As well as hosting some truly excellent colleagues speaking about their experiences delivering hospital-based violence reduction with a national focus, it was a great opportunity for like-minded professionals to meet and share knowledge and experience. There was also some spirited discussion that sparked reflection on how to include the community perspective of hospital-based provision.
Trauma Care was the first opportunity for some of us to meet in person, having built professional relationships remotely due to the pandemic. There was excellent turnout and engagement from colleagues across the UK, and we hope that this programme will become a staple of Trauma Care in years to come.
Martin Griffiths opened the conference by talking about the future direction of violence reduction in the NHS. On reflection of VR delivery over the last few years, we have learned that violence is driven by social determinants, that violence against women and girls is the most prevalent form of violence in the UK, and that some of our institutional design creates obstacles for those who need to access support most.
To improve the NHS service offer, Martin argues it is time to reframe the approach: to Realise the impact of trauma and paths for recovery; to Recognise signs and symptoms of trauma in clients, families, colleagues, and others involve in the system; to Respond by integrating our knowledge about trauma into policies, procedures, and practice; and to actively Resist re-traumatizing people. The NHS Violence Reduction Programme London has multiple workstreams, each playing a role in changing the understanding of violence, creating opportunities, building expertise in clinical staff, and championing principles of multiagency working which will form a foundation of future NHS strategy.
Luke Billingham and Keir Irwin Rogers introduced concepts that they explored in their new book published by Bristol University Press – Against Youth Violence. Keir underscored the prevalence of violence in modern UK society, especially drawing attention to an increase in offences involving the use of knives while other violent crime has been on a decline since the mid-90s. This violence tends to be concentrated in the most deprived boroughs, and most deprived wards within these boroughs.
Luke talked about violence generators in the UK and spoke about the four R’s – entwined inequalities of Resource, Recognition, Risk and (state) Retribution. People want to feel they are important to someone else, and they can make a difference to the world. Young people will put themselves in significant risk of harm to try and achieve this. This is described as the concept of mattering.
Keir and Luke finished their talk with some key challenges: we can’t programme our way out of a violent society; we should question whether any policy affecting children and young people will reduce or exacerbate inequalities from the four R’s; and that our aim should not be just to reduce violence, but to build a less harmful society for children to grow up in.
Inspector Katie Bradley and DS Mike Lewis talked about a novel approach to policing within a major trauma centre. Trauma support officers are specially trained in rapport building and trauma-informed principles and are encouraged to approach all patients as victims first, irrespective of whether they have been known to police for other reasons. They also ensure that continuity work – collection and labelling of evidence, clinical updates, and potential witness statements – are collected in an efficient manner, minimizing the disruption to clinical teams who rightly want to concentrate on time-critical interventions.
The pilot, which has been underway for just over a year, boasts a near three times improvement in charging rates against suspects compared to other similarly sized major trauma centres in London, as well as four times the amount of usable intelligence compared to the time before the team started. Both clinical staff and police colleagues from outside the hospital also report that their work has been made easier thanks to the implementation of this team.
Professor Christine Goodall spoke about the creation of Medics Against Violence in 2008 in response to a violence epidemic in Glasgow, which made it the second most violent city in Europe. MAV adopted a public health approach to violence and, following principles set out by the WHO, began to develop an understanding of social determinants. MAV currently runs a number of programmes in Scotland, including hospital Navigator programmes and MAV Academy. The Navigator programme is now in 9 hospitals across Scotland, meeting people in the emergency department at a time of crisis and providing support and advice. The three main needs in 2021 were alcohol misuse, drugs misuse and mental health issues.
Analysis of the programme demonstrated that those who engaged with the Navigator programme reduced their ED attendances over the year by 23.7%, while those who did not engage with the service increased their attendance by 15.3%. Break even analysis showed that the Navigator programme needed to prevent 30 drug or mental health admissions, 6 surgical admissions, or 4 ITU admissions per year to be cost effective.
Dr Rachel Jenner talked about clinical leadership within a Violence Reduction Unit, and her experience as an emergency department consultant working alongside the Manchester VRU. There have been 4 Navigators in place over four hospitals in Greater Manchester since May 2021, provided by Oasis Youth Services. By 2022 the team had increased to a total of 8 Navigators, and funding has been secured until 2025. The service in a little over a year has received over 558 referrals, over 400 of which were related to a violent injury. Young people referred into the service receive support with legal matters, education/employment, and advocacy when working with other statutory services. Young people also receive help with goal setting and building confidence.
As well as hospital-based violence reduction teams, the clinical offer within the VRU includes outreach engagement via Safer Street Roadshows, addressing social challenges and empowering young women through bringing girls and female professionals together as part of the uniteHER project, and a current pilot exploring preventative violence reduction work in primary care.
Melissa Gregan and Hazel Gregory spoke about the implementation of a Navigator service in East Lancashire as an extension of the existing safeguarding offer. The Navigator model in Blackpool is distinct from other UK hospital-based violence reduction programmes by virtue of being a nurse-led service.
A nurse-led approach means that all the needs of their client can be met by one service, and there is a significantly reduced need for further signposting or referrals. The navigators can meet young people in the hospital and help them to navigate health services as well as other challenges like returning to education, dealing with emotional trauma, or advocacy within the criminal justice system. The team have adopted principles of contextual safeguarding and meet frequently with other agencies as part of multi-disciplinary panels. Since December 2021, the team has reached out to nearly 2,000 young people.
St Giles Trust and Oasis Youth Support (panel discussion)
We held a panel session between case workers from St Giles SOS Project and Oasis Youth Support, also inviting a youth worker with lived experience from the audience to participate. The goal of the panel session was for clinicians to find out more about the hospital-based practitioner approach, and how clinical staff could become better advocates and communicators to young people.
Street Doctors, Your Stance and Knife Savers (panel discussion)
Three of the key bleed control educational outreach organisations also held a panel discussion to explore their various approaches to delivering life-saving training to young people, and topics included regional development of similar programmes, the feasibility of providing public bleed control kits in future, and whether there was scope to develop a national strategy or collaboration between all the organisations.
Video recordings of the individual talks will be available at a future date from the Trauma Care website at https://www.traumacare.org.uk/Conference2022
