Councillor Jeanie Bell, Kate Davies and Catherine Hinwood gave evidence.

Can I welcome the witnesses and ask you to introduce yourselves for the record, please?

Kate Davies:

Good afternoon, everyone. I am Kate Davies, a national director in NHS England. My formal title is the director of health and justice, armed forces and sexual assault services commissioning, and I have recently taken on a senior responsible owner role for the programme of work that NHS England is doing on domestic abuse and sexual violence.

Catherine Hinwood:

Hi everyone, it is lovely to be here. I am Catherine Hinwood, NHS England’s lead on domestic abuse and sexual violence.

Cllr Bell:

I am Councillor Jeanie Bell from St Helens Borough Council and I am here representing the Local Government Association.

Q Thank you very much for coming; sorry if we get interrupted in between with democracy—it gets in the way of all sorts. The part of the Bill that focuses mainly on your areas of work is the issue of collaboration between different partners. Could you quickly give us your views on how you think this the Bill will encourage a better duty to collaborate than currently exists and where it might need to be strengthened?

Kate Davies:

Thank you very much, Jess. We welcome the Bill and we welcome the duty to collaborate. From the perspective of sitting giving evidence or suggesting amendments, the Bill probably is not as up to date as we in NHS England would like it to be with the new legislation of the integrated care boards, the integrated care partnerships and the different elements of commissioning. There are some additions that would help to strengthen that reality of work that is now happening with 42 integrated care boards. I think that a lot of that was in good faith, and in consultation with the Health and Care Bill becoming an Act in July 2022, but there is certainly more that could be produced to give a clear element of prioritisation and advice to 42 integrated care boards, which ultimately are the population-based commissioning for NHS services.

NHS England has mitigated that collaboration element by putting together a single national programme of work on domestic abuse and sexual violence, which I am pleased to say Catherine Hinwood is the senior lead for, because we take very seriously the fact that we want to support, influence and also use legislation and current Act work to prioritise the needs of the 1.5 million people who are seen by the NHS every day, whether in primary care, hospital trusts, mental health or within some of the services that I directly commission.

I think the answer to the question is, “Yes, that is great,” but the Bill is probably in the past in the way that has been written and put. If we are looking into the future and what we now know, we could look at strengthening that for NHS collaboration with local authorities and also at how the ICPs in particular work across their populations with the voluntary sector, lived experience, the criminal justice sector and police and crime commissioners.

Catherine Hinwood:

If I could just add to that, I started leading this programme at the back end of last year. I visited a lot of ICBs and a lot of commissioners and I have spoken to the third sector. There is fantastic collaboration going on in some areas, so I welcome strengthening the collaboration through a duty, but there are a couple of things that I think we need to be mindful of.

The first is the serious violence duty and the duty in relation to prevention, ensuring that whatever we do in terms of thinking about the local structures and local infrastructure that exist—also in relation to the implementation of the Domestic Abuse Act and domestic abuse partnership boards—all comes together to be a really person-centred, locally focused duty that supports and enhances the structures that are already there at the moment, rather than comes in and brings in something new. From my perspective, there is great work that is already being done. Ensuring that collaboration is at the heart of the way in which key local partners work is brilliant, but I want to make sure that whatever we are doing aligns well with what is happening in local structures.

The next thing I would want to say is that I really welcomed the focus in the women’s health strategy on looking at violence against women and girls—in which, of course, we include men and boys as well—as a public health issue. One of the things that I would really like to see through the Bill, and across Government more widely, is thinking about violence against women and girls, domestic abuse and sexual violence through a public health lens, as well as the really important criminal justice lens. I would like to see the Bill thinking a little bit more about, and interacting a bit more with, that public health approach that we are taking to serious violence.

Q Before I come to you, Councillor Bell, I just want to focus specifically on health, because regardless of the quadrupling funding that we have been hearing about from some witnesses and the Minister today, the local authority is and always will be the biggest provider of victim services in our country. Certainly when we are talking about domestic abuse and sexual violence services, that has always been the biggest provider of funding and, obviously, that has definitely not been quadrupled.

Historically, health services have not been a commissioner in this particular space. When Rape Crisis England and Wales gave its evidence earlier, the witness said that she could not think of a mental health trust in the country that commissioned a specialist trauma service for victims of rape and sexual violence, and that has certainly been my experience as well—not that I could not think of one, but that it is very patchy. Kate, I noticed that you said it would be better if they had better advice. Do you think that the duty is strong enough to make the ICBs actually fund any of this work?

Kate Davies:

I think one of the reasons why I am also sitting here is that I do commission £50 million-worth of sexual assault referral centres—47 across the country—and NHS England has increased that from what was actually £6 million when it first came in as part of the Act of 2012-13, and also developed all the paediatric services as well as adult services. Most recently, the long-term plan in 2019 increased a baseline of £4 million of mental health trauma-informed services around sexual violence, and in fact, I announced another £2 million for that only last week.

I think the reality with this area of work is that, when you are working within the NHS in a busy hospital trust or a GP’s surgery, of course we give some brilliant support every day of the week to men, women, girls and boys who are victims of rape and sexual assault, and also other elements of violence. However, this could be an opportunity to look at how the resource, generically within the NHS as well as maybe a more targeted element, can support people’s knowledge, people’s understanding and sometimes people’s fear—how that can be an earlier Intervention, as well as a targeted intervention. That is why I am sitting here, and that is why we are sitting here for the NHS. I think that answer is yes.

Q I am delighted to see both of you in your positions—neither of your positions existed that long ago, so it is a delight to see you both in them. What I want to know is whether this Bill, and the duty to collaborate specifically around domestic and sexual violence—which does include health service providers—is actually going to make it so that the ICBs, for example, all commission services for domestic and sexual violence. If I were to think of the population of any particular area, you are talking tens of thousands of victims in the west midlands alone. If you were to have a similar health problem that tens of thousands of people had suffered from, you can bet your bottom dollar that my ICB is funding a specific service for them. Do you think that this is going to do that in this case? Do you think the duty to collaborate will lead to anybody actually doing that?

Kate Davies:

I will have to say yes; I think it will. We would like to see that consistency. One of the works that the national programme does, as well as obviously across ICBs with Steve Russell—who is actually the board sponsor for this work as the chief delivery officer for NHS England; it is a great approach, through both Steve Russell and Amanda Pritchard as chief exec—is to really evidence that importance to our ICBs, for not only patients but staff. We have 1.3 million staff, and certainly from a recent campaign we had a lot of feedback on the improvements we can make and also the good practice.

We have some great work going on. We have just done some audit work around ISVAs in some of our acute trusts and actually found out that we are doing more that is commissioned through the health budgets and through ICBs than we ever realised before. We have to build on that good practice, to be honest with you, but this is a very busy time in the NHS. It is really important that we can maybe use some additional resource that can target how this can be understood and also be focused as part of a planned programme of work.

Q Councillor Bell, from the point of view of the local authorities, how do you think the duty to collaborate will make a difference?

Cllr Bell:

I do not know if this will be controversial or not, because I am not sure what everybody else has been saying. Although I tried to tune in as much as I could on my train journeys down, the wi-fi has not been great. I would say that no, actually, I do not think that the duty alone is enough to make the collaboration work. Collaboration is formed on good relationships, good professional relationships and information sharing, and that is developed through strong partnership working practices. You cannot have that unless it is funded properly.

My concerns from what I see in the proposed Bill are that the funding assigned to it is for almost like a convener role to pull things together, whether that is at PCC level, who will help run the meetings and provide the support. Actually, we have local authorities and the NHS with significant capacity issues. I would go as far as to say that PCCs have capacity issues and cannot do everything either, so we cannot get away from that resource and capacity issue. It is an increasingly complex landscape.

We have to be really careful, when we talk about capacity in this context, that we are not duplicating as well. We have talked about the Domestic Abuse Act and the serious violence duty, but we also have collaboration happening through the combating drugs partnership. You have all these additional collaboration duties coming in—which we all want to comply with, because ultimately we all want a better service for victims—but there is no additional funding for victims in all this either, which is a concern.

I suppose the last thing I would say is when we look at the duty to collaborate, that will not solve the problem around the footprint that this will operate on. In terms of PCCs, ICBs, local authorities and violence reduction units—of which you have only 20—you are talking about lots of different organisations, some of which will be operating on different footprints, so how will you ensure that when you talk about the duty to collaborate, you have that flexibility built in to ensure that at a local level you can work in a way that meets the needs of your residents? You will all know from your own constituencies how complex that can be within that footprint, so there has to be a degree of flexibility as well.

Q For example, we already made a duty on the local authorities: unitary, tier 1 local authorities had the duty to offer refuge accommodation to victims of domestic abuse, and had to give priority to victims of domestic abuse in housing. In reality, that priority means that a person is almost certainly on a waiting list for a year—in fact they would be lucky if it were a year. Similarly, there is access to children’s services. The two biggest areas of victims’ lives—in the case of the duty to collaborate, which is only for domestic and sexual abuse—are housing and children’s services. The vast Majority of this will fall to the local authority. Once you have this duty, is there any sense that it will not just be another thing that creates long waiting lists?

Cllr Bell:

The pressure will increase. I was the previous Cabinet member for community safety, which included housing, domestic abuse services, homelessness, asylum and refugees, as well as community safety and our band A properties, which are for most urgent need. Domestic abuse is in that band A category. A person could still be waiting for a minimum of a year.

Ultimately, our refuges fill up very quickly. They remain at capacity and that can be seen right across the country. That is not specific to my authority either, so you will see it right across the landscape. There are not enough houses being built to provide accommodation that is safe for people. I know that that is not necessarily what we are here to talk about today, but you do have to address that. That is why I have a concern about the duty to collaborate. Obviously, I want it to work. I want us all to work together, but I just do not think that the duty alone is enough.

IQ will stick with the theme of duty to collaborate, and I should probably declare an interest as a former local government councillor and a paid employee of an integrated care board in the past. We know full well from the example of the integration of health and social care how even getting the NHS and local government to work closely together has been a challenge. In fact, that is still a challenge even to this day. Catherine, where do you think the responsibility should lie for overseeing the implementation of this collaboration at a local level? Should it be police and crime commissioners, the NHS, or the councils? Where do you think that it would be best placed?

Catherine Hinwood:

I am going to talk to you about the implementation of the serious violence duty and the way in which that worked, and some of the lessons that I think we should learn from that. Under the serious violence duty, police and crime commissioners were given the responsibility of overseeing the implementation of the duty and overseeing all of the funding for labour costs, which were given to responsible authorities for the set-up of the duty, as well as allocating the money for commissioning costs, which, again, were given once a new duty was put on responsible authorities.

What we saw with the way in which PCCs have taken that responsibility is that it has had a very justice-focused lens in the way that they decided to distribute labour costs. We know from the Home Office’s implementation work that a significant amount of money that ought to have been spread evenly across responsible authorities has not gone to ICBs. A significant number of ICBs did not receive their implementation costs.

What we have learned from the serious violence duty is that if you want to have some kind of equality of arms across responsible authorities to be able to ensure that they are all implementing the duty— I think that it is a great point about wanting to see ICBs much more in this space; they are talking about the fact that they want to be more in this space. If you put a PCC, for example, as the lead body—the convener—in relation to this, then the implementation of it needs to be done in a way that you are ensuring that funding is distributed equally and that responsibilities are clearly set out. I am not sure that I would put a lead authority or a lead body in place for the duty. There must be a way of ensuring equality between each of them.

Q Surely someone has to oversee this. Who will pull the bodies together?

Catherine Hinwood:

The way that I have read the legislation and the way that I understand the guidance is being considered is that there will be local flexibility as to what kind of body will be the convening body. For example, one area might say that they will use an integrated care partnership, one might use a violence reduction unit, and another might use a criminal justice board. If you build that flexibility in, I do not know how you can then give one body the oversight for the implementation. It might be that a national body needs to oversee it, I really do not know. But this is the kind of stuff that we need to work through, and work through in the guidance.

Order. I will suspend the Committee for Divisions in the Chamber. I will suspend for 15 minutes for the first Division and 10 minutes for the second and any subsequent ones. We are expecting at least two votes, so we will suspend for at least 25 minutes.

Sitting suspended for Divisions in the House.

On resuming—

We shall carry on with the session, and I would like to bring in Siobhan Baillie to ask a question.

Q This question is to Kate. In your role for the NHS, you do super work. We are now looking at this issue quite closely from an NHS and health perspective. You mentioned that you thought the Bill could do with some updating because of integrated care boards. I was looking through the Bill before—sorry, I am flicking through all these pieces of paper. Do you have a policy paper or is there something from your policy guys or Government liaison people that sets out what the changes should be to do that exercise of bringing the legislation up to date? Has that been done already? I could not find it anywhere, so I am sorry if you have already sent it in.

Kate Davies:

It is obviously our responsibility within NHS England, when there is a particular area like commissioning some victim services—as I do—to work with Bills as they are coming in. I worked across that with Catherine in a previous role; I declare that as an interest. We are aware of it from working with our colleagues in the Department of Health and Social Care as well. We now realise, because of the Health and Care Act of 2022—there are obviously lots of issues coming in as a Bill turns into an Act—what that means. We know much more than we did then, and I think it is fundamental now to look at how, with ICBs and ICPs, we can make better use of the local authority and NHS population-based commissioning. There is also a requirement with the voluntary sector. One of the objectives with ICBs is about health inequalities.

All those elements are now legislation. All those elements give us a real focus, a real lens, on, in particular, survivors and victims within a population, whether they come through a GP’s door or through a local authority door for something to do with housing. It is a question of that needs assessment at local level to say that we have a duty and the responsibility to work with that population number and also support that, whether that is through collaboration or governance. It goes back to Elliot’s earlier point about ensuring that we come round the table to ensure that that happens. I think the current wording in the Bill is helpful, but does not go far enough to ensure that there is that responsibility, accountability and governance in order to collaborate and provide as part of that needs assessment.

Q It would be really helpful if we could have a note on that.

Kate Davies:

There have been discussions with the Department of Health and Social Care recently on that, so I think that is an important element to go back to you on.

Catherine Hinwood:

I think we are going to submit written evidence on this, so we are really happy to do that.

Q You have all spoken a lot about ICBs, but I think it is fair to say that they are still finding their feet as entities and that they are doing so with a greater or lesser degree of success in different parts of the country. I would certainly say that in my own area of Buckinghamshire, the ICB we have is far from being where we would hope or expect it to be. It has had lots and lots of challenges.

In the context of, frankly, ICBs that are struggling to fulfil their core duties, I wonder how they will really do what is needed for victims through this proposed legislation, because I do not think that they are going to see it as their No. 1 priority. I wonder how you can leverage to ensure that this important legislation and the concepts behind it are delivered on by ICBs.

Catherine Hinwood:

ICBs now have a duty to set out in their joint forward plans how they are going to support victims of abuse, and it is specifically set out that they must talk about victims of domestic abuse and sexual abuse. We are starting to work with ICBs to help them. We issued guidance on what they might want to do to be able to fulfil that duty and how they might approach it, but we are starting to work with them in the coming months to assist them in how they are approaching that. I agree that they would be at different levels of maturity, but it is certainly something that we within NHS England have had to focus on in assisting them with and will over the next year, as they grapple with a number of different responsibilities. You are absolutely right: this focus that they have on victims of abuse is a new one. It is a different one and it did not come with any funding—it did not come with any ringfenced funding—so we are helping them to think about how they might be able to mature in this space.

Kate Davies:

One of the things at the moment is the maturity of the NHS, with the recovery from covid and everything else. I remember being in a forum during covid and looking at the issues of serious violence, victims and survivors. There are victims and survivors walking through the door of every GP, hospital trust and, perhaps, accident and emergency department. We have too much evidence or representation of people coming in years after they have actually been a victim— this may be related to childhood sexual abuse or to domestic abuse.

It is fundamental that someone in an NHS service has the opportunity to feel safe enough and supported enough to be part of their needs and requirements. They might come in for something else—for example, we have just done some work on cervical screening. I have to say that we are talking about superb interventions through lived experience. How do we get every woman who has cervical screening as part of their requirement also to have the opportunity to say, whether they know this or not, what needs they have or what support they need? This is about, “How can we support you? Have you ever been a victim of rape, sexual assault or domestic abuse?” It is those opportunities that we should be supporting.

I have been with the NHS quite a long time, so I am not saying this because I am sitting in front of the Committee, but there are massive amounts of evidence that people want to do more in this space, because that is part of so many people’s experiences, either personally or professionally; this could be as a clinician, with someone in front of them as a patient. This is a great opportunity to talk about the duty to collaborate, but it is also a great opportunity, as you say, when you have maturity of ICBs at this early stage, to make it a priority.

Lastly, as people are aware, I sat in front of a number of Committees to do with armed forces, as I am the senior commissioner for armed forces. I had exactly the same conversation about that maturity. Four or five years later, we had the armed forces covenant and a really important requirement around armed forces’ mental health and trauma, whereby we have commissioning and supporting a dedicated pathway. That is really why we have been commissioning more mental health enhanced services for sexual abuse recently, through the long term plan. It is a really good opportunity to build on this and build on that good practice, as well as to say where it is not working—we have to be honest about that, too.

Q Councillor Bell, perhaps you could say something specifically on the fact that in different areas there is a greater or lesser representation of local authorities on those ICB boards and that that can be controversial

Cllr Bell:

Yes, it can. Let me just to come back to add a little more detail. At a local level, we are talking about ICBs and we are quite heavily focused on them. They will be feeding into your health and wellbeing boards on your local authorities. Your community safety partnership should be feeding into your health and wellbeing boards, and there should be a joint commissioning approach to local services running through that process as well. When we talk about not duplicating, we need to look at them; we need to look at what is already in existence and how we can deliver that duty to collaborate without creating additional layers of bureaucracy that may not actually do anything other than exacerbate the pressure on capacity. If we do not have to reinvent the wheel, let us not do so—let us look at what is there already.

Local representation in the ICBs is a funny picture at the moment, because different places are operating in different ways. Let me talk from my experience. Our clinical commissioning group was integrated into our local authority a number of years ago, so we had an integrated health and social care model already. Our director of adult health and social care was also our director at the CCG, and is now the head of our ICB. It works quite well and quite seamlessly. Our Cabinet member sits within that structure as well.

Q Do you think that that is a better model to achieve the aims of this legislation, to give a better service to victims of crime?

Cllr Bell:

I do not want to overstretch. From my experience, it works well in our authority. I am certainly not a health specialist. Those are the people you should speak to, given their knowledge. In my experience, at our level, it has worked extremely well.

If there are no other questions, I thank the witnesses for coming along this afternoon and giving evidence, and I apologise for the Intervention of democracy. We will now move on to the next panel.