Contents
- Attendance
- Budget Scrutiny 2020-21
- Subordinate Legislation
Subordinate Legislation
Alcohol (Minimum Price per Unit) (Scotland) Amendment Order 2020 [Draft]
Under agenda item 2, we will consider an instrument that is subject to affirmative procedure. I welcome to the committee Joe FitzPatrick, the Minister for Public Health, Sport and Wellbeing, who is accompanied by Louise Feenie and Julie Davidson. I understand that the minister wants to make an opening statement.
I will be as brief as I can. I thank the committee for inviting me to give evidence.
This is largely a technical amendment to the Alcohol (Minimum Price per Unit) (Scotland) Order 2018, which sets the minimum price per unit of alcohol. We have been aware of an issue relating to minimum unit pricing for wholesalers that hold a licence—the issue has previously been raised at the committee. We have considered how to clarify the legal position and decided that an amendment to the 2018 order, which set the minimum unit price at 50p, would be helpful.
The draft 2020 order clarifies the current position that minimum unit pricing does not apply to sales to trade. This is a niche area and concerns only wholesalers that hold a licence. We issued a consultation on the proposed method for clarification and received 11 responses; eight of the 10 respondents who commented on the proposed clarification agreed with the proposal to amend the 2018 order.
Intelligence from national licensing standards officers is that they are content that this is not a live issue in practice and are happy with compliance.
I am happy to take questions from members.
Thank you. As will be the case with all the affirmative instruments that we consider today, we will have the opportunity for questions to the minister and his officials. Thereafter, we will move to the formal debate and ask the minister to move the motion. Are there any questions?
I am grateful to you for introducing the draft order. I was one of the people who, in 2018, raised the issue of the loophole for wholesalers, so I am grateful that that is to be closed.
My question is to do with the fact that the minimum unit price is still 50p. The Alcohol (Minimum Pricing) (Scotland) Act 2012 was passed a long time ago. It was through no fault of the Scottish Government that it was snarled up in legal proceedings, but over the period since the act was passed, 50p is less than it was, in real terms. The impact of that threshold is, arguably, less than the impact that a threshold of 60p would have. Is your Government considering revisiting the price per unit?
That is a good point. It is interesting that Wales, which is introducing minimum unit pricing on Monday, has chosen 50p per unit, too. I have said, and I will continue to say, that we need to keep the price under review. We said that we should do that after two years; we are not quite at that point yet. We need to look at the data and consider whether 50p remains an appropriate level; we also need to be mindful of affordability.
There are a number of factors that we need to consider before deciding whether to make a change. I confirm that we will be considering that issue this year.
I want to ask about research on the impact of displacement. There has been a decline in cider sales, for example, but an increase in the sale of products such as Buckfast tonic wine. What work have you done on displacement? People are still consuming the same levels of alcohol; they are just not buying the products that they used to.
I make it clear that the draft order relates to a very technical clarification of a problem that, in practice, we do not think is live.
On the wider discussion, I was really pleased that, ultimately, all parties supported minimum unit pricing. I am particularly pleased that that has been supported elsewhere on these islands, particularly Wales. The Republic of Ireland is considering the issue, too.
The intention of minimum unit pricing is to deal with the problem that too much alcohol is consumed in Scotland. The latest evidence shows that that successfully reduces the amount of alcohol that is consumed. That is despite a summer that resulted in an increase in consumption elsewhere on these islands.
The specific intention of the policy is to reduce the volume of alcohol that is consumed, and it has been successful in doing that. As a Parliament, we should be proud that we have taken this action, which others around the world are now looking to emulate.
As there are no further questions, we move to agenda item 3, which is the formal debate on the Scottish statutory instrument that the minister has just given evidence on. I remind members that this is not an opportunity for questions; it is an opportunity to speak in the debate and come to a decision.
I invite the minister to move motion S5M-20745.
Motion moved,
That the Health and Sport Committee recommends that the Alcohol (Minimum Price per Unit) (Scotland) Amendment Order [draft] be approved.—[Joe FitzPatrick]
I accept everything that the minister has said about waiting for two years to pass, and I look forward to continuing the discussion later. As it stands, the draft order is an elegant fix to a problem that I helped to identify in 2018. I am grateful to the Government for introducing it.
Following Miles Briggs’ question about displacement, I will raise one issue. In welcoming minimum unit pricing to Scotland, and the work that has been done on it, we have to be cognisant of displacement not only to other alcohol types, but to cheaper drugs. There is still a little bit of work to be done, and I hope that Parliament will do it.
One key aspect of this policy—we all want this—is to reduce alcohol consumption, given the problem that we in Scotland have with alcohol. However, one key aspect that the committee needs to look at is outcomes. The number of alcohol-related hospital and A and E admissions are still increasing across Scotland. We need to look at that collectively.
On the whole, this is one of a basket of measures to deal with our relationship with alcohol in Scotland. It is not the be all and end all, although it has made significant inroads in that people are drinking less. It is a move in the right direction, and one of many other tools that the Government is using.
The draft order that we are discussing is separate from the issues that has just been brought up. We need to look firmly at the evidence as we progress. There are people who are disclaiming what minimum unit pricing is achieving. We need time for it to embed, and we need to be very clear about the evidence that is presented.
Emma Harper is absolutely right that the things that we are discussing are not about the draft order. That is understandable, but the purpose of the order is for the reasons that Alex Cole-Hamilton has mentioned.
George Adam is right that we have never said—I do not think that anyone who supports the policy has said—that it is a magic bullet. It is part of a basket of measures, and the evidence shows that minimum unit pricing is moving us in the right direction.
I think that there is evidence that the trajectory of hospitalisations that we were on has changed, but I am not sure that Miles Briggs’s assertion about it increasing is entirely accurate. These are early days, and we expect the health benefits of the policy to take a number of years to come into effect.
It is important that we recognise that the order is part of a basket of measures. Crucially, we have recognised the particular problem that Scotland has with its relationship to alcohol. It is good if we all speak with the same voice on that.
Clearly, it is important that we carry out research that looks at a wide range of factors to do with the implications of the policy. That is happening—a range of research is on-going, which is helping to make it easier for others around the world to follow suit.
Motion agreed to,
That the Health and Sport Committee recommends that the Alcohol (Minimum Price per Unit) (Scotland) Amendment Order [draft] be approved.
Public Appointments and Public Bodies etc (Scotland) Act 2003 (Amendment of Specified Authorities) Order [Draft]
Agenda item 4 is consideration of the Public Appointments and Public Bodies etc (Scotland) Act 2003 (Amendment of Specified Authorities) Order. The minister will stay with us, but his officials will swap over. Joining the minister for this item are Derek Grieve, who is the interim head of the health protection division, and Alison McLeod, who is from the legal directorate.
I invite the minister to make a brief opening statement.
You might remember that, last November, the committee had a useful discussion about the Public Health Scotland Order 2019. That order constituted public health Scotland as a new national special health board, which will begin to exercise its full range of functions from 1 April.
This related draft instrument sets out an amendment to schedule 2 of the Public Appointments and Public Bodies etc (Scotland) Act 2003, which lists the specified authorities that are subject to section 2 of the act. Appointments to the specified authorities must comply with the code of practice that is published by the Commissioner for Ethical Standards in Public Life in Scotland.
The amendment that is set out in the draft instrument will enable COSLA to nominate councillors for ministerial appointment to the public health Scotland board. It does so by removing those appointments from the commissioner’s remit.
As set out at our previous committee session, the partnership between the Scottish Government and COSLA is a new and intrinsic feature of public health Scotland. Our view is that the levers for improving and protecting public health lie at local and national Government level. Joint decision making between the Scottish Government and COSLA holds the potential to achieve real and sustainable long-term change. By allowing COSLA councillor nominations, the order is intended to reflect that vital partnership in the public health Scotland board membership.
Healthcare is clearly not the sole determinant of our health and wellbeing: we know that social and economic conditions are equally significant. We have focused public health reform on joint action on the many factors across the whole system that determine our health.
As you know, the Scottish Government and COSLA have committed to a programme of reform and three key actions. The actions are: to establish shared public health priorities for Scotland; to establish a new national leadership body for population health, public health Scotland, which has been implemented by the Public Health Scotland Order 2019; and to strengthen and support local partnerships to take collective action with communities to improve health and wellbeing.
The collaborative approach to tackling the public health priorities is to be embodied through joint sponsorship arrangements for public health Scotland. Co-sponsorship will provide public health Scotland with an opportunity to support and influence national and local decisions that involve public health. COSLA’s participation will emphasise the importance of local delivery in recognising and influencing the determinants of health.
The public health Scotland board will consist of 13 members. The intention is that COSLA will nominate a shortlist of councillor members and that two councillor members will be appointed to the board by the Scottish ministers. This draft instrument is required to remove those appointments from the commissioner’s remit and to enable COSLA to nominate councillors for ministerial appointment to the board.
The COSLA nominations are to be councillor members who are recommended for appointment based on merit. For NHS boards, the practice of stakeholder nominations is long-standing, and is intended to reflect specific partnerships. Territorial NHS boards routinely have councillors appointed following local authority nominations. Those appointments are also included as an exception in schedule 2 of the 2003 act, in order to remove them from the commissioner’s remit.
The response to the public consultation on public health Scotland supported the principle of COSLA nominations, with some responses noting that the nominations should be made through transparent and appropriate selection channels. We have agreed with COSLA that the national selection process will be merit based, with oversight from the Scottish Government.
Our belief is that the partnership with COSLA will bring better opportunities for innovation and integration across the system.
There is good evidence that, although the NHS has a crucial role, many determinants of health are influenced strongly by local government. By way of joint sponsorship and diverse board membership, we can better influence and support wider local government decisions that will positively impact the public’s health.
12:00The Scottish Government and COSLA, in a new model of collaboration, have jointly contributed to the concept and structure of public health Scotland. I consider that the COSLA nominations will ensure a strong local government voice and perspective on the board.
I am happy to answer any questions that the committee might have.
Is it your view that this measure will complete the raft of legislative changes that are required in advance of the launch of public health Scotland?
Yes.
I understand what you have said about transparency with regard to the appointment of the two councillors to the board and the fact that those appointments will be merit based. From our earlier discussion, we know that conflicts can sometimes arise between councillors sitting on IJBs and between councils and health boards. Have you investigated any of that? Given that we do not know what will happen in the future with regard to public health Scotland, have you given any thought to any potential conflict of interests that those two councillors might encounter?
It is important to state that all the members of the board are there to represent the board. I think that, in the main, councillors are pretty good at wearing two hats. When the councillors are on the board, they will not be representing COSLA; they will be representing the board.
The mechanism that COSLA is developing for those appointments is different to what we have seen before. I think that it is the first time that it has taken a merit-based approach rather than just saying that the members must come from one particular party or another. That approach is new and it reflects the degree of partnership that there has been in the development of public health Scotland.
That is good to hear. That merit-based approach could be useful in relation to other bodies. Perhaps details of it could be shared with the committee so that we can see what it actually looks like.
As there are no further questions from members, will move to agenda item 5, which is the formal debate on the order that we have just taken evidence on. Once again, I remind members that we are no longer in a position of asking questions but of making contributions to a debate.
I invite the minister to move the motion.
Motion moved,
That the Health and Sport Committee recommends that the Public Appointments and Public Bodies etc. (Scotland) Act 2003 (Amendment of Specified Authorities) Order 2020 [draft] be approved.—[Joe FitzPatrick]
Motion agreed to.
Community Care (Personal Care and Nursing Care) (Scotland) Amendment Regulations 2020 [Draft]
Item 6 on the agenda is another item of subordinate legislation. For this item, Mr FitzPatrick is accompanied by Susan Brodie and Anne Mathie from the Scottish Government.
Thank you for the opportunity to speak about the amendment regulations.
The draft affirmative order reflects our continued intention to increase free personal and nursing care payments in line with inflation. The order, if approved, will continue to benefit self-funding adults who are resident in care homes. The rates are calculated using the gross domestic product deflator inflation tool, which this year suggests an increase of 1.84 per cent. That will mean that the weekly payment for personal care will rise from £177 to £180, and the weekly nursing care component will rise from £80 to £81. It is estimated that that rise will cost £2.2 million this year. That will be funded by an additional £100 million in the recent 2020-21 Scottish budget for social care and health and social care integration.
The latest available statistical report is for the financial year 2017-18 and it shows that more than 10,000 self-funders benefited from receipt of free personal and nursing care payments.
I am happy to take questions on the regulations.
Thank you. Are there any questions on the instrument, which the minister has described as a regular uprating as required by the original act?
Members indicated disagreement.
As there are no questions, we move to the formal debate on the instrument. I ask the minister to move motion S5M-20741.
Motion moved,
That the Health and Sport Committee recommends that the Community Care (Personal Care and Nursing Care) (Scotland) Amendment Regulations 2020 [draft] be approved.—[Joe FitzPatrick]
Motion agreed to.
Human Tissue (Authorisation) (Specified Type A Procedures) (Scotland) Regulations 2020 [Draft]
The next agenda item is on the final affirmative instrument of the day. It follows primary legislation that was agreed by the committee a few months ago. Joe Fitzpatrick is accompanied by Fern Morris and Claire McGill for this item.
Thank you for the opportunity to set out the context in which the instrument has been laid. The Human Tissue (Scotland) Act 2006 was amended by the Human Tissue (Authorisation) (Scotland) Act 2019 to introduce a statutory framework setting out how medical procedures that facilitate transplantation can be authorised, and what conditions are attached to them being carried out.
Those procedures are termed in the 2019 act as “pre-death procedures” and are defined in the act as the medical procedures which may be
“carried out on a person for the purpose of increasing the likelihood of successful transplantation after death”
and which are
“not for the purpose of safeguarding or promoting the physical or mental health of the person.”
The Human Tissue (Authorisation) (Specified Type A Procedures) (Scotland) Regulations 2020 set out the procedures that Scottish ministers consider are appropriate to carry out as type A procedures within the framework of section 16E of the 2006 act, as amended by the 2019 act. The regulations list the medical procedures that are frequently carried out in intensive care units at present to facilitate transplantation where donation for transplantation has been authorised and is proceeding. Those medical procedures are not new: they are required to ensure that donated organs can be matched and transplanted.
Without the ability to carry out those procedures, transplantation of organs is unlikely to go ahead in cases of circulatory death—which is almost 40 per cent of cases. The procedures are very important in helping to ensure that organs can be matched appropriately and that transplantation is as safe as it can be for the recipient.
The regulations are supported by the framework that was established by the 2019 act, which sets out the conditions or safeguards that must be met before the procedures that are specified in the regulations can be carried out. Those include authorisation being in place and the duty to inquire having already been undertaken; that the person is likely to die imminently; that the decision to withdraw life-sustaining treatment has been taken; and that the pre-death procedure is necessary and is not likely to cause more than minimal discomfort to the person or to harm the person.
Those conditions ensure that the procedures that are listed in the regulations cannot be undertaken prematurely. They also reflect the limited timeframe for donation and transplantation.
In practice, if no more can be done to save the life of the patient, and only after the family have come to terms with that, a sensitive discussion about donation will take place. Carrying out the procedures will be discussed in an appropriate and sensitive way, and the duty to inquire means that procedures will not be undertaken before that discussion with the family has taken place.
In developing the regulations, the Scottish Government has worked closely with, and taken the advice of, clinicians who work in intensive care and on the donation and transplantation pathway, in order to ensure that the procedures that are specified as type A will meet the requirements of the act and reflect current practice. I am very grateful for their input. We have also consulted publicly; the draft regulations take into account the responses to that consultation.
I am grateful for the opportunity to provide context on the SSI and am happy to take questions from the committee.
Thank you very much.
I took a close interest in the bill when it was being considered by the committee, and I thank the minister for the paperwork that he has provided.
I have two questions. The first relates to the duty to inquire. The minister mentioned potential consultation of a donor’s family, but I want clarification on what happens if a donor does not have immediate family. Is the Scottish Government permitted to give consent in such circumstances?
Secondly, do you propose to produce publications to ensure that the public are aware of what happens?
It is important to remember that such procedures are routinely carried out at present. An important aspect of the 2019 act is that the duty to inquire has to be carried out, in accordance with the law, prior to the pre-death procedures taking place.
We have already started the process of raising awareness about the change in the law. Folk might have seen posters that are in many pharmacies. We are also doing some radio work.
The number of cases in which there are no family members or friends is very small. NHS Blood and Transplant estimates that, in Scotland each year, there might be three to five cases of donors who have no family. As the minister says, the 2019 act includes a duty to inquire, and the guidance will set out the steps that should be taken in cases in which there are no family members or friends.
It is good that there will be guidance. My understanding is that we had a debate about whether the Scottish Government would take over as the family, as we might say, in such circumstances. When is the guidance likely to be produced?
The duty to inquire involves checking whether there are no family members. Work is on-going on the guidance.
The guidance is being developed to inform the training on the new system, which will take place from the spring.
I presume that everyone, including the Health and Sport Committee, will see the guidance.
Yes—it will be published.
Thank you.
To clarify, as a former member of a liver transplant team in Los Angeles, I know that it is usual for the listed procedures, which include blood tests, X-rays, urine tests and, potentially, ultrasounds, to be carried out. As the minister has said, such procedures are carried out already.
Yes.
Excellent.
It is good that the regulations have been brought to the committee. During the bill’s progress, some of the conversations were about NHS capacity and theatre capacity. This question does not relate to the regulations. What work has the Government done to assess the potential need for investment in those areas? A specific issue in the Highlands was highlighted during the passage of the bill.
We are of the view that capacity exists for implementation of the 2019 act. We have made it clear that we do not expect a massive overnight increase in donation. It is important to be realistic. Parliament agreed that the bill represented the right direction of travel, but I do not think that anyone was suggesting that, in response to the 2019 act, there would be a massive increase in the number of people in Scotland who donate.
As there are no further questions, we move to the formal debate on the instrument. I invite the minister to move motion S5M-20837.
Motion moved,
That the Health and Sport Committee recommends that the Human Tissue (Authorisation) (Specified Type A Procedures) (Scotland) Regulations 2020 [draft] be approved.—[Joe FitzPatrick]
I thank members of the committee, the minister, the clerks and the people who gave evidence. At times, consideration of the bill was quite harrowing. Everyone listened to the people who gave evidence and to the committee’s recommendations. I thank everyone for pushing the issue forward, because the 2019 act is very important. I look forward to the guidance being produced.
The bill received a lot of media attention—I do not know whether that was the case regarding television, but it was certainly the case for radio. Perhaps that medium could be a way of making people aware that change is coming, as well as posters in pharmacies and doctors’ surgeries.
12:15
The advertising campaign will ramp up as we move towards the autumn implementation date. I think that we are already advertising on radio, but we will bear in mind Sandra White’s point and make sure that the widest possible range of people are aware of the change to the legislation.
I thank the committee for its consideration of the matter. It is no surprise to me that there has been more discussion of this issue than of others, given the committee’s detailed look at the initial legislation as it went through. I also thank the clinicians who assisted in developing the regulations. Obviously, we will continue to work closely with the clinical stakeholders as we move towards implementation of the act.
Motion agreed to,
That the Health and Sport Committee recommends that the Human Tissue (Authorisation) (Specified Type A Procedures) (Scotland) Regulations 2020 [draft] be approved.
I thank the minister and his officials for their attendance.
National Health Service (Charges to Overseas Visitors) (Amendment) Regulations 2020 (SSI 2020/17)
Personal Injuries (NHS Charges) (Amounts) (Scotland) Amendment Regulations 2020 (SSI 2020/16)
The 10th agenda item is consideration of two instruments that are subject to the negative procedure. The National Health Service (Charges to Overseas Visitors) (Amendment) Regulations 2020 will amend regulations to take account of overseas visitors entering Scotland who require diagnosis of or treatment for the Coronavirus disease—Covid-19—and to enable that to go ahead quickly.
The Delegated Powers and Law Reform Committee noted that it is
“content with the reasons ... for bringing the Regulations into force”
as quickly as the Government has, but that,
“as required by Standing Orders, the Committee draws this instrument to the attention of”
our committee
“under reporting ground (j) for the failure to lay the instrument in accordance with section 28(2)”
of the Interpretation and Legislative Reform (Scotland) Act 2010, which is about time limits.
In my view, the circumstances justify the Government’s action. Members have no comments on the instrument, so does the committee agree to make no recommendation?
Members indicated agreement.
Members have no comments on the Personal Injuries (NHS Charges) (Amounts) (Scotland) Amendment Regulations 2020, so does the committee agree to make no recommendation?
Members indicated agreement.
12:18 Meeting continued in private until 12:21.Previous
Budget Scrutiny 2020-21