Giving violence the boot: how Cardiff is getting results
University Hospital of Wales accident and emergency department is to be included on regular morning, noon and night police patrols.
A&E has a confidential free phone line to the central police station to encourage patients to report crime.
A&E provides information on how to report crime and get help from the victim support scheme.
Psychiatric help is provided for staff and patients at an on-site post traumatic stress disorder clinic.
A poster campaign encourages people to report violent incidents.
Drinks licensing has been made responsive to assault injuries sustained in bars and clubs.
As hospitals around the country patch up the victims of new year festivities, staff in Cardiff are celebrating a 20 per cent decrease in the number of people treated for injuries caused by bottle, glass, knife and other violent attacks.
The improvement in the figures, drawn up by the Cardiff Violence Prevention Group, is attributed in part to the publication of a list of the most violent pubs, clubs and bars in the city.
The trend is more significant since the two-year-old project also encourages people to report assaults in order to curb violence.
It has also played a role in reducing violence and aggression against hospital staff and changed the treatment regime of some patients, who can now visit a post-traumatic stress disorder clinic.
Welsh secretary Alun Michael believes the approach could become a template for the rest of the UK, given its very New Labour 'big picture' long-term goal of societal change brought about by 'joined-up government'.
In his previous guise as Home Office minister, Mr Michael liked the initiative so much that it was included as an example of best practice in the Crime and Disorder Bill, which gives HAs a statutory duty to address crime.
The group is the brainchild of Jonathan Shepherd, professor of oral and maxillo-facial surgery at the University of Wales College of Medicine, who spends much of his time repairing faces damaged by bottle and glass attacks.
Professor Shepherd brought together Bro Taf HA, the police, medical school, victim support groups, local council and licensing magistrates to design a set of practical measures to cut street and domestic violence (see box).
When the group was set up five years ago, about 3,600 victims of violence a year were seen by Cardiff's main accident and emergency department, at University Hospital of Wales. This year the figure is down to about 2,800 and Professor Shepherd wants to cut it to 2,500 by next year.
By questioning patients in A&E, Professor Shepherd compiled a list of the 'worst' pubs, clubs and bars, which is published monthly in the South Wales Echo.
The partnership approach means that some pubs have had their licences revoked by magistrates or had a warning visit from the licensing police officer.
'It wasn't just name and shame. An important principle was that just a quarter of all assaults which led to hospital treatment are recorded with the police,' says Professor Shepherd. 'We thought to make licensees responsive and reactive to injury rates to illuminate that dark corner.
'I said to the manager of the Forum (the club at the top of the list ) that we could only do this by partnership. If this thing works you come down the list and everyone sees that because it's in the paper every month.'
His A&E questionnaire turned into a valuable crime and violence audit. It uncovered facts about frequency, weapons used and the extent of domestic violence.
Half of those presenting had been injured before. Three-quarters of those assaulted do not have access to victim support services.
'We also found one-third of the injured developed psychological problems - either flashbacks to the incident or depression and sleep problems known as hyper-arousal,' he says.
'We set up a crisis clinic in A&E so people at risk are seen by a liaison psychiatrist.'
Rupert Evans, A&E consultant at University Hospital of Wales and a member of the CVPG, is involved in a similar project to look at injuries caused by pub and club bouncers.
He says staff and patients are also reassured by a regular police presence in A&E and adds that it has also encouraged more people to report crimes.
'This is more reassuring from the patients' and staff point of view. It also means that patients who might not have gone and reported a violent crime actually have the opportunity of doing so there and then.
'One of the big problems is that crime has gone unreported - statistics say it is something like 40 per cent unreported. I have no hard facts, but I am sure that the presence of a police officer has reduced the risks. I have seen it personally on a few occasions when patients get quite aggressive, then do actually start to behave.'
Consultant psychiatrist Jonathan Bisson says the crisis clinic, which holds weekly sessions in the fracture clinic less than 100 yards from A&E, gets between eight and 12 referrals a month. Most are given counselling and, in some cases, pharmacological treatment for drug or alcohol misuse.
He says: 'It does provide for a better working relationship when you know that these sorts of support and back-up services are available.
'It is very important to provide that environment for people working in a hazardous and stressful job.'
More broadly, Professor Shepherd's campaign to get pubs to use toughened glass and plastic bottles to reduce the severity of injuries is also being taken seriously.
One of the biggest producers of pint pots in the country, Dema Glass in Chesterfield, is producing 12 to 15 million toughened glasses a week to replace the current pub stocks, which have a limited shelf life. In France, wine-glass maker Durand is also producing toughened products for the UK.
Owen Jenkins, who chairs the Cardiff justices' licensing committee, says he is happy with the multi-agency approach and the success of involving licensing authorities.
'I have been a licensing magistrate for 12 years. I have always thought that it was somebody's right to have a liquor licence,' he says.
'Now I think that they also have public responsibilities - which is what this government talks about a lot - and I am signed up to that now and I would revoke a licence if they failed in these public responsibilities.'