Why we need a culture change in the NHS to tackle domestic abuse

The NHS told me all trusts can provide access to domestic abuse specialists. A careful choice of words, I thought – they can, but do they? No, was the answer.

The NHS is a vital part of the response to domestic abuse - we need to make sure all victims get the best possible support.

It was last year when I first made the discovery that the NHS captures records of patients with domestic abuse-related injuries.

I was scrolling through an enormous dataset on diagnosis codes for people admitted to hospital because of an external cause, such as accidents or assaults – the glamorous life of a data journalist.

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At the time, End Violence Against Women said the figures were proof that health workers may have banks of information about victims and offenders that police do not, and that we needed to know whether survivors are guaranteed to get the best support in hospitals.

In response, NHS England told me that trusts can provide access to an Independent Domestic Abuse Advisor (IDVA) – specialists in addressing the immediate safety of victims and helping staff with patients they think have been abused.

A careful choice of words, I thought – they can, but do they?

Now NationalWorld’s investigation has found the answer – more often than not, no they do not.

In 2019 the Government said that “from April 2020, NHS England are planning for IDVAs to be integral to every NHS Trust Domestic Violence and Abuse Action Plan”.

With around one-third of all domestic abuse survivors in 2017-18 saying they received medical attention because of the abuse in the previous 12 months, the case for a strong healthcare response to the violence epidemic is clear.

And yet here we are, April 2021, and only around half of hospital trusts and one in five community and mental health trusts in England have them.

The Department of Health and Social Care made some moves in this area, funding a three-year programme across NHS pilot sites with a consortium of charities, to develop thorough guidelines and mechanisms on how to address domestic abuse.

But it pulled funding for the project last April – that means no funding to expand the programme, or to keep paying for what was put in place at the pilot sites.

That’s precisely when the new Domestic Abuse Commissioner, Nicole Jacobs, says funding was needed to embed the lessons that were learned across the NHS.

With health budgets already under strain, she believes it’s on the DHSC to step up and provide appropriate funding for what we now know is best practice – not individual trusts.

The DHSC says the toolkit of guidance –- including a recommendation that every NHS trust employ two IDVAs – is available online and free for trusts to use.

It was published last June – so we can see how well this ‘come and get it if you want it’ strategy is going.

Developing best practice guidelines is all very well and good, but not if they are then left on a virtual shelf, unadopted by the very organisations dealing day in day out with the patients they are designed to help.

Such a piecemeal approach is unfair on the victims left facing a lottery on the support they can expect when crossing paths with the NHS, and may very well lead to unequal outcomes for people in some parts of the country.

It has been 10 years since the NHS was warned by an official taskforce that its lack of action on domestic abuse was “a disgrace”. The Pathfinder project found major cultural change was still needed in the health service.

Ultimately, culture change needs more than warm words – it needs action.

Time for the powers that be to put their money where their mouths are.

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