Improving the healthcare response to gender-based violence lies at the heart of IRISi’s mission. Operating since 2017, the organisation has successfully implemented two distinct interventions across the UK. Its flagship programme, IRIS, is a cost-effective, evidence-based intervention that enables general practices to identify and refer victims and survivors of domestic abuse. With over 30,000 referrals since its inception in 2010, IRIS has consolidated its efficacy. IRISi’s second intervention, ADViSE, adapted the IRIS model for sexual health clinics and these programmes have received more than 500 referrals in Greater Manchester, Bristol, and South Gloucestershire over a period of only two years, addressing both Domestic Abuse and Sexual Violence. IRISi’s experience has shown that healthcare settings provide a unique opportunity for early identification of victims and survivors. Moreover, it also reinforces that trained clinicians play a crucial role in improving responses to domestic abuse and sexual violence – especially when they have a direct patient referral route to a named specialist, which is an essential part of all IRISi interventions.
While IRISi continues to make significant progress, accumulating valuable experience and data that reinforce the importance of addressing gender-based violence within healthcare settings, the National Health Service faces an ongoing and complex challenge. To overcome these difficulties, the NHS has undertaken substantial structural transformations. While this has led to some uncertainties for our work and sector, recent actions and announcements offer hope for a fresh approach to tackle GBV from within the healthcare system. These were some of the topics discussed during the health summit, “Improving Outcomes for Survivors in Healthcare,” held in partnership by IRISi, Women’s Aid, and the Health Foundation. The summit focused on creating a more inclusive and responsive healthcare environment to tackle gender-based violence effectively.
Held in June at the Health Foundation in London, the event served as a strategic platform for IRISi and Women’s Aid to unite health leaders, healthcare professionals, organisations within the Violence Against Women and Girls (VAWG) sector, and NHS leaders. The primary objective was to explore possibilities for enhancing health outcomes for survivors of domestic abuse. Two key insights emerged during the event: the importance of collaborative efforts to develop and adopt a whole-system response to GBV; and, secondly, the significance of genuinely listening to the voices and experiences of victims, survivors, and those committed to improving the healthcare response, to effectively shape this comprehensive approach.
Amplifying survivor voices and fostering partnerships: Towards a comprehensive whole-system approach to Domestic Abuse support
Farah Nazeer, Chief Executive of Women’s Aid, set the tone for the event by sharing insights from their recent report, Are you listening? 7 Pillars for a survivor-led approach to mental health support. The report revealed the distressing reality that many survivors still feel unheard, unsupported, or misunderstood by healthcare professionals. During her address, Farah also emphasised the significance of providing specialised mental health support for survivors as an integral part of a comprehensive whole-system response. She drew attention to the enduring mental health impacts of domestic abuse, which can persist long after a woman leaves her abusive relationship.
Following her, Medina Johnson, Chief Executive of IRISi, recounted the early days of IRISi’s journey: “I remember when we initially broached the topic of IRIS, and people struggled to envision how the healthcare system could effectively collaborate with the Violence Against Women and Girls sector, unsure of the potential outcomes. Yet, today, we proudly celebrate our successful interventions, built upon thriving partnerships with these very same systems and organisations.”.
Medina also recalled the inequitable response to GBV across the country, which poses significant challenges. Overcoming this issue requires victims and survivors to rely on local passionate and committed individuals and organisations, rather than having nationwide access to comprehensive, whole-system support. Medina highlighted how this reality significantly impacts the NHS: “This isn’t good enough for NHS staff or for patients. It’s also not sufficient to solely depend on frontline, third sector, and specialist organisations – represented by some attendees here today – who are tirelessly managing with limited funding to run services that should be fully supported by our health system. The key to addressing this issue lies in fostering effective partnerships, and I’m thrilled to see all of us gathered in this room together today.”
Throughout the rest of the day, the event featured various speakers, including Experts by Experience, who bravely shared their own personal stories of domestic abuse. Additionally, representatives from third-sector organisations, many in partnership with local health leads, also had the opportunity to showcase their best practices in responding to domestic abuse and sexual violence within the healthcare system across different regions in the UK. Many of these frontline organisations currently deliver IRIS and brought valuable insights from their local experiences with the intervention.
Integrated Care Boards (ICBs) will appoint Executive Leads to tackle Domestic Abuse and Violence
At the event, Catherine Hinwood OBE, Senior Lead Domestic Abuse and Sexual Violence Programme at NHS England, shared important news that may have a positive impact on the healthcare response to GBV. Steve Russell, Chief Delivery Officer at NHS England, called for all Integrated Care Boards (ICBs) to appoint new Domestic Abuse and Violence leads at the executive level by July 13, 2023. In a letter, he urged ICBs to prioritise victims of abuse in their Joint Forward Plans and review policies to support staff and patients facing abuse.
This milestone represents significant progress in recognising domestic abuse as a public health issue. The Executive Lead roles have the potential to yield cost reductions in public services. Furthermore, these leads hold full voting rights at ICB board meetings, ensuring that domestic abuse and sexual violence remain central to the healthcare agenda. By engaging with local communities and collaborating with specialist services, they aim to effectively understand and address survivors’ needs.
IRISi can effectively address the needs and requirements of each ICB to tackle Domestic Abuse
The recent announcement also holds significant potential to positively impact IRISi’s work. The organisation’s interventions are carefully tailored to meet the specific needs of each healthcare setting, and they all undergo a thorough evaluation to earn the seal of being evidence-based. Moreover, IRISi firmly believes that it can promptly address the demands of each ICB by providing cost-effective interventions.
A study evaluating the cost-effectiveness of the IRIS programme, for example, found that the net annual monetary benefit for IRIS was positive from both an NHS and a societal perspective (£22 and £42, respectively). This means that, according to NICE guidance, IRIS should be implemented across all primary care practices.
In turn, the research ”The social value of improving the primary care response to domestic violence and abuse: A mixed methods Social Return on Investment analysis of the IRIS programme” established the social value attached to IRIS while the intervention works to improve the primary care response to Domestic Abuse.
This research concluded:
- For each pound invested in the IRIS Programme, a monetary return of £16.79 is expected.
- For each pound invested in the IRIS Programme, a social return of £10.71 was obtained.
In addition to IRIS and ADViSE, IRISi is actively engaged in developing interventions for various healthcare settings, including dentistry, health visiting, optometry, paramedics, and more. Each of these approaches is being carefully and progressively developed to meet the same high-quality standards as the existing interventions.
This first Health Summit, ongoing discussions and the establishment of a dedicated role within ICBs to lead Domestic Abuse initiatives are significant milestones in an ongoing effort to improve the health system response to GBV. Medina commented, “While progress has been made, there is still much to accomplish, and we wholeheartedly embrace more collaborative approaches that can result in a comprehensive, whole-system response for victims and survivors. Our commitment is to ensure that every healthcare professional in the UK develops the necessary skills to identify GBV signs and has access to a sustainably funded simple pathway for referring affected patients to named workers in specialist third-sector organisations. Fostering collaboration defines our mission as we persist in our pursuit to create a positive impact for lasting change.”
If you’re interested in learning more about how IRISi interventions can enhance the ICB response to Domestic Abuse and Sexual Violence, don’t hesitate to get in touch at firstname.lastname@example.org.