Chamber and committees

There is no test of capacity set out in the Mental Health (Care and Treatment) (Scotland) Act 2003. In some circumstances different provisions and safeguards of the 2003 Act apply if the patient does not have capacity to make a certain decision in relation to treatment at a certain time.

A person has a Significantly Impaired Decision Making Ability (SIDMA) when a mental disorder affects the person’s ability to believe, understand and retain information, and to make and communicate decisions. All adults are assumed to have a decision-making ability or capacity as a starting point. A person with a mental disorder who retains unimpaired ability to take treatment decisions cannot be treated compulsorily under the 2003 Act.

The medical practitioner must believe there are sufficient grounds before deciding it necessary to grant an order for a patient who is refusing to accept treatment on a voluntary basis.

• The patient has a mental disorder.
• The patient has significantly impaired decision-making ability with respect to medical treatment for mental disorder, as a result of his or her mental disorder.
• Detention in hospital is necessary to determine what medical treatment is required and to provide that treatment.
• Significant risk exists to the health, safety and welfare of the patient or to the safety of others if the patient is not detained.

Mental health law in Scotland is based on rights and principles and offers patients significant safeguards where compulsory treatment is necessary. These safeguards include an independent Mental Health Tribunal which grants and reviews orders for compulsory treatment. The patient or the patient’s named person can appeal to the Mental Health Tribunal for Scotland to have an order allowing compulsory treatment revoked.

The Scottish Government does not collect specific data on how much each NHS Board spends on staff overtime. It is for Boards to manage service provision locally, including the use of overtime where appropriate.

The decision to invest further in CGM and insulin pumps was made on the basis of robust analysis of clinical evidence by NICE and SIGN. Effectiveness of these technologies is considered over the lifetime.

The Scottish Diabetes Survey enables us to track improvement over time against a range of important indicators including glycaemic control and the complications of diabetes. The Survey shows a developing trend of improvement in glycaemic control in the Scottish type 1 diabetes population over the wider period of investment in insulin pumps.

I would remind the Member that the decision to offer a CGM or insulin pump is a clinical one, and the results for the individual will be monitored by their clinical team. Where the expected outcomes are not being realised, clinicians will consider clinically appropriate changes to the care regime.

The Scottish Government has committed to £10m additional funding to increase, over the term of this Parliament, the provision of insulin pump therapy for adults and Continuous Glucose Monitoring (CGM).

The first £2 million was allocated to NHS Boards in financial year 2017-18.

A further £2 million will be made available to NHS Boards in financial year 2018-19.

Funding for subsequent years will be agreed as part of the Spending Review and Budget Bill processes for those years, which will be subject to approval by the Scottish Parliament.

It is current protocol for all NHS Scotland Health Boards to ensure appropriate referral and testing when Lynch syndrome occurs, and for all patients diagnosed with colorectal cancer before the age of 60.

In relation to the NICE guidelines recommendation to extend referral and testing for lynch syndrome to all patients diagnosed with colorectal cancer; the impacts of this recommendation are currently being reviewed by NHS Scotland’s Molecular Pathology Consortium (MPC).

All medical doctors, whether UK citizens or nationals of countries outside the UK, European Economic Area (EEA) or Switzerland, with a primary qualification from a medical school outside the UK, EEA or Switzerland must undertake parts 1 and 2 of the Professional and Linguistic Assessments Board (PLAB) test. Doctors who have European Community rights, a GMC approved sponsorship arrangement, an approved postgraduate qualification, or who are eligible to enter the GP or specialist medical register do not have to undertake the PLAB test.

In recognition of the difficulties refugees often face in providing the standards of verified evidence normally required for IMG registration, the GMC works with applicants to try to verify their home qualifications through other means if they have been formally recognised as a refugee under the 1951 United Nations Convention, granted limited leave (5 years), granted exceptional leave to remain (granted prior to 1 April 2003), granted humanitarian protection, or granted other leave. The GMC also offers two free attempts at part 1 of the PLAB test and reduced fees for part 2, with the option for successful candidates to pay their initial registration fee in installments.

The Bridges Programme works with NHSScotland to help refugee doctors to meet the criteria for IMG registration including, where necessary, assistance with attaining the International English Language Testing System score required to demonstrate that they have the English language skills to practise safely in the UK. Other assistance programmes are run across the UK by various organisations and professional bodies; however, the Scottish Government does not hold specific information on these.

The Scottish Government actively supports initiatives being led by the service to encourage practitioners to return to practice in known areas of need. The GP Returner Programme for instance, provides a supported opportunity for practitioners who are eligible to practice, but otherwise not practising, to safely return to general practice in Scotland.

Equally, we are actively supporting activity to encouraged qualified doctors who are settled migrants or refugees to work within NHS Scotland. Through the Bridges Programme, doctors from overseas living in Scotland can access a rolling programme of clinical placements during their pre-registration period and access linguistic support for the Professional and Linguistic Assessments Board examination, which is a pre-requisite of full registration with the General Medical Council.

Scotland’s health workforce benefits enormously from the contribution made by overseas staff. The Scottish Government has consistently signalled that we need to remain an open and welcoming destination for international medical graduates, both from the EU and further afield.

We support initiatives being led by the service to encourage former practitioners return to practice, alongside activity to promote the appeal of NHS Scotland to fresh international talent. NHS National Education Scotland currently operates a successful GP Returner Programme, for former practitioners who have had a career break of who have been practising abroad. Additionally, the service operates an Enhanced GP Induction Programme for overseas GPs, to facilitate their transition to practise in the UK.

Registration and licensing is undertaken by the General Medical Council (GMC), which is the statutory regulator of the medical profession in the UK. The chief executive of the GMC is the registrar for the medical profession; this information is not held by the Scottish Government.

Data on doctors who are registered and/or licensed to practice in the United Kingdom can be found in the GMC’s annual report on the “State of medical education and practice in the UK”, accessible online at: https://www.gmc-uk.org/static/documents/content/SoMEP-2017-final-full.pdf

The Universities and Colleges Admissions Service (UCAS) publish the number of applications received from Scottish domiciles to study pre-clinical medicine at any UK Institution, as well as the number of applications received from UK domiciles to study pre-clinical medicine at Scottish Institutions. Individuals may apply to more than one institution.