Agenda item

To consider submissions in relation to this scrutiny topic from:

 

·       NHS North East and North Cumbria Integrated Care Board

·       Primary Care Networks (PCNs)

The fourth evidence-gathering session for the Committee’s review of Children affected by Domestic Abuse considered information from the NHS North East and North Cumbria Integrated Care Board (NENC ICB), as well as survey feedback from local Primary Care Networks (PCNs).

 

NHS NORTH EAST AND NORTH CUMBRIA INTEGRATED CARE BOARD

 

The NENC ICB Strategic Head of Commissioning (Tees Valley) gave a presentation in response to the Committee’s lines of enquiry which covered the following:

 

·       Our Statutory Duties: The Domestic Abuse Act 2021 officially recognised children affected by domestic abuse as victims needing specific care and support.  From a health perspective, the Health and Care Act 2022 required ICBs to develop five-year strategic plans addressing needs of domestic abuse victims, including children.  As commissioners of care, ICBs must actively safeguard vulnerable individuals by integrating healthcare services focused on domestic and sexual abuse victims.

 

·       Safeguarding Children: Requirements were met through the appointment of executive leads to ensure safeguarding responsibilities were prioritised at the highest governance level, compliance with statutory guidance ('Working Together to Safeguard Children') to co-ordinate multi-agency protection efforts, and active participation in local partnerships to ensure adherence to safeguarding standards across services.  Furthermore, healthcare services must be safe and responsive to children's needs, promoting their welfare and protection, and the ICB had to ensure that services were aware of their own duties of care and that these were reflected within a service specification.

 

·       Commissioning & Service Planning: ICBs must commission trauma-informed services which centre on supporting children affected by domestic abuse, and domestic abuse considerations should be integrated into strategic planning and needs assessments by ICBs.  Services must identify and respond to domestic abuse early, particularly in primary care, maternity, and emergency departments.  Additionally, ICBs must ensure accessible and effective referral pathways for children and families affected by domestic abuse.

 

·       Workforce Training & Accountability: Staff roles and responsibilities in safeguarding were defined by the NHS England Safeguarding Accountability and Assurance Framework (SAAF).  Healthcare staff must be trained to identify domestic abuse signs and understand referral pathways for victim support, and it was acknowledged that training needed to be continuous and tailored to specific staff roles to ensure confident and appropriate responses to safeguarding issues.  Effective monitoring ensured compliance and maintained safeguarding as a priority across all organisational levels.

 

·       Multi-Agency Collaboration: Multi-Agency Risk Assessment Conferences (MARACs) brought together professionals from various sectors to share information and develop safety plans for high-risk victims, and ICBs participated in Domestic Homicide Reviews (DHRs) to learn from past incidents and improve future safeguarding responses (it was noted that communication between agencies can sometimes fail).  Collaboration among Local Authorities, the police, and voluntary organisations ensured comprehensive support for children and families – Stockton-on-Tees was well served in terms of partnership-working.

 

·       National, Regional, Local: Key safeguarding contacts were highlighted.

 

·       NENC ICB – Internally: Domestic Abuse was one of the main priorities of the ICB and was recognised within all NHS contracts, with Trusts expected to ensure that the workforce could prevent, identify and respond consistently through a ‘Think Family First’ lens.  The ICB was a strategic partner on the Community Safety Partnerships across the 14 Local Authorities, as well as the Domestic Abuse Board, and published a link around domestic abuse and safeguarding every month.  A Safeguarding Network for Health Professionals existed across the area, and in 2023, the ICB signed up to the Sexual Safety Charter.

 

·       NHS England (NHSE) – External: ‘Standing Together for Domestic Abuse’ was a network with learning opportunities which met four / six times a year.

 

·       National Initiatives: The REACH Plan (2024-2029), led by Foundations – What Works Centre for Children & Families, aimed to identify and evaluate effective programmes to prevent domestic abuse and support child victims.  ICBs were expected to collaborate in identifying, testing and scaling interventions across healthcare settings, and following investment of £75 million over five years, the focus was on prevention, early identification, and recovery support for children affected by domestic abuse.

 

·       NHSE Safeguarding Accountability and Assurance Framework (SAAF): Updated in 2024 to reflect the role of ICBs in safeguarding children and adults, the SAAF emphasised multi-agency collaboration, training and localised safeguarding leadership.  It also supported implementation of Children’s Social Care reforms and revised ‘Working Together to Safeguard Children’ guidance.

 

·       IRISi & NHS Collaboration: IRIS and ADViSE programmes were being expanded to support ICBs in embedding domestic abuse identification and referral pathways in general practice and sexual health clinics, with a focus on early intervention, clinician training, and direct referral to domestic abuse specialists.

 

Responding to the presentation, the Committee asked how the NENC ICB monitored / assured itself that learning around domestic abuse cases involving children was appropriately shared / acted upon by those organisations it commissioned.  The NENC ICB officer stated that learning was shared and discussed within established safeguarding and safety partnerships, though would seek further detail from colleagues following this meeting.

 

Members noted a lack of reference to the commissioning of mental health Trusts within the information submitted and queried how these organisations were monitored when it came to domestic abuse policies / practice.  Assurance was given that all commissioned providers should have a service specification which included up-to-date considerations around statutory obligations (safeguarding being a key feature of NHS contracts).  Again, confirmation around service monitoring would be provided after this meeting, as would a subsequent question on whether NENC ICB now had a seat on the Council of Governors of local NHS Trusts (which had not been the case in the past).

 

PRIMARY CARE NETWORKS

 

Led by the NENC ICB Head of Primary Care – Tees Valley (who had co-ordinated this particular element of evidence-gathering), and supported by a local GP Partner, a paper detailing and reflecting upon the responses to a Committee survey issued to the Borough’s four PCNs in relation to this scrutiny topic was summarised.  Key content included:

 

·       Stockton-on-Tees General Practice Overview: In Stockton-on-Tees, there were 20 practices (independent businesses) which were split between four PCNs (Billingham and Norton, BYTES, Norton Stockton, and Stockton).  PCNs were groups of practices working together to deliver services and work in collaboration with other providers to deliver proactive and personalised care.  They were responsible for delivering a national ‘directed enhanced service’ (DES) contract, though there was no requirement in the DES in respect of ‘domestic abuse’.

 

·       Approach (to survey): Based on the Committee’s stated lines of enquiry, the NENC ICB Tees Valley Primary Care Team developed and issued a Microsoft (MS) form survey via PCN Operational Managers to support co-ordination of response from the member practices.

 

·       Responses and key themes identified: All four PCNs responded on behalf of members practices.  Highlighted results included:

 

o   What mechanisms or tools do primary care staff within your network use to identify at-risk individuals, children and families who are affected by domestic abuse?: Key themes identified were collaboration across roles, identification and monitoring of at-risk individuals, structured information-sharing and early intervention, and training and use of safeguarding tools.

 

o   How confident do practice staff feel about spotting the signs of domestic abuse?: ‘Very confident’ – 2; ‘Somewhat confident’ – 2.

 

o   Is domestic abuse training promoted to staff within your network?: Yes – 4; No – 0.

 

o   Are primary care staff within your network aware of how to report domestic abuse?: Yes – 4; No – 0.

 

o   Are primary care staff within your network aware of local domestic abuse services?: Yes – 3; No – 1.

 

o   Would primary care staff within your network benefit from promotion of the local service offer provided by Harbour?: Yes – 4; No – 0.

 

o   What mechanisms do practices within your network use to promote how to report domestic abuse?: Key themes identified were using a variety of media channels and signposting, staff training and support, regular communication and support, accessible reporting pathways, and commitment to consistency and best practice.

 

o   Do practices within your network utilise the clinical system to record concerns relating to domestic abuse and or referrals they make to support agencies?: Yes – 4; No – 0.

 

o   Are practices aware of the Local GP Independent Domestic Violence Advocate (IDVA)?: Yes – 1; No – 3.  Feedback from the one PCN which answered ‘yes’ on the effectiveness of the IDVA arrangement was positive.

 

o   Do practices within your network feel there is effective collaborative working with Stockton Borough Council and NHS partners regarding domestic violence?: Yes – 1; No – 3.  Feedback from those PCNs answering ‘no’ included that ‘collaboration works in principle, but lack of feedback after referrals is a shared frustration’, ‘there seems to be little promotion of collaborative working, with Harbour and other societies working in isolation’, and ‘we would benefit from support to implement a single process across our PCN’.  A suggestion was also made for ‘regular communications from the department / nominated staff members to raise the service's profile’.

 

o   Are there any key areas that your network would like scrutiny to focus on in future in relation to this topic: Proposals included better interoperability / communication between agencies; enhanced training and education (e.g. ‘child behind the adult’), multi-disciplinary safeguarding training, and 0–19 service attendance at safeguarding meetings (possibly at PCN level); ensuring the current referrals to both CHUB and the Adult equivalent remain in place as they are working.

 

·       Potential opportunities: Emerging themes covered the following areas – enhanced collaboration and communication / feedback following referral; increased visibility and engagement with IDVA; ongoing training, promotion and awareness; improved use of digital tools and communication channels.

 

Welcoming the feedback, the Committee noted the lack of detail from Billingham and Norton PCN in comparison to the responses from the other PCNs.  Stating that Billingham and Norton was a large PCN made up of more practices than the Borough’s other three PCNs, NENC ICB officers agreed to seek further information after the meeting.

 

Responding to the Committee’s observation regarding three PCNs not being aware of the local GP IDVA, the GP Partner in attendance spoke of the very positive impact they and their patients had experienced via this arrangement.  Within their own practice, the GP IDVA worked with social prescribers and gave individuals who otherwise may feel stigmatised by having to walk into a support service the opportunity to raise concerns relating to domestic abuse within the safe space of the practice (and gave examples of solutions to enable the individual to be seen on their own by creating opportunities to divert the abusive partner).  The benefits of all the Borough’s practices utilising the IDVA resource was emphasised.

 

The Committee sought views on what single development within general practices might have the most significant impact in identifying and / or managing domestic abuse-related cases involving children.  The GP Partner drew attention to their experience in using the personal list system – a highly valued arrangement which enabled a patient to be seen by the same GP, allowing relationships to be developed and family backgrounds to be established.  However, as individual businesses, practices had differing operating models / staffing structures which may not make it possible to adopt a similar approach.

 

Continuing the theme of impactful developments, the NENC ICB Strategic Head of Commissioning (Tees Valley) informed the Committee of the need for professionals to be able to identify the reasons for patient behaviour, not just see / treat the behaviour itself.  Members were then notified of plans for a forthcoming complex trauma team (hosted by Stockton-on-Tees) which would work with a small number of complex cases involving young people.  Funded jointly by the ICB and the five Tees Valley Local Authorities, the team was due to be operational from April 2026 and would add to the local offer and support the national Family First Partnership Programme (FFPP).  Following subsequent Committee queries, confirmation would be provided after the meeting on the permanence of the funding for this new team, as well as whether there were any examples of a similar team anywhere else in the country (or if this was an innovative development).

 

SCOPE AND PROJECT PLAN

 

It was anticipated that the next evidence-gathering session during the November 2025 meeting would focus on information from Cleveland Police.

 

Prior to this, it was proposed that a survey be issued to ascertain the views of the Borough’s early years providers.  A list of suggested questions was shared with, and subsequently agreed by, the Committee – feedback on responses received would be relayed to the December 2025 meeting.

 

AGREED that the information provided by NHS North East and North Cumbria Integrated Care Board and local Primary Care Networks be noted, and further information be provided as requested.