Serious Crime Bill [HL]

Written evidence submitted by the Royal College of Nursing (RCN) (SC 04)

1.0 With a membership of more than 420,000 registered nurses, midwives, health visitors, nursing students, health care assistants and nurse cadets, the Royal College of Nursing (RCN) is the voice of nursing across the UK and the largest professional union of nursing staff in the world. RCN members work in a variety of hospital and community settings in the NHS and the independent sector. The RCN promotes patient and nursing interests on a wide range of issues by working closely with the UK Governments, the UK Parliaments and other national and European political institutions, trade unions, professional bodies and voluntary organisations.

1.2 The RCN welcomes the efforts made by the Government to legislate for tackling Female Genital Mutilation (FGM) within the Serious Crime Bill. This briefing sets out the RCN’s position regarding FGM and health professionals in regards to the legal structures.

2.0 Intercollegiate report

2.1 In November 2013, the RCN, as part of a unique coalition of royal colleges, trade unions and third sector organisations, published ‘Tackling FGM in the UK: Intercollegiate recommendations for identifying, recording and reporting’ [1] . This ground-breaking report and collaboration recognises that implementing a comprehensive multi-agency action plan is urgently required to ensure that young girls at risk of undergoing FGM are protected by the existing UK legal framework. The joint report from the Intercollegiate Group sets out nine recommendations aimed at health and social care professionals, who are key to bringing about the changes needed to help eradicate FGM.

2.2 Intercollegiate recommendations for tackling FGM in the UK

1. Treat it as child abuse.

2. Document and collect information.

3. Share that information systematically.

4. Empower frontline professionals.

5. Identify girls at risk and refer them as part of child safeguarding obligations.

6. Report cases of FGM.

7. Hold frontline professionals to account.

8. Empower and support affected girls and young women (both those at risk and survivors).

9. Implement awareness campaign.

2.3 Since the publication of the Intercollegiate report, tackling FGM has quickly become a Government priority, and the RCN very much welcomes the heightened awareness of FGM among parliamentarians, the media and the public.

2.4 The Department of Health has made significant steps to tackle FGM from a health care perspective and rightly recognises that health care professionals are crucial to tackling FGM. As set out in the Intercollegiate report, the RCN encourages a multi-agency approach to the implementation of the measures regarding FGM set out in this Bill. It is imperative that information is shared across health, local authorities, schools and the police to ensure the implementation of comprehensive and integrated strategies for tackling FGM.

2.5 The measures set out in this Bill to amend the current legal framework are very much welcome. However, the RCN is mindful that to ensure their success, appropriate training and education of professionals across health and other agencies is essential. It is crucially important that health professionals are comfortable working with survivors/victims of FGM and are aware of the legal structures in place which are there to benefit women and girls who may have been abused or are at risk of FGM. This will also enhance professional understanding and awareness, as well as wider public awareness of the legal parameters that protect victims/survivors and those at risk of FGM. Much work has been done this year to raise awareness of FGM and this effort must continue.

3.0 Clause 68: Anonymity for victims

3.1 The introduction of anonymity for victims of FGM is a welcome step. It is important, however, that the complexities of FGM are sufficiently considered, in comparison to victims of other crimes. For example, anonymity for victims of FGM might result in children, who have been subjected to FGM, being moved away from their families and communities.

3.2 The RCN is mindful that guidance following this legislation should be explicit in signposting survivors/victims of FGM to relevant support services and ensuring that there is sufficient resourcing of appropriate psychological support. FGM causes death, disability, physical and psychological harm for millions of women every year. The Intercollegiate group found that there is strong evidence of a correlation between FGM and psychiatric disorders, with young girls and women presenting with psychological distress and post-traumatic stress disorder.

3.3 The RCN has continually highlighted concern regarding the loss of services and nursing and midwifery posts in settings which would care for girls and women who require care and support. In August 2014, there were nearly 4,000 nursing mental health posts less than in 2010 [2] , an extremely worrying decrease which has negatively affected services, particularly in the community. The RCN’s recent Frontline First report highlighted these cuts in stark detail; ‘Turning back the clock’ [3] reveals that the loss of these vital services means many people experiencing symptoms of mental illness are having to wait extraordinary lengths of time to be treated and cared for.

4.0 Clause 69: Offence for failing to protect

The current law does not see FGM as a criminal dereliction of parents’/guardians’ duty to protect their children. The RCN strongly welcomes measures within this Bill to make it a criminal offence for parents’ and guardians’ who fail to protect girls from FGM. To ensure that parents and guardians understand these new laws, it is important that nurses and midwives working with young families are fully aware of the legal framework. In a wider public health role for nurses and midwives working in these settings, it may be appropriate, should a child be identified as at risk, to inform parents and guardians of the legal ramifications of their actions. This multi-agency approach will encourage further sharing of information and increase levels of reporting and consequentially, prosecutions.

5.0 Clause 70: Protection orders

5.1 A key barrier to achieving a successful prosecution for FGM offences relates to the low levels of reporting of the crime of FGM. The existing laws rely on victims of FGM to report the abuse to the police, despite the majority of victims of FGM being under the age of 10 with some under the age of 5, which is why these new measures are essential.

5.2 The Government recently consulted on the proposal to introduce protection orders, a specific civil law, which could provide an additional tool to prevent and help eliminate FGM, which complements existing criminal law. The proposals suggest that a professional authorised by the courts could make an application for a protection order. For this reason, it is imperative that health professionals are fully engaged and consulted without throughout the process, and in subsequent guidance.

5.3 As part of the Intercollegiate Group, the RCN responded to the Ministry of Justice consultation on its proposal for protection orders. The RCN supports this specific legal measure which will strengthen the case for prosecution, and more importantly, it offers protection to at risk girls and young women. It is appropriate that provisions to protect girls from FGM are placed in statute so that a more comprehensive approach is taken to safeguard these girls. The RCN is encouraged by the protection orders for a number of reasons; they will help to further clarify the role of health care professionals in preventing FGM and they complement the Department of Health’s and Home Office’s initiatives on the mandatory recording and reporting of all FGM.

5.4 In particular, the RCN is supportive of a range of reporting options being available to victims of FGM; should FGM be prevented, girls may prefer the civil enforcement route over the criminal one. However, to further strengthen the law the RCN believes it is necessary to place a limit on the number of civil breaches before criminal sanctions are imposed.

6.0 Mandatory reporting

6.1 The RCN welcomes steps towards the introduction of mandatory reporting of FGM by health care professionals and will be responding to the current Home Office consultation on this issue in due course.

6.2 At present, it is mandatory to record cases of FGM to safeguarding, to ensure that relevant authorities are informed. The mandatory reporting of FGM to authorities, or potentially the police, will alter the landscape of this issue for health care professionals. The RCN supports efforts to introduce mandatory reporting, which will increase information about the prevalence of FGM; this is an important component which will assist health care professionals, local authorities and the police to prevent and prosecute cases of FGM. These steps send a clear signal that FGM must be treated as a crime and as child abuse. For mandatory reporting to be successful, however, it is crucial that health professionals are sufficiently educated and trained in both identifying FGM and working across agencies to record and report the crime. The RCN believes further efforts should be made by the Department of Health and across Government to encourage this.

6.3 A large number of health care professionals, much like the public, are unaware of the nature of this crime, and how to deal with it effectively. It is imperative that all health care professionals are educated and trained to know that FGM is a crime, and know what to do when they have concerns when a girl or woman is at risk.

6.4 In light of recent developments in this area, the RCN will be publishing updated resource for nurses and midwives early 2015.

January 2015

Prepared 13th January 2015