Chamber and committees

On amendment 265, I acknowledge that the Scottish Government has pointed out that it is unusual for the Lord Advocate to have a role in developing statutory guidance, but I suggest that the issue merits such an approach. It is important to get the legal input of the head of the prosecution service on guidance into the bill ahead of its implementation. Has there been any conversation with the Lord Advocate about what is currently in the bill? Throughout the passage of the bill and the debate, I have returned to the need for medical staff who will potentially opt in to providing such services to have absolute confidence in the approach, which would be in guidance, rather than in the bill.

Amendment 288 would require Public Health Scotland to report on the health and social care services that were available to individuals who made a first declaration, including pain and symptom management and psychological support. That should also include reporting on the availability of information about accessing palliative care services to persons seeking an assisted death. I believe that that complements amendment 299, which we debated yesterday in group 15.

I thank Ross Greer for his advice. He managed to make me crash my computer, so I thank him for that as well. Luckily, however, IT staff are on hand.

I hope to use my amendments in the group to create a part of the bill that provides clarification, because members have had concerns throughout the debate about the advice on making someone comfortable and how that will sit in the bill.

Amendments 260 and 265 would require the Lord Advocate to be consulted on the development of statutory guidance on the provision of assistance under section 15. That would include what constitutes lawful assistance under section 15(4A) and distinguishes assistance from administration of the approved substance. I note that amendment 56 would pre-empt my amendment, but both amendments 56 and 265 seek to tidy up section 23(3A), which makes reference to a subsection that was not added to the bill at stage 2. I therefore urge colleagues to support my amendment 265 over section 56.

I lodged amendments 260 and 265 on behalf of the Royal College of Nursing Scotland to amend section 15. It is important that guidance is clear on exactly what is permitted and what is not permitted and, in particular, what constitutes assistance. That will require a level of clinical input, and it will also require legal input. We need to ensure that the practitioners who are involved in assisted dying are absolutely clear on what is legally permitted and what is not. That is why RCN Scotland is of the view that the Lord Advocate should have a role in developing and approving the statutory guidance governing the provisions around assistance.

Amendment 263 would require the statutory guidance that is produced by the Scottish ministers to include

“how the provision of assistance to terminally ill adults, in accordance with this Act should be arranged by health boards, including the development of patient pathways.”

Again, I lodged the amendment on behalf of RCN Scotland, which is concerned that, if the bill is passed, assisted dying will be part of the standard role for existing staff, such as district nurses, and existing teams will be expected to take on that role, which would not be safe or sustainable for the workforce or for those seeking to access assisted dying.

When a similar amendment was debated at stage 2, Stuart McMillan could not provide costings for holding a referendum. Does he have that information now that we have reached stage 3?

We have a good set of amendments in this group. I worked with Marie Curie Scotland on amendment 299 and on amendment 288, which is in group 20 and which we will come to tomorrow. One of my concerns about the bill from the outset has been the aspect that no one should choose an assisted death because they cannot access the care and support that they need. As we go through the process, that is one of the hardest aspects for anyone who will vote for the bill, because the number of people dying in Scotland is rising every year, and 90 per cent of them need some form of palliative care. I undertook my Right to Palliative Care (Scotland) Bill consultation with Marie Curie to look at how that can be improved.

It cannot be ignored that our palliative care and end-of-life system is currently in crisis, with significant inequalities in access to care, unmet need and highly variable quality and distribution across the country.

I thank Kate Forbes for that intervention, and I will come on to that point.

It is important to put this on record, because many people who have dedicated their lives and careers to our palliative care service have watched this debate, and I do not want them to think—as I know that some will—that we have spent any time talking the service down. They work across our communities to deliver for individuals and families at the most challenging times in their lives. They do amazing work, and we should all thank them for what they do day in, day out across our country. [Applause.]

We know that 18,500 people across Scotland each year die with significant unaddressed symptoms and significant concerns about their care, and that almost one in three people do not have their palliative care needs met.

21:15

To try to answer the Deputy First Minister’s question, I note that this debate is taking place ahead of an election and, in that campaign, we need to be honest—all of us, from all political parties—about what will be needed in the next session. It comes down to funding models.

After the election 10 years ago, I worked with Children's Hospices Across Scotland to lobby the then health secretary, Shona Robison, on match funding and I was pleased when she announced a 50 per cent funding package for CHAS. That funded hospice care for children across Scotland, and it was a really important step forward in meeting the funding needs of that sector. We have recently seen money put into the budget for that sector, but not what the sector asked for. The sector asked for £13.5 million to enable it to meet the agenda for change measures, but it did not even get that. If we cannot help it to match NHS funding, how can we look at the wider unmet need? There will be additional costs in future to meet the service needs that will be involved in enabling people to die at home, which is where people want to die. I hope that all our manifestos will be honest about that cost.

Whoever forms the Government after this election will have to seriously look at developing a new funding model for the hospice sector. What that sector does should not be brought into the NHS—I am not advocating that, as that would mean that the service would lose much of its quality as well as the personalisation of the service for families and individuals across our country. It needs an opportunity to meet that need on its own and to have access to safe funding models that will enable the service to be delivered in each and every one of our communities. I thank all the members who undertook local consultation exercises as part of the wider consultation that I undertook along with Marie Curie.

Amendment 299 would require there to be a five-year review involving Scottish ministers’ assessment of the

“availability, quality and distribution of palliative care services to people with palliative and end-of-life care needs”,

the

“availability of information to such persons about accessing palliative care services”

and the implications of the legislation that we are discussing for palliative care services. It would also require Scottish ministers to set out their assessment of the action that they intend to take in relation to palliative care services as a result of the review.

Regardless of the outcome of our deliberations on the bill, I hope that the current debate will provide a catalyst for further improvements to be made to the quality and availability of palliative care services across our country.

I do not have those notes in front of me, so I am not quite sure what the Government has said in relation to where the provision would sit.

As things stand, the review function sits only within section 27, and it is important that we look at expanding that. My understanding is that the review under section 27 would take place only every five years—it is not a panel to look at reviewing the detail of any death that does occur—so I do not think that the two provisions are comparable.

To try to answer the question, the establishment of the panel under my amendment would also then be reportable to the chief medical officer, which is where the Government would have a role in ensuring that that information is made available to ministers and to the wider public.

To conclude, I hope that the need for the establishment of the panel is clear. It is important, if the bill proceeds, that we understand the information and have it all made centrally available, in order for us to know how the bill is operating and to ensure that there is consistency. It would also enable our medical professionals to come together to review and discuss cases and make sure that everything that we have discussed, after sitting for a number of days now, is being looked at properly, that best practice is being provided and that we are learning as the bill is taken forward. If we do not have the opportunity to put in place the panel, as I said, we will not have all that, so I urge MSPs to vote for my amendment 293.

I note that Jeremy Balfour referenced the conversation that Finlay Carson mentioned previously. Medics have conversations with patients—often very ill patients—about “Do not resuscitate” orders, especially before they have surgery, if they might have to be resuscitated by medical professionals. Would Jeremy Balfour also not want those conversations to be able to take place? That would be concerning. We need to allow medical professionals to exercise their judgment, and I support people making sure that their views are known, as is currently the case, in relation to “Do not resuscitate” orders. I am not sure what his view is on those processes, which we already have in place, for medical professionals and patients.

Is the member referring to section 27 as it currently appears in the bill? I am trying to work out which part of the bill—

It feels as though there is a gap for medical professionals who would undertake this work in different parts of the country, in terms of understanding how learning and reviews will be implemented across Scotland. What does the member think that the bill can do to ensure that that is improved? I do not think that section 27, which proposes a review after five years, offers a strong enough process. The minister may touch on that in his remarks—he is shaking his head, so maybe not. It is important for medical professionals so that they would have confidence that reviews would take place and so that the learning can be taken forward.