Quality statement 1: Asking about domestic violence and abuse

Quality statement

People presenting to frontline staff with indicators of possible domestic violence or abuse are asked about their experiences in a private discussion.

Rationale

Some people who present to frontline health and social care practitioners have indicators of possible domestic violence or abuse. Services should ensure that they can provide a safe and private environment in which people feel able to disclose that they are experiencing domestic violence and abuse. In some healthcare settings (for example, mental health and drug or alcohol services, and sexual health services), more people will have indicators of possible domestic violence or abuse than in other settings.

Quality measures

Structure

Evidence of local arrangements to ensure that people presenting to frontline staff with indicators of possible domestic violence or abuse are asked about their experiences in a private discussion.

Data source: Local data collection.

Process

Proportion of people presenting to frontline staff with indicators of possible domestic violence or abuse who are asked about their experiences in a private discussion.

Numerator – the number in the denominator who are asked if they have experienced domestic violence or abuse in a private discussion.

Denominator – the number of people presenting to frontline staff with indicators of domestic violence or abuse.

Data source: Local data collection. The Adult Social Care Outcomes Framework indicator 1.11 gives the number of domestic abuse incidents reported to the police per 1,000 population.

Outcome

Incidence of domestic violence and abuse.

Data source: Local data collection.

What the quality statement means for service providers, health and social care practitioners and commissioners

Service providers (primary, community including third sector, secondary and tertiary care providers of health and social care services, including prison health services) ensure that health and social care practitioners are trained to recognise the indicators of possible domestic violence and abuse. They provide facilities which enable trained health and social care practitioners to ask people presenting with indicators of possible domestic violence or abuse about their experiences in private discussions.

Health and social care practitioners recognise indicators of possible domestic violence and abuse and respond appropriately. They make sensitive enquiries of people presenting with indicators of domestic violence or abuse about experiences as part of a private discussion and in an environment in which the person feels safe.

Commissioners (NHS England local area teams, clinical commissioning groups and local authorities) commission services that ensure that health and social care practitioners are trained to recognise the indicators of possible domestic violence and abuse, and to make sensitive enquiries about experiences as part of a private discussion with the person presenting with such indicators.

What the quality statement means for service users

People who go to health or social care services with signs of possible domestic violence or abuse are offered a private discussion about their experiences. This may help them to talk about any domestic violence or abuse, to know that they are not alone, to feel that they will be believed and that their experiences are not unusual. They will be offered help and support.

Source guidance

Definition of terms used in this quality statement

Indicators of possible domestic violence or abuse

The following symptoms or conditions are indicators of possible domestic violence or abuse:

  • symptoms of depression, anxiety, post‑traumatic stress disorder, sleep disorders

  • suicidal tendencies or self-harming

  • alcohol or other substance misuse

  • unexplained chronic gastrointestinal symptoms

  • unexplained gynaecological symptoms, including pelvic pain and sexual dysfunction

  • adverse reproductive outcomes, including multiple unintended pregnancies or terminations

  • delayed pregnancy care, miscarriage, premature labour and stillbirth

  • genitourinary symptoms, including frequent bladder or kidney infections

  • vaginal bleeding or sexually transmitted infections

  • chronic unexplained pain

  • traumatic injury, particularly if repeated and with vague or implausible explanations

  • problems with the central nervous system – headaches, cognitive problems, hearing loss

  • repeated health consultations with no clear diagnosis

  • intrusive 'other person' in consultations, including partner or spouse, parent, grandparent or an adult child (for elder abuse).

[Adapted from Domestic violence and abuse (NICE guideline PH50)]

Frontline staff

Frontline staff include:

  • nurses

  • accident and emergency doctors

  • adult social care staff

  • ambulance staff

  • children's centre staff

  • children and family social care staff

  • GPs

  • mental health professionals

  • midwives

  • health visitors

  • paediatricians

  • obstetricians and gynaecologists

  • health and social care practitioners in education (including school nurses)

  • prison staff

  • alcohol and drug misuse workers

  • youth workers.

[Adapted from Domestic violence and abuse (NICE guideline PH50) recommendation 15]

Equality and diversity considerations

Health and social care practitioners should understand equality and diversity issues and ensure that assumptions about people's beliefs, values, gender identity or sexuality do not stop them from recognising and responding to 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 should not act as interpreters for enquiries or discussions.