The Bedpan: Being stabbed is ‘a real teachable moment’

(Re)Introducing ‘The Bedpan’: The Bedpan is HSJ’s weekly interview series with influential figures from (usually) outside the health world who nevertheless have interesting views on the challenges facing the NHS. The Bedpan is named after Nye Bevan’s apocryphal quote and pays particular attention to how politics impacts the NHS and vice versa. The series began in October and has featured interviews with Spectator editor Fraser Nelson, Institute of Fiscal Studies director Paul Johnson and Dr Sarah Wollaston MP among others.

This week: Sarah Jones MP, chair of the all-party Parliamentary group on knife crime.

Why she matters: Despite being in Parliament for a little over two years, the Labour MP for Croydon Central, has rapidly risen to prominence – not least because of her central role in highlighting the threat of increased knife crime. She was appointed Labour’s housing spokesman following a powerful maiden speech on Grenfell Tower.

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Every time someone is stabbed – and does not die on the spot – the NHS incurs an average cost of between £25,000 and £30,000, claims Sarah Jones. She recalls talking to one youth worker in south London about a boy who had been stabbed eight times in eight years – and therefore has cost the NHS over £200,000.

But although “less violence leads to less cost for the NHS”, it is not the most important reason for tackling the problem.

“Violence,” says Ms Jones, should be viewed “alongside issues like obesity or loneliness” as a “major societal problem” and treated in much the same way.

The Croydon MP’s journey to becoming one of the most important figures in the drive to reduce the epidemic of knife crime began on the doorstep during the 2017 election campaign.

‘We know what the solution is, we know what to do because there’s evidence from across the world and we’re not implementing it. What does that say about us as a society?’

“There was a real sense of worry about the safety of young people and particularly [about] knife crime,” she remembers. “So, I said if I got elected, I would try and to do something about it.”

Her first few months in Parliament revealed to her that this was far from a London-only problem and that, with the Conservative government still clinging to power, the only way she was going to achieve change was by launching an all-party Parliamentary group.

Last year saw the highest number of fatal stabbings ever recorded in the UK.

“The nature of knife crime is that it spreads like a disease,” says the Croydon MP. “You have pockets where it emerges and you need to get into those pockets and tackle the issue and also then vaccinate or inoculate the rest of the population against violence.

“We know what the solution is, we know what to do because there’s evidence from across the world and we’re not implementing it. What does that say about us as a society?”

Adverse experiences

That solution – as is now widely acknowledged – is broadly a public health one. Ms Jones does not deny the importance of effective policing and sentencing, but suggests it is never going to be effective in reducing knife crime. Taking a public health approach, she says “unlocks” the ability to “do the right things to prevent it happening in the first place”.

The influence of poverty and austerity on the rise in knife crime has been “horrific” says Ms Jones.

Particularly telling has been the “decimation of youth services”, she continues. “Knife crime spikes between three and six o’clock, between when you leave school and your parents come home from work.”

Ms Jones says the APPG she founded has also tried to understand newer factors, such as the rise in school exclusions and “county lines” drug running.

Perhaps the main factor behind the latest rise in knife crime, she suggests, is the ubiquity of social media “which amplifies and spreads things at great speed. You have a generation of young people who see violence daily on their phones and it normalises it.”

But another factor is also emerging as especially telling – that of adverse experiences in childhood.

“If you have experienced violence in the home, you learn to understand violence and you learn to use it in your own life.”

Ms Jones says a study in Croydon of 60 young people who have been victims or perpetrators of serious violence revealed half of them were known to children’s social services by the age of five. The review exposed the fact that state interventions came “when the crisis had already occurred” and therefore “didn’t work”.

Little wonder perhaps, as the Labour MP explains, “we don’t even record the children [victims of a traumatic death] leave behind in any meaningful way”.

May’s committment and Hancock’s conversion

As a seasoned campaigner at Shelter and the NHS Confederation, Ms Jones tried to get the media interested in her new cause.

“I talked to lots of journalists who said, ‘This isn’t really an issue for us’. I think there was a perception that this was a problem within the black community that had nothing to do with their wider readership.”

That changed at Easter last year when the number of violent deaths in London briefly overtook those in New York. Then Donald Trump – in possibly his own contribution to raising the profile of public health matters – declared “a once very prestigious hospital right in the middle [of London] is like a war zone for horrible stabbing wounds”.

The media’s mind was finally changed (for the moment at least) when two (middle class) 17-year-olds were murdered on the same weekend.

A government response quickly followed, with the prime minister hosting a knife crime summit on 1 April with a range of experts from health, education and policing.

Treat the symptoms

According to Ms Jones the PM was “very engaged all the way through [the summit], and probably glad to be talking about something other than Brexit”. Ms May drew on the knowledge gained during her long stint as home secretary to raise the issues of domestic abuse and mental health as factors in driving knife crime.

Ms Jones remembers the PM saying: “If this was a devastating disease, yes we would treat the symptoms, but we would also treat the cause and that’s what we need to do.”

She says the PM “completely spoke the language of [knife crime] being a public health issue and something that we need to tackle through all the different government departments, including the health service”.

This was especially welcome news to the Croydon MP, who remarks that knife crime campaigners “really struggle to get the NHS involved”.

This concern was heightened when – in the run-up to the summit – Matt Hancock appeared to, in Ms Jones words, “poo poo” the idea of a public health approach to knife crime during a radio interview.

In the same week as the summit, two further meetings were held; the first an APPG-arranged discussion with health experts, then another government-convened session at 10 Downing Street with senior representatives from NHS England and other agencies.

Ms Jones says the health and social care secretary “hadn’t quite engaged” with the issue of knife crime before April, but that “to his credit” he is now “interested” and determined to demonstrate progress to the PM.

Present at the second session were NHSE medical director Steve Powis and chief clinical information officer Simon Eccles.

Both men were focused on the issue of improving the quality of data about knife crime says Ms Jones. There is significant evidence that the “Cardiff model” which seeks a limited but specific set of information about each incident of serious violence can have a profound impact on tackling the problem.

Being admitted to hospital with a knife wound is, says Ms Jones, often a time when young people “feel that maybe they need to re-evaluate their lives. It’s a real ‘teachable moment’”.

Professor Powis, according to Ms Jones, said he had written to “every NHS authority and asked them to look at what [data] they were recording, and how”.

She adds that the various agencies, including NHS England and Public Health England, all pledged to “write to the secretary of state and say, ‘this is what we’re doing to tackle knife crime’”.

One of the specific interventions discussed – which Ms Jones hopes and believes will be actioned – is “putting youth workers into A&E”. Being admitted to hospital with a knife wound is, says Ms Jones, often a time when young people “feel that maybe they need to re-evaluate their lives. It’s a real ‘teachable moment’”.

The best example of the use of these non-statutory workers who are more likely to be able to win the trust of the patients is, she says, to be found at King’s College Hospital major trauma centre.

The key is to create a situation in which the young person will willingly share information about their life without worrying that “suddenly loads of people are going to be on their case about whatever might have happened”.

Blaming the victims

The APPG chair is also hoping for a focus on “the role that GPs play”. GPs tend to have very little contact with the perpetrators or victims of knife crime, but – she says: “They will often know that a family is struggling.” She suggests that social prescribing and the wider reach and skill set of primary care networks may square that circle.

Finally, she echoes the hopes of many campaigners concerned with the wellbeing of younger people that CAMHS services can be better funded to tackle “really acute mental health needs that have been not addressed”.

Ms Jones recalls “a young boy who was murdered just before I became an MP. His brother clearly had severe post-traumatic stress and started having issues in school. He was referred to CAMHS and was put on a waiting list. We… tried to speed it up, but by the time he finally got to CAMHS, he wouldn’t engage.”

This failure to engage was treated as the young person’s “fault”, which says Ms Jones was “all wrong”.

Instead she believes that in the immediate aftermath of the murder, the state should have said to the brother and his parents: “You’re probably gonna have some issues here. You need some therapy. You need some counselling. Try… to stop him getting to the point [where he was unwilling to engage]. And even if [that was what happened], somebody at that point saying, ‘right, we need to try something else’.”

Most of all, Ms Jones is hoping for a focused cross-government effort led by the PM like the one which concentrated on reducing teenage pregnancies during the first decade of the century.

“They should be saying, ‘This is our target. We want to halve deaths from serious violence by x date. We’ll let you do what needs to be done locally, because local areas have different needs, but [you must] base it all on the evidence.’”

The Labour MP also hopes the raised profile of knife crime will result in more funding being provided in the public spending review due this autumn.

At last month’s summit Mrs May committed to setting up a team within the Cabinet Office to oversee cross-department and agency work. A call to Number 10 confirms the “serious violence reduction team” is still in the pipeline, but its staffing and operating model are both yet to be determined.

For those who would like to know more about how the NHS can help combat knife crime, I recommend this recent King’s Fund podcast. 

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Coming up: Gambling Commission chair Bill Moyes, press regulator and former government communications chief Matt Tee, and Department of Health and Social Care permanent secretary Sir Chris Wormald.

If there is any political or influential figure you would like me to interview, please email alastair.mclellan@wilmingtonhealthcare.com or if you are reading this on the website leave them in the comments box.

The past five Bedpans

Ben Page, pollster to PMs (part two)

Ben Page, part one

Trasngender activist Susie Green

Chris Bryant MP

NICE chief executive Sir Andrew Dillon

You can read all 22 Bedpans here