Equally Safe consultation: analysis of responses

Appendix 1: Functions of Health Boards

Given space limitations, singular comments in response to the consultation questions have been noted in the main body of the report with examples given where relevant.  These comments are summarised in the following appendices and the individual responses can be viewed in full (where permission for publication was granted) on the Scottish Government’s website.

Responses to question one: a specific statutory duty for Health Boards

Models of delivery and improved access to services

• Due to time sensitivities examinations should be a priority and that GP surgeries, hospitals or specialised clinics are all appropriate settings.
• Specialist provision for people with profound and multiple learning disabilities. 
• The ability of those who self-refer to request the sex of the medical examiner. 
• For forensic medical services to address other barriers to reporting abuse including provision of communication aids and advocacy where appropriate, suitable equipment, accessible service locations and specialist knowledge. 
• For the statutory duty to drive the development of a multi-agency delivery model.
• A call for the use of nurses for forensic medical examination and the provision of training to a standard that expert evidence can be provided where necessary. 

Capacity, Resourcing and Training

• One respondent questioned what extra training will be required to understand trauma.
• Another respondent asked for consideration to be given to requiring specialised training for doctors so that only those who have undergone training can act under the law.
• There was a suggestion that Health Boards could oversee the curriculum development appropriate to Scotland, training and possible mentorship programmes, and periodic re-certification exercises – arguing that this would ensure consistency, but could be adapted for more rural areas. 
• One respondent explicitly supported the creation of the forensic nurse examiner role and another suggested the creation of an authoritative body to oversee processes to recruit and train staff, moving beyond primarily physician-led forensic medical examinations to professionalise nurses.  
• Another respondent acknowledged progress in and called for further work to improve the gender balance of the workforce.

Evidence and relevant examples of current practice 

• One cited academic examples of barriers facing women with learning difficulties reporting sexual assault. 
• Another highlighted noted the on-going multi-disciplinary evaluation of Sexual Assault Referral Centres (SARCs) in England and Wales. 
• One respondent provided a very detailed response which has been signposted to the Scottish Government for review. It cited several academic examples pertaining to the value of forensic evidence to identification in instances of rape, to the knowledge, experience and role of nurse examiners. They also suggested that police should still be aware of and understand the process of and use of forensic medical evidence.
• Another respondent detailed the background and operation of the Archway Sexual Assault Referral Centre in Glasgow.
• One cited some evidence from Aberdeen Health Village and Havens in London that use of services by LGBTI people and men would increase if self-referral pathways were in place.

Disagreement with the proposal and other issues raised 

Calls for clarity

• Two asked for detail about what the legislation would involve for health boards particularly in situations where a victim is unable or unwilling to give consent to an examination or for medical rather than therapeutic recovery.
• One made a general call for ‘clarity around responsibility’.
• Another asked for clarity on what consideration has been given to children who have experienced sexual abuse. 

Other suggestions

• For the Scottish Government to establish an oversight body with audit and inspection powers to avoid variable practice.
• To consider the appropriateness of evidence gathering and the correct processes and pathways for information sharing; on this theme, another respondent highlighted the need for communication with victims around how their samples will be used. 
• For the development of an accompanying Code of Practice or best practice guidelines. 
• For public education to ensure there is awareness of the service provision. 
• To ensure that police are not distanced from the process of forensic medical examinations and evidence collection. 
• For the Scottish Government to consider having two separate duties – one for forensic medical services for adult victims of rape and sexual assault, and a separate duty around forensic medical services for children and young people suspected to have suffered abuse including, but not limited to, sexual offences.