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

Bury review

CSP: Bury Published: September 2023 Year of death: 2016 Extracted: 16 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

Agencies under-assessed the perpetrator's risk, leading to missed opportunities for intervention and comprehensive safety planning for the victim and child. Inconsistent information sharing, delays, and a lack of awareness among professionals and the community about domestic abuse risk factors were also identified.

Extracted recommendations

16 recommendations pulled from the report

#	Recommendation	Addressed to
1	That Team Bury Community Safety Partnership considers whether its constituent agencies training on assessing risk in domestic abuse cases needs enhancing to ensure all risk factors are identified before setting the final risk level.	Team Bury Community Safety Partnership
1	Future consideration should be given towards reviewing the existing guidance for staff relating to responding to domestic abuse notifications.	Pennine Care NHS Foundation Trust
1.	The level of knowledge and awareness concerning child safety for all police response staff is reemphasised and reinforced	Greater Manchester Police
1.	Line Managers to implement individual actions plans in relations to PK and MM to ensure implementation of learning from this DHR	Cheshire & Greater Manchester CRC
1.	There is a need to ensure that GP practices are aware of risk factors relating to DVA and to know what to do if a concern arises. This has been a previous recommendation and an IRIS training plan is already in place, together with training by the CCG link nurses.	North Manchester Clinical Commissioning Group
2	That Team Bury Community Safety Partnership considers how it can best reinforce the importance of professionals being aware that family and friends very often hold additional information to that which a victim reports, and to determine how such information might be accessed within an agency’s confidentiality framework.	Team Bury Community Safety Partnership
2	Future consideration should be given to reviewing the current MASH information sharing Pathway within PCFT.	Pennine Care NHS Foundation Trust
2.	The Head of the Public Protection Division to commission work to evaluate the effectiveness of the STRIVE programme, and consider its implementation with a structured and established police input into the process.	Greater Manchester Police
2.	There is a need for all GP practices to establish a DVA policy and procedure. This has been a previous recommendation and needs to be audited to assess compliance. This needs to include a system for recording health indicators for domestic abuse in line with the Guidance for responding to domestic abuse published by RCGP, IRIS, CAADA (2012)	North Manchester Clinical Commissioning Group
3	That Team Bury Community Safety Partnership reviews whether its advice to family and friends who have knowledge of domestic abuse has penetrated the community effectively.	Team Bury Community Safety Partnership
3	The process for reviewing A&E attendances by the health visiting service and the service response should be updated.	Pennine Care NHS Foundation Trust
3.	The Head of the PPD should ensure that awareness around policy and procedure where DV markers are in place be reinforced for all staff throughout the response policing establishment.	Greater Manchester Police
3.	There is a need to raise awareness of DVA and help and support services available, within GP practices to their patients.	North Manchester Clinical Commissioning Group
4	That Team Bury Community Safety Partnership considers how it can work together to know when a reconciliation between a victim and perpetrator has, or is thought to have, taken place when separation is seen as a protective factor for a child.	Team Bury Community Safety Partnership
4	All PCFT staff working with children and families should be competent and confident in their knowledge and skills to effectively challenge within health and partner agencies in complex decision making	Pennine Care NHS Foundation Trust
4.	Relationship Continuity of care was not provided to WM. It is know that this promotes patient compliance and would maximise opportunities to identify risk. Whilst this is not considered to be a significant issue for the practice, there may be usefulness in exploring this further.	GP Practice 2
Recommendations extracted from the published report. Source: Home Office DHR Library. View full report ↗