Examination of Witness (Question Numbers
80-87)
PROFESSOR KARIM
BROHI
25 NOVEMBER 2008
Q80 Mr Winnick: One senior officer,
a deputy assistant commissioner, says that, "Some forces
seem to have very good relationships where the hospital will always
notify but there are others where the relationship is less well
established." Clearly, from a police point of view it is
considered that you have a public responsibility to notify them
on the basis that criminality may be stopped as a result of them
knowing what is happening. Do you see their point of view?
Professor Brohi: Absolutely. It
is very important that hospitals, police, education and public
health agencies work together to deal with this as a public health
problem and manage their communities with the particular needs
and requirements of those communities in an organised way. 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.
Q81 Mr Brake: I want to go to the
5% of cases involving women who present themselves. Last week
at a seminar one issue identified was that involving women maiming
others as a form of punishment. I do not know whether that would
show up in the caseload you are dealing with because it may be
of a less traumatic nature than the cases you treat, but is there
any evidence that that is happening?
Professor Brohi: I do not have
any solid evidence one way or the other. I think there are more
teenage girls carrying knives than there used to be, but I cannot
comment on the question of domestic violence.
Q82 Mr Streeter: Are you aware of
anecdotal evidence that some stabbing victims do not come to hospital
because they think they will be reported and are treated in some
back street way? Do doctors talk about anything like that going
on?
Professor Brohi: I have not heard
about people being treated in back streets, although undoubtedly
there are people who are injured and do fine without going to
hospital and therefore may not need to go to hospital. We see
people who come to hospital perhaps not immediately following
an injury, but that tends to be a fairly small and minor proportion
of the injuries, because obviously if you collapse having been
stabbed you will go to hospital.
Q83 Chairman: Are you aware of any
outreach work being done by the NHS to prevent stabbings?
Professor Brohi: Outreach work
is not part of hospitals' remits, so it tends not to be formally
funded in any way. You will know that trauma care within London
has been undergoing a process of regionalisation to major trauma
centres and that is expected to be followed nationally. As a major
trauma centre you have a responsibility to your population to
be involved in injury prevention work. At the Royal London we
have always taken on that responsibility even though it has not
been funded. We have prevention programmes in our local area.
Q84 Chairman: Whereabouts is that?
Professor Brohi: It is in Whitechapel,
the City, Tower Hamlets and Hackney.
Q85 Chairman: I mentioned earlier
Professor Coats. Do you get together with the heads of other A&E
departments of hospitals to talk about these issues? Is knife
crime a specific matter about which you would talk to colleagues?
Professor Brohi: Penetrating injuries
are certainly part of the trauma research mandate. Whether you
research it as an injury and how best to treat the injury or you
research it as public health drivers of that injury are two different
things. I think the first—how to manage penetrating injury—has
received a fair amount of research. The drivers of this new wave
have received less joined-up and inter-agency research.
Q86 Bob Russell: Is there a requirement
for an accident and emergency department to have a book into which
all casualty arrivals with names, addresses and details are entered
which is available for public inspection?
Professor Brohi: There is a record
of all patients who present to emergency departments. I am not
an A&E doctor but a trauma surgeon. Trauma and knife crime
is a surgical disease which ends up with surgeons. But emergency
departments obviously keep records of those who attend and the
information provided to them.
Q87 Chairman: But not for public
inspection?
Professor Brohi: Absolutely not.
Bob Russell: The reason I ask the question—perhaps
we can find out from another witness—is that one of my joys
of being a junior reporter several years ago was that every Monday
morning I went to the accident and emergency department of Essex
County Hospital in Colchester and looked through a book that contained
some lovely stories. Obviously, it was then a legal requirement
for such a book record to be kept. Is it still a requirement?
If it is it is quite simple for the police to do what I did on
Monday morning.
Chairman: This is a very important point
to ask of another witness and we shall certainly do so in future.
Professor Brohi, if time permits at some stage during this inquiry
the Committee may visit one of the hospitals and look at this
programme. We would be grateful for advice or information you
can give us on any projects that you think may help us to reach
appropriate conclusions on the subject. We know that you must
be extraordinarily busy. We are very grateful to you for coming
today and giving evidence to us.
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