A Centre of Excellence for Child Abuse and Forensic Paediatric Medicine – a suitable model for the UK?
The provision of clinical forensic medical services is highly variable and in some locations, non-existent. Similarly, paediatric forensic medical services (child sexual and physical abuse and neglect) are variable in quality and availability of service. Very well organised services are available in some regions of the United States of America and some specific jurisdictions elsewhere. In many locations where services are provided, their provision is not always within the ideal location which is hospital based. Further, the training of paediatric practitioners in forensic medicine, medico-legal report writing, and the provision of expert witness testimony is similarly variable. Inadequate training may lead to injustices where the innocent may be convicted and the guilty exonerated, with subsequent adverse effects upon the children who may or may not have been appropriately safeguarded.
The Victorian Paediatric Forensic Medical Service (VFPMS), co-located at the Royal Children’s Hospital and Monash Children’s Hospital in Melbourne, has evolved into a Centre of Excellence for child abuse and forensic paediatric medicine. Established in 2007 as a 24 hour, 7 day a week specialist service, VFPMS provides inpatient and daily outpatient services in both hospitals. In addition, it provides advice to paediatricians and general practitioners throughout the state of Victoria, a state about the size of the United Kingdom a but with only a population of about 6.7 million people (5 million living in Melbourne). VFPMS is independent of police and the judicial system and is funded by the health department. It is staffed by a full-time director and deputy director, about 10 sessional specialist paediatricians (plus one forensic physician), 3 – 4 registrars/fellows, two effective full-time nurses, and two administrative staff. Patients range in age up to 18 years and include acute sexual assaults, physical abuse and neglect cases. Forensic opinions based on the available medical records are also provided on request from police. All the specialist staff are required to undertake or to have undertaken further training in forensic medicine and usually this means completing the Master of Forensic Medicine course run by Monash University. Research is encouraged and increasingly undertaken. Medico-legal reports are written for all cases seen and all reports are peer-reviewed before release. Case discussions and reviews are conducted on a monthly basis. The service is one of the few accredited training positions in forensic medicine in Australia. Despite initial hesitance from the general hospital paediatric community, the benefits of having a specialist forensic service familiar with the medico-legal system that is separate to the treating practitioners is now widely accepted. With direct benefits to both the patients and judicial system, VFPMS has become a Centre of Excellence and provides an ideal template for quality forensic paediatric medical services in other jurisdictions.
While there is a well-developed child and adolescent safeguarding system established in the UK, the implementation of a similar hospital-based unit in strategically located tertiary children’s hospitals would ensure a more uniform and high quality provision of Paediatric forensic medical services throughout the country and, by doing so, enhance the care of vulnerable children and adolescents, and ensure appropriate justice.