Knife Crime - Home Affairs Committee Contents

8  Reducing violence: long-term prevention strategy

Public health approach

177. A number of witnesses, particularly Detective Chief Superintendent Carnochan, the Policy Exchange and Professor Kevin Browne, argued that treating violence as a public health, rather than a criminal justice issue would be more effective at reducing violent crime levels in the long-term. This would put the focus of Government activity on prevention rather than enforcement. DCS Carnochan, who has helped to advance such an approach in Scotland through the Violence Reduction Unit, elaborated:

    We have come to the realisation that criminal justice is the service of last resort, not the service of first resort, and that we continue to fill prisons up … Rather than look and wait until after the point of impact, to look and apply a public health notion that would look then at primary prevention issues … So it is about the notion that it is preventable, that there are things that cause it. If you were looking from a public health perspective and you used the analogy of TB, for instance, if you applied a criminal justice model to looking for a cure for TB, all you would do is wait until someone got TB, turned up, identified, put into a sanatorium and, if they survived, they would get out and, if they did not, they would not, and that seems to be what we have been doing. We have been isolating those people who are violent but not treating them and not inoculating those around them. It is very long-term; it is a generational change.[257]

178. This does not mean that violent offenders should not be criminalised: "you still need a robust criminal justice system, you still need the police to play their part". But rather, "it is understanding what that part is and what police can deliver for you. What they can deliver is keeping a lid on it, containing and managing it while we start to look at the other things."[258] The theory states that if you invest resources in prevention, there will be far fewer offenders for the justice system to deal with in the longer term.

179. Witnesses argued that a preventative approach, while it would initially demand resources, would be cost-effective in the long term, in addition to the benefits it would bring for individuals and their communities. According to Frances Crook, of the Howard League for Penal Reform:

    This would all be cheaper than the criminal justice system which is the most expensive blunt instrument we have in this country and the most ineffective. We are spending a lot of money on courts and police and custody, but would it not be better to put in a multi-agency approach earlier into family support, not as part of the criminal justice system, but as soon as that child fetches up in the police station.[259]

Home Office research estimates that homicide and wounding costs society over £13 billion annually. An average homicide costs over £860,000 in terms of its emotional and physical impact on the direct victims; over £450,000 in 'lost input' and approaching £145,000 in criminal justice system costs, totalling £1,458,975. The estimated bill for a serious wounding is £21,422. The organisation Kids Count has used these figures alongside knife recorded crime statistics for London to make a very rough estimate for the cost of knife crime of £1.25 billion a year.[260]

180. Homicide and wounding cost society millions of pounds a year. The organisation Kids Count has roughly estimated that knife-enabled crime costs £1.25 billion a year. We heard convincing evidence of the long-term cost benefits of applying a public health approach to violence reduction, as well as the benefits to individuals and communities. A public health approach treats violence as a disease and invests resources in prevention.

181. The World Health organisation explained that there are four stages to a public health approach to violence:

  • To define the problem through the systematic collection of information about the magnitude, scope, characteristics and consequences of violence;
  • To establish why violence occurs using research to determine the causes and correlates of violence, the factors that increase or decrease the risk for violence, and the factors that could be modified through interventions;
  • To find out what works to prevent violence by designing, implementing and evaluating interventions; and
  • To implement effective and promising interventions in a wide range of settings.[261]

Understanding the problem: collecting and sharing knife data

182. In terms of the first stage, the sharing of information about knife attacks is vital to inform effective policy-making at Government level, as well as effective operations at a local level. Several witnesses complained that data is not currently being shared effectively, particularly between medical practitioners and the police. There are two issues involved: one is whether doctors have a duty to report specific details of an injury in order for the police to pursue their inquiries; the second is about collecting and sharing anonymous data to build up a better understanding of violence (as part of a public health approach).

183. Doctors were issued with specific guidelines in 2003 obliging them to report all gun shot wounds to the police as it is clear that this constitutes a "serious crime", thereby overriding their common law duty of patient confidentiality. The reporting of stab wounds has been more haphazard, owing to a lack of clarity over the term "serious crime", the range of injuries that can be inflicted by a knife and the level of risk posed to the wider public. The General Medical Council is currently consulting on interim guidelines on knife reporting, published in August 2008. Under these guidelines:

    The police are responsible for assessing the risk posed by members of the public who are armed with knives … For this reason, the police should be told whenever a person arrives at hospital with a wound inflicted in a violent attack with a knife, blade or other sharp instrument … Identifying details, such as the patient's name and address, should not usually be disclosed at the stage of initial contact with the police.

    When the police arrive, you should not allow them access to the patient if this will delay or hamper treatment or compromise the patient's recovery … If the patient's treatment and condition allow them to speak to the police, you or another member of the health care team should ask the patient whether they are willing to do so …

    Where it is probable that a crime has been committed, the police will seek further information. If the patient cannot give consent (because they are unconscious, for example), or refuses to disclose information or to allow health professionals to do so, information can still be disclosed if there are grounds for believing that this is justified in the public interest or disclosure is required by law. Disclosures in the public interest are justified where:

    - Failure to disclose information may put the patient, or someone else, at risk of death or serious harm.

    - Disclosure would be likely to assist in the prevention, detection or prosecution of a serious crime and failure to disclose would be prejudicial to those purposes.[262]

184. From his perspective as trauma and vascular surgeon at the Royal London Hospital, Professor Brohi agreed that "it is very important that hospitals, police, education and public health agencies work together". However, he argued that the issue of automatic reporting to the police is not as clear-cut as many would like it to be:

    In trauma if we are to save lives, limbs and prevent disability we need to have the person with us within minutes of the incident. If there is any delay about presenting to hospital because of concerns about whether the incident will be reported to the police and place the patient in more danger later on it is likely that more people will die because of it. Is there a difference between knives and guns? From our point of view one is much more likely to die from a gunshot wound than a knife wound. The injuries are very different. Is there any difference in terms of social responsibility? Probably not. In these cases it is very difficult to know who is at risk and whether this is a one-on-one injury or there is a wider danger to people at large and to make decisions.[263]

He went on:

    If you believe that informing the police when something has occurred without any real evidence as to what has actually occurred and who the perpetrator is and to focus on it as a criminal issue, therefore essentially criminalising a teenage generation, you are perhaps not doing society or public health the good you should be doing compared with perhaps the other way round, namely that the police should be liaising a lot better with a public health body whose responsibility it is to tackle this problem. Information should flow to a public health body rather than necessarily that it be the job of the police to look after it.[264]

185. In terms of anonymous data-sharing, when the National Audit Office (NAO) carried out its study to inform its 2007 publication, The Home Office: Reducing the risk of violent crime, it found that anonymised data on violence-related woundings from Accident and Emergency departments, and on children excluded from school for violence, had been used in only 45% and 26% of Crime and Disorder Reduction Partnerships respectively. More recently, Chris Huhne MP told us that of the 148 out of 169 NHS acute hospital trusts which had responded to a Liberal Democrat freedom of information request, only 25 said that were participating with local police forces in reporting where and how knife injuries were being sustained.[265] However, the Home Office Minister, Alan Campbell MP, told us that 38 key hospitals in the ten Tackling Knives Action Programme areas are sharing information in this way.[266]

186. The NAO also noted that "even if data was to be shared routinely, Partnerships do not currently have the capacity or expertise to make good use of it". In Cardiff, this analytical role is provided by the University, who are involved in the Cardiff Community Safety Partnership's Violent Crime Group.[267] The NAO highlighted their effectiveness:

    Since starting to use this more targeted approach Cardiff has moved from being average in its 'family' of most similar Crime and Disorder Reduction Partnerships in 2000, to being the least violent Partnership from 2004 onwards. Since 2002, Cardiff has outperformed its family's average monthly number of police recorded crime incidents by 111 incidents a month, a reduction of over 30%. Assuming a cost of approximately £9,600 per offence these results suggest a total annual saving of approximately £12.8 million, of which £2 million relates to the NHS.[268]

187. The Scottish Violence Reduction Unit replicate the Cardiff model. DCS Carnochan explained how the data is collected and used:

    It is anonymised. Where did it happen? When did it happen? What age are you? Male or female? Was there a weapon used? And other ones. We include sectarianism as a question - gangs, and so on. That information is then matched with what we know and we get a clearer picture of what is there …

    In paper form it is in almost every A&E [in Scotlland] … but it is difficult with the paper form because we still only get a return of maybe 60 or 70%. We have in Lanarkshire a Health Board, which will be kicking off, I think, at the beginning of next month, an electronic system where we actually merge the data, and we have an analyst and the analyst will merge the data and she will feed that information into the local police tackling and co-ordinating unit.[269]

Chris Huhne MP argued that the Government should introduce the so-called Cardiff model for all accident and emergency departments across the UK as a high priority.[270]

188. An effective public health approach depends upon accurate data about the incidence and nature of violent crime. Effective data sharing amongst local Crime and Disorder Reduction Partnerships about knife violence will assist in the development of preventative approaches, as well improving intelligence-led enforcement activity. Several witnesses cited the beneficial impact of an approach to sharing anonymous data about knife incidents pioneered in Cardiff on crime reduction levels. We were disappointed to learn that this has not been fully implemented throughout England and Wales and recommend that this is done immediately. All agencies within partnerships should have an equal duty to share.

189. The General Medical Council is currently consulting on guidelines regarding the duty of medical practitioners to report details of specific knife injuries to the police. We are sympathetic to concerns that an automatic duty to report may dissuade some victims from seeking treatment. We also appreciate that the first duty of doctors is to their patients. However, we think that it is in the public interest that the police are informed when a person arrives at hospital with a wound inflicted in a violent attack and that the draft GMC guidelines, which allow for anonymity and patient consent where appropriate, would provide adequate safeguards.

Breaking the cycle of violence

190. In terms of prevention, we looked at a number of approaches. Given evidence, summarised in paragraph 84, from the forensic psychologist Professor Kevin Browne about the effect of witnessing or experiencing violence in the home on later propensity to commit violence, it is clear that addressing domestic violence is important for preventing other kinds of violent crime, such as knife crime. Last year we published a Report into Domestic Violence, Forced Marriage and "Honour"-Based Violence, which contained a number of recommendations in this area.[271] Professor Browne told us that his key recommendation for tackling violent crime would be to introduce treatment orders in the family courts:

    Unfortunately a small proportion of children grow up in violent families and role model on violent fathers. Often these violent fathers, because there is not enough evidence to convict them in a criminal court beyond all reasonable doubt, go from one family to another because under the balance of probability in a family court they are not allowed to see their own children because they have been violent, so they move on and join another family and set a violent environment there. That is because we do not have treatment orders in the family courts. Only convicted violent criminals are given any form of treatment … I work in the family courts and I see many men leave those family courts just to move on, separated from the current family that we are discussing. They are the problem.[272]

191. Professor Browne was sceptical about the likely impact of greater censorship of violent films and video games, given the way in which young people are able to access material on the internet, and instead advocated:

    I would go down the road of education and public health education to parents and to health visitors. Health visitors should be checking what children are seeing in the home environment, but now we do not have a health visiting system that visits homes so we cannot do that sort of thing. We need to re-establish our interest in the homes of children and how they grow up and make sure that there is not inappropriate imaginary and that parents are responsible and we need to help them in that.[273]

However, he did posit that internet and telephone service providers "are getting away with 'murder'."[274]

192. Professor Browne was also adamant that vulnerable groups, such as the mentally ill and young offenders, should be denied access to violent materials: this is both easier to control and also, in light of his evidence set out in chapter four, more effective as a violence prevention measure. He advised that inmates in local authority secure units or youth offending institutions are able to borrow DVDs and computer games from the library that are "completely inappropriate" for those convicted of violent offences.[275]

193. In light of evidence that children who witness or experience domestic violence are significantly more likely to go to commit violent crime, we recommend that the Home Office implements our detailed recommendations on preventing domestic violence published in June 2008. The Government should also consider introducing Treatment Orders in Family Courts so that men for whom there is not sufficient evidence to convict of a criminal offence but who are judged to be too violent to see their own children, are treated for violence before they go on to infect another family.

194. We were disturbed to learn that young offenders who are convicted for violent offences are allowed to watch violent DVD and video games in secure units and young offending institutions, given that they may increase the risk of violent behaviour in those already predisposed to violence. We recommend that the Ministry of Justice should institute a ban on this kind of material.

Providing positive alternatives for young people

195. Deputy Assistant Commissioner Hitchcock argued that the key to tackling knife crime is maintaining momentum on detecting knife offences, addressing social deprivation and long-term support for diversionary activities for young people.[276] The Tackling Knives Action Programme has provided 7,000 places through the Department for Children, Schools and Families for young people to take part in diversionary activities on Friday and Saturday nights. Being involved in structured activities can help young people to develop the skills, confidence and sense of self-worth which will make them less likely to offend. This can be particularly true for those who do not excel at school. For example, Shaun Bailey told us that "sport does work because it gives you discipline and self-discipline is the answer to most of these problems. It gives you something to do and hopefully gives you something that you are good at."[277]

196. The Scouts Association told us about the benefits of Scout membership for young people:

    I think young people who have been involved in youth organisations have better relationships with their peers, with adults, they are more involved in their communities and they do better in their lives as a whole. We do not think that is accidental … We know that concern about knife crime is an issue within our Scout groups in some areas … but we also know there is something about scouting and the confidence and the skills it gives young people to make those positive choices that means our young people are more resilient.[278]

However, organisations like the Scouts face a number of barriers. We heard that there are 30,000 young people on waiting lists to join groups; but not enough volunteers to meet the need. The Association argue that the Government should explore the right for employees to request time off for training "because all of our adult volunteers are offered accredited training, and we work very hard to make sure that our leaders get something back from their involvement, skills that are transferable to the workplace"[279] The young Scout leaders who gave evidence to us told that there is a need for greater awareness-raising about Scout groups in schools.[280]

197. The young people we spoke to from London and from Merseyside stressed the absence of facilities for young people:

    You have got to book it [football pitch] well in advance because there are too many people going there nowadays … We have got two youth clubs, we have got the Midland Boys' Club which is for younger ages, like 13 and under, and you have got the Sefton YIP which is for the older groups, and even then, with the YIPs moving to Bootle, there will be even less things around our area to do. Boys' clubs you just cannot get in to because you are too old. The parks are always taken over by gangs so you cannot go anywhere and do anything.[281]

198. Witnesses emphasised the need for robust and consistent support for deprived young people. Frances Crook, of the Howard League for Penal Reform, explained the extent of what she believed was required:

    It has to be everybody working together at a local level to put into place more appropriate adults and to give these young people hope and a life. It is not just a question of putting in a skate park or putting in one hour a week at a youth club; it has to be a whole life approach to these young people so that they can see a vision of themselves which is an alternative to that being offered by the groups and the gangs of older young men.[282]

199. Ian Levy, whose organisation The Robert Levy Foundation seeks to provide employment-related opportunities for young people, told us:

    I do find that a lot of organisations are willing to get involved with helping young people, a lot of confidence through the CSRs to encourage the employers to offer at least a day a year to volunteer to help local voluntary groups to go into schools, et cetera. On that basis there is a willingness to do that, but what we are interested in is that long-term contact or that long-term support from employers to make this happen. What we found when started to look at this, one of the things that young people said to us is that there is always something there but it only lasts for so long and then it ends, and then they are back to stage one when there is nothing to do, nobody supporting them.[283]

Young people we met from London also argued for more part-time job opportunities to show that there are positive alternatives to a criminal lifestyle.

200. Participation in activities like sport or uniformed organisations can help young people to develop discipline, skills and confidence to control aggression, resist pressure to engage in street violence and raise their aspirations. We were greatly encouraged during our evidence sessions and visits round the country by the dedication shown by local public servants and volunteers to providing these activities. However, young people told us there is a shortage of places available for them. The Scout Association told us that a shortage of volunteer leaders in particular is preventing them from meeting demand. We recommend that the Government should work with employers to make it easier for their employees to volunteer their time. We also suggest there may be a need for a more strategic approach to provide consistent and tailored support for young people. In addition, young people told us that access to paid employment would make a criminal lifestyle less attractive. We recommend that the Government facilitates more part-time job opportunities for 14-18 year olds.

Early intervention

201. The Shadow Home Secretary, Chris Grayling MP, argued that early intervention with at-risk toddlers and their parents is the key to violence reduction.[284] Research commissioned by the National Audit Office from RAND Europe found that early interventions are a "highly effective means of targeting expenditure for reducing violent crime" and that interventions undertaken before the age of five are the most effective at preventing violent and criminal behaviour.[285] Those children who are most at-risk of going on to commit violent behaviour in later life can be identified by a statistician before they are born.

202. Shaun Bailey, of youth charity MyGeneration, argued that "the key difference between kids who succeed and kids who do not is normally the family".[286] Richard Taylor, the father of Damilola Taylor, drew a link between street gang involvement and parental neglect: "there is no parental guidance and no authority."[287] Assistant Chief Constable John Crowther, of the British Transport Police, noted that while many parents are willing to work with the police to address the situation when their child has been found with a knife, "with the current way that sometimes families are constructed, there are less opportunities for parents to be influential around what their children are doing."[288] Chris Grayling MP told us "I think one of the big challenges we have got is that in many households there is an utter absence of any sense of responsibility":

    I do not purport to say that strengthening the family is either easy or will make all the difference, but I am absolutely certain that if in the future we can get back to a situation where more young people are being brought up in a more stable family environment we are likely to reduce the incidence of criminality later on in life.[289]

203. Ministers argued that the Government is already taking steps to implement an early intervention approach with problem families. Home Office Minister Alan Campbell MP told us:

    Most of the support for parents with regard to TKAP comes via the Department for Children, Schools and Families through a whole variety of things like, for example, early intervention programmes, family intervention programmes and of course the fact that there are parenting practitioners in every local authority area. It is about giving parents access to the right advice to allow them to meet, perhaps together, in order not just to discuss with professionals how best they can resolve issues within their families but also to work with other parents in those areas, too. It is, as you suggest, a longer term, very much a preventative approach.[290]

The Justice Minister, David Hanson MP, drew our attention to a £10 million "intensive fostering" pilot scheme operating in three areas over the next three years whereby children from dysfunctional families who are prosecuted for low-level crime are taken out of their environment and supported by a foster family. There are currently 30 families involved.[291] The Safer Southwark Partnership described their work under the Family Intervention Programme with 20 high risk families, offering case work, counselling, parenting support and other support services.[292]

204. The Government estimates that real social failure comes down to about 20,000 "hard core" families out of an overall total of 110,000 "problem families". Around 5% of young people commit half of all youth crime.[293] Public Service Agreement Delivery Agreement 23, which aims to reduce serious violent crime, emphasises the importance of early intervention in preventing the escalation of violence.[294] The Youth Crime Action Plan also sets out the Government's aim to expand intensive family interventions for the most vulnerable and problematic families with children at risk of offending, with non-negotiable elements and sanctions for those who refuse to engage, and expanding Nurse Family Partnerships to support vulnerable families in the early years.[295]

205. In April 2008 Nottingham became the first 'Early Intervention City'. The five main areas of work include the Family Nurse Partner Project, in which family nurses support teenage mothers through pregnancy and early parenthood; a mentoring scheme for young people, focusing on those at risk of becoming involved in serious crime; supporting victims of domestic violence through a sanctuary scheme; and a drug awareness scheme. It is based on a programme in Colorado that was recently evaluated by Nobel economist James Heckham, who found that every dollar invested in early intervention saved between $6 and $17 in criminal investigation, court proceedings and custody programmes.[296]

206. In a publication for the Centre for Social Justice, Graham Allen MP and Rt Hon Iain Duncan Smith MP argued that:

    The two public policy strengths of Early Intervention are firstly that it is less expensive and second it is more effective than late intervention … suppose that we help a young mother and a toddler with a £1000 worth of health visiting at the time she and her baby need it most: that makes more sense than waiting 16 years in order to pay £230,000 to incarcerate that baby in a young offenders' secure unit for a year when he has gone astray".[297]

In the short-term it will be expensive to fund early interventions alongside the huge current costs of the criminal justice system. To manage this, the Centre for Social Justice has recommended that the Treasury and Cabinet Office explore "a form of financial instrument which could be devised to borrow against the future savings of Early Intervention".[298] Another way to reduce costs is through better targeting: Policy Exchange have criticised the Sure Start programme, for example, for its universal approach.[299]

207. There appeared to be cross-party support for early interventions with very young children born into dysfunctional families. The Government has already begun to invest resources in family nurse partnerships and intensive fostering. It will be difficult to measure the success of such schemes in this country as they will not become evident for a generation. However, evidence from the United States indicated that investing in similar interventions can save a significant amount in future criminal justice costs. Such measures are resource-intensive, but are only needed for a small minority: around 5% of young people commit half of all youth crime, and the Government estimates that real social failure comes down to about 20,000 "hard core" families. The Government should target resources very specifically on these families.

257   Q 191 Back

258   Q 197 Back

259   Q 302 Back

260   Home Office, The Economic and social costs of crime against individuals and households; June 2005; Kids Count, Knife Crime: Bringing the voice of the street to the House, 2008, p 33 Back

261   World Health Organisation,  Back

262   General Medical Council and Department of Health, Reporting knife wounds: interim guidance, August 2008 Back

263   Qq 73, 79 Back

264   Q 80 Back

265   Q 522 Back

266   Q 548 Back

267   National Audit Office, The Home Office: Reducing the risk of violent crime, February 2008, p 7 Back

268   Ibid, p 25 Back

269   Qq 208-9, 211 Back

270   Q 522 Back

271   Home Affairs Committee, Sixth Report of Session 2007-08, Domestic Violence, Forced Marriage and "Honour"-Based Violence, HC 263 Back

272   Q 493 Back

273   Q 491 Back

274   Q 497 Back

275   Q 486 Back

276   Q 122 Back

277   Q 321  Back

278   Qq 243, 247 Back

279   Qq 246, 256 Back

280   Q 256  Back

281   Q 355 Back

282   Q 301 Back

283   Q 235 Back

284   Q 501 Back

285   National Audit Office, The Home Office: Reducing the risk of violent crime, February 2008, p 21 Back

286   Q 312 Back

287   Q 392 Back

288   Qq 145-6 Back

289   Q 493 Back

290   Q 561 Back

291   Q 568 Back

292   Ev 177 Back

293   Home Office, Youth Crime Action Plan, July 2008, p 1 Back

294   National Audit Office, The Home Office: Reducing the risk of violent crime, February 2008, p 13 Back

295   Home Office, Youth Crime Action Plan, July 2008, p 7 Back

296   Kids Count, Knife Crime: Bringing the voice of the street to the House, 2008, p 35 Back

297   Centre for Social Justice, Early Intervention: Good parents, great kids, better citizens, September 2008, pp 113-4 Back

298   Ibid, p 119 Back

299   Q 44 Back

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