for SPCS and now further work must be undertaken to widen the nature and scope of the programmes on offer, and monitor their effectiveness and long term impact. 9.2.3 Health An effective health system should provide protection services for victims of family violence in both the immediate aftermath and in their long term recovery. Well trained front-line healthcare professionals are often best placed to identify family violence and then refer cases to the police and allied health workers who can address the causes and long-term impacts. However, the picture painted to the Inquiry was one of overwhelming shortages, lack of skills and knowledge, harmful attitudes and practices and huge gaps in the range of services required. 9.2.3.1 Hospital services For many, simply accessing hospital services can be difficult, due to the cost and distances of travel, cost of services or even because of a controlling partner who restricts the movements of the abused person for fear of the violence being discovered. The Inquiry was also told by those currently working in hospitals and doctors surgeries that there is currently a shortfall of around 230 doctors and 400 nurses. Inevitably, this has a detrimental impact on the level of care that can be afforded to patients and in being able to identify and adequately treat victims of family violence. “There is a high degree of understaffing at the hospital which means staff simply do not have time for screening, even if they wanted to.” Ramona Boodoosingh, PHD on Violence Against Women in Samoa, Inquiry document 82 The process of screening can be extremely effective in identifying victims of violence and referring them to the necessary justice and allied health care services. Many do not want to report violence because of feelings of shame, fear and acceptance. Intervention when they present at hospital can, if done well, overcome these barriers and make significant inroads into addressing family violence at a societal level. However, the current shortage of doctors and nurses leaves nowhere near enough time for this to happen, even if the hospital staff wanted to and had received the necessary training to be able to do so without the risk of causing further harm. A further barrier to effective protection of family violence victims within the hospitals is a lack of privacy, which leads to an environment where healthcare workers cannot have discussions with patients about the causes of their injuries. “The dividers are drawn so there is little privacy. Even doctors and nurses do not use these curtains so patients and families can watch others being examined. Beds are also in close proximity.” Ramona Boodoosingh, PHD on Violence Against Women in Samoa, Inquiry document 82