Health, Social Care and Sport Committee

Meeting date: Tuesday, November 7, 2023

Official Report 640KB pdf

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Subordinate Legislation

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Mental Health (National Secure Adolescent Inpatient Service: Miscellaneous Amendments) (Scotland) Regulations 2023 [Draft]

Our fourth item today is consideration of an affirmative instrument. The purpose of the instrument is to add the national secure adolescent in-patient service, Foxgrove, to the list of secure mental health services in the Mental Health (Safety and Security) (Scotland) Regulations 2005. The instrument also adds Foxgrove to the list of qualifying hospitals in the Mental Health (Detention in Conditions of Excessive Security) (Scotland) Regulations 2015.

The Delegated Powers and Law Reform Committee considered the instrument at its meeting on 3 October 2023, and it draws the instrument to the attention of Parliament on the general reporting ground, in that the title of the instrument is not in line with standard drafting practice.

The DPLR committee also draws its correspondence with the Scottish Government to the attention of the Health, Social Care and Sport Committee, for its information, in relation to the additional material provided by the Scottish Government in its response to the committee.

We will have an evidence session with the Minister for Social Care, Mental Wellbeing and Sport and supporting officials on the instrument. Once we have had all our questions answered, we will proceed to a formal debate on the motion.

I welcome to the committee: Maree Todd, the Minister for Social Care, Mental Wellbeing and Sport; Dr Aileen Blower, child and adolescent mental health services psychiatry adviser; Ruth Christie, head of children, young people and families unit; Douglas Kerr, Scottish Government legal department and Dr Gavin Reid, principal medical officer, forensic psychiatry. All are from the Scottish Government.

I invite the minister to make a brief opening statement.

Thank you, convener. I thank the committee for asking me to attend today to give evidence on the draft Mental Health (National Secure Adolescent Inpatient Service: Miscellaneous Amendments) (Scotland) Regulations 2023.

Before we begin the questions, I thought that it would be helpful for me to provide some short opening comments. I am pleased that, after many years of planning and development, the national secure adolescent in-patient service—known as Foxgrove—is almost ready to admit patients. Foxgrove will be a vital and important addition to children and young people’s mental health services in Scotland.

Foxgrove will provide services for children and young people aged between 12 and 18 who are subject to measures for compulsory care and treatment, have a mental disorder, present a significant risk to themselves or other people and require a medium-secure level of security in order to meet their needs. Having the facility in Scotland will mean that young people with extremely complex needs can have their needs met in a purpose-built and designed facility, with expert care delivering high-quality mental health care and treatment.

Members will hear me speak more about the mental health strategy in the chamber this afternoon, but the opening of the facility supports the vision that is set out in Scotland’s “Mental Health and Wellbeing Strategy” for a Scotland that is

“free from stigma and inequality, where everyone fulfils their right to achieve the best mental health and wellbeing possible.”

One of the outcomes within the strategy is:

“increased availability of timely, effective support, care and treatment that promote and support people’s mental health and wellbeing, meeting individual needs.”

Foxgrove will play a key part in that by providing a dedicated and appropriately skilled multidisciplinary healthcare team to deliver the level of care that young people deserve, closer to home.

Adding Foxgrove to the regulations will ensure that the service can implement a range of safety and security measures to support the therapeutic environment and ensure the safety and security of children and young people as well as staff and visitors. The measures will be applied only when necessary, and they will be applied in a proportional way that is sensitive to the developmental stage of the child or young person.

Of course, it goes without saying that, when the measures are applied, they will also uphold and protect the human rights of children and young people.

Moving on to the specific the statutory instrument that is before the committee today, the regulations make amendments to the Mental Health (Safety and Security) (Scotland) Regulations 2005 and the Mental Health (Detention in Conditions of Excessive Security) (Scotland) Regulations 2015, so that the same safety and security measures that are available in other medium-secure in-patient settings can be applied, where necessary, in Foxgrove.

Children and young people who are detained in Foxgrove will also have the same right of appeal against detention in conditions of excessive security as those detained in other medium-secure in-patient settings. I consider that a right of appeal is an essential safeguard in the process, and that children and young people should have that right when they are detained in Foxgrove.

The regulations do not create any new enforcement or monitoring mechanisms; they simply apply the existing mechanisms to Foxgrove.

Laying the regulations is an important step in preparing Foxgrove to admit patients, which it hopes to do early in 2024. They lay the framework for a safe, secure and—importantly—therapeutic environment, where children and young people’s human rights are upheld and protected, and they allow them to appeal the level of security at which they are detained.

I am happy to answer any questions that the committee has.

Thank you very much, minister. We will now move to questions, starting with Ivan McKee.

Good morning, minister and officials. My questions are on the consultation process. There was a fairly short consultation period, with a limited number of respondents. Does the Government consider that the period was sufficient, and that the consultation was shared widely enough, given that only nine responses were received?

Yes, we do think that it was sufficient. Although there were only nine responses received, they were from key bodies that were charged with upholding the human rights of children in Scotland.

Subsequent to receiving the responses to the consultation, my officials met each of the respondents to ensure that we captured any concerns that they had about the legislation. Therefore, I think that, in addition to the formal consultation, there has been a good level of engagement with people who are charged with scrutinising the process in this situation.

10:45  

That is helpful—thanks. Were any consultations undertaken with children and young people?

Yes, there were. There is a children’s panel, which helped us with the development of Foxgrove and has been part of the process of designing the building to ensure that it meets children’s needs. It also engaged in some consultation with children and young people who had been detained in medium-secure settings. Ruth Christie can say a bit more about that process.

The development of the Foxgrove facility has been on-going for a number of years. NHS Ayrshire and Arran, which is the health board that is responsible for developing the service, has set up a public and patient reference group and has engaged children and young people a great deal in the development of the facility so that the environment is in line with what children and young people feel would be beneficial to them. The health board has carried out quite a lot of consultation with children and young people throughout the process, so I feel confident that that their views were taken into account in the design of the physical building and of how the service will operate.

Great; thanks very much.

What assessment of the new unit has been undertaken in relation to the United Nations Convention on the Rights of the Child and the UN Convention on the Rights of Persons with Disabilities?

I will ask Dr Blower to tell you a little bit more about how CAMHS operates.

In general, and as you would expect, medical services that are available to children operate with UNCRC at their heart. In Scotland, we use getting it right for every child—GIRFEC—as a framework for all public service interaction with children and young people, so you would expect that to be human rights compliant and age appropriate.

With regard to the consultation, we have not done a formal children’s rights and wellbeing screening sheet and impact assessment to assess how compliant these regulations are, but we have asked a lot of the questions relating to the CRWIA as we have gone along. The reason for not doing a formal CRWIA is that these regulations are an amendment to existing regulations and they do not contain any new protective measures; they are about applying measures that are already available to a new site. We would certainly consider doing a full and formal CRWIA if that was what Parliament wanted.

That is great; thank you.

Do you want to hear from Dr Blower about how CAMHS operates from a human rights perspective?

Yes.

The main function of Foxgrove will be to ensure that children and young people are given effective treatment in the care of developmental specialists. The multidisciplinary team will have a unique role in ensuring that every aspect of care, including the nature of the building, the procedures that take place in it and the more clinical aspects of care, are delivered under the principles of the Mental Health (Care and Treatment) (Scotland) Act 2003. That includes the principle of meeting the welfare needs of the child, and it applies for all under 18-year-olds. Those principles will be met, but also, in the everyday care planning, there will be attention to GIRFEC principles and SHANARRI indicators—safe, healthy, achieving, nurtured, active, respected, responsible and included—in terms of outcome measures. All of that looks towards upholding rights.

The purpose of the regulations is to ensure that there are safeguards around the use of particular procedures relating to safety and security. The whole purpose of this is to ensure that there is a level of oversight and scrutiny for all the measures that are used for young people in the facility for the duration of their stay.

What are the criteria for undertaking a full or partial CRWIA and will those criteria change if the UNCRC bill does come into force?

A full CRWIA was not required because the regulations do not create any new enforcement or monitoring mechanism. As I said earlier, they simply take mechanisms that already exist and apply them to a new hospital. I do not think that that will change because of UNCRC incorporation. In everything that we do, and with all the public services that we deliver to children, the Government tries to work—as it has done for many years—according to and in compliance with UNCRC principles.

The difference was that, when UNCRC incorporation did not happen, that was justiciable. There were consequences to it not happening. However, incorporation would not make any difference in practice to how we approach the issues, because we try very carefully to be UNCRC compliant at all times anyway.

I am interested in the right of the child to a family life, because we can all imagine this subordinate legislation having an effect on that. How can we ensure that young people who are in that situation have that right? Does the legislation comply with the provisions in the European Convention on Human Rights and the UN Convention on the Rights of the Child regarding the right to a family life and support for legal agency?

I will ask Dr Blower to say a little more about how the legislation is likely to operate in practice, but all the legislation that comes through the Scottish Parliament is ECHR compliant and we always try to develop legislation that is UNCRC compliant, even though we have not yet incorporated that fully.

The right to family life is really important. Dr Blower was trying to explain just how much care is taken regarding the child’s developmental stage and their welfare. Family life is really important to all that. Restrictions on the use of mobile communications, for example, might be applied on some occasions, but that will be done thoughtfully and the general principle will be that it is important for children who are being held in the unit to be able to maintain their links with family and friends outside that unit.

I will let Dr Blower say a little more.

In general, family life and family relationships are core to the work of CAMHS. We know that the children and young people who are in the facility in Ayrshire will come from all over Scotland, perhaps from a long distance away. The referring team will make the referral in discussion with the child’s family and relatives. Even if the child is in care, the family will be involved from the beginning of the referral process and in their detention under the act.

The act says that every child under the age of 16 has a default “named person”, who is usually a parent. That person has a particular role under the mental health act. They are a party, can make appeals and have the right of access to all the legal documents. Young people who are 16 or 17 years old can nominate a named person, which is often a parent or another relative that they trust and are close to.

All actions within the unit will be discussed with the family. There will be provisions for family members to visit, and local authority colleagues such as mental health officers will be involved in supporting visits. If families come from a distance, there will be support for them to stay overnight, if that is helpful for them and if it facilitates contact. The named person would need to be informed about any of the measures under the regulations. As good practice, the parent would be informed of the child’s progress, in the same way that any hospital would communicate with family members about how a young patient is doing. Parents’ advice would also be asked about everyday things.

Given the complexities of the young people and the amount of support that would be required to maintain family contact, does it seem realistic that that could be maintained?

I can say yes to that because, currently, if children are in any of our regional adolescent units in Scotland, they can still be quite far from home. That also applies to the national child inpatient unit in Glasgow, which covers the whole of Scotland. Our services are well used to involving families in the care of children, even very young children.

Convener, could I talk a little bit more about the safety and safeguards that are in place?

Yes, minister.

They have been built in as safety and security measures that seek to protect rights while also protecting safety. There are conditions for how measures can be used. There are record-keeping requirements and, importantly, there is oversight and scrutiny by the Mental Welfare Commission for Scotland. All of those provisions act as safeguards for the rights of children and young people who might be detained in Foxgrove, while enabling the necessary measures to be taken to ensure that they are safe.

Good morning, minister and members of the panel. What steps are being taken to address the concerns about appeal rights that were highlighted in the Scottish mental health law review, particularly in relation to the way in which they apply to children and young people?

There is a right to appeal built in. As I said in my opening statement, that is absolutely crucial. The treatment interventions for children and young people who require a certain level of security are not brief: the average length of stay at the NSAIS is about 12 to 18 months. The appeal process is rigorous and thorough, and we consider the timeframes suggested within the current regulations to be appropriate and proportionate.

As for the care and treatment that is provided, each individual who is detained will be managed under the care programme approach, which is a legal framework. There will be regular review, with accountability for the responsible medical officers. There are safeguards built in. There are appeal processes at certain points during the care planning journey, which I think is crucial to upholding children’s rights.

Thank you for that. What consideration has been given to the timescales in which appeals are permitted? Is the current six-month period appropriate for children and young people? What consultation have you done on that?

We think that the timescales are right, because the patients are not likely to be short-stay patients; they are likely to be longer-term patients. We think that the appeal processes are appropriate.

I do not know whether it would be reasonable to ask Dr Blower about that. Would you like to give a little bit more information about that, Aileen? Ruth Christie could perhaps then pick up on the question about consultation on the timescales.

11:00  

All the young patients in Foxgrove will have access to independent advocacy, which is a mechanism for discussing their views, feelings and wishes and ensuring that those are properly communicated and taken account of. They will all have access to legal representation and, if they do not have capacity to instruct, a curator can be appointed at relevant stages.

There are lots of opportunities for appeal. They can appeal their detention and against excessive security. At each stage, the young person can seek legal representation. There are also safeguards. The young person can contact the Mental Welfare Commission themselves. They can ask for the RMO to review, in a timely way, the use of particular safety and security measures and other specified persons.

In practice, any measure will be reviewed much more frequently than the regulations might indicate. Care planning for young people is a daily thing, and is done at least weekly by the whole team. Again, that would be done in discussion with family, and the mental health officer would be involved as a link with that.

As well as legal safeguards, there is the practice of ensuring that a rights-respecting approach is taken, because all that promotes recovery, too. Young people are much more likely to have a speedy recovery if they are involved in that as much as possible.

The point about appeals in the consultation is obviously one that several respondents raised. After further discussion with the respondents, I think that they were satisfied that we had considered whether the appeal process would be appropriate to be applied to children and that the timescales would still be applicable. There is also a point to be made about ensuring that there is time for any appeal to be rigorous and for all the right information to be gathered so that children and young people are detained appropriately at the right level of security.

Good morning, panel. I am interested in the secure care standards and pathways. I have just read that there are 44 standards that describe care that should be delivered with dignity, compassion, sensitivity and respect and in a person-centred way, in the sense that children make their decisions but with the involvement of everybody in the team. How do the regulations intersect with the secure care pathway and standards, and should the standards be referenced in the regulations?

Foxgrove will be working to the secure care standards, so in its consideration of how it will operate once the regulations are in place, it is looking carefully at the secure care standards. It is a slightly different environment, but there is a lot of learning to be had from looking at how the secure care environment operates. It also looked at national standards that apply in England to pick up on good practice points. Therefore, to reassure you, Foxgrove will operate to the secure care standards.

Foxgrove is intended to be a medium-secure care facility. Is that right?

Yes.

We talk a lot about helping to deliver the aims of the Promise. How does that align with what is being proposed for the work at Foxgrove? That work is in addition to the secure care pathway, and it is also delivering the outcomes of the Promise.

It is a step forward for the care of children with complex problems. These regulations will help us to uphold and protect children’s human rights in those situations. It is generally regarded as a positive step. Children who find themselves requiring secure care are currently usually transferred to England for medium-secure care. Being able to care for them in Scotland and therefore provide continuity of education—different education systems operate in the two countries—will help us to uphold the Promise rather than cause any challenge to those principles.

The Scottish Government is absolutely committed to delivering on the Promise. We made the Promise and we intend to uphold it.

I have a final question. Foxgrove is aimed at young people between the ages of 12 and 18. We need to make sure that the care is age appropriate, so that we are not just transferring care from an adult facility and lifting and shifting to deliver and provide for young people. Will the care be targeted at the specific age of the young person?

That is absolutely correct. The application of the safety and security measurements are to help to protect the safety of children and young people who require to be detained in Foxgrove in conditions of medium security. The measures will be applied only when necessary and will be proportionate to the potential risk.

As we said in a number of previous answers, the service will absolutely be UNCRC compliant. The child will be at the centre and the child’s wellbeing will be core to all the facility’s work. Family links will be maintained and all those important pieces will be in place. It will be a child-centred service first, as well as being a medium-secure service.

I have two questions, minister. One is about staffing and one is about training. My colleague asked about the consultation. One submission to the consultation said:

“there also needs to be robust consideration of staffing in the community and links with appropriately confident and trained clinicians. Staff are already overstretched to capacity in existing teams.”

How confident are you that the new unit will be fully and appropriately staffed?

I am very confident that it will be fully and appropriately staffed. As I said, the service has been many years in development and we recognise that particular care needs to be taken of children and young people who find themselves in that situation.

It is a specialist in-patient service that we have not had previously, but we have expertise in forensic CAMHS in Scotland—for example, we have Dr Blower. We can look to examples from the secure care estate and at how the estate operates in England to learn what might be required in terms of training and operational procedures for the unit to work well.

We operate CAMHS in a way that has the child or young person at the centre of their care. The care plan is developed in line with GIRFEC, and trauma-informed practice is an important part of that jigsaw. Our aim is that our entire public services workforce will be trauma informed. For CAMHS, it is absolutely crucial that staff are trauma informed and that that training is available to them. Most of them will already be trauma-informed practitioners.

I do not know whether Dr Blower wants to say more about the workforce.

My question was just, “Are you satisfied?”, and you have answered it fully. Thank you.

My second question is around training. Has a children’s rights impact assessment taken place, and if so has a training program for the staff been put in place?

I will let Ruth Christie give a fuller answer, but, as I said previously, we have not done a full CRWIA. We have asked many of the questions as we have gone along and we have been satisfied that we are child rights compliant, but we have not done a full CRWIA.

I can give a little bit of information about that. Obviously, NHS Ayrshire and Arran is overseeing the recruitment and training of the staff who will work at Foxgrove, and it has already started to recruit staff. That has been gradual process that has been building up as Foxgrove gets closer to opening, which has allowed the recruitment of staff who might not necessarily have a forensic mental health background. There is time for staff to develop and to undertake training in conjunction with NHS Education for Scotland and with experts. As the minister said, that will draw on the experience of units in England. That process is already in place, so by the time the facility opens there should be a really well-trained and well-informed staff group ready to go and to link in with other local services.

That does not actually answer my question. My background is as a human resources professional. Normally, you would do a risk assessment and then, on the back of that, you would make sure that you have a training programme in place—ideally before the staff start. What you are saying is that the staffing is being done, but the complete risk assessment and the training programme have not yet been done.

To be clear, all of those operational details are the responsibility of NHS Ayrshire and Arran. A question with that level of detail should probably be put to NHS Ayrshire and Arran, which will be charged with that. It is easy for us to say what we expect to happen, but if you need reassurance on whether a risk assessment has happened and whether training needs were identified during that risk assessment, it is probably best to put that question to NHS Ayrshire and Arran.

I am going to pick up a little bit on that, because my question is about operational issues and some of the concerns that have been raised by stakeholders, particularly around about technology and mobile phone policy. I accept that we already have very well-established CAMHS services across Scotland, which will more than likely already have well-established policies on things such as mobile phones and iPads. Can the minister tell us what on-going discussions have been taking place with stakeholders in regard to that? I refer members to my entry in the register of members’ interests as a registered mental health nurse.

As mentioned in an answer to a previous question, access to a telephone to maintain contact with family and friends is a pretty crucial matter for any patient in hospital, and the Foxgrove team will ensure that young patients can safely use telephones within the unit. Procedures will be developed—again, those will be operational procedures developed by NHS Ayrshire and Arran—around access to mobile phones for all young patients in the unit and for children and young people as part of their individual care plan.

Under separate regulations, the use of telephones can be restricted if the RMO determines that a telephone call made to or by the person detained might cause distress to the person detained or to any other person who is not on the staff of the hospital, or significant risk to health, safety or welfare of the person detained for the safety of others. It is not a measure that is used lightly or in a blanket way. It is used very proportionately where there are specific care needs that need to be met.

11:15  

The submission from the Children and Young People’s Commissioner Scotland says that the proposals

“appear not to address issues such as training for staff”.

That is now a critical consideration for the committee, given that the Children and Young People’s Commissioner Scotland’s response cites that the proposals lack detail on training. The response from the panel so far has been that that is an operational matter for Ayrshire and Arran NHS Board.

There has been discussion about vague ideas about starting to recruit. I understand that the opening is to be in January next year, which seems quite close. How can the committee have any confidence that the concerns that the Children and Young People’s Commissioner Scotland raised are being addressed?

The opening is now scheduled to be in mid-March 2024. There have been some building challenges, as is often the case, in the completion of the construction projects, which have meant that there is a slight delay. The building is now expected to be completed and operational in mid-March next year.

The committee can have confidence that the health board—as in all the sites that it operates—is capable of identifying the staffing requirements for, and the training needs of, the people who are going to work in the unit.

As we have said, the recruitment process has already begun. As the service is completely new, we would expect that that process would need to begin early to enable the opportunity for any shadowing or networking that might be required on other sites. We do not have anything like that in Scotland yet, so we would expect that the process would begin early and that there would be a slightly longer lead-in time than there would be if we were just building a hospital like what we already have in Scotland.

Given that it is quite a new model, is it important to have more direct oversight of the detailed training programme, the detailed operational mobilisation for the facility, and information on where it currently stands on vacancies, recruitment and the appropriate training programmes for each person recruited, so that we can have more confidence that the concerns that were raised by pretty serious stakeholders are addressed?

I am confident that I have enough oversight to be certain that NHS Ayrshire and Arran is well prepared for the opening of the hospital, and I am confident that it is able to identify the right staff mix and that any training needs can be met through internal training, courses that are available through NES and informal networking.

I am confident that I have enough oversight that the building will be successful in opening. It has been many years in planning, and for many years it has been identified as a need for Scotland. Generally, aside from some construction constraints, we are motoring towards opening it healthily.

If I may be clear on the fundamental concerns, the national youth justice advisory group said:

“NYJAG don’t believe the measures should be authorised as they stand as children under eighteen have different levels of need and maturity and require appropriate age and developmental stage supports.”

The Children and Young People’s Commissioner Scotland said:

“We would recommend that alternative proposals be developed, using as a starting point the Secure Care Standards and Pathways”.

The centre for mental health and capacity law at Edinburgh Napier University said:

“There should therefore be a detailed human rights impact assessment undertaken in addition to this limited consultation.”

Is the minister’s position that the committee should disregard what those stakeholders have said?

As we stated earlier, officials have met each of the stakeholders who contributed to the consultation. They have had detailed discussions and have reassured the stakeholders that the processes are appropriate. We are comfortable that we have the support of stakeholders, that we have been able to adequately explain how the service will operate with regard to children’s rights, and that the service is an important step forward in upholding children’s rights.

I do not know whether Ruth Christie wants to say a little more about those meetings with stakeholders, which took place subsequent to the consultation.

Having those discussions and discussing the concerns that stakeholders raised was helpful. The framework is broad, and being able to discuss how it would be applied in practice to children and young people was helpful. We were able to reassure the respondents that we had thought it through and taken proper advice, and that we consider that what we propose is the right course of action.

I thank the minister and her officials.

We now move to agenda item 5, which is the formal debate on the affirmative instrument on which we have just taken evidence. I remind the committee that members should not put questions to the minister during the formal debate and that officials may not speak in the debate.

I will make a short comment. The regulations introduce a brand new facility for Scotland. It will be the only specialist adolescent in-patient service in Scotland, and I look forward to its progress. Because it is a completely new facility, I would be interested in the committee continuing to get further information by correspondence or face to face as the matter progresses so that we can inquire about operational issues and the facility’s effectiveness.

Having listened to the statements and evidence from the minister and the officials, I do not have enough confidence to support the recommendation that the Parliament approve the instrument, given the human rights concerns outlined in submissions to the committee.

I have noted the reassurances received but, until we have documentary confirmation of those, it is hard to come to a firm and confident conclusion that the stakeholders who are critical are content. Therefore, I propose that the statutory instrument be deferred with a view to incorporating safeguards that stakeholders feel are absent and to allow for a detailed human rights impact assessment and a children’s rights impact assessment to be undertaken.

I will outline the key takeaways for me. First, the consultation was too short—it spanned just two weeks, and it received nine responses. The Children and Young People’s Commissioner Scotland was not included in the initial consultation distribution, so contributed late.

There are also concerns about whether children and young people in facilities such as the one that is proposed can consent to measures that are authorised under the 2005 regulations, including invasive searches and swabbing. Adding a children’s facility to the list under the regulations that are used in adult services is, on the face of it, at odds with the Scottish Government’s commitment regarding incorporation into Scots law of the United Nations Convention on the Rights of the Child. Although we have noted the reassurances received from the minister, firmer protocols are needed to ensure that we have confidence in that behaviour.

No children’s rights impact assessment has been undertaken by the Scottish Government, which says that it is not necessary, as similar regulations are in place in similar facilities. However, the Children and Young People’s Commissioner Scotland says that that itself is of concern and notes:

“We are concerned that these proposals appear to have reached this stage without the creation of a Children’s Rights Impact Assessment (CRIA). It is likely that a CRIA would have brought to light, at an early stage, the concerns we outline”.

On that basis, it is not appropriate to recommend approval at this stage.

I am keen to proceed with the regulations. I am more than happy to conduct a CRWIA and to keep the committee informed of the outcome of that. I am more than happy to take on board Ms Harper’s suggestion of getting more operational detail from NHS Ayrshire and Arran but, fundamentally, the regulations would not change. Much of what members seek assurance on is operational detail, on which I can, by liaising with NHS Ayrshire and Arran, reassure them. Those concerns would not fundamentally change the legislation, so I am happy to proceed.

Thank you, minister. I ask you to formally move motion S6M-10534.

Motion moved,

That the Health, Social Care and Sport Committee recommends that the Mental Health (National Secure Adolescent Inpatient Service: Miscellaneous Amendments) (Scotland) Regulations 2023 be approved.—[Maree Todd]

The question is, that motion S6M-10534 be agreed to. Are we agreed?

Members: No.

There will be a division. I suspend the meeting briefly.

11:25 Meeting suspended.  

11:25 On resuming—  

We come to the vote on motion S6M-10534.

For

Harper, Emma (South Scotland) (SNP)
Haughey, Clare (Rutherglen) (SNP)
Mackay, Gillian (Central Scotland) (Green)
McKee, Ivan (Glasgow Provan) (SNP)
Torrance, David (Kirkcaldy) (SNP)
Tweed, Evelyn (Stirling) (SNP)

Against

Gulhane, Sandesh (Glasgow) (Con)
Mochan, Carol (South Scotland) (Lab)
Sweeney, Paul (Glasgow) (Lab)
White, Tess (North East Region) (Con)

The result of the division is: For 6, Against 4, Abstentions 0.

Motion agreed to,

That the Health, Social Care and Sport Committee recommends that the Mental Health (National Secure Adolescent Inpatient Service: Miscellaneous Amendments) (Scotland) Regulations 2023 be approved.

That concludes consideration of the instrument.

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National Health Service (General Medical Services Contracts and Primary Medical Services Section 17C Agreements) (Miscellaneous Amendments) (Scotland) Regulations 2023 (SSI 2023/281)

The next item on our agenda is consideration of a negative instrument. The purpose of the instrument is to amend the National Health Service (General Medical Services Contracts) (Scotland) Regulations 2018 and the National Health Service (Primary Medical Services Section 17C Agreements) (Scotland) Regulations 2018 to enable prisoners to apply to register with a GP prior to their release from a custodial setting.

The policy note states that the current regulations

“enable GPs to refuse an application to join a practice from a prospective patient if that patient does not live in the GP practice area. The effect of this for prisoners means that they are unable to register with a GP until after their release from custody, which can present delays to registration and access to healthcare.”

The policy note further states:

“allowing prisoners to apply to register with a GP in the community prior to their release safeguards continuity of care during the early stages of their rehabilitation.”

The Delegated Powers and Law Reform Committee considered the instrument at its meeting on 24 October 2023 and made no recommendations in relation to it, and no motion to annul has been lodged in relation to it.

I ask members for comments.

I declare an interest as a practising NHS GP.

I have a number of points to make, the first of which is that it is vital for people who are leaving prison to have continuity in their primary care, because a lot of what happens in prison with regard to medication and treatment is quite effective. When prisoners leave, they do not always, but often, fall through the gaps, and they no longer receive the care that they should, or as anyone in Scotland should.

However, I have multiple concerns. It is all very well to say that a prisoner should have continuity of care, but that will not happen if the GP does not get a summary from the hospital. On about three occasions, I have had a prisoner in front of me with absolutely no record of what has happened. That is of no use to my patient or to me, and that is detrimental. Therefore, that needs to be addressed.

We also need to be clear about what is intended, and I would like a response to some questions.

The regulations say that a practice cannot refuse. What if that practice has a closed list? If it is already oversubscribed with patients and has closed its list, will that practice still be forced to take on a patient who comes from the Scottish Prison Service?

How can we be sure that the person will be living in the area where they say they will be living? Ultimately, the reason why practices have an area is that practitioners are expected to do home visits in that area. Although many people may want to go back to the practice that they attended when they were children because they feel that it is a good practice in which they had good experiences, it might not be located where the person is living now—it might not be the nearest practice to them. In that context, the measure might not be appropriate.

We just need a little bit of safeguarding to ensure that the practice is able to say that it might not be the best practice for a person, rather than making the blanket statement, “You have to take this patient.”

That is noted, Mr Gulhane. I suggest that the committee write to the Cabinet Secretary for NHS Recovery, Health and Social Care asking him to answer the questions that you have raised. Would you be content with that?

Yes.

I have not had an indication that any other member wishes to speak. I therefore propose that the committee make no recommendations, but that we write to the cabinet secretary, in relation to the instrument. Does any member disagree with that?

Members: No.

Thank you very much.

At our next meeting, next week, we will hold an evidence session on vaping and e-cigarettes.

11:31 Meeting continued in private until 12:00.