Scotland's Redress Scheme: combined annual report 2023

6.8 NHS Boards

Published Redress Report:

NHS Grampian

NHS Greater Glasgow and Clyde

NHS Healthcare Improvement Scotland NHS National Education Scotland

NHS National Services Scotland (NSS)

This report sets out examples of wider (i.e., in addition to the redress scheme including non-financial) redress activities undertaken by NHS Scotland Health Boards from 7 December 2021 to 7 December 2022 as indicated in the Redress For Survivors (Historical Child Abuse In Care) (Scotland) Act 2021: Statutory Guidance.

Individual Support

All 22 NHS Boards confirmed that their corporate websites were updated in May 2022 to include the Public Statement to confirm their participation in the scheme created by The Redress for Survivors (Historical Child Abuse in Care) (Scotland) Act 2021. In addition, NHS Health Boards confirmed that individuals who have been in contact regarding the Redress Scheme have been made aware of the support available to them by both the Health Board and through the Scottish Government Redress Scheme.

All territorial NHS Boards provide a range of mental health services for individuals which includes support to survivors of abuse. In addition to these core services some specific examples of support offered to individuals by NHS Boards are as follows:

NHS Borders are due to open a new Forensic Examination suite (the Oakleaf centre) in February or March 2023 which will provide local access to a purpose-built forensic examination suite. This service will be available to any individual to self-refer and will provide another route for individuals who have suffered historical abuse to self-identify themselves to our services.

In addition to the suite NHS Borders has also established an integrated psychological trauma steering group with membership from NHS Borders, Scottish Borders Council, people with lived experience, and relevant third sector organisations. The agenda of this group is to de-stigmatise psychological trauma and provide governance and leadership in offering trauma training to the NHS Borders and Scottish Borders Council workforce to ensure staff are trauma-informed and are compassionate to the needs of individuals who have experienced psychological trauma.

Psychological services in NHS Borders are able to offer evidence- based psychological therapy for historic or current survivors of sexual abuse through usual referral pathways via GPs. Referrals can also be received from local people who have been affected by sexual abuse in care home settings outside the NHS Borders area and offer them evidence based psychological therapy according to their needs.

NHS Ayrshire and Arran (A&A) provide support, albeit not bespoke, to historical child abuse in care survivors. The NHS A&A Spiritual care team provides holistic support for residents and staff that cover a range of adverse childhood events and, where appropriate, onward referral or signposting to relevant therapies including those offered psychology and psychiatry services.

In NHS Fife adults are signposted to Kingdom Abuse Survivors Project (KASP) or secondary care psychology service. Clinicians in the psychology service work with survivors of childhood abuse as a core element of the psychology service provision, which includes therapy for individuals who experienced abuse in care settings and is part of the routine service provision. The NHS Fife Spiritual Care team provides a non-clinical listening Community Chaplaincy Listening (CCL) Service. CCL receives referrals from GP Practices and offers one-to-one support to individuals.

In addition, NHS Fife advised that many of their staff, for example within Addiction Services, have undertaken trauma-informed training and that individuals may be referred to KASP, psychology and/or third sector counselling services depending on their need and choice.

NHS Forth Valley confirmed that advice and assistance are available in terms of support to access historical records and tracing and reuniting families should this be required. They also offer Single Therapy (therapeutic interventions such as cognitive behavioural therapy, Trauma Focused CBT and Eye Movement Desensitization and Reprocessing) and Multi-modal Therapy (which include Compassion-focused therapy, Schema therapy, Acceptance and Commitment Therapy, Interpersonal therapy).

NHS Grampian endeavour to ensure that individuals will have access to the clinical support that best meets their needs and are reviewing access routes for services.

Through its Mental Health Services, NHS Lothian provides care and support to children, young people and adults who have experienced abuse which includes:

• Work delivered through the CAMHS Meadows Team to support children and young people who have experienced abuse. The focus of the team is working with a range of partners in social care, schools, and other partner organisations, while providing psychological treatment, care, and support to the young person.
• Provide Adult Mental Health (AMH) services through the Rivers Service, General Adult AMH and other Psychology Services, including psychological treatment for adults who have experienced abuse, many of whom have complex PTSD. Some individuals may have disclosed abuse and may be working with the police and legal representatives to bring a case to court. There are also times when individuals disclose abuse in psychological treatment and the clinicians work with them to help them to report this to the police.

Collective support

NHS Boards advised that they provide a number of group therapies, these therapies and services are available to all survivors and are readily available on request.

All NHS Boards were able to advise that they do provide overall therapy, which would include survivors of historical child abuse and can be amended to specific cases as required. NHS Ayrshire and Arran, for example, confirmed that their spiritual care teams offer rituals and ceremonies for a range of issues around, death, birth, hope, remembrance, letting go and that these ceremonies can be specified to survivors.

To date, the support provided by NHS Boards has been focused on individuals and therefore NHS Boards were not able to provide specific examples of collective support in addition to the aforementioned individual support.

NHS Boards are committed to providing ongoing support to all survivors and to ensure that advice and assistance is provided to any request from survivors in relation to access to historical records or tracing and reuniting families. NHS Boards acknowledge the harm caused and offer a full and sincere apology to survivors.

Wider Activities

The NHS Boards reported on a range of wider activities that have been initiated to provide meaningful ongoing support and acknowledgement to survivors. Examples of provisions by the Boards are.

• NHS Borders provides Public Protection services in conjunction with other key public sector partners, including Scottish Borders Council, Police Scotland and the Scottish Reporter. This service includes support for survivors, regardless of the location of the abuse. The Public protection services, for both Vulnerable Adults and Children, are provided via a co-located Public Protection unit and are overseen through the Critical Services Oversight group and Public Protection Committee. Within this structure there is specific work on Child Protection and improvement and quality assurance for these services.
• The Scottish Borders Child Protection services are currently being externally inspected through the Joint Inspection process any lessons learnt from this review will be reviewed by NHS Borders once available later in 2023.
• NHS Dumfries and Galloway Public Protection Team, provides all areas of Child and Adult Public Protection. They have established several processes for wider safeguarding of vulnerable individuals, including both children and adults.
• NHS Fife are establishing a group including staff from Legal Services, Mental Health Services (including Psychology Services and Addiction Services), Spiritual Care Service, Children’s Services, Medical Records, and Information Services to ensure that information in relation to Redress of Historical Child Abuse in Care Settings is collated, analysed, and monitored, and that the process is as supportive as possible.
• NHS Forth Valley work in partnership with 3 local authority areas to follow National Child Protection guidelines, and universally identify and respond to child adversity as early as possible to prevent long term, persistent harm. Learning Reviews are commissioned as a mechanism for all partners (i.e. health, police, and social care) to review and learn from. The NHS Forth Valley Chief Executive Officer has represented NHS Boards on national work, notably the NHS Public Protection Accountability and Assurance Framework guidance.
• NHS Forth Valley host the Transforming Psychological Trauma Implementation Coordinator role which supports the roll out of trauma-informed practice across the Forth Valley region. This service provides a range of activities, such as providing support to local authority and NHS trauma champions to influence change in their organisations, support the inclusion of lived experience expertise across service planning, provide specialist consultation to leaders and managers, and deliver Safety and Stabilisation training to staff across the sectors (i.e., mental health, physical healthcare, social work, justice, third sector and community organisations). This training encourages staff to use safety planning tools, provide basic psychoeducation and skills training to support emotional regulation. Further to this, NHS Forth Valley are developing a community of practice for staff operating at this trauma enhanced level to reflect on their work and wellbeing and build cross sector links with others who support individuals who have experienced trauma. The aim is that trauma will become ‘everybody’s business,’ and any individual, at any stage of their recovery, will be able to access the services they need in a safe way.
• NHS Lothian have strengthened child protection services through close inter-agency working between the NHS, local authorities, and Police Scotland. Currently, if concerns are raised relating to the abuse of a child (under 18 years old), NHS Lothian staff follow Interagency Child Protection Procedures and make a referral to either the Child Protection Hub, social work, or police. An Interagency Referral Discussion (IRD) is undertaken with the three key agencies (Police Scotland, Social Work, and Health Boards) and an interim safety plan is put in place including relevant supports, medical examinations, onward referral, and a decision to progress to a Child Protection Case Conference if required. Complaints made by adults relation to allegations of historical child abuse are supported in making a complaint to the police and, if required, appropriate referrals are made to other services.
• NHS State Hospital outlined their steps to fulfil their duty as Corporate Parent to individuals who are care experienced. For survivors of childhood sexual abuse there are several interventions provided:
  • Development of a trauma-informed approach to practice within The State Hospital
  • Direct support to survivors by way of supporting contact with Police Scotland (and PSNI) in order to report historic crimes and provision of Appropriate Adult services to promote meaningful engagement in these processes
  • Advice and guidance is provided to family members of patients who have been affected by these issues and signposting to relevant community-based resources.

Closing Remarks

The NHS Boards, in their entirety, have fully committed to being open, transparent, and caring in how they engage with anyone who was in the care of NHS Scotland and will support survivors to take steps to provide some redress for past trauma.