Chamber and committees

Clinical research in any area which may potentially have implications for clinical practice is considered by The Scottish Intercollegiate Guidelines Network as part of their regular processes for reviewing the need for and updating clinical guidelines for NHS Scotland.

The 2018 National Institute for Health and Care Excellence dementia guideline includes an evidence-based assessment of the benefits and risks associated with the prescribing of antipsychotic medications to people with dementia. The guideline does not identify an increased risk of premature death from prescribing antipsychotic medication in these circumstances.

The Scottish Government’s Dementia Standards are clear that people with dementia have the right to receive a full range of therapeutic interventions to help alleviate stress and distress and that psychoactive medications including antipsychotic medications should only be used if no alternative interventions are available. Carers should be fully involved in discussions on the use of such medications including their benefit and associated risks.

Mental health law in Scotland is based on rights and principles and offers patients significant safeguards where compulsory treatment is necessary. Anyone carrying out functions under the Act must have regard to certain principles, including having regard to the present and past views and feelings of the patient, the importance of the patient participating as fully as possible and carrying out functions that involves the minimum restriction on the freedom of the patient as is necessary. Additional safeguards include access to independent advocacy and the ability to appoint a named person.

While detained in hospital, patients may have capacity to consent to treatment and the Mental Health (Care and Treatment) (Scotland) Act 2003 sets out safeguards around obtaining consent and the strict procedures around giving treatment where consent is not given or is refused. Specific treatments authorised by the 2003 Act, or the Criminal Procedure (Scotland) Act 1995 may only be given in accordance with the range of additional safeguards set out in part 16 of the 2003 Act.

Service providers have a duty to inform the independent Mental Welfare Commission (MWC) if someone has been detained. The MWC has a statutory duty to ensure that the care, treatment and support for people with mental illness is lawful. Section 11 of the 2003 Act gives the MWC the power to carry out investigations in a number of specific circumstances, including unlawful detention.

On 30 March 2020, the Scottish Government announced a temporary pause to a number of national screening programmes, including the screening programmes for bowel, breast and cervical cancer. The decision followed careful consideration of all of the risks involved and advice from the Chief Medical Officer, Directors of Public Health and NHS National Services Scotland.

The announcement included NHS NSS’s modelling of the estimated number of scans and cancer diagnoses that would be delayed as a result of a three-month pause, based on the most recent figures available to Information Services Division:

• 248,177 patients received bowel screening, of which 220 diagnosed with cancer.
• 46,596 patients received breast screening, of which 291 diagnosed with cancer.
• 101,963 patients received cervical screening, of which 70 diagnosed with invasive cancer.

These figures are published here: https://news.gov.scot/news/health-screening-programmes-paused

All screening programme boards are meeting virtually throughout the pause, and these have already begun to capture the detail of the impact of the pause on each of the cancer screening programmes.

The Scottish Government does not record deaths in Scotland. Drug-related deaths are recorded by the Courts in Scotland and official statistics on these deaths are published annually by National Records of Scotland (NRS). The most recent set of NRS statistics was published in July 2019.

The Scottish Government is aware that the current situation may be placing additional strain on young carers.

Although most local carer and young carer services are unable to provide face to face support at present, many are offering alternatives such as telephone counselling and online sessions. We have therefore created a new fund of £500,000 to help local carer organisations and young carer services transition to supporting carers remotely. This will include tailored advice and training to help them understand how best to keep in touch with carers and young carers in their communities

We are working with Young Scot to ensure their young carer package is suitable for those who are social distancing or self-isolating. New digital opportunities have already been launched and will continue to be added to in the coming weeks. There are also plans to launch a social media campaign to support young carers to identify themselves and sign up for these opportunities.

The Young Carer Grant is available for young carers to apply for over the phone, online or by post. As with other carer benefits certain rules have been relaxed around the application process to ensure no young carer misses out. If a young carer could not apply before their 19th birthday due to the disruption caused by the COVID-19 outbreak, they can still apply now and their application will be viewed as being made on time.

Finally, SQA and Education Scotland are working directly with Carers Trust Scotland to understand how best to support young carers and ensure they receive fair appraisals in the absence of exams.

NHS Boards and GP Practices are responsible for the delivery of immunisation programmes locally, including training of staff. There is, however, a significant multi-disciplinary workforce in place to deliver the Scottish Immunisation Programme, including practice nurses, midwives and NHS Immunisation Teams. This workforce supports the delivery of over 2 million doses a year across a range of adult and childhood vaccinations, including administering over 1.5 million flu vaccines each year to various age groups within 10 to 12 weeks.

The Scottish Immunisation Programme Group (SIPG) has a well-established structure in place to support existing immunisation programmes and the introduction of new programmes across Scotland. The Group supports activity for immunisation programmes across a number of areas including workforce training requirements, which are delivered by NHS Education for Scotland.

The Scottish Government is clear that the Scottish Immunisation Programme should continue where safely and practicably possible throughout the COVID-19 outbreak.

The Interim Chief Medical Officer, Chief Nursing Officer and Chief Pharmaceutical Officer wrote to NHS Boards, most recently on 9 April, to highlight the crucial importance of the Programme, which will help to avoid outbreaks of vaccine-preventable diseases and provide important protection to children and other vulnerable groups. The letter recognises that the delivery of some individual programmes will be logistically difficult at this time, and sets out how this should be managed. This is published at https://www.sehd.scot.nhs.uk/cmo/CMO(2020)10.pdf .

Officials are in regular communication with Public Health Scotland and NHS Boards, through the Scottish Immunisation Programme Group, to monitor successful delivery of the Programme and to provide support to delivery partners if required. This includes keeping the public updated on immunisations via www.nhsinform.scot/immunisation or by following @NHSImmuniseScot .

I am leading work to support the psychological welfare and resilience of NHS staff during the COVID-19 outbreak. I have written to Health Boards about the importance of support for workforce wellbeing, highlighting key messages and approaches, and this was included in recent Scottish Government directives issued to Health Boards on mental health services.

All Boards have developed responses to support their staff in response to the Covid-19 outbreak. These responses include staff wellbeing ‘hubs’ and services, staff helplines and phone services, links with Occupational Health and Chaplaincy services, wellbeing and mental health guidance and digital offerings in relation to staff mental health and wellbeing.

NHS Education for Scotland (NES) is taking forward national resources, training models and systems of practice support for local delivery to promote and address staff psychological wellbeing and resilience arising from the Covid-19 response. The intention is to provide a ‘ladder’ of support spanning early intervention (Psychological First Aid) to complex care. This will help with prevention, early intervention and treatment of stress, anxiety, burn out, depression and post-traumatic stress disorder (PTSD).

The education and training of psychological professionals will continue through the work of NHS Education for Scotland (NES), with adaptations to take account of current circumstances. Training numbers are being expanded. NES is also delivering a programme of education and training to equip the wider workforce in health and social care with psychosocial skills and knowledge.

In relation to (a) psychological initiatives:

I refer the member to my response to S5W-28198 on 27 April 2020. Staff working in temporary hospitals will be included in these initiatives.

All answers to written parliamentary questions are available on the Parliament's website, the search facility for which can be found at: http://www.parliament.scot/parliamentarybusiness/28877.aspx

In relation to (b) physical welfare:

A programme of work is in progress to ensure that a range of wellbeing and practical support is in place for health and social care staff, covering guidance for staff, accommodation, catering and rest spaces.