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Medical forensics specialist group minutes: 16 November 2020

Updated 5 July 2022

Note of the twelfth meeting held on 16 November 2020, via teleconference.

1. Welcome and introductions

1.1. The Chair welcomed all to the meeting and welcomed three new members to the group. The new members included representatives from Forensic Physician and Specialist in Forensic & Legal Medicine, NPCC custody, and the Metropolitan Police Service (MPS). See Annex A for a list of representative organisations present.

2. Minutes from previous meeting

2.1. The minutes of the previous meeting held on 2nd June 2020 were approved as an accurate reflection of the discussion held, and subject to a minor amendment to section 5.3 the secretariat was asked to publish them.

Action 1: Secretariat to amend section 5.3 the lessons learnt document would now be available in Autumn 2022, and then publish the June 2020 MFSG meeting minutes.

3. Updates on previous actions

3.1. The following matters arising from the previous MFSG meeting were discussed:

Action log

3.2. Action 9: FSR and CQC representative to update the “Analysis covering what the CQC and FSR/UKAS regimes will respectively cover and any gaps” document. The Regulator and the CQC agreed to discuss this separately and update the group. The Faculty of Forensic & Legal Medicine (FFLM) representative queried if the document would include specific case examples, and the specific inspection process at each stage of the case. It was suggested an adult case and a child case could be used to identify which organisation/body would be responsible for them. The Regulator agreed and explained initially the document would be a spreadsheet identifying for which areas the FSR, CQC, and UKAS were responsible for within the forensic medical examination process. The Regulator suggested once this had been completed, they could look at mapping this to specific cases, and would welcome assistance from the FFLM representative. This was agreed.

3.3. Action 14: FSR to share EMSOU pilot report with the group. The report had been circulated to members, however it needed to be circulated to the new members.

Action 2: Secretariat to re-circulate the EMSOU pilot report for the new members.

Terms of reference

3.4. The members were asked if they had any questions or comments on the MFSG terms of reference (ToR) that had recently been published on the Regulator’s website. The ToR would be reviewed once a year. The Chair commented as there were new members the ToR may need to be reviewed and updated. The Chair highlighted that the name of NHS England (NHSE), listed under the composition section, had been recently updated to NHS England & Improvement (NHSE&I).

Action 3: FSRU/secretariat to update NHSE to NHSE&I in the next update of the MFSG ToR.

Custody standards requirements

3.5. The Regulator presented this item. In 2016 the FSR had published guidance on minimising contamination in both SARCs and Custody environments. The Regulator acknowledged custody medical facilities were not the most suitable facilities to take intimate swabs from suspects. It was noted that few police forces had made any progress on implementing anti-contamination practices in their custody settings, the Regulator proposed developing a separate standard for that area.

3.6. Before developing a standard for custody, it would be essential to identify the risks associated with taking intimate samples from male and female suspects in a custody environment. The greatest risk would be contamination of the samples taken, and other risks included mislabelling of samples.

3.7. The standard would address all the risks identified and would provide a proportionate set of requirements to address these risks, which would improve quality of evidence.

3.8. Once the standard had been developed, it would need to be decided how to assess custody for compliance against the requirements, once published. SARCs will be required to obtain accreditation against the international standard ISO by the assessment body UKAS, and the Regulator suggested this may not be the most suitable route for custody.

3.9. The Regulator had spoken to HM Inspectorate of Constabulary and Fire & Rescue Services (HMICFRS) who inspect police forces including custody and could include forensic medical examinations in custody. HMICFRS would be open to working with the FSR on compliance to the custody standard.

3.10. Members agreed that intimate samples should be collected following the same requirements in both SARCs and custody. Members also highlighted that suspects examined in police custody should be examined against the same standards/anti-contamination practices as individuals examined in SARCs.

3.11. Members agreed starting with a risk-based approach for custody with the aim of establishing a similar accreditation process to the SARCs. The Regulator acknowledged this and noted that it was one of the options being considered. It was important to identify the risks specific to custody first, rather than automatically applying the same requirements as SARCs, as the risks may be different for custody. Once the risks had been identified the standard can then be developed, and then the best inspection regime for those risks identified for custody.

3.12. It was agreed a sub group would be established for developing the custody standard. The sub group would start by identifying the risks specific to custody, followed by deciding what the requirements should be, and finally identify the best compliance and assessment for the custody standard. Once the Group had been formed an initial meeting would be held to agree the terms of reference, and work plan. A member suggested that the group include a representative from the CPS to provide a legal preceptive specifically around the anti-contamination practices in custody. This was agreed.

Action 4: Members to volunteer or nominate representatives to join the sub-group to develop the custody standard.

Action 5: FSRU to invite CPS/judiciary to sit on the custody sub group.

Action 6: FSRU to plan a meeting with the sub group in early 2021 to agree terms of reference and work plan to initiate work.

4. Review of Work Plan

Agree and sign off additions

4.1. The MFSG reviewed the MFSG 2020-2022 work programme.

4.2. The UKAS SARC pilot and standard estimated timescales were discussed. The UKAS representative agreed the pilot start date should now be Spring 2021, and the lessons learnt document Autumn 2022.

Action 7: FSRU to update workplan – UKAS pilot to Spring 2021, and lessons learnt Autumn 2022.

4.3. The members agreed the DNA anti-contamination – Forensic Medical Examination Guidance document, FSR-G-207, should be reviewed in Autumn 2022.

Action 8: FSRU to add review of DNA anti-contamination (FSR-G-207) in Autumn 2022.

4.4. It was agreed the review of the FSR SARC standard and guidance would commence in August 2022, and published in Autumn 2023.

Action 9: FSRU to update the review of FSR SARC standard and guidance to commence in August 2022 and publish Autumn 2023.

4.5. It was proposed the FSR standard for custody suites work would commence in Spring 2021 and be published in Winter 2022/Spring 2023. Members agreed with the new proposed dates.

Action 10: FSRU to update the FSR standard for custody suite to commence Spring 2021 and publish Winter 2022/Spring 2023.

4.6. It was agreed that the work plan and MFSG ToR would be reviewed at the next meeting in Spring 2021.

5. UKAS update

5.1. The UKAS pilot for SARC standards and guidance was progressing well. UKAS had held monthly Q&A drop in sessions for organisations interested in participating in the pilot. The main questions asked concerned legal entities, building facilities requirements, and custody suite accreditation. An FAQs document had been produced and was available on the UKAS website.

5.2. UKAS had received six applications from organisations who wanted to participate in the pilot and noted that some organisations were more prepared for the pilot than others.

5.3. The assisted application scheme had gone live. This web-based e-learning programme would allow participants to see each of the areas they needed to develop and implement before an assessment could commence.

6. Impact Assessment for SARC accreditation

6.1. The members received a presentation on the regulatory impact assessment for SARCs. The aim of the presentation was to provide members with an overview on the impact assessment and seek comments from members on the proposed methodology.

The main points of the presentation were:

• in light of the approaching implementation dates for compliance with the Codes of Practice and Conduct set out by the Forensic Science Regulator for Sexual Assault Referral Centres (SARCs) SARC-specific Regulatory Impact Assessments had been requested. This assessment would quantify the financial costs of implementing accreditation as well as monetising the benefits of gaining accreditation.
• it was noted that both the measuring and monetisation of benefits was particularly challenging prior to the adoption of the standards. However, other forensic science disciplines that have conducted post-implementation reviews have demonstrated significant improvements in practice from the adoption of standards. Collection of information on changes in practice due to the implementation of standards would facilitate both the measuring and monetisation of benefits in an SARC-specific regulatory impact assessment.
• voluntary involvement of SARCs in a pilot study of the accreditation process were in the planning stage, but it was noted that this scheme would provide an ideal opportunity for the collection of the information needed for a meaningful regulatory impact assessment for SARCs.
• in addition standard impact assessment methodologies would need to be tailored to the specific functions of SARCs. It was decided the ISO Methodology 2.02, which is used primarily for measuring economic benefits of standards, would be adapted and used for the regulatory impact assessment for SARCs.
• the first step of the four-step ISO method, value chain, would identify the core functions of SARCs that bring value to the organisation. This would determine the focus and scope of the impact assessment.
• the functions identified in step one would then be mapped against the activities undertaken in each function, and against the impact the standards would have producing a standard impact map.
• the third step was identifying value drivers. A value driver was a crucial capability which allowed an organisation to create and enhance public value. Once the value drivers had been identified, the activities within the core functions which contribute to enhancing the value drivers could also be identified. The operational indicators were the measurable variables of activities which show either improvement or degradation of performance. Potential operational indicators for SARCs had been identified for the project, however these would then to be refined to a smaller set of the most relevant and important operational indicators. Members and stakeholders’ views on these operational indicators would be sought.
• the final steps of the regulatory impact assessment would involve an evaluation of the financial impacts of the use of standards on each value driver. The appropriate measurement approach would be selected, based on measuring the impact of standards by comparing situation one (no use of certain standards) and situation two (use of certain standards). The data from the impact assessments from the SARC pilot would be collected and analysed. This would be combined with data from other sources, to evaluate the impact of the use of standards.

6.2. A member queried the scope of the impact assessment and which forensic science elements would be included. The FSRU representative explained the scope would include all forensic science elements covered within the standard, and the example provided in the presentation was only one example and there were other examples of operational indicators available.

6.3. A member also highlighted mitigating issues that could affect decisions made outside the SARC which could then affect the operational indicator and could potentially impact the standards outcome which was based on the operational indicator. The FSRU representative acknowledged this and explained the methodology does not include every aspect of the process, and if everything was included it would be too much to measure and difficult to obtain figures. The project would instead focus on variables which could be measured and were within the control of the SARCs. The Regulator commented it was important to identify the main areas within the process that could be impacted by the introduction of the standards.

6.4. The chair asked if the presentation could be circulated to members to review the project and provide comments.

Action 11: Secretariat to circulate Impact Assessment for SARCs presentation to all members.

6.5. Members were also asked if they would like to be involved in the Impact Assessment for SARCs project to contact the FSRU representative directly.

Action 12: Members to provide comments on the methodology proposed in the Impact Assessment for SARCs.

Action 13: Members to contact SD if they would like to volunteer to assist with the Impact Assessment for SARCs project.

7. Stakeholder Updates

CQC

7.1. The CQC representative provided members with a verbal update. CQC had to suspend their routine inspections activity during the COVID-19 pandemic and SARCs had not been inspected since March 2020. A risk-based approach to inspections had been introduced. Inspections were due to commence after the current lockdown restrictions had been lifted.

7.2. There were 12 SARCs awaiting inspections which would be carried out between December 2020 and March 2021.

7.3. A SARC evaluation project had been carried out and feedback was obtained from CQC staff and stakeholders in SARCs on the methodology used by CQC in their inspections. The feedback received was very useful and would improve the next stages of the inspection programme.

7.4. There were 12 SARCs that were not currently CQC registered. The CQC had contacted these SARCs informing them they must to be registered with CQC and were legally required to do so. A few of these SARCs had now submitted applications for registrations, however formal notices had been issued to the SARCs who had not contacted CQC and were continuing to provide un-registered services. A member queried whether registration was required before a SARC service was commissioned and this was confirmed. However, some SARCs that had been commissioned by the police had been exempt from CQC registration. A review conducted by CQC had determined that because of the health care aspects of the service these SARCs must now be registered.

FFLM update

7.5. The FFLM update had been circulated to members prior to the meeting, and members were asked if they had any questions.

7.6. The Regulator asked a question on the FFLM, RCPH & RCN training and competency framework for forensic nurse examiners. The Regulator had understood the competency framework would be for all forensic medical examiners not just nurses. The FFLM representative agreed they also believed the competency framework would include all clinicians who were undertaking forensic medical examinations and was unsure why this had been changed. The Regulator commented the competence required to conduct the forensic medical examinations would be the same for all forensic medical clinicians despite their background. The Regulator was asked by the MFSG if they could raise this issue with NHSE&I.

Action 14: FSR to write to NHSE&I to query why the proposed competency framework only includes forensic nurses and not all clinicians performing forensic medical examinations as previously agreed.

7.7. The Chair mentioned a letter that was sent to commissioners by NHSE&I in November 2019, confirming they were content with forensic medical examinations of young people over the age of 14 being performed by nurses. The chair agreed to share this letter with the Regulator and the CQC representative.

Action 15: The Chair to send FSR and CQC representative a copy of a letter sent by NHSE&I to commissioners in November 2019 regarding medical examinations services provided for patients over 14.

7.8. The FFLM peer review of the sensitive image’s guidance document was mentioned, amendments had been made to this document around the wording on clinicians sharing sensitive images for peer review. The FFLM were awaiting confirmation from the Crime Prosecution Service (CPS), and the police that any clinicians sharing sensitive images for the purpose of peer review would not face prosecution for doing so.

RCPH update

7.9. The RCPH had been collaborating with the FFLM to develop guidance for remote peer review of intimate images.

7.10. The RCPH had recently published its standards for delivery of child protection medical assessments. The new standards would promote high quality child protection services across the UK.

NHSE&I update

7.11. A written update had been provided by the NHSE&I representative, who was unable to attend the meeting. Members were asked if they had any questions on the update to inform the secretariat, who will forward them onto the NHSE&I representative.

Action 16: Members to send any questions on the NHSE&I update to the secretariat to forward onto the NHSE&I representative.

UKAFN update

7.12. The UKAFN representative provided the members with a brief update.

7.13. In Scotland the Advanced Forensic Practice ASET course had now been validated and would commence in January 2021. The Scottish Government had funded 20 places to train nurses to conduct forensic medical examinations on adult victims of sexual assault.

7.14. The Staffordshire University apprenticeship in Advanced Forensic Practice would commence in January 2021.

Policing update

7.15. The Forensic Capability Network representative (FCN) provided members with an update.

7.16. The FCN would be hosting a meeting in November 2020 with forensic leaders and quality managers within policing to support accreditation for SARCs. The meeting would discuss important topics such as, proficiency testing for the SARCs, analysing performance data from the sexual assault examiners within the Forensic Science Providers, and validation.

7.17. A research project was being undertaken by the University of Portsmouth that would involve requesting all SARCs complete a survey on their methods of recording evidence of injuries. The project would review any variation in practice between the SARCs. A number of queries were raised by members about the project which were:

• when the SARCs would be contacted to participate in the project?
• would paediatric SARCs be included in the project?
• would the project be looking at both general and intimate injuries?
• will the interpretation of injuries be included in the study?

7.18. The FCN representative agreed to find out more information on these specific points.

Action 17: FCN representative to obtain further information on the research project on when all SARCS would be contacted, and the scope of the project.

7.19. A member requested a link to access CEWS knowledge hub space on the College of Policing site mentioned in the policing update. The FCN agreed to share and circulate the link to this.

Action 18: FCN representative to share the link to College of Policing CEWS knowledge hub space with members.

7.20. The NPCC Custody representative had provided a written update of the work and changes being undertaken in custody.

7.21. The Regulator mentioned that they were developing a standard for evaluative opinion evidence. This standard would include evidence interpretation across all forensic science disciplines. A draft of the standard had been produced and the Regulator asked if the Forensic Physician and Specialist in Forensic & Legal Medicine representative and the FFLM representative could review the draft, and consider whether the approaches could also be applicable in the interpretation of injuries, and provide any feedback to the Regulator. Both representatives agreed to do this.

Action 19: FSR/secretariat to send the draft standard evaluative opinion to CW and IW for comments.

8. AOB

8.1. The Chair requested an update on the national procurement of forensic kits for SARCs to ensure all SARCs were using the same forensic kits. The FCN responded this work was still in progress and was being taken forward by the FCN SARC Working Group.

8.2. The next meeting would be held in spring 2021, date to be confirmed.

Annex A

Organisation representatives present

• Forensic Physician/sexual offence examiner (Chair)
• UK Association of Forensic Nurses & Paramedics (UKAFN)
• Wales NHS representative
• Care Quality Commission (CQC)
• Metropolitan Police Service (MPS) representative
• UK Accreditation Service (UKAS)
• Forensic Capability Network (FCN)
• UK Accreditation Service (UKAS)
• Scottish Police Authority (SPA)
• Royal College of Paediatrics and Child Health
• Criminal Case Review Commission
• Health and Justice Trailblazer Group
• Forensic Physician and Specialist in Forensic & Legal Medicine
• Faculty of Forensic & Legal Medicine (FFLM)
• National Police Chiefs’ Council (NPCC) custody lead
• The Chartered Society of Forensic Sciences
• Forensic Science Regulator (FSR)
• Forensic Science Regulation Unit (FSRU)
• Home Office Science Secretariat

Apologies

• NHS England and Improvement (NHSE&I) - Health & Justice
• General Medical Council (GMC)
• The Havens, London
• Department of Health (DH)
• Police Service Northern Ireland (PSNI)