Rural hospitals need more support to deal with the growing number of young people arriving at major trauma units and A&Es owing to violence linked to the drug trade, charities and doctors have said.

County lines drug dealing involves urban gangs moving drugs and cash between city hubs and provincial areas. Young people are groomed and offered money to sell drugs in out-of-town locations. It has been linked to an increase in violence, with a rise in knife crime across the country.

“We are dealing with it more and more and it’s so sad and such a waste. The whole culture is needless and a waste of young lives,” said David Kirby, a consultant in emergency medicine at Luton and Dunstable University hospital.

In Bedfordshire, where Luton is situated, a Home Office report found that knife crime has risen 86% since 2014. “We have seen increase in woundings of all methods – so beatings, stabbings and [the use of] firearms,” said Kirby.



He said it was hard to know what the story behind each case but that the hospital was working with the youth charity called Redthread, which comes in to help young people who may be involved in organised crime.

“Violence is always best tackled by prevention rather than cure and targeted input into these areas and working with youths and criminals to get out of it always going to be better option,” he said.

John Poyton, the chief executive of Redthread, said a growing number of hospitals were asking for help and that these were increasingly ones in less urban areas.

“What is really important is getting the rest of the country, not just urban centres, to recognise there are issues around violence and vulnerability for local young people,” he said.

“Health professionals are amazing at fixing physical and mental health problems but they are very wary of trying to ask questions unless they know an answer. I have a lot of clinicians, doctors and nurses, who may be starting to see these early signs of violence and vulnerability in emergency departments and either they just accept the answer from a child on how it happened, for example they fell on broken glass … which they can accept at face value or they can start to delve.”

He added: “Clinicians may feel it irresponsible to open a pandora’s box unless they can help with answers, and that is where there needs to be more cross-sector linking up. It’s not just charities but it is about joining up all services to support a young person.”

Evan Jones, of the charity St Giles Trust, said knife crime and drug activity had increased across the country and that stabbing, for example, could also be an opportunity to offer positive interventions at a time when a young person may be most receptive to offers of help.

“It makes sense to provide hospitals with the skills and expertise from charities like us to offer support at this crucial moment. This helps minimise the possibility of the young person returning to the life which put them in hospital in the first place and reduces the likelihood of them being re-admitted in the future … If we act now, we will help prevent lots of problems further down the line. These will not only put further pressure on already limited hospital resources but also result in more young people becoming victims of serious violence.”

David Hornsby, matron of emergency medicine at University Hospitals Birmingham NHS foundation trust, said it was difficult for doctors to establish a definite link between a trauma case and county lines drug dealing, although they were aware of an increase in “violent mechanisms of injury overall”.

He said youth worker charities could add value to any hospital experiencing an increase in the number of young people presenting symptoms of exposure to violence or other forms of exploitation.

Last month the Guardian revealed the scale of the knife crime problem. Figures from nine of the NHS’s 11 regional major trauma centres in England show that number of stabbing victims with life-threatening injuries increased from 1,697 in 2015-16 to 2,278 in 2017-18, a rise of more than 34%. Cases involving under-18s have jumped by 24.4%

Doctors are also reporting an increase in the severity of attacks, with more cases of multiple puncture wounds.

“Previously we used to see one or two wounds per victim. Now we are frequently seeing five or sometimes 10 stab injuries,” said Dr Ross Davenport, a consultant trauma and vascular surgeon at the Royal London hospital in Whitechapel, east London.

• The headline and standfirst of this article were amended on 4 December 2018 to more accurately reflect the content of the piece.