Publication - Consultation analysis
Supporting adults who present having experienced rape or sexual assault - draft clinical pathway: consultation analysis
An analysis of the responses to the consultation on the draft clinical pathway for healthcare professionals working to support adults who present having experienced rape or sexual assault.
Section 6: Focus groups summary
During the consultation period, 7 focus groups were held with practitioners across Scotland. The Clinical Pathways Subgroup would like to thank everyone who took part in focus groups during the consultation. The responses have provided a wealth of feedback on the clinical pathway and national form, and although a response has not been provided for every individual comment, the Clinical Pathways Subgroup has provided responses to the specific areas detailed below and all other comments will be taken on board.
Participants of the focus group included forensic medical examiners, lead clinicians, forensic nurses, support staff, third sectors organisation, service managers and sexual offences investigation officers. Participants of the focus groups were asked questions relevant to their area of expertise. All focus group participants were asked questions related to the following areas:
- Person-centred care
- Processes and existing pathways
- The use of the document
- The use of the proposed national form
Full discussion data can be found in Annexe 1. Where possible, identifying data has been removed and participants anonymised.
| Themes | Key Discussion Points | Clinical Pathways Subgroup Response |
|---|---|---|
| Person-centred care | Participants generally felt that many aspects of the pathway were person-centred and praised its ambition. In particular, groups commended the investment and drive for improvement in the service area. The document was believed to address some key barriers to reporting, but this was dependent on the training of personnel and available services. One key area was the provision of support and the difficulty in implementing ongoing follow-up care within existing overstretched services and an anxiety that the pathway would be letting survivors down, or not fulfilling its promise. Extensive questions and checklists were thought to be focussed on quality improvement indicators or data collection and risks unnecessarily extending examinations. Finally, some groups raised the issue that there were gaps in the pathway surrounding support and forensic stringency in relation to suspects of sexual violence. | The Clinical Pathways Subgroup acknowledges the ambition of the clinical pathway and the links with the training of personnel to deliver. The national preferred service model recognises the need for everyone involved in providing treatment, care and support to those with lived experience to have the relevant skills and competencies, backed by accredited training where appropriate. Specific and relevant training for individual roles, including forensic nurses, is being provided by NHS Education for Scotland. NHS Boards are best placed to reduce inequality of access to services in their local area and engage with partners to support all survivors of rape and sexual assault. Finally, the Clinical Pathways Subgroup deems suspects of sexual violence as outside the scope of the clinical pathway. Service specification and the detail of required facilities are out of scope of the clinical pathway; however, the feedback provided by the focus groups will be passed onto the subgroup that is responsible for the service specification, for consideration. |
| Processes and existing pathways | There was a large discrepancy between areas and services. Reports of poor experiences reflect those identified in options appraisal, HIS Standards development and HMICS report. Survivors (even within the same locality) reported widely different experiences. All of the participants reported that the implementation of the pathway depended on service design to reduce inefficient or non-person-centred processes such as travelling long distances for a forensic examination or having to ‘queue’ to access facilities. However, participants also reported that locally-accessed services were not always the best course of action, as a new workforce was difficult to recruit and retain. Participants reported that services needed to work more closely together; however, this was dependent on funding and available referral pathways. There were concerns about how the follow-up component of the pathway would be met; the information given to survivors; and further concerns about confidentiality. | The Clinical Pathways Subgroup acknowledges the feedback on existing processes. The implementation of the pathway will be for local determination as the Clinical Pathways Subgroup is aware of the differences in the services provided in more rural and island boards. The national model aims to deliver a multi-agency approach which is delivered as locally as possible, including forensic medical examinations and follow up care and support. All NHS Boards have local improvement plans in place to improve access to consistent, high quality care and support, including forensic medical examinations and through care. |
| The use of the pathway document | Participants reported that the document was more of a ‘guidance manual’ than a logical pathway. This was seen as a positive for some in areas where the workforce was expanding. Participants requested that the document be shortened and include more diagrams. Concern was raised that the document did not adequately outline roles and responsibilities. | The Clinical Pathways Subgroup acknowledges the feedback on the use of the document. Further work has been carried out on the pathway to improve the flow of the information provided. The Clinical Pathways Subgroup have developed guidance for staff in other services (such as primary care and A&E), who may be the first point of disclosure for someone who has experienced rape or sexual assault, to ensure that those professionals can provide a trauma informed response and signposting as appropriate to the relevant services. This was included in the package of resources produced in November 2020. There is now an Appendix which describes roles and responsibilities. |
| The use of the form | Participants noted that the form was extensive, repetitive and did not flow in a logical order with the process of forensic examination. Although it was deemed to be potentially useful to new forensic examiners, there were issues with the order. The number of questions and nature of some of the questions were thought to be too invasive, unnecessarily extend the examination or be otherwise not person-centred. Examiners raised concerns that the form required them to cite their medical opinion at the time of examination which was removed with the police and may later be used in court—many examiners were concerned that no time was allotted to review or ensure accuracy. Other participants queried whether the form encouraged re-telling people’s stories due to the lack of clarity over who was responsible for gathering information at each stage. Participants provided detailed feedback on individual form questions (see Annexe 1). |
The Clinical Pathways Subgroup acknowledges the feedback on the national form. Work has been undertaken to improve the flow of the form for healthcare providers and it was recognised that some individual questions required more work. It was also updated to suggest that examiners take evidence from Police statements to avoid the person having to repeat the same details. The Clinical Pathways Subgroup expects clinicians to ask questions in a person-centred way. Trauma-informed training is available for all NHS staff through NHS Education for Scotland. A period of testing took place with examiners in each of the regions to make sure it was fit for purpose and meets the needs of local services. Feedback from this testing has also been taken into consideration and the form has been updated accordingly. The National Form will be amended to align with the National Clinical IT System that the Quality Improvement subgroup are developing to support the improvement of services for victims of rape, sexual assault and child sexual abuse. |
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