ASSAULT SURVEILLANCE: ESTABLISHMENT OF A LOCAL INJURY SURVEILLANCE SYSTEM Zara Anderson and Linda Turner Thursday 8 th September – 12.15pm

Objectives Trauma and Injury Intelligence Group Injury Surveillance System Assault Surveillance Barriers Benefits Summary

What is the Trauma and Injury Intelligence Group (TIIG)? A partnership group across Cheshire and Merseyside with representation from PCT's, Academia, Fire Service, Police and Ambulance Objectives include: –Informing and advising the local Public Health Network and Strategic Health Authority on injury intelligence –Advising and supporting injury information providers –Informing injury prevention strategies through needs assessment, monitoring and evaluation –Making available the best evidence –Collaborating with partners on related initiatives (e.g. robbery and violent crime) The injury surveillance system is the primary mechanism for delivering objectives

Why is an injury surveillance system needed? Injuries are a key public health issue –cause people to die prematurely –major cause of disability, impairment, poorer quality of life –links to the inequality agenda National drivers Recommendation from BMA that: “injury surveillance centres should be established” Report to Chief Medical Officer - Preventing Accidental Injury: Priorities for Action “Public Health Observatories, together with their counterparts in local government, should play a key role in the surveillance of accidental injury” Local drivers Merseyside conference prioritised theme of improving information about injuries and those at risk

Steps in a surveillance system Defining the problem Collecting the data Entering the data Assessing the data Interpreting the data Reporting the results Using the results to plan prevention / treatment Evaluating the surveillance system Private sector and NGOs Other public service agencies Health departments Other stakeholders Source: Injury surveillance guidelines centres for disease control and prevention

What is the Merseyside and Cheshire model? Covers both intentional and unintentional injuries Brings together a variety of data sources in one place Sustainable surveillance system that is passive (data collected in the course of doing other routine tasks) Consistent collection of data items by using core data sets with local flexibility Wider coverage than other surveillance systems in UK and internationally Regular reporting on aggregated data

Injury datasets

Assaults – UK perspective

Some key facts Estimated 2.7 million incidents of violence every year in England and Wales Crime and Disorder Reduction Partnerships – crime audits Types of violence: youth intimate partner child maltreatment elder abuse sexual violence Reporting of violent crime and assaults – as low as 12% of worst cases of serious sexual assault Impacts on services – health, local authority, criminal justice Impacts on health – injuries, long-term physical, mental and sexual health problems, death At peak times 70% of A&E admissions are due to alcohol Costs of domestic violence per year £23 billion (NHS £1.4 billion) Costs of violent crime per year £24.4 billion

Drinking free-for-all 'will take police off the beat' Police fear late licences will lead to chaos

Assaults – Cheshire and Merseyside, UK Hospital admissions –Cheshire and Merseyside Accident and Emergency attendances –Arrowe Park –Royal Liverpool Ambulance call outs –Cheshire and Merseyside

Mortality and hospital admissions Cheshire and Merseyside: :- 7 deaths directly associated with assault 2002/2003: -2,978 assault-related hospital admissions –Leading cause of hospital admissions for males aged years –Second leading cause for males aged 25 – 34 years

Assault A&E attendances by age group April 2004 to March 2005 Royal Liverpool – 4,314 (12%) Arrowe Park – 2,872 (7%) Over 70% of assault attendances were male

Assault attendances by number of attackers

Royal Liverpool A&E 91% attackers male 70% attacked by a stranger 51% not informed police Type of attack: - 1,415 struck (e.g. fist), 212 blunt object, 206 bottled/glassed, 93 stabbed Arrowe Park A&E Type of attack: - 2,213 struck, 341 Wound/cut, 32 stabbed, 23 bites, 20 falls, 19 glassed

Assault attendances by location of incident, Royal Liverpool A&E Liverpool City Centre Bold Street Concert Square Slater Street

Assault attendances by location of incident, Arrowe Park A&E

49% of assault attendances drank alcohol prior to their attack 85% of assault attendances between 2am and 4am Saturday morning drank alcohol prior to their attack 86% of assault attendances between 2am and 4am Sunday morning drank alcohol prior to their attack

Mersey Regional Ambulance Service Cheshire and Merseyside Patient demographics Time/date Hospital of attendance Location of call out

Assault/Rape call outs, April to June ,313 Assault/Rape call outs 34% aged 15 – 29 years 67% male 50% taken to emergency room -Royal Liverpool 22%, Arrowe Park 16%, Whiston 13%, Aintree 12%

Time/day of assault/rape ambulance call outs, April to June 2005

Violence against the person offences by Crime and Disorder Reduction Partnership area, rate per 1,000 population, Cheshire and Merseyside, 2002/2003 to 2003/2004

Data summary Victims: 15 – 29 years, male Attackers: male Peak times: weekend evenings Peak location: night time environment 49% victims drank alcohol prior to attack Not all assaults reported to the police

Data Constraints Variations in data collection Data quality Resources/Targets Accountability/Ownership Training

Implementation of a local Injury Surveillance System

What can be achieved? Data has potential to….. Identify Hotspots Identify Licensed Premises Identify Vulnerable groups

Police and other agency response: - Short term Targeted Deployment of Resources ( multi agency ) CCTV Targeting Licensed Premises Longer term Planning/license restrictions Multi agency interventions e.g P.C.T re Binge Drinking Parenting programmes etc. Inform strategies/Evaluate interventions

Benefits Reduce: –Violent crime Reduce: –Ambulance call outs –A&E admissions –Hospital admissions Meet National Targets Improve: –Improve health –Improve night time economy –Increase diversity Free up resources Facilitate information sharing and partnership working

Summary Violence is a health and criminal justice issue Multiple data sources should be shared and used Priority to improve data collection Multi-agency approach

Contact details Zara Anderson (TIIG analyst) (Data queries) Centre For Public Health Liverpool John Moores University Castle House North Street Liverpool, L3 2AY Tel: +44 (0) Linda Turner (TIIG Commissioner) (Strategic queries) South Sefton Primary Care Trust Burlington House Waterloo Liverpool, L22 0QB Tel: +44 (0) Website: