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10.50 pm

The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears): I am delighted to congratulate my hon. Friend the Member for Luton, South (Margaret Moran) on securing this very important debate. I am aware of her tremendous record of raising these issues in the House in relation to almost every single Department. By her personal endeavours, she has raised the matter way up the agenda. I am also personally aware of the online consultation that she was responsible for organising, which gave women the opportunity to respond through the internet and to tell their own stories about their experience of domestic violence. There is nothing more moving than to read and understand the real experiences of women in the community and the impact of domestic violence not on only them, but on their families. I commend that consultation to all hon. Members who have not had the opportunity to hear and understand the views that have been expressed, which are extremely powerful and have been a great aid to us all in understanding the complexity of some of the issues that are involved.

The facts about domestic violence are shocking to all of us. About one in four women will experience domestic violence at some time in their lives. Although we have heard predominantly about women in this debate, there is a clear recognition that domestic violence sometimes involves men as its victims, and we must not forget that. More than 1 million incidents of domestic violence are recorded by the police every year. One in four of all assaults involve such violence. Two in every five women who are murdered are killed by a partner or ex-partner. Certainly, domestic violence is very rarely a one-off episode. More often, the experience is one of repeated and intensifying assault. On average, a woman experiences 35 incidents of domestic violence before seeking help. That is the extent of the problem.

About a third of domestic violence starts in pregnancy. Often, when there is domestic violence in a family, it escalates during pregnancy, when women are at their most vulnerable. Women with unwanted pregnancies often carry the greatest risk. Domestic violence is clearly associated with miscarriages, premature birth and labour, low birth weight, and foetal injury and death.

Almost all women will have contact with the health service by being registered with a GP. I agree entirely with my hon. Friend that the health service is ideally

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placed to pick up and monitor cases and, it is to be hoped, to take action in this very important area. A recent study showed that approximately 80 per cent. of women in a violent relationship had sought help from the health service on at least one occasion.

The issue is one for the Government as a whole and not just the NHS. The policy document "Living Without Fear", published in 1999, set out the Government's initiatives across all Departments, as well as good practice and our commitment to tackling domestic violence and other forms of violence against women. It is important that we consider not only the women who are involved, but the children, who can suffer if they live in households where there is regular domestic violence. It has been shown that such violence can have a serious impact on children's development and well-being.

The health service has a particular role to play in trying to counter domestic violence. Health professionals are most likely, out of those in all agencies, to come into contact with its victims. They are also the most likely people to be perceived as non-judgmental, which is a very important issue for women in these circumstances. Many women simply want the abuse to end, but they may be concerned that their children will be taken away from them once the agencies start to intervene. There is a genuine fear that, once social services become involved, the consequences can sometimes be dire for the whole family. Women's trust in health professionals whom they do not see as threatening or judgmental can therefore be vital in giving them the self-confidence to disclose what has been going on.

Health professionals have a key role to play in helping women to tell them what is happening in their homes, in providing support and practical advice about the available options, which is what many women are looking for, and in demonstrating a continuing understanding and a source of help or referral. Whatever decision the woman initially makes, the health service professional will be there to support her, to help her through the system and to help her to take advantage of the choices on offer.

My hon. Friend referred to the NHS resource manual for health professionals that was developed in March last year. I am grateful that she thinks that it is a valuable resource. The manual builds on and consolidates guidelines that have been issued by the various royal colleges. It provides greater clarity to stimulate the debate and to inform the development of good practice throughout the health service. It is aimed primarily at health care professionals, to try to increase their knowledge and understanding of the issues, to highlight the nature of domestic violence that takes place in a range of settings, and to show how it is likely to be evident among the patients for whom they care. They will then be able to see the warning signs and the symptoms, and be ready to intervene and to take action.

The manual is to be used as a resource that provides a starting point for health authorities and trusts to review their own policies and practices. I accept that it needs to be supplemented with information and data that will support local implementation, because the manual will only be good when it is keyed into what is happening in local communities and used as a source of practical help on the ground, providing real information to assist people.

It is essential that front-line workers be supported by their managers in implementing and developing the protocols to tackle domestic violence. There needs to be

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better monitoring and much more extensive information gathering, so that we can be aware of the full extent of the problem. My hon. Friend is right to say that if we can measure progress, things tend to get done. Unless we do so, this issue could slip down the agenda, which is certainly not what we want.

The resource manual has been widely taken up, right across the health service. The first print run of 10,000 copies has already gone, and the second print run is going well. We are trying to push it out into every part of the NHS.

We are also moving on from there. We are funding the Women's Aid Federation of England in a three-year project to raise awareness of domestic violence in the health service. The federation carried out an initial survey, the findings of which were published last year, as my hon. Friend mentioned. She is right to say that not enough health authorities or trusts have their own written policies, or an accurate way of monitoring the extent of the problem in their communities. We at the centre need to ensure that, as the primary care trusts begin to develop their commissioning policies, they take this matter seriously. The federation's survey has been tremendously useful in showing us what action is being taken on the ground, where the gaps are, and where we need to do even more.

The Women's Aid Federation will undertake a second survey next year to gauge how successful the manual and its awareness project have been. We intend to measure and monitor these processes and to ensure that they happen. The federation has also published a practice directory, a very useful document giving examples of new health care initiatives in tackling domestic violence. One of the challenges for the NHS is to try to spread good practice. There are pockets of excellence everywhere in this country, and it is sometimes frustrating that we try to reinvent the wheel rather than learn from each other and spread the good ideas across the country. The directory of good practice will be a useful tool for the whole NHS to use.

We have also considered domestic violence in relation to NHS Direct. If women telephone the service, they can get immediate advice, signposting and referral to appropriate support services in their community. The telephone number of NHS Direct is becoming much more widely known, and the service has now been rolled out nationally. In the east midlands, NHS Direct has been piloting a domestic violence protocol for use with callers to the service. It will report on the pilot, and if it is successful it will be rolled out to other areas of the country.

Although tackling domestic violence is important to the NHS, it is also important for us to respond to these problems on a cross-government, multi-agency basis. The Home Office has been active in supporting a whole range of initiatives under the crime reduction process. I want to highlight two examples in which the health service, eduction services and local authorities have been able to do really practical work in tackling these issues. The first is in north Devon and Torridge, which is a rural area. Often, support services for women suffering from domestic violence are particularly difficult to access in

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such areas, because they are concentrated in urban communities. The project provides services in the local accident and emergency department, which is where many women immediately go when they experience domestic violence.

It is hoped that the project will expand in its second phase to encompass every health centre and doctor's surgery in the district and two small local hospitals. It aims to provide advice from Women's Aid and legal advice from solicitors and to ensure that 24-hour victim support is available on the spot to help women—and, indeed, men if they are victims of domestic violence—through the health service. We can all learn from the project, and we should evaluate it to judge how successful it is. We must ensure that there is support in the community to help people in that situation, whatever the time of day or night. The project is extremely interesting.

The other example I want to highlight is supported by the health action zone project in Leeds. It is entirely different, but just as valuable. Three local schools and a mixed-sex group of boys and girls aged eight and nine are involved. The aim is to ensure that they are aware of the problems of domestic violence from a very early age, to extend awareness and to ensure that domestic violence is on their agenda.

I hope that, when we raise the next generation, we will not duplicate the problems that exist in so many families. Again, a multi-agency approach is involved—raising awareness and ensuring that we can support those young people if they happen to be in families where domestic violence unfortunately occurs, as well as giving them the self-confidence and self-esteem to tackle it themselves.

Those are two of about 22 projects being funded this year. There were 200 bids for support from a £10.7 million programme, which is making a tremendous impact on tackling domestic violence in communities. There is a great deal going on, but I would not claim to my hon. Friend the Member for Luton, South that we do not have a lot more to do on the issue. It is widespread and it infiltrates so many families in our community.

All Members of the House want to ensure that we send a clear message that there is never any excuse for domestic violence. It is a crime like any other. It turns people's lives into tragedies for themselves, their children and the rest of us. The Government have to put practical support in place so that we give people choices. Domestic violence is dreadful, because it traps many women and victims generally in a situation in which they feel there is no hope and nobody there to help. There is nobody they can turn to, and they are isolated and alone.

We must ensure that we put in place in our community support networks that give people the chance to live the kind of life that almost all of us take for granted. We are making progress, but we have a long way to go. I am delighted that my hon. Friend has again raised the issue in the House and ensured that we all have it at the forefront of our minds when we develop policy in this extremely important area. I congratulate her again on raising it in the debate.

Question put and agreed to.

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