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Kathy Bonney is Head of Safeguarding at East Lancashire Hospitals NHS Trust. In this blog post, she discusses the impact of having an Idva embedded within the hospital Safeguarding team.

Domestic Abuse and Safeguarding 

The Care Act 2014 came into force in April 2015 and defined adult safeguarding as 'working with adults with care and support needs to keep them safe from abuse or neglect'. It sets out a clear legal framework for how local authorities and other health and social care agencies should protect adults at risk of abuse or neglect.

Within the Act the list of recognised categories of abuse was expanded to include three additional types of abuse, one of which is domestic abuse. Domestic abuse is now recognised as the jurisdiction of Safeguarding Adult Boards across the country.

Health and Domestic Abuse

In addition to direct injuries sustained as a result of domestic abuse, there is good evidence to support the fact that women who are abused by their partners can suffer significant physical and mental health problems.

If we examine the reasons for attendance at hospital for those women who have experienced domestic abuse (who are known to us) we can see a picture of poor health including chest pain, recurrent infections, bowel complaints, anxiety and depression.

Within East Lancashire Hospitals NHS Trust, and other Trusts like ours, we have the opportunity to reach thousands of women who have experienced domestic abuse; they use our services every single day. With over 500 people coming through our emergency department and urgent care centres each day, over 1000 in-patient beds across our 5 hospitals, plus maternity services, hundreds of out-patient appointments, day case procedures and community appointments, we are likely to meet women who have experienced domestic abuse. We also employ over 7500 staff, many of whom could also be experiencing domestic abuse.

The Hospital Idva

East Lancashire Hospitals NHS Trust was in a fortunate position to be supported by the local provider of domestic abuse services. This started a few years ago as part of the IRIS project; bringing Idvas in to health, predominantly placed within the emergency department.

Integrating the Hospital Idva into our Safeguarding team enabled us to raise awareness of domestic abuse across our clinical services, which led to staff recognising the signs of Domestic abuse in their patients. The opportunity for patients to disclose domestic abuse was available, and the Hospital Idva became involved with the daily ward routines, including attending board rounds to assist staff in identifying patients at risk, and improving their knowledge and understanding of domestic abuse.

Most importantly, patients were afforded the opportunity for risk assessment, advice and initial safety planning before they left their hospital bed. We have also had patients who have been discharged from our hospital straight into a refuge, and we have had a few patients who were discharged to another life, simply taking the clothes and belongings they had with them in hospital to start a new life free from abuse elsewhere.

The Hospital Idva position lends itself perfectly to the 'One Chance Rule'. Many of the patients who we have supported have not been known to the police or other services; they have simply taken an opportunity to seek help and support whilst in our care. We have also had patients who may have denied they were experiencing domestic abuse, and those who have disclosed but do not wish to accept the help and support available. These patients may return to our Trust through another pathway, such as though our maternity services, and it may be at a later stage that these patients are ready to accept the specialist help they need.

Only recently a patient attending a gynaecology clinic appointment asked for help; she had been informed what was available during previous contact with our services, and she had made her mind up to ask for the support when she came to the hospital again; 'enough is enough' she said to the clinic nurse. 

Staff and Domestic Abuse

As a consequence of promoting the Hospital Idva role across our clinical services we found our staff began to refer themselves to us for specific advice and support in relation to domestic abuse. This simply grew – the more staff became aware of the Idva and her role, the more referrals we received. Staff were supported either by the Hospital Idva directly, or their local domestic abuse services.

Our own safeguarding team members, including myself, also engaged with individual staff members who chose to have ongoing support following initial assessment, safety planning and specialist support from the domestic abuse services. We learned so much;  staff had lots of episodes of short-term sickness, listed as 'back pain', 'stomach ache', diarrhoea and vomiting', and other minor conditions that simply disguised the truth that they were experiencing domestic abuse.

Patterns of sickness emerged, such as frequent days off on a Monday and Tuesday. Managers had been critical of these staff, never thinking for a moment that they may have bruises to hide following a weekend of drunken abuse. We have been privileged to support individual staff who have trusted us to ensure their story is sensitively told, and this has led to a greater understanding of domestic abuse amongst managers and HR Business Partners.

The support has been unbelievable within our Trust, from the Board members to our car park managers who willingly reserve safe car parking spaces for staff at risk. A special mention has to be given to our Occupational Health and Well Being service who have introduced Routine Enquiry of domestic abuse for all staff who access their service. Finally, we now have a cohort of people who have experienced domestic abuse and received support. In turn they are able to offer peer support to other staff, and this has been of great value to all involved. 

The Hospital Idva going forward

There have been many changes in relation to investment in services for domestic abuse. We now find ourselves, an Acute Hospital Trust, with limited access to an Idva. It would be wonderful to introduce Routine Enquiry across all in-patient services, but it is essential that we are able to meet the needs of those patients who disclose domestic abuse. As part of our safeguarding role, and high on the safeguarding agenda, we would like to strengthen the support in hospital for those who are experiencing domestic abuse.

We welcome the opportunity to prove that having Hospital Idvas working closely with Hospital Safeguarding Teams will not only increase the numbers of people disclosing abuse – and receiving support – but will ultimately improve the long term health outcomes of many hundreds of people.

We're calling for every hospital to have an Idva. Read about our Cry for Health research.