1. Executive Summary
In 2012, a Memorandum of Understanding was agreed between the NHS and the Police which set out the partnership arrangements for custody healthcare and forensic medical services. The transfer of responsibility for delivery of these services (from the Police to the NHS) took place in April 2014. Responsibility for health care in police custody is a function and responsibility of Health Boards under the Health Service (Scotland) Act 1978.
Forensic medical services (which cover the examination and collection of forensic samples from alleged perpetrators and victims of crime (including children) - are currently delivered by health boards but remain a function and responsibility of the Scottish Police Authority under section 31 of the Police and Fire Reform (Scotland) Act 2012.
In March 2017, the Chief Medical Officer (CMO) for Scotland, Dr Catherine Calderwood, was asked by the Cabinet Secretary for Health and Sport and the Cabinet Secretary for Justice, to chair a new Taskforce to set the vision and provide the national leadership required to support Health Boards to deliver consistent, person centred, trauma informed healthcare and forensic medical services and access to recovery for anyone who has experienced rape and sexual assault in Scotland, as close as possible to the point of need.
In October 2017, the CMO published a high level work plan which sets out a clear vision of how the Taskforce and its five sub groups wish to drive forward improvements over the next five years. The design and delivery of services sub group was tasked with making a recommendation to the Taskforce to ensure person centred, trauma informed, sustainable and accessible services across Scotland.
That work has now led to this formal options appraisal of the service model and service configuration. The scope for the option appraisal process was to include services for children, young people and adults.
In May 2018, at a meeting of the Taskforce it was agreed that a rigorous improvement approach was required to develop and appraise new service options for service delivery and give consideration to the service locations to ensure this criteria is met and progresses the vision for the taskforce outputs.
The Taskforce agreed to the appointment of an independent options appraisal lead, Kate Bell, NHS Lanarkshire to work closely with a sub-group of the taskforce as a short life working group (SLWG) chaired by Professor Elizabeth Ireland. Tansy Main, Rape and Sexual Assault Taskforce Lead and Jana Sweeney, Rape and Sexual Assault Taskforce have made a significant contribution to the planning, delivery and analysis of the option appraisal process.
This report delivers the remit set out by the Taskforce (May, 2018) to engage with a wide range of stakeholders in order to carry out a robust option appraisal process reflective of survivors of sexual assault & rape across Scotland.
The Option Appraisal event took the stakeholder group through a rigorous decision making process with recommended outcomes for the a multi-agency approach to service delivery that will ensure all those working in the field of forensic medical examination, social work and third sector organisations can deliver the highest quality of care, treatment and support to survivors. The event also recommended a service configuration model which features both a strong locally commissioned service with ongoing support for recovery within a model that will see centres of excellence developed across Scotland to meet the volume of need and ensure the best utilisation of staff required to meet the necessary standards and guidelines.
On June 27th, 2018 the all stakeholder engagement option appraisal process took place and arrived at the following recommendations:-
The service change proposals for forensic medical and healthcare services for approval by the CMO Taskforce (7th August, 2018) are:
- The recommended option for service delivery is:
Option 4 -Multi-Agency Centre/co-ordinated services for adults, children and young people who have experienced sexual assault and rape (acute and historic).
- The recommended configuration model for service delivery is:
Model D - Local services which meet the HIS standards, delivered as close as possible to the point of need and supported by a centre of excellence.
Please Note: Centres and/or co-ordinated services will be developed as close as possible to the point of need owned, funded and delivered by the relevant Health Board (s) and Integrated Joint Boards. Island services as well as rural and remote mainland communities to be supported by centres of excellence. "Multi agency centres" and "centres of excellence" do not have to be a physical location. These terms can describe a collection of services delivered out with a physical space. The taskforce will explore in more detail how the option will meet in particular, the needs of children.
Model D has been re-worded to reflect the participants' unanimous views shared at the option appraisal stakeholder event that the primary emphasis should be on locally delivered services, supported as appropriate by a centre of excellence. See page 13 for original wording.