Domestic abuse: Women's Aid says support for victims of violence in NHS trusts 'highly inconsistent'

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Exclusive: 10 years after the NHS was told it was “a disgrace” it had not done more on domestic abuse, an investigation has revealed only around half of hospitals provide the recommended specialist support

Support for domestic abuse victims in hospitals remains “highly inconsistent” more than 10 years after a major report concluded a lack of action to improve care in the NHS was “a disgrace”, Women’s Aid has warned.

It follows an investigation by NationalWorld into the provision of specialist services and the shocking scale of domestic abuse injuries NHS staff encounter among patients.

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In response to figures revealing hundreds of women are admitted to hospital with domestic abuse injuries every year in Britain, NHS England said that all trusts can provide patients with access to an Independent Domestic Violence Advisor (IDVA).

Women's Aid is concerned that provision for domestic abuse patients in hospitals remains patchy, and that a major culture change is needed in the NHS.Women's Aid is concerned that provision for domestic abuse patients in hospitals remains patchy, and that a major culture change is needed in the NHS.
Women's Aid is concerned that provision for domestic abuse patients in hospitals remains patchy, and that a major culture change is needed in the NHS.

IDVAs are specially trained to address immediate safety concerns for victims at high risk, support them to access services and navigate the criminal justice system, and advise staff with patients they believe have been abused.

But an investigation by NationalWorld has revealed only around half of acute hospital trusts and fewer than one in five community and mental health trusts in England actually provide access to IDVAs.

Freedom of Information (FOI) requests were sent to every NHS trust and health board in the UK, with 145 responding.

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In England, only 44 out of 78 (56%) acute hospital trusts and seven out of 42 (17%) community and mental health trusts had their own IDVAs.

Of the seven Welsh health boards that responded, two provided IDVAs, as did two out of 13 Scottish health boards. No health and social care trusts in Northern Ireland had IDVAs.

Many NHS bodies said their staff could refer patients to IDVAs employed by external agencies.

Of the 55 bodies in Britain that said they did have IDVAs, 13 said they did not provide them at every site.

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A domestic abuse toolkit for the NHS developed through a government-funded pilot project called Pathfinders recommends all trusts should employ at least two IDVAs to work in hospitals or other healthcare settings.

Healthcare-based IDVAs working closely with clinical staff “are best placed to increase adult and child survivors’ safety and wellbeing” and reach survivors quickly during the “golden window of opportunity” where they are most likely to accept support, the project concluded.

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Nicole Jacobs, the Domestic Abuse Commissioner for England and Wales and former CEO of Standing Together, one of the charities that led the Pathfinder project, said the health system is a “critical part” of the response to domestic abuse.

She added she would like to see the Pathfinder project – which piloted a ‘whole health’ approach to domestic abuse across eight NHS sites – rolled out across the country, but that the Department of Health and Social Care (DHSC) had pulled funding for the programme in April 2020.

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An independent 2010 report by the Taskforce on the Health Aspects of Violence Against Women and Children called for all NHS bodies to take urgent action to overhaul their response to domestic abuse, and adopt the same “rigorous and systematic approach” that had been taken in other areas such as diabetes or stroke services.

It was “a disgrace that so little has been done by the NHS so far”, the report concluded.

But Women’s Aid said the Pathfinders toolkit, published in June 2020, had also concluded a “major culture change” was still needed to “ensure the health system responds effectively to domestic abuse”.

Lucy Hadley, head of campaigns and policy for the charity, said healthcare settings may be the first place victims come into contact with a public service – and the only place they can safely disclose their abuse.

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“The numbers of women admitted to hospital due to assault from a partner show clearly that domestic abuse is a huge health issue for women,” she said.

“It is vital that hospitals, GPs and all health settings have robust partnerships with specialist domestic abuse services, who are able to deliver long-term support and safety for survivors – including locating IDVAs in hospitals.

“We are concerned that practice remains highly inconsistent across the country.

“Ultimately, without real focus and funding on domestic abuse and other forms of violence against women and girls from the Department of Health and the NHS at national level, we will not see the change we need.”

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A spokesperson for the DHSC said Pathfinder was intended to be a two-year project to develop model approaches in healthcare, and that it and the NHS would continue to work to embed these approaches throughout the healthcare system.

“All NHS staff must undertake mandatory safeguarding training, which includes a focus on domestic abuse, to ensure they can identify those at risk and take appropriate action,” they added.

“The Domestic Abuse Bill introduces a new duty on local authorities to provide support to domestic abuse victims and their children along with safe accommodation. In undertaking this duty they will be guided by local partnership boards bringing together public services, including health, criminal justice agencies, local government and the charity sector.”

An NHS spokesperson said: “Domestic violence or abuse can happen to anyone, which is why NHS staff are offered safeguarding training so they have the skills and knowledge to advise and support victims and survivors, and further work is underway to expand the availability of these services.

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“All trusts can provide the service of an Independent Domestic Violence Advisor and all mental health providers have been asked to establish 24/7 mental health crisis lines for people needing urgent support and advice, including domestic abuse and assault victims.”