House of Commons - Home Affairs

Select Committee on Home Affairs Sixth Report

5 Identification of abuse

"We need to ensure that every public sector employee understands that the next victim may be calling them asking for help with housing or their children but really they are screaming inside for help to stop the abuse. They might even be working with a colleague in need of help"

- eConsultation respondent

134. Professionals in front line roles are often best placed to identify when abuse is happening and refer the victim to appropriate agencies. This section identifies some of these professionals and makes recommendations to improve identification and referral rates for domestic violence cases.

The role of health professionals

Health professionals routinely come into contact with victims

135. Around 30% of domestic abuse begins during pregnancy and abuse is more common in pregnant women than gestational diabetes or pre-eclampsia—both conditions for which pregnant women are routinely screened.[137] One in three women seeking emergency medical treatment in UK inner city hospitals have suffered domestic violence,[138] and over one per cent of A&E department visits are due to domestic violence: to put this in context, an A&E department with 55,000 patients of all ages attending during one year would see over 550 adult patients suffering due to domestic violence.[139] The British Medical Association stated that victims approach a range of health services, including: accident and emergency, obstetrics and gynaecology, midwifery, psychiatry, health visiting, and most importantly, GPs and nurses.[140] Consultations with health professionals may be one of the few occasions on which the victim is not accompanied by their abusive partner or family member. Those writing on our eConsultation agreed that health professionals are often the first port of call for victims:

"Professionals, doctors in particular, may well be the first port-of-call for victims...they need to be fully comfortable about asking questions, never backing out of this responsibility. Surgeries should make it very clear that the doctor can be approached about domestic violence...Confidentiality is a shallow excuse. Child protection is a good model" - ksurvives

Initiatives have been introduced within the health sector

136. The Department of Health (DH) has introduced a number of measures to help health professionals identify victims of domestic violence. To date these have focused primarily on maternity and health visitor services, and, to a more limited extent, Accident and Emergency (A&E) departments. Pregnant women are now routinely screened by professionals taking a social history. The DH has also developed a training manual for health professionals, established a Domestic Abuse and Pregnancy Advisory Group, and introduced training events for senior maternity practitioners. In the south-east of England a number of pilot schemes to establish the feasibility of gathering data on patients at risk of violence and de-personalising this data to share with other agencies have been run in A&E departments. Representatives of some local health agencies also attend multi-agency risk assessment conferences (MARACs).[141]

But the health sector was still singled out as being poor at engaging with domestic violence

137. Despite recent Government initiatives, we heard concern about health professionals ignoring disclosure by victims or failing to refer them to appropriate support or advice.[142] One contributor to our eConsultation agreed:

"I had also on a number of occasions been slapped with such force across the face, that I had been physically knocked into the bath tub. I wasn't looking for sympathy. I just wanted her to know what the GP thought the cause of my injuries could be. The radiographer either hadn't heard me or had refused to listen. Her irritated reply to me was" have you fallen at any time"? This illustrates the lack of understanding that exists within some pockets of health professionals"- anonymous

138. At the local level, evidence from Gloucestershire suggested that routine enquiry by health agencies does not always happen in practice: "health professionals should ask about domestic abuse at routine contacts yet there is local evidence that this advice is not being followed".[143] Standing Together Against Domestic Violence told us that the DH document "Responding to Abuse", which introduced routine questioning "is for guidance only and has been very partially implemented".[144]

Victims of abuse particularly mentioned General Practitioners

139. General Practitioners (GPs) were particularly singled out for criticism. The Family Justice Council told us that "It continues to be felt by many in the field that General Practitioners are lagging behind in awareness and practice in relation to DV and this requires urgent attention".[145] This was supported by comments on our eConsultation:

"I first went for help to my GP. He gave me a course of anti-depressants and failed to refer me to any other agencies. I felt he wasn't taking me seriously so I didn't bother going back or taking the tablets, which he has so helpfully prescribed" - nadine

"I took my partner to the doctor to see if her temper was because of a medical reason, the doctor said 'no wonder you hit him' because I interrupted him during his suggestion of giving my then partner a prescription for vitamins to stop her severe mood swings" - george36

Perpetrators seek help from health professionals

140. In 2006 a joint University of Bristol and Home Office study found that perpetrators approach GPs or other health or counselling agencies to seek help with their offending behaviour. The study found that, out of 45 men attending perpetrator programmes interviewed about which agencies they were in contact with:

32 men stated that they had been to their GP prior to beginning the domestic violence programme;

26 men had contact with the police in relation to domestic violence (13 for non-domestic violence; 21 for other non-violent offences);

13 men had contact with Relate, 11 with Social Services, 6 with the Samaritans, 5 with hospitals, 5 with alcohol services, and 4 with drugs services;

Some men had also been in contact with services such as counselling, legal aid or solicitors, and welfare services at work.[146]

141. The research concluded that:

Other men may have contacted an agency, such as the GP, with which they were familiar, but without being explicit about their violence. Some may have reported problems with anger, while others complained about other ailments, most commonly depression or 'feeling low' or 'down'. According to some men, their GPs simply prescribed anti-depressants, or they referred the men to inappropriate counselling services.[147]

Respect reported that, as with victims, health services are insufficiently engaged with perpetrators with whom they have contact:

GPs occasionally refer clients to the Respect Phoneline and/or Respect members but this is very patchy and to be honest, uncommon. There is a huge job to do in engaging health professionals across the board with perpetrator issues. There are opportunities for early interventions and appropriate referral across a range of health settings, but without guidance and training for health professionals, this does not happen.[148]

Health professionals require accredited training

142. The special survey conducted for us by Women's Aid showed that:

60% [of respondents] said NHS trusts are training health professionals on domestic violence. However, it was apparent that only selected health professionals were receiving such training—predominantly health visitors (trained in 96% of cases ) and midwives (87%), and rather lower numbers of A and E staff (55%) and practice nurses.[149]

The British Medical Association (BMA) recommends that information on domestic violence services should be available in all settings and that all professionals should practise selective enquiry and sometimes routine enquiry.[150] Research cited by the BMA showed that doctors who have been trained in domestic violence are more likely to ask patients about domestic violence, and as such are more likely to have patients who disclose abuse.[151]

143. The Department of Health recognised the role of health professionals in tackling forced marriage:

Evidence suggests many victims assume that health professionals cannot help them and they may not feel confident in expressing their concerns. Consultations with health professionals may be one of the few occasions when the victim is unsupervised by a family member and by being aware of the warning signs, they may encourage victims to speak out.[152]

144. The Department of Health has issued a handbook for health professionals on responding to domestic violence.[153] However, there is evidence that health professionals have not been trained to respond to domestic violence[154] suggesting that this handbook has not been widely disseminated or promoted. The Department also described the Forced Marriage Unit guidelines for health professionals in dealing with forced marriage, which will be placed on a statutory footing this autumn. However, it did not say whether or how they are being implemented, or whether professionals have received any training in implementing the guidelines.[155]

145. We received evidence to suggest that victims of domestic violence and forced marriage often come into contact with health services. Victims identified health professionals, in particular GPs, as being poor at responding to disclosure of abuse or at referring victims to appropriate services.

146. The Department of Health must ensure that health professionals across the range of front-line services are trained to identify and respond appropriately to domestic violence and forced marriage. This should include compulsory training in the Guidance for Health Professionals produced by the Forced Marriage Unit, and in the handbook for health professionals on domestic violence. The Department of Health must closely monitor the implementation of both the guidance on forced marriage and the handbook on domestic violence.

147. GP surgeries and other community health centres should routinely display information on domestic violence and forced marriage, including advice on available support.

148. The Department of Health should consider ways in which GPs can be involved in the multi-agency risk assessment conference (MARAC) process. This might take the form, for example, of a representative of the local surgery or health centre attending the MARAC.

149. Joint University of Bristol and Home Office research has found that perpetrators also approach GPs for advice or help with offending behaviour. We recommend that the Department of Health work with Respect to develop accredited training and/or guidelines for GPs and other health professionals on how to identify domestic violence perpetrators and refer them to appropriate services.

The role of schools and education authorities: children "missing" from schools

150. Individual schools, and the education authorities which they report to, must have good systems in place to identify abuse and refer victims to appropriate support. As part of our inquiry we undertook a short investigation into the particular issue of children who have disappeared from school and who may have been forced into marriage. We considered this at some length since we heard that there were potentially very large numbers of such "missing children", which deeply concerned us.

Evidence from case studies shows some young people have been removed from school, temporarily or permanently, for forced marriage

151. The box below contains a case study of a girl who was taken from school for a forced marriage.

Forced Marriage Case Study: "Shahida"

"Shahida" was a well-behaved, able and keen student throughout her primary and early senior school years. However, by the time she was 14 she was becoming increasingly withdrawn, she began to truant on arrival at school and seemed to be losing weight. She also was significantly less interested in her schoolwork.

She was referred to the education welfare officer and the learning mentor in the school. The school logged, over a 7-month period, that she turned up with marks consistent with physical abuse and beatings as well as self-harming behaviour. She said that this was due to family conflicts but did not want to get her family into trouble.

She was referred to social services by the school. She refused to say anything against her family. Shortly afterwards she ran away staying with friends and stayed with various people locally. In each case, she ended up being returned to her family. Shahida would not press charges against them and therefore social services felt they had no grounds for any other action.

As the summer holidays approached (by now Shahida was 15 turning 16), her behaviour and attitude worsened, she missed several exams and at the start of the following autumn term she did not turn up for school. At this point the school, on speaking to some of her friends, discovered that she had told them she feared a possible forced marriage or at least being left overseas. The school then contacted the Forced Marriage Unit.

Shahida was finally located overseas and repatriated to the UK. She had to re-sit her GCSE year but is doing very well and living in foster care.[156]

152. Thirty per cent of cases seen by the Forced Marriage Unit involve minors (under the age of 18), many of whom will be in compulsory or further education. Based on survivors' testimony, a common pattern within the South Asian community seems to be for young people to be taken abroad for marriage aged 16 or shortly after, when they reach the legal age to marry, and finish compulsory education. Imran Rehman told the Committee that he was "taken out of school and taken to Pakistan on a holiday at the age of 17. I was kidnapped and drugged and abducted".[157] A contributor to the Committee's online consultation—a secondary school teacher in East London—stated:

I am very concerned about the issue of forced marriage, especially amongst the Year 12-13 group (sixth form). Of my current sixth form group I am likely to lose 2-3 young women to an arranged marriage [nb. posting says 'arranged', but refers to marriage without consent]. In all cases they do not understand that as a British citizen they do not have to agree to such an arrangement and that they have the right to turn it down.

153. Other victims, under the age of 16, have been taken abroad during school summer holidays to marry, and others have been taken out of school entirely. Shazia Qayum told us:

When I refused to get married I was told that I would not be able to finish my education. At 15 it was very important for me because it was my GCSE time. I was kept at home for a whole year; no one from the education welfare, no one from social services asked the question where I was. My parents handed in a sick note from the family GP telling them that I was not well enough to attend.[158]

Contributors to our eConsultation gave a similar story:

"There is little or no action when young men and women are taken from school to another country, and never return after their 'holiday'" - actecanni

"I know that some authorities find it difficult to investigate young Asian girls who disappear from the education system as that are not allowed by family members to interview the young girl alone, and are often accused of racism when they try to do so" - Cllr Davison

"If a young girl disappears from the school system, it is very difficult to gain access to her house without a relative being present, making it very difficult for her to say whether she is under any pressure, or to be honest about what is really happening. I think procedures need to be put in place where agencies work together to hold confidential interviews, in private, without any family members there who may intimidate her" - Cllr Davison

Data on children 'missing' from school rolls appeared to show large numbers of children unaccounted for

154. Jasvinder Sanghera of Karma Nirvana told us that "we are finding examples across England and Wales where children have gone off rolls and people have just allowed them to go off rolls without tracking where they are".[159] The Forced Marriage Unit recorded that "250 girls aged between 13-16 were taken off the school roll in Bradford during 2006 because they failed to return from a trip abroad".[160] We were alarmed by this report and investigated further with the Department for Children, Schools and Families (DCSF) and local authorities. The figure was also widely reported in the press.

155. The Parliamentary Under-Secretary of State at the DCSF, Kevin Brennan told us that "[Bradford] Council had identified 205, not 250. Of that number, 172 of these children were tracked to an alternative destination or known to be on roll at a school".[161] That left 33 children unaccounted for.[162] The minister agreed to conduct further enquiries in the 13 other local authority areas identified by the Forced Marriage Unit as having high prevalence of forced marriage. He subsequently reported that the figures for those areas—comprising all children listed as "not in suitable education"—were as follows:[163]

Table 3: Children in 13 local authority areas identified as "not in receipt of a suitable education" (March 2008)

Local authority	Number of children listed as "not in suitable education"
Birmingham	250
Blackburn with Darwen	6
Bristol	155
Derby	121
Lancashire	149
Leeds	250
Leicester	294
Luton	66
Manchester	385
Middlesbrough	23
Newham	40
Tower Hamlets	16
Waltham Forest	31

On investigation, data collected by schools and education authorities could not be related directly to forced marriage

156. The minister told us that, contrary to what had initially been suggested, the figures collected by local authorities could not be directly related to forced marriage. Following the introduction of a new statutory duty in 2006,[164] local authorities are obliged to keep a record of children who are considered to be "not receiving a suitable education". The Minister explained that the figures include children not attending school for multiple reasons, including:

a) Children who are resident in the local area but are not presently undertaking education. These could include children who have not yet been registered in schools on reaching compulsory school age and children who have not gained a place at their parents' preferred school and are being kept away from school altogether.

b) Children who are being educated at home, where the local authority does not judge that education to be of a sufficient standard.

c) Children who have been notified to the local authority by schools because they have not been attending school. These may include children who are on extended periods of leave. It will include a number of children of families that have moved away without giving details of their destination to the school, and who the local authority has not yet managed to trace to another part of the country using one of various mechanisms.[165]

157. Of these categories, (c) is arguably the one most likely to contain children who have been removed from school for forced marriage. However, we have no way of identifying how many might be at risk of forced marriage from within these figures. Local authorities which wrote to us to explain the situation in their area reported that they had little concern that those pupils who were recorded as missing and their whereabouts still unknown were at risk of forced marriage. For example, Tower Hamlets stated:

There had been 46 children referred since September 2007, 30 of whom had been admitted to school by 10 March 2008. This left 16 cases being worked with by the Attendance & Welfare Adviser (AWA) for Children Missing Education (CME). These were all children confirmed as living in Tower Hamlets who were not currently on a school roll and this figure did not relate in any way to forced marriage. There are 27 names on the missing children register, 12 have been added in the current academic year. Forced marriage was not reported as a contributory factor in any of the 27 cases.[166]

Blackburn with Darwen and Leicester City Councils also stated that they had no reason to suspect forced marriage in any of their cases of children missing suitable education.[167]

158. It was not therefore possible simply to equate those whose whereabouts are not known with victims of forced marriage. Despite this, and despite the fact that local authorities had not identified specific cases of forced marriage, we remained concerned about the numbers of children who were still unaccounted for. Using Bradford as a case study, we explored the scale of these figures with local authority officials. John Gaskin, Managing Director of Education Bradford, told us that, as of 7 March, there were 27 pupils not in suitable education whose whereabouts were not known.[168] In addition, Bradford provided us with data on pupils taking extended leave from school. In a four-week period from 25 February to 20 March 2008, 3 females and 3 males took holiday or extended leave for 15 days or more. None of these were of South Asian heritage.[169] John Gaskin, Managing Director of Education Bradford, told us that he had no concerns that any of those missing were the victims of crime or of forced marriage.[170]

159. John Freeman, of the Association of Directors of Children's Services, made enquiries about documented cases of forced marriage amongst local authorities:

I have checked further with the 14 named local authorities, and within my own authority, Dudley, which has a significant minority population, and can confirm that the casework relating to forced marriages presently in hand (as of 28 March) in these 15 local authorities is limited to four cases.[171]

There appears to be a discrepancy between the experiences of victims and what is reflected in official data

160. What was striking in evidence from local authorities is that all of them disagreed with the assertion that they had high incidence of forced marriage, and no cases of forced marriage were identified in any of the data returns. Only four cases were identified across 15 local authority areas, 14 of which were identified by the Forced Marriage Unit as having high incidence of forced marriage. The number of cases identified in local authority areas does not seem to match what we heard of individual cases. John Freeman, Joint Director of the Association of Directors of Children's Services, agreed with this assessment:

These figures [from local authorities] do not sit easily with the FMU estimate of 250 cases per year, together with many other cases resolved without reference to the FMU, and yet others not reported at all. And I am aware that there is other evidence, for example from the Luton study, of greater numbers.[172]

161. Mr Gaskin called for research to be carried out, led by DCSF or FMU in collaboration with the ADCS, to analyse the underlying facts from individual cases. He considered that the following information would be especially useful:

At a statistical level, it would help to know the ages of the young women known to the FMU as having been at risk of, or suffering, forced marriage; their home location; the country in which the forced marriage was threatened or carried through; any specific vulnerabilities such as special educational needs, or disabilities; and the outcomes for the young women concerned in respect of family reconciliation.

At a case study level, it would be helpful to analyse, for a sample of specific cases:

what the local authority, school or college, and other local agencies knew, and when; what action was actually taken; and the effectiveness of the action; and

what the local authority, school or college, and other local agencies could or should have known in advance, and what further action could or should have been taken, and by whom, that would have been more effective in securing better outcomes.[173]

162. The Parliamentary Under-Secretary of State at the DCSF wrote to HM Chief Inspector of Schools (HMCI) to seek her view on how well local authorities were implementing their duty to establish the identities of children not receiving a suitable education. Although the HMCI reported that most authorities have 'good' procedures in place, she reported that "in a few areas there is a lack of an over-arching co-ordinated approach to collecting and recording the data relating to missing children which makes it difficult to establish their whereabouts".[174] The Minister wrote to us that local authorities "are using different definitions of categories of children whom they are identifying and tracking".[175] He concluded that:

There is scope for developing some standard definitions for local authorities to use in collecting information and we plan to consult on this issue over the spring and summer, with a view to including these in updated, extended statutory guidance on identifying children not receiving a suitable education. [176]

Some children listed as 'home schooled' could be at risk

163. Director of the Crown Prosecution Service London West, Nazir Afzal, and District Judge Marilyn Mornington, both of whom work regularly with cases of forced marriage, were troubled that some children who were classified as not in suitable education and who were listed as being home schooled were in fact at risk of forced marriage. Mr Afzal told us that some children:

Are, allegedly, being home schooled and very many of them are not being home schooled at all because there is no means of being able to check what is happening to them. Very many of them will end up being victims of forced marriage or honour-based violence.[177]

District Judge Mornington told us that the DCSF has guidance for schools on children being educated at home, but that the system of inspection lacked teeth because parents could deny access to the home and the child.[178]

164. The evidence from victims collected by the Forced Marriage Unit and other survivors' groups, and heard in the course of our inquiry, convinced us that there are children in real danger of being removed from school, or further education, and forced into marriage.

165. However, when we examined the issue of these 'missing' children we exposed a confusing picture, of different data recorded by different schools and local authorities in different categories, none of which could give us concrete information about children at risk of forced marriage. The Parliamentary Under-Secretary of State at the Department for Children, Schools and Families himself recognised the shortcomings in the available data, and proposed to consult on developing a standard definition for local authorities in collecting information.

166. Currently, schools only record data on pupils listed as being 'not in suitable education'. This covers a wide range of reasons, and from our investigations it became clear that these data tell us little about children at risk of forced marriage. This caused us great concern. Rather than disproving that there are children missing from schools who have been removed and forced to marry, our investigation showed simply that there is no adequate mechanism of identifying these children.

167. We acknowledge that data collected by schools are unlikely ever to identify the true numbers of young people forced into marriage. Many victims are aged 16 or over, some may be listed as home-schooled, and others are taken abroad during school summer holidays. These categories are unlikely ever to be comprehensively captured in school data. Nevertheless, we consider that data collected by schools provide a vital mechanism by which some of those most at risk might be identified.

168. We consider that the measures outlined by the Parliamentary Under-Secretary of State at the Department for Children, Schools and Families—to develop a standard definition for local authorities, and reissue guidance on children listed as 'not in suitable education'—are urgently necessary as a first step to standardising data collection between schools and local authorities. However, more action is needed. We recommend that as a matter of urgency the Government commission research into the relationship between trends identified through cases of forced marriage and data collected by schools. In this, we support the broad framework for research set out by the Joint Director for the Association of Directors of Children's Service, John Gaskin.

169. We did not investigate the relationship of children listed as being home-schooled to possible cases of forced marriage. However, the link made by experts between home-schooling and forced marriage is troubling, and we recommend that the Government include this issue in a revision of data collection and procedures for identifying cases of forced marriage and child protection.

Training education professionals

170. It is vital that teachers and other education professionals are equipped to teach about domestic violence and forced marriage, recognise signs of abuse and know how to help students. This is particularly true if, as we recommend in this report, domestic violence and forced marriage should be made an explicit part of the school curriculum, under statutory sex and relationships education, since teachers will be required to teach and respond to these subjects.

171. However, Nicola Harwin, Chief Executive of Women's Aid, told us that research has shown that teachers "are worried that they do not have enough understanding...[schools] feel that it is a Pandora's Box and if they raise the issue, they do not know how they will deal with what comes back".[179] Respondents to our eConsultation felt that these findings applied to forced marriage too:

"It came to my attention that many of the girls sought refuge through education to avoid marriage to an unwanted partner. The longer they pursued their studies...they could avoid the inevitable. I admit then I was completely ignorant about such matters. I was unable to offer any constructive help or advice" - zander

"Train professionals, to make them aware of cultural issues and steps they can take when faced with an individual who may be going through this. There is also a fear to tackle cultural issues such as these, and sometimes due to cultural sensitivity gone too far" - dare2connect

172. All teachers are required to "be aware of the current legal requirements, national policies and guidance on the safeguarding and promotion of the well-being of children and young people" and to "know how to identify and support children and young people whose progress, development or well-being is affected by changes or difficulties in their personal circumstances, and when to refer them to colleagues for specialist support".[180] However, training in domestic and "honour"-based violence and/or forced marriage is not a specific training requirement. It came as no surprise to us, then, to hear that teachers are diffident in tackling these issues, and are unsure how to respond to disclosure from pupils.

173. The Forced Marriage Unit Guidance for education professionals, which will be placed on a statutory footing this autumn, includes suggestions about how to cover forced marriage within existing curricula and guidance on spotting warning signs. The Family Justice Council suggested that:

Designated teachers in each school should receive awareness training and there should be specific guidelines for school staff dealing with DV in all its forms—including information that may be required of them by the courts.[181]

There is currently a designated teacher in each school with responsibility for safeguarding children, but these teachers have not been specifically trained to respond to domestic violence and forced marriage.

174. The joint End Violence Against Women/Equalities and Human Rights Commission report, Making the Grade 2007, called for all PGCE and professional training qualifications to include specific training on violence against women.[182]

175. Teachers and other education professionals cannot be expected to deal confidently and effectively with sensitive subjects such as domestic violence and forced marriage without training and advice. We recommend that specific accredited training be introduced for all education professionals on these issues, including in the re-issued Guidelines for Education Professionals from the Forced Marriage Unit. In the first place this could amount to ensuring that a designated contact for domestic violence and forced marriage exists in each school. This person could take responsibility for implementing a programme of accredited training.

176. We consider that the approach outlined by the Making the Grade 2007 report—that all postgraduate certificate in education (PGCE) and professional development training specifically include modules on violence against women—is a good one. We recommend that the Department for Children, Schools and Families implement specific training modules on domestic violence in all PGCE and professional development training.

Ofsted has a role to play

177. Kevin Brennan MP, Parliamentary Under-Secretary of State at the DCSF, told us that "all schools should be dealing with matters relating to the safeguarding of children, including domestic violence and forced marriage" and that where schools were failing to deal adequately with the issues "in relation to the inspection of those schools, those matters should be brought out very clearly and remedial action taken".[183] We suggested to the Minister that the schools inspectorate should be involved in holding schools to account for their success or failure in tackling domestic violence and forced marriage. The Minister agreed: "Ofsted will have to look at this issue....[it] absolutely has to be a part of their inspection of schools".[184]

178. We recommend that Ofsted be tasked, as part of its inspection framework, to inspect schools specifically on their success or failure in tackling domestic violence and forced marriage. This should include the effectiveness of teacher training on these issues, and assessment of the implementation by individual schools of the Forced Marriage Unit Guidelines for Education Professionals.

137 Gazmarin J.A., (2000), Violence and reproductive health; current knowledge and future directions, Maternal and Child Health Journal 4, pp 79-84. Cited in The facts on reproductive health and violence against women, Family Violence Prevention Fund (Available at www.endabuse.org), cited by the British Medical Association, Ev 97 Back

138 Sethi, D., Watts, S., Zwi, A., et al (2004), Experience of domestic violence by women attending an inner city accident and emergency department, Emerg Med J 21, pp 180-184, cited by the British Medical Association, Ev 97 Back

139 Williamson, E (2006), Women's Aid Federation of England 2005 survey of domestic violence services findings. England: Women's Aid, cited by the British Medial Association, Ev 98 Back

140 British Medial Association Ev 98-99 Back

141 Ev 333 ff (Department of Health) Back

142 For example, the Mayor of London, Ev 258 Back

143 Ev 145 (Gloucestershire County Council) Back

144 Ev 106 Back

145 Ev 261 Back

146 Domestic violence perpetrators: Identifying needs to inform early intervention, Home Office (April 2006), p 11 Back

147 Domestic violence perpetrators: Identifying needs to inform early intervention, Home Office (April 2006), p 12 Back

148 Ev 385 Back