Continuation of clinically embedded youth support in Major Trauma Unit

Reference code: 
PCD 278
Date signed: 
19 March 2018
Authorisation name: 
Sophie Linden, Deputy Mayor, Policing and Crime

Executive summary

There are commitments in the Policing and Crime Plan and London Knife Crime Strategy to ‘continue to support youth workers and Independent Domestic Violence Advocates (IDVAs) in Major Trauma Centres, extending the programme to key A&E departments in Boroughs that have high levels of knife crime’.

The budget allocated from the Victim’s Fund to continue the Major Trauma Centre (MTC) support and expand to priority A&Es is £1,423,389 between April 2018 and March 2020 (DMPC Decision PCD 2017 174). £280,000 of this is committed to fund Solace Women’s Aid to provide IDVA provision within the MTCs.


This decision outlines the proposal to continue to fund Redthread through a grant for a further two years, until end of March 2020, to provide clinically embedded youth work to young victims of violence in the four Major Trauma Centres in London – Kings, St Georges, St Marys and Royal London – at a cost of £555,000. £30,000 of this amount represents a fee to Redthread to manage the IDVA provision provided by Solace Women’s Aid within the MTCs. 


MOPAC’s current grant agreement with Redthread to support the provision of specialist youth support to young victims of violence in the four Major Trauma Centres ends in March 2018. MOPAC has contributed funding towards Redthread providing these services since 2014-15.


Funding for a clinically embedded youth work service in priority A&Es will be covered in a separate decision.
 

Recommendation

That the DMPC:

(a)    agrees to commit £555,000 to fund Redthread, through a grant, continuing to support the delivery of specialist youth work support to young victims of violence in the four Major Trauma Centres between April 2018 and March 2020. £30,000 of this amount represents a fee to Redthread to manage the IDVA provision provided by Solace Women’s Aid within the MTCs;

(b)    delegates authority to sign the individual grant agreement related to the work described to the Chief Executive. 
 

Non-confidential facts and advice to the Deputy Mayor for Policing and Crime (DMPC)

1.    Police & Crime Plan and Knife Crime Strategy commitments

1.1.    Under the ‘Keeping children and young people safe’ strand of the Police and Crime Plan 2017-21 there is a commitment ‘to continue to support youth workers and Independent Domestic Violence Advocates in Major Trauma Centres, extending the programme to key A&E departments in Boroughs that have high levels of knife crime’.

1.2.    The London Knife Crime Strategy commits to ‘continuing to fund the youth support to victims of knife and gang crime in London Major Trauma Centres, ensuring that victims of knife crime are supported at a most critical time’ and ‘extending this programme to key A&E departments in Boroughs that have high levels of knife crime to maximise the power and value of this ‘teachable moment’’.

1.3.    Funding for a clinically embedded youth work service in priority A&Es will be covered in a separate decision.


2.    Support for young victims of violence in Major Trauma Centres

Existing service  


2.1.    Since April 2015, all four London Major Trauma Centres (MTCs) have had a specialist youth service for victims of serious youth violence and sexual exploitation (aged 11 to 25) provided by youth charity Redthread, in conjunction with St. Giles Trust (at Royal London Hospital). Clinically embedded youth workers engage with victims of serious youth violence who present at the A&E with assault-related injuries, gunshot wounds, stabbings, and those who report having been sexually exploited. The work is done in the hospital immediately after the incident, which research has shown to be unique ‘teachable moment’. It is at this critical juncture that young people are often willing to look at making significant changes to their lives.

2.2.    The approach, which Redthread call their ‘Youth Violence Intervention Programme’, was incepted over ten years ago in partnership with Kings College hospital (the MTC for South East London). In 2014 St Mary’s (MTC for the North West of London) became the second hospital to join the programme. MOPAC recognised the value in this approach – and seeking to support this innovative work and provide a consistent offer across London – decided to contribute grant funding which allowed Redthread to expand their service to cover all four London MTCs from April 2015 (overseeing St Giles Trust delivery in Royal London) and extend the age range they covered. MOPAC has continued to fund Redthread’s activities through grant funding at a value of £1.2M between 2015 and 2018; gradually reducing this funding year by year. Redthread have proved to be skilled at seeking and building up match funding from sources such as charitable trusts and foundations as well as from the hospitals themselves. 

2.3.    The following decisions approved the £1.2M spend between 2015 and 2018: DMPCD 2014 110 ,  DMPCD 2015 46  and DMPCD 2015 80 . At the time of the initial decision Redthread was the only service provider in the UK which provided support to young people through a team embedded within the clinical setting of the MTC. MOPAC’s current grant agreement with Redthread to support the provision of specialist youth support to young victims of violence in the four Major Trauma Centres ends in March 2018.

2.4.    Evaluation carried out by MOPAC’s Evidence & Insight team found that a total of 990 young people across London who have suffered serious violence have been supported by the service between April 2015 and March 2017 across three of the MTCs . The average age of a young person engaging with the Redthread service was 18 year and 10 months. 10% of these were under the age of 18 and not known to any agencies prior to their admission . 91% of the young people worked with are male and just under two-thirds had been stabbed. 74% of young people engaged were BAME and 25% were white. 30% were not in employment, education or training. 

2.5.    Results from the analysis of risk assessment scores had positive indications: 61% had seen a reduction in their total risk score 6 months after the intervention; 46% had seen a reduced involvement in violence (52% stayed the same ); and 32% had a reduced involvement in other criminal activity (67% stayed the same) .


Future support


2.6.    DMPC Decision PCD 2017 174 agrees the budget allocated from the Victim’s Fund to continue to grant fund the specialist youth support for young victims of violence in MTCs. £280,000 of this is committed to fund Solace Women’s Aid to provide IDVA provision within the MTCs.

2.7.    This decision seeks your approval to commit £555,000  to continue to fund Redthread, through a grant, to provide clinically embedded youth work to young victims of violence in the four Major Trauma Centres in London – Kings, St Georges, St Marys and Royal London between April 2018 and March 2020. £30,000 of this amount represents a fee to Redthread to manage the IDVA provision provided by Solace Women’s Aid within the MTCs. 

2.8.    In contributing funding towards this service in MTCs MOPAC is supporting via Redthread an activity that aligns with the Mayor’s priorities, but is the initiative and activity of Redthread. Our intention is to fund for a two- year period; delivery outcomes and the terms of the grant agreement will be reviewed annually and continued subject to evidence of impactful delivery. 

2.9.    The GLA Contracts and Funding code states that although a formal tendering exercise is not required by procurement law, MOPAC must give consideration to value for money, fairness, and transparency. Redthread and St Giles Trust are subject to robust quarterly performance management through which they demonstrate substantial throughput of cases and reach, ability to engage with and meet the needs of a vulnerable group, helping us to better understand the needs of young victims of violence in London. Redthread’s fundraising team have proved to be skilled at securing significant match funding from sources such as charitable trusts and foundations as well as from the hospitals themselves, increasing the numbers of young people that have received interventions. Redthread are already embedded in three of the four MTC sites (subcontracting and managing the fourth). Over the last three years they have built and developed a consistent, pan London model across the MTCs. They have provided a core co-ordination role, building links between the MTCs, providing shared recruitment and training, as well as performance oversight. Redthread key workers have built ongoing trusting relationships with a vulnerable caseload as well as establishing crucial relationships with hospital staff, becoming part of the hospital team. 

2.10.    To date, there are no directly comparable programmes in the UK that have been subject to robust evaluation . The Early Intervention Foundation’s 2015 report recognised the ‘opportunity’ of interventions within a hospital setting and found that there is initial evidence that these interventions may have positive results.  Redthread has pioneered this approach from its inception at Kings hospital over 10 years ago and has recently received funding to support their expansion of the approach outside of London, into Birmingham and Nottingham. While it has been challenging to prove impact on policing and criminal justice outcomes within the protections of the Caldicott principles, our intention is to continue to explore during these two years of further funding how to demonstrate impact, value for money, and support Redthread into the best position to be able to access funding from other sectors.  Evaluation of the programme to date, carried out by MOPAC’s Evidence and Insight team, demonstrates that Redthread delivers quality interventions to a high number of vulnerable young people (2.4 above). Results from the analysis of risk assessment scores has positive indications (2.5 above). The Evidence & Insight-led evaluation captured encouraging qualitative feedback from hospital staff, youth workers, young people receiving the service and through case studies. 


3.    Financial Comments

3.1.    This decision paper makes a recommendation to commit £555,000 to fund Redthread, through a grant, to continue to deliver specialist youth work support to young victims of violence and manage the IDVA provision provided by Solace Women’s Aid in the four Major Trauma Centres between April 2018 and March 2020.

3.2.    The MTC service delivered by Redthread will be a continuation of an existing funding arrangement, and bound by the re-issued Grant agreement.

3.3.    The funding breakdown is set out in the attached document.


4.    Legal Comments

4.1.    MOPAC’s general powers are set out in the Police Reform and Social Responsibility Act 2011 (the 2011 Act). Section 3(6) of the 2011 Act provides that MOPAC must “secure the maintenance of the metropolitan police service and secure that the metropolitan police service is efficient and effective.” This is a broad power which aims to support victims of crime and enable the efficiency and effectiveness of the police service. In addition, under Schedule 3, paragraph 7 MOPAC has wide incidental powers to “do anything which is calculated to facilitate, or is conducive or incidental to, the exercise of the functions of the Office.” Paragraph 7(2) (a) provides that this includes entering into contracts and other agreements.

4.2.    Under MOPAC’s Scheme of Delegation, all offers made of grant funding are reserved to the Deputy Mayor for Policing and Crime.  

4.3.    Section 143 (1) (b) of the Anti-Social Behaviour Crime and Policing Act 2014 provides an express power for MOPAC, as a local policing body, to provide or commission services “intended by the local policing body to help victims or witnesses of, or other persons affected by, offences and anti-social behaviour.” Section 143(3) specifically allows MOPAC to make grants in connection with such arrangements and any grant may be made subject to any conditions that MOPAC thinks appropriate.

4.4.    Officers must ensure that the arrangements comply with the Financial Regulations and Contract Regulations. 

4.5.    Officers must ensure that appropriate funding agreements are put in place between MOPAC and the recipients before any commitment to fund is made.


5.    Equality Comments

5.1.    Under s149 of the Equality Act 2010 (the Equality Act), as a public authority the Deputy Mayor and MOPAC must have due regard to the need to eliminate discrimination, harassment and victimisation, and any conduct that is prohibited by or under this Act; and to advance equality of opportunity and foster good relations between people who share a protected characteristic and those who do not. Protected characteristics under the Equality Act are age, disability, gender re-assignment, pregnancy and maternity, race, religion or belief, sex, sexual orientation, and marriage or civil partnership status (the duty in respect of this last characteristic is to eliminate unlawful discrimination only). The Deputy Mayor is referred to Appendix A which sets out the public sector equality duty in full.

5.2.    All providers and services commissioned by MOPAC must be compliant with the public sector equality duty set out in section 149(1) of the Equality Act 2010 and demonstrate a commitment to equal opportunities and understanding of equality issues. 

5.3.    The Police and Crime Plan 2017-21 Integrated Impact Assessment (IIA)  takes into account feedback from the public and stakeholders and makes an assessment of its impact on a number of objectives including Crime, Safety and Security, Equality and Inclusion and Social Integration.

5.4.    The Impact Assessment shows that young people are disproportionately impacted by crime as both victims and offender and that serious youth violence has increased steadily for the past three years, with 6,600 young victims in the 12 months to September 2016. The number of knife crimes with injury committed against Londoners under the age of 25 is, at 1,782 offences in the year to September 2017, the highest level since 2012. The evidence is clear that when young people are victimised, they are subsequently at much higher risk of both offending themselves and re-victimisation.

5.5.    Analysis also shows that repeat offenders tend to be young adults with 18-24 year olds recording the highest adult reoffending rates at 32.2% per offenders. They are also the largest cohort of offenders at over 26,000 individuals. 

5.6.    In terms of social integration evidence indicates that some areas of London are more vulnerable than others to crime, victimisation and offending. The evidence also indicates differential experiences of policing, victim satisfaction and confidence amongst different sections of London’s community – BAME, women, young people, boys/men, and people with physical and mental health disabilities.

5.7.    This decision supports initiatives and interventions for all victims, but particularly those of more serious crimes, vulnerable and repeat victims, and particular sections of the community who are over-represented amongst victims of crime. 

5.8.    Diversity monitoring is an integral part of quarterly performance management processes for the current MTC provision and forms part of the evaluation of the programme conducted by MOPAC’s Evidence and Insight team. The evaluation of Redthread’s delivery of the Youth Violence Intervention programme completed in August 2017 shows that a total of 990 young Londoners who have suffered serious violence received interventions from Redthread between April 2015 and March 2017 across three of the MTCs . The average age of a young person engaging with the Redthread service was 18 year and 10 months. 91% of the young people worked with were male and just under two-thirds had been stabbed. 74% of young people engaged were BAME and 25% were white. 30% were not in employment, education or training. Redthread and St Giles Trust youth workers are trained and experienced at providing trauma informed support to young people with complex needs.  


6.    Background/supporting papers

Appendix A: The Public Sector Equality Duty
    
 


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