Mental Health (Emergency Detention)
To ask the Scottish Government how it will increase protection for people subject to emergency detention under the Mental Health (Care and Treatment) (Scotland) Act 2003. (S4T-01282)
Emergency detention under the 2003 act is permissible only where it is necessary as a matter of urgency because of a significant risk to the health, safety or welfare of the patient or the safety of others. Medical practitioners are required to seek agreement from a mental health officer, unless it is impractical for them to do so, for example, where there is immediate, serious or life-threatening danger to the patient and/or others around the patient.
I am concerned by low levels of involvement by mental health officers in some areas, as identified by the Mental Welfare Commission for Scotland in its annual monitoring report in September 2015. Consent by mental health officers is an important safeguard, and it is essential that local authorities ensure that they have the appropriate levels of staff in place to meet statutory duties.
I am pleased to note that the Mental Welfare Commission has plans to meet one health board where this appears to be a particular issue, and I look forward to hearing the outcomes of that engagement. I have also asked the Mental Welfare Commission to undertake analysis of the reasons why the medical practitioner has reported that it was impractical to consult a mental health officer. Separately, I have asked the Scottish Government’s chief social work adviser to investigate issues to do with the shortfall in mental health officers in local authorities with chief social work officers, and I expect him to report back by the end of April.
I thank the cabinet secretary for her helpful reply. According to the Mental Welfare Commission’s most recent report, 45 per cent of the people who were detained under emergency detention system in 2014-15 did not have the consent of an MHO, which was an increase from 42 per cent in the previous year and 37 per cent in the year before that. We are in a deteriorating situation, to which the Mental Welfare Commission has drawn attention in repeated reports. Given that new funding is coming forward, will the cabinet secretary consider allocating additional funds to local authorities to recruit more mental health officers?
I recognise Richard Simpson’s interest in the matter. As he pointed out, the Mental Welfare Commission highlighted such issues in its report “Mental Health Act Monitoring 2014-15”. For example, it noted that the increase in emergency detention is “largely due” to an increase in use of the 2003 act to admit older people to hospital but said that the reasons for the rise in compulsory treatment are “unclear”.
The commission made the important point that, wherever possible, a short-term detention certificate should be granted in preference to an emergency detention certificate, given the additional protection for the patient that a short-term detention certificate provides.
There are therefore a number of issues that we need to consider and understand better. That is why, as I said, I have asked for a number of pieces of work to be done to look at the issues, identify the reasons for them and, more important, consider what action we can take.
Richard Simpson asked about the resources that have been allocated to health. Over the next five years, additional resources of £150 million have been allocated. Richard Simpson will be aware that there is a clear separation between the role of mental health officer, who is employed by the local authority, and the national health service, for the good reason that an MHO might investigate issues in the NHS. Although I would normally point to integration joint boards as the territory on which issues can be resolved, the issue is more complex, because of the potential for conflict of interest, about which we need to be quite careful.
If, when we have the reports, they point to specific action that needs to be taken and which requires an element of resourcing, I will of course consider whether further work is needed in that domain. We should wait and see what the issues are first.
I commend the cabinet secretary for both her replies, which indicate her concern about a problem that has been getting worse.
Another aspect, which I always raise in this context, is variation between boards, to which the cabinet secretary alluded in her first answer. The Mental Welfare Commission said:
“It concerns us that in Greater Glasgow and Clyde, the area with the highest use of emergency detention in Scotland ... the proportion of EDCs with consent is even lower this year (28%) than last year (37%).”
We should remember that emergency detention certificates tend to be used more in deprived areas. When 72 per cent of people are not getting an MHO, the matter requires fairly urgent attention. I understand from the cabinet secretary’s first answer that the commission will have a close look at that issue.
Yes. A number of local authorities responded to inquiries, which were in newspaper reports at the weekend, about their number of MHOs and how their services are organised. Richard Simpson is right to highlight the particular concern about local authorities in the NHS Greater Glasgow and Clyde area, which is why the Mental Welfare Commission plans to meet the board to consider what lies behind the figures and, more important, what action can be taken to overcome some of the concerns that he raised. I will be happy to keep Richard Simpson informed of the discussions and, more important, their outcome.
The shortage of mental health officers has been an increasing problem for some time. It is not a legal requirement for a mental health officer to be present for a patient to be sectioned, but it is an important safeguard and best practice. Will the Government consider making input and support from a mental health officer a legal requirement to ensure that there is such input when a patient is sectioned? Will it ensure that the number of fully trained and suitably qualified officers is increased to fill the gap?
I understand Mary Scanlon’s concern. On the shortage of mental health officers, there are issues around the requirements in relation to skill level and qualifications that immediately reduce the pool of people who are available. There are some issues there with the ability to recruit mental health officers. We need to look at that, and I am keen to look at what more can be done to expand the interest in that career.
We have to be cautious about the legislative suggestion that Mary Scanlon made because, as I set out in my original answer, where there is immediate, serious or life-threatening danger to the patient or others around them, it would be wrong to have to wait for a mental health officer’s involvement. In such a situation there are immediate concerns about welfare and safety and we can understand that, sometimes, things have to move quickly. However, it is best practice to involve a mental health officer. It is about getting the right balance so that we do not restrict action from being taken that is required for the immediate safety of the patient and, potentially, others around them, but we encourage the best practice of involving a mental health officer.
Again, I am happy to keep Mary Scanlon informed about the discussions that will be taken forward with the Mental Welfare Commission and the chief social work adviser.
Glasgow to Edinburgh High-speed Rail Link
To ask the Scottish Government what its response is to reports that plans for a high-speed rail link between Glasgow and Edinburgh have been shelved. (S4T-01281)
The plans have not been shelved. I refer the member to my recent written answer to a question on the issue from Tavish Scott, in which I made it clear that it is not possible to progress planning for a high-speed rail link between Edinburgh and Glasgow further until a cross-border high-speed route is identified. Once that happens, we can consider the integration of plans.
The Cabinet Secretary for Infrastructure, Investment and Cities has made it clear—in public at the high-speed rail conference in Glasgow last September and in the chamber in response to a direct question from Willie Rennie on 24 February 2015—that connecting Edinburgh and Glasgow with a high-speed rail link is inextricably linked to the route options that come from the south. The joint work that is being undertaken with the Department for Transport to identify route options for extending high-speed rail into Scotland is nearing completion and the cabinet secretary fully expects to be in a position to share the findings in the coming months.
The Scottish Government grandly told us that the high-speed rail link between Glasgow and Edinburgh was not dependent on the United Kingdom scheme. It said that the link, with journey times of just 30 minutes between Glasgow and Edinburgh, could be built independently by 2024, 10 years ahead of any UK plans. Nicola Sturgeon said that Scotland would “fire ahead” and would “not wait” for Westminster. When was the minister planning to tell us that the Scottish Government is waiting after all? Glasgow to Edinburgh journey times will not be 30 minutes by 2024, will they?
On the sharing of information with Parliament, I have answered a parliamentary question, but even before that, there have been a couple of debates. One was in committee with Keith Brown, who was then the Minister for Transport and Veterans, in answer to Alex Johnstone on 5 February 2014, which explained the position. There is also investment in the Edinburgh to Glasgow improvement programme, which is very much under way, and Keith Brown explained the position in answer to Willie Rennie on 24 February 2015. The position has been shared in the chamber and in an answer to a parliamentary question.
The infrastructure investment plan says in a number of sections that we still have the ambition for high-speed rail, but I have said that it makes sense to see what is proposed on high-speed rail coming from the south. That work is being undertaken in partnership with the UK Government and, as I have said, the cabinet secretary will say more in the coming months about how we are working with the UK Government on high speed 2.
When the position was outlined in 2012, there was no commitment from the UK Government—there was not even a suggestion—that high-speed rail would come to Scotland. In fact, the commitment was simply to take high-speed rail from London to Birmingham, Manchester and Leeds by 2032. With its partners and stakeholders, the Scottish Government advocated the case for bringing high-speed rail to Scotland, and we have worked in partnership with the UK Government to progress that. There is now an opportunity to integrate our stated ambitions and aspirations in a sensible approach that requires working in partnership.
I do not understand why the then Deputy First Minister, who is now the First Minister, announced at Glasgow central station that in just 12 years the journey time between Glasgow and Edinburgh would be cut to less than half an hour. We now know that that was simply overblown hyperbole and rhetoric in the extreme. We need to know why the scheme has been cancelled or shelved. The minister had the business plan back in September 2014—will he now publish it?
I have said that the cabinet secretary will over the coming months outline the findings of our joint study and our work. Our work with the UK Government should not be pre-empted. As I said, our aspirations for high-speed rail to connect Glasgow and Edinburgh can be integrated with the proposals that are coming from the south. That is a sensible approach, and the cabinet secretary will outline the findings from the work on that.
We still have aspirations for high-speed rail, and I have covered how the issues have been discussed in Parliament before—in response to Willie Rennie in the chamber and in response to Alex Johnstone in committee. I am happy to share the notes that I have on the approach that the Government is taking. It is not news and it really is not new.
As for on-going investment in rail, Willie Rennie will be aware of the Edinburgh to Glasgow improvement programme, which has received more than £700 million of investment for the whole package. It will improve journey times as well as investing in new rolling stock and new stations. The Scottish Government is investing in rail, particularly between the cities of Glasgow and Edinburgh, but there is more to come in terms of high-speed rail from our working in partnership with the UK Government through the Department for Transport. I would have thought that Willie Rennie would appreciate that kind of partnership working, given that he is a constructive and consensual figure. The cabinet secretary will say more about high-speed rail in the next few months.
Regardless of where the high-speed link crosses the border—whether that is on the east coast or on the west coast—surely a high-speed link between Edinburgh and Glasgow will be integral to completing the system. Is it too difficult to go ahead with that project earlier instead of waiting to see where the high-speed link comes in?
It is interesting that both members who have been given answers before are back to express surprise at the answers now. When he was the relevant minister, Keith Brown said that it makes sense to consider both proposals. If there are options to connect high-speed rail to Edinburgh and Glasgow, or to one city and then to connect both cities, surely it is right that we assess our proposals for Edinburgh and Glasgow in that light and that we integrate them with what is proposed for high-speed rail that comes from the south. That is a sensible and fair rationale for spending public money and it will mean that we make the right assumptions and take the right options.
As I said, once the cabinet secretary is in a position to report to the chamber following the completion of the work that we are doing with the UK Government, we will see a sensible way forward. Our aspirations to bring high-speed rail to Scotland have not changed, and we will continue to invest in rail and the high-speed connections. That is clearly expressed in the infrastructure investment plan.
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