Rape and sexual assault victims services taskforce: minutes April 2017

Attendees and apologies

In attendance

• Catherine Calderwood, chief medical officer
• Saira Kapasi, VAW Justice Lead
• Katie Cosgrove, Gender Based Violence Programme, NHS Scotland
• Sandy Brindley, National Co-Ordinator Rape Crisis Scotland
• Ria Phillips, VAW Justice SG
• Karen Auchincloss, Criminal Justice Reform
• Lesley Boal, Head of Public Protection Police Scotland
• Katherine Hudson, Child protection team
• Pauline McGough, Clinical Director, Sandyford for Sexual Health Advice
• Fiona Wardell, Healthcare Improvement Scotland
• Dr Kate McKay, Senior Medical Officer to Children and Families Directorate
• Lindsay Thomson, Medical Director of the State Hospitals Board for Scotland
• Mark Johnstone, Head of Business Unit – Chief Medical Officer for Scotland
• Gill Imrey, HMICS
• Tom Nelson, Director of Forensic Services, Scottish Police Authority
• George Laird, Manager West of Scotland Sexual Health MCN & Child Protection MCN
• Fiona Murphy, Director of National Services Division, National Service Scotland & Network Board Rep
• Elizabeth Ireland, Chair of NHS National Services Scotland – representing NHS Chairs Group
• Iain Logan, Crown Office and Procurator Fiscal Service
• Charlotte Kirk, Consultant Paediatrician
• Jane O’Donnell, Chief Officer for Education, Children and Young People CoSLA
• Iona Colvin, Chief Social Work Adviser
• Dr Mini Mishr, Senior Medical Officer

Apologies

• Karen Ritchie, Healthcare Improvement Scotland

Due to a failure with the teleconference facilities the follow members were unable to dial in to the meeting:

• Hong Tan, NHS England
• Louise Wilson, Director for Public Health NHS Orkney
• Elaine Mead, Chief Executive NHS Highland
• Ronald MacVicar, NHS Education Scotland

Items and actions

Welcome and introductions.

CMO set our her vision for the group. She was clear that radical change to how these services are provided is needed along with more collaborative working between Health and Justice and strong leadership from all partners involved in the process.

Introductions from members of the group were provided,

Action: CMO requested that members submit brief biographies (to be annexed to these agreed minutes).

Rape Crisis View

Sandy Brindley, National Co-Ordinator, Rape Crisis Scotland set out the position on feedback from rape and sexual assault survivors across Scotland on the forensic examination process. It is clear that a significant difference could be made by taking practical steps to improve how these services are arranged.

In general, the feedback provided be survivors is very poor. Some of the issues raised include:

• Lack of availability of female doctors, being examined directly after rape by a male doctor, where the perpetrator is likely to have been male is intrinsically difficult. A recommendation about separating out forensics and custody is needed.
• Concerns about attitude of medical professionals – could do more in terms of trauma informed approach
• Lack of follow-up – even most basic advice about emergency contraception and sexual health follow up is not being provided. Need to do much more to co-ordinate services for victims.
• Travel times, distances and amount of time people have to wait for examination to take place. Issues are particularly acute in rural and island locations. Having to travel to mainland for examination really jeopardises anonymity in rural areas. We need to consider how far we expect someone to travel in these circumstances and how we can develop services which are capable of being delivered locally. We need a system which puts survivors needs right at the centre.

RCS welcomes the CMO-led taskforce, it has the potential to make a big change. Important to link with the work on Evidence and Procedure Review. If looking at new facilities makes sense to tie it up with relevant developments elsewhere.

Opening Remarks Cabinet Secretary for Justice, Michael Matheson MSP

The Cabinet Secretary for Justice gave his thoughts on the need for a radical overhaul of the existing system, explaining that it’s not about tinkering with existing arrangements but fundamentally transforming the services delivered to women who are victims of these crimes. He wants to see a move to a victim centred-approach. The HMICS demonstrates in detail, the problems that exist in system.

This is the opportunity to start at beginning and develop a service which is victim centred and trauma focused and maintains the necessary evidential standards for prosecution. Key component to delivering this is an effective healthcare response and its down to the decision makers round the table to lead on taking forward work to make sure they can deliver for women and men who need to use these services.

Gill Imrey – HM Inspector of Constabulary in Scotland – reflections on Research

Gill Imrey, Assistant HM Inspector of Constabulary in Scotland spoke to the content of the HMICS report, noting that she had been impressed by the level of commitment expressed across all the services to improve the experiences of victims but that there are still inconsistencies across Scotland in how the services are delivered.

Ms Imrey gave her views on priorities for the group:

• Strategic leadership. There was a need for robust ownership and that ownership sits with health leaders. Common feature of all findings in HMICS is the lack of ownership and too often the issue is seen as a criminal justice issue.
• Location. Intimate examinations must not take place in a police building. There are good examples where there has been the will but this is not the case throughout the country.
• Gender. The Crown should give consideration to an expanded role for forensic nurses.
• Delay. Waiting long periods of time for forensic examinations, compounds the stress for victims
• Management of Forensic Services. There are examples of good practice but current governance is patchy. If governance of Forensic Medical Examiners could be clarified to make the service easier to manage.

CMO invited Ms Imrey to attend future meetings of the group, so she could continue to share her insight.

Initial Updates on Existing Landscapes

NHS Education Scotland – Survey of Doctors Ronald MacVicar

Mr MacVicar was unable to attend the meeting and will be invited to provide an update to the group at a future meeting.

Saira Kapasi provided an update on work the Scottish Government is doing in partnership with NHS Education Scotland to understand why the numbers of female doctors performing forensic examinations is low. Reference was made to paragraph 93 of HMICS report which states there are only 19 female doctors in Scotland providing FEs for victims of sexual assault. A survey of doctors issued in February to understand what barriers may exist to doctors enrolling on or accessing the relevant training. Scottish Government is continuing discussions with NES about making training more accessible for interested doctors.

Crown Office & Procurator Fiscal Service – Sexual Offences Expert Advisory Group Ian Logan

The Sexual Offences Expert Advisory Group meets every 6 months and is made up senior members of COPFS and representatives from Police Scotland, Scottish Children’s Reporter Administration, Scottish Police Authority, Archway, Children 1st, NHS, Rape Crisis Scotland and Scottish Government.

This is a unique group in COPFS which provides an opportunity for stakeholders and partners to raise strategic or specific operational issues regarding sexual offences. The next meeting of the group is 27 April 2017.

Forensic issues discussed at the group, reflect quite broadly a lot of the issues raised today. Forensic nurses, review of Archway service, HMICS review and also specific provision of forensic services around the country.

Action: CMO asked if a paper could be offered by COPFS which set out what discussion had taken place on the use of forensic nurses so that the Taskforce could consider solutions.

Healthcare Improvement Scotland (HIS) - National Standards - Fiona Wardell

HIS have responsibility for developing healthcare standards and indicators

The new standards will be developed around the National Health and social care standards which promote dignity and respect, compassion and also well-being, ensuring that the patient is at the centre.

Ms Wardell set out the timescale for the work

• 1st development group meeting for new standards in early June, when a cahir will be appointed
• Consultation period of 6-7 weeks. Go to people delivering services but also those who have experience of using.
• October meeting to develop evidence based standards
• Commitment to publish standards on 22nd December.

Ms Wardell undertook to provide a progress report to the group.

CMO set out her expectations for the standards and the importance of a well-informed consultation to ensure the standards are implementable. Important that HIS make contact with the Forensic Clinical Network Board (which has already been done) to draw on their experience in relation to the minimum standards and the lack of prioritisation by the system of those standards. CMO queried whether KPIs will be developed as part of this work.

Ms Wardell indicated that they could be but that the challenge will be around data sources and reliability of data sources. Number of challenges need to be mindful and how that work can be progressed in parallel.

CMO indicated that she would like to future proof the standards, be aspirational and plan for when we have data in place. Would like to see hard measure KPI that also records victims’ experiences. Accept that KPIs might be developed which can’t be met at the moment because of data collection.

Network Board – update - Fiona Murphy - National Services Division, National Service Scotland

Copies of presentation slides were provided by Ms Murphy and are attached to these Minutes.

The Network Board was set up in 2013 to support transfer of responsibilities for forensic examination services for accused persons in custody and victims of sexual assault, from police to NHS.

Responsibility for delivery of the service is down to NHS boards but there seems to be a lack of clarity across some health boards that it has happened. Network role to remind everyone that has happened. Far more success around healthcare in police custody have been achieved but same success has not happened in forensic service. There is a change in thinking that service required for victims of sexual assault is a healthcare service which includes the forensic aspect. But there is scope to move that thinking on further and the timing is right to make radical change.

Challenges faced by the Board in moving work forward have included:

• Lack of clarity around transfer of responsibility
• Challenges with workforce
• Lack of finances.

There has been progress on a number of issues:

• IT and data and Adastra.
• Good work on victim experience –rape crisis victim feedback process
• Building in of local audit and quality improvement in some services.
• Guidance on sampling, forensic kits, medical examination, capital equipment.
• Education and training.

CMO – Emphasised that it was important to maintain the pace on progressing this work and understood that there was a lot of work that had been done and was ready to be delivered eg. on sampling kits and colposcopes. These are basic things but could bring huge benefits to victims.

Elizabeth Ireland – Noted her disappointment that accountability and governance has been variable. This is the sort of co-ordinated response that we should all know what we are doing. If we get this rights in the first minutes, hours, and days and then it will help. Authorising mandate needs to be put Chairs.

Action: CMO requested that Ms Murphy, in conjunction with the Network Board, provide a note for the Task Force about what work has already be done. It is for the Task Force to ensure that the products of the network board is being picked up.

Standards of Service Provision and Quality Indicators for Paediatric medical component of child protection services - George Laird

Mr Laird presented to the group on the development of standards for service provision of child protection medical services. Copies of the presentation slides were shared with the group and attached to these Minutes.

Matters covered in the Standards include:

• Onward support
• Data
• Consent
• Provision of advice by paediatricians

The standards have now been distributed out to Health boards. A number of boards are looking to do a baseline assessment of their services. Indicators have been set to use for measurement and an audit and evidence guide has been developed. An annual return of evidence is expected, which is important to reinforce the culture of quality improvement and review.

Child protection standards workshops are planned. Mr Laird also noted that similar challenges were faced around availability of female medical examiners.

Ms Wardell queried how the child protection standards would sit alongside the new National Standards for forensic examinations for victims of sexual assault. Mr Laird indicated that there shouldn’t be any clashes between the two sets of standards and it was important to note that the child protection standards will be much wider and are not restricted to forensic examinations.

CMO noted that it was important that the two sets of standards looked like each other.

Ms Ireland highlighted the importance of workforce planning and training development will be required to make sure future services are sustainable.

CMO asked about the position of young adults in both sets of standards and the importance of ensuring need to make sure there are no gaps. Important that work on the new national standards and child protection standards are joined up to ensure that the 16-18 group is covered.

Decisions on Sub-Groups

CMO indicated that the following sub-groups should be set up to examine the issues. These are:

1. WORKFORCE – To include consideration of the NES Survey, education and training issues, work with GMC on sub-speciality of forensic physicians. Consideration of medical workforce, nurse workforce and workforce required in other parts of NHS.

2. REGIONAL DELIVERY OF SERVICES. Services need local ownership but perhaps organised on regional basis. This will be big group requiring real traction get to the nub of how services can best be designed to deliver for victims. It is open to consider the services being delivered differently in different parts of the country - what is appropriate for Glasgow may not be appropriate for rural areas as long as standards met and core services delivered.

3. CLINICAL PATHWAYS - Include consideration of standards and clinical referral.

4. QUALITY IMPROVEMENT – Audit and monitoring of service, using quality indicators

5. PREMISES AND INFRASTRUCTURE - This will include consideration of IT, Specialist cleaning services, equipment and how a transformed service fits with other changes, such as the use of pre-recorded evidence etc.

Ms McKay highlighted the importance of the involvement of victims in the work of the Task Force. CMO indicated that there would be a role for victim representation on the Task Force and suggested that a further group representing victims which would help the task force to co-ordinate work.

Ms Cosgrove raised the issue of cost asking whether it was for the task force to come up with costed proposals. Noting that the lack of a holistic approach in many parts of Scotland meant that it would likely involve significant costs to move to that model. CMO highlighted the need to be realistic about proposals and provide a costing for models.

Ms Ireland pointed to the importance of shared learning from the Network Board. Important to be clear on the remit of the groups and assurances that what they are doing will be different to what has come before.

Ms Boal, highlighted a particular issue in Edinburgh on the availability of forensic examination suites which required an urgent response.

Action: Scottish Government officials to follow up this issue directly with Ms Boal.

Names of proposed chairs were put forward by the CMO.

Action: Chairs were asked to establish membership and to set priorities for the group. Sub groups to have met before next meeting of the Task Force on 13 June.

Sub-group	Chair Name	Chair Title
Workforce	Elaine Meade	Chief Executive NHS Highland
Regional Service Design	Elizabeth Ireland	Chair of NHS National Services Scotland
Clinical pathways	Pauline McGough	Clinical Director, Sandyford for Sexual Health Advice
Quality Improvement	Fiona Murphy	Director NSSD
Premises and Infrastructure	Tom Nelson	Scottish Police Authority

Action: Sandy Brindley of Rape Crisis Scotland was tasked to consider how third sector organisations can best be involved to ensure that victims have a voice throughout the process. e.g reference group

CMO asked all members to consider whether there may be groups or organisations who are not represented but should be. She also made a personal plea for members to seriously think about whether they are the right person for the group, if others may be better placed to attend, then nominations would be welcomed.

Next meeting of task-force will take place on 13th June.

Ms Kapasi gave notice of Parliamentary Statement on Forensic Examination for Victims of Sexual Assault, which will be made in the next couple of weeks.

Meeting concludes.