Impact case study database

Bates’ research and general work in this field has created an evidence base for men’s experience of domestic violence, using an inclusive, non-gendered framework. Her work has been widely recognised, influencing policy at national and regional level, informing practice within a range of service providers and directly with male victims.

Impact 1: Informing and influencing national policy and legislation

On 17 February 2017 the Prime Minister announced a programme of work leading towards the introduction of a Domestic Abuse Bill, including enshrining of a definition of domestic abuse in law and establishment of a Domestic Abuse Commission. This was followed in March 2018, by a Government consultation document (“Transforming the Response to Domestic Abuse,” [S1i]) inviting responses. This consultation document cited Bates’ research (p.12, 43.) as part of a proposal to update the statutory definition of domestic abuse, which would “not be limited to women and girls and recognise abuse that happens in all relationships… this will ensure all victims and all types of domestic abuse are sufficiently captured and no victim is inadvertently excluded from protection or access to services.”

Bates also contributed directly to the consultation, and the resultant publication and proposed domestic abuse strategy was released in October 2018 (“Home Office Affairs Select Committee, Domestic Abuse, Ninth Report of Session 2017-2019 [S1ii]). The report cited Bates’ statement supporting the use of a gender-neutral statutory definition of domestic violence, directly quoting her evidence about how a gendered approach “marginalises men, women in same-sex relationships, and other groups on the gender and sexuality spectrums…” (p.10). The report’s recommendations state that “the Bill should provide measures which will help all victims of domestic abuse including women and men, and victims within LGBT and wider family relationships.” (p.43.)

These recommendations have been carried forward into the Domestic Abuse Bill, which in its current form includes a gender neutral definition of domestic violence. It is expected to retain this definition, and the Bill has successfully passed through the commons and is now being scrutinised by the House of Lords (2^nd reading 5^th January, 2021).

Public and practitioner perceptions of domestic violence have centred, predominantly, around a model of female victims and male perpetrators. Research challenging this entrenched view, and exploring men’s experiences of abuse as victims (as well as individuals identifying as LGBTQ+) is relatively new compared to the wider domestic abuse literature base (which is 50+ years old). This impact case study’s underpinning research is part of a wider body of work only emerging in the past decade, with those covering the UK context being even more recent. In a relatively short amount of time, this research (including R1-6) has both contributed to, and shifted, the discourse around male and other victims, and contributed to government forums and policy initiatives as well as the wider public for the benefit of practitioners and the victims themselves (see Impact 2 and 3). The impacts described therefore demonstrate significance in the context of this emerging field.

Impact 2: Informing and influencing practitioners working with user groups and victims

Bates’ research has been used to inform a range of practitioners, service providers, victims and survivors through a number of channels. The ManKind Initiative is the leading UK national charity supporting male victims of domestic violence. Bates has acted in an advisory role, providing guidance on use of statistics and research and has had a critical role in supporting their lobbying of Government. This role, and engagement with ManKind more generally, has enabled Bates’ research to reach a network of practitioners working in social services, domestic abuse services, victim support, IDVAs and ISVAs, those in the legal system, housing services and those concerned with community and public safety. Specifically, these practitioners have been engaged with via ManKind’s National Annual Conference on Male Victims of Domestic Abuse, a CPD accredited conference aimed at professionals and practitioners who work with domestic abuse victims/survivors. Bates has delivered sessions each year since 2017. For the 2019 conference, of the 100 delegates, 98% of them were practitioners. Her talks received positive feedback through their conference evaluations. At the 2017 conferences there were 91 delegates (45 feedback forms returned) and 10 mentioned her work directly, in 2018, there were 109 delegates (51 feedback forms received) and 12 mentioned directly (S10).

Bates’ work has also been helpful for other family organisations in lobbying Government, for example the National Manager of Families Need Fathers (S3) who meets with the Welsh Government to discuss domestic abuse issues said in December 2019 “I have referenced Dr. Bates work when recorded for a training module for Cafcass Cymru practitioners as part of their CPD on understanding male victims of abuse”. This was a video recording made by Cafcass Cymru (a division of the Welsh Government that provides expert and child-focused advice and support to safeguard children) as part of their training for their front-line staff to improve understanding of the experience of male victims.

Bates’ work has directly influenced practice within a number of police forces. Cumbria Constabulary invited her to present at their Domestic Abuse development day. Rob Ewin, a Detective Sergeant for Cumbria Constabulary (S4) said “Dr Bates’ work has been an influencing factor within the building of Cumbria Constabularies domestic abuse policy… Dr Bates’ work is well recognised within the Constabulary… Anecdotally, there is a feeling of increased reporting by men...the findings of her work have also been used to create training case studies by another detective who trains police recruits in Cumbria which is a hugely significant step in terms of changing how male victims are discussed in this type of training.”

Greater Manchester Police have also indicated this was impactful with their Domestic Abuse Coordinator and Public Protection Training Coordinator (S5) saying in 2019 “Within my own organisation it has opened up a whole conversation around typology. Our training school are now touching on this topic. It's a very new area for the police!” In January 2020, Bates’ work was cited in a presentation given at a male victims’ event by the Mayor’s Office for Policing and Crime in London, indicating the reach of her work into the main governmental offices that work with domestic violence policy (S2). These examples demonstrate the significance of this work and its importance in changing how services operate in practice.

Further evidence of how Bates’ research has impacted practice comes from personal testimonials from people working with male victims. Specifically, they have said the work has helped them evidence men’s experiences in a way that allows them to apply for funding, lobby for policy change, and support the work they do with men as victims. Her research has been used internationally, as well as within UK, demonstrating the boundary crossing nature of the work. For example, the Chair of a men’s and boy’s organisation in Canada (S6) has stated that the research has increased public awareness of male victims. Furthermore, it has been used to reassure funders of the ongoing need for service provision, for acquiring funding for programmes, and for developing public policy in Canada.

Similarly, in Australia, Bates’ work was cited in a submission to an Australian Government Select Committee (S7) by the organisation One in Three who raise public awareness of the existence and needs of male victims of family violence and abuse in Australia, recommending to the committee to “consider that perpetrators who might be seeking to extend their coercive controlling behaviour by declaring themselves as victims, may be either male or female.”

Impact 3: Direct benefit to male victims of domestic abuse through direct engagement with individuals and media presence

The ultimate goal of the research is to encourage more men to report their experiences and ensure there is better support available for survivors. Media and public engagement work has been a useful pathway to achieve this. The ManKind Initiative Chairman (E10), said “ultimately [this] is the impact of her work - more men (and any children they have) escaping domestic abuse because of the better support there is for them”. In November 2020, Bates was awarded The National Men and Boys Award for Public Understanding, for making an outstanding contribution to the understanding of men and boys and their needs with her research (S10).

In support of victims, the research has improved public awareness and understanding by featuring in mainstream television media including Channel 4 News (S8i), Channel 5 News (S8ii), and has been further cited in feature media pieces about male victims such as in the Daily Mail which has been shared over 8800 times (S8iii). Bates’ research was used by ManKind Initiative to create a video entitled “20 Stories” (S9i) which has been viewed over 2500 times on YouTube and has been shared through male victims organisations internationally. Her research was recognised in the top 100 breakthroughs by the Made at Uni campaign in 2018 (S9ii).

Bates has also been contacted directly by men who have felt personally affected by her research. They describe feeling alone in their experience of abuse and reassured and hopeful to see someone researching this topic. Some described having found the research online, but others had seen it through media engagement. She has been contacted over the past five years by approximately 25 men who have been grateful for her work and have referred to specific examples they had read in the media (such as those included above). One specific example (S11) includes one man who is both a survivor but also working now as an advocate for male victims. He described the ways in which the work has helped in his own recovery through better understanding his experience, in his advocacy work he frequently references my work including reference to the media examples (S8) he gave a number of local examples of organisations he had engaged with through this. In a later communication he referred to the “20 Stories” video (S9i) which was useful in communicating with local police in a “domestic abuse surgery”. He reported that information from the police constabulary indicates there was a fivefold increase in male MARAC cases (from one to five) in the first two weeks following the first surgery addressing male victims.

Other evidence of public engagement can be seen through both invited talks and blog posts. For example, Bates was invited to write a blog post (co-written with Dr Julie Taylor) for a popular online psychology blog (PsychReg) that has been now been read 2780 times (S9iv). Bates was also an invited keynote speaker at the annual Male Psychology conference, the talk which was shared on YouTube (S9iii) has been viewed over 2800 times. This talk has been referred to directly by male victims who have personally got in touch with Bates to thank her for raising awareness about the issue. This engagement with the media and more public engagement mediums has provided a useful pathway for impacting on individual’s lives.

Where there has been publicity about the research, it enters, and impacts on, the public narratives about domestic abuse and will continue to raise awareness around male victims. Discussing this area at a national level demonstrates the reach of this work and has increased help-seeking by victims, but also contribute to changing attitudes that are currently significant barriers for men in their attempts to leave or seek help.

Remote video consultations (telemedicine) are seen as a solution to the growing demand on services, reflected by a succession of policy documents, most recently the NHS Long Term Plan (2019). Yet digital innovation in health has proved challenging and many good innovations fail to be adopted. The Teleswallowing and Fetal Telemedicine studies demonstrated the viability of telemedicine as a clinical tool to facilitate improved patient access to specialist services and improved clinical management of patients. As a result of the systematic approach to stakeholder engagement and negotiation of barriers, services have now been adopted at scale across the country.

Impact 1: Adoption of teleswallowing services to improve patient access to services

The main beneficiaries of Teleswallowing are : dysphagic patients, nursing homes, and SLT services. Teleswallowing enables a swallowing assessment to be undertaken remotely, by an SLT, on a patient in a nursing home. This means that diagnosis is timely, suitable therapy can be provided without further exacerbation and disruptive hospital attendance can be avoided. For nursing homes, it supports and upskills nursing staff to deal with problems on site, provides greater staff efficiencies and reduces distress for patients. For providers of SLT services, it reduces travel time and costs for specialist staff, enabling efficiencies and reducing waiting lists. For all concerned, teleswallowing reduces infection risk.

The greatest impact from Teleswallowing came with the Covid-19 control measures. On 1 April 2020, NHS England advised SLT departments across the country to segment and prioritise urgent care needs; to cease delivery of services to medium and low priority cases; and to prioritise Teleswallowing assessments for Speech and Language Therapy with high priority patients (S1). Consequently, where Teleswallowing was available, patients continued to be assessed without risk of infection.

Following the pilot research, the lead SLT for the study was appointed Digital Health Clinical Lead within Blackpool NHS Trust, responsible for rollout of telemedicine to other services (winning the Nursing Times award for Data and Technology 2019), and is now leading the development of videoconferencing for outpatient services in Blackpool. The UOC study findings were used to develop and refine the Teleswallowing protocol and to subsequently establish Teleswallowing Ltd which offers training and resources for adoption, citing R3 as part of its evidence base (S2). Teleswallowing is being delivered by two other providers: Hobbs Rehabilitation SLT team (commissioned by West Hampshire CCG April 2018) (S3) and Isle of Wight NHS Trust Community Adult SLT team (December 2018) (S4). The Digital Health Clinical Lead for Blackpool NHS Trust commented: “ the research done by University of Cumbria facilitated adoption in the Isle of Wight and West Hampshire, as commissioners could see the approach had been independently and rigorously evaluated and validated” (S5) .

Prior to Covid-19 a total of 11 nursing homes were participating in Teleswallowing so impact was modest. However, both providers report extensive use following the UK’s first lockdown; having Teleswallowing in place was advantageous and enabled innovative approaches to care delivery. The lead therapist at Hobbs rehabilitation commented that: “The main benefit … was that service users were assessed promptly throughout lockdown and beyond. Our team, who were confident to use video as a means to assess the patients because of our experience with Teleswallowing, has also benefited as we have been able to keep our waiting lists to zero during this stressful time” (S6).

Impact 2: Improved access to specialist expertise for pregnant women

The main beneficiaries of fetal telemedicine are: pregnant women, obstetricians and sonographers. The fetal telemedicine protocol enables a shared consultation to take place across two locations. A sonographer attends the pregnant woman, supported by obstetricians, midwives or other professionals, and carries out the scan. The fetal medicine consultant joins the consultation remotely, working with the sonographer to guide the scanning process, as well as interacting directly with the pregnant woman. Shared consultations are provided only when an anomaly has been identified. These anomalies range from the presence of twins to a more major health risk. If it is expected that specialist treatment may be required, conventional referrals are made instead.

The main benefit is to the woman (and family), who avoid travel to a location potentially many hours away. The Consultant obstetrician at the DGH stated that “the largest impact is on the women who now don’t need to travel up to 3 hours there and back to Newcastle” (S8) . Fetal Telemedicine means less travelling, expense and discomfort for referred women, and also means they do not have to take extended time off work (with income implications); nor make complicated childcare arrangements (for dropping off and picking up children from school or nursery or having relatives take days off to look after children). During the first and second Covid-19 lockdowns the service has been particularly valued, as travel should be limited to the local area. Other difficulties with home schooling have also been a constraint for many women, making the local telemedicine option particularly attractive.

By June 2020, 381 telemedicine scans had been undertaken; 346 of these with women in West Cumbria (S7). The patient study calculated that 76.47% of journeys from West Cumbria had been undertaken by car, and an estimated, mean journey time saving of 420 minutes (S7). Calculations using these figures, and the 97.7-mile distance between sites (the DGH and the FMU), demonstrates accrued travel savings of 51700.5 miles by car; 162 journeys by public transport, and 100 days and 22 hours in time since October 2015. If a woman is accompanied by spouse, partner, friend or family member, that person often has to take time off work with potential childcare costs (£30-70). It should be noted that the service covers a mixed area, but one including ex-industrial and coastal towns, which have low social and economic wellbeing in the UK compared to commuter areas, market towns, new towns and university towns. Whilst our research did not directly study the effect of inequalities, it was noted anecdotally that the costs of travel were particularly significant for this population and that access to the remote service contributed towards reducing this inequality. The service has now been running for a further three years since the study and has been extended to Northumbria Specialist Emergency Care Hospital in Cramlington.

Staff at the DGH have also experienced benefits including having greater knowledge to monitor and manage high risk pregnancies and to respond to patients’ concerns; resulting in better continuity of care for women. The Consultant obstetrician stated that “The sonographers, midwives and myself have learned a lot about monitoring high risk babies, as well as dealing with women with abnormal results or babies with congenital abnormalities. The skill of the sonographers in particular have improved enormously, so they are able to do diagnostic tests in high risk women and we all are better able to answer the woman’s questions and support them when things are not going as well as they had hoped” (S8).

New ways of working collaboratively were developed during the study, using an iterative, negotiated process. This led to other, unintended benefits to the service. With the physical kit in place, DGH staff have made use of it to consult specialists more informally on other issues. Advanced training in the acquisition and interpretation of uterine artery (UA) and middle cerebral artery (MCA) Doppler has meant that sonographers are now able to provide these services locally, reducing referral costs for the DGH. In addition, the DGH has acquired greater understanding about the need to support front line health workers to implement a new telemedicine service. The sonographers were provided with a pre-training manual and remote guidance via the telemedicine link from an experienced midwife sonographer based at the fetal medicine centre.

Corroborating the impact of remote medicine in this context the Fetal Medicine Consultant at NUTH stated: ‘ The qualitative component of our Academic Health Science Network funded project, conducted by the University of Cumbria, was key to our understanding of the local workforce barriers and facilitators to the implementation of a unique new telemedicine service. This provided valuable insights for academic partners, local managers/commissioners as well as the manufacturers of the equipment…This has been transformational in supporting service delivery during the COVID pandemic’’ (S9).