Rape and sexual assault‎ victims services taskforce minutes: February 2018

Attendees and apologies

Taskforce members present

• Dr Catherine Calderwood – Chief Medical Officer for Scotland, Scottish Government (Chair)
• Dr Mini Mishra – Senior Medical Officer, SG
• Derek Scrimger – Scottish Police Authority (for Tom Nelson – Director of Forensic Services)
• Karen Ritchie – Deputy Director of Evidence, Healthcare Improvement Scotland (HIS)
• Dr Pauline McGough – Clinical Director and Consultant in Sexual and Reproductive Health, Sandyford Clinic
• James Crichton – Chair of Network Board, NSD and Chief Executive of the State Hospitals Board for Scotland
• Professor Lindsay Thomson – Medical Director of the State Hospitals Board for Scotland,
• Fiona Murphy – Director of National Services Division (NSD), NHS National Services Scotland
• Katie Cosgrove – Gender Based Violence Programme Lead, NHS Health Scotland
• Anne Marie Hicks – Head of Victims and Witnesses policy, COPFS
• Sandy Brindley – National Co-Ordinator, Rape Crisis Scotland
• Peter Croan – Programme Director, NSD
• Graham Milne – Programme Manager, NSD (for Elizabeth Ireland)
• Anne Neilson – Director of Public Protection, NHS Lothian
• Saira Kapasi – Head of VAWG Justice Unit, SG
• Jane Johnston - (for Iona Colvin, Chief Social Work Advisor)
• Tansy Main – Rape and Sexual Assault Taskforce Lead, SG
• Jana Sweeney – Rape and Sexual Assault Taskforce, 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)

  In attendance

• Louise Raphael – Associate Inspector, Her Majesty’s Inspectorate of Constabulary in Scotland (HMICS)
• Yousaf Kanan - SG social researcher

Items and actions

Welcome and apologies

1. Dr Catherine Calderwood (CC) welcomed everyone to the meeting and invited introductions. Apologies were noted from the following:

• Prof. Elizabeth Ireland – Chair NHS National Services Scotland, representing NHS Chairs Group
• Prof. Elaine Mead – Chief Executive, NHS Highland
• Tom Nelson (SPA) – Director of Forensic Services, Scottish Police Authority
• Dr Charlotte Kirk – Consultant Paediatrician, NHS Lothian
• Dr Kate McKay – Senior Medical Officer, Scottish Government
• Judith Ainsley – Head of Child Protection, Scottish Government
• DCI Lesley Boal – Head of Public Protection, Police Scotland
• Dr Boyd Peters – Assistant Medical Director, NHS Highland (representing the Scottish Association of Medical Directors (SAMD))
• Dr Hilary Ansell – Lead Forensic Physician, SEAT Healthcare and Forensic Medical Services
• Iona Colvin – Chief Social Work Advisor to SG
• John Wood – CoSLA

Minutes

2. The minutes of the meeting held on 7 November 2017 were agreed as a true record.

Action log

3. CC reviewed the action log.

001 – Biographies – so far, only 15 received. This will be looked at again when the Taskforce membership is reviewed prior to the next meeting. Action closed.
017 – Paediatric recording – Kate McKay to discuss with Fiona MacKenzie. Fiona Murphy advised that this has been addressed. Action closed.
024 – Barnahus. The Scottish Government are in the process of putting resources in place across justice, child protection and health to take forward work on Barnahus - in parallel to the work of the Taskforce. A further update will be provided in due course. Action will remain open.
026 – NHS Chief Executive responses. CC noted that a summary was circulated for noting and will be covered under item 4 (matters arising). CC added that she was extremely disappointed about the lack of progress in moving Forensic Medical Examinations (FMEs) out of police settings. On behalf of Chief Executives, Jim (JC) Crichton noted that availability of funding has been a barrier to progress. Action closed.
027 – Civic Centre visit. Members were invited to highlight any relevant issues to CMO. None were received. Action closed.

CC advised that her visit to the Civic Centre with Mr Matheson on 23 November 2017 had provided a valuable opportunity to walk through the victim experience and to have a good discussion with both NHS and Police Scotland staff about areas where this can be improved. CC thanked the staff for their support in facilitating this visit and noted that NHS and PS colleagues are working together to undertake remedial work to address some of the issues raised by the complaint which prompted the visit, including fixing the heating in the FME suites.

CC invited Anne Neilson (AN) to provide an update on progress with an additional FME suite in the Lothian’s to ease the pressure on the Civic Centre. AN advised that a site has been identified in Edinburgh as an interim measure and that the hope is to have that up and running within the next six months. AN noted that this work is being progressed in parallel to work on a new, multi-agency facility in Edinburgh.

031 – Broader engagement with children’s groups. Jane Johnstone (JJ) advised that she will speak to Iona Colvin and Jane Devine about this and will provide an update in writing. Action remains open. 039 – Members invited to contact Yousaf Kanan if they want to discuss his research project. CC advised that the Executive Summary has been circulated for noting. Action closed. 041 – Child protection interface with regional delivery model. As per action 31. Action remains open. 046 – HMICS follow up report. CC invited Louise Raphael (LR) to provide an update.

LR advised that HMICS has asked Police Scotland for an update on progress against delivery of the recommendations in the report and that this will inform other areas of inquiry, but that they don’t intend to re-visit all of work done for the March 2017 report. LR noted that she has an invitation to attend the Network Board meeting on 4 April and will speak to each of the Taskforce sub group chairs also. CC noted that health and justice partners need to work collaboratively to resolve any outstanding difficulties and asked for early sight of the timeline for the follow up report. Saira Kapasi (SK) queried whether the interim report had to go to Parliament. LR confirmed that she would check this. Action remains open.

Other outstanding actions to be covered under sub group chair updates and reflected in the action log.

4. Matters Arising

Terms of Reference

Draft Terms of Reference - for agreement.

CC advised that Diane Dempster (DD) had circulated a draft ToR for review after the last meeting for comment. None were received. The ToR was taken as agreed.

CC noted that proposals for a new governance structure for the Taskforce will be covered under item 6 and the ToR revised accordingly.

Health and Justice Collaboration Board Update

Update paper – for noting.

CC highlighted that one of the Scottish Government’s Mental Health strategy commitments is around increasing access to mental health professionals across GPs, A&Es, Police custody suites and prisons (800 additional MH professionals that will amount to an annual investment of £35m).

CC advised that Ministers have commissioned the HJCB to develop recommendations about what this commitment might look like in practice and that we have suggested that forensic medical examinations for rape and sexual assault would benefit from investment in this area. The board will next meet on 27 March and an update will be provided thereafter.

CC invited Lyndsay Thomson (LT) to comment. LT noted that investment in trauma recovery would be very positive.

Action: Update from the meeting of the Board on 27 March 2018

HIS Standards

CC advised that she and Mr Matheson went to the Rape Crisis Centre in Glasgow to launch the new HIS Standards which were published on 20 December. She noted that they both found it very helpful to have the opportunity to speak to helpline staff and volunteers whilst they were there. Sandy Brindley (SB) noted that the coverage in the media had been very positive.

CC thanked Fiona Wardle and the members of the project group, for delivering this key milestone.

Funding update

CC advised that on the same day the Cabinet Secretary for Justice announced over £2m in capital funding to the end of 2018/19 to help embed the new standards and improve services for victims of sexual crime, including forensic medical examination facilities. An early priority is to for Health Boards to ensure that FMEs are moved out of police settings and in to appropriate health and social care settings.

In line with Mr Matheson’s commitment, funding will be provided to Shetland and Orkney Health Boards to purchase a colposcope to help establish FME services on the islands.

CC noted that further work will be done with Health Boards to help prioritise the distribution of the remaining funding and that this will be informed by the proposed model of service delivery (to be presented under item 5).

CMO’s Letter to Chief Executives

Summary of responses – for noting.

CC advised that she had written to the Chief Executives on 2 November 2017 to ask for a short summary of the existing multi-agency arrangements in place to across the 5 broad areas in the HIS standards, including information about workforce and any immediate issues or concerns which may impact on their ability to deliver services that will meet the new HIS standards.

CC reiterated that she was disappointed that there hadn’t been as much movement as she would like to have seen.

Minute of meeting with Regional Planners on 22 January 2018

Minute – for noting.

CC advised that a meeting was held with the sub group chairs and regional planners on 22 January to discuss how we progress work to ‘operationalise’ the work of the Taskforce sub groups. This would be discussed further under Item 6.

There were no other matters arising.  

5. Sub group updates

Leadership and governance

(Scottish Government lead)

RAG status report for noting.

Mini Mishra (MM) advised that HMICS made 2 specific recommendations to the SG about the legal framework to deliver forensic medical services in Scotland. One relates to the MoU between PS and Health Boards requiring clarification and the other relates to self-referrals (where there is no police report).

MM advised that Justice officials, together with Health colleagues have provided advice to Scottish Ministers on options around these issues. A meeting with Ministers was scheduled prior to the Taskforce meeting but was postponed due to Parliamentary business. A meeting with the Cabinet Secretaries for Health and Justice is currently being re-scheduled and that an update on those discussions will be provided to the Taskforce as soon as we are able to.

She went on to note that if Ministers agree that legislation is the way forward, consultation on the options will follow before it goes through a bill process. AN noted that this clarity would be helpful in taking forward the multi-agency aspects of work to improve services.

Design and delivery of services - Elizabeth Ireland

(supported by Graham Milne, Programme Manager, NSD)

RAG report - for noting.
Note of sub group meeting on 25 January - for noting.
S-BAR paper – for discussion.
PowerPoint Presentation slides – for discussion.

CC advised that Elizabeth Ireland is on leave and invited Graham Milne (GM) to present the recommendations from her sub group on her behalf.

GM thanked Dr Louise Scott who has contributed considerably to the development of a proposal for a hub and spoke model in Scotland. He explained that this would be delivered on a regional basis with hubs in Edinburgh, Glasgow and Aberdeen providing a 24/7 service, with supported remotes in more rural areas. National pieces of work would be progressed through the Network Board.

GM said that discussions are progressing with NHS 24 on using the 111 service as a Single Point of Contact as it is more anonymous where victims/survivors could speak to a forensically trained nurse, but clarification was needed on where they would be referred on to. He went on to advise that an FME would be available if they wished (with or without a police report) and that support would be provided by RCS and SOLOs.

GM explained that matters such as peer support, training and information to victims and families would be co-ordinated at a regional level, with capacity for mutual aid across regional boundaries and links to island communities. He noted that the group are looking at whether staff working in sexual health services in more remote areas would be interested in becoming more involved in this work.

CC thanked GM for his presentation. She noted that a version of this had been presented by Dr Louise Scott about a year ago and queried the evidence base that this was the right model for Scotland and whether any alternative models have been explored since then.

GM said that the group had not looked at other options. FM noted that draft options had been considered but that the group had decided to focus on working with stakeholders to explore the feasibility of one rather than 3 or 4. FM added that the model was discussed at the last sub group meeting (with representation from the regions) and that it was agreed that this was the option to go for (albeit slightly tweaked from the original proposal that Dr Scott developed).

CC noted this but said that the workings were not transparent and that the Taskforce would need to understand more about the evidence base for the model if they are going to sign something off.

Jim Crichton (JC) asked if it would be helpful or viable to look at options that have been discounted. CC agreed that we need to surface and articulate the issues that people might want an answer or evidence for. CC asked why SARCs weren’t presented as an option for example.

Katie Cosgrove (KC) asked whether Boards had offered a view on the proposed model during discussions with them. GM noted that the regions were receptive to the model proposed.

JJ asked how the model fits with the work of multi-agency partners such as social work (both children and adults) as the governance arrangements around that are complicated. GM noted that paediatric services haven’t been looked at as part of the proposed model.

SB asked whether travel times for the individual had been mapped on to the model and noted that it would be helpful to see this, particularly for self-referrals. GM noted that the location of the hubs had been picked for their transport links / accessibility.

CC reiterated that more detail is needed on:

• the specifics of the model proposed i.e. the services that would be offered in a hub and in a spoke (the what, the who and the how) as well as on the service configuration (the where)
• an explanation of how a hub is different from a SARC (and whether it is more or less resource intensive) so that we can clearly articulate and evidence why the proposed model is better
• the other options that have been considered
• minimum and maximum travel times
• the extent of consultation with stakeholders on the different options considered (including Chief Executives, social work, paediatrics and people with lived experience)

Action: GM to feed back to Elizabeth Ireland and provide CC with the detail requested as soon as possible.

LT noted that there are links to the workforce subgroup in terms of the availability of staff, training, maintenance of skills, competence and credibility. She added that a hub could support supervision and peer support with the potential for staff to travel if necessary to rural areas. CC agreed that this level of detail needs to be captured, noting that the specification document for SARCs in England is very detailed.

Pauline McGough (PM) noted that the proposed model is very adult focused and that a parallel document is needed for children and young people (or at least we need to explain if / why we are sticking with current model).

SK noted the need to future proof services in the context of the Evidence and Procedure Review. She added that consultation with Health Boards on costs for the proposed model will be important for the financial memorandum accompanying any bill. SK also suggested that there is scope to learn from the work that is being done on the new multi-agency facility in Edinburgh.

Related to this, AN advised that resources for in hours and out of hours provision needs scoped and costed.

Derek Scrimger added that the travel time for an FME was important from a forensic science perspective.

CC concluded that due process had not been followed and that she doesn’t see the data behind or justification for the proposed model versus other models and made it clear that the timescales are now extremely challenging. GM noted this.

CC also emphasised that agreement needs to be reached on the service model and configuration so that the detailed specification can be developed to enable Health Boards to cost the model before we are too far in to the financial year. MM suggested that work to produce the evidence could progress in parallel to engagement with Health Boards.

FM advised that the regional planners have said that there is an opportunity to adopt a phased approach. Regional delivery plans could be updated before September (prioritising moving FME out of police settings and in to health and social care settings) with work to cost the model based on the service specification happening in slightly slower time.

CC agreed and suggested that a date be set for the next meeting of this sub group.

Social Research – Yousaf Kanan

Executive summary – for noting.

CC advised that Yousaf has undertaken a brief literature review on international best practice in relation to forensic medical services for victims of sexual crime and invited him to provide an update.

YK provided a brief summary of his initial findings. He noted that all best practice has similar characteristics and features and that there is evidence of the effectiveness of a SARC and spoke model (with Sexual Assault Nurse Examiners (SANEs) in remote liaising with a SARC.

He added that there is lots of evidence from North America about the effectiveness of SANEs and that their testimony has had no negative impact on the criminal justice system or sentencing. YK emphasised that issues in the Great Britain seem to be cultural rather than technical and that there is a need to ensure that myths and biases don’t affect people’s experience of and ability to access services. AH advised that the issue was not a cultural one but related to the specific requirements of the Scottish legal system and it was critical that forensic medical services were sufficient to satisfy the legal requirements in terms of the adequacy, admissibility and reliability of the factual and expert evidence which would be required to be led in court in relation to a criminal prosecution.

CC thanked YK and noted that his work is helpful in informing the proposed model. JK confirmed that a draft of his full report would be circulated by end of this week.

Action: JK to circulate draft report for comments as soon as it is complete.

Clinical pathways – Pauline McGough

(supported by Graham Milne, Programme Manager, NSD)

RAG status report – for noting

PM advised that personal sickness together with the complex nature of the work had meant that not as much progress had been made as hoped and that the meeting scheduled for 8 February had to be postponed.

Thanks to Dr Louise Scott and Hanna Cornish (NSD Programme Manager) were recorded for driving forward the adult pathway through the lens of trauma informed practice and for consulting widely on that. PM said this is on target for a final draft to be circulated in April and publication as planned and that work on agreeing a national standardised form between NHS, PS and COPFS will now come under this sub group.

PM advised that there are good existing pathways for children and young people and that the Managed Clinical Networks are well established, but there are complexities around the role of support/advocacy workers. Additional resources will be needed to progress the development of this pathway due to one of the key clinicians having to step back from this work due to other commitments. PM said she hoped this would not set the group back by more than a couple of months.

AN suggested approaching the MCNs and JJ advised that there is an offer from Judith Ainsley’s team in SG child protection, to support work on the children and young people’s pathway.

Action: Suggestions for a new paediatric representative on this group to be sent to PM. Action: PM to make contact with Judith Ainsley.

PM advised that progress is being made on the self-referral pathway being led by Mini Mishra, Deb Wardle (Archway) and Mel Wade (Police Scotland).

MM queried whether communications (i.e. information to GPs and the general public) was part of the pathway. CC suggested that the health literacy team could help with that. PM confirmed this would be looked at.

Action: PM to ensure communications is captured in all pathway documents.

JC asked whether there are anything critical elements in the pathways that will inform the development and costing of the proposed model of delivery (access to services for example). PM agreed that this could be looked at.

Action: PM to liaise with EI about this

CC asked PM to keep her informed if more help was needed on this group.

Quality Improvement – Fiona Murphy

(supported by Hannah Cornish, Programme Manager, NSD)

RAG status report – for noting Minutes of meeting on 21 November – for noting

FM advised that this group is on track for delivery against the plan. She noted that one area of the QI group’s work relates to the development of the HIS standards which has already been covered earlier in the agenda.

She noted that confirmation was received from the SG before Christmas of funding for the ISD business case and that a paper on activity and demand had already been circulated. FM advised that staff to progress the national data set are now in place and the work is under way identify what needs to be to captured at local, regional and national reporting levels.

A Terms of Reference has been agreed with the national IT service in NSS to develop the requirements for a clinical IT system to support this work. This will look at what exists already as well as what systems can be adapted or built.

FM noted that discussions have also begun with HIS about how to convert the new standards in to quality indicators and whether this information will be used for data collection, self-assessment or both.

CC said she had sympathy with the challenges around this work but queried the end date of 2022. FM clarified that a realistic amount of time is needed to deliver a national IT system but that the data will be collected and reported (through excel) before that.

CC asked that timescales for national reporting are clear in the RAG.

Action: FM to update RAG status report.

CC queried whether there is a ‘good enough’ system or phased approach would be possible given the small volume of people. FM confirmed that they will look at using an existing system and that the end date is based on the possibility of needing to build something new.

LT noted that the work plan splits data IT and clinical IT and that she has experience of clinical IT systems being put in place that you can’t interrogate or analyse. FM confirmed that the staff working on the data IT are also part of the clinical development work to ensure these are joined up.

LS queried whether work on the HIS quality indicators could be accelerated. Karen Ritchie (KR) advised that they are planning to scope the indicators very soon and noted that clarity is needed on where Quality Assurance would sit between HIS and NSS, noting that ‘inspection’ doesn’t give the same room for improvement.

MM advised that the intention is for joint inspections with health (including child protection and social work) and the police.

Action: KR and Fiona Wardle (HIS) to discuss QA.

Workforce and training – Elaine Mead

(supported by Graham Milne, NSD)

RAG report provided for noting.
NES Trauma training slides (Shetland) for noting.

CC advised that Elaine Mead had given her apologies and invited Ron MacVicar (RM) to provide an update on her behalf.

RM summarised the feedback from EM: more women are needed from other specialisms; Ts and Cs need to be equitable; the work needs to be better recognised and valued; the role should de-coupled from custody work; workforce plans need to be appropriate to the geography.

With regard to training, RM advised that the two Associate Post Graduate Deans had gone to Shetland in January to pilot the revised, portable ‘Introduction to Sexual Offence Examinations (SOE) training with a multi-agency team (including 4 Forensic Physicians (FPs). Caroline Bruce also provided a specific input on the Trauma Training Framework. This was in preparation for the main training at the end of March in Glasgow. A total of 37 attendees (mostly women), from 11 territorial health boards (including 2 FPs from Orkney) will have completed the training before the end of the Financial Year. There is a broad range of specialisms represented from obstetrics, gynaecology, GPs and sexual and re-productive health.

The revised training incorporates more e-learning and video walk throughs which will be available post training for people who less frequent need.

The main task for the next FY is to put in place local and regional peer support for FPs and to support them in to substantive roles as that workforce demand emerges.

CC noted that she was pleased to see good numbers coming forward and invited questions.

PM advised that 12 new sexual offences examiners had been appointed in the West and that they are keen to look at regional models of peer support.

Action: PM to liaise with RM about peer support.

LT noted that we now have the demand paper from the QI group, a proposed model from the design and delivery of services group and the number of people being trained from the workforce group and queried who will pull it altogether to assess the short fall between the numbers we are training and the numbers needed to meet demand based on the model.

MM advised that EM felt this would be premature because the proposed model had only been tabled today but suggested that it would be better to do this at a regional and local levels, rather than a national level, given that some areas prefer de-coupling and others don’t for example.

LT asked whether we know if the spokes can be staffed and if there is enough through put to maintain competence. RM agreed there is a need to understand this but that we first need to know the service model and configuration.

CC noted that NES has experience of working across specialities to match trainees with services and geographical locations and asked if there was scope to do that with this. RM noted that we have a good dispersal with FPs from 11 of the 14 Health Boards on the training.

SK noted that it was encouraging to see so many women undertaking the training but that the Chief Executive responses to the CMO’s letter highlighted issues around the ability to attract females in to these roles. She added that there is a myth that women don’t want to do this work and that may now have an opportunity to connect these things up. MM suggested that the variance in Ts and Cs across the country was a significant issue.

CC asked whether this group had looked at NHS Lothian Ts and Cs. GM advised that they were available if EM wanted them.

Sandy Brindley (SB) Sandy asked whether the regions should be left to decide whether to separate the roles given that we know this is a barrier and dis-incentivises women. CC noted that there are many layers to the workforce challenges and suggested that we look at this again in the context of the agreed service model.

SK added that micro study of the females who are undertaking the revised training would be beneficial and RM confirmed that NES are already committed to doing this.

Action: RM to provide an update on this in due course.

User Reference group – Sandy Brindley

Minutes from meeting on 14 December - for noting.

Sandy Brindley (SB) advised that NHS 24 as a Single Point of Contact was discussed at the last user reference group and that people were generally very positive about this but that further consideration would be needed to flesh out the overlap with RCS.

SB noted that the recent NSPCC ‘Right to Recovery’ research highlighted significant gaps in therapeutic services for children and that there is a danger of focusing too much on the adult pathways. SK advised that therapeutic services will be picked up under Barnahus and that resources are being identified within her team to progress this work. AN added that there is a piece of work underway across the child protection MCNs to scope out the therapeutic services that are currently available for children and what the gaps are.

SB suggested that it would be helpful to discuss the options for the model of service delivery at a meeting of the Reference Group to ensure appropriate consultation with survivors about their experience of services.

Action: GM to liaise with SB about this.

COPFS – Anne-Marie Hicks (AH)

CC invited AH to provide an update from the Crown.

AH advised that she has some anecdotal feedback from Advocate Deputes who have concerns about FPs undertaking this work without the appropriate training and who may be cross-examined in course. She cited examples of injuries not being photographed and Doctors not being willing to give any interpretation evidence. She queried what is being done about FPs already in this role that need training to ensure there is no negative impact on the quality of evidence.

RM noted that training those already doing the work is in the NES plan but that there is no mechanism to mandate it. SB reiterated that training in trauma informed practice is very important and is consistent with feedback from survivors about attitudes of those involved in their care.

PM suggested that we need to build refresher training and peer support in to the service model and that this should be mandated by the employer.

CC queried whether this would risk putting people off and LT suggested that it could actually be used to help increase the status of the work.

YK advised that in Canada and Norway – the forensic examiner doesn’t go to trial and that experts are trained to provide evidence in court to interpret findings using standardised forms. AH noted that it is not as straightforward given the different legal systems and that colposcopes are not consistently used to capture evidence for example.

RM noted that the HIS standards state that staff should be supported to maintain a high level of expertise but that the issue relates to holding Health Boards (as employers and “commissioners”) to account for this.

LR noted that it was interesting to hear that Advocates are saying it’s not about a Doctor versus a nurse issue but about the level of the individual’s experience. This dovetails in to recommendation 6 of the HMICS report about developing the role of FNEs.

AH said that there was a meeting with Law Officers last week about these issues and that the COPFS are now willing to consider proposals for a pilot of FNEs giving evidence in court, dependent on them being appropriately trained and accredited to take samples, give evidence and comment on injuries. CC advised that she has had informal discussions with the Lord Advocate about developing the role of FNEs in Scotland and that he was very supportive of this.

SK noted that this was very timely as she and Tansy Main had met with Jess Davidson and a representative for the Chief Nursing Officer to discuss what FNE training would look like in Scotland. It would be an intensive two year Post Graduate qualification (Advanced Nurse Practitioner level) - which is significantly more than the 2 days training in sexual offence examinations that Doctors undertake. She added that the RCN will host a round table to progress this and to develop robust proposals for a pilot.

Action: TM and SK to progress with Jess Davidson.

In relation to Doctors, CC suggested she could write to medical directors to ensure that best practice for medical examiners is included in their appraisal and to ensure that all those delivering the service are appropriately trained.

Action: TM to co-ordinate with Ron to progress this.  

6. Governance Model


Proposed governance model – for discussion.

CC advised that the Taskforce has met four times since April 2017 and has made good progress in a number of key areas and that we should acknowledge the collective efforts of everyone around the table to drive this agenda forward in addition to their other commitments. She added that this is an extremely difficult and multi-layered task and that all preceding attempts to resolve these issues had been unsuccessful. CC did however express concern about the ability to meet the timescales we have committed publically to in order to improve outcomes for people who use these services.

CC added that progress must be expedited and that we need to review our governance arrangements to ensure we have the appropriate mechanisms and reporting structures in place to enable the Taskforce to migrate to the next ‘operational phase’ as swiftly and efficiently as possible.

A proposed new governance model was drafted for a meeting with the regional planners on 22 January to discuss how we do this. One regional planner was present at that meeting (Jan McLean, SEAT) - with Rhoda MacLeod representing the West and Mark McEwan representing the North. There was broad agreement about the proposal circulated with the Taskforce papers.

CC advised that the SG will continue to lead work of leadership and governance sub group and will take ownership of the workforce and training sub group given that this has not met since September 2017. RM said he was supportive of this.

CC reinforced that she is not precious about the structure and would be happy to have a conversation about where things should sit to best effect change - but that she was precious about timescales.

FM reflected on the role of the Network Board in helping to operationalise this work and the need for clarity on lines of accountability. She summarised that Elizabeth felt that the work of her sub group was coming to an end and that the network could take over any residual pieces of this work. Similarly the work of the Clinical Pathways sub group is time limited and the network already have a role in providing national guidance and pathways (the QI group is separate from the Network and workforce will be SG led). However, she cautioned against moving too quickly on any such change. CC thanked FM for this helpful summary.

JC agreed with FM’s assessment and said that the CMO letter to the Chief Executives was a milestone and there was now an opportunity to look at how the network can add value going forward at a regional and national level.

CC noted that the Regional Planners sit on the Network Board but queried whether the Board would have the ability to push things if there wasn’t the necessary pace of change. JC said this would be less of an issue once we are clearer on deliverables.

LT suggested that given the earlier discussion around the service model, it may be too early for the Network to have an operational role here. JJ echoed this point.

SK advised that if legislation goes forward, respective roles and responsibilities will be laid out in a legal framework.

JC emphasised the need to consider the role of regional CE leads and IJBs accountable for some of these services.

CC agreed there is a need for clarity on the model and for further discussion with regional planners and Chief Executives. She added that she had planned to write to the CEs again but that we need an agreed model and service configuration and specification first, so that they can cost the model and access the funding in 2018/19.

Action: TM to consider next steps for cascading information to CEs and RPs.

7. Next steps

CC advised that the remit and membership of the Taskforce and each of the sub groups will need to be reviewed in conjunction with the sub group chairs to help inform the future governance arrangements. The outputs and outstanding tasks of each sub group also need to be captured and responsibility for delivery transferred to the new, agreed structures as soon as possible.

Action: TM to progress with sub group chairs.

8. Any Other Business

None received.

CC thanked members for their contribution.

9. Date of next meeting

• Tuesday, 15 May 2018 – 14.00 - 16.30 – Conf Rms C,D,E, SAH

Future dates:

• Tuesday, 7 August 2018 – 14.00 - 16.30 – Conf Rms C,D,E, SAH
• Tuesday, 6 November 2018 – 14.00 - 16.30 – Conf Rms C,D,E, SAH