Trailblazing in Forensic Paediatrics Dr Kate McKay National Clinical Lead for Children and Young People’s Health in Scotland

Current Policy Framework for Child Protection GIRFEC Early Years Taskforce Revision of Pink Book (ongoing) Report of SLWG Forensic Paediatrics (in press) MCN and Regional Planning Medical Workforce in Paediatrics/CCH21 NHS/Police Authority Partnership Agreements

Forensic Paediatrics Overarching principles Care should be provided in the best interests of the child and fit with the Quality Ambitions of the SG IRD process must be start of referral to ensure appropriate medical examination at appropriate time and place Accountability and scrutiny must be built in to clinical service delivery

Background to recent report on forensic paediatrics Lack of availability of sufficient competent,trained paeds and forensic physicians Lack of consistency of provision Out of hours service in remote and rural resulted in delays in examinations Lack of agreed standards for training and competency of Paeds and Forensic physicians in Child Sexual Abuse Mok and Bussitil Report in 2001 said the same !

SLWG Recommendations Data capture Standards Training Workforce

SLWG Standards Compliance procedures to ensure the MCN standards are adhered to e.g.for investigation and management of NAHI, bruising, fractures … All Boards will provide access to a consultant paediatrician 24 hours a day to give advice about physical injuries and neglect, and CSA. Joint 2 doctor forensic examinations should be conducted in significant and complex physical abuse Out of hours services should meet RCPCH and FFLM quality standards….regional out of hours services for medical opinion ?

Data for SLWG 422 examinations for CSA in 2009/ out of hours ( mostly in year old) Most arranged in hours

Workforce Data 42 paediatricians (31 consultants and 11 speciality doctors and AS ) Incl 6 ‘tertiary’ specialists 42 forensic physicians employed by police authorities ?number of Adult Sexual Offences Examiners ?Adult Forensic Nurses

Date/source of statistics BoardIn Hours (0900 – 1700) Out of Hours (1700 – 0900 plus weekends) CommentsTotal by Region BoardGGC (under 13s)308 Archway, Jan – Dec 2010 Archway (13-16 yrs plus LAAC) 13 (GGC: 8, A&A: 3, Lanarkshire: 1, Highland: 1) 30 (GGC: 22, A&A: 2, Lanarkshire: 5, Highland: 1) BoardForth Valley232 BoardLanarkshire213 BoardAyrshire & Arran8? BoardDumfries & Galloway 20 Total West

Date/source of statistics BoardIn Hours (0900 – 1700) Out of Hours (1700 – 0900 plus weekends) CommentsTotal by Region Fife263 SEATLothian RHSC9127Vega Suite 24 Includes paediatric gynaecological examinations Borders182 Total SEAT NorthGrampian804Includes 13-16yr olds NorthTayside71Tayside has opted to be part of NoS MCN NorthHighland194Includes 13-16yr olds NorthOrkney & Shetland Total North

What did we learn from this data ? Information is crucial to effective decision making Standard definitions do not exist across Scotland for CSA services Needed to monitor performance and ensure we learn from best practise No scrutiny is possible at health/ health interfaces ….

Recommendations Datasets for all specialist child protection cases should be created across a MCN region All MCN’s should implement quality assurance with tools from NHS HIS and NSD Regional Planning groups should scrutinise the MCN reports

Increase workforce AIM :Support more general consultant paediatricians to do CSA work Provide robust peer review, protocols Access to specialist expertise at any time Agree shared rotas to increase availability of forensic physicians Consistent ( regular ) staff will bring better working relationships

Structures to support Governance RCPCH and FFLM accredited training and qualifications GMC revalidation processes HIS role in quality assurance Single ( standardised ) partnership agreements between Health Boards and police forces

The Way forward ? Consider the benefits of new models of delivery e.g. Tayside Pilot Develop NHS Partnership Agreement with Police Grow some nurses Use telemedicine to support remote and rural (GP ‘s with credentialling …?)

Now I’ll hand over to…. Dr George Fernier Medical Adviser MPS Academic Adviser Faculty of Forensic and Legal Medicine (FFLM)