Transparency data

Medical forensics specialist group minutes: 2 June 2020

Updated 5 July 2022

Note of the eleventh meeting held on 2 June 2020, via teleconference.

1. Welcome and introductions

1.1. The Chair welcomed all to the meeting and welcomed four new members to the group. The new members included representatives from Scottish Police Authority, NHS Wales, the UK Accreditation Service (UKAS) and the Metropolitan Police Service. See Annex A for a list of representatives present.

2. Minutes from the previous meeting

2.1. The minutes of the previous meeting held on 27 January 2020 were approved for publication on the Regulator’s website.

Action 1: Secretariat to publish the January 2020 minutes.

2.2. The Chair queried whether the representative’s initials or organisation should be recorded in the actions within the minutes and in the separate action log. A member agreed it was confusing with only the initials recorded and suggested using full names. The FSRU representative agreed and suggested the separate action log (which is not published) should include the full names. The minutes published on the website would contain the initials and the representative’s organisation. The members agreed with this proposal. It was also noted Health and Justice Trailblazer Group name was incorrect in the terms of reference and needed to be updated.

Action 2: Secretariat to ensure full names are used in the action log and initials used for the minutes.

Action 3: FSRU to add “and” to the Health and Justice Trailblazer Group in terms of reference document.

3. Update on previous actions

3.1. Action 3: (January 2020 meeting) Health and Justice Trailblazer representative to contact colleagues in Gwent for contacts in NHS Wales and provide these to the FSRU. This action has been completed. The NHS Wales representative had now joined the group and confirmed they would be alternating attendance to meetings with another colleague. Action 4: Secretariat to update the membership list to include the SARC lead for Cardiff to the membership list.

3.2. Action 8: (January 2020 meeting) The Chair to contact the Chair of the forensic science subcommittee regarding anti-contamination guidance for out of SARC examinations. The Chair confirmed the forensic science subcommittee would meet on 15 June 2020, and feedback would be provided to the group after the meeting.

Action 5: The Chair to provide feedback to the group from the forensic science sub- committee meeting on anti-contamination guidance for out of SARCs examinations.

3.3. Action 11: (January 2020 meeting) FSRU to chase NHS England and Improvement (NHSE&I) representative on the final questions and answers document, including information on legal entities from the UKAS workshop to FSRU.

The following points were discussed:

• The FSRU had contacted the NHSE&I representative for an update and was informed they were looking into a number of questions in relation to legal entities.
• The NHSE&I was liaising with UKAS to discuss these questions. The UKAS representative confirmed they had met with the NHSE&I representative to discuss legal entities.
• The UKAS representative acknowledged this was a concerning issue for many organisations. A drop-in workshop held recently by UKAS highlighted legal entities as the main topic of discussion. A FAQ document had been produced by UKAS on legal entities and was available on their website. UKAS confirmed they were unable to identify who the legal entities were for organisations; however, they could assist in helping organisations in identifying their legal entities.
• The Chair queried what was meant by “legal entities”. The UKAS representative explained for accreditation requirements a legal, and responsible body would need to be identified and confirmed. The body would be responsible for ensuring the accreditation requirements were met and would be responsible if anything went wrong. Legal entities become a complex issue where there are multiple interested parties within the legal entity, for example the police, NHS, and charities. The interested parties within the legal entity would need to decide who would be the main legal entity.

3.4. The FSRU representative suggested this could be an agenda item for the next MFSG meeting in September 2020.

Action 6: FSRU to add Legal Entity discussions as an agenda item for the MFSG September 2020 meeting.

3.5. A member queried which body would be responsible for overseeing the accreditation of SARCs by the deadline October 2023. The Regulator explained the requirements to gain accreditation would be set by the Regulator. It would be formally the responsibility of each SARC to achieve that. The Regulator would be keen for the group to monitor the progress of SARCs accreditations between now and October 2023. This could be monitored by setting interim progress requirements. It was suggested this could be added as regular agenda item for future MFSG meetings. Action 7: FSRU to add ‘SARC progress on accreditation to standards” as a MFSG meeting regular agenda item until 2023.

3.6. Action 14: (January 2020) FSR to share East Midlands Special Operations Unit (EMSOU) pilot with the group. The Regulator had contacted EMSOU and was advised the report would be completed by mid-June, and EMSOU were happy for the Regulator to share this with the MFSG.

3.7 All other actions were complete.

4. Review of Terms of Reference

4.1. Members discussed the updated draft terms of reference (ToR) developed for the MFSG. A member queried the statement on examinations undertaken in alleged sexual assaults, and what elements of this were within the remit of the Regulator and Care Quality Commission (CQC). The Regulator agreed this statement within the remit section would need to be clearer, and state that only the forensic science aspects were within the remit of the Forensic Science Regulator for sexual assault examinations.

Action 8: FSRU to amend the scope section in ToR to clarify the scope only covers the forensic science aspect of the examinations.

4.2. The CQC representative commented the Regulator and CQC had drafted a document covering the elements the Regulator, CQC, and UKAS would review/inspect during the forensic medical examination.

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 and share this with UKAS and the Chair. Then share with the wider MFSG group.

4.3. The FSRU representative asked the group if they were content with the member composition section in the document. The composition listed the organisations represented on the group. The FSRU representative agreed to add NHS Wales to the composition section. It was noted an NPCC representative for custody would be required to assist in developing the custody standard and guidance. A representative had been recommended from Hampshire Police who currently worked in custody and could be a useful addition to the group. Members agreed the FSRU should approach an NPCC representative and the representative from Hampshire Police to meet this need. A member queried the work of the MFSG and if future meetings would mostly consist of the work on custody. The Regulator suggested detailed work should be conducted between the meetings. The Regulator acknowledged the custody input would need to be extended, however the SARC input would still be required as the group would be monitoring the SARCs progress to accreditation. Action 10: FSRU to invite other clinicians with custody background to join the group and the Hampshire custody representative to join the working group developing the custody standard and guidance.

4.4. The Chair suggested amending the number of MFSG meetings to: “A minimum of two meetings a year.” This was agreed by the members. It was also suggested that a link to the Seven Principles of Public Life, be included under the conduct section of the ToR. A member suggested including a representative from a Wales Police Force on the composition section of the ToR. The Regulator confirmed within the NPCC there was representation from Wales Police therefore they would not need to be included separately. A member queried who was the current NPCC custody lead representative on the group. The name of the representative name was provided, and the FSRU representative confirmed currently the group does not have an active NPCC custody lead that attends meetings. The FSRU and FSR agreed to recruit a new NPCC custody lead who would be available to contribute and attend meetings. The members agreed they were content with the ToR subject to minor amendments and were happy for this to be published.

Action 11: FSRU to amend the number of meeting to: “a minimum of 2 meetings per year” in the ToR.

Action 12: FSRU to add a link to the Nolan principles to the conduct section of the ToR.

Action 13: FSRU and FSR to follow up on the NPCC custody lead representative.

5. Review of workplan

5.1. The members were asked to review the MFSG 2019/2020 work plan. Members were asked to highlight anything that may have been missed from the workplan, and to confirm if the estimated timescales were achievable.

5.2. The FSR standard for ISO 15189 for examinations of patients had been published, along with the readiness self-assessment questionnaire (G-12 Annex). Members were asked if they were content with the estimated timescales for the UKAS workshops, on the FSR SARC standard and guidance. The planning and preparation would commence in spring 2020, and the sessions would be on-going. The group agreed with the timescales for this work.

5.3. The UKAS pilot for the SARC standard and guidance was discussed. It was proposed that planning would commence in summer 2020, the pilot would then commence in autumn 2020, and a lesson learnt document available in autumn 2020. The UKAS representative believed the lesson learnt document may not be completed by autumn 2020, as the pilot would continue into spring and summer 2021 and suggested it should be autumn 2021 for this document to be available. This was agreed by the group.

Action 14: FSRU to update the workplan section on the SARC pilot to autumn 2021 for the lessons learnt document.

5.4. The review of the DNA Anti-contamination Forensic Medical Examination in Sexual Assault Referral Centres and Custodial Facilities (FSR-G207) was mentioned. It was proposed that the review of the document would commence in spring 2020, the document would be updated in summer 2020, and the Regulator to sign off and publish in autumn 2020. This was agreed by the group.

5.5. The FSR standard for Custody Suites (guidance and standard documents) was discussed by the group. It was proposed that work would commence in spring 2020, and a draft would be sent out for public consultation in autumn 2020 with the intention to publish the document in spring 2021. The FSRU representative reminded the group that the public consultation could take up to three or four months to complete, and the document may not be ready for publication in spring 2021. The Regulator agreed the sign off and publication could occur in summer 2021/autumn 2021 instead of spring 2021. The members agreed with new proposed dates.

Action 15: FSRU to update FSR custody suites time scales. Consultation timescales amended to autumn/winter 2020 and sign off spring/summer 2021.

5.6. A review of the FSR SARC standard and guidance was proposed for spring 2021, followed by an update of the document in summer 2021, and publication in autumn 2021. Members were asked for their comments on proposed dates. The FSRU representative highlighted that these dates could be subject to change due to the UKAS SARC pilot, and publication of their lesson learnt document that could feed into the updated SARC standard and guidance. Members agreed the review of the FSR SARC standard, and guidance should commence in autumn 2021 instead.

Action 16: FSRU to update timescales for the review of SARC standard and guidance review to autumn 2021.

5.7. Members were asked if they agreed with the annual review of the workplan and Terms of Reference (ToR) to take place once a year in the spring MFSG meetings starting in spring 2020. An FSRU representative suggested amending the date to spring 2021. It was agreed the ToR would be updated to state this, and would be reviewed every year at the MFSG spring meetings.

Action 17: FSRU to update time scales for annual review of the work plan, and annual review of ToR to review at spring meetings instead.

6. G207 Anti-Contamination document

6.1. The FSRU representative presented this item. The working group met in April 2020 and May 2020 to review the G207 Anti-Contamination document. The group had made some suggested changes to sections 6, 8, and 9, and minor amendments on the other sections.

6.2. The Members were asked to agree the implementation date for this updated document. The document covered both SARCs and custody environments. October 2021 was proposed for SARCs as this matches the stage where validation of cleaning standard operating procedures should be in place. A separate and later date for custody was proposed as either April or October 2022, as the accreditation requirements and dates for custody had not yet been decided. It was suggested contacting custody representatives to check if the October 2022 date would be achievable.

Action 18: FSRU to contact custody colleagues to confirm October 2022 as the implementation date for the G207 Anti-contamination document.

6.3. A member highlighted that as this was only a guidance document for anticontamination practices, the approach was likely to be similar for SARCs and Custody. It was suggested the updated guidance document should be implemented on one date for both SARCs and Custody. The document could be amended or updated at a later date if required. The Regulator agreed with the suggestion, and would prefer not to withdraw the old guidance, and have a gap between the old guidance applying and the new guidance applying. This could result in removing guidance from operation that had been there for a reason. The Regulator would be content with a later date for organisations to update to the guidance, however the existing guidance would need to be in place until then. The FSRU representative suggested when the new guidance is published there would be a note included to confirm this is continuing from the old guidance with a four month implementation period. The Regulator agreed with this approach.

6.4. The working group had now completed their review, and updated sections where required. Members were asked to provide feedback and comments on the updated document. A member suggested aligning the terminology within this document with the SARC standard and guidance in relation to use of the term “patient” and “not yet accused”.

Action 19: MFSG members to send comments on the updated draft FSR-G207 document to the FSRU representative by 26th June 2020.

7. Custody suites – plan for work

7.1. The Health and Justice Trailblazer Group representative presented this item. The Health and Justice Trailblazer representative and the UK Association of Forensic Nurse & Paramedics representative agreed to review the SARC standard and guidance to highlight the information relevant to custody suites. The review highlighted the following areas where further work could be required; equity of service, training of professionals, governance framework, and facilities. The representative suggested forming a sub-group to review the following areas; legal entities issues; governance framework; patient journey; custody environment, including examination suite and toilet facilities; staffing competence, including cleaners; and collection of evidence. The Regulator emphasised that only forensic science activities within the remit of the Regulator, should be included within this document. For example; sampling for evidential purposes and setting the quality standards requirements. The Regulator said it was important to decide at what level to set the standards, what assurance mechanisms were available, and to identify the risks of contaminating, or compromising evidence in the Criminal Justice System. Additional considerations include what is achievable and proportionate to meet the requirements in terms of compliance. The Regulator proposed deciding first on the minimum set of requirements to assure quality of the forensic aspects of medical sampling in custody suites. Once this had been decided the requirements could then be developed.

7.2. A member mentioned the custody environment should be considered. For example, would a separate dedicated forensic suite be required or would a medical room which may be used by all patients be acceptable? The Regulator responded that a risk assessment should be carried out and used to support any changes needed to the examination rooms in custody. The risk analysis should be completed by individuals with a custody background. The Regulator agreed it was important to engage with the right NPCC custody lead to progress this work. The members agreed that a sub-group be formed to carry out the review of the draft guidance and risk assessments of custody facilities.

Action 20: The Chair, FSR, and FSRU to decide who should be part of the subgroup to review the draft guidance, assess the risk implications for custody, and decide time frames.

8. UKAS update

8.1. The UKAS representative provided members with an update.

8.2. A meeting was held on 5th May 2020 for organisations that had registered an interest in participating in the SARC pilot accreditation programme. The meeting was attended by over 21 interested organisations, and there had been good discussions in particular around legal entities. Terms of reference, and application forms were circulated to these organisations after the meeting. UKAS had confirmed the time frames for the pilot during the meeting, and anticipated putting applications through by end of next year.

8.3. Drop-in surgeries were introduced for organisations that had any questions or issues relating to the SARC pilot accreditation programme. The drop-in surgery would be held once a month. An FAQ document had been produced to capture the questions and answers in the drop-in sessions, and this available on the UKAS website.

8.4. UKAS had recently completed the assisted application scheme modules for the SARCs. This web-based e-learning programme would allow participants to see each of the areas they need to develop and implement before an assessment could commence.

8.5. UKAS had confirmed they had not yet received any application forms for the pilot. A member mentioned issues around funding could be the reason for this. Another member suggested issues with legal entities could also be a reason some SARCs may not have applied yet. UKAS acknowledged these issues and was happy to work with these SARCs to resolve these issues.

8.6. The Scottish Police Authority representative explained in Scotland they do not have SARCs, however they do have facilities which are used for sexual assault examinations that are run by NHS Scotland. The Scottish Police Authority representative queried if these facilities applied for accreditation how would this be possible, if one organisation was responsible for all facilities at different locations. The UKAS representation explained if it is the same legal entity which is responsible for multiple sites, this could come under one accreditation, provided all the facilities were governed by the same governance, used the same quality management system, and followed the same policies and procedures. The accreditation would be against the organisation, and all the different locations would be listed. As part of the assessment process each of the facilities would be assessed, to observe; how they work, how they demonstrate the competences, checking that they are using the same processes, and how the different sites interact with each other.

9. Stakeholder Updates

Care Quality Commission (CQC)

9.1. The CQC representative provided the members with an update on the work of the CQC.

9.2. Due to the COVID-19 pandemic all CQC inspections had been postponed. The CQC had recently introduced an emergency framework, which consisted of a series of questions the CQC was asking their organisations. The answers provided would be used to highlight issues which may require the attention of the CQC. The aim of the framework was to assess whether the provider could continue with running its services without an inspection visit from CQC.

9.3. Whilst reviewing the emergency framework it was identified the framework was not suitable for SARC providers as a result of insufficiently detailed questions. The CQC were in the process of adding more details for SARCs. The CQC would then share this with the SARC providers once this had been completed.

9.4. It was anticipated that the inspection programmes may have to be conducted differently as a result of COVID-19, however the inspection programme which had been started would continue in its present form.

9.5. CQC had recently contacted all the SARC providers who were not registered with them, to explain the need to register. As a result of this CQC received a number of queries from these SARC providers, and there had been an increase in applications received for CQC registrations from SARC providers.

Faculty of Forensic Legal Medicine (FFLM)

9.6. As a result of the COVID-19 pandemic the FFLM had been working with organisations such as Royal College of Paediatrics and Child Health (RCPH) and the Royal College of GPs, with sharing intimate images obtained during the forensic medical examination for peer review when working remotely. The RCPH representative queried if a platform had been secured for images from the sexual assault peer review. The FFLM representative was unsure on the progress of this.

9.7. The FFLM had produced guidance documents for management of SARC cases during the COVID-19 pandemic. The guidance documents had been shared with the FSR, as some of the practices may have changed. The guidance was available on the FFLM website.

9.8. The work on the issue with the competency framework for paediatrics examinations had been paused, however the FFLM anticipated that they would be addressing this issue very soon.

10. AOB

10.1. The FSR expressed her thanks to the Chair for smoothly conducting a virtual meeting, and to the members for their work on the SARC standard and guidance documents that had now been published.

10.2. The FSRU representative provided the members with a quick update on behalf of the Hampshire Constabulary representative. The environmental monitoring project in SARCs should be published soon. A collation of the validation work on the cleaning detergents used for the police DNA laboratories, had been requested so this could be documented and then shared to support the SARC pilots.

11. Date of next meeting

11.1. The next meeting would be held on Tuesday 29 September 2020 as video conference.

Post Meeting Note: meeting date re-scheduled for 16 November 2020.

Annex A

Organisation representatives present

• Forensic Physician sexual offences examiner (Chair)
• UK Accreditation Service (UKAS)
• Scottish Police Authority
• NHS Wales
• Care Quality Commission
• The Havens, London
• Faculty of Forensic & Legal Medicine
• UK Association of Forensic Nurses & Paramedics
• Royal College of Paediatrics and Child Health
• Criminal Case Review Commission
• Health and Justice Trailblazer Group
• The Chartered Society of Forensic Sciences
• Metropolitan Police Service
• Forensic Science Regulator
• Forensic Science Regulation Unit
• Home Office Science Secretariat

Apologies

• NPCC lead - Rape Working Group
• Forensic Capability Network
• NHS England - Health & Justice
• General Medical Council
• Department of Health
• Police Service Northern Ireland