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health, crime and community safety presentation


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This presentation and report on heath and community safety has been developed to identify links between health and crime

This presentation and report on heath and community safety has been developed to identify links between health and crime

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  • An example of data before full analysisA full analysis of the data for 2013 will be available later in April
  • 3 in 4 attendees are male (73.71%)
    61% arrived via emergency ambulance
    Average age of attendee – 26 (youngest 13, oldest 80)
    A quarter of all attendees arrived between 3-4am (70% between 1-5am)
    Despite the apparent density of incidents in Watford, much work has been done to reduce crime and alcohol related disorder eg Purple Flag, Pubwatch, Best Bar None, taxi marshals etc. Watford is a regional entertainment hub attracting revellers for a wide area and has a thriving night time economy. With a broad range of entertainment options.
  • information on these slides is taken from the DOMES report (Diagnostic Outcomes Monitoring Executive Summary) for Q3. Published by PHE, it takes into account all of the information that services send through to NDTMS, and benchmarks it against performance data from other areas
    Numbers in treatment are up on the same time last year, by some margin, particularly re alcohol and non-opiates.
    Significant improvement bucks the national trend.
    There were 1,713 opiate and/or crack users in treatment at the start of 13/14. Based on an estimated prevalence rate of 5.1 users per 1,000 population, approximately 45.6% of those using opiates and/or crack in Hertfordshire, are in treatment at some point in the year.
  • Primary alcohol users are coming into treatment more than users of other primary substances. Hardly any service users waiting more than 3 weeks, and the vast majority will wait only 2-3 days to be seen. Improvement from last quarter, and way below the national average.
    A third of those who go into treatment 91411 this year) successfully complete. We’ve improved slightly, and we’re more or less in line with the national average. But still, two thirds 9921 people) aren’t completing, so we’ve still got some work to do.
    Similarly, those who represent to services after successful completion. Still some work to do, but less than the national average. We know that re=presenting clients (i.e. those who have had many goes round the system) are less likely to complete treatment successfully, and those who do so may require more recovery capital to complete treatment and not return, such as access to housing and employment and a strong support network of peers, friends and family.
  • Public Health Outcome Framework indicators – the two big indicators for us
    Number of opiate users who complete and don’t represent is going up, which is positive. 1611 opiate users in treatment, 107 of which left treatment successfully and didn’t re-present, showing that treatment is working.
    We’re similar to the rest of England, but still have some way to go.
    28% of non-opiate users who completed, came back to treatment within 6 months. Better than we were in the last quarter, and lower than the average, but still over 200 people for whom treatment isn’t working. And we know that re-presenting clients are less likely to complete treatment successfully, and that those who don’t complete are likely to need more support to go beyond treatment and get into recovery.
  • Back to DOMES report
    Opiate abstinence – evidence tells us that clients who stop using opiates in the first 6 months of their treatment are 4x more likely to complete than those who continue to use. Almost half of opiate users stop using opiates in first 6 months.
    We’ve seen a slight increase in opiate users who’ve been in treatment for more than 6 years, and more than in our cluster. We know that they’re less likely to leave treatment and not return
  • Aging population and changing landscape. Opiate use is reducing nationally, but we are seeing an increase in the use of Novell Psycoactive substances (illegal highs). We need to adapt our services accordingly, so that they are geared up to address the needs of an ageing (not aged!) population. Also we need to get to and work with people who use illegal highs – they are often younger, don’t necessarily present with the problems that are associated with drug or alcohol addiction, and don’t necessarily see themselves as ‘having a drug problem’, so may be less inclined to access traditional services. We expect ketamine users to present in primary care, and then ref’d to urology services.
    Access to treatment is positive – never has access been easier, and waiting times so low. However, alcohol is a major factor, so we need to ensure that our services are suitably resourced to adjust to an increasing number of people who present – otherwise waiting times could increase.
    Need to focus on re-presentations particularly non-opiates – we know that non-opiate users are one of the groups who disengage before successfully completing, and even for those who do complete successfully, they don’t manage to stay drug free and re-present at services, so we need to look at support that’s out there to maintain their non-use.
    Need to focus on those who are longest in treatment – if you in treatment for longer, you become dependent on the service. So our services not only need to engage service users and get them into treatment, they also need to treatment them and get them out successfully within a relatively short timeframe.
    And we need to focus on 18-24 year olds who are also most likely to disengage from adult treatment services. Currently looking at extending the ages of people who can be worked with by A-DASH - they can already work with people until age 25 if they have a learning disability, so are looking to use this approach more broadly where its necessary to maintain engagement in services.
  • Drugs etc
  • Transcript

    • 1. Health, Crime and Community Safety: Links and Opportunities Hertfordshire Community Safety Board 20th March 2013 Jim McManus, Director of Public Health Longer version – for reference use
    • 2. This slide deck • Is the longer version of the presentation for the discussion session at the Herts Community Safety Board • Provides some information on links between health and crime • Accompanies the report on health and crime links which can be obtained from
    • 3. Summary • What’s the issue? • Links • What can we do • Some suggestions • The report for the workshop is here (double click on the icon) Word 2007 Document
    • 4. Some useful reading • The revolving doors briefing on inequalities in health and offenders development/programmes/spark/improving-health-cutting-crime-and-saving-public- money-workshops/ • Jim McManus – resources on community safety and health •
    • 5. Crime and Safety Indicators (EN Herts CCG) East & North CCG Comparators Crime and Safety Indicators Broxb o ur n e East H er ts North H er ts Steven a g e Welwy n H at fi el d Hertfor d s hi re Herts W or st Herts B es t Engla n d Youth Offending 5.0 3.1 6.1 10.5 7.3 5.4 - - 5.9 (per 1000 10-17 pop) Domestic Burglary 7.9 4.6 5.3 4.9 6.4 6.4 17.2 1.1 - (per 1000 households) Violent Crime 9.8 6.9 8.0 16.5 9.1 8.7 80.4 1.2 - (per 1000 population) Domestic Violence 12.2 7.4 9.6 17.2 14.2 11.1 41.5 2.3 14.1 (per 1000 population)
    • 6. Crime and Safety Indicators (Herts Valleys CCG) Herts Valleys CCG Comparators Crime and Safety Indicators Dacor u m Hertsm er e St. Al b a n s Three Ri v er s Watfor d Hertfor d s hi re Herts W or st Herts B es t Engla n d Youth Offending 5.3 5.6 4.5 2.7 6.3 5.4 - - 5.9 (per 1000 10-17 pop) Domestic Burglary 7.1 8.4 6.7 6.1 6.9 6.4 17.2 1.1 - (per 1000 households) Violent Crime 7.4 6.9 6.1 4.8 15.1 8.7 80.4 1.2 - (per 1000 population) Domestic Violence 10.0 13.2 7.4 9.2 14.7 11.1 41.5 2.3 14.1 (per 1000 population)
    • 7. A & E admissions due to assault Hertfordshire had significantly less hospital admissions due to assault between April 2012 and March 2013. However there were still 235 people in Hertfordshire who had to attend A & E due to assault.
    • 8. Trends in Violent Crime in Hertfordshire 2010- 2013 3 6 9 12 15 18 10-11 11-12 12-13 10-11 11-12 12-13 10-11 11-12 12-13 10-11 11-12 12-13 10-11 11-12 12-13 10-11 11-12 12-13 10-11 11-12 12-13 10-11 11-12 12-13 10-11 11-12 12-13 10-11 11-12 12-13 10-11 11-12 12-13 Hertford- shire Steven- age Brox- bourne Welwyn- Hatfield North Herts East Herts Watford Dacorum Herts- mere St Albans Three Rivers East& North CCG Herts Valleys CCG ViolentCrimeIncidentsper1,000population Violent Crime Trend In both England and Hertfordshire the reported rates of domestic violence have not varied significantly between 2010-13. Although East Herts has the lowest rates of domestic violence it was the only district to show a significant increase over that period.
    • 9. Youth Offending 0 2 4 6 8 10 12 14 16 08-09 09-10 10-11 11-12 12-13 08-09 09-10 10-11 11-12 12-13 Hertfordshire England FirstTimeEntrantsper100010-17pop Youth Offending Trend The rates of youth offending have been reducing faster in Hertfordshire than in England in recent years
    • 10. Alcohol related assaults presented at A&E • The ‘Cardiff Model’ of data sharing between Watford A&E and Community Safety Partnerships has been in place for several years • The Lister hospital has just started to collect this data • The aim is to enable CSPs to target resources more effectively at identified ‘hotspots’ • Evidence is also used to support license reviews
    • 11. Data from Watford A&E
    • 12. Data from 2012 showing top 15 locations Location Non Assaults Assaults Total Oceana Watford 25 30 55 Watford High Street 17 18 35 Area Watford 10 12 22 Batchwood St Albans 7 6 13 The Pararde Watford 4 8 12 St Albans Town Centre 3 4 7 Rehab Watford 3 4 7 Watford Junction 4 2 6 Outside Oceana Watford 4 1 5 Function Rooms Hemel 4 1 5 St Albans Road Watford 3 2 5 Clarendon Road Watford 4 1 5 Bed Watford 2 2 4 Hemel Town Centre 1 3 4 London Road St Albans 3 1 4 Total 94 95 189
    • 13. Adults in Drug and Alcohol Treatment Alcohol 1441 Up 18% Opiates 1611 Up 5% Non-opiates 803 Up 22% Drugs total 2414 (was 2195 in 12/13) Up 10% (compared to -1.5% nationally) Latest 12 month data compared to 2012/13 April 2013: 1,713 opiate and/or crack users in treatment, approx 45.6% of opiate/crack users estimated to be in Hertfordshire
    • 14. Alcohol Treatment Indicator Local Comparison Clients waiting over 3 weeks to start treatment 1.2% (3.9% in Q2) National: 7.1% Successful completions as a proportion of all in treatment 36.1% (was 33.1% in Q2) National: 36.6% Re-presentations within 6 months 6.9% (was 7.5% in Q2) National: 11.2% Adult DOMES report: alcohol; Q3:
    • 15. Drugs Treatment Indicator Local Comparison No of opiate users leaving drug retreatment successfully and don’t represent (% of total in treatment) 6.6% (was 3.9% in Q2) Similar to England No of non-opiate users leaving drug retreatment successfully and don’t represent (% of total in treatment) 28.2% (was 33.1% in Q2) Lower than England Adult DOMES report: drugs; Q3:
    • 16. Drugs Treatment Indicator Local Comparison Opiate abstinence 48.8% (same as Q2) Expected range 42%-54% Opiate clients in treatment over 6 years 28.8% (was 27.6% in Q2) Cluster: 25.0%
    • 17. Key messages – D & A Treatment • Aging population, reflected in treatment population • Changing landscape requires service flexibility • Access to treatment is positive • Need to focus on – re-presentations particularly non-opiates – those who are longest in treatment –18-24 year olds
    • 18. Health in the Criminal Justice System • Health inequalities higher and more complex than the general population • Most prevalent conditions: mental health including personality disorders, learning difficulties, substance misuse and physical health (BBV, musculoskeletal, respiratory) • 80% smoke • 60-70% have a personality disorder • Higher rates of suicide • Exacerbated by the wider determinants of health- poverty, lack of education, training and employment • Difficulty accessing services due to chaotic lifestyle • Inappropriate use of A&E services
    • 19. Work with Integrated Offender Management working with IOM to reduce reoffending Overall crime: Year 1-41% reduction Year 2- 35% reduction Year 3 (as at Q3)- 24% reduction Serious acquisitive crime: Year 1- 63% reduction Year 2- 53% reduction Year 3 (as at Q3)- 41% reduction
    • 20. Work in progress • Improving links between GP practices and probation offender managers • Implementing a pilot of nurses working in probation centres to identify unmet need, give advice, signpost into appropriate services and develop closer links with local health services
    • 21. Domestic Violence and abuse Some Risk factors for domestic violence/abuse • Gendered • Young age • Current/imminent separation • Stalking • Escalation – frequency/severity • Living in areas of high physical disorder • ‘Toxic Trio’ - MH or substance dependency • Suicidal thoughts/intent, depression • Pregnancy • Controlling and jealous partner – isolation • Weapons • Child(hood) abuse (perpetrators and victims) • Cultural norms tolerant of violence
    • 22. Police recorded DV crimes and non-crimes Crimes Non-Crimes Total DV Total DV 2012/13 2011/12 2012/13 2011/12 2012/13 2011/12 Broxbourne 377 439 753 751 Broxbourne 1130 1190 Dacorum 421 353 1034 978 Dacorum 1455 1331 East herts 325 351 680 531 East Herts 1005 882 Hertsmere 311 311 944 856 Hertsmere 1255 1167 N Herts 409 445 750 763 N Herts 1159 1208 St Albans 291 346 697 739 St Albans 988 1085 Stevenage 518 527 936 1007 Stevenage 1454 1534 Three Rivers 193 234 587 608 Three Rivers 780 842 Watford 330 325 931 930 Watford 1261 1255 Welwyn Hatield 360 466 1141 1165 Welwyn Hatield 1501 1631 Source: Hertfordshire Constabulary
    • 23. What are we doing in Hertfordshire • Awareness training for front line staff – mulit-agency; GPs • Sharing of recommendations from Domestic Homicide Reviews • ilearn training for HCC staff, and partners • Campaigns – Anti rape campaign; ‘True Love’; ‘Are you Ok?’ • Herts Sunflower Partnership – MARACs, IDVAs, SDVCs, Sunflower drop-ins, helpline and website, SARC • Community Perpetrator pilot in Stevenage about to start • IDVAs in A&E pilots – work in progress
    • 24. Some links from data • British Crime Survey, – 47 per cent of victims of violent crimes believed that their offender was under the influence of alcohol – 17 per cent believed that the offender was under the influence of drugs. – Another survey suggested that about 30 per cent of victims believed that the offender attacked them because they were under the influence of drugs or alcohol. – only 1 per cent of victims believed that the violent incident happened because the offender had a mental illness.
    • 25. Systems thinking The wider determinants of Health and Local Government functions (Must adopt a Lifecourse approach!) The Lives people lead and whether LA functions help or hinder healthy lifestyles (policy, service quality, access, behavioural economics, behavioural sciences) The services people access such as primary care (high quality, easy access, good follow up, behavioural and lifestyle pathways wrap around) •Our health and our offending occurs in a system •Criminology and public health/epidemiology share some concerns in the literature
    • 26. Health and crime is a system issue, health of offenders is a system issue • Pervasive health inequalities and poorer outcomes in offender communities • Multilevel issues – requires interventions across all levels of public health • Partnership across new responsibilities • Links between health and offending behaviour Levels of Public Health Action •Social •Environmental •Biological •Behavioural •Legislative •Structural
    • 27. Ways of addressing these • Example – Public Health is funding outreach nurses in probation settings to get offenders into NHS and drug and alcohol and mental health services – Addresses access issues directly – Identifies target population
    • 28. Ways of addressing these 2 • Extremism and mental health pastoral care, Birmingham
    • 29. Shared Ambitions/Initiatives • Health Needs Assessment of HPT Caseload - D Moorish (2011) • 23.8% reported a chronic health condition • 69% men & 53% women – alcohol misuse • 32% reported substance misuse • Offender Health questions included in service user survey 2013 • Access to GPs • Chlamydia tests available • MDO Panel/ court diversion • Smoking cessation groups • Vol. Drug testing • ?Access to Dentists? • Shared community safety strategies
    • 30. Personality Disordered Offenders Service Commenced July 2013 screening entire caseload. Specialist team in place 1 x clinical psychologist/forensic experience & 0.5 x probation officer Service includes: case consultation Formulation limited joint casework Training needs analysis • PD awareness training for staff and partners • Specialist training to be delivered by PD team Benefits already realised • Increased confidence in working with personality disordered offenders • More successful referrals to Mental health
    • 31. The Opportunities “Local government holds the ring on health and well being boards, which will be a genuinely joint forum , bringing together clinical commissioning groups and elected members. Between them they know their local populations inside out and so are best placed to assess their needs and decide together what needs to be done to meet them – not just in health but right across housing education, transport., planning etc everything that can make a difference”. Guardian 29 November 2012
    • 32. ‘Everybody’s Business’ • Police and Crime Plan • Community Safety Board • Monthly ‘cabinet’ • Shared ownership and delivery of strategies “Across service boundaries, we are working with the same communities, with the same victims and with the same offenders. We are trying to tackle the same causes and to manage the same effects” David Lloyd Police and Crime Commissioner
    • 33. Health System • Offender Health • Wider Determinants • Thriving Families • Shared Data/Intelligence • Shared Outcomes • Shared Responsibility • Local Accountability
    • 34. Making it Happen in Herts • Community Safety Board – Reducing offending and reoffending strategy • Health and Wellbeing Board – Health and wellbeing strategy • Criminal Justice Board – Criminal Justice strategy • Informal ad hoc Grouping already – PCC, Probation, DPH, CCGs
    • 35. Work under way • Drugs and Alcohol Programme – Easier access Thriving Families Programme – Easier access • Custodial Settings – Smoke free prison, drugs/alcohol services • In-reach – Nurse led access to primary care and health checks • Resilience and Strengths Psychology – Health Trainers for cohort • Partnership and Grants Funding • Shared strategies on safety and reoffending • Mental Health Access
    • 36. Some tools for going forward • Three domains model – Control and enforcement – Prevention (and diversion?) – Care, Treatment and Support
    • 37. Example Lead Enforcement and Control Prevention Support, Treatment and Care Community Safety County Community Safety Unit County Community Safety Unit? Probation, NHS, Public Health Domestic Violence County Community Safety Unit Domestic Violence partnership ?Childrens Services Drugs and Alcohol County Community Safety Unit Both working together Public Health Alcohol related violence County Community Safety Unit Multi agency NHS Acute Trusts People with learning disabilities who are victims County Community Safety Unit Multi agency LD Partnership
    • 38. Where next? Over to you Thanks