Forensic Paediatrics A Report by the Short Life Working Group

Report outlining findings and recommendations from expert group


Chapter 5 Governance, Data Collection and Activity

1. Data for the number of single and joint examinations in Scotland is not routinely collected across Scotland, and definitions are not standardised. However, for the SLWG the figures for 2010 were collated by the Chair after personal correspondence. In addition the MCN in SEAT had already establishes a database for all examinations in the south east.

Table 3 number of medical examinations for CSA

Date/source of statistics Board/service In Hours
(0900 - 1700)
Out of Hours
(1700 - 0900 plus weekends)
Comments Total by Region
Board GGC (under 13s) 30 8
Archway, Jan - Dec 2010 Archway (13-16 yrs plus LAAC) 13
(GGC: 8,
A&A: 3,
Lanarkshire: 1,
Highland: 1)
30
(GGC: 22,
A&A: 2,
Lanarkshire: 5,
Highland: 1)
Board Forth Valley 23 2
Board Lanarkshire 21 3
Board Ayrshire & Arran 8 ?
Board Dumfries & Galloway 2 0
Total West 97 43 140
Fife 26 3
SEAT Lothian RHSC 91 27 Vega Suite 24 Includes paediatric gynaecological examinations
Borders 18 2
Total SEAT 135 32 167
North Grampian 80 4 Includes 13-16yr olds
North Tayside 7 1 Tayside has opted to be part of NoS MCN
North Highland 19 4 Includes 13-16yr olds
North Orkney & Shetland
Total North 106 9 115

2. SLWG data suggests 422 examinations for Child Sexual Abuse (CSA) were carried out in 2009-2010. Of these, 84 were out of hours examinations, a large number of which were in the 13-16 year old age group. This age group often present with signs and symptoms similar to adult acute sexual assault and require similar services and follow up (e.g. for sexual health advice, blood borne virus screening, other contraceptive advice).

3. Clinical and financial governance of health services provided by NHSScotland is the responsibility of NHS Boards. The NHS Quality Strategy underlines the importance of clinical governance and sets out how it can support quality and minimise risks.

Scrutiny of healthcare and child protection

4. Gaps in service standards were previously highlighted in HMiE Children's Services Inspection reports from Angus Council, Argyll and Bute, South Ayrshire, Orkney, Western Isles, East Ayrshire and West Dunbartonshire.

5. The HMIE report "How well do we protect Scotland's children?" summarised integrated inspection reports of children's services from 2005-2009. The following comments were made regarding medical examinations:

"In most areas suitably trained doctors were available to carry out medical examinations and, in most areas, these were carried out without delay. In the few areas where there were delays in carrying out medical examinations of children, this was associated with a lack of clear guidance to staff or, was due to staff failing to follow established guidance or procedures. However, paediatricians were not always consulted appropriately when a medical examination of the child was a consideration. In these circumstances the wider health needs of children were not always considered or met well. In some areas children were examined by doctors without the required experience or training. In a few areas children were not always examined in appropriate facilities."

6. The Care Inspectorate is the independent scrutiny and improvement body for care and children's services. Healthcare Improvement Scotland (HIS) scrutinises healthcare services. HIS and the Care Inspectorate scrutinise these areas previously done by;

  • Her Majesty's Inspectorate of Education (HMIE);
  • NHS Quality Improvement Scotland (NHS QIS);
  • Social Work Inspection Agency (SWIA); and
  • The Care Commission.

MCN Governance

7. The three MCN's in Scotland are at different stages of evolution, for example South East and Tayside (SEAT) MCN deals with CSA only. All three received funding from the National Delivery Plan for Specialist Children's Services via regional planning groups, and are subject to scrutiny and governance from the regional planning groups. It is planned that Healthcare Improvement Scotland (HIS) will participate in the performance assessment of some MCNs.

8. In addition, MCN networks have their own governance requirements and arrangements. NHS HIS provides guidance and support for networks on implementing a programme of quality assurance. Network standards can be based on existing national standards or, where these do not exist, drawn up and agreed by the networks.

9. Given that the three networks already work collaboratively and intend to do so to a greater degree in future, there is an appetite for overall governance of the child protection networks. The suggestion from the networks themselves is to form a collaborative group comprising regional MCN leads and others which would report to the Child and Young People's Health Support Group.

Telemedicine

10. A project has been completed looking at the use of telemedicine conducted by the Scottish Centre for Telehealth in child protection in particular whether the required standards of evidence could still be met. The quality of the recording would be a crucial aspect for evidential purposes. The legal and ethical frameworks which govern forensic data management of physically or sexually abused children are complex. The project tested the efficacy of telemedicine and the reliability and robustness of the network. It concluded that it is technically possible to share images but infrastructure problems require improving to ensure optimal reliability and discussion with COPFS regarding evidential integrity is ongoing.

Contact

Email: Fiona McKinlay

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