Hospital emergency departments are increasingly recognised as key intervention points in tackling youth violence. But turning crisis into long-term change depends on how effectively support is delivered in those first crucial moments. SOS Project Founder Junior Smart reflects on this, highlighting a new report from Youth Endowment Fund and University of Bristol which demonstrates the benefits and gaps in such provision.
It is always tragic when a young person is hospitalised due to violence. Yet these moments can also create a vital opportunity to intervene. Surviving such trauma can open the door to change, but only if the right support is there to help young people take those first steps.
For over a decade, St Giles has worked in hospitals across London, the West Midlands and Bedfordshire, funded by Violence Reduction Units, supporting young people admitted due to violence, many simply in the wrong place at the wrong time. All are victims and just want to return to safety and stability.
Our hospital teams play a crucial role. Caseworkers provide non-judgemental, culturally competent support, often grounded in their own lived experience. This helps them build trust with young people who may feel fearful, traumatised, or disconnected from traditional services. Combining empathy with professional expertise, they offer both immediate reassurance and longer-term guidance.
The impact is clear. At the Royal London Hospital, re-admission rates among the young people supported by St Giles fell to 7%, compared to a national average of 35–40% for this age group.
A recent national review by the University of Bristol and the Youth Endowment Fund examined A&E Navigator programmes; the main model for hospital-based violence intervention, across England and Wales. Drawing on extensive research, it highlights both the promise of this approach and the challenges it faces.
A key finding is the mismatch between need and provision, with some high-risk areas lacking any service at all. Race equity is another major gap, with inconsistent data collection and limited frameworks to address disparities, despite the disproportionate impact of violence on certain communities.
The review identifies four essentials for effective programmes: stable funding, strong integration with emergency departments, consistent staff presence, and deep community links. Yet workforce instability and short-term funding often undermine these foundations.
More broadly, the system remains fragmented, with wide variation in delivery and no national standards. While engagement in hospital is often strong, many services struggle to maintain support after discharge, leading to a significant drop-off.
Overall, the findings point to a model with real potential but uneven delivery. There is a clear opportunity to strengthen consistency, equity and long-term impact particularly by embedding trauma-informed, community-based and lived experience approaches.
St Giles welcomes the review and looks forward to working with partners across health, safeguarding and violence reduction to ensure these vital services reach the young people who need them most.”
Junior Smart
Business Development and Founder, St Giles