My Lords, I thank the noble Lord, Lord Ramsbotham, for once again outlining the case for his amendment. Along with Chris Bryant MP, he has raised the importance and profile of the issue of acquired brain injury and the importance of early screening, for which both he and Mr Bryant should be commended. I was grateful to have the opportunity to discuss the issue in greater detail with the noble Lord, as he mentioned. However, as I indicated in Committee, we remain of the view that legislation is not the right course of action, for the reasons that I will now set out.
The amendment would introduce screening for acquired brain injury for female victims of domestic abuse, including female prisoners and those to be protected by a domestic abuse protection order. It is important that the healthcare and support provided for victims of domestic abuse and female prisoners, including those with acquired brain injury, meets the healthcare needs which may result from their abuse. We believe that this Bill is transformational in the support that it will provide for victims of domestic abuse in bringing their perpetrators to justice and raising awareness of domestic abuse, including the impact it can have on survivors.
It is for the NHS to provide the most appropriate care and treatment, based on an individual’s medical history and clinical need. That is the basis on which the NHS operates, providing healthcare and diagnostic tests for those who need it, including urgent referrals.
As I mentioned in Committee, domestic abuse can manifest itself in many ways, not just through physical injuries but mental harm through coercive control and
financial abuse. We do not think that such victims should be screened for brain injury, or that this would be an effective use of NHS resources. In addition, we would not want to deter women from coming forward to receive support if they are concerned about the possible outcomes of a brain screening.
I set out in Committee the improvements we have made to existing screening processes through non-legislative measures in prisons. This was in acknowledgement that more could indeed be done to improve current screening processes. The process I described will now identify and address specific circumstances where head injury or loss of consciousness has resulted from domestic abuse and other forms of violence. That is an important step forward.
As I explained, 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. NHS England and NHS Improvement have agreed the precise questions to be asked and how these will be reported against. The coding within the clinical system has been agreed, and we expect these changes to be implemented next month. I am sure noble Lords would agree that this is an important and significant step forward and a good demonstration of how we can make improvements without legislative measures.
In addition, 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 due to other reasons. This training is also designed to provide practical steps for those working with patients, and self-help tools for the individuals themselves to reduce and overcome the impact of any brain injury.
In his amendment, the noble Lord, Lord Ramsbotham, seeks to link screening to the issuing of a domestic abuse protection order against a perpetrator. It is important not to conflate the two issues. Domestic abuse protection orders, like other protection orders, 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. However, we can, and we will, use the statutory guidance to the police on DAPOs to recommend that the police refer victims to an independent domestic violence adviser or other specialist advocate who will be able to advise victims on their options on a range of issues, including healthcare. We will also include information on where victims can go to seek medical attention in the DAPO advice materials for victims which we will be producing ready for the pilots of the orders.
We remain of the view that these non-legislative interventions are the appropriate way forward to address the important issue that the noble Lord has again raised and will help improve screening for acquired brain injury. On that basis, I hope that the noble Lord, Lord Ramsbotham, will be reassured and will be content to withdraw his amendment.