4. Case for Change
As highlighted by the HMICS report, there is currently disparity in the quality and accessibility of services across Scotland.
Rape, sexual assault and all forms of gender based violence are a serious public health issue which is recognised as a violation of the most fundamental human rights. It can have short- and long-term consequences on women's physical, mental, sexual and reproductive health. Whether sexual violence occurs in the context of an intimate partnership, within the larger family or community structure, or during times of conflict, it is a deeply violating and painful experience for the survivor.'
The service model may vary according to the demographic or geographic nature of an area; however the resources and key elements of the current services try to ensure consistency of provision for service users nationally, with access to advice and information available 24/7.
The Taskforce and its sub groups are already progressing many different strands of work which will help NHS Boards and multi-agency partners to deliver the preferred model of service (the what) as well as the configuration of the service (the where/how many).
A Forensic Medical Examination (FME) of a victim of sexual crime has a dual purpose of addressing the clinical and health needs of the victim - at a time of significant trauma - as well as to collect forensic samples in support of a potential criminal investigation. However, delivery of these services has primarily been viewed through a justice, rather than a health and care lens. We know through feedback from people with lived experience of rape and sexual assault, that some individuals have received a health care response which has not been trauma informed or person centred. This can have a significant impact on their immediate and long term physical and psychological recovery.
These issues were highlighted in a HM Inspectorate of Constabulary in Scotland (HMICS) report published in March 2017 (A strategic overview of the provision of forensic medical and health care services to victims of sexual crime). The review highlighted significant gaps and disparity across the country and made a number of recommendations to improve this.
The HMICS report stated:
"The evidence in this review confirms the need for national standards, and highlights wider issues affecting the quality of service delivered to victims of sexual crime. The review shows that significant disparity in the services currently provided, and supports the need for further investment in healthcare professionals, premises, and equipment. The priority for forensic medical examinations should be to address the immediate health needs and future recovery of patients, with the contribution to potential criminal justice proceedings being an important but not the sole consideration."
At the moment, there are many different ways in which people can access a forensic medical examination and associated healthcare services following a rape or sexual assault. Adults who choose to report the crime can access these services through the Police. Some adults choose not to report to the police and self-refer to these services (where they are available). Others may contact Rape Crisis Scotland, their GP, their local sexual health clinic, NHS 24 (111 number) or the Breathing Space helpline for information.
An inter-agency referral discussion will take place between police and health and social work partners to determine the most appropriate course of action for a child or young person who discloses a rape or sexual assault. This may include referral for a forensic medical examination if appropriate. For children and young people, this would normally take place within a hospital setting by a Paediatrician and Forensic Medical Examiner.
The compelling Case for Change was set out in full as stand-alone document shared as pre reading material with all participants of the option appraisal event.
The recommendations of the options appraisal exercise is intended to help inform lasting and meaningful change for people who have experienced the trauma of sexual assault or rape. There is no doubt that they should be afforded the best possible healthcare response that the NHS (together with multi-agency partners) can provide and that is what we are striving to deliver.
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