In 2021, NHS England introduced a national pilot project trialling body-worn cameras (BWCs) in ambulance services across England to address the issue of increasing violence and abuse against ambulance staff. RAND Europe was commissioned to conduct an evaluation of this project over a three-year period.

Evaluation of the use and impact of body-worn cameras in the NHS England ambulance sector

Giulia Maistrello, Hampton Toole, Avery Adams, Michael Whitmore, Lucy Hocking, William Phillips, Tom Ling

ResearchPublished Dec 19, 2024

In England, violence and abuse against ambulance staff have been increasing annually, with many incidents not leading to prosecution, and causing harm to staff and costs for the ambulance service. To address this issue and ensure frontline staff feel supported, a national pilot project trialling body-worn cameras (BWCs) in ambulance services across England was introduced in 2021 by NHS England.

RAND Europe was commissioned to conduct an evaluation of this project. Over a three-year period (2021 to 2024), we conducted a literature review, two surveys with ambulance staff, two site visits to ambulance stations, analysis of the NHS Staff Survey, analysis of data on BWC use and reporting of incidents, and interviews and focus groups with frontline staff, ambulance trusts project managers, NHS leaders, members of the public and trade union representatives.

Our findings suggest 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, which is to be expected in such complex systems. Therefore, to answer the question 'do BWCs reduce violence against staff?' we looked at the broader conditions under which BWCs are more likely to be successful and provided recommendations to enhance these conditions.

Key Findings

  • The vast majority of ambulance staff report experiencing a threat of violence and abuse, and this negatively impacts most staff.
  • BWC use and reporting of incidents are both on the rise.
  • Ambulance staff hold mixed views on BWCs, with more positive than negative opinions.
  • On their own, BWCs do not necessarily de-escalate a situation. Participants suggest that wider strategies (e.g. effective communication) are key.
  • Institutional support strongly influences the effect of BWCs on staff wellbeing and sense of safety, and this is reflected in the wider literature.
  • There is a high correlation between reporting a positive work culture and positive views of BWCs.
  • There are several barriers to the uptake and use of BWCs amongst ambulance staff, but these can be mitigated.
  • There are potential additional applications for BWCs, but these would require careful consideration.

Recommendations

  • The evaluation cannot definitively recommend the continuation (or not) of BWCs; however, it does provide some insights on how to manage the continuation or discontinuation of the programme. We therefore present below two sets of recommendations. The first set are applicable if the BWC project is to be continued, and the second set apply if it is to be discontinued.

Recommendations if the use of BWCs in the ambulance sector is to continue:

  • The evidence from this study is persuasive 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 (such as learning and development). These additional uses should be carefully considered, piloted before being widely implemented and assessed with continuous monitoring and evaluation.

Recommendations if the use of BWCs in the ambulance sector were to be discontinued:

  • Thoughtful communication would be essential when explaining the discontinuation of BWCs (if that were the decision) following the end of the pilot project, particularly given substantial investment by ambulance trusts in BWCs.
  • Given that some staff have felt reassured by the implementation of BWCs, alternative interventions for violence and aggression reduction should be considered and communicated to staff, where these are not already in place.

Topics

Document Details

  • Copyright: The London Ambulance Service NHS Trust
  • Publisher: RAND Corporation
  • Availability: Web-Only
  • Year: 2024
  • Pages: 99
  • DOI: https://doi.org/10.7249/RRA2084-1
  • Document Number: RR-A2084-1

Citation

RAND Style Manual

Maistrello, Giulia, Hampton Toole, Avery Adams, Michael Whitmore, Lucy Hocking, William Phillips, and Tom Ling, Evaluation of the use and impact of body-worn cameras in the NHS England ambulance sector, RAND Corporation, RR-A2084-1, 2024. As of May 1, 2025: https://www.rand.org/pubs/research_reports/RRA2084-1.html

Chicago Manual of Style

Maistrello, Giulia, Hampton Toole, Avery Adams, Michael Whitmore, Lucy Hocking, William Phillips, and Tom Ling, Evaluation of the use and impact of body-worn cameras in the NHS England ambulance sector. Santa Monica, CA: RAND Corporation, 2024. https://www.rand.org/pubs/research_reports/RRA2084-1.html.
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This research was prepared for the London Ambulance Service NHS Trust and conducted by the Health and Wellbeing Program within RAND Europe.

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