Equally Safe consultation: analysis of responses

2. Functions of Health Boards

A specific statutory duty for Health Boards

2.1. The consultation document notes a transfer in the delivery of forensic medical services for victims of rape and sexual offences to the territorial health boards in 2013. This was provided for in a Memorandum of Understanding (MoU) between Police Scotland and the territorial health boards. The consultation explains the intention to build on the existing arrangements, noting ‘the legislation proposed in this consultation will provide a clear statutory basis for people to access self-referral services in all parts of Scotland’.

2.2. Respondents were invited to express views on the creation of a statutory duty for health boards, by responding to the following question:

Question 1: Should a specific statutory duty be conferred on Health Boards to provide forensic medical services to victims of rape and sexual assault for people who have reported to the police as well as those who have not?

2.3. A quantitative overview of responses to this question is provided below:

• 91% (48 out of 53) selected ‘yes’ 
• 2% (1 out of 53) selected ‘no’
• 2% (1 out of 53) selected ‘don’t know’
• 6% (3 out of 53) did not answer the question

Overview of responses to the proposed statutory duty

2.4. This question generated the largest number of comments across the consultation. Most respondents (44 out of 53) provided additional detail alongside their answer to the consultation question.  The comments varied considerably, reflecting the diverse skills and experience across the respondent groups.

• Most comments (29 out of 44) explained why the respondent supported the proposal. Themes included the value of a statutory duty, the importance of self-referral routes and the positive impact of embedding trauma-informed care and adopting a health-focused approach to forensic medical services.
• Thirteen respondents described their support for the proposals and also mentioned other issues for the Scottish Government to consider. These typically involved calls for resources, training and service delivery models.
• One respondent said they did not support the proposal. They described their preference for an alternative commissioning model which would enable delivery by private sector service providers.

2.5. A summary of respondents’ comments, presented by theme and frequency of the view expressed, is provided below.

The need for a statutory duty

2.6. Eleven respondents reflected on the value of introducing a statutory duty.  Within this group, five respondents suggested the statutory duty would provide guidance to the health boards and Police in terms of implementation, roles and responsibilities.

2.7. Four reflected that a statutory duty on health boards would build on the current Memorandum of Understanding between Police Scotland and Health Boards. 

2.8. Two respondents highlighted that the statutory duty should make it clear that health boards are responsible to deliver FMS. One felt a statutory duty would help hold local services to account and ensure health hoards comply with other requirements and public sector duties.

Self-referral

2.9. References to the importance of self-referral routes were identified in responses from 20 respondents. Most of this group (16 of the 20 respondents) expressed their support for offering FMS to those who self-refer and reflected that access to these services should not depend on reporting to the police. 

2.10. Ten respondents highlighted the importance of victims having time to decide whether to report, but nonetheless wish evidence to be taken. One respondent expressed concern that a statutory duty might prevent people being open about their circumstances but did not expand.

Shifting to trauma-informed care and a health focused approach

2.11. Discussion of trauma-informed care was identified in responses from fifteen respondents. Most of these (12 respondents) highlighted the need for trauma-informed care and the important role this plays in the recovery of victims. 

2.12. Three highlighted that health boards are better placed to provide trauma-informed care and support, because of the skills and expertise of staff. In reflecting on trauma-informed care, one respondent said victims should be given the choice of sex of the examiner. 

2.13. The shift towards a health-focus approach was endorsed by four respondents. In this discussion three respondents suggested that such an approach would avoid re-traumatising victims. Three respondents highlighted the importance of focussing on the health and wellbeing of victims, given the traumatic experience. 

Consistent service delivery

2.14. Twelve respondents reflected on the potential for the statutory duty to result in consistent service delivery for victims. These ranged from brief comments from seven respondents expressing a view that the statutory duty would produce a more consistent service, to more detailed responses from four respondents. In the more detailed comments were indications that the statutory duty would achieve consistency in relation to responsibilities and practice, with one specifically mentioning a need for this when considering delivery across urban and rural communities.

Potential to address under-reporting

2.15. Eleven respondents highlighted the potential for the proposals to address under-reporting of sexual offences. In these responses, nine respondents noted current under-reporting, or reflected on the reluctance of victims to report. Two respondents suggested the proposals could have a positive impact by increasing the number of incidents reported. 

Models of delivery and improved access to services

2.16. Issues related to accessing services were described by eleven respondents. In most of these responses (nine respondents) were brief or general remarks expressing a view that the proposals would lead to improved access to services. One respondent highlighted the current need for those in rural/island areas to have to wait or travel for an examination. 

2.17. Considerations in terms of the design and development or FMS were noted by seven respondents. The specific issues raised in these responses are summarised in Appendix 1.

Capacity, Resourcing and Training

2.18. Eight respondents reflected on capacity within health boards to provide the services outlined in the consultation, often expressing concerns about their capacity to do so within existing resources. 

• Five respondents made comments about the ability of the NHS or health boards to provide FMS given staff / resource / funding concerns or made calls for extra funding. 
• Three respondents made comments in relation to training.  These can be found in Appendix 1. 
• Singular responses can be found in Appendix 1.  These included the creation of the forensic nurse examiner role, the creation of an authoritative body to oversee processes to recruit and train staff and an acknowledgement of progress in and call for further work to improve the gender balance of the workforce.

Equalities and Human Rights

2.19. The proposals in the context of equality and rights were discussed by seven respondents. In these, three respondents mentioned the impact on LGBTI people, for example reducing barriers and increasing presentation to services. 

2.20. Two respondents made broader observations on this theme; one noted that the legislation should be principle based, reflect human rights and be sensitive of the need for equality. One commented that the system should be one that fits with the vision of a country which strives to uphold the rights of its citizens. 

2.21. Four respondents highlighted the needs and experiences of vulnerable groups in their response. Two of these referred to barriers faced by women who are physically disabled or have learning disabilities, one suggested that further work was required to develop expertise and interventions for those with severe-profound learning disabilities and questioned how they would be supported.  Another commented that many complainants of rape are vulnerable and would prefer relationship building prior to reporting.

2.22. One respondent asked the Government to be mindful of the specific experiences of Catholic women. 

Children and Young People

2.23. Impacts of the proposals in relation to children and young people were highlighted by six respondents. In these, four respondents noted the duty of child protection that health boards would have and the need to follow child protection procedures / share information with agencies responsible for intervention. They suggested that in these instances, self-referral would not be appropriate. 

2.24. One organisation gave a very detailed response based on their knowledge of the area which has been signposted to the Scottish Government for review. Another respondent suggested that consideration should be given to young people over thirteen to access self-referral services. 

Evidence and relevant examples of current practice 

2.25. Examples and additional relevant information were shared in five consultation responses. These are detailed in Appendix 1 and included a detailed response signposted to the Scottish Government for review.

Disagreement with the proposal and other issues raised 

2.26. One respondent expressed disagreement with proposal and gave a detailed response as to why.  They voiced doubt that the NHS is equipped to provide either state of the art FMS or recovery therapies for victims of sexual assault and shared concerns about the ability of nurses in Scotland to provide evidence in court.  This respondent suggested that “responsibility for providing services should be co-commissioned by Police and the NHS with a separate board overseeing the SARCs in each regional location”.

2.27. Four respondents called for clarity on certain issues which are listed in Appendix 1. 

2.28. A number of other varied suggestions were identified in comments about the creation of a statutory duty. These are available in Appendix 1.

A sample of illustrative quotes that typify the themes identified in this section:

“Statutory duty will oblige health boards to improve access of victims.” (Organisation, anonymous)

“A statutory duty would assist the progression of guidance for health to implement appropriate medical services to be provided.” (Individual, anonymous)

“People may need time to be in a position where they can report but wish evidence to be taken and secured.” (Individual, anonymous)

“Scotland is moving now towards a healthcare and recovery focused approach whilst recognising the importance of reliable forensic evidence gathering techniques to support the criminal justice system.  The legislation proposed in this consultation will provide a clear statutory basis for people to access self-referral services in all parts of Scotland.”  (Organisation, anonymous)