Knife crime: where's the public health approach?

05 July 2019

With stabbings at a record high, and public outrage palpable following a spate of deaths, journalist Juliette Astrup asks if the public health approach to youth violence could be forgotten amid the headline-grabbing rhetoric of ‘more boots on the streets’? 


Knife crime has scarcely been out of the news this year, with the number of people fatally stabbed in the UK topping 100 by May – including three 17-year-olds in the first seven days of March. The headlines have horrified the nation, and public concern about crime in general has jumped to its highest level in years (YouGov, 2019).

Official figures tell the same story. Homicides in England and Wales are at a 10-year high. In 2018, there was a 6% increase in police-recorded offences involving a knife or sharp instrument, with the number of fatal stabbings the highest since Home Office records began in 1946 (ONS, 2019a; ONS, 2019b).

Northern Ireland too saw a small year-on-year increase in serious offences involving a knife or sharp instrument, and possession of weapon offences reached 1064 in 2018-19, a 20-year high (PSNI, 2019).

As reported in Community Practitioner this time last year (Harris, 2018), Scotland alone appears to be bucking the trend. Homicides north of the border more than halved, from 137 in 2004-5 (Violence Reduction Unit, 2019) to 59 in 2017-18, the joint lowest level for a 12-month period since 1976 (Scottish Government, 2018). This turnaround has followed a shift in approach to tackling violence: treating it like a disease – something that is preventable, rather than inevitable.

A visit to the murder capital

The pioneering Violence Reduction Unit (VRU) was set up in 2005, at a time when Glasgow had become known as Europe’s murder capital. It introduced a radically new public health approach to violence: a multi-agency response that seeks to understand and address its complex root causes, as well as responding to incidents of violence and working towards long-term rehabilitation.

It proved so successful it was soon rolled out across the Scottish nation. The latest analysis finds serious assault and attempted murder cases fell by 35% in Scotland between 2008-09 and 2017-18 – largely due to fewer cases in the west, particularly in and around Glasgow. The study also found that serious assaults were now far less likely to involve a weapon than those recorded a decade ago, and there has been a large fall in offending rates for teenagers and people in their 20s (Scottish Government, 2019).

The divergence with the rest of the UK is marked — and hasn’t gone unnoticed. In April last year, the Home Office published its Serious violence strategy (HM Government, 2018), which placed the focus as much on looking for the root causes of the problem as on law enforcement, with early intervention, prevention and supporting communities and local partnerships key among its aims.

But in 2019, in the face of stark statistics, the barrage of media coverage and the understandable public fear, anxiety and outrage, could the slow burn and nuanced public health approach be overshadowed by demands for a tough, traditional police ‘clamp down’ to stem the blood flow? For example, in March this year, Greater Manchester’s mayor called for tougher police action, penalties and ‘stop and search’ powers following a spate of knife crimes (Day, 2019), and Durham’s chief constable, Mike Barton, said police officers were losing the war against knife crime because of a lack of officers available to conduct ‘stop and search’ activities (Warburton, 2019).

Stronger policing

Amid the furore around a ‘knife crime epidemic’, a number of steps to strengthen policing  have been taken, including a £100m Serious Violence Fund to support a surge in police activity announced in the Spring Statement. The lion’s share has gone to forces to help them deploy more officers, improve intelligence and carry out short-term operational actions, such as targeting habitual knife carriers. The 18 forces facing the worst problems with violence received a £12.4m boost to allow them to ‘take urgent action, including [putting] more officers on duty in the worst affected areas’ (Home Office, 2019).

In March, police forces across England and Wales joined Operation Sceptre, using intelligence-led stop and search powers and weapons sweeps in a concerted crackdown on knife crime (National Police Chiefs’ Council, 2019).

In May, the Offensive Weapons Act received Royal Assent, bringing in tougher measures – including making it illegal to possess dangerous weapons in private, such as zombie knives and death star knives, and making it a criminal offence to dispatch bladed products sold online without verifying the buyer
is over 18.

The Act also saw the introduction of Knife Crime Prevention Orders – so-called knife crime Asbos – that allow police to impose restrictions, such as curfews and geographical restrictions on individuals, as well as limiting their social media use, if they suspect they are involved in knife crime (HM Government, 2019a; HM Government, 2019b; Home Office, 2019).

The home secretary also took the step to give police in areas most affected by serious violence greater powers to use Section 60, giving officers the power to stop and search anyone in a designated area without needing reasonable grounds for suspicion. In London, searches under section 60 increased five-fold, from 1836 in 2017-18 to 9599 in 2018-19 (Murphy, 2019).

Public health measures

While police numbers, resources and powers have been stepped up to meet the rising tide of knife violence, at the same time strides have been made towards a public health response to the issue.

London now has its own VRU, and more recently a Violence Reduction Partnership was announced for Merseyside, which is looking to build on similar models launched across the country and overseas (Merseyside Police and Crime Commissioner, 2019). Other areas are set to follow suit, with a third of the £100m serious violence funding set aside to support the setting-up of VRUs and other preventative activity across the country (Home Office, 2019).

The Serious Violence Task Force, established last year to deliver the key commitments of the Serious violence strategy, has led on a raft of initiatives, including a £200m Youth Endowment Fund, which will support programmes and community partnerships working to reduce youth crime in England and Wales over the next decade.

The government is also supporting Redthread, a charity working to reduce youth violence by placing youth workers in A&E units in London, Nottingham and Birmingham to intervene with young people following violent incidents. The charity calls this ‘moment of vulnerability’ the ‘teachable moment’, when ‘many are more able than ever to question what behaviour and choices have led them to this hospital bed and, with specialist youth worker support, pursue change they haven’t felt able to before’ (Redthread, 2019).

A youth advocates programme has begun training local role models to have ‘safe conversations’ with young people, aimed at combating knife crime. Meanwhile, a major media campaign, #knifefree, targets teenagers to set out the risks of carrying a knife based on real-life stories.

The government has also consulted on controversial plans to introduce a new statutory ‘public health duty’ to raise concerns about children at risk of becoming involved in knife crime, in a bid to ensure professionals across health, education, police, social services, housing and the voluntary sector are held accountable for preventing and tackling serious violence in England 
and Wales (Home Office and Welsh Government, 2019).

In Wales, too, a public health approach is being pursued via Early Action Together – a multi-agency partnership between Public Health Wales, the country’s four police forces, police and crime commissioners, Barnardo’s and HM Prison and Probation Service). It is a public health approach to policing and criminal justice, which uses early interventions and precautionary measures to deal with vulnerable people and the root causes of criminal behaviour (Royal Society for Public Health).

What next?

A recent analysis by the APPG on Knife Crime found the average council has cut real-terms spending on youth services by 40% over the past three years

While positive work is being done in pockets across the UK, is there yet a rock-solid consensus around the public health approach? In April came the Serious Youth Violence Summit in Downing Street, bringing together experts and political leaders – including Prime Minister May – but what was its impact?

Sarah Jones MP, who chairs the All Party Parliamentary Group (APPG) on Knife Crime, was there. ‘It was a good conversation,’ she says. ‘Everyone was saying all the right things and the secretaries of state there were all saying they had a role to play, too. But my message was, if we are going to do something like this, it has to be driven from the top, with a big team in the Cabinet Office overseeing it and holding people to account – that hasn’t happened.’

She adds: ‘The political realities are that Brexit is squashing everything else and the prime minister is leaving.’ (An announcement confirming the new prime minister is expected in the week of 22 July.)

And, with Tory leadership campaigning bringing fresh promises of ‘bobbies on the beat’ to win the fight against knife crime (Javid, 2019), is she concerned a change of leadership could herald a shift in direction?

‘It’s tricky because what they’re saying is not wrong, we do need more police,’ says Sarah. ‘But it would be a crying shame if the progress that has been made – and there has been some, though nowhere near enough in terms of policy direction – is washed away by a new prime minister.’

While few would argue against more police on the streets as part of the solution, that austerity and cuts to youth services are also part of the picture is increasingly hard to ignore.

For example, a recent analysis by the APPG on Knife Crime reiterated the case; it found the average council has cut real-terms spending on youth services by 40% over the past three years, and areas suffering the largest cuts to spending on young people have seen bigger increases in knife crime (APPG on Knife Crime, 2019).

‘All we can do now is keep talking about it, keep making the arguments,’ adds Sarah.

A permanent shift

‘We need a long-term strategy with all departments and agencies working together with local communities, making sure we’re following the evidence. We need to treat youth violence like a disease and we need to stop the spread’

Turning the juggernaut of public and political attitudes around when it comes to the best way to tackle violence is no mean feat – but progress on that front is tangible. ‘A few years ago, no one was talking about this – at least we are now having those conversations,’ says Vicky Foxcroft MP, chair of the Youth Violence Commission, which has sought to gather evidence about the root causes of youth violence.

‘We need a long-term strategy with all departments and agencies working together with local communities, making sure we’re following the evidence. We need to treat youth violence like a disease and we need to stop the spread.’ 

John Poyton, CEO of Redthread, believes the term ‘public health approach’ has already helped shape public and political understanding of how to tackle violence. ‘On different levels, people get it,’ he says. ‘People understand it’s not just about policing – it includes health, education, social services and early intervention.

‘Where there still needs to be a shift in perception is that we need to be talking about all violence – not just youth violence, or knife violence.

‘Yes, at the moment the biggest concern might be young people stabbing each other, but that is inextricably linked with the violence that young person has been exposed to, or witnessed in their household or community growing up – that might not be knife violence, but domestic violence, or sexual violence.

‘We need to look at the whole of society and how young people need to be supported – what happened in that young man or young woman’s experience, where could we have intervened earlier – that still gets lost.’

Pursuing the rhetoric

And while John welcomes the likes of the Youth Endowment Fund, and the £22m Early Intervention Youth Fund it follows, he recognises the investment is far from sufficient, given the scale of the challenge and its expansive nature: ‘What we haven’t had yet is the commitment across departmental budgets to be able to know this will be concreted into the fabric of the way government works.’

‘I want to see what all government departments [in England and Wales] do in the next three-year spending review in line with the public health approach to tackling violence – that is when I think we will be able to feel more confident that this approach will be sustained and follow the rhetoric in the right sense.’

A dual approach

The truth is that a strong policing and public health approach are not mutually exclusive – when it comes to tackling problems as serious, as widespread and as complex as youth violence and knife crime, both are needed.

But with the former a familiar go-to approach, and the latter a yet-to-be embedded step change, it is vital to keep banging the drum.

Sarah Jones adds: ‘In the current political climate there is just such a small space to talk about issues like this – the more people that can make noise about this the better. For health visitors, school nurses and other professionals in this space, the more noise they make, the more evidence they can offer to show the issues they face, the better. The one thing we can all do is keep talking about it.’

So, while it might not be grabbing the headlines, the public health approach to tackling violence is not being forgotten then, and nor should it be – as long as those who do understand its value don’t allow that to happen.

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