Harlow review

General Practice should be included in the MARAC process, and elect their own representative who can cascade relevant information to all the practices.

All practices should have a named person for adult safeguarding, and clear polices for escalation of concerns.

Adult safeguarding needs to be given the same priority as children’s safeguarding, with all staff undertaking this training as mandatory. The training needs to extend through the practices to front line and administrative staff.

Individual practices should be encouraged to develop policies that make all staff aware of the issues of domestic abuse

The West Essex Clinical Commissioning Group (CCG) in its safeguarding role, should develop a simple to use toolkit which will enable clinicians and practice staff to ask four or five pertinent questions regarding domestic abuse, and be confident about the pathway for referral if there are concerns.

The WECCG should also develop specific training for GPs regarding domestic abuse, and this training should be repeated on a regular basis.

The PAH adult safeguarding policy should be ratified and implemented immediately.

PAH in partnership with Safer Places, should develop a robust business case for the expansion of The Daisy Project into A&E, and implement as soon as funding can be secured to make it sustainable.

There should be a named adult safeguarding person available at all times, particularly if and when the Daisy Project is extended to A&E.

Adult safeguarding training should continue to be delivered to all personnel as part of the induction process.

Where there are concerns raised, every effort should be made for the patient to have continuity of care and be seen by the same midwife.

Where a referral to CSC or any other agency is made there should be a more formal process for reporting back to the referring agency, thus ensuring appropriate follow up procedures are implemented.

Timely information regarding a patient’s urgent referral and non-attendance should be communicated back to the referring GP and a pro-active approach to follow up taken.

NEPFT must refer to any information pertinent to MARAC or to a MAPPA co-ordinator involvement, when undertaking patient assessments.

All front line staff should be trained in adult safeguarding, with a specific component covering domestic abuse and/or DASH.

Carers and family members should be included in the assessment process, and have their own separate assessment; especially if like the perpetrator's family, they have highlighted that they are living in fear.

Where there is proven evidence or research regarding the likely outcome of an abusive relationship, the trust should develop a clear escalation policy which alerts other statutory services or providers using an information sharing protocol

Children and/or an unborn child identified within an abusive relationship should be flagged as routine, and this process should initiate a referral to CSC.

All investigations should include a check with the MAPPA Coordinator as routine.

Where there is a “toxic trio” of drug abuse, alcohol abuse and mental ill health identified within a referral or subsequent investigation, the information should be flagged on all of the separate IT systems.

All aspects of domestic abuse behaviour should be factored into an evaluation of referral or risk regarding someone who has been identified as a cause for concern. It is too narrow and potentially dangerous to only look for evidence of physical violence, when other behaviours and their associated risks are well researched and documented. There also needs to be more acknowledgements of any risks to an unborn child.

The Housing Dept. should continue with face to face interviews with clients presenting themselves as “at risk” whenever possible. However it is noted that there is a telephone response service for all out of hours contact and this does not allow a more personalised approach to anyone presenting as homeless. This is not about the creation of a more efficient service, but would present a more compassionate and responsive service to vulnerable or abused clients.

Internal processes with Essex Probation should be able to flag an alert when an offender with a history of violence and domestic abuse discloses that they have started or are in a new relationship.

When an offender (who has been convicted of domestic abuse or violence) is released from the sentence early and on license, there must be appropriate conditions placed on the terms of the release. These should be related to the original offence and must include the requirement to stay away from previous victims as a minimum.

Essex Police should amend their approach to risk classification once there is a record of previous incidents of domestic abuse on file. This might include, but not be restricted to, issues of alcohol and or drug abuse.

Where possible information recorded on the DV/1 form should indicate any children or an unborn child who may be at risk together with the victim.

Agencies have requested information about previous incidents of domestic abuse to be included on the DV/1 form, however it is unclear whether this would comply with the law regarding the disclosure of spent convictions. More reference should be made to “the 7 golden rules for information sharing” which have been published by HM Government.

The CPS should put a “victims right to review” policy in situ. This would operate when a decision has been taken not to authorise a criminal prosecution in a domestic abuse case.

“Violence against women” panels must be set up to review domestic abuse cases which have proceeded into the criminal justice system but have failed to secure a conviction. These panels should make referrals into an Area Casework Committee when they feel a review is required. This committee can then issue appropriate guidance to the lawyers who handle domestic abuse cases.

A victims and witness committee should be set up to operate under the Essex Criminal Justice Board. This needs to be set up as a multi-disciplinary group and can review any shortcomings and recommendations made by the other panels or committees.

To raise the value and importance of adult safeguarding training and awareness to that of children’s safeguarding, and to ensure that domestic abuse features appropriately within the training.

To develop appropriate information sharing protocols that can override the barriers caused by separate IT systems, and the laws regarding data protection.

All agencies should familiarise themselves with the “7 golden rules of information sharing” as published by HM Government.

Consideration should be given to the status of an unborn child who is delivered within a homicide situation. As the victim's baby was not born there was no birth certificate, and as she was not recorded as a stillbirth there was no certificate to state that either. However the judicial system recognised that there was a child death involved in the perpetrator's actions and he was charged with child destruction as well as the victim's murder.

Where a victim of domestic abuse is likely to come across their perpetrator and/or their known associates within a statutory setting, a request to change an appointment time should never be dismissed as “not allowed” or impossible to do. All government agencies have a duty to respond appropriately if domestic abuse concerns are raised.