Scottish forensic programs

Neurocognitive Psychology. Learn more about our postgraduate taught programmes and our postgraduate research programmes. Skip to main content. Search: Search. School of Health in Social Science. 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.

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.

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

How have you sought to ensure that the bill reflects the principles of the barnahus model, which is used in Iceland? 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. 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. 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. 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. Is your question specifically about nurses or doctors, or is it about both? 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. In my opening statement, I touched on the work that we have been doing to increase the number of female doctors. However, it is still not 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 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. Tansy Main said that there are 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?

Bear with me for a wee second while I look through my papers. I have the numbers with me somewhere—. I have found the stats: there are 76 forensic examiners in Scotland at the moment, of whom 43, or 61 per cent, are female. 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. 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. 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. 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.

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. 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?

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.

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. 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. 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. 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. 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. 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. 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.

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

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.

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. The self-referral sub-group of the task force is trying to gather best practice from elsewhere in the UK. 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. Can you confirm that you will seek views and input from victims on the length of time that they want samples to be retained?

With any affirmative instrument, the committee will ask us what consultation we have done. We are actively thinking about that. Sandy also chairs a group that sits underneath the sub-group, which is looking at how survivors access services. 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? I clarify that that is not Government policy. 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. 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? 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.

Tansy Main might have something to add. 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. I understand the point about not overlegislating. There is clearly demand for advocacy services within rape and sexual abuse services, including in the Highlands, in my region.

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? That is ultimately a matter for the committee. 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. Another relevant factor is that we are applying the Patient Rights Scotland Act 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. On that point, will the police be encouraged to tell people about the option of self-referral services?

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.

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. 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. Have you considered the themes around victims commissioners in other nations in the UK and brought that thinking into this legislation? 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.

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. The committee might find it helpful to note that the bill will also amend the Victims and Witnesses Scotland Act , which has a section that allows. Therefore, that provision will apply also to people who are accessing services under the provisions of the bill.

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?

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 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. 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 , in the case of Montgomery v NHS Lanarkshire.

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