South East Tayside North of Group Scotland Planning

South East & Tayside North of Group Scotland Planning Group MANAGED CLINCIAL NETWORK FOR CHILD SEXUAL ABUSE Welcome to the SPRING EVENT 23 March 2011

South East & Tayside North of Group Scotland Planning Group INTRODUCTION SPRING EVENT 23 March 2011 Dr Ross Cameron, MCN Chair

Aims of the day (1): § § of Scotland To provide an update on progress. North so far Planning Group To learn from the ‘Manchester’ experience To use the collected expertise in the room to explore some of the most challenging issues Box for your questions for plenary discussion (on registration table at coffee and lunch time)

Aims of the day (2) § § North of Scotland Plenary discussion at the end of the day: Planning Group Very pleased Dr Mc. Kay, National Clinical Lead for Children and Young People’s Health, and Dr Herbison, Wo. S MCN Clinical Lead, will join Dr White and Dr Hammond Highlighted feedback from each workshop /Questions from ‘box’ & floor All input will be collated and fed back

Programme 10. 00 Aims of the Day Dr Ross Cameron, Chair of the MCN 10. 10 Introduction of the MCN and the Story so Far Dr Helen Hammond, MCN Lead Clinician, Planning Group Anne-Marie Pitt, Regional Manager of the MCN 10. 30 “The Manchester Experience” Dr Catherine White, Clinical Director, SARC, St Mary’s 11. 15 Questions & Answers 11. 30 Coffee Break 11. 45 Introduction to Workshops 12. 45 Lunch North of Scotland Ian Peterson, OD Facilitator 1. 30 -3. 30 Workshops 3. 45 Plenary Session 4. 30 Close Panel Members

Practicalities § § Toilets are off the main hall Fire evacuation procedures North of Scotland Planning Group

South East & Tayside North of Group Scotland Planning Group Managed Clinical Network for Child Sexual Abuse the story so far… Dr Helen Hammond Anne - Marie Pitt

Background to the establishment of SEAT MCN for Child Sexual Abuse North of Scotland Planning Group § Winter event December 2007! § looking for a solution to mounting concerns re sustainability and quality….

Paediatric forensic examination ‘solution’ North of Scotland Planning Group § fulfil requirements of immediate clinical care and evidence gathering- skills and facilities § must fit well into context of multi-agency process- investigation and protection § must be child centred and provide appropriate follow through care § fulfil requirements of any subsequent legal processes- reports court skills

Current situation 2007 North of Scotland Planning Group § what are the strengths and difficulties with the current services? § what does the paediatrician bring to the process? § why did we think a clinical network was the solution? § key issues in moving forward?

Paediatric forensic service: weaknesses/threats § § North of Scotland Planning Group small specialist workforce (ageing!) unpredictable workload- clinical, court difficulties with recruiting/retaining paediatricians combining acute and child protection responsibilities/job plans § sustainability of 24/7 § ? best value

Out of hours examination? ? North of Scotland Planning Group already working to clear and agreed criteria: need (bleeding, in pain, injured) nforensic need (evidence from locus or child) nneed to comply with police procedures (suspect nclinical in custody…) nchild care need nextreme anxiety/distress (child or family) subject to ongoing audit…. very tiny numbers overnight particularly <13 yrs

Why is a network the answer? North of Scotland Planning Group § offer wider access to limited highly specialist resources § ensure consistency/equity from referral ongoing care § ensure high quality child friendly facilities § offer a range of options and settings: clinics in paediatric settings clinical facilities in co-located units Multi-disciplinary/agency ‘one stop shop’ (e. g. SARC Sexual Assault Referral Centre)

Wider role of network North of Scotland Planning Group § setting and implementing standards RCPCH/AFP (now FFLM) § training: clinical, multi-agency, court skills § peer review essential (local, national - paediatric, forensic- clinical cases, topics) § service development/innovation eg use of telemedicine, single examiner if both sets of skills § audit and research

Key issues in moving forward North of Scotland Planning Group § agreeing appropriate balance local/ networked § travelling…children, doctors, social workers, police § standardised equipment § contracting/indemnity § acceptability to other agencies

Background to the establishment of SEAT MCN for CSA North of Scotland Planning Group § application for funding to SEAT regional panning group § child sexual abuse- seen as greatest priority § successful in securing funding from NDP for first 2 years of 3 year plan § Clinical lead appointed April 2009…

MCN structure SEAT Steering Group North of Scotland SEAT Planning Children & Young People’s. Group Health Planning Group MCN Steering Group Clinical Sub Group Objectives: n Clinical protocols, pathways & referrals n Identification of performance standards and measurement of performance n Agree clinical skills and competencies n Workforce Development including Paediatric Forensic Nurse Role Members: n Chair/Co-Chair, Lead Clinician n Specialist Paediatricians (all Health Boards) n FME – Fife n Senior Managers (all Health Boards) n Police n Crown Office n Social Work n Regional Planning Education & Training Sub Group Objectives: n Baseline training and support available n Training needs analysis n Development, education and training programme

MCN FOR CSA OBJECTIVES North of Scotland Planning Group § 10 objectives agreed – in pack § Objective 2 - Service Development & Improvement: establish and implement a clinically safe and sustainable model of service delivery supported by agreed clinical standards across the south and east of Scotland.

Obj. 2: Potential CSA Service models n n n From status quo to the SARC model North of Scotland Planning Group centralised non networked tertiary (paediatric) service to totally networked service with an out of hours regional service 9 in all reduced to 5 formal option appraisal Potential use of telemedicine

North of Scotland Planning Group Objective 6 - Education and Training: agree a model for training, support, supervision and peer review for clinicians. Objective 7 – Clinical Protocols: agree common protocols, pathways, proformas across the region

PROGRESS SO FAR North of Scotland § MCN Steering Group, work plan, Clinical Sub-Group, annual report and Planning Group MCN Quality Assurance framework have been developed. § A baseline assessment has been carried out across the region to capture the current services provided, staffing levels and equipment in place

Baseline Assessment Findings Borders Facilities North of Scotland Equipment Planning Group upgrades Borders General Hospital £ 39. 66 k - non specialist area Lothian Vega Building - adult facility/acute assault Royal Hospital for Sick Children - non specialist area and cramped Fife St Johns’ Hospital - non specialist area £ 14. 85 k Greenfield Clinic - small waiting area £ 10. 81 k Total = £ 65. 32 k

Baseline Assessment Findings Specialist Paediatricians trained in CSA In-hours Consultants Associate Spec Staff Grade North of Scotland 0 Planning Group Borders 2 0 Lothian 8 (7. 6 WTE) 3 (2. 6 WTE) 0 1 2 1 Fife Total 17 (16. 2 WTE) Out-of-hours Consultants Associate Spec Staff Grade Borders 2 0 0 Lothian 8 (7. 6 WTE) 0 0 0 Fife Total 10 (9. 6 WTE)

PROGRESS continued North of Scotland § A gap analysis on clinical equipment across the region and a successful business Planning case to obtain regional funds to update colposcope and photo-documentation Group equipment in all examination sites. § Links made with national telemedicine colleagues and pilots have begun to investigate the effectiveness of telemedicine to increase accessibility of specialist services in rural areas and increase specialist skills through sharing education and training. § The development of an MCN wide portfolio of protocols , pathways of care and signposting to national standards § Development of an MCN website www. mcncsa. scot. nhs. uk Registration documents in the pack to be completed and left at the registration table

North of Scotland Planning Group

North of Scotland Planning Group

North of Scotland Planning Group

PROGRESS continued North of Scotland § Feedback mechanisms from children, young people and Planning Group their parents about the medical examination process are being explored i. e. questionnaire § A training needs analysis has been carried out beginning with an electronic education, training and clinical experience survey completed by doctors carrying out csa examinations § Data on activity across the region has begun to be collected on CSA examinations in a standard and comprehensive manner.

Child sexual abuse examinations North of Scotland Planning Group

Types of examinations North of Scotland Planning Group

Times of examination North of Scotland Planning Group

Key priorities North of Scotland Planning Group § § § Complete options appraisal Implement an education and training programme Progress information gathering from children and families Collate information from today’s event Agree an implementation plan

Changing context § § of Scotland Dr Mike Winter’s paper re future. North shape Planning Group of paediatric forensic services nationally ACPOS response Scottish Govt- Short life working group New Sexual Offences Legislation (came into force 1 st December 2010)

Changing context § § North of Scotland Revision of national child protection Planning Group guidance Intercollegiate competencies, training, modular credentialing Revision of RCPCH CSA guidance Postgraduate qualifications DFCASA, MFFLM

North of Scotland Planning Group “the Manchester Experience” Key note speaker: Dr Catherine White

MANAGED CLINCIAL NETWORK FORNorth of Scotland Planning Group CHILD SEXUAL ABUSE Questions and Answers

MANAGED CLINCIAL NETWORK FORNorth of Scotland Planning Group CHILD SEXUAL ABUSE Introduction to Workshops – Ian Peterson

MANAGED CLINCIAL NETWORK FORNorth of Scotland Planning Group CHILD SEXUAL ABUSE Workshops sessions

North of Scotland MANAGED CLINCIAL NETWORK FOR Planning Group CHILD SEXUAL ABUSE Plenary Session