Meeting of the Parliament

Meeting date: Tuesday, May 9, 2017

Official Report 877KB pdf

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Forensic Examination

We move on to a statement by Michael Matheson on forensic examination. The Cabinet Secretary for Justice will take questions at the end of his statement, so there should be no interventions or interruptions.

14:19  

First, I acknowledge all those in the chamber and outside it who have raised awareness of concerns about the provision of forensic examination services to victims of sexual crime. Rape and sexual assault are the most horrendous crimes. Such crimes can rob victims of their self-esteem and dignity, and the effects last long after the original offence has been committed. The need to treat victims of crime sensitively is never more acute or important than with those who are victims of a sexual offence.

Last year, I had the privilege of meeting the author of “A Woman’s Story”. Members will be aware that “A Woman’s Story” is a powerful narrative of one woman’s traumatic personal journey through each step of the justice process after she had been raped. It is vital for me as the Cabinet Secretary for Justice to hear at first hand how an individual can be made to feel when they come into contact with the criminal justice system. That meeting with a very brave woman and the observations that she made have stayed with me.

Official statistics show an increase in reported sexual crimes in recent years. That is consistent with increasing confidence on the part of victims to report crimes and a robust approach by police and prosecutors to bringing perpetrators to justice. However, although the number of convictions for sexual crimes is at an all-time high, it is critical that we understand that a successful prosecution is not the only outcome that matters. Many victims will be on a long journey of recovery that continues well beyond the conclusion of a court case. It is therefore crucial for the healthcare response to be equipped to deliver the services that they need. Often, that begins with the forensic medical examination.

As a Government, we have committed to driving forward improvements for victims in this parliamentary session. The 2016 Scottish National Party manifesto included an undertaking to review how forensic examinations are carried out, to ensure that they are done appropriately and sensitively.

We know, for example, that the majority of victims would prefer to be examined by a female doctor, but the gender balance among doctors who have the necessary training does not offer that choice. A course designed by NHS Education for Scotland for the Scottish legal system exists, but its uptake by female doctors is low.

Only 19 female forensic physicians are working in Scotland. In partnership with NHS Education for Scotland, we undertook work to understand why that is the case. The work included a national survey of doctors, which was issued in February, to gather information about the perceived barriers to working in that area. More than 800 responses were received and more than half the respondents said that they would, in principle, be interested in working to provide forensic examinations for victims of sexual crime. Seventeen doctors followed up the survey by requesting further information about how they could get involved. That is a positive outcome, and discussions with NHS Education for Scotland and health boards will inform further actions to address the issue more sustainably.

In addition, also in February, we announced the commissioning of national standards, which Healthcare Improvement Scotland will develop. They will be the first published national standards for forensic examinations for victims of sexual assault. They will put beyond doubt what is expected of national health service boards in delivering care for victims and will build consistency of practice throughout the country.

We want to ensure that a victim who reports a rape is given the best care no matter where in the country they are. It is also important for victims to be made aware of the standards and to understand that forensic examination is only one part of a much wider package of healthcare to which they are entitled. The national standards for forensic examinations will be consulted on during the summer and published by the end of the year.

Members will have read the recent report on forensic examination services from Her Majesty’s inspectorate of constabulary in Scotland, which points clearly to improvements that we need to make. HMICS found significant variations in the provision of forensic medical services, recommended that a better balance should be achieved between the justice and health responses to appropriately address patients’ immediate healthcare needs and future recovery, and reported that some victims still require to attend a police building to undergo an examination, which is completely unacceptable.

A general theme of the report was the lack of strategic leadership and governance over the provision of forensic medical services. On 30 March—the day when the report was published—the Scottish Government announced that the chief medical officer would lead a group of key individuals to galvanise the necessary leadership in health and justice services to transform healthcare responses to victims of sexual crime. On 27 April, I addressed the first meeting of the task force for the improvement of services for victims of rape and sexual assault.

The task force has a clear mandate from the Scottish ministers: it is to provide national strategic governance and to take decisions that will make a tangible difference for victims. It has a strong membership that includes Police Scotland, the Crown Office and Procurator Fiscal Service, Rape Crisis Scotland and the chief social work adviser, as well as representation from NHS chief executives, the Royal College of Paediatrics and Child Health’s child protection committee and NHS chairs. The task force has identified five working groups to sit under it. Chairs have been nominated for each group, under the following headings: workforce planning, regional delivery of services, clinical pathways, quality improvement, and premises and infrastructure.

Members should be in no doubt that the Scottish ministers have empowered the task force, through the CMO’s leadership, to be bold and to deliver. Working groups have been tasked to agree their remits and priorities for the next task force meeting in June, and the Scottish ministers will receive regular progress reports. The chief medical officer will publish the task force’s work plan over the summer to clearly communicate how work will be driven forward.

Before I finish, I will refer to particular concerns about the provision of forensic examinations in rural and island communities. I met Liam McArthur and Tavish Scott in March to discuss the provision of forensic examinations in Orkney and Shetland, where no local services currently operate for victims. I share the concerns that have been raised about the current provision of forensic examinations for victims of sexual assault in island communities, and I give an assurance now, as I did in March, that the Scottish Government is committed to making meaningful changes to rectify the situation. Since the discussion, I am pleased that NHS Shetland has announced plans for a local, victim-centred service to provide forensic examinations and compassionate medical healthcare on the island. That is an encouraging development.

We are aware that much more requires to be done and that the challenges are many. I know that members will recognise that the issues require effective planning and appropriate training of staff over the coming period. I have confidence that the task force is the best place for the challenges to be considered, and I look forward to receiving its recommendations in the coming months.

We move to questions. I call Donald Cameron—[Interruption.] I beg your pardon; we start with Douglas Ross.

I have no problem being confused with Donald Cameron.

Like the cabinet secretary, I acknowledge the work of those who rightly seek to improve the provision of forensic examination services to victims of sexual crime. The HMICS report on forensic medical services for victims of sexual crimes highlighted a catalogue of failures. I thank the cabinet secretary for the advance copy of his statement responding to the report.

HMICS made it clear that the provision of services in some areas is not only unacceptable, but that Scotland as a whole is well behind the rest of the UK. Although I note the developments that the cabinet secretary mentioned in Shetland, I ask him to give more information on what is happening in Orkney and when victims on both of those islands can expect to receive the victim-centred service on-island. What does the cabinet secretary expect to change so that we can see the level of service in Scotland at least match that in other parts of the United Kingdom?

Finally, the Scottish Government accepts that not enough female doctors are coming forward to provide forensic examinations for female victims. Has the Government tried to understand why, although more than 400 people responded positively to the national survey in February and said that they would in principle be interested in providing forensic examinations, only 17 have proactively followed that up?

I turn to the issues that were highlighted in the HMICS report, which was a valuable report that helps us to understand the extent of the challenges that we face across the country.

The minimum standards that were set in 2013, which should have been taken forward by health boards, have not been implemented effectively across the country. There are areas where there is simply not the necessary strategic leadership within health boards to make sure that those minimum standards are being applied. There is also a suggestion and some evidence that some health boards have interpreted the minimum standards as being the baseline of good practice that should be applied in the way in which those services are delivered. That is why I took the decision to appoint Healthcare Improvement Scotland to look at establishing national standards, so that there is no question about what standards should be delivered at a local level. All health boards are well aware of what that national standard should be and what is expected of them. The national standards will give us greater clarity and will help to deliver greater consistency.

Douglas Ross referred to the progress that has been made in Shetland as a result of doctors in the island proactively choosing to participate in a programme to train them to carry out forensic examinations. Liam McArthur met me, and his colleague Tavish Scott, to discuss his Orkney constituency and his concerns about the approach that is being taken there. I assure him that there are on-going discussions about how to improve the services in Orkney and meet the challenges faced in our island communities. That is demonstrated by the approach that has been taken in the Western Isles, where they have been able to sustain and develop a service around forensic medical examinations, including being able to provide a female doctor. I am confident that we will be able to take that forward with the work that the task force is undertaking and with the new national standards that will be applied on how the services will be delivered in our island communities as well as in our mainland communities.

Douglas Ross asked what we can expect to change and about the approach that has been taken in other parts of the UK, in particular the sexual assault crisis service approach that has been used in England and Wales. The principles of the SACS are well-founded, but I am not convinced that it is an appropriate model for Scotland. The reason is that it is a joint health-justice commission model, while what we want is a health-led model that focuses on the needs of the victim, with the forensic examination being just a component of that. Wraparound healthcare for the victim is the key that we require for the approach that we will implement. We need to take a flexible approach, because the number of cases that will be dealt with in the central belt will be markedly different from that in our island communities. We need a model that reflects the different geographical population base in Scotland and one that is focused on the healthcare needs of the victim. I have no doubt that the task force will focus on that and that the chief medical officer will ensure that we have a sustainable model.

With regard to the 800 doctors who responded to the survey, that work is still being undertaken and the results analysed. The 17 who have proactively said that they want to participate in the training programme are individuals who have done that off their own bat. Many have expressed an interest in further information, and that will be pursued. The encouraging thing is that the vast majority of those who responded to the survey are female doctors. I have no doubt that we will be able to increase the number of female doctors who are able to carry out forensic medical examinations.

I welcome the cabinet secretary’s statement. It is right that the Government has come to the chamber with a response to what was a fairly damning HMICS report, which showed that some victims of sexual assault have been failed by the provision and that there is a need for drastic improvement.

Sadly, the failings that were identified are not new. Minimum standards of service delivery were accepted by ministers in 2013, when they recognised that improvements needed to be made. However, over the past four years there has been a lack of leadership, investment and delivery. I very much welcome the cabinet secretary’s focus, but I stress that this is a live issue and that there are victims who are still experiencing many of the failings.

When does the cabinet secretary expect the working group to conclude its work and the improvements to be implemented? In the future, how will services be audited and inspected to ensure that standards do not fall behind?

In its report, HMICS reported that there is a gap in provision for victims who need support and medical attention but who do not wish to report the attack to the police. What action is being taken to ensure that those victims will be able to get the support that they need?

I want to pick up on the point about the timeframe for the completion of the task force’s work. The task force has highlighted that the working groups will focus on key areas and, in addressing those, it is important that we deliver a model that is health focused and sensitive, that delivers the necessary forensic medical examinations and that recognises the on-going healthcare needs of the women who access the service. We must ensure that that model is sustainable. It is not a case of finding a way of quickly fixing the problem. We must have a steady flow of clinicians—female clinicians in particular—into training to become qualified in carrying out forensic medical examinations.

I will not set an arbitrary timeframe for the task force to complete its work, because I want to make sure that the approach that is taken is sustainable and that it delivers the level of change—the transformation—that we want to be implemented in how forensic medical examinations are carried out for victims of sexual crime. However, I can assure the member that the task force—under the leadership of the CMO—recognises the urgency that is necessary in making progress on the matter. That is why we have given it the ability to be bold and ambitious in its approach.

The task force will do detailed work over the coming months and we will receive regular updates on its progress. In addition, it will publish how it plans to take forward its work programme. I expect to see improvements starting to be made as that work is carried out. I do not expect health boards to wait until the task force has finished all its work before they start to make progress on the matter; I expect them to start to make progress on it now and as the task force proceeds with its work.

On the specific issue of self-referral, there are some health board areas where self-referral is not possible at present. A key issue that the task force will look at is how we can make sure that there is scope for self-referral. In taking a health-based approach, we must give consideration to the fact that self-referral has some legal implications that we need to bottom out. We want to make sure that women who choose to go along for a forensic medical examination and for healthcare support and who do not report a crime to the police can access a service that is delivered in a way that is appropriate to their needs and sensitive to their circumstances, and that is one of the issues that the task force will address in its work in the coming months.

Cabinet secretary, I am conscious that we have taken nine and a half minutes to get through the first two questions. I know that it is a very sensitive subject, but I would be grateful if you could try to be slightly briefer in your responses.

Given the urgency of addressing the issue that the cabinet secretary described, what are the task force’s immediate steps?

As I set out in my statement, the chairs of the five working groups that will sit underneath the task force have been appointed. They will now be responsible for setting out their remits and priorities, which they will report to the task force at its June meeting.

During the summer, a consultation will take place on the new national standards, on which Healthcare Improvement Scotland is leading. We expect the task force to publish its forward work programme by the end of the summer and we will receive regular updates from it following that publication.

The stress on rural and island communities, especially Orkney and Shetland, has been mentioned. I note from the recent HMICS report, however, that there is currently nowhere in Argyll and Bute for victims to receive a forensic examination. They have to travel to the Archway in Glasgow, which can involve some very long distances. What assurances can the cabinet secretary make to women in Argyll and Bute that, following the review, such a service might be available in their region?

If the member had listened to the comments that I made in my statement, he would have heard that that is one of the issues that the task force will look at. It will consider how best we can deliver services regionally to provide the level of clinical support that is necessary for women around the country. For some women in the Argyll and Bute area, Inverness is easier to access so, at the present time, the health board uses the facilities in NHS Highland as well as the Archway in Glasgow.

We need to make sure that the service not only meets healthcare and forensic needs, but is sustainable, so that women in more remote areas can access a service that is appropriate for meeting their on-going healthcare needs. I have no doubt that the task force will look at what the best model is for delivering that in not just Argyll and Bute, but other rural parts of Scotland.

Does the cabinet secretary recognise that, without the support of third sector organisations such as Rape Crisis Scotland, many victims could not engage with the demands of the criminal justice system? Will he make a commitment to continuing to support those vital and valued organisations?

Third sector organisations such as Rape Crisis Scotland play an invaluable role in supporting victims of rape and sexual crime from a very early stage in the criminal justice process and beyond. The value of that is recognised by the actions of this Government, which provided an extra £1.85 million to Rape Crisis Scotland to provide a greater range of services across the country on the mainland and, for the first time, in Orkney and Shetland, where Rape Crisis Scotland services are now available. Some of that has helped to demonstrate the areas where there are gaps in existing services that need to be addressed.

We recognise the invaluable role that third sector organisations play, which is why they are on our task force. We are committed to continuing to work with them to make sure that we meet the needs of women who experience sexual violence in Scottish communities.

The HMICS report that was referred to in the cabinet secretary’s statement found that

“sustaining sufficient numbers of paediatricians with the relevant experience is a challenge”

and that

“Due to the lack of availability of paediatric services in some areas, children who have been sexually abused are having to travel significant distances to be medically examined.”

Further, it stated that

“Adolescents can fall between adult and child services and, in the West of the country when Archway is unavailable, forensic medical examinations can be delayed.”

Can the cabinet secretary explain how he and the task force will address the issues that have been identified by the inspectorate that relate specifically to children and young people?

Mary Fee has raised a very important point about the way in which forensic medical examinations are conducted for children and young people. At present, a person under the age of 16 is covered by paediatric standards, which are currently in draft form and are being taken forward by the managed clinical network for paediatric forensic medical examinations. The regional partners are now considering how that will be taken forward.

Part of the challenge is in ensuring that we have sufficient paediatricians who have had the required training in conducting forensic medical examinations. Mary Fee will recognise that the HMICS report acknowledges that they are—broadly—working well across the country at present, but she has raised an important point about the travelling distance for some parts of the country, which is largely down to the availability of paediatricians to conduct such medical examinations.

On the standards that are being taken forward by the regional planning groups, we will work with the groups, through the task force, to consider how we can align the new national standards with the paediatric standards to ensure consistency of approach in respect of how services are delivered. That is one of the areas that the task force will take forward; there is a member of the managed clinical network on the task force to support that work, as we develop the new national standards for adults who have experienced sexual violence.

As the cabinet secretary has stated, the right to choose the gender of the person who conducts medical examinations is key to ensuring an appropriate and sensitive approach to victims of rape and sexual assault. Given that, how has analysis of the survey of female doctors informed next steps for increasing the number of female doctors who carry out such examinations?

The purpose of the survey was to try to identify barriers to female doctors participating in training in conducting forensic medical examinations, which is available through NHS Education for Scotland. We are very encouraged by the 800 responses that we have received, almost three quarters of which are from female doctors. Analysis of that work is on-going; once we have completed it we will be able to identify whether any further measures are needed to encourage more female physicians to participate in the forensic medical examination programme. Once we have completed that work, we will be able to look at how we can address that within individual board areas.

I assure Ben Macpherson that it is clear that there is a level of clinical interest in undertaking the work. We need to harness that and make sure that we increase the number of females who are qualified to carry out forensic medical examinations. I have no doubt that, once we have analysed the survey work, we will be in a position to take immediate action to address areas of concern and to increase the number of female doctors who are qualified to carry out such examinations.

I thank the cabinet secretary for early sight of his statement. He has talked about the survey; he will be aware that the issue is not just recruitment of forensic medical examiners, but retention. He will also be aware of the Justice Committee’s report on the Crown Office and Procurator Fiscal Service and specific evidence that we received on the subject from four forensic medical examiners, one of whom talked about being cited to attend court between five and 20 times a month but then being called in court

“only a handful of times a year.”

Will you encourage the Crown Office representative on the task force not to await a broader response to the Justice Committee’s report but to pursue action that will secure the retention of medical forensic examiners—not least, because the British Medical Association tells us that, faced with frustration, a number of clinicians are opting out of court service entirely? Perhaps there could be greater use of joint minutes of agreement, because the issue is about retention and not just recruitment.

John Finnie has raised an important and valid point. I referred earlier to the need to make sure that the model that we take forward is sustainable; it is about not just recruiting more doctors who can conduct forensic medical examinations, but making sure that we have a continuous flow of clinicians who are prepared to carry out that work on an on-going basis. That is why one of the task force’s subgroups is on workforce planning.

I am reluctant to give a date for when the task force will complete its work, because we need to undertake detailed work, not just within health boards but with the Crown Office, the police and others. We need a sustainable model that delivers the necessary forensic medical examinations and does so in such a way that women get the right healthcare support and clinicians are comfortable with what is expected of them. That is why planning for that workforce development will be crucial to making sure that the model that we expect to see being taken forward, once the task force has completed its work, is sustainable and delivers the level of service and care that we would, in the circumstances, expect and deserve.

I, too, thank the cabinet secretary for early sight of his statement, and more particularly for his constructive engagement with Tavish Scott and me on the particular needs of the communities that we represent and the wholly unacceptable situation whereby victims of rape and sexual assault are required to get on a plane and travel south for examinations.

I have had further discussions with NHS Orkney and Zelda Bradley from Rape Crisis Scotland in Orkney. Can the cabinet secretary give reassurance not just about developments in Shetland, but that the situation now in Orkney will ensure that no victim will be required to go off-island for examinations? What specific work will the task force do to address the particular issues that arise in Orkney? Like Shetland and the Western Isles, Orkney is an island setting, but it has different circumstances and different challenges to meet.

There is absolutely no doubt that the expectation that women have to wait to leave the island for the mainland in order to have a forensic medical examination completed is simply unacceptable. NHS Shetland has risen to the challenge, and clinicians on Shetland have committed to carrying out the necessary training in order to be able to provide the necessary services there. The service is already in place in the Western Isles; we now need the necessary clinical leadership in Orkney to ensure that there are clinicians with the necessary training to deliver the service there.

I assure Liam McArthur that we want a victim-centred and health-focused service that delivers the holistic care that is necessary for women who have experienced sexual assault or rape, and that we expect that service to be delivered across the country. The new national standards will allow us to ensure that, irrespective of whether a person is on Orkney or in Glasgow, the standards that should be expected of and delivered by the health board are the same.

I have no doubt that once we have the new national standards in place and with the work that is being taken forward with the task force, we will be able to ensure that, in areas such as Orkney, there is expectation and delivery of the necessary services for women who may require to undergo a forensic medical examination. I give Liam McArthur an absolute assurance of our determination to ensure that the services that will be delivered in Shetland and which are currently being delivered in the Western Isles will also be delivered on Orkney. A key focus will be on ensuring that we deliver those services with a victim-centred approach; I have no doubt that the new national standards will support us in achieving that.

The minister has said quite clearly that the task force for the improvement of services for victims of rape and sexual assault has “a clear mandate” and that it must deliver. Will he commit to return to Parliament to update us on the performance of the task force and its individual working groups, to ensure that it delivers on that mandate?

I am more than happy to return to Parliament with a statement once we have the finalised task force report with its recommendations.

I apologise to the three members whom I was not able to call.