CMO Rape and Sexual Assault Taskforce minutes: January 2022

Attendees and apologies

Attendees

• Chair – Professor Sir Gregor Smith (Chief Medical Officer for Scotland)
• Greig Chalmers (Head of CMO Policy Divison, CMO Directorate, SG)
• Tansy Main (Unit Head, CMO Taskforce Unit, SG)
• Vicky Carmichael (Acting Unit Head, CMO Taskforce Unit)
• Dr Edward Doyle (Senior Medical Adviser for Paediatrics, SG and Associate Medical Director for Women’s and Children’s Services, NHS Lothian)
• Colin Sloey (National Co-ordinator, CMO Taskforce Unit, SG)
• Lucy Dexter (Deputy Unit Head, CMO Taskforce Unit, SG)
• Fil Capaldi (Detective Superintendent, Police Scotland)
• Gary Jenkins (Chair of the Police Care Network, State Hospital GG and C)
• Leanne Tee (Clinical Lead for Forensic Services, NHS Highland)
• Jillian Galloway (Chair of the Self-referral Subgroup and NHS Tayside, Head of Justice Healthcare and Urgent Primary Care)
• Professor Amjad Khan (Associate Post graduate Dean, NES)
• Jack Murray-Dickson (Bairn’s Hoose Policy, SG)
• Carole Robinson (FMS Act Implementation Lead, CMO Taskforce Unit, SG)
• Michelle Harrity (CMO Taskforce Unit, SG)
• Ryan O’Donnell (CMO Taskforce Unit, SG)
• Jane Russell (CMO Taskforce Unit, SG)
• Mark Burgess (CMO Taskforce Unit, SG)
• Lynda Dobinson (CMO Taskforce Unit, SG)
• Louise Wilson (Director of Public Health, NHS Orkney)
• Carol Rogers (Interim Operations Manager for Biology, SPA)
• Tricia Marwick (Board Chair, NHS Fife)
• Colette Mackenzie (QI Subgroup Chair)
• Wendy Copeland (CMO Taskforce Unit, SG)
• Dr Nighean Stevenson (Interim Lead Forensic Scientist for Sexual Offences, SPA)
• Emma Kennedy (Organisational Lead for GBV, Public Health Scotland)
• Moira Price (Victims and Witness Policy Division, COPFS)
• Dr Fiona Wardell (Team Leader for Standards and Indicators, HIS)
• Katie Brown (Equally Safe Policy Coordinator, CoSLA)
• Gill Imery (HMICS)
• Hannah Taylor (CMO Taskforce Unit, SG)
• Stef Dinwoodie (CMO Taskforce Unit, SG)
• Rod Finan (Professional Social Work Advisor, SG)
• Sian Tucker (Senior GP Advisor, SG)
• Anne Armstrong (Mental Health Nursing Advisor, SG)
• Carol Potter (Chief Executive, NHS Fife)

Apologies

• Adam Bircham (CMO Taskforce Unit, SG)
• Chloe Poole (Deputy Unit Head, CMO Taskforce Unit, SG)
• Jamie Lipton (Policy Division, COPFS)
• Sandy Brindley (Chief Executive, Rape Crisis Scotland)
• Dr Duncan Alcock (Chair of the Information Governance Delivery Group)
• Safia Qureshi (HIS Taskforce Lead)
• Iona Colvin (Chief Social Work Advisor, SG)
• Vicky Norris (CMO Taskforce Clinical Pathways Project Manager, NHS NSS)
• Sybil Canavan (Director of Workforce Healthcare Improvement Scotland)
• DCS Samantha Faulds (Public Protection, Police Scotland)
• Anne Neilson (Director of Public Protection, NHS Lothian)
• Helen Haworth (Interim Head of Forensic Biology, SPA)
• Lesley Swanson (Bairns’ Hoose Unit Head, SG)

Items and actions

Agenda

Welcome, introductions and apologies: Chair – Professor Sir Gregor Smith (GS)

• minutes of previous meeting and actions log: GS
• matters arising: GS
• subgroup updates GS plus subgroup Chairs
• agreed actions/next steps GS/Colin Sloey (CS)
• any other business: GS
• date of next meeting GS

Welcome, introductions and apologies

GS welcomed members to the twentieth meeting of the Taskforce. GS explained that this meeting would focus on the detail of the necessary pieces of work for the commencement of the Forensic Medical Services (FMS) (Scotland) Act, on 1 April 2022

GS recorded his thanks to Gill Imery (GI) for the 2017 report that was the catalyst for change in this area and led to the formation of the CMO Taskforce, and passed on his best wishes for her retirement.

GS noted the apologies listed above.

Minutes of the previous meeting and actions log

GS asked members to approve the previous minutes (paper 1) as an accurate account of the previous meeting. The previous minutes were approved with no objections.

GS asked members to highlight any possible omissions from the action log (paper 2). No omissions were raised by members.

Matters arising

GS asked members to note the matters arising paper (paper 3).

Barnahus update

GS invited Jack Murray-Dickson (JMD) and Fiona Wardell (FW) to provide the ‘Bairns’ Hoose’ update.

JMD explained there was a Programme for Government (PfG) commitment that all children and young people that were subject to, or a witness of abuse or sexual violence, would have access to a ‘Bairn’s Hoose’ by 2025.

JMD added that a vision paper was published in September 2021 setting out the plan for implementation of a Bairns’ Hoose model in Scotland. Since the previous CMO Taskforce meeting, a Bairns’ Hoose Unit had been established in Scottish Government, headed up by Lesley Swanson, drawing on resources from the Children and Families, Justice and Health Directorates with expertise from professional advisors in police and social work, as well as linking closely to the work of the Taskforce.

JMD explained that Healthcare Improvement Scotland and the Care Inspectorate had been commissioned to produce a set of Scotland-specific standards for Barnahus based on the European Promise quality standards. FW would outline more on the standards work.

JMD added that the National Child Protection Leadership Group, chaired by the Minister for Children and Young People, had agreed to provide overall governance for the policy related to Bairn’s Hoose and work was ongoing to establish a National Bairn’s Hoose Governance Group which would report to the National Child Protection Leadership Group. Interviews for the position of Chair of the group had taken place recently and the outcome of those interviews would be announced shortly, with further membership of the group still to be agreed.

JMD commented that a project plan would be published in February 2022 and would detail how the PfG commitment would be met. A refreshed vision paper would also be published in February. There were also plans to reach out to multi agency sites and services across Scotland to understand existing service provision and local capacity to inform and help develop Bairn’s Hoose pilots.

JMD explained Ministers would be writing out to relevant leaders and service providers to outline the commitment to work with partners. JMD welcomed any comments from members.

GS thanked JMD and invited FW to add anything on the standards work.

FW explained it was a period of great activity in the Bairns’ Hoose development group. The first meeting of the group was imminent and a collaborative approach was being taken to this work, with clinicians and other professional’s part of the group, which was chaired by Dr Eddie Doyle (ED).

FW commented that hearing and amplifying the voices of young people and those with lived experience was paramount to the development of the Bairns’ Hoose. There would be an announcement that week for which organisations would be granted funds to kick-start engagement work with young people.

FW explained that the draft standards would be published in summer 2022 and these would go out to consultation before the final standards were published a the end of the 22-23 financial year. FW explained that updates would continue to be provided as work progressed.

GS thanked FW for this update and agreed that working with children and young people to shape this work would be crucial. GS invited any questions from members. No questions were raised.

Survivor Reference Group

GS explained that SB had passed on her late apologies and that there was no update from the Survivor Reference Group.

Subgroup updates:

Delivery and performance

GS noted that there was 1 open action for the Delivery and Performance Subgroup.

Taskforce members to review the 5 Year Plan and consider how progress could be marked against this.

GS added that members had the below papers for noting:

• RAG report (paper 4)
• stocktake summary paper (paper 5)
• stocktake report (paper 6)
• taskforce risk register summary paper (paper 7)
• taskforce risk register (paper 8)

Members also had the below paper for approval.

• National Strategic Network (paper 9)

GC asked CS to provide an update on papers 4-8 and Tansy Main to provide an update on paper 9.

CS commented that in regards to the open action he and Vicky Carmichael (VC) had been in contact with GI and Louise Rafael (LR) from HMICS to review the progress that had been made over the last 5 years against the 10 recommendations in the HMICS report of 2017. Evidence had been provided against these recommendations. This was captured in paragraph 1.6 of the Stocktake Report (paper 6).

GS thanked CS and reiterated the importance of driving this work towards commencement of the FMS Act on 1 April 2022.

CS explained that the RAG report status for the Delivery and Performance Subgroup was amber due to work that was still to be completed on the Environmental Monitoring Regime and the Information Governance documentation. However, this work was on track and due to be completed in the following weeks.

CS asked members to note that with the introduction of the Performance Framework for Adults and Children and Young People there were now 7 quarters worth of performance data for adults and 3 quarters worth of performance data for children and young people, set against the Healthcare Improvement Scotland standards. The data sets out the improvement actions taken against the standards Scotland-wide as well as highlighting the strengths and challenges faced.

CS added that work was continuing with Public Health Scotland to finalise the content of their annual report to Parliament as required by the FMS Act.

CS explained that members had the Stocktake Summary and paper (paper 5 and 6) for noting and highlighted that the actions that would be progressed in the following 6 months were detailed at the end of the paper.

CS noted that the Risk Register Summary and paper (papers 7 and 8) contained 3 live risks and these related to the NHS Borders SARCS, the potential delay in finalising the National Telephony Service and the launch of the National Awareness Campaign. CS explained that the subgroups leading on each of these had these under control CS informed members that the NHS Borders SARCS was due to open in spring 2022.

CS opened to the group for any questions, none were raised.

GS thanked CS for the helpful update and invited TM to speak to paper 9.

TM apologised for the paper being sent as late and passed over to Hannah Taylor (HT) to provide an update.

HT explained that following the commencement of the FMS Act, the focus of the work of the Taskforce would shift from government-driven service design to provision of national policy direction and oversight of service by the NHS. It was proposed that the Taskforce evolves into a Scottish Government led SARCS Programme Board. This group would have a more targeted membership than the current Taskforce and would report to the Cabinet Secretary for Health and Social Care.

HT added that National Services Scotland (NSS) recommended that a National Strategic Network (NSN) be established (chaired by a health board Chief Executive), to provide the required leadership and ownership of the improvement of these services within the NHS. Work had been completed with stakeholders to develop a proposal for the NSN which had now been approved by NSS.

HT highlighted Annex B, a diagram comparing the current arrangement of the Taskforce to the new arrangement of the NSN.

HT noted that the CMO, CNO and the Cabinet Secretary for Health and Social Care were content with the new proposal.

GS thanked HT for this update and acknowledged the amount of work that had gone into developing this proposal. GS recognised that this was the right time for the work of the Taskforce to transition into a service led by the NHS, with oversight from the Scottish Government. GS agreed that a network was a great way for improvement and national consistency in this work to continue.

GS welcomed comments and approval from members.

GI commented that she was very supportive of the proposal and agreed that it seemed a natural evolution for this work. GI noted that the diagram was useful in understanding where the escalation routes were, which provided accountability.

Gary Jenkins (GJ) also supported the proposal and agreed that a network structure was the right decision as there had been a lot achieved in other sectors of the NHS through the use of networks. GJ suggested that he and CP took this to the NHS Chief Executives meeting in March 2022 as part of the agenda.

TM commented that the paper had been discussed in detail with Sandy Brindley, Chief Executive of Rape Crisis Scotland and Sandy had been very supportive of the proposal.

CP added that she would be happy to take the paper to the NHS Chief Executives meeting with GJ. CP questioned whether the accountability of NHS Chief Executives directly to Scottish Ministers should be noted in the paper.

GS thanked CP for raising this and agreed it was important that the accountability of the network was right as one of the critical components of their ability to function at a high level was having the correct accountability in place.

TM replied that the diagram had been included more to show the vision of how the structure would look rather than capture the accountability lines. TM explained it would not be the role of the network to ensure that all health boards were fulfilling their responsibilities under the FMS Act. That would go through existing health board governance processes. Any quantitative or qualitative intelligence that the network may gather through its work could feed into those governance processes, but the network itself wouldn’t be responsible for holding boards to account for their performance.

GJ thanked TM and CS and requested a paragraph on the accountability structure in place to take to the NHS Chief Executives meeting.

TM asked GJ to let her know what he may need to take it the NHS Chief Executives meeting. TM added that next steps for this would be herself and HT getting in touch with all Taskforce members to discuss their involvement in the new network structure. TM thanked all members for their support in this work.

Legislation

GS noted that there were no open actions under the Legislation Subgroup and that the RAG report (paper 10) was for noting.

GS invited Carole Robinson (CRo) to provide an update on the Legislation Subgroup.

CRo explained that there had been a lot of progress made on the secondary legislation work of the Taskforce.  . Since the last meeting the Cabinet Secretary for Health and Social Care and the Cabinet Secretary for Justice and Veterans had given their agreement to the recommended 26 month retention period.

CRo thanked all members of the Taskforce involved in bringing together this recommendation which had a clear evidence base. Over 50% of consultation respondents agreed with the 26 month period and for those that disagreed with the recommendation there was no clear consensus on whether the period should be longer or shorter.

CRo explained that the responses to the consultation had now been published alongside the consultation analysis report.  She noted that Rape Crisis Scotland had collated responses from the Survivor Reference Group, who were in favour of a retention period of a minimum of 5 years. Discussions had taken place with Sandy Brindley and a paper had been produced for sharing with the Survivor Reference Group to outline the rationale of the 26 month retention period. No feedback had been received in response to this.

CRo added that secondary legislation had now been laid in the Scottish Parliament and it would come into effect on 1 April 2022. The Cabinet Secretary for Health and Social Care would be making a Committee appearance for the two affirmative orders, which related to the retention period and conferring functions to HIS as allowed for in the FMS Act.

CRo explained that attention was now being turned to the Committee appearance and the Taskforce team would be in touch with members of HIS in the coming weeks. There was not yet a date for the Committee appearance but the Taskforce team would let members know when this was available.

CRo also explained that an order made under the Scotland Act would be laid in the UK Parliament in the coming weeks which would ensure that the reserved police forces of the Ministry of Defence, the Armed Forces and British Transport Police have the same legal parity as Police Scotland when investigating sexual offences in Scotland.

GS thanked CRo for this update and acknowledged the important milestone of having the secondary legislation laid with the Scottish Parliament. GS opened to any questions from members, none were raised.

Workforce and training

GS explained there were two open actions for the Workforce and Training Subgroup. He also asked members to note the Workforce RAG report (paper 11).

A letter from CMO and the Chief Nursing Officer (CNO) to be drafted encouraging the forensic healthcare workforce to provide a sample to the DNA elimination database.

Taskforce Unit to link with RCGP’s to discuss how resources could be utilised.

GS confirmed that the he had signed off on the DNA elimination database letter and this had now been issued.

GS invited Michelle Harrity (MH) in Sybil Canavan’s (SC) absence to provide an update on the work of the subgroup.

MH explained that the bulk of the updates were contained within the RAG Report (paper 11) and highlighted the below points:

The Nurse Examiner Test of Change (ToC) had been initially impacted by Covid-19 which had an effect on the number of cases seen. As of December 2021, 12 cases had been seen as part of the ToC. Discussions had taken place with Archway and COPFS to explore measures such as additional nurse and preceptor hours, longer shifts and covering more days in the week that might facilitate more cases being seen. MH explained that the ToC was effectively on pause at this moment as one of the nurses had resigned and the other was on long term sick leave. Discussions were ongoing with COPFS about the ToC going forward and an update would be provided in due course.

The QMU course on Advanced Forensic Practice had also been impacted by Covid-19. Some of the nurses on the course had required extra time to complete the coursework and the Exam Board scheduled for January 2022 had been pushed back to February 2022. Jess Davidson (JD) confirmed 13 nurses would be going forward to the Exam Board in February.

The DNA Elimination Database letter had been issued on 20 January 2022 and was issued to all Nurse Directors, Medical Directors and Regional Planners who would disseminate to all relevant staff.

Work was ongoing in the Community Pharmacy Test of Change to recruit pharmacies in NHS Greater Glasgow and Clyde, NHS Lothian, NHS Forth Valley and NHS Highland and a further update would be provided as this work progressed. NHS Greater Glasgow and Clyde were planned to start in the first phase in March, with the other involved health boards commencing in April 2022.

MH opened to questions from members.

GS thanked MH for the update and recognised that although there had been a number of obstacles in the work of the subgroup, these would not impede the commencement of the FMS Act on 1 April 2022.

ED questioned whether Archway would be conducting an exit interview with the nurse that had resigned from the ToC to fully understand the reasons behind the resignation and incorporate lessons learned in any future ToC. MH confirmed that there would be an exit interview and that the Taskforce team were working with Archway to receive feedback on this topic.

Sian Tucker (ST) suggested that before the national telephony service commences on 1 April there should be some communication to GPs to inform them of the imminent changes.

VC thanked ST for raising this point and confirmed that work was ongoing to map out stakeholders and the information they would require.

Self referral

GS noted there were no open actions for the Self-Referral Subgroup and that members had the RAG Report (paper 12) for noting.

GS invited Lucy Dexter (LD) to provide an update.

LD noted that the current RAG status was currently amber and highlighted that 2 risks relating to self-referral were currently at red. However, this was due to the potential impact of these risks if no mitigating actions were put in place. These risks were being reviewed on an ongoing basis.

LD explained that significant progress was being made in the delivery of the national telephony service. Work was ongoing to finalise connection between the NHS24 and Cellma systems, to ensure that there was a seamless transition of data from NHS24 to the SARCS. Implementation of Cellma was overseen by the Quality Improvement Subgroup.

LD added that a number of health boards had developed proposals to host the hub and a panel of members within Scottish Government and NSS had appraised those. NHS Ayrshire and Arran had been identified as the host health board for the hub. The hub would support and manage the handover process from NHS24 to the local health boards.

LD confirmed that work was progressing well with NHS Inform to develop the content for the website, making it as user friendly as possible.

LD explained that a further update had been provided to health boards setting out everything that needed to be in place ahead of the go-live date for self-referral of 1 April 2022.

LD added that since the Taskforce last met in October 2021, the Lord Advocate had approved the Self-Referral National Protocol. This allowed the NES self-referral training to be finalised and the ‘train-the-trainer’ session had been delivered earlier in January 2022. Trainers would then go on to disseminate the training in their individual health boards in February-March 2022.

LD concluded that the national awareness raising campaign and related literature was progressing well with creative routes currently being reviewed by the Taskforce team.

GS thanked LD for this important update and opened to any questions from the group. None were raised.

Quality improvement

GS noted that there were no open actions under the Quality Improvement (QI) Subgroup and that the RAG Report (paper 13) was for noting.

GS asked Colette Mackenzie (CM) to provide an update on the work of the QI Subgroup.

CM confirmed that RAG status remained amber as there were only 9 weeks until go-live and several milestones still needed to be achieved.

CM added that work was ongoing with the self-referral team to finalise the connections between NHS24 system and Cellma. Testing and training was booked for the following two months and all work streams currently were on track.

CM opened to the group for questions.

GS thanked CM and asked members to note the QI Subgroup RAG Report (paper 13).

Clinical pathways

GS noted that there were no open actions from the Clinical Pathways Subgroup and invited ED to provide an update on the RAG Report (paper 14) and to speak to the CYP Clinical Pathway and Adult Clinical Pathway papers (paper 15 and 16) which were for approval.

ED explained that the RAG status was currently amber as some work was still ongoing. The CYP Pathway had been updated to take account of the revised Child Protection Guidance that had been published in September 2021 and to include self-referral relating to 16 and 17 year olds. Work on the adult pathway was slightly behind the progress made on the CYP Pathway and the version included in today’s papers was subject to review from the Scottish Government Legal Directorate (SGLD). Any amendments would be communicated to members electronically.

ED added that the FME leaflet and guidance had been updated to take account of self-referral with consideration given to how somebody under 16 would be supported if they attempted to self-refer. The paper versions of the National Forms had also been updated for use if there was an outage of the Cellma system.

ED explained that work was ongoing to update the consent form for self-referral. To align with the police referral consent form, perhaps condensing them both into one document. However, it had been agreed that two separate forms would be required.

ED welcomed any comments and asked members for their approval on the CYP and Adult Pathway papers (papers 15 and 16).

GS thanked ED for this update and opened to members.

ST commented that the pathways looked excellent and asked whether consideration had been given to what the process would be if a person called the national telephony number and arranged an appointment at a SARCS but then didn’t follow through. ST added this wasn’t an uncommon situation.

LD responded that the most recent discussions had been in relation to young people that called the national telephony service. Robust process were being put in place for anyone aged 13-15 years old (under 12s would be a direct police referral due to their age) to support them through the process.

LD added that for those over 16 years of age once the person had phoned NHS24 they would then be referred to the health board of their choice. A clinician would then phone the person back to arrange an appointment. If there was no answer initially the clinician would then use their professional#

judgement to assess whether the person might be in any danger and whether any adult support or protection measures need to be considered.  Although the finalised process for “drop offs” was still being worked on LD said ST’s comments would be taken into account.

Members approved both the CYP and Adult Pathways.

Agreed actions/next steps

GS asked CS to review the agreed actions from the meeting as noted above.

CS commented that it was now down to the Taskforce to finish what had been started and ensure that work continued apace in the lead up to commencement of the FMS Act.

Any other business

GS acknowledged that this was the penultimate meeting of the Taskforce and asked members to raise anything that they would like more detail on in the lead up to commencement of the FMS Act on 1 April 2022.

GI commented on the impressive amount of work that had been done and noted that there were 3 recommendations from the original 2017 report still outstanding. GI, however, acknowledged the work ongoing to ensure these recommendations were met. GI expressed her confidence in the FMS Act being delivered on 1 April 2022 and passed on her thanks to all involved in this work.

GS thanked GI for her kind words and added his thanks to all involved in driving this work forward.

TM commented that this wouldn’t be ‘job done’ on the 1 April 2022 but would signify the start of a new chapter with the SARCS Programme Board and the NSN building on the work of the Taskforce. TM thanked all members for their input to this work and noted that she looked forward to continuing to work together in the future.

GS thanked TM and agreed that it felt like the start of something new and looked forward to the work that was to come. GS thanked the Taskforce team for their hard work and commitment to this work.

Dates of next meeting

GS noted the next meeting on 26 May 2022 would be the last meeting of the Taskforce.

GS thanked members for their continued work and support and closed the meeting.