Chamber and committees

Amendments 73 and 84—amendment 84 is consequential—are to make it clear that a person is not considered terminally ill solely because they have a mental disorder.

Amendment 73 reflects the position of the Royal College of Psychiatrists in Scotland that mental disorders such as anorexia nervosa should not be classified as terminal conditions under the bill. It provides clarity and reassurance that the bill does not open the door to assisted dying for individuals whose suffering arises from mental illness alone. I believe that that safeguard is vital to prevent misinterpretation and to uphold the integrity of the bill’s intent, which is focused on those with a qualifying terminal physical illness.

I heard Liam McArthur’s earlier comments and, as amendment 24 captures the intent of my amendment, I will not move amendment 73.

No, I am not proposing a separate regulatory body; I am leaning into the current arrangements, and I am allowing for the circumstance that assisted dying might not be entirely delivered by the NHS, which is the case in other countries. It is a belt-and-braces approach that aims to make sure that we have the right regime in place, so that we are satisfied with the levels of scrutiny and regulation. I hope that that is clear.

Amendment 62 would allow the Scottish Government to bring forward regulations to prevent an assisted death from taking place in certain settings—for example, in care accommodation for people aged under 18, in a care service that is used primarily by children, in a drug and alcohol rehabilitation centre, in supported accommodation for people with mental health illnesses or in a women’s aid refuge. Those are all registered care settings, but providing assisted dying in them would clearly not be appropriate.

I also anticipate that the regulatory framework could make situations in which a person is asked to undertake an assisted death in a public place or outdoors a sensitive issue. The Scottish Government should bring forward the details in due course through secondary legislation. I also anticipate that secondary legislation will clarify whether the service can be provided privately on a for-profit basis. There are already legislative prohibitions on other types of care providers—for example, adoption agencies—operating for profit in Scotland.

In summary, the amendments are about ensuring that we have the right safeguards in place, that we allow only reputable and regulated organisations to be involved, and that a standard is set, that there is oversight of it and that we align that standard to existing bodies such as Healthcare Improvement Scotland and the Care Inspectorate, with which we are all familiar. I hope that members can support amendments 62 and 63, which provide for affirmative regulations.

Amendments 62 and 63 were lodged after discussion with CHAS—Children’s Hospices Across Scotland—which runs Robin house children’s hospice, in my constituency. The bill does not contain any details of the regulation, scrutiny or inspection of organisations that would provide an assisted dying service, nor of the reporting on the processes that they would operate. All of that happens in other types of care, so this would represent an unprecedented lack of regulation and scrutiny.

The requirement for regulatory arrangements needs to be made explicit in the bill, because we all want to ensure patient safety, and the quality of the service is a paramount consideration. Healthcare Improvement Scotland and the Care Inspectorate already ensure that non-NHS services are run by fit and proper people. They already have statutory powers to secure patient safety and significant experience of regulating the provision of social care and healthcare outwith the NHS. They are also accountable. To be clear, the amendments would not in any way prevent an assisted death in a person’s home; they would simply ensure that the organisation supporting that, if it was not an NHS service or a GP practice, met all the standards and was safe.

I am capable of many things, convener, but that level of detail is not in my gift. I will be happy to provide the information later.

I am going to attempt the impossible, which is to try to get the committee to keep the petition open. As you rightly pointed out, the Wishaw neonatal unit was the best neonatal unit in the country—not Scotland, but the whole of the United Kingdom—in 2022. For some reason, the Scottish Government then decided that it should close.

You are quite right to reference an earlier report that was presented to the Scottish Government, which recommended that there should be three to five neonatal units to cover Scotland, instead of the seven or eight that we have now. Nobody disagrees with that. What we disagree with is that the Scottish Government opted to go for three units—one in Glasgow, one in Edinburgh and one in Aberdeen—and that Lanarkshire, the third-largest health board, which covers a population of 655,000 people, would have its neonatal unit removed. I have to say, in contradiction to what the minister contends, that the evidence was partial. There was no voice from NHS Lanarkshire sitting around the decision-making table, but there were representatives from Glasgow and Lothian.

The thing that we need to hold on to is that the Wishaw neonatal unit does not only deal with mums and babies from Lanarkshire; it deals with those covered by Greater Glasgow and Clyde, because the two Glasgow units that are currently there do not have enough capacity to cope with the mums and babies from Glasgow. Lanarkshire plays a key role for the whole of Scotland. It has been said that when the Wishaw neonatal unit closes and mums and babies cannot go to there, to Glasgow or, potentially, to Edinburgh, Aberdeen could be the default.

We think that there is not enough capacity in Glasgow to cope, so you would be putting the sickest babies in ambulances to make the two-and-a-half to three-hour journey to Aberdeen to be seen. It is entirely ridiculous, not just because of the risk, but because the sickest babies are likely to be in hospital for long periods. What happens to the mums and families who are rooted in their community in Lanarkshire? How do they spend time with the baby up in Aberdeen? That would be impossible and impractical.

It is not only the families who are very pragmatic in resisting these changes; it is the clinicians as well. The committee saw that very powerfully in its visit to the unit.

The solution, if I can posit one, is that we should have four units. It is common sense—it is not rocket science. I wonder whether we could invite the committee to write to the Government to suggest that it pauses any changes, that there should be a fully independent review and that it should consult the clinicians and the families affected in more than just a tokenistic way. Perhaps the committee could even invite the minister to come before the committee.

That would be a valuable conclusion to the committee’s visit. To be frank, if we do not keep the petition open, the Government will downgrade the neonatal unit between now and May, and that will not benefit anybody.

Absolutely. Not you, convener—the Government.

Well, what can I add to what you have already said, convener? You have been tireless in pursuing this petition, and you, the former health secretary Alex Neil and my colleague Neil Findlay campaigned alongside the mesh-injured women and championed their cause. Clearly, you continue to do that.

I concede that the Government has taken some action. There is a specialist clinic and access to mesh removal abroad, but waiting lists remain too long, and some women are still waiting. For me, the issue is the continuing use of mesh, whether it is in hernia operations or others.

I am persuaded by your efforts and by the response from the petitioners that we should keep the petition open, because the information is outdated. It is clear that your meeting with the First Minister was very welcome, but it throws up some gaps that I hope the committee will explore further.

I suggest that we keep the petition open, because the job is not yet quite done. On that basis, I commend the committee to do exactly that.

Patient experience tells me that that is not happening on the ground in a real way. When might we expect that to make a difference that people can see?

I very much agree with what the cabinet secretary said, but where is the evidence that that is happening on the ground? It is not happening in my area or in other areas. How do we stop people entering the system when they are experiencing a greater degree of crisis and trying to access services that are either not there or under such strain that they cannot cope with what is coming at them?

I think that everybody would support having community link workers in deep-end practices and elsewhere. However, the truth is that, because there was not a dedicated income stream, Glasgow ended up cutting the number of community link workers that it had. West Dunbartonshire did, too, and I am sure that that was the case in other areas as well.

How do we ensure that the things that you are describing are actually there on the ground, when there is not a dedicated funding stream to support them?