Northern General: The Sheffield A&E scheme hoping to stop 'revolving door' of violence as crimes rocket

As South Yorkshire experiences a concerning rise in the number of violent offences being recorded across the county, a team of dedicated professionals based in Sheffield’s Northern General Hospital are hoping to break the cycle of violence. 

A person’s life, health and future can be changed, sometimes irrevocably, in a split-second when they become the victim of serious violence. 

Worryingly, the devastating consequences of violence are touching more and more people in South Yorkshire.

Huge rise in violent offences recorded in South Yorkshire

Figures from the Office of National Statistics (ONS) show that over the last five years the number of offences of violence against the person recorded by South Yorkshire Police has risen sharply by 28.16 per cent, increasing from 44,892 in the year ending June 2019 to 57,534 for the year ending June 2023. The year ending June 2023 - running from July 2022 to June 2023 - is the most recently-released dataset from the ONS. 

Offences relating to knife crime in South Yorkshire have also risen considerably over the same period, ONS data shows. The total of selected serious offences involving a knife has consistently increased over the last five years, in spite of the impact of the Covid-19 pandemic and the corresponding fall in recorded offences, going from 996 in the year ending June 2019 to 1,618 in the year ending June 2023. This represents a rise of 622, or 62.44 per cent. 

The vast majority of people in South Yorkshire who are subjected to serious violence are taken to the Northern General hospital in the Fir Vale area of Sheffield for treatment, which is the region’s major trauma centre. 

Kristy O’Brien, Trauma nurse coordinator at Northern General explains: "It's a major trauma centre, so all people who have been seriously injured including seriously assaulted from South Yorkshire will come to us. Say, if somebody has been stabbed or you know there's various…it's a bit complicated but, generally speaking, if someone has been seriously seriously assaulted yeah in South Yorkshire they will be brought to the major trauma centre, so we have the clinicians that are able to look after their injuries."

Helping violence survivors to move away from toxic 'revolving door'

For those lucky enough to survive serious injuries, what happens next, after the ambulance’s blue flashing sirens have faded, and the life-saving measures implemented by dedicated medics are well in place? 

Some people may have a support network in place, meaning they will be looked after during their recovery, and supported to move on with their lives when they are ready to do so. 

But for others, moving on, and away, from the circumstances that led to them being subjected to violence, or a toxic 'revolving door' of offending and being offended against, is not so easy. 

Northern General A&E Navigators

That is where the team of Northern General’s A&E Navigators come in. Their aim is to provide ‘non-judgmental support’ and help with problems which are 'preventing people from living a safe and positive lifestyle'. 

It is an initiative provided by the South Yorkshire Violence Reduction Unit (SYVRU), and is based on a model from Medics Against Violence in Scotland.

Medics Against Violence was established at a time when Glasgow was recognised as the murder capital of Europe, with a homicide rate that was double that of their neighbouring countries.

In addition to her trauma nurse coordinator role, Kristy is also the Clinical Lead for the Navigator service at Northern General. 

Explaining why she is passionate about the Navigator service, Kristy said: "So from the point of view of me, and my colleagues, we were really noticing that people were coming in through assaults and violence and it was a kind of revolving door and they were coming back again. We wanted to help more than just patching them up and sending them on their way, but there wasn’t  much that we could do to help, other than that, until the Navigator service came."

She added: "It's a bit of a time out of the normal lives and time they can possibly reflect, be a bit more reflective and they may decide they want to make some changes in their life and that's when the ED (emergency department) Navigator service can get involved with them. 

"So when I was offered a chance to be involved with the service a couple of years  ago I absolutely jumped at the chance because it's just something, myself, my colleagues and my team, have been wanting to help and support in any way we can."

'They get to their home environment and it hits them like a tonne of bricks'

Claire Bidwell is one of four Navigators working for the service, and stresses that every single person they help is different, and their approach is tailored accordingly. 

"Some people want to engage straight away; they can't believe what's happened," said Claire. 

She added: "Others think yeah, everything's fine, and they get to their home environment and it just [hits them] like a tonne of bricks and [it’s then that they have a] realisation of what's happened to them."

Commenting on the importance of meeting victims of violence while they are still in hospital, Kristy added: "I think it is nice though when the Navigators can meet the person while they’re still in the hospital because you've seen their face, you've had a chat with them. You've helped them and supported them emotionally when they’re in a really vulnerable position, so I think it's a very nice start if that can happen."

Claire continued: "I would say the majority of my patients that I've got now, I've met first in the hospital. That putting a face to someone rather than a phone call introducing yourself."

"That's why through the week, we do our community shifts, but we always try to make sure that there's a clinical member of staff in the hospital, so there's always one Navigator there to go and meet someone if they do come in."

The Navigator team hopes that by engaging with, and supporting, survivors shortly after an incident has occurred, they may be more open to reflection; and intervention at that stage may help to prevent a further escalation of violence. 

When asked whether preventing such an escalation is always at the forefront of their minds, Kristy responded: "Well it is for me, because as a nurse, I've been there when we've had young people come in that have actually been fatally injured; and when you have to deal with that and you have to speak to their family, and tell the family what's happened, it's something you'll ever forget and it's something that you never want to have to do again.

"Which is another reason that I'm really really passionate about the Navigator service, because hopefully that's gonna stop that kind of thing happening. So yeah, if we can just help one person, then it's worth getting out of bed for."

The public health approach

The SYVRU is one of 22 areas allocated funding to run such units by the Home Office, a requirement of which is to take a ‘public health approach’ to reducing violence. 

Explaining what a public health approach entails, a SYVRU spokesperson said: "In South Yorkshire, we are taking a public health approach to preventing and reducing violence. This means that we look at the causes of violence, working in partnership to stop violence before it starts (primary prevention), halt the progression of violence once it has already begun (secondary prevention) and provide ways out for people already entrenched in violent behaviour (tertiary prevention). We acknowledge the importance of criminal justice and enforcement to ensure that people are held to account for their actions and we work to change attitudes towards violence in our society."

The SYVRU also runs a similar custody Navigators scheme, operating in custody suites across the county. 

Both Navigator schemes focus on what is described as a ‘reachable, teachable moment’. 

Kristy explained: "For me, as a clinician, if somebody comes in and they’ve been seriously assaulted as well as initially obviously I'm helping them physically. I'll be aware that I want to support them more so I will offer the Navigator service at the first reasonable opportunity. It might not be reasonable to do it straight away. They might not be in the right mindset for that and then the Navigators, once they receive a referral or are asked to come and see a patient.

"They try to come to see them very quickly when they're in the emergency department or on the wards, so we can utilise this time out that they're having really into explain what our services are and and also as equally importantly find out about the situation, what their life looks like, what their experiences are, what their hopes are and what kind of barriers are in place."