Contents
- Attendance
- New Petitions
- Continued Petitions
Continued Petitions
Pernicious Anaemia and Vitamin B12 Deficiency (Understanding and Treatment) (PE1408)
Agenda item 2 is the consideration of continued petitions, the first of which is PE1408 on updating pernicious anaemia and vitamin B12 deficiency understanding and treatment. We last considered the petition on 25 May and, at that meeting, agreed to reflect on the evidence that we heard from the Minister for Public Health and Sport and Scottish Government officials, and to consider a note by the clerk at a future meeting. The clerk’s note provides a summary of that evidence session.
Do members have any comments or suggestions for action?
I am struggling to think of where else we could get evidence from. We have taken a lot of evidence on the petition and I do not think that any more evidence sessions are required. The issue is what we do with the evidence.
Do members think that we could take evidence from anywhere else? Angus MacDonald has been involved with the issue for longer than anybody else. Does he have a view?
I cannot see where else we could go for evidence on the issue. We are very well briefed on it.
When I was reading through it, I thought about the extent to which the conversation is now more of a detailed clinical debate. It is not about the medical profession’s level of awareness of the issue; rather, there is a dispute about the right approach. I wonder whether the petitioner has managed to highlight something quite important that is now being looked at. I know that she remains unhappy with what has happened but, realistically, is there anything else that we could do?
I am new to the issue, so I had to read through the papers several times. It seems that the conflict about how the guidelines should look and whether they should be rewritten exists within the profession. The information appears to be there, so the issue is about how it is understood and translated. It seems to be an internal debate for the profession to make sure that general practitioners and other clinicians all understand what is available. I do not know whether the clerk can enlighten me about that. By the time that I had read to the end of the papers, I had the feeling that the petitioner had highlighted the lack of understanding of the guidelines. In going through this work, people had taken the time to look at and think about it, which I guess is what the convener is referring to.
10:00
A short-life working group has been established, which the petitioner is asking to speak to. Dr Alistair Hart has said that the group’s work is at an early stage and that a request for a meeting would be premature. I wonder if an assurance that she would be able to contribute to its thinking and its work would be of use?
Perhaps a wider level of commitment would be that the group would take evidence from patients and sufferers and people who had something to contribute, in which the petitioner would obviously be a leading person.
Could we write to the Government to point out that the petitioner feels that none of her requests has been met? She talks about parietal cells not even being acknowledged.
We could point out that the committee is not sure how much more evidence can be taken, but we could ask that the Government keeps the petitioner updated on developments and keeps her in the loop on the on-going work and group work.
Rather than closing the petition now, we recognise that our work is done, to a large extent, and ask that the group will liaise with the petitioner at a reasonable point and that the Government will keep her and the people that she represents informed.
For the record, I pick up your point about Dr Alistair Hart and the request by the petitioner for on-going liaison. His response was that the short-life working group activity is still at an early stage and still to be fully scoped. I would have thought that an early stage was an ideal time to speak to the petitioner, rather than later on. It might be an idea to suggest that to the group.
That suggestion might satisfy the petitioner’s sense that there is miscommunication about her concerns.
Do members agree that we are coming to the point where there is not much more that we can do, but that we recognise the importance of the issues that have been highlighted? We ask that the Scottish Government keeps the petitioner informed and we look for an assurance from the group that it would want a discussion with the petitioner. Angus MacDonald makes a strong point that a discussion would be useful and valuable at the early stage.
Members indicated agreement.
Polypropylene Mesh Medical Devices (PE1517)
PE1517, by Elaine Holmes and Olive McIlroy, is on polypropylene mesh medical devices. We last considered this petition on 28 September, when we heard evidence from the petitioners and Dr Wael Agur. The clerk’s note provides a summary of that evidence session, and circulated with it are a number of submissions from mesh survivors. We record our thanks to the people who have taken the time to make those submissions; many are highly personal and were probably difficult to draft.
Members will recall that we agreed to write to the Cabinet Secretary for Health and Sport, Shona Robison, to set out our concerns about the availability of the updated patient information leaflet and the presence of outdated information on Scottish Government and NHS Scotland websites. The cabinet secretary provided a response on Tuesday this week, confirming that the chief medical officer wrote to all health boards in May to request that the literature that is available in hospital and primary care premises is up to date. She advises that NHS inform has reviewed and updated its website and has provided a link to the current version of the stress urinary incontinence patient information leaflet. That link has been added to the Scottish Government’s website.
The cabinet secretary adds that the Scottish Government is working with Healthcare Improvement Scotland to establish a mesh oversight group, which will work with health boards to ensure that the recommendations of the independent review are fully implemented and give further consideration to the patient information that is available.
We have previously agreed to publish a report on the petition and we have secured time for a debate, although we await confirmation of the timing of that debate. The deputy convener and I hope to meet Professor Alison Britton to discuss the issues and concerns that have been raised in evidence to the committee about the review and Professor Britton’s review of the review.
Do members have any thoughts or suggestions for further action on the petition?
A lot of evidence has been taken on the petition that is very much weighted in one direction. I will not speak for all the members of the committee, but I get the strong sense that we are all driving in one direction. We have secured a debate in the chamber, and I am not sure that I need to hear any more evidence on the topic. I have formed a very clear view on the direction of travel that we are going in.
The convener and the deputy convener will meet Professor Britton. Will that meeting be soon? Has it been arranged yet?
It will take place as diaries permit. Professor Britton contacted us and said that she thought that it would be useful for us to meet. That is helpful, because we are wrestling with, and there is no doubt that the petitioners are wrestling with, the purpose of the review. It is clear that the review is not to address the substance of the report, which the patients have been unhappy with; it is about the process and what the Government can learn from that. My concern is that that review might misrepresent to the petitioners what its outcome might be. I do not think that it will revisit the findings or recommendations of the report.
No. It could be a diversion from the core issue of what has happened to the women and the undoubted tragic effects that the mesh has had on them. I think that the draft report will crystallise something for us. Either way, the issue has to continue and move on.
It is interesting to note that there was a debate on the issue in Westminster Hall. It strikes me that public awareness is catching up with the individual experiences of those women, and it feels as if something bigger will develop out of this rather than the consideration of individual clinical decisions. We recognise the petitioners’ work in highlighting the matter.
One of the big issues for me is how the process has allowed the issue to evolve to the stage that it is currently at. The process has taken such a long time—in fact, it has required the petitioners to bring the issue to people’s attention before it has been picked up. I am interested in the initial reporting and how the process has allowed this to happen.
There is also the fact that, when Alex Neil was Cabinet Secretary for Health and Wellbeing, he stepped in and said that there should be a moratorium but the practice still continued.
That is what I find confusing.
Given the evidence, it is difficult to see why that moratorium would not have been sustained. However, we are not clinicians, so we do not really know what the other options might be.
We have come back time and again to the issue that the petitioners were not believed. That is clearly an issue for them. It was not believed that the procedure and their subsequent suffering were connected.
Do we agree to meet in private to look at the report ahead of the debate? That would help our consideration.
Members indicated agreement.
Is there anything else that we can usefully do at this time, apart from recognising where we have got to on the issues that have been highlighted? I recognise that we will have a debate, that we will produce a report, and that there are still issues for the Government in respect of what its authority is. The issue for the Government is really whether it can follow through on the question of the moratorium.
Yes. There is obviously a worry that this operation is still being carried out. We heard evidence that, in some places, it has ceased through patients being given effective, informed choice, but I am concerned that there are potentially still women out there having this done who are not well informed about what is going on.
It is worth remembering that it is too late for the women who have been conducting the campaign. They are not doing it for themselves; they are doing it for women in the future—and men as well, I believe. It is important that we keep the issue up there.
Very much so. We would be failing if we did not make sure that the debate is being heard out there so that people can make informed choices.
Going back to the moratorium issue, I note that, when Dr Agur was here giving evidence, he explained that the decision to halt mesh procedures ultimately rested with NHS boards and he was unaware whether they had provided any feedback to the cabinet secretary or the Scottish Government about their views on the moratorium. If they have not provided any feedback, I would find that astonishing. We need to get to the bottom of that. If a moratorium is not worth the paper it is written on, what is the point of it?
Can we write to health boards to ask how many mesh operations are occurring at the moment?
We might want to reflect on that in considering what other information we want to add to the report. We can go back and establish what evidence we were given in that regard. I think that there was some evidence that enabled us to establish that there was not an absolute moratorium.
As we have already agreed that we will consider a draft report in private session, I suggest that we look to gather any other evidence that will inform that report. I do not mean oral evidence; I mean an up-to-date report from health boards about their understanding of the use of these procedures. In due course, the deputy convener and I will report back on our meeting with Professor Britton. Is that agreed?
Members indicated agreement.
Residential Care (Severely Learning-disabled People) (PE1545)
PE1545 is on residential care provision for the severely learning disabled. Members will recall that, when we last considered the petition, on 11 May 2017, we agreed to seek an update from the Scottish Government on the preliminary results of phase 1 of a project to improve data collection on demand for residential care and identify suitable alternatives to out-of-area placements.
The Scottish Government’s submission states that the themes that are emerging from phase 1 of the project include
“solutions to improving the discharge of people with learning disabilities with complex needs, focussing particularly on suitable accommodation.”
The submission also highlights that
“further consultation is required ... before any recommendations can be made in terms of strategic direction to support ... people with learning disabilities with complex needs.”
The committee also agreed to seek a response from the Scottish Government to the concerns that had been raised that the research will not address the gap in knowledge about people with profound and multiple learning disabilities. The submission highlights that
“a range of work streams”
have been commissioned to address
“the data visibility of people with learning disabilities in Scotland”.
The petitioner’s view on those projects is that
“this work fails to address the ... issues raised by our petition and ... the gap in data relating to people in Scotland with profound and multiple learning disabilities”.
The petitioner also raises concerns that the focus of the project is largely concentrated on the prescription and effect of antipsychotic drugs.
Do members have any comments or suggestions for further action?
We could write to the Scottish Government to inform it of the petitioner’s response and raise the point about antipsychotic drugs. We could try to find out where the consultation is going and point out that it is perhaps not going to address the petitioner’s concerns.
Yes. There is a frustration from the petitioner’s point of view that lots of work is being done—
But is it the right work or is it missing the point?
Yes. It is not bad work, but it is not really addressing the questions that the petitioner has raised.
10:15
We seem to be going round in circles. In the final sentence of her submission, the petitioner says:
“We need action, we need substantial funding and we need a clear plan.”
At the moment, all three of those are missing, but the absence of substantial funding is probably the stumbling block.
Without knowing the scale of the problem or where people are, what their issues are and what support they require, we cannot meet that need in communities.
What is interesting is that all those individuals will be on the radar. They are not flying under the radar; all of them will have medical and social work involvement at some level.
I am not sure that that is true. The point of the petition is that—
If someone has complex needs, they will almost certainly have some input at some level. The issue is whether we have a system for gathering that data. Information is missing, because the information on those people is not all being put into the same data system.
We are obviously in a state of flux, with the advent of the integration joint boards and their role in how such services are delivered. Is that impairing the delivery of services?
It might simply be the case that what is sought in such circumstances is residential care options, but no such options are available, with the result that folk remain supported at home or are sent outwith their local area because there is not sufficient appropriate accommodation or support where they live.
Data is important, but the focus should not just be on data, because there is undoubtedly a problem with residential care. Data is useful to back that up, but the fact that there is a problem seems to have been overlooked.
I suppose that the main point that we want to highlight is the one that Rona Mackay made about the mismatch between the problem and the response. There is nothing wrong with the response, but it does not really relate to the core issue that has been highlighted.
We could write to the Scottish Government to ask about the consultation and to invite it to respond to the petitioner’s comments. Is that agreed?
Members indicated agreement.
In Care Survivors Service (PE1596)
PE1596, by Paul Anderson, is on the In Care Survivors Service Scotland.
When we considered the petition in January, we agreed to write to the Deputy First Minister and Cabinet Secretary for Education and Skills to seek clarity on the interim finance arrangements, and to ask him to address the petitioner’s concerns about the long-term sustainability of funding and the potential adverse impact on service users in the event of a loss of skills and a loss of continuity of contact.
In his submission of 13 February, the Deputy First Minister indicated that, since the change in funding, there had been continuity in support. He added that survivors were able to access a broader range of support to address their individual needs through the in care survivor support fund. In its previous submission of 18 January, the Scottish Government indicated that it had employed a survivor engagement manager and that it intended to create an engagement plan that was designed to
“capture the views and concerns of more survivors in the future.”
The petitioner has acknowledged that the interim finance arrangements have led to improvements, but he expresses concern that there is no formal agreement on the provision of on-going support to survivors by Open Secret. He stresses how important he believes consistency and continuity of relationships between survivors and their counsellors to be, and he asks whether survivors have been consulted about their needs, and what opportunities they have to provide input to discussions about their health.
Do members have any comments or suggestions for action?
It is worth noting at the outset that the Deputy First Minister has said that
“no survivor has had to change or lose support since the change in funding.”
I note that the petitioner has acknowledged that the Scottish Government has provided assurances with regard to the crossover of service delivery between Open Secret and the in care survivor support fund and that that has been delivered.
However, the petitioner raises a couple of other questions. He asks whether survivors from the ICSSS have been consulted about what they need and about the changes that are now in place and those that will be made in the future, and whether there is any evidence that survivors have had the opportunity to provide input when decisions about their future health have been discussed.
Those are two valid questions and I would be keen to seek an update from the Scottish Government on the role of the survivor engagement manager, which you mentioned, convener, and any progress with regard to the on-going engagement plan, given the questions posed by the petitioner.
I completely agree with everything that Angus MacDonald said. I get the sense that the petitioner is looking for some security and there is still a doubt in his mind. He asks valid questions about survivors’ involvement and whether there has been enough of that. There are questions that we need to ask the Government on behalf of the petitioner.
With such changes we quite often find that the issue is not about whether there is a service available for people but about the model of the service. If it would be feasible to do it, it might be useful to have a side-by-side comparison of what people had and what they are getting, because things such as time-limited interventions significantly change a user’s experience and the value of what they get. The reason for the frustration of workers and the petitioner is the lack of recognition of what was being offered. The new model is stripping out what they consider to be the important content of what was being offered. It would be useful to have that direct comparison.
I think that the point was that in-care survivors who were getting support from Open Secret were still entitled to that support. They were still getting that support if they wanted it.
There is a separate question about what would happen if someone referred themselves now. There is an on-going debate among survivor groups. I am a member of the cross-party group on adult survivors of child sexual abuse, and I know that that issue very much exercises them. Some of that is reflected in the petition.
Angus MacDonald is absolutely right to say that the service will continue for those who received it before the change. The questions that he asked are legitimate ones to pursue with the Government. The broader questions about strategy have been highlighted. Do members agree that we should pursue the specific questions that Angus MacDonald asked?
Members indicated agreement.
Congestion Charging (Scottish Cities) (PE1607)
Our next petition is PE1607, by Peter Gregson, on behalf of Kids not Suits, on congestion charging in major Scottish cities. We previously considered this petition in November 2016, when we agreed to defer further consideration until the publication and scrutiny of the draft climate change plan, or third report on policies and proposals.
The clerk’s note provides an update on scrutiny of RPP3 and notes that the final draft of RPP3 is expected to be published in the first quarter of 2018. The note also refers to an inquiry into air pollution in Scotland that is currently being undertaken by the Environment, Climate Change and Land Reform Committee. It also highlights the Scottish Government’s undertaking, in its programme for 2017-18, to introduce low-emission zones in Scotland’s four biggest cities by 2020, with the first zone being introduced by the end of 2018.
Do members have any comments or suggestions for action?
I find this a very interesting petition, in that we will have to get some capital from somewhere if we are going to change transport in our cities. Personally, the issue for me is being able to cycle.
I would like to pass the petition on to the ECCLR Committee. There is not much more that we can do, given that the Government is already making some moves on the issue, but the evidence that the petitioner has given and the evidence that we have taken would really help that committee with its consideration.
As a member of the ECCLR Committee, I can say that we have just started our work on the air quality inquiry. We would certainly welcome the petition—although I cannot speak for the committee.
You just have.
It is on the record.
We have considerable work still to do on the issue but for me the main point is that the petitioner’s requests have basically been addressed in the programme for government, with the Scottish Government saying that it will introduce low-emission zones—LEZs—in the four biggest cities by 2020. I do not know how long the petition has been going—quite a few months, I think—but it is a prime example of how the petition system can help to direct Government policy.
The fact that the Scottish Government has made a commitment on LEZs is to be welcomed and, therefore, I think that we want to close the petition. The only question is whether we choose simply to make the other committee aware of the petition or refer it to the committee. I bow to your wisdom on that, Angus—which would be better? Which would cause us less grief?
I suggest that we make the committee aware of the petition rather than refer it fully to the committee. We are in a far better place on this than we were when the petition was submitted.
I think that we are agreed that we want to close the petition on the basis that the underlying issue to much of what the petitioner sought has been recognised as being important.
It is right to underline Angus MacDonald’s comment about the role of the petitioner and the Public Petitions Committee in highlighting the issues and securing some progress. We will, of course, also want to make the Environment, Climate Change and Land Reform Committee aware of the petition given its inquiry into air quality in Scotland. Is that agreed?
Members indicated agreement.
Parking (Legislation) (PE1616)
The next petition is PE1616, on parking legislation. We last considered the petition in February and agreed to defer further consideration until the Scottish Government’s consultation on parking was complete. It has now closed and an analysis of the responses that were received is expected to be published in autumn 2017. Do members have any comments or suggestions for further action?
Given that the consultation outcome is now due, we should write to the Scottish Government to ask what action it proposes to take.
So we will ask for an update from the Government.
That would be common sense.
Having looked at it, I find the issue unbelievably challenging, given the number of households that have cars now compared with in the past. Clearly navigating around some of our streets is a big issue if you are in a wheelchair or have a pram or whatever, particularly in my city of Glasgow. It would be worth while to find out more from the Scottish Government. The analysis of the consultation is due to be published, then presumably there will be a Scottish Government response, so we will ask the Government to keep us updated on its intentions.
It is a no-brainer not to park in front of a dropped kerb.
Unless it is your own dropped kerb.
Sepsis Awareness, Diagnosis and Treatment (PE1621)
PE1621, by Jim Robertson, is on sepsis awareness, diagnosis and treatment. When we last considered the petition, on 29 June, the committee agreed to write to the Cabinet Secretary for Health and Sport expressing our view that it would be appropriate for the Scottish Government to launch a national public awareness campaign.
In her initial response on 11 August, the cabinet secretary indicated that the Scottish Government did not feel that it was necessary to launch a national public awareness campaign but would continue to work closely with NHS Scotland, the Fiona Elizabeth Agnew Trust and other stakeholders on raising awareness of sepsis.
Subsequently, on 27 September, the cabinet secretary announced a national public awareness campaign and, in correspondence to the committee, on 17 October, indicated that the campaign is expected to commence in early 2018.
The petitioner has stated in his submission that he is very pleased that a national public awareness campaign will now go ahead—I am not quite sure whether the cabinet secretary met the petitioner directly. Do members have any views on what action to take on the petition?
10:30
We are delighted that the campaign will go ahead. On that basis, I think our work is done.
Excuse my lack of knowledge of Latin but, as volte-faces go, this was a cracker. We were told that there would be no awareness raising; now we are told that there will. I am delighted that the Government has paid heed to the petition and the committee’s call for awareness-raising sessions to be held.
We should acknowledge the role of the petitioner who, in terrible circumstances, has tried to improve public policy. The petition has achieved a public awareness-raising campaign that the Scottish Government was clearly not inclined to engage in—it had been advised not to do so—because of the force of the argument. The petitioner is to be commended for his fortitude in bringing the matter forward.
I was interested in the argument that there could not be a national awareness-raising campaign because people would then refer themselves inappropriately. Wherever that thinking came from, we would hope that the cabinet secretary has had a look at what formed that advice. I get that we do not want people to worry about their health or refer themselves inappropriately, but surely that is better than someone not realising what is happening and not getting the medical attention that they need.
The whole point of a national campaign is to enable people to identify correctly what is happening and know how to respond quickly. It is hugely beneficial to the NHS if people come early and things are caught before they have progressed too far. The decision was very odd.
I agree with everything that has been said. The petitioner is a constituent of mine, and he is extremely grateful to the committee and for the decision that was eventually taken—he feels that bringing the matter before the committee was very worth while. Personally, I am delighted, and I know that he is, too.
The petitioner has been part of a broader campaign and all those who took part in it should be commended. Pushing the Government to do things that it does not want to do is a great achievement.
Are we agreed to close the petition on the basis that the Scottish Government has confirmed that it will launch a national public awareness-raising campaign?
Members indicated agreement.
I note again the efforts of the petitioner and other stakeholders in securing this positive outcome.
Mental Health Treatment (Consent) (PE1627)
Our next petition is PE1627, on consent for mental health treatment for people under 18 years of age. We last considered the petition on 20 April, and at that meeting we agreed to write to the Scottish Government and the Royal College of Psychiatrists in Scotland’s faculty of child and adolescent psychiatry. The committee asked the Scottish Government how the petitioner could contribute to the chief medical officer’s review of the consent process for people who receive care and support in Scotland. The response indicated that patients are already represented in the review process but that the Government would consider how the petitioner could be further involved. The committee also asked what funding is available for the links worker programme and the number and location of the general practices that are participating in the programme.
The clerk’s note summarises the information that has been provided by the Scottish Government. The committee asked the Royal College of Psychiatrists in Scotland’s faculty of child and adolescent psychiatry for its view on the clinical guidelines for mental health conditions in children and adolescents in the context of the petition, and its response stated that there is
“universal support for maintaining the right to confidentiality of young people who can give informed consent to treatment.”
The faculty’s response concluded by stating that it
“would be very happy to think together with other colleagues about how to support young people accessing high quality, timely services for mental health disorders in Scotland.”
The petitioner has indicated that she does not feel that answers have been received to the questions that the committee raised. Do members have any comments or suggestions for further action?
I think that we were all moved by the petitioner when she came here and talked about her experiences. No one could fail to be moved by such testimony.
The petition raises not only a massive issue of confidentiality but the question of whether somebody with mental health issues who presents to a doctor is competent to take their medication as prescribed, especially if they are given a month’s worth of drugs. I appreciate that this is not what the petitioner is asking for, but the petition opens up a whole different ball game in relation to how we approach the treatment of mental health.
I appreciate that the petitioner is talking about under-18s, but I am thinking much wider than that. I would quite like to bring the Minister for Mental Health before the committee to get her and the Government’s opinion on how we can take this forward. It is obviously an extremely complex process.
I agree, but I wonder whether we ought to ask the chief medical officer to be present because of the complexity and nature of the case. The minister alone would not be adequate.
There is no doubt that the minister could bring along whomever she likes, but we would be content if the chief medical officer was here.
I agree with what Brian Whittle said. This is a big issue; indeed, there are almost two separate issues to do with how mental health care is delivered to young people. I can understand why the petitioner feels that her questions have not been answered because the question of confidentiality was not directly addressed; the answers that we have been given are more about support, links workers and so on, not about the specific question of confidentiality for under-18s.
As I understand it, the solution that Annette McKenzie has identified is that if she had known, she would have been able to support her daughter. That is utterly compelling, but it is up against the view of the medical profession and youth organisations on the importance of a young person feeling that they can seek help and have confidentiality.
There must be a middle ground. Having the support of your family if you are in those circumstances is not necessarily a bad thing. The compelling point that Annette McKenzie makes is that if she had known, she might have managed the dispensing of the drugs.
This terrible case highlights something, although the solution might not be what the petitioner suggested. There must be another answer and I am certainly interested in exploring that broader question with the minister. What are the guidelines around the amount of medication that is handed to somebody who might be in a vulnerable situation? Are there other ways of managing the prescription of drugs? I do not know a great deal about this area, but the petitioner has described circumstances that we think need to be addressed, although some people might feel that the solution that she identifies is problematic. We would want to look at it further with the minister.
We might have asked this in the initial evidence session, but I am interested to know how widespread it is that children or under-18s who are still living at home are being prescribed drugs without anyone else knowing. Is it down to a doctor’s decision? Is the situation quite unusual or is it widespread? I am not sure, so we need to find that out.
I suppose that it is difficult for every GP to have that depth of knowledge and understanding of mental health issues, as well as having the time to assess a patient to the necessary degree. For a young girl who is reporting night terrors and all the rest of it, I would have expected to see a wider assessment. Sometimes that is down to the availability of services and the ability to refer to child and adolescent mental health services or whatever.
There is something about the pathways that are available. We know that, for many young people, there is a huge delay in assessment. There is a wider issue here.
I might also like to hear from some of the leading mental health charities for young people that provide some of that wider support. Young people will often talk to a voluntary agency, because they feel that their confidence will be kept; but at least that means that they have a point of support.
I suppose that I had always thought that there would be an aversion to prescribing drugs to a young person—that all sorts of things would be tried first. Clearly, I am not in a position to understand what the consultation that took place was like.
When we asked GPs for comments, they emphasised confidentiality, too, but they also said that they would advise a patient to speak to family members and to look for support.
There are a number of issues that we will want to explore with the minister. We also need to consider which other witnesses we want to have before us.
We want to know why the petitioner’s daughter was not signposted to mental health support.
My understanding of the individual case is that no action is pending against anyone. We would be looking at the matter in policy and practice terms, rather than looking at the individual case.
It is about care pathways. If a person comes in, they should always be referred to mental health support.
The petitioner is looking for guidelines for GPs and whether such prescribing should happen at all.
Doctors have a high degree of autonomy in how they deliver care. The issue is their training.
We do not want to take away their autonomy, but we want there to be very good guidelines.
If a GP practice is under phenomenal pressure, is it easier to prescribe medication than it is for the GPs to speak to people and to direct them elsewhere?
We want to bring in the minister, who might bring along the chief medical officer. Do we want to take oral evidence or seek written evidence from some mental health charities, too?
It would be interesting to have them altogether on the same panel, so that views could be shared, because—
I am sorry to interrupt, but if we are to ask the minister to respond, there would need to be two separate panels; we might also need to allow time for the minister to reflect on the evidence from the mental health charities. Perhaps we could timetable it that way.
My suggestion would be to speak to the voluntary sector first so that we can reflect what they say when we speak to the minister.
That would be logical.
I am not absolutely clear what direction we will go in with this petition. That is probably the same for everyone else here, too, but we all recognise that there is an issue of some description.
It would be fair to the petitioner and their family to ask them: if what is proposed in the petition does not happen, what should happen instead? Clearly, something here is not right. If breaching confidentiality is not the solution, what is the solution?
There is quite a lot here. We recognise how difficult it is for the petitioner and her family, because of their individual and direct experience of the issue.
Child Welfare Hearings (PE1631)
PE1631 is on child welfare hearings. We last considered the petition in May, when we agreed to write to the Scottish Government and the family law committee of the Scottish Civil Justice Council. The committee sought to establish the cost of implementing digital recordings of child welfare hearings. The Scottish Government estimated that the cost would be about £390,000, with additional on-going running costs. Regardless of the costs, the Scottish Government’s view is that it would be inappropriate to record child welfare hearings because they are not structured as evidential hearings, so there is a risk that to do so would increase their formality.
The petitioner stated in her response that the Scottish Government’s cost estimate seems to be prohibitively expensive, and that child welfare hearings should not be measured only in terms of costs. The petitioner also highlighted that child welfare hearings are recorded at the proof stage and questioned why that could not be the case for ordinary child welfare hearings.
The committee also sought to establish whether the pro forma that is used in children’s hearings to produce a record of proceedings could be adapted for use in child welfare hearings. The Scottish Government confirmed that there is scope for that pro forma to be adapted.
In its submission, the family law committee of the Scottish Civil Justice Council highlighted that a sub-committee has been set up to take forward work on case management, including consideration of ways in which to achieve greater continuity in how child welfare cases are handled. The Scottish Government is represented on the sub-committee and will provide an update to this committee after the sub-committee has reported to the family law committee on 23 October 2017. Do members have any comments or suggestions for further action?
10:45
I was not present when the petition was discussed previously. Why cannot a verbatim recording be made in the very simple form of a little recording?
It seemed remarkable to us that it would cost so much, when most of us could probably record such things on our phones.
That is what I was getting at. Hearings could be recorded on one of those little digital recorders, which are not expensive. I suppose that there would be a cost if the recording had to be typed up, but the digital recording could just be stored. It is unclear why that cannot be done.
There would be costs involved with recording hearings and storing the recordings. The petitioner’s point is that when different people are dealing with a case, the case has to be restated, so evidence that has established the issues is sometimes missed. There is frustration because people have to make cases again or the point of an argument is lost because there is not a record of every stage.
I agree with the petitioner that child welfare hearings should not be measured only in terms of costs. A cost of £390,000 sounds like a lot for what we are asking for but, weighing that up against the service that it would provide, I do not think that it is too much.
The sub-committee that has been mentioned was due to report a few days ago to the family law committee, so we should ask the Scottish Government to update us on the outcome, so that we know where we are.
Okay. Do members agree to that suggestion?
Members indicated agreement.
There is probably nothing else that we can do just now.
Drinking Water Supplies (PE1646)
PE1646, by Caroline Hayes, is on drinking water supplies in Scotland. We first considered the petition on 25 May, when we agreed to write to the Scottish Government, Scottish Water, the Drinking Water Quality Regulator, the Scottish Environment Protection Agency, NHS Highland and the Water Industry Commission for Scotland. It is encouraging that they have all provided submissions, which are included in our meeting papers.
The committee sought to establish whether the protocols in the regulatory regime are sufficiently robust, and whether there is any conflict of interests in the regime. The submissions clarify responsibilities under the framework and say that there is no conflict of interests. The Drinking Water Quality Regulator’s submission included a background note on the specific local issue that led to submission of the petition.
In response to our request for comments on the concerns that are raised in the petition about potential health impacts, NHS Highland provided a summary report of the local investigation that was conducted by its health protection team. The summary report identifies “anecdotal opinion” of an increase in health impacts, for example skin complaints, but notes that there is a
“lack of evidence of any increased prevalence”.
The petitioner reiterates in her submission concerns about disinfectant by-products that are associated with chloramination, and asks how Scottish Water monitors those by-products.
We have had a substantial response from the various groups and people to whom we wrote. Do members have any comments or suggestions for further action?
On a wider note, I have had a few constituency cases on the quality of water and measurement of water quality. It seems to me that there is ambiguity about whether SEPA or Scottish Water is responsible for that measurement. I would certainly welcome clarification of that. I do not know how we would go about getting it, but I would like to know whose responsibility that is.
We can provide that information to members.
We have so much in the submissions and some of it is quite technical. The main issue seems to be safety. The petitioner acknowledges that the water supply is safe, but asks whether the Drinking Water Quality Regulator is sufficiently effective in ensuring that water is also pleasant to drink. We need to ask Scottish Water what measures it has or will put in place to measure the quality and safety of water subsequent to chloramination, so that we know where we are with that.
Safety and the pleasantness of the water are slightly different things. As we go across the country, the water is pretty icky to drink in some places, because it has to be more heavily chloraminated to make it safe. The issue is quite difficult, but I presume that safety has to come first.
On balance, yes it does. [Laughter.]
The water might not be particularly pleasant to drink, but it will not kill you. The problem will always be on-going—I do not think that it will go away any time soon. We are free to ask for our water to be tested, and SEPA is the primary environmental regulator, as I understand it.
It is worth noting that SEPA and Scottish Water operations come under the remit of the Environment, Climate Change and Land Reform Committee, so it may be worth highlighting the issue to that committee, depending on how the petition progresses. I do not have the work programme details before me, but Scottish Water may be due to come soon to give evidence, which may be an opportune time to raise the issue at the ECCLR Committee.
We can liaise with that committee through the clerks and make sure that the issues are highlighted to it ahead of such a meeting. If that is agreed, we will write to Scottish Water, as suggested, and highlight the issue to the ECCLR Committee.
Members indicated agreement.
NHS Scotland (Protection for Employees) (PE1647)
The final petition for consideration is PE1647, by Angus O’Henley, on protection for all employees in NHS Scotland. We previously considered the petition on 25 May.
The submissions that have been received from the Scottish Government, the Crown Office and Procurator Fiscal Service, the Health and Safety Executive and the British Medical Association Scotland all consider that the existing legislative framework provides the protections that are requested by the petition, whether under existing common law and statutory offences, or specifically within the terms of the Emergency Workers (Scotland) Act 2005.
The BMA Scotland, however, considers that an extension of the legislation, as requested in the petition, may act as a deterrent, and that a potential benefit of adding non-medical staff to those who are protected under the 2005 act might be to raise the profile of assaults on receptionists, porters and auxiliary staff, for example—although it also considers that that could, equally, be achieved through education. Education is identified by the Scottish Government as a
“priority area of focus at this time”,
along with “enforcement of existing legislation”. The petitioner acknowledges the protections that are available under common law, but considers that a
“specific offence with a statutory sentence … may well deter would be assailants from attacking all NHS employees and volunteers”.
Do members have comments or suggestions for further action?
I have a vested interest, as I spent many years in the NHS and have been on the receiving end of such treatment. It is a management issue, and most hospitals now have clear signs that say that they take a zero-tolerance approach to aggression towards staff.
The law is there and has been used: people have been prosecuted for attacking NHS staff. It is not just about NHS staff; we have the problem across the public sector, to some degree, for police officers and the fire service, as well as in the private and voluntary sectors. I am wary of saying that one group needs protection more than others do. The issue is how we use the law and how we structure things such as how front doors are operated. Ultimately, the issue is cultural: it is about how people behave.
The issue is not just about NHS staff; we know about attacks on police officers and the fire service. The statute exists: the issue is whether it is within our remit to suggest that the law should be strengthened and whether an assault on staff in the health service should be deemed to be a worse crime. I know what I think.
Having been around when the legislation came into force, I know that the idea behind it was to protect ambulance workers from being attacked as they were trying to treat people, and to protect firefighters from being attacked on their way to put out fires. Also, at the time, the Union of Shop, Distributive and Allied Workers had a campaign about protection of shop workers, who will—again, as we come up to Christmas—be subject to all sorts of abuse. The issue concerns general protections, but it also involves the question of sending out a message and the deterrent effect of having legislation. We are, of course, dealing with those issues in relation to other legislation, at the moment. I see the motives behind the petition and the merits of the proposal, but the question is whether the initiative is necessary. It somehow seems that saying that it is not necessary implies that we do not think that there is a problem. That, too, is a challenge that we have.
Attacks on staff come in different forms. There are people who think that attacking people is quite reasonable, and there are people who are under massive stress or are in pain and therefore behave in ways that they would not behave in other situations.
We need to send out a clear message that the behaviour that we are discussing is unacceptable, but there is an issue about creating layers of law. If we are not prosecuting people who exhibit such behaviour already, why would we suddenly start doing so? The law under which they could be prosecuted already exists. The issue is about using the law that we already have, being very clear about our position and sending out a clear message that we will prosecute people who assault staff in a department or on the street when they are trying to help someone. Of course, having sent that message, we then have to do it. If we are not already doing it, why would bringing in another law suddenly make us do it? That is my question.
The Government’s submission states that, in 2008, the Emergency Workers (Scotland) Act 2005 was extended to provide legal protection to ambulance workers, doctors, nurses and midwives, and that the applicable penalty is up to 12 months’ imprisonment or a £10,000 fine, or both. As Michelle Ballantyne said, applicable legislation is already in place, so it might be that a campaign for greater public awareness is the answer. The problem is to a large extent cultural, so it is difficult.
Do we want to write to the Scottish Government to ask how it could develop a focus on public education and ensure that the current legislation is enforced, and also whether it is examining how many such cases there are each year?
It comes back to starting at the beginning, in terms of prevention: it is about how we educate our young people at school. We used to use a programme that was about how a person can find himself or herself in a situation in which they behave violently. It set out the fact that the consequences can be massive not only for the person who suffers their violence but to them as an individual, as they might end up in a court procedure.
If we are looking at how to stop this kind of behaviour, we should be thinking about the processes that we have in education, the messages that are sent up front, and the action that is taken when an individual misbehaves. There would a three-pronged attack, so to speak. We have to be consistent; I do not think that we always are, at the moment.
That is a much broader issue. The question for the committee is whether we hold on to the petition to establish what the Scottish Government is doing in relation to any public education programme, or close the petition on the basis that the current legislation is adequate, even though there might be a question about enforcement. Do members have views on that?
Is there an argument for bringing the issue to the chamber for a debate? That would highlight feelings on it.
We have already been overallocated committee business slots, so it is unlikely that we would get another. Parties might want to propose the issue for debate, but I do not think that the committee would be entitled to another slot. I think that there are 12 to 15 slots in the year; we have had one and expect another two, so I do not think that a debate would be an option.
Does the committee want to take the issue further and ask the Scottish Government for more information, or close the petition?
I am minded to close the petition under rule 15.7 of the standing orders, because existing legislation and common law are considered to provide sufficient protection for staff, but to do so in the hope that there will be better public education in the future.
We could agree to close the petition, but to write to the Scottish Government with our reflections on the petition and the importance of enforcement and public education, and to say that those matters must sit alongside the legislation itself.
We recognise that there is an issue, but we do not think that more law is the way to address it.
Do we agree to close the petition on the basis that existing legislation and common law are considered to provide sufficient protection for staff, but also to state that we believe that the Scottish Government has to be alive to the issue of public education and must monitor enforcement?
Members indicated agreement.
With that, I thank everyone for their attendance and close the meeting.
Meeting closed at 11:00.Previous
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