The Victorian surgeon, Robert Liston, was known as “the fastest knife in the West End”, supposedly amputating a leg in under two and a half minutes.1 In 1846, he also pioneered the use of ether as an anaesthetic, allowing patients to undergo surgery pain-free. The practice was rapidly adopted by surgeons, operating on patients in often squalid conditions.
In 1800s Britain, the surgical profession was driven by personalities and signature methods. Joseph Lister, a surgeon working at the Glasgow Royal Infirmary, was different. Devoted to scientific study and particularly to understanding post-surgical infection (around half of all amputees died from sepsis in the aftermath of surgery), he developed an antiseptic for surgical use and a system for preventing infection through the washing of hands and surgical instruments.
Though Lister backed his findings with multiple studies, it took years for his innovation to become commonplace – maybe because it wasn’t attention-grabbing like Liston’s anaesthetic, or maybe because it required meticulous compliance with a procedure. Once adopted, countless lives were saved as a result of Lister’s work, and his research helped build the foundations for medicine as the pinnacle of evidence-based practice it is today.2,3,4
Fast forward to present-day Glasgow. Anyone reading the news will know the city is a violence reduction success story. In the early 2000s, Glasgow adopted a ‘public health approach’ to violence and in 2005 set up the Glasgow Violence Reduction Unit (VRU). Its role was to drive collaboration across agencies to combine enforcement with early intervention programmes and support services for young people and their families. Since it was set up homicides in the city have dropped 65 per cent.
But what was it about Glasgow’s approach that was most effective? Though the approach of Glasgow’s public services in working together to tackle the city’s violence problem is rightly celebrated, the lack of robust evaluations about the specific elements of Glasgow’s approach makes it difficult to draw practical lessons that can then be applied elsewhere.
Despite the expansion of rigorous evaluation techniques across many public policy areas, our understanding of what actually works to prevent violence is still very limited. To illustrate: by 2016, there had been only 122 randomised controlled trials in policing (of which 10 per cent were run by BIT), yet 1,017 in education, and well over 200,000 in medicine.5,6,7
Caught between this limited evidence and the pressing need to respond to violence, it can be tempting to reach for acclaimed approaches that seem to have been effective elsewhere and simply replicate them. But we should be wary of applying evidence without interpreting it for a different context. As our report for the Mayor of London shows, the effects of some programmes like multisystemic therapy (or MST) or focused deterrence strategies tested in the US have not translated when they are “lifted-and-shifted” to the UK. 8,9
Fortunately, there are countless opportunities for innovation. From using data to understand who is most at risk, to making better use of the time young people spend in police custody or isolation during the school day, to finding ways to deliver the benefits of approaches like CBT at scale. And, by improving data-sharing between agencies, encouraging innovating and testing, and building long-term evaluation into the design of the programmes from the outset the Home Office-funded VRUs and the £200 million Youth Endowment Fund can enable the kind of systematic scientific study through which Joseph Lister saved so many lives.
If this post has sparked your ideas, we’d love to hear them please contact us at info@bi.team.
- Gordon, R. (2001). Great Medical Disasters.
- https://www.theguardian.com/books/2017/oct/09/butchering-art-review-joseph-listers-quest-grisly-world-victorian-medicine-lindsey-fitzharris
- https://www.lrb.co.uk/the-paper/v40/n13/sarah-perry/hospitalism
- Fitzharris, L. (2017). The butchering art: Joseph Lister’s quest to transform the grisly world of Victorian medicine. Scientific American/Farrar, Straus and Giroux.
- Neyroud, P. W. (2017). Learning to Field Test in Policing. University of Cambridge.
- Connolly, P., Keenan, C., & Urbanska, K. (2018). The trials of evidence-based practice in education: a systematic review of randomised controlled trials in education research 1980–2016. Educational Research, 60(3), 276-291.
- Shepherd, J. (2007). The production and management of evidence for public service reform. Evidence & Policy: A Journal of Research, Debate and Practice 3(2), 231-251.
- Fonagy, P., Butler, S., Cottrell, D., Scott, S., Pilling, S., Eisler, I., Fuggle, P., Kraam, A., Byford, S., Wason, J. and Ellison, R. (2018). Multisystemic therapy versus management as usual in the treatment of adolescent antisocial behaviour (START): a pragmatic, randomised controlled, superiority trial. The Lancet Psychiatry, 5(2), 119-133.
- Davies, T., Grossmith, L. & Dawson, P. (2016) Group Violence Intervention London: An Evaluation of the Shield Pilot. MOPAC Evidence and Insight.
