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Medical forensics specialist group minutes: 6 June 2024

Updated 4 March 2025

1. Welcome and introductions

1.1 The Chair welcomed the members to the first meeting of the FSR’s Medical Forensics Specialist Group (MFSG) under the Statutory Regulator’s remit. A list of attendees by organisation is available at Annex A.

1.2 As there were new members since the last MFSG meeting, all members provided a brief introduction as to who they were and the organisation they were representing.

2. FSR update

2.1 The Regulator thanked the members for being a part of this advisory group and that they were looking forward to the working with the group and seeing what the group would achieve.

2.2 The main focus has been to sort the Code of Practice and has made it a task to reinvigorate the Specialist Groups

2.3 The Regulator provided an update to what the role and focus is within the regulation of forensic science is and covered it in four themes, were as follows:

• Preparation of the Code
• Admissibility of the code and declarations of non-compliance
• Enforcement and FSR Statutory Powers
• Guidance and FSR advice.

2.4 The Regulator mentioned to the group how they would assist with the regulation of Forensic Science Activities (FSAs) within Medical Forensics and highlighted to the members that he is not there to regulate the medical profession and are only looking to the group to provide advice at FSAs that apply within the Code.

2.5 The representative from the Scottish Police Authority (SPA) confirmed with the Regulator if the remit would solely remain within England and Wales

3. Biology Specialist Group Update

3.1 The Chair of the FSR’s Biology Specialist group (Bio SG) provided an update, the main points were as follows:

• As a result from the statutory powers of the FSR, the Specialist Groups have changed. The Biology SG is the overarching group under which this group and other Biology groups will fall.
• Bio SG Chair provided a list of the FSAs covered in the Code and that there will be groups set up to address those FSAs, including input from those relating to the MFSG.
• A brief overview of the Bio SG terms of reference provided which will also relate to MFSG members and issues of ensuring current work which has been outsourced to wider jurisdictions who fall outside of the Regulator’s remit know the standards and expectations when presenting their findings within UK courts.
• It was highlighted the Bio SG do not deal with ethical matters and any ethical issues should be raised the Biometrics and Forensics Ethics Group (BFEG)

3.2 Bio SG chair stated a member of the MFSG is needed to attend the main Bio SG meetings to represent the MFSG (this could be the chair of the group) providing updates and feeding back what work the Bio SG is planning or in the process of to the MFSG.

3.3 The next meeting of the Bio SG was to be confirmed for planning to take place in November 2024, to allow progression of the MFSG workplan which could be shared with the Bio SG.

ACTION 1: Members to nominate an individual to represent the MFSG at the Biology SG meetings.

4. Draft Terms of Reference

4.1 The group reviewed the draft Terms of Reference (ToR) for the MFSG and suggested amendments and comments. This would be reflected in the document and shared again with the members.

4.2 Key changes to the terms of reference were as follows:

• The addition of meeting frequency and how the meeting would be held i.e., hybrid or face to face.
• The addition of expectations of the representative to assist with their daily roles.
• The addition of how members will be addressed within meeting minutes.

5. Workplan

5.1 The group reviewed the workplan and one of the representatives from the Office of the Forensic Science Regulator (OFSR) highlighted to the group that this plan has been set out in twelve-month blocks.

5.2 The OFSR representative highlighted that within future meetings the members would be asked to provide written updates that could be circulated prior to the meeting.

5.3 The main aims for the work plan were to reinvigorate the Custody working group and establish two new working groups which would focus on interpretation and declarations.

ACTION 2: OFSR scientific support to contact members of the MFSG to engage volunteers for the custody working group, the interpretation working group and the declarations working group.

5.4 A brief update regarding the work of the interpretation specialist group was given to the MFSG members, the main points were:

• Overarching interpretation guidance being produced.
• MFSG then will take the overarching guidance and amend to produce interpretation guidance which is specific for medical forensic reporting.

5.5 The OFSR representative mentioned to the group the FSR’s annual conference which will be held over two days on the 9th and 10th October 2024, with day one focusing on interpretation in which a select few volunteers from the MFSG would be needed to attend the workshop.

ACTION 3: OFSR scientific support to contact MFSG members for volunteers to attend the interpretation workshop at the FSR’s conference in October 2024.

6. Code v2 feedback and terminology within the Code

6.1 The OFSR representative highlighted to the members that recently there had been a consultation regarding version 2 of the code and shared that there had been fourteen comments raised by Forensic Medical Practitioners regarding the following categories:

• Clarification on accreditation date
• CED/SED and elimination samples
• Cleaning
• DNA consumables

6.2. The OFSR representative also highlighted the following key points:

6.3 The duplication within the code and the FSA specific requirements, is necessary as the FSAs is based on the code.

• The terminology used within the sections relating to Medical Forensic examinations would need updating to reflect the terms currently used within the field.
• The term ‘forensic healthcare practitioners’ within the glossary section of the code had been updated with additional words to further clarify its definition and meaning.

7. Stakeholder updates

The Faculty of Forensic & Legal Medicine (FFLM)

7.1 The FFLM representative shared an update, which included the following key points:

• The continued publication of an evidence-based review of the best practice for forensic sampling guidance every six months.
• Various quality standards for all forensic healthcare practitioners have been updated.
• The publication of the joint Royal College of Paediatrics and Child Health (RCPCH) & FFLM quality standards in paediatric sexual offences medicine will have a finalised publication date soon.
• Interim faculty statement regarding the retention of self-referral samples, evidence and records had been published.
• There has been a continuation of work to establish full formal GMC recognised speciality in forensic and legal medicine. a standardisation of the GMC registration, training plan and career pathway that FFLM should be considered a speciality as they look after a high level of cases which require specialist knowledge and training.

Royal College of Paediatrics and Child Health (RCPCH)

7.2 The RCPCH representative shared an update to the members, which included the following key points:

• The recommencement of face-to-face annual training course regarding child sexual abuse, which has had a good uptake in those wanting to attend. The course includes the observed assessment of swab taking, whilst also referencing the relevant FSR guidance and the Code.
• A refresher course for forensic paediatricians which focus on observed assessments of the necessary forensic skills would be held next week.
• The systematic review of evidence in paediatric sexual offences signs, also known as the ‘purple book,’ should be published soon. It was highlighted that there was a delay in publication due to publishing issues with the website.
• The publication is a joint venture with the FFLM however, there have been international endorsements from the American Academy of Paediatrics and the Royal Australasian College of Physicians.
• The publication contains guidance developed with reference to the internationally recognised signs of torture protocol, (sometimes known as the ‘Istanbul Protocol: Manual on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment’) for the first time which includes recommended terminology and interpretation.

The UK Association of Forensic Nurses and Paramedics

7.3 The UKAFNP representative shared an update to the members, which included the following points:

• There is now an addition of the letter ‘P’ to the UKAFN acronym, to include paramedics so it is now ‘UKAFNP,’ and the full title would now be ‘The UK Association of Forensic Nurses & Paramedics.’
• There has been an update to the new website, and no other significant update provided to the group.

Care Quality Commission (CQC)

7.4 The CQC representative shared an update to the members, the following points were raised:

• New single assessment framework has gone live for their non-rated services, which encompasses prisons and SARCs. This has been published on the internet for the public to understand how the regulations have been mapped out.
• For the non-rated services, the reports will be shorter and in a slightly different format and will also determine the distinction between regulations being ‘met’ or ‘not met.’
• The use of the term ‘assessment’ replaces the old terminology of ‘inspection’ used within reports. Furthermore, assessments can take place remotely or on-site.
• The CQC are continuing stakeholder engagement.

United Kingdom Accreditation Service (UKAS)

7.5 The UKAS representative shared an update to the members, the following points were raised:

• The UKAS representative highlighted that the October 2025 deadline for SARC accreditation is fast approaching, so UKAS are still offering drop- in sessions to assist with gaining accreditation by that time.
• The representative shared their positive view regarding the number of new facilities, updated facilities, quality management systems and resources being put into place at SARCs to reach accreditation by October 2025. However, there is still a worry as a large number of SARCs are not in the position to have assessments done, despite this some assessments have already been carried out.
• The concern with the status of self-referral samples, particularly with the issues of retention and sample handling was shared with the members but have been reassured with the statement regarding self-referral samples from the FFLM.

National Police Chiefs’ Council (NPCC)

7.6 The NPCC representative shared an update to the members, the following points were raised:

• Adult sexual offences update – Operation (Op.) Soteria has improved response times regarding rape and serious sexual offences. It started in 2021 at Avon and Somerset police force, then with five pathfinder forces, it has now expanded to approximately fourteen forces.
• In July 2023 NPCC, College of Policing and the Home Office helped forces to implement a national operating model, which will assist in trying to improve response to rape and serious sexual offences.

7.7 Increased charging for rape cases nationally which is a positive however, the risk with this now is due to ‘court backlogs’ where there is an increase in delays to trials taking place.

• In the future, there are plans to take ‘lessons learnt’ approach to apply to wider ‘relationship’ crime or vulnerability portfolios, such as domestic violence, violence against women and girls or child abuse.

Scottish Police Authority (SPA)

7.8 The SPA representative shared an update to the members, the following points were raised:

• New legislation has been passed which covers examinations of victims of sexual assaults. In Scotland these solely are done through the NHS and in NHS settings, so the buildings and examination rooms are all up to the required standards.
• National DNA decontamination protocol across all the NHS facilities which recover DNA samples as well as an environmental monitoring regime are in place at those facilities.
• New pilot being carried out to train forensic nurses to take samples, as currently only doctors are qualified to take samples. This is to add more choice for the patient as to whom they would like to carry out their examinations.
• The SPA representative made the members aware that Scotland follow what happens in England and Wales despite falling out of the FSR remit for regulation, to ensure all processes are mirrored and all facilities are at the same standard as each other.
• A concern was raised regarding the sampling techniques used within custody facilities, highlighting the same standards used within SARCs are also required within custody.

Criminal Case Review Commission (CCRC)

7.9 The CCRC representative said they do not have any specific updates to provide to the group, at this stage.

Chartered Society of Forensic Science (CSoFS)

7.10 The CSoFS representative said they do not have any specific updates to provide the group at this stage. However, they expressed that they are happy to volunteer for the working groups and assist in whatever way they can.

SARC Providers Mountain Healthcare

7.11 The Mountain Healthcare representative shared an update to the members, the following points were raised:

• Currently looking at Streamlined Forensic Reporting for their clinicians as a collaborative exercise with the Forensic Capability Network (FCN). This will look to implement this in one area to determine how effective this would be for ‘clarity when receiving requests.’
• The representative said they are currently facing challenges from some forces regarding SED/CED and asked the group if they are facing the same issues.
• It was highlighted that there were also challenges regarding air flow. There has been some ‘pushback’ regarding the updated FSR guidance which included the new air flow parameters, was a potential risk, some SARCs are going to include a swab in the room, in lieu of amending their current air flow to monitor indirect environmental air contamination.

The Havens

7.12 The Havens representative shared an update to the members, the following points were raised:

• Currently there are assessments being carried out regarding non-fatal strangulation as it is part of both sexual assault documentation and injury documentation.
• A potential for documentation, reporting and sharing of information and the standards required around that to be added to the workstream for the MFSG.
• The variation of SARC services nationally, as some SARCS can carry out anonymous reporting to the police as part of information sharing and others are not able to carry out that function.
• Currently reviewing their peer review process and how this could feed into the criminal justice process, which would look at people attending peer review and independent statement writing around findings.

Forensic Capability Network (FCN)

7.13 The FCN representative presented to members of the MFSG their current and future workstreams. Key pieces of work included:

• Development of SARC quality management system (QMS). The FCN first engaged with the SARC community 3 years ago and asked them what the biggest challenges they were facing in achieving accreditation and meeting the FSR’s requirements. The main areas highlighted from the SARC community were ‘Validation, Verification, and not knowing what the risks were.’ To address these the FCN put together a National SARC Network, which includes UKAS, NHS, OFSR, 43 Police Forces, and SARCs.
• End-to-end verification for SARC process, which included a non- intimate DNA swabbing experiment. The aim of the end-to-end verification process was to demonstrate every process conducted in a SARC was fit for purpose, by testing every single part of the process. There were six SARCs who took part in this experiment, the FCN was able to show the processes were fit for purpose, and the data collected demonstrated this.
• National consumable validation for SARCs. This study sought to address two assumptions: firstly, every SARC uses consumables which are free from DNA, to recover DNA evidence, and secondly the consumables which are called forensic DNA grade (FDG), are assumed to be free from detectable levels of DNA. It was found not all SARCS were using FDG consumables, to collect DNA evidence, and so the FCN sought to ensure all SARCs were using the correct consumables, and this was achieved.
• Centralised cleaning validation for SARCs. The FCN selected six of the most used cleaning products within the SARCs and ran eight experiments. The results demonstrated all the cleaning products used were sufficient in removing DNA from body fluids. The experiment also found the couch cover surface was the hardest to clean and recommended that this should be ‘double cleaned’ with a bleach-based cleaning product, if possible.
• Environmental monitoring study for SARCs. The purpose of the study was to demonstrate the SARC Environmental Monitoring (EM) standards should not be regulated in the same way as forensic laboratories. SARCs across the country participated in the testing, mock medical examinations were conducted, swabs were taken from different areas of the medical rooms, and from the air to see if any DNA was picked up floating in the air. The study found despite there being high levels of contamination in the environment, forensic samples recovered did not contain contaminated DNA. The FCN shared the data from the study with the FSR, with the recommendation that SARCs should no longer be required to close, due to DNA contamination in the room, as would be required by a forensic DNA laboratory. This was approved by the Regulator, and guidance was updated.
• Non-intimate swabbing competency assessment. The aim of the study was to prove the FFLM recommendations and guidance for recovering DNA and body fluids from a patient in a SARC is successful. Human skin, pig skin, and a grained vinyl surface were covered in body fluids and sent to the SARCs with a scenario to recover DNA, from the ’skin’ without contamination.
• Mobile SARC project. A mobile SARC could be used if the main SARC was unavailable due to building work for example, and a patient would not be required to travel to another SARC. A mobile SARC could improve access for victims. The project was in its early stages, and plans were underway to create one or two mobile SARCs which could be available nationally, and possibly at festivals.

7.14 The FCN’s future projects were:

• Collation of live SARC casework data
• End-to-end verification
• Support Forensic Information Database Service to establish Proficiency testing (PT) solutions, and to set up a first strategy PT.
• DNA elimination database
• Declarations guidance and compliance survey
• Shared learning – SARC new articles, shared learning publication of scientific research papers, and FCN guidance documents.

7.15 The MFSG were supportive of the projects, a member commented swabbing from an anatomical dummy, may not be the same as swabbing from a patient. The mobile SARC should be accredited, and consent and confidentiality may be an issue if it is used at festivals.

7.16 There were no updates provided by the following organisations:

• NHS England
• NHS Wales
• Crown Prosecution Service (CPS)
• Police Service Northern Ireland

8. AOB

8.1 The chair noted Physician Associates (PAs), are currently not regulated as are doctors, nurses, and midwives, however, once they are regulated, it is possible that they may be recruited to carry out forensic medical examinations.

8.2 The chair highlighted the new position statement released by the FFLM regarding records, including management of forensic notes and samples.

8.3 The chair highlighted to the group their anticipation of stepping down as chair next year and would be looking to ensure early succession planning.

8.4 The approximate timing of the next meeting was to be held late October or early November.

8.5 The chair thanked all members for attending and closed the meeting.

9. Annex A

Organisation Representatives present:

In person

• Office of the Forensic Science Regulator Science Lead
• Office of the Forensic Science Regulator Scientific Support
• Medical Forensic Specialist Group (MFSG) Chair
• Forensic Capability Network (FCN)
• Mountain Healthcare (MH)

Online

• Scottish Police Authority (SPA)
• Royal College of Paediatrics and Child Health (RCPCH)
• Faculty of Forensic & Legal Medicine (FFLM)
• Crown Prosecution Service (CPS)
• Chartered Society of Forensic Science (CSoFS)
• UK Association of Forensic Nurses and Paramedics (UKAFNP)
• National Police Chiefs’ Council - Rape and Serious Sexual Offences (NPCC RASSO)
• National Police Chiefs’ Council – NPCC Custody
• Forensic Science Regulator (FSR)
• Care Quality Commission (CQC)
• United Kingdom Accreditation service (UKAS)
• Biology specialist Group Chair
• Criminal Case Review Commission (CCRC)
• The Havens
• The Havens Children’s and Young People’s Service
• His Majesty’s Inspectorate of Constabulary and Fire & Rescue Services (HMICFRS)
• NHS Scotland

Apologies

• Faculty of Forensic & Legal Medicine - Forensic Science Sub- Committee (FFLM FSSC)
• Police Service Northern Ireland (PSNI)
• NHS Wales
• NHS England
• NHS Northern Ireland