Department of Civic Design

URPERRL

Crystal Clear – Reducing Glass Related Injury

An evaluation conducted on behalf of the Safer Merseyside Partnership

Chris Young and Dr Alex Hirschfield

Urban Research and Policy Evaluation – Regional Research Laboratory

November 19th 1999

Crystal Clear

Reducing Glass Related Injury

Contents

Executive Summary

1 Introduction

1.1 A review of the problem

1.2 Operation Crystal

2 Crystal Clear: The campaign

2.1 Concept and Development

2.2 Operational issues

3 Results

3.1 Campaign Awareness

3.2 Recorded Crime data

3.3 Accident & Emergency (A&E) data

3.3.1 Introduction

3.3.2 Royal Liverpool University Hospital Trust

3.3.3 Aintree Hospital

4 Conclusions and further research

Acknowledgements

References

Appendices

2

Executive Summary

There are no indications that any single city has a particular problem with glass

related injuries; they are unfortunately endemic throughout the United Kingdom.

However, a rising number of violent incidents involving bottles and glasses being

used as offensive weapons in Liverpool City Centre prompted Merseyside Police

to adopt a proactive attitude to the problem. This came in the form of Operation

Crystal in 1997/8, and in the main it targeted licensees and door staff. In 1999

agencies on Merseyside joined together to build on the success of Operation

Crystal in the run up to the millennium celebrations and beyond, by running a

summer campaign entitled Crystal Clear. Several aspects of the campaign were

similar to Operation Crystal, but most notably, attention was directed towards the

‘users’ of Liverpool City Centre. Increased awareness of the causes and

consequences of glass-related injury, and the steps required to reduce the risks

would be communicated via assorted media messages.

Crystal Clear and Operation Crystal before it, confirm that a combination of

measures (education and awareness amongst customers, licensees and staff,

and policy-led policing) that channel attention and resources towards the problem

of violent glass related injury, produces positive outcomes.

The campaign messages were delivered to the intended audience (primary target

group) via various forms of media, and a linear chronological trajectory so that

the right messages were given out at the appropriate time, to obtain maximum

impact.

The education of the secondary target group continued where Operation Crystal

left off – with licensees and door staff being reminded of the importance of

keeping a tight rein on their bottles and glasses. In conjunction with Merseyside

Police Licensing Unit, procedures and vigilance were given a heightened

importance during the campaign.

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Measures of the number of glass-related injuries in Liverpool and throughout

Merseyside are published in the evaluation. They include police recorded crime

statistics and figures for Accident and Emergency Department attendance, and

from the campaign's perspective the results are very encouraging.

Bass Brewers have taken the lead in offering safer drink receptacles and it can

only be hoped that others will follow, especially when considering the extensive

Millennium celebrations envisaged for Liverpool City Centre, and the thousands

of revellers that this will involve.

Partnership working between Citysafe and local hospitals developed throughout

the campaign. Further work should improve the availability of specialised

strategic data, a vital component in the planning, management and monitoring of

community safety issues, of which Crystal Clear forms an integral part.

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1 Introduction

1.1 A review of the problem

If Home Office estimates are correct, that each year between 3400 and 5400 offences occur in

which glass is used as a weapon, there is an obvious requirement to reduce the opportunities for

the infliction of what are clearly avoidable, yet horrific, injuries. Awareness amongst customers,

and vigilance of door staff would ensure that glass and glass bottles remain within the curtilage of

licensed premises, where they can be safely collected. Another step in the right direction would

be for licensed premises to provide either toughened glassware and/or plastic receptacles,

particularly in busy city centres at night, for the safety of both staff and customers (Shepherd

1994).

A one week study (Hutchison et al., 1998) in 163 of the A&E departments throughout England

and Wales in 1997 (Friday to Friday) revealed 6,114 patients with facial injuries presented, out of

a total of 152,692 attendances. The mean age of male patients was 23.2 years, and of females

29.8 years. 24% of the facial injuries were caused by assault, the commonest sites being the

street followed by public drinking establishments, although more women than men were

assaulted at home. 55% of the assaults were related to alcohol consumption, and 8% of assaults

were with bottles or glasses. This equates to an average of 117.4 bottle/glass assaults per week

in England and Wales, or over 6100 per year. This figure represents only the 163 UK A&E

departments, but still exceeds the Home Office estimate stated above. Other estimates

(Shepherd) are higher still; 125,000 people a year suffer facial injuries in assaults and in 2 out of

10 assaults, glasses and bottles are used as offensive weapons.

A similar study (Wright and Kariya, 1997) over a 2 months period in Paisley, Scotland found that

2.4% of total new A&E attendances were victims of assault. Alcohol had been consumed by 69%

of victims and the commonest place of assault for men was the street.

A recent study conducted on behalf of South Lancashire Health Authority (Howe 1999) revealed a

total of 260 assault victim attendances at Chorley A&E department over a 3 month period. (Just

as importantly, this study highlights the nuances and subtleties of A&E data - see section 3.3 for a

detailed discussion). Other work by Dowey (1993) endorses further the link between assault,

facial injury, alcohol consumption and time of incident (9pm thru 9am).

All of the above findings support the use of the 18-25 year old age group as the main target for

Crystal Clear (see 2.1), and they also stress the importance of keeping bottles and glasses off the

streets.

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1.2 Operation Crystal

Liverpool City centre is arguably the heart of Merseyside when it comes to the sheer number and

diversity of café bars, pubs and clubs. Around 70% of its 150 licensed premises are also licensed

for public entertainment and operate beyond the normal permitted hour of 11pm. The recent

increases in the number of premises, especially late-night venues, has lead to more open-air

drinking and more revellers moving to and between premises whilst consuming drinks. Many of

the café bars also have outside drinking areas, but trying to contain people within the curtilage of

such areas was becoming increasingly difficult. Pressure of numbers lead to more ‘on street’

alcohol consumption because more people were drinking outside licensed premises, whilst

standing in non-licensed areas.

During 1997 Merseyside Police Officers responsible for Liverpool City centre were becoming

alarmed at the increasing number of violent incidents involving bottles and glasses being used as

offensive weapons. These ‘weapons’ had been removed from unlicensed premises unchallenged

by either the licensee or door staff, or had been left lying around by people drinking in unlicensed

public areas. Analysis of crime data showed that almost half of all serious assaults involved a

bottle or glass used as a weapon, usually in specific areas of the city, approximately between

1.30am and 2.30am in the early hour of Sunday morning. At issue was the safety of city centre

patrons late on a Saturday night.

Merseyside Police (City and Kirkdale) therefore launched Operation Crystal and set itself the

following objective:

“Substantially reducing violent crime within the city centre involving persons leaving or having left

licensed premises, or drinking in public areas, with either a bottle or a glass, which is then used

as a weapon in assaults, particularly in and during ‘hot spot’ places and times”.

Some elements of the method and approach of Operation Crystal are listed below:

Consultation with licensees and door staff to prevent and dissuade pub/club goers from

leaving licensed premises, including outside drinking areas, with bottles and/or glasses.

Notices placed inside On and Off licensed premises at exits, reminding customers of the

dangers of bottles/glasses when used as weapons.

A co-ordinated regional press campaign to increase public awareness regarding the danger

of bottles and glasses being taken from licensed premises, or whilst drinking on the street.

Uniformed foot patrols at the ‘hot spot’ areas during the relevant times to solely concentrate

upon persuading pedestrians around the city centre, drinking from bottles or glasses, to

dispose of or relinquish them accordingly.

Presentations and consultation with the Liverpool City Centre 24 Hour Working Party and

Council Licensing Sub-Committee in order to look at the possibility of introducing a local

byelaw prohibiting public drinking in designated areas (Map 1).

6

Map 1Liverpool City Centre 'Designated Area'

90 0 90 180 270 360 MetersN

Reproduced from the Ordnance Survey Mapping with the permission of the controller of Her Majesty's Stationery Office. Crown Copyright.Unauthorised reproduction infringes crown copyright and may lead to prosecution or civil proceedings. Licence no. LA076228.

Operation Crystal Results (Beats C114, C131 to C135 inclusive): Table 1

Period Violent Crimes Serious Assaults Bottles/glasses used

1/7/97-20/8/97

(6 weeks) 93 31 15

1/9/97-21/9/97

(3 weeks) Operation Crystal 22 4 2

22/9/97-1/12/97

(6 weeks) 111 21 6

5/12/97-4/1/98

(4 weeks) Operation Crystal 55 9 1

13/6/98-10/7/98

(4 weeks) 34 6 2

11/7/98-14/8/98

(4 weeks) Operation Crystal 24 6 0

15/8/98-15/9/98

(4 weeks) 34 5 0

The results of the different phases (Table1) of Operation Crystal include reductions in violent

crime in general and the use of bottles/glasses in those crimes. These results are partly

7

attributable to the greater police presence (uniformed and plainclothes) in the City Centre under

Operation Crystal.

Operation Crystal clearly had a very positive effect. However table 1 does emphasise the

influence of the seasons. The 4 weeks Christmas (1997//8) period of Operation Crystal saw a

higher proportion of violent crimes and serious assaults than the following non-Operation Crystal

period (13/6/98-10/7/98). The most pleasing aspect of the results is that the use of bottles and

glasses in these violent crimes and assaults always fell during an Operation Crystal period, and

the absolute number of glass/bottle incidents was nearly always higher in non-Operation Crystal

periods.

It should be noted that Police Officers collected (to the extent that they carried a bottle bin in a

police van) a large number of bottles and glasses from members of the public. However, this was

more by persuasion, and there were particular times when this unfortunately became

confrontational, and the officers had to resort to using other legislation. This is unsatisfactory

because the Courts tend to take a dim view of public order offences in which the confrontation

was initiated by a Police Officer, especially when acting close to the limits of their lawful powers.

Operation Crystal was biased towards the licensees and door staff (Crystal Clear would extend

this to customers and the public) and the principles of the operation appear to have been widely

accepted. Public Entertainment licenses now include a condition that puts responsibility on the

holder to prohibit bottles or glasses being taken from their premises.

The multi-agency Operation Crystal panel laid the foundations for Crystal Clear, by obtaining

further multi-partner funding and promises from the City Council to install more modern and

appealing bottle banks. These developments consequently lead to HIT’s appointment, and the

idea that the public should be educated as to the dangers of glass and bottles, now that the

licensees had largely been won over.

Operation Crystal recommended that the education of the general public (in particular the target

group of 18-25 year old pub and club users) would create a ‘self-policing’ element, regarding the

removal of bottles and glasses from licensed premises. If this first line of approach failed, the

barrier of already educated (Crystal Clear would further educate) licensees and door staff would

come into play. In the event of these approaches failing, and a person removes a bottle/glass

from a premise, or is found drinking alcohol in the designated area, a third option is a Police

Officer persuading that person to dispose of the item before any further harm or danger can be

caused. Finally, if all else fails, it would be beneficial if the Police Officer could resort to using the

legitimate power of a local byelaw to enforce compliance.

8

The byelaw could have one or more constituent parts. The first arises from the fact that it is not

generally a litter problem that leads to a bottle/glass being used as a weapon. Incidents, and their

devastating effects, happen in a split-second with the offender using the bottle or glass in their

hand from which they are currently drinking. Therefore, if the byelaw could classify carrying

(within a designated area) a bottle or glass as an offensive weapon, before it is raised in anger,

then many ugly incidents could be prevented. An other or additional part of the byelaw could be

like those already enforced successfully in cities such as Coventry, Chester and Blackpool, where

drinking alcohol in designated areas is categorically prohibited.

It should be added that a byelaw does not give a Police Officer a new power of arrest. However a

person’s name and address can be demanded for the purpose of issuing a summons. If this

demand was refused then an Officer could consider arrest utilising existing legislation. A byelaw

would not affect existing licensed pavement café areas because Home Office approval suggests

that the Local Authority provides exemption certificates.

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2 Crystal Clear: The campaign

In response to the number of young people sustaining glass related injuries in violent situations,

both inside and around clubs, pubs and bars, several agencies joined forces in Liverpool to

address the causes and effects of alcohol related harm in the city; Crystal Clear was one of the

outcomes.

Since 1997, Merseyside Police aimed to discourage the violent misuse of bottles and glasses.

Through ‘Operation Crystal’ (see 1.2) they worked closely with many licensees and door staff in

trying to achieve this aim. Although prevalent in Liverpool, the problem is not unique to the city.

Extensive research by Professor J Shepherd of the University of Wales College of Medicine, in

Cardiff, has highlighted glass-related injury as a problem facing the whole of the UK.

Crystal Clear builds upon the success of Operation Crystal and takes it into the millennium, by

promoting safer drinking environments for young people. The campaign aims to reduce the

number of incidents where glass related injury occurs in violent situations in Liverpool City centre.

HIT, the Liverpool based drug training and information centre, were commissioned by SMP, Bass

Brewers, Liverpool Health Authority and Merseyside and Cheshire Alcohol Services to carry out

the Crystal Clear campaign. Liverpool Vision (formerly Liverpool City Partnership), Merseyside

Police, Dr. L C Luke (Consultant in A&E Medicine for the Royal Liverpool University Hospital

Trust) and the North West Brewers and Licensed Retailers Association support the campaign.

The main objective of Crystal Clear is to offer an effective campaign to reduce the misuse of

bottles and glasses in violent situations in and around Liverpool City centre drinking

establishments.

The campaign was launched on the 26th May 1999 at the Metz bar in Liverpool, and would run

officially for a period of 8 weeks. It would feature, thought-provoking posters in prominent places

throughout the city centre (on hoarding, at city train stations, buses, and on the side of taxis for

instance), and advertisements on Radio City. Beer mats, tee shirts and posters would also be

distributed to pubs, clubs and bars in the city centre.

Owners and managers of licensed premises would assist by communicating the aims of the

campaign to both staff and customers, ensuring that the removal of bottles and glasses from

premises is as limited as possible. Police Officers and Special Constables would also be fully

briefed about the campaign and vigilance would be increased.

10

Licensed premises staff, the police and Police Licensing Unit, and HIT would distribute posters

and ensure that they remain on display. Replacements would be provided if posters were

damaged or removed.

Plastic bottled versions of well-known drinks (already in use at large events and festivals) would

also be on sale throughout and beyond the campaign.

Sample images of some of the campaign material can be seen in Appendix 2.

2.1 Concept and Development

The branding ‘Crystal Clear’ was chosen for the positive connotations associated with the slogan.

It plays on the saying ‘crystal clear’: everything is understood, honest and complete. There is the

additional dual meaning linking the campaign’s association with glass misuse. The slogan

‘Operation Crystal’ was not advocated because the word ‘operation’ offers connotations of

negative experiences such as hospital and criminal investigation.

Crystal Clear targets two distinct groups with key messages:

i. Primary target group – young people aged 18-25 years, particularly males.

Discourage the target group from carrying bottles and glasses to/between venues

Obviate the use of bottles/glasses in potentially volatile situations

ii. Secondary target group – Licensees and door staff

Minimise the use of glass, and glass bottles at all times

Limit the number of customers leaving with glasses and glass bottles

Crystal Clear used the following media to target the primary and secondary groups

Posters: 400 of 4 types

Beer mats: 250,000

Materials to licensees

Taxi cabs

Hoarding

Radio advertisement

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Primary target group

The campaign followed a staged ‘linear/chronological’ trajectory based upon the assumption that

the young person’s ability to receive cognitive information changes in accordance with the level of

alcohol consumed.

Stage 1 – Local radio is a traditional medium listened to by young people whilst getting ready to

go out drinking, and the advertisement was of a deliberately obscure nature, but with the key

objective of mentioning the campaign name. Attention would also be gained and intrigue created

within the target group.

(Five radio advertisements per night on both a Friday and Saturday, were given airplay for the

first 3 weeks of Crystal Clear.)

Stage 2 – Transportation used by the primary target group to reach their chosen destination.

Detailed, factual information on taxis, buses/bus stops and at train stations is crucial at this point,

because of the attention gained by the radio advertisement and the fact that a restrictive level (in

cognitive terms) of alcohol consumption will have not yet been reached.

Stage 3 – The pubs and bars at which the target group arrive, contain starker, more evocative

images and less factual information, as the young people begin to drink. To counter complaints

against visually disturbing images that may not be in keeping with the theme and ambience of the

premises, the most shocking posters are reserved for the toilet areas.

Stage 4 – The beer mat advertisement works on a different level and towards a different audience

within the primary target group. The information is tailored to address people who mix alcohol and

drugs, amphetamines and cocaine in particular. Beer mats can be handled, played with and are

more accessible to the personal habits of a stimulant user. With increased psychomotor activity,

users are more likely to read text in front of them or something that they are actively playing with

rather than read a poster on the periphery of vision. Adverse effects of stimulants such as hyper-

activity and paranoia also cause the user to look towards something to focus upon, as an

alternative to social interaction.

The trajectory respects the delicate balance that must be achieved by not placing particularly

explicit posters where they might offend minors for example. However the constant use of the

‘brand’ Crystal Clear maintains curiosity, and interplays with all levels of the campaign, right up to

the most shocking and explicit messages found on the posters in toilet areas.

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Secondary target group

To promote a safe, relaxed customer environment a ‘partnership’ between the licensees and

Crystal Clear would be formed. To emphasise the point again, licensees and door staff would be

encouraged to:

Minimise the use of glass and glass bottles

Limit the number of customers leaving the premises with glass and glass bottles

Increase awareness of drug interactions and effects

Where possible, endorse the use of plastic bottles

Focus group testing was undertaken before the campaign. Members of both target groups were

approached, and copies of the respective questionnaires can be seen in Appendix 1. The groups

were questioned in and around city centre venues. One of the main aims of the initial testing was

to assist with the final choice of four posters (from a short listed selection), which would be used

in the campaign itself.

Most of the respondents guessed correctly that the campaign was about glass-related injury. The

images and messages evoked a range of emotions from shock and horror, through to feeling

upset, depressed and disturbed.

When asked if any of the pictures shocked them, around half said that yes they did. However

nearly all of those questioned felt that the issue of glass and bottle related injury warrants strong

imagery.

Keeping bottles and glasses off the streets through stricter door control and the use of plastic

glasses/bottles were the best ways to reduce glass-related injuries in the opinion of most people.

One respondent did add however that,

“plastic is too pliable and drinks spill too easily”.

This would emphasise the need to provide either plastic bottles, thicker plastic pint receptacles or

toughened glassware. However, there are critics of even these proposals; the following quotes

are extracted from a letter sent by a Specialist Environmental Health Officer from the south west

of England, to the Federation of Licensed Victuallers’ Association.

“…an accident in which a customer fell and cut his hands very badly on some broken disgarded

plastic glassware …on New Year’s Eve when many public bars revert to the use of these items.

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Unfortunately this gives customers a false sense of security, causing them to throw them about in

a manner which they would hopefully not adopt with real glass. …earlier and cheaper versions of

the publican’s stock of plastic glasses were clearly unsatisfactory in that they offered little tactile

security to the customers holding their pints. Later types were much more substantial but while

one user throws the plastic glass away another feels that it must be crushed underfoot …

unexpectedly revealing very sharp edges. One suggestion is that the earlier mentioned thin

walled version be used in conjunction with a caged structure similar to that used in the hot

beverage vending industry.”

Whilst this may be an isolated incident, and from the victim’s point of view far more preferable

than falling onto broken glass, the case for pliable plastic with an appropriate holder, or a pliable

plastic bottle with it’s much narrower neck, is made.

To continue, when asked, “are you more or less likely to take a glass or bottle out of the

pub/club”, most people agreed that they would indeed be less likely now that they were more

aware of the consequences. Useful counters to this and other questions given by the target

groups are reproduced below.

“Less likely to take a bottle or glass out of a pub/club, but I’m sober now; when I’m drunk I

probably won’t think about it.”

“Bouncers can stop you taking bottles out, as much as stopping you get in because you’re

wearing trainers”.

“Increase opening times to reduce tension”

“The poster with the guy been stitched up in hospital looks like he’s a smackhead, not like he’s

been glassed.” (Several interviewees were actually concerned that the person on the poster may

have started the trouble that lead to his injuries and did therefore not deserve their full sympathy).

“This man is going to have to live with these scars for the rest of his life.”

“On the spot fines for anyone found drinking on the street.”

“It shouldn’t happen but it does.”

HIT was responsible for the management and promotion of the campaign. They organised all of

the campaign materials from design through to production and distribution. Some of these

14

processes were attended to by agencies such as the design company (Splinter), Bass Brewers

and the Police.

In the run up to the campaign launch (26/5/99) HIT liased with organisations ranging from local

radio (planning the Radio City advertisement and an interview on Radio Merseyside) to senior

A&E consultants (obtaining support, and appearances on posters and at the campaign launch).

Prior to the confirmation of poster and other campaign material design, HIT carried out focus

group testing (primary and secondary) of draft posters both at lunchtime and in the evening.

Through HIT, the Channel 4 television programme ‘Brookside’ agreed to display a large poster on

their billboard. Sites for other materials including taxi cabs and the Leece Street hoarding were

also obtained by HIT.

Press releases were forwarded to various media such as ‘The Big Issue’, ‘The Publican’, and

‘Cheers to Inns’.

2.2 Operational issues

Merseyside Police Licensing and Pro-active Licensing Units, along with HIT, distributed and

replenished campaign materials throughout the duration of the campaign. The lifetime of these

materials would obviously extend beyond the official ‘end’ (23rd July 1999) of the campaign

depending on the circumstances of their location.

The Pro-active Licensing Unit ensured that 16 Special Constables were fully briefed about the

details of the campaign so that they, along with full-time police officers, could continuously check

and re-supply premises if required. Whilst looking out for bottles and glasses on the streets on

patrol, Special Constables (following a strategy adopted by Operation Crystal) paid particular

attention to known ‘hotspots’ such as taxi ranks, telephone boxes and bars/clubs that had been

cause for concern in the past. Regular liaison and contact with door staff revealed a greater

vigilance in relation to the removal of bottles and glasses from their premises.

A change in procedure around certain bars in the city centre, meant that at busy times customers

were not allowed to ‘drift’ freely in and out of the various premises (including specified outdoor

drinking zones). Instead, barriers were used to channel people in and out in a more controlled

fashion, therefore giving door staff a better opportunity to stop glasses and bottles being taken

from premises. Some of these same bars also admitted that they had a policy of phasing out all

glass products and bottles, replacing them with plastic, throughout the summer.

Police officers also operated undercover and could approach individual premises in certain

circumstances. For instance, if undercover officers noted that customers carrying open bottles

were being allowed to leave a pub or bar for a prolonged period of time, they would confront the

door staff in order to rectify the situation.

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Research has shown that toughened glassware can reduce devastating injuries (Shepherd 1994).

Replacing glass altogether with plastic would substantially improve the safety of the drinking

environment. Bass Brewers successfully launched a multi-layer polyurethane (PET) bottle at a

series of concerts held at Battersea Power Station in December 1997. These bottles were made

available in licensed premises supplied by Bass, throughout the Crystal Clear campaign. The

multi-layer plastic creates an oxygen barrier preventing air from getting at the beer, and because

of this, the shelf-life is twice that of other plastic bottles. The PET bottles are also quicker to chill

and faster to serve than standard glass bottles. If other branded products could follow this lead

the likelihood of injuries, sustained both in violent and accidental situations, would be further

reduced (Bass Brewers, 1998).

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3 Results

3.1 Campaign Awareness

Further focus group testing was also undertaken during the mid/late stages of the campaign to

ascertain if some of the following outcomes had been achieved:

a) Improvement of knowledge by the target group about bottle/glass injuries

b) Enable the target group to identify the potential risks and harms

c) Enable the target group to eliminate or minimise the risks

d) Provide the target group with a telephone number for further information

e) Gain significant satisfaction of the campaign by the target group

Again, copies of the pro forma, which was used to approach members of both target groups in

bars and pubs during the early evening, can be found in Appendix 1. 41% of those approached

were not aware of the campaign at all, which is an acceptable ‘hit rate’. Interviewers quickly

briefed these people about the campaign, but then moved on, to question others in order to fill in

answers on the pro forma. (Some of the reasons given for not been aware included “being over

25” and “this doesn’t happen in the gay bars that I go to.”)

48% of interviewees were male, the rest female, and all stated that they visit the city centre bars

at weekends, either socially or to work. 69% of all interviewees were in the 18-25 year old age

group. The remainder, over 25 years of age, were approached either because they looked

younger, or were licensees or other members of staff.

Some remarked that they had seen some or all of the posters on more than one occasion. Others

couldn’t remember individual posters, but had definitely seen them, and were fully aware of the

campaign. The percentage of people who could remember exactly which one of the four posters

they had seen is shown below:

Poster image Seen by (%):

Man with facial wound 38

Smashed glasses on kerb 41

Person about to smash a bottle 21

Hospital surgeon in mask 28

(Copies of the posters and other campaign materials can be found in Appendix 2).

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Remarks were made by several of the interviewees that they wouldn’t forget the poster of the

man with the facial wound. More people remember seeing the poster of the smashed glasses on

a kerb, perhaps because it was placed in more prominent locations for longer periods of time.

This poster also appeared on station escalators and perhaps was lodged in the mind of those

who regularly use the train, without them remembering specifically where they saw it. This point is

supported by the percentage distribution of exactly where people saw the posters:

Poster location Seen by (%):

Club 10

Bar 41

Café 7

Newspaper article 10

Radio/TV 10

Magazine 3

Bus 7

Escalator 0

Billboard (hoarding) 21

Taxi 14

Other 3

Other campaign materials such as the beer mats and certificates did not leave as much of an

impression amongst the interviewees since less than 3% could recall seeing them anywhere.

17% did report that they had seen the ‘tall, stand-up information leaflet’ however.

None of those interviewed had the illusion that the campaign concerned anything other than

encouraging people not to remove bottles/glasses from premises to reduce glass related injury.

One respondent did think that the campaign inferred that glass related injury is a product of

alcohol abuse.

Particularly pleasing were the 48% of responses, aware that some drinks are now available in

plastic bottles, with 50% of these people admitting also that they had tried these products for

themselves.

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Awareness of the campaign amongst licensees was available from a second source. Liverpool

City Council’s Millennium Unit circulated a questionnaire to 1,240 licensees in the city, as part of

the planning process for the forthcoming Millennium celebrations. It included two questions

relevant to the Crystal Clear campaign:

i. Are you aware of Operation Crystal?

ii. Will you be using plastic glasses?

It was circulated at the end of May 1999 and 342 (27.6%) had been completed by the 21st

November 1999.

Licensed premises

342

Will you be open on Millennium Eve?

No

118

Yes

224

Are you aware of Operation Crystal? Will you be using plastic glasses on the night?

Yes Yes

73 23*

*19 of these licensees were also aware of Operation Crystal and therefore only 4 licensees had

made the decision to use plastic independently of 'Operation Crystal'.

The wording in the questionnaire refers to the earlier ‘Operation Crystal’ campaign, and this may

have been slightly misleading in the quest to gauge awareness of ‘Crystal Clear’.

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HIT staff visited over 25 city centre pubs and bars during the campaign. The purpose of these

trips was to inform licensees, distribute and replenish campaign materials. The small number of

premises that were not already aware of the campaign were quite happy, with a little persuasion,

to take it on board. The Police covered the remaining city centre licensees. It was during these

visits that both HIT staff and the police were informed that some posters were being regularly

ripped down in the toilet areas. This was obviously problematic, the only solution being to replace

those posters as quickly as possible with new ones.

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3.2 Recorded Crime data

Recorded crime data from the police ICJS central computer database for the city centre

designated area (Map 1), was made available for the evaluation.

Care was taken to extract from the database, only those incidents containing crime code details

of assault with glass and/or glass bottles. The ‘parent’ crime code of these details was either

assault occasioning actual bodily harm, wounding, wounding with intent to cause grievous bodily

harm or possession of an offensive weapon without lawful authority (i.e. mainly crimes of

"violence against the person"). A search of any of these parent crime codes, without also

consulting the crime code details, would have yielded many more incidents unconnected with

glass/glass bottles.

For the purposes of the campaign, the city centre is defined as the region covered by the

‘designated’ area of the proposed byelaw, shown in Map 1.

The designated area boundary excludes any incidents recorded in beats immediately adjacent to

the city centre (eg C112 Mount Pleasant/Cathedral/University, and C142). However, if the ICJS

"location" field indicated that the incident was on a street, or at a point, on the border between two

beats, one of which is inside the designated area, the incident would be included in the results.

Therefore a serious violent assault with a bottle or glass was included in the results despite

officially being classified within a beat 'outside' of the designated area.

Map 2 shows how this designated area matches the outline of police beats C114, C131, C132,

C133, C134, C135 and parts of C113 and C121.

There were 13 separate incidents (one incident did appear twice under 2 different offence

categories) involving the use of glass, recorded by the police specifically during the 8 week

Crystal Clear campaign, inside the designated area. They were distributed geographically as

follows:

Beat Number of separate crimes/incidents

C111 1

C114 2

C132 1

C133 3

C134 5

C142 1

21

As explained above, all of the incidents should have occurred within the ‘designated’ area.

However, a closer inspection of the records (the ICJS "location" field) revealed that a single

incident occurred close to the boundary of three beats; C142, C133 and C135, and was added

into the results despite having been classified within C142.

Without exception all of the incidents occurred at known hotspots, such as outside or near public

houses.

C135

C134

C131

C113

C132

C133

C142

C114 C112

C172C195

C192

C191

C151

C121

C122

Map 2Liverpool City Centre Police Beats(incorporating 'Designated Area')

90 0 90 180 270 360 MetersN

Reproduced from the Ordnance Survey Mapping with the permission of the controller of Her Majesty's Stationery Office. Crown Copyright.Unauthorised reproduction infringes crown copyright and may lead to prosecution or civil proceedings. Licence no. LA076228.

Where the gender of the assailant/offender was not unknown, 4/13 incidents involved a male

perpetrator(s) and 2/13 a female perpetrator(s). 8 of the victims were male against 4 female. One

incident involving possession of an offensive weapon without lawful authority, fortunately, did not

include a victim. Only one of the 13 records indicated that a member of staff (door) was a victim.

The time of day of each incident is shown below:

Time of incident Number of separate crimes/incidents

Before 8pm 1

11pm – midnight 1

Midnight to 1am 5

1am – 2am 4

After 2am 2

22

For the relatively small number of incidents that occurred during the campaign, the times at which

they happened are perhaps expected. The day of the week on which the incidents occurred also

displays an unsurprising pattern. Frequencies are shown below:

Day of week Frequency

Tues night 1

Wed night/Thurs morning 1

Fri night/Sat morning 3

Sat evening 1

Sat night/Sun morning 7

The number of glass related incidents occurring during Crystal Clear are shown in table 2, along

with data for periods one year before, immediately before, and after, the campaign period.

Table 2

Period (inclusive) Number of violent incidents (recorded

crimes) in which bottles/glasses used

26th May 1998 to 23rd July 1998

(same period in previous year)

11

1st April 1999 to 25th May 1999

(8 weeks prior to Crystal Clear)

5

26th May 1999 to 23rd July 1999

(8 weeks Crystal Clear)

13

24th July 1999 to 18th September 1999

(8 weeks after Crystal Clear)

8

It is necessary to qualify table 2 with a few remarks:

The period 26th May 1998 to 23rd July 98 overlaps with 'Operation Crystal'. Numbers in table

2 will not concur with table 1 because extra police beats have been considered for Crystal

Clear

The 8 weeks prior to Crystal Clear are for the spring/early summer period and seasonal

effects may be evident (i.e. less outdoor drinking)

For Crystal Clear itself, seasonality (summer) could again be influential. It could also be

argued that the campaign did not reach 'top gear' until later on during, or indeed after the

23

campaign had officially ended (for example the 'trickle-down' educational effects of media

longevity gradually reaching a wider audience)

Raising the awareness of the issue (the aim of Crystal clear) could in theory lead to more

reporting of this type of violent crime to the police, and therefore increased recorded crime

figures, if the public believe that the profile has been raised within the police

The lower number of offences recorded in the 8 weeks after Crystal Clear are therefore

encouraging because this period also included the late August Bank Holiday weekend

The total number of recorded offences of "violence against the person" during all of the 4

periods listed in table 2 exceeded 400

Although this analysis is useful, only the most naïve observer would fail to see that these results

represent only the ‘tip of an iceberg’. Many incidents will not be reported, and so analysis of A&E

records would perhaps give a better indication of total numbers of glass/bottle related assault

injuries. A direct temporal comparison between A&E and police data in section 3.3 highlights the

numbers of glass related injury cases turning up at A&E, that appear 'hidden' from police records.

3.3 Accident & Emergency (A&E) data

3.3.1 Introduction

The majority of people with glass related injuries sustained in Liverpool City centre would

probably attend the nearby Royal Liverpool Hospital. A substantial minority may attend other

Accident and Emergency Departments both within and outside Merseyside for reasons ranging

from convenience to confidentiality.

We would expect A&E data to represent more accurately, the numbers of glass and bottle related

assault injuries (see 3.3.2), since actual levels of crime are usually higher than police recorded

crime figures otherwise indicate (1998 British Crime Survey). A direct measure of this

discrepancy has not been attempted here because the Crystal Clear target area (i.e. police beats

within the city centre designated area) is much smaller than the catchment area of the Royal

Liverpool Accident and Emergency Department. However graph 1 does attempt to show the

discrepancy, but it cannot confirm whether this is due to two different sized (but overlapping)

geographical areas - police beats and A&E catchment - or an under reporting of the crime.

24

Graph 1

0

10

20

30

40

50

60

70

Count

20th May - 19th June 20th June - 19th July 20th July - 19th August 20th August - 19th September1999

RLUHT A&E glass injuries

Police ICJS glass-related assaults

Most health data is collected from operational systems and is held on large databases. There are

a number of datasets, some going down to patient level and some in aggregate form. Individual

records could be analysed to small area levels and aggregate data is available to Health Authority

level only. The data is collected around health service processes and for hospital care include:

i. Inpatients

Each inpatient admission has a data set associated with it. It includes, age, sex, postcode,

diagnosis, operation (if applicable), dates of activity, length of time in hospital, length of wait

(where admission is planned), and a number of other administrative details.

Each HA in Merseyside has a resident database. This is a database of all hospital activity for

residents of their area wherever they are treated. All hospitals use a standard classification

system for diagnosis and operations. These are the International Classification of Disease (ICD

Version 10) and the OPCS4 Procedure Codes. This enables analysis to be done for all patients

wherever they are treated.

ii. Accident & Emergency

All A&E departments in Merseyside have a computerised record keeping system for A&E data

sets. There is a standard data set (A&E Minimum Data Set) collected that includes age, sex and

25

postcode. Codes for reason for attendance and treatments do vary between hospitals. The data

is not routinely sent in individual record format to Health Authorities and so any analysis of the

data has to be by negotiation with hospitals.

Within primary and secondary care there are audit departments who carry out data collection on

particular areas of work. The results of these are shared with Consultant colleagues within

departments of Public Health. Again, if there was a particular research proposal then there are

mechanisms to apply to carry these forward. The first point of contact would be the Director of

Public Health within a Health Authority.

In terms of establishing a baseline of activity that is specifically related to crime, there is little

which can be universally measured. The one exception to this might be hospital admissions with

a diagnosis that identifies an “External Cause of morbidity and mortality“ as the reason for

admission. The International Classification of Diseases version 10 (ICD10) referred to above has

a whole chapter of such codes and they cover accidents, e.g. victims of road accidents, falls, and

assaults. However for the clinical coder to use these codes, they would require full information

within the case notes which may not be present.

The effect on health of crime and fear of crime is of interest to the NHS and in particular Public

Health. The impact of the new legislation on the NHS will be something that the NHS (particularly

Mental Health Services) will need to monitor. A general overview of the types of standard data the

NHS collects has been presented here. It identifies that there are very few data sources that

might immediately be of use to a Crime Audit, never mind a targeted study such as this, where

A&E attendance data is more valuable than admissions data.

Admissions via an A&E Departments with External Causes as a Proportion of All Admissions through A&E by Age and Sex for Liverpool Residents 1997/98

Sex Age Group

% of Admissions related to Assault

% Admissions related to all External Causes

Males 0-14 0.2% 9.7%15-44 5.6% 28.8%45-64 0.9% 12.9%65+ 0.1% 9.8%Total 2.0% 16.4%

Females 0-14 0.1% 10.6%15-44 1.1% 18.1%45-64 0.5% 12.5%65+ 0.2% 18.0%Total 0.6% 16.3%

Grand Total 1.3% 16.3%

26

As an example the table above illustrates what proportion assaults and total accidents represent

of all admissions through A&E.

Clearly only more serious cases get admitted to a hospital bed and attendances at A&E would

give a better picture. The data for inpatient admissions could be analysed by time of admissions

as could A&E attendance data.

As mentioned earlier, only serious cases are admitted to hospital. A&E attendances would give a

clearer indication of the number of glass injuries related to assaults. Ongoing NHS Executive

research is developing the future specification of the current A&E Minimum data set, with the

possibility that collection might be further standardised, and more specific and pertinent injury-

related information included.

A&E attendance data is confounded by the usual data analysis problems. A person injured may

choose not to attend A&E at all, or may attend on a day other than the day of the incident,

therefore blurring the link between incident and location.

27

3.3.2 Royal Liverpool University Hospital Trust (RLUHT)

Dr Luke, Consultant in Accident and Emergency Medicine at the RLUHT, ensured that staff

'flagged' up all relevant attendances for auditing purposes once Crystal Clear started. Relevant

attentances include patients with glass injuries complaining of assault. Any other patient who did

not state that they had been assaulted, but were attending with a violently inflicted glass injury

was also flagged in the computer records. All of the violent glass injuries are expressed as a rate

per 1000 new attendances at RLUHT A&E in table 3.

Table 3

1999 May June July Aug Sept Oct Nov

Violent glass injuries per

1000 new A&E attendances

(RLUHT)

11.92 5.53 2.57 2.81 1.49 2.46 1.34

(On average RLUHT A&E Department deals with more than 7000 new attendances each month)

Graph 2

The procedure to flag up glass related injuries at RLUHT, was only instigated in May 1999. The

pattern displayed in graph2 cannot be described as a 'typical' 7 months in A&E because no other

data is available. There are several possible explanations for the small rate increases that

occurred in August and October 1999, although none can be confirmed:

The August Bank Holiday weekend

Football related violence

Clocks going back in October

Overall, graph 2 and its implications are very encouraging for all of the agencies involved in

Crystal Clear.

3.3.3 Aintree Hospital

To fulfil the local crime audit requirements of the Crime and Disorder Act, staff at the A&E

department of Aintree Hospital, Merseyside have been completing an ‘Assault Patient

Questionnaire’ (see Appendix 1) since the 25th June 1999. This work is an example of a

particular research proposal carried out by an audit department, as described in 3.3.1.

Information gleaned from this source can be used to identify problem establishments and

particular times of the day/month for example, so that targeted action can be taken by the police.

This might include:

28

Making suggestions to licensees about management procedures regarding safer use of

bottles and glasses

Deploying more officers to 'hotspots' at 'hot-times' and making more use of support facilities

such as CCTV.

Naming and shaming persistently troublesome licensed premises

Withdrawal of license to sell alcohol

Guidance, support and assistance for the assault patient questionnaire work is provided by the

Merseyside Police Citysafe team (Liverpool Community Safety Partnership), and efforts are being

made to continue this project long term.

Results show that between 25/6/99 and 17/9/99 (Crystal Clear operated between 26/5/99 and

23/7/99), 605 questionnaires had been completed. 19 patients stated that they had been attacked

with a glass, and 34 with a bottle. Combining these totals and comparing them against other

forms of attack during the same period shows that it was the third most favoured ‘weapon’ after

‘body part’ and ‘other’:

Method of attack Number of incidents

Body part (e.g. fist) 395

Other 71

Glass or glass bottle 53

Not known 35

Blunt object 34

Knife 14

Firearm 3

Total (12 weeks) 605

This evaluation can really only highlight what is required of such data. Statistics for all A&E

departments within a region are needed (not just those located closest to the city centre, or those

which choose to co-operate with projects such as Crystal Clear). Experimental ‘control’ could be

offered by data recorded at the same time in A&E departments of a similar sized city in another

part of the country. Ideally, for comparative purposes, statistics for the same period within one city

in a previous year(s) should be obtained to provide some measure of change over time, but

consistent recording procedures would need to be implemented in order to obtain data of this

nature.

29

4 Conclusions and further research

Crystal Clear and Operation Crystal before it, confirm that a combination (education and

awareness amongst customers, licensees and staff, policy-led policing) of measures directing

attention and resources towards the problem of violent glass related injury produces positive

outcomes.

The Police and A&E data presented in this report will provide a useful benchmark for future

evaluations. It will also hopefully act as a catalyst to encourage consistent and continuous

information collection by the agencies involved, so that partner's can co-ordinate further

appropriate and effective responses to the problem of violent glass-related injuries.

Other integral solutions include plastic bottles/glasses and reinforced bar glasses (shatterproof).

Crystal Clear aimed to reduce the number of glasses and glass bottles taken out on to the street,

since most injuries from glass occur outside rather than inside licensed premises. If these

receptacles are left inside, they can be safely collected.

It would be helpful if a more extensive range of branded drinks were sold in plastic bottles, in

addition to those already made available by Bass Brewers, especially in and around the ‘hot spot’

times and places. The use of plastic glasses or pint-sized paper cups, similar to those used at

large festivals and events, should also be encouraged, especially during city centre occasions

such as Millennium Eve.

The experience of posters being ripped down, and having to be regularly replaced could be

avoided in future campaigns by providing funds for more robust versions, that would also last

much longer than the official campaign duration, and act as more permanent reminders. This

should not be at the expense of the ‘blanket’ coverage seen during Crystal Clear.

The Consumption of Intoxicating Liquor in Designated Places byelaw was rejected in it’s

enhanced version – consisting of parts 3a, b and c – by the Home Office. The rejection was

based upon the HO position that offensive weapon laws exist already and these could be used on

people carrying bottles/glasses. However the police argue that a bottle/glass must be waved

around or broken before it can be classed as an offensive weapon and yet it takes only a split

second for an intact bottle/glass to be used offensively by it’s carrier. A revised standard

application (adopting only part 3a of the enhanced application) similar to those already operating

in Blackpool, Chester and Coventry will be resubmitted to the HO. For the purposes of evaluation

30

it will be very interesting to observe the effect of this byelaw on assaults and glass-related

injuries. It would have been even better if the enhanced version was accepted, so that future

analysis could evaluate the Liverpool City Centre situation against rates of victimisation in the

three cities discussed above.

31

Acknowledgements

A&E Department and IT staff Royal Liverpool University Hospital Trust (RLUHT)

Andy Howe - Department of Public Health, University of Liverpool

Caroline Rand – Liverpool Health Authority

Citysafe and Aintree Hospital A&E staff

Dr L C Luke– RLUHT

HIT – Kirsteen and Amanda

Liverpool City Council Millennium Unit

Lynn Owens – RLUHT

Operation Crystal Panel

PC Hussain and PC Farlam - Merseyside Police Pro-Active Licensing Unit

PC Rice - Merseyside Police Licensing Unit

Professor J Shepherd – University of Wales College of Medicine

32

References

Bass Brewers (1998) News Release http://www.bass-brewers.com/

Dowey, K. E. (1993) Alcohol – related attendances at an accident and emergency department,

The Ulster Medical Journal, Vol. 62, No. 1 pp58-62.

Howe, A. (1999) Victims of assault in Chorley A&E Department, Unpublished Master of Public

Health Thesis, Department of Public Health, University of Liverpool.

Hutchison, I.L., Magennis, P., Shepherd, J. P., Brown, A.E. (1998) The BAOMS United Kingdom

survey of facial injuries. Part I: aetiology and the association with alcohol consumption,

Br. J Oral & Maxillofacial Surgeons 36:1, 3-13.

Mirrlees-Black, C., Budd, T., Partridge, S., Mayhew, P. (1998) The 1998 British Crime Survey

Home Office Statistical Bulletin 21/98. London. HomeOffice.

Morton, S. (1998) Regional Task Force on Accidents, Trauma and Environmental Safety, NHS

Executive North West.

Shepherd, J. P. (1994) Preventing injuries from bar glasses: Temper the nonik, BMJ Volume 308

pp932-933.

Wright, J., Kariya, A. (1997) Assault patients attending a Scottish accident and emergency

department, J R Soc Med 90:6, 322-6

33

Appendix 1

Questionnaires and pro forma

34

Appendix 2

Campaign materials

35