Support to young victims in London’s Major Trauma Centres and A&Es

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 initiate a commissioning process to identify a provider to deliver new clinically embedded youth work services in five priority A&E sites. It also recommends that MOPAC continue to contribute funding to support delivery of clinically embedded youth work to young victims in London’s four Major Trauma Centres: Kings, St Marys, St Georges and Royal London through to financial year 2021/22. This funding will align funding and delivery periods of the Major Trauma Centre services with the funding and delivery periods of the to be commissioned A&E services.

Aligning this service delivery creates a reasonable timeframe for MOPAC to develop a hospital-based youth work commissioning strategy – which can be supportive of the Violence Reduction Unit workplan - seeking a joint commissioning and sustainable funding arrangement with health partners post 2021.

The Deputy Mayor for Policing and Crime is recommended to:

• Agree a budget of up to £1.7million from October 2019 to procure a new service/s to deliver support to young victims of violence in five priority Accident & Emergency sites.

• Approve up to a maximum of £840,000 grant funding to continue to deliver specialist youth support to young victims in London’s four Major Trauma Centres from April 2020 through to 2021/22 financial year.

• Agree a budget of £60,000 to support a more comprehensive evaluation of the hospital based youth work commissioning; to enable the development of a longer term sustainable hospital based commissioning strategy to tackle violence.

• Delegate authority to sign the associated grant agreement and agree the specific funding amounts related to the work described to the Chief Executive Officer.

1. Introduction and background

1.1. The Mayor’s Police and Crime Plan 2017-2021 (PCP) puts victims at the heart of everything MOPAC does, making significant commitments regarding the provision of better services and improving the experience of for victims of crime.

1.2. MOPAC has been contributing funding towards, and commissioning hospital-based support for young victims of violence since 2014/5. 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.

1.3. Commitments were made in the PCP and London Knife Crime Strategy to ‘continue to support youth workers and Independent Domestic Violence Advocates (IDVAs) in Major Trauma Centres (MTCs), extending the programme to key A&E departments in Boroughs that have high levels of knife crime’.

1.4. The current grant agreement with Redthread – to deliver the services to young victims of violence in MTCs – ends in March 2020. The current grant agreement with Solace Women’s Aid – to deliver the services to young victims of domestic abuse/violence in MTCs – ends in March 2020.

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

2. Issues for consideration

2.1. MOPAC funding allowed the “youth worker in a hospital setting” model that had been developed by Redthread and Kings College hospital (the first in the UK) to expand the service to cover all four London MTCs from April 2015; not just extending the reach but also extending the age range the service worked with from under 18 to under 25. MOPAC saw the value in this innovative approach and wanted to provide a consistent offer across London. This service is being delivered by youth charity Redthread, in conjunction with St. Giles Trust (at Royal London Hospital).

2.2. MOPAC has funded a youth IDVA service to support young victims of domestic abuse and domestic violence since November 2015. This service is being delivered by Solace Women’s Aid.

2.3. Across both these services MOPAC has contributed £2.3M funding to youth workers embedded in London’s MTCs since 2014/15. 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. This has made it possible for MOPAC to reduce its contribution year on year.

Commissioning of new youth work in A&E services

2.4. This decision seeks DMPC approval for a budget of up to £1.7million from October 2019 to procure a new service/s to deliver support to young victims of violence in five priority A&E sites.

2.5. The five priority A&E sites are :

• Newham

• Queen Elizabeth II (Woolwich) – covering Greenwich & Bexley

• Croydon

• Lewisham

• Whittington – covering Islington & Haringey

2.6. Analysis was conducted by MOPAC’s Evidence & Insight team and Information Sharing to Tackle Violence (ISTV) analysts to identify priority sites; defined as those having high numbers of young people presenting as victims of violent crime and located in boroughs that have high levels of knife crime .

2.7. The service specification has been co-designed with clinical leads to ensure the service meets the needs of the young people attending each Emergency Department. An open and competitive procurement route, guided by TfL’s procurement process and governance arrangements, will be followed to identify a suitable provider/s and leading to the award of a commercial contract.



2.8. The intention is that the new A&E services will start delivering at the beginning of 2020 and deliver for a period of 24 months.

Youth support to young victims in MTCs

2.9. This decision seeks DMPC approval to commit up to a maximum of £550,000 grant funding to Redthread to continue to deliver specialist support to young victims of violence in London’s four Major Trauma Centres from April 2020 through to 2021/22 financial year. This funding will be directly awarded to Redthread via a grant agreement for reasons described at section 4.6 below.

2.10. This decision seeks DMPC approval to commit up to a maximum of £290,000 funding to continue to deliver specialist support to young victims of domestic abuse and violence in London’s four Major Trauma Centres from April 2020 through to 2021/22 financial year. This funding will be allocated following an open and competitive commissioning process.

2.11. Continuing to fund these services allows PCP and London Knife Crime Strategy commitments to be met but is also desirable for wider reasons:

• The services are delivering to high numbers of vulnerable young people with some positive indications of impact. In 2018/9 MTC young victims of violence services have successfully contacted 993 young people and engaged and delivered interventions to 492 young people, of which 52 were under 18s not known to services. Analysis of risk assessment scores shows positive indications. The services receive positive feedback from clinical staff at each of the sites and from the young people supported. Evaluation of the longer-term impact of the services (on future victimisation, offending and readmissions) has been limited due to the challenges of sharing the personalised information within the protections of the Caldicott principles.

• In 2018/9 MTC young victims of domestic abuse/violence services supported 391 young people predominantly for DA (79%) or as the victim of sexual offences (8%) resulting in 38 referrals into MARAC and 27 Children’s safeguarding referrals.

• Continuing to fund MTC services in 2021/22 aligns the funding and delivery periods of the MTC services with the funding and delivery periods of the five new youth work in A&E services that are being commissioned. This will enable a more strategic and co-ordinated approach to hospital-based youth work in the future.

• Clinical leads are clear about the demand and complexity of young victims of violence they are treating. MPS and MOPAC data show that there have been longer term increases within violence in London. ISTV data indicates that 7% of A&E admissions for assault were because of knife use and 44% of offences were body sourced (use of a body part). Data from our MTC services tells us that 67% of all those the services engaged with during 2018/19 were treated at the MTC because they had been stabbed.

• With the creation of London’s Violence Reduction Unit (VRU) and its emphasis on a public health approach – looking at violence as a preventable consequence of a range of factors, such as adverse early-life experiences, or harmful social or community experiences and influences – there are clear benefits to MOPAC and the GLA working collaboratively with London’s hospitals. By working across organisational boundaries, we can better understand and define the population affected by violence as well as identifying what is effective in tackling the problem.

2.12. We need to ensure that there are sufficient resources to fund a comprehensive evaluation of the expansion of youth workers provision into A&E settings, this will support the development of the future approach to hospital commissioning, engaging fully with health commissioners.

3. Financial Comments

Commissioning of new youth work in A&E services

3.1. This decision seeks DMPC approval for a budget of up to £1.7million from October 2019 to procure a new service/s to deliver support to young victims of violence in five priority A&E sites.

3.2. The total budget for youth work services in A&Es for the period 2018 – 2019 to 2021 - 2022 is £2,628,389. This includes funding already allocated to Oasis Youth to deliver services in North Middlesex and St Thomas’ A&Es from October 2018, consultancy support to the procurement and project evaluation costs, leaving a budget of £1.7 million to support the expansion of these services to the five identified priority sites. A breakdown of the budget sources for the total £2.5 million budget is set out below. The additional £60,000 requested for evaluation will be paid for from the MoJ victims grant.

3.3. The proposed profiling of spend of the £1.7 million for the new A&E service/s is set out below.

Table 2: Indicative budget profile for commissioning of A&E services for 5 new sites

Youth support to young victims in MTCs

3.4. This decision seeks DMPC approval to commit up to a maximum of £840,000 grant funding to continue to deliver specialist youth support to young victims in London’s four Major Trauma Centres from April 2020 through to 2021/22 financial year.

3.5. £550,000 of this amount will be awarded directly to Redthread via a grant agreement to deliver a service to young victims of violence. MOPAC is a part funder of the MTC services - funding Redthread’s activities through grant funding between 2015 and 2019 - gradually reducing this funding year by year. In financial years 2018/19 and 2019/20 MOPAC funds less than half of the total MTC service costs. This reduction in the proportion of the funding has been possible because 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.

3.6. £290,000 of this £840,000 will be allocated to the delivery of a youth IDVA service in MTCs. A suitable provider will be identified following an open and competitive commissioning process.

3.7. Funding for youth work in MTC services in 2020/21 and 2021/22 will continue to come from the MoJ Victims Grant. It is noted that this is an annual funding allocation from the MoJ to the Mayor and therefore funding would need to be provided at risk, backed by provision within MOPAC reserves until MoJ funding is confirmed.

Table 3: Funding breakdown for continuation of funding to MTC services

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.” 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. 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.

4.3. The powers in section 143 were given to MOPAC following the Government’s response to the consultation Getting it Right for Victims and Witnesses (2 July 2012) in which it set out a package of reforms to the way in which support services for victims of crime are to be provided.

4.4. The recommendations in this decision are in line with the legislation and in line with MOPAC’s Scheme of Delegation as set out below.

4.5. In line with section 4 of MOPAC’s Scheme of Consent and Delegation, the DMPC has authority for the:

• approval of business cases for revenue expenditure above £500,000 and for the strategy for the award of grants (section 4.8);

• approval of the strategy for the award of individual grants and the award of all individual grants (section 4.8); and

• approval of the procurement strategy and requests to go out for tender for contracts of £500,000 or above, and the award of contracts with a value of £500,000 and above (section 4.13).

4.6. A further DMPC Decision will be submitted regarding the award of contracts for the expansion of A&E-based services following the end of the procurement process.

4.7. In line with section 5.22 of MOPAC’s Scheme of Delegation, the Chief Executive Officer has authority for the finalisation of planning and contractual/grant arrangements, including relevant terms and the signing of contracts and grant agreements.

4.8. Officers have sought legal advice to ensure that the arrangements of direct grants to existing hospital-based youth services comply with legal requirements. In contributing funding to Redthread to deliver in MTCs, MOPAC is supporting an activity that aligns with the Mayor’s priorities but is the initiative and activity of Redthread.

5. Commercial Issues

5.1. The funding for the provision of services to young victims of violence in MTCs will be directly awarded to Redthread via a grant agreement. MOPAC is no longer a majority funder for the young victims of violence in MTCs – Redthread fundraises for a larger proportion of the service costs. Therefore, in contributing funding to Redthread to deliver in MTCs MOPAC is supporting an activity that aligns with the Mayor’s priorities but is the initiative and activity of Redthread and it is appropriate to award this funding via a grant agreement.

5.2. Delivery outcomes and spend profile will be bound by the terms of the grant agreement negotiated with Redthread 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.

5.3. The funding for the provision of services to young victims of domestic abuse and domestic violence will be subject to an open and competitive grant process. This process will be conducted in line with MOPAC’s governance processes and Scheme of Delegation.

5.4. Professional, technical advice is being sought from MOPAC’s Procurement Manager and TfL procurement colleagues in relation to the commissioning approach which is being followed for the A&E service expansion, in order to ensure that the process is fully compliant with the Public Contract Regulations 2015.

5.5. The Procurement and Evaluation Strategies for the A&E expansion will be reviewed and approved by TfL’s Strategy, Evaluation, Award Recommendation (SEAR) panel, in line with their procurement oversight and governance processes, prior to the tender being published to confirm that the process is fully compliant with UK and EU procurement regulations.

6. Public Health Approach

6.1. The principle of youth workers embedded in hospital Major Trauma wards and A&Es aligns well with the public health approach that is at the heart of the VRU. These services identify and delivery interventions to young people at point of crisis – a significant number who are under 18 and not previously known to services. They provide trauma-informed and child-centered support with the aim of disrupting the cycle of violence, in particular tit-for-tat retaliation. They also support the victim to cope and recover more effectively, accessing wider health services, with the aim of supporting that young person to be able to access services necessary (e.g. training, education, mental health support) for them to be able to make more positive life choices.

6.2. The VRU is also informed by data and evidence to understand and tackle the causes of violence. The data received quarterly from the MTC and A&E services allows us to see a picture of victimisation that police and even ambulance data does not show us. Hospitals receive substantial proportions of ‘walk ins’ so the data collected helps us to better understand the locations, age, ethnicities and genders overrepresented in the violence data.

7. GDPR and Data Privacy

7.1. A full Data Protection Impact Assessment will be completed by all providers as part of the mobilisation for the services, to ensure that all delivery is fully compliant with the requirements of the GDPR.

7.2. All bidders for the A&E expansion contract(s) will be required to supply copies of their data protection policy to evidence their compliance with data protection legislation as part of the tender process.

7.3. All contracts and grant agreements will include clear provisions relating to compliance in this area, and in relation to the processing of personal data. These terms have been drafted following consultation with MOPAC’s GDPR Project Manager.

8. Equality Comments

8.1. Under section 149 of the Equality Act 2010 (the Equality Act), as a public authority the Deputy Mayor/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).

8.2. The Police and Crime Plan and associated commissioning plans are based on two principles:

• Victims First – putting victims at the heart of everything we do.

• Reducing inequalities in communities – a focus on setting an agreed standard and addressing the disparities we see across the city.

8.3. To address the inequalities that exist in London, MOPAC has four targeted priorities directed at those people who are disproportionately affected by crime. The priorities aim to provide specialised services that safeguard the most vulnerable in society and reduce evident existing inequalities. These priorities are reflected in MOPAC’s victims’ commissioning plans over the next three years and are as follows:

• A better police service for London

• A better Criminal Justice Service for London

• Keeping Children and Young People Safe

• Tackling Violence Against Women and Girls.

8.4. 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.

8.5. 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.

8.6. 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.

8.7. 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.

8.8. Diversity monitoring is an integral part of quarterly performance management processes for current MTC and A&E provision. This monitoring helps us to understand the needs of those accessing service/s 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. Youth workers delivering these services are trained and experienced at providing trauma informed support to young people with complex needs.

9. Background/supporting papers

None