An insight into the work of sexual assault referral centres and the role of the forensic nurse examiner

The subject of this article is timely. Sexual violence and issues of consent and respect are frequently in the headlines as survivors find a voice and the courage to come forward. Events following the death of Sarah Everard in London earlier this year and the increasing number of survivors anonymously disclosing sexual assault via the ‘Everyone’s Invited’ platform cannot have gone unnoticed. Other high-profile historic sexual abuse offences, such as those perpetrated by convicted serial paedophile Barry Bennell and, more recently, Reynhard Sinaga, the 36-year-old PhD student convicted of 159 sexual offences against 48 men, run alongside reports of child sex exploitation, sex trafficking and drink spiking. Raising public awareness means that it is more likely than ever that healthcare staff of all grades and in all settings will have clients who will disclose a sexual assault, recent or historic, and it is crucial that they know how to respond appropriately to achieve the best outcome for survivors.

Health and social care workers engage with clients in a range of situations, and the privileged nature of the trusting professional relationship means that they are well placed for someone to disclose—but how many are armed with the right information to respond and signpost to the right support? For some of those who disclose their experience, particularly if the assault is recent, time is of the essence. Any delay can result in the loss of vital evidence and may jeopardise a potential conviction.

Personal journey

The purpose of this article is to explain the role of the sexual assault referral centre (SARC): this is a service that few people actually know about, a service that no one ever needs … until an assault happens. It is probably fair to say that I am not alone in never having heard of SARCs—I can say honestly that it was the first job I had ever applied for that I did not have a clue about what it entailed.

I have never had any regrets about training as a nurse. Health care in general offers flexibility, a good career pathway and there is a wealth of different work environments. I recall saying to a nursing student once, if you ever feel stuck in a rut, move on, find a new challenge. Then one day, as I sat in my office, feeling drained and realising I was not really enjoying my work as a lecturer anymore, I reminded myself of that advice. I knew that I had probably 10 years left to work, enough time to finish my career doing something I really wanted to do, back working with patients again. I reflected on my time in nursing and concluded that the most enjoyable and fulfilling work that I had done, and where I had felt I was making a valuable contribution, had been in genitourinary medicine (GUM) and contraception clinics. I was also acutely aware that research relentlessly moves all specialties forward, and my knowledge and skills would most likely be outdated and rusty. Undeterred, I turned to the NHS jobs website and entered the word ‘sex’ into the search criteria and set up an alert.

One of the first jobs that came up was for a crisis worker with Mountain Healthcare Ltd (MHC). It did not need a nursing qualification, just a passion to work with victims of sexual assault. I ignored it initially. I was wary of leaving the NHS, and the job description appeared confusing—I really did not understand what role or salary were on offer. Over the next week, I came back to it several times: my curiosity got the better of me and, in the end, I just knew something felt right. The interview was a revelation and the other candidates were amazing, all with experience in a wide range of work: a recent graduate in forensic science, a nurse, a counsellor, a social worker, one worked with the homeless and another with commercial sex workers—and all were united by a deep sense of wanting to help people.

I discovered that the role of the crisis worker involved providing emotional and practical support to victims of sexual assault and to those who accompany them while they are in the SARC. The crisis worker is also responsible for doing what is known as a forensic clean following a case in order to prevent contamination of future cases. The role was a zero-hours contract and I knew I could do it alongside my other post, as most crisis workers do. However, during the interview the role of forensic nurse examiners (FNEs) was mentioned and also that such a role was about to be advertised in my locality.

I accepted the crisis worker post and then immediately applied for the FNE post. A few months later, after interview and passing the police vetting process, I started work on a zero-hours contract. It did not take me long to realise how fortunate I was to have become part of such an amazing team and field of work, albeit accidentally, and I had no hesitation whatsoever resigning my other job only 3 months later to cover a maternity leave post that I eventually took on permanently.

What is sexual health?

In the definition of the World Health Organization (WHO) (2015) sexual health is:

‘… fundamental to the overall health and wellbeing of individuals, couples and families, and to the social and economic development of communities and countries.’

In addition, achieving good sexual health requires a:

‘… positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion discrimination and violence.’

WHO, 2015

The ability to achieve good sexual health is inextricably linked to the notion of respect and protection of human rights. Sexual rights embrace certain human rights that are already recognised in international and regional human rights legislation. WHO (2015) outlines rights critical to the realisation of sexual health, namely:

• A right to equality and non-discrimination
• The right to be free from torture or to cruel inhumane or degrading treatment or punishment
• The right to privacy
• The right to the highest attainable standard of health (including sexual health) and social security
• The right to marry and found a family and enter a marriage with the free and full consent of the intending spouses, and to equality in and at the dissolution of marriage
• The right to decide the number and spacing of one’s children
• The rights to information, as well as education
• The rights to freedom of opinion and expression
• The right to an effective remedy for violations of fundamental rights.

The responsible exercise of human rights requires that all persons respect the rights of others. Unfortunately, for most of the clients that access the SARC, their fundamental human rights have been violated, and their experience will most probably not have been ‘consensual, pleasurable or safe’ in accordance with the above WHO definition. For some survivors, it may have been a single event, for others, it may be part of a pattern of ongoing abusive behaviour, such as seen in victims of child sexual exploitation (CSE), people trafficking, or those subject to domestic violence.

It only takes a quick look through the press to know that there is a problem, and that reported figures probably grossly under-represent the reality of the situation. Sexual offences, as defined in the Sexual Offences Act 2003, are listed in Box 1. Other offences seen in the SARC and that are also covered by law include non-fatal strangulation, which is punishable by 5 years’ imprisonment and which was added recently as an amendment to the Domestic Abuse Act 2021, along with post-separation coercive control and revenge pornography.

Box 1.Definition of sexual offences

The latest Crime Survey for England and Wales reported that, for the year ending March 2020, an estimated 1.8% (773 000) of adults aged 16-74 years had experienced sexual assault in the preceding year. This equates to a prevalence of 2 in 100 adults, with four times as many females affected as males. According to the survey, 22.9% of women said that they had experienced a sexual assault since the age of 16 years, ranging from indecent exposure and unwanted sexual touching to rape and assault by penetration.

More than half (53%) of women who had experienced rape or sexual assault by penetration, including attempts, had been victims of domestic violence, 10% having been attacked by a family member. Women’s Aid (2021) defines domestic violence as:

‘… an incident or pattern of incidents of controlling, coercive, threatening, degrading and violent behaviour, including sexual violence, in the majority of cases by a partner or ex-partner, but also by a family member or carer.’

For men, 20% were victims to a partner or ex-partner and 9% to a family member. The incidence of domestic violence appears to have increased during the pandemic and many undoubtedly continue to suffer in silence. Consequently, whatever our role, the importance of being able to recognise the signs, and to proactively engage with someone whom you may feel is being abused, cannot be overestimated.

It should be noted that criminal justice outcomes currently remain low and many alleged offenders walk free after what, for many victims, is a long and sometimes re-traumatising process. Sometimes, though, there are convictions and it feels good to know that SARCs play their role in this process. However, it is not surprising that there is a reluctance to report these events and that there are constant calls for reform of the entire process. The past few months have seen a further shift in speaking out, particularly about historic abuse, including that which occurred in schools. Hopefully, this will continue to add fuel to the calls for an overhaul of the system of reporting and prosecution.

History of SARCs

Historically, all reporting survivors of sexual assault would have been seen and examined by doctors, known as forensic medical examiners (FME). The role is now increasingly being undertaken by FNEs, who are employed by companies such as MHC. There are around 50 SARCs in England, many located in urban areas with dense populations, all offering a similar service based on guidance from the Faculty of Forensic and Legal Medicine (FFLM) of the Royal College of Physicians. Some centres, such as the one I work in, are located in police-owned, customised facilities, and some are located in NHS or residential premises. MHC currently manages SARCs in 12 counties, alongside providing custodial healthcare services in three police forces, attending to individuals who are detained in custody. The NHS website (2021) has information on actions to take following rape or sexual assault, along with a means to locate your nearest SARC by entering your local postcode.

The SARC service is commissioned by NHS England and the police in accordance with the NHS England (2018)Strategic Direction for Sexual Assault and Abuse Services Lifelong Care for Victims and Survivors: 2018-2023 document. SARCs provide specialist sexual assault referral services for adults and children who have experienced sexual violence and/or sexual abuse. The Topaz Centre SARC in Nottingham, where I work, sees clients aged 18 years and over; some SARCs see those aged over 16 years and, in the case of younger clients they will be offered a paediatric service where they will still be seen by FMEs. The MHC website describes a SARC as a ‘one-stop’ location for those who have experienced sexual violence or abuse. Services take a whole-person approach, with the emphasis placed on the survivor being in control, and they can include:

• Support and guidance following an incident
• A forensic examination
• Medication provision including emergency hormonal contraception/HIV post-exposure prophylaxis/hepatitis B vaccination
• Referrals to other agencies/support services
• Safeguarding interventions
• Aftercare materials.

Accessing the SARC

The SARC ethos is person centred in accordance with the NHS England (2018) guidance. It is important that victims feel that they will be believed, that their needs are the priority, that they will be treated with dignity and respect, and that choice will be facilitated. At Topaz, as at all SARCs, we make it clear that they are in control, and take great pains to explain our role and their options. SARCs are accessible 7 days a week, 24 hours a day.

Survivors of sexual assault generally access the SARC either through the police, having reported an allegation of rape/sexual assault, or as a self-referral, without police involvement. Types of sexual offence defined by the Sexual Offences Act 2003 are identified in Box 1. If the police consider that an offence has been committed, the alleged victim will be offered the opportunity to attend a SARC to enable forensic samples to be collected. This also gives individuals access to follow-up support.

Those who use the self-referral route learn about the service through a variety of channels, for example through personal online research, friends or are signposted by other agencies, such as through contact with 111, emergency departments (EDs), GUM clinics or wellbeing services at local universities. The SARC is proactive in engaging as widely as possible with third-sector local organisations, to create pathways for referrals. Because of this, referrals come from organisations and charities that work with and advocate for vulnerable groups, such as clients with learning difficulties, commercial sex workers, LGBT groups, homeless people and victims of domestic abuse.

Collecting DNA evidence following an assault is time limited. The FFLM (2021) guidance, Recommendations for the Collection of Forensic Specimens From Complainants and Suspects is reviewed and published twice a year (the latest guidance was published in July 2021 with an update due in January 2022). The time frame for recovering semen, for example, from the mouth and lips following oral penetration is currently 48 hours, while obtaining samples following vaginal penetration is 7 days. Although the police are aware of the forensic window relating to each type of sample, a person who wishes to self-refer will probably not be aware of this. Clients who make contact with the service will therefore, initially, have a discussion with an FNE who can assess what kind of support can be offered and whether samples can still be obtained. The self-referral process assures complete confidentiality: any samples taken remain in the SARC untested for a period of 2 years. At any time during that period a survivor can report the incident to the police and, with their consent, the samples will be released, along with documentation recorded at the time. It is a valuable process, and one that buys time for an individual who, for whatever reason, does not feel able to report the incident at the time.

If someone needs the services of a SARC, but is unable to attend, under certain circumstances the FNE and crisis worker will go out to undertake an examination. This can be as a police case or as a self-referral and applies, for example, to a person who is in prison, a care home, someone sectioned under the Mental Health Act 1983, or someone who is still in the ED or on a hospital ward and is not fit for discharge. Although this is not ideal, it is important that forensic evidence is obtained as soon as possible.

What happens at the SARC?

SARCs are an acute service, and consultations take place face to face. COVID-19 has presented some difficulties for the service and the FFLM was quick to provide guidance, for example, on the use of personal protective equipment (PPE), telephone consultations, and on screening clients and those accompanying them. COVID-19 did affect the demographic of those who attended. The lockdown periods saw a reduction in the number of young people and students, as they returned home from universities and social venues closed. There was, however, an increase in the number of those attending as a result of domestic violence. The pattern is now changing yet again as venues have reopened and people are socialising once again.

In Nottingham, Topaz staff remain diligent in assessing risk and have maintained face-to-face consultations throughout the pandemic, although it has been hard to stick to maintaining a social distance from clients who are understandably distressed.

On arrival at Topaz, clients are met by an FNE and a crisis worker, and are taken into a pre-examination suite. Efforts are made to make the SARC a relaxed and welcoming place; however, the choice of furnishings is dictated by the rigorous process of forensic cleaning that must be adhered to in order to limit contamination. Once cleaned, all rooms are sealed and tagged, with the tags removed only when a client enters the space. Although attempts are made to limit the number of people in the SARC, clients are allowed to bring someone for support, and those with learning difficulties may need their case worker alongside to support and advocate for them. The services of signers and translators are also requested, if required, to ensure the client can engage fully.

Clients may be at the SARC for 3-4 hours and therefore for all clients, on arrival, an assessment is made on both fitness to carry on and capacity to consent. Those who attend via the police route may have already spent some time with the police, they may not have slept or eaten, and may be tired and hungry. Some may have injuries as a result of the assault or be withdrawing from alcohol or drugs. Understanding the process is vital, and clients are continually assessed to ensure that they are able to continue. All clients are informed of the process and made aware that it is voluntary, that they remain in control throughout, and food and drink is always offered.

If police are in attendance, the FNE will read and clarify the client’s police statement and agree on what samples will be collected—this is known as the forensic strategy. Depending on the circumstances, the police may have already collected some early evidence, such as oral swabs, and there may also be a collection of clothing and bedding, swabs from injuries, urine sample etc. The role of the SARC is to collect intimate samples pertaining to the assault, along with body mapping, which is a means of documenting any injuries sustained during the assault.

Increasingly, clients are given the opportunity to write their own account of what happened to them because there is growing evidence that this is, in itself, therapeutic. Aspects of the account are then clarified by the FNE. Particular attention is paid to the time the offence occurred and the type of offence committed. More specifically, the FNE needs to know whether any orifices were penetrated, whether ejaculation occurred, whether any other specific parts of the body were touched. The possibility of drug-facilitated assault is also explored. On the basis of the account, a forensic strategy—a list of samples to take and areas to swab—is compiled and agreed with the police, if present. This is then put to the client to consider with a rationale as to what it will be used for and why it is deemed necessary.

The FNE then takes a client history, focusing on their health and circumstances rather than on the assault, as we do not want to influence the client prior to their police interview. A continuing assessment of the client’s presentation and behaviour is made to ensure that the client remains well enough to continue. This is an important aspect of SARC attendance, primarily so that a client’s support needs can be identified and planned for, but also in the event of the case proceeding to court. With any police case, the FNE may be called upon to provide a statement and possibly attend court to give evidence; the history provides the basis of the statement that may not be requested for several months. Thorough contemporaneous documentation is therefore crucial: never before in my career have I been so convinced of this.

The examination and collection of evidence

The implementation of the forensic strategy varies according to the sample, and the client’s needs. Oral samples may be taken soon after arrival, so that the client can then eat and drink. Urine and blood samples, if indicated by the FFLM guidance, provide important information about alcohol and drug levels and are collected as soon as practicable. This may be used to provide information regarding a person’s ability to give consent to sexual activity or to indicate a drug-facilitated assault. The taking of intimate samples and undertaking a full top-to-toe injury check takes place in a forensically cleaned examination suite.

The client is informed as to what the process will entail and is given a gown to change into. The FNE and crisis worker wear suitable clothing and, unless there are good reasons, no one else is allowed in the room. If support is required, for example from a translator, the person is requested to wear a gown and gloves with overshoes to limit contamination. Swabs are taken as agreed, a speculum and/or proctoscope may be used, if indicated. Other samples that may be taken include nail clippings, hair samples, clothing, specific sanitary wear and condoms. Debris found on the skin or in the hair may be collected and areas of skin where the client recalls being touched or injured are swabbed. This may be from bruises, bite marks, abrasions, around piercings or from the neck following attempted strangulation.

With the client’s consent, a video of any anogenital injuries may be taken. This is encrypted and anonymised and deleted from the recording device once downloaded and saved to a DVD that is kept in a secure place. It does not leave the building, even in the event of a court case—anyone requiring access as part of a court case will need to attend the SARC and will have supervised access to view the DVD. A full top-to-toe assessment takes place and any injuries such as bruises, abrasions that the client believes were a result of the assault are measured and drawn on to body maps with a full description. The crisis worker provides invaluable support and distraction to the client throughout this process, which can be understandably distressing. Afterwards, the crisis worker accompanies the client back to the more comfortable rooms so that aftercare and support can be discussed, and a shower is available, should the client want one.

Aftercare

Aftercare is hugely important, both in the healing and recovery processes and in protecting from further harm. The FNE takes a comprehensive client history, which includes any medical and mental health issues, previous surgery and medications. For women, we ask about pregnancies, contraception and menstruation. Following a risk assessment, the person may be offered emergency hormonal contraception or onwards referral for a coil fitting, if appropriate. The initial 5 days of a 28-day course of HIV post-exposure prophylaxis can be provided, again after assessment and, if within 72 hours of an assault, this is continued and monitored by the local GUM clinic. The British Association for Sexual Health and HIV (2011) recommends that hepatitis B vaccination should be considered for all victims of sexual assault unless already vaccinated. Following a risk assessment and discussion with the client, the first dose is offered and followed up by the GUM clinic, if accepted. A full sexual health screen is recommended 2 weeks from the assault and appointments are usually made by SARC staff on the client’s behalf. If the client is registered with a GP, we will offer to update them and can request a GP appointment/call, if needed.

The SARC offers a totally holistic approach and aftercare involves a thorough assessment, so that care and referrals are tailored to each individual’s requirements. Part of the assessment involves consideration of safeguarding for both adults and children, and this is an area where we are particularly thorough. All incidents involving domestic violence where children were present must be reported to the safeguarding team, so that the child can receive support. For those experiencing domestic violence, a domestic abuse stalking and harassment (DASH) assessment is completed, which may lead to a request for a multi-agency risk assessment conference (MARAC). Temporary accommodation in hostels or refuges can be found for those who are homeless or wish to escape a violent partner. Support from an independent domestic violence advisor (IDVA) can be arranged and safety planning is discussed with those who do not feel ready to leave the relationship. All clients are offered support from an independent sexual violence advisor (ISVA), who aims to contact them within 72 hours.

Having a good relationship with the local police service is important for SARCs and my experience has been extremely positive. Nottinghamshire police have specially trained officers (STOs) to care for victims of sexual assault. I have found officers to be sensitive to the needs of the client and their safety; they endeavour to find accommodation for those escaping domestic violence, and can also arrange for locks to be changed and take action such as applying a place of interest marker (POI) on an individual’s property. This alerts the police that there is a vulnerable individual if a call is made from that property. Police officers also complete domestic violence assessments and safeguarding referrals.

Since working at the SARC, I have been amazed at the wealth of agencies that offer support that clients can be referred into or to which they can self-refer, should they choose to do so. Just a quick online search will reveal a multitude of services in your own area, which will include drug and alcohol services, counselling services, LGBT support groups, and organisations that support those who self-harm or have eating disorders. Most universities now have good student wellbeing services that can offer psychological support and academic support, if required. In our area, one of our local universities now has a dedicated sexual violence officer on campus. We also have connections with organisations such as the Muslim Women’s Network and POW Nottingham (a group that works with commercial sex workers), Equation (support for both women and men who are victims of domestic violence) and Karma Nirvana (support for victims of honour-based abuse). See Box 2 for a list of national organisations that provide support.

Box 2.Resources
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Another important part of the FNE role is undertaking a mental health assessment as part of safety netting measures to ensure that appropriate support is put in place. For example, if there are immediate concerns, clients may be referred to the emergency department for assessment by the mental health team. Nottinghamshire police also have the services of a mental health worker who can attend and assess the client if the FNE has concerns. Alternatively, support can be put in place following the assault. Poor mental health can manifest in many ways, and SARCs are able to make referrals directly to NHS psychological therapies (Improving Access to Psychological Therapies, or IAPT), to request the intervention of a client’s GP with their consent, and refer to organisations such as Harmless, which works with those who self-harm. We also furnish clients with places to which they can self-refer should they feel they need to do so, for example to the mental health crisis team. COVID-19 has clearly had an impact on the availability of services, with many moving to provide online rather than face-to-face sessions. Responses to this change have been mixed: some clients prefer the ease of access, while others have felt the online sessions were impersonal and they could not engage. For some, the lack of technology presented problems. There have also been issues with long waiting times due to staff sickness coupled with the increased demands that COVID-19 has placed on mental health and wellbeing services in general.

When not dealing with a case, FNEs, along with administrative staff, have a more office-based role during daytime hours, making new referrals for cases that have attended during the night when agencies are closed, and generally chasing up and updating old referrals and following up cases. SARCs also take phone calls throughout the day and night from people ringing for advice or to book a self-referral appointment. SARCs run by MHC always offer a 6-week follow-up call with attenders, to make sure that the client is coping and to see that all the promised referrals have come to fruition. We check at this point how well the client has engaged with agencies and ask questions about their health, looking specifically for signs of post-traumatic stress disorder.

Conclusion

Although there is so much more to the SARC than I have been able to present here, I hope this article has given readers an insight into the existence and function of these centres and has better equipped you to signpost people to help and support should they disclose a sexual assault to you. I also hope that reading the article may have inspired my nursing colleagues to want to work in a SARC as a crisis worker or as an FNE.

Box 3 provides a list of FAQs that will hopefully address some of the questions that may have arisen in the reading of the article, or that may arise in your work, to enable you to offer help when you encounter these issues, while Box 2 contains some useful resources. I hope that you will take a moment to find the contact number of your local SARC, and some of the agencies and charities in your area that may be useful, to add to the list.

Box 3.Frequently asked questionsWhat if a patient on my ward discloses that they have been sexually assaulted?Find out as much detail as you can, for example, when the assault occurred and who the perpetrator was. If it happened in the past 7 days, ask if they want to report to the police via 101. If they choose not to, then call the nearest sexual assault referral centre (SARC) on their behalf and ask for advice, if the client is in agreement. SARC staff will advise you on preserving evidence, and will come to your ward if the client is unable to leave. Discuss the assault with your safeguarding lead, particularly if this is domestic violence related, or if it involved someone in a position of trust such as care staff. If the assault is historic, a referral to services (see Box 2) is appropriate and, again, consult your safeguarding lead or ring the SARC for advice and information.Can I report an assault anonymously?All crimes can be reported anonymously via the Crimestoppers website. Police look for patterns of crime and this information is very useful.Does the SARC offer sexually transmitted infection (STI) checks?SARCs do not offer any tests for sexually transmitted infections. Testing is done via a genitourinary medicine clinic, usually 2 weeks after an assault has taken place. SARCs do provide emergency contraception, post-exposure HIV prophylaxis and hepatitis B vaccination first dose for victims of assault.If someone does not want to report an assault to the police, what is the point in attending the SARC?If someone is still within the forensic window, SARC staff can take specimens. These are not processed, but will remain in the SARC for 2 years, after which they will be destroyed. At any time during this period, a client can contact the police and make a report. Police will then request the samples for analysis with the client’s consent. Even if the person does not report the incident, it is important that they access support and advice to help them recover, heal and rebuild.What if someone tells me they were abused as a child?Forensic samples will not be possible. However, encourage police reporting, particularly if the perpetrator is still alive. If the client chooses not to report, referrals can be made to support services (see Box 2), a counselling service and to their GP, if they need support.What if someone tells me they are still in an abusive relationshipIf you spot signs of an abusive relationship, do not ignore it. Try to speak to the client alone. Always share your information and concerns, particularly if there are children involved. Offer safety advice if in a position to do so; suggestions can be found on the Women’s Aid website (see Box 2). Apps such as Bright Sky and Hollie Guard are available to download free of charge for those in an abusive relationship, or those concerned about someone they know. Make sure that you always have information and telephone numbers available. You never know when you may need them.What do I say if someone tells me they were raped, but are too afraid to report it to the police?Find out why they are scared and support them to report, if you can. If they cannot, discuss the self-referral option with them. Contact the local SARC on their behalf, which can make support referrals over the phone and encourage a forensic examination. SARC staff can also arrange places in a refuge for someone who has been sexually assaulted and who wants to leave a domestic violence situation.What advice can I give to someone who tells me they have been assaulted in the last 7 days and is thinking about reporting it?Support them to ring 101, or the SARC for advice. It is important to preserve evidence for example: advise them not take any further showers, not to wash their hair and, in an oral assault, not to brush their teeth. If they still have the clothing worn at the time of the assault, this should not be washed, but placed in a bag and taken to the SARC. Save any items that may have been contaminated, such as a discarded condom or sanitary towel. Advise the client that, if they have any messages on their phone, any contact/photos on social media or dating sites, they should not delete them. Suggest that they try to write down what they recall from the incident. If it was a stranger, to consider their characteristics, height, weight, smell, clothing, hair colour/style and tell them to give this information to the police/bring it to the SARC with them.Is there anything else I can do?Be prepared. Go to the NHS website and enter ‘rape or sexual assault’ in the search box. Follow the link ‘Find rape and sexual assault referral centre service’ and enter the postcode of the place that you work to find your nearest adult and paediatric SARC. Make a note of the details. Use display boards to advertise the SARC, display phone numbers of domestic violence services in suitable areas such as toilets (male and female), and be aware of your local services. Familiarise yourself with useful apps such as Bright Sky and initiatives such as ‘Ask for Angela’, where individuals who feel threatened can ‘ask for Angela’ in bars and clubs as a signal that they need assistance. Above all, never ignore it, engage with men and women on the subject, pick up on cues during conversations and, if in any doubt, phone your local SARC for advice.

People make the comment about our role, ‘I don’t know how you do it’, but I am confident that I speak for the whole team when I say that we would not do anything else. For me, ending up working in the SARC was a complete accident, rather than a planned move. It is, however, an enormous privilege to work at Topaz, with such an amazing team and such a caring company, in a job where we make such a massive difference.

KEY POINTS

• All people subject to sexual assault within the preceding 7 days should be encouraged to report it to the police. Those who do not want police involvement at that time should be offered the opportunity to self-refer to the SARC as soon as possible for advice and support
• Those who self-refer can still have samples taken depending on the nature of the assault and time frame. Samples are stored at the SARC for 2 years, giving the person time to report to the police, knowing evidence has been collected
• As reporting of incidents of rape and sexual abuse gains wider coverage in the media, it is more likely that victims of historic or current sexual abuse may disclose to healthcare staff in the course of their daily work. It is important that staff are equipped with appropriate knowledge and information to enable them to access timely help and support

CPD reflective questions

• Think about your work environment. Is there anything you can do to make sure that anyone who is a victim of domestic abuse or sexual violence can access information that will help them report?
• What opportunities do you have to engage with children/young people on their understanding of respect and consent? It is important they understand consent, for example, are they aware that ‘stealthing’ (removing a condom during sex without consent) is rape? Visit the Consent Coalition (https://nottssvss.org.uk/consent-coalition) for further information and free resources
• A friend plans to join an internet dating site. You know that this has risks. What issues do you think they should consider to stay safe? What measures can they take?