Introduction

Healthcare and forensic medical services standards
Healthcare Improvement Scotland

The physical and psychological impacts of rape, sexual assault and child sexual abuse are considerable.1 Figures estimate that 3.6% of adults in Scotland have experienced at least one type of serious sexual assault since the age of 16.2 One in three women are likely to experience sexual violence.1 Other population groups which report higher prevalence of sexual assault include minority ethnic groups, people with disabilities, people with mental health problems and sex workers.1 Health and social inequalities can also impact recovery from traumatic events.

Figures indicate that at least one in twenty children in the UK have been sexually abused.3 Recorded crime statistics in Scotland for 2019-2020 indicate that at least 40% of the sexual crimes recorded by the police related to a victim under the age of 18. Official statistics also show an increase in online child sexual abuse, which includes grooming and exploitation.4

The prevalence of sexual violence is most accurately based on population-level studies.1 It remains underreported and in the majority of cases unreported. There are many reasons why people may delay disclosing or reporting incidents. Children may not recognise abuse and this may contribute to a delay in disclosure, sometimes until many years after the abuse took place. For others, societal and cultural attitudes can have a significant impact, which results in under-reporting.

People who have experienced rape, sexual assault or child sexual abuse may be re-traumatised by recounting their experiences. A disclosure of previous abuse may occur at any time or in any setting. Wherever and whenever a disclosure is made, a coordinated response that incorporates effective communication between services helps mitigate this risk of re-traumatisation.

Information and support

Support is available from NHS Scotland, Police Scotland and various charities and support organisations. For more information, refer to:

Policy context

In recent years, there has been an increased focus on taking a public health approach to tackling rape, sexual assault and child sexual abuse. This has been taken forward through the implementation of Scottish Government policies including Equally Safe and Bairns’ Hoose. The Scottish Government is committed to developing a trauma-informed and trauma-responsive workforce and services for people who have experienced rape, sexual assault or child sexual abuse. The introduction of the trauma-informed justice framework acknowledges the commitment to embed trauma-informed principles into everyday practice. The framework provides complainers with increased confidence that they will be listened to, and legislation used effectively in response to their disclosure.

In 2017, a Chief Medical Officer’s Taskforce was set up with the vision to deliver consistent, person-centred, trauma-informed healthcare and forensic medical services for anyone who has experienced rape, sexual assault or child sexual abuse. The five-year work of the Taskforce led to the development and implementation of legislation, standards and indicators and clinical pathways.

In April 2022, the Forensic Medical Services (Victims of Sexual Offences) (Scotland) 2021 Act commenced. The Act provides the statutory basis for the provision of certain forensic medical services and associated healthcare and support. This includes the person being referred to other services provided by NHS boards.5

The Sexual Assault Response Coordination Service (SARCS) Network (part of NHS National Services Scotland) was established by the Scottish Government to:

  • provide NHS leadership and strategic oversight of services
  • support the continuous improvement of healthcare and forensic medical services
  • coordinate the collation of a range of data, including patient feedback
  • support the delivery of coordinated holistic, person-centred, trauma-informed healthcare and forensic medical services across Scotland.

In 2023, Healthcare Improvement Scotland undertook a review of the 2017 standards for healthcare and forensic medical services for people who have experienced rape, sexual assault or child sexual abuse. The review recommended that the standards be updated to reflect changes in legislation, policy and service delivery. This led to Healthcare Improvement Scotland being commissioned by Scottish Government to review the 2017 standards. For further information on the updates to the standards, refer to Healthcare Improvement Scotland website.

The standards are mapped to key legislation and policy.6,7 This includes the principles of person-centred and trauma-informed care,8,9 human rights and equality.10-14 These standards should be considered within the wider policy context and approach to gender-based violence.15 Services and staff should be aware of the possible wider context of gender-based violence, including coercive control, domestic homicide and suicide, and non-fatal strangulation and that distress as a potential corroborating factor should be understood.16

The standards should be read alongside the following:

Healthcare and forensic medical services: adults

In Scotland, a Sexual Assault Response Coordination Service (SARCS) is available in each territorial NHS board. This dedicated service provides trauma-informed care and support, including forensic medical examination services, in the days following an incident. The service can also coordinate support for people with non-recent disclosure, for example through signposting to appropriate services.

People over the age of 16 can self-refer to a SARCS through NHS 24 or may be referred, following initial disclosure, by another healthcare professional. If the person reports the assault to the police first, the police will make the necessary arrangements for them to access a SARCS.

The standards should be read alongside the following:

Healthcare and forensic medical services: children and young people

It is the Scottish Government’s ambition that all children in Scotland who have been victims or witnesses of abuse or violence have access to trauma-informed recovery, support and justice.17 The Bairns’ Hoose standards provide an operational and organisational framework for a new, high-quality model for the response to abuse which is designed around the needs and rights of children. The Scottish Government has set out the scope for who will access Bairns’ Hoose. This includes all children under the age of 18 in Scotland who may have been victims or witnesses of abuse. This includes sexual abuse or violence.

The aim of the Bairns’ Hoose model is to provide a child-friendly environment for assessments and investigative interviews which can help to reduce the child’s anxiety and enable effective coordination of follow-up support. This reduces the risk of the child experiencing further trauma and enables them to start recovering from their experiences from the point of disclosure.18

NHS boards are a key delivery partner for Bairns’ Hoose. Bairns’ Hoose is an approach to care, protection and child-friendly justice that requires leadership and effective collaboration between agencies. Bairns’ Hoose partnerships across Scotland are currently in development.

The standards should be read alongside the following:

Scope of the standards

The standards apply:

  • wherever people may disclose that they have experienced rape, sexual assault or child sexual abuse
  • to anyone who has engaged with healthcare and forensic medical services.

The standards cover adults, young people and children. The standards also refer to care partners and representatives of people accessing services.

The standards aim to support current and future service provision and improvement in the delivery and coordination of care and support for adults, young people and children who have experienced rape, sexual assault or child sexual abuse. The standards cover all NHS staff involved in the multidisciplinary delivery of relevant services including locum staff, contracted staff and those covered by reciprocal work arrangements.

The standards cover:

  • trauma informed care and shared decision making
  • collaborative leadership and governance
  • staff training, education and support
  • supporting and responding to initial disclosure: adults
  • access to coordinated healthcare and support: adults
  • forensic medical examination: adults
  • healthcare, medical examinations and support for children and young people.

The standards should be read as a collective rather than linear document. For example, the information noted in Standard 4 should be provided in line with the principles set out in Standard 1.

These standards are intended to support children and young people who have experienced rape, sexual assault or child sexual abuse and should be implemented alongside the Bairns’ Hoose standards. Standard 7 specifically reflects the additional responsibilities and requirements for services supporting children and young people.

The Bairns’ Hoose standards cover:

  • key principles
  • collaborative leadership and governance
  • inclusive access
  • design and environment
  • planning for children
  • interviews in the Bairns’ Hoose
  • support through the court and legal process
  • health and wellbeing
  • therapeutic recovery services
  • multidisciplinary staff training and support
  • prevention, sharing knowledge and learning from good practice.

Format of the standards

All HIS standards follow the same format. Each standard includes:

  • an overarching standard statement
  • a rationale explaining why the standard is important
  • a list of criteria describing what is needed to meet the standard
  • what the standard means if you are a person receiving care and support
  • what the standard means if you are a member of staff
  • what the standard means for organisations
  • examples of what meeting the standard looks like in practice.

Implementation

Healthcare Improvement Scotland has published these standards to inform self evaluation and improvement. Healthcare Improvement Scotland may use these standards in a range of assurance and inspection activities. They may be used to review the quality and registration, where appropriate, of health and social care services.

The standards sit alongside Healthcare Improvement Scotland’s healthcare and forensic medical services for people who have experienced rape or sexual assault indicators. The indicators support wider monitoring of services and provide data which is published annually by Public Health Scotland.

The Scottish Government will monitor NHS board performance against the Healthcare Improvement Scotland standards and indicators,19, 20 in line with the NHS Scotland Support and Intervention Framework.

The Healthcare Improvement Scotland Quality Management System (QMS) Framework supports health and social care organisations to apply a consistent and coordinated approach to the management of the quality of health and care services. More information about this framework is available on the Healthcare Improvement Scotland website.

Terminology

Wherever possible, we have incorporated generic terminology that can be applied across all settings. All terminology used is defined in the glossary.