Mitigating the risks of domestic abuse

Domestic abuse and coercive control are pervasive issues that affect millions of people in England. An estimated 5% of people aged 16 years and over (6.6% of women and 3% of men) experienced domestic abuse in the year ending March 2024. This equates to an estimated 2.3 million adults in England (1.6 million women and 712,000 men).¹ Coercive control, a form of psychological abuse, is also common.

Perpetrators of domestic abuse and coercive control are increasingly using technology to abuse victims, with 1 in 3 women experiencing online harassment, according to a survey by the charity Refuge.² Tactics include spreading false information, hacking accounts, using spyware, and tracking with GPS locators. This creates a constant sense of surveillance, leaving victims without privacy or safety.

The need for new guidance became clear during our work to help patients nominate someone to manage their GP health services on their behalf, also known as 'proxy access'. Proxy access can be set up for someone who needs support with booking appointments or ordering prescriptions. Once the GP practice sets it up, the patient’s chosen person can do this via the NHS App.

The National Proxy Service has worked hard to make sure that patients are safeguarded and that proxy access is reviewed by GP staff, acting on relevant guidance. As we consider the future of proxy access, it is important now to address the risk of technology-facilitated abuse and minimise this risk in the service design process.

We collaborated with a group of user-centred design (UCD) and business analysis colleagues, who volunteered their time. The group has now grown, as more and more people wanted to make a difference. We were also joined by colleagues from NHS England’s domestic abuse and sexual violence programme.

The service manual team, who manage the NHS service standard, interviewed service design teams and clinicians about their experience of considering the risks around tech abuse. We held collaborative workshops, consulted researchers in the area and reviewed the guidance that’s available. We decided to introduce some minor changes to the NHS service standard as the first step towards raising awareness and supporting our colleagues in digital product teams in identifying and mitigating the risks.

Standard 9 on creating a secure service which protects users’ privacy now says:

• “Make it easy for users to actively make informed decisions about privacy settings, update their settings and track any changes (for example, by carers or other people who have access to their records).”

As we learned, empowering users with the right tools to control and manage their personal data is a key tactic in combating coercive control.

Standard 15 on supporting a culture of care now asks service teams to:

• “Take users’ fears, concerns and emotional state seriously and consider their circumstances, including any trauma they may have experienced, so you can meet their needs better.”
• “Consider both positive and negative scenarios for your service, including whether it could be used to control or abuse someone.”

Trauma-informed design recognises the impact of trauma on individuals and acknowledges its role in their lives. By incorporating trauma-informed principles into the NHS service standard, we encourage service teams to design digital services that are both empathetic and supportive.

At this stage, the aim is to raise awareness of the potential for digital teams to inadvertently build services that can be used to facilitate abuse. We recognise that more detailed work is needed to understand how to make sure that patients have safe and positive experiences. We want to encourage collaborative discussion to shape future guidance, so please send any suggestions or questions to [email protected].