What do survivors of domestic abuse tell us about their NHS care?

Domestic abuse is one of the most pervasive public health crises in England, affecting people in every community.

For many survivors of abuse, the NHS is the first – and sometimes only – public service they interact with. Analysis by Standing Together Against Domestic Abuse (STADA) shows that the NHS has more contact with survivors and perpetrators than any other service, including the police.

However, the experiences that domestic abuse survivors share with the Healthwatch network describe a system that is not always set up to support them. We heard examples of warning signs missed, poor levels of support, inaccurate records systems that put them at risk, and survivors who feel unheard or that their concerns aren’t taken seriously.

What is domestic abuse and how common is it?

Domestic abuse can include things like controlling behaviour, emotional harm, taking away someone’s money, or physical or sexual violence. You can find a clear explanation of the different types of abuse, and where to get help, on the GOV.UK website.

Women are most affected by domestic abuse, with the Office for National Statistics (ONS) estimating 2.2 million females (9.1%) and 1.5 million males (6.5%) in England and Wales have experienced it in the last year alone.

An estimated one in four adults in England and Wales have experienced abuse since the age of 16.

Recent national findings echo what people tell us. In 2024, research from STADA found that around 90% of reviews of domestic abuse related homicides and suicides cited safeguarding failings by the NHS, most commonly a lack of domestic abuse training among NHS staff.

What is already being done to address the issue?

The government recently announced new commitments to support survivors navigating the health system. These include a Steps to Safety referral programme that aims to connect survivors to specialist support through their GP in every part of England by 2029. It has also introduced a “whole of society approach” to tackling Violence against Women and Girls (VAWG).

In light of the government’s new commitments on VAWG and the major reforms underway in primary care, we reviewed feedback shared with us over the past year by people who have experienced domestic abuse.

What have we heard?

Our new review highlights three key themes: missed opportunities to identify abuse, systems that put survivors at risk, and care that was not sensitive to trauma.

Opportunities to identify and support survivors are being missed

For most survivors, their GP is their first port of call for their health issues. It is also where many of the biggest opportunities to identify abuse are being missed. 

In their 2025 report In Safe Hands, Healthwatch Surrey asked survivors about their experiences in primary care.  Although over half (53%) saw a GP for issues they thought were linked to their abuse, such as a urinary tract infection or stomach pain, three-quarters of the respondents (75%) said their GP never asked them about domestic abuse.

The report found seven barriers to talking about domestic abuse: GPs not asking; lack of confidentiality; fear of authority; perpetrators accompanying survivors to appointments; cultural pressures; difficulty recognising what was happening as abuse; and not feeling understood by staff.

Survivors told Healthwatch Surrey that asking simple, open questions would help: 

“If the GP asked a series of questions in a way that would look behind the symptoms, such as “Is everything at home, okay?”, I think most people would want help if they needed it and wouldn’t mind being asked it if they didn’t.”

Story shared by a man with Healthwatch Surrey

Survivors also told Healthwatch Surrey that the shift to digital and telephone appointments is making it harder to seek help. Online forms often require patients to explain exactly why they want an appointment, which can leave a digital trail and place the person at risk of harm from their abuser. 

Remote consultations can also reduce the chance that staff notice nonverbal signs that something is wrong. Survivors asked for easier access to unhurried, in-person appointments without having to disclose the reason in advance.

When people seek help, systems are not supportive 

We heard that NHS systems and processes can make life harder for people trying to access care after fleeing violence. 

Inaccurate records are putting survivors at risk. When someone changes their name or contact details to stay safe, NHS systems need to be updated quickly and completely. We heard that this sometimes does not happen.

One survivor told us that even after notifying their GP, hospital and specialist services, multiple NHS systems still held their old name. They were called by that name in a waiting room, in front of other patients at both an emergency admission and a treatment centre. They told us it put them and their child in danger.

“I am not happy that my domestically violent ex's family details are on my contact list at my local GP's! My GP surgery says they do not know how these have got on there, nor do they know how to remove them.”

Story shared by a woman with Healthwatch Cambridge 

Care is often not trauma informed

Many survivors live with trauma-related conditions such as Post-Traumatic Stress Disorder (PTSD). This can make routine healthcare interactions extremely difficult, especially when services do not respond with sensitivity. Survivors of abuse described staff failing to make basic adjustments, such as repeatedly ignoring women’s requests for female dentists.

Lack of access to care can be especially damaging for survivors with trauma-related needs. We heard from survivors unable to access dentistry for injuries directly linked to abuse, which created more shame and slowed their psychological recovery.

Findings from Healthwatch Sheffield’s Your Voice Counts report, produced with Sheffield Women’s Aid, found that women living in refuges often felt their health concerns were not taken seriously or properly investigated.

“I went to my GP 5 months after an incident where I was strangled as I wanted to get checked to make sure there was no damage and get a scan. My GP said ‘You will be fine. When the incident was reported [they] would have checked everything was ok’.  I felt like I was being fobbed off”

Story shared by a woman with Healthwatch Sheffield

For some survivors, previous experiences of insensitive treatment increased their fear of being judged or disbelieved, which in turn became a barrier to seeking help.

"What is my GP going to do? Even if I did say something, I am going to get judged. I am not the perpetrator, but I am made to feel that I must have done something. I have lost my trust."

Story shared by a woman with Healthwatch Surrey

Mental health support is not meeting people's needs

Survivors describe gaps in mental health care, long waits, unclear pathways, and a sense of being passed from service to service.

“GP referred me to a mental health practitioner. My case worker at Refuge told me to go back to the mental health practitioner at the surgery. I have contacted Talking Therapies, they said they can't help me as my case is too complex. The Crisis team gave me a week of intervention and increased my medication, then discharged me. My GP surgery won't give me the increased dose. The adult mental health team keep saying there is nothing more they can do. They tell me to use my coping strategies and keep myself distracted.”

Story shared by a woman with Healthwatch Warwickshire

Women speaking to Healthwatch Sheffield reported difficulties understanding what support was available and finding help for complex needs:

“IAPT treat stress and anxiety but if you have something more complicated, no one can help you and you get referred back to your GP” 

Story shared by a woman with Healthwatch Sheffield

The lack of mental health support often goes hand in hand with a lack of practical support. People told us that living in temporary accommodation after fleeing violence made their mental health worse due to isolation, uncertainty and lack of community. These pressures can make it even harder for people to get the support they need.

“Transport is difficult. People that flee domestic abuse, housed in a place they don’t know, having to navigate the buses and bring kids along even if the appointment isn’t for the children. It gets expensive.”

Story shared by a woman with Healthwatch Doncaster

What needs to change?

The Secretary of State for Health and Social Care appointed Jess Asato MP in December 2025 as his new advisor on VAWG. He said he wanted her to help “reform NHS culture so that whenever and wherever a victim or survivor contacts the NHS, it is there for them and treats them with compassion, care and dignity”. 

In particular, Jess Asato has been asked to examine how to reduce the negative impact of alcohol on VAWG, embed VAWG in new neighbourhood health services and improve commissioning of services. She is expected to send recommendations to the Secretary of State this summer.

This is an important opportunity for the NHS to act, and ensure that everyone who seeks help is treated with dignity, compassion and understanding.