Healthcare professionals - supporting adults who present having experienced rape or sexual assault: clinical pathway

Appendix B – Roles and Responsibilities

All staff members working with people who have experienced rape or sexual assault should have completed the relevant NHS Education Scotland training which incorporates the principles of the national trauma training framework. In addition, details on the desired level of trauma training for each role are noted below.

Sexual Offence Examiner

The term Sexual Offence Examiner (SOE) is used to refer to the healthcare professional carrying out the forensic examination. It is good practice for a female Sexual Offence Examiner to be available at all times. Standards for Healthcare and Forensic Medical Services for People who have experienced Rape, Sexual Assault or Child Sexual Abuse: Children, Young People and Adults (Healthcare Improvement Scotland 2017)^[121].

At present in Scotland, Sexual Offence Examiners are medically trained. All doctors fulfilling this role for people who have experienced rape or sexual assault should have completed the NES Essentials in Sexual Offences Forensic Examination and Clinical Management (Adults & Adolescents) - Best Practice for Scotland training course. Trauma-informed principles underpin the approach to clinical and forensic management decisions following disclosure of sexual violence. In terms of trauma training, SOE’s should be trained to a trauma-skilled level.

Forensically Trained Nurse

A forensically trained nurse (FTN) (who has attended the NES training) can provide trauma-informed support and expertise and is able to fulfil the requirements of a chaperone. However, they are not trained to carry out an examination. In some areas, the forensically trained nurse has the responsibility for coordinating the follow up care and support for the person and to help them to navigate the healthcare system, including onward referrals to other services as required. In terms of trauma training, FTNs should be trained to a trauma-skilled level.

Chaperone

In line with the GMC’s Guidance on Intimate Examinations and Chaperones^[122], everyone should be offered a chaperone for intimate examinations.

The chaperone should be:

• A healthcare professional
• Familiar in general terms with the examination procedure being carried out
• Sensitive and respect the individual’s dignity and confidentiality
• Present throughout the entirety of the examination
• Present to reassure the person being examined if they show signs of distress or discomfort
• Prepared to raise concerns if they are concerned about the clinician’s behaviour or actions.
• Trained to a trauma-skilled level

The role of the chaperone is to safeguard both the individual and the SOE, and to provide additional support and reassurance to an individual where they are being examined by a sole SOE.

The CMO has asked Health Boards to ensure an appropriately trained nurse is available to fulfil this role.

Nurse Coordinator

The Nurse Coordinator is responsible for coordinating the follow up care and support for an individual and to help them to navigate the healthcare system, including onward referrals to other services as required. The Nurse Coordinator may also fulfil the role of FTN and chaperone during the examination. However, the coordinator role could also be undertaken by other staff groups. A Nurse Coordinator should be trained to a trauma-skilled/enhanced level.

Corroborating Witness

All FMEs should be witnessed, preferably by a healthcare professional who is a forensically trained witness in accordance with the requirements of the Scottish Criminal Justice System. The forensically trained witness should be appropriately positioned to observe the full examination including the taking of all swabs and samples and observation of any injuries. Ideally this role is undertaken by a FTN.

The witness should be able to confirm that the examination took place at a specific time, by whom, the samples that were taken and the presence or absence of injuries.

A healthcare professional acting as a chaperone, who is not forensically trained, should only corroborate the examination if no other forensically trained healthcare professional is available.

Both the SOE and the forensically trained corroborating witness should:

• Provide the police with witness statements
• Label and sign all productions taken during the examination in accordance with Forensic Regulator guidance^[123]
• In police referral cases, ensure that the productions are passed to the SOLO in attendance
• In self-referral cases, ensure that the productions are stored securely
• Be prepared to attend court to give evidence if cited

A corroborating witness should be trained to a trauma-informed level.

Sexual Offences Liaison Officer

The Sexual Offence Liaison Officer (SOLO) provides the critical link between the victim, Senior Investigating Officer (SIO) and the enquiry team in all rape investigations and serious sexual crime cases including other penetrative sexual offences i.e. sexual assault by penetration.

The SOLO must be deployed within 24 hours of the incident being reported to police. They have an important role in key processes including providing time critical updates to the SIO to identify the locus, significant witnesses, suspects and investigative opportunities. They also have a role in gathering vital information to inform a victim risk assessment, victim safety plan and victim strategy. Due to the role of the SOLO during the process, SOLO’s should be trained to a trauma-skilled level.

The role of the SOLO is wide and varied and this specially trained officer forms an integral part of the investigation team. Their duties include:

• Obtaining a full statement from the victim
• Requesting the FME (in cases where a police report has been made ahead of examination)
• Briefing the attending health professionals
• Attending the FME
• Seizing clothing for evidential purposes
• Seizing forensic samples for evidential purposes
• Ensuring the police and RCS referral procedures are completed
• Providing information to victims on referrals to external agencies
• Providing enquiry updates to the victim
• Supporting the victim during any other police process (e.g. suspect identification)
• Photographing evidence when the SPA photographer is unavailable

The SOLO’s attendance at the FME is primarily to support the criminal investigation; ensure the chain of evidence is recorded and protect the forensic integrity of productions seized from the forensically trained nurse or healthcare professional corroborating the examination.

Administrative and Clerical Staff

The Administrative and Clerical staff may the first point of contact for someone when they access as service. Administrative and clerical staff will prepare forensic medical reports and assist with data collection and monitoring. Staff in these roles should be trained to a trauma-skilled level.

Future Developments

Work to develop the role of forensic nurse examiners in Scotland is being progressed under the remit of the CMO Taskforce Workforce and Training Subgroup.