Hansard

As a non-member of the committee, I begin by thanking the committee, the clerks and in particular the witnesses who gave the evidence that has brought the bill to this stage. I welcome the debate and I thank the Royal College of Nursing and Rape Crisis Scotland among others for their excellent briefings.

The Scottish Greens support the general principles of this important bill, which seeks to deliver equity of access to healthcare for those hurt by rape and sexual crime. Crucially, it would enable people to access trauma-informed healthcare services without first having to make a police report. The RCN and others support a statutory duty for health boards to provide forensic medical examination to victims. Placing such a duty on health boards would also ensure that the clinicians undertaking those examinations could refer to other NHS specialties without barriers, which would enable the provision of more holistic care to victims of sexual assault. As the committee report notes, victims would be able to access and be signposted to other key services, such as sexually transmitted infection testing, emergency contraception and mental health support, while their forensic examination takes place. Clearly, a healthcare environment is more suited to caring for someone who has just experienced a physically and psychologically traumatic event.

Health and social care integration also has an important role to play as, when an individual is accessing forensic services in a healthcare setting, they can be signposted to community services that can continue to support them. I am particularly interested in how the bill may allow health boards to take a more preventative approach. The mental trauma experienced by some who have experienced sexual assault is not always immediately apparent and may manifest later in time, but if people can access or be signposted to mental health support when attending an examination, that may prevent or lessen such trauma before they reach crisis point.

It is entirely appropriate that victims of sexual assault should access forensic examinations in healthcare settings. Rape Crisis Scotland cites examinations taking place in inappropriate and unsuitable locations, including police stations, as a major flaw in the current system. It is important to note, as colleagues have done, that further physical and mental trauma can be caused by forensic examinations. The bill has an important role to play in lessening any further harm and ensuring that victims can access the support that they need in an appropriate environment, without having to make an extremely difficult decision about whether they want to go to the police when they may still be in shock.

The decision to inform the police of a sexual assault can often be difficult, for many reasons, and no one should feel pressured into reporting as a means of accessing forensic examination. Self-referral is therefore an extremely important aspect of the bill that has the potential to transform and improve sexual assault victims’ experiences when accessing help.

However, as the committee report notes—and as others have mentioned, as it is clearly a major point—self-referral will be of benefit only if victims are aware of its existence. I have been contacted by constituents who were retraumatised by their experiences when reporting their assaults, largely because they did not know what choices were available to them.

Health boards and the Scottish Government have a responsibility to ensure that the public is aware of those services and of how to access them. I support the committee’s call for a public awareness campaign about the changes to the law that are contained in this important bill.

There should also be a multitude of pathways for people to access forensic examination services. We must ensure that barriers to access are removed or minimised. Some victims may not be aware of the self-referral service or of how to access help, and may even be unaware that what they have experienced is a crime.

Other healthcare services should be able to direct victims to forensic examination services. In its response to the committee’s consultation on the bill, Community Pharmacy Scotland stated the need for a recognised pathway for people who seek help in the first instance at a pharmacy. I support that call.

Once victims have accessed forensic services, it must be made clear to them—by people who have been trained to deliver the message—what their rights are, what the self-referral service is for and how it can help them. The report makes the point that, if victims are not fully informed, they may not be aware that other evidence pertaining to their case, such as closed-circuit TV footage, might be lost if they do not promptly report to the police.

Victims are also impacted by a lack of available staff. The Rape Crisis briefing tells the heart-rending story of a woman who was left unable to shower for two days after a sexual assault. We cannot allow victims to continue to be retraumatised when they report sexual assault. Rape Crisis Scotland says that a lack of female doctors is exacerbating long delays, a point that colleagues have raised already. I am glad that the bill contains a provision for victims of sexual offences to be given the opportunity to request that the person who is to carry out a forensic medical examination be of a specified gender.

The changes will result in increased demand for those services. The evidence suggests that that will be the case: the Scottish Government estimates an increased service demand of 10 per cent following the introduction of self-referral. Future workforce planning is key to delivering equity.

Rape Crisis says that we must proactively ensure that there are sufficient female doctors who are able to undertake the role of forensic examiner. Rape Crisis also notes a major issue when the role requires doctors to cover custody cases as well as undertake forensic examinations, and states that to make that a dedicated role would have a significant and positive impact on the availability of female doctors. I would be grateful if the cabinet secretary would respond to that and outline how she plans to address the issue.

The RCN has worked to develop the role of nurse sexual offence examiners to enable them to undertake forensic medical examinations and to give evidence in court. Enabling expert nurses to undertake that work will improve access and will support the provision of trauma-informed and person-centred care.

I know that there has been some debate about the decision to place an age limit on access to self-referral. The RCN questioned the restriction to over-16s, as did my colleague Alex Cole-Hamilton. The bill should reflect the sad reality that significant numbers of children are victims of sexual crime. If children could self-refer, that would provide another important route towards help and safeguarding. I note and appreciate the cabinet secretary’s openness to amendments at stage 2.