, and may wait hours for a specialist mental health assessment.

This is not an attack on people with mental illness or the crucial importance of caring for them.

In most circumstances, very few of these patients are violent. But they need a calm, specialist environment. A&E is often a terrible place for them – overstimulating, undignified and completely unsuited to the care many of them need.

But being compassionate cannot mean pretending there is no risk of violence.

Three months ago, an A&E doctor in his 50s at Hillingdon Hospital in west London was stabbed several times. A 27-year-old man has since been charged with causing grievous bodily harm with intent, possessing an offensive weapon and stealing knives.

And in January last year, a nurse at the Royal Oldham Hospital was repeatedly stabbed with scissors by a patient who had been admitted for a mental health assessment. She suffered life-threatening injuries, required emergency surgery and spent the night in intensive care.

Every doctor and nurse who read that story will have had the same thought: that could have been me or one of my colleagues – or one of my patients.

These are not just ‘incidents’ to be reviewed at a hospital committee some weeks later. They change how staff feel when they come to work. They also change how safe patients feel when they are waiting to be seen.

After the episode I described at the beginning of this article, the corridor fell silent. Patients, some of them elderly and frail, lay on trolleys staring at us, visibly shocked. You could see the fear on their faces – one violent patient had traumatised an entire corridor.

But I am lucky where I work. We have an excellent 24-hour security team and the violent patient was swiftly removed.

We are also bringing in metal detectors to use on patients on entry and so alert security staff if anyone has anything suspicious on them.

Without that, I would feel very exposed. I am a 5ft 8in wimp without this sort of security behind me. Even with them there, I may still be frightened at times, and I was on this last shift – but at least I know there were people who understand the risks and know how to step in and protect me.

Many hospitals employ dedicated A&E security teams, but the level of round-the-clock cover, training and immediate availability varies considerably across the country.

So I’m asking our new Secretary of State for Health, Yvette Cooper, to make the changes we need.

All emergency departments must have visible security staff 24 hours a day: we need secure entrances with metal detectors to ensure people can’t just wander into the department, let alone wander in with a weapon.

We need consultation rooms with two exits so no one can be cornered, easily accessible panic alarms and furniture that cannot be used as a weapon.

To help reduce numbers of violent people in A&E, we need to bring back police custody doctors.

We also need proper emergency mental health facilities, separate from A&E departments, where people in crisis can be assessed and treated in an environment designed for their needs.

And this has been said before – we need enough mental health beds. England had 23,447 NHS mental health beds in 2010-11. By 2024-25, that had fallen to just under 18,000.

When all these failures collide, A&E becomes a violent and frightening place, not just for staff but for the patients who come to us expecting safety.