Part of: Domestic Abuse
Related to: Children Exposed to Domestic Abuse , Domestic Abuse Characteristics, New Way Service Families Profile, Domestic Abuse Offenders, Domestic Abuse Victims, Inequalities, Ill Health and Disability, Mental Health and Illness, Alcohol, Employment and Economic Activity, Homelessness, Safeguarding Adults, Self-Harm, Substance Misuse Suicide and Mortality of Undetermined Intent
For information about the help that is available in Bath and North East Somerset see the Domestic Abuse Partnership* Leaflet on Domestic Violence and Abuse Services.
* Formally the Interpersonal Violence & Abuse Strategic Partnership (IVASP)
Link to the NICE (National Institute for Health and Care Excellence) guidance on how health and social care services can respond effectively to the problem of domestic abuse. This guidance was published in February 2014.
- In 2010-2011, only around 15% of women who suffer domestic abuse had any reference to this fact in their primary care medical record.
- In 2014, 30% of people working at DA safeguarding agencies stated in surveys that they had not received any domestic abuse training.
Despite the considerable impact of domestic abuse on health and healthcare services, it has become apparent that there are problems with the recording processes, and a limit and inconsistency in the recording taking place. There are also issues with acquiring what limited data there is. These issues are by no means restricted to Bath and North East Somerset, as they appear to be widespread.1
NHS services have a notably poor record when it comes to the identification and handling of cases of domestic abuse. In 2010-2011, only around 15% of women who suffer domestic abuse had any reference to this fact in their primary care medical record. 2
The health professionals that are most likely to come into contact with those experiencing domestic abuse, especially lower level abuse, are GPs. It is estimated that 6-23% of women attending general practice will have experienced physical or sexual abuse from a partner in the preceding year. 3 However, even though studies have indicated that people would most like to receive support from their doctors rather than any other professional, domestic abuse is almost invisible in primary healthcare. 4
Research in Canada, United Kingdom and Australia in Primary Health Care settings indicate that the reasons why doctors largely do not identify people who have experienced domestic abuse include: 5
- Doctors' fears or experiences of exploring the issues of domestic abuse
- Lack of knowledge of community resources
- Fear of offending the woman and jeopardising the doctor-patient relationship
- Lack of time
- Lack of training
- Infrequent patient visits
- Unresponsiveness of patients to questions
- Feeling powerless, not being able to fix the situation
Also the medical model of care may well have a significant impact on how often domestic abuse is identified as well as doctors' subsequent response. Patients are placed in a diagnostic category for which there is a defined treatment. 6
Furthermore, any GP data linked with domestic abuse that is available locally is very difficult to acquire as there is no direct access to even anonymised data.
There is a need to improve the recording of domestic abuse by GPs, and coupled with this the support they offer to victims of domestic abuse, either directly, or by referral to other agencies. Furthermore, more needs to be done to make GP data accessible in order to help develop the comprehensive understanding of domestic abuse that is required to address the problem and its impacts effectively.
The IRIS trial 7 - The Identification and Referral to Improve Safety (IRIS) trial commissioned by The Health Foundation was carried out in three GP practices in Hackney and Bristol (2007-2009). It was a cluster randomised controlled trial of a primary care training and support programme to improve management of women experiencing domestic abuse. The results of this trial indicated that the training and support model used gave an incremental cost-effectiveness ratio of approximately £2,450 per quality adjusted year of life. Consequently, the chief conclusion was that a training programme for primary care teams to increase identification and referral of people experiencing domestic abuse is likely to be cost-effective.
Using national hospital admission codes relating to domestic abuse, there were fewer than 10 hospital admissions recorded for 2009-2011 in Bath and North East Somerset and no A&E admissions, however these figures are evidently nowhere near a true reflection of the actual numbers of admissions that are likely to be linked to domestic abuse. In fact, according to the North West Health Observatory’s 2012 report highlighting the link between violence and the health services, there were on average 33.47 to 45.43 emergency hospital admissions for violence per 100,000 of an age standardised population each year in Bath and North East Somerset. Many of these emergency hospital admissions for violence are likely to be linked to domestic abuse. 8
Review of the B&NES MARAC (Multi Agency Risk Conference) process 9
A review recommended to the B&NES LSAB that more should be done to promote a strengthened awareness of domestic abuse and responses to it, including the functioning of the MARAC (Multi Agency Risk Conference) process. Therefore the B&NE’S MARAC underwent a 12 months’ self-assessment in 2013-14. This was carried out by SaveLives (formally known as CAADA (Co-ordinated Action Against Domestic Abuse)). In this period of time they analysed the gaps in MARAC’s service provision, including training, use the risk assessments, and understanding of the process by those involved. The analysis used one to one interviews with team managers, safeguarding leads and practice managers and survey questionnaires.
23 one to one interviews were carried out with either team managers, safeguarding leads and practice managers and 398 surveys were sent out, 140 of which were returned.
Although the results of the review identified examples of good action management and excellent levels of joint working between panel members, it also uncovered some issues:
- Potential barriers to agencies identifying and referring high risk cases to MARAC.
- Gaps in training and awareness raising options, as well as in managing disclosures, assessing risk and referrals.
Policies and procedures to respond to domestic abuse - 75% of respondents said there were policies and procedures in place, whereas 25% of respondents said that they either didn’t know whether these procedures existed or that they did not exist.
Training - Of the 132 people who answered the questions about receiving domestic abuse training, 30% said they hadn’t received any training, and these came from a range of agencies.
This analysis did not identify what type and levels of training the remaining 70% had received.
Figure 1: Proportion of respondents that received Domestic Abuse Training in the 2014 MARAC Review.
Use of risk assessments - Almost half (45%) of respondents said that their service did use the SaveLives (CAADA) DASH (Domestic Abuse, Stalking and Harassment) risk assessment.
Of the 59 respondents who said that their service did use the SaveLives DASH, 63% of those said they had not received any training.
Figure 2: Proportion of users of the SaveLives DASH that received Domestic Abuse Training in the 2014 MARAC Review.
- 1. Urry N (2013) Domestic Abuse Profile 2012/13, Bath and North East Somerset Council
- 2. The Health Foundation (2011) GPs step up to the challenge of domestic violence, http://www.health.org.uk/news-and-events/press/gps-step-up-to-the-challenge-of-domestic-violence/ (viewed 19.04.2013)
- 3. The Health Foundation (2011) Why was IRIS needed? http://www.health.org.uk/publications/identification-and-referral-to-improve-safety/case-study/why-was-the-project-needed/ (viewed 19.04.2013)
- 4. The Health Foundation (2011) Why was IRIS needed? http://www.health.org.uk/publications/identification-and-referral-to-improve-safety/case-study/why-was-the-project-needed/ (viewed 19.04.2013)
- 5. General Practice UK (2009) Domestic Violence, Identifying Domestic Violence in Health Care Settings, http://www.generalpractice.co.uk/domvio01.htm (viewed on 19.04.2013)
- 6. General Practice UK (2009) Domestic Violence, Identifying Domestic Violence in Health Care Settings, http://www.generalpractice.co.uk/domvio01.htm (viewed on 19.04.2013)
- 7. The Health Foundation (2011) Improvement in practice: The IRIS case study, February 2011 http://www.health.org.uk/publications/identification-and-referral-to-improve-safety/ (downloaded 19.04.2013)
- 8. North West Health Public Health Observatory (2012) Protecting people Promoting health – A public health approach to violence prevention for England http://www.nwph.net/nwpho/Publications/Protecting%20People%20Promoting%20Health%20Web.pdf (downloaded 25/10/2012)
- 9. Parsons J (2014) Multi-Agency Risk Assessment Conference, B&NES Domestic Abuse Gap Analysis, Julian House