Agenda item 4 is day 2 of stage 2 of the Health (Tobacco, Nicotine etc and Care) (Scotland) Bill. I welcome the Minister for Public Health, Maureen Watt; Dan Curran, who is the bill policy manager; Craig White, who is the divisional clinical lead; Lynne Nicol, who is the quality team leader; Ailsa Garland, who is a principal legal officer; and Meryl Skene, who is parliamentary counsel. I also welcome back to the committee Mary Scanlon, who is here for this agenda item.
Thank you.
Members should note that part of the way through the debate I will pause proceedings to enable a change of Government officials. I shall introduce the other officials at that point.
Everybody should have a copy of the bill as introduced, the marshalled list of amendments and the groupings of amendments.
As all members know now, there will be one debate on each group of amendments. I will call the member who lodged the first amendment in the group to speak to and move that amendment and to speak to all the other amendments in the group. Members who have not lodged amendments in the group but who wish to speak should indicate that by catching my attention in the usual way.
The debate on the group will be concluded by my inviting the member who moved the first amendment in the group to wind up. Only committee members are allowed to vote. Voting in divisions is by show of hands.
The committee is required to indicate formally that it has considered and agreed each section and schedule of the bill, so I will put the question on each at the appropriate point.
Section 21—Incident which activates duty of candour procedure
Amendment 3, in the name of the minister, is grouped with amendment 4.
Amendments 3 and 4 relate to outcomes of incidents that trigger the duty of candour procedure.
On amendment 3—which addresses an issue that was raised by North Ayrshire health and social care partnership in written evidence to the committee at stage 1—the duty of candour procedure can be triggered by
“an unexpected or unintended incident”
that results in the affected person needing treatment to prevent their death or injury. At the moment, however, the bill provides that treatment given to prevent death or injury would trigger the duty of candour procedure only where that treatment was given by a registered doctor. Amendment 3 will change that to ensure that the procedure is activated by an incident that results in the affected person needing treatment by a registered health professional. The definition of “registered health professional” is wider and includes not only doctors but nurses, midwives, paramedics, dentists and others, and amendment 3 reflects the reality that
“an unintended or unexpected incident”
in the course of treatment or care in health or social care settings could result in the intervention of any one of a number of health professionals to prevent death or injury.
Amendment 4 relates to outcomes of incidents that trigger the duty of candour procedure. One of those outcomes is the affected person requiring treatment to prevent certain injuries, and the amendment will add another category to the types of treatment that will trigger the duty of candour procedure. Section 21(4)(b) covers incidents that result in “permanent lessening” of one or more functions of the body, which is otherwise described as “severe harm”, and the effect of amendment 4 will be that the duty of candour procedure will be triggered if as a result of an incident a person requires treatment to prevent such harm. I am glad to have had the opportunity to lodge amendment 4, which does not reflect a change in the intended policy but corrects an omission in the bill.
For the reasons that I have outlined, I ask the committee to support amendments 3 and 4. I move amendment 3.
Amendment 3 agreed to.
Amendment 4 moved—[Maureen Watt]—and agreed to.
Section 21, as amended, agreed to.
After section 21
Amendment 11, in the name of Rhoda Grant, is grouped with amendment 12.
The bill outlines the use of the duty of candour in quite extreme circumstances, and I think that the previous amendments were helpful in highlighting just how extreme those circumstances are. The bill also sets out the bureaucracy and reporting process for the significant incidents in question, and amendments 11 and 12 seek to ensure that the duty of candour is not required in all circumstances. Patients must be at the heart of their own treatment and must, in order to have faith in the system, know what is going on. Although we have moved away from clinicians making decisions that they believed were in patients’ best interests and have instead put patients at the heart of that decision making, we need to go further. I do not want to set up another level of bureaucracy, but I want to ensure that patients are informed and able to make decisions for themselves. When an incident happens that is not of such extreme proportions, patients should at least be informed of what has happened so that they can make a decision for themselves.
Although the governing bodies of many professional organisations stipulate a duty of candour, we heard in evidence that that is not the case for all of them. As a result, amendments 11 and 12 seek to ensure that patients are informed about their own treatment and any adverse circumstances that might have arisen.
I move amendment 11.
Amendments 11 and 12 would require that “unintended or unexpected incidents” that
“did not or could not have resulted in”
harm or injury be reported to a person whose care has been affected. The result would be an unreasonable and unnecessary burden on health, social care and social work organisations. Furthermore, the amendments’ inclusion would depart from the principles that have led us to propose the duty of candour. The purpose of the statutory duty of candour for organisations is to require that organisations implement procedures for unintended or unexpected events that result or could have resulted in death or harm but for the treatment given by a health care professional.
We should focus on cases in which real harm has occurred or in which there was a risk that real harm could have occurred, rather than creating for organisations statutory requirements that would cover every case—even those in which no harm had occurred. Rhoda Grant’s amendments 11 and 12 would remove the focus on harm and require that everything that happens that is unintended or unexpected be judged to assess whether care has been affected. They would also require that incidents be reported to an affected individual, whether or not there has been a negative outcome to the event. Such a procedure would not be helpful to those receiving care or treatment, nor to the staff who deliver our health, social care and social work services.
The introduction of the statutory duty of candour must not become a box-ticking or form-filling exercise. The procedure that is proposed by amendments 11 and 12 is not proportionate. The additional procedure would result in the duty of candour for cases in which real harm has occurred becoming diluted and not having the desired impact on culture change, safety and learning.
For those reasons, I ask Rhoda Grant to seek to withdraw amendment 11 and not to move amendment 12.
I do not understand what the minister is trying to say. She stipulated the circumstances in which the duty of candour would apply as death or real harm. Those are extreme circumstances. Amendment 11 would mean that
“if an unintended or unexpected incident occurred in the provision of a health service, a care service or a social work service to the person and in the reasonable opinion of a registered health professional that incident—
(a) affected the person’s care, but
(b) did not result in or could not have resulted in an outcome mentioned in section 21(4)”
that person should be informed of what had happened, given
“an account of the incident”,
told about what steps had been taken to put it right and given “any other information” that they require.
It would be very simple: “Something has gone wrong: here is what happened and this is what we have done.” There would be no added bureaucracy or tick-box exercise. It is extreme for the minister to say that people are not entitled to very basic information about their own treatment.
I seek to withdraw amendment 11, but I will look at the matter again, in the light of the unintended consequences that the minister suggested it would have—although I believe those to have been overstated.
I am very concerned, however, that the minister does not believe that patients should have that kind of information on their treatment. That does not provide leadership to health service professionals.
Amendment 11, by agreement, withdrawn.
Section 22—Duty of candour procedure
Amendment 17, in the name of Malcolm Chisholm, is in a group on its own.
I am a strong supporter of the duty of candour, but various concerns about it have been expressed by clinicians. The particular concern that amendment 17 picks up was expressed to those of us who visited Ardgowan hospice in Greenock in September. The visit was part of our palliative care inquiry, but we took the opportunity of asking the clinicians who work there about section 22. In summary, the concern is that some people might not want to be told about incidents. The clinicians at the Ardgowan related the concern particularly to people in hospices, but it could well apply to others.
10:45I raised the matter as part of the evidence session on 22 September and I thought that the comment by Peter Walsh of Action against Medical Accidents was interesting. It might be helpful if I read out what he said:
“The point about some people not wanting to know that a mistake has been made is a valid one. One must respect each individual’s wishes. When the discussions took place in England about its version of the duty of candour, we made that very point. The way that it has been dealt with in England is that there is a requirement to tell the patient or service user or their family that there is something to report and to discuss, and they can simply say, “Thanks, but I don’t want to know.” Let us say that mum or dad has passed away: the family can say, “We’re moving on and we don’t want to know another thing.” That is their absolute right, but it is not the right of any individual health professional or organisation to decide for them that they do not need the opportunity to know.”—[Official Report, Health and Sport Committee, 22 September 2015; c 9.]
The last part of that is absolutely fundamental. We are clearly moving away from a paternalistic culture in which health professionals decide “whether” someone is to be told something, but there can be no objection in principle to a health professional asking whether somebody wants to know. The decision is then entirely the concern of the relevant individuals.
The approach that has been adopted in England is what I have tried to incorporate in amendment 17, which I will refer to when I find it—I cannot see it at the moment because the numbers are confusing me. The first subsection in amendment 17 states:
“the responsible person must ask the relevant person”.
The second subsection describes what has to happen, and states that
“a written record is to be kept of the communications”.
That will protect against any abuse of the requirement. Quite a lot of clinicians and members of the public might be concerned if people did not have the right to say that they do not want to know.
I move amendment 17.
I support Malcolm Chisholm’s amendment 17. I was particularly struck by the evidence that we received about the procedure in England. Having grown up through a very paternalistic health service, I think that the amendment is probably a step in the right direction.
Amendment 17 in Malcolm Chisholm’s name would require that
“the responsible person must ask the ... person”
who has been affected by an unintended or unexpected incident that causes harm “whether” they wish
“the duty of candour procedure to apply to”
them.
It might not always be in the best interests of the individual to be told about what has happened, and organisations will be required to consider that carefully and to ensure that they do not take a one-size-fits-all approach to disclosing information. Additionally, not everyone will wish to know the details of what has happened: their not knowing should always be an option. The Scottish Government’s guidance development group will consider such issues as part of its remit in taking forward implementation of the bill.
Although I acknowledge that the procedure should, as far as possible, take into account the preferences of those who have been affected by unintended or unexpected incidents, an undesirable effect of amendment 17 might be that, when an affected person does not want to be told about the incident, the wider duty of candour procedure might not apply. We would still want reporting and learning to take place in order to prevent the same type of incident happening again.
As members will be aware, under the bill the duty of candour procedure is a series of steps that are to be taken by the responsible person. Section 22 of the bill leaves the detailed steps of that procedure to be set out in regulations. Under section 22(2)(a), the regulations may make provision about
“the notification to be given by the relevant person”
who is affected, and section 22(2)(e) will allow the regulations to provide detail in
“an account of the incident“
that is to be given.
I intend that the regulations that will be made under section 22, which will set out the duty of candour procedure, will reflect the aim of amendment 17, to the extent that the purpose is to provide an affected person with an opportunity to decline to be told about what had gone wrong. However, it is important that in such cases the wider duty of candour procedure continues to apply to the responsible person so that lessons can be learned from such incidents even when someone does not want to know what happened.
Having set out that intention, I ask Malcolm Chisholm to seek to withdraw amendment 17.
I thank the minister for that explanation. I am to an extent unsure whether she really is objecting to the substance of amendment 17. She says that she will ensure that the procedure is delivered in regulations, but I am not sure what her objection is to having it in primary legislation. I accept what she says about learning lessons from what has happened, but it does not follow that lessons will not be learned just because the person does not want to know. I am therefore not entirely clear that there is a fundamental objection to what I am proposing. It becomes a judgment about whether the provision should be in regulations or in primary legislation, and I do not understand the rationale for its being in regulations. I am happy to seek to withdraw amendment 17, but I am minded to lodge the amendment in modified or extended form again at stage 3, perhaps building in something about ensuring that lessons have been learned in order to cover concern about that.
Amendment 17, by agreement, withdrawn.
Amendment 12 not moved.
Section 22 agreed to.
Sections 23 and 24 agreed to.
Section 25—Interpretation of Part 2
Amendment 6, in the name of the minister, is grouped with amendments 7, 8, 5, 9 and 10.
The amendments make changes to the interpretation section for part 2. Amendment 6 aims to assist with the interpretation of “provide” by adding a definition of “provide” that clarifies that providing
“a health service, a care service and a social work service means to carry on or manage such a service”.
In relation to care services, the term “provide” is already defined in other legislation in a similar way; it is helpful to define it in the bill so that it is clear that the term operates in the same way.
Amendments 7 and 8 relate to the Care Inspectorate’s written evidence to the committee at stage 1, in which it raised concerns that care service providers might opt for a different business model—for example, trading as an individual but employing others—to avoid the duty of candour. Amendments 7 and 8 will ensure that self-employed individuals who employ others or have arrangements with others whereby those others are directly involved in providing care services will be brought within the definition of a responsible person and will therefore be subject to the duty of candour.
Amendment 5 is a technical amendment to correct the name of an act that is referred to in section 25.
Amendments 9 and 10 will give the Scottish ministers the power to modify the definition of a responsible person in section 25(1). That will ensure that, if the definitions in section 25 do not cover a particular arrangement that it is envisaged should be subject to the duty of candour, secondary legislation can be laid to address that. Equally, the power will enable the Scottish ministers to exempt persons from the definition of a responsible person.
Amendment 10 makes the power that is conferred by amendment 9 subject to the affirmative procedure, which we consider to be appropriate, given that it is a power to amend primary legislation.
I ask the committee to accept the amendments. I move amendment 6.
Amendment 6 agreed to.
Amendments 7, 8, 5 and 9 moved—[Maureen Watt]—and agreed to.
Section 25, as amended, agreed to.
Section 26—Care worker offence
Amendment 18, in the name of Mary Scanlon, is grouped with amendments 21 to 23 and 25.
I am grateful for the committee’s time in considering my amendments. I also thank the clerks for assisting me with the amendments.
Over my years as an MSP, I have met many families who have been left with the guilt that they should have done more to protect their parents when they were in residential care. I spoke to one such lady last night, which is why I am here. She has given me permission—I am sorry; this issue is quite emotive—to use her name and her mother’s name. The woman’s name is Mrs Blan Bremner and her mother was Mrs Doreen MacIntyre, who died some time ago in the Kingsmills care home in Inverness. Rhoda Grant will be familiar with that care home.
The family were concerned about their mother’s care and treatment and decided to install a tape recorder in her room. They were shocked when they played back the recording. I have read the transcripts, which is why I find the matter so upsetting. Dr Ian McNamara of the Highland senior citizens network said:
“Having listened to the tapes no one could be in any doubt that abuse of an older, vulnerable adult had taken place.”
I appreciate that time is limited, convener, so I will be as brief as possible. Police Scotland was given the tape. It confirmed that
“staff are behaving in an unprofessional manner and making inappropriate comments”.
It also said that
“insulting comments made by care staff were highly inappropriate, derogatory, insensitive and fell significantly below the standards any reasonable person would expect for the care of a relative”
but did not reach the
“threshold set by Case Law to proceed to a criminal investigation.”
Had the family installed a closed-circuit television camera, the situation would have been different.
I will give an example of how the staff treated Mrs MacIntyre. When the lady asked kindly for a hand to help her, staff gave her a round of applause and they laughed at and ridiculed her. The police stated that there was no evidence of assault by care staff and no evidence to meet the threshold for cruel treatment, which they stated is essentially a serious wilful neglect offence. They also stated that the conduct of the care by staff at the Four Seasons Health Care home required investigation by the relevant agency.
The family went to the Care Inspectorate. Its response was that it does not investigate alleged abuse. The family went to social work services, and the social care manager told them:
“you have to move on from the issue as legally nothing can be done and it will affect your health.”
The family are finding it more difficult to move on than the social work services appreciated.
10:00The care home response was to send a letter that said that the two members of staff who had been suspended were no longer employed and that
“Four Seasons Health Care bears no admission of guilt as a consequence.”
I will come back to that when I speak to my next group of amendments.
I told the family about the bill because I thought that it would be an opportunity to look at what could be done. I am afraid that the family were not too impressed with the reference to “wilful neglect”, and they pointed out the difference between neglect and abuse. To neglect is to pay little or no attention and to fail to care for or attend to properly, whereas to abuse is to hurt or injure by maltreatment, to assail with insulting or hurtful words or to use insulting or hurtful language and speak insultingly or cruelly. In my view, “abuse” clearly describes the experience at that care home—and it is not the first time that we have heard of such abuse in a care home in Scotland.
In my book, many of the problems that arise from poor care standards are not simply neglect—they are abuse. I lodged the amendments to seek clarity on the issue, given that the bill is a unique opportunity to put in place something to help to protect elderly, frail and vulnerable people.
I move amendment 18.
I thank Mary Scanlon for lodging her amendments. There are standards of professional conduct for people who are registered to provide care and, if they fail to meet those standards, they can be held responsible and criminal charges can be brought against them. Such matters are usually dealt with under the standards of professional conduct that already exist for registered social care and social work organisations. I am not sure that the amendments would assist with dealing with the issue any more than the standards of professional conduct that exist for registered organisations already do.
Nobody who listened to Mary Scanlon could help but be horrified by the experience that she described. Sadly, it is all too common in some care homes—we have seen care homes have their licences removed because of such cases.
If I was the daughter of the person who was named, I would not be happy if all that could happen in such cases was the removal of professional registration. Such abuse needs a legal sanction, so I am minded to support Mary Scanlon’s amendments.
I would be concerned if what Mary Scanlon described happened in any care home. However, there are many care staff in many care homes who deliver an excellent service. I remember a care home that my father-in-law was in, which he said was not a five-star hotel but a seven-star hotel. I take the point that there may be deplorable situations that should be dealt with under the law, but I must put on record the fact that many care workers in this country are delivering an excellent service and working hard to help elderly people.
I hear what Richard Lyle says; we would all agree that there is excellent care in many cases. Nonetheless, there are cases such as the one that Mary Scanlon told us about. I remember her telling me about it some months ago. It really is an appalling thing and the law should be able to provide a means for dealing with such abuse, in addition to wilful neglect and other practices.
The care worker and care provider offences in part 3 are committed when there is ill treatment or wilful neglect of individuals who are in receipt of care. As the committee knows, the expressions “ill-treatment” and “wilful neglect” are established in law and cover a wide range of harmful behaviours, including what we would understand by the term “abuse”.
As has been made clear previously, those offences are intended to deal with—among other things—the sorts of abuses that occurred during the breakdown of care at the Mid Staffordshire hospitals. On that basis, adding the term “abuse” would not broaden the range of behaviours that the offences cover, as we are content that such behaviour would already by caught by the bill. The term “ill-treatment” is distinct from neglect and covers a range of behaviours, including behaviour such as that described graphically by Mary Scanlon.
The amendments would mean a departure from the wording of existing offences in relation to those receiving mental health care and treatment and in relation to adults with incapacity. That could cause confusion and cast doubt over the width of the existing offences. Throughout the Government’s processes of consultation and engagement on the provisions, there have been many comments on the wording of the offences, and we have sought to reassure stakeholders that the terms “ill-treatment” and “wilful neglect” are familiar to the police and the prosecution service. For those reasons, I ask Mary Scanlon to withdraw amendment 18 and not to move the other amendments.
I appreciate Dennis Robertson’s point. The care workers would be registered with the Scottish Social Services Council. Until a few weeks ago, one of them was still working in the national health service, at Raigmore hospital in Inverness. In the example that I gave, the workers were suspended, they left and there was no investigation, so the police, the Care Inspectorate and social work services could do nothing. Rhoda Grant is right to say that there have been quite a few examples of that in and around Inverness and it is all too common.
I should have said this earlier, but I was so focused on the issue that I did not mention it. Two, three or 20 poor care workers do not take away from the commitment that 99 per cent of our care workers have. They are not always the best-paid workers either, so I should have put that on the record. Like Richard Lyle, I have nothing but respect for well-managed, excellent care homes. Thankfully, most of them are well managed with excellent staff, so I hope that, by citing the example that I gave, I did not give the impression that it was true of every care home. I whole-heartedly agree with the points that Richard Lyle made and I cannot speak highly enough of care staff.
Because I am a bit of an outsider at this meeting, I am not au fait with all aspects of ill treatment in the bill. I am not sure that the bill goes far enough but, having said that, I am grateful for the responses from the committee members and the minister. I felt that the provisions needed probing because people are asking how much better the bill can make the situation and whether it can ensure that people who do not have the commitment to caring that we expect are not put in charge of their family members. Having heard what I have heard today, I will withdraw amendment 18 and not move the other amendments, but I might consider lodging them again at stage 3.
Amendment 18, by agreement, withdrawn.
Amendment 19, in the name of Mary Scanlon, is grouped with amendments 20, 24 and 26.
My comments on the amendments follow on from the good point that Dennis Robertson made about professional conduct. I have described the poor experience of care standards, and it is worth noting that the tape-recorded evidence related to only two care staff. With a camera installed in the room, the evidence would have been much clearer and the position on a court case and prosecution would have been different. The staff were suspended and were no longer employed by Four Seasons Health Care, but they were instantly able to gain employment elsewhere in the care sector, because there is a national shortage of care staff.
One of the care workers got work with NHS Highland at Raigmore hospital; I am not sure whether he was still employed there after the family and I raised the matter with the NHS. Nevertheless, the ease with which that individual found further employment and had further opportunities to continue his unacceptable practices angered and continues to anger the family in question.
With the amendments that I have lodged, I want to examine what can be done to protect others from care workers who do not live up to their job descriptions. The issue is relevant to the particular case that I have described and to successful prosecutions.
This was a very difficult case. There was tape-recorded evidence, and the police said that the comments that had been made were inappropriate and so on. However, no charges were brought, no investigation was carried out, no one picked up the matter and the care workers just walked away and got jobs elsewhere. The amendments that I have lodged in this group are probing ones.
I move amendment 19.
Amendments 19 and 24, in the name of Mary Scanlon, would remove the option for ill treatment and wilful neglect offences to be tried under the summary procedure. That would most likely result in fewer cases of neglect or ill treatment making it to court, as the Crown Office and Procurator Fiscal Service would proceed with only the most serious cases of ill treatment or neglect, for which solemn procedure would be appropriate.
For the existing offences of wilful neglect and ill treatment under mental health and adults with incapacity legislation, nearly 80 per cent of the prosecutions have been dealt with under summary procedure. Removing that option would severely limit the procurator fiscal’s discretion in dealing with less serious cases.
Amendments 20 and 26 seek to require the Scottish ministers to make regulations to prevent convicted care workers from working in care roles. I thank Mary Scanlon for giving me the opportunity to set out my intention to lodge amendments at stage 3 on the issue. First, I will set out the background. The Protection of Vulnerable Groups (Scotland) Act 2007 requires employers and regulators to refer individuals who have harmed a protected adult to Disclosure Scotland for the purposes of considering them for listing as unsuitable for regulated work. In addition—and more specifically in relation to the offences in part 3 of the bill—a court may, when convicting an individual, refer that individual to Disclosure Scotland if it thinks that it might be appropriate for the individual to be considered for listing. Disclosure Scotland will then consider whether the individual should be listed as unsuitable to work with vulnerable adults.
In standard and enhanced disclosures under the Police Act 1997 and PVG scheme record disclosures under the 2007 act, a conviction for ill treatment or wilful neglect under part 3 of the bill would be disclosed to a prospective employer. Given the seriousness of such offences, I intend to lodge amendments at stage 3 to ensure that they continue to be disclosed even when, as a result of the passage of time, the convictions would otherwise be spent.
I am therefore satisfied that sufficient safeguards are in place to ensure that unsuitable people are not employed as care workers. For those reasons, I ask Mary Scanlon to withdraw amendment 19 and not to move amendments 20, 24 and 26.
I would obviously be concerned if fewer cases were getting to court as a result of my amendments, because that is certainly not my intention. However, I have to say that I am delighted with the minister’s tone and response; I had hoped that the issue would get a good airing, because this is an area that we are all concerned about. I am grateful that the minister is giving the provisions further consideration and will lodge amendments at stage 3. As a result, I will seek to withdraw amendment 19 and not to move the other amendments in the group.
Amendment 19, by agreement, withdrawn.
Amendment 20 not moved.
Section 26 agreed to.
Section 27—Care provider offence
Amendments 21 to 24 not moved.
Section 27 agreed to.
Section 28 agreed to.
Section 29—Power to order offence to be remedied or publicised
Amendment 25 not moved.
Section 29 agreed to.
Sections 30 and 31 agreed to.
I thank the officials for their attendance and suspend the meeting to enable new officials to join the minister.
10:16 Meeting suspended.
I welcome the officials from the Scottish Government bill team who are now accompanying the minister—Angela Bonomy, sensory impairment national delivery support adviser; David Wilson from the directorate for legal services; and Meryl Skene, parliamentary counsel.
After section 31
Amendment 1, in the name of the minister, is in a group on its own.
The Scottish Government recognises that the provision of communication equipment and the associated support that is required to use it are key requirements of children and adults who have lost their voice or have difficulty speaking. Communication equipment ranges from low-tech equipment such as picture symbol books to high-tech equipment such as dedicated voice output aids.
Individuals who use communication equipment, service providers and organisations that represent service users tell us that provision across Scotland is inconsistent and inequitable and does not always meet the needs of people with communication difficulties, particularly in the case of those who require high-tech devices. The majority of them told us in response to a call for written evidence that there is a need for the bill that we are discussing today.
The aim of amendment 1 is to provide a more explicit duty on Scottish ministers to provide or secure the provision of communication equipment and associated support. That will consequently raise the profile of the service, bringing it to the forefront of service delivery. It is expected that health boards, which will discharge the duty on behalf of Scottish ministers, will review their current services, systems and processes and consider the service as a priority.
The breadth of the proposed duty is deliberate. It provides flexibility to determine who might receive communication equipment and what type of equipment might be provided, and it allows for responses to future technological developments.
In addition, under the existing powers of the National Health Service (Scotland) Act 1978, Scottish ministers will issue directions to health boards in the near future to help to support the discharge of the duty. The directions will need to be considered carefully. They must contain the correct level of detail to address the operational issues and deliver person-centred care. We know that that is a cause for concern among a number of our stakeholders and we thank them for bringing their concerns to our attention.
The directions will be developed in consultation with stakeholders. Discussions are under way with the Royal College of Speech and Language Therapists to develop a Scottish Government-funded programme of operational improvement work, which will build on the recent right to speak strategy and lay strong foundations for the introduction of directions.
I also highlight the on-going work on voice banking, which is an important development in augmentative and alternative communication. The Scottish Government will fund the Euan MacDonald centre to pilot voice banking in three NHS sites from April this year. We thank Gordon Aikman for bringing the research work to our attention and we look forward to the findings of the pilot.
The financial implications of the duty are expected to be cost neutral as it will not lead to an increase in demand. Any future directions are likely to incur modest financial costs for health boards and local authorities. To be clear, I add that the more immediate operational improvement work with the Royal College of Speech and Language Therapists and the voice banking pilot are being funded by the Scottish Government.
Loss of voice and the need for voice equipment affect only a small number of people, but the loss has a huge impact on their lives—imagine if we in this room had difficulty in communicating and could not convey our message. I therefore feel that legislating is the right thing to do, and I know that a number of people agree.
I move amendment 1.
The principle of this amendment on the provision of communication equipment and the associated support that is required is excellent. I was glad to hear what the minister said about guidance to health boards, because I was quite concerned when I saw the number of suggested amendments coming in from the Royal College of Speech and Language Therapists in response to the minister’s amendment. I hope that the issues have been taken care of.
Another issue that has been raised and which concerns me a bit is funding. I cannot find it on my iPad, but the Convention of Scottish Local Authorities made a late submission in which it expressed concern about whether there will be enough funding to cope with the likely demand for such equipment. Will that be looked at in detail? I am happy with the principle of the amendment, but there might be some detail to be sorted out. I presume that that can be done later in regulations or guidance.
Will the proposal remove the duty on the Department for Work and Pensions to provide similar equipment through the access to work programme? I rely on communication equipment; although I have my own voice, I rely on speech-activated equipment all the time. Will the proposal remove the requirement on the DWP to provide such equipment for people who are in work?
I welcome amendment 1, which is very important. It is very important for people who are faced with a devastating illness and who know that they will lose their voice and not be able to communicate properly to have something to hold on to that will be a comfort to them and to be able to take proactive action in mitigation of that. I am glad to see this amendment and I am glad that the minister paid tribute to Gordon Aikman, who has brought the issue to the fore. He has probably given an awful lot of people who would not have had such assistance access to it. I was unaware of things such as voice banking until that point, so I am grateful to him and to the minister for bringing it to my notice.
In reply to Nanette Milne, I say that we have taken the view that, in terms of what we put into the bill, less is more. We do not want to be too prescriptive, because technology moves on and, in a couple of years, something might replace voice banking, for example. We did not want to restrict ourselves.
The answer to Mr Robertson’s question is that this duty would not remove the duty on the DWP. The duties are complementary.
On funding and local authorities, the funding comes from the Scottish Government through health boards, but how that is worked out will be addressed as we develop the direction of travel with the legislation.
Amendment 1 agreed to.
Section 32—Regulations
Amendment 10 moved—[Maureen Watt]—and agreed to.
Amendment 26 not moved.
Section 32, as amended, agreed to.
Sections 33 to 35 agreed to.
Long title agreed to.
That ends stage 2 consideration of the bill. I thank the minister and her colleagues.
10:29 Meeting suspended.