Cornwall review

We recommend that there should be clear domestic abuse policies/policy written for all GP surgeries in the county. These policies should be regularly reviewed by practice managers and subject to audit at regular intervals. Such a policy should be distinct and separate from policies relating to safeguarding.

We recommend that a training needs analysis for GP’s, mental health workers and others for example, NHS Kernow commissioned services such as psychological therapies should be conducted to identify which staff would benefit from training in recognising high risk markers for domestic abuse. Further work should be undertaken across local agencies to ensure the dissemination of regular training and information in relation to domestic abuse. In particular the use of a specialist package like IRIS to support GPs in their responses to domestic abuse should be used.

The DHR Panel recommend that direct enquiry into domestic abuse is used by all agencies in any assessment or risk assessment process. In addition we recommend that pastoral care in schools have issues relating to domestic abuse as part of their work plans and processes. Direct enquiry should be considered as part of the tool kit of skills and interventions to be utilised within the pastoral care process. There weren’t indicators of abuse regarding concerns relating to the child. The consideration of domestic abuse in these circumstances should not be reliant on specific indicators, it should form part of routine enquiry when a child presents with anxiety issues.

Create a Culture of TELL, ASK and REFER by;  Raising awareness of Domestic Abuse in the Community to encourage increased reporting to REACH  Ensuring the commissioned provider delivering LSCB Safeguarding Children Training includes a Domestic Abuse Specific module including the DASH Risk Assessment.  Including a specific Domestic Abuse DASH module on the Safeguarding Adults Board Training  Ensuring all Designated Child Protection Officers working for the Cornwall Education Authority attend DASH training as part of enhanced Child Safeguarding Training.  Commission Domestic Abuse & DASH Training for Multi Agency Practitioners including the Voluntary Community Sector, Probation, Mental Health, Drug & Alcohol Services and the Health Sector.  Provide DASH Training to all Special Constables, First Response Officers, Supervisors (including Communication staff), Call Handlers and Sexual Offences Domestic Abuse Investigation Teams.

The DHR Panel recommends a programme of work be developed to raise public awareness of domestic abuse. It should include information about where members of the public can appropriately and safely share concerns or information about individuals they believe may be at risk of domestic abuse or at risk of perpetrating domestic violence.

The DHR Panel recommend that guidance relating to the identification and management of morbid jealousy by primary care workers and those working in primary care mental health services should be developed to aid those workers in supporting individuals who may be exhibiting those symptoms.

The DHR Panel recommend that assessment and risk assessment processes in health and social services be reviewed to ensure clearer guidance about the need to consider and respond not only to the needs of the presenting individual, but to spouses, partners and children within the family unit.

The DHR Panel recommend that a focused themed review of previous DHRs in Cornwall be undertaken to identify common themes and issues, from which focused learning and practice development can take place with local organisations. We make this recommendation in the context of there having been three previous DHRs in Cornwall where the perpetrator has exhibited symptoms and risk assessed as risk to self as opposed to risk to others. This emerging theme around quality of risk assessment in the wider context of an individual and the effect this may have on understanding whether they pose a risk to others is an area of practice that should be considered for wider learning and practice development. There may be other commonalities and it would be of benefit to the local system to know and understand these so that a co-ordinated approach to learning and development can be undertaken in response to DHRs undertaken as a whole rather than seeing each in isolation.

The Service Treatment guidance should be reviewed and updated to include guidance on pathological jealousy

It is further recommended that a) cases are referred on for specialist psychological therapy in secondary care, and b) that specific risk questions are asked. (See Action Point below)

Staff should receive training in identifying this condition

It is recommended that the Clinical Governance team will co-opt a working group to develop a tool for risk screening to others

Referring to High Intensity therapy – It has been recommended that a procedure to fast track priority patients if there is an urgent need should be developed. This is to be discussed and reviewed by the Clinical Pathway team.

It has been recommended that guidance is to be produced for staff relating to situations where a proposal to refer to the CMHT is refused by the patient.

NHS England in association with the Care Quality Commission audit/confirm the completion of training by GPs and other primary care practitioners to ensure that appropriate training has been completed.

GPs undertake an agreed formal process to identify thresholds that trigger joint multi professional assessments of particular cases.

Paper record search to ensure that all relevant information is included on electronic record

Consideration of how to tighten documentation regarding any referrals, outcomes or follow up?

Agree and design joint approaches and thresholds for multi-agency working when risks to individuals have been noted and include further exploration of the needs of the wider family to enhance joint family care.

Joint training is undertaken as standard, wherever possible

Information regarding episodes where child in care of Local Authority to be shared with General Practitioner and other health professionals. (Note: practice has changed since 1960.s)

That the full impact of understanding and acting in a timely way where individuals display symptoms of depression, particularly where it is apparent that other family members are being identified is one of the key causal factors.

That there is a requirement for relevant early history, such as fostering, to be included as an integral part of GP records.

That the learning from these domestic homicide reviews is routinely shared with children’s safeguarding teams to facilitate early joint approaches where children may be involved

That consent issues pertaining to engaging and sharing information in a timely way for the purposes of contributing to this Domestic Homicide review, is clearly understood by all health partners, to minimise any unnecessary disputes or delays.