Blueprint for early intervention to support vulnerable A&E patients developed at Oxford Brookes

A guide for launching Hospital Navigator schemes to help improve the lives of vulnerable people has been developed by Oxford Brookes academics.

The resources were developed by Dr Sarah Bekaert, Senior Lecturer in the Oxford School of Nursing and Midwifery and Dr Georgia Cook, Research Fellow in the Oxford Institute of Applied Research at Oxford Brookes.

They came after Dr Bekaert and Dr Cook carried out an official evaluation of a pilot Hospital Navigator scheme carried out by the Thames Valley Violence Prevention Partnership.

Hospital Navigators quickly establish trust with patients and provide informal, flexible follow-up support. By creating a safe space for people to discuss their concerns and set achievable goals, Navigators help them re-engage with education, secure employment, and improve their overall mental and emotional well-being.

Dr Bekaert said: “The Hospital Navigator Scheme is a collaboration between five hospital trusts and five local Voluntary and Community Sector Organisations (VCSOs). It places trained volunteer Hospital Navigators in emergency departments to support vulnerable people who present for emergency treatment. 

“This early intervention provides support such as mentorship after discharge from hospital and links people with essential community services, helping to break the cycle of violence and promote positive life outcomes. The resources we’ve developed provide a blueprint for launching similar initiatives in other regions.”

The evaluation included many examples of positive outcomes as a result of the Hospital Navigator scheme. One participant shared, “Her mentor gave space for Jo* to talk about what was worrying her and come up with what a realistic study/work/social life/rest balance would be. It was the simplicity of meeting every week for a coffee, a chat, and having clear goals to work towards, that had a positive impact.”

Another success story involved John*, who secured a job interview after being connected with a local education and employment programme recommended by his Navigator. Jenny*, a young woman referred for mental health and domestic violence issues, found solace in arts and crafts clubs at a partner site, which significantly boosted her confidence and reduced anxiety.

The evaluation found that since its launch, the Hospital Navigator Scheme has engaged approximately 600 patients over a 21-month period, with 64% of participants being 24 or younger. The primary reasons for referrals included violence (40%), mental health issues (29%), and substance use (18%). The average age of participants was 23/24 years, aligning with the program’s focus on early support for violence, substance use, and mental health.

Notably, 70% of those referred through the hospital went on to actively engage with the scheme. Among these, 24% received signposting to services, 52% received brief interventions, and 24% benefited from ongoing support. The impact of the scheme is further highlighted by the fact that 77% of young people who accepted Hospital Navigator support did not re-attend an emergency department.

Detective Inspector Kelly Reed, Interventions Lead at the Thames Valley Violence Reduction Partnership, said: “The Thames Valley Hospital Navigators is a person-focused scheme. It ensures that tailored support is identified with those that need it at a point of crisis or difficulty in their life. It has enabled many to thrive. I know this as I have met several of them. It is a privilege to have listened to their experiences of how the scheme has helped them navigate through their difficulties towards stability and success on their goals.”   

Rob Deeks, CEO of Together as One, a youth organisation based in Slough which took part in the Hospital Navigators project, said: "We are incredibly proud to have our work validated in this prestigious report, and we want to thank Oxford Brookes University, Dr Sarah Bekaert and Dr Georgia Cook for their outstanding work. 
“It highlights the importance of addressing violence through early intervention and ongoing support, which leads to meaningful, positive changes in young people’s lives. As our scheme continues to expand, it represents a promising model for other regions to adopt, ultimately contributing to safer, healthier communities."

The evaluation noted figures from the Crime Survey for England and Wales show 1.1 million violent offences recorded in England and Wales in 2022, demonstrating that violence remains a significant public health concern. 

Dr Cook said: “The 2022 figure was shocking enough but the recent riots in our communities have demonstrated the need for violence reduction and positive pathways for anyone at risk of becoming involved in violence. Couple that with the need for more mental health support and it’s clear why a scheme that shows success like this one should be rolled out across the UK.”

The consequences of violence extend beyond individuals, affecting communities and society, with substantial financial costs to health services, police, and the criminal justice system. 

The evaluation of the Hospital Navigator Scheme has led to the development of two key resources:

Navigator Scheme Implementation Framework: An 8-stage guide to planning and delivering similar schemes in other regions. 

Early Intervention Integrated Delivery Model: A three-stage model for identifying, contacting, and engaging vulnerable young people in acute settings.