Chamber and committees

The Adults with Incapacity (Scotland) Act 2000 provides a framework for safeguarding the welfare and managing the finances of adults (people aged 16 or over) who lack capacity due to mental illness, learning disability or a related condition, or an inability to communicate.

Some people are not able to give consent, either permanently or temporarily.

Part five of the Act gives a general authority to treat a patient who is incapable of consenting to the treatment in question, on the issuing of a certificate of incapacity (section 47 certificate). Doctors can issue certificates for a range of medical treatments. Dentists, optometrists and registered nurses, who have specialist training can also issue certificates for treatment related to their speciality.

Section 47 (1A)(a) allows the medical practitioner primarily responsible for the medical treatment of the adult to certify that an adult lacks capacity in relation to medical treatment, and to carry out that medical treatment. Part five defines "medical treatment" to include any procedure or treatment designed to safeguard or promote physical or mental health. If there is a welfare attorney or guardian with the power to consent to treatment then their authority must be sought unless it is impracticable to do so.

There are no official statistics which record the length of time taken to secure authority from a persons relevant attorney or welfare guardian.

The key to providing appropriate support, is to take a person-centred approach and to use the range of tools and strategies which will ultimately result in the best outcomes for that individual. The use of interventions based on ABA is identified both in the SIGN 145 Assessment, diagnosis and interventions for autism spectrum disorders guideline (http://www.sign.ac.uk/guidelines/fulltext/145/index.html) and in the NHS Education for Scotland Matrix of psychological interventions for children and young people with autismhttp://www.nes.scot.nhs.uk/education-and-training/by-discipline/psychology/the-matrix-(2015)-a-guide-to-delivering-evidence-based-psychological-therapies-in-scotland.aspxas being recommended in response to particular behaviours or needs.

NHS Education for Scotland also have a learning resource on Positive Behavioural Support

(http://www.nes.scot.nhs.uk/education-and-training/by-theme-initiative/mental-health-and-learning-disabilities/publications-and-resources/publications-repository/positive-behavioural-support-a-learning-resource.aspx).

Additionally, within the CAMHS workstream in NHS Education for Scotland there have been recent Masterclass events on Applied Behavioural Analysis.

However, whilst the Government sets national policy direction to local authorities and health boards, ultimately it is the responsibility of local authorities and NHS and their integrated local planning partnerships to deliver services and allocate resources according to local priorities and considerations. Ultimately, NHS and local council care services are free to implement behavioural approaches depending on circumstances and needs.

The Scottish Government is not prescriptive in the use of particular autism interventions. The Scottish Strategy for Autism’s publication the Menu of Interventions was published in 2013 link: http://www.autismnetworkscotland.org.uk/menu-of-interventions/. It provides a guide to interventions and the supports required by people diagnosed with autistic spectrum disorder.

The Scottish Intercollegiate Guidelines Network develops evidence based clinical practice guidelines for the National Health Service in Scotland. SIGN guidelines are derived from a systematic review of the scientific literature and are designed as a vehicle for accelerating the translation of new knowledge into action to meet our aim of reducing variations in practice, and improving patient-important outcomes. The SIGN 145 Assessment, diagnosis and interventions for autism spectrum disorders guideline can be viewed using the following link:

http://www.sign.ac.uk/guidelines/fulltext/145/index.html. Ultimately, NHS and local council care services are free to implement behavioural approaches depending on circumstances and needs.

A supported person’s needs and outcomes will not always respect the traditional boundaries between healthcare services and social care services. The Statutory Guidance accompanying the Social Care (Self-directed Support) (Scotland) Act 2013 encourages the respective professionals and organisations to work together, to conduct assessments based on personal outcomes. An individual’s allocated budget may then be spent in anyway, provided that it meets the outcomes within the support plan.

The Scottish Government will be consulting on adults with incapacity legislation in the course of 2017 and consideration of whether extending registered medical practitioners to include clinical psychologists for the purposes of the AWI legislation will be part of that consultation.

Health Protection Scotland are working with Glasgow Caledonian University to undertake work to ascertain the cost-effectiveness of performing birth cohort hepatitis C screening among the population of Scotland. A report will be prepared and submitted to Scottish Government in 2017.

In common with other behaviours that cause difficulties in people’s lives and contribute to their ill health, problem gambling is addressed as part of wider health issues that a person may be experiencing including mental health problems and substance misuse problems. Where a person is referred to a service for treatment, the clinical team will work with the person to identify the issues or problems that are important to support their recovery in a holistic person-centred way. Specialist psychological skills and competencies used in the management of alcohol and drug misuse have some applicability to some problem gamblers as do problem solving counselling skills.

The Scottish Government is committed to delivering faster access to psychological therapies for people with mental illness or disorders, including those who have problems with gambling which is recognised as a type of impulse-control disorder. The delivery of psychological therapies is a core part of NHS activity. NHS boards have made good progress in recent years in improving access to many psychological therapies.

The Scottish Government intends to lay changes to planning legislation regarding betting offices before the Scottish Parliament by the end of the year. The proposed changes will remove the current exemption from planning control that applies when certain premises change to betting shops.

The rules governing the use of Fixed Odds Betting Terminals are reserved to the UK Government.

The Scottish Government argued in the Smith Commission for the full devolution of gambling policy to Scotland on the grounds that this would enable problem gambling in Scotland to be tackled more effectively.

The UK Government is currently undertaking a wide ranging review of gaming machines. The review covers a number of areas including maximum gaming machines stakes and prizes, allocations of gaming machines in licensed premises, and social responsibility measures to minimise the risk of gambling related harm.

The Scotland Act 2016 included only a limited power in respect of the number of Fixed Odds Betting Terminals in new betting shops. This does not include any powers in respect of existing premises, or those found in premises other than betting shops. The Scottish Government will consider the outcome of the UK consultation before taking a view on what use of the limited powers available in Scotland might be proposed.

The power to legislate on the maximum bet permitted on Fixed Odds Betting Terminals remains reserved to the UK Government.

The Scotland Act 2016 only included a limited power in respect of setting the number of Fixed Odds Betting Terminals in new betting shops.