Section 1 - Case Study 1

Case Study 1

Forensic medical services provided to victims of sexual crime in the islands/rural communities versus the mainland.

In 2016 HMICS conducted a review into forensic medical services provided to victims of sexual crime. The findings were published in 2017 and recommendations for National standards were created. One issue raised was the disparity in healthcare provision due to geography, particularly when comparing services provided to the islands/rural communities versus the mainland.

The Chief Medical Officer (CMO) taskforce was established in 2017 and a five-year, high-level plan was devised to set out a vision for improvements. This work was underpinned by new legislation, in the form of the Forensic Medical Services (Victims of sexual offences) (Scotland) Act 2021 which places a statutory duty on all NHS health boards to provide forensic medical services and access to ‘self-referral’ medical examinations. SPA Forensic Services was represented on the CMO taskforce and worked collaboratively with partners to drive these improvements. In all discussions, there was cognisance of the requirement to ensure that any proposed improvements would create an equitable service for all, regardless of geography.

Some of the notable improvements in terms of remote communities are as follows.

Self-referral medical examinations are now available to those living in island/rural communities and not just the mainland.

Appropriate, NHS run forensic medical examination facilities are now available to those living in rural/island communities. Ensuring such facilities are suitable for forensic sampling requires effective DNA decontamination supported by an environmental monitoring (EM) regime. SPA devised a DNA decontamination protocol for all NHS health boards and provided training on DNA decontamination and environmental monitoring. Training was delivered online and bespoke videos were created to ensure those in remote communities had full access to training. Additional support was provided by online meetings during ‘go-live’ and continues to be provided by a SPOC within SPA Forensic Services.

All samples taken for EM sampling are analysed within the SPA laboratory at the Scottish Crime Campus. To ensure the veracity of these samples a process was implemented by SPA whereby ‘double ended’ swabs, which can be sealed and air dried were utilised. Due to this EM samples are posted to SPA with no requirement for freezing. This removes the onus from remote health boards to freeze or air-dry samples within their facilities.

SPA Forensic Services assisted in the training of sex offence examiners (SOE) in the photography of medical injuries for instances of self-referral medical examinations. This allows for greater flexibility in recording injuries in remote areas. SPA is also involved in the pilot to train specialist forensic nurses, supporting the QMU PgCert Advanced Forensic Practice. Nurses from remote health boards have gained or are working towards this qualification. If the pilot is successful this will result in an increase in the number of SOE, providing an improved service to those living in island/rural communities.