Read Standard 6: Forensic medical examination: adults

Standard statement

NHS boards ensure forensic medical examinations are high-quality, person-centred and trauma informed.

Rationale

Adults who disclose having been raped or sexually assaulted, may be offered a timely forensic medical examination through the SARCS.^26,44 Staff will speak to the person about why an examination is offered and what to expect. The person does not need to report to the police to have an examination. The decision to proceed to examination will follow discussion with the person and a healthcare assessment.

To minimise trauma and aid recovery, a trauma-informed and person-centred approach, which puts the person’s best interests at the centre, should be taken for all forensic medical examinations. The key principles of communication, information provision and support are covered in Standard 1. Examinations are carried out in age-appropriate, person-centred and trauma-informed healthcare facilities. Facilities and equipment for examinations should reflect the different needs of all people who use the service, including additional physical, sensory and communication needs. Informed consent and provision of information to the person is vital throughout the examination (see Standard 1).

Examinations are carried out by a trained sexual offence examiner and supported by a forensically-trained nurse. NHS boards have a duty to offer people a preference of sex of the sexual offences examiner involved in their care and should demonstrate and document how this preference was met.^25,44

The timing of the forensic medical examination should be person centred, trauma informed and put the person at the centre of all decisions. The timing should align with national timelines outlined in the quality indicators. Where there is a delay or exceptions in meeting the indicators, these should be fully documented, recorded in the national proformas and shared with appropriate partners. The person should always be kept informed of any delays to the examination.

Staff should maintain and develop competencies in line with their roles and responsibilities set out in professional guidance, national clinical pathways and service specifications.^{25,26,28,44,45}

Staff should follow the national DNA decontamination protocol and comply with the relevant Scottish Police Authority environmental monitoring protocols.⁴⁶ Evidence obtained from the forensic medical examination is retained in line with relevant legislation, protocols and guidance.²⁵^,26,47 People should be informed of timelines around forensic sample storage.

This standard may, where considered appropriate, apply to people aged 16 and over who have self-referred to SARCS through NHS 24. For young people aged 16 and 17, professional judgement should be used to decide whether the adult clinical pathway or the pathway for children and young people is most appropriate. Decisions about children must be made in the child or young person’s best interest, with their input where appropriate.⁴⁸

Criteria

6.1

NHS boards provide timely and coordinated forensic medical examinations in line with national guidance and pathways.

6.2

People can access a timely, trauma-informed and person-centred forensic medical examination and:

are provided with information about their appointment at a SARCS
are advised about timings
are advised what to bring with them
can bring someone with them to the appointment
are able to pause or stop the examination at any time
are offered the opportunity to request the sex of sexual offence examiner involved in their care²⁰
are provided with support and information to make decisions that are right for them
have access to a nurse coordinator to arrange their onward care and support, as appropriate.

6.3

People will receive information about what happens to any evidence obtained from the forensic medical examination and any related consent requirements.

6.4

Where a person has additional support or communication needs, services will work in partnership to meet these wherever possible.

6.5

NHS boards and staff ensure that forensic medical examinations are:

in the best interest of the person
trauma informed
undertaken in line with national timeframes,²⁰ the clinical pathway(s) and professional guidance.

6.6

NHS boards and staff involved in forensic medical examinations ensure that:

all relevant data points are captured through the national proformas and in line with the national indicators²⁰
delays or exception reporting to the provision of examinations are documented and shared with partner agencies
regular communication is maintained with the person to minimise distress and address any concerns they may have.

6.7

Ongoing informed consent is actively sought for each element of the examination in line with the national clinical pathway.

6.8

Forensic medical examinations are carried out by a trained sexual offence examiner in line with clinical guidance, pathways and protocols.

6.9

A forensically-trained nurse is present during all forensic medical examinations.

6.10

To maintain the forensic integrity of the examination, protocols are in place to ensure examinations are undertaken:⁴⁷

where there is no risk that the person will come into contact with the suspect(s)
by a different sexual offence examiner from the one who examined the suspect.

6.11

Forensic medical examinations are carried out in a SARCS:

that is forensically secure and compliant with the national service specification²⁵
that has been decontaminated in line with the national decontamination protocol and other guidance⁴⁶
with access to the relevant equipment and supplies to support examination
that has appropriate adaptations for people with additional needs where possible.

Exceptions to this, for example, where adaptations are not available in a forensically-secure environment such as a care home, are recorded, shared with partner agencies (where relevant) and discussed with the person or their care partner or representative.

6.12

The location of the examination, and facilities, should maximise privacy and safety for the person.

6.13

Staff ensure that the collection, retention, destruction and transfer of evidence to the police, is carried out in line with national protocols and legislation.⁴⁷^,49

6.14

For self-referral cases, any paper copies of the forensic forms should be stored securely together with any evidence retained, in line with the national self-referral protocol.

6.15

There are systems in place to ensure that facilities, equipment and peripherals used in the provision of forensic medical services have:

regular environmental monitoring to ensure forensic integrity
planned maintenance and replacement schedules
mechanisms for routine checks and testing.

What does this standard mean for...

What does the standard mean for people receiving care and support?

You will be supported by healthcare professionals when you arrive and throughout your appointment.
Your healthcare professional will advise you what you need to bring with you to the appointment.
Showers and toiletries are available if you wish to use them after the examination. You can bring your own toiletries and clothing if you want.
You will be offered the opportunity to request an examiner of the sex you feel most comfortable with. Every effort will be made to meet this request.
You can decide to pause or stop your appointment or examination at any time.
During the examination, samples will be taken as part of the evidence-gathering process.
If you self-refer, you will know how long evidence related to your care will be kept for.

What does the standard mean for staff?

Staff, in line with roles, responsibilities and workplace setting:

have access to education and training in the requirements of relevant national protocols, pathways, forms and guidance
provide support and information that meets the needs of the person
can access suitable, high-quality and maintained facilities and equipment
ensure all documentation is stored and shared appropriately.

What does the standard mean for the NHS board?

NHS boards:

ensure the provision of forensic medical examinations are in line with national guidance and pathways
ensure service design and delivery of forensic medical examinations is informed by the national trauma framework and feedback from people who have accessed the service
have well-coordinated referral pathways to ensure timely access to a forensic medical examination
monitor and review data relating to the provision of forensic medical examinations
ensure workforce arrangements are in place for forensic medical examinations, including offering choice of sex of the examiner
provide high-quality equipment and healthcare facilities that are decontaminated in line with national protocols and subject to regular environmental monitoring.

Examples of what meeting this standard might look like

Documentation relating to decision making around the forensic medical examination, including the involvement of multiagency staff and professionals, where appropriate.
Documentation and monitoring of who is undertaking examinations.
Clear documentation recording any reasons where access to a forensic medical examination within national timelines of referral or contact with a SARCS has not been met. For example, due to the person’s choice or decision, capacity to consent or where significant travel is involved.
Documentation demonstrating all forensic medical examinations have been undertaken by sexual offence examiners with a forensically trained nurse in attendance.
Audit and review of learning from data on timings of medical examinations and where the person’s preference of sex of examiner is not met.
Environmental monitoring documentation to demonstrate compliance with the national decontamination protocol.
Accessible and trauma informed facilities and equipment with appropriate washing facilities, refreshments and replacement clothing.
Information and data on the availability of high-quality facilities for medical examinations, which comply with national specifications and protocols.
Evidence of appropriate storage, retention, destruction and transfer of evidence in line with legislation and protocols.
Evidence of pathways to support people with additional needs, including specialist equipment such as a hoist.