Official Report 321KB pdf
We turn to our stage 1 consideration of the Mental Health (Scotland) Bill, for which the Local Government Committee is a secondary committee. I welcome from Fife Council Mike Sawyer, the head of the social work service, and Kate Thomson, the mental health project manager. I welcome from Fife Advocacy Kate Milliken, the co-ordinator, and John Dow, the chairperson. I understand that Mike Sawyer and Kate Milliken will make some opening remarks, after which I will open up the session for questions.
Thank you for inviting us to the committee. I guess that one reason why you did so is that Fife is a mixture of urban and rural areas—we have to provide a service over an area that covers 70 miles. However, in some areas there is an intense need for services. We are also lucky because we have coterminous boundaries with Fife NHS Board, the health trusts and the local health care co-operatives. Therefore, there is close working within Fife, not only with the health board but with the voluntary sector, service users and carers. If you want to talk in detail about that, Kate Thomson can say more about our current initiatives.
Kate, would you like to make a statement at this time?
Members may want to put questions to us first.
Do you agree with the definition of advocacy that is contained in the bill? Do you think that it is wide and clear enough?
I do not have a problem with the definition of advocacy that the bill contains. However, I am concerned about the extent to which people would automatically have access to advocacy. They ought automatically to have access to information about advocacy, but it should be for individuals to decide whether they want to make use of advocacy.
The definition of independent advocacy should be clearer. The word "advice" should be removed from the bill, because it is misleading. Independent advocacy is not about advice, although advocates seek to ensure that people have enough information to enable them to make an informed choice.
In its written submission, Fife Council social work service states:
We want to be sure that people have the opportunity to know fully about advocacy and to understand what it involves. We want to encourage referrals and to ensure that people are given every opportunity to make use of advocacy. However, we want the advocacy service to have the bottom-line responsibility for deciding what it will do about referrals. We should not dictate to the service the kind of involvement that we want it to have. We want to ensure that advocacy retains the independence that it has had until now.
Fife Advocacy has always made decisions independently and we assume that it will continue to do so.
How is Fife Advocacy funded?
We have different sources of funding.
You indicated that in your submission. Will you receive any money from the social work budget next year?
Yes.
How independent does that make you?
We are mental illness specific grant funded on a year-to-year basis. That funding has sustained us for quite some time. An organisation cannot be truly independent if it is funded by the health service or social work department. However, we try to minimise any conflicts of interest that may arise. In Fife we are free to bite the hand that feeds us.
Do you believe that you are sufficiently independent as regards delivery of service, rather than funding?
We are as independent as we can be. There are some funding issues that I would like to address later.
I, too, want to talk about funding and independence. Do you think that there is a conflict of interest between the bill placing a duty on local authorities and health boards to provide independent advocacy and their seeking to do that through organisations such as Fife Advocacy, which they fund? Can you say that you would act independently at all times, in the best interests of the client?
Although some conflict of interest is always inevitable, we try to minimise that risk as much as possible. However, in order to do so, we must raise awareness of independent advocacy. Fife Advocacy regularly provides staff on the acute side of the trust with such awareness raising. Such an approach should be extended to the primary care side.
Do you agree that there is a conflict at the heart of the bill, because it places a duty on local authorities and health boards to collaborate to ensure provision of independent advocacy services in their area? Presumably that means that they will also have to collaborate to provide funding. Given that they will have to provide both funding and services, will that not cause a conflict of interest with an independent advocacy programme that relies on those two bodies for funding?
We certainly rely on the health board and the council for funding. However, from my 10-year experience of advocacy programmes in Fife, I would say that we have been free to act as independently as possible with the funding that we have been allocated.
But we have never had a mental health bill that places such duties on local authorities and health boards.
No.
That is why I have suggested that there is a conflict at the heart of the bill. Is it possible to introduce another funding mechanism that is separate from local authorities and health boards? Those bodies could still encourage advocacy projects, but should they also continue to fund them?
It would be ideal if advocacy organisations could source funding from outwith health boards and councils. However, I do not think that that will be possible right at the beginning and we have to start somewhere. Most advocacy projects—certainly the two in Fife that I am aware of—seek their funding from a variety of sources to reduce any potential conflict. We receive a minimal amount of money from health boards; most of our funding comes from the council.
Would placing the money that the bill will allocate to the advocacy service somewhere other than with the local authority and the health board not guarantee the advocacy service's independence from those bodies?
Yes, I agree. I do not know whether this would be a possibility, but it would probably be better if that money were placed with the Advocacy Safeguards Agency or a similar body, which could oversee it.
That would be the ideal target in relation to perceptions of what Fife Advocacy offers. The bottom line is that the user of Fife Advocacy services should feel that he or she is getting an independent service. Whether we feel that Fife Council is going to try to impose some kind of control does not enter into the matter, as far as the practical delivery of Fife Advocacy services is concerned. In an ideal situation, it would be brilliant if the funding was totally separate from Fife Council and/or Fife NHS Board. However, as we have heard, although the ideal is the target, asking how long it will take to reach that is like asking how long a piece of string is.
We have always attached great importance to advocacy, which is one of the reasons why the schemes have been funded for more than 10 years. This is not something that we have just done yesterday. The schemes work well. The issues that Tricia Marwick raises also apply to the relationships between local authorities and the voluntary sector in relation to the activities in which they engage. I accept that there are issues around the separateness of the funding source. However, there are also issues about the importance of people working in partnership locally.
Are you supervised by an officer from social work services?
Yes.
There is a link officer.
What kind of involvement does that person have? For example, how often do you see them?
They come to our management committee meetings.
I declare an interest, as I know Mike Sawyer from my previous employment and, as an MSP, I have done some work on behalf of clients of Fife Advocacy. A further interest is that Stratheden hospital, which is the main psychiatric hospital in Fife, is in my constituency.
Yes. We are currently funded to carry out advocacy work at Stratheden hospital for people who are moving back into the community through the reprovisioning process there. However, funding for that work will end in March and we have absolutely no guarantee of funding after that. The issue will go to a board of directors on 4 November, but the staff who are delivering the advocacy may well face redundancy. I am concerned because Fife NHS Board is committed to joint funding for advocacy provision only until the end of March. That flies in the face of what will happen under the bill. I would like more appropriate funding for advocacy to be put in place. It is a concern for us.
I appreciate the current situation regarding advocacy funding. There is no lack of commitment from the council and the health board to continuing the advocacy service. It is just a matter of timing and the way in which things have happened. We are actively considering the issue.
Is your funding yearly, rather than three-yearly?
The health board funding, through the health improvement plan, is for three years. That is the only health funding that we receive and it will end at the end of March.
What about funding from the local authority?
That is MISG funding, which we receive on a year-to-year basis. It is not quite ring fenced; it is semi-guaranteed. We would like that funding to be allocated on a three-yearly basis.
Do you know what your budget will be over the next three years?
No, not yet.
My second question is for the Fife Council representatives. In your submission, you state that, in relation to the provision of care and support, you feel that
We have been trying to get our heads round the potential implications of the bill and the demand that would come our way. When one looks at the figures, the worry arises that the funding might not be sufficient. The hospital discharge programme means that more people will be able to be supported in the community. Although we fully support that aim, we do not know what the financial implications will be. If there is not enough money, pressure will build and people might have to become the subject of a compulsory treatment order to get the resources that they need. That would be unfortunate.
In your written submission, you indicate that you are more concerned about people than about money. It is difficult to get social workers and mental health officers. On the health side, difficulties are being experienced in attracting appropriate specialists in mental health—both nurses and doctors—to Fife. There might be problems in attracting people to take on advocacy work. In promoting the bill, is there anything that the Executive should do to encourage more people to go into such areas?
I welcome the current campaign on the recruitment and retention of social workers, which is important. However, improvements in standards and training have had an unintended consequence. There is a new requirement for people to have undertaken the post-qualifying award part 1 training before they can train as mental health officers. It takes six months of full training to become a mental health officer, which represents a heavy commitment. A number of people who have worked for two years and who would be prepared to train to be mental health officers—one must have worked for two years after qualifying, because the job of mental health officer is an onerous and responsible position—have not taken the PQ1 training. In future, people who have not done the PQ1 training will not be accepted on to training courses for mental health officers.
Will the bill have other unintended consequences for aspects of the council's operation? For example, might the bill conflict with the joint future work?
No, the joint future programme is very positive. There is an issue that perhaps I do not understand. The bill imposes explicit duties on local authorities. Will people have a right to services, irrespective of the state of a local authority's resources? Will that right extend to anyone in the community who has had a mental disorder? The bill lays out duties to provide residential accommodation, personal care, training, employment assistance and social, cultural and recreational activities. If an assessment indicates that someone could benefit from any of those services, will the local authority have a duty to provide such services, irrespective of its resources?
Iain Smith has asked many of the questions that I was going to ask. Is it possible to get more information about the resource implications? You say that you cannot be certain because you are unsure how the bill will be interpreted, and of course the bill may be altered as it goes through Parliament, but would it be possible to get an idea? You mentioned various duties that are put on local authorities, described by phrases such as
Yes, we are prepared to do that. This is just guesswork, but we reckon that, as a result of the bill, Fife would get an extra three MHOs. We operate mental health services in three different areas of Fife, so we would get an extra MHO for each. MHOs' role is increasing significantly, and rightly so as they have to take great care over their work. However, the volume of people using the service will also increase. People who had, for want of a better phrase, personality disorders were not included in the past, but we know that they will be included now. It is impossible for anyone to say what the increase will be, but because mental health needs a 24-hour service, we are concerned about how we will provide it.
Sorry, my question goes back to money again, because it is important. The financial memorandum allocates £1.5 million per annum to support advocacy services throughout Scotland. Will Kate Milliken and John Dow tell me how much they receive at the moment from their various funding sources?
At the moment, our mental illness specific grant funding is £89,600. Our Stratheden advocacy project, which is funded by Fife NHS Board, receives £49,493. Volunteer advocacy receives £10,666 from the Nationwide Foundation, £8,000 from the Lloyds TSB Foundation for Scotland and £848 from Fife Council under section 10 of the Social Work (Scotland) Act 1968. That comes to a total of £19,514. Our volunteer advocacy funding is due to stop at the end of March, but we are seeking other sources.
I did not catch what you said about the Fife Council money and the total.
Section 10 money is £848, and the total for volunteer advocacy is £19,514.
So roughly we are talking about £140,000 in total per year for one advocacy service in Fife. It is suggested that £1.5 million per annum will be used to support advocacy services and that local authorities will get their share of that, but Fife is likely to receive a heck of a lot less than the amount of money that we are talking about at the moment. Perhaps Mike Sawyer can help me out here. Is it possible that the £1.5 million allocation to support advocacy services might be the maximum, and that neither Fife NHS Board nor Fife Council will give any more than it is allocated?
We are committed to the sums that we are currently making available. Actually, we have three-year funding agreements with voluntary organisations. The difficulty is that the MISG is not provided on a three-year basis; it is annual. We know who our long-term partners are and they know that we will not deprive them of funding and that we will continue to make the investment. I am not the best person to speak about this, but health gets money for advocacy, which is dealt with separately and is not included in the figures. That would need to be examined separately.
May I comment on that? I have a memo from discussions with the Advocacy Safeguards Agency, which states:
First, I give my apologies for missing a large part of the beginning of the meeting. That was due to an urgent phone call, which I will explain to the convener after the meeting.
We examined the potential number of people who, over the next period of time, could manage in the community if we were able to build up the support infrastructure that is required to prevent hospital admissions. We are probably looking at the potential for another 100 people over the next 10 years, or however long the programme takes, so it is a considerable number.
We all accept that it is a bit of a guessing game, but does that mean that you are desperately trying to train more staff to handle what could come in the future? Is that premature? I know that it is not easy to do that.
I suppose the point is to be sure that there is a support infrastructure in the community before people are discharged, because people need to leave long-term care knowing that the support services are there for them. That is fundamental.
I will ask a question for clarification. When I was a mental health officer, I had a case load over and above my work as a mental health officer. Does the situation remain the same? If so, we are not talking about a group of people who do only mental health officer work. That needs to be clarified for the committee and other members. In reading the evidence, people might think that a mental health officer did mental health work and nothing else. That was not the case when I practised, but I do not know whether that remains the situation.
The situation varies in Fife. The mental health officers who operate in mental health teams do almost exclusively mental health work in their working week. However, mental health officers in other community care teams, in criminal justice and in child and family teams tend to be involved in mental health work that revolves around a rota and set pieces of work per month. That could be measured in hours a week rather than as full-time work. The situation varies, but we can usually quantify the amount of work.
About 50 per cent of our social workers who are mental health officers are in mental health teams. The others are in other teams.
You talked about the mental illness specific grant. I remember that Michael Forsyth made increases in the grant, which will thrill John Young. We have increased the grant each year, but we could consider putting it on a three-year plan, like the rest of our budgets. I do not know why that slipped through; perhaps there is a reason for treating specific grants differently.
The six-month commitment involves a teaching programme, placements and study time. For six months, people spend minimal time in their normal place of work, so we tend to think that their work must be covered for that time.
We noted that people cannot undertake MHO training without the PQ1 qualification. Fife Council's evidence suggests that some staff would have trained if they had had that qualification. The thrust of what you said and what others have said in written evidence is that we will not have enough mental health officers when the bill is implemented.
We are grateful for the opportunity to meet the Local Government Committee to discuss the Mental Health (Scotland) Bill. As Aberdeen is a city area, we work with one health board and one trust but three local health care co-operatives. Issues result from the overlapping boundaries.
The bill places a duty on local authorities and health boards to collaborate to ensure the provision of an independent advocacy service in their area. Do you agree with that approach? You have indicated that Aberdeen City Council provides an advocacy service. The bill will place a duty on local authorities and health boards to do that. Do you think that that is appropriate?
Yes. We commission all mental health services on a joint basis, through the mental health framework. The local authority and the health board have worked in partnership to fund an additional advocacy worker. That is the most appropriate way of proceeding.
Is the supply of independent advocacy services in Aberdeen sufficient to cope with the new bill, which will make significant changes?
We will need to consider where advocacy workers can be accommodated, but the advocacy service should welcome the additional resources that it will receive.
It is likely that the advocacy service in Aberdeen will receive between £40,000 and £50,000 of the £1.5 million that will be made available. Is that enough to support it, given that its duties will change under the bill?
Those resources are a good start. The position in Aberdeen is different from the position in some areas, because Aberdeen already has two mental health workers in post. We need to consider where advocacy services should be directed. Should services be concentrated on people who have been detained under the bill? At the moment, we provide a generic service for people with mental health problems. If we prioritise people who have been detained under the bill, the resources that have been allocated should be sufficient to begin with.
In your written evidence, you suggest that a duty should be placed on local authorities, health boards and health trusts to co-operate in the provision of local services. Will you elaborate on your reasons for believing that such a duty should be placed on those bodies?
As the witnesses from Fife Council indicated, there is concern that local authorities' duties are spelled out clearly in the bill, whereas the duties of health boards and trusts are not. Given that in Aberdeen we are pursuing the joint future programme and have joint mental health teams and joint commissioning, it seems odd that clearly defined duties should be placed on the local authority but not on the health service.
We talked with the Fife Council representatives about
Until now, the mental health framework has meant that we have had to concentrate on people with severe and enduring mental illness. Compulsory treatment orders are for people at the more severe end of the spectrum who are being cared for in the community. My concern is that there will not be enough resources left to spend on promoting social development.
Are you saying that that phrase is okay, but that it is a question of resourcing?
It is really a question of how we manage the situation.
Your paper mentions several times the difficulties that you think will arise. It says that
That would be really helpful. We have tried to address that, but I do not think that we have done so terribly successfully. We must try to be clear about assessed needs and future needs. The fact that the city has a population drift of people who come in from the outlying areas presents us with difficulties. The hospital and a lot of the resettlement resources are in the city, so we have to fund additional resources. Although people might initially be funded by their own local authority, eventually there are additional aspects of their care that the city has to fund when they move on. It would be helpful to have clearer information to enable us to plan better for future need.
When we see the Deputy Minister for Health and Community Care in a few minutes' time, what questions should we ask her about finances and funding?
It is a question of the distribution of resources, rather than the total pot. We made a clear statement in our written submission about the fact that GAE allocations would allow us perhaps 4 per cent of the total. Our spending at the moment is around 6 per cent, which highlights the fact that the population who are suffering from mental health problems in the city is larger than the GAE provides for. The distribution of the funding needs to be highlighted, because there are too many uncertainties about what will be required from the total pot when it comes to implementing and taking on the new duties and responsibilities.
I also read the paper by the Scottish Parliament information centre, which has done some research in that area. It says that the amount of money that councils spend on mental health depends largely on priorities rather than on need. That seems to be the same as what you are saying. If that money were to come from central funds, would you want it to be ring fenced in some way?
I am not sure that we would want to ring fence money in all instances. Although that may be useful for getting services up and running, it is as useful for the local authority to have the necessary flexibility to deliver services that are appropriate to the population of Aberdeen. Ring fencing the money in every instance is perhaps not the be-all and end-all of new funding under the bill.
At a recent conference, an academic said that mental health is the cinderella service and that it is perhaps not getting sufficient money. Would earmarking the money offer one way around that problem?
That could be done through the mental illness specific grant, for example. What if money came directly from the centre rather than through the council, which would require the council to make decisions on how much mental health should get? I can hardly believe that we are talking about ring fencing.
The mental illness specific grant comes through us. In Aberdeen, it is distributed among a large number of organisations. However, there are issues around the funding because there have been very few increases over the past six years. The announcement of some additional funding for next year is obviously welcome, but I think that there was only one increase over the previous five years. This year, the level of funding has been static. There would be concerns about ring fencing if the level of funding ended up static for a number of years. If growth in the sector required more funding to meet it, where would the money come from? Local authorities would, in that case, be left with a decision to increase the funding by drawing on resources elsewhere.
Mention has been made of the fact that Aberdeen has 26 mental health officers.
That is right.
Aberdeen City Council's written submission says that
The 26 officers work during the day; additional mental health officers work for an out-of-hours service. Given officers' extended role, particularly under the Adults with Incapacity (Scotland) Act 2000, their number is not adequate. We would probably benefit from having at least another five mental health officers.
So you need between 30 and 40 officers.
Yes. Two people are currently undergoing training, and should be coming on stream fairly soon. We hope to train a further batch of three people and that the correct number of staff will have attained their PQ1, which was referred to earlier. We also hope that we will be able to fund the number of trainees who are coming through.
Do you share the concerns expressed by Fife Council that the duties under sections 20 to 27 are not sufficiently specific? If they are too wide, they will potentially place burdens on councils that they will be unable to meet.
Yes—those points have been well made. The bill's description of our duties is very wide. We have to prioritise services, so local authorities are left in a difficult position if, because of a lack of resources, they are not able to provide a service for someone whose needs are not as great.
Do you have any suggestions about how the bill could be tightened up so as to avoid that problem? Have you had a chance to consider drafting an amendment to that effect?
It is a difficult matter. Eligibility for services is normally determined on the basis of need, so the question arises whether some sort of hierarchy of need could be drawn up. That would be my suggestion.
Your written submission mentions the problem of "unmet" needs that might need to be addressed. Do you mean unmet or unidentified? Are you referring to people in the community about whom you do not know?
There are always people about whom we do not know and there are unmet needs. As I said, we are not funding everyone whom we identified as needing a befriender; we are not able to meet the level of need for services such as befriending.
Do you foresee any difficulties in operating the proposed duties in the bill where local authorities and health boards do not have coterminous boundaries—where the health board area boundary runs across several local authority areas—such as Fife has?
We deal with that issue daily. It has arisen in the context of the Adults with Incapacity (Scotland) Act 2000 and for our multidisciplinary mental health teams covering general practices. I do not know whether the bill would increase those difficulties, because we have worked out systems for dealing with cases in which there are overlaps.
I do not think that there are any more questions. You have the distinction of having come to the committee for us to tell you that funds should be ring fenced, although we seem to spend our lives trying to do the opposite. Thank you for coming. I apologise for your having had to wait so long. If we need to get in touch with you again, we will do so.
Thank you. I am aware that the meeting has been long, so I will keep my opening comments brief. We are here to discuss the Mental Health (Scotland) Bill. The Executive's aim is to improve the way in which we deliver mental health services throughout the country. That will be facilitated through several agencies. The committee's specific interest will be local authority provision, and I am more than happy to answer any questions.
Could you outline for the committee what you consider to be the principal aims of the bill and how the bill will improve mental health services in Scotland?
The main aim of the bill is to bring into statute the recommendations of the Millan report. We want improved day care and improved aftercare services. We want to ensure that support for people who have mental health problems is available not only in hospitals, but in the community. We want to ensure that the staff who provide services—particularly mental health officers—are fully resourced and trained, and that they are given the support that they need. We want to ensure that those who suffer from mental illness are able to have a major say in the decisions that are made about their treatment. They will be given the support that they need to do that through development of advocacy services. We have picked up various recommendations of the Millan report that we believe will bring about improvement in mental health services.
What do you regard as being the main difficulties that affect the provision of mental health services in Scotland?
There is confusion about who is responsible for providing mental health services and there is a perception that professionals do not always involve the individuals concerned as much as they could. People feel that they do not have the control over their lives that they should have, so the bill seeks to co-ordinate the different aspects of the service to ensure that everyone knows what they are responsible for and how to deliver the service coherently. We want individuals to feel that they are a part of the service that they receive.
A key aspect of the bill is the provision of an independent advocacy service. In the Executive document "Independent Advocacy: A Guide for Commissioners", which was published in 2001, you state:
I do not think so. The advocacy organisations to which we spoke when drafting the bill made it clear that there is always a funder. Those organisations are used to managing professionally the possibility that their funder might be a body that they have to challenge; they are not unhappy with that situation. Obviously, we want clear guidelines to be set out that will ensure that advocacy services do not encounter interference when providing support to individuals. I believe that that can be delivered.
Is there an argument for setting up a separate stream of funding, directed by the Scottish Executive or by an agency on behalf of the Scottish Executive? It would then be clear that there was no conflict of interests between the advocacy service and the funding bodies.
So far, it has not been suggested to us that such a step is necessary. People will be keen to put in place strict frameworks to ensure that there is no interference in provision of advocacy services. We expect advocacy agents to deliver an independent service—their role is to provide independent advocacy to individuals. My colleagues who took part in discussions with advocacy groups may want to comment further on that issue.
The Executive would not want to be too prescriptive because we want to allow the development of appropriate models in the field. The bill's proposal that there be a general duty placed on local authorities and health boards to deliver that service is conducive to that objective.
The bill is intended to build on the non-statutory development of advocacy. As members will know, the Executive has funded the Advocacy Safeguards Agency as an independent body designed to safeguard the independence of, and standards in, advocacy provision. The agency will act to support advocacy services and commissioners of advocacy services.
The financial memorandum provides £1.5 million per annum to support advocacy services. Is that additional to the moneys that are already in the system for supporting advocacy services, such as those that are provided through the NHS plan?
Yes—the moneys will be additional. We expect expenditure on advocacy to be £3.7 million this year. The £3 million that has been identified is additional.
How was that figure arrived at? Whom did the Executive consult? How was it decided that that was an adequate sum?
The group that has been considering the development of the bill examined the advocacy that is provided at the moment. We are not starting a completely new service; we want to build on the good practice that exists. We need to look at how that good practice can be developed while recognising that everything will not be turned on immediately when the bill is enacted and that services will need to be developed incrementally. Over the next three years, we will build up the advocacy service and develop the provision that is already available. That is the way in which the moneys that are identified within the financial memorandum will address the development of the service.
I have a final question on advocacy. At the moment, there is uneven provision of advocacy services throughout Scotland—some areas are better than others. It is obvious that there will be particular difficulties in providing adequate services in rural areas, so how does the Executive propose to improve on the existing advocacy service to ensure that there is an adequate service wherever people live in Scotland?
As I said, we recognise that there is some provision of advocacy at the moment but, as Iain Smith mentioned, that provision is not available throughout Scotland, nor is it at a level that would meet the requirements of the bill. Therefore, we need to develop that.
In recent years, several pieces of legislation have placed additional duties on local authorities in relation to mental health services. Is there a danger that the bill will simply place additional burdens on an already overstretched service that is provided by local authorities? I am playing devil's advocate in asking that question.
We are aware that enactment of the bill will result in additional burdens for local authorities. The financial memorandum is designed to address those additional burdens. However, we are also aware that, over the past two to three years, local authorities and NHS boards throughout Scotland have received substantial increases in resources. The projections for the next three years also show increases in resources.
In a submission from a witness who gave evidence earlier it was suggested that social workers do not receive additional remuneration when they act as mental health officers. I assume that social workers would act as MHOs only if they had appropriate training and qualifications. Do you know whether additional remuneration will be made available?
I understand that in some areas that may be the case. However, local authorities have the power to reward those who take on additional responsibilities. I have to say that, as that point was put to me only today, I am still checking it. My colleagues may want to respond, but the decision comes down to local authorities.
The situation can be variable. Thank you.
I would have to check the statutory position. It is certainly the case that people are not paid extra for acting as mental health officers. However, one of the issues that is being considered as part of the review of mental health officers is whether other incentives should be made available that would make it worthwhile for people to train as mental health officers or to take on that role for reasons of professional development or personal satisfaction. The issue is not only about remuneration.
I want to ask about finances. One of the duties that is to be placed on local authorities is the promotion of well-being and social development for people who have mental health problems. It could be argued that that provision is very broad—in saying that I am looking at Colin McKay, who drafted the provision. One would think that the financial implications of that provision could be enormous. I would like to hear ideas on that issue.
I will answer the last point before I hand over to my colleague who will reply on the original point. Ring fencing is often raised in respect of the moneys that are made available to local authorities for specific duties. It is also discussed in respect of the moneys that are made available to health boards.
Are you considering increasing the specific grant?
The MISG has been increased by £1 million this year and it will be increased to £20 million next year. The reasoning is that we recognise the benefits of a specific direct grant that is ring fenced. Local authorities are spending additional amounts of their own money—money that is not ring fenced—on mental health. The benefit of not ring fencing everything is that it offers the best of both worlds. Although we will continue to offer the MISG to local authorities, we do not intend to ring fence other moneys in relation to the bill.
Sylvia Jackson asked about the research that was likely to be undertaken in relation to the bill. A manager has been appointed to establish a research programme for the bill. The financial memorandum identifies £250,000 a year to run a research programme for a five-year period. We have not been too specific about what that research should involve. We will consult on that and the shape of the research will develop as the implementation process develops.
Have you had discussions on the bill with COSLA or with individual local authorities? If so, have the bodies to which you have spoken mentioned the phrase
We have not received any great criticism of the phrasing of the bill. There is a mental health legislation reference group, which involves a variety of stakeholders. COSLA and the Association of Directors of Social Work are represented on that group. Although we have probably had more direct discussions with the ADSW than we have had with COSLA, they are both involved in our consultative networks.
I have just one more question. I know that it is difficult in my area to deliver a 24-hour crisis service, for example. You have said that the phrase already exists, but will you not be raising expectations? Such services do not happen at the moment, so how will we ensure that we can provide them in the future?
We want to raise expectations. We want people to demand a better service and are willing to support that demand, financially and in other ways. We want to see the improvement so that we can respond to people who need such services 24 hours a day, seven days a week. The point of introducing the bill and putting such phrases into statute is to ensure that people recognise their importance and that they must fulfil the demand.
I want to follow up on the duties that are imposed on local authorities. Fife Council, supported to some extent by Aberdeen City Council, was concerned that the duties in sections 20 to 27 are too open-ended and without any clarification. It seems that anyone who has or has had a mental disorder or illness may be able to demand open-ended services. There is no counterbalance of needs and resources, so will you examine the drafting to ensure that it clearly provides for such a counterbalance?
On the open-ended nature of certain sections, we would be willing to examine suggestions about how we could make those sections clearer. However, the wording is deliberate so that it allows the flexibility that we want in the system. We have to strike a balance, but we would examine any suggestions.
We heard evidence from Aberdeen City Council and from Fife Council, particularly about advocacy. They seem to be concerned not so much about the amount of money that they get as about the way in which they get it. It sounded to me as though they were going through the whole hassle of having to apply for funding again every year, although I thought that we had already done something about that. Is there a reason why the MISG is not allocated on a three-year funding basis, so that councils know what they are going to get? They seem to be saying that it is not, and that is where some of their money comes from.
I happened to be passing through the office when the question on annuality for the mental illness specific grant was being asked, and I realised that that is perhaps an anomaly. In other areas, we are tending to move towards longer-term awards, or at least longer-term indications. I am more than happy to consider the practicalities of making such a move on the MISG. I recognise that annual allocations can prove difficult, particularly for voluntary sector groups that await their award each year, so that is something that we must examine.
Neither had I.
I am in good company.
Thank you very much.
Meeting continued in private until 17:29.
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Budget Process 2003-04