26 June 2025

Reading Anna Bawden’s powerful piece in The Guardian earlier this week further underlined something I’ve carried with me over my nearly 30 years of working in the social care sector: domestic and sexual abuse is everywhere – in our homes, our communities, our workplaces – and yet it remains dangerously invisible in our public consciousness.

 

Domestic abuse is a ‘public health emergency’

Domestic abuse is not a niche issue. Over 21% of people in England and Wales experience domestic abuse in their lifetimes – that’s one in five adults. The signs are everywhere, but all too often go unrecognised. The missed appointments, unexplained injuries, chronic pain, anxiety, depression. These are not hidden. They’re happening in GP surgeries, maternity wards, emergency departments, therapy rooms every day.

Yet despite the NHS having more contact with both victims and perpetrators than any other service, opportunities to intervene are still being missed. A recent review of domestic-abuse-related deaths and suicides found that around 90% referred to safeguarding failings by the NHS.

While I acknowledge the response from the Royal College of GPs, which highlights workload and workforce demands as factors meaning that the time GPs have with patients is often inadequate, this is a systemic failure. And it is costing lives.

 

The role of employers

The NHS isn’t just a critical public service; it’s also the UK’s largest employer with a workforce of 1.4 million people. And many of those staff are not just treating victims - they are victim-survivors.

Some may be living with abuse while performing some of the most vital and stressful roles in our society. They are being sent threatening messages during their shifts. They are hiding bruises under uniforms. They are managing coercive partners while working night shifts, saving lives, and supporting others.

For these individuals, the workplace might be the only space where they are unmonitored. That’s why workplaces, including the NHS, have a crucial role in both preventing and responding to abuse.

Our Everyone’s Business programme works with employers across sectors, including NHS Trusts, to create safer, more supportive work environments. That means domestic abuse policies, staff training, safe disclosure pathways, and clear referral routes. It means treating every employee not just as a worker, but as a whole person - one who might be in need of protection and support.

 

Taking action can be lifesaving

Policies and training programmes are not tick-box exercises. They’re lifelines. We need every teacher, GP, nurse, receptionist, pharmacist, housing officer, and manager to know how to: spot the signs including subtle indicators like financial control or social isolation; respond safely with empathy, discretion, and understanding of safeguarding procedures; and refer effectively connecting people to the right specialist services at the right time.

At Hestia, we’ve developed simple yet powerful tools to help turn awareness into action.

• Everyone’s Business: Training and policy development for employers, helping teams recognise and respond to abuse within the workplace.
• Safe Spaces: Discreet rooms in high street pharmacies and banks. Places where someone can make a call, reach out for support, or simply breathe without being watched.
• Bright Sky: A free app offering immediate access to support, service directories, self-assessment tools and incident journaling. Designed for victim-survivors, friends and family, and employers.

These tools are already saving lives. But their reach must expand, especially across health services.

If we are serious about tackling domestic abuse, we must integrate prevention and response across every level of our health system. Just as we do with mental health, infection control, or child safeguarding. That means:

1. Mandatory training for all NHS staff
   Including coercive control, post-separation abuse, and non-physical indicators such as restricted access to medication or threats to pets.
2. Supportive policies for NHS employees
   This includes flexible leave, safety planning, HR protocols, and clear access to specialist support.
3. Wider access to Safe Spaces and Bright Sky
   Visible signage, patient-facing materials, and staff inductions should embed these options from day one.
4. Accountable leadership
   NHS trusts and boards must treat domestic abuse as a priority, not a peripheral issue.

After all these years, I’m still staggered by how little is understood about domestic abuse. How often it's dismissed as “a private matter” or minimised until physical violence occurs. How many people don’t see it - even when it’s right in front of them.

Anna Bawden’s article should be a wake-up call. Domestic abuse is not just a women’s issue, or a housing issue, or a police issue. It is a societal issue, a workplace issue. a health issue, and crucially, an NHS issue.

Abuse thrives in silence. But with the right tools, training, and collective will, we can break that silence. We can open doors. We can save lives.

Because once you learn to spot the signs, you never unsee them.

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