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Medical forensics specialist group minutes: 22 June 2021

Updated 5 July 2022

Note of the thirteenth meeting held on 22 June 2021, 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 new representatives from the National Police Chiefs’ Council (NPCC) custody, and Care Quality Commission (CQC).

1.2. The Chair also welcomed the new Forensic Science Regulator (FSR) Gary Pugh and congratulated him on his appointment.

1.3. The FSR acknowledged there had been a lack of quality standards in the forensic medical examinations of victims and suspects, but noted there had been improvements in the last few years, for example the development of the FSR standard Sexual Assault examination: Requirements for the Assessment, Collection and Recording of Forensic Science Related Evidence that had been published in May 2020. The FSR recognised the MFSG was an effective and important group and would continue to support the MFSG in developing the proposed standard for examining alleged suspects in custody.

1.4. The FSR informed the MFSG he would be focusing on defining forensic science activities for the Forensic Science Regulator Act, and then developing a Code of Practice that would be applied to the activities. There could be forensic science activities that may be relevant to the forensic science medical examinations, and this would be bought to the MFSG for discussion.

1.5. The FSR was looking forward to working with the MFSG and thanked the group for all their hard work and contributions.

2. Minutes from previous meeting and update on previous actions

2.1. The minutes of the previous meeting held on 16 November 2020 were approved as an accurate reflection of the discussion held, and had been published. A member requested if abbreviations in the minutes could be also written in full. It was also noted RPCH in the minutes should be RCPCH. It was agreed this would be corrected.

Action 1: Secretariat to amend RCPCH in the November 2020 minutes.

The following actions from the previous MFSG meeting were discussed:

2.2. Action 16: The Chair to send FSR and the CQC representative a copy of a letter sent by the NHSE&I to commissioners in November 2019 regarding medical examinations services provided for patients over 18. The letter had been circulated to the MFSG. This action is complete.

2.3. All other actions were complete.

3. Terms of reference

3.1. The members were asked to review the MFSG terms of reference (ToR).

3.2. A member noted within the composition section Crown Prosecution Service (CPS) was listed, however there was currently no CPS representation regularly attending MFSG meetings. The FSRU responded they had received feedback from CPS, and due to their availability, their preference would be to review and comment on standard documents, instead of attending MFSG meetings.

3.3. It was also noted there had been no regular representation from NHS England & NHS Improvement (NHSE&I) at the MFSG meetings, however the MFSG received written updates from NHSE&I.

3.4. A member commented both CPS, and NHSE&I should be involved in discussions held at the MFSG meetings. Both organisations were involved in the commissioning of Sexual Assault Referral Centres (SARCs), and therefore should have an input in these discussions. The Chair agreed and suggested a letter should be sent to both organisations requesting representatives who could regularly attend MFSG meetings. It was agreed a joint letter from the FSR and the Chair of the MFSG would be sent to both organisations.

Action 2: Chair and the FSR to draft a letter to NHSE&I, and CPS and request regular representatives to join the MFSG, contribute to discussions, and attend meetings.

3.5. It was queried if the version of the ToR was 3 or 4. The FSRU representative confirmed it was issue 4, and this would be updated. It was also noted in section K on page 5 a minor amendment was required for the Faculty of Forensic & Legal Medicine of the Royal College of Physicians (FFLM).

Action 3: The FSRU representative to update the MFSG ToR to Issue 4 and section K on page 5 to the FFLM.

4. Work Plan

4.1. The MFSG reviewed the MFSG 2020-2023 updated work programme.

4.2. The UKAS SARC pilot and standard estimated timescales were discussed. UKAS representative agreed with the estimated timescales proposed in the work plan.

4.3. Members agreed the review of the DNA Anti-Contamination - The Control and Avoidance of Contamination in Forensic Medical Examinations (FSR-G-207) document, should commence in Autumn 2022.

4.4. It was agreed the review of the FSR SARC standard and guidance would commence in Summer 2022, with the intention to publish in Autumn 2023.

4.5. The proposed timescales for the FSR Standard for Custody Suites (guidance document and standard document) was agreed by members.

4.6. It was agreed that the MFSG ToR would be next reviewed in Summer 2022.

5. SARC Accreditation update

5.1. The MFSG was provided with an update on the Regulatory Impact Assessment of SARC Accreditation project which had been presented to them at the MFSG November 2020 meeting.

5.2. In light of the approaching implementation dates for compliance with the Codes of Practice and Conduct set out by the FSR for SARCs. A request had been made for the provision of an impact assessment on achieving compliance.

5.3. It had been decided a tailored version of ISO Methodology 2.0 would be used for this impact assessment. This methodology was selected instead of the traditional methodology as it showed good potential to help produce a quantifiable benefit of SARC accreditation. Volunteers that included some MFSG members were asked to assist in refining the chosen method, as well as defining the metrics for data collection, and assist in providing data collection for the project via the UKAS SARC accreditation pilot scheme.

5.4. The FSRU representative thanked members of the MFSG who had assisted in the project so far.

5.5. The FSRU representative had consulted with stakeholders from SARCs, policing and governance, and a paper had been drafted summarising their responses.

5.6. The metrics for data collection proposed were selected as they were highlighted most often during the consultation with the stakeholders and were deemed the easiest to collect data from.

5.7. The metrics for data collection for this project can be grouped into the four following themes:

• contamination

• patient satisfaction

• staff confidence

• efficiency gains

5.8. Within each of the four themes there was a combination of short term, and long-term metrics. Short term metrics was defined as showing the difference before and after accreditation, and long-term metric was to show the continual improvement due to accreditation.

5.9. An additional meeting was held with stakeholders on the proposed metrics, and the metrics for data collection would be finalised shortly.

5.10. The proposed timeline for the project had been updated to be in line with the UKAS SARC pilot timeline.

5.11. Data metric collection would commence at end of July 2021, and the data collected would be from staff competence, patient satisfaction with the other metrics to follow.

6. Custody guidance subgroup work

6.1. The Custody sub-group (CSG) met for the first time at the end of March 2021. The ToR for the group was agreed during the meeting.

6.2. The CSG had discussed accreditation options for accessing examinations in custody. The previous FSR had agreed accreditation for examinations in custody was not the most appropriate mechanism for accessing quality. The CSG recommended most of the requirements in SARCs should also apply to custody. It was agreed the custody guidance would be based on the SARC ISO standard requirements; however, it would not be under accreditation standard, but as an inspection standard.

6.3. The areas that posed the highest risks were discussed. The areas identified by the group as highest risk were:

• accommodation

• environmental monitoring

• DNA decontamination, including cleaning

• consumables, including personal protective equipment

• medical examination methods, procedures, and evidence collection

• sample collection and handling

6.4. It was agreed a custody guidance document would be developed first, and if required a standard would follow. The CSG agreed FSR-G-207 should be incorporated into this guidance.

6.5. The CSG had started drafting a proposed custody inspection standard guidance document. The MFSG was asked if they were happy with the approach of combining the inspection standard and guidance in one document. The MFSG agreed.

6.6. The draft custody inspection document had been circulated to the MFSG for comments on whether any additional information should be included, and what the next steps for the CSG should be. The Forensic Capability Network (FCN) representative mentioned the Ministry of Justice (MOJ) were reviewing their building specification manual for police forces, which did not currently include the custody specification for the forensic medical rooms. It was proposed the CSG could define the specification and this could be included in the MOJ building specification manual. This was agreed. It was also suggested by a member of the FFLM had produced guidance and documents for custody and medical rooms specifications which could also be included in the MOJ building specification manual. It was agreed this could also be useful, and the Chair agreed to share the relevant links with the FSRU representative.

Action 4: CSG to agree the building specifications for the forensic medical room requirements that should be included in the MOJ manual.

Action 5: The Chair to share the FFLM Operational procedures and equipment for clinical rooms in Custody and clinical facilities in SARCs with the CSG.

6.7. A member asked why custody suites would not be accredited in the same manner as SARCs. The FSRU representative responded that there were over 100 custody suites that would require inspections for accreditation. UKAS would not have the capacity to conduct such a large volume of inspections. Joint inspections were already conducted by HM Inspectorate of Constabulary and Fire & Rescue Services (HMICFRS), and the CQC of the medical and custodial areas. The forensic medical examinations could be included in their scope of inspections. It was highlighted the standards for custody would be the same as the SARCs accreditation standards, however, would be subject to inspections rather than accreditation.

6.8. The question was asked if there had been discussions with HMICFRS around the future plans for inspections, and the possible impact of inspecting additional areas for over 100 custody suites. The FSRU representative responded the previous FSR had held initial discussions and no further discussions had been held.

6.9. The Chair asked what would happen if a custody suite failed to meet the requirements for inspection. The FSRU representative responded that HMICFRS often publish the findings of their inspections. The medical forensics examinations performed in SARCs and or custody suites could be defined as forensic science activities that could be incorporated in the FSR statutory code. If it was included in the statutory code the FSR could issue improvement notices, and even seizure notices. The CQC inspections in custody would still cover the healthcare areas as it currently does in SARCs.

6.10. The MFSG was asked if they could provide comments on the draft custody inspection standard, which would be considered by the CSG at their next meeting.

Action 6: Members to send comments on the draft Custody Inspection Standard by 8th July (CSG meeting 12 July).

7. UKAS update

7.1. The UKAS project to develop accreditation for SARCs to ISO 15189 and the FSR codes continued to progress, although more slowly than anticipated as a result of the COVID-19 pandemic and continuing issues around legal entity, commissioning contractual considerations, resources, funding and facilities.

7.2. The applicants were continuing to progress though the UKAS Assisted Application Scheme (UAAS) – a bespoke set of eLearning modules that have been created for these applicants. The UAAS also included a document review steps at key points.

7.3. The project team continued to receive questions and queries regarding the accreditation process, requirements and compliance, these tended to relate to the standing issues of around legal entity, commissioning contractual considerations, resources, funding and facilities.

7.4. A member asked if there would be any changes to the accreditation if issues were identified during the pilot. The UKAS representative explained once organisations were enrolled on the pilot, a pre-assessment would be conducted, followed by a formal initial assessment. If both assessments were successful accreditation would be granted. After six months from the date of accreditation UKAS would conduct a follow up visit to the organisation, and then annual inspection visits.

7.5. The Chair asked if UKAS had experienced this level of complexity with other services. The UKAS representative responded there had been same issues around volume of applicants and short deadlines for other forensic services, however none with the same complexities as the legal entities issues for SARCs, which resulted from more than one party being involved in the SARC set up such as policing, NHS, and charities. Identifying which party had legal responsibility for the SARC service was one of the main challenges to accreditation.

8. Stakeholder updates

CQC update

8.1. The CQC update that had been circulated to members prior to the meeting.

8.2. The Forensic Physician and Specialist in Forensic & Legal Medicine representative noted in the previous CQC update there were 12 police forces providing SARC services, but not the CQC registered and asked if this had been resolved. The CQC representative responded all the 12 police forces had now applied for the CQC registration, however there were also issues around legal entities. The CQC representative added it was anticipated that all outstanding SARC inspections would be completed by April 2022, dependant on completion of the CQC registration process.

8.3. The FFLM representative asked if there was any progress on the gap analysis covering the roles of the CQC, and FSR/UKAS. The CQC representative responded both the previous FSR and the CQC had reviewed the forensic medical examination process and had identified which section each was responsible for. The CQC would consider next steps after all registered SARC inspections had been completed. The FFLM representative also mentioned they had drafted a document that mapped out the different activities during an adult forensic medical examination in a SARC. This document had been shared with the previous FSR, and the CQC. The previous FSR had highlighted the activities that would be within the remit of the FSR, and any unmarked areas would be within the remit of the CQC. The CQC representative was aware of the document, and there had been no gaps identified, however some activities could be reviewed with a different perspective by both the FSR, and the CQC. The FSRU representative asked if the CQC representative could share the document with the FSRU. The CQC representative agreed.

Action 7: The CQC representative to share the updated FSR/CQC gap analysis co document with the FSRU representative.

NHSE&I update

8.4. The Chair asked if the MFSG had any questions on the NHSE&I update that had been circulated to members prior to the meeting.

8.5. The Chair noted the FFLM representative had enquired on the progress of the review of the purple book. The purple book was an evidence-based document for clinicians conducting medical forensic examinations and required an update and review. The Royal College of Paediatrics and Child Health (RCPCH) representative informed the MFSG that funding had been secured to conduct the review and it was expected to commence in Autumn 2021.

8.6. The update from NHSE&I included information on their national communications campaign to raise awareness of the health functions of NHS SARCs specifically for men, BAME women, and the LGBT community. The FFLM representative asked the reason why the campaign was focusing on men, and the LGBT community. The Chair was unsure of the reason for this, and the secretariat agreed to contact the NHSE&I representative to find out.

Action 8: Secretariat to contact the NHSE&I representative for an update on the review of the purple book.

Action 9: Secretariat to contact the NHSE&I representative for the reason for the focus on men and the LGBT community in the SARC training guides.

8.7. The Chair asked the MFSG if any of them were involved in the Enhanced Mental Health Pathfinders that had been included in the NHSE&I update. The Enhanced Mental Health Pathfinders would look at how pathways of care could be improved for individuals that attend SARCs. The Havens representative confirmed they were involved in this work and agreed to provide updates to the MFSG.

Action 10: The Havens representative to update the MFSG at the next meeting on the progress of the Enhanced Mental Health pathfinders.

Policing update

8.8. The FCN representative provided the MFSG with an update on policing. The FCN were continuing to support police forces with SARC accreditation. A specialist SARC Accreditation Group had been established to assist police forces in developing their accreditation pathways.

8.9. The FCN were also working on the NPCC rape portfolio and their work on custody with a focus on medical forensic examinations on alleged suspects.

8.10. The FCN and Transforming Forensics (TF) were working on a project as part of the end to end rape review on digital forensic investigations.

8.11. A project was underway for the development of a CPS Forensic toolkit. The FFLM representative commented that some forensic scientists had reported they often did not receive the relevant paperwork with submitted samples that were taken in custody suites. The FCN representative agreed this was a known issue, and the FCN had previously circulated communications to the NPCC leads, and the senior leaders within the police forces that this remained an issue. The FCN representative added different police forces had different forensic submission processes when submitting samples to the forensic science providers (FSP’s).

8.12. A member also highlighted some police forces were not conducting medical forensic examinations in nursing homes, and individuals who lack capacity as they considered it too invasive. The FCN representative agreed they would raise this issue along with the lack of paperwork included with samples submitted from custody with the NPCC portfolio leads. The Chair also noted there was FFLM guidance available in relation to individuals who may have been sexually assaulted and were unable to consent to forensic medical examinations.

Action 10: The FCN representative to report back to the NPCC portfolio board to issues around custody suite sample paperwork.

Action 11: The Chair to share the FFLM guidance on individuals who had been sexually assaulted and may not be able to consent to an examination.

Health and Justice Trailblazer Group update

8.13. The Forensic Practitioner for sexual offence, and custody care apprenticeships had been rolled out successfully. The Health and Justice Trailblazer Group were working on the independent end point assessment component of the apprenticeship. The Chair asked if the end point assessment would include a clinical assessment. The Health and Justice Trailblazer Group representative explained the end point assessment had been written and had been published. The first element of the end point assessment would consist of a cross examination and preparation of a statement within a court context. The second element would include questions based on the competency document.

8.14. The Forensic Physician and Specialist in Forensic & Legal Medicine representative asked what would happen if individuals failed the end point assessment. The Health and Justice Trailblazer Group representative responded there would be the option to re-take the end point assessment. Another member asked if the end point examiner would work at the same provider as the apprentice. The Health and Justice Trailblazer Group representative confirmed the end point examiner would be independent and not work for the same providers as the apprentice.

FFLM update

8.15. The Chair asked if members had questions on the FFLM update that had been circulated prior to the meeting.

8.16. The Chair asked if there was an update on the review of the retention of SARC medical records being conducted by the FFLM and NHSe&I. The FFLM representative responded a document had been drafted that would support SARC providers in implementing an appropriate records management approach, and had been shared with policing, CPS, and Information Commissioner Office (ICO) for comment.

RCPCH update

8.17. The Child Sexual Abuse (CSA) course had commenced virtually, and the course included remote assessment of forensic swab skills.

8.18. The RCPCH child protection medical assessment standards had been published, an audit based on the standards was being developed, and would be included in the audit for the peer review RCPCH guidance for child protection cases.

United Kingdom Association of Forensic Nurse and Paramedics (UKAFN) update

8.19. Scotland had begun to allow nurses to undertake forensic examinations of victims of sexual assault. The Scottish Government had funded 18 places for the United Kingdom Association of Forensic Nurse and Paramedics (UKAFN) Advanced Standards in Education and Training (ASET) approved Advanced Forensic Practice course.

9. AOB

9.1. The date of the next meeting was to be confirmed.

Annex A

Organisation representatives present:

• Forensic Physician/sexual offence examiner (Chair)

• The Chartered Society of Forensic Sciences

• United Kingdom Association of Forensic Nurse and Paramedics (UKAFN)

• Care Quality Commission (CQC)

• Royal College of Paediatrics and Child Health (RCPCH)

• The Havens, London

• UK Accreditation Service (UKAS)

• Forensic Capability Network (FCN)

• Metropolitan Police Service (MPS)

• Scottish Police Authority (SPA)

• Health and Justice Trailblazer Group

• Faculty of Forensic & Legal Medicine (FFLM)

• Forensic Physician and Specialist in Forensic & Legal Medicine

• Forensic Science Regulator (FSR)

• Forensic Science Regulation Unit (FSRU)

• Home Office Science Secretariat

Apologies:

• National Police Chiefs’ Council (NPCC) custody lead

• NHS England and Improvement (NHSE&I) - Health & Justice

• Criminal Case Review Commission

• Wales NHS