What would it take for the NHS to treat violence against women and girls as a public health emergency?

One in three women and girls in the UK experience physical or sexual violence during their lifetime. The NHS has more contact with victims and perpetrators than any other public service. Yet the uncomfortable truth is that many women and girls who seek help from the health service do not receive the right support. The government and expert organisations supporting victims and survivors say there should be no wrong front door for those seeking help. In reality, it can feel like there is no right door.

Violence against women and girls (VAWG) is often discussed as if it sits solely in the realms of policing or criminal justice. Yet the physical and psychological consequences of VAWG endlessly show up across primary care, emergency departments, maternity and mental health services. The government has rightly named VAWG as a national emergency. It is also a public health emergency.

So, what would it take for the NHS to recognise and play its part in tackling VAWG? To consider just that, The King’s Fund – in partnership with the Institute for Public Policy Research (IPPR) and Standing Together Against Domestic Abuse (STADA) – recently held a roundtable chaired by Jess Asato MP, VAWG adviser to the Department of Health and Social Care (DHSC). The discussion brought together NHS leaders, parliamentarians, commissioners and specialist support services. What came through unequivocally is that the NHS is a critical but underused partner in the government’s mission to halve VAWG by 2034.

The gap between intention and reality

It is estimated that four in five victims and survivors of VAWG seek help from the NHS at least once. Health care professionals are trusted more than other statutory services and so are uniquely positioned to help. Each contact is an opportunity to identify someone at risk and offer care and support. Yet too often, clinicians do not spot the signs of abuse. They do not know where to refer or signpost individuals. Even when they do, the specialist support in the local area has been scaled back or cannot accept new referrals.

This is not about a lack of good intentions. Health and care professionals want to help, and many go above and beyond to do so. The problem lies in the incentives and structures around them: fragmented commissioning, inconsistent data, safeguarding teams being cut as integrated care boards (ICBs) restructure, and the growing list of national priorities that squeeze out everything else.

The pressures on the system holding it back 

It is of course necessary to acknowledge the wider context facing the NHS. Pressures on local government and policing have pushed more demand onto the front door of the health service precisely as it is asked to do more with less. Headcount reductions in ICBs are leaving some safeguarding functions hollowed out. Commissioning teams facing tight budgets have to make tough choices and specialist support is too often relegated to ‘nice to have’ status. 

Recognising VAWG as core health business will require the leadership and resourcing to match. However, it has been made clear this will need to be found from the existing funding envelope, meaning trade-offs will need to be made if VAWG is prioritised. 

What would actually make a difference?

A few themes came up repeatedly at the roundtable.

First, commissioning. The variation of services commissioned between integrated care boards and regions is wide and unjustifiable. Many clinicians do not have a clear referral pathway due to a piecemeal and cyclical approach to commissioning by their ICB. In some areas, specialist support exists but is ‘hanging by a thread’. In others, there is no support at all despite a legal duty to collaborate to jointly commission services.

Solutions could include:

• Financial incentives and mechanisms to enable ICBs to shift from short-term contracts to sustainable, multi-year commissioning.

• Using the full range of tools available, including statutory mandates, to ensure there is comprehensive commissioning of specialist support services for victims of VAWG.

• Embedding VAWG support in new neighbourhood health services.

Second, data. The lack of consistent coding or information sharing between organisations makes it harder to identify need, track outcomes or build the case for investment. Voluntary, community and social enterprise (VCSE) organisations hold rich data, but it is not integrated into NHS systems and therefore not fully utilised for system change. The rollout of the single patient record is an opportunity for commissioners and clinicians to understand the scale of the issue and act on it to better support victims and survivors.

Third, culture. Mandatory and continuous training on VAWG for all staff is essential, with particular emphasis on those providing frontline care, where disclosure is most likely and responses matter most. But training alone is not enough. Progress depends on wider cultural change and buy-in at every level of the NHS to confront medical misogyny, backed by clear leadership and accountability. We cannot continue to rely on individual staff to sustain good practice.

Lastly, cross-sector working. None of this is possible without specialist services run by voluntary organisations. 'By and for’ services in particular are at the heart of any effective response because they are trusted by survivors in ways statutory services often are not, particularly among communities that are marginalised. Yet we heard that voluntary support organisations are ‘on [their] knees’, unable to absorb rising referrals. Any whole system response to VAWG will require treating the voluntary sector as a crucial part of that system.

People also noted the importance of learning from other public health initiatives such as the teenage pregnancy prevention programme, which succeeded due to its cross-government, multi-agency approach, strong support at the highest levels, and financial backing.

So where does this leave us?

The government’s Steps to Safety initiative, with its plan for universal GP training and embedded specialist workers by 2029, is a welcome intervention. Jess Asato MP has also been tasked with improving how VAWG services are commissioned and integrating specialist support into the neighbourhood health model and The King's Fund, IPPR and STADA look forward to seeing her recommendations.

The refreshed women’s health strategy reasserts the health secretary’s commitment for DHSC to play its part in halving VAWG within a decade. It reinforces the expectation that integrated care boards play a central role in commissioning support. However, the strategy offers little detail on how promised initiatives and commitments will be implemented in practice, or how variation between areas will be reduced. Given the scale of the challenge, £5 million of funding per year falls short of providing the long‑term certainty specialist services need.

Those sat around the table reflected that VAWG has been ‘admired as a problem’ for far too long. In other words, what will be different this time? There was no single answer but a strong idea of where to start. Treat VAWG as the public health emergency it is. Revive the cross-government mission-led approach. Give the NHS a clear mandate for action. Commission the referral pathways and specialist services to support victims and survivors in all parts of the country. And above all, listen to women and girls and design a response around them.

The NHS sees the effects of violence against women and girls every day. The task now is to ensure it also plays its full part in preventing and responding to it.