Certification of Death (Scotland) Bill: Stage 2
We move to stage 2 consideration of the Certification of Death (Scotland) Bill. Members should have a copy of the bill, the marshalled list of amendments and the list of groupings for debate. I welcome the Minister for Public Health and Sport, who is so fond of us that she will remain with us for the rest of the day.
Section 1 agreed to.
Schedule 1—Status and appointment of medical reviewers
Amendment 1, in the name of the minister, is grouped with amendments 2, 3, 4, 6, 7, 8 and 10.
The committee raised the issue of where responsibility for checking, prior to disposal, certificates that are associated with deaths abroad should lie. I reflected on the matter and listened to stakeholder concerns about the proposals in the bill to give that function to superintendents at local burial grounds and crematoria. As a result of that reflection, I lodged amendments 1 to 4 and 7, to require the medical reviewers office to carry out the function instead. I hope that the amendments will address the concerns of stakeholders and the committee.
The task of ensuring safe disposal for cremations is currently performed by medical referees. In future, the revised medical certificate of cause of death form will have the relevant information about implants and other devices, and that information will be transposed to the registration of death form. For deaths abroad, an application will have to be made to the medical reviewers, who will ascertain the presence of such devices.
Amendment 6 will ensure that the medical reviewers have powers to make any additional inquiries that may be necessary. Amendment 8 is simply technical, to provide consistent language in the bill. Amendment 10 confirms that we will not charge a fee for the change of responsibility for verifying foreign death certificates to the medical reviewers office.
I urge members to support the amendments in the group.
I move amendment 1.
I would like a little more explanation of how the medical reviewer will ascertain the presence of implants in people who died abroad. Will he simply ask about that? The issue is tricky.
I presume that investigations would be made and that some information on the death would be gathered in situ, wherever that might be. Paperwork might or might not reveal the presence of implants. If necessary, and if doubts remained about whether devices were present, medical reviewers could seek advice and expertise. In many cases, medical reviewers will be able to ascertain through paperwork that a person has a device—because of their medical history, for example. However, as a fallback position, further investigations could be made if required.
It is worth adding that most people who die abroad are on holiday and are registered with a GP in Scotland, so much of the paperwork about medical devices that have been fitted is available. However, the fallback is that external advice can be sought.
That is helpful. I support the amendments, but problems exist. I suggest that the minister seeks advice before stage 3. About 250 deaths a year occur abroad and the number of those people who have implants is of course small. However, any cremated implant would be explosive—the situation is really dangerous. Funeral directors abroad might check for implants—systems will be in place—but will the minister tell us at stage 3 how the issue will be dealt with? Would it be better to have a register of individuals in Scotland who have such devices, which the reviewer could access automatically? That suggestion might be impractical, but it has been raised with me for consideration.
Richard Simpson reminds me of a case that I dealt with that involved a young man who went to work in Thailand, where he stayed for several years. His parents were my constituents and came to seek my help when he died as the result of an accident in Thailand, because the costs of bringing his body home were enormous. In the end, they had him cremated, which reduced the costs significantly. I had to work closely with the embassy in Thailand, which made no comment on any of the checks that the minister talked about. As Richard Simpson said, perhaps the minister might consider the point further before stage 3. In my experience, it has been an issue.
I am happy to undertake to give more information on the process. Guidance will be issued on such matters.
Amendment 1 agreed to.
Amendments 2 to 4 moved—[Shona Robison]—and agreed to.
Schedule 1, as amended, agreed to.
Section 2—Referral of certain medical certificates of cause of death for review
Amendment 15, in the name of Helen Eadie, is grouped with amendments 17, 18 and 20. I draw members’ attention to the pre-emption information. Amendment 15 in this group and amendment 16 in the next group are direct alternatives.
For the record, I state that I lodged my amendments because I was approached to do so by the British Medical Association and the National Association of Funeral Directors—I met the funeral directors just before the meeting.
Why is amendment 15 important in the associations’ eyes? It acknowledges that the Government recently re-examined the numbers and decided that the number of reviews needs to be increased, but it believes that that is still not enough. In England and Wales, 100 per cent of death certificates will be seen by more than one doctor. In the associations’ eyes, that is an improvement on the current system, in which all certificates for cremations—which represent 67 per cent of deaths—are seen by more than one doctor.
However, Scotland is moving to a system under which only 25 per cent of certificates will be seen by more than one doctor and only 4 per cent will be examined in any depth. The amendments that the minister has offered would mean that approximately 75 per cent of funerals—be they burials or cremations—will go ahead with only one doctor seeing the death certificate or the body.
The BMA and the funeral directors by no means question the ability or professionalism of doctors, but they recognise that the proposed system is significantly less robust than the current system or the new one in England and Wales. They believe that the bill provides no reassurance to the public and that it would be preferable to set the benchmark to the current number of cremation cases rather than burials.
The resources for general practice that are aligned with amendment 15 are imperative to avoid any disruption to patient care and protect patient services.
I move amendment 15.
I am not minded to support Helen Eadie on amendment 15, but I repeat the position that I made clear at stage 1, when I invited the Cabinet Secretary for Health and Wellbeing and the minister to endeavour to produce for the committee at stage 2 or 3 a more statistical and analytical basis for the minister’s doubling of the number of checks that are to be carried out.
Although we heard in evidence from Professor Fleming that a figure of 10 per cent might be appropriate, I made it clear that I did not necessarily think that it was. He based that estimate on past experience, but I thought that it would be helpful to the committee to have a more mathematical assertion of how our degree of confidence in the system could be described in statistical terms.
I understand where the BMA and Helen Eadie are coming from with amendment 15 but, on the other hand, I wish to have some assurance about the statistical basis for the numbers that we would use under the minister’s proposed amendment.
I am conscious that death certification is to be largely self-financing. It would be interesting to know from the minister what the cost implications would be for the issuing of death certificates if Helen Eadie’s amendment 15 were agreed to.
I have a great deal of sympathy with the sentiments that Helen Eadie and Ross Finnie expressed, but I cannot support amendment 15 because moving to a system in which all cases were referred would involve a great deal of expense.
I hesitate to use the word overkill in this context—
You just have.
It was not a great hesitation.
Can that be the first and the last of the grim reaper remarks, please?
I could not resist it. I beg your pardon.
Referring all cases is more than is needed to ensure the system’s integrity and would be expensive. As my colleague Michael Matheson said, if the system is meant to be largely self-financing, 100 per cent referral would impose a large financial burden on patients.
I am reassured by the fact that the proposed legislation would allow ministers to direct that more death certificates be reviewed. I hope that that will be the case, because I have concerns about the low level that has been proposed so far.
11:15
The bill as introduced would have given us considerable difficulties, but the Government has moved a considerable way and 25 per cent of certificates will have level 1 reviews, with a further 25 per cent being reviewed because the death is reported to the procurator fiscal. I feel strongly that even the 100 per cent review system in England and Wales will not necessarily prevent another Shipman. We need to bear that in mind. In trying to create certainty, we may mislead the public in that respect. I believe that the Government’s proposed measures are proportionate and cost effective.
I also hope that reviewers or the procurator fiscal can involve not just GPs but relatives of the deceased. My colleague Dr McKee may return to that point at a later stage.
Reviewers can focus on areas of concern, but I regret that an electronic approach will not be taken, although the bill does not exclude that approach and the Government has made positive noises about it. I believe that an electronic approach is necessary to underpin the whole system. Well-written software will lend itself to analysis that might demonstrate outliers much more effectively than any random review system, which is unlikely to pick those up. I hope that whoever is in Government after May will consider carefully whether we pilot a flawed paper system or delay the pilots until there is an electronic system; otherwise, a piloted paper system might have to be followed by an electronic system pilot.
I understand the motivation behind the amendments in this group, but I regard them as disproportionate and unnecessary. They also have major cost implications. To answer Michael Matheson’s question directly, based on the BMA’s proposed model the costs to the public purse would be £15.3 million annually or, if the public was charged, that would result in a fee of £285 per case, a not insignificant cost. In contrast, our proposals in the bill cost £30 per case, plus an additional £640,000 a year for the increased reviews, which, as I said, will be paid for by the Scottish Government, bringing total annual costs to £1.84 million.
The Scottish Government has always preferred the medical reviewer model, which is a much strengthened version of one of the options proposed by the independent expert review group. I stand firm on my reasons for this. I am confident that the number of reviews currently proposed will allow a reliable assessment of the accuracy and quality of death certification and will introduce a proportionate and robust level of deterrence while introducing a number of changes that will make the new death certification system fit for the 21st century rather than the 19th century. However, Richard Simpson is right to say that no system, no matter how good it is, can be failsafe. We should acknowledge that.
We have worked closely with expert statisticians and I am happy, to address Ross Finnie’s point, to get a bit more from them at stage 3 about their calculations, but we are content that the 1,000 random reviews that are proposed will give us a Scotland-wide benchmark for the quality of death certificates in the first year of operation, and we will monitor improvements after that.
The system must be seen as a whole package. As well as the 1,000 comprehensive, random, real-time level 2 reviews, the medical reviewers will carry out additional targeted reviews where they believe that there may still be cause for concern. Crucially, the bill will, for the first time, empower individuals to request a review where they have concerns. All those levels of review will be part of a systematic quality improvement approach.
We agreed with the committee that there would be additional level 1 reviews for 25 per cent of all deaths. That will provide additional deterrence, public reassurance and independent scrutiny. Together with the deaths being reported to the procurator fiscal, which amount to around a further 25 per cent a year, this means that around 50 per cent of deaths will be subject to scrutiny under the new proposals. That means that every doctor has a one in two chance of their actions being scrutinised, which I hope reassures the committee on deterrence and public reassurance.
Our approach, coupled with the safeguards provided by random and targeted scrutiny and national statistical analysis of deaths data, will achieve more effective outcomes than a second signature on all certificates, which can lead to a focus on checking, rather than driving up quality at source.
Our proposals will also maintain an appropriate balance between cost and scrutiny. The need for such balance was acknowledged by more than one speaker in the stage 1 debate. There is sufficient flexibility in the system to allow the number of reviews to be adjusted up or down in future in response to the test site information and the early operation of the system. However, that would be firmly based on evidence.
If the amendments to require scrutiny of 100 per cent of certificates were agreed to, it would lead to a huge increase in costs, either to the taxpayer or to bereaved families, through a massive increase in the fee, which is not justified by the benefits. I hope that I have managed to illustrate why I believe that our proposals make that unnecessary and unnecessarily expensive. For the reasons that I have outlined, I believe that our approach is correct. I do not support amendment 15 or the other amendments in the group and I ask Helen Eadie to withdraw amendment 15 and not to move the others.
I am grateful to colleagues and to the minister for taking my concerns so seriously. I am also grateful to Ross Finnie for reminding us that the committee requested the statistical analysis and it is good to hear that the minister will bring the expert statistician’s report to the Parliament for stage 3.
On that basis and because of what I have heard about the degree of sympathy or otherwise around the committee table for the points that I have made this morning, I seek leave to withdraw amendment 15.
Amendment 15, by agreement, withdrawn
Amendment 16, in the name of Mary Scanlon, is grouped with amendment 19.
I appreciate that amendment 16 is similar to Helen Eadie’s amendments, although it focuses on cremation. There is no doubt that the main concern at stage 1 was that there would be what witnesses described as a much less rigorous system than exists at the moment. It was unusual and unfortunate that the Government’s response to the stage 1 committee report on the bill was not available until after the debate. However, although the bill will introduce a single system of independent scrutiny of medical death certificates that do not require procurator fiscal investigation, I am not yet convinced that it will succeed, as the minister states, in providing us with a robust and modern approach to the scrutiny of death. I feel that we need further information and reassurances as well as clarity before we agree to this part of the bill.
I welcome the plan that, for the first time, will allow individuals to request a review of the death certificate. That proposal is very welcome, but in comparison with the current system the new proposals just do not stack up. Moving from a system that requires three doctors to countersign cremation forms, which are required for 62 per cent of deaths in Scotland, to a system in which only 1,000 random level 2 reviews will be carried out each year, and in which 25 per cent of all death certificates will have a level 1 review, is a significant change. On that basis, I still find it difficult to be convinced that that level of scrutiny will deliver the deterrent that we are seeking or that it will be proportionate. The quality remains questionable.
As others have said, the proposed system contrasts with the English proposal, which is, I understand, to review 100 per cent of cases. The proposed system might be more cost effective, and I appreciate that that is a huge consideration, but I need to know that we are doing the right thing.
As I am not an expert on death certificates, I will quote from the responses of two of our stage 1 witnesses and the Government’s response to our stage 1 report. Professor Stewart Fleming, who is professor of cellular and molecular pathology at Ninewells hospital in Dundee, said:
“I welcome the new proposals as a step in the right direction but believe they still fall short of what I would consider safe and accurate death certification. The level 2 review is more detailed than the current cremation confirmatory procedure but the level 1 review of 25% of deaths is less detailed than currently required.”
Ishbel Gall, from the Association of Anatomical Pathology Technology, said:
“The proposals to remove the current scrutiny prior to cremation should not be about cost to the bereaved rather it should be about an improvement to what is current practice.”
She went on to say:
“I am most concerned that there will be less scrutiny than there is presently where the deceased is to be cremated. The Bill also needs to address the issue of whether or not it is to be mandatory that the doctor issuing the MCCD should examine the deceased. For disposal, especially by cremation, to proceed without any examination of the deceased would seem to be a backward step.”
I ask the minister to address the issues that I raised and, in particular, the responses from experts in the field.
I move amendment 16.
I have a great deal of sympathy with the sentiments behind the amendments in Mary Scanlon’s name, because I, too, am concerned about the proposed low number of deaths that will be subject to level 1 and level 2 scrutiny. I am a little worried about evidence from test sites, because if we are missing things we do not have the evidence—because we have missed it. However, I am consoled by the bill’s provision for the ability to increase quite swiftly the number of deaths that are scrutinised, and I hope that the provision will be used.
I am concerned about amendment 16, because I strongly believe in random selection, which is the best way of finding out imperfect practices. If we are to go to a system whereby we have high standards for cremations while also scrutinising deaths when there is to be a burial, we will get back to the situation that we discussed in the context of Helen Eadie’s amendment 15, in which the system would be very expensive. Therefore, I think that we can have a trade-off, whereby not every cremation gets the full inspection but we start to include in the selection people who are being buried. I prefer the mechanism whereby the Scottish ministers can direct that there should be an increase in the number of MCCDs that are scrutinised to the requirement that Mary Scanlon proposes including in the bill.
I wonder whether there is merit in having different levels of scrutiny for cremations and burials. I think that that is what amendment 19 seeks to achieve. I am not keen on amendment 16, but amendment 19 might be helpful. Under the current system there is much greater scrutiny in cremations, given that when a body has been cremated evidence is lost. I suppose that there is a fear that if someone were trying to cover up a crime, cremation would be the preferred option. It might be helpful to raise the level of scrutiny of cremations—I am just thinking around the issues.
May I make a quick request to the minister, convener? Minister, you said that before stage 3 you would make available information on the statistical basis for the proposed amount of scrutiny. I take it that you will do that before the final date for lodging amendments, because I think that the possession of such information will be material in deciding whether amendments are needed on the issues that Helen Eadie, Ian McKee and Rhoda Grant raised. An assurance in that regard would be most helpful.
That was a timeous request.
11:30
Starting with that last point—yes, we will get that information to you as quickly as possible.
Regarding the two amendments before us, for the reasons that I outlined earlier in response to Helen Eadie’s amendments, the Scottish Government has always preferred the medical reviewer model and I stand firm on my reasons for that.
Referring to the points that Mary Scanlon made, the proposed measures very much involve an improvement in current practice. It is not a matter of having less scrutiny; it is about more proportionate scrutiny. There is already flexibility in the system, so that the number of reviews can be adjusted. I explained earlier why that is important, and I outlined the rationale for our proposals.
I will explain why the bill specifies a random system of sampling—and this comes back to Rhoda Grant’s point. A random selection of certificates through the General Register Office for Scotland’s computer system is important for deterrence, as it will ensure that there is no selection bias or undue interference. Random selection will roughly reflect the proportion of cremations, so that we expect about two thirds of cases to be deaths for which the chosen method of disposal is cremation. At the time of issuing the MCCD and registering the death, such information is not always available. It is therefore not clear how the proposal in amendment 19 to select a minimum number of cremation cases for independent review can be implemented in practice. It would be extremely difficult.
On a more general point on the signing of the MCCD without examining the deceased, although there is currently no express requirement on doctors completing the MCCD to view or examine the body, they would have to do so if they considered it necessary to ascertain the cause of death. We are not making any changes to that. In instances where the cause of death is unclear, the case would be referred to the procurator fiscal.
As I said earlier, 25 per cent of deaths are reported to the PF. Every person’s death is already confirmed by a trained professional—a doctor, nurse or paramedic, who will examine the body to verify that life is extinct.
It is important that there is no evidence that a new requirement on certifying doctors to externally examine bodies will prevent or detect anything except the most apparent criminal activity or malpractice—and such a requirement certainly would not have detected what Harold Shipman did.
Bearing all that in mind, and for the reasons that I outlined earlier, I do not support amendment 16. I ask Mary Scanlon to withdraw it and not to move amendment 19.
I do not know whether I made myself clear about this. The minister has spoken about a more robust and accurate system. Professor Fleming acknowledged that the level 2 procedures were more detailed than the current procedure. He also stated that the level 1 procedures are much less detailed than what is currently required.
I thank all my colleagues for their responses. Rhoda Grant spoke about increasing the number of cremations to be reviewed, and I hope that we can consider that again at stage 3. The main factor concerns statistics, as was discussed by Ross Finnie. I would certainly find it helpful to have further information, and in plenty time, so as to lodge amendments prior to stage 3.
On the basis that we will get another opportunity to address the matter, and noting that committee members are uncomfortable with many of the proposed changes, I am happy to withdraw amendment 16 and not to move amendment 19.
Amendment 16, by agreement, withdrawn.
Amendments 17 to 19 not moved.
Amendment 5, in the name of the minister, is grouped with amendment 11.
I have carefully considered the delegated powers in relation to the bill. The rationale for using the negative procedure to make orders suspending the review system during an epidemic was to ensure that, if necessary, the referral of certificates to medical reviewers can be suspended almost immediately during an epidemic or a situation in which an infectious disease or contamination is spreading rapidly, particularly if there are large numbers of deaths.
In such circumstances, funerals may need to take place straight away to prevent the development of a danger to public health if there is risk of infection or contamination. In addition, certifying doctors and medical reviewers may need to be redeployed to provide front-line assistance. However, in response to the suggestion that was made by the Subordinate Legislation Committee, I have considered the matter further and I am content to amend the bill so that emergency affirmative procedure can be used, discounting periods of recess from the period before approval. I am reassured that that is appropriate and will allow an order to come into force immediately and remain in force despite a long parliamentary recess.
I move amendment 5.
The minister is making Ian McKee, Rhoda Grant and I feel very good about the work that we do on the Subordinate Legislation Committee.
The Health and Sport Committee always gives plaudits to the Subordinate Legislation Committee. With three of our members on that committee, what else can we do?
Amendment 5 agreed to.
Section 2, as amended, agreed to.
Section 3 agreed to.
Section 4—Application for review of certificate by interested person
Amendment 20 not moved.
Section 4 agreed to.
Sections 5 to 13 agreed to.
Section 14—Power to require documents
Amendment 6 moved—[Shona Robison]—and agreed to.
Section 14, as amended, agreed to.
Sections 15 and 16 agreed to.
Before section 17
Amendment 7 moved—[Shona Robison]—and agreed to.
Section 17—Medical reviewers to authorise cremation
Amendment 8 moved—[Shona Robison]—and agreed to.
Section 17, as amended, agreed to.
Sections 18 to 22 agreed to.
Section 23—Fees in respect of medical reviewer functions
Amendment 9, in the name of the minister, is grouped with amendment 12.
When I outlined the additional reviews—first, the doubling of the random level 2 reviews and then the new level 1 reviews—I made a commitment that the costs associated with those will be borne by the Scottish Government. The fee that is expected to be charged to the public therefore remains £30. For those who currently pay cremation fees—which is around 60 per cent of the public—that represents a substantial saving of about £120. I appreciate the committee’s positive comments about the setting of the fee and the abolition of the higher cremation fee in favour of a lower universal fee for all deaths.
Section 23(5) provides currently that Scottish ministers must have regard to the reasonable costs of the revised functions when setting a fee. We have decided to amend that to make it clear that the fee can be set below cost recovery levels. Likewise, I am content to accept the Subordinate Legislation Committee’s recommendation to change the affirmative resolution procedure, which we originally proposed be used for the power to set the amount of fees and prescribe arrangements for the collection of those fees, to the negative resolution procedure because, as the Subordinate Legislation Committee notes, the arrangements
“would more usually be subject to negative resolution procedure.”
I move amendment 9.
Amendment 9 agreed to.
Amendment 10 moved—[Shona Robison]—and agreed to.
Section 23, as amended, agreed to.
Section 24 agreed to.
After section 24
Amendment 21, in the name of Mary Scanlon, is grouped with amendments 13 and 14. I call Mary Scanlon to move amendment 21 and to speak to all the amendments in the group.
Sorry—I have so many papers and I am not prepared. Can I just say, “Not moved”?
You have to move the amendment.
All right—I will just move it. It relates to my previous comments.
I move amendment 21.
Mary, I take it that you wish to withdraw the amendment. I know that it is a technicality, but we have gone through the necessary hoops. Is it agreed that amendment 21 be withdrawn?
The minister must be given the opportunity to speak first.
Sorry—I beg your pardon, minister. I am so desperate to whizz on. I call the minister to speak to amendment 13 and the other amendments in the group.
Given that it is proposed to withdraw amendment 21, I will not refer to it.
Amendments 13 and 14 are technical amendments that update the regulation-making power in the Cremation Act 1902 and the related provision in the Cremation Act 1952, as a result of the new arrangements that will be brought in under the new certification of death system in Scotland.
Amendment 13 adjusts the existing power of Scottish ministers to make regulations on the burning of human remains so as to remove aspects of the power that will become redundant as a result of the bill. It also adjusts the power to prescribe the notices, certificates and applications that are specific to cremation cases to make that discretionary rather than mandatory.
The amendment confirms that regulations made under the 1902 act are subject to negative procedure. That is a restatement of the current position, which is dealt with in the Cremation Act 1952. Consequential on amendment 13, amendment 14 repeals the relevant part of the Cremation Act 1952.
I ask members to support amendments 13 and 14.
This morning I met representatives of the National Association of Funeral Directors, who expressed concerns about a situation in which they find themselves. They have in their offices virtually a mountain of ashes, going back many years, which they cannot dispose of. They mentioned the issue in evidence to the committee but they feel that we have overlooked it. I put my hand up as one of those who are culpable in that regard. The NAFD is seeking to be allowed to dispose of the ashes that no one has claimed after a reasonable time has passed. It may not be possible for the minister to address the issue at this stage, but perhaps it could be addressed at stage 3.
I thank Helen Eadie for raising that important and sensitive issue. I would like to reflect on the issue and perhaps I can get back to the member on it. I do not know whether we can do anything in the short period before stage 3, but I will certainly consider the issue.
Under the proposed section entitled “Forms of documentation for burning”, is it the minister’s intention to define in the regulations what human remains are? After all, if a leg is amputated it is often just chucked into the incinerator. Is that a human remain, or does a human remain have to be a certain proportion of the body? It would be useful to know, although I do not expect the minister to provide an answer at the moment.
I will have to get back to you on that. I was just asking whether the definition would be the same as in previous legislation.
I was ahead of myself earlier. It is now time for Mary Scanlon to withdraw the amendment. We are both doing things twice this morning—it comes with my age, Mary, not yours. Do you wish to wind up?
No. All the points were made earlier.
Amendment 21, by agreement, withdrawn.
We are back on script now.
Sections 25 and 26 agreed to.
After section 26
Amendment 22, in the name of Ian McKee, is in a group on its own.
Amendment 22 is a probing amendment. No one can doubt that the tasks undertaken by nurses have increased in complexity and responsibility over the years. When I was a junior doctor working in Edinburgh’s royal infirmary, nearly all the nurses were university graduates, yet I had to be called out of my bed in the middle of the night to authorise the prescription of a couple of paracetamol tablets for minor pain relief.
Today, specialist nurses run cardiovascular risk clinics, supervise drug misusers, have responsibility for much maternity work and play a leading role in palliative care, to name but a few tasks that they undertake. The most recent prescription that I got from my GP was signed by the nurse. As we move forward into the remainder of the 21st century, it is obvious that those roles will increase in number and complexity. When that happens, it is possible to envisage a situation in which signing a death certificate will be a logical extension of a specialist nurse’s duties, thus allowing more sympathetic handling of a relative’s grief, greater accuracy in what is recorded and greater efficiency in the running of the health service.
11:45
I had hoped with amendment 22 to allow the opportunity to add to the duties of a minuscule number of nurses the ability to sign death certificates. It was not my intention that that should happen now, nor that all nurses should routinely have that function, but merely that it should be given to specialist nurses who are in a position such that it would be beneficial to society and the running of the health service.
I appreciate that the suggestion will not always meet with mass approval in the health professions as a whole and it has not been put out to consultation. I would therefore be happy to withdraw the amendment later, but our discussion should be on the record because I feel that we will need such a development to take place in the future.
I move amendment 22.
I welcome amendment 22 and Ian McKee’s current intention to withdraw it, although we may need to reconsider the matter at stage 3. Despite the amendment being withdrawn, might we seek to take some evidence on it? I appreciate that time is extremely short.
I will add two points to Ian McKee’s remarks. First, there may well be an increasing reliance in remote and rural areas on nurse practitioners who, as Ian McKee said, are able to prescribe. Secondly, some practices in England are nurse led. Such practices are already in existence so, as Ian McKee said, we are moving into a new situation. When we discuss the primary legislation, we should give future sessions of Parliament and future ministers the scope to allow the extension that is proposed, if that seems to be appropriate and proportionate.
On your question about taking evidence, we can look at the remainder of our programme and discuss whether we have space between now and going into purdah to deal with the issue. That is not a matter for this debate, but we can certainly look at it.
I, too, have sympathy with amendment 22. Richard Simpson mentioned rural areas. When someone is terminally ill, it is usually a community nurse or the like who spends time with that person and with their family and builds a close relationship with them. In that situation, having to wait until a doctor arrives to certify a death is perhaps not appropriate and does not help the family.
I would like to consider widening the provision as suggested in amendment 22, but I am well aware that we may need to take more evidence. If we do not have time to take evidence, would it be possible to lodge an amendment to allow that to happen, perhaps through a super-affirmative procedure, so that the Parliament could scrutinise any such decision? We could perhaps consider at stage 3 whether such an approach would give us the appropriate safeguards.
Obviously, we do not want to change things dramatically without having taken evidence and scrutinised the issue properly, because there are always unintended consequences. However, the amendment makes a fair and reasonable suggestion that we should have the opportunity to work through. The stage that we are at in the parliamentary timetable might not allow for that to happen, but if the proposal could be scrutinised and legislation brought forward in the new session that may be worth while.
The Scottish Government has considered Ian McKee’s amendment 22, which would incorporate nurses within the definition of “registered medical practitioner” to give them the power to certify cause of death.
I agree with Ian McKee’s comments on the role and contribution of nurses, which have changed considerably over time. We very much acknowledge the importance of that, both to the NHS and to nurses themselves in having fulfilling and rewarding careers. However, that aim also has to be aligned with the current requirements of the service and the needs of the public. Weighing up the pros and cons of the proposal, I do not think that we are yet in a position to know whether there is a demand for such a fundamental change. I understand that the Royal College of Nursing had a very limited consultation on the matter and got a very limited response.
In addition, putting the proposal in place would have a significant impact on the operation of the review system in the bill, because it is designed to deal with the review of medical certificates of cause of death completed by doctors.
A benefit of the new system lies in its links between the review system and the systems of clinical governance, annual appraisal and revalidation that are applicable to doctors. Full consideration must be given, in the light of discussions that we have had on other amendments, to how those aspects will work together to ensure that completed certificates are effectively scrutinised and standards improved.
Some of those links, such as revalidation, do not apply to nursing staff and further thought would have to be given to how those aspects could be accommodated in the new review system. That could prove to be very complex and there may be additional costs. For example, separate random checks of death certificates provided by nurses and doctors would need to be done as the numbers that would be required to give confidence in the system would be quite different. As that illustrates, the proposal represents a significant departure from current policy and is therefore not simply a technical issue, nor is it about future proofing the bill.
Although I do not disagree that there may be valid reasons to consider the issue further, I believe that it would not be correct to create a statutory power to give nurses the power to certify cause of death without further detailed public consultation on the issue and further consideration of the policy implications, some of which I have briefly outlined. I therefore ask Ian McKee to withdraw amendment 22.
I will add to what the minister said. I am not very concerned about the low number of respondents to the RCN’s poll of its members. A vast number of nurses would not be affected at all by the proposal, so it is not surprising that they did not respond. I am talking about a very small number of nurses and we should judge the proposal on an intellectual and practical basis rather than on a poll of nurses, most of whom would not be involved.
However, I accept that the proposal is fairly radical and that it would be unfair to introduce it by means of a stage 2 amendment. I therefore seek leave to withdraw amendment 22.
Amendment 22, by agreement, withdrawn.
Section 27 agreed to.
Section 28—Orders and regulations
Amendments 11 and 12 moved—[Shona Robison]—and agreed to.
Section 28, as amended, agreed to.
Section 29 agreed to.
Schedule 2—Minor and consequential modifications
Amendments 13 and 14 moved—[Shona Robison]—and agreed to.
Schedule 2, as amended, agreed to.
Sections 30 and 31 agreed to.
Long title agreed to.
That ends stage 2 consideration of the bill. I thank the minister for her attendance.
As previously agreed, we move into private session.
11:52
Meeting continued in private until 11:59.