Government failing on violence reduction scheme via A&E departments
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Version 0 of 1. Ministers are failing to fulfil a coalition pledge to roll out a violence reduction scheme that has been shown to reduce attacks by as much as 40%, leading accident and emergency surgeons claim. The Tories and Liberal Democrats agreed in 2010 to introduce the nationwide scheme, which involves A&E departments sharing anonymised information about violent incidents with police forces, allowing problem spots to be targeted. But as few as a third of A&E departments in England have fully adopted the programme, which was pioneered in Cardiff 20 years ago and has been copied as far afield as South Africa and the US. Department of Health officials have made it clear that A&Es ought to share information with police, but a spokesperson admitted it simply did not know how many hospitals were operating the model. It is undertaking a review this summer to find out. Dr Adrian Boyle, chair of the quality in emergency care committee of the College of Emergency Medicine (CEM), said he was frustrated at the lack of progress. "The implementation is not working as well as we would have liked," he said. "It is frustrating." Boyle, an A&E consultant who has worked closely with the Department of Health and NHS England to get the system up and running, called for the government to give hospitals incentives to introduce the scheme. He said there was a wariness within hospitals about staff to liaising with professionals "out of their silo". The reorganisation of the NHS may also have hampered the programme, he said. An audit two years ago found two-thirds of A&E departments were not sharing data to the standard recommended by the CEM. Boyle said he did not believe the new audit would show any progress. The architect of the original Cardiff scheme, Jonathan Shepherd, professor of oral and maxillofacial surgery at the Cardiff school of dentistry, expressed concern at the slowness of the adoption of the model. He said there was still too great an acceptance of "routine" street violence. "People become immune to the issue and the social disaster it represents. For medical staff, police and local authority workers it becomes a routine part of what happens when you're on shift at the weekend. "Professionals are used to being reactive, suturing people up and arresting offenders rather than taking a more preventative approach. I'm not surprised it's taking some hospitals so long [to adopt the Cardiff model] and others aren't doing it properly." Shepherd's idea stemmed from research he did in the 1980s which found only a quarter to a third of violent incidents resulting in a trip to A&E come to the attention of the police. He realised that for forces to have a full picture of what was happening they ought to know about all cases of emergency treatment. His scheme – the Cardiff violence prevention programme – launched in 2003. Hospital staff recorded anonymised details of where, when and how a victim had been attacked. This information was shared, allowing maps of violence hotspots to be produced and the organisation of operations to tackle the problem. The results were striking. Within five years there were an estimated 42% fewer woundings in the Welsh capital compared with similar cities. There was a 35% decrease in the number of patients seeking emergency treatment and one study put the savings in economic and social costs at just under £7m a year. For every £1 spent on the scheme, £82 was saved. Shepherd said he realised the scheme was working when the rate of violence in Cardiff, a popular party city, dropped to levels seen in towns such as Eastbourne and Harrogate. Shepherd suggested the government needed to do more to fulfil its coalition agreement promise. He said: "In the runup to the 2015 election I think people will want to be reassured that this government commitment has come to fruition." Shepherd's model or variations of it are in place in Amsterdam and the Western Cape in South Africa. Milwaukee in the US has also been investigating it. Alun Michael, a former Labour minister and now police commissioner for south Wales, was also surprised that more hospitals had not adopted the model. "Analysing incidents which brought victims of violence to A&E has led to significant and sustained reductions in the number and seriousness of violent incidents," he said. Gary Smith, the director of Cardiff Street Pastors, which helps keep revellers safe in the city centre on Friday and Saturday nights, said he had noticed a difference in the city over recent years. "It feels a safe, place to be now. I think that's partly because everyone works together so well now." Michael and Smith both said the programme in Cardiff had led to a wider cultural shift with agencies more used to working closer and better together. South Wales police made it clear it believed the scheme was worthwhile. A police spokesperson said the scheme had made a "significant contribution" to the reduction in violent crime. "It is an excellent example of how partnership work in Cardiff is making a real difference to keeping our communities safe." There are examples that show the scheme has worked well in other places where it has been adopted. In some, violent crime has fallen by 40%. In Cambridge, for example, analysts realised foreign students were being injured on Monday evenings after Addenbrooke's hospital shared information. Officials found that drinks promotions aimed at foreign students were being offered by bars. The premises were told they should stop such promotions. In the south-east of England, people started attending an A&E having been hit by planks of wood and bricks. The data was passed on and council officials realised an open skip had been left near a nightclub. Such skips were banned from the area. Mark Bellis, who advises the World Health Organisation on violence prevention who has implemented a successful information sharing scheme in the north west of England, said there remained a reticence in some places to take it up. "It can work phenomenally well but some are reluctant because of the investment and the time." Caroline Shearer, of the anti-knife campaign group Only Cowards Carry said the government needed to do more to tackle violent crime – including making sure hospitals shared information. "The government talks tough, it needs to act tough," she said. A spokesperson for the Department of Health said: "We have been clear A&E departments must share information with police and we are about to review compliance ahead of the rollout of a new legal standard which all major A&Es will be obliged to meet. We're also supporting hospitals to train nurses to specifically champion this." |