On average, five people a week die because of domestic abuse in this country. In recent years, more of those deaths have been from suicide than homicide. Behind each statistic is a life lost and a family devastated, and, in far too many cases, repeated contact with health services where opportunities to intervene were missed.
As a GP for more than 30 years, I know that the NHS is often the most consistent point of contact for people living with abuse. Around half a million people seek support from the NHS each year in relation to domestic abuse. 85% of them will ask for help at least five times before they receive effective support. This is not because clinicians do not care, but because the system is not designed to respond in a coordinated and consistent way.
If we are serious about preventing domestic abuse–related deaths, then we should be serious about the role of the NHS in primary care (i.e. via GPs), mental health services, maternity, emergency departments and community care. We need to move from missed chances to meaningful intervention, and from repeating the same mistakes to saving lives. Staff need to be trained to spot the signs, from depression to covering up of injuries. Often domestic abuse is only revealed as a ‘hidden agenda’, i.e. patients present with other symptoms although the cause is the abuse they are suffering from.
Healthcare professionals want to help, but too many are unsure how to identify abuse, how to respond to coercive control, or where to refer patients. That uncertainty costs lives.
We are committed to halving violence against women and girls (VAWG) by 2029. I welcome the government’s comprehensive strategy, which includes, for the first time, a delivery target that by 2029 any victim or survivor in England will be able to get the help they need via their GP. That is a vital step, but targets alone will not save lives unless backed by a whole-system plan that is measured and monitored at every step of the way.
We must have a comprehensive, whole-health approach to tackling domestic abuse and VAWG, covering primary care, mental health, maternity, emergency and community services, and published by 2027 at the latest.
That plan needs to be backed by serious and sustained investment. The level of NHS funding allocated to tackling VAWG is welcome, but it does not reflect either the scale of damage, or the financial cost which domestic abuse already imposes on the health service.
I welcome the government’s largest-ever investment of £550 million in victim support services over the next three years, alongside an additional £5 million every year from the Department of Health and Social Care (DHSC). While £5 million a year for DHSC is a good first step, achieving the 2029 primary care target will require many times this figure.
It is estimated that £53 million a year is needed to deliver a well-integrated, whole-health response to domestic abuse — from primary care to acute services, maternity to mental health, and both patient and staffing needs. By contrast, the Home Office estimates domestic abuse already costs the health service over £2 billion a year. If we get this right, we can ensure victims and survivors are properly cared for, whilst public money is spent efficiently and effectively.
From April 2026, DHSC will roll out a domestic abuse and sexual violence referral service across Integrated Care Boards called “Steps to Safety”. This will give general practices the tools and ability to identify and refer victims and survivors to specialist support services. But it needs to be delivered to a high standard and properly integrated with the existing provision. We need a simple pathway, ideally with a single contact point, and close working with specialist organisations. Poorly delivered interventions can sometimes be worse than nothing at all.
Done well, this programme has the potential to transform how GPs identify and support patients experiencing abuse. Done poorly, it risks creating false reassurance and missed opportunities — and we cannot afford either.
If we get these things right, the NHS can move from being a service that repeatedly sees abuse to one that actively helps prevent it.
DHSC’s ‘Steps to Safety’ programme could be a game changer for tackling domestic abuse, but only if it properly resourced
