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IRISi is a social enterprise committed to improving the healthcare response to gender-based violence through health and specialist services working together. In 2021, IRISi’s “16 Days of Activism against Gender-Based Violence” campaign is themed as, “16 ways for the 16 days of action: how health care settings can improve their response to Violence Against Women and Girls”. Our aim is to reinforce that health care professionals have an undeniable and fundamental role in identifying victims and perpetrators so we can end violence against women and girls.

It is increasingly important that local IRIS sites are able to demonstrate to commissioning organisations, in financial terms, the health benefits of the work they have done so that IRIS continues to be sustained into the future. The IRIS cost-effectiveness analysis tool has been created to help local sites to do this and it has been just launched as part of IRISi’s “16 days campaign”.

During an online session led by Dr Estela Barbosa, Data Scientist at IRISi and developer of the CEA Tool, all participants were introduced to the tool and how to fill in the data from their own sites to produce the cost-effectiveness measures automatically.

“The IRIS Programme is proven to be a cost-effective intervention to improve the general practice response to domestic abuse, with a cost effectiveness analysis conducted during the randomised controlled trial and again in a ‘real world’ setting in six IRIS sites. Although this national evidence base has existed for many years, we know that IRIS Partners and commissioners are frequently under pressure to demonstrate the cost effectiveness of their local IRIS service. We have developed a tool to enable them to do this”, explains Dr Barbosa.

Gill Smallwood, Chief Executive at Fortalice in Bolton, and Dr Clare Ronalds, FRCGP, former Clinical Lead in Manchester, were also panellists in the event since both were involved in piloting and refining the CEA tool. Fortalice was the partner organisation first invited to test the CEA Tool: “The tool assists with some aspects of added value for commissioning”, reinforces Gill Smallwood.

“In Manchester we trialled the updated IRISi Cost Effectiveness Analysis template using data and real-life costs for a year 2019-2020. The results show Manchester Women’s Aid IRIS programme is highly cost-effective, cost-neutral for the NHS, and cost-saving when combined with societal savings.”, explains Dr Clare Ronalds.

What data is needed for the CEA?

All the modelling is done behind the scenes on the excel spreadsheet file, to calculate the figures shown on the results pages. In order to do that, the CEA tool has a page with a number of pieces of data to enter including:

  • Number of women aged 16 or over, registered in IRIS trained practices.
  • Number of women aged 16 or over in non-IRIS practices in locality – Data available from NHS Digital.
  • Number of women referred to IRIS for first time in a year – standard IRIS data collected.
  • Number of women referred with whom contact made – standard IRIS data collected.
  • Number of o. women referred to non-IRIS DVA services in locality (e.g. non-IRIS DVA agencies, MARAC, IDVA services) by non-IRIS trained practices.
  • Total local IRIS programme budget for year.
  • Prevalence of DVA in locality – from Crime Survey England and Wales.
  • Cost of onward referral based on average contact time – use IRIS trial data.

Interpreting the results

We know from previously published studies that the IRIS programme, when implemented, improves the quality of life of the women it supports. This cost-effectiveness exercise looks at how costs and quality of life improvements are related. Results are presented from two cost perspectives: the NHS perspective and the societal perspective.

Put simply, the NHS perspective takes into account change in healthcare system (NHS) costs as a result of the IRIS programme – for example, any change in how often service users visit their GP or attend A&E or need hospital treatment, or how many prescriptions they require.

The societal perspective takes a wider view considering how the IRIS programme affects costs to the healthcare system, the legal system (civil and criminal), costs of housing, social care, personal costs, costs of specialised services and loss of productivity due to days lost at work.

“Cost Effectiveness Analysis is so important as it demonstrates to the NHS and other IRIS commissioners the value for money that IRIS offers, and provides evidence that it is highly cost-effective, virtually cost neutral to the NHS, and with combined NHS and societal costs, it saves money.

The CEA contributes to our IRIS funding review. Our IRIS Steering Group Chair said: ‘The CEA was really useful to demonstrate the cost effectiveness of the IRIS service and why commissioners could be confident to reinvest in the service. It explained that we were investing to save’”, affirms Dr Clare Ronalds.

The CEA Tool is available to all IRIS sites and it will be delivered to each one of them by our Regional Managers from IRISi. “The IRIS CEA tool should enable each local IRIS site to provide its funders with real life, locally relevant results. It should be helpful when building business cases for further funding or recommissioning” said Dr Estela Barbosa in her concluding remarks at the CEA event.

Numbers to have in mind

  • The estimated cost of domestic violence and abuse, including physical and mental health costs, is £ 66 billion per year (Home Office, 2019);
  • Most recent research shows that the IRIS programme is sustainable and that practices with IRIS are 30 times more likely to make a referral to specialist support for their patients than those without IRIS (Panovska-Griffiths et al, 2020);
  • The cost effectiveness of the model was assessed in this study and it found that the IRIS programme saved £14 for each woman aged 16 or older registered in the IRIS trained general practice (Barbosa et al, 2018); the same study shows an increase in quality of life for each woman affected by domestic abuse;
  • The IRIS programme is therefore cost-effective and cost-saving from a societal perspective in the UK and cost-effective from a health service perspective (NHS perspective) (Barbosa et al, 2018).

At IRISi, we understand we work in partnership. This means that while we are keen for your network to use the CEA tool autonomously, we are happy to be involved in the process. If you are an IRIS service requiring support on running your local cost-effectiveness analysis, please get in touch with your Regional Manager or email us at info@irisi.org.

>>> Click here to access the slides.

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AVA is an expert, groundbreaking and independent charity working across the UK.

Their vision is a world without gender based violence and abuse. They aim to  inspire innovation and collaboration and encourage and enable direct service providers to help end gender based violence and abuse particularly against women and girls.AVA’s work is focused around those areas where they can make the best contribution to ending violence and abuse. They do this by making sure that survivors get the help and support they need in the here and now, through providing innovative training that has a proven direct impact on the professional practice of people supporting survivors of violence and abuse

developing a range of toolkits, e-learning and other material that supports professionals to provide effective and appropriate support to survivors of violence and abuse

using our influence and networks to ensure survivors voices are heard. We work closely with AVA in many areas including the Pathfinder project



SafeLives are a national charity dedicated to ending domestic abuse, for good. We combine insight from services, survivors and statistics to support people to become safe, well and rebuild their lives. Since 2005, SafeLives has worked with organisations across the country to transform the response to domestic abuse, with over 60,000 victims at highest risk of murder or serious harm now receiving co-ordinated support annually. SafeLives are members of the Pathfinder consortium.



Imkaan is a UK-based, Black feminist organisation. We are the only national second-tier women’s organisation dedicated to addressing violence against Black and minoritised women and girls i.e. women and girls which are defined in policy terms as Black and ‘Minority Ethnic’ (BME). The organisation holds nearly two decades of experience of working around issues such as domestic violence, forced marriage and ‘honour-based’ violence.

They work at local, national and international level, and in partnership with a range of organisations, to improve policy and practice responses to Black and minoritised women and girls. Imkaan works with it’s members to represent the expertise and perspectives of frontline, specialist and dedicated Black and minoritised women’s organisations that work to prevent and respond to violence against women and girls. Imkaan delivers a unique package of support which includes: quality assurance; accredited training and peer education; sustainability support to frontline Black and minoritised organisations; and facilitation of space for community engagement and development. They are a part of the Pathfinder Consortium.


The University of Bristol CAPC
The University of Bristol CAPC
The University of Bristol CAPC

The Centre for Academic Primary Care (CAPC) is a leading centre for primary care research in the UK, one of nine forming the NIHR School for Primary Care Research.  It is part of Bristol Medical School, an internationally recognised centre of excellence for population health research and teaching.

A dedicated team of researchers at the Centre work on domestic abuse projects and IRISi is a co-collaborator and partner on some of these projects including ReProvide, HERA and DRiDVA.

The Health Foundation
The Health Foundation
The Health Foundation

The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK. The Health Foundation’s Exploring Social Franchising programme aims to generate a deeper understanding of the potential of social franchising models for scaling effective health and social care interventions within the NHS.

We are one of four project teams participating in the programme to develop a social franchise to enable the sustainable spread of our intervention, the IRIS Programme. We receive funding and support from the Health Foundation, including technical expertise on social franchising, and attend programme learning events. The Health Foundation has also commissioned a programme-wide evaluation to support understanding of the use of social franchising in the UK health and care system. We and our franchisees will support the evaluation through co-designing data collection requirements, providing access to data as requested, hosting site visits and attending learning events.



Standing Together Against Domestic Violence is a UK charity bringing communities together to end domestic abuse. They bring local services together to keep people safe

Most public services weren’t designed with domestic abuse in mind, and they often struggle to keep people safe. Poor communication and gaps between services put survivors at risk.

STADV aim to end domestic abuse by changing the way that local services respond to it. They do this through an approach that they pioneered, called the Coordinated Community Response. The Coordinated Community Response brings services together to ensure local systems truly keep survivors safe, hold abusers to account, and prevent domestic abuse.

Their model of a coordinated local partnership to tackle and ultimately prevent domestic violence is now widely accepted as best practice. They are also a part of the Pathfinder consortium.


Spring Impact
Spring Impact
Spring Impact

Spring Impact is a not-for-profit social enterprise born out of the frustration of seeing social organisations constantly reinventing the wheel and wasting scarce resources. Spring Impact uses a combination of tested commercial and social principles and extensive practical expertise to support organisations to identify, design and implement the right social replication model to scale their social impact.

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