Contents
- Attendance
- Continued Petitions
- New Petitions
Continued Petitions
Residential Care (Severely Learning-disabled People) (PE1545)
Welcome to the 10th meeting in 2018 of the Public Petitions Committee. I remind members and others in the room to switch phones and other devices to silent. We have received apologies from Angus MacDonald.
The first petition for consideration is PE1545 by Ann Maxwell, on behalf of the Muir Maxwell Trust, on residential care provision for the severely learning disabled. We last considered the petition at our meeting on 15 March and agreed to invite the petitioner to make a written submission; we also agreed to write to the Scottish learning disabilities observatory to ask for information about its work to address the data visibility of people with learning disabilities in Scotland. The observatory’s submission provides a detailed outline of its work programme, which is included in our meeting papers.
The petitioner’s written submission expresses concern that there are limited references in the work programme to epilepsy, despite 60 per cent of people with profound learning disabilities having that condition. The petitioner is of the view that residential care would resolve many of the issues that the observatory is currently researching, and suggests that the financial consequence of inadequate care for the profoundly learning disabled should be a focus of the observatory’s work.
Do members have any comments?
We should focus on the fact that the petitioner is saying that not enough emphasis is being put on the epilepsy question. We need to tease out some of the points that they raise about the work that is being undertaken by the observatory in order to find out in detail what is being done.
I was quite struck by the petitioner’s argument. Historically, someone with a learning disability was put into long-term care. That policy has quite rightly changed and I think that that has been a massive benefit to people who have been able to live and work in the community and achieve their potential. However, it almost feels as if, because of that policy, there is a view that it is not appropriate to have residential care in certain circumstances.
Yes, it has gone too far.
Although you would not want the general rule to be that people are put into residential care, the petitioner makes quite a strong case for there being a community where resources and support can be brought around about people. I agree that we should explore the issue further. Is the issue of epilepsy being considered sufficiently and, if not, why not?
I was going to say something similar on the question of whether the pendulum has swung too far the other way with the result that the option of residential care is now limited. That would be worth exploring. We should also explore the financial consequences of—I do not want to say inadequate care. We should explore both options, and compare the financial consequences of one with that of the other in relation to the willingness to give that care.
The petitioner makes the case that there are financial consequences of not making this provision available in certain circumstances, because further along the line there are consequences for the individual. That could be something that we could look at.
A point was made about the Scottish Government measuring the demand for long-term residential care based on the current number of children and young people in residential care. They make the point that it is a flawed way of measuring demand and fails to capture the true need that currently exists in Scotland. Is the methodology of calculating the number of people currently taking up residential care places affecting this issue as well?
If the facility is not available, in a sense you are ignoring demand; you are not seeking it out.
Do we agree to ask the Scottish learning disabilities observatory about its work in relation to links with profound learning disabilities and epilepsy and to look at the question of the financial consequences of what is seen as—if not inadequate—inappropriate care that is not totally supporting the person?
Members indicated agreement.
Healthcare Services (Skye, Lochalsh and South-West Ross) (PE1591)
The next petition is PE1591 by Catriona MacDonald, on behalf of SOS-NHS, on the major redesign of healthcare services in Skye, Lochalsh and south-west Ross. Rhoda Grant MSP, Kate Forbes MSP and Edward Mountain MSP, who have attended previous meetings at which we have considered the petition, are not able to attend today but have provided some comments to which I will refer shortly.
We agreed to defer further consideration of the petition until the external review by Sir Lewis Ritchie on out-of-hours urgent care and minor-injury clinical services had reported. That report was published in May and a full copy is included in our meeting papers. The clerk’s note identifies the theme and key messages within the report about the need for NHS Highland and the local communities to work together, which has been regularly highlighted during our consideration of this petition.
The petitioners have provided a written submission, in which they indicate a willingness to engage in co-production with NHS Highland and others to help to deliver some of the key recommendations in Sir Lewis Ritchie’s report. Rhoda Grant has indicated that she would like the petition to remain open until the six-month review of the key themes that were identified in Sir Lewis Ritchie’s report has been completed.
Edward Mountain notes that this is a long-standing petition of great importance to the people of Skye and Wester Ross, which came about as a result of the actions of NHS Highland, which he says were far from inclusive. He considers that Sir Lewis Ritchie’s review has been a significant step forward, and has managed to reunite the majority of the community. He adds:
“There however remains a genuine fear that NHS Highland, although accepting the report, will revert back to their original position and will not implement all the findings. I have been asked by many to speak to this petition and to ask the committee to keep the petition open for a further six months. While I know the committee may feel the matter has been dealt with, it would give my constituents confidence in the political system to know that it was not closed.”
Kate Forbes has indicated:
“I offer my apologies to the convener and to constituents watching at home for being unable to be here in person. We have made huge progress since the last meeting, with Professor Sir Lewis Ritchie’s report stating unequivocally that Portree Hospital should remain open, with a resilient 24/7 emergency care and beds provided in the north end of Skye. The priority now is to ensure this happens. Until it is implemented in full, I would ask the committee to keep the petition open.”
Do members have any comments?
In my constituency work, a few constituents have raised concerns about situations in which the recommendations of a review have not necessarily been implemented in full, or in which a decision has been taken that there is no need for them to be implemented in full.
I am inclined to agree with the written submissions from our colleagues. We should leave this petition open for six months and revisit it to check whether the recommendations have been implemented.
It is clear that the decision has been made on the restructuring and that that is not going to change. Edward Mountain is right to say that that has been dealt with.
It is good that progress is being made now on the collaboration between NHS Highland and the community—that is really good news—but I agree with Brian Whittle that we should keep the petition open for six months until Sir Lewis Ritchie can come back and update us with progress on the implementation of the recommendations. It is an important petition, and I think that another six months would do it justice.
I agree that we should keep it open for another six months, which would give us reassurance that significant progress was being made with the review.
Do we agree to keep the petition open for a further six months and to ask the Scottish Government to provide its views on the findings of the review, particularly with regard to the recommendation that it should seek regular and robust assurance that satisfactory progress is being made, and ask how it intends to do that?
Members indicated agreement.
That will give us an idea of whether Sir Lewis Ritchie’s review is being attended to by the health board.
Mental Health Treatment (Consent) (PE1627)
The next petition is PE1627 by Annette McKenzie. At our meeting on 29 March, we discussed a suggestion that was made by the petitioner to introduce the use of written consent forms for young people who have been prescribed antidepressants, and asked the Minister for Mental Health for her view on the suggestion. The minister is of the view that the introduction of written consent forms would undermine the whole concept of capacity and confidentiality, and could be considered discriminatory towards young people as well as creating inequity between mental and physical health.
Members will recall that, at our meeting in March, we reflected on the outcome of a survey that was conducted by the Scottish Association for Mental Health in 2014, which found that general practitioners would like more information about non-pharmaceutical treatment options for common mental health problems and that almost half of general practitioners are not aware of, or not sure if they are aware of, the Scottish intercollegiate guidelines network’s guideline on non-pharmaceutical treatments for depression. We therefore asked the Minister for Mental Health to reflect on the findings of this survey and how it intends to promote the SIGN guidelines to all GP practices in Scotland.
In her written submission, the minister states that the Scottish Government is currently working with the Royal College of General Practitioners, the Royal College of Psychiatrists and the British Medical Association to provide information for GPs on training and guidance on non-pharmaceutical treatment options for common mental health problems and to promote the relevant SIGN guidelines. That information is expected to be sent to GPs by the end of June.
At our meeting in March, we agreed to ask for information about the work of the youth commission, led by Young Scot, to explore the potential for people aged 18 to 25 to continue their care within child and adolescent mental health services. We also agreed to ask Healthcare Improvement Scotland about its work to improve child and adolescent mental health services redesign with individual NHS boards. Responses have been received and that information is set out in our meeting papers.
Members will recall that we also considered the petition in private on 10 May to reflect on all the evidence that we have received to date.
Do members have any comments?
It is fair to say that this petition has exercised this committee probably more than most and has affected us more than most. It is a hugely important petition and we have recognised all along the tension around confidentiality and the need to explore the issues of somebody presenting with mental health issues and their capacity to administer medication, especially if they are under 18. It is something that I have wrestled with a lot. I indicated to you before that in the Health and Sport Committee we have been doing some work around this as well.
The issue opens up a whole can of worms for me. It would be interesting to hold some sort of inquiry and ask young people how they access mental health services and what they feel mental health services should look like. On Monday, I happened to be with a group of people who had poor mental health. The meeting was eye opening with regard to their understanding of what mental health services should look like and their various experiences with GPs and mental health services. Hearing from such groups would hugely benefit this Parliament’s understanding of how mental health services are currently being accessed. I suggest that we think about holding an inquiry into access to mental health services.
10:00
I was disappointed in the minister’s response on the question of written consent, because it is not a question of discrimination. The fact is that we are wrestling with a dilemma and a major problem. There is an issue about being confident. My understanding of best practice is that you do not offer medication in the first instance unless there is a crisis. The default position is that you would look to other therapies first. I am interested in establishing—perhaps through an inquiry—whether GPs are under such pressure that they do not have the time to go through that process and they perhaps end up feeling the need to prescribe rather than do anything else.
I also think that a person with a physical condition would routinely be told, “Make sure you get support from home.” If you have had a terrible diagnosis of cancer, presumably you would be encouraged to tell your family, but somehow there seems to be an inhibition to give that advice in relation to mental health. We are almost tipping the approach in the other direction.
I think that everybody is aware of how serious this issue is for families and of the impact that it has when there are tragic circumstances involved. Perhaps it would be interesting to ensure that young people themselves are part of that conversation.
I totally agree. It is a significant and complex issue. I find the system hard to understand when trying to help constituents or families who come to me with problems. It is difficult to navigate the system and signpost people in the right direction. I think that an inquiry that could ensure that those issues are discussed, with the involvement of young people, is necessary. The process for helping young people with mental health issues is not easy.
I see that the commission intends to report the findings to the minister and the Scottish Government in March 2019. That is a long time to wait, because there are people out there at the moment who need treatment. If there is any way of speeding up the process, that would be fantastic. Why does it have to take so long?
Currently there are complicated pathways to receiving the right treatment. The point about helping our constituents is key because GPs currently use the CAMHS service. Are they using that to the best effect? This is a really important subject and if we could do anything to speed it up I would be behind that.
I mentioned the understanding that the point of change between CAMHS and adult services is a major issue. The petitioner’s daughter sat in the age group that is affected by that change. As part of what we do, I would like us to consider how the system delivers the change from childhood treatment to adult treatment.
That is one of the things that the commission is considering. I suggest that we agree to hold an inquiry into how young people can access mental health services and treatments, that we ask the clerks to produce a paper on what that inquiry might look like and what the timescales for that would be, and that we do the scoping work on that in private at a future meeting. Do members agree to that approach?
Members indicated agreement.
Child Welfare Hearings (PE1631)
The next petition is PE1631, by Maureen McVey, on child welfare hearings. At our last consideration of this petition, in March, we considered a suggestion that was made by the petitioner to use fixed specialised family law courts for child welfare hearings and we sought the Scottish Government’s view on that suggestion.
The Government highlights that the Lord President has the powers to determine that family cases be heard by specialist family sheriffs, but advises that a number of matters would need to be considered before making that decision, as outlined in our meeting papers. In her written submission, the petitioner asks whether there are criteria for the Lord President to determine when and in what child contact cases that happens.
Members will recall that, at our last consideration of the petition, we also considered a recommendation that was made to the Scottish Civil Justice Council, based on independent research that it had commissioned, to use note sheets to ensure that information flowed between sheriffs in situations in situations where scheduling meant that the same sheriff was not able to remain with the case. We therefore agreed to write to charities providing advocacy and support to children for their views on the current practice of recording discussions at child welfare hearings.
The Scottish Child Law Centre is supportive of the idea of note sheets, stating that they would improve the quality of decision making and promote and safeguard the best interests of the child. However, it also highlights that note sheets should be used only to facilitate information flow between sheriffs and should not compromise judicial impartiality.
With regard to striking an appropriate balance that ensures that the recording of discussions at child welfare hearings does not make the process overly burdensome, the Scottish Child Law Centre suggests that it would improve the child welfare hearing process if sheriffs provided a written account of the basis on which they made their decision in the child welfare hearing in the form of a child welfare hearing decision note. The petitioner is supportive of this suggestion.
Members may also wish to note that there are currently two consultations underway relevant to this petition. The first is a consultation by the Scottish Civil Justice Council on a report by a subcommittee on case management of family actions. The second is a consultation by the Scottish Government on a review of part 1 of the Children (Scotland) Act 1995. Both consultations close in August 2018.
Do members have any comments on what we should now do with this petition?
I do not think that we should defer it until the close of the consultation by the Scottish Civil Justice Council because I think that there are things that we could do now. I would like to see some positive outcome from this petition as soon as possible.
We need some detail from the Lord President’s office on the criteria for the decision around whether a case is heard in a family court. We need more detail around what is used to determine that and around child contact.
The Scottish Law Centre’s support for child welfare hearing notes was interesting. That could be a positive development, so we should ask the Government to respond to that.
I agree.
I thought that the idea that having a note of a discussion somehow inhibits judicial impartiality later was odd. In any walk of life, you have a set of notes about a case and you follow it through. The point in the original petition was that people should not have to keep re-telling the story and that there should not be a misrepresentation of what was discussed previously.
That is why it is taking such a long time to get through some of these cases.
Yes. Do we agree to ask the Scottish Government to respond to the issues around how the Lord President’s office determines what family cases are heard in family courts, and the suggestion about child welfare hearing decision notes?
Members indicated agreement.
I suspend the meeting briefly before we consider the next petition.
10:08 Meeting suspended.10:10 On resuming—
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