Violence in one form or another is rarely out of newspaper headlines or our social media feeds. We have all become used to seeing a school photo staring back at us – ‘Cut short’ reads the headline, or ‘Stabbed on his way to school.’ That smiling photo of a boy in his uniform becomes a moment frozen in time that friends or family will never be able to recover from.

The homicide rate is 1 per 100,000 in the UK. Every murder is too many. They fracture communities, devastate loved ones and inevitably lead to further trauma, a ripple effect emanating from the first terrible incident.

The NHS has realised, thanks to the work of colleagues in places such as Boston, California, and Glasgow, that strong partnership working between services is a key component of what makes a violence reduction approach effective. By working with other key sectors we can devise collaborative working processes to allocate resources and support where needed. Most importantly, by engaging with young people, their families, and the communities they live in, we can move beyond the health service being there to merely dress wounds and become an institution that can stop the wounds from happening in the first place.

We have been piloting hospital-based violence reduction models with a public health-based approach for the last five years. Understanding risk factors that can lead to violence exposure; developing effective interventions that address unmet needs; and becoming better advocates for young people. Together, we can eliminate drivers for violence in our communities. Evaluation over the last five years has been promising, in some cases, we have more than halved the likelihood of a young person sustaining violent injuries in future.

Working with experts and those with lived experience, we have produced The In-Hospital Violence Reduction Guide.
Intended for health care professionals and partners in local authorities and third sector organisations, the guide is of particular relevance to:

• medical and nursing professionals working in emergency care or trauma settings
• those working with vulnerable and at-risk young people.

The guide provides:

• background information on the public health approach to violence reduction
• an understanding of In Hospital Violence Reduction Programmes; and
• key recommendations to support violence reduction service implementation.

Using many of the methods outlined in the In Hospital Guide, The Royal London Hospital has seen a reduction in the number of young people returning to the hospital with further injuries from 25% to less than 7% over a six-year period, the longest observed period so far recorded. Further evidence of the programme’s success is available within the guide.

Our hospitals can’t just be places that receive traumatised young people, fixing them up and then sending them back out into the world that hurt them in the first place. We must become a true place of safety, a place that understands the needs of our community and become a beacon of hope for those affected by serious violence.

Violence reduction has been a public health priority for the World Health Organisation (WHO) since it first published guidance on the public health approach to violence reduction in 1996. Now we aim to make it a priority within our NHS and care sectors, and I hope you will want to join us.

The Violence Reduction Programme aims to make reducing serious violence a priority for health and care services in London and this really useful guide, I believe, will go some way to achieving that aim.

Download the In-Hospital Guide and find out more about The Violence Reduction Programme London.

Michael Carver
Clinical Lead for Hospital-based Violence Reduction Models – NHS London
Trauma Research Fellow –The Centre for Trauma Sciences – QMUL/The Royal London Hospital