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

Haringey review

CSP: Haringey Published: April 2023 Year of death: 2014 Extracted: 11 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 identifies inadequate safeguarding responses by health agencies, poor information sharing regarding the perpetrator's threats, and systemic failures in domestic violence policies and management at the GP surgery where the victim worked. It also highlights issues with diversity-sensitive help-seeking and the ill-defined role of practice managers.

Extracted recommendations

11 recommendations pulled from the report

#	Recommendation	Addressed to
1	That the Care Quality Commission (CQC), (supported by NHSE) undertake a further inspection of the Avenues Surgery to consider the issues raised in this review along with their earlier inspection, especially around issues of management, supervision, domestic violence policies, Health and Safety and the role and oversight of non-clinical managers.	Care Quality Commission (CQC) \| NHS England (NHSE)
2	Utilising the NICE Guidelines and the findings around mental health in this review, all NHS services covering Haringey should develop (preferably jointly) an improved safeguarding policy that addresses not just the safety of the patient concerned, but any intimate partners or family members (especially given the dynamics of domestic abuse). This policy should include clear use of interpreters, where necessary.	All NHS services covering Haringey
3	That Pembrey Medical Centre institutes a domestic abuse policy based on good practice and the NICE guidance.	Pembrey Medical Centre
4	That the Haringey Violence Against Women and Girls Strategic Group seeks to enhance its broader response to the issue of domestic abuse and wider VAWG issues – leading to a Violence Against Women and Girls Strategy and partnership VAWG policies.	Haringey Violence Against Women and Girls Strategic Group
5	Family Mosaic to introduce a policy which includes a system of enquiry for all their clients to assess whether they are experiencing domestic abuse and to take appropriate action following any disclosure of abuse.	Family Mosaic
6	That this review is disseminated to the Safeguarding Boards in Haringey for consideration within their local strategies and consideration be given to further dissemination within London or nationally, especially in light of the additional responsibilities for adult safeguarding contained within the Care Act, 2014.	Safeguarding Boards in Haringey
7	That all agencies involved in this review brief the employees who interacted with the victim or the perpetrator about the findings of this review (and NHSE to be specifically responsible for informing the Avenues Surgery of the outcome of this review before publication).	All agencies involved in this review \| NHS England (NHSE)
National Recommendat	That any individual reporting suicidal thoughts within an NHS environment be routinely questioned about partners or those close to them to assess the risk to those individuals, in the light of the findings of this review and record and respond to that risk appropriately, if necessary informing the police or Multi Agency Risk Assessment Conference (MARAC).	NHS
National Recommendat	That proper recording of all such events within a NHS setting and the risk assessment leads to appropriate information sharing to other agencies that are in contact with either the potential victim or the client. The records must show a decision making process which has considered information sharing and shows the action taken.	NHS
National Recommendat	That all NHS practices institute a domestic violence policy based on good practice and the NICE guidance.	NHS
National Recommendat	That the Department of Health considers defining a specific role of practice manager (with appropriate job descriptions and person specifications) and provide appropriate guidance and support to GP Practices that utilise this function to ensure that such guidance is embedded in any contractual arrangement.	Department of Health
Recommendations extracted from the published report. Source: Home Office DHR Library. View full report ↗