Introduction

This quality standard covers domestic violence and abuse in adults and young people aged 16 years and over. It covers adults and young people who are experiencing (or have experienced) domestic violence or abuse, as well as adults and young people perpetrating domestic violence or abuse. It also covers children and young people under 16 years who are affected by domestic violence or abuse that is not directly perpetrated against them. This includes those taken into care.

The term 'domestic violence and abuse' is used to mean any incident or pattern of incidents of controlling behaviour, coercive behaviour or threatening behaviour, violence or abuse between those aged 16 or over who are family members or who are, or have been, intimate partners. This includes psychological, physical, sexual, financial and emotional abuse. It also includes 'honour'‑based violence and forced marriage.

This quality standard does not cover violence and abuse perpetrated against children and young people under 16 years by adults ('child abuse'). This will be covered in a future quality standard on child abuse and neglect.

For more information see the domestic violence and abuse topic overview.

Why this quality standard is needed

At least 1.4 million women and 700,000 men aged between 16 and 59 experienced domestic abuse in England and Wales in 2013/14 – 8.5% of women and 4.5% of men[1]. At least 29.9% of women and 17.0% of men in England and Wales have experienced domestic abuse at some time[2]. These figures are likely to be an underestimate, because all types of domestic violence and abuse are under‑reported in health and social research, to the police and to other services[3].

Both men and women perpetrate and experience domestic violence and abuse, but it is more common for men to perpetrate violence and abuse against women. This is particularly true for severe and repeated violence and sexual assault.

A report from Lancaster University – Cost of domestic violence up-date – estimated the costs associated with domestic violence and abuse in the UK in 2008 to be £15.7 billion. This included over £9.9 billion in 'human and emotional' costs, more than £3.8 billion for the criminal justice system, civil legal services, healthcare, social services, housing and refuges, and more than £1.9 billion for the economy (based on time off work for injuries).

Multi‑agency partnership working at both an operational and strategic level is the most effective approach for addressing domestic violence and abuse. Training and ongoing support from within an organisation are also needed for individual practitioners. Without training in identifying domestic violence and abuse and responding appropriately after disclosure, healthcare professionals may fail to recognise its contribution to a person's condition and to provide effective and safe support.

The quality standard is expected to contribute to improvements in the following outcomes:

  • harm from domestic violence and abuse

  • mortality from domestic violence and abuse

  • emergency attendances for domestic violence and abuse

  • quality of life

  • personal safety

  • duration of domestic violence and abuse

  • re-occurrence of domestic violence and abuse.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measurable improvements in the 3 dimensions of quality – patient safety, patient experience and clinical effectiveness – for a particular area of health or care. They are derived from high-quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 2 outcomes frameworks published by the Department of Health:

Tables 1 and 2 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 Public health outcomes framework for England, 2013–16

Domain

Objectives and indicators

1 Improving the wider determinants of health

Objective

Improvements against wider factors that affect health and wellbeing and health inequalities

Indicators

1.11 Domestic abuse

1.12 Violent crime (including sexual violence)

2 Health improvement

Objective

People are helped to live healthy lifestyles, make healthy choices and reduce health inequalities

Indicator

2.23 Self‑reported well‑being

Table 2 The Adult Social Care Outcomes Framework 2015–16

Domain

Overarching and outcome measures

4 Safeguarding adults whose circumstances make them vulnerable and protecting from avoidable harm

Overarching measure

4A The proportion of people who use services who feel safe

Outcome measures

People are free from physical and emotional abuse, harassment, neglect and self‑harm

People are supported to plan ahead and have the freedom to manage risks the way that they wish

4B The proportion of people who use services who say that those services have made them feel safe and secure

Placeholder 4C. Proportion of completed safeguarding referrals where people report they feel safe

Indicators in italics in development

Service user experience and safety issues

Ensuring that care is safe and that people have a positive experience of care is vital in a high‑quality service. It is important to consider these factors when planning and delivering services relevant to domestic violence and abuse.

Coordinated services

The quality standard for domestic violence and abuse specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole care pathway. A person‑centred, integrated approach to providing services is fundamental to delivering high‑quality care to people experiencing or perpetrating domestic violence and abuse.

Clear protocols and methods should be adopted within and between agencies for sharing information about people at risk of, experiencing, or perpetrating domestic violence and abuse. Protocols and methods should align with the Data Protection Act and professional guidelines that address confidentiality and information‑sharing in health services, including how to apply the Caldicott guardian principles to domestic violence and abuse.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high‑quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high‑quality domestic violence and abuse service are listed in related quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All health and social care practitioners involved in assessing, caring for and supporting people experiencing or perpetrating domestic violence and abuse should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard. Quality statements on health and social care practitioners' training and competency are not usually included in quality standards. However, recommendations in the development source on specific types of training for the topic that exceed standard professional training are considered during quality statement development.

Role of families and carers

Quality standards recognise the important role families and carers have in supporting people experiencing domestic violence and abuse. However, health and social care practitioners need to speak to people alone to facilitate and support disclosures of domestic violence and abuse. When interpreters are needed for discussions, these should be professional interpreters who are impartial and have a duty to maintain confidentiality. Family members or friends must not act as interpreters for enquiries or discussions.



[2] Smith K (editor), Osborne S, Lau I et al. (2012) Homicides, firearm offences and intimate violence 2010/11: supplementary volume 2 to Crime in England and Wales 2010/11. London: Home Office.

[3] Official published Crime Survey for England and Wales data 'caps' the maximum number of incidents in a series at 5. Evidence suggests that once this cap is removed, domestic violence and abuse increases by 70% and this is mostly against women (Walby, Towers and Francis. The decline in the rate of domestic violence has stopped: removing the cap on repeat victimisation reveals more violence, 2014).