Rape and Sexual Assault Victims Taskforce: High Level Work Plan - October 2017
High Level Work Plan of the Taskforce for the improvement of services for victims of rape and sexual assault.
In March of this year, I was asked by the Cabinet Secretary for Health and Sport, Shona Robison MSP and the Cabinet Secretary for Justice, Michael Matheson MSP, to chair a new Taskforce to provide the leadership for the improvement of services to children and adults who have experienced rape and sexual assault. There were several drivers for this work including feedback from people who experienced these services and a report by Her Majesty's Inspectorate of Constabulary (HM inspectorate of Constabulary in Scotland: Strategic Overview of the Provision of Forensic medical Services to Victims of Sexual Crime, March 2017) which made a number of recommendations for improvements in this area.
The Cabinet Secretary for Justice, in his statement to Parliament on 9 May 2017, was clear that the immediate health needs and future recovery of those who have experienced rape and sexual assault should be addressed first, followed by the contribution to potential criminal justice proceedings.
As chair of the Taskforce reporting directly to the Scottish Ministers, I am focused on providing the necessary leadership to support and enable Health Boards to work collaboratively with partners to make meaningful changes to improve services for forensic medical examination and general healthcare for those who have experienced rape and sexual assault. The recently established multi-agency health and justice collaboration improvement board, made up of senior leaders in health and justice agencies, has committed to supporting the work of the Taskforce.
The Taskforce has met three times since March and has wide representation from across health, justice, social work and the third sector services.
The Taskforce has agreed an ambitious vision for the national improvement of services and the attached high level work plan sets out how we plan to achieve that over the next five years. Four sub-groups have been tasked with driving improvements where gaps have been identified, with the overarching national leadership and governance considerations led by myself and Scottish Government colleagues.
A representative from Rape Crisis Scotland will continue to engage with users of these services to ensure that the Taskforce's work plan is centered on learning from lived experience and on improving outcomes.
I am clear about the urgency in progressing this work, but clearly some issues - such as increasing the availability of female doctors - will take time to deliver.
The timescales set out in this high level work plan are therefore indicative at this stage and may be revised as our scoping work develops. However, I will endeavour to accelerate these timescales wherever possible.
The national co-ordinating network for healthcare and forensic medical services for people in police care will continue to play a key role in improving outcomes for people who have experienced rape and sexual assault by supporting delivery of this work.
A summary of the priorities for each sub group of the Taskforce and some of the key achievements to date, are highlighted below.
Leadership and governance
The Scottish Government, Police Scotland, Health Boards, the Crown Office and Procurator Fiscal Service (COPFS) and Local Authorities, must agree a clear vision and demonstrate leadership and commitment (at national and local levels) to ensure the effective governance, management and continuous improvement of a high quality, co-ordinated and consistent response to those who need these services.
Clarification and understanding of the roles and responsibilities of all the agencies involved is an important first step to agreeing a joint vision and approach. This may require guidance and even further underpinning legislation.
Arrangements for audit and inspection will be put in place to ensure that performance of these services is appropriately monitored, evaluated and reported.
Improving the forensic medical services to those who have experienced rape and sexual assault to gather the necessary evidence for the criminal justice system, can also have a considerable impact on an individual's health and wellbeing and requires sensitive management. The Taskforce recognises that this can only be delivered by all partner agencies working together to address the challenges and find workable solutions. For example, on-going consideration is being given to whether there are opportunities to broaden the range of health professionals available to deliver services, whose evidence will be permissible in court.
In parallel to the work of the Taskforce, the Scottish Government intends to introduce a Bill that will build on the work of the Scottish Courts and Tribunals Service's Evidence and Procedure Review, to remove legislative barriers to the greater use of pre-recorded evidence for children and potentially vulnerable adult witnesses. These changes are intended to help move Scotland's criminal justice system much closer to achieving the vision that children, wherever possible, should not have to give evidence in court during a criminal trial.
Workforce and training
A high quality, consistent national service can only be delivered by a workforce who has the required knowledge, skills, training and support to provide a trauma informed response. We have listened to the experiences of women who have been raped or sexually assaulted and it is clear that they want to be given a choice about the gender of the medical professional who carries out the forensic medical examination, should they wish to have one. A key priority is therefore to ensure there are a sufficient number of female practitioners available to meet the required demand.
To ensure a balanced, sustainable and flexible workforce across Scotland, the Taskforce will develop and support the delivery of an action plan which will seek to address some of the wider workforce challenges in this area. For example, we have already identified the need to review existing recruitment practices, terms and conditions of employment and contract, non-monetary reward and recognition, retention and succession planning, continuous professional development, trauma informed training, mentoring and peer support.
Training to deliver forensic medical services for doctors and nurses is an established component of the professional development work stream of NHS Education Scotland (NES). All these courses are accredited by the Faculty of Forensic and Legal Medicine (FFLM).
The Scottish Government has announced new funding for NES to train an additional 50 forensic physicians by the year end 2018/19 and to redesign the course to be more portable to allow the training of doctors in rural and/or remote locations. This will be piloted in Shetland and Orkney. A lead clinician will also be recruited by NES to lead the education and training developments in this area, as well as providing the support required by clinicians.
Design and delivery of services
To deliver high quality, sustainable and affordable services, Health Boards, Police Scotland, COPFS, Local Authorities and other partner agencies need to work together in regional groups to design services to meet local needs, with relevant aspects of the service delivered and managed nationally.
Work is underway to consider the optimal model of service delivery based on international benchmarking and best practice. The absence of be-spoke facilities for forensic medical examinations for adults in Edinburgh, presents an opportunity to explore a multi-agency approach for both adults and children, which may encompass elements of the Nordic Barnahus concept for children who have experienced rape and sexual assault. This concept puts the child or young person's needs at the centre and treats them from the start with their recovery in mind. This work will inform the Taskforce's considerations in respect of the optimal model of service delivery for adults and children when the policy decisions are made. Paediatric and social work professionals are represented on the Taskforce to ensure children's interests are met.
I am mindful of the need for services to be sustainable in the long term, with equity of access to those who need them. My priority is to ensure that where possible, forensic examinations take place in health and social care settings and that the doctors carrying out the examination have access to the necessary equipment and training. Some areas have already been progressed such as the national framework for procurement of forensic kits.
The Taskforce is also exploring the feasibility of establishing a 24 hour single point of contact for those who need to access these services and to improve the information available to practitioners (such as GPs) to help signpost individuals to the relevant services.
Clinical pathways
The Taskforce's aim is to improve people's health and wellbeing by ensuring a consistent experience of healthcare and forensic medical services which is person centred and trauma informed. My priority is to ensure timely access to integrated, multi-agency services informed by best practice, to reduce any further trauma, harm and re-victimisation for affected individuals.
I am clear that individuals must be supported to make informed choices about their immediate and on-going (clinical or non-clinical) health and social care needs. This should include access (both for the individual and those who support them) to specialist sexual violence support and advocacy services.
Work is already underway to develop new clinical pathways for adults, young people and children in line with Health Improvement Scotland (HIS) standards, including accompanying guidance for clinicians and other professionals and practitioners working in this area.
Quality improvement
I want to maximise the use of (SG funded) IT systems, to help ensure the effective management and monitoring of services. The SG has also provided funding to scope requirements to establish a baseline of activity, as well as to develop a national data set to ensure consistent recording and reporting of data going forward. Quantitative and qualitative intelligence gathered from this will help us to track progress in the continuous improvement of services.
The Quality Improvement subgroup is also considering the Information Management and Technology system needed to support healthcare delivery to this vulnerable group to ensure that services are equitable, safe and person centre across the whole country.
As noted above, HIS has produced draft National Standards for the healthcare and forensic medical services for people who have experienced rape, sexual assault or child sexual abuse (children, young people and adults). These have been consulted on and will be published by the end of the year. This will support consistent practice throughout the country and ensure that Health Boards can be in no doubt about the quality standards expected of them.
We will work with Health Boards to ensure that they are ready to implement the standards as soon as possible. To help drive the continuous improvement of services, Health Boards will also be expected to report on the underpinning quality indicators (to be developed by HIS).
The high level work plan for the improvement of services for adults and children who have experienced rape and sexual assault will be subject to internal governance and monitoring arrangements to provide assurance for the timely delivery of the proposed outcomes. Regular updates will also be provided to the Scottish Ministers as this important work progresses.
Dr Catherine Calderwood
Chief Medical Officer for Scotland
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