Milton Keynes review

The Hertfordshire multi-agency risk assessment conference (MARAC) sub-group should consider which organisation, agency or individual is best placed to undertake an independent review the MARAC records and produce an individual management review for any potential future domestic homicide reviews.

Hertfordshire Constabulary Information Management PNC (Police National Computer) Unit to consider reviewing the process for removing warning markers when they are no longer required

Hertfordshire Child Protection School Liaison Team should provide a report to the Hertfordshire Safeguarding Children Board setting out what system is in place to identify any pupil who is frequently moved between schools and the reasons for those moves

To ensure Hertfordshire Community Trust staff are aware of the record transfer process for adults

The learning from this review should be brought together with the learning from other domestic homicide reviews in Milton Keynes to inform strategy and practice

To ensure that the supervision prompt list for discussion includes cases heard at the multi-agency risk assessment conference (MARAC)

The learning from this review should be brought together with the learning from other domestic homicide reviews in Hertfordshire to inform strategy and practice

To seek assurance that the multi-agency risk assessment conference (MARAC) notes are attached to the record by the individual practitioners

SaferMK should review the governance arrangements around violence against women and girls (VAWG) and the domestic homicide review process within Milton Keynes

To ensure professional curiosity and challenge is included in all Hertfordshire Community Trust training around domestic abuse

The Government Domestic Abuse Bill (currently out for consultation, March 2018) should ensure that when a perpetrator uses financial/economic abuse, they cannot then benefit financially from killing the victim

To ensure that domestic abuse policy adherence is audited regularly with particular focus on partners/ father’s records and the sharing of domestic abuse information by health visitors to GP’s for the victim and perpetrator

Hertfordshire Domestic Abuse Partnership should facilitate a meeting between Debra's sisters and managers from the multi-agency safeguarding hub (MASH) and the multi-agency risk assessment conference (MARAC). This should ensure that Debra's sisters understand the changes that have been made since their sister's death and are reassured that positive improvements have been implemented.

To ensure that Hertfordshire Community Trust universal services include the necessity to record which adults are present at each contact

To review Hertfordshire Community Trust universal services process for movement in and out reflects Safeguarding Policy and includes record sharing guidance.

The review of eviction cases by the Housing Panel will be reviewed to include a section that specifically deals with domestic abuse and safeguarding – the template will be updated to reflect this and will be an essential part of any report

Staff who come into direct contact with victims (housing officers, ASB officers etc.) must attend the DASH training so they are familiar with the risk assessment process and can identify coercive control at the earliest opportunity

All cases involving victims of domestic abuse, or where there is a reference or concern about domestic abuse should be followed up by the case officer and not closed without the case officer making contact with the victim

To ensure that all victims of domestic abuse are risk assessed using the MARAC/DASH assessment process

To ensure that all victims of domestic abuse are offered access to the Domestic Abuse Case Worker and given contact details of women's organisations (including culturally specific organisations).