Evaluating body worn cameras in the ambulance service

Background

In the year leading up to June 2021, 3,569 ambulance staff were subject to physical assault by members of the public. This is approximately a one third increase compared to the same period five years prior to this and represents a growing trend in physical and verbal abuse suffered by frontline ambulance staff. Further, just a fraction of these assaults result in prosecutions, meaning many assailants go unpunished after abusing ambulance staff.

One measure to address this growing trend is to pilot body worn cameras (BWCs) across ambulance trusts in England. BWCs are wearable recording devices that are able to collect audio and video data and are intended to make staff feel safer, invoke greater confidence when in challenging situations, help de-escalate potentially abusive situations and record evidence to assist the police with prosecutions in the event this is necessary.

How did we help?

RAND Europe was commissioned by NHS England and the London Ambulance Service (LAS) to evaluate the BWC project, over a three-year period from Summer 2021 until Summer 2024.

The aims of the evaluation were to understand:

1. How and to what extent does the adoption of BWCs by the ambulance trusts affect outcomes of interest, primarily a reduction in violence against ambulance staff?
2. How is the project implemented in practice?
3. What are the factors that influence the implementation and outcomes of the project, and how?
4. The costs and value of investing in BWCs.

A range of different methods were used in the evaluation, including a survey, focus groups and interviews with frontline ambulance staff, support staff, trade union representatives and members of the public. In addition to these methods, we conducted analysis of trust-level administrative data, worked with trusts to harmonise data collection approaches, produced a cost-consequence analysis and did ‘deep dives’ into trusts where BWC implementation is perceived to be going particularly well.

What did we find?

The vast majority of ambulance staff report experiencing a threat of violence and abuse, and BWC use and the reporting of incidents, are both on the rise. However, there are still barriers to the uptake and use of BWCs amongst staff.

Ambulance staff hold mixed views on BWCs, though there were more positive than negative opinions. A significant influence on the effect of BWCs on staff wellbeing and sense of safety is institutional support. It was found that where a positive work culture was reported, there was a high correlation between this and positive views of BWCs.

BWCs do not necessarily de-escalate situations on their own. Other strategies, such as effective communication, are also just as important.

What can be done?

Whilst the evaluation cannot definitively recommend the continuation of BWCs, it can provide two sets of recommendations on the next steps if the BWC project is to be either continued or discontinued.

If the use of BWCs in the ambulance sector is continued, it is recommended that:

• BWCs work best in conjunction with other measures to reduce violence (e.g. BWCs, with de-escalation training, communication and ensuring footage is used in the criminal justice system).
• There needs to be an optimal balance between centralised support and ambulance trusts’ autonomy in order for the BWC project to be effective.
• When ambulance trusts make decisions about recommissioning BWCs, usability, comfort, administrative burden, fitting to uniform and battery life should be prioritised.
• There are other uses of BWCs that might be beneficial to staff, but these should be carefully considered and piloted before wider implementation.

If the use of BWCs in the ambulance sector is discontinued, it is recommended that:

• Thoughtful communication would be essential when explaining the discontinuation of BWCs (if that were the decision) following the end of the pilot project.
• Given that some staff have felt reassured by the implementation of BWCs, alternative interventions for violence and aggression reduction should be considered.

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