 Welcome to the Equal Opportunities Committee, the 11th meeting of 2014. Please set any electronic devices to flight mode or off. Today's first agenda item is an update from the Equality and Human Rights Commission, the EHRC. You agreed to seek an update from the EHRC in a range of policy areas. In paper 1, members will see that a response was received last week. I would also flag up that we sought information on EHRC reforms from stakeholders in 2013 and any further work should take these views into account. The current EHRC response could be used to feed into your work programme considerations later this year, particularly on the public sector equality duty and the EHRC's business plan. You will also see that the EHRC is to publish its annual report and accounts for 2013-14 later in the summer. If you would like to hear formal evidence, we could either programme an evidence session with it in September or October, or hold an additional meeting in August. Can I seek your agreement on which approach we should take, please, from everyone? I think that September or October would be a good time once they have published some more evidence and some of the things that are detailed, particularly around gypsy travels as well. It would be quite interesting, so I think that maybe waiting until then would be good, but definitely an evidence session would be helpful. I agree entirely with Siobhan. I wonder, though, in the interim, and in line with the other work that's been done by the committee, if could we be possible to get the parameters of the research they're doing into gypsy traveller accommodation at this time, please? Thank you. Anybody else have any comments? Christian? Yes, we want to make sure that we get the research before we have the meeting. Yes, I'm looking forward to it. I have a lot of time to study it. We all agreed that we will look at September or October to have this meeting. Thank you very much. I now need to suspend the meeting just now while we wait on our next session to start. We're waiting on some witnesses to come along and give some evidence, so the meeting will be suspended until then. Good morning, everyone. We're now going to move on to our second item of business, which is an evidence session on female genital mutilation. Can I just remind everyone again that it's just come in to switch off any electronic devices that you may have, please? We'll start the session with some introductions. At the table, we have our clerking and research team, official reporters and broadcasting services. Around the room, we're supported by the security office and also welcome to the observers in the public gallery. My name is Margaret McCulloch and I'm the committee's convener. I'm now going to invite members and witnesses to introduce themselves in turn by starting on my right. Can I also ask the witnesses when you're introducing yourself just to give a wee introduction about the organisation and any other information you may feel that it's relevant? Thank you very much. I'm Mark Obiagie. I'm the deputy convener and I am the MSP for Edinburgh Central. Good morning. Good morning John Finan, MSP Highlands and Islands. Good morning Christian Alad, Member of the Parliament for the North East of Scotland. I'm from Mcmaren MSP Central Scotland. I'm John Finan, Member from North East Scotland. I'm John Mason MSP for Glasgow Shetleston. I'm Gillian Smith. I'm the director of the Royal College of Midwives in Scotland. The Royal College of Midwives is a part of the intercollegiate guidelines and recommendations that were launched in Westminster Parliament. I'm particularly committed to this issue and engaged in the Scottish Government working group around FGM and how we take some of the recommendations forward. Also, I'm newly starting to be with the national FGM charity group that's there. In my time working overseas in the Sultanate of Oman, I experienced an almost daily basis. I have considerable understanding of the issues around it. Good morning. My name is Jim Doyle. I work for Glasgow City Council. My job title is quality improvement officer, but my strategic remit is child protection. That involves working with other partners, other services like social work health from the voluntary sector, and people like that, to do with any issue to do with child protection. One of the biggest part of my job is to make sure that all of the 300 node child protection coordinators in school receive annual training and biannual training, actually, on anything relevant that children are protected. Good morning. My name is Dr Kate Darlow. I'm a senior registrar in obstetrics and gynaecology, so I'm a front-line health worker based in the Royal Infirmary here in Edinburgh. I've been asked to represent the Scottish Committee of the Royal College of Obs and Guiney, as asked because I've got an interest having worked in Ethiopia and lived in Somalia, so first-hand experience. Good morning. My name is Anna Bonny. I'm the lead officer for safeguarding in Education Scotland. That means ensuring that Education Scotland staff have a good understanding of all matters safeguarding and also supporting inspectors within schools, because that's an element of our inspection work. Thank you very much. I'm going to hand over to Christian Allard, who is going to start by asking the questions, and then we'll go round the panel and turn. Thank you. Thank you, convener. I've got a few questions about statistics and numbers, first of all, maybe a question hearing what you've said as an introduction. You talked about FGM. Is people know what FGM is, or do we need sometimes to use the female genital mutilation terms just to make sure that people understand what it means? I think I'd probably like to come back in that because I think it's a very good point that you make, and if you spoke to women who have suffered from that abuse, they may not know it as the term female genital mutilation. They may know it as female circumcision. They may know it as sooner, or they may know it as something else that they know from their country. So they may not, because of their culture, see it as mutilation. I think often that what we've not got right, and I think it's a great question to ask what we've not got right, is the terminology when we ask women if they have been subjected to that form of abuse. Anybody else like to come in on that, Anna? Yes, in a recent letter in February 2014 that went to every school, the terminology we used was female genital mutilation. That was a letter that was signed by the Capsaic Michael Russell and Shona Robinson. So that was the terminology we used at that stage, but we're very open to getting the terminology right. Could I just ask the witnesses if you want to come in and any of the questions just to indicate to myself or my clerk in my left-hand side? Thank you, Christian. If I can follow up on statistics and numbers, we got some conflict evidence giving to us. Some people attach more importance to statistics and numbers, and others didn't. One particularly said that it's not a matter of numbers, but a matter of need, and if one child is affected, that is one too many. So I would like to have your views and first of all, have you got any idea of the numbers of women and girls who have been subjected to FGM as a number of girls who are on the threat from FGM? I think we don't entirely know, and hopefully once we get the report from the Scottish Refugee Council, then we'll be able to understand better. But I think there is increased awareness, which is helping to generate more services for people, and then hopefully when there is more access to these services, we'll be able to understand exactly what it is that we need to offer. I think just building on that is that I think that the statistics that we have of the women who have had this procedure carried out are woefully inadequate. What we do have is we've got the Scottish Women's Health maternity record, which is often the first time that we know about her and counter it. Every midwife is obliged under what's in the Scottish Women's Health maternity records to ask the question. However, to extrapolate that information is very difficult when we do not have an electronic maternity record, and I have been plugging for this for some time, because if we were to do it retrospectively and you were to go through 58,000 maternity records in Scotland to extrapolate that information, it's a real challenge. Whereas if we had that information on an electronic system, it would be there and it would be readily available. So I don't think that the statistics that were given, whether it's in our intercollegiate guidelines, recommendations or not, I think that they are woefully inadequate, because I don't think we'd know the real challenges here. Can I come in on that and ask a basic question about why isn't there an electronic system for it? I think it's a finance issue. To get that electronic patient record, there are some areas to be fair, which have done that around maternity services, and Lothian is one of them. Airstream, Arnz and other. Glasgow is currently looking at it, and as we know Glasgow is a major area because it was a dispersal area for asylum seekers. So it would be really good to have that kind of information on an electronic basis. I think there are also challenges, and I have to take this from my own profession, that the question is there to be asked. And some of the feedback we've had from organisations such as DARF is that I'm not entirely sure that midwives are always asking that question because of cultural sensitivities, and I think we have to part cultural sensitivities when they do their booking in. So I think it's perhaps the terminology of how they're asking the question, but I do think that that is a piece of work that we require to do around it. Anybody else like to come in to that question? No? Kate? Just to add that, as Julian said, we do have an electronic system in NHS Lothian, so we are considering the possibility of a service evaluation because there is some information that we can access there. We have a question which is asked to all the women at booking where we can tick that on our computer system, so we have the potential to be able to look back at that, and I think that we're just considering it at the moment. There's a line of thought on this, and thank you very much for your answer. Should gathering data be a priority? I think you touched on it. Is there not going to be a problem with relationships with certain communities if we search too much for gathering data, as opposed maybe to see what's the best way to address FGM? I think it's difficult if you don't gather the data to have an idea what your benchmark is and what the size of the matter that we have to deal with is, and where resources are tight within, whether it's education, health, justice, wherever it is. If we don't know when we're making a case to have resources behind something, what the real issue is, then it is very difficult. I don't think it takes away from your initial comment of one child is one child too many, so it doesn't take away from that initial comment, but if you are looking to see how you plan a service, and we're currently sitting in Scotland with only one midwife, which is allocated to an asylum seeking community, but deals a lot around FGM, and that's in Glasgow. That's because we don't know the scale of the issue, and if we don't have the data, we don't know it, how do you channel your resources into that way? So I think that's my reasoning for data. Anybody else? To John Finnie now. Thank you. It's important to bring about attitudinal change. Do you have views about how we would engage with communities to do that? I appreciate it's a very challenging issue, but do you have views on that? Yes, I'm happy to start. I suppose we're looking at, I don't know whether there's attitudinal change where teachers are concerned, but certainly raising awareness that we have this letter that's gone to all schools and authorities making them aware of the concerns that Scotland has about female genital mutilation, and that will be followed up every teacher in Scotland at the beginning. It's usually in the Augusts, when the authorities vary, but they do it on a very regular basis. They provide an update to all teaching staff on issues of safeguarding and child protection, and female genital mutilation is such an aspect. So we are preparing with partners some additional information that will go to every teacher. So I think that's awareness-raising and being more sensitive to the issues, which will certainly help community awareness. Just working along those lines. We're working with Anna on that. I'm one of a group that's working on putting those guidelines together, the presentation for August for staff. When I'm doing my training with CP co-ordinators, we do them twice a year. We do one in November, one in May, and the May round has just finished, and each one of those, I brought the subject up just at a very, very high level. And the reaction from the audience, from all of the teachers was they were certainly concerned about it, about the sensitivity and how much information they need. But what we were emphasising to staff is it's a child protection issue. First and foremost, it's a child protection issue, and we follow child protection procedures. In terms of attitudinal change, I think staff are, teachers are always prepared to protect children, whether it's FGM or something else, but they need slightly more information about FGM, I would say. When you say they need more information, do they need more information, and how should it come from? I think child protection co-ordinators need to know, and staff need to know what the issues are, and if you're a teacher in a classroom, you would need to know, or a head teacher, for example, if there was a possibility that a child was going to be operated upon because of that taken away, and the information they need is to look out for the sort of signs for that. And similarly, if they find a child, if they think a child has had this procedure carried out, they need to know what to do, and what to look out for, that sort of information. I mean, I think that the fact that we're here today, and I was sharing my card on the way up in the lift, because I think that we need to work more collaboratively, and I think it's interesting what Jim says around it, because that's the kind of issue that I think it would be good for midwives to go into school and talk about, and I think it's that close working together. Some of the work that we're now picking up with the Scottish Refugee Council, I met yesterday with NSPCC, all of these areas, it's that collaborative working, and the work that the Scottish Government group are still looking at now to bring those groups together, it's only if we work together that we'll deal with some of these. But an interesting aspect of it is that this is generally carried out by the communities of women on the girls, and what I think we need to do, and it's perhaps an influencing area, is influencing the imams to churn around the change in this, or influencing the religious leaders depending on where that is, and that's how you influence the communities. So we need to work with them as well. Can I bring Mark on that just now, and then back to you, John? It's intrigued Mr Dyle by your discussion of this, having come up in a context where there were a lot of teachers. Were there any examples of people feeding back with specific concerns? Did anybody say that rings a bell with me? I've got, if possible, I'm suspicious, or was it the case that people were completely lacking in information of that statement? They weren't completely lacking, they were certainly aware that there was an issue generally. I didn't get any specific examples of cases having that in place, but it's something that I think the teaching profession are becoming more aware of, like the general public probably. John. I'm going to say something that's not meant to the criticism of any of you. I've had a look at your designations, and the question maybe is a bit unfair, but it does seem that you're talking with each other, and that's to be commended, but also the issue of engagement with who you're talking to that's talking to the communities, if you've all. I suppose, and if I take it from the Royal College of Midwives, we're working with a number of these groups, and I can say that a number of the groups, I've already had some conversations with DARF and some of the other groups, and I think you're right, because usually these groups that are there, they're already, you're preaching to the converted because they understand it, but we need to see how we can get in and around those communities, and I think that is the real challenge to do that. Sorry, didn't put my hand up. The City Council Education Services, we sit on the Glasgow Violence Against Women group, and they work with the community, and we also work with the Women Support Project, fairly closely at the moment, on the FGM specifically, and they link with the community, and they've got a role there. Does it really carry on from that? I mean, when Jim mentioned child protection as design, and that's a multi-agency process that's well embedded in all local authorities and in all the schools in Scotland, and they're engaged considerably with their parental community, but authorities where there are particular worries or concern, as Jim's been outlining, go much further than that, and we know very good relationships and fact finding and working with partners to make sure that staff have the information that they're required, and also to talk to communities about how to move forward. So there are a number of good examples of engaging further. Kate, do you maybe like to comment as well? I know from our side Dr Alison Scott, who's based here in Edinburgh. She would have liked to have been here today, but couldn't. She's been working very closely. She sits on the Scottish Government group, so she has a strong interest from our side. I think there's a benefit and an unequivocal statement that this is child abuse, and that perhaps can be a double-edged sort too, and brings me on to my next question, which is the balance between, if you like, education and enforcement, because whilst there might seem to be a greater traction in having a significant penalty associated with someone perpetrating these acts, maybe that has a negative effect in some communities too. Do you have a view on that at all, please? Dylan? I'm almost talking it now. But I think that that's a big issue, and when we get them when they're pregnant, and I'm sure Kate has the same issues, they're very vulnerable, and often there is the concern around how... you don't want to over-egg the pudding and have them stop coming from maternity care, because you've put so much emphasis around that, and I think that's the real difficulty with a number of these things, and that will be the sensitivity about how we deal with this. But when some people use the label of it's culturally sensitive, for me, I don't think we can afford to have that label any more. I think the sensitivity is around, do we prevent them from seeking help from us in the future? And if you look back at some of the confidential enquiries into maternal death, they will tell you that women from migrant-immigrant populations are less likely to seek help, and some of that help you worry is that because of those types of sensitivities. And I think we need to know how we're going to deal with that in the future, because we know it's child abuse, and if we highlight the female children of women who come from these communities, and we know that because of the women who've already been subjected to it themselves, is how do we deal with that, and how do we take that forward once they know they're going to perhaps be put on the children's at-risk register? So I think that's a huge challenge for all of the departments of health across the UK. I've forgotten the thrust of your question, Mr Finlay, I'm sorry. It is the balance, if you like, between education and enforcement, if you like. I think our role in it is very much child protection, and it's awareness-raising with staff so that they know if there's a concern which procedures to follow, and it's an interagency procedure where it would go to social work in the police to investigate. We've always got to be very careful of our relationships with our parents, but I think we're fairly skilled in schools at doing that. I agree with Jim. I think that's right, and I think also. Teachers are very clear they have a duty to raise any concern that they have about any child that they're teaching. They're not necessarily the decision makers. There's a due process that they go through, but that is very well embedded in Scotland. But I think there's other things like how we relate to our pupil community as well. And these guidelines for raising awareness for teachers have to come first. But Education Scotland again with other partners are looking to develop maybe some curricular materials so that young people can be made more aware in a very sensitive manner, which is why we'll need a lot of experts to support these issues and they can begin to explore them within the educational context. I agree with Gillian that as clinicians we feel that we really need to support women rather than criminalise them. We want them to be able to feel comfortable that they can disclose that they've had FGM done in the past so that we can then tailor the care that we offer them. We don't want them to be going underground. And then for us to discover that they've had FGM when they're in labour, that's not a very helpful time to find it out. So we need to empower these women to feel comfortable to disclose this information to us. It was this issue of being culturally sensitive and maybe I picked up my smith wrongly. Did you say at one stage, park cultural sensitivities? Because it seems to me I've lived in Asia as well and we in the West, we're obviously used to our kind of society, but we talk about things, especially anything to do with the sexual realm in a much more open way and other cultures would be quite critical of us for doing that, for not being a little bit more modest and a little bit more sensitive and these kind of things. And I just wonder how we strike that balance. I think what I'm saying is park cultural sensitivities on this issue because it is child abuse. There's no other way that we can look at this. It is child abuse and it's, and generally of the age that it's done, there is no consent around this. The girls think that they're going off for a nice party before they're pinned down and this is done to them. And that's when I say, we can't afford to say, well we'll not discuss that issue because it's culturally sensitive. And I think that's where I mean around the cultural sensitivities. We have to discuss the issue, we have to deal with the issue and we have to put a stop to this child abuse. I totally agree with that, but would you say then that the way you would talk to somebody from a different culture would be different? I mean I think part of that's the language as well and their understanding. And when I was describing earlier on where you wouldn't necessarily say female genital mutilation because they may not understand it as mutilation, then that's the kind of thing when you're being culturally sensitive about how you raise those issues, that's what I mean about that's when you use your cultural sensitivities. But the issue itself can't just say, well we'll not deal with it because it's culturally sensitive. So I think, I hope that describes what I meant by that. Thank you. Michael? Part of the issue of this is about public awareness and there has been a bit of public awareness in the last week or so connected with the deportation of Nigerian women with two young children, which I personally found shameful. Do you think that particular instance will help address the problem in Scotland or hinder it in any way? I think really in terms of public awareness there's been growing attention since January that I've become more aware of and there's been a number of incidents, letter to schools here and also in other places in the UK. So I think that people are more aware and big focus just on women in terms of education so that there seems to have been over the last while the whole issue of women and inequality and human rights with regard to women being explored. I think it's a very good time for us to explore this issue because I think it's more in the public mind than it has been in the past and to become clearer about how we're going forward with it. Kate, would you like to comment? I think that raising public awareness can only help the situation. We know from the DARF study that FATI showed that women were disappointed if they weren't asked about it antinatally, so if we're raising awareness from both sides, women expect the question to be asked and also the health personnel are quite used to the concept as well. Dawn, you're okay now? Can I reassure the panel I'm not seeking to employ all them in some sort of constitutional issue, I just wonder if they felt that this was in any way beneficial on one level that the issue is being raised but the perception is that it having been raised nonetheless the authorities, whoever the authorities are have disregarded it and someone has been deported. I think there's absolutely no doubt that because in a daily basis through my organisation I get all of the media reports and since probably the launch of the intercollegiate guidelines this has just taken off. I was talking to my colleagues from the Scottish Refugee Council outside earlier on and I was saying the international congress of mitwais is on in Prague and has been on all week and on a day and daily basis that is what's being has been on Twitter, it's about FGM there's been huge workshops about it there's been a recognition in some of the countries overseas that they are reducing the amount of FGM and we perhaps need to take some lessons from that so I know that my colleagues in the Royal College of Mitwais have been heavily involved in that to a work in Prague this week so to see what comes out from that certainly as an organisation we are really interested but it has been Twitter mad all week about it Perhaps to move away from the mitwais parent interaction one of the concerns that was raised before by our previous panel was that a strong criminalisation approach would make it very hard for family members or the children at risk themselves to come forward or to raise a suspicion because it would involve criminalising a close relative what are your views on that especially Mr Doyle and Ms Boney the ones that are dealing with it from a safeguarding approach would you agree with that or is there a balance to be struck there a balance to be struck I think it comes back to sensitivity and knowing what you're dealing with and knowing your community I think that's really important because if you focus so much on the criminalisation aspect your role is child protection it's not law enforcement that might sound contradictory obviously you want to enforce the law but you have to make sure that children feel safe and are safe and the families feel safe and are safe the analogy in my head just to give isolated to the last question about public awareness is that I do a lot of work on child sexual exploitation and one of the big factors there is publicity around the utri operation about that and it is a kind of mixed blessing but there are more and more referrals and more and more public awareness and people are much more likely to come forward now to talk about that kind of issue and it's probably similar for FGM but there's an added level of sensitivity because of the communities you're dealing with and their own perception of the procedure and I think talking a gradual process of awareness and then education I was about to draw a similar parallel myself because presumably in safeguarding and child protection there are already going to be instances where a child's reports are going to lead to potential prosecution of parents how do you handle that how can you address that and get over that difficulty is that something that is just going to be present from a teacher point of view the duty of care overrides all of that and they're concerned about the child for whatever reason within their class and then due process takes place so then there are discussions with health colleagues social work colleagues they can bring in other people and it's how that has then progressed and there are opportunities for discussions and thoughts so it's not a sort of a brutal process I think we've learned through various other child protection issues that there's got to be good data gathering good exploration good dialogue with the families in this process people who are involved in child protection have gained those skills this is perhaps for some people a newer area to consider and though there has to be further reflection and training in it but I think the process is already probing but appropriately sensitive Alex can I pass on to you now please I just did a couple of questions that cover the background of your views the Scottish Government guidance on child protection in general terms does it specifically give you enough on FGM to work on within child protection can you expand on your question basically the Scottish Government's guidance on child protection does it specifically specifically the section on FGM is it sufficient for your needs I think we're still really understanding exactly what we need to do in these circumstances obviously I'm dealing normally more with the mothers who are presenting in pregnancy and we need to understand best how to make sure that we're sensitively referring them either to health visitors or whether that be social work and I don't think we're fully on agreement on what the best approach is because we don't want to criminalise these women and my understanding is that there's some disagreement between the intercollegiate report that's been written and from the Scottish side whether we take on all of the advice there and go with quite such a heavy handed approach so I don't think that we've fully decided on that yet Yes the guidance was refreshed in May 2014 and it does have a page and a half of information about female genital mutilation basically it is and taking your point basically the guidance outlines the areas that this can happen in the justifications for female genital mutilation then goes on to talk about the ways children might leave school or they might come back uncomfortable so it gives the beginning though teachers' detection would not be a role for teachers they could be sensitive to children's change but in terms of the physical aspect couldn't get involved in that so they're very clear it also offers further advice in terms of forward as an organisation it quotes UNICEF and also quotes the legislation of 2005 which make it a prohibition so it covers a number of things but the fact that it has been refreshed suggests that these things this document can the guidance can change and respond to requirements I wasn't personally involved in this but certainly know that schools have found it helpful I'm not entirely sure that it does to answer that question I think that we've got a lot of initiatives at the present moment whether it's the early years collaborative getting it right for every child whether it's the Children and Young People's Bill and the named individual and when I was talking yesterday to representatives from the NHS Education Scotland and I was saying that the part that they mustn't forget to put in that because I think it's really important especially around the named individual is female genital mutilation and it's got to be part of getting it right for every child so we need to make sure and that's why we're certainly working with the maternity and children quality improvement collaborative to make sure it's somewhere in there that they've got it right but I think we're at the start of her journey and how to change things and it's probably raising their awareness to make sure that anything that comes out has that somewhere and is involved in it We have to disagree GERFIC is about getting it right for every child and it covers all aspects and child protection is one model of that but we have very strong pastoral care in our schools going from early years all the way through and we have staff who deal with all sorts of issues within the school and getting it right for every child deals with all manner of issues that a child walks through the school with so the child protection is one aspect of getting it right one aspect of the additional support for learning and one aspect for the other legislation that was mentioned I just really wanted to clarify on that I didn't mean it should be the sole part of it but I meant it shouldn't be ignored as part of it I wouldn't say it being ignored because then we wouldn't be getting it right for every child Just to reflect what Anna has said that our training in August for all staff and that includes non-teaching staff if there's such a thing as non-teaching staff because you can't be a non-teacher I should have said support staff Our training in August is to embed child protection that's part of the GERFIC approach they're getting the right approach but most teachers do instinctively Kate, do you have any comments to me on the question? I think Alex you finished The one other thing I was going to ask and to touch on what Jim Doll mentioned the issue of training do you feel that well what level of training do you people who share your professional responsibilities tend to have an FGM is it something which you do receive training on or is it something that where your experience simply evolves as it goes along Training on the subject is collaborating with other agencies and learning from them and to go back to the child protection issue that although the issue itself may present itself differently the procedures and the concerns and all the other things are the same but in terms of FGM itself I've had no formal training I'll go for the other professions As obstetricians we're given formal training in FGM and that's noticeably recently increased so it's been added into our core training so that all doctors have to have attended a session on it and that just means that if any women are seen then we're all in understanding of different types of FGM and what their needs are but we do also recognise and it's part of the Royal College of Obstetricians Gynaecologist's green top guideline that it is preferable that there is still a named person in each unit that these women can receive more expert care from and have much more of a first-hand experience and then obviously all of our other colleagues and the midwifes as well should be receiving the same sort of training We talked about within the midwifery curriculum but I think now that we have a challenge to raise that awareness because our society is becoming more multicultural and that multicultural there's a spread in it so that might be when you look at some of the more remote areas that you don't see quite as much as you do as you see in Glasgow or you see in Edinburgh and in Abertyn or places like that so I think that we certainly have to make sure that there's a little bit more emphasis around it than that is just in the student midwifery curriculum and it's perhaps something that we need to look at post doing a wee bit more continuing professional development around and I think there are a number of groups who are looking at that just saying Alex Yes, you referred to your own specialisms Do you know if periatricians and GPs receive similar training? Kate I know that they can access it through choice but I don't know if it's a requirement I couldn't comment on the general practitioners but I'm fairly sure that it probably features quite strongly in the periatricians not perhaps so much the neonatal periatricians Can we pass you on to John Mason now? Thank you My area of interest was kind of around resources perhaps because I'm on the finance committee but one thing I was interested in was the fact that the name person was mentioned just now so I'm wondering if we're taking this forward are we needing more resources or is it more just a question of the current midwives, GPs, everybody else being more aware, being better trained that kind of thing or you did, Ms Smith, you mentioned already that there was just one dedicated midwife I mean are we needing 20 dedicated midwives or are we not at that stage yet? And I think that's an interesting question because it goes back to what I said before until we have the statistics you don't really know what the issue is and anybody who's looking at how they build their resources within a health board and how they put them out there really needs to know what is the size of the issue Could you do this across a regional basis so that there's somebody there who can give specific advice and I'm only looking for the midwifery side of things because as Kate says there should be somebody in every unit who has particular interest in the aesthetic and gynaecology side of things and I think that it's looking to see whether that is the issue I think we do need more awareness reasons and more training I think that the group because we have the women we have them antenatally so that we have some opportunities around education then what we do is we have the women for around about 10 days before we discharge them into the care of the health visitor so I think the health visitor are probably quite a good group that I'm not sure whether you've already spoken to a community or the Royal College of Nursing community because the Royal College of Nursing will be in the accident emergency departments pediatric departments so that might be some area where you want to take some evidence from but I think for us we have them for a relatively small period of time it might run to 28 days or it might run to 6 weeks depending whether there are particular issues but I see our role is perhaps raising the flag to see that this female child comes from a community which may put them at risk I mean if I was asking you what was your top ask be from a kind of resources point of view is it going back to your previous point it's about data, it's about making more things on electronic records all that kind of area and there's some way to keep this record by highlighting that this is a female child of a mother who has had this carried out on her so that you can actually start that child health record from knowing that this is a flag that you need to keep an eye on not stigmatising isn't it I wouldn't say it's stigmatising I would say it's a flag I mean how else this is my difficulty in knowing how else are you going to start that record how are you going to know how am I going to as a midwife pass on to the health visitor that this woman has had female genital mutilation carried out she's had a female child and her child is at risk of that being carried out by the community or being taken overseas if I don't raise that flag how are they going to know ask the others about resources I mean is it a resources question or is it really just over time education training all these kind of things I don't think it's a resource issue particularly for education I think we have good systems so that we'll develop about three or four slides initially for use to the thousands of teachers in August so we've got very far reach and then on the basis of that then as I said earlier look at some curriculum materials but we have to be sensitive of the stigmatisation because we could be presenting something to a class where there's one young person or one girl where that might be related to directly so that's why we're not rushing into that and we want to take really strong advice so that we get the balance of discussing and informing with the potential of stigmatising or alienating a young person who that might be something that's either happened or may happen and that takes us back to some of the work we did a long time ago when we were introducing the keeping safe and other child protection issues so we'll take that same approach but again that's something that we will be able to consider and budget for Do you think having the named person in place in any way helps this whole process? Does it make it clearer to say a young person who they should speak to? I think whatever process we put in legislation we find that young people as well as talking to the named person or the registration teacher or the pastoral support teacher go to the teachers they get on best with and that is something that all young people do so we have legislation and we have other mechanisms but young people talk to people they feel comfortable with All I was going to say was that we also have to be sensitive when we're speaking in August to all staff in schools that there may well be people in the staff who've been subjected to this who are taking a different line on it Absolutely So from the council's point of view of your education in Glasgow where you have some schools presumably where you would reckon that more kids are at risk than other schools Is it a resource issue for yours again more about teachers? It's an education issue it's information Are you getting teachers coming through from the wide variety of cultural backgrounds that we now have? Yes We need to think of using some of these teachers then I just know we don't know them because it's too early in that process Okay Dr Barlow resources not a problem? Again I think we're in the early days so the midwife in Glasgow that Gillian has mentioned is really just only beginning to set up her service so it will be interesting to see how many women she sees in the same here in Edinburgh we're just setting up a service and trying to have a multidisciplinary approach to it so we don't really know how well utilised that service will be so we need to see what happens And you'd be supportive of the idea of putting a bit of resource into improving the record system a bit more IT? Absolutely I think that we definitely need to do that across Scotland as we said in NHS Lothian we have that already but we do need to work on the way that the information is gathered and that would be very helpful and equally if we make sure that every midwife is appropriately trained in FGM then they will miss the opportunity to feel comfortable to ask the question of the women in the beginning because currently the way the system is you can just opt to not ask the question and it looks like the answer is no but if you haven't asked it then we don't actually really know so we do need to make sure that that opportunity isn't missed Why are people not asking the question that they are trying to build up relationships? I think not everyone thinks of it and they want to build up relationships and not entirely comfortable with how to ask the question of a woman or possibly they do ask the question but the woman doesn't understand what she's been asked we know that we need to use interpreters a lot of the time for women and possibly that isn't always being done so sometimes there are missed opportunities and we need to work on that area a lot Thank you Does anyone have any other questions about Siobhan? Just simply on best practice or good practice that we could learn from in Scotland do any of the witnesses know of of anything that's happening in other countries we know the committee have heard that there are 15 clinics for FGM in England and how that works again I know we're waiting on stats and other parts of the country are establishing as Dr Dallo said their practice at the minute can we look at other countries should we be looking at other countries or should we simply be focusing on what the outcomes are at the minute for Scotland? Absolutely, definitely we need to I know that the Scottish Refugee Councillor including that in their study that they're doing would be very interesting to see what their findings are from other European countries we'll look forward to their report we do try and learn from our colleagues particularly down south and some of the courses that I've attended have been from midwives and obstetricians who work down south so we definitely need to use their experience because that's definitely something that we're lacking here so that's what we're doing at the moment I think Kate's right and everything that she said about that I do think we need to see what's happening and I think that on this one probably London in areas like that are further ahead than we are on it and we have to take cognisance of some of the work now that's not to say that we need necessarily and Kate referred to earlier on we need necessarily to go down the same path as they have with the recommendations but we perhaps need to look and see what they've done in some of the overseas countries that has managed to reduce it significantly and at the current moment I'm not in the position I'm sure there'll be a lot that has come back from the international congress in midwives but I'm not in the position to say what they've done to reduce that but certainly I mean we'd be very difficult to say that we stick to our own area and we don't think about some of the work that we do and we can look at that kind of reciprocity and see what we are taking to other countries and what they are bringing back to us Speaking from an education point of view and safeguarding and child protection point of view I think the systems we have in Scotland are robust and have been proven to be robust not to say that we can't learn from other people but I think our structures and our approach are good I agree with Jim but it's always helpful to look and benchmark your practice with other people and in the developing of the August refresh and the curriculum materials I was talking about will certainly look far and wide to get the best practice we can Does anybody else have any questions you'd like to ask? No Do the witnesses have any other comments by no comments you would like to make? No? Yes, Gillian I'd like to say that coming from a midwifery point of view and I'm sure Kate will feel the same thing and having been around women who have been subjected to this and to have seen babies and young children subjected to this I'm absolutely delighted at the way that the Scottish Government and this committee is taking it forward to look at the evidence and I think it's probably now a start of a journey that's for a wee while been long overdue on that That actually concludes the public part of today's meeting and our next meeting will take place on Thursday the 19th of June which will include further oral evidence on female genital mutilation and I now suspend the meeting to move into private Thank you very much