About this page. This page summarises a Domestic Homicide Review published in the Home Office DHR Library. The full report is available at the source link below. Victim and perpetrator names are not included in extracted summaries on this page.
Source · Domestic Homicide Review
Dudley review
CSP: Dudley
Published: December 2022
Year of death: 2016
Extracted: 15 recs
Statutory domestic homicide review under section 9 of the Domestic Violence, Crime and Victims Act 2004. Source: Home Office DHR Library.
View full report (PDF) ↗
Source: Home Office DHR Library
Summary
The review highlights the victim's consistent refusal of care and support, alongside the perpetrator's escalating stress and mental health challenges as a carer. Agencies missed opportunities to identify and address the perpetrator's distress and the complex family dynamics, including the victim's self-neglect and long-standing abusive behaviour.
Extracted recommendations
| # | Recommendation | Addressed to |
|---|---|---|
| 1 | Dudley’s Community Safety Partnership works with Dudley Safeguard Adults Board to ensure that Dudley’s Multi-Agency Hoarding Framework and the DSAB Self Neglect Policy are launched and implemented as soon as is possible in 2019 and that further multi-agency Self Neglect and Hoarding Training is commissioned by DSAB. | Dudley’s Community Safety Partnership | Dudley Safeguard Adults Board |
| 2 | Dudley’s Community Safety Partnership should work with Dudley Safeguarding Adult Board and Dudley’s Safeguarding Children Board to re-establish multi-agency training in respect of domestic violence and abuse. | Dudley’s Community Safety Partnership | Dudley Safeguarding Adult Board | Dudley’s Safeguarding Children Board |
| 3 | Dudley’s Community Safety Partnership to receive assurances from all agencies that professional curiosity is included within training and the CSP is assured within 6 months from the date of publication of this report. | Dudley’s Community Safety Partnership |
| DDS-1 | More timely carer’s assessments to be arranged especially in instances whereby carers have expressed stress, distress or inabilities to cope with their caring role. | Dudley Disability Service |
| DDS-2 | To take allegations of harm to others seriously and raise these as safeguards in the first instance when we are made aware of any concerns. | Dudley Disability Service |
| DDS-3 | Collateral checks to be made with other agencies, family and background information sort to inform our safeguarding investigations and threshold decisions on raising cases to a safeguarding investigation. | Dudley Disability Service |
| DGNHSFT-1 | Develop a level three Adult Safeguarding Training Programme which will include an in depth look at a domestic abuse and self-neglect/hoarding | Dudley Group NHS Foundation Trust |
| DGNHSFT-2 | Raise the awareness of the role of the Carer Coordinator in the Trust | Dudley Group NHS Foundation Trust |
| DGNHSFT-3 | Complete the Domestic Abuse Guideline that is being developed. | Dudley Group NHS Foundation Trust |
| DWMHP-1 | To ensure that all professionals continue to access the safeguarding practitioners for advice and/or supervision on complex cases, request attendance at multi-disciplinary discussions and reflective practice. | Dudley and Walsall Mental Health Partnership |
| DWMHP-2 | To ensure that professionals continue to work with the MDT following agreement of the information pathway and make sure it is embedded within our workforce. | Dudley and Walsall Mental Health Partnership |
| DWMHP-3 | To continue to ensure all professionals complete required mandatory training enabling them to play a key role in the early identification and response to domestic abuse and coercive and controlling behaviour. | Dudley and Walsall Mental Health Partnership |
| DWMHP-4 | For the Trust to produce further education for staff with the development of a Top 10 Safeguarding Tips including professional curiosity and voice of the adult. | Dudley and Walsall Mental Health Partnership |
| DWMHP-5 | To ensure lessons learned are embedded in the Trusts learning lessons process. | Dudley and Walsall Mental Health Partnership |
| DWMHP-6 | To ensure that any recommendations from the DHR case are included in the safeguarding newsletters, domestic abuse training and bulletins which are circulated to all staff. | Dudley and Walsall Mental Health Partnership |
| Recommendations extracted from the published report. Source: Home Office DHR Library. View full report ↗ | ||