Data and Intelligence can be boring! Most people will not have read this far after reading the title as most of us (particularly us frontline clinicians) are ‘doing people’ who are inspired to respond to the issue of interpersonal violence from direct experience with patients, and who want to not only treat the acute physical and psychological problems but also have options with primary and secondary prevention at our disposal.
So, I will try here to answer the question: Do tables, graphs and dashboards really help us respond to violence?
In short – yes! Understanding current NHS activity following violent incidents is a vital step in the system knowledge of the quantity and severity of the issue to populations and services, and therefore the designing, commissioning, targeting and effectiveness of violence prevention programmes. We have looked at the various sources of relevant data across different parts of the NHS to see what is reliable and accessible for people who want to make use of it.
Different parts of the NHS – primary care, school nurses, sexual health services – all record lots of relevant information, but it’s rarely collected in a way that allows it to be brought together and analysed. The organisations which have the most usable data at the present are the ambulance services and emergency / urgent care providers.
It’s thought that over 60% of violent incidents are never reported to the police (Sutherland et al, 2002), so a small dataset called Information-Sharing to Tackle Violence (ISTV) was developed in Cardiff in the 1990s to allow the NHS to help the police in pinpointing hotspots for violence.
This kind of data, which consists of the time and place of the incident and the weapon used, is now collected by Emergency Departments across the NHS and shared with Community Safety Partnerships, which are made up of representatives from the Police, Local Authorities, fire and rescue authorities, health and probation services. Community Safety Partnerships can then use the information for practical purposes, for example, improving youth service provision, street lighting/cameras, licensing or increasing police presence in specific areas.
In London, data is sent from Emergency and Urgent Care providers to the Greater London Authority, who bring it together with information from the Metropolitan Police, British Transport Police and London Ambulance Service to give a broad picture of what is happening across the capital. In a large urban area aggregating data from 28 EDs for 32 local authorities is the approach taken through our regional partners.
We rely on Emergency Department (ED) staff to collect as much detail as possible about the location of an incident. I know it’s not easy. There’s a lot of pressure, very little time and IT systems may not be set up in the most supportive way. Vicki Golden, a Senior Sister at Whittington ED, has been appointed as a Darzi Fellow (an NHS clinical leadership programme) to the workstream and she will be working with key staff in EDs across London to improve ISTV data collection and submission over the next year.
In early 2023, the NHS will be required to work with the police, local authorities and other agencies as part of a new legal duty to prevent and reduce serious violence. The duty includes sharing relevant data and information and using it to monitor the impact of local strategies. Over the next few months, we’ll be working with the Integrated Care Boards (ICBs) in London to ensure they have access to the information they will need to comply with the duty.
We also want to support research by directing anyone interested in risk or protective factors, or any other specific aspects of interpersonal violence – we probably know where you can find the bits of data you might need and we should be able to support with the insight gained in the last 3 years.
Adam Woodgate is the Clinical Lead for the London Violence Reduction Programme, Consultant in Emergency Medicine and Clinical Lead Adult Emergency Department (ED) at the Royal London Hospital and Consultant with Physician Response Unit (London’s Air Ambulance).