Trauma-informed health care in the UK needs top-down support and evidence-informed policy, strategy and commitment from the government and NHS

27 September 2022

While a trauma-informed approach in health care is being endorsed in government and NHS policies, its implementation has been driven by trauma experts at the level of organisations and local authorities, finds a new study led by the University of Bristol’s TAP CARE Study team. A coordinated, evidence-informed government and NHS position statement, guidance, and explicit commitment are needed alongside UK evidence on the effectiveness and acceptability of trauma-informed approaches in health care.

Trauma-informed approaches recognise the high prevalence and negative impact of psychological trauma on patients and staff, and transform organisational culture, processes and practices to prevent re-traumatisation in services and improve experiences and outcomes for everyone.

Despite limited evidence for effectiveness, trauma-informed approaches are gaining international support, including in UK policy. The TAP CARE policy review study aimed to understand how trauma-informed approaches are being introduced into policy, and how these policies are being interpreted and applied within UK health care.

Researchers analysed 50 UK policy documents and interviewed 11 professionals from health care organisations and local authorities, with experience in developing and implementing a trauma-informed approach.

They found that trauma-informed health care was endorsed in a wide range of UK policies; however, this was not supported by a UK evidence base or UK-wide or NHS-wide leadership, legislation, strategy and funding commitment. Piecemeal implementation of trauma-informed health care was found in England, with more coordinated strategy and leadership in Scotland and Wales.

Local trauma-informed leads emphasised the importance of a UK evidence base for the effectiveness of trauma-informed health care. They wanted more coordination and collaboration between organisations and regions implementing trauma-informed approaches, as well as UK-wide spaces where trauma leads, professionals, and experts by experience can share resources and learning to prevent resource waste and ‘re-inventing the wheel’. Professionals mentioned working groups on trauma-informed health care, which have already been established in specific regions.

The findings, published in BMC Health Services Research, highlighted a need for an evidence-informed, nation-wide strategy, with clear guidance and commitment on trauma-informed health care in the UK.

Dr Natalia Lewis, Research Fellow in Primary Care at the Centre for Academic Primary Care, University of Bristol and senior author of the paper said: “This study of policy and practice has helped us understand the landscape of trauma-informed health care in the UK to inform future UK-specific policy and implementation.”

Dr Elizabeth Emsley, Clinical Teaching Fellow from the Centre for Academic Primary Care at the University of Bristol, and first author of the study, said: “As reported in this study, the creation of working groups on trauma-informed care is a promising development and highlights a need to continue collaboratively building a UK evidence base on the effectiveness of trauma-informed approaches.”

Paper: Trauma-informed care in the UK: where are we? A qualitative study of health policies and professional perspectives by Elizabeth Emsley, Joshua Smith, David Martin and Natalia Lewis in BMC Health Services Research. September 2022.

For more about the study, visit www.bristol.ac.uk/tapcare-study.

Further information

About the Centre for Academic Primary Care, University of Bristol
The Centre for Academic Primary Care (CAPC) at the University of Bristol is a leading centre for primary care research in the UK, one of nine forming the NIHR School for Primary Care Research. It sits within Bristol Medical School, an internationally recognised centre of excellence for population health research and teaching.