South Wales VPU
Nurse-led teams in hospital emergency departments that aim to identify and support patients who attend hospital with injuries associated with violence.
Evaluation type
Implementation and Process evaluation
Related Project
South Wales VPUOrganisation name
South Wales VPUFunding round
Another chance – Diversion from the criminal justice systemFunding
£541,014Regions
Wales, WalesActivity Type
Hospital-based intervention
Setting
A&E and health services
Evaluator
Cardiff University
Completed
October 2024What does this project involve?
Violence Prevention Teams (VPTs) are led by nurses in hospital emergency departments and aim to identify and support patients who attend hospital with injuries associated with violence. After identifying vulnerable patients (who include children and young people), nurses provide advice and support and signpost them to other services. Unlike ED navigator programmes delivered elsewhere (that tend to use youth workers to support patients), VPTs use nurses. This project explored the delivery of VPTs in South Wales where the programme has been established in two hospitals (one in Cardiff at the University Hospital of Wales and a second in Swansea at Morriston Hospital).
Why did YEF fund this project?
A and E navigator programmes like VPTs are associated with a large estimated impact on reducing further violence. However, the evidence that underpins this estimate is severely limited, and we lack a robust estimate of impact in a UK context. There is also limited guidance that can inform their current implementation and delivery.
YEF and the Home Office therefore funded this implementation and process evaluation to explore the development and delivery of the VPTs. The evaluation aimed to explore a range of implementation questions, including how embedded VPTs have become in the two hospitals, to what extent delivery aligned with the desired model, to what extent patients engaged with the intervention, and what strategies and practices are used to support good implementation.
To explore these questions, the project conducted a scoping review of the literature, before using documentary analysis, emergency department data (including data on patient demographics and engagement rates), and 49 interviews: VPT staff (n = 5), university health boards (n = 15), partnered third sector organisations (n = 17), local authorities (n = 7), South Wales Police (n = 2) and national organisations (n = 3). No interviews were undertaken with patients and service users. The National Institute for Health Research has funded an accompanying effectiveness and cost-effectiveness evaluation that will publish in 2025.
Key conclusions
| VPTs faced challenges embedding themselves into EDs. High hospital staff workload and turnover and the changing physical locations of VPTs made it difficult to keep hospital staff aware of them. Cardiff VPT addressed this by moving into a permanent safeguarding hub, a known location that ED staff could refer patients to. |
| Staff and stakeholders perceived that the model was largely implemented as intended. However, varying staffing levels, emergency department workload, and VPT staff work patterns (where staff mainly worked Monday to Friday, 8am to 5pm) hampered delivery. |
| Between November 2019 and December 2022, Cardiff VPT identified 2,312 patients who had experienced violence; 1780 of these patients engaged in the intervention. From January 2022 to September 2023, Swansea VPT identified 602 patients, of which 304 engaged with the intervention. An analysis of ED patient data suggests that VPTs improved the ability of hospitals to identify patients who had experienced violence. |
| VPTs across both sites were viewed by stakeholders to be acceptable, important and needed. VPT staff were seen as “violence prevention champions”. Their nursing experience, skillset, personalities and abilities to work in an agile manner with varied and complex patient needs were praised. |
| VPT staff were trusted to make adaptations to the model to ensure effective delivery. For instance, Swansea VPT trialled evening and weekend staff shifts to improve engagement with the most in-need children. |
What will YEF do next?
YEF will wait for the National Institute for Health Research’s accompanying effectiveness and cost-effectiveness evaluation before deciding whether to continue with further evaluation of VPTs.