The Bridgeway SARC

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We assessed 2 quality statements under the effective key question. Patients received thorough assessments and staff made appropriate referrals, provided required medicines, carried out routine peer reviews of each case, and ensured practice remained aligned with updated clinical guidance. Staff understood the importance of seeking informed consent.

Find out what we look at when we assess this area in our information about our new Single assessment framework.

Prior to attending the SARC, patients underwent an initial telephone screening with call centre staff and then triage by a clinical staff member. This helped identify medical risks that needed to take priority over the forensic examination, consideration of safeguarding risks and vulnerabilities and any additional patient requirements to inform the planning and timing of their visit to the SARC.

Patients aged 0-12 were seen by one of the provider’s doctors, supported by a nurse or crisis worker. Patients aged 13 years and over were examined by a nurse, supported by a crisis worker.

Patients attending the SARC received a comprehensive assessment of their needs, including their medical and sexual history, mental health and any safeguarding concerns. All examinations were undertaken in the clinical examination room, any injuries identified were documented and included the use of a body map.

Staff used standardised templates in assessing and examining patients that reflected current national guidance. Patient records that we reviewed were detailed and described the care and treatment offered and provided to patients, as well as any follow up actions.

Recognised clinical screening tools were used to identify anyone who might be experiencing withdrawal symptoms from drugs or alcohol. Staff described an example of working with the police ahead of an alcohol‑dependent patient’s attendance at the SARC, because there were concerns about possible alcohol withdrawal. A plan was agreed with the patient to have supervised access to alcohol during their time at the SARC, this ensured the risk was managed and the patient’s needs were met.

Health needs arising from exposure to unprotected sexual activity, such as the need for post exposure prophylaxis and emergency contraception, were identified through assessment that met guidelines issued by the British Association of Sexual Health and HIV (BASHH) and the Faculty of Sexual and Reproductive Healthcare (FSRH) respectively. The service did not provide testing for sexually transmitted infections for those aged 13 or over but made referrals to local sexual health services if needed. Testing was available for children aged 0-12.

Patients who had experienced suspected female genital mutilation could also access the SARC. Staff had received additional training; a policy was in place to inform decision making and advise staff on the action to take for those aged under 18.

Where necessary the SARC staff made referrals to relevant services for follow on support for children and adults, including local independent sexual violence advisor services. The SARC referred patients to other services, such as sexual health, counselling and the patient’s GP for any follow-on care needed.

Following a full assessment, patients were provided with any required prescribed medicines, such as hepatitis B vaccination or emergency contraception. Staff made referrals to the patient’s GP for follow up vaccinations.

Staff routinely peer reviewed each case following its completion. This involved a review of the notes and any colposcope images that had been taken and checking that appropriate care and treatment had been provided to the patient. Adult cases were discussed twice daily and children’s once each day across the region. In addition, all staff presented individual cases on a quarterly basis for peer review, this supported individual and wider staff reflection and learning. We observed informal support and guidance being offered to staff during our visit.

MHC ensured that updates to guidance were made available to staff, such as when changes to NICE or Faculty of Forensic and Legal Medicines (FFLM) guidance were made.

The judgement for Delivering evidence-based care and treatment is based on the latest evidence we assessed for the Effective key question.

The judgement for How staff, teams and services work together is based on the latest evidence we assessed for the Effective key question.

The judgement for Supporting people to live healthier lives is based on the latest evidence we assessed for the Effective key question.

The judgement for Monitoring and improving outcomes is based on the latest evidence we assessed for the Effective key question.

Staff understood the importance of gaining consent from all patients or their responsible adult prior to carrying out any examinations. Staff consistently reviewed patients’ consent throughout their time at the SARC. Children and adults were supported to communicate and make decisions to enable the service to deliver person-centred care and treatment in line with their best interests.

Patient records we viewed documented consent, capacity, and choice in relation to physical examination, management of intimate images, information sharing, and onward referrals. Staff consistently told us how they explained in detail forensic procedures to ensure patients fully understood what would happen during their examination. Staff stated they always made patients aware that they could withdraw consent at any time. Patients signed clinical records to evidence their consent to care and treatment.

Staff understood the importance of gaining consent from younger children, even where their age meant they could not formally give consent, this was obtained from their advocates or carers.

Staff received training on the Mental Capacity Act, staff we spoke with were aware of the requirements of Gillick competence and Fraser guidelines.