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 is covered in NICE's quality standard on child abuse and neglect.
For more information see the domestic violence and abuse topic overview.
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 (Crime Survey England and Wales. Office for National Statistics, 2013–14). At least 29.9% of women and 17.0% of men in England and Wales have experienced domestic abuse at some time (Homicides, firearm offences and intimate violence 2010/11. Home Office, 2012). 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. Note that 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 (The decline in the rate of domestic violence has stopped: removing the cap on repeat victimisation reveals more violence, Lancaster University, 2014).
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 on the cost of domestic violence 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
duration of domestic violence and abuse
re-occurrence of domestic violence and abuse.
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:
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.
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 NICE quality standards.
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.
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.