CMO Rape and Sexual Assault Taskforce minutes: June 2021

Attendees and apologies

Attendees

• Chair – Greig Chalmers (Interim Deputy Director, CMO Directorate, SG)
• Vicky Carmichael (Interim Unit Head, CMO Taskforce Unit, SG)
• Dr Edward Doyle (Senior Medical Adviser for Paediatrics, SG and Associate Medical Director for Women’s and Children’s Services, NHS Lothian)
• Lucy Dexter (Deputy Unit Head, CMO Taskforce Unit, SG)
• Jillian Galloway (Chair of the Self-referral Sub Group and NHS Tayside, Head of Justice Healthcare and Urgent Primary Care)
• Lesley Swanson (Child Protection, SG)
• Fil Capaldi (Detective Superintendent, Police Scotland)
• Professor Amjad Khan (Associate Post graduate Dean, NES)
• 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)
• Dr Duncan Alcock (Chair of the Information Governance Delivery Group)
• Mark Burgess (CMO Taskforce Unit, SG)
• Stefani Dinwoodie (CMO Taskforce Unit, SG)
• Sandy Brindley (Chief Executive, Rape Crisis Scotland)
• Sybil Canavan (Director of Workforce Healthcare Improvement Scotland)
• Katie Cosgrove (Gender Based Violence Programme Lead, NHS Health Scotland)
• Iona Colvin (Chief Social Work Advisor, SG)
• Carol Rogers (Lead Scientist, SPA)
• Leanne Tee (Clinical Lead for Forensic Services, NHS Highland)
• Tricia Marwich (Board Chair, NHS Fife)
• Colette Mackenzie (QI Subgroup Chair)
• Safia Qureshi (HIS Taskforce Lead)
• Nighean Stevenson (Forensic Scientist, SPA)
• Sian Tucker (CMO Taskforce GP representative)
• Vicky Norris (CMO Taskforce Clinical Pathways Project Manager, NHS NSS)
• Emma Kennedy (PHS Taskforce Lead)
• Moira Price (Policy Division, COPFS)

​​​​Apologies

• Dr Gregor Smith (Chief Medical Officer for Scotland)
• Colin Sloey (National Co-ordinator, CMO Taskforce Unit, SG)
• Adam Bircham (CMO Taskforce Unit, SG)
• Katie Brown (Equally Safe Policy Coordinator, CoSLA)
• DCS Samantha McCluskey (Police Scotland)
• Louise Wilson (Director of Public Health, NHS Orkney)
• Karen Ritchie (Deputy Director of Evidence, Healthcare Improvement Scotland)
• Gary Jenkins (Chair of the Police Care Network, State Hospital GG&C)
• Chloe Poole (Deputy Unit Head, CMO Taskforce Unit, SG)
• Susie Buchanan (Director, NHS National Services Scotland)
• Anne Neilson (Director of Public Protection, NHS Lothian)
• Jamie Lipton (Policy Division, COPFS)
• Helen Haworth (Head of Biology, SPA)

Items and actions

• agenda

• minutes

Agenda

1. Welcome and introductions: Chair – Greig Chalmers (GC)
2. Minutes of previous meeting and Actions Log: GC
3. Matters arising: GC
4. Sub Group updates: GC plus Subgroup Chairs
5. Agreed actions / next steps: GC/ Wendy Copeland (WC)
6. AOB: GC
7. Date of next meeting: GC

Minutes

Welcome, introductions and apologies

Greig Chalmers (GC) welcomed members to the Eighteenth meeting of the Taskforce.

GC explained to the group that Dr Gregor Smith, Chief Medical Officer, was unable to attend the meeting and introduced himself to the group.

GC informed members that Tansy Main (TM), Head of the CMO Taskforce Unit had returned to work on a part-time basis. Vicky Carmichael (VC) would remain in her role as CMO Taskforce Interim Unit Head.

GC acknowledged the recent Scottish Election and explained that the Taskforce Unit had engaged with the new Cabinet Secretary for Health and Social Care, Humza Yousaf, on the CMO Taskforce work.

GC welcomed members that were attending the meeting for the first time:

• Colette Mackenzie
• Safia Qureshi
• Helen Haworth
• Nighean Stevenson
• Sian Tucker
• Vicky Norris
• Emma Kennedy

Carol Rogers (CR) informed GC that Helen Haworth (HH) had passed on her late apologies for this meeting.

GC also welcomed Wendy Copeland (WC) who had join the Taskforce Unit as Self-Referral Policy and Project Manager. GC explained that WC would continue as Chair of the Access to Services Task & Finish Group.

GC passed on his thanks to Karen Ritchie (KR) for all her hard work and dedication to the Taskforce.

GC congratulated Katie Cosgrove (KC) on her retirement and thanked her for her significant contribution to the Taskforce’s work.

GC asked all members to briefly introduce themselves to the group.

GC noted the apologies listed above.

Minutes of the previous meeting and actions log

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

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

Matters arising

GC asked members to note the Matters Arising paper (paper three).

Survivor Reference Group

GC asked Sandy Brindley (SB) to provide an update to the group.

SB explained that Rape Crisis Scotland (RCS) support the work of the Survivor Reference Group (SRG) whose view was that the Self-Referral retention period should be for a minimum of 5 years.

SB added that it would be useful to understand how many of the responses to the consultation were from survivors.

GC thanked SB and noted that hearing from those with lived experience was essential.

GC then suggested that agenda item 5.2 would come ahead of 5.1 to allow Carole Robinson (CRo) to provide a breakdown on the consultation.

Action: SB to share information about a roundtable taking place later this summer, on access to complainers' medical records as part of criminal proceedings once a date had been agreed.

Subgroup updates

Legislation

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

GC invited CRo to provide an update on the Legislation Subgroup.

CRo explained that there had been a good response to the retention period consultation with 63 responses received in total.

Of the 63 responses; 33 had been from organisations and the other 30 from individuals. Organisational responses had been received from a range of sectors including health, justice, education, equality groups and victims organisations.  CRo added that the analysis of responses to the consultation was ongoing.

CRo advised that the Legislation Subgroup had targeted key stakeholders and had publicised the consultation via the Scottish Government’s victims organisations monthly  forum and via a blog produced for Victims Awareness Week.

In response to SB’s earlier point CRo explained it was difficult to determine whether a response had come from a survivor unless that was specified in the response.  A consultation  analysis report would be published in due course although it would not specify whether respondents were survivors.

CRo added that the RAG report (Paper 9) detailed the work that was ongoing in the lead up to commencement of the FMS Act.

SB thanked CRo and added that it would be helpful for the views of survivors to be taken into account when analysing the responses.

GC thanked SB and added that the retention period regulations would be subject to  affirmative procedure. CRo explained that this meant that this piece of secondary legislation would be subject to greater scrutiny and there would be a Ministerial appearance in the Scottish Parliament.

CRo stressed she was aware how important this subject is and explained that the team were taking an informed, sensitive approach throughout.

Delivery and performance

GC noted that there were no open actions under the Delivery & Performance Subgroup and invited Mark Burgess (MB) to provide an update on the below papers.

• RAG Report (paper four)
• Stocktake Summary Paper (paper five)
• Stocktake Report (paper six)
• Taskforce Risk Register Summary Paper (paper seven)
• Taskforce Risk Register (paper eight)

MB explained that the Delivery & Performance Subgroup was continuing to monitor service improvements against the Local Improvement Plans, Healthcare Improvement Scotland (HIS) standards and the HIS quality indicators, while working with HIS and Public Health Scotland (PHS) on a long term performance management framework.

MB added that performance management was undertaken using the interim performance management framework, which included quarterly performance review meetings which  took place between Taskforce and territorial health board colleagues.

MB noted that all health boards had returned their Q1-Q4 performance update reports and the resultant summary reports had been prepared at both board and regional level. It was noted that these had now been issued by Colin Sloey (CS).

MB explained that significant progress had been made so far and while there were still areas outstanding, these were due to be addressed within the next nine months. 

MB added that the Environmental Monitoring (EM) Short Life Working Group was in the process of finalising the EM Regime which would accompany and underpin the DNA Decontamination Protocol that was signed off by the Lord Advocate in 2019.

An EM video filmed at NHS Forth Valley, the Meadows facility, would assist health boards in undertaking the end to end process. EM checking had been arranged with board nominated leads and would commence once the Standard Operating Procedure had been finalised by Scottish Police Authority (SPA) forensic services colleagues.

MB moved onto papers five and sixand explained that these were a summary of progress against the HMICS recommendations, the 5 Year Work Plan and the 10 CMO asks. It was noted that significant progress had been made and that health boards continued to make improvements against the HIS quality indicators as well as strong compliance with the DNA Decontamination Protocol.

MB gave a brief synopsis of each area detailed on the Stocktake Summary Paper (paper five) and Stocktake Report (Paper six).

MB moved onto the Taskforce Risk Register papers (paper seven and eight) and explained that there were five archived risks:

TDP-1 the National Preferred Model would not be consistently implemented in all health board areas due to variations in delivery schedules set out within Local Improvement Plans. This could potentially be seen by stakeholders as maintaining a “post code lottery” approach not in keeping with Taskforce objectives.

TDP-5 The service improvements delivered with support from SG ring-fenced funding through to the end of fiscal year 2020-21 would not be sustained due to financial pressures within health boards. This would result in diminution of service quality and lead to inconsistency in service quality across the country.

TDP-6  Workforce Development Plans would not deliver the numbers of skilled and competent staff or gender balance required to deliver services that meet HIS standards and HMICS recommendations because there were either insufficient training places or lower than necessary uptake. This would compromise performance against HIS standards.

TDP-7 There was a risk that there would be evidence of cross contamination in FME suites due to failure of health boards to fully implement the agreed Decontamination Protocol. This would potentially compromise court cases.

TDP-9 There was a risk that the COVID-19 pandemic would reduce the capacity and capability of health board teams to deliver on agreed actions set out in LIPs due to redeployment of key staff in to alternative frontline services. This could result in a delay to the achievement of HIS standards.

MB added that there were two new risks:

TDP-13 Delays in delivering the SARC premises in NHS Borders would impact on its capacity to deliver forensic medical examinations in its health board area. This would result in people having to travel to NHS Lothian for this service. When self-referral is implemented in accordance with the FMS Act 2021, NHS Borders would not be able to meet the requirements of the Act.

FMS-ITR-14 the Data Protection Impact Assessment (DPIA) for the FMS IT System was not finalised and signed off by all health boards because all of the identified remedial actions are not yet completed. *Note the DPIA is designed to identify risks and to mitigate these prior to health boards processing data.

MB asked members to note the amendments to risks TDP-10, TDP-11 and TDP-12.

GC thanked MB for this update and asked members for their thoughts on the commencement date.

Sybil Canavan (SC) commented that having a date was useful so that there was a something to work towards although work would continue past this date to tackle the longer term workforce planning.

Eddie Doyle (ED) noted that cautious optimism was needed and highlighted that the risk in regards to the NHS Borders facility seemed to be becoming unmanageable.

Vicky Carmichael (VC) responded that work is ongoing to tackle the NHS Borders facility and the CMO had been in touch with the NHS Borders Chief Executive to progress the work.

Tricia Marwick (TrM) asked if a representative of the CMO Taskforce would be able to attend the NHS Board Chairs meeting to provide an updates on the legislation to Chairs. TrM added that she welcomed the proposed commencement date.

vC responded to TrM that she and Colin Sloey had previously been in attendance at NHS Board Chairs and Chief Executives and would be happy to attend in the future. VC added that the CMO would shortly be writing to NHS Board Chairs and Chief Executives in relation to the commencement date.

SB said there had been a significant improvement over the previous year in survivor feedback in regards to the forensic examination experience. SB added the level of improvement had been remarkable and this indicated the progress made by the Taskforce. SB noted there was work still to be done to guarantee survivor access to a female examiner.

GC thanked SB for this feedback and passed on his thanks to members for their work.

Action: Vicky / Colin to meet with NHS CEO and Chairs to provide an update on the work of the CMO Taskforce and the Act.

Workforce and training

GC explained there were four open actions for the Workforce and Training Subgroup. He also asked members to note the Workforce RAG report (Paper 10).

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

Katie Cosgrove (KC) to bring a revised proposal for the Community Pharmacy Test of Change (ToC) with COVID-19 implications to the next Taskforce meeting.

Lucy Dexter (LD) to provide a detailed update to members at the next Taskforce meeting on the proposed Justice System Training Short Life Working Group.

LD to update members in due course on the Training Framework and how it would aim to progress work around the recruitment and retention of Sexual Offence Examiners.

MB explained that the CMO/ CNO letter was still being finalised before going through the internal clearing process.

GC invited Sybil Canavan (SC) to provide an update on the work of the Workforce & Training Subgroup.

SC outlined the work captured in the RAG report (Paper 10) and explained that the Nurse Sexual Offence Examiner Test of Change (SOE ToC) had been significantly impacted by COVID-19 and would considerably extend the ToC.

SC explained that the Training Framework SBAR (Paper 11) and the revised Community Pharmacy ToC (Paper 12) required approval from members.

LD provided an update on the Justice System Training Short Life Working Group (SLWG). LD explained that the SLWG would not be taken forward. After engaging with justice sector stakeholders it was agreed that awareness raising within the justice sector would be undertaken as part of the wider communication strategy in the lead up to commencement of the FMS Act.

GC invited KC to provide an update on the revised Community Pharmacy ToC Proposal (Paper 12).

KC explained that due to COVID-19 the previous proposal was no longer viable. The intention of the revised proposal was to take into account the changes that had occurred due to COVID-19 and widen the scope of the ToC to include domestic violence and look at how the pharmacist role can be utilised as a first disclosure.

KC explained there had been some acknowledgement from some community pharmacies of their role in this process although this was not an across the board response.

KC explained the ToC would take a more systematic approach to upskill/ empower pharmacists to take a more proactive stance when having initial conversations with customers.

KC explained that due to COVID-19, online training was being considered and while this can provide benefits in terms of attendance, it does make it more difficult to understand how the training was received.

KC added that there had been positive engagements with many pharmacists across the country such as Boots. This hadn’t happened with the initial proposal.

GC thanked KC and highlighted the support of Alison Strath, Chief Pharmaceutical Officer on this work. GC asked if members were content to approve the revised Community Pharmacy ToC (Paper 12). Members approved.

SC spoke to the Training Framework SBAR (Paper 11). The SBAR highlighted the challenges around recruitment of SOEs and detailed strategies that could be used to effectively attract more SOEs to the service.

SC asked members for their approval for work to progress on the short, medium & long term options that were detailed in the SBAR.

Sian Tucker (ST) commented that GPs were being targeted by many sections of healthcare work and noted that the GP workforce was limited.

ST suggested that contact was made with the Royal College of GPs about how the health service could work together to address staffing issues.

GC thanked ST and asked MH to provide an update on the ability for SOEs to provide evidence remotely.

MH explained that a working group had been set up by the Scottish Courts and Tribunals Service to consider how evidence could be given remotely by professionals and what would need to be put in place to make that happen.

Carole Rogers (CR) explained that the SPA had been involved in a pilot as part of this work. CR added there was a definite appetite to progress this work.

GC asked members if they were content to approve the Training Framework SBAR (Paper 12). Members approved.

Action: Taskforce Unit to link in with the Royal College of GPs to discuss how resources could be utilised to address resourcing issues.

Self-Referral

GC noted there were no open actions for the Self-Referral Subgroup and highlighted the RAG report (Paper 13) and National Telephony Service paper (Late Paper) were for noting.

LD detailed the content of the RAG Report (Paper 13) and explained that they were in the final stages in the development of the National Protocol following the comments received at the previous Taskforce meeting.

LD explained that there were a number of points that were in the process of being finalised before the National Protocol could be brought to the Taskforce for approval.

LD advised that work had begun with NES to develop training for the self-referral process which would be delivered through a “train the trainer” approach.

LD shared that work was ongoing with NHS Inform and Scottish Government colleagues on the National Campaign for awareness raising and that it had been decided that this would be a tier 2 campaign.

LD explained that a health board Readiness Assessment had been developed to ensure that health boards were ready for the commencement of self-referral. A dashboard had also been developed to contain all health board’s responses which would be shared with the Self-Referral Subgroup. LD added that there was work required nationally to ensure that the Information Governance process was in place.

LD moved on to the National Telephony Service paper (Late Paper). LD explained that work had been ongoing through the Access to Services Task & Finish Group to progress the work on the scope and specification of the national single point of contact which would be provided by NHS 24.

LD explained that the national awareness raising campaign would point people in the direction of the national telephony service. LD added that the specification of the service had been outlined in the document and highlighted the minimum requirements which were:

• The service was accessible 24/7, 365 days per year across Scotland
• The contact number was clear and advertised as a stand-alone service
• Calls were answered quickly with an automated message feature
• Call responders were appropriately trauma trained
• There was a smooth electronic handover from NHS 24 to the health board
• The local SARCS were able to contact the person at an appropriate time to triage their needs
• The service was to be trusted and reliable

LD also explained that call handler requirements had been identified which were:

The ability to undertake a basic triage when the person first calls, to assess their safety and clinical needs.

The ability to establish basic contact details for follow up.

The ability to understand when the incident happened so that the next steps could be assessed.

The understanding of location of the person to decide which SARCS was best placed to follow up.

The understanding of when the SARCS would call back to follow up.

To provide a trauma-informed and person centred response and be able to respond to the detailed information that may be provided by the person.

LD added that the Task & Finish Group had outlined Psychological Wellbeing Practitioners (PCPs) as the most appropriate people to handle the service within NHS 24.

LD explained that there would always be one person available to take calls.

LD requested approval from the Taskforce for the Access to Services Group to proceed with this work.

GC thanked LD and JG for the progress on the work of the subgroup.

Iona Colvin (IC) questioned what the interface was for child and adult protection as this would be useful to provide an understanding on how to deal with calls that were suspected to be from those under 16 years old.

LD responded that discussions had been ongoing with NHS 24 on this topic and they were aware of the need to ensure PWPs were appropriately trained to deal with those situations.

IC thanked LD and emphasised the need for clear pathways between NHS 24 and other authorities involved. IC recognised that professional judgement would be required although this would be more challenging over the phone rather than face-to-face.

ED added that these principles would be familiar to NHS 24 through their other services and call handlers would be trained on Child Protection procedures.

Fil Capaldi (FC) echoed IC’s point regarding the assessment of risk, and that this would be more challenging to do so over the phone.

GC asked members for their approval on the Late Paper. Members approved.

Quality improvement

GC noted that there was one open action under the Quality Improvement Subgroup and that the RAG Report (Paper 14) was for noting.

Subgroup Chairs to take time to have introductory talks with new QI Chair.

GC asked Colette Mackenzie (CM) to provide an update on the work of the Quality Improvement Subgroup.

CM confirmed that the action could now be closed as she had met with all the Subgroup Chairs ahead of the Taskforce meeting.

CM detailed the content of the RAG report. A number of concerns were raised in relation to the Data Protection Impact Assessment on audit; granularity; ongoing system governance and data minimisation. These concerns had been discussed with colleagues and were being worked through.

CM asked for members’ views on working towards a single go-live date for the IT system, rather than the original Phase 1 and Phase 2 plans, as a result of the confirmed commencement date. CM agreed to work with VC and CS offline on what that timescale would look like.

CM added that there had been discussions with LD and the Self-Referral Subgroup in regards to the data protection and data privacy systems issues that had been experienced to ensure nothing was missed in hand over points during the self-referral process.

GC thanked CM for this update.

VC explained that there had been discussions with CM and the Taskforce’s preference would be for a single go-live date. However, there was still some detail to be worked through. VC echoed CM’s comments on the importance of linking in with the national telephony service work.

Clinical Pathways

GC noted that there were no open actions from this subgroup and invited ED to provide an update on the RAG Report (paper 15).

ED explained that the Clinical Pathways Subgroup had been waiting for developments in other policy areas so that the effect on the Adult and Children & Young People (CYP) Pathways could be assessed.

ED added that the Children & Young People Expert Group (CYPEG) had restarted to assess the impact that the revised Child Protection Guidance, Barnahus, United Nations Convention for Rights of the Child (UNCRC) Bill, Getting it Right for Every Child (GIRFEC), The Promise and the Self-referral Protocol would have on the Children and Young People Pathway. Timescales for these issues were currently being assessed.

ED noted that the CYPEG were meeting later that week to discuss how best to handle the sensitivities around the 16/17 year old age group.

ED explained that due to the commencement date, the revision of the pathways would be completed towards the end of 2021 rather than early autumn 2021 as originally planned.

ED explained that he and Chloe Poole (CP) were meeting with Regional Planners shortly to discuss how the work to implement a nationwide Children and Families Support Worker post could progress.

ED noted that Vicky Norris (VN) had joined the team to lead on the revision of the pathways and assist in other areas of the work.

GC thanked ED for the update.

Agreed actions / next steps

GC asked WC to review the agreed actions from the meeting as noted above.

AOB

GC asked for any other business.

MB noted that he had attended the Equally Safe Multi Agency Steering Group meeting.  Transfer of premises from the City of Edinburgh Council to NHS Lothian, which would pave the way for capital work on the ESMAC facility, was continuing at pace. The planned opening date for the facility is now the first quarter of 2022.

TrM passed on her thanks to the Taskforce for all the work that that had been progressed as well as her congratulations on the passing of the FMS Bill.

Dates of next meeting

GC asked members for approval to reschedule the next meeting of the Taskforce, originally scheduled for August, until September. The following two meetings would subsequently require to be pushed back. Members approved.

GC explained that the Taskforce Unit would be in touch with new meeting dates.

GC thanked members and closed the meeting.