Rape and sexual assault victims services taskforce minutes: September 2017

Attendees and apologies

Taskforce members present

• Dr Catherine Calderwood – Chief Medical Officer for Scotland (CMO), Scottish Government (Chair)
• Dr Mini Mishra – Senior Medical Officer, SG
• Saira Kapasi – Violence Against Women and Girls Justice Lead, SG
• Jane Johnstone – (for Iona Colvin – Chief Social Work Adviser), SG
• Dr Kate McKay – Senior Medical Officer, SG
• Katherine Hudson – Child Protection Team Leader, SG
• Dr Hilary Ansell – Lead Forensic Physician, SEAT Healthcare and Forensic Medical Services
• Fiona McKenzie – Service Manager, NSD (for Fiona Murphy - Director of NSD)
• Karen Ritchie – Interim Director of Evidence, Healthcare Improvement Scotland (HIS)
• Iain Logan – Crown Office Procurator Fiscal Service (for Anne-Marie Hicks)
• Katie Cosgrove – Gender Based Violence Programme Lead, NHS Health Scotland
• Professor Lindsay Thomson – Medical Director of the State Hospitals Board for Scotland, representing Scottish Association of Medical Directors
• DCS Lesley Boal – Head of Public Protection, Police Scotland
• Anne Neilson – Director of Public Protection, NHS Lothian
• Dr Charlotte Kirk – Consultant Paediatrician, NHS Lothian
• Professor Elizabeth Ireland – Chair NHS National Services Scotland – representing NHS Chairs Group
• Derek Scrimger – Scottish Police Authority (for Tom Nelson – Director of Forensic Services)
• Sandy Brindley – National Co-Ordinator, Rape Crisis Scotland
• Tansy Main – Rape and Sexual Assault Taskforce Lead, SG

On tele-conference

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

In attendance

• Gill Imery, Assistant Inspector of Constabulary in Scotland (HMICS)
• Louise Raphael – Associate Inspector, HMICS

Observing

• Tasha Geddie – policy official, SG
• Jo Kanan - Social Researcher, SG
• Diane Dempster – CMO business unit and Taskforce Secretariat

Items and actions

Welcome and apologies

1. CMO welcomed everyone to the meeting and invited introductions. Apologies were noted from the following:

Elaine Mead, Chief Executive , NHS Highland Dr Pauline McGough – Consultant in Sexual and Reproductive Health, Sandyford Clinic Fiona Murphy – Director of National Services Division (NSD), NHS National Service Scotland (NSS) & Network Board Representative Anne Marie-Hicks – Crown Office and Procurator Fiscal Service Iona Colvin – Chief Social Work Advisor, SG Tom Nelson – Director of Forensic Services, Scottish Police Authority

Minutes

2. The minutes of the meeting on 13 June 2017 were agreed as a true record.

Action log

3. The action log was reviewed.

007 – Outstanding: CMO requested that any outstanding biographies be sent before the next meeting.
009 – Outstanding: ISD local demand picture (covered under sub group update) 011 – Outstanding: Paediatric representation on QI group. Fiona Mackenzie to follow up with Fiona Murphy. 012 – Outstanding: workshop proposals (covered under AoB) 013 – Closed: NES paediatric training. Kate McKay confirmed that this is in hand.

Matters Arising

4. Taskforce name: The Chair advised that for the avoidance of doubt, the name of the Taskforce had been tweaked. It is now: Taskforce for the improvement of services for adults and children who have experienced rape and sexual assault. The Taskforce’s remit excludes all perpetrators and is not gender specific.

5. Governance: The Chair noted that she has been given the direct authority of Ministers to improve services and that the Taskforce has tight timescales in which to make progress and provide update reports to Parliament.

6. Chief Executive input: The Chair confirmed that Elaine Mead is the Chief Executive representative on the Taskforce.

7. Membership – The Chair noted that queries had been raised about the role of regional planners on the Taskforce and invited Elizabeth Ireland to comment. EI advised that she met with 3 regional planners the previous day and that the health and social care delivery plans being developed over the next 6 months provide a key opportunity to progress the Taskforce’s work. They are keen to hear recommendations from the Taskforce and to help operationalise our plans through her sub group. Gill Imery (GI) added that she had great co-operation from the regional planners when drafting her report and that they showed commitment to improving services.

8. Role of Network in NHS National Services Scotland (NSS). The Chair noted that the Network presented at the first meeting of the Taskforce on the current state of play. Although their role had been ‘parked’ until the Taskforce established itself, she recognised that they would play a very important role in helping to implement the work of the sub groups. It was noted that the regional planners already sit on the network. There was some discussion about the need to maximise the engagement of all the people represented on the network to help deliver improvements.

Action point: The Chair asked Fiona Mackenzie (FM) to take an action back to Fiona Murphy to check that the current network members are able to commit to it fully.

9. Administrative support. The Chair thanked Fiona Murphy for the resources being provided through National Services Division (NSD) of NSS. She noted that Laura McDonnell is providing administrative support to all 4 sub-groups; Graeme Milne is aligned to support the work of three subgroups (workforce, clinical pathways and the design and delivery of services) and that Hannah Cornish is aligned to the quality improvement group).

10. NHS Education Scotland (NES) pilot. The Chair invited Saira Kapasi (SK) to provide an update on the Cabinet Secretary’s recent visit to the islands. Saira advised that Mr Matheson has a successful visit to Shetland and Orkney on 18 and 19 August which coincided with the announcement of funding for NES to review the course currently provided to forensic medical examiners with a particular view to making it more accessible to rural/island locations. Saira noted that Shetland have 3 GPs willing to provide a local service and that they were willing to pilot the re-design of the NES course, which can be delivered remotely. Orkney are also now keen to be part of the pilot and this has been agreed with NES. This will contribute to the aspiration to train 50 new doctors by the end of 2018/19.

11. SK also noted that Sandra Ferguson from NES is undertaking a review of how FME services in Shetland need to be adapted in line with trauma informed principles (macro and micro adjustments from point of view of the victim) and how this can be incorporated effectively into the training of staff. The Chair invited Ronald MacVicar (RM) to comment. RM advised that funding had been provided to make the course more portable and that this work was well advanced. Interviews for an Associate Post Graduate Dean to lead on the work to support graduates of that course in to substantive roles within the service, will be held the following week. Dr Louise Wilson noted that she is delighted to be part of the Orkney pilot.

Health and Justice collaboration meeting.

12. The Chair advised that the first meeting of this new group was also taking place on 7 September and that a paper had been provided to them regarding the work of the Taskforce and our asks of them. The CMO added that the Taskforce has a high level reporting line in to this group within SG, which is jointly chaired by Paul Gray (Director General for Health and Social Care) and Paul Johnston (Director General for Education, Communities and Justice). This oversight of the Taskforce’s work adds teeth and provides an opportunity to gain the commitment of strategic leaders.

Action point: Diane Dempster (Taskforce secretariat) to circulate note of first meeting.

Sub group updates

13. The Chair noted that Elizabeth Ireland (EI) was the only sub group chair in attendance and invited her to provide an update on behalf of her colleagues. The minutes of the sub group chairs meeting on 22 August was provided for noting.

Workforce and training

14. On behalf of Elaine Mead (EM), EI noted that whilst the original NES survey of GPs had been a positive exercise, EM was keen to engage with other people who might consider becoming a forensic physician. EI advised that she had recently visited services in Grampian who are currently operating with one female Forensic Physician (FP), noting that although there is interest in the role, retention appears to be an issue. One reason for this is understood to be the huge discrepancies in Terms and Conditions across the 3 regions (including access to CPD) which is impacting on the sustainability of the workforce. The Chair invited Hilary Ansell (HA) to comment. HA noted that the South East and Tayside (SEAT) region had 4 rounds of recruitment and appointed everyone who applied and that the Ts and Cs in NHS Lothian were good, with provision for paid study leave etc. EI noted that NHS Lothian ‘host’ the Ts and Cs in the East but that doesn’t happen in the West and North. There was some discussion about the challenge for FPs to take time out of general practice or to plan family holidays against court requirements etc.

15. The Chair noted that the workforce sub group should see that can be learnt from the arrangements in NHS Lothian to ensure sustainable/24 hour cover. Mini Mishra (MM) suggested that Human Resources (HR) Directors of Health Boards should be involved with any review of Ts and Cs.

Action point: EM to take forward

16. Lindsay Thomson added that there is a need to gain clarity about both the number of people presenting and any unmet need/demand to ensure that workforce planning is appropriately aligned. It was noted that the action to provide this information rests with the Quality Improvement sub group.

Quality Improvement

17. Fiona MacKenzie (FM) provided an update on behalf of Fiona Murphy. She advised that NSD are looking at the information currently available in order to establish a baseline and a consistent national data set which will also be important to help track improvements (taking account of the new HIS standards). FM noted that the data landscape is messy with many duplicate recording processes. They have estimates of activity based on the SEAT region but want to test their assumptions with the experts. Katherine McKay (KM) noted that the National Network located in NSD, had talked about Adastra being a good system to collate data. FM advised that not everyone uses it (although primary care out of hours tend to). It was noted that recording practices for children are complex and particularly challenging to collate. KM said this had been discussed in the MCNs and suggested that they take that offline.

Action point: KM to discuss paediatric recording with FM.
Action point: FM to circulate paper summarising current data landscape for next meeting.

18. FM added that the resourcing for this work had been agreed and that they are getting a team in place within ISD to extract the necessary information from the systems. They are also looking at products being used in other areas which could be replicated. The Chair noted that we need a solution that can be implemented across the whole system and asked whether NHS England has a national data set. FM wasn’t sure if NHS England have a national data set (although there is a commissioning service specification for children). She confirmed that ISD will collate and can analyse the information extracted in Scotland. EI noted that people access services through a variety of routes, not solely through forensic medical services and that there is a need to capture unknown need rather than unmet need and to design something which can withstand future demand.

19. There was some discussion around the complexity of the governance landscape given that many of the services are devolved to the Integrated Joint Boards (IJBs) but that Chief Executives would be held to account for delivery of the new HIS standards. It as was noted that the Taskforce shouldn’t lose sight of this.

Clinical pathways

20. EI provided an update on behalf of Pauline McGough (PM). The subgroup has met twice and is looking at developing new pathways for adults, children and young people. A meeting had also taken place to review the pathway for self-referrals which Mini Mishra attended. The Chair noted that Charlotte Kirk (CK) and KM are leading work on the children and young people’s pathway. They are being advised and supported by the MCNs for child protection and Child Sexual Abuse (CSA) and are using the template used by Lothian and the South East as an example of best practice. The Chair queried whether Dr Louise Scott was involved in developing the adult pathway, which was confirmed. It was agreed that we need to get to an understanding about the future of self-referral for adults as that will inform a lot of what we will do going forward.

Design and delivery of services

21. EI advised that the next meeting of her sub group is on 27 September but that there was a need to let the other groups come together, mature and make recommendations in order to inform the work that her group would progress. However, as mentioned previously, she had a positive meeting with the regional planners and a good session with the IJB managers, sexual health consultants, police and FPs in Grampian. She has a report from the manager of the service in Aberdeen that captures the main challenges they are facing (both locally and nationally), which she will circulate to the CMO and sub group chairs. For example, there are issues around who has responsibility for the stocking and cleaning of equipment and ensuring that the environment is appropriate and person centred. EI added that this highlights the need for there to be clarity about where the accountability lies between health and justice for capital expenditure and maintenance etc of forensic examination rooms. The Chair noted that work to establish the legal basis for the delivery of services is currently being progressed within SG.

22. EI advised that the Network is currently without a chair. The Chair agreed to follow this up with the Chair of the Chief Executives group.

Action point: EI to circulate Grampian report to CMO and sub group chairs. Action point: CMO to speak to chair of the CE group

User reference group

23. Sandy Brindley (SB) advised that she chairs the user reference group for the Taskforce which meets every two months. The minutes of the meeting on 27 July were provided for noting. The groups’ remit is to ensure that the work of the Taskforce is informed by the views of adults, adolescents and children who access services. SB said that the group membership includes people representing survivors, BAME, LGBTI and rural and island communities for example and that the minutes of meetings are deliberately detailed to help inform the work of the sub groups. SB invited sub group chairs to flag any specific issues/proposals that they would like her to take to this group for a view. SB also noted that Rape Crisis Scotland receive direct feedback from the police about people’s experience of forensic medical examinations and that a lack of female doctors is the single, biggest, most distressing issue people are raising. The Chair welcomed this update and asked that the PS feedback be circulated.

Action point: SB to send this to DD for circulation to members.

Social research

24. MM introduced Yousaf Kanan (JK) - who is a Fast Stream Research Officer in SG and is able to undertake some short term desk based research in to this area of work. JK explained that he will look at comparative international models of delivery and best practice. His aim is to identify strengths and weaknesses in the different approaches and anything that can translate in to a Scottish context, taking account of specific challenges of rurality etc. The Chair invited members of the Taskforce to offer any ideas to JK regarding areas of practice worth looking into.

Action point: DD to circulate JK brief to the Taskforce.

COPFS update

25. The Chair noted that Iain Logan (IL) had provided a paper to the last meeting of the Taskforce on the role of Forensic Nurse Examiners (FNEs) and that he was asked to undertake a ‘look back’ exercise to establish when medical evidence is actually contested in court. The Chair invited IL to provide an update on this.

26. IL advised that this work was on-going but that his aim was to have something ready for the next meeting on 7 November. IL explained that his look back (of 79 cases) is trying to identify when Forensic Physicians (FP) were on indictment, when they actually gave evidence, whether that evidence was challenged and the potential impact of that on the overall case. He noted that many cases were historical and a Forensic Medical Examination (FME) did not take place. More detail will be provided in writing before the next meeting.

27. Lesley Boal (LB) asked whether the look back included section 18 (s. 18) offences (when the defence might not want to cross examine a child witness and is more likely to call an expert). IL noted that in those circumstances, the defence would not be cross examining the child, they would be cross examining the FP/paediatrician. For the avoidance of doubt, IL said he would check with his statistical colleagues whether s.18 cases are included in the 79 he is looking at.

28. KM advised that under English law, the prosecution and defence are allowed to agree evidence in advance of a trial to avoid the need for calling experts to give evidence. IL said that in Scotland, there is a legal duty to agree any evidence in advance but acknowledged that in practice, it doesn’t always happen. It was agreed that the COPFS should explore how this can be encouraged. Dr Charlotte Kirk (CK) advised that child cases would be jointly handled between a paediatrician and a FP and queried whether both would be called to give evidence. KM noted that there isn’t a standardised practice across Scotland yet.

29. IL said that it may in some cases, be to do with the time that the prosecution has to prepare for the case, in addition to the defence not agreeing to it happening. The fixed timescales for solemn cases in Scotland is less than in England which may also make it harder to get matters agreed prior to a trial. IL noted that the COPFS can encourage better agreement of evidence but that the timescales for criminal proceedings are the responsibility of the Scottish Government. SB noted that it can take up to two years for cases to get to court so there is plenty of time for agreement. There was some discussion around the fact that more could be done to educate the workforce and increase awareness of joint conferences. IL confirmed there is currently no available data on how frequently these happen. SK suggested that IL take this issue to Anne Marie-Hicks. The Chair requested that a coherent narrative be brought back to the next meeting.

Action point: IL agreed to report on the look back exercise at the next meeting Action point: IL agreed to take forward the issue of agreeing expert evidence in advance.

30. SB queried whether it was possible to link this with the pre-recording of children’s evidence under the Evidence and Procedure review. IL noted this but advised that this work is in its early stages.

Taskforce work plan

31. The Chair noted that a draft high level work plan had been circulated to sub group chairs for comments. Tansy Main (TM) advised that this, together with an accompanying narrative from the CMO, would be published on the Taskforce’s web page by the end of September and that Ministers would write to the relevant parliamentary committee’s to draw their attention to this. The Chair noted that the Taskforce will be held to account for delivering the work plan and that we need to strike the right balance between being ambitious and realistic, starting with some early wins. EI noted that the high level plan was very helpful in capturing all of the Taskforce’s work and that the clarity of vision was the most important element as the governance and culture shift will flow from that. Discussion followed about the need to scope out which elements of the plan may require funding so that this can be put to Ministers.

32. The Chair invited any other comments. FM noted that we need to use the information flowing from the QI group to improve outcomes. GI commented that some of the timescales in the work plan are quite unambitious (such as timescales for moving FMEs out of a police setting by 19/20) and advised that HMICS will follow up on the ten recommendations in the report. The Chair welcomed this challenge and noted that we will not wait for the whole country to be ready before we start moving towards that change and that Paediatric services are already delivered in healthcare settings. MM noted that the accompanying narrative will explain what work is already underway in these areas and that it is not a single point in time document but intended to be an iterative process with many interdependencies. There was some discussion around the need to commence discussions on a Single Point of Contact but that people need clear pathways to be referred into for example. The Chair reiterated that some things may be able to be brought forward but that we should endeavour not to allow any slippage.

Action point: All sub group chairs to review their section and provide comments to TM.

Workshop

33. The Chair invited Katie Cosgrove (KC) to provide an update on this. KC advised that the possibility of holding a workshop was discussed at the last meeting but that it was subsequently decided that this was a bit premature because sub groups were still finding their feet. She suggested that a facilitated discussion could come after the driver diagrams and high level work plan had been agreed. Members discussed that this could provide an opportunity to explore / agree the vision. The Chair noted that she was very clear about that. It was agreed to decide off line what the purpose of a workshop would be and if need be, to look at a date in early November. KC noted that she would need clarity from the sub group chairs about what they would find most useful.

Action point: Sub group chairs to provide any thoughts to on purpose/outcomes from a workshop to KC.

Any Other Business

34. The CMO invited LB to provide an update on the Barnahus fact finding visit to Iceland. LB advised that she was part of a Children’s First delegation to Reykjavik, which included Mr Matheson, Mr McDonald and SG health, social work and child protection colleagues. LB noted that a key focus of the visit was around the forensic interviewing and the court and legal processes (which wouldn’t correspond to Scotland) but reiterated that it is a concept which can be adapted (as it has been in other Nordic countries). The concept is focused on the best interests of the child and ensuring a trauma based response from first disclosure, whilst balancing this with due process (civil and criminal). The Barnahus is a child friendly setting, where an interview is carried out and an assessment for treatment undertaken including a whole range of support and therapy for the child and their family/carers.

35. The Chair sought clarification about whether the Barnahus deal with acute cases of child sexual assault. LB advised that a FME within 72 hours of the disclosure would take place in an acute hospital setting and that the paediatric examination in the Barnahus was for historical cases not requiring a FME. The Chair noted that there is a misperception that this would replace the current (acute) service for children in Scotland. There was some discussion around some of the challenges of adapting the principles of the Barnahus model for Scotland such as the higher level of demand (1 million children compared to 70,000 in Iceland) and the need to join up with other services such as trauma recovery. KM noted that Scotland has a good, standardised hospital based paediatric services but she can see the value of the holistic Barnahus approach. The Chair noted that this is a big piece of work that needed careful consideration in parallel to the work of the Taskforce. It was noted that a Barnahus event for stakeholders had been held the previous day to explore some of the opportunities and challenges further.

Action point: DD to circulate output from that event when available.

Any Other Business

36. SK advised that the Programme for Government had been announced earlier in the week and that it contained three paragraphs on the Government’s commitment to victims of sexual assault and rape.

Dates of next meetings

7th November 2017 – 10:00-12:30 – Room 3, Victoria Quay 7th February 2018 – 10:00-12:30 – 4ER, St Andrews House