APPENDIX 59
Memorandum submitted by the Department
of Health
1. OVERVIEW
OF HEALTH
WORK ON
TACKLING DOMESTIC
VIOLENCE
Progress with maternity services
The Department of Health (DH) has taken
integrated measures to address domestic violence including making
significant progress in the early identification of, and intervention
with, domestic violence victims. Routine enquiring of all pregnant
women has been rolled out, when taking a social history and providing
information, irrespective of the response with the intent of raising
awareness around support services. This provides a safe and confidential
environment.
Related work to disseminate and underpin
with training includes:
— DH set up the Domestic Abuse
and Pregnancy Advisory Group in 2005 with representation from
the relevant Royal Colleges and voluntary organisations with an
interest in domestic abuse. The Group's recommendations informed
the production of the updated domestic abuse handbook, Responding
to domestic abuse: a handbook for health professionals.
— Development of a framework
to underpin and support practical, evidence-based guidance.
— A training manual for Health
Professionals was published in partnership with DH and the Home
Office.
— A number of regional "Train
the Trainer" workshops took place to impart domestic abuse
training in order for senior practitioners to return to their
localities to train midwives in improved practice in responding
to domestic violence and abuse.
Work being done with A&E Departments
An expert group including leading clinicians
and cross government officials have overseen this work and have
ensured that patient confidentiality, legal and ethical issues
have been addressed. We are working to increase the early identification
of and intervention with, victims of domestic violence through
appropriate de-personalised information sharing between health
and CJS and develop evidence based response and national standardisation
of data collection and sharing. Work is in hand to develop a national
dataset template, and the evaluation and findings of the A&E
pilots have informed that work.
Violent crime has significant costs to
the NHS; bed days related to crime and disorder cost the NHS between
£1.1 and £2.3 billion per year. By focusing efforts
on violence prevention, both costs and violent assaults can be
reduced through an integrated and informed process.
In the south-east, pilots have taken
place in 22 A&E departments, which has helped inform the dataset
feasibility, and applicability nationally.
— Domestic and sexual violence
and abuse diagnostic codes were agreed and went live in 2006.
— The 22 A&E pilots rolled
out in the Southeast illustrated that it is feasible to roll out
a sound evidence based model across the majority of A&Es.
The pilot sites established electronic A&E data collection
systems with a minimum data set and produced protocols on data
safety and transfer and management of patients who are identified
as vulnerable/at-risk.
— A system was created to transfer
de-personalised data to local CDRP/Community safety collation.
— Alongside this the "Do
Once & Share" pilot at Addenbrookes Hospital demonstrated
that data could be collected in a busy clinical setting. Data
was collected in three environments including A&E, a Maternity
Hospital and a single GP Practice. A referral pathway was established
between A&E and maternal health.
— Within the 22 A&E pilot
sites many A&E's are now providing an alcohol/domestic violence
liaison nurse. Consensual referral designed & developed linked
into local Multi Agency Risk Assessment Conferences (MARACs).
GP Practices and Primary Care Trusts
Primary Care Trusts were encouraged to
engage with the Tackling Violent Crime Programme and supported
to deliver their responsibilities regarding Crime and Disorder
Reduction Partnerships and to develop good practice.
— The Health Technology Assessment
Programme has a current project, a systematic review looking at
"how far . . . screening women for partner violence in different
health care settings meet the UK National Screening Committee
criteria for a screening programme in terms of condition, screening
method and intervention."
Children
— In work on domestic violence
and children, there has been further progress on integrating an
awareness of domestic violence into wider work to safeguard children.
— We are producing a children
and domestic violence toolkit (Spring 2008).
— The Department is working
with NICE on developing guidance on the identification and recognition
of all forms of child abuse. Guidelines are expected in late 2008.
— Domestic Violence is one of
the areas highlighted within identification of need and risk in
the Child Health Promotion Programme guide, Pregnancy and the
first five years of life published March 2008.
Mental Health
Between 2002 and 2008, the DH has provided
20 streams of funding totalling over £1.95 million to 12
mental health voluntary and community sector organisations providing
therapeutic services for victims of abuse. This funding goes towards
their central administrative costs and/or innovative projects.
DH funded "Oppressed Voices: understanding
the effects of domestic violence in mental health" (2006)
which explores the impact of culture on women's views of domestic
violence and help seeking in particular within the South Asian
Community.
The Improving Access to Psychological
Therapies (IAPT) programme seeks to deliver on the commitment
to provide improved access to psychological therapies for people
who require the help of mental health services. It also responds
to service user's requests for more personalised services based
around their individuals needs.
It will test the effectiveness of providing
increases in evidence based psychological therapy services to
people with "common" mental health problems such as
anxiety and depression, in providing improvements in health, well-being
and in maintaining people or returning people to employment and
community participation.
The DH Victims of Violence and Abuse
Programme will report in early summer 2008 and will include guidance
for PCTs on the impact of domestic violence on mental health.
The guidance will emphasise the need for close collaboration with
the voluntary sector as well as other statutory agencies in providing
a comprehensive service for both adult and child victims of abuse.
For all victims of violence and abuse
We will be publishing a National Violence
& Abuse Prevention Strategy (health) in Spring 2008. The National
Violence & Abuse Prevention Strategy will identify risk factors
for violence and abuse and what works in terms of prevention.
MARACs
Initiatives such as Multi-Agency Risk
Assessment Conferences (MARACs) and Specialists Domestic Violence
courts have demonstrated their effectiveness in respectively reducing
repeat incidents of domestic violence offences and higher conviction
rates for perpetrators. Health authorities provide representation
towards these initiatives that incorporate safety planning and
risk assessment/management and safe information sharing.
Forced Marriage
We have commissioned and funded a voluntary
sector organisation to produce a report on developing effective
responses for Asian women experiencing domestic violence. This
is due to be published in Spring 2008.
Guidelines were produced to assist health
professionals who suspect cases of forced marriage. Aimed at frontline
practitioners such as GPs, school nurses, midwives, and A&E
staff, the guidelines provide practical advice on how to recognise
the warning signs, and what to do if a patient discloses that
they have been, or are about to be, forced to marry.
Each year approximately 300 cases of
forced marriage are reported to the Government's Forced Marriage
Unit. But many more come to the attention of the police, social
care services, health, education and voluntary organisations.
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.
The guidelines, which are a joint initiative
by the Foreign & Commonwealth Office (FCO), Home Office and
the Department of Health, detail cases such as Sanita who came
to the UK following a forced marriage. While attending a local
hospital to tend to injuries that were inflicted by her husband,
the consultant was able to speak to Sanita alone and she told
him everything. To this day, Sanita still genuinely believes the
consultant saved her life.
March 2008
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