Violence against ambulance staff is a major problem. The vast majority of ambulance staff report experiencing threats of violence, which impacts the well-being of workers already carrying out important, stressful, and challenging work. Up to 2020, incidents of violence had been increasing annually, causing harm to staff and additional costs for the ambulance service. However, many incidents were not resulting in prosecution. NHS England, the ambulance service, and the unions all agreed on the need for action and implemented several initiatives to reduce the number of staff who see violence as just a part of the job. These initiatives included the introduction of Body-Worn Cameras (BWCs).
One problem was that, although cameras have been widely adopted across the world to reduce violence (including in the police service or in public transport), and there was anecdotal evidence of their effectiveness, there was only limited robust evidence available to policymakers about how best to make them work. Therefore, it was decided to conduct a research study alongside the introduction of BWCs to evaluate their impact.
RAND Europe was commissioned to conduct this evaluation. Over a three-year period (2021 to 2024), we gathered and analysed data, closely engaging with ambulance staff workers and managers. For a closer look at our methods and findings, please see our full report.
We have found that BWCs are just one small part of a broader system of policies and practices aimed at reducing violence and aggression. Their effectiveness depends on the specific circumstances in which they are used, such as workplace culture and supportive management, which are often beyond the programme's control. Local factors can either enhance or hinder the impact of BWCs, leading to uneven and variable outcomes over time—something that is to be expected in such complex systems. Therefore, to determine whether BWCs reduce violence against staff, we examined the broader conditions under which BWCs are more likely to be successful and provided recommendations to enhance these conditions.
Body-worn cameras are just one small part of a broader system of policies and practices aimed at reducing violence and aggression.
The implementation of BWCs in the ambulance sector was devolved to the ambulance trusts on the grounds that local trusts were best placed to identify local barriers and opportunities and to communicate effectively with local staff. Consequently, implementation varied, and data were collected in different ways. This influenced how we were able to conduct our evaluation, but by combining data sources, we arrived at several important findings.
Key Findings
In our research, we found that ambulance staff hold varied views on BWCs, with more positive than negative opinions. Our findings also indicate a notable increase in both the use of BWCs and the reporting of incidents since their introduction. However, it is clear that BWCs alone are not a panacea for de-escalating tense situations. Participants in our study highlighted the necessity of broader strategies, such as effective communication, to complement the use of BWCs.
The role of institutional support emerged as a crucial factor in determining the impact of BWCs on staff well-being and their sense of security. This aligns with existing literature, which highlights that supportive environments can enhance the benefits of BWCs. Moreover, a strong positive correlation was found between a favourable work culture and positive views of BWCs, suggesting that organisational climate plays a significant role in shaping perceptions.
Despite the potential benefits, several barriers hinder the widespread adoption and utilisation of BWCs among ambulance staff, including poor battery life and a lack of adequate attachment points on uniforms. Fortunately, these obstacles can be addressed with targeted interventions.
Recommendations
Based on these findings, we aimed to develop recommendations that were feasible (practical to implement), suitable (effective in achieving their intended purpose), and acceptable (engaging to stakeholders). Working collaboratively with NHS England, the Association of Ambulance Chief Executives, the unions, and other stakeholders, we tested our initial recommendations, which are outlined below. While we concluded that the balance of evidence supports the continued use of BWCs as a valid option, within the scope of this evaluation, we could not definitively prove that BWCs will always reduce violence more effectively than some alternatives. Therefore, we presented two sets of recommendations: one for the continuation of BWCs in the ambulance sector and another for their discontinuation.
If the use of BWCs is to continue, the evidence strongly suggests that they are most effective when paired with other strategies to reduce violence. These include de-escalation training, effective communication techniques, and ensuring that footage is utilised appropriately within the criminal justice system. When considering decisions about recommissioning BWCs, ambulance trusts should prioritise addressing barriers to their use, such as improving the usability and comfort of the cameras themselves. Additionally, BWCs may have potential applications beyond violence prevention, such as in learning and development; however, these would require careful and thoughtful planning to ensure effective implementation. Alongside these considerations, it would be helpful to determine which actions should be coordinated centrally, and which should be managed at the individual trust level. Central coordination is ideal for identifying and sharing best practices, while implementing these is best handled by each trust.
If the decision is made to discontinue the use of BWCs, it will be critical to manage the transition with clear and thoughtful communication. This is particularly important given the significant investment ambulance trusts have made in the initiative. Transparent explanations will help manage expectations and maintain trust among staff and stakeholders. Recognising that some staff members have found reassurance in the presence of BWCs, it will be important to identify and implement alternative measures to reduce violence and aggression. These alternatives should be clearly communicated to staff, particularly in areas where such interventions are not yet in place.
Adding to the Global Research on BWCs
As part of our evaluation, we conducted a nonsystematic literature review to examine the real-world outcomes and cost-effectiveness of BWCs across various settings. We also reviewed research on BWCs and other forms of surveillance adopted in the UK health care sector, such as CCTV and vision-based patient monitoring and management systems (VBPMM). Our review identified minimal literature specifically related to surveillance and BWCs in the ambulance sector. While there is substantial evidence concerning BWCs and violence prevention more broadly, much of it is of poor quality, anecdotal, and focused on specific professions, limiting its generalisability.
There is some evidence that BWCs, when combined with other measures, have the potential to address violence and abuse directed towards ambulance staff. However, they are not a stand-alone technological solution, and their impact is influenced by other factors. As such, any cost-benefit analysis should be approached with caution. The literature does not clearly identify the underlying mechanisms through which BWCs might support violence reduction, and it is likely that any benefits are mediated by the complex and unpredictable environments in which they are deployed. These environments are likely to exert strong independent effects on outcomes.
The more that BWC research explores these mechanisms in detail—helping us understand how and under what conditions specific outcomes are achieved—the better we will be able to interpret the variable findings produced in this area to date.
While there is substantial evidence concerning BWCs and violence prevention more broadly, much of it is of poor quality, anecdotal, and focused on specific professions, limiting its generalisability.
Conclusions
In this context, our research represents an important piece of an as-yet-unfinished jigsaw puzzle. We are developing a much clearer understanding that pieces of 'kit' alone cannot solve complex behavioural and organisational problems. They 'work', when they do, because they are embedded within policies, practices, and organisational behaviours. In other words, it is becoming increasingly clear that what matters is how cameras are used by people within their social settings and workplaces.
The challenge for policymakers, managers, staff, and the public is to create social settings and workplaces where violence against staff is no longer a routine part of the working day. Cameras may play an important role in achieving this.
