Rape and Sexual Assault‎ Victims Services Taskforce minutes: August 2018

Attendees and apologies

In attendance

• Dr Catherine Calderwood – Chief Medical Officer for Scotland, Scottish Government (Chair)
• Colin Sloey – National Co-ordinator
• Dr Mini Mishra – Senior Medical Officer, SG
• Kate Bell - Head of Service Change and Transformation, NHS Lanarkshire
• Judith Ainsley – Head of Child Protection, SG
• Jane Johnston – Professional Social Work Advisor, SG (for Iona Colvin, Chief Social Work Advisor)
• Karen Ritchie – Deputy Director of Evidence, Healthcare Improvement Scotland (HIS)
• Gill Imery – Her Majesty’s Chief Inspector of Constabulary in Scotland
• Detective Chief Superintendent Lesley Boal - Head of Public Protection, Police Scotland
• Dr Pauline McGough – Clinical Director and Consultant in Sexual and Reproductive Health, Sandyford Clinic
• Fiona Murphy – Director of National Services Division (NSD), NHS National Services Scotland
• Lucy Fergusson – Project Manager, NHS National Services Scotland
• Professor Lindsay Thomson – Medical Director of the State Hospitals Board for Scotland
• Anne Neilson – Director of Public Protection, NHS Lothian
• Sandy Brindley – Chief Executive, Rape Crisis Scotland
• Jamie Lipton – Senior Manager for Victims and Witnesses Policy, Crown Office and Procurator Fiscal Service
• Professor Elizabeth Ireland – Chair NHS National Services Scotland, representing NHS Chairs Group  
• Derek Scrimger – Head of Operations, SPA Forensic Services (standing in for Tom Nelson)
• Dr Mona Rahim – Consultant Paediatrician, Lead Clinician for Child Protection, NHS Ayrshire and Arran (standing in for Dr Kate McKay)
• Dr Edward Doyle – Senior Medical Adviser for Paediatrics, SG and Associate Medical Director for Women’s and Children’s Services, NHS Lothian
• Dr Kirsten Woolley – Scottish Clinical Leadership Fellow, SG/NES
• Dr Alexandra Rice – Scottish Clinical Leadership Fellow, SG/NES
• Jana Sweeney –Taskforce Policy Manager, SG

On tele/video-conference

• Dr Louise Wilson – Representing Directors of Public Health, NHS Orkney
• Prof Ronald MacVicar – Postgraduate Dean, North of Scotland Region of NHS Education for Scotland (NES)
• Boyd Peters - Assistant Medical Director, NHS Highland (representing the Scottish Association of Medical Directors (SAMD))

Items and actions

1. Introduction and apologies

Dr Catherine Calderwood (CC), welcomed everyone to the meetings and invited introduction. CC introduced Dr Edward Doyle who has joined the Scottish Government and a senior clinical advisor and will be support the work of the Taskforce. CC also informed the group that Sybil Cavanan, Head of People and Change at Glasgow City HSCP has agreed to chair the Workforce and Training Sub-group. CC also noted that Elaine Mead has left the Taskforce and thanked her for her contribution as chair of the Workforce and Training sub-group.

Apologies were noted from the following:

•    Elaine Mead – Chief Executive, NHS Highland
•    James Crichton – Chair of Network Board, NSD and Chief Executive of the State Hospitals Board for Scotland
•    Tom Nelson – Director of Forensic Services, SPA Forensic Services
•    Iona Colvin – Chief Social Work Adviser, SG
•    Dr Kate McKay – NHS GG&C
•    Sybil Canavan – Head of People and Change, Glasgow City Health and Social Care Partnership
•    Anil Gupta –  COSLA
•    Anne-Marie Hicks – Head of Victims and Witnesses Policy, COPFS
•    Tansy Main – Taskforce Lead, SG
•    Diane Dempster – Taskforce Secretariat, SG

2. Minutes of last meeting

Attendees agreed the minutes as a true record of the meeting held on 15 May 2018.

3. Action log – review

CC referred the Taskforce to the open actions and status reports in the action log. Elizabeth Ireland (EI) asked for Action 52 to be closed. Pauline McGough (PMG) asked for actions 51 and 85 to be closed.

4. Matters arising

National Co-ordinator

CC informed that Taskforce that Colin Sloey (CS) formally started his role as National Co-ordinator on 31 July.

CS updated that work has progressed since the last meeting, Nominated Leads are in place in every board and initial meetings have already taken place. CS has started to get returns on self-assessments and is looking towards receiving Gap Analyses in the coming weeks. These will inform SG’s position and will link in to engagement with Regional Directors of Planning.

CS will provide a written update on progress for the next meeting.

AP: Colin Sloey will provide a written update on self-assessment and gap analysis 

Network Board update

CC informed the Taskforce that Tansy Main provided an update to the Network on 5 July on activity across Taskforce subgroups.

HMICS update 

Gill Imery (GI) thanked the Taskforce for their response to the questionnaires which included sub-group leads, Managed Clinical Networks, Forensic Medical Examiners, Police Scotland, Regional Planning Directors, Children First and Rape Crisis Scotland. Louise Raphael is progressing this work, with the intention to publish after the parliament returns from Summer Recess.

GI noted that it had been challenging to engage with Forensic Physicians (FPs) themselves, HMICS had  only a dozen returns from FPs and would be grateful if anyone could chase that.

CS noted that the content of this report is important, with work still to be done to achieve the Taskforce’s goals. He also noted that a conversation about future quality monitoring and  auditing requirements will need to happen.

CC enquired if the follow-up report is a one-off or if there will be multiple reports? GI responded that it was a one-off, that auditing health services is more within the mandate of HIS and when quality indicators are in place it should HIS to follow up.

EI stated that any auditing should inspect and monitor the service but also keep an eye on outcomes for individuals.

CC said that a joint inspection is the preferable way going forward and asked Karen Ritchie (KR) if is it was possible to build this in to the indicators. KR informed the taskforce that the quality indicators group has has an initial meeting, the group is currently ranking draft indicators and that the indicators would include outcomes, not just process.

Dr Lindsay Thomson (LT) proposed that the group could look at a mutual system of inspection as the Forensic Network are on their second cycle of joint inspections. CS agreed and KR was asked to contact Jim Crichton (JC) to discuss links and learning from the Forensic Network.

AP: KR will contact JC and discuss link-up between the indicators and Forensic Network

Health and Justice Collaboration Board update (for noting)

CC updated the Taskforce on her presentation to the June 26 meeting of the Health and Justice Collaboration Improvement Board. CC’s presentation highlighted the main findings of the HMICS report and the five asks made of Chief Executives. The HJCB are eager to support the Taskforce, as a Board and, where appropriate, in their own organisations. They asked that the Taskforce to take barriers and challenges to them for high-level support.

CC also updated the Taskforce on the following points from the meeting:

1. The HJCB discussed improving users’ pathways to mental health services from the point of contact with public services and exploring how Police Scotland, NHS24 and the Scottish Ambulance Services can be more joined up in how they achieve that; and by considering how those national services can best work with health services in individual localities, such as A&Es and mental health services in individual NHS Boards and IJBs. They agreed to set up a sub-group to drive progress on this work.
2. The Board discussed how well their organisations share relevant information between them. It was noted that when information sharing works well, it can transform our workforces’ ability to deliver outcomes which are genuinely person-centred. But there is very mixed practice: different interpretations of data protection laws, a perception of risk that results in a culture of “no sharing” by default, differing advice from professional bodies, and so forth. They want to get to a stage where there is more agreement and more transparency about the data protection frameworks we all operate within. Users’ outcomes should not be inhibited by information sharing practices which fall short of what the law permits. They agreed to hold an event to explore this in greater detail with data protection champions, Caldicott Guardians, legal advice, the Information Commissioner, service providers and service users. CC will ensure that connections are made between this work and the Information Governance project which the Taskforce has commissioned NSS to take forward over the next six months.
3. Following on from their last update to the Taskforce, the Board again looked at the plans for 800 new Mental Health Workers. A letter has gone to IJBs and Health Boards to look at what they might need (responses due by end July).

Mini Mishra emphasised that the Information Governance work will support clinicians, colleagues and patients. Links will be made with other work being undertaken by Digital Health and Care and NSS (via their Medical Director).

LT advised that there is a multi-agency public protection agency, NHS is a key member of that and has Information Governance agreements which the group could look at that.

EI agreed and said that NSS are looking at this across the public sector for examples. The group will look at appropriate secure methods for sharing information, including through the SWAN network (secure). EI also informed the group that this linked in to service access, people will come into services in to a multiplicity of ways and information governance would need to look at that.

CC agreed and said she would to keep the board up to date and link in to on-going work. 

Research paper

CC noted that a final version of Yousaf Kanan’s research report has been agreed and has been published on the Taskforce’s webpage. CC thanked Yousaf for his time and dedication.

5. Options appraisal feedback

CC thanked Kate Bell, Tansy Main, Jana Sweeney, Susan Ferguson and Elizabeth Ireland for their invaluable work on pulling together the event and a report based on a rigorous and robust approach. CC also thanked the members of the Short Life Working Group for their advice and input throughout the process.

EI also gave thanks to SLWG, Kate, Jana and Tansy. A particular thanks went to George Laird for gathering feedback from MCNs. She noted that the options appraisal delivered a preferred option for service delivery and configuration in Scotland which was based on best practice. The recommended options were overwhelming supported by the attendees of the event. She also noted that further development would need to be undertaken when it came to Children’s Services. She also suggested that the name of the service e.g. Centre of Excellence, could be taken to the User Reference group for further development, Sandy Brindley (SB) agreed to take that forward.  

AP:  Sandy Brindley to bring back suggestion of the name of the service from the User Reference Group

Judith Ainsley (JA) asked how the group had come to agree  model that included adult, children and young people under one roof. Kate Bell (KB) then explained the Short Life Work Group process, which included representatives of Child Protection and MCNs and that these options were developed and agreed with subject matter experts.

JA then asked if there was an option to split out children. EI recognised that there is a gap around Children’s services and recommended that the Taskforce give more thought to these needs. KB also informed the taskforce that further detail on services will be coming out of the Planning and Implementation sub-group.

JA felt that the report was calling for a multi-agency centre that provides services for adults, children and young people and asked for more detail on that. JJ said that there had been a lot of debate in advance of the Options Appraisal meeting, and pointed to point 3.1.4 within the report which recommends a service rather than a centre. She also said that the Taskforce will be looking at Barnahus Principles and ensuring that these are incorporated in any new service. KB also said that social work were involved and represented on the day to ensure that their views were reflected in the final recommendation. SB also agreed that the model needed to ensure that any new model was not a roll-back in terms of the services for children. Currently there is a gap around therapeutic services for children. The issue will be in the implementation discussion to ensure that it is not a one size fits all.

Anne Neilson (AN) informed the group that St Kats model allow forensic services to be provided for children and adults. DCS Lesley Boal (LB) said that having looked into Barnahus, the new model was almost taking those principles and apply them to adults. There will be further discussion on service specification. The principles of Barnahus are key to the new model and multi-agency services and should be located as close as possible, with separate age-appropriate examinations spaces that allow for sharing of expertise and standards of care across all ages.

JJ stated that improvement has a key role in the new model and the national child protection leadership group, chaired by Ms Todd, could be helpful. Dr Edward Doyle (ED) agreed. CS said we could put together a facilitated discussion on children and asked for nominees to be sent to JS. CC agreed and said that the aim is to improve services for all ages and that services may be co-located but that is dependent on local facility availability and reviewing the progress of St Kats. KB agreed to amend the report with JA to ensure that point 3.1.4 is reflected earlier on in the document.

KB then informed the group that further work would need to be undertaken around the workforce to support the new model.

CS proposed that the group take the report to Chief Executives in November with a  compendium including their gap analysis, allowing them to develop plans to meet the new service standards. The Options Appraisal has provided a clarity of vision allowing work to be undertaken to deliver against the goal of providing person-centred and trauma-informed to survivors across Scotland. CS also said that the report would need the endorsement of expert groups that fed in to the work.

CC asked the group if they were happy to agree recommendation 3.1.1: “Approve and endorse the Options Appraisal Report as a true reflection of the process and acknowledge that the process and report fulfils the remit given to the SLWG by the Taskforce (May 2018)”. The Taskforce unanimously agreed.

EI informed that group that Option 4 on service delivery and Model D were clearly preferred. These are aspirational and based on best practise. She asked the taskforce if there are any major concerns that have yet to be identified? KB informed the group that sensitivity analysis has shown that these were the clearly preferred options across all groups.  

A discussion was then had around information for those who were less aware of the work. ED said that the report will go out with additional information to provide context to those who are less familiar with the work. CS agreed and said that a Comms Plan is under development and a covering letter will be provided with the report when it is circulated to stakeholders.

CC asked the group if they were happy to agree recommendation 3.1.2: “Discuss and approve the preferred option for service delivery and model for service configuration of sexual assault and rape healthcare services in Scotland”.

Karen Ritchie (KR) felt that the proposed model was not a hard choice to make on the day, there was no obvious downside. However thought it might be aspirational it is the most complex and most expensive. EI responded that the Taskforce needs to move to an operational mind-set. The new model has to be multi-agency and though it may be complex it is necessary. KB agreed that the Option 4 came out on top because it is person-centred, trauma-informed and holistic.

JA stated that some discomfort comes from the fact that additional work needs to be done to define the Barnahus model in Scotland. She felt any agreed model should not tie children and adult services to being under the same roof. CC responded that the remit of the taskforce was to look at services for all ages and the learning from Barnahus, through subject matter experts, has been included in to the new model. ED proposed that an extra sentence could be added to the report. Dr Mona Rahim (MR) agreed and said the wording of Option 4 could be changed to provide clarity.

GI stated that HMICS were support of the proposals and that it is key to ensure that services provide high-quality care to all ages.

PMG informed the group that the discussion around a centre were about a philosophical idea, colocation will depend on the geography. The group were not talking about a physical building. KB agreed and said that the report refers to a service not a building. PMG, EI and LT agreed that this could be clarified by replacing centre with service which would ensure that the holistic element of the service was clearer.

SB asked whether the document could say co-ordinated service?

CC agreed to amend Option 4 to saying co-ordinated service. She said the report would be re-drafted and circulated.

EI and KB agreed to meet with JA to update the report for circulation before Friday.

CC asked the group if they were happy to agree recommendation 3.1.3, “Note the requirement to carry out further work on a detail specification on the option and model as they relate to services delivery locally and regionally with respect to the number of centres of excellence (CoE) to be developed in Scotland”, and 3.1.5, “Establish a process to capture any views on what the service model should be named that captures the Taskforce vision for Scotland”?

The Taskforce agreed.

LB said on 3.1.4,  “Take on board the views shared at the options appraisal to explore in more detail how the options will meet in particular, the needs of children”, and 3.1.5 about delivery – if these are local and national centres of excellence and multi-agency, that has to be multi-agency discussion on service delivery and locality. Third sector organisations will also have to be involved. CS agreed.

CC summarised that there was approval of 3.1.1 was agreed; 3.1.2. will re-word the option 4; Planning and Implementation sub-group will be taking that work forward recommendations 3.1.3 and 3.1.4; and regarding 3.1.5, SB and the User Reference Group will be leading on the name.

CS asked that those wishing to be involved in 3.1.4 should submit their names to JS.

CC and EI again gave thanks to the work of KB and the SLWG.

AP: Taskforce members to submit their names to Jana Sweeney to take forward recommendation 3.1.4

6. Sub group updates

Design and delivery of services – Elizabeth Ireland

• The group noted the RAG report.
• EI formally closed the group and handed over on-going work to the Planning and Implementation sub-group.
• CC thanked EI, as chair, and her sub-group for their commitment and contribution to the taskforce.

Planning and Implementation – Colin Sloey

• The group noted the RAG report.
• CS updated the group on progress. All Boards have nominated leads and he has received some self-assessments and sent out a chaser for the rest. These will now be used to inform the gap analyses.
• CS will be reaching out to regional planning leads over the coming months. The group will also be looking start a resource plan, which will look at detail on capital and non-recurring resource funding. CS will be taking forward conversation with SG finance around additional levers when necessary.

Legislation and Governance

• The group noted the RAG report.
• MM provided an update on legislation. The Year 3 Parliamentary programme was signed off by the FM. There is work being undertaken to finalise the year, scope and resource needed for the bill. Intention is to legislate in this parliamentary term – the consultation document is being developed and then the following legislative steps can be progressed.

CC said that the group will be updated on the progress.

• EI proposed that the group needed a risk register. CS agreed to take that forward.

AP:  Risk Register to be set up by Vicky Carmichael 

Clinical pathways – Pauline McGough

• The group noted the RAG report.
• PMG said that the draft of the National Form and Adult Pathways had been circulated for comment. The C&YP pathway is still under development. The Clinical Pathways sub-group now has project support from Lucy Fergusson, from NSS. PMG will be meeting with Lucy Fergusson to take progress this work.
• EI asked if the guidelines are going to be available through an app or the internet. She also asked how the form will tie in to the IT system. PMG said she has met with Fiona Murphy (FM) to discuss how that might happen. These are interdependency but they will agree what the shared content will be.
• FM asked how quickly PMG wanted comments back on the form. The IT group are aware of the form and are thinking about an e-version whilst an IT platform is being scoped. Some questions around items that are on the form which were not suggested to be part of the national data set, e.g. particular questions around the gathering of sensitive data. PMG and FM will catch up on standard data definitions and what should be stored on the clinical record and national dataset.

AP:  PMG and FM to agree the data sets to be stored in clinical records only and those included in the national data collection

Quality Improvement – Fiona Murphy

• The group noted the RAG report.
• FM updated the taskforce on progress on the dataset and clinical IT system. Some questions have come from ISD about when data collection would begin. Some detail is available on page 2 of the highlight report. FM clarified that they would not be collecting data retrospectively. The group would be looking at numbers of individuals who do and do not want an examination. All reports would be made publicly available and data will be collected continuously in the long-run but in the short-term it might be on a fixed basis, potentially quarterly but this is still to be confirmed. The group will be consulting further on the format.

Workforce, training and terms and conditions – Elaine Mead

• The group noted the RAG report.
• Ronald MacVicar (RMV) welcomed Sybil Canavan as the new chair. He then updated the group on training and education. Two further iterations of the essential course planned in December ‘18 and March ’19. An annual update is planned for 2 November ’18, the new Cabinet Secretary, Ms Freeman, will be speaking at that event. NES are hoping to deliver an adapted version of the essential course for nurses in December '18. There will be common element to the pre-course material and first day for both doctors and nurses, with a bespoke second day for nurses. NES are currently undertaking polling around the nominated leads to get an idea of the uptake to estimate the costs of the course, but have only received one response so far. On supporting regional education, NES are attempting to define what is there at the moment and how best to support that work. They will also be working with Police Care Network to ensure there is no duplication around Police Custody Education.
• CS provided an update on the Forensic Nurse Examiner (FNE) Roundtable and said that the agreed next steps will be to set up a SLWG. RMV agreed to help support this work. AN asked if the group was linking in to Scottish Executive Nurse Directors (SEND), CS said that the SLWG would have a representative on the group from SEND.
• MM said that once SC is in place, the group will be looking at all relevant HR issues.
• CC thanked Jess Davidson and the RCN for pulling the Roundtable together. 

User Reference group – Sandy Brindley

SB said there was no update on the User Reference Group. She commended KB on the Options Appraisal report which had managed to capture the voice of survivors. She had also received positive feedback, on the podcast provided by them, at the event. 

COPFS – Jamie Lipton

• Jamie Lipton (JL) updated the group on two key pieces: Firstly, related to the FNE roundtable, he gave an input on the requirements of the Lord Advocate around FNE acting as expert witnesses in rape and sexual assault cases. He is currently awaiting a proposal on how to take that forward. Secondly, at the request of PMG COPFS are looking at the possibility of corroboration of an examination through colposcopes – they intend to issue a definitive statement soon.

AP: Statement on the use of colposcope to corroborate a forensic medical examination.

7. Communications Plan

JS updated the group on a draft communications plan. She asked for comments to be sent to her by 24 August.

8. Next steps

CS updated the group. He said that Options Appraisal is at the heart of the next steps, SG will be looking at the comms and output of that. He has also sent out a chaser on the self-assessment. Further work needs to be undertaken on performance reviews, he will link with HIS and HMICS on this. On workforce requirements, SG will be looking at skills and competency requirements for nurses undertaking forensic medical examination. This work will need the sign-off of the SG Director of Nursing and COPFS.

He will be part of the review of the governance structure of the Taskforce, following the agreed changes to the sub groups, including the supporting resource required.

He will provide progress report on the CMO’s “five Asks” from the Chief Executives of Health Boards (NHS CE), at the next meeting.

EI also said that work around point of entry will be key to on-going work.

AP: Colin Sloey to feedback on the CMO’s ‘5 Asks’ of the NHS CE.

9. Any Other Business

CC invited any other business and thanked members for their contribution.

10. Date of next meeting

CC update the group that the next meeting will be on Tuesday, 6 November 2018 – 14.00-16.30 – Conf Rms C,D,E, SAH

Rape and sexual assault victims services taskforce minutes: August 2018

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