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Violence Against Women

My Lords, I am grateful to the House for allowing me to speak briefly in the gap in this important and powerful debate initiated by the noble Baroness, Lady Gould. I want to focus on healthcare and a concern as to whether the NHS reforms might inadvertently promote, rather than decrease, abuse blindness in healthcare. We know that one in four pregnant women is abused, that in just under a third of these cases abuse starts in pregnancy and in just over a third of those being abused, abuse worsens in pregnancy. We must recognise child abuse in the womb in policy, because the outcomes for these infants are worse, including an adverse effect on brain development, as the noble Baroness, Lady Walmsley described, an increase in risk of death in the first year of life, and underperformance throughout the rest of child development. A study of midwives recently published showed that three-quarters in hospital practice and almost a half in the community had no training in domestic violence, and many had no child protection training. Even when trained, the training effect wears off, so abuse awareness needs to be part of clinical service contracts, with a requirement to ask the question and act on the response, and follow the Welsh example. In that study, although 12 per cent of community midwives encountered definite child abuse, only 2 per cent reported it, leaving a 10 per cent gap between identifying and acting on abuse. Double vision requires simultaneously looking at the woman who is being abused and the child. The GP is in a unique position to ask about abuse; such questions are overwhelmingly acceptable to women, particularly those frightened of instigating any action themselves. Children in those households are 30 per cent to 60 per cent more likely to be abused, with poor performance and aggressive and disruptive behaviour. Will the quality outcome framework that has changed general practice behaviour be looked at? Have the Government considered using QOF as a way of encouraging GPs prospectively and sensitively to ask about abuse and to signpost support? It has to be tackled at every opportunity.