Identification and Referral to Improve Safety (IRIS) programme: Service Evaluation (NHS Nottingham West Clinical Commissioning Group (CCG))

Executive Summary

Domestic violence and abuse (DVA) is recognised as a significant global public health issue (World Health Organisation (WHO) 2013). DVA is a serious, multifaceted societal issue with profound health and mental wellbeing consequences with the potential for longer term health care needs in supporting survivors. The Home Office (2011) reports that 7% of women aged between 16 and 59 and 5% of men have experienced domestic abuse with 24% reporting repeated (three or more times) domestic abuse incidents. In 2013, 77 women in the UK were killed by partners or ex-partners and 19 men (figures for 2014/2015) as a result of domestic violence (Mankind 2016 & 2014). Estimates indicate that 4% of men and 8.2% of women experienced domestic abuse in 2014/15 (Mankind 2016). Furthermore, new data reports that 85% of DVA victims sought help, on average five times from professionals, including healthcare professionals, in the year before they received effective help (Safe Lives 2015). The cost to public services of domestic abuse (uprated to 2013 prices) is £4.3 bn with the majority of costs attributed to the health service (£1.9 bn) (Walby 2004, 2009).

In May 2014 Nottingham West CCG commissioned a 2-year programme for the 12 General Practices of the CCG to receive the IRIS training programme (Identification and Referral to Improve Safety Programme). The IRIS programme comprises of a structured approach to support and manage DVA by providing training to clinical and non-clinical staff located within GP surgeries with a minimum of 75% of staff trained per practice. The commissioned service commenced in May 2014, with the IRIS training programme commencing in September 2014. This report forms part of the overall evaluation of the service offered within Nottingham West CCG delivered in accordance with the national IRIS model (see Feder et al., 2011) of DVA support and management within primary healthcare. To date 100% (all 12 general practices) in the CCG are engaged with the IRIS programme.

The evaluation comprises three components: review of the pre and post IRIS training questionnaires (completed by those attending the IRIS training sessions), clinician led case studies and interviews with clinical and non-clinical staff working in the 12 practices. For the purposes of this evaluation data was made available for October 2014 until December 2015 and is based on over 90 staff attending IRIS training from the CCG area. Whilst patient case studies were compiled by the clinical lead for the Nottingham West CCG for inclusion in this report, on balance, the steering group decided not to include these in the report or for general circulation.

The findings from the pre and post questionnaires, indicates that across the eight measures of knowledge and understanding of DVA there is a statistically significant difference (within a confidence level of 95%CI) for all trained clinical and non-clinical staff scores. This is further supported by inclusion of IRIS participant’s written feedback, at the end of each training session, as to its value and application of the training to their provision of healthcare. Two thematic themes emerged from a small quantity of qualitative free text data: (1) Supporting patients through new knowledge and (2) Raising awareness. At this stage we are unable to provide thematic analysis from interviews that are planned for spring 2016 with clinical, non-clinical staff and the IRIS team.

During the introduction of the IRIS training programme in Nottingham West CCG (May 2014 to February 2016) there have been 71 patients who gave permission to be referred to the Advocate Educator and 2 high risk DVA cases directed to MARACS by trained staff across the 12 CCG GP surgeries. Nationally the average referral to services is 61 cases (data for 2013/2014) (Howell et al., 2014) and locally the Mansfield and Ashfield CCG area had 64 referrals to services and 3 high risk DVA cases directed to MARACS across 31 CCG GP surgeries (Hinsliff-Smith, 2015). This would indicate a significant higher number of referred patients to the AE in the Nottingham West CCG area than the national average across other IRIS sites.