Rape and sexual assault victims services taskforce minutes: June 2017

Attendees and apologies

In attendance

• Catherine Calderwood, Chief Medical Officer (CMO), Scottish Government (CHAIR)
• Mini Mishra, Senior Medical Officer, Scottish Government
• Saira Kapasi, VAW Justice Lead, Scottish Government
• Tansy Main, VAW Health Lead, Scottish Government (from mid-July 2017)
• Katie Cosgrove, Gender Based Violence Programme Lead, NHS Health Scotland
• Lesley Bagha, Head of Criminal Justice Reform and Licensing Unit
• Katherine Hudson, Child Protection team, Scottish Government
• Kate McKay, Senior Medical Officer, Children and Families Directorate
• Fiona Murphy, Director of National Services Division, National Service Scotland & Network Board Representative
• Elizabeth Ireland, Chair, NHS National Services Scotland, representing NHS Chairs Group
• Ian Logan, Crown Office and Procurator Fiscal Service
• Charlotte Kirk, Consultant Paediatrician, NHS Lothian
• Hilary Ansell, Clinical Lead, Healthcare and Forensics Medical Services, SEAT
• Karen Ritchie, Interim Director of Evidence, Healthcare Improvement Scotland (HIS)
• John Wood, Senior Policy Officer, CoSLA

On Videoconference

• Elaine Mead, Chief Executive , NHS Highland
• Ronald MacVicar, Postgraduate Dean, North of Scotland Region of NHS Education for Scotland (NES).
• Louise Wilson, Director of Public Health, NHS Orkney

On Teleconference

• Pauline McGough, Clinical Director, Sandyford for Sexual Health Advice

Apologies

• Sandy Brindley, National Co-Ordinator, Rape Crisis Scotland
• Lesley Boal, Head of Public Protection, Police Scotland
• Ria Phillips, VAW Justice SG
• Lindsay Thomson, Medical Director of the State Hospitals Board for Scotland, representing Scottish Association of medical Directors
• Tom Nelson, Director of Forensic Services, Scottish Police Authority
• Iona Colvin, Chief Social Work Adviser, Scottish Government
• Hong Tan, NHS England

Items and actions

Minutes of last meeting – 27 April 17 and Matters Arising

The Chair noted that a number of tasks had progressed since the last meeting which demonstrated that there was a will to keep pace of work and achieve the outcomes that had been set. This was welcomed. Minutes were considered and most of the actions were completed. There was no further matters arising. Minutes were formally agreed and the Taskforce agreed to the minutes being published in the current format.

Action – Members to provide their biographies to the CMO Business Unit SK to ensure Minutes are added to the public website: /groups/taskforce-to-improve-services-for-rape-and-sexual-assault-victims/

Matters Arising

Fiona Murphy, Director of National Services Division (NSD) gave an update on the work taken forward by NHS National Services Scotland (NSS). The Chair thanked Fiona for the paper. It was noted that many of the developments of the Network for Healthcare and Forensic Medical Services to those in police care (The Network) would fit in well within some of the activities of the sub-groups. Fiona said that they would have members of staff available to assist with the sub-group’s work to ensure that work is aligned with what the Network were already working on, so there would be no overlap.

Subgroup Updates

The Chair brought to the Taskforce members’ attention that there were now 4 rather than 5 groups. It was explained that due to a number of factors the regional delivery of services will take on premises and infrastructure work stream. Separately it was noted that IT would be taken on by the Quality Improvement Group.

Workforce, Training and Terms & Conditions – Elaine Mead (chair of sub-group)

This group hasn’t met yet but a few reflections were provided. The 2 areas of custody and victims are often brought together. It is important to take these two work streams separately and there was a feeling of confusion about what the Taskforce’s remit was. The Chair emphasised that the Scottish Government’s Taskforce remit is victims of sexual assault and not police custody work.

It was raised that the current model of staffing appears unsustainable and that COPFS’ paper on forensic medical examinations by nursing staff would shed light on what the model going forward could look like. Hilary Ansell explained that doctors who delivered these healthcare and forensic medical services, including to the victims of sexual assault work part-time. This part of their role is secondary to another primary role e.g. general practice. It was felt that there was a lack of clarity on what the actual demand is currently, particularly in terms of frequency, time and location.

Elizabeth Ireland, Chair of NHS National Services Scotland stated that she had spoken to a number of sources to estimate the demand. It was agreed that it would be useful to do some planning around the patient/ victims’ experience and the size of demand. The Chair suggested that extracting some local data would be helpful. John Wood, COSLA pointed out that Improvement Services had done some work on the VAW framework which could be helpful from the point of view of local planning.

There was no date yet set for the subgroup to meet but this would be done after the Taskforce meeting.

Action – Fiona to consider whether analysts and ISD could assist in providing a local demand picture.

Regional Delivery of services update

Papers circulated and discussed but it was noted this didn’t include issues relating to children - work will continue on this at a later point. The Chair queried whether a separate group was required? Kate McKay commented that in relation to Forensic medical examinations for children there were:

• Standards available and have been agreed.
• No standardised data sets.
• No paediatric forensic nurses.
• The 3 existing Managed Clinical Networks (MCNS) in this area, work well together
• A national agreed paediatric pro forma is used in all cases.

As a follow up point Pauline McGough said nurses at Archway are not acting as forensic examiners but they support the medical practitioners’ work. This means they don’t take samples however they do follow up care to vicitms. This applies to both adults and Under 18s seen at Archway.

It was agreed that Kate McKay and Charlotte Kirk should continue to raise the issues around children in the discussions regarding service delivery to adult victims.

Elizabeth Ireland raised some concerns that the MOU was difficult to interpret on the provisions regarding forensic medical examinations, however on the delivery of healthcare in police custody there is less ambiguity. It was commented that it would be helpful to have a review of the MOU done to offer some clarity as this underpins the governance around these services. It was confirmed that SG are taking this forward.

It was mentioned that NHS 24 were happy to enter into conversations about future work to see what could be achieved in terms of developing a service which had a single point of contact. NHS 24 could offer a preliminary service and this might be able to include remote support for professionals as well. Dr Mini Mishra referred to the Rape Crisis Scotland helpline and that they might want to bid for the line – however this is currently only open for limited hours, it is not 24 hours, although the number may be more familiar to victims. Fiona said that Wales currently have a single point of contact and it would be helpful to know more about their arrangements and whether there was scope to have one recognisable number but routed through another agency, such as NHS 24. Mini said that Sandy Brindley had made the point in a sub-group discussion that the websites/ social media were also used often to access information about sexual assault and this needs to be considered.

A Regional model had been presented at the sub-group meeting – this was on a hub and spoke model. In summary, Elizabeth commented that it would require a robust finance and work force delivery plan to deliver it.

Clinical Pathways – Pauline McGough

The first meeting date will be 29th of June. A Terms of Reference will be circulated to the group before that date. However, initial discussions have been had with Elizabeth Ireland, Mini Mishra and Healthcare Improvement Scotland. It was noted that the 16-18 year age group, who may have additional needs (vulnerabilities), may need to be considered flexibility – with services to be delivered via the children’s services or adult services. Elizabeth noted that the clinical pathways work was essential before a model/s of service delivery in Scotland could be decided.

QI Group – Fiona Murphy

The sub-group met last week [8th June] and Fiona requested that the Taskforce agree the remit they had produced. In response to the 4 questions posed to the members of the Task Force, the initial discussions were about the scope of the data collection –e.g. include adults and children, to support operational issues as well as demonstrate quality outcomes, data linkages to other data such as crime statistics, etc. Comments on the key deliverables were welcomed. Iain Logan, from the perspective of criminal justice - saw value in seeing how the evidence has been used in court. Also the experience of the individual would be useful to see from the point of service quality improvement. Charlotte Kirk thought there would be value in collecting data for the point of view of work force planning.

The Chair commended the group on its aspiration but commented that we need to get to a compromise on what is achievable on data collection. Katie Cosgrove raised the issue that one of the outcomes for data collection was the impact on health and well-being of the victims. The Chair requested that the sub-group look at what can be done taking into consideration all the points raised.

It was noted that Paediatric services currently collect data via a nationally agreed pro forma but some areas are more advanced than others. Concerns were raised about embedding the paediatric standards in the work of Health Boards as the only lever the regional Managed Clinical Networks have is to persuade the Health Boards. The preference would be for the requirement to deliver services to the agreed paediatric standards to have a formal position. It was confirmed that the HIS standards will cover paediatrics. Fiona Murphy said a data set from paediatric services would be very helpful to inform the adult data set to be developed.

Action: Fiona Murphy to seek nominations for membership of the group to represent paediatrics.

Timescales were sought by Fiona in terms of the expectations of the Taskforce. The Chair confirmed that 3 to 5 years is the timeframe she is working to but that some areas must be progressed much sooner. The Chair emphasised the need to report to parliament every 6 months and that Ministers want to see tangible progress.

COPFS paper - Role of Forensic Nurse Examiners

The Chair thanked Ian Logan for the paper. Ian confirmed the position of the previous law officers – that they were not in support of nurses giving opinion evidence. It was discussed whether the role in court, of the nurses in England, has been misinterpreted. In terms of the law officers revisiting their previous views and advice, it was felt that there has not been a material change in circumstances to merit a re-consideration. The Chair noted that it is clear in the information provided that nurses are being used to deliver services in different ways in Scotland, but there is work that could be done to enhance the nursing function to provide additional support to doctors than is already provided. This might not mean court appearances but it could improve the services e.g. taking the samples.

It was noted there is no information about the number of times that forensic medical examinations are used in court.

Action: A look back exercise would be produced for the next meeting by COPFS, which would give an indication of when examinations are being used and contested in court and nature of cross examination by defence agents – 7th September.

Taskforce work planning session

Mini Mishra introduced the item by reflecting that different colleagues have had different involvement in this area of service delivery prior to the setting up of the Task Force. Some of the short time from the first meeting of the Task Force has rightly been spent in trying to understand the current position.

The sub-groups have begun the process of confirming the remit and the prioritised deliverables. However, The Task Force is expected to deliver a “work plan” to Ministers after the summer break e.g. September. This is challenging as the work in the sub-groups has only just begun. To avoid duplication, the prioritised deliverables from the sub group can inform and enable the development of a draft “work plan” which could be agreed at the next meeting in September, to meet the ministerial time scales.

It was noted that there are challenging areas eg premises and the model/s of service delivery. In order to understand the challenges and interdependencies in depth, a half day facilitated workshop was also suggested before the next meeting of 7th September.

Katie highlighted there are early deliverable that can be outlined in the plan, including clarification about whether we are looking at a model within existing services with a push for new resources or a new model (which includes capital investment).

Elizabeth Ireland highlighted that there was a need to consider the short term and sustainability of services as well. It was also noted that we should be mindful of the unintended consequences of some measures – for example de-coupling rotas for police custody and victims. This could cause pressures on other areas.

Action: Katie Cosgrove to provide a paper with proposals about a facilitated workshop.

Education and Training – Ronald MacVicar

An update provided by Ronald, and the challenges around gender specific choice of doctor were noted. 9,328 doctors in training were surveyed – 819 responded, 78% were female. NES noted that there are a number of doctors that if the right support was provided, may be interested in working in this area. And there may be further numbers of trained doctors who were not surveyed, that may be interested. NES noted that there are considerations around how the training is delivered and NES are keen to look at whether this could be made more accessible and portable. A task and finish group has been set up within NES to look at this. They are hoping to redesign the course for forensic medical examination for victims of sexual assault by the end of August and pilot a new training course by September in Shetland. A key aim is to assist doctors who have expressed an interest in working in this areas self-identification to finding substantive roles – looking at this now not just within a 3 – 5 year period.

NES and the Chair confirmed that this work was just on training for doctors to provide forensic medical examination for victims for sexual assault – it was not about appointment of roles which is out with NES’ remit. It was noted that there might be a need to market the recruitment so that the right audience is engaged to offer a choice of gender for examiners for victims. Charlotte Kirk raised the importance of peer review especially in areas where there are not many examinations. NES confirmed that there is very much an aspiration that the course will continue to be accredited.

Action: Kate McKay to consider the issues for paediatrics training and speak with NES about this.

Any other business and dates of next meetings

No other business was raised and the dates of the next meeting were agreed as follows:

7th September 2017 – 14:00-16:30 – Rooms 4 & 5, Victoria Quay
7th November 2017 – 10:00-12:30 – Room 3, Victoria Quay
7th February 2018 – 10:00-12:30 – Rooms A & B, St Andrews House

The meeting ended at 5 pm.