Posts tagged ‘HMIC’

January 24, 2015

Inspired by the Reith lectures

One doesn’t immediately expect that the distinguished thoughts of a Reith lecturer would have immediate relevance to our work to address domestic abuse – but this year’s lecturer, Atul Gawande, who spoke so eloquently about different issues affecting the future of healthcare, mentioned three points that felt highly relevant. You can listen to the lectures which are brilliant at http://www.bbc.co.uk/programmes/b00729d9

His second lecture talks about systems – how medicine is moving from the ‘magic bullet’ of penicillin to complex systems involving many practitioners, technology and inter-related problems. You will see the link with making a proper safety plan for a victim and children – it involves the resources of several agencies, clear communication and attention to detail as every case is different and the risk of getting it wrong is high. He suggests (I hope I do his lecture justice) that not only do the really complex aspects of a surgical procedure need to be done well, but also all the mundane but vital (literally) elements such as hand washing by nursing staff. To ensure consistency of practice he recommends….using a checklist. Does this sound familiar? And just like the CAADA-DASH risk checklist which was not/is not uniformly popular, nor was his checklist for medical staff. While many practitioners did not welcome the new medical checklist, nearly all of them said that they would want the procedure to be followed in exactly this way if they were undergoing an operation. Why didn’t we think to ask that about the risk checklist?! Of course any sensible person would want to have all those elements covered by an IDVA or police officer before a safety plan was made. The types of abuse suffered, the additional vulnerabilities and needs of a victim or particular risks associated with a perpetrator need to be identified if they are present. You can read more about his thoughts on this at http://www.nytimes.com/2007/12/30/opinion/30gawande.html?_r=2&oref=slogin&

Secondly, in a later talk, he comes back to the idea of how we implement systems. He talks about developing standards, writing guidance, and last of all when there is still a lack of consistent quality, he notes that there are sanctions for individuals who do not ‘follow the guidelines’. Again, this sounds all too familiar. In fact, we have done our fair share of guideline writing… Rather he argues, we should reward good practice and encourage those who are doing it right. A message for those responsible for driving culture change following the HMIC inspection?

Finally, and most importantly, he argues eloquently that the medical profession needs to listen to the patient. Radical. The same is true as we develop our response to domestic abuse – ensuring that lived experience is at the heart of what we do. For the group of victims, family members, survivors and thrivers who are helping us to shape our thinking at CAADA, I can only say, ‘Thank you – your input is vital – literally’.

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September 8, 2013

Just Imagine…

…That you are the Chief Inspector of Her Majesty’s Inspectorate of Constabulary.

How would you respond to the Home Secretary’s announcement of an inspection by HMIC on standards of policing domestic violence in England and Wales?  In particular she has asked the Chief Inspector to focus on:

  • the effectiveness of the police approach to domestic violence and abuse, focusing on the outcomes for victims;
  • whether risks to victims of domestic violence and abuse are adequately managed;
  • identifying lessons learnt from how the police approach domestic violence and abuse;
  • making any necessary recommendations in relation to these findings when considered alongside current practice.

I will set out some thoughts over the coming weeks- but would love to hear yours first.

I think that the last thematic inspection by HMIC (someone is going to tell me I am wrong) was in 2004 together with the CPS inspectorate, the HMCPSI.  This inspection looked at the ‘care pathway’ from first police callout through to the end of a court case.  I quickly re-read parts of their report and a few things struck me.  Firstly, there are phrases which sadly still resonate with all of us today.  For me one big theme remains about the quality of leadership and implementation.  For example, “many police forces have appropriate policies…however, in practice implementation is far from universal.”  In a similar vein, “Inspectors came across considerable amounts of good practice and good work in the Areas visited….Overall, the priority given to domestic violence locally was variable and depended heavily upon local initiatives and commitment.” Plus ça change….

The report also called for local Chief Constables, Chief Crown Prosecutors and Local Criminal Justice Boards to develop effective performance management arrangements.  We have seen real progress in this regard from the CPS but perhaps less consistently from the police, perhaps in part reflecting the challenge of achieving this focus across so many forces.

Secondly, I was struck by what wasn’t mentioned in the 2004 report.  There is no mention of course of either the work of Independent Domestic Violence Advisors (IDVAs) or Multi-Agency Risk Assessment Conferences – since neither really existed other than in a very few local areas at that time.  The spirit of the 2004 report is one of the criminal justice system working much more in isolation than today, with only limited references to the need to liaise with support agencies such as Victim Support and local Women’s Aid services.  This looks very different today with MARACs operating in every area of England and Wales, IDVAs supporting victims through the court process and at MARAC, and now with the growing introduction of Multi Agency Safeguarding Hubs (MASH).  However, before we get too smug, we need to remember the conclusions of the HMIC team in Essex recently who wrote: “We found poor communication between those providing victim care, investigators and voluntary sector support workers.”  So no chance of retiring just yet.

Let me know what you think the answers to the Home Secretary’s questions might be.  I definitely believe that they should include a mix of practical recommendations around multi agency work and MARAC, in particular with links to specialist support for victims.  We also need a focus not only on consistency, quality, accountability and leadership, but also we should highlight the need for solid evidence.  This can be used not only to identify best practice, but also to keep learning.  Wouldn’t it be great if there was clear evidence for every Force of both safety and justice outcomes that was produced annually which allowed us, not to take a snapshot of practice once every 10 years, but rather drove a focus on constant, practical, realistic improvement?  Evidence which could be used by every PCC and Chief Constable to inform their response?  And most crucially, evidence that would start to bring down the rates of repeat victimisation, shorten the time that victims suffer before they call the police and reduce the risk that they, and their children, face.  Without this, the police response risks remaining too reactive when there is a real opportunity to take a much more positive approach.