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Miss Anne McIntosh (Vale of York): I have the honour to present a petition from Mrs. Jonete Coates, of Redmain cottage, Tollerton road, Huby, Yorkshire and 100 other residents of Huby or neighbouring villages, objecting to excessive speeds on country roads in and around Huby.
And the Petitioner remains, etc.
The Petition of the readers of the Wilts and Gloucestershire Standard newspaper, Cirencester. Declares that the decision by the East Gloucestershire NHS Trust to take junior doctors away from Cirencester Hospital casts serious doubts over the future of health provision in Cirencester and the Cotswolds, especially with regard to the Accident and Emergency facility.
The Petitioners therefore request that the House of Commons resolves that Her Majesty's Government instructs Gloucestershire Health Authority and the East Gloucestershire NHS Trust to maintain the present level of quality of NHS provision at Cirencester Hospital.
And the Petitioners remain etc.
Margaret Moran (Luton, South): I congratulate the Department of Health on its guidance to health care professionals working on domestic violence. Its manual, which is a key resource for health care workers on domestic violence, is a model to be proud of. I welcome the fact that, over the past few years, it has been increasingly recognised by health professionals and the Department that health services play a critical role in providing access to help and protection for abused women and children and are a front-line point of contact for anyone experiencing domestic violence.
Until recently, the health service has tended to disregard all but the immediate medical needs of people experiencing domestic violence. Any refuge relying on the support of GPs and health visitors will confirm that that has been a mixed experience, subject to the resources and understanding of the staff who work with it. Recent initiatives by the royal colleges and the crime reduction programme have undoubtedly improved responses to domestic violence, as has the welcome funding of a Women's Aid programme to raise awareness of the issue.
However, much more remains to be done. Domestic violence is a key issue for the national health service, so why is it not referred to at all in the NHS plan? We need a more systematic approach across front-line health services to training; we also need to enable domestic violence survivors to access safely help that they may desperately need. In particular, we need clear measures to show how health trusts and, more importantly, primary care groups and trusts are implementing the guidance. A recent survey by Women's Aid shows that performance is patchy and the measurement of outcomes almost non-existent. General practitioners, dentists, health visitors, nursing maternity services, psychiatric and mental health care, general medicine, surgery and accident and emergency departments all need to be provided with training and confidence to identify and provide guidance.
Survivors should not have to rely on enlightened health care professionals; they should be sure that help is available wherever and whenever it is needed. Domestic violence, particularly violence against women, is a problem in all countries, whether rich or poor. According to the British Medical Association, in this country it affects about one in four women, regardless of ethnic origin or status. The BMA found that about one in nine women using the health services have been hurt by someone they know or live with. The Department's own 1997 publication, "On the State of the Public Health", acknowledged that
Violence and abuse are a public health scourge and their effects on health and well-being should never be underestimated. Many health professionals see patients whom they suspect of being abused at home, but may be unsure about to how to deal with the issue. That was the depressing finding of a recent Women's Aid report. Health care professionals have to engage with those embroiled in violent situations to deliver the appropriate care. Research has found that, in some cases, health professionals are seeing abused women as many as eight times before action on domestic violence is taken. It can be difficult for someone to acknowledge that the abuse that she is experiencing is domestic violence. That is not helped by professionals who do not recognise the seriousness of the matter.
It is an appalling fact that violence against women is more likely during pregnancy and early parenthood. The extent and level of abuse was well illustrated by a midwife who recently confessed that she had little idea about the
Pregnant women in violent circumstances look to midwives to help them confront the issues and receive support. It is a sad fact that maternal morbidity and pre-natal morbidity and mortality are significantly higher in women who live in violent and disadvantaged circumstances, and the numbers have been increasing. For the first time, domestic violence is included as one of the causes of death in the last maternity mortality report, "Why Women Die".
The recently produced Department of Health midwifery action plan includes a clear steer for midwives towards developing their public health role. It acknowledges the need for midwives to be skilled in recognising the emotional, sexual or the often more evident physical abuse which take place against women, and to be able to act in the best interests of the woman and baby who are the primary focus of midwives' care. Sadly, that is not the norm throughout the national health service. I can cite an example from my constituency, where a GP told a woman who came to him after being set on fire by her husband to go home and not to annoy her husband again.
That approach is reflected in a recent survey by Women's Aid, which found that only 27 per cent. of health authorities had a written practice or protocol for dealing with domestic violence. Fewer than a quarter collect information on the incidence and prevalence of domestic violence, and about half included the issue in their health improvement programme, which might simply mean the inclusion of a sentence on the subject and might not mean much action in practice.
The survey reveals a similar or worse picture of practice among health trusts, yet health care professionals working in trusts are in an ideal position to encourage disclosure of abuse and to record it in order to highlight the scale of the problem and the need for relevant services. The report concludes that most trusts seem to ignore that.
In areas such as mine, there has been a large increase in the reporting of domestic violence, with about 250 incidents reported a month. Increasingly, those reporting are women from ethnic minorities, but as is the case in many trusts, little or no information about domestic violence is available in ethnic languages. Like many primary care trusts, the focus of what training exists is on health visitors alone. In Luton primary care trust health visitors have, in the past, attended training sessions set up by Women's Refuge and have updated training. Like other primary care trusts, it relies on one identified health visitor with experience in domestic violence who is a resource for her colleagues. But what happens when she leaves?
As for general practitioners, once again the picture is pretty desperate for those seeking help with domestic violence. General practitioners do not have formal training, either as junior doctors or as postgraduates. Locally, Luton primary care trust has encouraged GPs to be involved with training undertaken by health visitors, but it is not compulsory. Nationally, less than 9 per cent. of primary care trusts have a domestic violence policy and less than a quarter have a member of staff with some responsibility for domestic violence issues.
It is clear from the survey that most senior staff in primary care trusts have given the matter relatively little or no thought. Where they have, they have cited difficulties of developing and implementing a policy throughout the various independent GP practices and other primary care services.
Despite the increasing importance of primary care groups and trusts as the front line of resources and contact for survivors, the picture does not look good. Many respondents felt that the only way to effect change was for domestic violence to become one of the designated priority care groups and have their performance measured.
Worryingly, there is still no systematic monitoring of the extent to which women experiencing domestic violence make use of the health service, nor of the outcomes when they do, and very few health authorities collect their own data on incidents or referrals.
Responding to domestic violence is the responsibility of all agencies, not just the police or Women's Aid. The health service has a pivotal role to play in the identification, assessment and responses to domestic violence, not only because of the impact and cost of domestic violence to women's health, but because of the cost to the health service itself. For example, the financial cost of domestic violence for health agencies in Hackney in 1996 was estimated at £580,000, and that did not include hospitalisation and medicine.
It is essential that health professionals are sensitive to signs and indicators that might suggest domestic violence. Women may find it hard to make the first step by disclosing domestic violence, but they may hope that the health professional will notice that something is wrong and put them in touch with support.
What can the NHS do? I urge the Minister to take action on reinforcing the guidelines, particularly to primary care groups and trusts where their involvement is so vital. We need systems which monitor how or whether the guidelines are being used throughout the health service, but especially among front-line provision such as GPs and accident and emergency services.
We need training on domestic violence issues to be included within the initial professional education of all health care staff and as a regular part of on-going training. For the national health service effectively to respond to the needs of those experiencing domestic violence it needs to ensure that it is raising awareness among staff of domestic violence and its effects; to instigate compulsory training; to create a safe environment which encourages disclosure by those experiencing domestic violence; to develop safe protocols for helping those in this situation; to develop good referral systems as part of a multi-agency response; to ensure that women health professionals are
It is clear that, unless responses to domestic violence are included among the criteria against which the performance of health care providers is measured, many will continue to ignore the issue. The health service may be a lifeline for women whose contact with the outside world is restricted by a violent partner. For them, access to front-line health services that recognise and respond to their needs may be a matter of life and death.