Jonathan Shepherd on a career as a crime-fighting surgeon

Episode Summary

Executive Summary: Jonathan Shepherd describes how a clinical career in maxillofacial surgery led him into violence prevention, using A&E and police data to expose hidden patterns of assault and create the Cardiff Model. The conversation covers his research-driven reforms in pubs, wisdom tooth surgery, cycle helmets, and his broader push for evidence-based practice across public services.

Main Topics: The Cardiff Model for Violence Prevention (Priority: 5/5): Shepherd explains how hospital A&E data, combined with police information and a multi-agency executive board, identify violence hotspots, weapon use, and trends so cities can intervene proactively. Violence as a public health issue (Priority: 5/5): He argues that violence should not be treated only as a criminal justice problem, but as a health issue that clinicians, police, and local authorities should jointly address. Research origins in trauma and A&E admissions (Priority: 5/5): His early observations in Leeds and Bristol linked assault injuries to specific settings and revealed that police were missing most hospital-treated violence cases. Practical prevention campaigns (Priority: 4/5): He details interventions such as toughened pint glasses, alcohol policy changes, and better cycle helmet facial protection, showing how research translated into reduced harm. Professional reform and evidence-based institutions (Priority: 4/5): Shepherd discusses helping create bodies like the College of Policing, the Chartered College of Teaching blueprint, and the What Works Network to spread authoritative guidance. Career, faith, and resilience (Priority: 3/5): The interview also covers his upbringing, depression as a teenager, his Christian faith, overseas surgical work in Nigeria, and how those experiences shaped his outlook.

Key Arguments: Hospital injury data can reveal violence that police never see, because many victims do not report assaults to police. Violence prevention needs a coordinated executive board linking health, police, local government, education, and victim support. Treating violence as a public health problem enables prevention, not just response, and can reduce both injuries and public-sector costs. Evidence-based interventions can change policy at scale when findings are translated into practical advocacy and regulation. Clinicians working close to practice are well placed to identify problems, test solutions, and implement reforms. Public services need professional bodies and 'What Works' institutions to ensure decisions are grounded in research rather than tradition.

Data Points: Reduction in A&E violence admissions in England and Wales: 60% since 2000 - Shepherd cites annual violence reports based on A&E data. Police awareness of violence cases: about 25% - In Bristol, police knew only a quarter of violence causing hospital admissions. A&E violence study sample: 539 consecutive patients - His Bristol PhD studied patients injured in violence. Glass-related injuries among violence cases: 10% - Found in his PhD follow-up on injury mechanisms. Toughened glass trial sites: 54 pubs - Randomised trial of tougher pint glasses in West Midlands and South Wales. Benefit of toughened glasses: 60% - Reduction in breakage and injury in the pub trial. Estimated fewer glass assaults: at least 40,000 fewer - Home Office estimate after the pub trade switched to toughened glass. Cardiff Model 10-year cost saving: £858 million - 2019 Home Office impact assessment if implemented in 5% of local authority areas. Annual report on violence: 25th report due in April - He continues to publish national violence surveillance from over 100 A&Es. Alcohol-duty effect: dip in violence every April - Observed when alcohol duty rose annually before the escalator was scrapped.

Pivotal Quotes: "The Cardiff Model for Violence Prevention is the use of specific data from A&Es, combining that with police data, and then the use of that data by an executive group of police, local government, health, education executives." — Jonathan Shepard: He defines the core mechanics of the Cardiff Model. "Violence was seen almost exclusively as a criminal justice issue. And I thought ... there is myself and 250 consultant surgeons up and down the country whose work is dominated by people injured in violence. So it's clearly a health issue." — Jonathan Shepard: He explains why he reframed violence as a public health problem. "I think there would be great benefit in moving that model forward." — Jonathan Shepard: He advocates for practitioners in policing and education to combine work and research roles.

Implications: The interview shows how frontline clinical data can reshape public policy, proving that prevention works when institutions share evidence. For health, policing, and education, the takeaway is to build systems that turn observed harm into coordinated action.