Home / Sources / Domestic Homicide Reviews / Norfolk · Aug 2024
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

Norfolk review

CSP: Norfolk Published: August 2024 Year of death: 2018 Extracted: 14 recs

Statutory domestic homicide review under section 9 of the Domestic Violence, Crime and Victims Act 2004. Source: Home Office DHR Library.

Original review (PDF) ↗ Source: Home Office DHR Library

Summary AI-generated

Verify against the full report at the source link
The review identifies missed opportunities by health and social care agencies to identify and respond to the victim's coercive control and financial abuse, exacerbated by her Huntington's Disease and isolation. Key concerns include inadequate routine enquiry, insufficient follow-up on disengagement from services, and a lack of holistic risk understanding.

Home Office classifications

33 tags

Source-supplied classifications used by the Home Office to catalogue this review.

  • Victim - physical disability
  • Victim - mental ill health
  • Victim - anxiety
  • Victim - depression
  • Victim - serious or life limiting illness
  • Perpetrator - was a carer
  • Perpetrator - carer for victim
  • Perpetrator - alcohol misuse
  • Perpetrator - mental ill health
  • Perpetrator - depression
  • Perpetrator - known to agencies as a domestic abuse perpetrator
  • Perpetrator - known to social services as a domestic abuse perpetrator
  • Perpetrator - known to others as a domestic abuse perpetrator
  • Perpetrator - known to friends as a domestic abuse perpetrator
  • Perpetrator - known to family as a domestic abuse perpetrator
  • Perpetrator - died by suicide
  • Aggravating factors - separation
  • Aggravating factors - coercive or controlling behaviour
  • Aggravating factors - economic abuse
  • DHR process - family contributed to dhr
  • DHR process - family supported by expert specialist advocate
  • DHR process - family received draft report
  • DHR process - family attended dhr panel
  • DHR process - health services recommendations
  • DHR process - community safety partnership recommendations
  • DHR process - technology systems recommendation themes
  • DHR process - identification of risk recommendation themes
  • DHR process - training recommendation themes
  • DHR process - policy recommendation themes
  • DHR process - multi agency working recommendation themes
  • DHR process - record keeping recommendation themes
  • DHR process - awareness raising recommendation themes
  • DHR process - other recommendation themes

Extracted recommendations

14 recommendations pulled from the report · 12 matched to organisations in the index

Recommendation 1

Addressed to Cambridge University Hospitals NHS Foundation Trust

Creation of a standalone Missed Appointments Policy/Process for adult patients, which includes guidance for specialist clinics for when a patient does not attend successive appointments.

Verified wording from the published review · Original review (PDF) ↗

Recommendation 2

Addressed to Cambridge University Hospitals NHS Foundation Trust

The introduction of a Routine enquiry process for all patients within the Emergency Department, Assessment Units, and Outpatient Clinics.

Verified wording from the published review · Original review (PDF) ↗

Recommendation 3

Addressed to Norfolk and Waveney Integrated Care Board

An in-house process introduced for Practices, for communication regarding disengaging patients in primary care by notification to the Safeguarding Lead GP for the Practice, or the responsible GP for the patient.

Verified wording from the published review · Original review (PDF) ↗

Recommendation 4

Addressed to Norfolk and Waveney Integrated Care Board

All GP practices should be encouraged to adopt a safeguarding adult policy.

Verified wording from the published review · Original review (PDF) ↗

Recommendation 5

Addressed to Norfolk and Waveney Integrated Care Board

GP practices should be encouraged to adopt a domestic abuse policy.

Verified wording from the published review · Original review (PDF) ↗

Recommendation 6

Addressed to Norfolk and Waveney Integrated Care Board

To encourage GP Practices to have a DA Champion, primary care practitioners should be made aware of the Domestic Abuse Champion role and how to access staff training.

Verified wording from the published review · Original review (PDF) ↗

Recommendation 7

Addressed to Norfolk and Waveney Integrated Care Board

GP Practices to ensure that they have a process in place when patients do not respond to requests to attend for a monitoring check, related to their medication – for example a blood test or blood pressure check.

Verified wording from the published review · Original review (PDF) ↗

Recommendation 8

Addressed to Norfolk and Waveney Integrated Care Board

New patient registration forms, and annual health check forms to include a question about domestic abuse.

Verified wording from the published review · Original review (PDF) ↗

Recommendation 9

Addressed to Norfolk and Waveney Integrated Care Board

Task and finish group to be created to research feasibility of Routine Enquiry across health services.

Verified wording from the published review · Original review (PDF) ↗

Recommendation 10

Addressed to Norfolk County Council

Evaluation report for the Financial Abuse and Safeguarding Officer role to be shared with the Domestic Abuse Commissioner’s Domestic Homicide Review Repository to aid wider learning around financial abuse, and to be made available within the overview report (see Appendix B).

Verified wording from the published review · Original review (PDF) ↗

Recommendation 11

Addressed to Norfolk County Council

The provision of an anonymised case study for this review, to aid early learning around routine enquiry for all agencies.

Verified wording from the published review · Original review (PDF) ↗

Recommendation 12

Addressed to Norfolk Community Safety Partnership | Independent Chair

Learning to be shared from this review, via the Domestic Abuse Commissioner’s DHR repository, in respect of DHR family engagement processes.

Verified wording from the published review · Original review (PDF) ↗

Recommendation 13

Addressed to Norfolk Community Safety Partnership

Learning to be shared from this review, via the Domestic Abuse Commissioner’s DHR repository, regarding the invisibility of intimate partner carers who are claiming Carer’s Allowance.

Verified wording from the published review · Original review (PDF) ↗

Recommendation 14

Addressed to Norfolk Community Safety Partnership | Department for Work and Pensions

Once published, the learning from this review will be shared with the DWP Retirement Services Directorate and Customer Experiences Directorate, regarding the invisibility of intimate partner carers who are claiming Carer’s Allowance.

Verified wording from the published review · Original review (PDF) ↗