A watchdog has warned that NHS staff in Wales are still not reporting attacks and abuse in the workplace four years after the problem was highlighted.
The Welsh Audit Office says reporting remains an "unresolved concern" with the full extent of the problem hidden.
In 2005, concerns were raised that staff were not coming forward, partly because some simply accepted it as part of the job and also due to the length of forms which had be completed.
The watchdog said: "Under-reporting is still a problem, with staff continuing to be reluctant to report all incidents of violence and aggression."
Pressure at work, a lack of support from managers and acceptance of verbal abuse in the workplace were often blamed by staff who kept quiet.
Staff who need to restrain people physically require more guidance and training, according to the report, which also says health bodies must act faster when staff need support after attacks.
In an attempt to reverse the low numbers of prosecutions, a memorandum of understanding has been reached between the Assembly Government and Crown Prosecution Service
Auditor General Jeremy Colman said: "Further steps need to be taken and, with under-reporting still a problem, the full extent of violent incidents is not yet known."
Copyright © Press Association 2009
Your comments (terms and conditions apply):
"This appears to be an issue in many hospitals, not just in Wales. In my experience as a hospital executive and a magistrate, staff do not come forward because they feel they the system is too bureaucratic, they are afraid of repercussions and the legal process is too daunting. I have encouraged staff to come forward but they need some clear messages of support from inside the NHS and the courts" – Name and address withheld