CMO Rape and Sexual Assault Taskforce minutes: March 2021

Attendees and apologies

Attendees

• Chair – Dr Gregor Smith (Chief Medical Officer for Scotland)
• Colin Sloey (National Co-ordinator, CMO Taskforce Unit, SG)
• Vicky Carmichael (Interim Unit Head, CMO Taskforce Unit, SG)
• Dr Edward Doyle (Senior Medical Adviser for Paediatrics, SG and Associate Medical Director for Women’s and Children’s Services, NHS Lothian)
• Carol Rogers (SPA National Lead Forensic Scientist - Sexual Offences)
• Martin Morrison (Chair of Quality Improvement Sub Group and Associate Director NHS National Services Scotland)
• Lucy Dexter (Deputy Unit Head, CMO Taskforce Unit, SG)
• Lesley Swanson (Child Protection, SG)
• Fil Capaldi (Detective Superintendent, Police Scotland)
• Professor Amjad Khan (Associate Post graduate Dean, NES)
• Carole Robinson (FMS Act Implementation Lead, CMO Taskforce Unit, SG)
• Michelle Harrity (CMO Taskforce Unit, SG)
• Ryan O’Donnell (CMO Taskforce Unit, SG)
• Jane Russell (CMO Taskforce Unit, SG)
• Jamie Lipton (Policy Division, COPFS)
• Susie Buchanan (Director, NHS National Services Scotland)
• Leanne Tee (Clinical Lead for Forensic Services, NHS Highland)
• Dr Duncan Alcock (Chair of the Information Governance Delivery Group)
• Mark Burgess (CMO Taskforce Unit, SG)
• Adam Bircham (CMO Taskforce Unit, SG)
• Anne Neilson (Director of Public Protection, NHS Lothian)
• Greig Chalmers (Interim Deputy Director, CMO Directorate, SG)
• Stefanie Dinwoodie (CMO Taskforce Unit, SG)

Apologies

• Jillian Galloway (Chair of the Self-referral Sub Group and NHS Tayside, Head of Justice Healthcare and Urgent Primary Care)
• Iona Colvin (Chief Social Work Advisor, SG)
• Katie Brown (Equally Safe Policy Coordinator, CoSLA)
• Sandy Brindley (Chief Executive, Rape Crisis Scotland)
• Katie Cosgrove (Gender Based Violence Programme Lead, NHS Health Scotland)
• DCS Samantha McCluskey (Police Scotland)
• Sybil Canavan (Director of Workforce Healthcare Improvement Scotland)
• Louise Wilson (Director of Public Health, NHS Orkney)
• Moira Price (Policy Division, COPFS)
• Karen Ritchie (Deputy Director of Evidence, Healthcare Improvement Scotland)
• Gary Jenkins (Chair of the Police Care Network, State Hospital GG&C)

Items and actions

• agenda

• minutes

Agenda

1. Welcome and introductions: Chair – Dr Gregor Smith (GS)
2. Minutes of previous meeting and Actions Log: GS
3. Matters arising: GS
4. Sub Group updates: GS plus subgroup chairs
5. Agreed actions / next steps: GS/CS
6. AOB: GS
7. Date of next meeting: GS

Minutes

Welcome, introductions and apologies

Dr Gregor Smith, Chief Medical Officer (CMO) welcomed members to the seventeenth meeting of the Taskforce.

GS informed members that Tansy Main (TM), Head of the CMO Taskforce Unit would be absent from the work of the Taskforce for a period of time due to a recent cancer diagnosis and conveyed his support and best wishes to TM.

GS noted his thanks to Vicky Carmichael (VC) for agreeing to return from maternity leave early to step in as CMO Taskforce Interim Unit Head.

GS asked all members to briefly introduce themselves to the group.

GS welcomed Susie Buchanan (SB) who would shortly be taking over the position of Chair of the Quality Improvement subgroup from Martin Morrison (MM).

GS extended his thanks to MM for all his hard work and effort as Chair of the QI subgroup particularly in getting the IT system back on track and to the stage it is now at.

GS noted the apologies listed above.

Minutes of the previous meeting and actions log

GS asked members to approve the previous minutes (paper one) as an accurate representation of the previous meeting. The previous minutes were approved with no objections.

GS asked members to highlight any possible omissions from the action log (paper two). No omissions were raised by members.

Matters arising

GS asked members to note the Matters Arising paper (paper three).

Survivor Reference Group

GS commented that, unfortunately, Sandy Brindley (SB) had sent her apologies but that she had provided a brief update for GS to share with the Taskforce. GS explained that the Survivor Reference Group (SRG) had met on 18 February 2021 where the retention period consultation had been discussed. The SRG felt that the proposed period was too short and the view was that there should be no time limit on the retention of samples. GS then invited Carole Robinson (CRo) to provide some further information on the consultation.

CRo explained that the SRG’s thoughts were a reiteration of the views of survivors which had been heard at the evidence session during stage one of the Forensic Medical Services Bill process. The views of the group were that if an indefinite retention period was not possible then a clear rationale should be set out for the agreed period.

CRo added that the 26 month retention period recommended by Scottish Ministers, following consideration of the Taskforce, looks to take an appropriate and proportionate approach. She outlined that the consultation paper sets out the reasons for the proposed 26 month period is based on the evidence and experience of self-referral services elsewhere, clinical guidance from the Faculty of Forensic & Legal Medicine and the views of survivors who the Taskforce engaged with during the initial consultation to inform the Act.

GS thanked CRo for the update.

Subgroup updates

Delivery and performance

GS invited Colin Sloey (CS) to provide an update on the Delivery & Performance RAG report (paper four).

CS highlighted that all boards had submitted their interim performance framework quarter three returns. He stated that he had collated the data and would provide a summary report to all boards on their performance to date over the reporting year. A narrative report will be provided alongside the summary, highlighting each board’s strengths and weaknesses in each area.

CS commented that TM had joined him at the NHS Board Chairs meeting in January 2021 and that they had received strong support from Board Chairs on the Taskforce agenda and on the progress that had been made to date.

CS explained that Board Chairs had requested board-specific performance reports and that he would work to produce these.

CS added that there had been significant progress made on the development of premises. He acknowledged that COVID-19 had caused delays to sites in NHS Greater Glasgow and Clyde and NHS Borders. He noted that NHS Lothian were making progress with its partners on the development of the ESMAC site and that it would shortly be in a position to move forward with the refurbishment.

CS moved on to talk about Information Governance matters. He stated that positive feedback had been received from the NHS Central Legal Office in getting recognition that Police Scotland were to be considered data controllers which was important for producing the correct Information Governance documentation.

CS noted that all delivery and performance risks were continuously monitored and managed.

GS commented that delays in progress due to COVID-19 were understandable, although he assured members that he and the Taskforce Unit were working with the affected boards to ensure progress on premises was still being made.

GS also assured members that the CMO’s Directorate’s internal governance had increased and improved since the last meeting which would give any of these risks a strong and transparent route of escalation if necessary.

CS asked members to approve the content of the Stocktake report (paper six) and endorse the key deliverables set out at the end of the report for the next six months. The group approved the Stocktake report.

CS summarised that it was evident from all the performance reviews that strong progress was being made in the delivery of the Taskforce ambitions, although it was acknowledged that there was still much work to be done.

CS highlighted the delivery of the national clinical IT system, which had a high level of clinical buy-in, and he advised that there had been feedback raised during user testing by the clinician group. CS stated that he was working with the project board, senior users and RIOMED to make changes. He noted that there may be a small amount of feedback that won’t be taken forward at this point but may be included in phase two of the project. CS reassured members that they were doing everything possible to make the system more user friendly.

CS highlighted the need to conclude board premises work as it was very important to ensure services are provided in an appropriate physical environment.

CS added that essential Information Governance documentation was being finalised as referenced earlier in the meeting. He also stated that the self-referral work was progressing well and that the consultation on the retention period was currently open to the public.

CS commented that important progress had been made by the Workforce and Training subgroup through the progression of the Nurse Sexual Offence Examiner Test of Change.

CS asked members for any questions.

MM commented that every IT system had teething problems during implementation and stated that there was an allowance within the Final Business Case for changes and alterations within the current financial year. He noted that the contract with RIOMED had a small change budget built in for each year to create capacity for ongoing changes in the system.

CS agreed with MM’s comments and explained that the biggest impact concerned the 10 step implementation plan and any resultant delays which would affect the go live date, requiring the system to be rolled out in phases rather than all at once.

GS agreed that it was a feature of user testing that certain glitches were highlighted when developing new systems.

CS then moved onto the Risk Register (paper eight).

CS drew attention to risks T.DP 2,3,4 & 8 that had been archived but would continue to be reviewed and detailed four new risks that had been added:

T.DP9 - There was a risk that the COVID-19 pandemic would reduce the capacity and capability of key personnel involved, either within the subgroup structures or within NHS Board teams, to deliver on agreed actions set out in subgroup Terms of Reference and/or Local Improvement Plans due to the redeployment of key staff into alternative frontline services. This could result in a delay to the achievement of key objectives and, in turn, delivery of the Taskforce five year plan.

T.DP10 - There was a risk that there may be delays in the implementation of the FMS IT System, Cellma, as a direct result of 1) delays in finalising the Hosting Environment within NSS. This was due to the staffing capacity required to prepare both the Production and Pre-production Environments which were scheduled in the 10 step plan to be concluded by 14 January. It was noted that there had been one week slippage on this to date. 2) The level of end user buy-in to the system due to the change process involved in moving from current systems; lack of clinician confidence that the system adds value to the process; difficulty in using the system during an examination; and time required after the examination to enter the information on to the system.

T.DP11  - There was a risk that a personal data breach (a breach of security leading to the accidental or unlawful destruction, loss, alteration, unauthorised disclosure of, or access to, personal data) may occur on the application. This means that NHS Boards may face reputational damage and a regulatory fine.

T.DP12 - There was a risk that it may not be possible to implement a common colposcopy interface across all Health Board settings due to variation in the specifications of colposcopes currently in use in NHS Boards.

CS asked members to review the risks on the register themselves. He stated all risks were actively being managed to bring them down to the lowest possible level.

GS explained that it was important that members were content with the risk approach. He went on to say that risks that were influenced by the pandemic were likely to fluctuate over time depending on the community transmission rates of Covid-19.

CS introduced the Taskforce Governance Diagram (paper nine) which explained the architecture of the CMO Taskforce Unit within the Scottish Government. Members were content with the governance structure paper.

New Action

CS to produce health board specific performance reports.

Legislation

GS noted that there were no open actions under the Legislation subgroup and that the RAG report (paper 10) was for noting.

GS congratulated everyone involved in delivering the Forensic Medical Services (FMS) Act which received Royal Assent on 20 January 2021. GS noted the effort and hard work that had gone into this important piece of legislation and explained it would make a real difference to survivors of rape and sexual assault, allowing them to self-refer across the whole of Scotland. 

GS recorded his thanks to Greig Walker (GW) and the Bill Team in taking this work forward. GS noted that GW had now returned to work within the SG Legal Directorate.

GS invited Carole Robinson (CRo), who had taken over as Chair of the Legislation subgroup, to provide a brief update on the Act.

CRo explained that implementation work has begun with the planning assumption that the Act will be commenced in November 2021.

CRo stated that she was working with solicitors and the Parliamentary Liaison Unit on timetabling as there were five pieces of secondary legislation to prepare, four of which were Scottish Statutory Instruments (for the Scottish Parliament to consider).  A Scotland Act Order in relation to the operation of the UK-wide police forces (British Transport Police, Ministry of Defence Police and the Armed Forces Police) was also being prepared for consideration by the UK Parliament.  

CRo explained that the consultation had now gone live regarding the self-referral retention period. The consultation was published on 5 February 2021 and runs until 30 April 2021.

CRo outlined that it was a short and very specific consultation and as such she was taking a proportionate approach towards engagement with stakeholders and survivors.

CRo asked members to respond to the consultation and promote it across their local networks. She explained that an easy read summary had also been produced to encourage more people to take part.

CRo explained that the work of the subgroup was on course at the moment and the RAG status was green. She noted that capacity issues were being monitored and she was working closely with subgroups across the Taskforce (especially the Self-Referral subgroup) and would update members if there were any alterations to the timetable. CRo advised that the subgroup was monitoring responses to the consultation as these were submitted which would allow her to update the Taskforce and subgroup Chairs ahead of the production of an analysis report. This would ensure that the risk of the consultation not producing a clear consensus on the retention period is well managed.      

GS thanked CRo for the update and noted three issues that would unfold throughout the year;

Firstly the Scottish election, which could provide a potential new Government and definitely a new Cabinet Secretary for Health and Sport as Ms Freeman was stepping down. Therefore, the Taskforce Unit’s early engagement with the new Ministerial Team was very important.

Secondly, GS noted the implementation of the Act was not an easy thing and to get the processes into place we would need to make sure we captured the hearts and minds of the people in our networks to make it work.

Thirdly, GS also referenced the consultation and echoed CRo’s comments and asked members to share the consultation widely so that we could capture as many views as possible on the retention period.

GS asked members for comments. There were no comments from members.

New action

The Taskforce Unit to ensure that it had early engagement with the new Executive and Ministerial Teams post-election.

Members were requested to promote the retention period consultation and encourage their colleagues and networks to take part.

 Workforce and training

GS explained there were three open actions for the Workforce and Training subgroup, with two of the three having been delayed due to COVID-19. He also asked members to note the Workforce RAG report (paper 11)

A robust proposal to be developed for the Remote Evidence Test of Change (ToC). Delayed due to COVID-19.

An update to be provided on the Community Pharmacy Test of Change. Also delayed due to COVID-19.

A letter from GS and the Chief Nursing Officer (CNO) to be drafted encouraging the forensic healthcare workforce to provide a sample to the DNA elimination database.

GS invited Lucy Dexter (LD) to comment on the open actions.

LD stated that two actions had been delayed due to COVID-19. She noted that the proposal for remote evidence ToC may not be needed as courts were using remote evidence during the pandemic. LD suggested this action be put on hold until COVID-19 restrictions were lifted. Members were content for this action to be put on hold.

LD then explained Katie Cosgrove (KG) was developing a revised proposal for the Community Pharmacy Test of Change with COVID-19 implications being considered. An update would be provided at the next Taskforce meeting.

LD explained that for the third action, Mark Burgess (MB) had drafted the letter with input from the Scottish Police Authority and this was now ready for internal clearance before being passed to GS and CNO for sign off.GS thanked the outgoing CNO, Fiona McQueen, for her contributions and welcomed the appointment of the new CNO, Amanda Croft. GS said he was looking forward to working with Amanda in the coming months.

GS noted the commencement in January 2021 of the Nurse Sexual Offence Examiner Test of Change (SOE ToC) at Archway as well as the first intake of students on the Advanced Forensic Practitioner course at Queen Margaret University (QMU.

GS then invited LD to provide an update on the work of the Workforce and Training subgroup in Sybil Canavan’s absence.

LD noted that the group was approaching a green RAG status across a number of areas.

LD highlighted to members that a Justice System Training Short Life Working Group would be set up beneath the Workforce and Training subgroup to build awareness and confidence within the legal profession in relation to the FMS Act.

LD explained the remit of the group had been drafted and Taskforce Unit members would engage with SG Justice colleagues to discuss the membership of the group before engaging with external stakeholders. She stated that a more detailed update would be provided at the next Taskforce meeting.

LD noted that 18 nurses from 10 health boards had matriculated on the course at QMU.

LD then commented that work was ongoing to understand how to attract more female Sexual Offence Examiners to the role while at the same time developing a cohort of forensically trained nurses through the ToC and QMU course. An update would be shared in due course on how the Training Framework would progress work around the recruitment and retention of SOEs.

LD added that the nurse SOE ToC had been impacted by COVID-19. One of the two nurses on the pilot had been unable to travel from England to physically take part in the ToC. A schedule of virtual training and review sessions ensured that she would be part of the ToC until she could travel to join the ToC in person once restrictions allowed.

LD noted that day one of the two day COPFS training had been undertaken virtually on 20 January 2021. The second day would be delivered in person once restrictions allowed.

LD explained that the NHS Education Scotland (NES) annual conference would take place virtually this year and the Taskforce specific session would be pre-recorded. She said that this was an opportunity to highlight the work that had been produced by the Taskforce Unit over the last year as well as to inform attendees about the work ahead.

LD added that self-referral protocol training was to be delivered by NES to all staff in SARCS ahead of the implementation of self–referral. NES had provided LD with a high level proposal and work would continue to develop the detail of the training.

LD highlighted a key risk around trying to get more SOEs, particularly female SOEs, in post across all boards.  LD then opened up to the group for any questions on the Workforce and Training work.

GS commended the volume of work ongoing under the Workforce and Training subgroup.

New action

LD/ KG to bring a revised proposal for the Community Pharmacy Test of Change with COVID-19 implications to the next Taskforce meeting.

LD to provide a detailed update to members at the next Taskforce meeting on the proposed Justice System Training Short Life Working Group.

LD to update members in due course on the Training Framework and how it will aim to progress work around the recruitment and retention of SOEs.

Self-Referralf

GS commented that Jillian Galloway (JG) was unable to attend the meeting and asked LD to provide an update. He noted there were no open actions for the subgroup and highlighted the RAG report (paper 12) for noting.

LD explained that the work of the Self-Referral subgroup was continuing at pace following the FMS Act receiving Royal Assent.

LD added that significant progress had been made under the National Protocol & Retention Task and Finish Group and the Access to Services Task and Finish Group.

LD noted that members would have received a draft of the national protocol (paper 13) and thanked members for comments that had been already received. The protocol was shared with Board Nominated Leads, inviting comments from them and the document would be updated based on the comments received.

LD stated that the plan was for the protocol to be finalised in the coming months as it was crucial to ensure that it was completed well in advance of the go live date.

Eddie Doyle (ED) asked whether the SG’s Child Protection Team had had sight of the protocol for comment.

LD commented that the Child Protection Team had had sight of the document and had provided comments and highlighted that it was important that the protocol only covered what was relevant for self-referral and many comments received may be better covered in the updated Clinical Pathways. LD advised that she would be working with Chloe Poole (CP) to make sure those comments were addressed in the revised pathways.

Lesley Swanson (LS) agreed that certain input was better suited to the Clinical Pathways and commented that the consultation for the revised National Guidance for Child Protection in Scotland had closed in January 2021 and responses were being collated and analysed and the guidance was to be finalised for publication in June 2021. The Children & Young People’s Pathway would require to be updated on the back of this.

GS asked members to feedback comments to LD or to Stef Dinwoodie (SD) by 05 March 2021.

LD also noted work had commenced with health board leads to develop a health board readiness assessment to ensure boards were ready for self-referral implementation and again welcomed any comments on the protocol.

LD added that an Options Appraisal was undertaken by the Access to Services Task and Finish group to scope a national service for a single point of contact. A formal agreement with NHS 24 was in the process of being completed for a national phone line alongside developing a website that would contain easily digestible information. A project board would be developed to take this work forward.

LD explained that a national campaign was also being planned and she would provide a greater update on this work at the next Taskforce meeting.

LD stated that the subgroup completed a detailed review of the risk register and risk scores had been reduced due to the good progress that had been made.

GS thanked LD for the update and asked members for comments. There were no comments from members.

New action

Members were asked to provide comments on the draft national protocol to LD by 05 March 2021.

LD to provide a detailed update at the next Taskforce meeting on the national campaign.

Quality improvement

GS again thanked MM for all the work he had contributed to the Taskforce before he handed over the Chairs role to SB. He asked members to note the RAG report (paper 14), that there were no open actions for the subgroup and asked MM to provide his final update.

MM recorded his thanks to all members involved in the Taskforce and QI subgroup.

MM stated that the amber RAG status reflected that there were certain issues that had emerged through the user testing of the IT system.

MM thanked all clinicians that had been committed to carrying out the testing work and added that RIOMED had been performing well.

MM added that the QI subgroup had been discussing the need for a formal annual report under the FMS Act. He noted that a detailed review of the data sharing protocol was to be signed off to go to Public Health Scotland (PHS) to ensure that PHS were able to report against the specified data.

GS invited SB to contribute to the update.

SB commented that she would be setting up meetings with the other subgroup leads to plan for any cross-over work that may affect the QI subgroup.

GS thanked MM and SB for their update and encouraged the other subgroup chairs to take time to introduce themselves to SB.

New action

Subgroup chairs were to take time to have introductory talks with new QI chair SB.

Clinical Pathways

GS asked members to note the RAG report (paper 15) and that there were no open actions for the subgroup. He asked ED to provide an update.

ED noted that most of the subgroup’s work had been previously touched upon and thanked everyone for their efforts to get the package of resources rolled out and the roadshows completed.

ED explained work had been quiet since the passing of the FMS Act and work would start to pick up in the following months with revisions of both pathways, especially on the children and young people’s side, in light of the UNCRC Bill, updated child protection guidance and the implementation of self-referral.

ED added that the Children & Young People’s Expert Group would continue under the same structure but the Clinical Pathways subgroup would become a Task and Finish Group.

ED explained that a meeting with the child protection managed clinical networks (MCN’s) would be forthcoming to understand the agenda for the rest of 2021.

GS thanked ED for his update and opened up to members for comments. There were no comments from members.

GS noted his thanks to those involved in producing the papers for the quality and content that they had provided.

Agreed actions / next steps

GS reviewed the agreed actions from the meeting as noted above.

CS added that the responsibilities of all subgroups were well defined and members should note ED’s comments on the Clinical Pathways subgroup’s transition into a Task and Finish Group which would be working closely with the Self-Referral subgroup. CS said it was important that subgroups progress their area of the agenda as planned.

AOB

GS asked for any other business but none was raised.

GS acknowledged how busy everyone had been and how difficult virtual working was for everyone.

GS said how pleased he was that momentum on the work of the Taskforce had continued despite the pandemic. GS noted it was important we continue this in the coming months and thanked members for their contributions.

Dates of next meeting

GS suggested the next meeting on 27 May was postponed until late June because of the Scottish Elections. This would allow for engagement with the new Ministerial Team ahead of the next Taskforce meeting. Members were content with this approach.

GS thanked members and closed the meeting.