Review highlights the importance of risk assessment and recognising all forms of domestic abuse
A joint Domestic Homicide Review* and a Safeguarding Adults Review** into the death of Doris (pseudonym) has today been published by the Norfolk Community Safety Partnership (NCSP) and the Norfolk Safeguarding Adults Board (NSAB) to enable lessons to be learned and shared as widely as possible to safeguard victims in the future.
Doris was in her eighties when she was killed by her lodger Chris (pseudonym). The review examines the agency contact with Doris and the perpetrator in the months prior to her death.
Mark Stokes, Chair of the Norfolk Community Safety Partnership said: “The Review Panel and members of the Norfolk Community Safety Partnership wish to express their sincere condolences to Doris’s daughter, grandchildren, great grandchild and friends for the untimely loss of one of the most important people in their lives.
The involvement of Doris’s family and friends in the review and their engagement with the panel was critical – through the information that they provided to honour the wonderful, kind woman that they loved, the panel were able to gain a full understanding of Doris as a person and what she had experienced throughout her life and in her final months.
Our partnership is committed to supporting the families whose lives will never be the same by ensuring that there is lasting, effective change and the voice of the victim is heard loud and clear to prevent future harm. The learning from this review and the subsequent changes that have been made since Doris’s death will safeguard victims in the future.”
Natalie Cowland, Independent Chair for the Norfolk Safeguarding Adults Board said: “On behalf of members of the Norfolk Safeguarding Adults Board (NSAB) I would like to offer our sincere condolences to Doris’s family and friends for their loss. Words cannot fully capture the pain and grief caused by this, and our thoughts remain with those whose lives have been forever changed. I would like to reiterate the value that Doris’s family and friends input played in gaining an understanding about Doris and her life, and to identifying areas of improvement in safeguarding practices. NSAB and its partners accept the recommendations and are committed to using the lessons to make improvements in the way services work together.”
The learning and recommendations coming from the review highlighted themes around listening to families when concerns are raised; recognising coercive control and the links to cuckooing; informed risk assessment; professional curiosity; mental capacity assessment; recording and sharing information between agencies; and improved training to recognise all forms of domestic abuse.
The review recommendations form a multi-agency action plan that is overseen by the NCSP and NSAB to ensure that the lessons and recommendations are actioned, embedded and shared widely to support and drive changes in practice. Training is delivered through regular webinars across the partnership and a dedicated professional’s portal to continue to raise awareness and understanding among practitioners to safeguard and protect future life.
The full review into the death of Doris can be found here
*Domestic Homicide Review
A Domestic Homicide Review (DHR), now referred to as a Domestic Abuse Related Death Review (DARDR), is a locally conducted, multi-agency review of the circumstances in which the death of a person aged 16 or over has, or appears to have, resulted from violence, abuse or neglect by a relative, partner or member of the same household. DHRs/DARDRs were established on a statutory basis by the Domestic Violence, Crime and Victims Act 2004.
A DHR/DARDR panel consists of key members of staff from statutory, non-statutory, third sector and charitable agencies who provide support for victims of domestic abuse. Working together in this way will ensure the voice of the victim is addressed through the lessons learnt and recommendations of this DHR.
**Safeguarding Adult Review
A Safeguarding Adult Review (SAR) is a multi-agency review process for all partner agencies to identify any lessons that can be learned from particularly complex or serious safeguarding adult cases where an adult at risk has died or been seriously injured, and abuse or neglect has been suspected.
The aim of the process is to learn lessons and make improvements, especially in the way we all work together to safeguard adults at risk; it is not to apportion blame to individual people or organisations.
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