State Hospital (Redevelopment)
Good morning. The first item of business is a statement by Nicola Sturgeon on the redevelopment of the state hospital. The cabinet secretary will take questions at the end of her 10-minute statement, so there should be no interventions.
Recent media coverage has raised questions about the decision to reduce the number of beds at the state hospital as part of a planned redevelopment of that facility. I welcome the opportunity to provide reassurance to Parliament and to explain exactly what is planned for the state hospital.
The current policy on the management of mentally disordered offenders was established in January 1999 and is outlined in the document "Health, Social Work and Related Services for Mentally Disordered Offenders in Scotland". That document established a number of key principles that were intended to provide protection for the public and to ensure the provision of appropriate care and treatment services. The four key principles that were articulated are that mentally disordered offenders should be cared for with regard to quality of care and their needs as individuals; in the community, as far as possible, rather than in institutional settings; under conditions of no greater security than is justified by the degree of danger that they present to themselves or to others; and in such a way as to maximise rehabilitation and their chances of sustaining an independent life as near as possible to their homes and families. Those principles have informed the development of the forensic mental health services in Scotland since 1999.
The third principle, which is about ensuring that such offenders are cared for in conditions of appropriate security, has since been enshrined in section 1(4) of the Mental Health (Care and Treatment) (Scotland) Act 2003, which states that functions under the act should be discharged in a
"manner that involves the minimum restriction on the freedom of the patient that is necessary in the circumstances."
We are rightly proud of our mental health legislation and in opposition I was pleased to support it. It gives appropriate consideration to public protection and to the care and treatment of individual patients.
In 1999, when the current policy was developed, it was clear that the national health service estate that offered secure care for mentally disordered offenders did not comply with the principles that I have outlined. With the exception of mentally disordered offenders who received the high-security service that was provided by the state hospital, all such offenders who were cared for in in-patient settings were in low-secure settings. The fact that there was no intermediate stage between high security and low security meant that patients were spending longer at the state hospital than was necessary for their rehabilitation or for public safety. It also meant that when they transferred on to another hospital, the step down in security level that they made was in some cases greater than might have been desirable.
The policy direction that has been pursued since 1999 has resulted in the creation of two regional facilities that provide treatment in conditions of medium security—in other words, in settings where the level of security is somewhere between the level of security at the state hospital and the level of security of a locked ward.
The Orchard clinic in Edinburgh, which opened in 2000, provides 50 medium-secure beds, primarily for the population of the east of Scotland. The Rowanbank clinic in Glasgow, which opened last year, provides 74 beds, primarily for the population of the west of Scotland. Plans are in hand to establish a similar facility for the north of Scotland. Those units have been specifically designed and built to conform to an agreed environmental, procedural and relational model of security within mental health services. Each medium-secure unit is designed to meet and operate to exacting standards, thereby ensuring that patients are cared for in conditions that are appropriate to the level of risk that they are assessed to present.
The creation of those new units has resulted in a reduction in the number of beds required at the state hospital. Work was done by the forensic network, the three regional planning partnerships and the Scottish Government to model the future requirement for beds, and the outcome of that work was published as a Health Department letter in 2006.
The reduction in the number of beds required enabled the previous Administration to agree that the business plan for the redevelopment of the state hospital should include a planned reduction from 240 beds to 140 beds. I will put that in context: at the moment, there are only 115 restricted patients in the state hospital.
So far, good progress has been made with careful and considered planning for the redevelopment and modernisation of the state hospital. When that process has been completed, in 2011, the institution will offer a standard of care and accommodation that is appropriate to the age that we live in and to the expectations that we have of modern health care facilities. Next month, my colleague the Minister for Public Health, Shona Robison, will attend the ceremony to mark the start of the building works.
I know that the state hospital staff welcome the development, which fits with their focus on the provision of modern care in a safe, secure environment, in which the objective remains to match each patient with the appropriate care and level of security.
It is important for me to stress that the redevelopment will not, as some people have rather irresponsibly suggested, result in a sudden exodus of 100 patients from the state hospital. Nevertheless, recent coverage has prompted discussion about the process for the transfer of patients from the state hospital, so I want to set out the legal and the policy position.
As members are aware, many patients who enter the state hospital are very ill and, for that reason, present a high level of risk at the time of committal. However, with modern treatment, through drugs and therapies, their mental illness can be treated and managed and the level of risk that they present can be reduced. In such circumstances, it is appropriate that they be considered for a move to a lower-security setting. Although we want patients to make progress, the process for managing the rehabilitation of patients at the state hospital is a careful one. No patient is transferred unless a robust risk assessment has been carried out for the patient and there is clinical agreement that the level of risk that the patient presents can be managed by the receiving hospital.
I take the decision on the transfer of restricted patients and, in each case, will want to assure myself that appropriate arrangements have been made and that safe care will be provided following the transfer. Scottish ministers' consent is required under section 218 of the Mental Health (Care and Treatment) (Scotland) Act 2003, which allows for no exceptions.
The 2003 act creates a parallel process to the transfer process by allowing patients to appeal against being held in conditions of excessive security at the state hospital. All appeals are carefully considered by the Mental Health Tribunal for Scotland and only when the tribunal is satisfied that the patient no longer requires to be detained in the special security of the state hospital on the grounds of risk will it find that the patient is being detained in conditions of excessive security. Patients who are successful in their appeals are generally transferred to a medium-secure unit but, in the case of restricted patients, that still requires the consent of Scottish ministers.
In addition to our role in respect of a transfer, Scottish ministers have the right to be represented at any appeal, and to argue that the conditions are not excessive and that the patient is appropriately detained in the state hospital.
We recently introduced a further safeguard for the public, whereby all restricted patients, from the time that they enter the mental health system, should be managed through a robust care programme approach, as part of which care plans are developed and monitored by a multidisciplinary care team, including members of the police. It is the responsibility of all NHS boards to ensure that the CPA regime is implemented effectively for all such patients in their care and for other patients about whom there are concerns about the risk that they pose.
I hope that my statement will reassure members that the current developments in the physical forensic estate are part of a long-standing policy to ensure that public safety is protected and that mentally disordered offenders are properly cared for and managed in settings that are appropriate to the level of risk that they present.
The cabinet secretary will take questions on the issues that have been raised in her statement. I will allow around 20 minutes for such questions, after which we will move to the next item of business.
I thank the cabinet secretary for the advance copy of her statement and, having asked that such a statement be made, I welcome the fact that that has now happened.
Can the cabinet secretary confirm that no recommended transfer of appropriate patients will be delayed as a result of a lack of resources or a lack of places?
My second question is more complex. On 21 February, the First Minister claimed that ministers are required to consent to any hospital transfer of a restricted patient—a requirement that the cabinet secretary, in a letter to The Herald on 26 February, claimed
"is not subject to any exception or exclusion."
However, sections 264 to 273 of the Mental Health (Care and Treatment) (Scotland) Act 2003 allow patients in the state hospital, including those with restricted status, the right to appeal against being kept in conditions of excessive security. If the Mental Health Tribunal for Scotland rules that they are being held in conditions of excessive security, that order can be enforced in the Court of Session. Would the cabinet secretary therefore be prepared to amend her position in order that she is not seen to take a view that is contrary to article 5(4) of the European convention on human rights, which states that any person who is deprived of liberty by detention must be entitled to take court proceedings by which the lawfulness of that detention can be challenged? Does the cabinet secretary agree that, under section 193 of the 2003 act—which she supported—ministers do not in any case have the final say on who remains on a restriction order?
I thank Margaret Curran for those questions. I am sure that she agrees that although she asked for today's statement, the law and the policy are a continuation of the law and the policy that were followed by the previous Administration. She asked whether I could assure her that the recommended transfer of patients would not be delayed because of a lack of resources. I assure her that the Government's objective—again, I believe that we are continuing the policy of the previous Government—is to ensure that adequate resources are in place at the right levels of security to ensure that patients are cared for in appropriate settings. That is the thrust of our policy on mentally disordered offenders. Like the previous Administration, I think that that policy is right.
I turn to Margaret Curran's second question. I covered that aspect in full in my statement. Ministers are required to consent to transfers of restricted patients out of the state hospital. There is no ambiguity about that. There is a parallel process under the Mental Health (Care and Treatment) (Scotland) Act 2003, which I detailed in my statement. It allows patients to appeal against being held in conditions of excessive security. As I said, ministers have a right to be party to those proceedings, and indeed can object to a finding of a patient being held in conditions of excessive security. If the Mental Health Tribunal for Scotland finds that a patient is being held in conditions of excessive security, there is an obligation on NHS boards and the Scottish Government to ensure that that patient is transferred to a more appropriate setting. However, the critical point is that no transfer takes place without the approval of Scottish ministers, and Scottish ministers do not give the approval to transfer unless they are satisfied that the setting to which a patient is being transferred is appropriate both for the patient and for public safety.
Margaret Curran says, rightly, that patients can appeal ultimately to the Court of Session. She will want to be aware, though, that that has never happened because the Government, working with NHS boards, complies with orders that are made by the Mental Health Tribunal for Scotland. However, we do so in a way that ensures that ministers are responsible for determining that any transfers are appropriate. That system is right—it strikes the right balance between public safety and the needs and interests of patients. I will continue to apply that policy with a great deal of care.
I, too, thank the Cabinet Secretary for Health and Wellbeing for the copy of her statement. The issue was under discussion in 2003 and I welcome the progress that we seem to have made.
First, the health secretary states that
"with modern treatment, through drugs and therapies … mental illness can be treated and managed".
Will she confirm that all patients with a personality disorder, both in Carstairs and in the community, will be given the appropriate diagnosis, treatment and support?
Secondly, I agree with the health secretary that patients should be cared for as near as possible to their homes and families. Will she give more information on the proposed medium-secure unit to serve patients from the north and north-east of Scotland?
Finally, with 100 patients from Carstairs about to be moved to medium-secure units—I appreciate that that will happen over a period—and only 124 medium-secure unit beds in Scotland, will the health secretary give an assurance that those patients who are currently in the Orchard clinic and Rowanbank will not be moved into the community to make way for the Carstairs patients unless and until it is clinically safe for them to be independent in the community, and public safety is assured?
I thank Mary Scanlon for those questions. First, I assure her that nobody will be moved anywhere unless it is right for the patient and right in the interests of public safety. In the case of restricted patients, those decisions lie with me and I will make them with a high level of care and attention.
The point that I tried to make as gently as I could in my statement, but which I want to emphasise very strongly indeed, is that it is not the case that 100 patients are about to be transferred out of the state hospital. We are talking about a planned redevelopment of the state hospital, which will, over a period of years, lead to a reduction in the number of beds. The number of beds at the end of that process is estimated to be 140. To put that in context, as of today there are fewer than that number of restricted patients in the state hospital. Whatever the temptation, I appeal to members not to indulge in a scaremongering exercise about some mass exodus from the state hospital—that is not based in fact.
The planning for a medium-secure unit in the north of Scotland is on-going. I undertake to fully inform Mary Scanlon—as I will inform the whole Parliament—of developments in that respect. It is important that Parliament is informed as those plans develop.
Mary Scanlon's first question was whether patients with a personality disorder would get the appropriate treatment and support. First, what treatment and support any patient needs is a clinical decision and not a decision for any politician to take. However, it is of the utmost importance—from the perspective of public safety and of the proper care and treatment of patients—that the care and treatment a patient is considered to need upon diagnosis, and relating to their diagnosis, are the care and treatment that they receive. That is what I intend to happen.
I, too, thank the Cabinet Secretary for Health and Wellbeing for the advance notice of her statement. On behalf of my party, I particularly welcome the fact that the Government is continuing the policies that developed from what was regarded as a seminal work, "Health, Social Work and Related Services for Mentally Disordered Offenders in Scotland", which was published in 1999. The cabinet secretary's statement has clarified the current state of play. She mentioned the medium-secure units. That report, having dealt with the inadequacy of not having such units, identified the danger that we might not properly manage the procedure of taking patients from medium security to lower security. That is, if you like, the other side of Mary Scanlon's question. Will the cabinet secretary expand on that?
Among the major deficiencies in the previous system was the absence of adequate care for those with learning disabilities and services for children and adolescents. How is the cabinet secretary taking forward those two important aspects?
I thank Ross Finnie for those constructive questions. He raises an accurate point about the concerns expressed in the report that once we dealt with the inadequacy of a lack of medium-secure capacity in the forensic estate, there was a danger that there would be problems further downstream. However, I reassure him that one of the four principles at the heart of our policy is that people are treated as close as possible to their homes, communities and families. The decisions that are taken around that must have due regard to public safety as well as the interests of patients. I assure Ross Finnie that we want to ensure that that principle is enacted in practice. I do not want people to be detained in conditions of excessive security, whether that is in the state hospital or in medium-secure units. It is important that we get people into the right conditions and care settings, and that we have the right capacity and services in place to enable that to happen.
Ross Finnie asked about taking forward adequate care for people with learning disabilities and for adolescents and children. I am happy to write to him in detail about how we are taking forward that aspect of our policy.
We come to questions from back benchers. Members know the form by now.
Will the cabinet secretary expand upon the level of liaison and communication that she has had with staff working in the state hospital?
Brevity is indeed beautiful.
It is commendable.
Shona Robison chaired the annual review of the state hospital last year. As I said, next month she will return for the opening ceremony of the start of the building works. As with staff anywhere in the NHS, I set great store on good communication and the good relationships that we have in NHS Scotland as a whole. There are excellent staff partnership arrangements, which apply in the state hospital as they do in all other parts of the NHS.
As the constituency member for the state hospital, I welcome the cabinet secretary's statement and pay tribute to the staff in the hospital for providing a valuable service to patients and the public.
On the bed configuration, particularly in medium-secure facilities, you will be aware that the Orchard clinic is operating at capacity and that the Perth unit is not yet available. Are you content—
I am sorry, Ms Gillon, but I must ask you not to use the word "you".
Sorry.
Is the cabinet secretary content that the proposed bed configuration is adequate for appropriate transfers? As someone who has always supported appropriate transfers, I would not want to be accused of scaremongering in any way, shape or form. Is she also content that the beds are in the right place to enable patients from across Scotland to be housed as close to home as is appropriate?
I acknowledge Karen Gillon's close interest in these matters as the local member. I echo the point that she made about the staff in the state hospital: they do a difficult job very well. I am sure that we would all want to pay tribute to them and the commitment that they show.
Karen Gillon raises some important issues about bed configuration. She asked whether I am confident of the bed configuration that we have proposed. The short answer is yes, but—as with any other aspect of bed planning in the NHS—there is always a need to keep the situation under review. We will do that in this case, as we do in any other part of the NHS.
It is important that we have the right number of beds in the state hospital, but to ensure that people are not being detained inappropriately in the state hospital we must ensure that there are also the right number of beds in the medium-secure estate and the right services in low-secure settings to ensure that people can be treated as close to home as possible. I think that the planning assumptions that underpin where we are now are right and robust, but I assure Karen Gillon and other members that we will continue to keep these matters under close review.
What will be the benefits to patients and staff at the state hospital once the redevelopment has taken place? Can the cabinet secretary remind us exactly where we are with the medium-secure unit for the north, in respect of where it will be and approximately how many beds will be available?
The benefits of the redevelopment to patients and staff are considerable. I hope we would all agree that we have an excellent facility in the state hospital and that those who work there do an excellent job. However, the facility is not as it should be in the modern age and there is a need to ensure that we modernise and develop it to ensure that the staff who work there are working in the conditions that they have a right to expect; more important, the patients must be in the proper conditions, which add to and enhance their opportunities for rehabilitation and recovery. The redevelopment, which is due to be completed in 2011, will result in us having modern, fit-for-purpose facilities of which we can be proud and which will match the modern, fit-for-purpose legislation that the Parliament passed back in 2003.
The medium-secure unit in the north of Scotland is not yet on stream. I want to ensure that members are properly advised of the current state of planning around it. I undertook to give that information to Mary Scanlon in writing—I will ensure that Brian Adam gets it, too.
I will pursue the north-east question a little further, because the issue of resources is clearly important for the speed of transfer, given that the development of the state hospital will be completed by 2011. The cabinet secretary said that she will write with the detail, but can she tell us a little more at this stage? Has the consultation process begun in the north-east? I ask because in 1999 I was the reporter to the Health and Community Care Committee on the medium-secure unit at Stobhill. The cabinet secretary will remember that that was the subject of a bad set of consultations, which led to big changes in the NHS. That meant that there was a long lead time to the development of Rowanbank. I am concerned that the cabinet secretary's time plan will be difficult.
I also have a technical question, in order to be clear about the cabinet secretary's answer to Margaret Curran. Are we saying that the minister does or does not have the final say in the transfer of restricted prisoners? If the Court of Session decides that the restriction of the prisoner is excessive, surely the prisoner must be transferred? Is the minister's power only to delay the transfer if a suitable medium-secure unit place is not available, or is she still saying that the minister has an absolute right to say that no transfer will take place, despite a decision of the Court of Session on appeal?
I acknowledge the need to move quickly on the north-east medium-secure unit, which is integral to our overall plans. I assure Richard Simpson that plans are well in hand and well developed. It is important that I give full details of that to Parliament in due course.
I want to be clear on the issue about the legal responsibility of ministers. Under the 2003 act, patients can appeal against being held in conditions of excessive security. The appeal can ultimately go to the Court of Session, although no case has yet gone to that court. In such cases, if the tribunal or the Court of Session said that a patient was being held in conditions of excessive security and should be transferred, it is not the case that a minister would attempt to stop the patient being transferred. The minister's decision would be to assure him or herself that where the patient was being transferred to was appropriate. Approval has to be given by ministers before the transfer takes place, and approval has to be given to where the transfer is to. That is the safeguard that is in place. It is an appropriate safeguard, which balances the needs and human rights of patients with the duty and obligation of ministers to protect public safety. We have that balance in our system; Parliament said that that was right in the previous session, and I continue to think that it is right.
I welcome the continuity of policy on these matters, but I will question the cabinet secretary further about patients appealing against an excessive level of security; her colleague Shona Robison said that that was one of the most welcome parts of the bill when it was debated in the Parliament five years ago this month. To some extent, the cabinet secretary clarified the position in her answer to Richard Simpson. Is it not the case that the First Minister has to give consent to the specific place with a lower level of security but does not have the right to stop the transfer altogether? Does she agree that the First Minister was misleading Parliament when he implied that he could stop a transfer? Can she give a guarantee that the First Minister cannot stop a transfer when the Court of Session has demanded it?
I am disappointed that Malcolm Chisholm, whom I respect greatly, has reduced a serious issue to baseless allegations of members misleading Parliament. I make it clear that no patient, regardless of any appeal against conditions of excessive restriction, will be allowed to transfer out of the state hospital unless the minister approves the place to which they are transferring. The transfer would not take place without ministerial approval. That is crystal clear, and it is laid out in the 2003 act. The Parliament should accept that the act strikes the right balance between the human rights and needs of patients and the very important issue of public safety.
We have proper judicial oversight, which is exercised through the Mental Health Tribunal for Scotland and ultimately the Court of Session. However, we also have a role for ministers, who must undertake their obligation to ensure that, before any transfer takes place, they are satisfied that the proper arrangements are in place. I think that that is crystal clear, and I hope that all members agree.