Meeting of the Parliament

Meeting date: Tuesday, February 26, 2019

Official Report 924KB pdf

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Topical Question Time

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Child Death Review Process

To ask the Scottish Government, in light of recent Office for National Statistics figures showing that 218 avoidable child deaths occurred in Scotland in 2017, what progress has been made in implementing a child death review process, and when it will report. (S5T-01516)

We are establishing a national hub for the prevention of child deaths, which will launch in March this year. Its focus will be to oversee the child death review process to drive a reduction in child deaths, and it will start in full in early 2020. We are currently piloting that process in three health board areas, with a further two pilots commencing later this year. We will be investing £1 million from April in that important work.

As the cabinet secretary will be aware, the number of avoidable deaths among infants and children is proportionately higher in Scotland than elsewhere in the United Kingdom. The 2017 figures include victims of violence and accidents, and birth defects, sometimes linked to smoking and alcohol. Does she agree that, for the parents and those closest to the children who have died, it can be particularly traumatic to consider a death to have been avoidable, and therefore that minimising such fatalities must be an absolute priority?

Mr Gibson is right that the number of avoidable deaths among infants and children is proportionately higher in Scotland than elsewhere in the UK. However, it is important to note that, since 2008, there has been a 32 per cent reduction in the number of child deaths under the age of 18 in Scotland.

I agree that minimising avoidable child deaths should be a priority for the Government, and it is. We are committed to driving down the rate of child deaths in Scotland by learning from the child death review process and working with the Royal College of Paediatrics and Child Health to ensure that we get the process right and, most important, that we apply the learning across the whole of our health service.

Professor Russell Viner, the president of the Royal College of Paediatrics and Child Health, said that the Scottish Government is

“certainly moving in the right direction”

by

“tackling child poverty and obesity. However, despite recommending a Scotland-wide child death review process to be implemented over four years ago, this is yet to ... be established.”

I welcome the 32 per cent reduction in deaths that the cabinet secretary has just mentioned and the new hub. Does she agree that the delay over the past four years implies that avoidable child deaths are not getting the priority that they deserve? How will she convince parents and others that the Scottish Government is urgently addressing this matter?

I am grateful to Mr Gibson for that important supplementary question, and I understand why people are frustrated at what they feel has been too long a time before the process is fully in place. It is a priority for me and for the Government. We will launch in full in a month’s time. We will continue to update the Parliament on that process. It really does matter.

Over the past 10 years, we have seen a 32 per cent reduction in the number of child deaths under 18, a 28 per cent reduction in neonatal mortality and a 25 per cent reduction in the number of stillbirths. Nonetheless, there is more that we need to do. We are working to establish the hub and to run the pilot processes in a staged way so that learning can be replicated across our boards. We will keep a close eye on the process and, as we make progress in the course of this calendar year, we will update the Parliament in order to reassure people that it really is a priority for the Government.

It should concern every member of the Scottish Parliament that avoidable deaths among children, babies and teenagers are higher in Scotland than anywhere else in the UK. Figures that were released in November 2018 showed that 600 babies have been born addicted to drugs in Scotland since 2015. What is the Scottish Government doing to take forward the pre-birth approach, as recommended by Sir Harry Burns?

Much of the work in the best start programme, which I know Mr Briggs will be familiar with, as well as an innovative and improved approach to maternity care and the work that has been undertaken by Mr FitzPatrick on the healthy weight and diet programme, looking at preparation for pregnancy, all feeds into working with mums and those who are about to be mums on what they need to do to be as healthy as they can be so that their child can be as healthy as it can be when it is born.

That work is also picked up by our community-based midwives and our increased number of health visitors. It all comes together to begin to tackle issues such as smoking in pregnancy. We know that women want to address those issues, but sometimes they can feel that it is all too much and they are not quite sure where to start. Using those healthcare supports through the midwife and the health visitor, who can develop important relationships with pregnant women and new mothers, is important in helping people—in a non-judgmental way—to make some of the changes that are critical for the healthiest possible birth of their new babies.

There remains a significant link between material deprivation and life expectancy. Figures that were released in December 2018 revealed that a boy who is born in one of the most affluent areas of the country can expect to live more than 10 years longer than one who is born in one of the poorest. What specific steps will the cabinet secretary and the Government take to end the scandal of health inequalities that persists in Scotland?

A number of areas of work to tackle health inequalities are under way. As I am sure Mary Fee appreciates, not all of those sit in the health portfolio, and we need to tackle such inequalities much more widely. Work is being done on measures, such as the baby box and the new best start grant that is being administered by our new social security agency, that attempt to get practical support into the hands of mums, babies and small children. With our deep-end practices, community-based healthcare workers, community mental health workers, link workers and others, we are also looking at how we can reach all the people we need to reach on the preventative and improved lifestyle approaches that we need them to take.

However, we need to do that in a way that reflects where people are, rather than appearing to be judgmental and lecturing or being open to the accusation that it is easy for someone like me to say how they should stop smoking, eat more healthily or exercise more. When people are struggling to make ends meet and have families to bring up, such advice can seem too much and too impractical. By using connections with trusted healthcare workers and others to help people to identify practical ways within their means to make changes and improvements to their lifestyles, we will begin to tackle health inequalities. Such work can be done not only in this portfolio but more widely across the Government; work that is going on in education and elsewhere also plays a part.

It would be beneficial if, at some point—perhaps Mary Fee and I could co-operate on this—the Parliament could have a wider debate about how we might tackle health inequalities in the round, across our portfolios in the Government. I would be very happy to meet her to see whether we could make progress on that.

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Fatal Accident Inquiries (Legal Aid)

To ask the Scottish Government what its position is on providing legal aid to victims’ families for fatal accident inquiries. (S5T-01518)

We acknowledge that the families of the deceased may find attendance at a fatal accident inquiry distressing. The purpose of an FAI is to investigate, in the public interest, the circumstances of a death. At an inquiry, the procurator fiscal leads evidence to address the matters upon which the sheriff must make findings, including the cause of death. Where family members seek their own representation to participate in FAIs, applications for legal aid towards the costs of such representation are subject to the statutory tests of probable cause, reasonableness and financial eligibility, which are consistent with the tests for other forms of civil legal aid.

Those arrangements were considered during the passage of the Inquiries into Fatal Accidents and Sudden Deaths etc (Scotland) Act 2016. However, the independent strategic review of legal aid in Scotland, together with recent high-profile cases, including the FAI into the Clutha bar tragedy, have highlighted the need to review the current legislation with regard to the eligibility of families who are involved in inquiries.

I assure Parliament that the Scottish Government will consider the issue in planning a new bill on legal aid in Scotland. The Legal Aid (Scotland) Act 1986 provided for the regulations that are still in force today, which is why we have now set up an independent strategic review of legal aid in Scotland. We will consult on a new bill on legal aid before the summer recess.

Many members will have been shocked—as I was, last week—to learn that, following a decision of the Scottish Legal Aid Board, the families of victims of the Clutha tragedy are being asked to contribute as much as £8,000 each for legal representation. I hear what the minister has said about a review, but will the Government intervene immediately to reverse that specific decision?

On the review, does the Government think that the normal means of assessment for legal aid are appropriate in the case of fatal accident inquiries into disasters such as the Clutha tragedy, given the wider public interest?

Under the statutory regulations that are in place, the Scottish ministers cannot intervene to change the Scottish Legal Aid Board’s decision and the legislation, which was passed by the Scottish Parliament, requires contributions to be paid depending on an individual’s financial circumstances. Contributions reduce the cost of legal aid to the public purse and so help to fund vital services.

The figure that I have seen in the media of £8,000 for a family is not correct—that is actually the cumulative amount of money across all the families. The Scottish Legal Aid Board has exercised the full discretion available to it in making its decision in that case.

I thank the minister for that clarification.

The question raises broader issues with fatal accident inquiries. In recent weeks, we have heard from families whose loved ones have died abroad and who still cannot get post-mortem examinations; and the family of Craig McClelland are frustrated because the person who committed his murder was on one side of the prison fence rather than the other. Thanks to the work of the Lib Dems, we have learned of the shocking total cumulative backlog of FAIs.

Does the minister accept that there is something seriously wrong with the way in which FAIs work in Scotland, despite the fact that legislative reform took place in 2016?

As I am sure the member accepts, the decision to hold any fatal accident inquiry and the timing for initiating it are entirely matters for the Lord Advocate, operating independent of Government.

Depending on the circumstances, death investigations can sometimes be very complicated and technical and can involve a number of agencies working together. The Crown Office is committed to the prompt investigation of deaths, but it accepts that, in some cases, the time taken to complete a thorough investigation has been too long.

The Scottish Government has made available additional funding to the Crown Office, and it has used some of that to allow the Scottish fatalities investigation unit to try to reduce the time required to complete death investigations.

On the delays that Daniel Johnson referred to, will the minister tell us what the cumulative delays in on-going FAIs are? What conclusions does she draw from those delays about whether staffing levels at the Crown Office and Procurator Fiscal Service are adequate?

That is slightly broader than the original question, but I will allow it.

I can answer the member’s question. The average length of time to complete an inquiry has been gradually decreasing, which is obviously going in the direction that we would like. We are pleased that the figure is decreasing, although we would like further progress to be made. That is why the Government has made available to the Crown Office additional funding to address the issue and to reduce the amount of time required to complete death investigations.

Does the minister agree that a system that makes families wait years to find out the circumstances surrounding their loved ones’ death, and then asks them to make a financial contribution towards the process, is broken? Is she aware of recent reports that the family of a victim of an M9 crash were sent a bill by the highway authority to replace the shrubs that were damaged at the side of the motorway? Does she agree that it is time for an independent review of FAIs?

I thank the member for raising that point, which is important. I agree that a review is required.

To reiterate, it is the role of the Scottish Legal Aid Board to make determinations on whether legal aid funding is to be awarded. The Scottish ministers cannot overturn the board’s decision and there is no flexibility for the board to decide to disapply or disregard the statutory requirement to assess an applicant’s finances. Any changes to the system can be made only through changes to primary legislation, which is why we plan to consult on a new legal aid bill. That will be a full consultation and it will happen this year, before the summer recess. I will consider carefully the issue of FAIs as part of the wider planning for the new legal aid bill. I am happy to meet any member who wants to discuss the issue further and contribute to that bill.