Mental Welfare Commission Report
The next item of business is a statement by Susan Deacon on the Mental Welfare Commission for Scotland report. As the minister's statement will be followed by questions, there should be no interventions.
Please proceed to your statement right away, minister. [Interruption.] I say to ministers collectively that we have more than one lectern in the chamber, and it would be easier for them to make use of a second one, rather than shifting places. Let us begin.
I am grateful for this opportunity to make a statement to Parliament on the Mental Welfare Commission's "Report of Inquiry into the Care and Treatment of Noel Ruddle". As members will recall, we took swift action to close the legal loophole following Noel Ruddle's discharge from hospital last summer.
As part of our thorough review of this case, I asked the Mental Welfare Commission to conduct an inquiry into aspects of the care and treatment that Mr Ruddle received in the state hospital between 1994 and 1999 and to provide a report with recommendations. I am grateful to the Mental Welfare Commission for carrying out such a thorough inquiry. I received its report two days ago, and made it publicly available today. Mr Ruddle also received a copy of the report today.
I welcome the commission's report, which sets out clearly what happened, recognises that some changes for the better have already taken place and offers practical recommendations to improve further the situation for the future. It does not seek scapegoats, it seeks only solutions, an approach that I endorse. As we strive to keep improving the quality of care and treatment, we must be willing to examine past practice and experience openly and critically, to learn and to make changes for the better.
Few of us face jobs as daunting as those of the many dedicated professional and other staff who run our state hospital and who look after patients there. Day in, day out, they are asked to balance the safety and security of the public with the care and treatment of the individual. The report makes it clear that, in the case of Mr Ruddle, certain psychological therapies, such as anger management and therapy for substance misuse, were not secured for him by the state hospital. In addition, security concerns caused inappropriate restrictions to be imposed on him. The commission's chief finding is that the combination of those factors led to a deficiency in care.
In the light of that and other findings, the commission made 12 recommendations, most of which relate to the state hospital. The commission recommends that the hospital's board of management should acknowledge that there was a deficiency in care, carry out a review of communication between security and clinical teams and examine its management systems. It is recommended that the hospital's clinical board make changes in the organisation of specialist psychological therapies and take other steps in relation to the care of individual patients. The commission recommends that responsible medical officers in the state hospital should have all security, medical and other information relevant to patients in their care made available to them.
This afternoon, I give an assurance to the chamber that I am determined to work with the state hospital management and clinical staff to help them to implement in full those recommendations. I told the chairman of the state hospital's board that I expect action to be taken without delay, and that a full report should be submitted to me within six months.
I have also asked Professor Brian Edwards to work with the state hospital's board to push through those changes as quickly and as effectively as possible. Professor Edwards brings with him a wealth of experience in health care management including his recent membership of the committee of inquiry, known as the Fallon inquiry, that investigated the operations of the personality disorder unit at Ashworth special hospital. He will be able to call on further clinical resources if he feels that they are necessary.
The commission has made other recommendations through the Scottish Executive to the Millan committee, which is currently reviewing Scotland's mental health legislation. It also recommends a review of the current procedural memorandum for dealing with restricted patients, and consideration of the development of a national care plan to assist in the planning and provision of community care for certain patients discharged from the state hospital. The Scottish Executive will act on all those recommendations.
I have written today to Mr Bruce Millan, asking him to convey to his committee the commission's suggestions for legislative review. I am also making the report available to the MacLean committee, so that it may consider it as part of its work on the sentencing of personality disordered offenders. Work is already in hand in the Scottish Executive to review the procedural memorandum on restricted patients. We will consider how we might develop a protocol for handling such cases in future and will develop that with local authorities and other relevant interests.
The commission's final recommendation is that its own co-ordination of information received on the state hospital, and the way in which potential deficiencies of care are identified, should be reviewed. I am determined to act quickly on the findings and recommendations of the report to ensure that the changes that are needed happen.
The action that we are setting out today will confirm our determination to achieve the right balance between security and care in the state hospital. That will help to ensure that its reputation for being at the forefront of similar facilities in the UK is maintained. We need appropriate levels of care for each patient—care that is secure, flexible enough to meet changes in need and best able to tackle the disorder, so that the patient and the public benefit.
Like other national health service bodies, the state hospital management and staff expect to improve the quality of the services that they provide year on year, and much progress has been made in recent years. The recommendations in today's report are essential steps in that continuing process of improvement. I have made it plain to the state hospital's board that supporting and encouraging the hospital's staff will be vital in making the important further changes recommended by the commission.
The Mental Welfare Commission's report has been published in full. That approach is consistent with our commitment to deal with such matters in an open, honest and transparent way. The report raises sensitive issues about a complex service. I hope that members, the media and the general public will recognise that complexity and support us in our aim of improving services, informed by this report.
The minister will now take questions on the issues raised in her statement. I intend to allow up to 20 minutes for such questions, after which we will move on to the next item of business. Members who wish to ask questions should press their buttons now.
I am grateful to the minister for the cross-party briefing that she provided earlier today. As she said, we have only just received that complex report and it will be some time before we have fully absorbed the details. I welcome her statement, particularly in relation to the issues surrounding the state hospital. I support the quick action that she has taken and I welcome the fact that the chairman of the state hospital's board will be reporting progress to her within six months.
Does the minister share my concern that the report again raises the question of treatability and whether treatment could have been delivered elsewhere in the system? Does she agree that we must never allow ourselves to forget that the state hospital at Carstairs, although it is a secure hospital, is a hospital none the less, and that a hospital should be in the business of providing treatment, not simply containment?
I thank the minister for the inclusive approach that she has taken on this occasion. In that spirit, will the minister consider making available to the Health and Community Care Committee the report from the state hospital, to allow the committee, and this Parliament, to play a constructive role in ensuring that the changes that are outlined in today's report are brought to fruition?
I thank Kay Ullrich for the constructive nature of her comments. A number of the points that she made demonstrate the sensitivity and complexity of these issues. The difficult challenge that is facing us all, and which is certainly facing management and staff in the state hospital, is to reach an appropriate balance between security and care.
It is fair to say that as a society we have moved a long way on these issues in recent years, as has the state hospital, and it should be commended on that, but this report demonstrates that there is still a long way to go. Much can and should be done to improve the treatment and care of all patients in the state hospital. I endorse Kay Ullrich's emphasis of the fact that the individuals that we are talking about are patients and that they deserve the highest standards of care and treatment that we can offer.
I am happy to agree to come back to members and to the Health and Community Care Committee with further details of how the report's recommendations will be implemented. The recommendations require action on the part of the state hospital, the Scottish Executive and the Mental Welfare Commission. Of course, some recommendations will be implemented more quickly than others, but I hope that we can adhere to the general principle of discussing these matters further.
I hope also that the tone and substance of today's comments will serve us well in the future when we look at the wider issue of mental health legislation, which will be a challenging and important subject for this Parliament to address. I look forward to parties across the chamber addressing the issue in the months and years ahead.
I also welcome the Mental Welfare Commission's report on the care and treatment of Noel Ruddle, and the honesty, openness and transparency of the minister. Problems have to be identified before addressing them. I will ask my questions in the light of the report and the positive and constructive way in which it has been delivered.
Given that the deficiencies in Ruddle's care have been identified and addressed in the report's recommendations, and in the light of the Scottish Prison Service's announcement that it is to put general medical services out to tender, will the minister consider extending the system of assessment and health therapies to those in Scottish prisons, many of whom suffer similar problems to those identified in the state hospital?
Given the Ruddle experience, will prisoners throughout the system receive the same standards of health care and appropriate treatment for their problems? That would help to address the high rates of reoffending by concentrating on treatment and rehabilitation, not just containment. Will the health care in Carstairs and our prisons be of the same standard as in the rest of Scotland? The British Medical Association requested that in its response to the announcement by the Scottish Prison Service.
Finally, there should be an integrated and seamless service for the continued care of ex-prisoners and ex-patients in the community, not only to ensure health care for prisoners, but to assure the public on safety.
I thank Mary Scanlon for her constructive comments and questions. All the points that she touched upon are relevant, and I will attempt to respond to each of them briefly.
First, I will comment on the relevance of the report to other parts of the public sector. It is important that as we conduct such exercises, we ensure that experience and information is shared. Although the report focuses specifically on the state hospital and the matter of restricted patients, I am sure that there are wider lessons that can be learned from it by other parts of the public sector. We will make the report more widely available.
I should stress that the state hospital is part of the NHS and is distinct from prisons, which are managed by the Prison Service. We will, however, share information as we ought when lessons on good practice can be learned.
Mary Scanlon made a point about the importance of attempting to achieve integrated and seamless care—that is crucial. It is also covered in the report and it is a subject that we discuss often in relation to health and community care generally. One of the keys to successful delivery to patients of effective services in future is to ensure that the different parts of the system are connected. That comes through in the report in relation to restricted patients.
Finally, the other issue about integration and working together that is emphasised in the report is the importance of multi-disciplinary working and effective team working that is centred on the patients in the state hospital. Good progress is being made on that, and progress must continue in the state hospital. That is the direction that I want to encourage throughout the NHS.
I thank the minister for her statement and for her positive actions to date on the matter. I also welcome the Mental Welfare Commission's report on what is, as colleagues have mentioned, a sensitive and complex subject.
The Executive has a duty to protect citizens, but it also has a duty of care to patients while they are in the state hospital and on their release. It is worrying that the report finds that there was a deficiency in Mr Ruddle's care, but I am sure that the lessons that must be learned will be learned. Those lessons are outlined in the report's recommendations. The Health and Community Care Committee will welcome the opportunity to play a full part in any future monitoring of the recommendations.
I have a couple of questions raised by points that the minister made in her statement. There are a number of other reports that we await with keen interest, especially the reports from the MacLean committee and the Millan committee. How will the report from the Mental Welfare Commission fit in with those, and how does the Executive intend to monitor progress on the recommendations in that report?
I thank Margaret Smith for her comments and I welcome the fact that every speaker this afternoon has stressed the importance of restricted patients getting the standard of care and treatment that they deserve. While security and public safety are key issues, they should not be achieved at the expense of an individual's right to a high standard of care and treatment.
Margaret Smith made points about further discussion on the report and further action on its recommendations. The report is being issued to both the MacLean committee and the Millan committee so that it can inform their work. The MacLean committee will report to ministers relatively soon and the Millan committee report is expected some time in the summer. Both reports will be important watersheds in our consideration of the wider issues.
As far as continuing discussion and debate on the issues is concerned—I will, if I may, return to a point that was made by Kay Ullrich—there is always a question of judgment regarding the appropriate gap between publication of a report and the time at which it is discussed in Parliament. Members must have time to consider various matters, but I stress that we see this as the start of a process of improvement and discussion.
I will be happy to receive further questions and correspondence from members if there are matters that they want to raise after today's debate. I am sure that the Health and Community Care Committee will also want to discuss the matter further.
Another five members want to ask questions. It might be possible to fit them all in if questions are kept short and specific.
As the constituency member for the state hospital, I welcome the minister's statement and the positive recommendations in the report. It is a significant development for the state hospital and the care of patients.
Will the minister agree that the staff work in difficult circumstances, which many of us in the chamber could not even begin to understand? Will the minister indicate, as detailed in recommendation 4, that appropriate training, support and supervision will be given to all staff in the hospital? What steps will the Scottish Executive take to ensure that communication between staff and management improves, as it directly affects the care of patients and has clearly done so in this case?
I am conscious that, yet again, I will start an answer with words of congratulations, but I feel that it is appropriate. I welcome not only Karen Gillon's question but also the fact that, as the local constituency member for the state hospital, she has played a constructive and effective role in liaising with the hospital and assisting the local community's relationship with the hospital.
I recognise the difficult job that is done by all the staff—not only clinical staff—who work at the state hospital. I visited the state hospital recently and spent considerable time in discussions with a range of staff and patients. It is a difficult and challenging environment in which to work. That is why I am so keen to ensure that we take forward the work that flows from this report on as constructive and managed a basis as possible.
The issues that Karen Gillon raises in relation to training and communication lie at the heart of moving those recommendations forward. The actioning of many of those matters will be for the state hospital management to take forward as part of their local action. I will ensure that the Scottish Executive supports and facilitates that as far as possible. We have placed considerable emphasis, in our national efforts, on improving investment in training and development for all NHS staff. Similarly, we are working hard to improve communication across all parts of the service. If we can work in partnership with local management at the state hospital to facilitate that process, I will certainly want to do so.
At the risk of putting the minister into a state of severe shock, I also thank her for the helpful tone that she has taken throughout the publication of this report.
The report settles the argument that was basic to the debate about treatability that we had, all those months ago, as to whether Mr Ruddle was not capable of receiving treatment or whether treatment was available. Will Susan Deacon tell us what additional steps are being taken, before the national care plan that this report mentions, to identify other individuals within the system who might be in a similar position now that this report has identified that there is a problem?
What is the Executive's view on the recommendation made in the report that an independent body should assume the powers and responsibilities of Scottish ministers in relation to restricted patients? An indication of where the Executive stands on that would be useful.
Duncan Hamilton's point about the bearing that this report will have on other individuals and the steps that will be taken to ensure that similar deficiencies do not occur is an important one. The difficulty is that it is impossible to give a general answer to that because, by its nature, each case is different.
What is important is that the recommendations contained in the report, specifically recommendation 4 I think, set out the steps that need to be taken, within the hospital, to ensure that the appropriate processes are in place to deal with each case in an appropriate way and to make appropriate therapies and treatments available. Remember that this report covered a period from 1994 to 1999. Progress in those areas has been made over that time, but we want that to continue.
On the point about the handling of restricted patients, and the possibility of an independent body considering certain decisions in future that are currently taken by ministers, I stress that the existing practices in this area are laid down in statute so any change made in the future would be through statute. Again, that will be for the MacLean and Millan committees to advise and this Parliament to consider.
While I welcome the minister's statement that there have been substantial improvements at the state hospital, will she give an assurance that those patients who have taken a life will only be released under supervision?
I must repeat the general point I made in my answer to Duncan Hamilton: every individual case is different. It is complex terrain. Our particular emphasis today is on health care but, as I know James Douglas-Hamilton is aware, there are important legal issues. The MacLean committee is looking at sentencing mentally disordered offenders whereas the Millan committee is looking at mental health legislation. I do not think that we can give short, general answers to questions such as that posed. Each individual has a different disposition and clinical condition. The most important thing is that we have a robust legal framework and the health services to deal effectively with each individual case.