My Lords, I am grateful to the noble Lord, Lord Ramsbotham, for setting out the case for these amendments, which, as he explained, follow similar suggestions from Chris Bryant MP when the Bill was debated in another place. I am pleased that my honourable friend the Minister for Safeguarding was able to meet Mr Bryant and the noble Lord, and that their discussions were—as the noble Lord said—helpful.
Amendment 155 seeks to introduce screening for acquired brain injury for female victims of domestic abuse within two weeks of a domestic abuse charge being made, including those victims to be protected by a domestic abuse protection order. Amendment 156 seeks to introduce screening for brain injury for all female prisoners within two weeks of starting their sentence, with a subsequent assessment to take place if an injury is found.
I say from the outset that we want to make sure that we provide healthcare and support that meets the specific needs of all victims of domestic abuse, and female offenders too, including those with acquired brain injury. We have carefully considered these amendments, and while we appreciate their overarching intent, we feel that legislating would not be the appropriate course of action. The noble Baroness, Lady Finlay of Llandaff, set out clearly the clinical difficulties that would be involved if we were to put this in the Bill.
The National Health Service is there to provide appropriate care and treatment for everyone who needs it, based on clinical need. This key principle on which the NHS operates means that anyone who needs a certain diagnostic test based on clinical need should receive it. The healthcare needs of victims of domestic
abuse will vary greatly based on their individual circumstances and experiences but, if they need urgent assessment or treatment, they will receive this from the National Health Service.
Moreover, as we have heard throughout the scrutiny of the Bill so far, domestic abuse can manifest itself in many ways, including—as in the group of amendments we have just discussed—through coercive control or financial abuse, and it would be inappropriate to invite victims of these forms of domestic abuse for brain injury screening. That is why we do not consider that testing all female victims of domestic abuse, as this amendment suggests, would be an effective use of NHS resources or provide the personalised care they need.
Nevertheless, we believe that improvements can be made to existing screening processes through non-legislative measures. I will provide some background to that. All people entering prison receive an early health assessment within the first 24 hours. This initial assessment is comprehensive so that their health needs can be identified and addressed at an early stage. It includes a standard requirement to undertake a screening questionnaire for head injury and loss of consciousness, which focuses on issues with memory or concentration. As noble Lords have said, these can be important signs.
We acknowledge that more could be done during this screening process to identify and address specific circumstances where head injury or loss of consciousness has resulted from domestic abuse. I am pleased to say that NHS England and NHS Improvement have confirmed that they would be happy to add further questions to the existing screening tool to ascertain, where an acquired brain injury has been identified, whether that acquired brain injury occurred as a result of physical injury related to domestic abuse, sexual violence or another form of abuse.
The national screening tool is reviewed and updated by NHS England and NHS Improvement on an annual basis to allow for any changes in NICE guidance or any recommendations arising from a coroner’s report to prevent future deaths. To amend the existing screening tool, NHS England and NHS Improvement will need to agree the precise questions to be asked and how these will be reported. I am pleased to say that the initial screening questions on domestic violence and the coding that is required have already been agreed and will be implemented by April this year.
Alongside this, NHS England and NHS Improvement are continuing to work with the Disabilities Trust on a training package for healthcare practitioners to increase effectiveness when supporting people with impaired neurological functioning, either as a result of domestic abuse or for other reasons, and also to support them by providing practical steps to those working with patients and self-help tools for the patients themselves to reduce and overcome the impact of any brain injury.
In so far as Amendment 155 seeks to link screening to the making of a domestic abuse protection order, it is important to recognise that, like other protective orders, these are designed to impose requirements on the perpetrator. They cannot impose requirements on
the person to be protected by the order, such as requiring them to undertake a screening for an acquired brain injury.
We will, however, use the statutory guidance to the police to recommend that they refer victims to an independent domestic violence adviser, or another specialist advocate, who will be able to advise victims of their options on a whole range of issues, including healthcare. In addition, we will include information on where to go to seek medical attention in the advice materials provided to victims which we will be producing ready for the pilots of the orders.
I hope that these non-legislative measures reassure the noble Lord, Lord Ramsbotham, that we are acting to support women with acquired brain injury and that putting this in the Bill is therefore not necessary. I am glad to repeat our thanks to him and to Mr Bryant for the discussions we have had on this important issue. I hope that the noble Lord will be willing to withdraw his amendment.