My Lords, I congratulate the noble Lord, Lord Harris of Haringey, on securing this important debate. I shall focus principally on health—public health in its broadest sense, but also advances in treatment caused by experience of violent crime in emergency departments. Knife crime increased by 22% between December 2016 and December 2017 in England and Wales. The rate of possession over the same period also rose by more than a quarter. Noble Lords have already commented on the connection between pupils, students and other young people already at risk. It is worthy of note that more than one in three local authorities have no vacant spaces in their pupil referral units for permanently excluded children and young people, leaving them vulnerable to exploitation and a lack of hope for the future.
I am grateful to Barnardo’s for its helpful briefing, which states:
“Almost 60% of its children’s services managers said they thought they had supported a young person involved in criminal activity over the last year”,
and three-quarters of its staff said that they thought the young person had been coerced, deceived or manipulated by others into criminal activity. We have heard of some of the statistics in London, but we know that it is much broader than that. It is absolutely clear that we need to take a public health approach to tackling serious violence. That has already happened in the Cure Violence model in Chicago and the Violence Reduction Unit in Glasgow. The intervention itself acts as a deterrent to future violence by disrupting its spread by changing cultural norms about the acceptability of violence.
The key elements of any public health approach will be identifying high violent crime areas. The model focuses very much on the epidemiological spread of violence and employs interrupters known to the community, often ex-gang members. Using the map of where violence happens, they seek to disrupt its spread and divert young people into alternative interests, giving them other means of dealing with conflict.
This is the alternative route to facing the lack of services available for young people. We heard in the previous debate of the pressures on schools to do anything other than deliver the barest curriculum. But it is broader than that. We heard from the noble Baroness, Lady Donaghy, about one young surgeon talking to young people—I will refer to others later—to make them understand the consequences of carrying knives.
Today, interestingly, Sky News has published a report on drug runners and the famous “county lines”. It is very long but certainly worth a read; it confirms that there are over 2,000 county line routes, with operations from big cities to smaller locations. Tellingly, one of the drug runners said, “Once I’ve established an area, I’ll get the kids to go there for me”. The children are paid £300 or £400 a week and are aged between 12 and 16. “The younger the better”, said one dealer, adding, “They need money. Mummy and daddy ain’t got no money, so they come to me as uncle”.
We need to understand that the comments about reduction and Sure Start are absolutely right. Austerity caused massive cuts to local government budgets, which means that children’s services, particularly safeguarding, are under real pressure. All those things are making it much more difficult for any multiagency approach to succeed.
Moving from public health to general health and the survival rate for knife wounds, we heard in August from the NHS that there are more than 1,600 extreme trauma survivors in the UK today. This is not just about stab wounds, but acid attacks, gunshot wounds, and car and motorbike accidents. It has become absolutely clear that the establishment of trauma centres, which ensure that patients receive the right care, even before they arrive in hospital—with paramedics trained to deal with them and with the targeting of trauma victims through the leading hospitals—has meant a reduction from 31% to 24% of patients receiving critical care, as well as a reduction in the amount of time patients spend in intensive care.
It was telling that the noble Baroness, Lady Donaghy, referred to young people thinking that there was not very much to a stab crime and it probably would not hurt. I shall not read out the detail of a clamshell thoracotomy, but it is clear that medics have to take emergency action very fast. In many past cases, patients would have died before even getting to hospital, so medics have a very narrow window of opportunity to bring them back. Duncan Bew, clinical lead for trauma and emergency at King’s College Hospital in London, says that it is imperative that his team are familiar with this procedure because of the volume of patients in the hospital. He said:
“My team sees more people with stab wounds then it does people with appendicitis—25% of our trauma wounds come through stabbings. Some days it’s higher. Sometimes we go to 50% of injuries. Somebody tweeted that on average there were three stabbings a day in London. Actually it’s much higher than that: we get more than three stabbings a day here in this hospital alone”.
Dr Malcolm Tunnicliffe from King’s says that the most critical stage of treatment for stabbing victims happens before they reach the hospital. At this stage, doctors stabilise patients and prevent many needing that emergency surgical procedure. Pre-hospital treatment includes locating the wound to assess damage to internal organs and blood loss, and very urgent imaging scans and X-rays.
I have questions for the Minister. We know that the NHS has excellent pockets of good practice, but what is happening to disseminate that practice across the country, particularly if county lines practice means that is moving out of our major city centres? Secondly, do the Government agree that taking a public health approach to tackling violent crime, working with local partners to identify risks, is the most effective way to prevent the spread of violent crime in a community? Thirdly, will the Government provide an increase in baseline funding for all services expected to pick up the tab for this, including children’s services? It includes education and the public health budget, which has been drastically cut. Finally, how have the Government been engaging with children and young people who have experienced serious youth violence to inform them of their approach?