Chamber and committees

Regarding the use of restraint in education, we anticipate that the new guidance on physical intervention and seclusion in schools will be published in January 2021. The Children and Young People’s Commissioner Scotland and the Equality and Human Rights Commissioner reached agreement with the Scottish Government on the membership of the working group, which will meet for the first time in January 2020. There will be a full public consultation on the new guidance prior to publication.

The new guidance will be clear that physical intervention and seclusion should only ever be a last resort, and never used for disciplinary purposes. The guidance will sit within a ‘suite’ of documents in the ‘Included, Engaged and Involved’ series, that places at its core positive relationships and behaviour, and early intervention and prevention of the use of physical intervention and seclusion, as well as de-escalation techniques. We are committed to taking an explicitly human rights based approach to the new national guidance, which everyone can have confidence in.

Regarding use of restraint in mental health settings, the Scottish Government is clear that alternatives to physical restraint should always be considered first, and the use of physical restraint should only ever be a last resort, for the shortest period of time, to ensure safety. Health Boards have a duty to ensure that they have policies in place covering all forms of restrictive practice and that staff receive appropriate training.

The Scottish Patient Safety Programme for Mental Health has, over the last 6 years, led to reductions in restraint, self-harm, seclusion, and violence and aggression across a number of areas through collaboration and innovation from staff, service users and carers and the use of quality improvement and improvement science.

Health Boards in Scotland have a duty to ensure that they have policies in place covering all forms of restrictive practice and that all staff receive appropriate training.

It is the expectation that episodes of restraint are recorded in clinical case records, that a critical incident review should take place locally if an injury occurs during the use of restraint and that any serious injury is reported to the Mental Welfare Commission for Scotland.

In 2019, I wrote to all Health Boards to confirm that they each had policies in place covering all forms of restrictive practice and that staff receive appropriate training.

We expect NHS Boards to adhere to current guidelines on the treatment of anaphylaxis from authorative professional sources such as the Resuscitation Council UK and National Institute for Health and Care Excellence (NICE).

Community pharmacists provide information, advice or assistance to people on the use of and any risks associated with medicines, and medical devices to prevent harm. This includes people who require an Adrenalin Auto Injector (AAIs) device.

Paediatric allergy services are organised through the Children’s and Young People’s Allergy Network Scotland (CYANS), which is a National Managed Clinical Network that focuses on improving health service provision for children and young people with allergies in Scotland.

NHS Inform provides information about the causes, treatment and prevention of anaphylaxis, including the possibility that someone suffering from anaphylaxis may go into cardiac arrest. We are committed to improving out-hospital cardiac arrest outcomes and, since 2015, over 508,000 people across Scotland have been equipped with cardiopulmonary resuscitation (CPR) skills. National public health campaigns have also been run to raise the overall awareness of using CPR skills.

In wider terms the Scottish Government is taking action to prevent anaphylaxis, for example in a move towards the introduction of full ingredient listing, with allergens emphasised, for foods sold on a Prepacked for Direct Sale basis, Food Standards Scotland is currently undertaking public consultation to inform the development of draft regulations, supporting technical guidance and a robust impact assessment for new Scottish regulations that are due to come into force in Autumn 2021.

Listed below are the six public inquiries constituted under the Inquiries Act 2005 since 2007. There have been a variety of other reviews and non-statutory inquiries for which costs are not held centrally.

Treatment for anaphylaxis may take place in primary care, in accident and emergency departments and in hospitals. Statistics provided by ISD shows the number of patients aged (a) under 16 years and (b) 16 years and over, who were discharged from hospital following treatment for anaphylaxis.

Table 1: Patients treated in hospital for a diagnosis of anaphylaxis in NHS Scotland; 2007 to 2018

The Scottish Government is clear about the priority we place on ensuring people can access high quality palliative and end of life care.

Our Strategic Framework for Action on Palliative and End of Life Care sets out our ambition that we want those who would benefit from palliative and end of life care to have access to it by 2021. This ambition was re-affirmed in our Health and Social Care Delivery Plan which was published in December 2016.

The Scottish Government recognises the need to ensure that health professionals have the knowledge, skills and confidence to provide high quality palliative and end of life care, relevant to their role.

In April 2018, we published a new palliative and end of life care Educational Framework that can be used in all health and social care settings to support staff who care for those with palliative and end of life care needs in their professional development. This can be found at: https://www.nes.scot.nhs.uk/newsroom/features-and-articles/palliative-and-end-of-life-care-enriching-and-improving-experience.aspx .

The Scottish Government continues to provide funding to NHS Education for Scotland (NES) and the Scottish Social Services Council (SSSC) to support training associated with the Framework across relevant health and social care settings.

The Scottish Government recognises the need to ensure that health and social care professionals have the knowledge, skills and confidence to provide high quality palliative and end of life care, relevant to their role.

In April 2018, we published a new palliative and end of life care Educational Framework that can be used in all health and social care settings to support staff who care for those with palliative and end of life care needs in their professional development. This can be found at: https://www.nes.scot.nhs.uk/newsroom/features-and-articles/palliative-and-end-of-life-care-enriching-and-improving-experience.aspx .

Good care at end of life requires collaborative, multi-disciplinary support, which is why Integration Authorities have been given statutory responsibility for meeting this need. Integration Authorities regularly report on their progress using the 23 indicators (https://www2.gov.scot/Topics/Health/Policy/Adult-Health-SocialCare-Integration/Outcomes/Indicators/Indicators ) that support the statutory outcomes set out in the Public Bodies (Joint Working) (Scotland) Act 2014.

The indicator currently used nationally to gauge progress on improving the availability of palliative and end of life care is the percentage of last six months of life spent in the community. Since the publication of the Health and Social Care Delivery Plan in 2015-16, the percentage of time spent at home or in a community setting continues to increase from 86.7% to 88.1%. This is an encouraging shift as it equates to, on average an extra five days within the last six months of life being supported at home or in a community setting. However, we recognise that this indicator is not sufficient on its own. We are working with partners in local systems and health and social care professionals to improve our understanding of the quantity and quality of palliative care across Scotland.