New duty to stem gang violence would require nurses to 'use their instincts'

A multi-agency public health duty covering emergency departments would extend safeguarding approach

A multi-agency public health duty covering emergency departments would extend safeguarding approach

  • Worries over breaching confidentiality, but duty seen as ‘being more proactive’
  • Idea is to spot young people at risk, modelled on method adopted in Glasgow
  • Charity workers seen having a role alongside ED in befriending young patients
Unhappy youth
Picture: SPL

By mid-May, the 100th fatal stabbing of 2019 had been recorded in the UK. Those killed range in age from a boy of 14 to a pensioner aged 80.

This sombre landmark comes amid rising rates of violence that have prompted the government to look at new ways of tackling violent crime.

One of the proposals put forward by the Home Office in England is the idea of introducing a new multi-agency ‘public health duty’.

‘We ask them to trust their instincts – staff know when something is not right’

Teresa Cleary, programme manager for Redthread

The intention is to encourage staff working in settings such as emergency departments (EDs) to spot young people at risk.

Teresa Cleary

The government believes the introduction of a ‘duty’ on EDs, schools, youth services and the like would prompt greater collaboration and early intervention.

The duty is modelled on the public health approach adopted in Glasgow, which has seen violent offences halve in the past nine years.

Taking the initiative

A final decision on whether to introduce legislation has not been taken, although a consultation has been held and the results are due to be considered by ministers.

There are already plenty of areas that are taking the initiative. London has promised to follow Glasgow’s lead, while a number of hospitals have introduced some of the elements that have proved so successful north of the border, including placing youth workers in EDs to work with staff to engage young people at risk of violence.

In many cases these youth workers are employed by charities such as Redthread. The charity is currently working in seven hospitals across London, Birmingham and Nottingham with its youth workers on site and called in by ED staff when they are concerned about young people.

Redthread programme manager Teresa Cleary says: ‘We are big fans of the public health approach – the interest is really welcome.’

Signs to look out for

She says ED staff need to know the signs to look out for beyond just violent injuries. ‘We ask them to trust their instincts. Staff know when something is not right. The story does not fit, or the parents are not there.’

‘Working in EDs we can have a real impact – this is not just a police matter’

Rob Jackson, emergency nurse clinician

All hospitals have safeguarding leads – often nurses – who can report cases to social services, but given cuts to council services Ms Cleary says it can be hard to ensure an appropriate response is available.


firearms offences were recorded in England and Wales in 2017-18

Source: Office for National Statistics

This is where charities like Redthread come in. The charity’s workers befriend patients, advocate for them and develop a safety plan. That can involve liaising with social services, police and the criminal justice system. If they do not believe the patient would be safe when discharged they are kept in hospital.

A network around them

Ms Cleary says: ‘We basically facilitate a network around them, make sure they are safe and reduce the risk of them returning. Busy ED staff simply do not have the time to do what we do – that is why it is so important to work together.’

But the Home Office proposals have raised concerns, with some arguing that the public health duty could put doctors and nurses in the awkward position of feeling they have to breach patient confidentiality by calling in services when they have concerns.

Extending safeguarding

National Major Trauma Nursing Group member Justin Walford says staff should not be overly worried, pointing out it is already the case that all knife and gun injuries must be reported to the police.

He says the idea seems to be more about extending the ‘safeguarding’ approach, likening it to the requirements in place to identify those at risk of child sexual exploitation or being lured into terrorism.

Justin Walford

But he believes there would need to be greater investment in safeguarding leads and dedicated liaison staff such as the Redthread youth workers if the proposed public health duty was to work.

‘In some areas – where there is the most violent crime – hospitals will need extra support.’

Talking about consequences

The approach is also about getting EDs, and the staff who work in them, to be more proactive and outward looking.

Royal Liverpool University Hospital emergency nurse clinician Rob Jackson believes this is just as important.

He spends time visiting schools and youth groups talking about the consequences of stabbings and shootings and his experiences in caring for victims.

‘I make my presentations graphic on purpose. I show them injuries – hands that have been chopped off – I tell them what it is like telling families that their loved ones have died. The idea is to stop them doing it before they do it.

‘Working in EDs, we can have a real impact. This is not just a police matter.’

The scale of violent crime in England and Wales


offences in England and Wales in 2017-18 involved knives and sharp instruments

Source: Office for National Statistics

Violent crimes, such as murder and gun and knife crime, account for about 1% of all crime in England and Wales. But there are clear signs the numbers being reported are rising.

There were more than 40,000 offences reported to police involving a knife or sharp instrument during 2017-18 – a 16% rise from the previous year and the highest level since comparable recording started in 2011. On top of that there were more than 6,000 firearms offences.

Trend towards tragedy

While better reporting is likely to be a factor in the figures there is plenty of evidence to suggest an actual increase, with police reports, hospital records and crime surveys all showing similar trends.

Nearly all police forces have seen an increase, which is being linked to the county lines phenomenon in which drug-selling gangs from major urban areas exploit children, young people and vulnerable adults to commit crimes and supply drugs to markets elsewhere.

What worked in Glasgow

Strathclyde Police established a violence reduction unit in 2005 after studying how police in Boston in the US achieved success in cutting violent crime in the 1990s after working with schools, doctors and other partners.


of recorded crime in England and Wales involves homicides, guns or knives
Source: Office for National Statistics

The aim was to create a long-term change in attitudes in society as well as working with violent individuals to help them break the cycle of violence.

The unit was soon expanded to other parts of the country and is now funded by the Scottish Government.

Role of the ‘navigators’

It involves a range of projects. ‘Navigators’ work in several EDs to engage people who arrive with violence-related injuries and try to connect them with other services to break the cycle of violence.

Hospital staff visit schools to talk about treating victims of violence, while employment programmes and mentoring in schools have been organised.

The work has had a significant impact. Glasgow was once known as the murder capital of Europe, but in the past nine years the number of violent offences – homicides, attempted murder and serious assaults – has halved to less than 1,000 a year.

Home Secretary Sajid Javid praised this approach, saying it has a proven track record and could help to create long-term change if introduced elsewhere.

Nick Evans is a health writer

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