Chamber and committees

In recent weeks, the Tertiary Education and Training (Funding and Governance) Bill went through its stage 3 process in Parliament. Most of the really good work that I have seen in schools has been around those who are disconnected from their education and are put on to a foundation apprenticeship. That bill abolishes foundation apprenticeships, which I know is a key concern for many members.

Whether or not some of the aspects of your report have been taken forward, do you think that there is a total vision for different models of learning in school, especially for those who will not necessarily be put forward for exams, or is it only piecemeal? A lot of good work is happening with the school-college partnerships, but it is not universal, which is where we are missing a great opportunity. Some of your report, in which you said that you wanted to see that work taken forward, does not really seem to have been prioritised by Government.

Good morning. Thank you for joining us. I have a quite open question to start with. Is there a clear understanding of what school education is seeking to achieve for all learners in Scotland? I ask that question because of some of the evidence that we have heard in different inquiries over the past year. For example, we heard about schools having part-time timetables of 15 minutes. I put that question out there: is there is a clear understanding of what we are trying to achieve in schools?

It is about final outcomes. I have met a lot of young people who have had a great school career and gone to university but are now working in Starbucks here in the capital. The jobs are not there for them. I have also met young people who were about to drop out of school but were given access to construction skills through apprenticeships or training and are now earning £36,000 a year working on building sites here in the capital. Aligning opportunities in school to where there are jobs in our economy is working sometimes, but, sometimes, it is clearly not. That is a big area that any vision needs to work backwards from.

However, that is me on my high horse.

11:30

The proposals for these amendments have come from the British Medical Association and the Royal College of Nursing. Both organisations are neutral on the principle of introducing legislation on assisted dying, but want to ensure that any legislation that may be passed protects the needs both of healthcare professionals, whether they choose to—or choose not to—provide assisted dying, and of their patients. If assisted dying were to be introduced by the bill, there would be a significant change for healthcare professionals. It is therefore vital that they are given the genuine choice about whether—and to what extent—they participate. That is why it is important to have an opt-in system, whereby only those who have positively chosen to opt in to provide the service are able to do so and it is not something that is expected of all healthcare professionals.

At stage 2, Liam McArthur, the member in charge of the bill, accepted that the bill should be based on an opt-in model, and tabled amendments aimed at bringing that into effect. An opt-in model has been accepted in other parts of the UK and in Crown dependencies, and all current legislative proposals in those jurisdictions are based on that opt-in model. In Jersey and the Isle of Man, the model is that doctors and nurses register their intention to provide the service. An opt-in model has several benefits. It reassures health professionals that they have a choice about whether they wish to participate and, if they do, the extent to which they do so. It protects the health professionals from being expected and/or persuaded to participate. It avoids healthcare professionals who do not want to participate—

This debate has demonstrated the heart of what many of us are balancing up. It is not just about those individuals who want access to an assisted death but about those who work in the field. During the time when I was consulting on my bill on a right to palliative care, one of the best parts of that job was meeting those who work in our palliative care sector and seeing both the passion that they bring to the job and their delicacy around the families.

Fundamentally, the bill aims to ensure that the wishes of the person who is dying are fulfilled. However, many individuals have expressed to me—and to every member in the chamber—that, if the bill passes, they will not want to be involved in some of that work. Like other members who have lodged similar amendments, I want to make sure that the bill includes that voice, because, fundamentally, it must.

With that in mind, I press amendment 142.

Everyone is talking about hospices, but this point does not just concern hospices. Most people concerned are at home. That is where the vast majority of people want to die; they are telling us that that is their wish.

Under Mr Mason’s amendment 231, would he not expect people to be supported at home by the same organisations? Would that just be within the hospice boundaries? If that is the case, the capacity that would be removed to care for people at home would be vast. I am not quite sure what Mr Mason is trying to achieve through his amendment.

To pick up where Jackie Baillie left off, the regulation of training for authorised health professionals is a devolved issue. I will support all the amendments in group 5, which do exactly what we want: they ensure that training opportunities are put in place.

Like Jackie Baillie, I have been working with CHAS, and my amendment 147 would ensure that, if Scotland legalises assisted dying, any professionals who are involved in eligibility assessments, information provision or application support have the specialist training that is required to work safely with adults aged under 25. Young adults often receive paediatric or transitional care, including from CHAS, and present with unique clinical, developmental and social needs.

Why is such protection needed? Evidence that was given at earlier stages of the bill process shows that assessing capacity in young adults with complex conditions is challenging and demands specialist expertise. Coercion might be harder to identify due to reliance on family and carers for communication and support. Uncertainty is also greater among young adults, which makes terminal illness harder to determine. Such decisions carry irreversible consequences and require consistently high clinical standards.

Amendment 147 would establish mandatory minimum national training standards that would include: assessing capacity in young adults with complex or fluctuating conditions; identifying subtle or relational coercion that is often experienced by young disabled adults; understanding the prognostic uncertainty that is associated with rare or unfamiliar conditions in people under 25; communicating sensitively with families during emotionally complex decisions; and signposting palliative, hospice and home‑based care options across Scotland. Those standards would ensure that assessments are safe, informed and nationally consistent. Jackie Baillie touched on why that matters. Young adults’ illnesses and trajectories are often unpredictable and do not match adult timeframes. Many experience fluctuating capacity, communication differences or different periods of stabilisation in their conditions. That makes eligibility assessments particularly difficult and increases risks of misinterpretation and safeguarding issues.

Amendment 147 would ensure that training standards are developed through expert consultation that is led by the chief medical officer. They would be reviewed every three years to reflect new clinical evidence and supported by guidance to be published when regulations commence. If the Parliament legalises assisted dying, the safeguards would ensure that young adults’ assessments are safer and more ethical and consistent.

This is why the drafting of amendment 142 has been modelled on the provisions in the Mental Health (Care and Treatment) (Scotland) Act 2003, which Parliament passed. That set up a register of approved medical practitioners who can carry out particular roles, which demonstrates that that approach is within the competence of the Scottish Parliament, and that is exactly how I have modelled my amendment 142. I believe that the proposal is within the competence of Parliament and that it would offer the opt-in model that we are all trying to achieve for the bill.

I totally recognise that there is sometimes a psychological difference between participation in assisted dying being something that could be expected of all health professionals—unless they use formal processes of opting out—versus it being expected only of those who have chosen to opt in. I welcome the recognition of the importance of that to health professionals, but the bill does not currently say explicitly that it is an opt-in system. I have very much heard from the BMA and RCN that their members are concerned that the opt-in provision needs to be fully transparent and that they need those reassurances in the bill. In addition to providing that—

It is not an opt-out model that I seek, but an opt-in model. The 2003 act is the only clear piece of legislation that the Parliament has agreed to that has established such a register for healthcare professionals, which is why I sought to model the amendment on it.

Other options would have been available. I was part of the Health and Sport Committee—I think that Clare Haughey was as well—when it dealt with the Human Tissue (Authorisation) (Scotland) Bill and considered the issue of how we could get a group of healthcare professionals to undertake the work that the legislation was concerned with. However, I think that amendment 142 would provide the cleanest possible approach, which is to establish a register that people can opt in to. The amendment would provide clarification and reassurance by ensuring that an opt-in for healthcare professionals is explicit in the bill, allowing for patients to identify and be directed to a doctor who would fulfil the role of a coordinating registered medical practitioner. In the long term, the register would also help health boards to accurately map the staff who are available locally to provide assisted dying.

I do not accept that. The 2003 act set up a registered group of approved medical practitioners to carry out a particular role. I do not see any problem in what I am proposing, which is to provide a similar register for those who would take forward work on assisted dying. Amendment 142 would provide an opt-in system for the medical professionals who will be looking to the Parliament to provide clarification, and I think that that would be within the competence of our Parliament, which is important.

I urge members to vote for the establishment of such a register. We need to make an opt-in system explicit in the bill to provide assurance, which is needed by the healthcare professionals who would positively choose to participate and by patients who would be able to know that they are being cared for by those who want to be involved in assisted dying and who are appropriately trained and supported to do so.

I move amendment 142.