Meeting date: Thursday, October 1, 2020
Meeting of the Parliament (Hybrid) 01 October 2020
Agenda: First Minister’s Question Time, Portfolio Question Time, Forensic Medical Services (Victims of Sexual Offences) (Scotland) Bill: Stage 1, Forensic Medical Services (Victims of Sexual Offences) (Scotland) Bill: Financial Resolution, Business Motion, Parliamentary Bureau Motion, Decision Time
- First Minister’s Question Time
- Portfolio Question Time
- Forensic Medical Services (Victims of Sexual Offences) (Scotland) Bill: Stage 1
- Forensic Medical Services (Victims of Sexual Offences) (Scotland) Bill: Financial Resolution
- Business Motion
- Parliamentary Bureau Motion
- Decision Time
Forensic Medical Services (Victims of Sexual Offences) (Scotland) Bill: Stage 1
I have completed the cleaning process up here, which is why there was a delay.
Our next item of business is a debate on motion S5M-22884, in the name of Jeane Freeman, on the Forensic Medical Services (Victims of Sexual Offences) (Scotland) Bill. I invite members who wish to take part in the debate to press their request-to-speak button now.14:59
I am pleased to open the stage 1 debate on the Forensic Medical Services (Victims of Sexual Offences) (Scotland) Bill. At the outset, I repeat my thanks to the Health and Sport Committee for continuing its scrutiny of the bill at a uniquely challenging time for our country. I also extend my thanks to the Finance and Constitution Committee and the Delegated Powers and Law Reform Committee for their work on the bill at stage 1. I hope that the progression of the bill by the Parliament at a time when we have necessarily had to reduce areas of our planned legislative programme sends the very important message that we are collectively committed to improving the way that the health and justice systems support victims of sexual crime. Finally, I thank the staff who have continued to deliver high-quality services to victims of sexual crime throughout the pandemic.
As the Health and Sport Committee has recognised, the bill puts the holistic healthcare needs of victims first. The bill will enshrine in law the fact that the service is a health board responsibility; it will provide a legal framework to ensure consistent access to self-referral across Scotland; and it will deliver on two of the key recommendations in the strategic review that was published by Her Majesty’s Inspectorate of Constabulary in Scotland.
Self-referral means that, if a person who has experienced rape or sexual assault does not want to tell the police straight away or is undecided, the health board can obtain certain forensic evidence and keep it safe. If the person decides not to tell the police, the evidence will be destroyed after a period of time or on request. Having that choice available to people after a significant trauma is vital to giving them control over what happens to them at a time when control has been taken away.
The cabinet secretary will know that there was some debate in the committee about the age of consent. Will she undertake to keep under review the age at which young people should make a decision about that?
I undertake to keep that under review, and I am sure that we will return to that issue when we get to stage 2. I note that Rape Crisis Scotland and the Law Society of Scotland support the position that we have taken at this point in the bill process. However, as with other matters, we should be open to further discussion and to keeping that under review.
It is important to be clear that the principles of trauma-informed and person-centred care will apply whether or not a police report is to be made.
There has been very strong support for the bill’s objectives, with 91 per cent of respondents to the 2019 consultation agreeing with the proposals in the bill. The chief executive of Rape Crisis Scotland welcomed the bill and said that it was a “significant ... step” that had
“the potential to transform how forensic services”
I am pleased that the committee’s stage 1 report welcomes the bill. It recognises that the bill will help to improve the experience of victims of sexual crime across Scotland.
The bill will underpin the work of the chief medical officer for Scotland’s rape and sexual assault task force, which was set up in April 2017 to provide national leadership for the improvement of services in response to the 2017 report by Her Majesty’s Inspectorate of Constabulary in Scotland. I put on record my sincere thanks to our former chief medical officer, Dr Catherine Calderwood, for her support and leadership in driving that work forward.
A five-year work plan that was published in October 2017 set out actions across a range of issues, and the bill is one important part of that. Through the work of the task force, and supported by funding of £8.5 million, the transformation of the national health service’s response to rape and sexual assault is already well under way. Healthcare Improvement Scotland published national standards in 2017 to ensure consistency in the approach to healthcare and forensic medical services and to reinforce the high-quality care that everyone should expect. All health board chief executives have committed to working towards the delivery of sustainable trauma-informed services, in line with those standards. Quality indicators underpinning the HIS standards were published in March this year, and health board performance against those standards is being closely monitored.
Another key recommendation was the establishment of dedicated healthcare facilities across Scotland. Funding is being invested in all 14 territorial health boards to enhance existing, or to create new, sexual assault response co-ordination services across the country, in line with the national service specification. All examinations that were previously located in a police station have now moved to an appropriate healthcare setting, which paves the way for a national model of self-referral. Funding is also being provided to develop regional centres of expertise to support those local sexual assault response co-ordination services.
We know that having access to a female sexual offence examiner is very important for anyone who requires a forensic medical examination following a rape or a sexual assault, and improving that access was an early priority for the task force. Since 2016-17, funding has been provided to NHS Education for Scotland to provide specific training for doctors, with the aim of increasing the number of female examiners who are available to undertake that work. That training is also open to nurses who are involved in providing trauma-informed care for victims. In response to Covid-19, NHS Education for Scotland is now delivering key elements of that course virtually to ensure that demand for the training continues to be met.
Baseline workforce data indicates that 61 per cent of sexual offence examiners in Scotland are now female, which is an increase of around 30 per cent on the indicative figure in the 2017 HMICS report. The task force is committed to developing the role of nurse sexual offence examiners, as recommended by HMICS. For the first time in Scotland, two appropriately qualified and experienced nurses are currently being recruited to that role, which will mean that they can undertake the forensic medical examination of a victim of rape or sexual assault and give evidence in court, as doctors currently do. I am grateful to the Lord Advocate for his willingness to explore and evaluate that important initiative.
I am also delighted to announce that we are funding 20 priority places on a new postgraduate qualification in advanced forensic practice at Queen Margaret University, in Edinburgh. Those funded places bring the total funding allocated to the task force to develop the role of the nurse sexual offence examiners in Scotland to £250,000. The QMU course, which starts in January next year, will offer the first qualification of its kind that is available in Scotland. Enabling access to that training is vital to developing a multidisciplinary task force and a workforce for the future, so that health boards are better placed to offer a female examiner if that is the person’s preference.
Other important improvements that are being progressed include the development of a national clinical information technology system, which is due to go live in spring next year. Before the end of the calendar year 2020, the task force will launch a comprehensive package of resources to ensure a consistent national approach to the recording, collation and reporting of performance data on those services.
The package includes Scotland’s first national clinical pathway for adults as well as for children and young people, which the committee has recognised will sit alongside the bill. Work is also well under way to develop a robust protocol for health boards on how to maintain the chain of evidence in a way that meets the requirements of the Scottish criminal justice system; to prepare for a public consultation on the appropriate retention period for evidence that is obtained from a self-referral examination; and to progress plans around how individuals will access self-referral services. That work is being carried out together with a national awareness-raising campaign, so that people know about the options that are available to them. All that preparatory work will help to ensure that health boards are ready for the commencement of the bill.
In my remaining time, I will briefly address the Health and Sport Committee’s recommendations in its stage 1 report. The committee has delivered a fair and full report, which was no small challenge given the wide range of oral and written evidence that was provided to it, which, in some respects, offered quite different perspectives on key matters. The Government’s response to that report was published on 25 September, and I hope that members will have had an opportunity to review that ahead of the debate. I am pleased that we can support a number of the committee’s recommendations, particularly those concerning a new delegated power to modify the minimum age for accessing self-referral, a statutory annual reporting requirement and a revised data protection impact assessment for the bill.
On the first of those recommendations, I consider it prudent that the minimum age for accessing self-referral remains prescribed at age 16, in line with current clinical practice and the most relevant and applicable legislation, while we are keeping open the possibility of that age changing in the future should wider changes to law and guidance make that appropriate.
Does the cabinet secretary recognise that, when children are sexually assaulted or even raped, that can often happen at the hands of somebody they know? Does she recognise that, by setting the minimum age of self-referral at 16, a problem can be created for children who might otherwise come forward for forensic examination but cannot do so with a parent?
I recognise the point that Mr Cole-Hamilton raises. As I said in response to Mr Stewart, I am open to further discussion at stage 2, with the committee and others, of what we might do to begin to address some of those concerns. We can tease some of that out in full at that point.
Although the Government has not been able to support the committee’s other recommendations for stage 2 amendments at this point, I hope that the Government’s response demonstrates that the matters that are highlighted are recognised as being important; that significant non-legislative work is already in train through the work of the chief medical officer’s task force to address them; and that, as I have said, I remain open to further discussion with the committee and members at stage 2.
Sandy Brindley, the chief executive of Rape Crisis Scotland, is one of the many stakeholders who have supported and influenced the development of the bill. Ms Brindley indicated to the Health and Sport Committee that improvements in service delivery are bedding in and making a real difference to survivors.
I invite the Parliament to endorse the bill, to complete the journey from a policing model of forensic medical services to a model in which the wellbeing and recovery of victims are, rightly, our prime considerations.
That the Parliament agrees to the general principles of the Forensic Medical Services (Victims of Sexual Offences) (Scotland) Bill.
Thank you very much, cabinet secretary. I can see from my screen that only one member has pressed their request-to-speak button—just as I say that, a few faces have appeared on my screen.
I call Lewis Macdonald, the convener of the Health and Sport Committee, to open on the committee’s behalf.15:11
As the convener of the Health and Sport Committee, I am pleased to speak to our report on the Forensic Medical Services (Victims of Sexual Offences) (Scotland) Bill.
We support the objective of putting people first, so let me start by thanking all those who assisted the committee with our scrutiny: those who responded to our call for views, those who gave evidence in person or online, and, not least, the committee clerks and other Parliament staff who enabled our report to be made despite Covid-19 and the circumstances that it caused.
I particularly thank those women who had suffered rape or sexual assault who spoke to us back in March, facilitated by Rape Crisis Scotland. We were truly grateful for the insights that they offered, as well as deeply impressed by their courage in doing so.
As we have just heard, the bill will require national health service boards to provide forensic medical services to victims of sexual offences and will allow victims over the age of 16 to refer themselves to the NHS for forensic examination before deciding whether they want to report to the police.
The committee supports those changes and, more broadly, we support the general principles underlying the bill. Those principles are that victims should be given choice, through the power to consent, and control—the very things that were denied to them by the perpetrators. Placing a duty on NHS boards to provide those services and allowing victims to self-refer to the NHS gives individuals the opportunity to decide whether and when they want to report a sexual assault to the police. That gives them the choice, first and foremost, to get the medical and healthcare support they need, which may help to reduce future psychological trauma. At such a time, the victim’s health and wellbeing must be the top priority. The decision on reporting to the police and undergoing the process that follows that can be a secondary and separate choice for the individual to make.
Self-referring for a forensic medical examination allows victims to make decisions about what happens going forward. Section 4 of the bill details the information that individuals must receive before an examination takes place, which allows them to give their informed consent to what happens next. Under the bill, individuals should have the right to control what happens next, after they have self-referred. They can control whether and when they enter the criminal justice system; they can control the timing of reporting an incident; and, if they choose not to report an incident to the police, they can request that the collected evidence be destroyed and any clothing or belongings returned to them.
We support the legislation in principle, as a step forward in putting victims’ needs and rights first and improving access to forensic medical examinations. Those are things that the victims of such offences told us were greatly needed.
Our report concentrates on areas where we think that the bill, as it is currently drafted, might not quite achieve its three fundamental objectives; where we think the bill needs to be strengthened to make sure that everyone gets the support they need; and where we need to make sure that its laudable rights and principles will work for all those who need to access such services.
People will benefit from the right to self-refer only if they know the right is there. By its nature, the bill and its provisions might not be widely discussed. Many people will not consider the process until after they are victims of sexual assault, and, in those circumstances, it is understandably difficult for victims to be clear about what to do next. Self-referral will benefit victims only if they are, or someone they confide in is, aware that it is an option.
We believe that there needs to be a focus on raising public awareness of the principles, rights and choices in the bill by making information readily available and easily accessible to everyone. There also needs to be an early and on-going public awareness campaign as the law comes into force. It should be accompanied by local online content, and actual information should be made available in healthcare and police settings.
The Government’s response is that it will achieve that by providing dedicated sexual assault telephone lines as the first point of contact. That is welcome, but I ask the Government to consider the risk that such a service might be visible only to those who have already taken the first step of presenting and to consider what more can be done to reach those victims who simply do not know that such dedicated phone lines exist. Likewise, those who present to the NHS to access self-referral services need clear information to allow them to make informed choices.
Psychological and physical trauma following an incident can have devastating effects on individuals. We are, therefore, delighted to see the Scottish Government’s commitment to trauma-informed care and that it has informed the bill, but we think that it is important that the bill explicitly requires NHS boards to deliver trauma-informed care. That is another of the committee’s recommendations.
That should go hand in hand with a statutory right to independent advocacy. If people are to have the choice and control to make informed decisions, they might well need support to do so, especially if they are suffering from psychological trauma. We do not believe that advocacy should be offered on a case-by-case or opt-in basis; it should be a right that is provided to everyone as standard across every service. Individuals must be given the choice and the opportunity to accept, to decline or to opt out of receiving such support if they so wish.
Advocacy support should be on-going from the moment of engagement, through interaction with the health service, once the individual has returned home, and through all subsequent interactions with Police Scotland and the court process. We look forward to hearing how that can be achieved consistently across Scotland.
We will undoubtedly reflect on the Government’s response that this is, first and foremost, a health bill. That might well be true, but it is also a justice bill, and the portfolio heading should not be what decides the provision of vital support. Much of the point of the bill is about services being joined up and the provision of support throughout the whole experience of examination, reporting and, ultimately, prosecution.
In the spirit of delivering trauma-informed care, we believe that the bill should seek to eliminate any potential for further trauma in the process itself. Victims of rape and sexual assault, as well as organisations that are working to support them, were clear on two priority areas. First, we need to ensure that there are no delays in forensic examinations, thereby minimising the psychological impact on victims who are unable to shower or change following an incident. The second priority is that we give victims the opportunity to choose the gender of the person carrying out the examination. I was pleased with what the cabinet secretary had to say on that matter. Many of the women who are victims of rape or sexual assault say that guaranteed access to a female examiner would be the most important single improvement to the current system.
We have, therefore, recommended that the bill should be strengthened to require a 24/7 forensic medical examination service and to guarantee victims the right to choose the sex of the examiner. Those recommendations are vital to support and give choice and control to people who have experienced such crimes.
Again, I note the Government’s response and the intention to report when delays exceed three hours. The risk could be that three hours becomes by default an “acceptable” time to wait. Reporting on the operation of the service should therefore also have a strong focus on actual waiting times, to encourage the service to do everything possible to meet the needs of those who are seeking assistance.
For the bill to deliver on its fundamental principles and its main policy objective of improving the experience of people who have been affected by sexual offences, there also needs to be robust monitoring, evaluation and learning from experience. We have, therefore, further recommended that IT systems should be in place to collect, store and access data from services across Scotland, alongside an annual reporting requirement on NHS Scotland to evaluate and drive forward service improvements. Joined-up and effective online health records have been called for by the committee in report after report this session. I hope that the cabinet secretary will agree that this is one of the many areas in which achieving that objective could make an enormous difference to service users.
In conclusion, the committee unanimously supports the general principles of the bill while seeking further clarification on the issues and concerns that we raised in our report. I am sure that the cabinet secretary will reflect further on our report, this debate and the concerns that were raised by witnesses in the committee’s inquiry, and that the bill will, as a result, be even better and stronger after stage 2.
We have some time in hand, so I will be light on timings—to an extent. I have made Mr Cameron smile.15:20
I refer members to my entry in the register of interests as a member of the Faculty of Advocates.
I welcome the opportunity to open for the Scottish Conservatives in this important debate at stage 1 of the Forensic Medical Services (Victims of Sexual Offences) (Scotland) Bill. We will support the bill at stage 1 and we welcome its long-overdue introduction. It is another step forward in delivering a system that ensures that victims are put first—something that Conservative members have long advocated.
I am delighted that not only my colleague Brian Whittle, who sits on the Health and Sport Committee with me, but Liam Kerr, our justice spokesman, and Margaret Mitchell, who was for a long time the convener of the Justice Committee, will be speaking for us today. As Lewis Macdonald pointed out, there is a cross-portfolio element to the bill and I am pleased that the Scottish Conservative speakers reflect that.
I pay tribute to all my colleagues who sit on the Health and Sport Committee and to the clerking team for their work in drafting the report. Although I now sit on the committee and was among the MSPs who signed off the report, I was not a member for the evidence sessions. However, I have had the opportunity to read through some of those representations and, obviously, the report. I pay tribute to the people who gave evidence, particularly the survivors of sexual offences, many of whom gave evidence themselves while others gave evidence through organisations such as Rape Crisis Scotland and local support groups. It is clear that their experiences have been a key driving force in getting the bill to this point.
As we all know, the bill was brought forward in response to a report from Her Majesty’s Inspectorate of Constabulary in Scotland in 2017 on the provision of forensic medical services to victims of sexual crime. That report found that the quality of services offered to victims was unacceptable and it concluded, quite starkly, that victims are being let down. It highlighted a lack of leadership and governance, a lack of audit or inspection of services, a lack of female forensic physicians, equipment—
I agree with the member’s points. Does he share my view, which is based on my experience in social work going back many years, that there is a huge problem with low reporting rates and with low conviction rates of perpetrators? Does he feel that anything in the bill will turn that trend around?
I hope so. I fully agree with David Stewart that there has long been an issue around conviction rates in relation to sexual offences, particularly rape. That is a longstanding problem that we require to correct.
The HMICS report highlighted the lack of overnight and weekend provision and the practice of medical examinations taking place in police buildings in many areas of Scotland. It also referred to the lengthy journeys that were often faced by victims and noted that victims were being asked not to wash for a day, or more, after an assault, which is something that Sandy Brindley of Rape Crisis Scotland spoke about during the committee’s evidence taking, when she said:
“We cannot overstate how much distress is caused by having to wait hours or even days for a forensic examination after being raped or sexually assaulted”.—[Official Report, Health and Sport Committee, 17 March 2020; c 29.]
From my perspective, as a Highlands and Islands MSP like David Stewart, I was horrified to read an article from 2017 that noted that rape victims in our island communities were forced to travel to the mainland for an examination, unwashed and hungry, due to a lack of island-based facilities. In no society should that level of degradation be acceptable, least of all ours.
Of all the aforementioned issues that the HMICS report raised, those issues need to be dealt with urgently, especially given their scale. The most recent figures available show that in 2018-19 Police Scotland recorded 13,547 sexual crimes, of which 40 per cent of the claims relate to a victim under the age of 18. That is a very high proportion, and such figures should concern us all. Although the bill sadly cannot prevent such crimes from happening, it can help to drastically improve the experience of victims of such crimes.
I will make a few general points on key elements of the bill. The Scottish Conservatives fully welcome the work that has been carried out to develop a vision for what trauma-informed care could look like in the context of the bill. As I said, the committee heard from victims of rape and sexual assault who had experienced physical and mental trauma as a result of medical forensic examinations. It was acknowledged that trauma-informed care recognises the impact of trauma on an individual’s health and their social and emotional wellbeing, and aims to deliver services that minimise the risk of further trauma. The committee recommended that the bill should explicitly state that as a requirement.
That issue also relates to other elements of the bill. Many statements from witnesses at the committee noted the need for greater access to female doctors as a means to reduce trauma. Rape Crisis Scotland said that that is the single most pressing issue that requires to be addressed to improve survivors’ experience.
Another aspect that the Scottish Government should consider further is the provision of out-of-hours services, which was raised on several occasions by various witnesses. They spoke of the delays that victims have experienced while undergoing forensic examination, and they mentioned in particular the psychological impact on those who, as I said earlier, were unable to wash or change their clothes. I hope that the Government will consider that issue as the bill progresses to stage 2.
Other members have referred to the provision that seeks to make forensic medical examination available on a self-referral basis for people who are over the age of 16. That would mean that victims of sexual abuse and rape would be able to access a forensic medical exam without first reporting the incident to the police. That is important, and it has been broadly welcomed by Victim Support Scotland and Rape Crisis Scotland, which both said that it is an advantageous provision. However, Rape Crisis Scotland highlighted that the provision must be consistent across the country and available 24/7.
Alex Cole-Hamilton has already referred to one concern that was apparent during committee evidence: that restricting self-referral by age may unintentionally act as a barrier to prevent younger or vulnerable victims from coming forward. As other members have said, the Law Society’s view is that the age limit needs to be kept under review, but, in the view of the Scottish Conservatives, there is an issue here. It is plain that there is further work required, and a debate to be had, around that part of the bill.
I could have spoken about many more issues, and I hope that other members will cover them during the debate, given the extensive nature of the bill. The Scottish Conservatives will support the bill today at stage 1 and scrutinise it further as it makes its way through stages 2 and 3. It is a positive and welcome step forward to ensure that victims’ needs are prioritised. Survivors of sexual offences have waited long enough for this legislation and the changes within it, and it is now down to the Scottish Government to listen to the concerns that have been raised; to respond positively and proactively to the committee’s report; and to make the necessary changes to ensure that the bill meets all the needs of those whom it is intended to support.15:28
As a member of the Health and Sport Committee, I am pleased to contribute to this important debate. I am glad to say that Labour will support the general principles of the bill, and I am convinced that parliamentarians across the political divide will recognise that the bill makes victims of sexual abuse a key priority for forensic medical services.
As I touched on in my intervention, many years before I joined Parliament I worked for over a decade running a very busy child protection team in an area of social deprivation. However, that comprehensive experience did not prepare me for the round-table event that Health and Sport Committee staff organised with survivors and victims. The survivors and the organisations that represented them spoke of the horror and anguish that they faced after reporting their attack.
There was an underlying consistency in their messages: that
“criminal procedure re-victimises the victim”,
“Forensic examination opens up the horrors of the attack”,
“System does not function correctly,”
and, in particular, that there was a
“Lack of support for victims.”
A strong theme was the need for change, particularly of self-referral for forensic medical examinations and for independent advocacy and psychological support. I am glad that the cabinet secretary and other members echoed those important points, on which I wish to concentrate.
As other members, including the cabinet secretary, have said, we all know that the overall aim of the bill is to require health boards to make forensic medical examinations available on a self-referral basis to people over 16. That means that victims would be able to undergo a forensic examination without any requirement to report the incident to the police.
Donald Cameron has already touched on some of the history of that. Her Majesty’s Inspectorate of Constabulary in Scotland closely examined the provisions for healthcare and forensic medical services, and it drew out three key points, which I wish to emphasise. The inspectorate said, first, that there was a need for increased innovation, especially in relation to island and rural areas; secondly, that there was potential for more collaboration among boards to share specialist staff; and, thirdly, that there was a gap in service provision in cases where a victim of a sexual crime sought support and medical attention but did not wish to report it to the police.
We have already touched on the important issue of self-referral, but I would draw the Parliament’s attention to the fact that section 2(4) of the Age of Legal Capacity (Scotland) Act 1991 states:
“A person under the age of 16 years shall have legal capacity to consent on his own behalf to any surgical, medical or dental procedure or treatment where, in the opinion of a qualified medical practitioner attending him, he is capable of understanding the nature and possible consequences of the procedure or treatment.”
Many respondents to our committee’s call for evidence for the inquiry believed that self-referral should not exclude children and young people under 16. Victim Support Scotland considered that it would be detrimental to restrict under-16s from the self-referral process. VSS wrote:
“Due to their age and the potential nature of the harmful sexual behaviour, especially in instances that may involve a family member, they are likely to feel less comfortable seeking a forensic medical examination through the police and prefer an alternative setting for their initial steps towards seeking the involvement of criminal justice agencies.”
There was other evidence that I found very interesting, from the rape and sexual health centre in Perth and Kinross. As the cabinet secretary will be aware, it reported that one fifth of survivors accessing the centre’s services were aged between 13 and 15. The view of the centre was that self-referral should start at 13. The Royal College of Nursing also supported self-referral for younger children.
A number of members, including the committee convener, have raised the issue of public awareness, which I agree is important. Self-referral will benefit victims only if they are aware that it is an option. The RCN was right to say in its submission that there needs to be a focus on ensuring public awareness of the provisions of the bill.
I would be grateful if the cabinet secretary, in her closing remarks, could specify the Government’s strategy for public information and education. We will all support the bill at 5 o’clock but, if we do not have public information and awareness, the bill will not be worth the paper it is written on.
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 made a strong recommendation on that point. The key is informed consent and equality of access, taking into account travel, rurality and low population density.
It is important that vulnerable young victims, who are likely to be shocked and traumatised, have a statutory right to independent advocacy across Scotland.
I agree with the comments made by other members that it is crucial to have female practitioners. Rape Crisis Scotland noted:
“The feedback that we have from survivors is that the most important issue is access to a female doctor. The lack of access to a female doctor is what causes the most trauma.”
The committee recommended that the bill be amended to guarantee an individual’s right to choose the gender of the examiner. I know that the cabinet secretary will say that the Scottish Government’s response is that section 9 of the Victims and Witnesses (Scotland) Act 2014 ensures that people who access forensic medical examinations can request a female examiner. However, we perhaps need to strengthen the bill in that respect.
I will make a point that I do not think others have raised. It is important to stress that the bill does not give an individual the right to a forensic medical examination; examinations are carried out on the professional judgment of a healthcare professional. As the stage 1 report made clear,
“professional judgment can include both clinical and non-clinical elements supported by guidance from the Faculty of Forensic and Legal Medicine.”
The fairer Scotland duty assessment of the bill notes that
“women 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, for example, uses data collection along with advice from third sector groups to target resources in areas of deprivation. That reflects the committee’s recommendation to require all health boards to capture analysis and publish data addressing equity of access.
This is an important bill for protecting the healthcare needs of victims of sexual offences, and we must listen to the voices of survivors. We need a criminal justice system that puts victims squarely in centre court, does not revictimise or repeat the sin and where victims are listened to, respected and supported. As one survivor said,
“Violators cannot live with the truth: survivors cannot live without it.”
I support the general principles of the bill.15:36
As a non-member of the committee, I begin by thanking the committee, the clerks and in particular the witnesses who gave the evidence that has brought the bill to this stage. I welcome the debate and I thank the Royal College of Nursing and Rape Crisis Scotland among others for their excellent briefings.
The Scottish Greens support the general principles of this important bill, which seeks to deliver equity of access to healthcare for those hurt by rape and sexual crime. Crucially, it would enable people to access trauma-informed healthcare services without first having to make a police report. The RCN and others support a statutory duty for health boards to provide forensic medical examination to victims. Placing such a duty on health boards would also ensure that the clinicians undertaking those examinations could refer to other NHS specialties without barriers, which would enable the provision of more holistic care to victims of sexual assault. As the committee report notes, victims would be able to access and be signposted to other key services, such as sexually transmitted infection testing, emergency contraception and mental health support, while their forensic examination takes place. Clearly, a healthcare environment is more suited to caring for someone who has just experienced a physically and psychologically traumatic event.
Health and social care integration also has an important role to play as, when an individual is accessing forensic services in a healthcare setting, they can be signposted to community services that can continue to support them. I am particularly interested in how the bill may allow health boards to take a more preventative approach. The mental trauma experienced by some who have experienced sexual assault is not always immediately apparent and may manifest later in time, but if people can access or be signposted to mental health support when attending an examination, that may prevent or lessen such trauma before they reach crisis point.
It is entirely appropriate that victims of sexual assault should access forensic examinations in healthcare settings. Rape Crisis Scotland cites examinations taking place in inappropriate and unsuitable locations, including police stations, as a major flaw in the current system. It is important to note, as colleagues have done, that further physical and mental trauma can be caused by forensic examinations. The bill has an important role to play in lessening any further harm and ensuring that victims can access the support that they need in an appropriate environment, without having to make an extremely difficult decision about whether they want to go to the police when they may still be in shock.
The decision to inform the police of a sexual assault can often be difficult, for many reasons, and no one should feel pressured into reporting as a means of accessing forensic examination. Self-referral is therefore an extremely important aspect of the bill that has the potential to transform and improve sexual assault victims’ experiences when accessing help.
However, as the committee report notes—and as others have mentioned, as it is clearly a major point—self-referral will be of benefit only if victims are aware of its existence. I have been contacted by constituents who were retraumatised by their experiences when reporting their assaults, largely because they did not know what choices were available to them.
Health boards and the Scottish Government have a responsibility to ensure that the public is aware of those services and of how to access them. I support the committee’s call for a public awareness campaign about the changes to the law that are contained in this important bill.
There should also be a multitude of pathways for people to access forensic examination services. We must ensure that barriers to access are removed or minimised. Some victims may not be aware of the self-referral service or of how to access help, and may even be unaware that what they have experienced is a crime.
Other healthcare services should be able to direct victims to forensic examination services. In its response to the committee’s consultation on the bill, Community Pharmacy Scotland stated the need for a recognised pathway for people who seek help in the first instance at a pharmacy. I support that call.
Once victims have accessed forensic services, it must be made clear to them—by people who have been trained to deliver the message—what their rights are, what the self-referral service is for and how it can help them. The report makes the point that, if victims are not fully informed, they may not be aware that other evidence pertaining to their case, such as closed-circuit TV footage, might be lost if they do not promptly report to the police.
Victims are also impacted by a lack of available staff. The Rape Crisis briefing tells the heart-rending story of a woman who was left unable to shower for two days after a sexual assault. We cannot allow victims to continue to be retraumatised when they report sexual assault. Rape Crisis Scotland says that a lack of female doctors is exacerbating long delays, a point that colleagues have raised already. I am glad that the bill contains a provision for victims of sexual offences to be given the opportunity to request that the person who is to carry out a forensic medical examination be of a specified gender.
The changes will result in increased demand for those services. The evidence suggests that that will be the case: the Scottish Government estimates an increased service demand of 10 per cent following the introduction of self-referral. Future workforce planning is key to delivering equity.
Rape Crisis says that we must proactively ensure that there are sufficient female doctors who are able to undertake the role of forensic examiner. Rape Crisis also notes a major issue when the role requires doctors to cover custody cases as well as undertake forensic examinations, and states that to make that a dedicated role would have a significant and positive impact on the availability of female doctors. I would be grateful if the cabinet secretary would respond to that and outline how she plans to address the issue.
The RCN has worked to develop the role of nurse sexual offence examiners to enable them to undertake forensic medical examinations and to give evidence in court. Enabling expert nurses to undertake that work will improve access and will support the provision of trauma-informed and person-centred care.
I know that there has been some debate about the decision to place an age limit on access to self-referral. The RCN questioned the restriction to over-16s, as did my colleague Alex Cole-Hamilton. The bill should reflect the sad reality that significant numbers of children are victims of sexual crime. If children could self-refer, that would provide another important route towards help and safeguarding. I note and appreciate the cabinet secretary’s openness to amendments at stage 2.15:43
It gives me great pleasure to speak in favour of the bill. I pay tribute to the victims and witnesses who gave such compelling evidence during stage 1. Their testimony will stay with me for life and members of the committee will recall that I was rendered almost incapable of moving on to the next piece of business after hearing that testimony.
I am sure that I echo the thoughts of colleagues in the chamber when I say that, because that evidence was so powerful, I feel a sense of grave responsibility, not only to speak to ensure that the bill fully serves its purpose, but also to use this platform to give voice to those who have been silenced for so long.
The recommendations contained in the HMICS report must be urgently addressed. There has been some progress in the intervening years, but the scale of the challenge should not be underestimated.
There has been a long-term upward trend in sexual crime in Scotland since 1974. Sexual assault, rape and attempted rape have increased significantly in the past 10 years. At the same time, reports by victims of rape and of sexual assault have consistently shown that the criminal justice system is a traumatic arena for victims.
The Scottish crime and justice survey for 2017-18 reported that only 23 per cent of respondents reported the most recent or only incident of forced sexual intercourse to the police. Evidence heard throughout the committee’s consideration of the bill confirmed much of what was already known about the lack of trauma-informed care. That aspect was harrowingly described in Dr Lesley Thomson QC’s “Review of Victim Care in the Justice Sector in Scotland” of January 2017, which stated:
“Victims often speak of feelings of re-victimisation or secondary victimisation once they enter the criminal justice arena. In the course of this Review, a victim of rape described the trial experience as worse than the crime itself.”
That is truly unacceptable and a failure of our duty to those women.
I believe that the bill’s ambitions are good in attempting to alleviate, at least in part, the trauma of post-sexual-crime forensics. There are, however, hurdles in the bill that we must overcome for it to reach its full potential. Self-referral offers the chance to help stop victims being pulled into a system that they are not ready for; it will give people time and space to consider whether they want to report an issue to the police; and it will offer some sense of empowerment in a situation where people have been made to feel utterly powerless. At the same time, the opportunity to seek prosecution is not lost. As the Crown Office and Procurator Fiscal Service said in its evidence, the bill will also enable
“potential evidence to be obtained and preserved at the outset, thereby potentially strengthening any subsequent investigation and prosecution should the person decide to report the incident to the police at a later stage.”
Making sure that important evidence is not lost is vital. Conviction rates for rape and attempted rape remain the lowest for all criminal prosecutions, with only 39 per cent of cases being successful. One of the largest declines in conviction rates in the past 10 years is that for sexual assault.
What makes the bill so important is the opportunity that it will provide for those who suffer from rape or sexual assault to seek help and secure justice. My concern, however, is that the bill fails to do that for children and young people—I intervened earlier on the cabinet secretary about why I believe that the bill’s minimum age of referral makes that the case. The bill proposes that the minimum age of self-referral should be 16, which would mean that those under the age of 16 would require to be accompanied by an adult. I understand that the logic of that is to ensure child protection, but I am afraid that it is not that simple. Victims of sexual assault who are under the age of 16 are most likely to be sexually assaulted by a parent or another adult whom they know, so the lack of autonomy given to young people in the bill would disadvantage them in accessing the bill’s full benefits.
Representatives from Children 1st spoke to the committee and to me directly, laying out concerns about how the bill as introduced risks inadvertently excluding children from the support that the bill seeks to offer. Children’s recovery needs are inherently different from those of adults. Children do not naturally compartmentalise their experiences, so they often need to address a multitude of experiences when recovering from a sexual crime. If, as the Government has stated, there will be no practical difference from meeting the needs of children who have experienced other types of abuse, it is not clear what the role of the associated clinical pathway is. Both of the concerns expressed by Children 1st highlight how important it is that any pathway developed alongside the bill must set out clearly how it will meet the forensic, medical, recovery and justice rights of all children.
Further to the issue of accessibility, I am concerned that certain areas of Scotland risk being disadvantaged by the bill as introduced. The Scottish Government’s assurance about a consistent approach being taken to accessing self-referral services needs to be more than just words. My colleagues in the northern isles of Orkney and Shetland have pointed out before that those from the islands face unacceptable hurdles in accessing the specialist support that an incident such as sexual assault or rape demands. We heard about some of that from a Conservative member earlier in the debate.
I completely agree with the sentiment that Mr Cole-Hamilton and other members have expressed about the unacceptability of victims who live in our island board areas having to travel under the circumstances described. I am therefore sure that Mr Cole-Hamilton will welcome that every island board now has its own healthcare facility where forensic medical examinations can take place.
I accept that, and it is highly welcome, but we need to be sure that every aspect of the bill is island-proofed so that every citizen in our islands receives exactly the same kind of service as everybody on the mainland.
The bill’s ambitions should be praised, as it has the potential to at least in some way alleviate the terrible trauma that the criminal justice system can inflict on victims of sexual crime. However, in order for it to do so to its full potential, it must be completely inclusive for all demographics, irrespective of age, gender or postcode.15:50
I, too, thank the clerks, the many groups and individuals who came to the committee in person or who provided written submissions and the organisations that have sent briefings for today’s debate.
I also want to thank in particular the women whom the Health and Sport Committee met in private to hear about their experiences, which Alex Cole-Hamilton summed up well. It was an emotional meeting, and I congratulate them on their courage in coming to speak to us. They were very brave and their tenacity was fantastic. I hope that, through this debate, and as we move through stages 1, 2 and 3, the bill, once passed, will do justice to all the victims who spoke to us and to all those who we have not heard from.
As the Law Society of Scotland’s briefing for the debate said,
“The Bill’s main policy objective is to improve the experience of people who have been affected by sexual crime.”
That is an important point. We must all remember that the bill will, I hope, achieve that.
The committee covered many aspects of the bill. There are too many to cover, but I have picked out a couple. One is the health-led approach that is taken in the bill. That is really important. We know that the reporting of sexual crimes falls between the two stools of the health and justice systems. The victims we spoke to—this was brought out in the recommendations that were sent to the committee, too—felt that they were badly let down by that. By ensuring that the approach is health service led, the bill gives an assurance to victims that they will be treated with compassion and empathy.
We covered that aspect in great detail with the women we met in private. I know that this has been mentioned, but it was appalling how some of those women were treated. They had to wait for hours, and sometimes for days before they were examined. Some of them sat in a cold police room. They were not given tea or coffee, they were not allowed to drink anything and they were not allowed to change their clothes.
We should be proud of moving to health-led forensic services once we pass the bill. All victims must get compassion and help. They must be given an assurance that they have done the right thing when they report an offence and they must be treated with compassion.
That brings me on to the issue of self-referral. That very important part of the bill has been mentioned. Other members have spoken about the age of referral. We heard evidence on both sides of the argument. Alex Cole-Hamilton and others are right. People younger than 13 have been victims of sexual abuse. Maybe, as the cabinet secretary said, the current provisions will be kept, but we will consider the issue and see where we can go with it, perhaps at stage 2, or further down the line in the bill process.
We have to remember, as I am sure that we do, that the victims of sexual abuse and crime are sometimes in shock and they do not always realise that they have been victims. There are a multitude of reasons why they might not report what has happened straight away. It is difficult for someone to recollect such a crime within 24 hours when they have to sit in a room in a police station—or even, as we heard about in the case of one lady, in the back of a police car. It is hard for them to recollect exactly what happened to them, so being able to access a self-referral system will be important.
As has been mentioned already, we must also ensure that, when such a crime is reported, health-led services are available. Advocacy and support have not been mentioned so far, but having someone there to support victims is very important. There is no point in introducing such a bill if we do not have the resources to cover those aspects. The Cabinet Secretary for Health and Sport has mentioned that resources will be made available, and I am sure that they will be. However, as the bill goes through its parliamentary stages, we will need to ensure that such aspects are not only considered but delivered. In delivering the self-referral system, we must also provide information, advocacy and support. We need to have provision on those aspects in place in the bill before we can make progress.
Another issue that has been mentioned by previous speakers is the need for victims to have access to female doctors. As Donald Cameron and others have mentioned, and as Rape Crisis Scotland has said, the single most pressing issue that requires to be addressed is the lack of access to female doctors. That also came across very clearly from the women to whom committee members spoke in private.
I welcome the cabinet secretary’s announcement of extra funding for 20 places on a dedicated course at Queen Margaret University. The fact that 61 per cent of sexual offence examiners in Scotland are now female is also fantastic. However, Rape Crisis Scotland went on to say:
“We note that this is not currently a single-sex role. Replacing the word ‘gender’ for ‘sex’ in the bill is not going to address the barriers to survivors being able to access female doctors.”
I ask the cabinet secretary to address that point either in her closing remarks or at stage 2, if the bill progresses. It was one of the most pressing aspects of the evidence that the committee heard. I do not decry the approach of most male doctors, but we heard that, in certain cases, empathy and compassion were not shown when they were treating female victims of sexual abuse. We must remember, although I think that we all know, that the vast majority of sexual crimes are perpetrated by men on women.
We must be absolutely certain that, when we promote the self-referral system, as it is important that we do, by telling people how they can access it, we ensure that we also offer them access to female doctors. We cannot deny them that. I know that achieving that might be difficult, but for me and others that lack of access was one of the main driving forces behind wanting the bill to progress. I feel that changing the name from “sex” to “gender” is not—[Interruption.]
I am sorry, Presiding Officer. Have I gone over my time?
Can you see my face, Ms White?
The topic is a serious one, and I know that we have time in hand, but I wasnae giving it all to you. [Laughter.] Please conclude.
I am very sorry about that, Presiding Officer. You should have said so. I thought that I had more time.
I will conclude by saying that I very much support the principles of the bill, as I hope that all members will do.
Thank you for your leniency, Presiding Officer.
Thank you very much, Ms White. You are a wonder.15:59
For full transparency, I remind members that I am a practising solicitor and hold a practising certificate from the Law Society of Scotland.
I have not had much involvement in the bill’s development so far, because it has come within the health and sport rather than the justice portfolio—and rightly so. Rape Crisis Scotland made a good point when it said:
“this is a health issue and therefore falls under the responsibility of Health”.
However, I heard the Health and Sport Committee convener’s remarks that the justice portfolio must play a role in this and I am pleased to have the opportunity to speak and to welcome what will be a critically important piece of legislation. I say that because, looking back, I can see that the bill is a response to the powerful and damning 2017 HMICS report on the provision of forensic medical services to victims of sexual crime. Many of the recommendations, including the establishment of a system of self-referral for examination, of which more later, have made it into the bill. That is all good and that is why I will strongly support the principles of the bill at decision time.
Listening to the debate so far, I have some thoughts that may be useful for the committee as the bill progresses. First, I listened when a number of speakers talked about the bill making forensic medical examination available on a self-referral basis for people over the age of 16. That is one of several positive aspects of the bill and reflects a call in the HMICS report.
Setting the age of self-referral at 16 is interesting. I worry about the argument that restricting self-referral may unintentionally act as a barrier to younger vulnerable victims coming forward. I think that the committee, the Scottish Children’s Reporter Administration and Children 1st are right that that is the correct age currently, but let us recall Donald Cameron highlighting the recorded crime in Scotland figures, which show that at least 40 per cent of the 13,364 sexual crimes recorded in the last year related to a victim under 18. That being so, I think that the committee is right to recommend keeping the age of self-referral under review. I thought that David Stewart and Alex Cole-Hamilton spoke particularly persuasively in that regard and I was pleased with the cabinet secretary’s response to David Stewart’s intervention. I wonder whether, in closing, the cabinet secretary could give an indication of the timescale of when and how that would be assessed.
The cabinet secretary also raised the issue of data collection. I note from the committee evidence that the Faculty of Advocates highlighted possible issues around the integrity and security of samples collected when a constable is not present.
Apologies for not being in the chamber for the start of the member’s speech.
In light of his background, what is the member’s view on the creation of an anonymous DNA database, which is particularly useful in relation to repeat offenders? As the member will know, that happens quite regularly in the States—the Federal Bureau of Investigation has managed to locate lots of serial offenders. To be clear, the committee did not recommend that, but I think that there is some work to be done in this area to pursue it.
The member makes a good point. There is something to look at here. The member would not expect me to give a commitment one way or the other, because he is right—this is a huge area, which we need to look at, but there are a lot of issues inherent in it that need to be explored in some considerable depth.
To go back to the evidential point, I was talking about the Faculty of Advocates expressing concern about the integrity and security of samples and I notice that the Law Society submitted a note earlier on, stating:
“We continue to have concerns over the ambiguity in the Bill as to how data is processed, stored and transferred”.
The collection and storage of evidence could have a significant impact on the evidential basis for a subsequent prosecution, so I acknowledge the preparatory work that the cabinet secretary alluded to earlier.
The committee raised concerns that healthcare professionals may be required to make decisions on what should or should not be stored. The committee believed that it would be a matter for Police Scotland. I note the committee recommendation that the Government set out in regulations what is to be stored by health boards and I also note that the cabinet secretary accepts that a revised data protection impact assessment needs to be undertaken. One would hope that that is prioritised in order to give sufficient time for stage 2.
The final thought that occurs is one that Rape Crisis Scotland’s submission made me think on. It stated that this legislation
“has the potential to transform survivors’ experience”,
but it caveated that by adding
“if implemented properly”.
That is a crucial point and something that I think Sandra White was getting at, because what is clear from the committee’s report and the various submissions that have been received is that the bill provides a framework but it is what is ultimately put in place around it that will determine whether the bill is successful in achieving that transformation.
From going through the report and the various submissions, I can see that the success of the bill and its principles hinges on various moving parts, such as the duty on each territorial health board to provide or secure the provision of an examination service, to provide victims with information on what will happen with any evidence that is collected and to identify and address the healthcare needs of the victim, even where a forensic medical examination did not take place.
The bill’s success also hinges on whether it mandates trauma-informed care, as I think it should, and which I presume requires training. It hinges on the recommended consistency of approach across all health boards and on public awareness. The committee noted:
“Self-referral will only benefit victims if they, or someone they confide in, are aware this is an option.”
Like David Stewart, I hope that the cabinet secretary might respond to that in closing the debate.
The bill’s success also hinges on the advocacy and mental health support that the committee convener rightly focused on. Success also requires the Government to put in place a national clinical information technology system as soon as possible, as the committee has urged, and access to female doctors. According to Rape Crisis Scotland, that is the single most pressing and important issue that requires to be addressed. I believe that that is the case, but that needs training and resources. At this stage, it is only fair to acknowledge the cabinet secretary’s remarks about the 20 priority places.
Overall, all those measures are good and right, but they are all expensive. The financial memorandum contains the Government’s estimate that the bill will result in a 10 per cent increase in forensic medical examinations. I have no idea whether that will prove to be correct, but I do not see equivalent provision for those other aspects that the committee has referred to. That concerns me because, logically, what is not resourced will not be provided. Perhaps that will be revisited as a result of amendments at stage 2.
Will the member take an intervention?
I am over my time by a long way.
All that having been said, I reiterate my support for the principles of the bill, and I look forward to voting for it at decision time.16:06
I am pleased to speak in the stage 1 debate on the Forensic Medical Services (Victims of Sexual Offences) (Scotland) Bill, which is a vital piece of legislation that is very much to be welcomed. As we have heard, the bill is designed to improve the experience of victims of sexual offences by dealing with the state’s role. I hope that, in turn, that will have a positive effect on recovery for victims and will perhaps facilitate better engagement with the justice process.
The backdrop is that, incredibly, in the not-too-distant past, many victims of sexual assault were required to be forensically examined in a police station. It is very difficult to imagine how traumatic that would have been—it was simply adding trauma upon trauma. Even though we have seen a welcome shift in the intervening years, with such examinations being transferred to a health setting from a police setting, the whole process has still been seen very much through the prism of the justice system rather than that of the health service.
The bill will correct that, for it sets forth the overarching principle that forensic examinations are a health issue and not a justice issue. The bill will place on a statutory footing the current arrangements that are set forth in the non-binding memoranda of understanding between health boards and Police Scotland. In fact, the bill will impose a legal duty on health boards to provide forensic medical services for victims of sexual offences and, crucially, it will require health boards to ensure that the healthcare needs of such individuals are addressed at the same time. Taken together, those key provisions represent a major step forward and reflect the compassionate country that Scotland strives to be.
A key issue in that regard, which has been referred to already, is the clear preference for female victims of sexual offences to be examined by a female doctor or by one of the new female nurse practitioners who are trained especially for that purpose. I welcome the cabinet secretary’s announcement in that regard this afternoon. I support the Health and Sport Committee’s recommendation in its stage 1 report that the bill should be expressly amended to make it absolutely clear that the victim should be able
“to choose the sex of the examiner.”
If we conflate gender with sex in this instance, I do not believe that we will discharge our obligation to put the interests of the victim first.
As we have heard, another of the bill’s key provisions concerns the self-referral process. That process will enable victims of sexual offences who are 16 or over—I note the on-going debate about that issue—to self-refer for a forensic medical examination without having first reported the matter to the police. Given that that is not possible—with a few limited exceptions—at present, the new provision will give the victim more choice and more control, which is absolutely fitting.
A number of technical but important issues have been raised. Those include the arrangements for the retention of samples and other physical evidence, and the length of time for which data can be retained. I am pleased to note that a debate is taking place with the Scottish Government about how those matters can be satisfactorily resolved.
On the important issue of independent advocacy support, which was mentioned by my colleague Sandra White, I consider that the arguments in favour of putting a requirement to provide such support on a statutory footing as a matter of principle are strong. I would welcome clarification from the cabinet secretary, when she winds up the debate, of what would be practically feasible in that regard, further to the committee’s clear recommendations on the matter.
Finally, I want to bring to the chamber’s attention an example of where such arrangements are working well in practice. The state-of-the-art forensic medical suite that was set up by NHS Fife at the Queen Margaret hospital in Dunfermline opened in June 2019. It was the culmination of many years’ hard work, including on the part of members of the Fife Rape and Sexual Assault Centre. They worked extremely hard to convince a host of people that the unit should be set up. I believe that it is running very well indeed, so I congratulate them and NHS Fife on being in the vanguard of the work in this area.
I am happy to support this important piece of proposed legislation at stage 1, as I believe that it will ensure that victims of sexual offences will get the care, understanding and compassion that they are absolutely entitled to.16:12
I welcome the opportunity to take part in the stage 1 debate on what I know to be an important and essential bill.
First, I thank the Health and Sport Committee for its thoughtfulness and diligence in producing its stage 1 report on the Forensic Medical Services (Victims of Sexual Offences) (Scotland) Bill.
Secondly, I am very grateful to the individuals and organisations that provided such valuable insight into the issues surrounding the bill, including the victims of sexual assault and rape who showed incredible strength and courage in helping to shape the bill. Their input will be essential as the bill progresses through Parliament.
As my colleague David Stewart has already stated, Scottish Labour supports the bill. I hope that, as a Parliament, we can produce a strong and effective piece of legislation that will support the health needs of victims of rape and sexual assault.
Many of the provisions in the bill are long overdue, including those on self-referral, although I am aware that two health boards already provide such a service. The bill will ensure that all victims of sexual offences in Scotland have the same access to the healthcare that they need.
We are all too aware of the pain and the misery that sexual violence causes victims. The option of self-referral, with or without criminal justice involvement, is a major step forward in reducing the barriers that exist to seeking the right physical and psychological support. Wraparound, trauma-informed support is vital, and improvements are required if we are to consistently deliver the trauma-informed care, information, advocacy and holistic healthcare services that victims need.
The committee’s report highlights several areas of concern, and I welcome the Scottish Government’s commitment to ease those concerns and strengthen the bill at stage 2.
I note that there is a difference of opinion on the age of self-referral, which the bill sets at 16. Although that falls in line with the age of consent, I worry when I see statistics that the Rape and Sexual Abuse Centre Perth and Kinross has provided, which show that 20 per cent of survivors who access its services were between 13 and 15 years of age when their abuse started, and a further 27 per cent were under 13. Those are worrying figures—and each case is one that should not have happened, regardless of age.
The Scottish Children’s Reporter Administration and Children 1st have highlighted that children and young people are automatically considered within child protection procedures. However, concerns have been raised that restricting self-referral for under 16s may act as a barrier to younger victims, especially where the abuse involves a family member. I sincerely hope that the Scottish Government will closely monitor the age of self-referral in order to better support all victims of rape or sexual abuse when access to services is sought.
It is important to ensure that all victims are aware of their healthcare rights, and I back the Royal College of Nursing’s call for public awareness of the bill. As well-intentioned and well-resourced as the eventual act will be, we will require information to be spread as widely as possible to all parts of Scotland.
The mental trauma of rape and sexual abuse can last significantly longer than the physical injuries that are suffered. However, mental health services are stretched at present, just as they were pre-Covid. A guarantee of access to appropriate mental health services must be delivered as part of any wraparound, trauma-informed care, and it must be delivered with the right degree of advocacy. I know that many fantastic, essential organisations are providing such advocacy in all parts of Scotland.
Scottish Labour supports the calls for 24/7 forensic medical examination services but, again, they must be available consistently across the country.
I believe that the bill has the potential to support all victims of sexual offences by removing barriers to healthcare and ensuring that the decision to become involved in the criminal justice system is in the hands of the victim. In my time as a member of this Parliament, I have heard the range of emotions, including anxiety and fear, that individuals face when reporting sexual assault. Although the vast majority of people who experience sexual assault are women, we must remember and be mindful of the fact that men and boys can also suffer sexual assault.
The bill will rightly put the victim at the centre of their treatment and recovery, with or without the added pressure of police and court involvement. I support the general principles of the bill.16:19
I very much welcome the Forensic Medical Services (Victims of Sexual Offences) (Scotland) Bill, which will place on health boards a statutory duty to provide forensic medical services for victims of sexual offences. At present, such examinations can, for the most part, be carried out only after an incident has been reported to the police, and following a referral from them.
The bill balances health and justice issues. Crucially, it includes a self-referral provision that will be available to individuals aged 16 or older, and which will ensure that individuals who have been sexually assaulted can access the healthcare that they need, and that evidence is collected for possible future proceedings without the immediate pressure of having to involve the police.
The police support the self-referral provision, which was one of 10 recommendations that was made in the damning 2017 report by Her Majesty’s Inspectorate of Constabulary in Scotland on provision of forensic medical services to victims of sexual crime. The report was scathing about medical examinations being conducted in police buildings. In effect, the self-referral provision will give the individual control over the situation, empower them when they feel powerless, and give them time to decide whether they want the evidence to be collected and transferred to the police.
In the time that remains to me, I will focus my remarks on how the bill will impact on children who have been sexually abused. A visit to Oslo with the Justice Committee in 2018 provided the opportunity to see first hand how the barnahus model deals with child sexual abuse cases. It provides wraparound support to child victims of sexual abuse and child witnesses, using a trauma-informed multidisciplinary approach to children who have been sexually assaulted, and a forensic examination that secures the best evidence. Crucially, that is all provided under one roof in a child-friendly environment.
I would be grateful for the cabinet secretary’s assurance that the bill will consolidate Scotland’s journey towards a full barnahus model, and will not create a separate parallel approach for children, which Children 1st was concerned about. I would also be grateful if, in her closing remarks, the cabinet secretary could provide an update on the work of Healthcare Improvement Scotland and the Care Inspectorate on developing Scottish standards for a barnahus response to child victims and witnesses of violence, which I believe were due this summer.
I turn to the self-referral provision and the fact that it applies only to individuals aged 16 years or older, which has been one of the more contentious aspects of the bill. It means that for people under the age of 16, child protection processes apply. Consequently, if a child presents to a health board, the health board is duty bound to report what has happened to the relevant authorities, including the police.
The Royal College of Nursing argued that allowing children under 16 to self-refer would offer another route for them to seek help and care immediately, and would offer children the same benefits of self-referral as adults have. Mary Fee and Dave Stewart referred to the sobering statistics from the Rape and Sexual Abuse Centre Perth and Kinross, which outlined that over the past 5 years, a staggering 20 per cent of survivors who accessed its services were in the 13 to 16 age group, and a further 27 per cent were under 13 years of age.
Other local groups have argued that the age limit should be 13 in order to address concerns that making it 16 could prevent young vulnerable people from coming forward. That is a valid concern that was recognised 12 years ago, when the cross-party group on adult survivors of childhood sexual abuse had the privilege of hosting the launch of a booklet entitled “See us—Hear us!”. The booklet was produced by the charity Eighteen and Under with support from Barnardo’s, and was edited by Dr Sarah Nelson. It contained young people’s comments, as well as recommendations for schools that work with sexually abused young people. It revealed the need for a safe space for an interview when young people disclose; the need for more time to be given before their confidence is broken and the police or parents are informed; the need for young people to be assured that they are believed and taken seriously by professionals; and the need for children and professionals to be prepared for what comes next in child protection and the justice system.
Given that the vast majority of child sexual abuse is not committed by strangers but by family members and people who are in positions of power and trust, and given the unpalatable fact that, during lockdown, child abuse incidents have spiralled, I firmly believe that the exclusion of under-16s from the bill’s self-referral provision needs further consideration. In conclusion, I ask the cabinet secretary, please, to ensure that we do not let those young people down again by denying those who are aged 13 and over the prospect of early intervention, which access to the self-referral forensic medical examination could provide.
In the meantime, I welcome the bill and support its general principles.16:26
As the deputy convener of the Health and Sport Committee, which is the lead committee for the Forensic Medical Services (Victims of Sexual Offences) (Scotland) Bill, I welcome the opportunity to speak in this stage 1 debate. I support the bill’s general principles.
The Scottish Government introduced the bill in November 2019. It proposes to place a duty on health boards to provide forensic medical services to victims of sexual offences, and the duties in the bill place the responsibility for delivery and improvement of the services with health boards rather than with the police.
As we have heard from colleagues, the bill proposes that persons who have been raped or sexually assaulted can self-refer for a forensic medical examination without having to go to the police first. As we have heard from colleagues, we welcome that principle. That is extremely important, because the main policy objective of supporting the psychological and physical aspects of the process will improve the experience.
In relation to forensic medical services, we know that there is underreporting of offences. The fact that we are progressing the bill should, in itself, raise awareness and improve reporting of sexual offences and rape.
The committee held five evidence sessions, including a session with victims of rape and sexual violence. Perhaps a better word to describe those women—which they used—is “survivors”. It was a very emotional evidence session. I thank the women for their bravery, and I thank Sandy Brindley from Rape Crisis Scotland, who helped to support and co-ordinate that powerful and informative evidence session with the survivors.
The committee’s stage 1 report made a number of recommendations. I will not reiterate all of them. I will not rehearse or reinform members about issues relating to age or the barnahus model, which I will be interested in, as we take the bill forward, but I will talk about a couple of issues that came out in committee scrutiny.
Trauma-informed care was highlighted as being crucial in delivering the best healthcare and follow-on care and treatment for persons who are affected. That was explored in an informal meeting—in particular, in relation to HIV post-exposure prophylaxis and the current lack of co-ordination of continued care and follow-up appointments. The principle of trauma-informed care is included in the bill, and the committee was informed that that would be delivered using multi-agency services. The committee recommended that trauma-informed care be on the face of the bill. I am interested to hear more views on that.
The chain of evidence is an important issue. I helped to write a chain of evidence policy for when bullets had been removed from gunshot victims, so I would be interested to know how that process will be secure; how evidence will be collected and stored; how long it will be stored for; what will happen if a case is not taken forward; who will own and dispose of evidence; and, of course, what will happen with data, which others have mentioned. I note that that is in discussion already.
Another concern that was expressed in evidence sessions was that victims need to be informed about and, where appropriate, given access to advocacy and support. We heard that in current practice, information is provided by various means, including by forensically trained nurses at Archway in Glasgow and by rape crisis support workers in NHS Tayside. The need for adequate and consistent information led the committee to make the recommendation that
“all health boards, alongside Police Scotland, should follow a consistent approach to the provision of information about self referral. This must include clear information allowing for individuals to make informed decisions.”
I would appreciate further information from the cabinet secretary on that recommendation.
In my constituency work and in learning about the bill and preparing for scrutiny of the bill, I visited the rape crisis centre in Dumfries to hear from its manager Jill Cochrane and her team about their direct experience and what they want to see in the bill. They welcome the bill’s proposal to change provision of the forensic medical service from provision by the police to provision by health boards, and they agree that a self-referral process will allow for choice and personal control for rape survivors. I imagine that we will see more people reporting offences as the bill proceeds and the process around self-referral moves forward, and as people come to know more about self-referral and health board engagement. Through that and the chain of evidence, perhaps we will see more convictions, which have not been the highest, so far. I thank Jill and her team for the vital work that they do and the support that they have given me.
I also visited the Mountainhall treatment centre’s forensic medical suite in Dumfries. Wendy Copeland met me there and gave me a detailed tour, and a walk-through and description of the holistic trauma-informed process that is already being provided. We spoke in particular about supporting persons who have been raped or sexually assaulted who live in rural areas, such as Dumfries and Galloway in the South Scotland region that I represent. That also came up during the committee’s evidence sessions. Rurality poses challenges in access to services, forensic or otherwise.
Having a 24/7 service and being able to choose the gender of the person undertaking the forensic examination were also raised as rurality concerns. The calls for a 24/7 service and choice in the gender of the examiner are potential challenges in rural areas. A 24/7 wraparound service and the need for adequate staffing were supported by the Royal College of Nursing.
I was pleased to hear from the cabinet secretary about the extra funding that has been allocated for training additional forensic medical examiner nurses. I welcome the fact that Dumfries and Galloway already has a commitment to having a women-led forensic medical service.
Areas with smaller populations might have issues with protecting confidentiality, which could mean that a person who is living in Stranraer should attend a forensic suite outside Dumfries and Galloway. A procedure is already in place so that people from Stranraer can be treated outside their area.
Finally, I say that I welcome the stage 1 debate and look forward to stage 2 and seeing the bill make progress. I thank everyone for their input so far, and look forward to hearing the cabinet secretary’s closing remarks.
We now move to the closing speeches. I have a little time in hand. Claire Baker has a generous six minutes.16:33
I am pleased to have the opportunity to speak in the debate. This is an area of healthcare and justice policy that has needed to be addressed for some time, as the system has been failing too many survivors of rape and sexual assault. The care and attention that are given to someone who has experienced a sexual assault is critical to how they respond to the trauma they have experienced, their ability to take control of a terrible situation and the recovery that they can go on to experience.
The initial treatment of someone who seeks help after an assault can have a lasting impact on them, and I welcome the changes that the bill aims to bring about. It is an important piece of legislation, and I very much welcome the work that the committee has done to scrutinise the proposal, make suggestions for how the bill can be effectively implemented and provide suggestions for the cabinet secretary to consider. However, I want to recognise even more than the contributions of MSPs the contribution of the Rape Crisis Scotland survivor reference group, whose members shared their experiences with the committee. Their openness and honesty have had a significant impact on the bill.
As an MSP, I have worked with Rape Crisis Scotland on issues of forensic examination. We all know that the service for victims has not been good enough and that, at times, it has been completely unacceptable. At the time of the report by the Inspectorate of Prosecution in Scotland in November 2017, which Margaret Mitchell mentioned, I raised the case of a young woman who spoke to me about her experience of the forensic service following a rape. Her description of the care that she received was heart-breaking, and she was not alone in having this experience. She told me:
“Think, just think, how it felt at the time of the assault, how it felt being in a barren environment where basic needs were only just being met (heating, water, food), where the male Forensic Medical Examiner did not have the tools to do the job.”—[Official Report, 21 November 2017; c 9.]
At the time, I asked for urgent action to be taken to address the clear deficiencies in how forensic examinations were carried out, and I recognise that some initial progress has been made. However, the legislation that is before us is an important lever in enabling us to deliver significant improvements across Scotland, and it is important that it is properly resourced and implemented.
The environment in which victims are being examined is not appropriate. Although there has been some progress, there are still situations that are uncomfortable and undignified. Rape Crisis Scotland highlights the unacceptable waits that women have had to go through in very recent months before they have had an examination. The situation has been unacceptable.
There is another reason why I wanted to speak in the debate, in relation to which I welcome Annabelle Ewing’s contribution. Last year, NHS Fife opened a dedicated suite for forensic medical services at the Queen Margaret hospital in Dunfermline. It has transformed the service that is offered in Fife. Developed in partnership with the Scottish Government chief medical officer’s task force, the Fife health and social care partnership, NHS Fife, the police, third sector agencies and local organisations, the suite contains a consulting room, a sitting room and a medical examination room. A holistic approach has been adopted, with additional staff available to provide support, and it is led by a care co-ordinator who will work with victims of rape or sexual assault to ensure that there is follow-up care and that access to additional services is co-ordinated. Jan Swan from the Fife Rape and Sexual Assault Centre has described it as a “massive milestone”, and it shows what can be done.
As others have said, the responsibility for forensic medical services has often fallen into the cracks between justice and health, and those services have not been prioritised or centred on the needs of the victim. The bill makes it clear who has responsibility. It is right that that will be health boards, and we need to ensure that they are supported and resourced to deliver.
The committee emphasises the importance of 24/7 provision and the need for consistency across the country while understanding and addressing the challenges of rurality and inequalities. All those issues will need to be addressed and the response to them strengthened in the implementation of the bill. I note that some health boards are advancing their preparations, and I encourage them to look at the good practice that has been developed in Fife.
A number of issues were raised in the stage 1 report, and members have explored both the evidence that was laid before the committee and the recommendations that have been made.
The introduction of self-referral is a welcome and sensible policy. It recognises the reality of people’s response to sexual violence and the fact that survivors are often in shock and might need time to decide whether they want to report the crime to the police. Making the change to self-referral will mean that evidence can be collected and stored, and it will then be available to a criminal case if the decision is made to raise one. The committee has made points about the need to raise awareness of the service and to build in future proofing around the age of self-referral. Members made a very good point about raising awareness. It is important that, once the legislation is passed, people are aware that it exists and know how to access the service when they are in need.
Women who experience rape and sexual assault routinely ask for a woman doctor, and I am pleased that, since 2017, following the report of the Inspectorate of Prosecution into the investigation and prosecution of sexual crimes, we have seen an increase of 30 per cent in the number of female examiners after a concerted effort to bring them into the service. I also welcome the number of doctors and nurses who have received NES training.
I note the committee’s recommendation to replace the term “gender” with “sex”. The cabinet secretary will need to reflect on that.
I would like to raise a point that Rape Crisis Scotland made in its briefing, on access to female doctors. It describes such access as the single most pressing and important issue that needs to be addressed, but it argues that key to that is ensuring there are sufficient female doctors to undertake the role. It identifies the requirement for doctors to cover custody cases as well as forensic examinations as a potential barrier, and it proposes introducing a dedicated role for forensic examinations, which would have a positive impact on the availability of female doctors. I hope that the cabinet secretary will consider that.
I support the proposal to establish a statutory right to independent advocacy. In designing the system to deliver forensic medical services, health boards should include independent advocacy services and work in partnership with them from the point of self-referral. There are examples of good partnership working already, and putting it into the bill embeds the role of advocacy and recognises its value, which then attributes a worth to it. Although I accept that there has been investment in independent services, they are often under pressure and have more referrals than they can cope with. A statutory right would underline their importance and deliver for survivors.
I welcome the legislation, and I believe that it can make a difference for people who are going through a very difficult experience. It recognises the need for compassion and that it is not always a case of coldly gathering evidence—there is a person here who needs respect and support. I hope that the bill dramatically improves how people are treated at a traumatic time in their lives.16:42
I am pleased to be closing the debate on behalf of the Scottish Conservatives. I thank those who gave evidence, the clerks and my fellow committee members and, as many of my fellow committee members have done, I offer my thanks and admiration to those women who gave evidence about their journey following a rape or sexual assault. It was compelling and moving, as Alex Cole-Hamilton and others have said, and it will follow us for a very long time.
The bill is incredibly important because it starts the process by considering the plight of the victim first and foremost. I purposely say “starts the process”, because it is but one point of many that need to change if we are truly going to change the way in which victims of sexual crimes are treated. The bill can be a message to those who have suffered that Parliament, the law and society are prepared to start listening to and believing them, and are ready to set out a path that will begin to tackle the issue of retraumatisation.
I have written to John Swinney and Humza Yousaf about the issue of retraumatisation and asked specifically for a meeting. As some members know, for the past three years or so I have been working with a constituent whose continual retraumatisation is shocking, to say the very least. She has just managed to get her alleged abuser charged and into court after 44 years. The number of times that she has had to tell and retell her story to so many agencies is, without question, secondary victimisation. Neither cabinet secretary has responded to me so far and I do not intend to let it go, so I would gently say to them that we can speak about the matter in private and perhaps help to develop other legislation, or we can debate it in the chamber. Either way, we will be discussing it because we cannot allow the system to continue to treat victims in such a callous way.
Why is the bill so crucial? A meta-analysis of 28 studies of women and girls aged 14 and over who had had non-consensual sex through force, threats, or incapacitation found that 60 per cent of them 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 and an indicator of post-traumatic stress disorder in avoiding reminders of the trauma. Giving people the ability to self-refer without initially reporting a crime while they are assimilating what has happened to them is, I think, a significant positive step.
I want to highlight two issues. The first is the debate around record keeping and the retention of samples. I start with the cabinet secretary’s admission during the evidence session that records would be kept in a paper format, at least initially, which is incredible. I do not understand. That would hamper the ability to cross-examine data. What century are we living in?
However, that aside, I want to discuss the arbitrary timescale for the destruction of evidence, which is sitting at two years and two months. When we looked at the retention of samples, many respondents called for consideration to be given to the length of the retention period, but there was no consensus on what that timescale should be. The two months is presumably included to avoid the destruction of evidence on the two-year anniversary of the incident. However, many members of victim support groups suggested that the period should be much longer.
I am not clear why the Cabinet Secretary for Health and Sport suggested that there was consensus around that period. No rationale seems to have been provided for setting that two-year period and it does not take into account the points included in the draft report, which could be summed up as “one size does not fit all”. In my mind, when I am looking at that period, I am thinking of the abuse of a 16-year-old who is then asked about the evidence being destroyed at the age of 18, when they are still very young and unlikely to have processed what has happened to them.
Retention periods must be based on the purposes for retention. The bill states that the retention service is for evidence that
“has not been transferred to a constable”
“The purpose is the preservation of the evidence for use in connection with—
(a) any investigation of the incident which gave rise to the need for the examination,
(b) any proceedings in relation to the incident.”
That is, it is for the maintenance of examination evidence held by health boards to support possible future investigations and related proceedings in relation to the incident.
There is the potential for a rolling review of that retention period, with alleged victims being asked whether they wished the evidence to be retained for a further iteration of that time period. David Stewart made the profound point that having an advocate to support the victim would help with that—it would help victims to make the decisions that were right for them at the time. I was heartened to hear the cabinet secretary raise that matter in her opening speech.
The evidence that is retained is very specific and when developing a robust framework for the implementation of the legislation we will need to consider how that evidence will be managed, which should be in such a way that it can be linked to other records relating to the same incident, which will almost certainly be held by other organisations, and so that the value of DNA evidence relating to the alleged incident can be used in identifying a multiple offender in the future—another point that was made by David Stewart.
There is an opportunity for the bill to set a precedent for getting records retention and wider records management requirements right within legislation. A key aspect of compliance with and implementation of legislation, and the exercising of people’s rights as set out within legislation, lies in the creation and retention of records. Standards relating to that aspect of legislative content are varied and there is an implicit requirement to create and retain records to a detailed prescriptive list.
Explicit retention periods are rarely included and tend to state a minimum period, with the obvious exception of data protection, which specifies a maximum period but requires to be considered case by case.There is a need to balance a number of often conflicting factors and it is therefore open to wide interpretation. I recommend the input of records management expertise via a memorandum of understanding with the keeper of the records of Scotland when drawing up new legislation and amendments to existing legislation.
My second point concerns limiting the age of people who can self-refer to 16 and above. I do not think that there is a standard level of maturity for a 16-year-old to start with, and in my opinion the bill may fall foul of United Nations Convention on the Rights of the Child legislation. GIRFEC is about getting it right for every child and the bill does not follow that ethos. If it is not in this bill, I ask the cabinet secretary what the Scottish Government proposes to bring forward to afford appropriate rights for under-16s. That cannot be an afterthought.
Alex Cole-Hamilton noted the dilemma of someone who is under 16 being assaulted by a family member. That is very similar to what happened to my constituent, who was 12 when she was allegedly assaulted.
I ask the member to come to a close now.
I will finish where I began: by stating that the bill is a crucial and important piece of legislation, not only because of its content but because of its potential as a statement of intent to those who have suffered trauma and sexual abuse. As Desmond Tutu once said:
“If you are neutral in situations of injustice, you have chosen the side of the oppressor. If an elephant has its foot on the tail of a mouse and you say that you are neutral, the mouse will not appreciate your neutrality.”
There has, for a long time, been an injustice in the way that victims of sexual abuse have been treated by the system. Let us not miss the opportunity to right those wrongs.16:50
I am grateful for and pleased at, but not surprised by, the consensual nature of the debate. I think that we all want to right the wrongs of the past—as they have rightly been described—and create the best legislation that we possibly can.
I hope that any survivors who are following the debate, and the organisations that support and represent them, welcome the support that we have heard from members on all sides of the chamber and across parties and committees.
The bill is ultimately intended to improve the experience of victims and to consign to the past practices that do not put victims’ healthcare and recovery front and centre in forensic medical services.
Will the cabinet secretary take an intervention?
No—I am sorry, but I have a great deal to get through, including responding to some of the points that Mr Stewart made.
It is important to recognise that although the bill is important, it is only one part of a suite of work that has been under way since 2017, led by the task force, which has significantly improved many of the aspects that we are trying to address. Members have commented on some of those improvements, not least the fact that facilities are now significantly improved, and the days of victims being examined in police stations are now over.
There has been a full debate on our position on stage 2 amendments; I have listened carefully to all the points that have been made and noted them all down. We want to deliver the best bill possible, and I have not closed my mind to any suggestions from members that might improve and clarify the bill during the remaining part of its parliamentary process.
I will address some of those points—I hope that members will forgive me if I do not have the time to touch on all of them. On behalf of the Health and Sport Committee, Lewis Macdonald talked—as other members did—about how people need to know about the rights and choices in the bill, and about the importance of ensuring that information is clear and is made widely and consistently available in a range of formats. I could not agree more with him on that.
My previous experience as Minister for Social Security has served me well with regard to understanding the full range of accessibility needs in order to ensure that information is widely available. I am happy to commit to do much more work on that and to discuss it further with the committee as we go forward.
Lewis Macdonald also made the point, as the committee report did, about putting trauma in the text of the bill. The bill already legislates for a healthcare focus on trauma-informed care, but I have no particular reason not to discuss that further with the committee, and I would be happy to do so.
Lewis Macdonald and others made a point about advocacy. There is already appropriate statutory underpinning for advocacy. As Rape Crisis Scotland made clear, advocacy services do not necessarily need to be underpinned by legislation, but I will be happy to look at that aspect further and discuss it with the committee when we get to stage 2.
Sandra White and many other members mentioned a guarantee for victims of the right to choose that their examiner will be female, if that is what they wish. In my opening remarks I mentioned the 61 per cent increase in the number of women doctors who are now trained and ready—a considerable increase of 30 per cent since this work began. The key thing is our multidisciplinary approach, which allows us to ensure that the right to a female forensic examiner is there for every victim, if that is what they choose. That is why the work being done with nurses and the new places at Queen Margaret University that I mentioned are so important. We will continue to do that work so that we can offer—consistently and across the country—what I personally consider to be a very important right.
Mr Cameron spoke about a number of issues, many of which are already being addressed by the task force, and I take this opportunity again to thank the task force, which was drawn from many different disciplines and types of experience, for the work that it has undertaken over a very short space of time and for the achievements that it has secured. I recognise that the bill is just one part of that work.
I made this point before, but I want to repeat it: it is important to recognise that all island boards now have on-island services, and no adult needs to travel outwith their islands unless they choose to do so.
On a particular point that Mr Cameron rightly made, and which I think his colleague Mr Kerr also made, we recognise the cross-portfolio nature of the bill. The Cabinet Secretary for Justice launched the consultation in 2019 and is a co-signatory to the bill itself.
On the point about the age of 16, at which self-referral is possible, which was made by Mr Stewart and a number of other members, the bill is consistent with the Age of Legal Capacity (Scotland) Act 1991, as we have specifically clarified in the policy memorandum to the bill, but we are persuaded of the need for an additional delegated power to keep that under review. We will discuss that further.
On the point that Mr Cole-Hamilton made, the issue is not one of the person under 16 being accompanied by a parent or guardian, which is not necessary; the issue, which I think was touched on by Ms Mitchell, is about whether clinicians would be obliged to report sexual assault on a young person under 16, as is current practice. We can consider whether there are any ways around that or what else we might do. That is one of the many reasons why the children and young people’s pathways—to which Children 1st is a key contributor—are so important. We can consider how we bring those two things together.
For Mr Cole-Hamilton’s benefit, I should say that we have published an island communities impact assessment, which was welcomed by his colleague Mr McArthur.
Mr Kerr also made a point about finances—indeed, he made some very important points in that respect. We can pass legislation, but we need to be sure that we can implement it. Mr Kerr has my personal assurance that I am not interested in legislation unless I can be sure that we can implement it—I see no point otherwise. In my opening statement, I made a point about the additional resources that have been given to health boards to ensure that they can do that and that they can put the services in place. Of course, we have to be very sure—through Healthcare Improvement Scotland quality indicators and through the monitoring of all that—that those services are actually delivered, and delivered to the level that we require.
As regards the integrity of the justice system, I point out that the Crown Office and Procurator Fiscal Service is involved in the task force. As Ms Harper and Mr Whittle pointed out, it will be the Lord Advocate who will approve the final protocol on how we secure evidence and on the processes for that. On the matter of retention of evidence, we are now consulting on a timescale, and that will have survivor input so that we can ensure that we get it right.
Many important points have been made in the debate, and I am grateful to members for the thought that they have given to the matter and the points that they have raised, and we will take them all away. I look forward to further constructive discussion with the Health and Sport Committee and with other members, if they wish to take me up on the offer.
Rape and sexual assault are among the very worst experiences that any one of us can face in our life, and their impact lasts—there is no question about that. The bill is one part of the work that we have to do to ensure that we put the victim first and look after their healthcare, their trauma and their recovery as best we can. We will not do that alone; we will do it with many partners across the public sector and third sector, but we always need to listen to the views of victims, survivors and the organisations that represent them. I hope that as we move forward, the Parliament will stand as one to endorse the bill, and I look forward to the stage 2 proceedings when we will continue to improve what is already a very good start to the legislation.
That concludes the debate on the Forensic Medical Services (Victims of Sexual Offences) (Scotland) Bill.
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