Ealing review

Widely disseminate learning to services mentioned in this review. This should be in the form of a written briefing to all relevant staff and dissemination session(s).

Work with NHS England to clarify responsibilities and requirements of commissioning GP IMRs to help resolve issues with delays and quality of GP IMRs submitted to DHRs.

Ensure that the circumstances and findings of this review are incorporated into any commissioned domestic violence training delivered in the borough.

Seek to rectify the patient information systems used across all clinical settings so that attendances at health care settings can be linked and viewed in their entirety.

Produce a multi-agency domestic violence referral pathway/protocol in consultation with the Police and specialist domestic violence services and ensure partnership staff are aware of the document through training and publicity.

Review and address the funding provision to domestic violence support services concerning the support offered to cases that are classed as Police non-crime domestic incidents.

Review and improve access to specialist support provision for families affected by domestic homicide, (this should cover step or blended families when the biological parent is the perpetrator).

Commission a borough domestic violence publicity campaign to include provision of an awareness poster and a palm size/Z card which should be distributed across the partnership to outline to victims the domestic violence support available locally.

Review and address the funding provision to domestic violence support services concerning the support offered to cases that are classed as Police non-crime domestic incidents.

Work to secure inclusion of vulnerable adults within the evolving borough’s Multi Agency Safeguarding Hub.

Audit adult safeguarding links and information sharing processes between GPs, the Police and mental health services.

Work with services in the borough who support domestic violence victims, vulnerable adults and carers so that there is an understanding of these agendas and ensure that this is addressed in training.

Audit referral processes so that agencies working with domestic violence victims, vulnerable adults and carers have effective referral and safeguarding systems to respond to concerns raised by their client groups (such as Multi Agency Risk Assessment Conference, and safeguarding adult alerts).

Ensure that the circumstances and findings of this review are incorporated into any commissioned safeguarding and domestic violence training delivered in the borough as well as into any routine audits of safeguarding adults practice. The training should have a specific focus on carer abuse and the dynamics of domestic violence that may feature and also the connection between the use of alcohol, substances, mental health and the incidence of domestic violence.

Review the process of carer assessments and include domestic violence screening enquiry questions into the process.

Produce a specific housing and domestic violence policy and procedure, to especially detail responding to repairs, noise nuisance reports and making referrals to specialist services.

Ensure all staff are trained on the domestic violence policy and procedure.

Ensure staff and residents have access to up to date domestic violence information, highlighting services and support available.

Pilot an assessment criteria, to support and improve consistent decision making and practice when officers are considering making a referral to a specialist domestic violence support service for victims involved in a non-crime domestic.

Ensure that there is a follow up for every domestic violence victim where they are seen/contacted and are provided with information on local domestic violence support services (linked to recommendation 4) and that this action is then recorded on CRIS.

Ensure that officers responding to noise nuisance or housing related anti-social behaviour complaints are trained on safeguarding vulnerable adults and understand how to identify concerns and make a safeguarding adult alert.

Conduct a domestic violence needs analysis to identify and understanding staff training requirements.

Create a Level 2 and 3 safeguarding training package that includes domestic violence so that staff understand their roles and responsibilities.

Raise awareness of the MARAC processes risk assessment tools and referral processes.

Identify and audit DV attendances in the urgent care centre to establish if cases have been managed appropriately, including if they have been provided with information and advice and if the case has been subject to a domestic violence risk assessment.

Explore options of commissioning independent domestic violence advocacy service provision to be located with the urgent care centre.

Implement clinical domestic violence enquiry within the triage system for the urgent care centre.

Scope the opportunity to devise a liaison meeting (reflecting the weekly safety net meeting held to discuss child safeguarding concerns) to share vulnerable adults concerns.

Provide specific training to the Met Police Community Safety Team to include information on the domestic violence referral pathway.

Create and distribute a domestic violence card to be provided to all uniformed Police officers to give to all callers at all non-crime domestics.

Engage in a jointly delivered programme of community engagement activities to raise the profile and promote the domestic violence services available in the borough.

Commission and deliver domestic violence dynamics and domestic violence risk assessment training for all clinical staff.

Implement enquiry for domestic violence as part of intake assessment for all clients (both as victims and perpetrators) and ensure there is a referral pathway in place to specialist domestic violence services for both victims and perpetrators.

Ensure that the learning points from this review are shared across the CCG partner practices.

CCG Safeguarding Team to work with the GP practice in close proximity to the domestic violence refuge to support their immediate take up of the offer from the refuge service provider of domestic violence training.

Consider how mental health diagnosis and domestic violence issues are coded or flagged within GP records.

Review the use and effectiveness of the IRIS Project across London GP practices to consider potential for wider commissioning of the project.

Via the Named GP audit GP compliance with LSCB safeguarding training in Ealing.

To advise Practices to use the Royal College of General Practitioners toolkit which include a domestic violence audit.

Consider ways to commission domestic violence training for GP staff relevant to their roles and responsibilities (doctors, practice nurses and reception staff).

Encourage all GP locations to display and have available up to date information on domestic violence and support services.

When prescribing antiviral medication (such as Peginterferon) which has documented side effects of inducing psychiatric disorders, a specific verification from the patients GP concerning any mental health concerns should be obtained.

Hospital Safeguarding Team to link to Ealing Safeguarding Adults Board and ensure that the Hepatology Clinic has access to information on safeguarding adult process and support services.

Amend the notification letter sent to the GP concerning commencing antiviral treatment to specifically request that if they have any information which may have an impact on the patient to notify the Hepatology Clinic without delay.

Arrange a meeting between borough safeguarding GPs and Safeguarding Vulnerable Adults Leads with the Hepatology Clinic to improve partnership working and support offered to patients who are considered vulnerable.

Share information with all Ealing GP’s about the Hepatology care pathway so that they are aware and understand their role in the care plan for patients being treated by the Hepatology Clinic.