Serious Crime Bill [HL]

Written evidence submitted by the British Medical Association (SC 08)

The British Medical Association (BMA) is an apolitical professional association, representing doctors and medical students from all branches of medicine all over the UK and supporting them to deliver the highest standards of patient care. We have a membership of over 153,000, which continues to grow each year.

Executive Summary

· Female Genital Mutilation (FGM) is a serious crime and form of abuse that no child should have to suffer. The BMA recognises that doctors have a vital role in breaking the generational cycle of this illegal and harmful practice.

· The BMA welcomes recent measures as part of the Serious Crime Bill that aim to help protect girls and women who are at risk of, or have undergone, FGM. Nevertheless, we have significant concerns about the potential amendments on mandatory reporting for under-18s.

Context

1. The BMA’s interest in the Serious Crime Bill relates to Part 4 of the Bill and concerns mandatory reporting of FGM by health professionals.

Mandatory Reporting

2. The BMA is opposed to mandatory reporting as we believe that it does not always put individual survivors and potential victims of FGM first. There are significant risks attached to the introduction of mandatory reporting which we do not believe have been fully explored.

3. In most cases where FGM is identified in under-18s there is already a legal and professional [1] obligation to report through established safeguarding mechanisms. These are sensitive to the individual interests of a girl or young woman.

Exceptions

4. In circumstances where a decision is made not to report, the justification for not reporting must be linked to the wellbeing of the girl or young woman concerned. Advice should be sought from experienced colleagues, and the decision and its justification should be carefully recorded. Any decision not to report must not mean inaction. Steps should be taken to ensure the girl or young woman receives appropriate care and support.

5. The introduction of a blanket mandatory obligation could, in some cases, act against an individual girl or young woman’s interests: for example, by discouraging vulnerable girls and women from accessing health services, where there is little or no benefit to reporting.

Case examples

6. Below are two hypothetical examples where the introduction of mandatory reporting may result in vital opportunities to offer help and support being lost, with little or no benefit to reporting.

Case 1 (hypothetical)

A competent 17 - year - old wishes to access medical services to address the physical and psychological consequences of having undergone FGM. She is reticent to access health services and she does not want anyone other than the healthcare team she contacts to know that she has undergone FGM. If the FGM was carried out on her when she was five, in another country, by her grandmother who is long dead, against her parents’ wishes, and it is clear from the way the 17 - year - old presents that she will never let a child of her own undergo FGM , in this situation there is no risk to other girls and there will be no prospect of a prosecution for her case. The priority for health care professionals will be to establish a relationship of trust with the young woman and ensure that she is supported and her physical and mental health needs are met. It is difficult to see any benefit in reporting.

Case 2 (hypothetical)

A child has undergone FGM in her country of origin. Since moving to the UK the family is made aware of the harmful consequences of FGM and wish es to seek health assistance to reduce the risk of complications following the FGM. The family has no intention of continuing with the practice now that they are aware of the harm and risks. The mother of the girl is concerned that if she accesses health services she will be reported to social services or the police and her daughter will be taken away from her.

7. These examples highlight why t he BMA is opposed to a blanket mandatory obligation to report that does not take into account the individual circumstances of the survivor or potential victim.

8. Furthermore, the BMA has serious concerns that automatic reporting will move the focus away from the young woman as a victim of a crime to making her feel stigmatised, and in some cases, criminalised. Doctors may cease to be seen as independent providers of medical care and will be viewed, by victims of FGM who are in need of care and support, as part of the Criminal Justice System.

Evidence base

9. The BMA strongly believes that, as with medicine, a rigorous evidence-based approach in important to ensure that the outcomes intended by any legislation are delivered. In the case of FGM, the outcome must be that the best interests of girls and women are effectively protected.

Empowering professionals

10. The BMA welcomes the government’s recent work to raise awareness of FGM, including the development of practical training materials. We believe that this approach is the most effective way to empower professionals to tackle this serious form of abuse, along with the prop er resourcing of care pathways to support survivors and potential victims of FGM.

11. It is critical that doctors are aware and have the ability to identify the risk factors for FGM; and if they report a case to social services and/or the police, that they are confident there are appropriate care and safeguarding pathways in place to manage the situation sensitively and supportively for the girl or young woman.

January 2015

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