New research shows that Hospital Accident and Emergency (A&E) violence prevention programmes are effective in reducing harm, costs to the NHS and improve emergency care.
A series of research studies, led by Cardiff University, University of York, and Swansea University, looked at the effectiveness of Hospital Violence Intervention Programmes in Wales - known as Violence Prevention Teams.
Violence Prevention Teams aim to break cycles of harm and prevent future victimisation and offending. The teams consist of specialist nurses and advocates embedded directly within A&E. They identify patients attending due to violence, sensitively explore personal circumstances and risk factors, provide immediate support, and refer patients into health and social care.
Violence Prevention Teams were first introduced at the University Hospital of Wales in Cardiff in 2019, and at Morriston Hospital in Swansea in 2023 through funding provided by the South Wales Police and Crime Commissioner.
This new body of research provides the first evidence that a targeted A&E-based public health approach can meaningfully reduce repeat harm while easing the burden on stretched emergency services – with UK-wide implications.
South Wales Police and Crime Commissioner Emma Wools said: "I am immensely proud that funding from my office has supported the development and growth of Emergency Department based Violence Prevention Teams. The success evidenced within this evaluation is also testament to the dedication and passion of nurses, caseworkers, the many statutory and third-sector partners who stand alongside them and the health boards that have enthusiastically adopted the approach. These Violence Prevention Teams are an example of partnership working at its very best."
Accident and Emergency is the single most common point of contact for people seriously injured in violence. Up to 75% of patients are not known to the police, meaning the NHS is often the first and only agency able to identify those at risk.
Co-Director of the Security, Crime and Intelligence Innovation Institute
Director of Violence Research Group
Professor Simon Moore, Director of the Violence Research Group at Cardiff University, said: "By integrating programmes that identify patients experiencing violence, Violence Prevention Teams can play a fundamental role in delivering interventions and preventing future harm.
"Our reports are the first in the UK to examine the economic and social impacts of these teams."
The researchers analysed data from Violence Prevention Teams in the University Hospital of Wales and Morriston Hospital, spanning over a decade, to evaluate their impact and cost-effectiveness.
Key findings:
- From both a health system and societal perspective, Violence Prevention Teams were cost-effective and cost-saving, mainly due to reductions in follow-up A&E attendances and hospital admissions, and visits to patients' GP. The probability that Violence Prevention Teams were cost-effective was 83–84%, and the probability that they were cost-saving was 84%.
- Among the patients who engaged with Violence Prevention Teams, repeat unplanned A&E attendances fell by 5% overall, with women and girls seeing a 14% reduction in repeat attendances. Young people aged 11-17 and 18-30 experienced reductions of 12-14%.
- Reductions in attendances were observed, not only for violence-related injuries but across all reasons for future A&E attendances, suggesting that the Violence Prevention Teams were able to identify underlying vulnerabilities, and provision support that translated to a general improvement in patients' circumstances.
- A qualitative evaluation of 49 practitioners found that Violence Prevention Teams are widely viewed as credible, trusted champions within the clinical team.
- Nurses described supporting patients with needs including mental health conditions, homelessness, substance misuse, neurodevelopmental conditions, exploitation, gang involvement and criminal justice contact - many requiring long-term, coordinated support.
The researchers looked at more than 6.7 million emergency department visits across Wales. They found that after Violence Prevention Teams were introduced in Cardiff and Swansea, the hospitals became much better at spotting when someone's visit was caused by violence. Some patients can be reluctant to disclose their experiences of violence, such as those accompanied by the perpetrator and those involved with illegal activities.
In Cardiff – where the service had been running for some time - staff identified up to 44% more violence-related cases than they had before, whilst in Swansea, they identified 21% more.
Professor Moore said: "Some groups are most likely to be missed under usual care, and therefore most helped by Violence Prevention Teams. This includes men, younger people, patients living in deprived areas and black and mixed‑ethnicity patients."
Our research shows that Violence Prevention Teams can help tackle long-standing inequalities in who receives support for violence-related risk and trauma. From this body of research, we believe that Violence Prevention Teams represent a transformative and equitable model for the NHS.
Co-Director of the Security, Crime and Intelligence Innovation Institute
Director of Violence Research Group
The research recommends that Violence Prevention Teams should be prioritised for national rollout, offering long-term benefits for patients, the NHS, and wider society including violence prevention, enhanced safeguarding, reducing NHS pressures, and improving health and wellbeing for some of the most vulnerable members of society.
The findings also suggest that Violence Prevention Teams contribute substantially to NHS and UK Government priorities on violence against women and girls and high-intensity Emergency Department users.
The research papers – Investing in safety: evaluating the cost-effectiveness of the nurse-led Hospital Violence Intervention Programme relative to standard care in Wales, Effectiveness and Cost-Effectiveness of Emergency Department–Based Violence Intervention Programs in the United Kingdom: Protocol for a Quasi-Experimental Study , A Quasi-Experimental Effectiveness Evaluation of a Nurse-led Hospital Violence Intervention Programme in the United Kingdom Using Linked Routine Health and Administrative Data , Nurse-led hospital violence intervention programmes improve emergency department identification of violence-related visits , and Practitioner experiences of developing and implementing two UK ED-based hospital violence intervention programmes: a process evaluation , were undertaken by the University of York, the Violence Research Group at Cardiff University, Swansea University, Cardiff and Vale NHS Trust, Department of Military Surgery and Trauma, Defence Medical Services, Public Health Wales, Cardiff Liver Unit at the Cardiff and Vale NHS Trust, World Health Organization Collaborating Centre on Investment for Health and Wellbeing, Swansea Trials Unit, and the Academic Department of Military Surgery and Trauma.
