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Forensic Medical Services (Victims of Sexual Offences) (Scotland) Bill

Overview

The Bill would mean health boards must provide forensic medical services. These services are for victims of sexual offences. 
It would mean health boards will have to offer a self-referral service for victims. The Bill will make this process clear for victims and to health boards.

This lets any person self-refer without first having to report an incident to the police. Any evidence collected is stored while the person decides if they want to report the incident to the police. 

If the person decides not to report the incident, they can ask to destroy the stored evidence. If they decide to report the incident Police Scotland will keep the evidence. 

If the incident is not reported after a set time the evidence will be destroyed. It's still possible to report an incident after this time but no forensic medical evidence will be available. 

Police Scotland already refer victims to health boards for forensic medical examinations. This Bill will also put that practice into law. 

The Bill also applies to harmful sexual behaviour by children. Harmful sexual behaviour is inappropriate sexual behaviour displayed by children under the age of 12.

You can find out more in the Explanatory Notes document that explains the Bill.

Why the Bill was created

The Scottish Government believes that victims of sexual offences should have access to forensic medical services. 
It’s important so that: 

  • organisations providing the service know what is expected of them
  • people using the service know what they are entitled to 

The Scottish Government expects that the Bill will improve services by making the responsibilities of health boards clear. It will also support working between health boards and the police. 

The Bill will let victims refer themselves to their health board for an examination. They will not have to go to the police first. This gives them time to decide if they want to report an incident without losing any evidence needed.

The Bill supports recovery health services for anyone in Scotland who has experienced: 

  • rape 
  • sexual assault
  • child sexual abuse

You can find out more in the Policy Memorandum document that explains the Bill.

The Forensic Medical Services (Victims of Sexual Offences) (Scotland) Bill is currently at Stage 1

Introduced

The Scottish Government sends the Bill and related documents to the Parliament.

Forensic Medical Services (Victims of Sexual Offences) (Scotland) Bill as introduced

Scottish Parliament research on the Bill 

Stage 1 - General principles

Committees examine the Bill. Then MSPs vote on whether it should continue to Stage 2.

Stage 1 timetable

The Parliament agrees that consideration of the Forensic Medical Services (Victims of Sexual Offences) (Scotland) Bill at stage 1 be completed by 2 October 2020.

Have your say

The deadline for sharing your views on this Bill has passed. Read the views that were given.

Committees involved in this Bill

Who examined the Bill

Each Bill is examined by a 'lead committee'. This is the committee that has the subject of the Bill in its remit.

It looks at everything to do with the Bill.

Other committees may look at certain parts of the Bill if it covers subjects they deal with.

Who spoke to the lead committee about the Bill

Video Thumbnail Preview PNG

First meeting transcript

The Convener (Lewis Macdonald)

Welcome to the seventh meeting in 2020 of the Health and Sport Committee. We have received apologies from Miles Briggs. I ask everyone to ensure that mobile phones are off or in silent mode, and not to use them for recording proceedings or for photography.

The first item on the agenda is a panel evidence session on the Forensic Medical Services (Victims of Sexual Offences) (Scotland) Bill at stage 1. We have received apologies from the chief medical officer, who is unable to attend because she is required at Cabinet. I look forward to hearing from the witnesses on her behalf and in relation to the bill. The evidence will give us an opportunity to hear about the work of the task force for the improvement of services for adults and children who have experienced rape and sexual assault, and to hear about the bill’s provisions.

The CMO is unable to be with us because of the coronavirus. The committee will not discuss the virus today, but we recognise that it is of central importance to us, to Parliament and to our constituents, and it is a matter to which we will return.

I welcome Dr Edward Doyle, who is a senior medical adviser in paediatrics; Greig Walker, who is the bill team leader; Tansy Main, who is unit head of the CMO’s rape and sexual assault task force; and Katy Richards, who is a solicitor from the legal directorate of the Scottish Government. Tansy Main will make an opening statement.

Tansy Main (Scottish Government)

I am the head of the unit within the CMO directorate of the Scottish Government that has responsibility for the CMO’s rape and sexual assault task force and for the Forensic Medical Services (Victims of Sexual Offences) Scotland Bill.

I will not cover the bill itself, but Greig Walker will be happy to answer any questions about the bill process and about what the bill’s provisions do. I will provide a brief overview of the strategic context for the work and will then briefly highlight some of the task force’s key achievements to date.

I understand that you met survivors last week. The CMO and I have also met survivors and have heard similar, if not identical, accounts. Their experiences were distressing and, frankly, unacceptable. Indeed, it was feedback about the quality and consistency of the services that they received that prompted Her Majesty’s Inspectorate of Constabulary in Scotland to undertake a strategic review.

The inspectorate’s report, which was published in March 2017, highlighted significant gaps and disparities across Scotland and made 10 recommendations to improve those. In April 2017, the CMO was asked by the then Cabinet Secretary for Health and Sport and the then Cabinet Secretary for Justice to chair a task force to provide national leadership for improvement of those services. The task force vision is for consistent person-centred and trauma-informed services across Scotland. Our ambition is to ensure that the shortcomings of the past are not repeated. The chief executive of Rape Crisis Scotland makes an important contribution to that work and helps to ensure that the voice of lived experience is always front and centre of everything that we do.

In order to deliver against the HMICS recommendations under the remit of the task force, the CMO published in October 2017 a five-year high-level work plan. That set out actions to be taken across a range of issues between now and the end of 2022. The Scottish Government has committed £8.5 million to support that ambitious programme of work.

In December 2018, HMICS published a progress review that recognised the joint strategic leadership across health and justice but highlighted that challenges remained. At the time of that review, the CMO commented that the work of the task force was at a tipping point. Considerable progress has been made since then.

We know that having access to a female doctor is important for anyone who requires a forensic medical examination following a rape or sexual assault. Improving that was an early priority for the task force. Funding has been provided to NHS Education Scotland since 2017 to provide specific training for doctors, with the aim of increasing the number of women available to undertake the work. The training has also been adapted to allow participation by nurses who are involved in providing trauma-informed care for victims of rape and sexual assault.

So far, 118 doctors, 70 per cent of whom are female, and 68 nurses, 97 per cent of whom are female, have been trained. A further 10 doctors and 21 nurses were due to attend the NES training today, but NES decided late last week to postpone that due to the Covid-19 situation. That training will be rearranged as soon as it is practical to do so.

Baseline workforce data indicates that, now, 61 per cent of sexual offence examiners in Scotland are female. That is an increase of around 30 per cent on the indicative figure in the HMICS report, but we are not complacent. The availability of a female sexual offence examiner is the first quality indicator underpinning the Healthcare Improvement Scotland standards and the work to continuously improve that remains a top priority for the task force and for health boards.

Task force funding has also been provided to recruit more forensically trained nurses to be present throughout an examination and to help to ensure that an individual receives appropriate follow-up healthcare and support. In addition, the task force is supporting a new initiative to develop the role of nurse sexual offence examiner in Scotland. That was a key recommendation in the HMICS report.

09:45  



Funding is being provided to train a cohort of community pharmacists to look for indicators of rape or sexual assault and to provide a trauma-informed response to any disclosure. We have also begun work with the Scottish Courts and Tribunals Service to pilot sexual offence examiners giving evidence remotely in rape and sexual assault cases.

Another key HMICS recommendation was that dedicated healthcare facilities should be established across Scotland. Task force funding is being invested in each of the 14 territorial health boards to develop their sexual assault response co-ordination service, in line with a national service specification. Funding is also being provided to develop regional centres of expertise to support those locally delivered services.

All examinations that were previously carried out in a police station are now carried out in an appropriate healthcare setting, and funding has been provided to ensure that all health boards that require a colposcope are able to purchase one. In addition, the fact that a national decontamination protocol has been published and is being implemented by health boards addresses another HMICS recommendation.

A package of resources has been developed to ensure a consistent national approach to the recording, collation and reporting of data in relation to these services. That package includes the final Healthcare Improvement Scotland quality indicators that underpin the standards that were published in 2017, as well as a new national form to consistently capture information that is obtained during a healthcare assessment and forensic medical examination. That form has been agreed by all key partners to ensure that it meets the respective needs of the healthcare and criminal justice systems. The package also includes national data sets to monitor health boards’ performance against the quality indicators as they progress through their improvement journey; the first national clinical pathway for adults who present following rape or sexual assault; and a summary clinical pathway for wider healthcare professionals who might be the first to respond to a disclosure of rape or sexual assault.

You will appreciate that we want to ensure that all health boards are appropriately supported to understand how those resources knit together and what their role is in ensuring a successful nationwide roll-out. As such, my team held roadshows in NHS Shetland and NHS Orkney just last week, and four more were scheduled for the remaining health boards over the course of this week and next to explain what the change in practice means for them.

However, in light of the current Covid-19 situation, we are mindful of the unprecedented pressure on the national health service to prioritise its response to the pandemic, so we are considering when it would be appropriate to ask chief executives to implement the new measures. The cabinet secretary will write to the convener about that as soon as the position has been clarified. In the meantime, we can provide copies of all relevant documents, if that would be helpful.

As we announced in the policy memorandum for the bill, a new sub-group of the task force has been established to develop detailed protocols for health boards on the provisions of the bill as they relate to self-referral. The sub-group’s work is already well under way.

The task force is now halfway through its five-year plan. Although we still have much more to do, the impact that we are having is tangible, and the bill will be an important anchor that will underpin everything that we plan to achieve.

We would be happy to answer any questions that members might have.

The Convener

Thank you; that was helpful.

The recommendation was made that what was sought was a victim-centred and trauma-informed way of working. I hear what you say about the provision of more female examiners and the carrying out of examinations on health board premises, which are obviously important, but over the piece, how do you think that the work of the task force is contributing to the aim of having a victim-centred and trauma-informed approach?

Tansy Main

As I said, we have a lot more to do, but we have come a long way. Prior to the existence of the task force, health boards in many areas already delivered such services under the memorandum of understanding, but in many places they were delivered in a police station, and many staff were not trained in trauma-informed care. Colposcopes were not always available.

In the work that we have done over the past few years, our first priority was to ensure that we moved services to an appropriate healthcare setting. I mentioned the national specification document that has been published; it sets out the requirement for age-appropriate person-centred surroundings. Although the procedures take place in a healthcare setting, the emphasis is on ensuring that the setting is as homely and person centred as possible in order to minimise the feeling that it is a clinical environment.

As you will appreciate, the suite for the forensic examination is understandably clinical to an extent, because it has to be decontaminated, but the other rooms and spaces in the suites are being designed to ensure that the environment is as comfortable and supportive as possible for people.

The other key aspect is to ensure that there is a multi-agency approach to the setting. Health colleagues have been working closely with Police Scotland, local rape crisis centres and other key partners to develop that multi-agency approach so that a survivor can have their forensic medical examination, meet their rape crisis advocacy worker and give their recorded interview to the police in the same setting. They can also shower and get fresh and clean clothes—little things that we know from feedback from survivors are really important. Things such as having a cup of tea and something to eat and some time and space to talk to someone before they leave all help to make a big difference.

Health boards are at different stages in that regard but, overall, we have made considerable progress. One of the chief medical officer’s first asks of the chief executives was to ensure that all doctors who are involved in providing the care have undertaken the NES training, which was specifically designed around the principles of the trauma training framework. The majority of the doctors and nurses who are involved in providing the care have done that training, which will make a big difference to the person-centred care that is provided.

The Convener

It is clear from what you have said that the views of and feedback from survivors are informing the work of the task force. Is there a formal read-through from the survivors of rape and sexual assault?

Tansy Main

Sandy Brindley, who is the chief executive of Rape Crisis Scotland, is a key member of the task force. We have a survivor reference group, and she has kindly taken a number of issues to survivors in order to talk to them about the task force’s work and to get their views and opinions. A recent example concerns the generic name for services in Scotland. You might be aware that, in England, services are called sexual assault referral centres—SARCs. We thought long and hard about what would be an appropriate name in Scotland and, based on feedback from survivors, the agreed name is now sexual assault response co-ordination services, with the emphasis on the response and the co-ordinated, multi-agency aspect of the service that we are trying to provide. We also sought survivors’ views on the service specification that I mentioned, which describes the creation of that person-centred environment.

In addition to that formal channel to engage with survivors, Catherine Calderwood has met survivors directly, as I have, and their stories and experiences, which have been invaluable, are our touchstone that we always come back to. In my early days in my post, I met a survivor who had had an appalling experience. She very bravely spoke about that and explained that the process that she was involved with was not person centred or trauma informed at all. We keep coming back to such stories and thinking about how what we are doing will make a difference for people so that those things are not repeated.

Sandra White (Glasgow Kelvin) (SNP)

You talked about healthcare settings, but the evidence that we have received suggests that the actual practice does not match what you said is available to people. We have been told about people having to sit in police cars or offices and being unable to change clothes, get a drink of water or even go to the toilet, and all of that is recent. How many of the healthcare settings that you talked about are in place, with the on-going support that you mentioned? Is there a timescale for them? When are they likely to be in place and providing services to survivors?

Tansy Main

We work closely with all 14 territorial health boards. Each board has a dedicated nominated lead whom we liaise with directly, and we also work closely with chief executives.

I will summarise the position by region. In the north region, prior to the creation of the task force, there were no on-island adult services for forensic medical examination. That is no longer the case, because there is a dedicated healthcare suite in the new hospital in Orkney and there is a dedicated suite in Shetland. The Western Isles service was in a general practice surgery but has now moved into a hospital setting, for which we supplied some funding. NHS Grampian has dedicated healthcare facilities in the Aberdeen community health and care village, which were there before the task force was established. We have provided funding to NHS Tayside to move its suite out of a police station and into NHS premises.

In the south-east, there are dedicated new facilities in NHS Fife and NHS Forth Valley. They were previously located in a police station, but we provided funding to ensure that they were moved into an appropriate healthcare setting. In NHS Lothian, there is a suite in the Astley Ainslie hospital in Edinburgh and another suite in the civic centre in Livingston, which is a multi-agency centre with a dedicated healthcare suite. We recently provided some funding to make improvements there as well. In Edinburgh, we are providing a significant amount of funding for a new regional centre of expertise that will, hopefully, open in the summer. NHS Borders is progressing work for its local facility. Unfortunately, we had word recently that it has had to pause that because it needs the space for patients with Covid-19, which is the priority.

In the west, NHS Greater Glasgow and Clyde has its service at Archway, which is a healthcare facility. We have also provided funding for a new regional centre of expertise in Glasgow that will increase capacity and will be a multi-agency facility with more space so that police can also do their interviews and so on there. I visited the new NHS Lanarkshire suite just a couple of weeks ago and I believe that it is due to open at the end of April. NHS Ayrshire and Arran has a lovely new suite in Prestwick in a dedicated NHS facility, which I visited. The NHS Dumfries and Galloway facility was in a police station, but we provided funding to create a new suite in the Mountainhall treatment centre, which has been open since last June, with locally trained staff providing the service.

I do not know the timescales regarding the experiences of the people Sandra White heard from, but certainly no examinations should take place in a police station any more.

Sandra White

Thank you.

The Convener

Can you tell us what the process of evaluation will be when the task force has completed its work?

Tansy Main

Yes. As I said, we are working very closely at the moment with health board chief executives and we get quarterly returns from each board for performance against HIS standards. Going forward, the package of resources that I mentioned in the opening statement will ensure that data on health board performance against the quality indicators is collected and reported against. Those reports will be published and will be publicly available.

We are also looking to establish a managed clinical network for the services. MCNs exist for children’s and young people’s services just now, but we want to create one that brings together the adult and sexual abuse element of the child MCN so that we have an overarching body to oversee how services develop, monitor performance against indicators and identify where improvement might be needed. We are working with Healthcare Improvement Scotland to develop that quality assurance process to ensure that issues that arise can be dealt with appropriately. We envisage that that would also be part of the health board annual appraisal process and so on.

The Convener

Thank you.

Alex Cole-Hamilton (Edinburgh Western) (LD)

Good morning, panel. We appreciate your being here today.

The “Forensic Medical Services (Victims of Sexual Offences) (Scotland) Bill: child rights and welfare impact assessment” states:

“The Scottish Government considers that the best approach is to align the Bill with the general age of legal capacity (16) and the ‘age of consent’”.

That means restricting self-referrals to those who are 16 or over. Obviously, rape is the antithesis of consent and there is no connection there. Why was it felt that the age of 16 is appropriate? In particular, if a child or young person aged 13 or 14 who has the mental capacity to understand self-referral is raped by a family member, it might be very difficult for them to find somebody to come with them to report that rape, given that they might be in quite a coercive family relationship to begin with. Will you explain your thinking there?

10:00  



Tansy Main

I ask Greig Walker to cover that point from the perspective of the bill.

Greig Walker (Scottish Government)

Another relevant factor is that 16 is the age that is applied at the existing self-referral services—the Archway facility in Glasgow and the facility in Tayside.

I will ask Dr Doyle to comment on the paediatric clinical element, the children and young people expert group and the work that he is doing on the future children’s pathway. However, it is right to recognise that a range of evidence has been submitted to the committee. Some stakeholders have asked whether the minimum age for accessing self-referral could be lower, although there is no guarantee that anyone who is above the age will always be able to access it. With evidence coming from the National Society for the Prevention of Cruelty to Children and Social Work Scotland, there are also those who are asking whether there is a case for upping the age. It will be interesting for the Government to see the committee’s assessment of that in due course.

The child rights and welfare impact assessment, which Alex Cole-Hamilton mentioned, is where we have set out in the most detail the rationale for the age of 16. Following the 2019 consultation, the key pieces of legislation to be considered seemed to be the Sexual Offences (Scotland) Act 2009 and the Age of Legal Capacity (Scotland) Act 1991. It is also relevant that the mental health and incapacity legislation, including the Adult Support and Protection (Scotland) Act 2007, defines an adult as someone who is 16 or over. That is all the subject of a live review by John Scott QC, of course, and we do not want to pre-empt that.

It is important to focus on section 3 of the bill, which refers to professional judgment. I am not sure that that point has been fully understood by everyone who has read the bill. The reference to professional judgment is there because we recognise that there will be very difficult cases and that clinicians and paediatricians are well placed to work through those. In many ways, the bill does not give rise to new issues, because young people in those difficult situations will be phoning Rape Crisis Scotland, accessing community pharmacies or going to genito-urinary medicine services.

Alex Cole-Hamilton

Before you continue, I have a supplementary question. I am sure that Dr Doyle will have a view on this, as well. I understand all that and I am not saying that I have a problem with it. We are all quite new to this landscape, but many of the acts and thresholds that you mention are about rights and responsibilities and the choices that children make, whereas this is about a service that they can receive. In the current set-up—and the future set-up, if the age remains at 16—what happens if a 15-year-old presents at the Archway? Are they turned away if they have just been raped?

Greig Walker

No. Everyone already has the right to access healthcare under the National Health Service (Scotland) Act) 1978. As I think we may have said in the policy memorandum, no one will be turned away. If people cannot access self-referral for one reason or another, rather than our disempowering them by saying, “We’re calling the police, whatever you think”, best practice is for their situation to be explained to them.

We now have the rape crisis advocacy project and the trauma-informed workforce. Ideally, young people who are under the cut-off age and vulnerable adults will be put in a situation where they understand their position under the child protection reporting guidance and so on and are empowered to make the decision themselves. Giving people access to healthcare is the function of the bill, as I am sure Tansy Main will agree.

Another relevant factor is that it is quite rare for a young person to access a forensic medical examination, because child sexual abuse is generally disclosed quite some time outside the seven-day forensic window. We have tried in the bill to accommodate a situation where someone seeks forensics but it is not relevant to them. Section 4 has a focus on healthcare needs, which are an absolute priority even if no FME goes ahead. I note again that section 3 is about professional judgment. We are offering legal clarity and underpinning the task force and the health boards, but we do not want to overlegislate and be inflexible.

New voices have come into the debate since the 2019 consultation closed, so it will be interesting to see the committee’s assessment. Will there be different options for the bill? The cut-off at 16 could in theory be left to professional judgment, as is the case in relation to vulnerable adults, or a different cut-off age could be introduced. It is interesting that some of the written evidence suggests that the age should be kept at 16 for now and changed in the future. Perhaps a delegated power would be an option in that regard.

As I said, I will be interested to see what the committee makes of that. I believe that you have a panel of children’s stakeholders coming up.

The Convener

We do indeed.

Dr Edward Doyle (Scottish Government)

There is no intention that anyone who needs healthcare will be turned away. A strong view came through in the work that we did—

Alex Cole-Hamilton

I am sorry to interrupt, but I want to clarify my question, because it is important to get this right. I accept that and I do not expect that anyone who needs healthcare would be turned away. I am really talking about somebody who wants access to justice—someone against whom a crime has been committed, who does not have anyone to support them and does not want to go straight to the police. That is the issue that I am talking about, rather than healthcare.

Edward Doyle

The provision there would be for the professional who sees the young person to make an assessment of risk and vulnerability and, either with the young person’s consent or potentially without it, to involve other agencies and invoke the mechanism that we call an interagency referral discussion. That is the key decision point in child protection procedures. The legal situation is that child protection procedures apply to children and young people up to the age of 16. A child or young person who was in that situation would clearly receive healthcare, but the input would not be limited to that. There would be an assessment of risk and vulnerability.

To widen that out a bit, I note that that would always be the situation with other forms of abuse—physical abuse as well as sexual abuse, emotional abuse and neglect. This is core business for many of the professionals that we are talking about. In this case, the detail would be restricted to child sexual abuse, but the concepts are well understood and widely practised, and the responsibilities, as well as being part of the legal framework in Scotland, are embedded in professional responsibilities with the regulatory bodies.

The Convener

How have you sought to ensure that the bill reflects the principles of the barnahus model, which is used in Iceland?

Greig Walker

The aim is that the bill should be barnahus-ready, but barnahus is about much more than forensic medical examination and sexual abuse. The Scottish Parliament information centre briefing acknowledges that it does not necessarily involve having FME done on the premises—in some international barnahus models, it takes place in a separate hospital. It remains to be seen where Scotland is going with that.

I cannot remember it off the top of my head, but there is definitely a stakeholder organisation—it is possibly the Scottish Children’s Reporter Administration—that sees the bill as a step towards barnahus, while other stakeholders are unsure. This is not a barnahus bill, but we want to be barnahus-ready. That is very much in the spirit that my colleague talked about. Although the bill legislates for health boards to deliver the legal clarity and underpinning that Her Majesty’s Inspectorate of Constabulary in Scotland is looking for, it is intended to work in a multi-agency context where the police and social care have their due roles, the third sector has its role and everything comes together under the national performance framework, which is the glue that binds it all together.

Tansy Main

The service specification that I mentioned refers to the fact that services should be designed to ensure that there is an age-appropriate environment. We have been clear that our facilities that are used by adults, children and young people need to be designed with the principles of barnahus in mind. That approach is about creating a child-centred environment that is appropriate for the age group. Some health boards have their FME facilities for all ages in one place, where there is the space to do that. In other health boards, child examinations will happen in a paediatric environment unit, which is existing practice. However, it is absolutely the case that the services have been designed with barnahus in mind.

Emma Harper (South Scotland) (SNP)

Good morning, everybody. I am interested in issues around the sex of the examiner. Tansy Main talked about the need to develop more female forensic medical examiners, and the SPICe briefing mentions that the policy memorandum proposes a nurse sexual offence examiner project so that it would not just be general practitioners who do examinations.

When I visited the Mountainhall centre in Dumfries last Friday, Wendy Copeland, who does a fantastic job, told me a lot about the plan to have a women-led service. It would be interesting to hear more about the proposals to widen access so that we have more women examiners.

Tansy Main

Is your question specifically about nurses or doctors, or is it about both?

Emma Harper

It is about doctors as well. Chaperones are female, and I heard last week that even men who are raped and assaulted choose female examiners. People might not be aware of that.

Tansy Main

In my opening statement, I touched on the work that we have been doing to increase the number of female doctors. As I said, our statistics show a 30 per cent increase since the HMICS report was published. However, it is still not 100 per cent. We recognise that there is a long way to go and we are working hard with health boards to continuously improve that.

We have had feedback on the NES training in relation to remote evidence to courts from female examiners, and particularly GPs who work in the north of Scotland. If they are called to the High Court to give evidence in a trial but they have childcare responsibilities and a clinic to run, that can disincentivise them from being involved in such work, so we are looking at facilitating remote evidence-giving in order to retain the female doctors that we have.

The key to ensuring that people who want a female examiner can have one is the nurse examiner model. That is not new. Sexual offence nurse examiners have existed in England for almost 20 years and they regularly undertake examinations and give evidence in court if they are required to do so. Since the HMICS report, we have done a lot of work to develop detailed proposals on how we can adopt that model in Scotland. We have approval from ministers and the Lord Advocate to undertake a test of change, and we are recruiting this month for two nurse examiners to do that work.

In England, in order to qualify as a nurse examiner, nurses have to undertake a postgraduate qualification in advanced forensic practice for a year, and they have to do a period of on-the-job shadowing before they fly solo. The nurses that we will recruit to the test of change will have the levels of qualifications, experience and knowledge that are required for the role. At present, only a couple of nurses in Scotland have the qualification, because only Staffordshire University in England offers the course.

In parallel with the test of change, which I will come back to in a moment, we are working with Queen Margaret University to create a new postgraduate qualification in Scotland so that the workforce here can access the training. That course is due to start in September this year and the Government is providing funding for 10 places. Priority will be given to boards in rural and island areas, where it is particularly challenging to have female examiners.

We hope that the test of change will start around June, and it will be hosted at the Archway service in NHS Greater Glasgow and Clyde. We have worked closely with the Crown Office and Police Scotland around that to ensure that they have in place the safeguards and reassurances that they require so that there is no risk to the criminal justice process. We are also working with Rape Crisis Scotland, which will be involved in the evaluation and in getting feedback from survivors on the impact of nurse examiners.

We see the model as being key to creating a multidisciplinary workforce. It will never be the case that it will comprise only nurses or only doctors. We want to increase the pool of people who are available.

A majority of the nurses who are interested in this work are female, which is understandable. There is a lot of appetite from health boards to send nurses for the training, and they are keen to do it. I hope that, when the test of change concludes, the first couple of cohorts will have come through the postgraduate qualification at Queen Margaret University and we will be ready to commence the work. We hope that that will be the landscape for the future.

10:15  



Sandra White

Tansy Main said that there are 118 doctors, 70 per cent of whom are female, and 68 nurses, 97 per cent of whom are female. In answers to Emma Harper you mentioned two forensic practice nurses. How many female doctors and nurses are there in Scotland who are capable of doing forensic examinations of the type that we are talking about?

Tansy Main

Bear with me for a wee second while I look through my papers. I have the numbers with me somewhere—

Sandra White

You can send them to us if that is easier.

Tansy Main

I have found the stats: there are 76 forensic examiners in Scotland at the moment, of whom 43, or 61 per cent, are female.

Sandra White

Okay. That is grand. I just wanted to get the numbers, because we are talking about training, too. I am sorry for labouring the point, convener. You mentioned the course at Staffordshire University and the one that is opening at Queen Margaret University. Have there previously been no courses in forensic examination of this type in Scotland? That is what I cannot get my head around.

Tansy Main

There is NHS Education for Scotland training, which all the doctors and nurses who currently deliver the service are required to attend. The doctors undertake a shorter training programme, by virtue of their having a medical qualification, before they are able to do the work. The nurses who attend examinations, to assist doctors and provide trauma support to survivors, are also able to attend the training, so that they can understand and explain the process.

Sandra White

But is that training available in Scotland?

Tansy Main

Yes. The NES training happens in Scotland and has been adapted, so that it is portable and can be delivered in remote and rural locations.

The Queen Margaret University training is specifically for sexual offence nurse examiners. There is a year-long training programme to get that qualification, which is not currently available in Scotland but will be available.

Sandra White

That was my point. If we are pushing for the training, it is important to make the point that it has not previously been available in Scotland.

Tansy Main

Nurse examiner training was not available, but it will be.

Sandra White

We touched on healthcare needs. We heard lots from the witnesses who talked to us in private about their needs and the psychological trauma that they had gone through. Even 10 years later, if they were going for a particular examination, it brought it all back. People had had no support whatever.

You talked a lot about healthcare needs and the terminology in that respect. I have two quick questions—well, they might be quick, depending on how people want to answer them. What does “health care needs” as set out in the bill mean? Will there be guidance on that? Is it anticipated that the two big issues of mental health needs and psychological support will be included under the healthcare needs umbrella?

Tansy Main

Let me give a brief answer and then pass the question to Dr Doyle, who chairs the clinical pathways sub-group for the task force.

The clinical pathway that has been developed is very much about a holistic healthcare response. Forensic medical examination, which, as we know from feedback from survivors, can be the most traumatic part for people, is actually a small part of the services that should be provided. There should be wraparound care involving an assessment of people’s psychological and emotional wellbeing, their safeguarding needs and what referrals they may need to other services, such as mental health services or Rape Crisis Scotland services.

Through the task force, the chief medical officer has asked the board chief executives to ensure that they have nurse co-ordinators in place. That may be the same nurse who attends the examination, but in some boards it will be a different role. In some places, the role is embedded in the gender-based violence service or sexual health service. That person’s role is to ensure that, after the forensic medical examination, the victim is not left to navigate their own way round the health system, and that they are supported to access the on-going care and support that they need. As I said, some health boards already have that approach in place and others are working towards it. That will make a big difference by ensuring that people have a single point of contact for support as they progress on their recovery journey.

Dr Doyle

We use the term “health care needs” as a broad umbrella term. For example, the situation might start with managing an acute injury, such as control of haemorrhage, and then we would have the actual forensic examination. In the clinical pathway, we have tried to give practitioners a structure to work through. As well as dealing with acute injuries and forensic examination, they are prompted to think about things such as emergency contraception, vaccination for hepatitis B and HIV prophylaxis—there is guidance in the pathway about that. Practitioners are also asked to think about whether the person should be referred to sexual health services and, in the medium term, they might think about drug and alcohol services.

We are also mindful of the need for on-going mental health support in its widest sense. That might not be psychiatry; it might be psychology or counselling. We have done quite a lot of work on how that would look for people after the acute episode, including for children and young people. We are working on some tests of change in the west to inform further developments in that regard. The expert group on children and young people has done an awful lot of work on how we provide consistent and high-quality therapeutic support for young victims across the piece in Scotland. We are mindful of that issue.

All those things come under the umbrella term “health care needs”.

Greig Walker

I said earlier that the section that deals with healthcare needs is section 4, but it is actually section 5. I cannot add to what Dr Doyle has said on what the term is intended to mean, but I will pick up on some related points on the bill.

The first is about the way in which we have drafted the bill generally, and specifically the definition of “forensic medical examination”. In considering the FME process, we cannot ever entirely disentangle the healthcare and clinical needs from the forensics and justice needs, so we have not attempted to do so. We have tried to find the best interface between wider law and practice in the bill.

Another point that I could usefully pick up on that has been mentioned in a few of the exchanges so far is about the principle of trauma-informed care. In the schedule to the bill, on page 9, we propose to add that principle to the statute book for the first time. That has been welcomed by NHS Education for Scotland, which feels that the approach complements all the good work that it has been doing on guidance and training.

Tansy Main

I have a brief point about the final HIS quality indicators, which have been published. Indicator 4 is on assessing support needs and on-going safety planning, and indicator 5 is on access to immediate sexual health care. Those measures were not previously available, so we risked people slipping through the net and being discharged from the FME service without that on-going safety planning and support in place. The quality indicators will help to focus health boards’ minds on the importance of ensuring that that is all provided in a holistic manner.

Sandra White

I am interested in Greig Walker’s evidence about the trauma-informed workforce. Tansy Main talked about advising in that regard, but Greig Walker said that the provision on a trauma-informed workforce will be in legislation. This is up to the committee, but I am keen to ensure that, after hearing from others, we can make amendments to the bill on that issue, because it is important. We have talked a lot about clinical and forensic issues, but this is about the victims and their trauma—that is the important part. Thank you for that evidence. I will look at section 5 to see what I can see, and at page 9 of the bill, which I think Greig Walker mentioned.

Greig Walker

If it is at all helpful, the precise legislative reference is part 2 of the schedule, in paragraph 3(5)(b).

Sandra White

I will pick that up from the audio recording.

Greig Walker

The clerks can perhaps help with that. It is on page 9.

Sandra White

Thank you.

Brian Whittle (South Scotland) (Con)

Why was it decided that the timescales for retention of samples would not be specified in the bill but would be set out by the Scottish ministers in regulation?

Greig Walker

When we launched the 2019 consultation entitled “Equally Safe—A consultation on legislation to improve forensic medical services for victims of rape and sexual assault”, we realised that people would express views about self-referral on a general basis, but we perhaps did not think that they would get into the details of which body holds the samples for how long and what victims’ rights are. About a year ago, we had a useful workshop involving Rape Crisis Scotland, health boards, Police Scotland and others at which we fairly easily reached consensus on health boards having to hold samples for the retention period.

One point that came out strongly was that, given that rape and sexual assault completely take away the victim’s autonomy and consent, we need to give victims real rights. That is why the bill provides a right to instruct the destruction of samples, a right to instruct transfer to the police and a duty to ensure that victims are informed at the time of examination of what the retention period is and have that explained to them.

Frankly, we did not reach a consensus on the retention period. Tansy Main mentioned that there is now a self-referral sub-group. From considering practice around the United Kingdom, it seems that there is no consistency in any part of it, other than Northern Ireland, which has a single retention period because one facility covers the entire province.

The Faculty of Forensic & Legal Medicine has recommended that the period should be two years, but occasionally it has been put to us that any retention period that ends on an anniversary could be triggering and traumatising. That is very much a live question for the self-referral sub-group. If, during the course of parliamentary proceedings, the committee takes a view or there appears to be a consensus on that issue, an amendment could be made to the bill.

Another reason why the matter has been left to regulations is that services around the UK have changed their retention periods. The FFLM guidance and other guidance could change. We propose that the period should be prescribed by regulations, which would be dealt with under affirmative procedure so that there would be due scrutiny by the committee and Parliament. That approach allows for evolution of medical and forensic science. Another issue is that survivor input will be important before the period is prescribed.

Tansy Main

The self-referral sub-group of the task force is trying to gather best practice from elsewhere in the UK. The group is looking primarily at the SARCs in England, which are well established. As Greig Walker said, there is no real consistency. However, from the evidence that we have gathered so far, it seems that most places have a retention period of around two years; in some places, it is one year. One interesting thing that we have heard from the SARCs is that the majority of survivors who self-refer decide to report to the police fairly soon after the event—within a month or a couple of months. One service in London has reduced its retention period to a year, because it found that the majority of people decide to report fairly quickly. We will look at all the evidence and share it with ministers and the committee to help to inform the debate on that issue.

Brian Whittle

Can you confirm that you will seek views and input from victims on the length of time that they want samples to be retained?

Greig Walker

With any affirmative instrument, the committee will ask us what consultation we have done. We are actively thinking about that.

Tansy Main

The fact that Sandy Brindley, who is the chief executive of Rape Crisis Scotland, is a key member of the task force’s self-referral sub-group will ensure that survivors’ voices are heard in all our deliberations. Sandy also chairs a group that sits underneath the sub-group, which is looking at how survivors access services. We are very much seeking to ensure that survivors’ voices are front and centre in those deliberations.

10:30  



The Convener

Emma Harper has a supplementary question.

Emma Harper

When you mention evidence being retained for two years, are you talking about physical evidence such as DNA? Other types of evidence, such as photographic evidence, could last for ever. Does the two-year period relate specifically to physical evidence such as DNA?

Greig Walker

I clarify that that is not Government policy. I was simply pointing out what is in the UK Faculty of Forensic & Legal Medicine guidance. At present, however, that is not fully adhered to across the UK.

The bill proposes that victims will have control of all types of evidence that are provided by them, including samples, clothing and colposcope images. If they instruct deletion, the evidence will be gone. If they instruct its transfer to the police, it will be seized by the police and become a criminal production. However, the bill recognises that, in addition to the retention period, the nature of what is retained will be open to clinical judgment and subject to what the victim consents to, depending on what they think is best for them. Again, the self-referral sub-group is actively thinking about that.

David Stewart (Highlands and Islands) (Lab)

Last week, as the panel will know, we met 10 women survivors, and among the key issues that came up were lack of support and the need for independent advocacy. Was consideration given to those in development of the bill?

Greig Walker

In the policy memorandum, we reference the Rape Crisis Scotland advocacy project. Perhaps you will hear from Sandy Brindley later about how the situation feels to Rape Crisis Scotland, but we would not want Parliament to overlegislate and say that other bodies should do this or that, because the advocacy project already exists and is working quite well. It could have a particularly important role to play in relation to self-referral, which will be a new proposition in most parts of Scotland and is perhaps not in many victims’ minds at present. Tansy Main might have something to add.

Tansy Main

I do not have a great deal to add. The funding for the Rape Crisis Scotland national advocacy project comes through our equality and violence against women and girls colleagues. The Government is committed to the project and to ensuring that people can access those advocacy services.

David Stewart

I understand the point about not overlegislating. However, I think that, in the harrowing meeting that we had last week, we were all struck by how nightmarishly horrible the women’s experiences were, and I am sure that that is replicated throughout Scotland for other victims. There is clearly demand for advocacy services within rape and sexual abuse services, including in the Highlands, in my region. I am not convinced that I would use the word “overlegislating” in relation to the bill. I believe that there is a huge gap here and that such services are vital. Is anything being done at this late stage to change that?

Greig Walker

That is ultimately a matter for the committee. In relation to what the bill does to dovetail with advocacy services, I note that section 4, which is essentially on victims’ rights, says that people must be given information ahead of the examination. I understand that you heard last week that it was not made clear to victims what was going on, why things were being taken or what would happen next. Section 4(2)(b) says that information must be explained, which could be done by the health board’s trauma-informed workforce, working in partnership with others.

Another relevant factor is that we are applying the Patient Rights (Scotland) Act 2011 to everything under the bill. That act covers the accessibility of information, and in that spirit we have published an easy-read summary of the bill, which was called for by bodies including People First Scotland.

I think that a lot of good work is going on. I appreciate that the committee heard some pretty terrible things but, as Tansy Main said, we are beginning to turn a corner; people are having better experiences because they are getting positive support from advocates and are having a good experience with the examiner and forensically trained nurse. It no longer feels like a police process; it feels as though their healthcare and recovery is front and centre.

David Stewart

On that point, will the police be encouraged to tell people about the option of self-referral services?

Tansy Main

Yes. The access to services sub-group of the self-referral group that Sandy Brindley chairs is looking at how survivors will access services and what information will be available. Police Scotland and the Scottish Police Authority are part of that work and will ensure that Police Scotland information materials point people to the fact that they do not need to speak to the police first, and that other options are available to them.

David Stewart

Did the Government examine best practice in other parts of the United Kingdom, such as the England, Wales and Northern Ireland victims commissioner project? I declare an interest, because, some years ago, I proposed a bill on that subject. As members of the panel know, the issue is about who stands up for victims. A number of years ago, I took a lot of evidence on that; I met the Victims Commissioner for England and Wales in London and telephoned the Northern Ireland Commission for Victims and Survivors. The Government did not choose that model, and I accept that the legislation is not specifically about that, but there is a huge issue about who stands up for victims. Independent advocacy is one argument; sharing victims’ experience so that we can improve the law is another. Have you considered the themes around victims commissioners in other nations in the UK and brought that thinking into this legislation?

Greig Walker

I will pick up a few of those points. We have absolutely considered services in the rest of the UK, because self-referral is well established in other parts of the UK. There have been a number of facility visits, and colleagues around the UK have been generous with their time and expertise. They produced as much data as they could to help us inform the modelling assumptions in the financial memorandum. We were planning additional visits but they are on hold for the time being.

On the point about victims policy, this is a healthcare bill but it is also a justice bill and a victims bill. Therefore, the task force that you have heard about is complementary to the victims task force, which is under way. It has important survivor liaison; Sandy Brindley is also involved in it and the work is well co-ordinated within Government. It is within the remit of that task force to consider the question of the creation of a victims commissioner but that is a wider justice system measure that is not specific to this bill. We deliberately included the word “victims” in the title of the bill because it is a victims bill.

David Stewart

With joined-up Government, I hope that we are not in silos. Victims on the front line are experiencing the horrors of rape and sexual assault and their needs must be highlighted in the legislation.

Katy Richards (Scottish Government)

The committee might find it helpful to note that the bill will also amend the Victims and Witnesses (Scotland) Act 2014, which has a section that allows

“referral to providers of victim support services”.

Therefore, that provision will apply also to people who are accessing services under the provisions of the bill.

David Stewart

That is positive. It is also essential not just that the services are there and are developed, but that people know about them. We picked that up from the harrowing evidence that we took last week.

I will move on to capacity and consent to be examined. Convener, I do not think that we have covered it yet but stop me if we have. Particularly in relation to self-referral, what guidance will be issued to health boards in relation to legal capacity and consent?

Greig Walker

To return to something that Dr Doyle and I said earlier, the bill does not give rise to new issues; FME services exist across Scotland and there are some self-referral services. There is extensive guidance from the General Medical Council and the Royal College of Nursing. There are also pieces of Scottish guidance, such as adult support and protection guidance and the current and future child protection guidance. I keep coming back to the point about providing sufficient legal basis and clarity, but guarding against the risks of overlegislating, we felt that, because principles of consent and informed consent are so well embedded in general Scots law and clinical practice, we did not need to replicate them in the bill.

Certainly, the policy is that absolutely everything should be done on the basis of informed consent, with as much survivor input and control as possible. Tansy Main mentioned the adult clinical pathway; what comes out strongly in that is the principle of supported decision making in the United Nations Convention on the Rights of Persons with Disabilities. That relates to adults with learning disabilities, but the general idea is that people should be empowered to make as many decisions as possible for themselves and to know what is going on.

Dr Doyle might want to add something about clinical practice.

Edward Doyle

I do not have anything to add at this stage. All health boards have revised their approach to consent in the wider sense, in the light of a significant medical legal ruling in 2015, in the case of Montgomery v NHS Lanarkshire. There has been a lot of work on that, and the process that we are talking about today is captured in that thinking.

David Stewart

Do we need changes and improvements to examinations, to ensure that people are truly able to give informed consent?

Greig Walker

I would say that that is current best practice and is what is being delivered on the ground.

David Stewart

Thank you.

The Convener

Just before we move on, in response to a question from Brian Whittle about retention, Greig Walker referred to the victim of a sexual offence having control over the evidence. Is the implication of what you said that, once evidence was passed to the police, witnesses did not have control over it?

Greig Walker

The bill legislates for health board responsibilities. It legislates for the interfaces in police referral cases, where a constable brings a victim to a facility. That is the usual model in Scotland, and a sexual offence liaison officer handles the matter; police processes have improved a lot. The bill also picks up on the point that the constable takes the evidence away.

The wider justice process is legislated for separately. Parliament recently passed the Scottish Biometrics Commissioner Bill, which is part of the mix of the law that applies on the criminal justice side. As Katy Richards said, we recognise the important role of the Victims and Witnesses (Scotland) Act 2014, which is partially applied to the bill, where relevant. The Patient Rights (Scotland) Act 2011 is the most relevant rights act in relation to healthcare and is fully applied, including the wording about trauma-informed provision of healthcare. The victims code for Scotland under the 2014 act applies fully to victims after they have made a police report. There is also the appropriate adult service.

A number of reforms have been made to put in place measures for victims once they are in the justice system, but the bill has to accommodate the possibility that the victim chooses never to go there.

The Convener

But in practical terms, what does that mean for the victim’s control over the evidence?

Greig Walker

We know from feedback from survivors that, in a police investigation, more evidence may be taken, such as jewellery and scarves. Under the 2014 act, victims can request to have that back. The process should be smooth, under the guidance, but it was suggested that a few years ago it was not as smooth as it should be. I am certain that the victims task force will look at such issues.

Emma Harper

Some respondents were concerned about the increased costs for health boards, which must implement the provisions of the bill, but it seems that the Scottish Government has provided funding to set up sexual assault centres in healthcare facilities. What concerns have health boards raised about long-term funding and what action has the Scottish Government taken to support boards in that regard?

Tansy Main

As I said, the Scottish Government has committed £8.5 million over three years to support health boards to embed the Healthcare Improvement Scotland standards and prepare for the forthcoming legislation. That has been pump-prime funding, to build workforce capacity, improve the physical environment, procure essential equipment and deliver national projects such as an information technology system.

10:45  



Everyone was at different starting points. Some health boards were already delivering services; others were not or had significant improvements to make. Therefore, our aim was to bring everybody up to a similar standard. In order to do that, we asked each health board to do a self-assessment against the HIS standards. That informed a gap analysis; from there, they could identify what funding they would require in order to help them meet the HIS standards. To ensure that the funding was targeted where it was needed most, each health board brought those costed local plans to the task force to bid for funding. At the moment, we are in the process of reviewing their funding needs for this coming financial year. All the funding has been provided on the basis that the health boards commit to sustaining the services that are developed using the task force funding beyond the lifetime of the ring-fenced task force allocation.

A significant amount of the funding has gone into capital developments, such as premises and equipment. As I said, we have also provided funding for pump-prime recruitment of staff, such as forensically trained nurses, to be present during examinations, and to increase the number of female doctors in the Archway service. We are on an improvement journey. With regard to the workforce, come the end of the task force funding, there will be a revenue tail. We are working with health boards to see what that fully costed model would look like beyond 2021-22. As I said, health boards have committed to maintaining the services that are developed utilising that task force funding.

Emma Harper

Are health boards concerned that there will be a big increase in the number of people coming forward? Are they worried that that might impact where we are? We want people to come forward and to feel safe and secure. There needs to be a holistic approach, and any rape or sexual assault needs to be dealt with in a trauma-informed way.

Tansy Main

There is some concern around that. The modelling in the financial memorandum was based on the best available information at the time; that indicates an expected increase of around 10 per cent in demand for self-referrals. Bearing in mind that the police referral model already exists, the increase in demand on health boards will primarily arise from those who choose to access a self-referral instead of a police referral. That 10 per cent is spread between the 14 territorial boards. Understandably, the larger boards will have a greater proportionate share of that demand. The financial memorandum indicates a cost of between £220,000 and £290,000 per year across all 14 boards. Therefore, the cost per board is not significant in the grand scheme of health board funding from the Government.

However, time will tell what the level of demand looks like. Sexual crime is often underreported; as awareness grows of the availability of the service, that demand might gradually increase but, rather than a big surge at the beginning, we expect it to be incremental. From when the bill is implemented, we expect the cost of the increased demand for self-referral to be not too great per board.

Emma Harper

As people find out about the self-referral process, they will get to the right place and the right people. You will track all the data to see whether the numbers are different in rural and urban areas. Is there any additional concern? The modelling says that from a low-demand scenario to medium demand, there is a projected 20 per cent increase. However, from a low-demand scenario to a high-demand scenario, there is a projected 35 per cent increase. Is that just part of the modelling that has been done to look at how numbers will be projected?

Tansy Main

Yes. As I said, it has been very difficult, because we have not had a consistent means of gathering data on existing demand for services. We asked health boards to trawl through and provide figures for the task force and we understand that, in the previous calendar year, there were 697 police referrals for forensic medical examination and 46 self-referrals. At the moment, the number of self-referrals is low in comparison with the number of police referrals. We now have that baseline and will be able to closely monitor how demand increases over time.

Emma Harper

Thanks.

David Torrance (Kirkcaldy) (SNP)

What consideration was given to including a provision in the bill to require monitoring and reporting by health boards?

Greig Walker

I imagine that you are aware that the Law Society of Scotland raised that point.

The package of resources that Tansy Main mentioned in her opening remarks would include consistent national data collection, to allow for modelling assumptions to be replaced with real data, to make it much easier to plan.

An assessment must always be made about what a bill needs to cover and need not cover. There is much good stuff in the task force’s work that we felt was adequately covered. For example, we did not feel that the arrangements on the national form, quality assurance and how the information is collated and reported back needed to be statutory. I imagine that the committee will take its own view on that.

David Torrance

How will data collection on forensic medical examinations drive improvement in the service?

Tansy Main

As I said in my opening remarks, the package of resources includes a national form, to ensure that information is recorded consistently. Each health board will provide data to the Information Services Division, to demonstrate its performance against the Healthcare Improvement Scotland quality indicators. That information will be used as part of a quality assurance process that we are developing with HIS, to ensure that the improvement of services is always under consideration, through, for example, the health board annual appraisal process and the managed clinical network that I mentioned.

Brian Whittle

I want to consider the areas that are not in the bill. The memorandum of understanding between Police Scotland and health boards covers more than forensic medical services for victims of sexual assault and rape. Police Scotland pointed out that the wider provision of forensic medical examinations continues to remain outside the legal framework in the bill.

In its submission, the NSPCC said that the examination of children and young people who are alleged to have been involved in sexual assault and abuse is not included in the bill, although

“many children suspected of perpetrating sexual offences are subject to forensic examination in police custody.”

The NSPCC went on to say that it would support the bill’s provisions being extended to cover the forensic examination of all children, on a statutory basis, and to cover the provision of therapeutic interventions.

How will the arrangements in the MOU that are not in the bill be continued? Will the MOU be revised in light of the bill?

Greig Walker

I will answer the points that I can answer and ask Dr Doyle to talk about the paediatric practice element.

Forensic services is a wide concept, and Scotland has very little legislation on forensics. Even if we narrow it down to forensic medical services, we are still looking at a wide concept, including toxicology, dentistry and all sorts of things. In the 2019 consultation, we asked whether there was a consensus on the need for legislation to deliver the clarity and scope that HMICS was looking for.

Ninety-one per cent of responses endorsed the consultation proposals, which were focused on addressing the HMICS report and the sorts of issue that you have heard about from survivors. I suppose that we made the assessment that we could make relatively quick progress on specific legislation, in the context of the MOU remaining in place for everything else.

It is fair to put on record that the NSPCC and Children 1st also made that point last year. We recognise that. We take the view that, whether someone accesses FME under the bill or under the MOU, there will be no second-tier service. There could be situations in which an FME is accessed on both bases. We have the trauma-informed workforce, the Patient Rights (Scotland) Act 2011 and so on.

In essence, FME for children is rare, because of when things are reported. In the rare instances in which FME is needed in the context of non-sexual child abuse, the basis for that is the MOU; I will ask Dr Doyle to explain how, in essence, the practice is the same.

Dr Doyle

There is very little difference in practical terms between a paediatric forensic examination for suspected sexual abuse and one for abuse. Such examinations tend to be done by the same people, in the same facility.

The bill was not created in a vacuum. There have been standards, guidance and training in paediatric forensic examination for a long time. We have had the three managed clinical networks for child protection in Scotland for some years now; they set standards, gather data and report through their own governance structures.

The fact that non-sexual abuse is not legislated for in the bill will not be detrimental to the service for children and young people in the context of other forms of abuse.

Greig Walker

The barnahus concept encompasses all forms of child abuse. The bill would not limit the approach to FMEs for sex crimes.

Brian Whittle

Has consideration been given to including in the bill children who are alleged to have perpetrated sexual abuse, or do such children sit outside the approach?

Greig Walker

In its report, HMICS made a recommendation about child suspects that was directed to Police Scotland and health boards. The issue is currently being considered through a police care network, so we did not see a need to address it in the bill. However, I understand that the Age of Criminal Responsibility (Scotland) Act 2019 will be the legal basis for alleged perpetrators under the age of 12 providing samples.

Tansy Main

The police care network has been developing standards for the examination of children and young people under the age of 12 who are suspected of sexual crime. The HMICS recommendation was that that does not happen in a police setting, because the suspect is still a child, albeit that they are suspected of a crime. The draft standards that are being considered will embed the principle that an IRD will always take place to determine the most appropriate place for the examination to happen and that that should be a healthcare facility, where at all possible. Protocols will need to be in place between the health board and the police, to ensure that a suspect is not in the same location as the victim at the same time—they must be dealt with separately. The principle of a child who requires an examination being in a healthcare setting rather than a justice environment is very much at the centre of the approach.

The Convener

You referred to an IRD; will you spell that out for us?

Tansy Main

Sorry. It was mentioned earlier; it stands for interagency referral discussion.

The Convener

Serious sexual assault and severe forms of child sexual abuse are sometimes associated with socioeconomic disadvantage. Are the work of the task force and the bill designed to make it easier for victims in such circumstances and those who live in the poorest areas to come forward and seek support?

Greig Walker

We published a number of impact assessments with the bill, including a full fairer Scotland duty assessment, which you can read.

We recognise that there are socioeconomic and other equalities dynamics. The bill talks about people—that is modern drafting practice and you will also see it in the clinical pathways. Everyone is entitled to the same service, but how the boards offer the service from a position of equity is something that they will think about through implementation that is co-ordinated through the task force.

Impact assessments are being done not just for the bill but for the package of supporting documentation that Tansy Main mentioned

Tansy Main

The task force undertook an options appraisal in 2018 to look at the model and configuration of services in Scotland. It was a rigorous process, which involved all our key stakeholders. The preferred model is very much one in which services are delivered as closely as possible to the point of need. That is why we have been developing local services in each of the 14 territorial health boards. Some boards have more than one local service, and there is support from the regional centre.

It is important that people do not have too far to travel to access the service. That is why we focused on there being a local service as far as possible.

The Convener

I thank the bill team and all the witnesses who have given evidence this morning. I am sure that we will talk about these matters again. If witnesses think that it would be helpful to provide further points of information arising from our questions this morning, feel free to do so.

I suspend the meeting for a few minutes, to allow for our round-table evidence session to be set up.

11:01 Meeting suspended.  



11:12 On resuming—  



The Convener

We resume with our next evidence session as part of our scrutiny of the Forensic Medical Services (Victims of Sexual Offences) (Scotland) Bill at stage 1. We are joined by Sandy Brindley, who is the chief executive of Rape Crisis Scotland; Anne Robertson Brown, who is the vice-chair of Angus violence against women partnership; Gwen Harrison, who is manager of Rape and Sexual Abuse Service Highland; and Jen Stewart, who is centre manager of the Rape and Sexual Abuse Centre Perth and Kinross.

This round-table session will involve members of the committee asking for your views, opinions and experience, but it is more informal than the session that we have just had with the Government witnesses, which you might have watched. Feel free to ask us questions if you think that that will help the dialogue. Do not feel that you have to answer every question—just come in when you have something that you want to add. We are a little spread out, but that is appropriate in the circumstances.

I have a question for any of the witnesses that relates to the discussion that we have had today and informally in the powerful and moving evidence session that we had last week. Which aspects of the examination service are most important for those who have been victims of rape and sexual abuse?

Sandy Brindley (Rape Crisis Scotland)

The feedback that we have from survivors is that the most important issue is access to a female doctor. The lack of access to a female doctor is what causes the most trauma.

Another significant issue, which came up at the closed session that we had with survivors last week, is delay. We cannot overstate how much distress is caused by having to wait hours or even days for a forensic examination after being raped or sexually assaulted, which means that victims cannot wash. That can cause huge distress for people. Those are the two key issues.

There are also broader and more general issues. There is a lack of trauma-informed practice. At the closed session last week, one survivor spoke about how the male doctor who examined her did not say a word during the examination. That is clearly not trauma-informed practice. That is a cultural issue, but it is also about how medical staff who are involved in examinations are trained.

11:15  



Jen Stewart (Rape and Sexual Abuse Centre Perth and Kinross)

I reiterate that the issue of access to a female examiner has come up consistently, as has communication. That comes under the heading of trauma-informed practice. It is important that examiners are clear about what they are doing, when they are doing it and why. Survivors have told us what a difference that makes.

A non-judgmental approach is vital. In Tayside, we have SARN—the sexual assault referral network—which supports survivors and connects them with a rape crisis worker from the beginning. They are met by the worker and a nurse. Follow-up support work has also made a significant difference.

Gwen Harrison (Rape and Sexual Abuse Service Highland)

Survivors also tell us that people should be able to pause the process to get the information that they need and take stock before they decide how to proceed. People tell us that that would make a huge difference.

In Highland, there are big concerns about travel and how people access services. We have had instances of people being transferred from one police car to another because it is time for a change of shift, or because they are going from one area to another. That can be retraumatising, as part of that journey.

Anne Robertson Brown (Angus Violence Against Women Partnership)

I echo what has been said. Our area is semi-rural, so we have issues with travel, too.

We asked specialist agencies to hold focus groups before we responded. One key idea that came through was about victims being given back some control and being able to pause so that they can say when, how and how fast the process goes ahead.

The Convener

One thing that shocked me in the session that we had last week—because I was not aware of it—was the situation in which somebody who wanted to report a rape on a Sunday night found that the service was so much poorer than it would have been on a Monday morning. Is it important for victims for there to be an out-of-hours or 24/7 service?

Sandy Brindley

Absolutely. No matter when somebody is raped or when they choose to access health or forensic services, they should be able to access the service when they need it. It should not be a two-tier service in which someone who is raped out of hours or at the weekend has to wait overnight, without washing, in the clothes that they were raped in. It is inhumane to expect that of people in those circumstances. The services should be resourced 24 hours a day.

It is different if the offence is historical and there is no immediate need for a forensic examination or for a health response, but if somebody has just been raped they should not wait days for an examination.

Alex Cole-Hamilton

It is great to see you all here. I reiterate our thanks for the services that you provide. The testimony that we heard last week will stay with me forever.

One thing that struck me in the stories that we heard was that there is sometimes a lack of consent in rape examinations. One example that stuck with me was about a situation in which there was a female healthcare professional, but she said, “We’ll just do your smear test now.” She did not ask; she just did it. That seemed horrifying. I would like to think that that is the exception rather than the rule, but can you give us an understanding of that?

Jen Stewart

Particularly in the past two years, the feedback on the forensic medical examiners has been very positive. Survivors in our area have fed back that, in their experience, things have been explained and the process has been more trauma informed. Many experiences have been shared with us where that has not been the case, but we have definitely seen progress at local level.

Sandy Brindley

We are seeing progress nationally, too. We have a feedback protocol when we get referrals from Police Scotland. Through the national helpline, we ask people questions, which they can choose to answer, about their experience of the police and the forensic process. That means that we get quick and on-the-ground feedback about what is happening. It is fair to say that, over the past six months in particular, the feedback has started to improve. We are starting to see the impact of the work of the CMO’s task force on those issues, which is definitely being reflected in the better feedback that is coming through from survivors who are in contact with us.

However, delays, which cause a lot of distress, continue to come up. The two issues that still come up in the feedback that we get are delays and the lack of female examiners.

The Convener

Is there anything in addition to those two points that you would like to see in guidance to health boards on examinations?

Sandy Brindley

The point about links to advocacy services was well made earlier. Rape Crisis Scotland runs a national advocacy service in partnership with all our local rape crisis centres. The feedback from survivors is that it is a life-saving service, but there are real issues with capacity and funding. Some of our advocacy services have to operate waiting lists, which is not acceptable for services of that nature. We need to consider how to properly fund the health response as well as the services that should go alongside it.

On the issue of resourcing the health response, we should not look only at the number of additional cases through self-referral; we are asking the health service to transform its response to rape and to survivors of rape. Doing that properly will require a significant injection of resources above that which is required for the number of self-referral cases.

For me, the bill has two key functions. One is self-referral and the other, which is just as important, is about making it clear that the health service has a responsibility to respond to the needs of rape survivors. That has not necessarily happened to date, because it has been focused on the old model of provision of the actual forensic examinations rather than the wraparound care. If we are to get the services to a stage where they are not an embarrassment to us as a country, significant investment will be required.

David Stewart

The issue of advocacy has been highlighted. I agree with the points that have been made and echo that the meeting that we had last week was harrowing; the 10 women who came along were extremely brave.

I was certainly struck by the need for independent advocacy. Sandy Brindley was in the room earlier when I raised that point with the bill team. I still feel that the bill should be clearer about advocacy services. It is not enough that they are there; my sense is that they are still patchy and are probably underfunded across the country. Survivors or victims need to know about those services, and clearer emphasis in the bill would help in that regard.

The committee and individual members have a role in relation to amendments, so I would be grateful for the other panellists’ views on that. I gave Gwen Harrison’s service an advert earlier, so I ask her to respond.

Gwen Harrison

That highlights some of the capacity issues that we have in Highland, especially as a lot of forensic exams will be carried out more locally. If we have two advocacy workers in Highland, it will be really challenging to ensure that they can go to Fort William, Skye or Wick. We expect that the need for our service and for independent advocacy will go up. We are predicting that we will really struggle to continue to deliver the level of service that we provide at the moment.

Sandy Brindley

Advocacy support should be a core part of the clinical pathway that is being put in place and that lies underneath the provisions in the draft legislation. For that to work, it needs to be resourced properly.

Anne Robertson Brown

I echo some of the things that my colleagues have said. Support and advocacy must be part of the core pathway, but we also need equity across the country. For example, we need to consider issues of travel, rurality and low population density. We face a postcode lottery in the services that women access.

We also need to be mindful that rape can often happen within a relationship. Coercive control presents barriers to women coming forward, including concerns about what will be done with evidence and who will have access to it.

I go back to my point that women should have control over how they report, who they report to and when they go into a police investigation, but we should capture the forensic evidence so that it is there for when they are at that point.

Emma Harper

As an MSP for a rural area, I am interested in how we protect confidentiality in such areas. If we are establishing a standardised approach across health boards, somebody in Stranraer could go to Ayr rather than to Dumfries, for instance. Should there be a process whereby people can self-refer to a place of their choice, rather than being directed to a place within their NHS board catchment area?

Sandy Brindley

Yes, absolutely. Also, somebody might live in one area, but the incident might have taken place in a different area. In my view, where they access the service should be determined by their need and wishes, rather than by what health board area they live in.

Emma Harper is absolutely right to raise anonymity as an issue. Gwen Harrison might be able to say more about that. For example, there were particular issues on Shetland and Orkney before they finally moved to delivering the service locally there, because people were having to travel to the mainland for examinations. People in the community said that, if somebody was getting on a boat or a plane accompanied by police officers, everyone on the island knew that something terrible had happened to them. If that is not a deterrent to reporting rape, I do not know what is.

We need locally delivered services. People should not be travelling significant distances, say from Campbeltown to Glasgow, in the back of a police car. That is unacceptable, so I hope that those days are over as a result of the advent of more locally delivered services. At the same time, people should have some choice about where to go for self-referral. It should be what is comfortable and convenient for them while protecting their anonymity.

Jen Stewart

I echo the point about the challenges due to the geography of our country. If there is an incident in Kinloch Rannoch and the person has to get to Dundee, there are significant problems in supporting access to services. We definitely have a long way to go.

The Convener

So local delivery is important.

Jen Stewart

Yes.

Anne Robertson Brown

I echo what Jen Stewart said.

Angus is part of NHS Tayside, but we are finding that many services are located in Dundee, and that there is a movement back almost to the old regional approach. For women living up in the glens of Angus or rural parts of Perth and Kinross, public transport is horrific, never mind everything else, and everyone knows everyone. So I echo concerns about confidentiality, and I am keen for discussions to take place on what could be offered to protect women’s confidentiality, because violence against women knows no boundaries—it happens right across society.

Sandy Brindley

Access to public transport is an important point when it comes to self-referral. With non self-referral, the person is often taken in a police car to where the examination is carried out, whereas, for self-referral, people generally make their own way there, unless they are being supported by, for example, one of our advocacy workers. That is why locally based services that still protect people’s confidentiality are important. Somebody should not have to travel on three buses followed by a long walk to get to a service of that nature. Such services must be locally based.

Sandra White

That was an interesting aspect of the topic; I am sure that the committee will discuss it afterwards.

I want to take you back a wee bit, to training for examiners. The evidence that we heard from survivors was horrific. We have just questioned the civil servants, who gave good answers about the bill, and we were absolutely told that there were female doctors. However, one of the horrific things experienced by the survivors who spoke to the committee was when there were no female doctors, and the male doctors had no empathy, were very dismissive and did not speak or anything.

11:30  



They are now looking at training, wellbeing and that type of thing. Does the panel consider that the health boards will have appropriate guidance? That is why I was asking about legislation and guidance—I will certainly look up what is in the bill. Funding is also important, to ensure that there is a well resourced and trained workforce and that people do not have the sort of experience that happened before. Is there enough in the bill to ensure that the examiners will have guidance, that they will adhere to the guidance, and that they will be well resourced and trained?

Gwen Harrison

We have been discussing the need to make sure that, as we move towards more trauma-informed training, people are implementing the training and working in that way. We do not want the training to become a tick-box exercise that people complete without then working in that manner.

A whole team of new forensic nurses started in NHS Highland a few months back and we were asked to train them on the kind of trauma-informed care that we do from day to day. They found that quite powerful, because our training made the approach real. There may be a need for that sort of training, as well as the guidance.

Anne Robertson Brown

I echo some of Gwen Harrison’s points. I would love it if in Scotland we stopped talking about trauma-informed care and moved towards trauma-responsive care. We should be delivering trauma-responsive services at the point of need.

There absolutely must be training for the NHS. Why are we not making use of the expertise on the ground? You said that the committee had heard from survivors. They are the experts with the lived experience. How do we get the golden thread of that lived experience pulled through the training? My suggestion is to involve the specialist agencies on the ground in either writing or delivering the training.

Sandy Brindley

The Scottish Parliament information centre briefing refers to a woman who went through the forensic service and, very bravely, took the time to make an audio recording of what was most difficult about the experience for her. We have used that in training forensic service doctors and staff. It is important to make sure that the people who are delivering the services hear directly from survivors about what was difficult and what made things a bit easier, which includes things that people might not even think of.

In the podcast that I am referring to, the survivor talks about how distressing it was to go into the forensics room and see that it was obviously also used for child examinations, because there was a mobile hanging from the ceiling above the examination bed. Trauma-informed or trauma-responsive practice means thinking about the bigger things, but also the smaller things that could be really upsetting to somebody at such a time. That includes making sure that the physical environment is appropriate.

Although it is starting to change, a lot of feedback that we have previously had included a sense that care was not given to people’s wellbeing. Somebody might be there for quite a time without being offered a drink or anything to eat. That is not how to get the best evidence from somebody, for a start, but it also conveys a lack of care. In those circumstances, people need a sense that somebody is looking after their wellbeing.

Some of those are broader issues. The bill is one part of a wider package of work, particularly around the clinical pathways and the specification of the services that will be set up across the country. We should be asking not only what the bill can achieve, but what else needs to be put in place and how we can make sure that once it is in place, the work continues and is funded and delivered properly.

Sandra White

Thank you. That raises other questions. I think that Gwen Harrison asked how we will know that the work will continue. We will have to look at the evidence, as people have said, which will mean asking the women and men who go through the service whether it is satisfactory. That type of thing should be put in the guidance. We need to consider that and consider asking you and others who have experience of such work or are survivors, to give the training.

I am talking about giving both information and training. I also want to ask about information for victims, which is a huge issue. We have heard that victims do not really know what they will go through. In particular, I am talking about providing information before an examination.

I have two straightforward questions. Should information be provided to victims prior to and after forensic medical examinations? Section 4 of the bill, which is on “Information to be provided before examination”, has been mentioned. Is there anything else that you would like to see in that section?

Those are big questions. I am sure that you can also write to us about them.

Gwen Harrison

There is probably quite a lot of opportunity for independent advocacy in those areas. If an independent advocate is a port of call for people, the options can be laid out and the advocate can ensure that people have all the relevant information. That advice would not be linked to services, and people could decide whether they wanted to report to the police or to self-refer. People would be given information in advance of that.

I agree that, as things come into play, how we ensure that people are aware of them will be crucial. A lot of survivors who come to us have real concerns about speaking to the police, for example, simply because they have never done that before. Obviously, there will be a lot of changes, and how the messages go out will be really important.

Jen Stewart

All the professionals who are involved in the process need to give consistent messages. The point about reporting is really important. If somebody is spoken to prior to a self-referral, for example, and they are told about being able to make a decision on reporting in their own time, to give them some space, it is very important that every professional who is involved communicates the same messages. People opt for self-referral because it gives them space, and it is quite concerning that there is sometimes feedback that they then feel a certain amount of pressure.

Sandy Brindley

People also need written information. Professionals need to be well informed to talk people through things, but we heard clearly from the survivor session that people were simply not in a place to take in information. That will maybe happen in the hours that immediately follow a rape or sexual assault. A person is likely to be traumatised and in shock, and they will not take in a lot of information.

I go back to the point about feeling that there is some level of control. How can we create some sense of control throughout the process for a person who has had all control taken away? We must ensure that they get enough information in order to give informed consent to a forensic test beforehand, and that should be written information. That is being developed through the work in the CMO’s task force. There should also be information that can be taken away on what has happened, what will happen next, and the samples that have been taken. With the best will in the world, a person will not take in the information that they have been told at the time, or they are unlikely to retain it. There must be lots of different leaflets. They will not be able to remember who gave them what or what is going on.

At Rape Crisis Scotland, we are doing work on the Government producing an information booklet that pulls things together for people immediately after a forensic examination. It is really important that people have clear information that has been informed by what survivors have said about what information they needed, and that is written in an accessible way. We can meet information needs through that approach, combined with training for professionals who can talk things through.

Anne Robertson Brown

I absolutely agree with my colleagues, and I will add one thing. We already have an example with the Domestic Abuse (Scotland) Act 2018. Information went out and flow charts were created. Police Scotland put an awful lot of information out there so that people knew the procedures and timelines ahead of requesting a disclosure. I suggest something similar.

We should not wait until a woman has been raped. With regard to the process, the timelines and who would be involved, we should use the KISS principle—keep it simple and straightforward. Social media is a massive influencing platform. We should use all the media possible to make sure that everyone is getting a consistent message about what is involved. That could also be part of an overall communication strategy that includes the content of the training and so on.

Sandra White

Thank you.

David Stewart

I will ask a wider question at this juncture. We know from the statistics and the discussion that we had last week with victims that there are low reporting and conviction rates for sexual offences. I am interested to hear from the panellists whether anything in the bill would affect those factors positively. I appreciate that the bill is a health bill and not a justice bill, but the point that I made earlier was that the Government should apply joined-up thinking across the portfolios, so it would be useful to hear the views of today’s panellists on that point.

The Convener

Certainly, although only briefly as we need to discuss other areas. However, it is an important question.

Sandy Brindley

One of the issues, and the reason why we are so behind in our forensic and health response to sexual crime, is that there is a gap between health and justice. The matter has fallen into that gap, so we need to be really careful that that does not happen again. I think that the bill will help, because it will place a clear responsibility on health boards.

The bill has the potential to deal to some degree with the levels of underreporting. Currently, if somebody does not feel able to report to the police, they cannot get a forensic examination, unless it is in the Archway centre in Glasgow, or in the NHS Tayside area. The bill will mean that there is no postcode lottery. People will be able to access a forensic examination anywhere in Scotland without reporting, which means that evidence will not be lost, which in turn may lead to more reporting. I do not think that we are talking about significant numbers—there is a lot of data from many countries that have self-referral about how many of the people who self-refer actually go on to report to the police. We should be realistic about what the bill will achieve; however, even if it involves small numbers in terms of reducing the level of underreporting of rape, the bill is very important, because everybody across the country should have access to self-referral. The bill will also put a clear responsibility on health boards to co-ordinate responses, which is one of the strongest aspects of the bill.

Anne Robertson Brown

I echo everything that Sandy Brindley has just said. I will put my day hat on for a second. I am here as the chair of Angus violence against women partnership, but my day job is as executive director of Angus Women’s Aid. A significant number of women disclose to us, and to every other women’s aid service across the country, the level of rape and sexual assault that they experience as part of domestic abuse. The bill will allow such women to self-refer and, as a country, we will get a better idea of the scale of sexual assault and rape.

Like Sandy Brindley, I do not know how many of the self-referrals in Scotland will convert to prosecutions in the short or medium term, but we would have a better idea of the social issues that we need to deal with.

Jen Stewart

I work in an area that has self-referral. It might not be the case that significant numbers of survivors go on to report, but some have gone on to do so and have got justice. It is about giving people choices.

Brian Whittle

I echo my colleagues’ sentiments about the evidence that we heard last week, which was harrowing. It was brave of those victims to speak and it was necessary that we heard their evidence.

I also echo what David Stewart said. We are discussing a crime that is underreported and has low levels of conviction, so the importance of getting the bill right cannot be overstated. There are serious health implications for mental and physical health that arise from women’s or men’s ability to be heard. It is not as simple as separating justice and health—they are intertwined.

I want to ask about people’s ability to self-refer when they have additional support needs—I include within that category children, older adults or individuals with mental disorders or an intellectual disability. Are there issues with their ability to self-refer?

11:45  



Gwen Harrison

I think that there will be issues, but I also think that we need to consider the definition of a vulnerable adult, because that might be different. Someone who has previously been traumatised by something and has now been retraumatised by an assault will have issues in terms of how they process that, but they might not necessarily be someone who is recognised as being a vulnerable adult. We need to think about that. I do not know how we support such individuals better, but I think that it probably involves ensuring that they have somebody beside them on that journey to make sure that they have truly independent support.

Sandy Brindley

I will deal with children first, because there has been quite a lot of discussion about whether the bill has got it right by setting the minimum age for self-referral at 16. Some people have suggested that it should be 18 while others have said that it should be under 16. I am sympathetic to the arguments about extending it to under-16s, but I think that the bill has got it right by setting the minimum age at 16.

Alex Cole-Hamilton is absolutely right. We are talking about vulnerable people’s access to services. Obviously, children are vulnerable and we do not want to exclude them from accessing something that might assist them in these circumstances but, in reality, in almost all circumstances in which somebody under the age of 16 self-refers, the clinicians would decide that they needed to call an interagency discussion, which would mean that the process would not constitute self-referral. I am wary about us offering young people a meaningless right. There is no point giving a right if it is not meaningful, and, as I said, in almost every such case, the clinicians would feel that they had to notify social work, who would notify the police.

Alex Cole-Hamilton

Would you lower the minimum age for self-referral?

Sandy Brindley

On balance, I think that the bill has got it right by setting the minimum age at 16. If clinicians could assure us that they could offer self-referral in a meaningful way to people under the age of 16, that would be different, but, if they cannot do that, there is no point in lowering the minimum age.

We need to think about how we provide services to young people who are experiencing sexual abuse. There is a huge gap in relation to support and advocacy for young people. Our support and advocacy services for children who have been sexually abused work with children over the age of 12, but there is a huge gap for children under that age, particularly with regard to the court process, as well as the process that we are discussing.

A lot of important related work has been done around the barnahus approach, and I know that it has been considered in work that is running alongside the bill. However, the bill has quite a narrow focus: it is about making it clear that the provision of forensic medical services in these circumstances is the responsibility of health boards, and introducing self-referral. Those are my views with regard to the age limit.

On capacity more generally, I think that we should not be restricting access to self-referral unless it is absolutely essential that we do so. We need to be careful not to be paternalistic and not to make decisions on behalf of people unless they are genuinely unable to consent to a medical procedure. Clinicians are experienced in assessing whether someone has the capacity to consent to medical procedures. That experience is even more important in these circumstances. I think that the role of support agencies can be helpful with regard to helping people to navigate the process—I am thinking about services such as ours, as well as ones such as People First, which works with people with learning disabilities.

Anne Robertson Brown

As I said, I am here today as chair of the Angus violence against women partnership, but we shared our response with the Angus child protection committee for comment. It was in favour of having a stage 2 of the process at which the issue of under 16s could be considered, for some of the reasons that have already been outlined.

One of the things that we are concerned about is the number of young women—those around the ages of 14 or 15—who are disclosing but not reporting rape and other sexual assaults in their relationships. That is why it is our view that there should be a stage 2 to this change of process. At that point, we could look carefully at how to guarantee that what was happening was a self-referral and that child protection guidelines were being followed. We could also bring Gillick competencies into the discussion. We should not do that yet, at stage 1. However, we could possibly do it later, because it might be a ticking time bomb.

The Convener

Am I right to think that you are talking about a second piece of legislation?

Anne Robertson Brown

Yes. A second stage: a follow-up.

The Convener

Okay. That is understood.

Sandy Brindley

It is also important to look at why young people and women in those circumstances are not reporting. I do not know that self-referral alone will fix that, because there is a wider issue about cultural attitudes toward sexual violation, what is happening in schools, the messages that young people are getting and whether certain behaviour is normalised and acceptable.

It is also about whether people have confidence in our justice system. Looking at how people are treated, the conviction rate and how many cases never get to court, we can understand why young people say that going through that process is not for them. That is beyond the scope of this committee. Self-referral is important, but we must also be realistic about what else needs to happen to reduce underreporting. That will not all be dealt with by the bill.

Brian Whittle

The other point that has been raised is about the implications of socioeconomic deprivation. Anne Robertson Brown was right to say that this kind of crime is perpetrated across society. Therefore, we have to be careful that we do not pigeonhole it. However, I want to know whether we should have the ability to target better, based on socioeconomic deprivation.

Sandy Brindley

I am not aware of any evidence that sexual crime is any higher in working-class communities than it is in middle-class or upper-class communities. Therefore, for me, it is about ensuring that the services are available and accessible to everyone.

We should be proactively looking at how we can remove barriers to the service. One way of doing that is to look at the practical barriers to people in general society and to those who are in poverty. For example, if someone has to travel to get to the service, is returning their travel costs or arranging taxis facilitated? Barriers are often financial. However, they might be childcare barriers—what do people do with their kids when they come to get the examination? It is important to think about what we can put in place to ensure that there are no financial barriers to people accessing the services.

Anne Robertson Brown

I echo what Sandy Brindley said, and add that one of my colleagues made a point about confidentiality. We need to ensure that the services are accessible to all women.

Gwen Harrison

I echo that. We must look at how we can remove barriers to people accessing services—we spoke about people sometimes not coming forward because of cultural differences—and at how we can ensure that people are more aware of the service.

I had a chat with some of my colleagues about people whom they have supported previously, including homeless people, who are assaulted regularly but are limited in how they can access services. Often, they do not have a phone, so they cannot phone the service. We need to ensure that there are different access routes for people, and that they are supported through that.

Emma Harper

We have covered wraparound and complete support. I know that the clinic in Dumfries is planning to relocate its sexual health and psychology services next to the sexual assault centre, so that there is a properly engaged wraparound service. There are major challenges in rural areas. We have covered the fact that there needs to be access to psychology and that the service has to be wider. If engagement is better, self-referral rates might improve.

Last week, we heard from some witnesses that it might be useful to record something in the case notes so that if someone was to have a smear test, there would be a red flag to say whether they were a rape survivor. That would mean that they would not have to retell their story every time. For example, if someone was going for a blood test, the case notes could say that the person was afraid of needles. Has there been further feedback about what needs to be in a person’s medical record? Who should access that information? How do we protect confidentiality? In rural areas, everybody knows everybody.

Gwen Harrison

I completely agree. There are real confidentiality issues in relation to rural communities, depending on who can access the information. People who work in the service might know the perpetrator. We should recognise that it is not just about knowing the survivor who has been for the examination; people might also know the perpetrator who has been involved. There needs to be clear consideration of how people access such information and of what information is relevant to be stored. The system would also be much more powerful if people did not have to retell their story every time.

Sandy Brindley

In their feedback, there was an assumption from survivors that their GP would know or that, if they went for a smear test, the nurse would know. It is distressing to think that they would have to retell their story numerous times. It goes back to consent. It would be helpful if, as part of the clinical pathway, we asked somebody clearly, “Would this be helpful? Do you want us to do it?” We should give them the chance to think about that if they are unsure.

I have some anxiety about access to people’s medical records, because they have been brought up during rape trials, which is distressing for people. If people knew that that was a possibility, they might not consent to certain things being in their medical records. The NHS could do more to protect the confidentiality of the medical records of people who are going through criminal proceedings. That issue aside, as part of the clinical process and as we co-ordinate that pathway, we should be considering asking survivors whether they would like us to put something on their record, so that they do not need to retell their story. They could then make a choice about whether they want that to be done.

The Convener

I presume that that would be at the point of the examination.

Sandy Brindley

Yes, or it could be part of the immediate follow-up.

Jen Stewart

It would be important to get right exactly what would happen with that information. Would people have the right to retract the information? Earlier, we spoke about what information people get, and that issue is vital.

Emma Harper

Dave Stewart mentioned advocacy. How will the bill support people from ethnic minorities who might have English as a second language or who might face challenges in accessing healthcare? Those challenges might relate to rape or sexual assault, or the fact that a person is going to see a healthcare professional in the first place. There will also be challenges in some of our black and Asian minority groups.

Sandy Brindley

The self-referral sub-group, which I am chairing as part of the CMO’s task force, is looking to ensure that any information that is produced is accessible across all our communities. It is important that anything that we produce can be used by any community in the country that might need it.

David Torrance

All the written evidence that the committee has received has highlighted the need to raise awareness and promote self-referral. How should the option of self-referral be publicised? Who should be responsible for the promotion of self-referral services?

Jen Stewart

Responsibility should be shared. In order to promote the services locally, we used social media, posters and GP talks, and we spoke to local hospitals. There has been a shared approach between NHS partners, the rape and sexual abuse centres in Dundee and Perth, Rape Crisis Scotland and the police.

Sandy Brindley

In the self-referral sub-group, we are looking at what information will be needed once we are clear what the routes into the self-referral process will be and how we make sure that people know about that through an awareness-raising campaign.

Part of the difficulty is that people either do not know what to do or are not going to inform themselves about what to do until they are in those circumstances. I think that an awareness-raising campaign is important, but it will probably have a limited impact. The most important thing to do is probably to make sure that the services that people go to straight after being raped—if not the police—know about self-referral and how it is accessed.

12:00  



If people do not go to a service such as Rape Crisis Scotland, they will go to somebody such as their GP. One of the most common routes is through front-line healthcare workers, with people presenting either at accident and emergency departments or at GPs. We have to make sure that those staff know how somebody can access self-referral.

We also have to look at online provision. At the moment, if you go on to any health board site or NHS 24 and type “rape” into the search box, I do not think that anything comes up at all. That is because rape services have not been a core part of health service delivery up until now.

We need to look at online information. The self-referral sub-group is looking at what information people can access online. After somebody is raped, they might go online to find out what they should do and where they should go. We need to make sure that the available information is accurate and quickly points people in the right direction.

The Convener

The risk with online information is that somebody gets bad advice.

Sandy Brindley

Indeed.

The Convener

So having information that is provided and branded by the NHS would clearly be helpful.

David Torrance

How do we engage with public services to make sure that they are all aware what the right self-referral pathway is? As you have said, sometimes they will be the first port of call for anybody who has been raped.

Sandy Brindley

It is for the CMO’s task force to make sure that, through all the health boards, it cascades to front-line workers all the information on what to do if somebody has just been raped.

General practitioners are a common port of call for somebody who has been raped but has not reported it to the police. We have to make sure that GPs not only get information, but get written information that they can give to somebody. I have spoken to people who have said, “I didn’t report, but I saw my GP. I hope he’s kept the samples.”

People in that situation just do not take in what is happening, so we need to make sure that they are given clear written information throughout the forensic pathway and at the first point of contact, which might be their GP.

Emma Harper

I assume that nursing schools are also important for passing on information.

Sandy Brindley

Yes.

Emma Harper

You mentioned the retention of evidence. What is the best way to retain samples? How do we make sure that victims or survivors are informed about their samples? Again, this is about choice, control and allowing people to decide where they want their samples to be. What are the main factors regarding retaining samples and other evidence that would be important to victims? Do any issues need to be addressed?

Sandy Brindley

People definitely need to be given clear written information that they can take away with them that says, “This is what we’ve collected. This is what we’re going to do with it. This is what we’ll tell you. This is when it’s going to be destroyed”.

We need to decide what somebody’s essential care will be. However, let me leave that issue aside for one moment. Somebody will not necessarily have at the forefront of their mind that, if they do not report to the police within two years, the information will be destroyed. Therefore, we really need to look at making sure that, when somebody is giving consent in a very traumatised situation, there needs to be, at the very least, a check-in a little bit further down the line. We do not want to pressure people into reporting, but we need to make sure that they know that their samples have not been tested. Some people assume that, because the samples have been taken, they will be tested and somebody will get back to them if there has been a hit. That is not how it works.

Clear information must be provided so that somebody knows exactly what the situation is. The only way to enable informed choice is to inform people properly at the start about what is happening with their samples. That information needs to be provided verbally and in writing, because people are unlikely to take in and retain that information.

The Convener

Yes, I guess that the point of having written information is that it will be taken away.

Emma Harper

One thing that I learned last Friday is that a person gets a named nurse, who would do the checking-in. That might make it easier not to trigger the one or two-year anniversary of a horrific event. With the development of forensic nurses, might it be a good idea to have a named person, or a named nurse?

Sandy Brindley

Absolutely. The forensic nurse pilot or test of change is important and could transform services across Scotland. The pilot involves nurses actually doing the examination, but even areas that are not participating in it are still involving nurses in forensic examination, often in a supportive and co-ordinating role. Across the country, people should be given a named nurse or named contact who is responsible for their care and who can do the follow-up work. That is done with consent. It is about saying to people that they can come back in a few days, setting out what will happen with the testing and saying that the nurse will check in. The nurse might then phone up in two months to see what the person thinks about the samples. As long as the person is clear about what is happening and they consent to that contact, it will not feel like pressure. That checking in will be important in the circumstances.

Emma Harper

Should the bill determine the length of time for which samples should be retained? For example, it could be for one year, two years or three years. In the previous evidence session, we heard that there is flexibility in other places.

The Convener

I think that the phrase that was used was that there is no consensus on that.

Jen Stewart

From what we know, survivors ask that the samples are kept for as long as possible. Locally, we tell women that it can be for up to eight years.

The Convener

I take it from the nods of the other witnesses around the table that that is the general view.

Emma Harper

How should victims be advised that their evidence is about to be destroyed by a health board?

Sandy Brindley

They need to know in advance. It is not acceptable for someone to get a call out of the blue saying that everything will be destroyed next week. People need to know and have in their mind what timeframe will be applied in their case, so that they can process what that might mean and make a decision. There will be negotiation at an appropriate point about what people want to happen. Some might say that they do not want to be contacted at all and that the samples should just be destroyed if they have not got in touch. Others might definitely want to be contacted, because they will want support with the decision.

Alongside that, if advocacy workers or rape crisis workers are part of the clinical pathway, we can provide support for people to allow them to reflect on what they feel about the issue in a way that does not feel like pressure.

Gwen, what do you think?

Gwen Harrison

I was just going to say that, if people have an advocacy worker, that can help them to navigate the journey and discuss such issues. If the advocacy worker has been part of the process and is aware of the timescales, they can almost prepare the person to start to think about making that decision.

It all comes back to giving back control to the survivor. They have come through a situation where they have lost all control, so it is important to ensure that they are informed and can give consent and permission on how their information is stored and for how long. If people have an advocacy worker throughout that—or a forensic nurse as a named person—that might provide better support.

Emma Harper

It sounds as though Women’s Aid and Rape Crisis Scotland are absolutely essential. We do not want to take away advocacy workers and say that we now have the new forensic nurses, who are the new named nurses. There has to be continued engagement with whichever service people choose to engage with.

Gwen Harrison

As we have said, it is about giving people choice. Somebody might decide that they do not want support from Rape Crisis Scotland or Women’s Aid but that they are happy to have contact with the nurse and that is their preferred route. However, if individuals have chosen Rape Crisis Scotland, that could be the route. It is important to give back choice to people.

Anne Robertson Brown

I echo that point about choice. There is also a point about the survivor having a loop back with the contact and having the right to say, “I have reflected and decided that I do not want to report, so destroy my samples now.”

The Convener

That is clear.

Brian Whittle

There will obviously be a cost to implementing the bill. The financial memorandum states that

“There are no direct costs to local authorities”

and that third sector organisations will

“play an important part in raising awareness of self-referral”,

but that

“costs on the third sector to support the Bill’s implementation will be modest.”

There are aspects to that that concern me. One aspect is the phrase

“no direct costs to local authorities”,

which implies that there will be a cost somewhere or other. The other word that I do not like is “modest”.

The third sector is of huge importance to what we are discussing this morning. Given the financial pressures that the sector is already under, what are your comments on the financial memorandum suggesting that the costs to the sector of supporting the implementation of the bill will be “modest”?

Gwen Harrison

RASA Highland does not think that the costs will be “modest”. If we have to extend our support to people in more rural communities, our geography alone will mean that there will be increased costs in travel and staff time. They will be much more than modest. We have some real concerns about what the costs will mean for delivery of our service.

Jen Stewart

I agree. I do not necessarily think that the costs will be modest, and I wonder what that would look like.

We have been such close partners in self-referrals so far. We definitely want to keep that going and be one of the key partners in the future, but we would need additional resources, because our capacity and what we can do are limited. The pilot has been done within existing resources, so it has been a significant challenge.

I think that somebody talked earlier about the importance of people getting a hot drink and access to clean clothes. We can provide those things because we approached one of the local supermarkets and it donated to the service to enable us to do that. We need to be creative about how we resource services.

Anne Robertson Brown

I am very interested in the definition of “modest”—exactly what does that mean? I think that it might be somewhat optimistic. Angus has no dedicated rape crisis service, and that is true of many parts of Scotland. The implication of that is not modest in cost terms.

We have something that I am sure that many other parts of Scotland have. RASAC in Dundee offers a short part-time outreach service to Angus. Women’s Aid works closely with that service and gives office space and what have you to reduce costs and so on. I think that the cost implications of the bill are significant as opposed to modest. It is not that I do not think the third sector is up for the challenge, but we cannot tackle the challenge without resources.

Sandy Brindley

It depends on the model of service delivery that we are talking about. If the model is designed to meet the needs of survivors of sexual crime, rape crisis support should be indicated in that model. That is what we are looking to do in Edinburgh. A new multi-agency centre is going to be opened that will respond to people’s needs immediately following rape or sexual assault, and an advocacy worker will be based in the centre.

Sometimes people do not care about who is delivering the service; they care that the service that they get is the right service, and it is for us to co-ordinate those services behind the scenes.

What I have mentioned is an urban model; the model would be different in rural and remote communities. However, we should be looking at the delivery of co-ordinated services, and at what the evidence tells us about how we meet the needs of somebody who has just been raped or sexually assaulted.

A video remote interpreting pilot on visual recording of statements to the police is being funded, but that is not being funded through this workstream.

12:15  



If we are to create a model that integrates rape crisis support within the service, as we should be doing, and address the gaps in provision—Moray is the only part of Scotland where there is no advocacy worker—the costs will probably be more than “modest”. They will be more than modest for the health service, too, if it is to do this properly.

The Convener

What about costs to local authorities? Brian Whittle raised the issue of direct versus indirect costs. I am not sure whether there is expertise at the table from the local authority point of view.

Sandy Brindley

It is probably the health sector, the third sector and the police who will be involved in delivery of services.

Brian Whittle

I should clarify that we are discussing implementation of the bill. Emma Harper talked about the requirement for dedicated health professionals. Integration with the third sector is an issue, too. Resource for the whole system is really what we are talking about.

Anne Robertson Brown

There will perhaps be costs to local authorities to do with training, some of which might be one-off costs.

The Convener

Thank you.

As you perhaps heard, we asked the previous panel of witnesses about monitoring and evaluation of the changes that the bill will introduce, when they are in place. Do the witnesses have views on that? In particular, from the point of view of your organisations and victim support organisations in general, what information about the roll-out and the practical effect of the approach would be useful?

Sandy Brindley

The bill will implement—finally—the provision in previous legislation to allow people to choose the gender or sex of the examiner. That has never been implemented because we have never had enough female doctors and medical staff to do the work. It will be crucial to monitor implementation in that regard. We need to know how many times people are offered a female doctor and how many times they get a female doctor. That is the single most important issue that people raise with us. We will definitely need the data so that we can see whether the approach is working.

On a more general point about the CMO’s task force, we will need to know about delays and how long people are waiting for examinations. Monitoring that will be crucial.

We will also need rich information about self-referral. Where is it taking place? What are the timeframes for which people are waiting after making a self-referral? What is the conversion rate—that is, how many cases go on to become reports to the police? What happens to those cases? Is sufficient evidence collected?

The approach is relatively new for us in Scotland—it has been happening in Tayside and Archway, but the numbers have been small. We are introducing the approach nationwide for the first time and we need really rich information. The CMO’s task force has done a lot of the work on data collection, to put in place monitoring from the start and ensure that there is a clear review of the effectiveness of implementation.

Emma Harper

Last Friday, I heard that, depending on when events happened, 60 per cent of self-referrals can happen on a Wednesday between lunchtime and 5 o’clock—I thought that that wee nugget of data was surprising. The numbers were very small, though.

It is important that we monitor the data. I agree that there should be 24/7 support, because people might choose to self-refer out of normal hours. It will be interesting to consider when self-referral happens after incidents.

Sandy Brindley

The feedback from survivors at the closed session last week was that there seems to be a particular issue with reporting on a Sunday.

A lot of providers say that there is hardly any demand for an out-of-hours service. That suggests to me that something is going wrong in the system, because survivors are telling us that there is an intolerable wait for services. There is something about the process by which people access services that is not working at the moment.

Gwen Harrison

I wonder whether we need to collect more qualitative data on people’s experiences, so that we can make sure that their experiences are similar across the country.

In relation to Highland, the experience in Inverness could be different from the experience in Wick. It is about making sure that there is equity and that people are able to access the same service. Perhaps capturing that softer data would also be useful.

Jen Stewart

We have found it helpful to have regular meetings with the police and the NHS to look at the issue, to speak about people’s experiences and to reflect on that feedback.

The Convener

Would you want to continue that under the new arrangements?

Jen Stewart

Yes.

The Convener

Excellent. Thank you. Before we wrap up the session, is there anything that witnesses have not said but are itching to say? We will hear from a lot of people about the legislation as we progress.

Sandy Brindley

I have a comment on a question that was put to the previous panel of witnesses about whether the bill’s provisions should be extended to alleged child offenders. Although that is an important issue, my strong feeling is that it is not one for this bill. The bill is about victims of rape and sexual assault. It is important that the guidance on forensic integrity says that, wherever possible, the examination of the victim happens in a separate location and at a separate time from the examination of the alleged perpetrator.

The Convener

I thank our witnesses for their evidence today, which has been informative, helpful and much appreciated.

12:21 Meeting suspended.  



12:26 On resuming—  



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Second meeting transcript

The Convener (Lewis Macdonald)

Good morning and welcome to the 11th meeting in 2020 of the Health and Sport Committee. I thank members for their attendance in these unusual circumstances and thank our parliamentary staff, particularly the broadcasting office, for their hard work in setting up this remote formal meeting. We recognise the challenging times in which we are living and pay tribute to all the organisations in the health and care sectors for their continued dedicated service and hard work. I ask that all members ensure that their mobile phones are on silent.

Agenda item 1 is our second evidence session on the Forensic Medical Services (Victims of Sexual Offences) (Scotland) Bill at stage 1. Scrutiny began in February and was subsequently delayed due to the pandemic. We will now take evidence during May and June, with the intention that stage 1 of the bill will be completed in the Scottish Parliament in autumn 2020, if it is approved.

Today’s session is to discuss a range of issues with national health service boards. I welcome Dr Anne McLellan, who is a consultant in sexual and reproductive health at NHS Lanarkshire. Thank you for joining us.

Due to the challenges of managing a virtual meeting such as this, we will take questions in a pre-arranged order. I will ask the first questions and then invite others to ask theirs in turn. I ask for succinct questions and answers. I ask those who speak to give broadcasting staff a few moments to operate their microphone before asking a question or providing an answer. I also ask members to indicate when they are on their final question, so that the broadcasting staff will be ready to move on to the next member.

Dr McLellan, we have heard a lot of evidence about examinations and how important an appropriate examination place is for those involved. Are appropriate facilities in place, or would they need to be put into place in order to implement the bill successfully?

Dr Anne McLellan (NHS Lanarkshire)

Boards have done a lot of work on establishing capital projects that will enable them to have suitable premises. Importantly, most of those will move the examination site out of police custody into healthcare facilities or into sites that are near to healthcare. In Lanarkshire, we are almost ready to open a facility in the grounds of, but not in, University hospital Wishaw, which I hope will be more user friendly.

I know that good work has been done in Larbert. I am not sure about the other boards, but most of them are moving to improve premises, which is a welcome step forward.

The Convener

You think that the boards are on board and are progressing plans on premises. What about the workforce? Are workforce plans in place? Is the workforce already there? What is the prognosis for development on that side?

Dr McLellan

The workforce is a challenge, particularly with regard to the gender of the examiner. That is going to be a challenge in the next year or two. However, the west of Scotland is making big steps to improve the workforce and increase the number of female forensic examiners. There has also been a good training programme nationally to encourage female forensic examiners to come together. The bill is a welcome improvement to the care of victims and survivors, but it would be good to have a network for female forensic examiners throughout Scotland.

Although the workforce is a challenge, there are ways that it can be facilitated. What I mean by that is that there are sexual health staff in every health board at the moment who are used to seeing patients who have experienced sexual assault but have not involved the police. There is a body of staff there who can be tapped into with the appropriate training. I think that that is the way forward.

In some of the quieter or more rural boards, it will still be challenging to maintain skills and provide a 24/7 service of high quality, but it is doable with a network and with remote training. In Lanarkshire, I anticipate that some of the staff whom we have put forward as eminently suitable to be forensic examiners may be working at a different site and not in the centre of excellence. However, they will be linking in with the centre of excellence for updates, or to do virtual training to keep them all skilled and to ensure a consistent approach. There are challenges, but I think that we can address them.

The Convener

If I understand you rightly, you are saying, essentially, that networking is the way to deliver a 24/7 service. Clearly, it would make a huge difference to those involved.

I think that you mentioned work that is being done at west of Scotland level. Do I take it from that that the north, west and east are already working on a regional basis to identify female forensic examiners and create the kind of network that you are talking about?

Dr McLellan

Yes. Most of my experience is in the west of Scotland, but there has been national training, and boards in other areas are linking in.

I am not worried about the rural issue. Obviously, forensic examiners do not see so many cases per year in a rural area, and there will be a mandate that someone needs to see so many cases to keep their skills up, but there is so much of a move now to remote and virtual working, partly because of the coronavirus, that people will become very familiar with remote consultations or remote supervision. There are ways in which we can get round the rural issue.

The Convener

That is very interesting—I am sure that it is something that we will follow up with the three regions. I am also interested to hear how the changes resulting from the coronavirus are already creating new possibilities for training and so on. That is very encouraging.

Sandra White (Glasgow Kelvin) (SNP)

Good morning, Dr McLellan. Among the many issues that have been raised is the retention—the recording and storage—of evidence and the cost of that to health boards. I think that your health board has raised that issue. How do you think that the retention service should operate?

Dr McLellan

We have to be sensible here. I am sure that, as a result of the bill, more people will come forward; more people may also self-refer. The problem will be the storage of large items such as a duvet or clothing. It is unrealistic to take all of that on board for an indefinite period. However, at the moment, the retention of samples from self-referrals is of swabs only. There is a compromise here. The timescale for retention is up for debate, but after three or six months—whatever is decided—the evidence can be destroyed.

The other thing is that we could opt to say that clothing, or large items such as duvets, should not be stored beyond a certain time, whatever happens, but that we would keep the forensic swabs, because the swabs are smaller. The swabs also require to be in a freezer. Freezer storage capacity will be needed.

The issue of sample ownership may be challenging but, again, I think that it can be worked through. We can agree that, if samples are taken on health board premises, they are health samples until they are destroyed. That will need to be managed properly. If a self-referral went down the police route, the samples would need to be transferred to Police Scotland, or to the Scottish Police Authority. I think that that is workable.

From a practical point of view, we cannot store loads of stuff for years, and certainly not indefinitely. We could limit storage to swabs only, and limit the time period.

It may be different for children or adolescents. I am not a paediatrician, but I can say that, although we keep sexual health records for most of the population for only eight years, we keep young people’s records until they are 25 in case something comes out later, so we may have to think about how long we store material that relates to the young people who come in. That would be for the paediatricians to decide, with the police—I am not a child forensic medical examiner; I do not examine people who are under 13.

Does that make sense?

Sandra White

Thank you—it does, and it opens up another avenue. You might call it a two-track approach to retention: swabs would be kept for longer, albeit not indefinitely, and bigger items would be kept for just a couple of months. That is interesting.

The issue of ownership is delicate, and includes the storage of data. It has been suggested by the Information Commissioner’s Office that perhaps we should look at a data protection impact assessment. Would that be a good way to go forward?

Dr McLellan

I find it a bit confusing myself, but I understand that the concern is that the swabs of another person would be retained without their knowledge. Advice on that would need to be taken from the Information Commissioner.

One solution for the larger items would be to photograph them, so that there would be at least some evidence. We would not have the DNA analysis, but the items could be photographed before being discarded. Once they were—

Sandra White

Thank you—

Dr McLellan

Sorry—

Sandra White

Not at all. I am interested in what you have said, and you have answered the questions that I wanted to ask. That was my last question. Thank you so much.

David Torrance (Kirkcaldy) (SNP)

It is hoped that the bill will address service variation across Scotland by standardising forensic medical examination services in urban and rural communities. What is needed to ensure that a consistent service can be delivered across Scotland?

Dr McLellan

There is an appetite and a will among the female workforce in Scotland to deliver that. I attended the update training with NHS Education for Scotland. A lot of good female doctors are willing to work in, or are already working in, these services.

As I have said, we should have a network with national updates, each done once for Scotland. We should be providing consistent services. I do not see big challenges in that, apart from some people not seeing the appropriate volume of cases, and there is potential to bring those people into the bigger centres, for example for a week a year, or to enable them to do virtual consultations, for which they would have mentoring.

We need to try to get an equitable service across all health boards. Putting premises near patients is good, but we need the same, or similar, very clear pathways, with the same level of commitment from clinicians, police and the voluntary sector, so that, wherever someone presents in Scotland, they will get a quality service, with a seamless provision of high-quality care.

10:15  



David Torrance

Is there a risk that health boards will implement the legislation in different ways, leading to variation in service provision across Scotland?

Dr McLellan

Yes, that is a risk. If the bill goes through, there will perhaps have to be an agreement, for example among the lead clinicians for sexual health. Every single board in Scotland has a lead clinician for sexual health. They are employed by the health board and they need to drive forward implementation to make sure that we do not do things differently, and that we come up with a minimum that must be delivered, as a benchmark.

To be fair, we are getting better data now, and a sub-group of the task force is looking at data. There must be an on-going quality assurance process. We must look at how many people are seen within three hours, and, by looking at the indicators, how many can choose the gender of their examiner, how many were not able to be seen because the suite was in use, and so on.

There needs to be a stepwise implementation of the legislation. If we have a new bill that encourages self-referral across Scotland, with loads of awareness raising, it could be a huge project and we could be totally inundated. However, I do not think that that will happen if we do it in a logical, stepwise fashion.

We must keep the smaller health boards on board with everything that is happening—it cannot just be a Glasgow and Edinburgh project. I think that we will get there, and the Healthcare Improvement Scotland standards will help.

George Adam (Paisley) (SNP)

On that point, you said that the west of Scotland is ahead in this area. If we are talking about consistency of service across Scotland, what is the difference between services in the west of Scotland and those in certain rural areas, or maybe even those in some rural areas in the west of Scotland?

Dr McLellan

The only reason why the west of Scotland is ahead is that it has traditionally had the Archway service, which was really the first functioning sexual assault referral centre in Scotland. Actually, in the west of Scotland there have been huge problems with recruitment and service provision, so it has not all gone smoothly there.

In the model that is proposed by the task force, which involves a centre of excellence and a hub-and-spoke model, it will be necessary to identify centres of excellence that support the smaller boards. I am quite clear about that. There are other things that could be done that are not in the bill. For sexual health, there were HIS standards that said that we had to provide 12 hours of clinical care in every settlement of 150,000 people. Therefore, we would expect patients to be seen within X hours, X per cent of the time, or we would expect a person from a rural area not to have to travel further than X miles. With regard to clinical service provision, there are things that we can do that are outwith the bill, if the clinicians get behind them, which they hopefully will if they are given direction by the health boards.

George Adam

Is there any guidance that you would you like to see from the Scottish Government on the examination and retention service?

Dr McLellan

It has to be consistent, and there has to be regulation of the training, so that all forensic examiners are of a certain standard, doing a certain number of cases and linking into a centre of excellence. On retention, to be honest, I think that the length of time that we keep samples might become a problem.

Obviously, somebody can report a sexual assault any time in their life but we cannot keep samples indefinitely for people who self-refer but who might or might not report. Even if we allow samples to be stored, I am not sure that it would be realistic to store big items for life for the whole population. That would be difficult. It would be good in a way, because we would have that DNA evidence for 30 years, and we have seen cold cases being settled 30 years later, but if the large items are discarded and there are still swabs, we will still have that DNA.

The only question, which is not in the bill or in anybody’s mind, is whether there should be an anonymous DNA database. That would be a whole piece of work on its own. In other words, should DNA samples be taken, analysed, and stored in an anonymous database? That might be useful if the same DNA appeared four or five times, even if a crime has not been reported.

The Convener

Thank you. Emma Harper has a brief supplementary question.

Emma Harper (South Scotland) (SNP)

I just want to pick up on what Dr McLellan said about the ability to do an examination within three hours. Early data from the self-referral service in Dumfries and Galloway shows a peak of self-referrals on a Wednesday, which does not relate to the person having been assaulted on a Saturday, Sunday, Monday or Tuesday. Will that factor be gathered during any data collection?

Dr McLellan

The three hours is an arbitrary standard that patients—[Temporary loss of sound]. If there was only one examining room in Dumfries, it would be unfortunate if three people were to present at the same time; it would not be possible to hit the target.

We should aim to examine people within three hours because they cannot shower or wash until they have been examined. However, in reporting on the three-hour target, we would have to say, for example, that two patients had not been examined within three hours because the suite was already in use, so one had waited six hours and the other had waited nine hours.

Alternatively, we could give the patient the option to travel elsewhere, if that meant that they would be examined sooner. I think that it is possible to get to the Lanarkshire suite from Dumfries in under six hours, so if the Lanarkshire suite was free a person could go to that suite rather than waiting six hours. One of the other two patients could go, which would mean that nobody would have to wait for nine hours. Does that make sense?

Emma Harper

Yes.

Dr McLellan

We have seen some long waits, even in Glasgow. In the past year or two, when staffing has been a major issue, we have seen patients having to wait overnight or over weekends without having a shower. Many people will just not do that, but will instead decide that they will not pursue their case. Most people who had been sexually assaulted would not want to wait 48 hours to have a shower.

David Stewart (Highlands and Islands) (Lab)

I will move on to discuss the role of professional judgment. The explanatory notes confirm that the bill

“does not confer on individuals a right to have a forensic medical examination”.

Examinations will be carried out only based on the professional judgment of the healthcare professional. Please expand on that. What would it mean in practice?

Dr McLellan

I am with you on that. I think that what it means is that, for example, for someone who presents nine days post assault, there is no point in a forensic examination to capture DNA. The person could demand a forensic examination, but it would be inappropriate because it would not capture DNA, so they could not have a forensic examination for DNA at that stage.

If a patient were to demand that they be looked at, and was bruised, our professional judgment would be that we would look at the bruise and document the injury, but we would not do the full swabs because they would not get DNA. That might change as DNA tests get better; some DNA tests pick up DNA up to 10 days afterwards. However, we are not quite there yet: throughout Scotland at least, it is seven days for DNA.

David Stewart

Thank you. That was very clear. You have given a good example of a clinical aspect of professional judgment. However, there are also non-clinical factors. Could you give me an example? For example, would you consider the age or maturity of the individual before making a decision to go ahead?

Dr McLellan

Yes. I was trying to think of scenarios in which we would not do a forensic examination despite the patient being really keen to have one. The issue is not about consent; it might be inappropriate to do forensics on someone who was acutely psychotic, for example, although that is probably also a clinical factor.

However, there are workarounds in such situations. We might be able to do an examination of a psychotic person if the matter was serious—for example, if the patient was badly injured. In such a case, we might feel that the person needed to be examined, even if not for forensics—although we would capture the forensics at the same time. To be honest, we would probably need to take legal advice—possibly from the Medical Defence Union—and we would obviously take advice from a psychiatrist. I am thinking also about the issue of fluctuating capacity: it would be unusual for someone who was acutely psychotic to demand a forensic examination and not need one, although that could happen.

David Stewart

You mentioned legal advice, which takes me nicely on to my next question. How important is the guidance from the Faculty of Forensic & Legal Medicine? I presume that Scotland-wide consistency is very important.

Dr McLellan

Yes, it is. As you know, unfortunately the laws in England and in Scotland sometimes differ. For guidance on retention of samples and on clinical matters, the Faculty of Forensic & Legal Medicine is useful. However, it has come into its own only in the past few years, and the training has changed a lot. It is better that people train through the faculty; however, five or 10 years ago, that was not mandatory. It can be difficult for us when the legal situations in England and Scotland differ. The training in Scotland has to reflect the legal process in Scotland, which the doctors in Scotland have to work to. Does that make sense?

David Stewart

It does.

Is there a wider philosophical issue in this about patient rights versus professional judgment? I am thinking about the European convention on human rights. This might not be your area of expertise, but do you see any dilemma in terms of the legislation around human rights?

Dr McLellan

There could be a dilemma for adolescents. There are two points to make: all people have the right to good clinical care and all people have the right to have forensics captured, if doing so is indicated. What I find challenging is the human rights position when an alleged perpetrator’s DNA has been captured and stored, and there is the question whether it should be destroyed. I am not sure about that aspect of human rights.

I think that there would be very few, if any, situations in which the human rights of a patient would be overruled by a doctor in a forensic setting. I would be very surprised if that were to happen. Most doctors are empathetic and sensible. If the doctor had any doubt, or was in a dilemma about a human rights matter or other challenging issue, such as someone’s capacity, or if they were not in tune with what the patient wanted, they could take advice from more senior people or from the Medical Defence Union.

There are, in Scotland, channels through which such matters can be sorted out sensibly, without their going in front of a court. Some cases might need to go in front of a sheriff, but we would hope that most of the time in Scotland, through good working, having multidisciplinary teams and taking the right advice from the relevant professionals, we would not go in front of a sheriff unless we needed clarity.

10:30  



The Convener

Thank you. I am sure that we will come back to those issues in a future meeting, when we hear from witnesses about legal rights and the justice system.

Alex Cole-Hamilton (Edinburgh Western) (LD)

Thank you for your evidence so far, Dr McLellan. Should self-referral be available only to people who are over 16, and if so, on what basis do you think that?

Dr McLellan

That is one of the most difficult areas. To be honest, we should encourage self-referral in 13 to 15-year-olds, because 40 per cent of last year’s 13,000 sexual assaults were on under-18s.

We see a lot of adolescents. One in four under-16s in Scotland is sexually active. There are a lot of challenging scenarios and it is not easy when an adolescent comes in but then refuses police involvement—that is the big challenge. We need to encourage those young people to come forward for clinical care. They should be supported by an advocacy worker—maybe a youth specialist.

Obviously, if there is a clear child-protection barn door, we have to involve the police. However, certain scenarios are difficult. For example, two 14-year-olds go to a party, they get drunk and go into the bushes, something happens and one of them wakes up with all their clothes on inside out and feeling sore down below. If we say that the police must be involved in all cases that involve under-16s, with no consideration of different circumstances, we will miss an opportunity to get adolescents to come forward.

Alex Cole-Hamilton

I share your concern about restricting self-referral to over-16s—not least, because if sexual abuse or assault happens at home, perhaps at the hands of an older family member, it will be much harder for the person to find an appropriate adult to come with them, or to talk to someone in their social network.

What happens at the moment if a 14-year-old who has been assaulted or raped appears at the Archway? What is the protocol when children try to self-refer?

Dr McLellan

There is no capacity for under-16s to self-refer in Archway at the moment. [Temporary loss of sound.] If the person comes in to our sexual health service outwith the seven-day period, we cannot do the forensics anyway.

Let us forget about Archway—if an under-16 comes to any sexual health service at the moment, they will get clinical care. A risk assessment is performed for all under-16s who come to sexual health services, whether or not they have been sexually assaulted. We look at the age of the partner. Was there coercion? Was there grooming? Where did they meet the person? Did they meet them online? That happens routinely for under-16s in sexual health services. There are robust systems in place—[Interruption.] If there is definitely sexual assault or statutory rape, we will open up the matter to police and social work.

Alex Cole-Hamilton

I will ask this question, if I may, very briefly. If a 14-year-old girl came in and said, “I’ve just been raped and I want you to examine me, because I want to press charges”, and she understood the landscape in that regard, would you proceed? Would the Archway or an equivalent clinic proceed with the medical examination and take samples?

Dr McLellan

Yes, it definitely would. If a 14-year-old came in within seven days of the sexual assault, forensic samples would be taken. A paediatrician or forensic examiner—or both—would examine her properly to get all the evidence that they need.

The challenge for self-referrals among under-16s is when under-16s come in and do not want police involvement. Obviously, if it is barn-door clear that there has been sexual assault by an older partner, family member or neighbour, that is easy, but there are difficult scenarios. We operate for 13 to 15-year-olds on the basis of the age of legal capacity; we allow them to have contraception and we allow them to have a termination, provided that they understand all the risks and benefits. It is hard to say, across the board, that all under-16s must have police involvement and cannot self-refer.

That is a challenge. However, I am confident that we can put things in place to mitigate the challenges. We encourage police reporting, of course, and we look at the risks of reporting or not reporting.

The main thing, for us, is to keep such kids engaged. If we become too intrusive, dictatorial and black and white, they just go underground. We do not want that. We link with social work and schools, and in NHS Lanarkshire we have two lifestyle nurses, who work with very vulnerable and chaotic adolescents. A lot is going on behind the scenes. I am confident that we can put things in place to make the system robust.

However, limiting self-referral to over-16s would be a missed opportunity.

Alex Cole-Hamilton

That is helpful.

The Convener

I remind members not to talk across witnesses; it makes it hard to hear what people say. Do you want to come back in, Alex?

Alex Cole-Hamilton

No, that is it from me. Thank you, convener.

Emma Harper

I agree that the bill offers the correct way to move towards a more holistic and person-centred health approach. I have a couple of questions about the financial implications for health boards. In its submission, NHS Lanarkshire expresses concern that the bill will create additional resource requirements for health boards in the longer term, to ensure that there is, for example, adequate staffing, “on-going training” and “Psychological support ... for workforce”. The board also talked about resources for storage facilities, suitable premises, family support and equipment. The bill’s financial implications are therefore very broad. Do you have concerns about the long-term funding for the approach in the bill?

Dr McLellan

Yes, I have concerns about the long-term funding. At the moment, following-up of patients who have been sexually assaulted can involve several visits back to the health service. The person might need to come back after one or two weeks for a sexual health screen and at three weeks for vaccination, and they might be put on post-exposure prophylaxis and have a month of anti-HIV drugs. Follow-up after a sexual assault can involve six appointments.

In self-referral, when the bill is passed the clinical workload will go up and the amount of follow-up work will go up. I suspect that the awareness raising that follows the bill and promotion of self-referral will also mean that the numbers will go up. The number of sexual assaults has gone up; there has been an 8 per cent rise in Scotland in the past two years.

It is difficult to cost all that. There will be a need for mental health services, child and adolescent mental health services, alcohol and drugs services and so on. The package of care will not be small, and that alone will require increased resources. Storage facilities—freezers—are also needed, which will have cost implications. Buildings will require to be maintained. Victims’ travel will have cost implications.

I am confident that we can tap into the nursing workforce, who can help. Sexual health nurses are working across services and can be used, but that will mean transferring resources from the things that those nurses are currently doing. We can transfer resources maximally, but there will still be financial pressures on boards to deliver the new approach, and resource will have to be redistributed if there is no additional resource—if that makes sense.

Emma Harper

It is good to hear about that wide range of issues. It is interesting that we are transferring some skills and services to the nursing workforce. Today is international nurses day, so it is good to hear that we are widening the workforce’s ability to support the forensics service.

Has sufficient consideration been given to the increased costs? You mentioned the increase in assaults; we are hearing about an increase in assaults during the coronavirus lockdown. Given all those issues, does further consideration need to be given to the financial implications?

Dr McLellan

Yes, absolutely—the financial modelling really must be thrashed out, because we do not want to open up a service that is not sustainable and that goes backwards. The cost modelling in the financial memorandum uses three predicted levels for the number of people coming in for self-referral. I think that you will have to go for the high one, which is an additional 90 cases per year.

The number of patients who might come forward if the bill is passed probably needs to be reconsidered. For example, just as an indicator, I have a report from 2019, which I am holding up. I do not know whether members can see it—you probably cannot. I can send it electronically. It gives data on how many sexual assault cases were seen at Archway last year. There were 66 from Lanarkshire, 61 of which were police referrals and only five of which were self-referrals. However, I think that people who might self-refer are not so willing to travel to Glasgow, so the figure will go up once services are delivered locally. Therefore, the financial memorandum needs to cost self-referrals at the highest level.

Only 66 people from Lanarkshire were seen at Archway last year. Yesterday, we ran a report quickly from our electronic records in Lanarkshire. My information technology person, who is shielding, did a quick snapshot and found that, in the past 12 months, of about 29,000 patients in Lanarkshire, 118 had said that they had experienced a forced sexual assault. I do not know whether those 118 include the people who attended Archway—we will need to look at that—but our records suggest a much higher number of people than are coming forward to Archway. The big risk with the financial modelling is that the number of cases could be much higher than the number that has been costed for.

Another issue is that the financial memorandum does not anticipate NHS Lanarkshire requiring to see any more patients because we already have self-referral to Archway. However, on a practical level, patients are not self-referring to Archway.

Also, Archway has been very understaffed for the past couple of years. The year before last, when it was using COMS—Custody & Offender Medical Services—for its out-of-hours service, there was no capacity for self-referrals after 5 o’clock, because COMS is employed by the police.

We have to be cautious—the figure for self-referrals might be an underestimate. For the financial modelling, we should err on the side of assuming that larger numbers will come forward. The trade-off is that not all those people will go down the court route. It is good that the costings are quite high for the justice process, but not all self-referrals will go down that route. More people might come forward who need forensic examination, but the knock-on effect might not be that 100 per cent go to court.

The Convener

Thank you very much. I will briefly go back to the questions that I asked at the outset. If a health board puts in place the facilities that it needs, and staffing is made available for 24/7 operation, how big a difference will it make to the costs whether there are 90 self-referrals, or a different number?

10:45  



Dr McLellan

Do you mean 90 additional self-referrals per year?

The Convener

Some of the costs will be necessary in order to implement the bill, regardless of the numbers who come forward. How much of the extra costs that you have described will have to be incurred anyway, regardless of the level of future demand?

Dr McLellan

I am not sure how to answer that—I am sorry. My understanding is that the unit cost per patient is in the financial model, although I am not sure where the figures came from: they were, for example £3,000, £3,600, and £5,000, and the figure was £12,000 for Shetland.

If we were operating 24/7, we would need to look at staggering our patients, if that makes sense. I cannot answer the question, to be honest. That is partly because we have not had a fully staffed service, so we have not looked at that. We will, once we have a fully staffed service running.

I can, however, say that Archway is now doing much better, and that there are more in-house examiners, who operate until midnight. That is definitely helping. I think it will happen stepwise, but I cannot yet give you a figure for costs.

The Convener

The fact that that figure is not readily available is important, and is something that we will pursue with other witnesses.

Miles Briggs (Lothian) (Con)

Good morning, Dr McLellan. Thank you for joining us this morning.

What is your view on there being a public awareness campaign for self-referral, and how should it be co-ordinated?

Dr McLellan

A public campaign on self-referral would need to be pushed at people aged 16 and over. We could then look at how that went. I do not think that we should do a campaign on self-referral by 13-year-olds—we should focus on people aged 16 and over using a wide public awareness campaign. That could be done through the usual media—the police, television and an app. We would use health promotion teams around the country, which are well versed in delivering such messages. There is a specialist health promotion team in every health board, and a lead national group of health promotion specialists. It would not be a problem for them to deliver such a campaign.

Miles Briggs

Thank you.

From your experience, how could health boards, in implementing the legislation, take into account inequalities and ensure that it improves equity in access to services?

Dr McLellan

As you know, we have high deprivation in Lanarkshire, so we are familiar with targeting services at areas of deprivation. We are always looking at postcode data and data from the Scottish index of multiple deprivation. We should be capturing who is already coming to services; perhaps the data group is already doing that. If they are not, we could do that.

In Lanarkshire, we look at the postcodes of people who come to our young persons’ services. If, for example, we found a high number of people from Airdrie going to a service elsewhere, we would put more resources into Airdrie. Alternatively, if we found that nobody was coming in from Airdrie, we would address that. I think the situation would be similar; we would look at the data for postcodes and at data from the Scottish index of multiple deprivation.

We would also need to take advice from third sector organisations about where they would want services to be targeted. That is not just about where people live; we might, for example, want to promote the service through domestic abuse organisations.

I would take advice from our health promotion people, who usually have relevant data and can give us intelligence. Postcode data and the Scottish index of multiple deprivation are quite good. There might be, within a board’s area, a cluster that will have a higher rate. We would expect North Lanarkshire to have a higher rate than South Lanarkshire, so we would target more support at North Lanarkshire. We usually target more support for deprivation there: we use such intelligence.

Miles Briggs

What should be done, through the bill, for people from ethnic minorities and people who experience language barriers? How should we provide services and reduce inequalities for black and minority ethnic communities?

Dr McLellan

We would go to Hina Sheikh, who gives us intelligence on that matter. We have done a lot of work on blood-borne viruses through faith groups—with mosques, for example—and workers for Waverley Care are tapping into the Chinese community. We can use intelligence and advice from them. We also obviously need interpretation services. We would get the message out there similarly to how we did it for blood-borne virus testing: hepatitis B, for example, is a problem in the Chinese community. We would look at what is out there already and use it.

Interpreters are fine unless people are using a language that is not very well known or a dialect that is not commonly used. Sometimes there is a problem in that because there are not many interpreters, the patient might know the interpreter. We could address that by using someone from the board. Telephone interpretation in cases of sexual assault is not ideal; the telephone interpretation service is not ideal for a lot of people.

Google Translate is excellent. I have done consultations with a North Korean woman on the phone when that was necessary—although it was not about sexual assault, but about coil fitting. I knew, at least, that they were reading what I was telling them and that there was no one else involved. That was possible in a busy clinic. There are ways round things. It would not hold up for forensic work, but at least we could use Google Translate to tell people, “We need to sort this out. Hang on.” It is common sense.

The Convener

Another mechanism for remote working rears up in front of us.

Dr McLellan

Exactly.

Brian Whittle (South Scotland) (Con)

Evidence to the committee has highlighted the importance of psychological and mental health support, and the role that supported decision making and advocacy play in sexual assault and rape victims’ recovery. Should the bill give victims a right to advocacy services? What importance would you place on that?

Dr McLellan

Advocacy and the psychological aspect are very important. They are not outwith my control, but they are areas in which we need to be backed up. Even with a good clinical and forensic examination, we need advocacy so that the woman has support through the court process—preferably from the same person throughout. It is important that it starts from the moment of engagement; the emphasis should be on getting advocacy and the clinical care in early. The forensics and the police are not secondary, but advocacy and clinical care are paramount at the start of the process. If they are done well, there are better outcomes for everybody.

Psychological support is extremely important. Mental health services are under huge strain and will be under even more strain after the coronavirus outbreak settles, however long that takes.

When people come in for a forensic examination, part of the package of care is a psychosocial assessment. It is quite brief, but it is included. We want to know whether people are safe, so we ask about their mental health issues, and there is a brief suicide assessment and self-harm assessment.

In Rape Crisis Scotland and in Archway, support from advocacy workers is crucial. It is they who keep in touch with the person once they have gone home. We can refer people to general practitioners and to mental health services, but the advocacy work is crucial. The psychological impact often comes later—it does not come in the first 24 hours. An early assessment might be made, but the issue is on-going support.

In the west of Scotland, we have been considering a clinical pathway. We previously discussed the point that, sometimes, even with the best psychological support, people have pulled back by the time the court process starts. However, an advocacy worker can keep things going and can link the person with services that they need when the court trial starts or at times in the future when the person might be more vulnerable.

Ideally, the advocacy person should be engaged from the start and should see the person through the whole process. That is an essential component.

Brian Whittle

You are indicating that, to an extent, NHS boards are providing immediate and on-going psychological support to victims of sexual assault and rape. For me, the key point that you are highlighting is that there should be a continuing advocacy service, from start to finish. Where do things currently stand in that regard? How much do we need to upskill, and how well is the system prepared for handling the requirements?

Dr McLellan

The rape crisis centres are keen to help. People might be allocated at the start of the process, but it would be overwhelming if they had to see 20 people constantly for a year and a half. It might be possible to step in and out and to touch base with each person at three months, six months and nine months, for example.

From a psychological point of view, the general practitioner can be a good link for those who are linked into mental health services. There are differences: advocacy workers take people through the court process and provide support, and formal counselling services are separate. We do not have the arrangements for that clearly thrashed out, to be honest, but there is a need for both those services.

Brian Whittle

Another question springs to mind, on the impact of the third sector and how we utilise that sector and bring it into the fold. Where are we with that, and how important will it be to utilise the third sector?

Dr McLellan

The third sector is very important. We have good links, although they have been haphazard in the past. However, there is now a chance to create a more consistent service for everyone. We are working on a pathways approach in the west of Scotland. Rape Crisis Scotland is with us at the table and is keen to be involved.

It would be ideal if voluntary sector organisations such as Rape Crisis could be involved from the very start, when a person hits the service. What tends to happen is that a patient is seen and gets their forensic package. They will then go away, having been given information about rape crisis services. It would be better if they were linked in right at the start of the process for a face-to-face discussion. That is what we want to provide, although not everybody will want that.

The Convener

Thank you. That was very helpful.

You made a number of comments related to recruitment and staffing. You mentioned delays in Glasgow because of staffing over the past year, and difficulties in recruiting to Archway. We know about such things and have heard about them from other witnesses.

You mentioned networking and you talked about resources. What is the single most important thing that could come with the bill in order to make all that a reality? It is great to have legislation that strengthens the system, but it will clearly only be as good as the system can be made in practice. You have identified some existing practical challenges. What should the Government do to back up the legislation once it is in force?

11:00  



Dr McLellan

We will need a strong clinical network that links with the police and brings in the voluntary sector, so that everyone, wherever they are, has the same care pathway. Networks are key, so that we know who the local police are and so that they know what is happening.

There is no time to train a batch of new young female doctors in time for the legislation. However, such training is happening anyway, and there are already a lot of female examiners who could be brought into the network. We should be bringing nurses into the training, too.

There has to be a network that people can link into. There also needs to be a multi-agency policy document on how to progress the legislation, with implementation being driven by lead people in sexual health services and the police.

I had not realised that, sometimes, people are signposted back to the 101 telephone number to report a rape, because not every police area has a dedicated team that deals with rape in that area. If we have information about the police’s teams, we will be better able to work together. Multidisciplinary working and improving the service need to be the focus, following the legislation.

The Convener

Thank you very much for taking part. It has been a very helpful meeting, and I know that all members have appreciated your answers. We might come back to you on one or two points; we will certainly be seeking comments from others on issues that you have highlighted.

That concludes the public part of the meeting. Our next meeting is provisionally scheduled for Wednesday 20 May. Notification will be given in the Business Bulletin and via the committee’s social media, as usual.

11:02 Meeting continued in private until 11:25.  



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Third meeting transcript

The Convener (Lewis Macdonald)

Good morning, and welcome to the Health and Sport Committee’s 12th meeting in 2020, which is an online meeting. I ask all those who are taking part to ensure that their mobile phones are on silent.

The first item on our agenda is our third public evidence session on the Forensic Medical Services (Victims of Sexual Offences) (Scotland) Bill at stage 1. Scrutiny of the bill began in February but was interrupted due to the pandemic. We are now taking evidence in May and June, with the intention that Parliament will be able to debate our stage 1 report in the autumn.

Today’s session gives us the opportunity to discuss the implications of the bill for forensic medical services for children, including the provisions that make self-referral available only to those over the age of 16.

I welcome to the committee Chloe Riddell, who is the policy manager with Children 1st. Thank you for joining us today. Due to the challenging nature of managing a virtual meeting, we will be a little less spontaneous than usual, and will take questions in a pre-arranged order. I will ask the first questions, and will then ask each member to ask questions in turn, to which I will invite you to respond. Once each member has asked their questions, I will invite the next questioner, and so on, until the evidence session is concluded. I ask all concerned to keep questions and answers succinct in order that we can cover all the topics that we want to discuss today. When you are called, please give the broadcasting staff a few seconds to operate your microphones before beginning to ask your question or give your answer.

I will start by asking you about your approach to the general principles of the bill. Some evidence that we have received from you and other organisations including the NSPCC mentions missed opportunities or things that might have been done in addition to what is in the bill. First, what is your view of the general principles of the bill as they relate to children and young people?

Chloe Riddell (Children 1st)

Good morning, committee. Children 1st welcomes the opportunity to give evidence today, and we appreciate the value that the committee is placing on progressing this important bill amid the pandemic. To begin with, it is important to be clear that Children 1st warmly welcomes the introduction of the legislation, which we consider to be an important step forward as part of the overall improvements to forensic medical examination for adult victims of sexual assault. The evidence that I will be providing on behalf of Children 1st today will focus on what we know from the experience of children and families in our services.

The most important thing to start with is to recognise the significant issue that the bill is trying to address, as was highlighted in the report from Her Majesty’s Inspectorate of Constabulary in Scotland, which found major issues for those who have experienced rape or sexual assault. We strongly agree with Rape Crisis Scotland and other organisations that there is a need for continued leadership and significant on-going investment to bring services up to the standards that survivors need and deserve.

The written evidence that we have provided has been really clear that there are significant issues relating to children that are different from those that affect adult victims. The majority of children do not disclose abuse during childhood. Only a small number of children disclose abuse, and only a small number of them disclose within the seven-day timeframe that is specifically required for forensic medical examination.

For Children 1st, the key questions are why that is the case and what we can do to ensure that there are wholesale improvements not just to small areas but to the entire system. For us, that means that there needs to be a rights-based response to make sure that children’s voices are heard and their physical and emotional needs are met, and that there is an interagency interdisciplinary response that takes into account exactly what a child who has experienced abuse needs to help them not just access justice, but recover from trauma.

I am sure that the committee has heard about the things that we have been speaking about, but Children 1st has called for a long time for a barnahus model in Scotland, which involves having everything in one place and a child-friendly approach to access to justice. In relation to the bill, we believe that there is real value in considering what forensic medical examinations look like for children and their families, but we want that to be wrapped up in an overall discussion about what is required for children in the context of a barnahus model.

Would you like me to comment a bit further on the specific things in the bill, or is that enough for the moment?

The Convener

That is certainly enough to get us started. I think that, broadly, you are saying that you support and welcome the general principles of the bill, but that there are areas where you would like to see a more holistic approach. Is that fair?

Chloe Riddell

Yes, I think so. For adult victims, it is a different conversation. In the consultation before the bill was introduced, Children 1st proposed that children should have a specific consideration, but we have not seen that in the bill. There are different areas that apply to children, and we need to ensure that we do not cut across the work that is going on in other areas around barnahus.

The Convener

Thank you. Your mention of barnahus model prompts me to ask Emma Harper to ask her questions.

Emma Harper (South Scotland) (SNP)

Good morning, everybody. I will ask a couple of questions about the barnahus model. Paragraph 34 of the policy memorandum on the bill says:

“The Scottish Government is committed to exploring how the Barnahus concept could operate in Scotland, which includes consideration of cases where the child may have suffered other forms of abuse than, for example, child sexual abuse. Barnahus provides Scotland with an opportunity to design a genuinely child-centred approach to delivering justice, care and recovery”.

Barnahus is therefore in the policy memorandum. I like the fact that it is “bairn’s hoose” in Scots, which shows how connected we are to our Nordic neighbours. Will you tell us a wee bit more about whether you believe that the bill supports the barnahus model?

Chloe Riddell

That is the central thing that I want to talk to the committee about today. I am not sure whether the committee is aware of this, but the barnahus model is recognised as a

“child-friendly, multidisciplinary and interagency model responding to child victims and witnesses of violence.”

According to the European standards, it is not specifically about child victims of sexual abuse. The model that we should be looking at in Scotland, which Children 1st is really clear that we would like to see, would adhere very closely to the European standards. Healthcare Improvement Scotland is working to develop Scotland-specific standards, but we hope that they will adhere to the European standards as far as possible.

The central point about the barnahus is that everything happens in one space. In other countries, in relation to forensic medical examinations, it is not always possible for children to attend a barnahus when there are acute needs, particularly when there is an issue about ensuring that evidence is taken within the seven-day timeframe. As far as possible, however, we would hope that children’s physical and medical needs would be met in the barnahus when the medical needs are not acute.

As is mentioned in the policy memorandum, the Government has been clear that the barnahus is the preferred destination for child victims and witnesses across Scotland and we are now considering carefully how that will work in practice. Children 1st has just received a £1.5 million award from the People’s Postcode Lottery to begin to pilot a child’s house in one of the localities in Scotland. We are at the early stages of planning what that would look like, but it is important for the committee to be aware that this is not a vision or a pipe dream—work on barnahus is happening.

We have some concerns about parallel processes going on. We do not want to be making small improvements in silos when what is needed is a wholesale change for children and their families.

The programme for Government commits the Government to exploring how the barnahus concept can operate in Scotland. As the Vulnerable Witnesses (Criminal Evidence) (Scotland) Bill was going through Parliament, the Minister for Community Safety was really clear about the Government’s support for barnahus.

We are concerned that this bill may inadvertently cut across some of that work and have unintended consequences and impact on the progress of the barnahus approach in Scotland. The child rights and welfare impact assessment for the bill states:

“The Bill supports multi-agency working and is therefore ‘Barnahus ready’”.

However, we are not clear how that will happen in practice. How will the bill align to the barnahus provision, particularly if a pathway is being developed that would go through the rape and sexual assault task force clinical pathways subgroup? Is there guidance around how that will apply to children in relation to the bill? We are looking for a holistic interagency model of support, whereas the bill looks at a specific area.

Emma Harper

When we took evidence at the round-table session on 17 March 2020, we spoke about the processes for supporting children who have experienced abuse, and Sandy Brindley suggested that we would need a separate approach or a separate bill. I might need to go back and check the Official Report to see what was specifically said.

On the issue of unintended consequences, is one of your main concerns that there will be some silo working or some working at cross purposes, which might not take into account the best model or the best processes for children?

Chloe Riddell

We recognise that this is a vital bill and it is particularly important for adult victims. For children, we have been talking about a different kind of approach. We do not want to create separate, parallel processes for children and we do not want to inadvertently invest in lots of state-of-the-art suites that are child friendly but sit outwith a barnahus process.

Our intention is to begin to pilot barnahus; it is not something that we are looking at doing in 10 years, although I hope that in 10 years, we will have something that works across the whole of Scotland. Our caution around some of the measures in the bill is about ensuring that the bill sits within a wider framework of what works for children.

David Stewart (Highlands and Islands) (Lab)

One of the key elements of the bill is self-referral for forensic medical examinations. Are you comfortable with 16 being the minimum age for self-referral for young people? If so, why?

Chloe Riddell

That is a good question. As we state in our submission, our understanding is that child protection processes would apply for the majority of children and young people under the age of 16. We agree with the evidence from Rape Crisis Scotland—we would not want to add in what Sandy Brindley referred to as “a meaningless right”, given the statutory duties and processes, and the option to involve child protection and the police where necessary. Of course, children and young people’s safety must be of paramount concern.

10:15  



We note the evidence that the committee heard last week from Dr McLellan, who said that we do not want to miss opportunities to ask young people to come forward and that there are some cases that are not quite as clear cut. We have experience of that in our own services, particularly relating to children who have been victims of child sexual exploitation but who might not necessarily recognise that they are victims. On balance, Children 1st believes that a rights-based approach to this is needed, taking into account a child’s evolving capacity, in line with the United Nations Convention on the Rights of the Child. We acknowledge that there might need to be room for professional judgment and risk assessment. We also note that Social Work Scotland has submitted evidence about the complexities of the different pieces of legislation with regard to 16 and 17-year-olds and issues around legal capacity.

Children 1st’s central point goes back to what we were talking about earlier, when we spoke about understanding why we are having these discussions about self-referral. The vast majority of children who experience sexual abuse do not receive a forensic medical examination and do not report that they have been abused. Again, we agree with Rape Crisis Scotland that we need to be much more realistic about what else needs to happen to reduce underreporting. For Children 1st, the answer is not necessarily to have broader discussions about self-referral. We would go to a much higher level than that and look at the entire system and at what needs to change so that children and families are comfortable and are able to receive a multiagency response that allows them to access support as well as justice. Children have a right to recovery, but at the moment that recovery need is not being met. Our sense is that, if there was a much more holistic response and a system that allowed children and young people to speak out in a safe way, we would not need to discuss why people are not referring and what we can do to address that.

David Stewart

I generally agree with your answer, but there have been calls from organisations such as Victim Support Scotland for the age limit to be lowered to 13. Would lowering the age not help detection and prosecution of child sexual abuse, particularly within families, where it has been historically low?

Chloe Riddell

When we add in the complexities that I set out relating to child protection, issues to do with lowering the age limit are quite complex. I do not think that it would be possible for us to have a blanket statement on 13-year-olds, because of the interaction, duties and professional responsibilities to engage with child protection and the police. Further consideration needs to be given to what evolving capacity looks like and what would be necessary to make a lower age limit a realistic option. We would probably need to do a bit more thinking and have discussions with, for example, the police, Social Work Scotland and the child protection organisations, which would be able to talk about what happens in practice.

David Stewart

My concern, as someone who worked on the front line in social work and child sexual abuse for many years, is the low detection rate. If we are talking about rights, lowering the age to 13, with the proviso that any self-referral would require to go to the police, would seem to give more rights to 13 to 16-year-olds and would, hopefully, improve the detection rate of child sexual abuse.

Chloe Riddell

As I mentioned, Children 1st’s position on that is that a barnahus process or system in Scotland, which ensured that the needs of children and families—their physical needs as well as their emotional needs—were met in one place, would provide more of a wraparound service. We would be able to meet the needs of children who have experienced abuse in one place, which, hopefully, would mean that children would feel much more comfortable talking about what has happened and disclosing abuse. That would be one way of dealing with the very low rates of referral and the underreporting of abuse, and it would ensure that abuse became much more visible.

Alex Cole-Hamilton (Edinburgh Western) (LD)

I have a follow-up question to ask before I move on to my substantive question. It is also about the age of referral.

Without the barnahus model that you have described, young people who have suffered a sexual offence have to go through a traumatic process that the committee has heard about at first hand from those who have been through it. Can you explain the trauma that might be associated with the experience of presenting at somewhere such as the Archway and of having a forensic medical examination without the wraparound support of the barnahus model?

Chloe Riddell

The children and families that we work with have often experienced lengthy delays. Some children even say that their experience of the current justice system almost retraumatises them. It adds to the trauma that they have already experienced.

In our evidence, we say that there is a shortage of paediatricians who are able to carry out forensic medical examinations and that they have difficulty in gaining and maintaining experience due to the low number of examinations. We have heard of children waiting for hours in a medical examination room, and, when the examination does take place, it happens with a number of professionals in the room. There is a lot of work to do on what the experience looks like for children.

We are not looking at the improvement only of medical needs; we want to ensure a whole-system response and to look at what a child needs in addition to having their acute medical needs addressed. We might want to look at improvements to joint investigative interviews or to how the court system works. It is about providing wraparound support so that, from the moment a child discloses abuse, they feel safe and that there is support for them and their non-abusing parent or carer. That support should continue throughout the process, so that the process itself does not become even more traumatising than what they have already experienced.

Alex Cole-Hamilton

If we start promoting self-referral for those aged over 16, is there a possibility that that might unintentionally act as a barrier for younger victims? There is a corollary to that: are we anxious about driving younger people into a system that might cause them additional trauma when there are other routes by which they could receive justice and receive attention for the offence that they have suffered?

Chloe Riddell

Those are very good points. There are lots of unintended consequences for us to think through. Something that we raise in our evidence, and which might come up later, is that the bill is deliberately very narrow in scope: it deals with children who have experienced sexual abuse. However, we know that medical examinations are required for children who have not experienced sexual abuse but who have experienced other types of abuse. We have some concerns about the accidental creation of a two-tier system whereby there is statutory provision in one area and non-statutory provision in another.

Mr Cole-Hamilton raised the issue of what might happen if we raised awareness of reporting. What would that look like for someone who has experienced a non-sexual offence? Would we not want to encourage children to come forward and talk about all types of offences? We must make sure that, when children come forward and are brave enough to talk about their experiences, they are met with a trauma-informed, compassionate and rights-based response. That response should not be fixed in one area; it should be provided across the entire system.

Alex Cole-Hamilton

There could be a situation in which a young person does not necessarily want to involve the police right away but wishes to self-refer so that evidence could be collected and used in the future. Would there ever be a situation in which self-referral for people under the age of 16 would be appropriate, given the current system?

Chloe Riddell

In my initial response on self-referral, I said that Dr McLellan talked about the need for professional judgment in some cases. We absolutely do not want to put up barriers that mean that children do not talk about what they have experienced because they do not want to involve the police at a certain time. As I mentioned, that is particularly relevant to child sexual exploitation, because it might take a while for a child to realise that what they experienced was abuse, so there are some issues to think through.

The primary way of looking at the issue involves ensuring that we take a rights-based approach and consider what evolving capacity looks like. We need to look at it in the context of the current child protection system, because we do not want to accidentally put in place measures that cannot be implemented or to suggest to children that they will be able to undergo forensic medical examinations without the involvement of the police, given that there could be statutory processes or professional duties to refer cases to child protection services in order to keep children safe.

Brian Whittle (South Scotland) (Con)

As you have already mentioned, Social Work Scotland has suggested that, if self-referrals always remain confidential unless the individual subsequently contacts the police, that could be at odds with child protection. If we are going to legislate, it is important that the bill provides the flexibility to allow the kind of treatments that you have suggested. Are the provisions in the bill in line with child protection guidance? If not, should they be?

Chloe Riddell

That goes back to what we talked about previously. Children are not referred to in the bill at all. There are no specific provisions for children and there is no reference to child protection processes, so there is probably some work to be done to think that through. If the decision is that additional guidance will be provided or if we are looking at a particular pathway, we have some concerns about how that might cut across what we are trying to achieve through the barnahus approach.

There are definitely complexities relating to confidentiality and child protection, but they do not apply only to forensic medical examinations and certainly not only to sexual abuse. The complexities are much broader than that. To some extent, we need a much wider discussion to ensure that there is clarity for professionals about what the expectations are and how we keep children safe. We should not prevent children from coming forward to talk about what they have experienced, and we should gather that important evidence within the seven-day window so that, if they want to, children can access justice at a later date as part of their recovery journey.

Brian Whittle

Is the child protection element relating to abuse missing from the bill? Does that need to be considered?

Chloe Riddell

Yes. Children and young people have distinct needs, particularly when they experience abuse. As it stands, the bill does not differentiate between a child and an adult, and the provisions apply only to examinations that are carried out in relation to sexual offences. We have already talked a little about our concerns about narrowing the scope to that specific area and the possibility of creating a two-tier system.

10:30  



The issue is much wider than only forensic medical examinations; it is a question of creating a whole-system response to any type of abuse that includes the justice, health, social work and education systems. Children do not separate each part of the process. They do not work in silos—we do—so we have to think about the whole framework. Children are not going to think, “This is my forensic medical examination, and that bit went really well. Now, I am going to move across to my interview”. We need a whole-system response.

We have always been really clear that any proposals to strengthen and improve forensic medical examinations must align effectively with wider child protection processes. Forensic medical examinations should form part of a holistic multi-agency approach to protection needs.

There are complexities that do not apply to adults. There are certain complexities around vulnerable adults, but for children there might be interactions with hearings, for example, and also wider health and safety assessments. There is potential for children to be looked after or removed from a home if there is a risk to their safety.

In our written evidence to the committee, we said that forensic medical examinations

“must ... be seen as fully supporting the child protection as well justice processes”.

As it stands, there is nothing in the bill on that. There is potential for some guidance. However, our concern is that guidance or a children’s pathway that is specifically focused on forensic medical examinations would not be part of the whole-system approach that the barnahus model would offer.

Brian Whittle

I will go back to David Stewart’s point. If the expectation is that a self-referral by a 16 or 17-year-old could initiate a child protection process, the question is why the self-referral provision is not extended to children under the age of 16.

Chloe Riddell

As I said, there are a number of complexities and—at the risk of sounding like a broken record—for us it is a question of taking a rights-based approach and considering what is in the best interests of the child involved.

There is some further thinking to do about the child protection processes, both on the other legislation that Social Work Scotland mentioned in its evidence to the committee, and on the other guidance and processes. An update of the child protection guidance is also coming. There is a lot more to think through, which means that I cannot give a cut-and-dried answer.

The priority has to be keeping children safe, which is why child protection processes might kick in. However, there needs to be an allowance for professional judgment and flexibility, because there is such a narrow window in which to collect the evidence. It is important to a child’s recovery needs that—where possible, and where they want to—they are able to access justice, and the forensic examination is an important part of that.

David Torrance (Kirkcaldy) (SNP)

My questions are on specific issues that relate to the ability of looked-after children who are over the age of 16 to access self-referral services. Should those children be able to access self-referral services without triggering police involvement?

Chloe Riddell

I do not have much more to add than what I have said already about all children.

There are really important considerations for looked-after children, and lots of considerations about existing child protection processes that they might already be involved in. However, it is key that we do not separate children into groups by saying that there would be a certain response if the children were looked after or if they came from a particular socioeconomic background, for example.

We are talking about children—often children who have experienced horrific abuse. Children 1st takes the view that we need to consider a multi-agency response that takes into account those children’s physical and emotional needs, and that ticks the boxes on access to justice while supporting recovery. In those circumstances, there does not need to be a significant difference between how we respond to a child who is looked after, and how we respond to a child who is still living at home.

The Convener

On that last point, a person who has been a looked-after child is covered by the bill, as you said, as self-referral covers everyone over 16. I take your general point about not distinguishing between one group and another, but are there specific questions around self-referral that might be more pertinent for young people who have been looked-after children?

Chloe Riddell

It is probably worth exploring that a little further. I am not able to comment in a lot of detail. The Scottish Children’s Reporter Administration and organisations such as Who Cares? Scotland might have a view on the particular needs of looked-after children and their interaction with services.

As I said, the bill is not specific on the interaction with child protection processes. I imagine that such issues might be dealt with in a pathway or guidance, and when an assessment is made, consideration will certainly need to be given to how to keep a child safe. That will involve consideration of where the child is living and how they can access appropriate support and justice while remaining safe in their current situation.

George Adam (Paisley) (SNP)

There is a debate about children and young people who are alleged to have perpetrated sexual assault and abuse, and different organisations have different opinions. The NSPCC commented:

“NSPCC would support the provisions in the bill being extended in order that the duty on health clearly covers the forensic examination of all children. We would equally welcome a statutory basis for the provision of therapeutic interventions to address children’s harmful sexual behaviour.”

However, Rape Crisis Scotland thinks that the bill should not be extended to cover child perpetrators. What is the opinion of Children 1st on that?

Chloe Riddell

There are practical considerations that would need to be taken into account. We and I think other organisations, including Rape Crisis Scotland, mentioned in our written submissions the importance of training and resources to ensure that there are secure, safe and appropriate spaces for children and young people.

There are practical considerations around ensuring that a child under 18 who requires an examination and is alleged to have perpetrated an offence does not come into contact with someone who is accusing them of a crime, by meeting them in a corridor, for example. Those practical issues need to be thought through.

Children 1st takes a rights-based approach and would consider the rights of the child in either situation, but further thinking is needed before I can give a definitive answer to your question. We must uphold the rights of the child in both situations. We must meet the recovery needs of a child who has or is alleged to have perpetrated a crime, as well as those of a child who has experienced a crime.

George Adam

Thank you.

Brian Whittle

At last week’s meeting, we discussed the length of time for which evidence and records should be retained. From your experience, and given the potential for a person to decide to act on the evidence much later in life, how long should evidence be retained in a multi-agency context?

Chloe Riddell

We have put some detail in our written submission. There are a number of issues around the safe storage of the information that pertains to children—and this goes back to our point about there being no specific recognition of children in the bill.

Specific issues for children need to be considered. We have experience of children who have decided much later in life to revisit a disclosure. I have mentioned children who have experience of child sexual exploitation. As the Parliament will have heard during the passage of previous legislation, and as we know through our work, children often do not initially recognise themselves as victims; that understanding may take a while.

A number of young people and adults have returned to us, years after previous contact, and shared that they recognised, at that point, and in a way that they were not able to understand or communicate when they were younger, that what they experienced was grooming or abuse.

It is not cut and dried. A lot of children and young adults do not subsequently want to make a further disclosure. However, it is important that the option should be there, as much as possible. For some children and young people, having the option—to think through whether it might be appropriate for them, or might help in their recovery journey—is really important.

The question goes back to what we talked about earlier: what would prevent someone, whose forensic medical evidence was stored, from wanting to access justice? We need to take a hard look at the justice system, and why it would prevent children and families from wanting to seek justice. There is a multitude of different reasons.

If we had a multi-agency response that was child centred and trauma informed, and that allowed children and young people to share their story in a way that was not traumatising, we might be able to increase reporting, or the number of convictions, because children and families would be much more willing to share their stories.

Miles Briggs (Lothian) (Con)

Good morning, Chloe, and thank you for joining us.

I want to pick up on some of your answers to David Torrance and to George Adam, with regard to supporting children. What does the bill need to include in order to support children who have additional needs or who are disabled?

Chloe Riddell

I am trying to find my notes on that.

As I mentioned, the bill does not specifically mention children. The policy memorandum says that the Government’s view is that

“the healthcare response must be sensitive to the specific needs and circumstance of children and young people”;

however, that is completely absent from the bill.

Our view is that children have the right to recovery. In Scotland, we are about to incorporate the UNCRC, so we must make sure that we are meeting children’s recovery needs in a way that is currently not happening. There is an absence of high-quality recovery support services for children.

As we have, the NSPCC has highlighted that the bill includes a statutory duty of forensic medical examination, but not of other aspects of justice and recovery for children. The bill deals only with sexual offences. There are wider issues about the recovery needs of children beyond those who have experienced sexual offences. We do not want a system that has in place statutory obligations around children’s recovery needs for sexual offences, but no similar statutory obligations for other areas. Section 4 of the bill includes the information that is to be provided to children before examination. Section 5 is about healthcare needs. Those are the obvious places where something could be added.

However, we need to give the matter further thought before we make amendments. Children 1st’s view is that there needs to be a whole-system look at the matter, and a complete redesign of the system for children. It is not simply about additional support for children’s recovery in relation to sexual offences or forensic medical examinations; it is about the system that is in place when a child discloses abuse and it is about their recovery needs in the round.

10:45  



I know that some evidence suggests that there is a need for a second bill or a part 2 bill, as was mentioned earlier. The issue for us is that wraparound holistic support must accompany forensic medical examination, whether it is in relation to sexual offences or other offences, but the bill does not achieve that, at the moment.

Miles Briggs

Thank you. That is helpful.

On including support for children in the bill, what support would you like to be put in place—for example, involving youth work organisations to provide peer support—and what would best practice look like?

Chloe Riddell

I would use some caution. I know that I sound like a broken record, but I repeat that our concern is that legislating for specific support services for children who have experienced sexual offences will leave children who have experienced other types of offences without the support that they require.

There is a huge gap in therapeutic support—the type of support that Children 1st provides, for example, where we look at the recovery needs of the child and the non-offending parent, as well as the support that other third sector organisations can offer.

You are right to mention advocacy and peer support, but that support is not specific to forensic medical examinations; it is required to meet children’s recovery needs when they have experienced abuse. It is not limited to the support that they require around a forensic medical examination; it includes support to recover from their experiences.

Our issue is that putting something on children’s recovery needs in the bill and having guidance on how that would be implemented in a pathway document would mean that we have a process that is parallel to the barnahus process. It is absolutely vital that we make sure that children can access the support that they require, but I have concerns about inadvertently putting in place things that either contradict or that unintentionally run parallel to something that is happening in the wider context for children.

Miles Briggs

You touched earlier on reporting of cases. I believe that the Barnardo’s evidence suggests that the number of cases of sexual offences that have been committed by children against other children has doubled in the past four years. What other models around the world are you aware of? I know that work has been going on in this field in the indigenous populations in Australia and North America. Is there already a model in other legal systems?

Chloe Riddell

I am not sure whether I have mentioned the barnahus approach before. [Laughter.] That approach would be the starting point for us. There are a number of examples of how it can be used; in different countries, barnahus works in different ways.

As I have mentioned, Children 1st would like to ensure that we in Scotland adhere as closely as possible to the European standards. There is some room within that to consider what has worked in other countries and what has not. We have done a number of fact-finding missions to Iceland and other countries that use barnahus. We are part of the PROMISE exchange, which is a network of countries that have implemented a barnahus model, and we are able to draw on best practice there. You are right that there is a lot that we can learn from internationally.

Of course, because we are about to incorporate the UNCRC, we can do a lot of thinking about what that looks like for children who have experienced or are victims of crime or abuse, or for children whose recovery needs must be met elsewhere.

Emma Harper

I will continue on what you said about barnahus. The policy memorandum says that the Care Inspectorate and Healthcare Improvement Scotland have been

“commissioned by the Scottish Government to develop Scotland-specific standards for Barnahus based on the European PROMISE Quality Standards”.

I am concerned that if we take a piecemeal approach with regard to barnahus, the expectations or needs of children will not be met by the bill. What do we need to do? Do we need to create a whole barnahus approach in a separate bill? Are we at risk of dealing with the matter piecemeal if we do not include our barnahus approach completely in the bill?

Chloe Riddell

You have very neatly summarised our concerns and worries about the bill. Our view is that we need to make improvements to various parts of the system, but we need to do a whole-system redesign, rather than try to make improvements separately in silos. The discussion about what should happen next is challenging, and should probably involve a broader conversation among the Government, the committee and other organisations, including the police, healthcare and social work, about what that would look like.

We are not yet clear exactly what legislation would be required, because we do not yet have Scottish standards. As you mentioned, the first step is to work with Healthcare Improvement Scotland on Scottish standards. As I have mentioned a number of times, we want to ensure that the standards, guidance and pilot schemes involve a real multiagency response, and that they have buy-in from all the sectors that are involved. We have concerns about parallel processes that are really well intentioned, but might accidentally cut across work that needs to be considered as a part of a whole.

Sandra White (Glasgow Kelvin) (SNP)

Good morning, and thank you for your evidence so far. It has been really interesting.

I am interested in data that has been collected. Your submission mentions subject access requests that are made by a parent who is seeking access to full medical records, even though, unfortunately, that parent committed the crime. Are there data protection issues that need to be addressed in relation to children and young people?

Chloe Riddell

Children 1st has raised the issue a number of times with regard to the criminal courts and the civil courts. We are currently discussing the Children (Scotland) Bill with the Justice Committee and have raised with it the issue of ensuring that children’s best interests are at the heart of any decision to share information that Children 1st and others hold with potential perpetrators of abuse, in discussions around contact, for example. The same principles that we are discussing there would apply here. As we mention in our written evidence, some such parents who have made subject access requests to see their child’s medical records have been successful.

It is the same discussion as the one in respect of the civil courts. We do not want to put in place barriers to accessing justice, or to stop the courts from exploring what has happened to someone, but we need to ensure that children’s best interests are taken into account. Clear safeguards need to be put in place because of the potential sharing, with alleged or convicted perpetrators, of personal, private and sensitive information.

Sandra White

That highlights the difficulties that have been raised previously. This is not just a health issue. You mentioned that the Justice Committee is looking at the issue, and that you have spoken to it, too. If we were to go further, and cover children in the bill, we would need to correspond with the Justice Committee.

Should information from forensic medical examinations be linked to, or be part of, an individual’s healthcare record? What does that mean for confidentiality and the rights of children? Children should have ownership of their health records.

Chloe Riddell

The information that Children 1st holds is not necessarily about children’s health needs. Questions on what information can be accessed are probably for health boards and legal professionals.

The discussion on civil courts is about the different information that we would hold, but the same principle applies: the child’s best interests should be taken into account. That does not necessarily mean that information should not be provided to courts, or that information should not be shared. Rather, it means that it should be shared in an appropriate way and, crucially, that the child should be aware of what is happening to their information—they should have a sense of who is being told what—and feel that their voice and views are being taken into account. We are not saying that information that is pertinent to a case should be withheld from criminal or civil courts, but that information should be shared in a sensitive way that takes into account children’s rights.

Sandra White

If we incorporate children’s rights into the bill, should the child have ownership of their data, including their forensic medical records? If the child is too young for that to be appropriate, should ownership be with an advocate? Having read your submission, my greatest concern is that perpetrators, or alleged perpetrators, could access information that they could use against the child. Many others share that concern.

Chloe Riddell

Without seeing any proposals, it would be hard to comment on the specifics. In some cases, it is appropriate for information to be shared with the court in order to secure a conviction. That is the case in relation to forensic medical examinations—we need to have all the information and the evidence. However, it must be gathered in a trauma-informed way that must take into account children’s rights, so that the process is not traumatising for them and they do not feel that they do not know what is happening.

That brings us back to the high-level broader discussion about a child’s whole experience—not just their experience of forensic medical examinations, but of court processes and interviews and how they all knit together in a trauma-sensitive way that leaves the child feeling that their recovery needs have been met. We know that some systems and processes are traumatising, but rather than fix small parts of the system, we need to look at it as a whole.

The Convener

Thank you for your evidence, which is extremely helpful to the committee. I am certain that we will be following up with others some of the issues that have been raised.

That concludes the public part of our meeting. Our next meeting will be at 10 o’clock on Wednesday 27 May, when we will discuss Covid-19 testing. Additional details will be made public in the Business Bulletin and via the committee’s social media, in the usual way.

11:00 Meeting continued in private until 11:19.  



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Fourth meeting transcript

The Convener (Lewis Macdonald)

Good morning, and welcome to the 16th meeting in 2020 of the Health and Sport Committee. The first item on our agenda is our fourth public evidence session on the Forensic Medical Services (Victims of Sexual Offences) (Scotland) Bill at stage 1. We will hear from two witnesses on the provisions of the bill, with questions on matters including the retention service and data protection.

I welcome first Gillian Mawdsley, who is the secretary to the criminal law committee of the Law Society of Scotland. Welcome, and thank you for joining us.

Due to the challenges of managing a virtual meeting, we will take questions in a prearranged order. I will start with the first question and will then ask each member in turn to ask their questions, then invite the witness to respond. I ask members and witnesses to be succinct. Members—please say when you are on your final question. It would be very helpful if everyone could, please, give broadcasting staff a few seconds to operate the microphones before you begin to speak.

I will start with the first questions, on the retention service and provision in cases of self-referral. Is the Law Society content that victims in such cases should be able to request that evidence that has been collected for forensic medical examination be destroyed?

Gillian Mawdsley (Law Society of Scotland)

The bill is very important because it intersects the interests of private law, public law and, obviously, healthcare. On retention, it is fundamental that the victim or the person from whom samples are being obtained is clear about what is being obtained, why it is being obtained and what it will be used for. Therefore, it is that person’s right to say what will be kept.

That is largely about information. Fundamentally, I have, as a criminal lawyer—which is what you know me best for—always been a believer in clarity. When someone is clear about what is being done, I think that they should have the right to say yea or nay, because they have self-referred. We are not talking about a case that has gone to the police, which would move it into the criminal sphere, where the interests and balance can be slightly different.

Is that what you were aiming at, Mr Macdonald?

The Convener

Yes—that is certainly helpful. Given some of the evidence that we have heard, when a victim in those circumstances has the right to request the destruction of evidence, should a cooling-off period be applied?

Gillian Mawdsley

My understanding is that, from a scientific perspective, there might be a limited period for which samples are live for the purposes of collecting evidence. That is a problem. You will have heard from experts who are much better placed than I am to answer, but my understanding is that that period is roughly seven days, depending on what has been collected.

However, I understand exactly where you are coming from. To say “a cooling-off period” is perhaps a bit graphic; the idea is to say, “Here’s the advice. Think about it.”

That raises the role of advocacy, which the committee will come on to. Who is there to support the victim? Who is the person who allows them to leave the room? When we obtain medical or other information that we do not understand, we often take somebody else with us and we go away, we think about it, then we come back. Therefore, there is an opportunity for that to happen. The trouble is that, with the person having self-referred in the first place, it might retraumatise them to come back. There is something be said for getting it over with. However, as we see, victims’ responses are very different, and until we are in that position, we cannot say how we would respond.

I understand about giving the person time to think, but perhaps it is as much about support as it is about time. No one should be badgered about whether they might, at some point, change their mind. This is the danger: if the person is told to go away for 48 hours to think about it, then come back, will they realise that after 48 hours the sample will be worthless? There is a finite period in which to act. There are many issues, but I stress the importance of the information and support that must be given at the first point of self-referral.

The Convener

Thank you. You mentioned the possibility that some evidence is of value, in terms of a criminal investigation, for only a limited period. Other evidence might be very bulky and take up a lot of space. When evidence that has been kept for a period is due to be destroyed, should victims be notified of that in good time? When should they be notified? Should they be able to request that samples be retained, even if they have not reached the point of saying that they want to pursue a criminal case?

Gillian Mawdsley

My understanding is that the proposal is to make secondary legislation to deal with retention periods. Various periods have been talked about. The problem is when the period ends and where the line is drawn. Samples could be retained for up to two years then automatically destroyed at the end of that period, if nothing has changed. An end point is needed, but that is my personal opinion.

The trouble for the person whose samples they are is that that refreshes their experience. Their getting a letter two years down the line to say that samples will be destroyed unless they say otherwise could raise complex issues. I think that there is a point when retention should end, provided that the period is sufficiently long and the process is guided by professionals.

The Convener

Thank you. I call Brian Whittle to ask his questions. I am sorry—it is George Adam. I have the running order back to front.

George Adam (Paisley) (SNP)

There is no difference between us, convener. One of us used to be an Olympic athlete, and the other one comes from Paisley. [Laughter.]

Good morning, Gillian. On storage of some items, we heard from Dr Anne McLellan, who said:

“The problem will be the storage of large items such as a duvet or clothing. It is unrealistic to take all of that on board for an indefinite period.”—[Official Report, Health and Sport Committee, 12 May 2020; c 3.]

Does the Law Society have a view on storage of evidence such as clothing and duvets? Should that be done by the health board? What should we do with that type of evidence, and who should store it?

Gillian Mawdsley

I am aware of the physical problem of storage of productions. It is necessary to consider what the item is and to look at the rule of best evidence for the purposes of criminal proceedings. On a number of occasions, productions have been retained that were not physically required in the future. We need to differentiate between something that is required for forensic examination and the item itself being physically required. On most occasions, the item itself will not necessarily be required for criminal proceedings. There is a very well-known case that involved a poached salmon; the question was whether it was required. A clear decision needs to be taken on why we would keep an item: are we keeping it because someone might want to examine it in the future, or have we extracted from it and retained every evidential part for analysis, be it on slides or whatever? That is the first question.

There is a question of law as to whether an item is required. Clearly, keeping large items in storage costs money and will become increasingly complicated. However, I am not sure that the number of self-referrals is so high that the number of productions would be great, or that the productions themselves would be so enormous that that would cause a problem.

The matter goes back to the guidance that accompanies the legislation—it is not part of the legislation—for those who would be involved in seizing and examining items. Furthermore, even when a case has not been reported, the prosecution authority can advise on whether something should be retained, or on whether photographs can be taken.

George Adam

Finally on that, should health boards be required to store that type of evidence? Is there a need for such evidence to be stored for any length of time?

Gillian Mawdsley

There is not a yes or no answer to that. Guidance to accompany the legislation will be needed to make it clear what questions health boards should be looking at when considering whether something needs to be retained. Advice could be sought on a one-off situation that is not clear-cut.

Generally speaking, some items might need to be retained, but I suspect that, in most cases, once the scientific evidence has been extracted, photographs should suffice, unless the item is unique and needs to be retained for the purposes of defence examination in due course, if there are to be criminal proceedings.

However, that comes down to guidance that will need to be drawn up by all those who are interested and involved, and it will require relevant legal advice, because fundamentally this comes back to the fact that one would not want to lose a criminal prosecution because an item was not there for examination by the defence when required. It is about the interests of justice, and that is a question that could be seen coming down the line. Therefore, there is not a yes or no answer.

The Convener

Thank you.

Brian Whittle (South Scotland) (Con)

Good morning, Ms Mawdsley. I want to discuss the timescale for retention. I am thinking specifically of cases of historical sexual abuse and how it can be decades later that a prosecution is brought to court. Does the Law Society of Scotland have a view on the retention period for evidence in cases of self-referral?

Gillian Mawdsley

We do not have a specific view on that; advice from scientists who are involved in forensic examination is needed. They understand the conditions under which it is necessary to keep items that might need to be examined in due course, and they understand what can be extracted from items to allow appropriate examination to be carried out. I have heard mention of periods of between two and three years. I am not a scientist; I have no reason to dispute that.

My concern, which perhaps ties in with Brian Whittle’s question, is that it is important that the bill be future proofed. We are aware that advances in science might in the future make examination possible, or could mean that it might later become possible to obtain some aspect of DNA or biometric data, so there is a balance to be struck.

However, the trouble with a lot of historical sexual abuse cases is that—for example, for a self-referral now that is reported for criminal proceedings only many years from now—there is a limit on the efficacy of the actual product and the actual examination. Therefore—to come back again to the clarity that I stressed—there is an advantage to having a clear period, but that could be looked at again. The period could be kept under review, such that if scientists were to say that samples would last longer, that might be an appropriate stage at which to consider a longer period. However, that would be some way down the line.

This legislation is important, at this stage. We stressed in our evidence the need for monitoring and for taking account of all the other areas of law that are dealt with by the Parliament. For example, the Scottish Biometrics Commissioner Act 2020 has just been passed. All the legislation needs to come together.

Does that help?

Brian Whittle

Thank you—yes. I do not want to put words in your mouth; I want to be absolutely clear about what you are saying. My understanding is that, if scientists said that, for example—I do not want to be too graphic—fluids could be frozen and kept indefinitely, they could be retained. Does the Law Society have a view on that?

09:15  



Gillian Mawdsley

If the scientific advice was that what was being retained could be kept indefinitely, or for the foreseeable future, I certainly do not think that the Law Society would object, provided that the victim was told that and the information was clear. We have to be guided by scientists about how long items remain effective.

Again, there is the question about storage, but that can, ultimately, be reviewed. I think that to hold items indefinitely is too long. It might be that, from looking at victims’ groups’ responses, it could be considered that the time for reporting such things would be 10 to 15 years, so the legislation might specify that period, if scientists said that a sample could be examined effectively after that time. I do not think that the Law Society would oppose a longer period, subject to the appropriate expert advice from various parties.

The Convener

Thank you.

Alex Cole-Hamilton (Edinburgh Western) (LD)

Good morning and thank you for coming to the committee. Does the Law Society of Scotland foresee issues relating to processing or storing of personal data?

Gillian Mawdsley

Yes—we have some difficulties in relation to data. I cannot say much more than what we said in our original evidence. The bill does not talk about data in an effective way, and it is not clear that it differentiates between samples and data. We stated:

“Clarification as to the position regarding the data obtained would be welcomed. Section 9 of the Bill refers to transfer of evidence but the definition of evidence under section 13 of the Bill does not include data. The Data Impact Assessment does not differentiate between the samples and data to be obtained.”

Having looked at some of the evidence that has been submitted so far, I am not sure that that has been explained, so that remains an issue for us.

Alex Cole-Hamilton

Would you and the Law Society therefore recommend to the committee that we amend the bill to provide that clarity and to differentiate between evidence samples and data? It strikes me that that is an important distinction.

Gillian Mawdsley

Yes.

Alex Cole-Hamilton

Thank you. A straightforward answer—that is terrific. Does the bill throw up any potential issues with continuity of evidence?

Gillian Mawdsley

No, it does not, immediately. Continuity of evidence is vital, and we stress that. Again, I would say that, with my background as a criminal lawyer. Every stage in the chain of evidence must be sufficiently corroborated. There is nothing more frustrating than being unable to have an item, or to refer to evidence, in court because the chain has broken down. It needs to be very clear who—medics, police or whoever else—took the sample and at what point. Continuity right through to the criminal process, if that takes place, must be clear.

The Convener

Thank you.

David Stewart (Highlands and Islands) (Lab)

What assessment has the Law Society made of the value of an anonymous DNA database?

Gillian Mawdsley

We have not made any assessment of that. If that is something that you wish us to look at, I will need to take it back to the relevant committees and obtain their respective views. As I said earlier, the bill was very much looked at from the criminal law perspective, with the support of our privacy and other committees. If you would like us to come back on the issue, we can certainly seek the views of the committees.

David Stewart

Yes—thank you. I am sure that the committee would be grateful for that. Perhaps you could discuss the matter with one of your committees and drop our committee clerks a line.

My next question is probably related to the previous one, so it might get the same answer. What is the Law Society’s view of DNA samples being analysed without the victim reporting the offence?

Gillian Mawdsley

That is a difficult one, because it very much depends on the facts and circumstances of each case. We are aware that the person from whom DNA might have been extracted might not need to be a witness in a criminal proceeding. The interests of justice might override that factor in certain circumstances, but decisions would be taken on a case-by-case basis.

David Stewart

The national police care network said:

“in certain circumstances, some information may have to be handed to the police in the wider public interest—for eg. In the case of stranger rape, where”

other victims are involved. Do you agree?

Gillian Mawdsley

I can understand the interests of justice requiring that. Again, it comes back to the interests of justice and the balance, of which we are all aware, between the rights of the state, the rights of the individual, the case circumstances and the greater need. As I said, I can see circumstances in which handing that information to the police would be justified; equally, I can see circumstances in which that would not be justified. The decision would have to be taken on a case-by-case basis.

Sandra White (Glasgow Kelvin) (SNP)

Good morning, convener and Ms Mawdsley. The Law Society submission says, “Equality considerations are paramount.” Is there a risk that the bill might discriminate against people with learning disabilities who wish to access the self-referral service?

Gillian Mawdsley

That is an interesting question. I do not think that the bill discriminates against people with learning disabilities, but it is vital that the guidance for health boards, the police and supporters is very clear about the need for a person with learning disabilities to be supported with appropriate help at each stage of the process.

As I think I said, the appropriate adult would normally be available in a police station, so perhaps they could play a role in helping people with learning disabilities in self-referral circumstances. I stress that it is not about discrimination as much as it is about ensuring that the system can support those people to make the best choices with the best information available. The issue is not whether the bill is discriminatory but what we can do to support such vulnerable people.

One of the submissions to the committee raised the issue of the word “vulnerable”, which the Law Society is very challenged by. We are concerned about the use of the word “vulnerable” across civil and criminal legislation and about what exactly it means. I would therefore go one stage further than your question and ask how we will ensure that we can support people with learning difficulties and all those in other recognised areas of vulnerability to understand the self-referral process and make the decisions that they need to make.

Sandra White

Thank you. That is very interesting and helpful. In your answer to the convener’s first question you referred to advocacy, clarity and people being given full information. Should the committee push for the bill to take account of issues to do with advocacy, clarity and full information with regard to not only people who are vulnerable but all who seek self-referral?

Gillian Mawdsley

Yes. We have highlighted that we support this important bill, and victims’ groups very much support it. However, it is just a bill; there needs to be a clear steer, perhaps from the committee, on all the aspects that you have stressed, as the bill progresses through the Parliament, to ensure that those necessary areas are covered and supported. After all, the people who are the most vulnerable in society are possibly more likely to seek self-referral. However, there is a difficulty with the lack of a clear definition of vulnerability, because someone who is vulnerable today might be a perpetrator tomorrow.

There are so many factors involved in vulnerability. The bill gives the opportunity to raise awareness of them and ensure that advocacy, guidance and support are all available for the groups whom we recognise as vulnerable and in need of additional support—that is not quite right, though, because everyone should get the same standard of support; however, we recognise that some people need extra help and time.

Mr Macdonald referred to cooling-off periods. Perhaps dealing with vulnerable people is an example of where more time should be taken to explain matters to them; they should also be given more time to process the information before making decisions that are appropriate for them. That would be what the committee has talked about: a victim-centric process.

Sandra White

Thank you for that. The word “vulnerable” includes many different aspects, and there could be issues to do with the forensic medical examination of vulnerable adults. In some cases, people are frightened to come forward for self-referral because they are worried about social work becoming involved and about being put under guardianship—I read that somewhere. Would that prevent vulnerable adults from seeking self-referral? Are there other issues that would prevent them from doing that?

Gillian Mawdsley

I am not the best person to ask, because I do not represent groups of vulnerable people; people who do so would be best placed to answer your question about whether that category of client would come forward for self-referral. Vulnerable people could have concerns because of social work involvement or because of language difficulties and lack of cultural understanding arising from their background or community. A vast range of issues, including those around family members and so on, could prevent people from self-referring. It would be good to ask people who represent vulnerable groups what prevents people from coming forward; I think that myriad factors are involved.

The important point to stress is that people must be adequately supported, in whatever way they come forward. I would not want to see anyone in the system failing to give adequate support, including lawyers, when they are involved. It is important to be aware that one size does not fit all and time must be taken to ensure that vulnerable people get appropriate care and attention. In our submission, we referred to education. Not only must awareness be raised but there must be education for everybody, including those in my profession.

Sandra White

That is fine. Thank you.

David Torrance (Kirkcaldy) (SNP)

Good morning to Gillian Mawdsley. My question is about sharing best practice and continuous improvement. The Law Society of Scotland commented on section 11 of the bill, which sets out the requirement for co-operation between health boards

“in relation to the planning and provision of ... services ... with a view to securing, across Scotland, adequate provision and continuous improvement in the delivery of those services.”

What is the Law Society’s view on the sharing of best practice between NHS boards?

Gillian Mawdsley

Again, I am probably not the best person to ask about that. It goes back to a point about education that I have always raised, which is that, for best practice to prevail, there must be communication among those affected. A number of territorial boards will be involved in implementing the bill’s provisions, and I am aware that some of them were ahead of others in doing bits of work previously. The boards involved must therefore have a forum for sharing experiences.

That is why we talked about monitoring the bill’s provisions after they are implemented. I do not know how monitoring will be done, but there must be opportunities for health boards to meet and exchange experiences. I have no doubt that all that information will be pooled and distilled down as doctors, nurses and others who are involved share practices and ensure that those who are trained in the required processes get the benefit of innovative and creative methods that the territorial boards develop. I am not an expert in this area, but I know that boards will have ways of sharing, through conferences and so on. Monitoring will be useful, to see how the provisions are working and how effective they are, given that the aim of the bill is to make the situation better for the people whom the legislation serves—that is, the victims and therefore us, as the public interest.

09:30  



David Torrance

How could or should continuous improvement be facilitated by legislation?

Gillian Mawdsley

Once legislation has been passed, an opportunity for review and monitoring is needed to look at whether the laudable aims of the bill, as they were set out, are being achieved. This bill involves healthcare, aspects of criminal law and other areas of law, and its purpose is to make the system clearer and better for victims and to ensure that it is easier for victims to get support and help. It is essential to monitor and review the situation and to report on how well the approach is working, in whatever period of time this committee and the Parliament feel is appropriate.

This is important legislation. Members might touch on whether it should, in due course, involve children. There are mixed views on that. It will be important to see whether and how the legislation is working before you extend it to other areas.

Miles Briggs (Lothian) (Con)

Good morning, Ms Mawdsley. Thank you for joining us today. The Law Society of Scotland’s submission states that

“absent from the Bill seems to be any provision as to ongoing monitoring and reporting of how well the delivery of these statutory functions are being achieved.”

In your opinion, what reporting of standards should be in place?

Gillian Mawdsley

There are means to report through the health boards on how the standards are being applied, and those standards can be reviewed. Fundamentally, we were talking about the standards that apply to health boards and we saw such a review as involving a health board process. I am not an expert in how health boards work and it would very much depend on that. However, we certainly felt that there should be a review of the standards and how they were operating, with a view to maintaining best practice and sharing experiences.

Miles Briggs

That is helpful. Should the reporting requirement around those standards be in the legislation, so that we, too, can find out what is going on in health boards? Should that report be made to Parliament, in a set time period?

Gillian Mawdsley

Again, I am not the best person to answer that. It is a matter for the committee. If boards have appropriate standards, that does not necessarily require to be reported to Parliament. I do not think that I can take that any further.

It is for the committee to obtain information from health boards and decide what scrutiny and monitoring should be involved. I repeat my point that scrutiny and monitoring are required in respect of all legislation. I am saying that carefully because I am here as a criminal lawyer from the Law Society of Scotland, not as someone with any healthcare or medical background.

I stress again that I felt that absent from the bill was the business of reporting on the overall effectiveness of the legislation. Part of that is about the standards, obviously, but whether that is a health board matter is for the committee to determine.

Miles Briggs

That is helpful.

The Convener

Brian Whittle would like to ask a supplementary question.

Brian Whittle

As things stand, the length of time for retention will not be included in the bill, but will be decided by Scottish ministers, through an instrument that is subject to affirmative procedure. Does that create any concern for the Law Society? Should there be more clarity on that in the bill?

Gillian Mawdsley

I have just lost my visual connection with the committee—it is back again now; I beg your pardon. Could you repeat your question, Mr Whittle?

Brian Whittle

Of course. Technology is a wonderful thing, if it works.

I was asking about the timescale for retention, which, as things stand, is not included in the bill. It will be down to the Scottish ministers to decide, through an instrument that is subject to affirmative procedure, how long that timescale will be. Does that concern the Law Society? Should there be more clarity in the bill, given what it is trying to achieve?

Gillian Mawdsley

No. Usually, we would very much promote inclusion in primary legislation, but I understood from the policy memorandum that there was not a consensus. I was happy enough that the issue would be agreed to through affirmative procedure by Parliament after appropriate consultation of the relevant parties. I see that as a perfectly appropriate use of affirmative procedure. Again, I would stress that, once the period of retention has been agreed, that very much needs to be communicated. I do not know whether what you are getting at is that there could be a review of the period of retention at some point—that is certainly the sort of thing that could be included in primary legislation. In these circumstances, though, secondary legislation by affirmative means would be appropriate.

The Convener

I thank Gillian Mawdsley for her evidence, which has been extremely helpful and was well focused on the issues that the committee will have to consider. She has given us some very clear pointers to areas on which we will want to take a lead.

We will now move to questions for Police Scotland. I welcome to the committee Detective Superintendent Filippo Capaldi. Thank you very much for joining us. I think that you will have heard the previous evidence session. We will follow a similar format in your case.

One of the issues that has caught our attention is the estimate in the Scottish Government’s financial memorandum of the potential increase in demand as a result of the new provisions in the bill in relation to self-referral. Does Police Scotland believe that those estimates of the increase in demand are reasonable?

Detective Superintendent Filippo Capaldi (Police Scotland)

Good morning, convener. The estimates that have been used are highly subjective. I know from personal experience of the self-referral process that is operating in NHS Greater Glasgow and Clyde and NHS Tayside that the numbers are very low. I think that the situation is highly dependent on the number of people who come forward for self-referral, and it is difficult to properly assess and articulate that. I have looked at the methodology, and the numbers appear reasonable. However, at present, the actual numbers for self-referral are low.

The Convener

You will know from your own sources that the Covid pandemic and lockdown have resulted in an increase in domestic abuse. We know that Scottish Women’s Aid and other organisations in that field have raised concerns about that. In your view, would that have an impact on the estimates of the potential impact? Is it a reason to reconsider the estimates?

Detective Superintendent Capaldi

In terms of reporting during the Covid pandemic, over the past 11 weeks, we have seen significant decreases in the numbers of sexual crimes and rapes that are reported to Police Scotland. The numbers are down by about a quarter on what we would usually experience, if we compare them with the numbers from this time last year. That will be a blip, so to speak. Without being blunt about it, I think that the figures will increase. We know that those crimes have not gone away and, when things settle down and we return to some normality, the reporting will increase again.

I would not say that a reassessment of the estimates is required; the estimates that have been made are probably the most accurate that can be pulled together using the assumptions that are made in the financial memorandum.

David Stewart

What assessment has Police Scotland made of the effect that self-referral for forensic medical examinations may have on the future reporting of relevant offences?

Detective Superintendent Capaldi

Sorry, just to clarify, are you asking how that will impact on us operationally?

David Stewart

Has Police Scotland done an assessment of the effect on the reporting of, for example, sexual offences in the future, once we have self-referral for forensic medical examinations? Will that have an effect on individual victims coming forward and reporting sexual crimes?

Detective Superintendent Capaldi

The short answer to whether such an assessment has been made is no. I do not think that self-referral will impact on victims coming forward. With regard to dealing with victims of rape and serious sexual crime, it is business as usual for Police Scotland. We know, and no doubt the committee will have heard from other witnesses, that such crimes are vastly underreported, so we do not know the true nature of the criminality. The reality is that self-referral will not have a significant impact on what we do day to day.

David Stewart

Thank you. My final question is, in the future, when victims contact the police about an offence, such as sexual assault, will they be informed about the option of self-referral for forensic medical examination?

Detective Superintendent Capaldi

To clarify, self-referral means no contact with the police. It is for the victim to make the referral directly to the health board without police involvement. Therefore, we would not know if somebody had self-referred. We would not give someone advice to self-refer if they are reporting to us. Does that clarify the position?

David Stewart

Yes, thank you. To give an example, in my early life in social work, I worked closely with the police on managing child sexual assault. I realise from my personal experience in social work over many years, that reporting rates are incredibly low, particularly for family abuse. How well known will the option of self-referral for forensic medical examination be? I assume that it will not be well known, even after the legislation goes through; therefore, will the police have a signposting role, whereby they will say to victims, “Have you thought about self-referral for forensic medical examination?”

If you have not considered that point, is it something that you could discuss with your colleagues in Police Scotland?

Detective Superintendent Capaldi

That work is on-going as part of the work of the self-referral sub-group of the chief medical officer task force. It is considering a number of options around the promotion of the self-referral process. For anyone who has not come to us directly, we would advise that there is an option of self-referral, through media campaigns or in the literature that we display or give out to potential victims.

09:45  



Alex Cole-Hamilton

I have a couple of questions about storage and collection of evidence by health boards. Is Police Scotland confident that the evidence that is collected and stored by health boards in self-referral cases will be robust enough for your standards?

Detective Superintendent Capaldi

I think that extensive additional discussion is required on what measures, protocols and procedures health boards have in place.

It is difficult to ask doctors to make decisions on secondary evidence and on what samples should and should not be taken. In our submission to the committee, we are clear that samples that are obtained by doctors should be limited to forensic samples obtained at medical examinations.

We heard from Gillian Mawdsley in response to previous questions on the storage of certain items. That is problematic to say the least, particularly in relation to the conditions in which those items should be stored, how they are packaged and what medics seize at the time from the victim. Should we limit that to clothing? Should we extend it to bottles, cans and cups? There is the potential for DNA to be obtained from all or any of those items.

There are significant concerns about the range and nature of what should be seized and what should be stored, but I do not think that the issues are insurmountable in terms of providing advice on that and ensuring that health boards are aware of the required procedures to store, properly package and retain the evidence.

Alex Cole-Hamilton

Does your organisation share the concerns of the Faculty of Advocates that health board professionals may lack training in handling forensic samples and reports, which would potentially lead to the integrity of samples and reports being compromised? Do we need to underpin the standards and training that we would expect in guidance?

Detective Superintendent Capaldi

I suppose that the short answer is yes—we share the concerns of the Faculty of Advocates. I have read its submission. It shares the same concerns not only as Police Scotland, but as the Crown Office and Procurator Fiscal Service and the Law Society of Scotland. Again, I do not think that the issues are insurmountable, and adequate training and the provision of the correct information could achieve what is required. Forensic examiners routinely retain medical samples in the correct conditions and packaged in the correct way.

You asked about the need for guidance. I referred to the self-referral sub-group. I know that that work and those discussions, particularly on the storage and retention of samples, are on-going.

Emma Harper (South Scotland) (SNP)

I am interested in issues to do with the retention service, which we have touched on with Alex Cole-Hamilton’s questions. Does Police Scotland have any concerns about the type of evidence that should be collected and retained by health boards in self-referral cases? In recent evidence sessions, we have heard about the collection of duvets and even mattresses, and you have just given other examples, including drink cans.

Detective Superintendent Capaldi

We are quite clear in our submission that the items to be collected should be limited to forensic samples obtained during a forensic medical examination. Seizing and retaining other items might be problematic. There have to be very good reasons for doing that. That includes items such as underwear, where there may be opportunities for forensic recovery.

As I mentioned, we would have to have those on-going discussions. However, asking forensic medical examiners to make an assessment of whether an item might yield additional specific evidence probably blurs the lines between investigation and the role of the forensic medical examiner.

Emma Harper

We know that the optimal time for the collection of evidence is between day 1 and day 7, and that it is better for forensic evidence such as cells, fluids and samples for DNA analysis to be obtained as early as possible. However, photographic evidence is also critical, and bruising and bite marks can develop over days. Could important evidence be lost if health boards are not able to store it? There are alternative ways to store evidence—for example, through the use of photographic evidence.

Detective Superintendent Capaldi

You are absolutely right. The optimum timeframe is within seven days for forensic—[Inaudible.] Obviously, there are opportunities with other items, such as clothing, cups, glasses and bottles, which will last a lot longer and will enable forensic recovery for a much longer period.

It is difficult to be able to provide advice and direction, because each report will be based on the circumstances of the particular incident that it relates to. We are not asking forensic medical examiners to be detectives or investigators. We should take the opportunity to retain as much as we possibly can but, ultimately, when it comes to the provision of a forensic medical examination, we must give the option to the victim while allowing their health and wellbeing to be catered for.

Emma Harper

Does Police Scotland think that there needs to be a national storage standard across health boards to ensure consistency in storage and compliance with evidential considerations?

Detective Superintendent Capaldi

Yes. There has to be a consistency of approach across all health boards, primarily to ensure that the process is sufficiently robust to enable any legal challenges to be repelled or to allow the process to be accounted for further down the line. If a case goes as far as court proceedings, there has to be a way to demonstrate and audit the process, whereby—as Gillian Mawdsley pointed out—there is continuity of evidence and each part of the chain of evidence can be corroborated. Therefore, national standards are a very good starting point, and we would certainly be supportive of such an approach.

Emma Harper

What information should be given to people about the implications of choosing a self-referral examination rather than reporting the incident to the police?

Detective Superintendent Capaldi

It is a question of having choices and options. Advocacy services are best placed to do that work. It is important that the service and its availability and accessibility are promoted, and Police Scotland has—[Inaudible.]—signposting, but I think that advocacy has a central role in the end-to-end process, from the point of reporting all the way through to potential court proceedings.

Sandra White

I want to ask about the transfer of evidence. I am interested in what you said previously about self-referral, which is that there would be no contact with the police. You mentioned corroboration in response to a question from Emma Harper. What is Police Scotland’s view on the transfer of evidence from health boards?

Detective Superintendent Capaldi

We would have to be assured—[Inaudible.]—that there were proper and auditable measures in place for the storage and retention of that evidence. Thereafter, we would have to evidence the—[Inaudible.]—in terms of the corroborated aspects of when that evidence was seized, where it was stored and who had moved it from A to B. Ultimately, when we take possession of evidence, in order for the court to accept the admissibility of that evidence, we have to be able to demonstrate not only to the prosecution but to the defence that the opportunities for that evidence to have been tainted or tampered with in any way, shape or form have been absolutely minimised. Ultimately, admissibility is a matter for the court. In order for us to be able to defend the processes that were followed, sufficiently robust processes must be in place at the outset.

Sandra White

As someone who was previously on the Justice Committee, I know about the difficulties of obtaining evidence without corroboration—in the absence of two policemen going to get evidence, for example. Do you see any difficulties with that aspect of self-referral—the presenting of forensic evidence in court? You mentioned that the evidence had to be robust.

Detective Superintendent Capaldi

We face the same situation that is faced with the implementation of any new process. What is proposed is very new and it will take time for it to become business as usual. It is important to set a bedrock for that at the outset, in terms of proper guidelines and protocols for seizing and retaining evidence and passing it on to the police. If we can demonstrate that such guidelines have been followed, there will be credibility around the process. I envisage that, initially, as with anything new, there will be some teething problems. However, further down the line, I think that it will become routine and business as usual.

Sandra White

I know that you cannot do anything unless the matter is reported to the police. From the point of view of your ability to investigate crime, would there be any advantage in Police Scotland being made aware that a self-referral forensic medical examination had taken place?

Detective Superintendent Capaldi

Absolutely. There is obviously intelligence information there, particularly, as mentioned earlier, if a rape—[Inaudible.]—it can cause significant public concern. It would be beneficial to know that a self-referral report had been made. Again—[Inaudible.]—the self-referral process if we obtained detailed—[Inaudible.]—of that, to protect the rights and anonymity at that point of the victim. There would be value in that.

Sandra White

There has been talk of having an anonymous database, which you touched on. Obviously, the police would be informed of the number of self-referrals with regard to rape or other serious crime. Would Police Scotland welcome an anonymous database? Would that be helpful in looking at not just—[Inaudible.]—crimes but historical crimes?

10:00  



Detective Superintendent Capaldi

That is a very difficult question. When we process items at our lab, we have DNA extraction and a DNA profile. Loading that on to a database would probably necessitate a search against the national database. If we subsequently get a hit on that DNA for a named individual, what do we do with that? Where do we go with it?

Although there are benefits, there are ethical issues around the storage and retention of that information for individuals, and it might cause more problems than it would solve. It would be very beneficial for us from an intelligence-gathering point of view, but we would need to look at how we would act on that intelligence and progress that aspect of the inquiry.

Miles Briggs

I have some questions on advocacy, which you touched on in response to Emma Harper. Does Police Scotland believe that advocacy services should be available for victims? What model do you currently use?

Detective Superintendent Capaldi

Yes, is the short answer. Since the establishment of Police Scotland in 2013, we have developed close links with Rape Crisis Scotland. At the point of reporting, we offer advocacy to victims of serious sexual crime, which has significant benefits. [Inaudible.]—engage with them or stay engaged throughout the process. It is one aspect of the overall package of provision to individual victims.

With Rape Crisis Scotland, we operate a model of self-referral at the point of reporting. We offer that to every victim of rape and serious sexual crime and, to date, we have found it to be very beneficial. However, a concern that has been highlighted with the self-referral process is that we are asking a lot of medics—doctors and/or nurses—if we are asking them to provide that initial advocacy support as well as look at the evidential requirements. Are we really asking that of doctors and medics? Are we asking them to focus on the health and wellbeing of potential victims, or are we asking them to provide that early evidence capture as well as the on-going healthcare and treatment?

Police Scotland certainly supports advocacy for self-referral cases.

Miles Briggs

That is helpful. One area that we have not been able to pursue in the bill is same-sex victims. From your experience, what is the current level of such victims in Scotland? Is the same advocacy provided to them?

Detective Superintendent Capaldi

I do not have the stats on the reporting of that to hand. We know from a recent look at our statistics for rape—[Inaudible.]—per cent of victims were female and 4 per cent were male. That is the kind of breakdown that we have at the moment. However, we know that such crimes are vastly underreported for a variety of reasons, so we do not know the true numbers. There is no differentiation—[Inaudible.]—female, gay, bisexual or lesbian. Any victim of a sexual crime is offered services via the advocacy support route. No distinction is made on the basis of someone’s sexuality.

The Convener

Thank you. Does Miles Briggs have a final question?

Miles Briggs

I do. The sound was breaking up during the evidence on statistics, so maybe Detective Superintendent Capaldi could provide them to the committee after the session. Wider information would be useful.

Would Police Scotland welcome the inclusion in the bill of a statutory right to independent advocacy, or do you think that it is already in place, so we do not need to legislate?

Detective Superintendent Capaldi

I do not think that there is a requirement to legislate—[Inaudible.] Existing agreements and alliances with the third sector, particularly advocacy support services, are sufficiently robust. It is probably more for the health boards to have an on-going discussion about the provision of advocacy support at the point of self-referral. I am relatively comfortable with what we have in place for—[Inaudible.]—but there might be a small gap when it comes to self-referral. We have identified that gap, so we should put provisions in place to fill it.

The Convener

Thank you. Emma Harper has a brief final supplementary.

Emma Harper

I will pick up on the importance of advocacy. The Rape, Abuse & Incest National Network in the USA reported the statistics that 45 per cent of rape is perpetrated by a person with whom the victim is acquainted and 25 per cent is perpetrated by a current or former partner. I assume that that makes it challenging to prosecute; it also shows how important advocacy is in supporting the victims.

Detective Superintendent Capaldi

I would not disagree with those figures. From my experience, familial sexual abuse is a significant problem and is vastly underreported. [Inaudible.]—close relationships is also, unfortunately, too common in some of the reports that we get. Ultimately, we would encourage people to come forward; some will require more support than others, and advocacy will play a key role in ensuring that people have the confidence and faith in the police and the justice system—[Inaudible.]—these matters.

The Convener

I thank Detective Superintendent Capaldi very much for his evidence.

I apologise to people who have been following proceedings for the fact that, at times, the sound quality has been poor. We will check the Official Report when it becomes available—I am sure that both our witnesses will do the same—to make sure that there are no gaps in what has been said. However, we have certainly found the evidence of Gillian Mawdsley and Filippo Capaldi extremely helpful.

That concludes the public part of this morning’s meeting. The next meeting of the committee will be next week and will be notified in the Business Bulletin and via the committee’s social media.

10:08 Meeting continued in private until 12:00.  



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Fifth meeting transcript

The Convener

The fifth item on our agenda is a final public evidence session on the Forensic Medical Services (Victims of Sexual Offences) (Scotland) Bill, at stage 1. We have discussed a number of issues with witnesses in previous evidence sessions, and the committee has also received significant written evidence. This meeting is an opportunity to discuss the Scottish Government’s position on the issues.

I welcome Jeane Freeman, the Cabinet Secretary for Health and Sport. She is accompanied by Dr Gregor Smith, who is the interim chief medical officer, Greig Walker, who is the bill team leader, and Tansy Main, who is the unit head in the CMO’s rape and sexual assault task force. I thank you all for joining us.

We will ask questions in a prearranged order. I remind members and witnesses to keep questions and answers succinct and, please, to give broadcasting staff a few seconds to operate the microphones before you begin to ask a question or provide an answer. Members should, please, indicate when they are on their final question. I invite the cabinet secretary to make a short opening statement.

The Cabinet Secretary for Health and Sport (Jeane Freeman)

Thank you, convener, and good morning to you and colleagues. I offer my apologies for the technical problems that we had at our end, which have held you up.

Thank you for continuing your scrutiny of the bill at what is a uniquely challenging time. The progress of the bill sends the important message that we are committed to improving the experience of victims of sexual crime in the health and justice systems.

I record my appreciation for all the staff who work in those services, notwithstanding the fact that they have also been addressing the challenge of the pandemic. I give my grateful thanks to Dr Gregor Smith, the interim chief medical officer for Scotland—who, as the convener said, has joined me this morning—for providing continued national leadership of the task force that is overseeing improvement of the relevant services across the country.

This is an important and focused bill that we, as a Government, have chosen to prioritise. It will underpin the work of the task force, which has firmly positioned forensic medical services first and foremost as a healthcare response. All health board chief executives have committed to delivery of sustainable trauma-informed services, in line with national Healthcare Improvement Scotland standards.

Transformation in the response to rape and sexual assault is already well under way through the work of the task force, and is supported by Government funding of £8.5 million over three years. Together, the work on the bill and the task force address recommendations in Her Majesty’s Inspectorate of Constabulary in Scotland’s report from 2017.

As I set out in my letter to the committee on 5 May, a comprehensive package of resources has been developed to ensure consistency in the approach to pathways of care, as well as to recording, collation and reporting of data in relation to services. Implementation of the clinical pathway, national documentation and national data sets for adults has been delayed due to Covid-19, but plans are now being developed to deliver virtual training for health boards to prepare them for implementation of a wider package of resources covering all age groups before the end of the calendar year.

Other important improvements are also being progressed over the next 12 months, including development of the role of nurse sexual offence examiners, implementation of a national clinical information technology system, and preparation of health boards for commencement of the bill.

I welcome the committee’s having spoken to survivors of rape and sexual assault; the Government shares the committee’s commitment to learning from people with lived experience. I was heartened that Sandy Brindley of Rape Crisis Scotland acknowledged in her oral evidence that improvements to victims’ experiences resulting from the work of the task force are beginning to bed in, particularly in recent months.

The bill will enshrine in law an holistic healthcare and recovery focused model, and will provide access to self-referral consistently across Scotland. That will mean that when a person who has experienced rape or sexual assault does not want to tell the police straight away, or is undecided, the health board will be able to obtain certain forensic evidence and keep it safe. If the person decides not to tell the police, the evidence will be destroyed after a period, or on request. That choice being available to people after a significant trauma is vital to giving them control over what happens to them at a time when control has been taken away.

I emphasise, however, that the principles of trauma-informed and person-centred care will apply whether or not a police report is made. The bill supports the delivery model of a co-ordinated multi-agency service to ensure a smooth pathway of care for the person. In that regard, I consider the bill to be barnahus ready.

A number of issues have been raised with the committee, and the committee will have a number of questions. I and my colleagues look forward to answering your questions.

The Convener

Thank you, cabinet secretary. As you said, the committee heard directly from survivors of rape and sexual assault. We heard from Sandy Brindley in person, as well as in writing. She put on the record that the single most important issue for survivors is access to a female doctor or examiner. How confident is the Scottish Government that, through the bill and the other changes that you have described, victims of rape and sexual assault will have a real choice about the gender of the examiner?

09:45  



Jeane Freeman

I am confident about that, based on the following. I say first that I agree completely that people should have that choice; it is particularly important in circumstances such as we are discussing.

Now, some 61 per cent of sexual offence examiners are women, and 70 per cent of the doctors who have completed NHS Education for Scotland’s essentials in sexual offences forensic examinations foundation training are women. In addition, introduction of the role of nurse sexual offence examiner improves availability of choice, and work to maximise choice across the country will continue.

There are clearly some restrictions to that. For example, where a team of sexual offence examiners is predominantly male, those individuals will be on contracts, so we have to find other ways to add to the number in order to offer choice. The task force has that work well in hand. The 61 per cent figure is, however, a significant improvement and illustrates the commitment to ensuring that choice is available.

The Convener

We heard from Dr Anne McLellan from NHS Lanarkshire about the work that is being done at regional level, with what are, in effect, recruitment networks. She spoke about the potential benefit of a national network for recruiting female examiners. Do you envisage recruitment causing a difficulty? Are there, for example, issues in recruitment of paediatricians for instances in which a paediatrician would be appropriate? What is your view of the mechanism for identifying and recruiting female examiners, and networking in that regard?

Jeane Freeman

There are two points to make in response to that. With your agreement, I will ask Dr Smith to contribute on this.

It would be foolish to deny that there are recruitment challenges in just about every area of our healthcare workforce at this point. Clearly, there are recruitment challenges when it comes to paediatricians. However, work is under way to ensure that the training and the pathway that I have described create a career. Dr Smith might say a bit more about that.

Dr Gregor Smith (Scottish Government)

I thank you, first of all, for the opportunity to speak to you today about what is, for me, a very important bill on an area in which a tremendous amount of work has been done.

Recruitment and retention are incredibly important. The task force has, over the years since it has been in place, sought to make the role of forensic medical examiner much more attractive. That is not only to attract more people; the aim is also to ensure that we retain expertise in the role.

When I was first involved with forensic medical examiners, it was a very male-dominated profession, or specialty. Over the past decade, I have seen far more women coming forward and expressing a desire to develop a career in the area. The career-development aspect is important. We need to ensure that people are working within safe and effective pathways of care and that they get support, as part of a multidisciplinary team that provides that care. We also need to ensure that they work to quality-of-care standards that they can buy into. Those things together make the role much more attractive.

However, we need to make the practicalities of the role much easier to deal with. Many doctors who get into the line of work do so as part of a portfolio career. As has been mentioned, they might have a background as a paediatrician, a gynaecologist or a general practitioner. We need to ensure that the work that they do fits with their wider portfolio of work. An issue that was commonly raised in the past was the need to facilitate court appearances. People have enjoyed doing the work of a forensic medical examiner but have found the practicalities of shifting the rest of their portfolio of work to accommodate court appearances to be incredibly difficult. Our work with the justice system to facilitate that much better and more proportionately has made the role a more attractive career choice, and has made it much more likely that we retain expertise in the service.

The cabinet secretary touched on use of specialist trained nurses as sexual offence examiners. That is also very important, because it ensures that the basis of everything that we do, in the care that we provide, is that the choices and preferences of people who experience sexual assault are catered for.

The Convener

This is my final question. Is it the Government’s aspiration to have a 24/7 examination service throughout Scotland? If that is your ambition, how optimistic are you about progress towards it?

Jeane Freeman

The HIS standards set a time frame of three hours for someone who has experienced rape or sexual assault to be able to access forensic medical examination. That is the objective that we are working to. Each health board has made progress in building the capacity and capability of the workforce to achieve that aim.

However, as the convener will understand, there are undoubtedly challenges in remote and island communities in meeting that standard as easily as we might be able to do elsewhere. That said, it is still our intention to do so, and the task force is working with the relevant boards and colleagues on steps that we might take to overcome the particular challenges.

At this point, I am confident that we will be able to meet the aim in most of Scotland, and I am confident about our commitment to ensuring coverage of all Scotland, notwithstanding the fact that challenges exist that we need to find ways through.

David Stewart (Highlands and Islands) (Lab)

Good morning. Why was it decided to restrict self-referral for forensic medical examination to people over the age of 16?

Jeane Freeman

There is some debate about that. It is only sensible to acknowledge that. Some argue for the age being 13 and others argue for 18, for example. Consensus was reached on its being 16. However, I am conscious that there is a debate; we have not closed our minds to further discussion of the age limit.

David Stewart

You might be aware of other evidence that the committee has had on that matter. Dr Anne McLellan from NHS Lanarkshire made two quick but powerful points when she said that

“we should encourage self-referral in 13 to 15-year-olds, because 40 per cent of last year’s 13,000 sexual assaults were on under-18s”

and that

“One in four under-16s in Scotland is sexually active.”—[Official Report, Health and Sport Committee, 12 May 2020; c 10.]

Do you share my view that the extremely low reporting and conviction rates for child sexual assault could be reversed if we were to encourage self-referral by under-16s?

Jeane Freeman

Again, I might ask the chief medical officer to comment, but I am cognisant of the debate, the different views on the issue and the many strongly held opinions and powerful points that have been made. I am open to discussion of whether there is a case to be made for us supporting a lower age. As I said, consensus was reached on the age of 16. As I have noted, other arguments favour an age limit of 18, but it seemed to us that 16 would fit in with the age of majority in other areas of life in Scotland. We are happy to have a further discussion on that aspect.

Gregor Smith might want to add something on the process that was undertaken to reach the position in the bill.

Dr Smith

The age threshold is an important area for discussion. As the proposals were developed, there was a great deal of discussion with stakeholders, in particular about whether, on balance, the age for self-referral should be 13, 16 or, as the cabinet secretary mentioned, perhaps even 18. The strongest view among the clinical community in particular, which balanced the aims that self-referral is intended to achieve with the need to ensure that we safeguard young people, was that 16 is the right cut-off point.

We have always adopted a position of being open to further discussion on the matter, but we should recognise that the current clinical consensus, which balances all the needs that relate to young people, sits with the age of 16.

David Stewart

I thank both witnesses for those helpful suggestions. I will suggest two possible ways forward. A sunset clause could be inserted in the bill so that we would keep the age limit at 16 but it would be reviewed within a certain time—for example, three years—and/or we could encourage post-legislative scrutiny of the legislation.

I understand that the committee would have a role in that regard, but a strong steer from Government that the legislation will be reviewed in the future to see whether the provision is fit for purpose would be a helpful way forward. I would welcome the cabinet secretary’s views on that. It might be that she has not yet considered those points, but I would be happy if she could get back to the committee on my suggestions.

Jeane Freeman

I am grateful to Mr Stewart. Those suggestions are both very positive and they recognise that there is not necessarily a single right answer. I am happy to consider the matter further and to respond to the committee in due course.

David Stewart

The Scottish Children’s Reporter Administration notes in its written evidence that the bill

“does not offer therapeutic supports beyond the forensic medical examination”.

Do you agree with that view?

Jeane Freeman

The bill needs to be viewed alongside the work of the task force in the context of what we are trying to achieve. It provides a legislative underpinning where that is necessary. The approach is trauma informed, so it is, by its nature, multidisciplinary and therapeutic. I think that the SCRA’s view is an unfair criticism of the bill, given that what it highlights is not the bill’s purpose; rather, the bill sits alongside the overall work of the task force and the commitment to a trauma-informed and health-based service.

David Stewart

I move on to my final question. You said in your opening remarks that the bill is consistent with the principles of the barnahus model, which is—as our viewers might know—the name of the original Icelandic scheme. It means “children’s house”. It is about involving children in the justice system, and it is geared up to be more efficient and sensitive to children’s trauma.

Will you say a bit more about that important principle, which has, as you will know, been picked up by many other European countries?

10:00  



Jeane Freeman

It has indeed, and the Scottish Government is committed to pursuing that model across portfolios.

As I highlighted in my opening remarks, I believe that the approach in the bill, when set alongside the wider work of the task force and the overall approach that I have described, which involves an interagency multidisciplinary therapeutic model that is focused on both the physical and psychological needs of the individual, as well as the collection of appropriate and recognised forensic evidence, will contribute to the overarching barnahus principle. That is why I have said that I believe that the bill is barnahus ready.

In and of itself, the bill will not deliver in total what we seek in pursuing a barnahus model, but it will contribute to that work, and it certainly does not contradict that overall ambition.

Brian Whittle (South Scotland) (Con)

Good morning, cabinet secretary and colleagues. I have a question on whether children and young people who are alleged to have perpetrated sexual assaults and abuse should be included in the bill. I think that it is fair to say that there is quite a bit of conflicting opinion in that regard. The National Society for the Prevention of Cruelty to Children seems to be favour of their inclusion whereas Rape Crisis Scotland is not. What consideration has the Scottish Government given to extending the bill’s provisions to cover alleged child perpetrators?

Jeane Freeman

Mr Whittle is absolutely right: there are conflicting and often strongly held views in that area. The task force has undertaken, and continues to undertake, some work on the matter. I ask our chief medical officer to advise the committee what the task force is doing through its sub-group in considering the issue.

Dr Smith

It is important that that aspect be addressed, and it has certainly been picked up as part of the task force’s work. A specific sub-group of the task force is examining the approach to children and young people who have been accused of being perpetrators of sexual assaults.

It is important that we understand that this is a very complex area. We are already starting to see some movement on the guidance with regard to how such young people should be examined and the type of interagency discussion that would be necessary in respect of those in older age groups—for example, those aged between 13 and 16—before any decision to examine, and a decision on the location of an examination, is made. That work is under way.

My view is that it is right that the issue is picked up as part of a pathway approach to this complex clinical area. Such young people might have experienced trauma themselves, and that needs to be carefully and sensitively explored. Rather than using the bill in a way that might complicate and delay its greater intent and focus, it is right that we pick up the issue appropriately by other means.

Brian Whittle

Has the Scottish Government considered allowing for examination and collection of forensic samples from alleged perpetrators in a healthcare setting rather than in police custody?

Jeane Freeman

There is no straightforward yes or no answer to that question. The starting point is probably to say, as Dr Smith has just said, that alleged perpetrators are oftentimes themselves victims of abuse. In that situation, one would want to collect the evidence in a way that is supportive, and certainly in a way that does not create more trauma or difficulty for the individual. However, there must be case-by-case consideration in consultation with Police Scotland to determine in each individual circumstance what is the right approach.

As I said, there is no straightforward yes or no answer. We would certainly not want healthcare facilities to bar individuals who are alleged perpetrators but, equally, I understand that there will be circumstances in which it would not necessarily be appropriate for such facilities to be used.

Brian Whittle

I will move on to a question about retention services and the retention periods for evidence that is collected from forensic medical examinations. I should probably declare an interest in that I have been working with a constituent over the past couple of years regarding historical sexual abuse. The case, which goes to trial tomorrow, is from 40 years ago. You will therefore understand my interest in this line of questioning.

We heard in oral evidence that there is a lack of consensus on the matter between organisations, and I can understand that. What progress has been made on seeking a consensus about the appropriate timescale for the retention of evidence?

Jeane Freeman

Quite a lot of work has been done on that, and my colleagues may wish to add to what I am about to say. A group that is part of the task force’s self-referral sub-group is working to develop a national protocol under which the provisions of the bill would be implemented.

There is no consistency among self-referral services across the UK. Retention periods in England, Wales and Northern Ireland range from one to seven years. The Archway service at NHS Greater Glasgow and Clyde currently retains its evidence for 18 months. Having gathered information, the membership of the group, which includes the health service, Police Scotland, the Scottish Police Authority and the Crown Office, has reached a consensus that a period of two years and two months feels about right. However, further work needs to be undertaken before we can be confident in settling on a period.

I am mindful of what you have self-declared, with your parallel interest in the area. The question is not a straightforward one, but we will work through it. At this point, however, the consensus is around a period of two years and two months.

Brian Whittle

As has been mentioned, we heard some incredibly compelling evidence from victims of sexual crimes. Will you consider victims’ views in making a decision of that nature?

Jeane Freeman

That is a very important point. With your agreement, convener, I will ask Tansy Main, who has been involved in the area, to say a little more about how we will make progress.

Tansy Main (Scottish Government)

As the cabinet secretary highlighted, we have a sub-group under the remit of the CMO task force that is considering the implementation of the bill’s provisions, and a task and finish group that sits beneath the sub-group is specifically considering the protocol for health boards for the retention and storage of evidence and the retention period, which will be set out in secondary legislation.

As the cabinet secretary said, that work involves the Crown Office, Rape Crisis Scotland, the police and health boards. Sandy Brindley, who is chief executive of Rape Crisis Scotland, plays a very important part in that group, helping to ensure that the voice of lived experience is fed into its considerations. Our proposal would be that, when we do some further work and analysis on what the appropriate retention period might be, we will take that to survivors through the survivor reference group that is linked to the task force and ask them for their views on it.

When survivors gave evidence to the committee in early March, they suggested that they would like the retention period to be as long as possible. That must of course be balanced with the need to provide an element of closure for survivors, and the period should not carry on for ever. The storage requirements on health boards are a further consideration.

On the point about historical abuse, it is worth noting that abuse often does not come to light until many months or years after it has taken place. In such cases, DNA evidence will not be obtained. DNA evidence in acute child sexual abuse cases is normally obtained within seven days. However, because the abuse in historical cases does not come to light within that timeframe, the retention period for such cases will be less relevant.

Brian Whittle

Given the lack of consensus between organisations on retention timescales, will they be subject to regular review? Will the bill contain a provision on that?

Jeane Freeman

That is a sensible and reasonable question. It goes back to Mr Stewart’s line of questioning and our recognition that, although we will have to settle on particular matters as the bill progresses, there will nonetheless be no absolute right or wrong answers in some areas, so we should be willing to review provisions after a particular time.

As I said to Mr Stewart, I am happy to consider how we might do that and to come back to the committee on it in due course; and I will incorporate Mr Whittle’s point in that consideration. Of course, if the committee has particular views, I will be grateful to hear them.

Sandra White (Glasgow Kelvin) (SNP)

Good morning, cabinet secretary. I will follow on from Brian Whittle’s questions on the type of evidence that health boards are expected to retain. Tansy Main mentioned a protocol. Can you clarify what type of evidence health boards would be required to store? Have you made a decision on that yet? Would it be part of the protocol that Tansy Main mentioned?

Jeane Freeman

For speed, it is probably best to go straight to Tansy Main and get her to clarify what the protocol covers and the procedure on retention.

Tansy Main

At the moment, the sub-group that is developing the protocol is doing so on the basis that the evidence that will be retained will be, as it is now, in accordance with the guidance published by the Faculty of Forensic and Legal Medicine, which sets out what forensic examples should be obtained following a rape or sexual assault. That guidance applies in both police referral and self-referral cases.

At the moment, the sub-group considers that biological samples will be retained, which might also include images from a colposcope from an internal examination and, if relevant to the case, underwear, sanitary wear or condoms. The clinician will be able to judge what is required, on the basis of the information that the complainer has provided to them. In the rare circumstances where there is evidence of ejaculation on clothing, the clinician would make a decision about whether to retain that item. If they were in any doubt, they could contact the lead scientist at the Scottish Police Authority, who is on call 24/7, to check whether they think that retaining that item would provide an opportunity for a DNA analysis and have some evidential value.

The two health boards in Scotland that currently provide self-referral are of the view that when we have a national protocol, all health boards should take the same approach, which should be limited to the evidence that I have just set out: biological samples; underwear and so on, if required; and, in exceptional circumstances, another item of clothing. However, there is no proposal at the moment to retain large or bulky items, or anything that might be within the scene-of-crime remit, which is very much investigative territory that resides with Police Scotland.

Sandra White

You said that the clinician would decide on the evidence and whether to contact the police. However, what about the victim in all this? What would happen if the victim was insistent about a certain piece of clothing? Would they have a say on what evidence was being retained?

10:15  



Tansy Main

It is important to emphasise that, in the process of the initial consultation when someone attends for a self-referral, information is provided to the person to explain what self-referral is and what it is not. It is explained that self-referral is not the same as a police investigation and that the retention of biological samples and other relevant evidence that might have evidential value from DNA testing does not mean that all evidence relating to the suspected crime will be obtained. The complainer therefore needs to decide whether self-referral is for them. If someone was insistent that something should be kept, a decision would have to be taken on whether DNA evidence could be found on that item. As I said, if there was any doubt, the expert advice of the forensic scientists at the Scottish Police Authority would be sought.

Sandra White

If there was a self-referral but the incident was not reported to the police, could the evidence from the medical examination be lost?

Tansy Main

No, the evidence would not be lost in that case. It would be stored securely by the health board according to the national protocol that is being developed, which will be agreed with Police Scotland, the Crown Office and Procurator Fiscal Service and the Lord Advocate. I am not quite sure what you mean by loss of evidence, though. Do you mean loss of evidence in terms of things that the police might be looking for?

Sandra White

Yes.

Tansy Main

The nature of self-referral is that the police are not involved, so if there is closed-circuit television evidence or fingerprints on glasses in a nightclub, for example, it is explained to the person that that kind of evidence will be lost if they do not report at that point in time. The person can then decide whether they wish to go ahead with the examination and just have the forensic evidence from that retained, and then consider whether to report to the police at a later date.

The Convener

Thank you. I remind members and witnesses that it is important not to talk over each other, because of the sound quality—[Inaudible.]

Sandra White

That is my fault, convener. Having just spoken to Tansy Main about evidence, my next question is for the cabinet secretary. Would there be advantages in allowing analysis of samples by the Scottish Police Authority prior to a case being reported to the police?

Jeane Freeman

We need to hold carefully in our heads the distinction between a report to the police that then triggers an investigation—Tansy Main covered what a police investigation would look at—and a self-referral, which is largely a healthcare-led service that focuses on the physical and psychological needs of the individual but has the capacity to retain forensic evidence that has evidential value. Part of the approach to the self-referring individual is ensuring that they understand the difference between self-referral and reporting to the police, and are therefore able to make a better-informed choice about how they want to progress and what they want to do.

On the SPA analysing samples in the way that Ms White described, I cannot see the value of that. We should remember that we have properly trained sexual offence examiners, whose training includes not only how to secure samples with evidential value, but how to know where those samples might be and how to go about that exercise. I am therefore not entirely sure where the value might be in bringing in the SPA. Who would decide that and what would that add to the process? I could be wrong, and the committee might want to say more to us about that but, at this point, I do not see what the value of that might be.

Sandra White

I must admit that I agree with you. I think that that would go against the grain of the bill.

There has been talk about anonymous databases. Has the Government considered establishing an anonymous DNA database?

Jeane Freeman

The most recent written evidence from Police Scotland and the UK Information Commissioner’s office cautions against any anonymous DNA databases, and the Crown Office has been clear that a proposal to do that would need how that would operate to be fully defined before it would comment on it.

I know that the issue has arisen in the stage 1 evidence, but it has not been consulted on. The existing national UK and Scottish DNA databases, which contain DNA profiles of people who are suspected or convicted of having committed a crime, are subject to pretty rigorous legal and governance controls. We have not considered the matter, but if the committee wants to make any points to us about it in its stage 1 report, I will, of course, consider them along with any other points that it makes.

Emma Harper

Good morning, cabinet secretary and witnesses. I thank you for the work that you have done so far.

I am interested in the process for raising public awareness of self-referral and signposting services. How do you envisage people being made aware of self-referral services?

Jeane Freeman

A workstream that is chaired by Rape Crisis Scotland is undertaking a feasibility study and an options appraisal to consider how individuals will access self-referral services—in other words, how they will be made aware of their existence—and is looking across to see what other partners might help in the delivery of that. A national awareness-raising campaign is being considered, and the group is consulting other stakeholders, including deafscotland, the Royal National Institute of Blind People, People First (Scotland) and Young Scot, as it progresses that work to try to ensure that it captures as many contributions as possible before it determines how we will raise public awareness and perhaps target specific groups of people to ensure that they know that the services exist.

Emma Harper

I am sure that there has been consideration of targeting the black, Asian and minority ethnic community in a national public awareness campaign. Can you touch on that a wee bit?

Jeane Freeman

I did not name that community, but it will, of course, be part of the range of stakeholders in the group of consultees in the workstream that is led by Rape Crisis Scotland. We want to be able to reach a range of groups, such as young people, the BAME community, of course, and the Traveller community. The messages that are conveyed should be consistent, but the means by which those messages are channelled will differ, depending on the group.

I am sure that the sub-group of the task force will come back with some key pieces of information that it wants to ensure that people receive and, I suspect, a range of methods by which that should be promulgated. That should be consistently followed up, because there is no point in just doing a big “Ta-dah!” moment at the point when a service becomes available—we want people to be consistently aware of it. Of course, we want to ensure that other important partners such as Police Scotland have information that they can pass on to individuals who might benefit from the service.

Emma Harper

I should have also mentioned that persons with additional support needs should be considered.

You said that £8.5 million of Scottish Government money has been utilised for the process. Who would be responsible for funding the public information or education campaign? Would there be additional funding for that?

Jeane Freeman

We would need to make sure of whether more funding was needed. It would be an NHS Scotland-led campaign, because it is a health service and because the NHS brand is well recognised and trusted. We would want to have that at the forefront and we would make sure that there was resourcing to support a consistent information campaign.

Emma Harper

Will Police Scotland have a role to play in informing people about self-referral services, so that they can make an informed decision about whether to report an incident to the police?

Jeane Freeman

Yes, it will. Police Scotland is an active and enthusiastic partner in all of the work and we have benefited from that input.

Miles Briggs (Lothian) (Con)

How will the Scottish Government ensure that people who have self-referred for a forensic medical examination have early access to advocacy?

Jeane Freeman

Advocacy is an important element. We are talking about a trauma-informed service that recognises the importance of the individual’s psychological and mental health and their needs in that regard. That includes having support to express what they want in a situation in which they might, for understandable reasons, find that difficult.

We have had a lot of advice from Rape Crisis Scotland, which has a role. The CMO might want to say more about how the task force is looking at advocacy.

Dr Smith

Advocacy is becoming increasingly important in all aspects of healthcare, and the bill should be no different. The Rape Crisis Scotland advocacy project has been helpful in informing, through the task force, the approach that we should adopt.

It is important to make a distinction between the underpinning elements of the legislation and the work of the task force in ensuring that we have optimal care pathways that we can monitor to ensure that quality standards are as good as we can make them.

I see advocacy fitting into that latter part. It is about how the NHS in Scotland responds to the need for advocacy for the relevant group and how it works with our third sector partners in making sure that advocacy is accessible and available when it is required. The issue is not unique to this sphere of clinical practice; it is much broader.

Miles Briggs

What research has the Scottish Government undertaken into same-sex cases? Might the Government put in place bespoke support for those individuals?

Jeane Freeman

If Mr Briggs does not mind, perhaps he could explain what he is asking about a little bit more.

Miles Briggs

I am talking about individuals who have been involved in same-sex cases.

10:30  



Jeane Freeman

Whether it is someone of the same sex or of the opposite sex who perpetrated sexual abuse on an individual, the individual’s health and mental wellbeing, and their psychological needs, will by and large be comparable.

Part of the discussion is to look at and make sure that our proposals for the establishment of the service are equitable and accessible to all individuals, regardless of their sex or sexual orientation. I do not quite follow why there would be any difference in the trauma-informed approach and the service on offer as a result of the sex of the individual who perpetrated the abuse. I apologise if I am missing something, and it might be that the committee will want to say something about that issue to the Government in its report.

If either Tansy Main or Greig Walker wants to add to that, I am happy for them to do so.

Greig Walker (Scottish Government)

The bill has been deliberately drafted in gender-neutral language. It talks about people; it does not talk about female victims. That approach is deliberate, and it follows on from the development of the equality impact assessment, which I think is included in members’ papers this week. That means that all victims have the same legal entitlements under the bill, irrespective of sex, age, race or other distinguishing characteristics.

Following Detective Superintendent Filippo Capaldi’s oral evidence to the committee, he provided interesting statistics that show that the predominant dynamic in sexual offending is male perpetrator and female victim. I have just used the phrase “drafted in gender-neutral language”. That is carefully crafted, because we do not consider the bill to be gender neutral; it is informed by the gender dynamics that are in play in the “equally safe” portfolio.

Miles Briggs

My final question is about mental health assessment and support. What does the cabinet secretary consider should be available for people accessing services? How will that be provided? How will ministers ensure that the same level of support is put in place across Scotland?

Jeane Freeman

As I have said more than once, the service is a trauma-informed service. That is deliberate. It is also intended as a national service, hence the national standards and the overall national protocol and approach.

The Government’s overall intention is that, regardless of where someone is in Scotland—notwithstanding the challenges that we talked about at the outset with delivery in remote and rural communities, for example—they will receive the same standard and quality of service and access to the services around that service. That includes psychological support, which may be continuing psychological support, depending on the individual’s needs. Because the forensic medical service is a health service, the psychological support would come through the health service.

David Torrance (Kirkcaldy) (SNP)

How will health boards be encouraged to co-operate with one another and share best practice? How will that be overseen and monitored?

Jeane Freeman

The CMO may want to add a few words to what I have said on the implementation of the national clinical pathway.

Our health boards are heavily involved in the work of the task force, and the bill will underpin that work. The national service, protocol and standards are designed to involve our health boards but not be open to local interpretation. It is a national service that boards are required to deliver and report on, according to various quality standards. Underpinning that is the clinical approach—the CMO may want to add a few words on that.

Dr Smith

I emphasise to the committee the degree of co-operation that has taken place, not just in the clinical community but between the clinical community and the wider group of stakeholders, in relation to the aims of the task force and what we are trying to achieve with the legislation.

There are various ways in which we can start to achieve consistency of approach across the country. The first of those is through the specialty organisations—the Faculty of Forensic and Legal Medicine, for example—that are associated with this area of work. There are also the clinical networks that have formed between forensic medical examiners throughout the country, which have broadened over time to include other disciplines and professions.

I could also point towards the co-operation that has occurred between boards to develop regional approaches to care, all with the aim of achieving much greater access, and quality and consistency of service. Underpinning all that are the national clinical pathways that are being developed and the national quality standards that were developed by Healthcare Improvement Scotland, which were launched first on an interim basis and then more fully in March 2020.

All that points towards different vehicles that we can use to maximise the enthusiasm and eagerness to continue to improve care, and to harness the broader clinical communities in a way that gives them something to wrap their approach around.

We continue to explore different ways that we might continue to enhance that in future, for instance through the emergence of a managed national clinical network. As I say, though, we have a variety of approaches to ensure that there is consistency in the quality of services across the country.

David Torrance

What plans does the Scottish Government have for monitoring and reporting of quality indicators? Will that information be made publicly available?

Jeane Freeman

As we have said, there are HIS quality indicators, and the service will be monitored against those. The results of that monitoring will be made public. I think that we would anticipate an annual report of performance against those quality indicators.

David Torrance

Will additional support be needed for smaller health boards to implement the legislation, and will the implementation of the legislation be evaluated in relation to the impact on people according to protected characteristics and socioeconomic disadvantage?

Jeane Freeman

The latter point from Mr Torrance is very important and I am grateful to him for raising it. No matter what we collectively agree on how the legislation should be evaluated, that evaluation should take account of its impact on protected characteristics and areas of socioeconomic disadvantage. I am sure that there will be other areas of evaluation.

On support for smaller health boards, there is a long-standing tradition in the NHS of inter-board support on a range of services. As we look to deliver the national service, we will instinctively begin by seeing where smaller boards can be assisted in what they are doing by larger boards. If further support is needed, we would look at that, because we are determined to ensure that a national service is delivered.

George Adam (Paisley) (SNP)

I have a question on the financial implications of resourcing the bill. It is important that the bill delivers what it sets out to do. However, NHS Greater Glasgow and Clyde has made a number of claims, including that

“The estimated costs do not take into account changes to existing service ... Or the potential for increased provision leading to increased demand on existing service resulting from increased public confidence in the service.”

I serve a constituency that is part of the NHS Greater Glasgow and Clyde area, and I know that a lot of things that the board says do not necessarily reflect what it does in reality. However, taking that into consideration, how would you respond to those claims?

Jeane Freeman

To start, I remind us all that health boards are already delivering a police referral service under the existing memorandum of understanding, and that there was a baseline transfer of £7.6 million for forensic medical services from the police to health in 2014, when health boards took over responsibility for delivery of those services. The modelling assumptions that we make in the financial memorandum predict an incremental 10 per cent increase in demand from self-referral, and each health board would incur a proportional share of that cost.

All that notwithstanding, we accept that there could be a revenue tail—as we would describe it—from the initial pump-priming funding of £8.5 million that I mentioned. Government finance officials continue to work through any additional financial pressures that may be expected to arise. However, at this point I am comfortable that, notwithstanding the fact that such services are already delivered by health boards to a degree and are therefore accommodated in boards’ financial envelope, and that there has been a baseline transfer, the planning assumption in the financial memorandum is sensible. I have not yet seen any evidence from a health board or from anywhere else that a 10 per cent increase in demand as a planning assumption in the financial memorandum is in any way off kilter.

George Adam

As always, the cabinet secretary has given an impeccable answer, and she has already answered my supplementary question, so I have no further questions.

The Convener

In that case, we have time for a brief supplementary from Brian Whittle.

Brian Whittle

I apologise, cabinet secretary—I should have asked this with my initial questions. You will know of my interest in ensuring that we have the correct technology to deliver on Government policy. To go back to retention, do we have a digital platform that will allow for the digital retention of evidence for an extended period of time?

Jeane Freeman

I wondered why you had not asked me anything about technology, Mr Whittle—I thought that it might have been a first, but there we go. If you do not mind, I will ask Tansy Main to respond in detail to that question.

Tansy Main

The package of resources that the task force will introduce before the end of the current calendar year includes new national forms to ensure that information and data from forensic medical examinations are collated consistently across Scotland. The forms will initially be paper based, but we are already working on a national clinical information technology system for the whole of Scotland, which will mean that the forms will be online and the information can then be transferred to the analysts in Public Health Scotland, who will use the data to assess health board performance against the Healthcare Improvement Scotland quality indicators. Part of that clinical IT system will provide the functionality to enable things such as colposcope images to be retained securely on file.

I am not sure what Brian Whittle means when he asks about how long information will be kept. The clinical IT system will contain a mechanism to ensure that, when the end of the retention period is reached—whether or not that is determined to be two years and two months—the forensic information will be deleted from that record, and only health information will be retained.

The Convener

I thank the cabinet secretary and her officials for taking part in the meeting. That concludes our formal evidence session, and we now move into private session.

10:45 Meeting continued in private until 11:35.  



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23 June 2020

Health and Sport Committee Committee's Stage 1 report 

Delegated Powers and Law Reform committee

This committee looks at the powers of this Bill to allow the Scottish Government or others to create 'secondary legislation' or regulations.

Read the Stage 1 report by the Delegated Powers and Law Reform committee published on 31 January 2020.

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