Funding to existing A&E services to support young victims of violence

Reference code: 
PCD 432
Date signed: 
30 July 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…in Major Trauma Centres, extending the programme to key A&E departments in Boroughs that have high levels of knife crime’.

This decision outlines the proposal to contribute funding to Oasis Youth to support their existing provision of clinically embedded youth work to young victims of violence in Accident & Emergency departments in North Middlesex and St Thomas’ hospitals.

Recommendation

The DMPC is asked to: 

  • Approve up to a maximum of £490,000 grant funding to Oasis Youth to continue to deliver specialist youth work support to young victims of violence in North Middlesex and St Thomas’ Accident & Emergency departments up until September 2020. 
  • delegate authority to sign the grant agreement and specific funding amounts related to the work described to the Chief Executive. 
     

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

1.    Introduction and background

1.1.    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’.

1.2.    Knife crime recorded by police in the year to December 2017 has risen by almost a third (30.7%) across the Metropolitan Police Service (MPS). Data from the Redthread and St Giles’ Trust run youth support services in London’s Major Trauma Centres (MTCs) also tells us that there are increases in young people attending those hospitals who have been injured through knife crime – 837 between July 2017 and June 2018; 251 in the last quarter. Redthread’s work estimates that when a young person attends an MTC having been the victim of serious violent incident, they have equally presented at local Emergency Departments four or five times before with lower level injuries relating to violence or exploitation. There is an opportunity to intervene earlier – and potentially stop more serious harm - through A&E based services.

1.3.    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.

1.4.    MOPAC has contributed funding towards clinically embedded youth support to young victims of violence in London’s four MTCs since 2015. Results from the analysis of risk assessment scores from those that have received interventions from the MTC service had positive indications showing reductions in risk scores, reduced involvement in violence and reduced involvement in other criminal activity. 

1.5.    There are 29 A&E departments in London. To maximise the effect of the new service provision, the most affected Emergency Departments (EDs) should receive the interventions. Analysis has been conducted by MOPAC’s Evidence & Insight team and Information Sharing to Tackle Violence analysts to identify priority sites suitable for the expansion of the initiative.

2.    Issues for consideration

2.1.    DMPC Decision PCD 2018 377 agrees the budget allocated from the Victim’s Fund to fund youth services in MTCs and EDs. The Mayor’s Young Londoners Fund increased this funding by £640,000 in 2018-19 and a further £640,000 in 2019-20 (MD 2265). 

2.2.    Currently three hospitals have existing youth support services already operating in their Emergency Departments. Oasis Youth have run a service for young victims of violence in St Thomas’ A&E since 2010 and in North Middlesex A&E since 2014. To date the services in North Middlesex and St Thomas’ have been funded through local boroughs via (MOPAC) London Crime Prevention Funding, via short term pots of funding from CCGs or through ad hoc funding bids. Redthread have fundraised sufficient sums to launch an A&E service in Homerton from the end of July 2018 for two years.

2.3.    For the priority A&E sites where there is no existing service in place the budget will be allocated via a competitive tendering process to identify a voluntary sector provider with the right capabilities to deliver the required service.  

2.4.    In relation to the sites where priority need has been identified but an existing service in place, 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. Legal advice has confirmed that it is legitimate to provide a direct grant without competitive tendering in circumstances where value for money is demonstrated without detrimentally affecting fairness or transparency. Paragraph 2.5 sets out why this is the case the for North Middlesex A&E and St Thomas’ A&E.

2.5.    The analysis identifies North Middlesex A&E – serving Enfield and Haringey - as the highest demand A&E across knife crime data (Emergency Department, London Ambulance Service and MPS data). St Thomas’ A&E demand profile across the data is lower however performs an important role within the boroughs that it serves – Lambeth and Southwark. Oasis Youth should be funded directly for these services for the following reasons:

  • North Middlesex is our highest need A&E as evidenced by the data so we would like to use our funding to support Oasis to move towards a more stable and sustained funding position. 
  • The Oasis services within North Middlesex and St Thomas’ have been developed closely with the hospital clinical leads and local authorities to respond to local needs. The services have been in place since 2010 (in the case of St Thomas’) and 2014 (in the case of North Middlesex).
  • Oasis 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. 
  • The service has been independently evaluated to show positive impact. 
  • Commissioning competitively for these sites risks duplication, unnecessary mobilisation costs and disrupting a service that is already clinically embedded.
  • Commissioning Oasis gives us ready access to the young people that we know need services to divert them from further violence or victimisation. 
  • The Oasis service continues to work with the young person as they go back in to the community; for up to six months after admission. 
  • The Oasis A&E service offers value for money as it is integrated within the other community services that Oasis delivers – such as school and sporting services, food bank, debt counselling – which means that young people attending A&E services can be effectively supported and diverted into these services to help them address underlying reasons they may have led them to become victims of violence.

2.6.    On this basis this decision seeks approval to commit up to a maximum of £490,000 grant funding to Oasis Youth to continue to deliver specialist youth work support to young victims of violence in North Middlesex and St Thomas’ Accident & emergency departments up until September 2020. This will fully fund North Middlesex’s A&E service for an 18-month period, fully fund St Thomas’ A&E for a 12 month period and then offer part funding, requiring match, for the following 6 months.

2.7.    Delivery outcomes and the terms of the grant agreement will be reviewed annually and continued subject to evidence of impactful delivery. In contributing funding to Oasis MOPAC is supporting an activity that aligns with the Mayor’s priorities, but is the initiative and activity of Oasis. 

2.8.    A separate decision will be submitted to cover the award of the contract to the provider for the additional priority A&E sites.

3.    Financial Comments

3.1.    DMPC Decision PCD 2018 377 agreed £1,143,389 from the Victim’s Fund to fund youth services in MTCs and EDs. The Mayor’s Young Londoners Fund increases this funding by £640,000 in 2018-19 and a further £640,000 in 2019-20 (MD 2265), £1,280,000 in total.

3.2.    Together these mean that MOPAC are providing £2,423,389 towards hospital embedded youth services across London’s Major Trauma Centres and Emergency Departments (EDs) throughout 2018-2020.  

3.3.    Of this, £1,868,389 is being provided for services within A&Es (see table 1). 

3.4.    This is composed of: £588,389 Victims funding, now supplemented by £1,280,000 from the Mayor’s Young Londoner’s Funding. 

Table 1

Funding source 2018-19 2019-20 Total
Victims Fund £192,668 £395,721 £588,389
Mayor’s Young Londoners Fund £640,000 £640,000 £1,280,000
Total £832,668 £1,035,721 £1,868,389

3.5.    This decision provides approval for £486,287 of that £1,868,389 Victims funding and Young Londoner’s Fund, which will be provided to Oasis in the form of a grant to deliver specialist youth work support to young victims of violence in North Middlesex and St Thomas’ A&Es:

  2018-19 2019-20 Total
North Middlesex A&E service £163,990 £146,652 £310,642
St Thomas’ A&E service £142,516 £33,129 £175,645
Maximum total MOPAC contribution £306,506 £179,781 £486,287

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 have sought legal advice to ensure that the arrangements of direct grants to existing hospital-based youth services comply with legal requirements as set out above. Additionally, MOPAC officers can confirm that this approach is consistent with MOPAC’s Financial Regulations and Contract Regulations. 

4.5.    Furthermore, in contributing funding to Oasis MOPAC is supporting an activity that aligns with the Mayor’s priorities, but is the initiative and activity of Oasis. The GLA Contracts and Funding code (section 4.1) advises that the appropriate route in these circumstances is to progress through a grant award rather than a procurement route. Under MOPAC’s Scheme of Consent and Delegation (section 4.8) the approval of the award of all individual grants whether to secure or contribute to securing crime reduction in London is a function which the DMPC has reserved to herself. 

4.6.    Delivery outcomes and spend profile will be bound by the terms of the grant agreement negotiated with Oasis Youth before any commitment to fund is made. The terms of the grant agreement will be reviewed annually and continued subject to evidence of impactful delivery.

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). 

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.    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.

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

5.7.    Diversity monitoring is an integral part of quarterly performance management processes for the current Major Trauma Centre(MTC) provision and forms part of the evaluation of the programme conducted by MOPAC’s Evidence and Insight team. We will replicate this monitoring within the A&E services to understand who is accessing this service and enable us to evolve our services to ensure they fit the needs of those using it. We know from the evaluation of Redthread’s delivery within MTCs that of a total of 990 young Londoners receiving interventions between April 2015 and March 2017: 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. Oasis youth workers are trained and experienced at providing trauma informed support to young people with complex needs.  

6.    Background/supporting papers

None. 


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