Meeting of the Parliament (Hybrid)

Meeting date: Thursday, December 10, 2020

Official Report 1128KB pdf

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

Members will be pleased to hear that the final item of business today is a debate on motion S5M-23646, in the name of Jeane Freeman, on the Forensic Medical Services (Victims of Sexual Offences) (Scotland) Bill.

17:47  

I am pleased to open this stage 3 debate on what is a very important bill indeed. Rape and sexual assault are among the very worst experiences that any of us can face in our life, and the impact lasts. There can be no question about that.

The Forensic Medical Services (Victims of Sexual Offences) (Scotland) Bill is one important part of what we have to do to make sure that, in all that we do, we put the victim first—that we recognise and understand the trauma, and embed that recognition, and the actions and approach that necessarily flow from that, in the healthcare support and the support for recovery that we provide.

Members may have watched a recent Scottish Television segment on the bill, where Katie Johnston and Lisa Walsh, two survivors of rape and sexual assault, bravely waived their right to anonymity and shared their experiences of forensic medical examination. To them and to the other survivors who have helped us so very greatly to get to this place, I say, “You have my undying gratitude for your courage and your honesty.” There is no doubt at all that too many experiences of forensic examination in the past were poor and retraumatising.

The chief medical officer’s rape and sexual assault task force has provided national leadership for the improvement of these services, following an important report by Her Majesty’s Inspectorate of Constabulary in Scotland. I put on the record my sincere thanks to Dr Catherine Calderwood, our former CMO, for her leadership in driving that work forward, and to Dr Gregor Smith, our current CMO, for continuing that focus.

To take just one extremely important example of improvement, victims are no longer examined in police facilities. I am pleased that Rape Crisis Scotland has recognised that a corner has been turned and that improvements are bedding in. The bill provides a legislative underpinning to ensure secure and continued improvements for the future.

Importantly, the bill makes it a requirement for all health boards to provide consistent access to self-referral across Scotland. That matters because we know from survivors that access to self-referral is important in giving people control over what happens to them at a time when that control feels like it has been—and has been—taken away. The bill ensures access to healthcare and a request for forensic medical examination without first making a report to the police.

The Health and Sport Committee’s scrutiny of the bill at stages 1 and 2 has unquestionably improved it. I commend the committee for its careful work in taking evidence not only from health stakeholders but from justice and equality stakeholders and from survivors. As a result of amendments recommended by the committee and agreed unanimously at stage 2, the bill now more prominently enshrines a requirement for health boards to provide trauma-informed care—care that actively works to avoid retraumatisation and is delivered to the national Health Improvement Scotland standards.

Nothing in the bill prevents victims of any age from accessing healthcare and support ahead of a police report. To support health boards in that regard, on 24 November, a package of resources was launched by the task force for the improvement of services for adults and children who have experienced rape and sexual assault. That package includes Scotland’s first adult clinical pathway and Scotland’s first children and young people’s clinical pathway, alongside new forms and datasets for all ages, establishing a more robust and consistent gathering of performance data than has ever been available.

A patient information leaflet has also been developed, setting out what people can expect during and following a forensic medical examination and making it clear to the individual that they are in control of the process. I am grateful to People First for its important help in developing the easy-read summary of the leaflet.

Key refinements to the bill that were prompted by the Health and Sport Committee also include a statutory requirement for Public Health Scotland to publish an annual report on the delivery of these services and, importantly, a new delegated power to allow the minimum age for accessing self-referral to be varied in the future, should that become justified by wider changes to legislation or guidance and should this Parliament agree.

In order to enable the successful implementation of self-referral services, the task force is advancing work on a robust self-referral protocol that will be submitted to the Lord Advocate for his approval. That protocol will set out the detailed procedures for how health boards will collect forensic evidence in a way that, again, gives control to victims, while securing the integrity of evidence, should the victim choose to report to the police at a later date.

In the earlier debate on Margaret Mitchell’s amendments 1 and 7, I announced an additional £0.5 million in this financial year to help to improve the NHS response to child sexual abuse, through the development of child and family support workers across Scotland and to support implementation of the children and young people’s clinical pathway. I am delighted to confirm that, in addition to that investment, and subject to the Parliament’s approval of next year’s budget, the Scottish Government will commit a further £1 million to support the implementation of the bill, should members pass it today. Those two announcements bring our investment in improving forensic medical services to £10 million over four years. That is in addition to the Scottish Government’s continued support for Rape Crisis Scotland and its national advocacy project, which will undoubtedly play an important role in the successful implementation of the bill.

Before I conclude, I want to share with the chamber some feedback from a survivor, which I have been given permission to share, on their experience of attending an NHS sexual assault response co-ordination service that is funded by the task force. The survivor said:

“The staff supporting us were both very skilled, professional and empathetic. They helped us as a family work through the medical and emotional process. We knew they were always there when we needed them.”

I want to enshrine in legislation NHS-delivered forensic medical services that are person-centred and compassionate and which deliver quality of care and support in every case.

I move,

That the Parliament agrees that the Forensic Medical Services (Victims of Sexual Offences) (Scotland) Bill be passed.

17:55  

I begin by stating our support for the bill, and I note the welcome financial commitments that the cabinet secretary laid out in her speech. As others have said, the changes that the bill will bring about will refquire financial underpinning.

I pay tribute to colleagues on the Health and Sport Committee for their work in getting us to this point, and to the committee’s clerks. I have been on the committee for only a short period—since September—and I was not present for the evidence-gathering process for the bill. However, I have read some of the powerful submissions that were received.

It was clear from the stage 1 debate on the bill and the stage 2 process in the committee that, although the bill deals with very difficult issues, it has nevertheless brought considered, measured and deeply held thoughts and views to the issues that it raises. It is an immensely important bill to help to support victims of some of the worst crimes imaginable, and we will certainly support it at decision time.

It is important that we do not stop here in our drive to improve the rights and experiences of victims of crime—particularly victims of sexual offences—because there are still injustices. However, many of those arguments are for another time.

I will turn to some of the remarks that I made at stage 1 and reflect on whether they have been properly considered as the bill has passed through the Parliament. At stage 1, I noted the comments in the committee’s report on trauma-informed care and the need to make it clear that the bill should recognise the impact of trauma on an individual’s health and social and emotional wellbeing as well as deliver services that minimise further trauma. I am pleased that the Scottish Government recognised the importance of that and made amendments to the bill to that effect.

I also noted in the stage 1 debate the need to consider out-of-hours care and how it is delivered, particularly considering the delays that many victims of sexual offences have experienced. I note that the cabinet secretary provided some clarity on how out-of-hours care would be provided, but the reduction of those delays must be prioritised if the bill is passed, as we expect it to be.

Consideration must also be given to how forensic examination services are provided to victims who live in rural and remote areas, such as our island communities. That can often be logistically challenging and involve days of travelling, with victims being unable to wash or change clothes. It is clear that that can cause significant trauma. I represent the Highlands and Islands, so that is a particularly pertinent point for me. I hope that the Government will look at that further if the bill is passed.

Many of the statements from witnesses have spoken about the need to increase access to female doctors as a means to reduce trauma. That was touched on in the amendment stage this afternoon. As Rape Crisis Scotland has noted:

“around 60 per cent of forensic doctors in Scotland are”

female

“compared to 30 per cent in 2017.”

That is plainly welcome. However, Rape Crisis Scotland went on to note that there are still not enough women carrying out forensic examinations for rape survivors to be guaranteed access to a female doctor. It seems to me that that is a hugely important point for the Government to acknowledge and to seek to change.

I do not intend to dwell on Johann Lamont’s amendment, which was agreed to. I am very glad that it was agreed to, and it accords with what the Health and Sport Committee stated in its report.

Finally, I turn to the amendments that were lodged by my colleague Margaret Mitchell, one of which was agreed to and one of which was not. At stage 1, we noted the need for self-referral to exist in a consistent way across Scotland. We also backed the calls to reduce the age of self-referral from 16 to 13 to encourage greater self-referral from younger people, given that 40 per cent of last year’s 13,000 sexual assaults were committed against under-18s.

We recognise the cabinet secretary’s position that changes to the minimum age of self-referral should be carried out through affirmative regulations as well as proper consultation, and we note her amendment at stage 2 to create a new delegated power to allow for a future review of the age of referral. We welcome that change. However, as Margaret Mitchell set out, we were also strongly of the view that that should be reviewed regularly and that there should be a reporting function in the bill. Therefore, we are glad that Margaret Mitchell’s amendment 1 succeeded in securing the agreement of members in the chamber. We are grateful for the support of others.

Regrettably, amendment 7 did not succeed. The point was made that it was a pilot scheme and that there was a choice, but I do not intend to rehearse those arguments.

I reiterate the Scottish Conservatives’ support for this important bill, and I look forward to hearing other contributions from colleagues across the chamber. The bill has been immeasurably improved at all parliamentary stages of its passage, and I hope that we have improved it further today, to the benefit of those who sadly may need to access such services in the future.

18:01  

I am pleased to open the debate for Labour on this important and significant bill. Labour will support the bill at decision time and I am convinced that parliamentarians across the political divide will recognise that the bill puts the needs of victims of sexual abuse as the key priority of forensic services.

If I were to encapsulate the benefits of the bill in one word, then it would be “empowerment”, in that it returns to the survivor some semblance of retaking control after the horror and humiliation of abuse, whatever unacceptable form it takes. Many years before I joined the Parliament, I ran a very busy child protection team in an area of social deprivation for over a decade. However, that comprehensive and front line experience did not prepare me for the roundtable event that was organised by Health and Sport Committee staff with survivors and victims.

The survivors and organisations that represented them spoke of the horror and anguish that they faced after reporting their attack. There was a wide range of comments, but there was an underlying consistency in their message that, in their words:

“criminal procedure re-victimises the victim;”

“forensic examination opens up the horrors of the attack”

and that the

“system does not function correctly.”

A strong theme was the need for change, particularly to self-referral for forensic medical examination and for independent advocacy and psychological support. As we have heard, the aim of the bill is to require health boards to make forensic medical examinations available on a self-referral basis to people who are over 16. That means that victims would be able to undergo a forensic examination directly, without any requirement to initially go to the police.

In 2017, there were calls by Her Majesty’s Inspectorate of Constabulary in Scotland to review the contract between Police Scotland and NHS Scotland for the provision of healthcare and forensic medical services. The review highlighted significant disparity in the forensic healthcare services that were being provided to the victims of sexual crime. The key findings were that there is a great need for increased innovation, especially in relation to the rural and island communities; that there must be more collaboration among boards to share specialist staff; and that there is a need to develop the role of specialist nurses to support victims of sexual crime.

However, there is a gap in service provision, where the victim of a sexual crime seeks support and medical attention, but may not wish to report the crime to the police. Both Children 1st and NSPCC Scotland support self-referral at 16, and argue that children under 16 will be automatically considered under the child protection pathway. In tandem with that, the UN Convention on the Rights of the Child will be incorporated into Scots law and the Scottish Government is preparing new child protection guidance to reflect that. In any case, in my assessment, the Scottish Government appears to be keeping the door open to reduce the age of self-referral in future through delegated powers as circumstances allow.

However, self-referral will benefit victims only if they are aware that it is an option. The Royal College of Nursing was right in its submission that there needs to be a focus on ensuring public awareness of the provisions of the bill. I ask the cabinet secretary in her closing remarks to outline the strategy for public information and education.

Particular thought needs to be given to equality of access to information and services for those with learning disabilities and for same-sex victims. The committee, of which I am a member, made a strong recommendation on that point—the key is informed consent and equality of access in relation to issues such as travel, rurality and low population density.

It is vital that vulnerable young victims, who are likely to be badly shocked and traumatised, have a statutory right to independent advocacy across Scotland. It is important to stress that the bill does not give the individual a right to a forensic medical examination and that they are carried out on the professional judgment of a healthcare professional. As the stage 1 report made clear,

“professional judgement can include both clinical and non-clinical elements supported by guidance from the Faculty of Forensic and Legal Medicine.”

Unfortunately, the shortage of female forensic examiners is a real practical problem and we need to have a goal of change through workforce planning, as Johann Lamont articulately stated when speaking to her amendment, which I welcome and support.

The fairer Scotland duty assessment on the bill notes that women, and indeed men,

“in lower socioeconomic groups are more likely to be the victim of sexual offending and are thus more likely to benefit from the objectives of the Bill.”

NHS Lanarkshire uses data collection along with advice from the third sector to target resources in areas of deprivation, which reflects the committee’s recommendation to require all health boards to capture and publish data addressing equity of access.

This is an important bill for protecting the healthcare needs of victims of sexual offences. We must listen to the voices of survivors. We need a criminal justice system that puts victims squarely on central court and does not revictimise and in which victims are listened to, respected and supported. As one survivor said,

“Violators cannot live with the truth: survivors cannot live without it.”

18:07  

Legislation must be seen to make things better, and the bill clearly does that. My party is not represented on the committee, but I thank Her Majesty’s Inspectorate of Constabulary in Scotland for its report—the genesis of the bill. I thank, too, the Scottish Government bill team, the committee, the clerking team and all who provided evidence and briefings. I particularly thank the survivors for their private testimony—I know from my experience on the Justice Committee how humbling it is for members to receive such testimony and how informative it can be. I also commend the Scottish Government’s victims task force, which is jointly chaired by Rape Crisis Scotland and Scottish Women’s Aid.

I was taken by a briefing that we received from the Law Society of Scotland, which states that, as the bill reaches the final stage of its parliamentary process,

“it is important that in achieving its policy objectives, a balance must be maintained of the interaction of the various interests.”

It then goes on to list those interests, one of which is public law. We must increase the reporting of sexual crimes, and the self-referral provisions in the bill will help with that. We must also secure more convictions in sexual offence prosecutions, and the victim-centred approach that the bill encourages can only help.

The Law Society’s briefing also talks about

“private law in respecting the individual’s privacy and autonomy”.

Some fundamental individual rights are at stake here, such as the individual’s right to make choices in relation to reporting and their right to have their privacy respected.

I like the cabinet secretary’s phrase when she talked about individuals being “in control”, with reference to the timing and location of an examination. As someone who is familiar with cold police stations, I welcome the fact that respect is being shown to victims and that appropriate facilities are being provided. There is an obligation on the state, which the bill clearly addresses, to provide a humane regime that is capable of providing redress to the victims of crime.

Healthcare is another factor. Someone’s wellbeing is not simply to do with their physical health, and I welcome the increasing recognition across a lot of our discussions about the benefits of good mental health. Public agencies’ interaction with third sector partners in providing support for victims will be important. I also thought that it was very telling that the Law Society honestly mentioned the importance of training, including for the legal sector, in ensuring that all are aware of the bill’s provisions and the importance of support.

Previously, such work was carried out by police surgeons, but it was subsequently outsourced. That was a bad idea, and it disadvantaged rural communities. The memorandum of understanding does not completely remove the challenges of rurality that my colleague Donald Cameron referred to, and we must be aware of those challenges.

In the short time that I have, I want to say that the holistic approach to care will bring not only better results in terms of victims’ wellbeing, but a significant improvement in the number of successful prosecutions, which we really need. That will perhaps come about because complainers feel supported but also because of the provisions on the acquisition and quality of the evidence, and continuity in how that evidence is referred to in all the reports, which is hugely important.

I warmly welcome what the cabinet secretary referred to as “person-centred and compassionate” legislation. The Scottish Green Party will support it at decision time tonight.

18:11  

I begin my speech by paying tribute for a final time to the witnesses who came to our committee and told us of their personal experience in very harrowing terms. This may be the last time that I speak of their experiences in the context of the bill, but it will not be the last time that I think of them—I will carry their stories with me.

We did a lot of work in the foothills of the bill. It was necessary for us to do so, as the bill is a complex and technical piece of legislation. Since its inception, it has succeeded in its aim of giving a voice and rights to people who have been through some of the most horrific crimes imaginable.

In speaking on the bill in an earlier debate, I voiced my concerns about the minimum age for self-referral being 16, about which there been an on-going debate throughout the bill’s passage. I referred to the concerns of Children 1st that the bill excludes those under 16 from the vital services that the passing of the bill will provide. We know that children under 16 who are victims of assault are most likely to be assaulted by a family member or someone whom they know. Last year, 40 per cent of sexual assaults were against those under 18. I am sure that I echo the sentiments of all members when I say that those figures are devastating and deeply shocking.

A stage 2 amendment sought to reduce the minimum age for self-referral from 16 to 13. My party had a lot of sympathy with the amendment, but we reluctantly voted against it because we recognised the child protection concerns that the cabinet secretary put forward at the time and because she signalled that she was willing to give thought to the issue. I am glad that we have made at least some progress in that area today.

However, in order for us to make adequate progress and to realise the rights of all child victims—so that they, too, can have access to suitable clinical and forensic pathways—we need to properly implement an innovative, barnahus-led approach. The cabinet secretary has shown support for such an approach, not just at stage 2 of the bill, but in many other debates in the chamber. The Scottish Government claims that the bill and the associated clinical pathway are barnahus ready, yet it has still not offered a clear commitment, details or funding for the national roll-out of a barnahus-led scheme, similar to the pilot that Children 1st led in the west of Scotland. I would be grateful to the cabinet secretary if she could signal to members her views on how we might better support and fund that national barnahus initiative.

The bill is important. In many ways, it answers the challenges that were set out to the committee on that early Tuesday morning many months ago, when we met the witnesses, heard their testimony and were gripped by their candour, bravery and depth of feeling. The bill means that people will not be pulled into a system that they are not ready for and that they will have the time and space to consider reporting an assault to the police without losing vital evidence. It will offer autonomy to those who have suffered in a way that has seen them robbed of control of their bodies.

Sexual assault is one of the most horrific crimes in the world. It has happened to people who are very close to me. No victim should be excluded from receiving compassionate aftercare, especially not children and young people. The complex way in which children and young people process traumatic events requires an approach that is specifically tailored to their needs, and that is what barnahus offers.

I passionately support the bill and all its ambitions, on the basis that the Scottish Government has already made it clear that it is committed to ensuring that child victims of sexual assault are not excluded from the pathways and that we find an appropriate approach for them.

18:15  

As a member of the Health and Sport Committee, I welcome the opportunity to contribute to the final stage of the bill. Like others, I thank the committee clerks and the professional groups and organisations that gave evidence. Most of all, I thank the women who came forward to give evidence to the committee. As Mr Cole-Hamilton said, it was a harrowing experience—for them, obviously, but also for us. The strength, courage and bravery that they showed in giving their evidence enabled us to move the bill forward, and I sincerely thank them for that. I am sure that the bill will pass tonight, and that will be a testament and a tribute to their bravery.

The bill is hugely important. It confirms and delivers our commitment to improve the way that the health and justice systems support victims of sexual crime. The issue has been raised on numerous occasions, and it is pertinent that, during the consultation process, 91 per cent of respondents agreed that health boards should offer the service that the bill provides for—a holistic healthcare service that, importantly, puts victims first.

The bill enshrines in law the responsibility of health boards for the operation of forensic medical services, and it provides an important legal framework to ensure that access to self-referral is consistently available across Scotland. When addressing problems in the system, access to services must be first and foremost. That important point was raised by survivors.

The professionals involved in the system and the organisations that offer valuable and crucial support to victims raised a number of areas that are covered by the bill, two of which are particularly significant. One is access to female doctors, which was covered in the debate on amendment 28. The other is the need to have access to forensic examination as quickly as possible.

We heard evidence from a survivor who waited in a police office for hours on end, not being able to change their clothes, not being given support, not being able to have anyone with them while they were there, and not being able to get a cup of tea or coffee or anything else to drink. That evidence was quite harrowing. The bill means that victims will no longer have to go through that experience. It is a basic human right that victims should not have to sit in a cold, dark place. The bill will ensure that victims of these horrendous crimes do not have to go through that additional trauma.

A lot has been said about access to female examiners, and I welcome the progress that has been made. At the moment, we have 180 sexual offences examiners, of whom 70 per cent are women. I know that we are making further progress—for example, there will be 20 priority places on a new postgraduate course at Queen Margaret University in Edinburgh, which starts in a month’s time, in January 2021. That is good news. We must ensure that when a woman asks for a woman examiner, one is available to her. I suppose that that is a big ask—it is one of the biggest asks that was put to us during the committee stages.

I think that everyone believes that the bill is a fundamental step in ensuring that all victims of sexual assault and rape are treated with dignity, compassion and respect.

I thank everyone who will take part in the debate, and the committee and everyone else for considering the evidence that was provided.

18:20  

I am very pleased to speak in favour of and, later, to vote to pass the bill. It is an important bill that seeks to make the process of medical examination easier for victims of sexual crimes and to transform survivors’ experiences of healthcare following sexual violence. It is long overdue and responds to the conclusions of the HMICS report that forensic medical services in Scotland have been patchy, inconsistent and, at times, arguably, traumatising. The report concluded that victims have been “let down”.

We all sincerely hope that the bill succeeds. Much of that will depend on resources. At stage 1, I flagged that the financial memorandum reflects the estimated 10 per cent increase in the number of additional forensic medical examinations. I have no idea whether that will prove to be correct, but I do not see similar provision for other aspects of the bill in the financial memorandum. There is only the rather throwaway line that

“The Scottish Government considers that costs on the third sector to support the Bill’s implementation will be modest.”

The supplementary financial memorandum deals only with the costs to Public Health Scotland of the annual report. That concerns me because, logically, what is not resourced cannot be provided. I fear that, if the bill is about a complete overhaul of the response to such matters, it will cost a significant amount of money on an on-going basis, which might not be provided for. However, I welcome the cabinet secretary’s remarks about the additional £1 million that will be allocated to the bill. I acknowledge that such issues are clearly in her thinking.

Many respondents flagged the lack of access to female doctors. According to Rape Crisis Scotland, that is the single most pressing and important issue that requires to be addressed. The bill contains provision for victims of sexual offences to be given the opportunity to request that the person who carries out their forensic medical examination be of a specified sex. I associate myself with Donald Cameron’s comments in that regard.

That is all well and good, but I presume that when someone who complains of rape, for example, asks for a female doctor, whether they get one will depend on whether one is on the rota at the time. I presume that, if there is not one on the rota, they will be given the option of going ahead with a male doctor or waiting until a female doctor is working.

I am sure that we all noted the evidence that was supplied to MSPs last night from HEAL, a survivors’ group. In one passage that I thought was particularly hard hitting, it suggests that

“survivors, who are unable to tolerate male examiners giving them an intimate examination when they are newly traumatised and wounded to the core of their being, often face long waits until a female examiner is available.”

My understanding is that, prior to the examination, complainants are strongly encouraged not to wash, drink or eat, as vital evidence could be lost, so what kind of choice is that?

The recruitment and training of female forensic doctors must be prioritised. In fact, as Monica Lennon said, increasing the numbers is where our focus must be. I accept that, in answer to Sandra White and in the stage 1 debate, the cabinet secretary referred to a new course and associated funding for forensic nurse examiners at Queen Margaret University. That is good, and it reflects the cabinet secretary’s stated aim to ensure that we provide 24/7 access to female examiners, should that be what an individual wants. Leaving aside the inevitable time lag until qualification and deployment, the question begged is whether that is sufficient. If it is not, when will that aim be met?

Perhaps, in closing the debate, the cabinet secretary could address how confident she is that there are sufficient places to address the need and achieve 24/7 access. Perhaps she could say whether she would agree to provide a regular report to Parliament on progress in recruitment and training in order to achieve that goal—perhaps through the Mitchell report that was agreed to today or the NHS Scotland report in section 11A.

In any event, I reiterate my support for the bill, and I look forward to voting for it at decision time.

18:24  

I am glad to speak in support of the bill as it nears completion of its progress through the Parliament. It is fair to say that there were times when such a positive outcome seemed a little less than certain. As convener of the Health and Sport Committee, I have had plenty of opportunities to consider the interaction of Government and Parliament over the past three years. This has, of course, been a year like no other.

In March members of the committee met survivors of rape and sexual abuse. It was both a sobering and a heartening experience. Women who had suffered sexual violence by men talked about being traumatised again by what happened when they reported the crime. Some felt that so strongly that they told us that they might not have gone to the police if they had known what would happen next.

The heartening bit was the courage and the commitment to help other victims come forward—informally and privately, but directly—to members of this Parliament to share their experience and ask us to make the system better.

This bill puts victims at the centre. It changes the forensic medical examination of victims from being a matter for the police service to one for the health service. It allows those who have been raped or sexually assaulted to refer themselves for examination without having to report a crime to the police first. It provides that women who are raped should be able to say that their forensic medical examiner should be a woman. It provides choice for all victims and requires services to all victims to be delivered in a trauma-informed way.

The women we met and the voluntary organisations that worked with them did not ask for change for its own sake; they asked for change for the sake of future victims, to make the system more sensitive and responsive to their needs.

Some women found police officers to be caring, compassionate and understanding, and some praised the skills and empathy of male medical examiners. But having women instead of men in those roles was still their strongest single demand, and focusing on the health and wellbeing of victims first was even more important than bringing the perpetrators to justice.

We took that evidence in March, at which point we also met some of the Government officials working on the bill. Then along came Covid-19, and for a few weeks the process of taking evidence on the bill was knocked sideways and its progress seemed in doubt.

The upshot of that uncertainty was that the bill did proceed. Like Parliament as a whole, the Health and Sport Committee went online to hear from expert witnesses in May and June, and it obtained fresh written submissions from other experts on the back of those online evidence sessions.

That progress of legislation in difficult circumstances is a credit to all those in the health service, the police service, the voluntary sector and elsewhere who were committed to the proposed change in the law and adapted to the new normal to make it happen. It is also a credit to the ability of Government and Parliament to work together in the face of adversity when there is a shared objective to be met.

I acknowledge the cabinet secretary’s personal commitment to this bill and the support across the chamber for long-overdue reform that will affect people’s lives.

As has been well said this afternoon, changing the law is not enough. There needs to be awareness of the new system on the part of those it can help and resources to make that change happen. However, a change in the law is a good place to start, and I will be delighted to vote for the bill today.

18:28  

The importance of this bill cannot be overstated. In Scotland, 4 per cent of women and 1 per cent of men have experienced serious sexual assault since the age of 16. The bill is a landmark piece of legislation; it is hugely important for survivors of sexual crime and allows far greater choice for survivors of sexual abuse.

As deputy convener of the Health and Sport Committee and someone who cared for and treated survivors of rape when I worked as a nurse, I welcome the opportunity to speak in this debate and I, too, thank everyone who has contributed to the bill for their work: the clerks, members of the committee, Rape Crisis Scotland, the chief medical officer’s task force and the survivors who powerfully and bravely spoke at our evidence session.

The Health and Sport Committee held seven evidence sessions on the bill—including with survivors of sexual violence—and we received 38 submissions in response to our call for evidence from survivors, their representative organisations and justice and legal service providers.

One of the key themes that we considered and agreed with the Scottish Government—as affirmed at stage 2—was the need for survivors of sexual offences to have improved access to forensic medical services. The bill will let survivors refer themselves to their health board rather than a police station for an examination. That is significant, because they will not have to go to the police first. That means changing from a law environment, which can be very frightening and intimidating, to a holistic healthcare environment, which will reduce stress, stigma, fear and anxiety.

That gives people who have gone through that horrible and traumatic experience time to decide whether they want to report an incident to the police without losing any vital evidence.

Donald Cameron mentioned the out-of-hours availability of forensic examiners and Sandra White spoke about early access to gather forensic evidence. I was given a piece of information by my local rape crisis team and raised it with the committee. I was told that self-referral numbers were higher on a Tuesday between 12 o’clock and 4 o’clock. Although it might be difficult to gather evidence, out-of-hours provision is vital to provide adequate staffing. I would be keen to hear whether self-referrals should be monitored according to their day and time, or whether what I was told while we were gathering information was merely an anomaly.

The steps to improve the overall experience for survivors of sexual offences are welcome and excellent. Evidence presented to the committee made it clear that female victims prefer female practitioners. We have heard about that, but it is worth repeating that more female forensic practitioners and doctors have been trained in the past couple of years. It is also great that 68 nurses have been trained to support the forensic medical examination process. We are moving in the right direction and I commend NHS Scotland, the Scottish Government and other partners for that positive action.

I was pleased to see the development of the new forensic medical examination suite at the Mountainhall treatment centre in Dumfries, in one of the rural areas that David Stewart spoke about. I was invited to see the suite last year and the whole process was explained to me. I also met Rape Crisis staff so that I could gain an understanding of the varied needs of people who have endured sexual assault and rape. The forensic medical examiners who work in that suite are trained in trauma-informed care and the team is working to ensure that victims of rape and sexual assault endure as little stress, stigma and anxiety as possible.

I support this significant bill. It is important for survivors of sexual crime and I encourage everyone to support it.

18:32  

This is an important bill for all women and men who have been the victims of rape and sexual assault. I thank all the members who have contributed to making this a stronger piece of legislation. The speeches by Emma Harper, Sandra White and Lewis Macdonald strengthened the quality of the debate.

It is a widely accepted reality that many sexual offences are not reported to the police. There are many reasons why people hesitate to report sexual assault: some fear having to relive the event; some are concerned that they will not be believed; many victims of rape and sexual assault blame themselves. Some victims feel guilty because they did not fight back. They may even blame themselves for trusting someone. But victims are never to blame.

There is a duty on us, as parliamentarians, to create the right conditions for victims, whoever they are. Men and women come forward to undergo necessary, intimate and harrowing physical examination to provide the evidence that will be required should they decide to take their case forward. That examination is traumatising and painful for many women and in many ways. The bill will make forensic medical examination available on a self-referral basis and, crucially, with no requirement to report it to Police Scotland. That is a significant development for our criminal justice system.

I was shocked when I read that 40 per cent of last year’s 13,000 sexual assaults were against people under the age of 18. More than 5,000 children reported being sexually assaulted last year. Scottish Labour welcomed the amendments at stage 2 that provided the option to lower the age of self-referral in the future. We must make victims aware of those provisions.

Amendment 28, which was lodged by Johann Lamont and has been agreed to, sought to change the wording of the Victims and Witnesses (Scotland) Act 2014 so that individuals undergoing an examination would have the right to choose the “sex” of the examiner as opposed to their “gender”—113 members agreed to that. The sex of the examiner was raised as an issue that was important to the victims of sexual abuse and rape at the beginning of the stage 1 process. The change in wording from “gender” to “sex” was one of the committee’s recommendations at stage 1, following evidence that we gathered from survivors about the re-traumatising nature of the examination and how the lack of access to a female doctor was the most important thing that needed to be addressed.

NHS Lanarkshire commented that the

“patient’s choice of sex of forensic examiner must be guaranteed by this legislation”.

Rape Crisis Scotland provided a briefing for MSPs today, which says:

“The single most common complaint we hear from survivors of sexual crime about their experience of the forensic examination is lack of access to female doctors.”

I agree with that. In the briefing, Rape Crisis rightly points out that changing the term from “gender” to “sex” will not guarantee a female doctor, but I still find it puzzling that the conclusion to be drawn is that there is no requirement to change the bill.

Like many other members, I have had emails on the subject, but I have to say that none of them have been abusive. I also want to point out that, when we talk about victims, we are talking about all victims, including trans women and trans men. However, most of the people who wrote to me were women and rape survivors, and they said that rape survivors need to know that, when they are torn and bleeding, they will not be pressured into accepting intimate touch from a strange male. HEAL, a survivors group, said:

“Even as survivors, we are met with accusations of bigotry and hatefulness, as well as threats of violence, when we express our need for female-only provisions publicly.”

We have removed that ambiguity in law and have provided clarity for those women.

This has been a dignified debate, and it is important that it continues to be a dignified debate. We all agree that the way forward is to increase the number of female doctors. We know that we have a long way to go on that, but that is what every single person in the debate has said, and that is what the Government has committed to achieving.

With that, I am delighted to support the bill this evening on behalf of Scottish Labour.

18:37  

I am pleased to close the debate on behalf of the Scottish Conservatives. As other members have done, I start by thanking all the victims of sexual abuse who bravely gave evidence to the committee. It moved us all and helped to shape this important bill.

The bill is incredibly important, and it is the start of a process of considering the plight of victims first and foremost, as Donald Cameron said in his opening speech. I talk about the start of a process because it is just one point among many that need to be addressed if we are truly going to change the way in which victims of sexual crime are treated. The bill can be a message to those who have suffered that the Parliament, the law and society are prepared to listen to them and believe them and that they will set out a path towards tackling the issue of re-traumatisation.

I note at this point that, next week, we will have a debate on the redress scheme for survivors of historical child sexual abuse in care homes. Again, that is the start of a journey towards recognising the serious flaws in the system for victims of sexual crimes. However, I will say again next week that the bill does not go far enough.

Why is the bill so crucial? A meta analysis of 28 studies of women and girls aged 14 and over who had non-consensual sex that was obtained through force, threat or incapacitation found that 60 per cent of those victims did not acknowledge that they had been raped. It is common for victims to need time to acknowledge what has happened to them; it is a gradual process with an indicator of post-traumatic stress disorder in avoiding reminders of the trauma. Victims being able to self-refer without reporting a crime while assimilating what has happened to them is a significant positive step forward.

I want to highlight a couple of issues. The first goes back to the debate that I talked about at stage 2 around record keeping and the retention of samples. I say again, as I said during that evidence session, when the cabinet secretary suggested that the records would initially be kept in paper format, that the issue needs to be addressed quickly. That aside, the setting of the timescale for the destruction of evidence at two years and two months is arbitrary. Victims and victim support groups suggest that the period should be much longer. Retention periods must be based on the purposes of the retention—for example, the linking of forensic evidence with related case records. I recognise the cabinet secretary’s acknowledgement that the issue will be revisited.

The bill could have set a precedent for getting records retention and wider records management requirements right in legislation. A key aspect of compliance with and implementation of legislation, as well as the exercising of people’s rights that are set out in legislation, lies in the creation and retention of records. At stage 2, I recommended the input of records management expertise via a memorandum of understanding with the keeper of the records of Scotland in relation to drawing up new legislation and amendments to existing legislation.

My second point, which addresses Margaret Mitchell’s amendments, is about limiting the age group of those who can self-refer to those aged 16 and above. I do not think that there is a standard level of maturity for 16-year-olds, to start with. I am of the opinion—others have also suggested this to me—that the legislation might fall foul of the United Nations Convention on the Rights of the Child. The getting it right for every child—GIRFEC—policy is about exactly that, but I am not sure that we are quite there yet. Nevertheless, I recognise and welcome the fact that the Government is moving to a regular review of the age at which self-referral will start. I also welcome the cabinet secretary’s commitment and investment in support to tackle child sexual abuse. We must afford appropriate rights to those aged under 16.

I will finish where I started, by stating that this is a crucial and important piece of legislation not just because of its content but because of the potential statement of intent that it makes to all those who have suffered the trauma of sexual abuse and to all those who fear stigmatisation that this Parliament is waking up to the fact that their journey is, in far too many cases, appalling and the fact that how the system is set up is largely responsible for the crimes going mainly unreported and for there being so few convictions. The bill is welcome, although I cannot help but feel that an opportunity has been missed to make a significantly greater impact, which future legislation will have to pick up and deal with.

Parliament should also consider how to connect up other legislation pertaining to a victim’s journey. We must accept that, for some, the victim’s journey falls well short of decency and that the support that is offered to victims is often unsatisfactory. If Parliament had been a tad braver, we could have made progress in how we deal with such abhorrent crimes.

The way in which victims of sexual abuse have been treated by the system has been an injustice for such a long time. The bill is a welcome start, and the Scottish Conservatives will support it. However, I cannot help but feel that an opportunity has been missed.

18:42  

I am grateful to members for a debate that has been full of powerful and important contributions. I will have time to respond to only one or two of them.

Before I do, I welcome, as I did in the stage 1 debate, the strong support for the bill across parties and committees. The Parliament is uniting and acting as one to signal that victims must have access to NHS-led healthcare and forensic medical services, whether they choose to report an incident to the police or not. I also believe that Parliament is uniting to send to victims of some of the worst crimes possible the clear message that they matter, that their voices count and that we care.

I turn now to points that members made. I would never say that we have finished making progress, but it is important to recognise some of the progress that has been made, partly through Government support but also, crucially, through listening to survivors and through the work of our NHS staff and boards.

Since 2017, we have made progress by increasing the number of female sexual offence examiners by 30 per cent. We now have two nurse sexual offence examiners qualified and experienced. As has been mentioned by others, we also have 20 priority places on a new important postgraduate qualification in advanced forensic practice at Queen Margaret University. The course begins next month.

All that is critical to ensuring the multidisciplinary approach that will allow us to ensure that the right to choose a female forensic examiner can be delivered. It is the case, as I said earlier, that in the second quarter of this year, 75 per cent of examinations were carried out by female examiners and within the three-hour timeframe that national standards require. That is progress, but it is not enough progress.

Donald Cameron and others rightly said that there is no point in such legislation if victims do not know about it. Right now, the task force is preparing a national awareness-raising campaign, and work is under way to establish national telephone access to self-referral, through NHS 24.

The Government has agreed that work on the barnahus standards, which was necessarily paused, will restart so that draft standards can be consulted on next year.

Public Health Scotland’s statutory annual report, the requirement for which is now contained in the bill, will provide important information that will allow scrutiny of progress on a number of issues on which members have legitimately and correctly expressed concerns, including the number of female examiners and how well we meet the three-hour timeframe.

In my remaining time, I repeat my thanks to the Health and Sport Committee, its convener, its members past and present, and its clerks for their thorough work on the bill, which we can all agree has improved it immeasurably. In particular, the committee’s scrutiny has resulted in greater prominence for the need for trauma-informed care that avoids retraumatisation. I also thank the Delegated Powers and Law Reform Committee, the Finance and Constitution Committee and the Scottish Parliament information centre for their work on the bill.

I thank Rape Crisis Scotland, the very many stakeholders who have inspired and helped to develop and improve the bill, and the healthcare professionals and wider staff of sexual assault response co-ordination services for all their hard work, which has led to much improvement. I repeat my earlier thanks to our interim chief medical officer, Dr Smith, for his continued leadership of that important work throughout the Covid-19 pandemic, and to all the members of his task force. Their expert advice has helped to shape the improvements that we are now seeing in health boards across Scotland.

Of course, I thank the bill team, who have been quite extraordinary in the thoroughness with which they approached their task, in the degree to which they have reached out to stakeholders far and wide, and in the quality of the information that they have given me, which has enabled me to understand so much of what we are doing and what we still need to do. As I said yesterday in a meeting with them, I am merely their frontwoman. All credit for the quality of the legislation should go to that team.

I extend my personal thanks most of all to the survivors who shared their personal experiences. In doing so, they have not only increased our understanding of the impact of such crimes, but have shaped the legislation. For me, one of the most important aspects of the bill is the enshrining of the principle of trauma-informed care.

If I may, I will quote from a book entitled “The Body Keeps the Score” by Dr Bessel van der Kolk, which was published in 2014. It says:

“trauma is ... remembered not as a story, a narrative with a beginning, middle and end, but as isolated sensory imprints: images, sounds, and physical sensations that are accompanied by intense emotions, usually terror and helplessness.”

The survivors experienced such trauma, but they had the courage and honesty to step forward and inform Parliament and its members about what is needed.

In the stage 1 debate, I said that I was not interested in legislation unless we are sure that it can be implemented. We now have a bill whose implementation in the course of next year will be led by the chief medical officer’s rape and sexual assault task force, backed by clinical pathways and other resources, and supported by the additional investment that I announced earlier. Most important is that it will be scrutinised, challenged and considerably improved as we respond in kind to the courage and honesty of those survivors.

I invite Parliament to pass the Forensic Medical Services (Victims of Sexual Offences) (Scotland) Bill, to guarantee all victims in Scotland access to self-referral and trauma-informed care, and to confirm our collective agreement and commitment that, in Scotland, we will put the healthcare needs of victims first.