Chamber and committees

Scottish mental health and incapacity legislation is based on rights and principles. We believe that the 2003 Act is fully compliant with the European Convention on Human Rights (ECHR). The 2003 Act has never been found, in part or in whole, by the European Court of Human Rights to be not compliant with ECHR.

Most people who use mental health services receive treatment without being subject to an order or certificate under the Mental Health (Scotland) (Care and Treatment) Act 2003. For some individuals however, compulsory treatment is used to provide the person with medical treatment to alleviate suffering and for the protection of both the person and others. Compulsory treatment is only allowed under mental health legislation in Scotland in very strict circumstances.

Official statistics on hospital beds are routinely published on the ISD website.

In line with modern health care systems, care patterns are changing in Lothian, more care is being delivered in the community, there are shorter hospital stays, and more same day surgery without need for overnight stays – which is good for patients. The published statistics show there were 2,518 in 2006-07 and 2,357 in 2015-16. Statistics for 2016-17 will be published in the autumn.

The length of hospital stays has fallen – in the last four years elective lengths of stays have reduced by 10% and emergency length of stays by 4%.

The bed statistics only measure beds that are in operation 24 hours a day. They do not measure beds used only for day surgery. In 2015/16 there were over 60,000 day case discharges - up 8% from 2006/07.

It is worth noting that the Royal Infirmary of Edinburgh in NHS Lothian is a PFI hospital.

The UN Human Rights Council is currently in session and is considering the report presented by the UN High Commissioner for Human Rights. The Scottish Government has contributed to the discussion of a resolution which looks to address the global burden of obstacles in mental health, to provide effective mental health and community-based services, and to respect the enjoyment of legal capacity on an equal basis with others. We await the outcome of the negotiations amongst UN member states.

In Scotland, we are proud that our mental health legislation promotes rights and is based on principles. The Mental Health (Scotland) Act 2015 improves existing legislation to ensure the system works as effectively as possible for service users and builds on existing measures and principles around named persons, advocacy and advance statements, which will encourage service users’ involvement in decisions about their care and treatment and help strengthen support for decision making.

Article 12 of the UNCRPD requires that persons with disability should be able to access the support they need to exercise their legal capacity. This means the person should be at the forefront of all decision making. Supportive decision making and the determination of the rights, will and preferences of the person are paramount. We are currently reviewing the Adults with Incapacity (Scotland) Act 2000 and developing a range of proposals for legislative reform, including the introduction of supported decision making. We take the view that by devising a system which makes it easier to secure only those powers that are absolutely necessary will safeguard the financial status and welfare of the person concerned. Under such an arrangement, the person would then be free to make other decisions about their lives, with the appropriate support if required. Informal consultation has already been carried out with a range of stakeholders and a full formal consultation will launch later in the year.

We believe that this approach is aligned to the ideals enshrined in the UNCRPD and our intention is for legislative changes to the Act to include the provision of appropriate support for decision making.

The Edinburgh Tram Inquiry is a statutory Inquiry, and as such, it is independent of Scottish Government. Therefore, how and when Inquiry staff are paid is a matter for the Inquiry and not the Scottish Government. However, officials maintain an on-going engagement with the inquiry team to ensure appropriate financial control and monitoring arrangements are in place.

Scottish mental health and incapacity legislation is based on rights and principles. The most recent reform of mental health legislation was through the Mental Health (Scotland) Act 2015, which was passed by the Scottish Parliament last year. The 2015 Act strengthened measures in the Mental Health (Care and Treatment) (Scotland) Act 2003 that promotes support for decision making, including those for independent advocacy, advance statements and named persons.

The Scottish Government is working with partners including the Mental Welfare Commission, the Office of the Public Guardian and professional and human rights bodies to develop changes to the Adults with Incapacity Act (2000) in relation to deprivation of liberty, and to assess compliance with UN Convention on the Rights of Persons with Disabilities by 2018. The Code of Practice which accompanies the Adults with Incapacity Act explains that the use of covert medication is permissible in certain, limited circumstances e.g. to safeguard the health of an adult who is unable to consent to the treatment in question, where other alternatives have been explored and none are practicable. It follows a rights based approach and also refers practitioners to the Mental Welfare Commission Scotland's guidance documents covering Consent to Treatment and Covert Medication.

Covert medication must never be given to someone who is capable of deciding about medical treatment. In the case of adults, there is a presumption in favour of capacity and individuals must be supported to enable decision-making so far as possible. Individuals should be given as much information as possible to enable them to make a decision regarding medical treatment. It is important to assess capacity in relation to individual decisions and not to make blanket ‘all or nothing’ assumptions. Capacity may change or fluctuate over time. The practitioner with primary responsibility for the individual’s medical treatment has the ultimate responsibility to decide whether or not to authorise covert administration of medication. This decision should be taken following consultation.

Healthcare staff should not give medication except in accordance with the law, and even where the law allows its use it should not be given in a disguised form unless the adult has refused and their health is at risk because of this. Staff are obliged to record this in the patient's records. Practitioners who may be requested to administer covert medication should make themselves fully aware of the guidance of their own professional bodies.

The role of the Scottish Government is to provide policies, frameworks and resources to NHS boards in order that they can deliver services that meet the needs of their local population. Within this context, it is for clinical audit and local clinical governance structures to monitor how well clinicians and NHS Boards are complying with existing clinical SIGN guidelines and to ensure that new and emerging evidence and good practice guidelines are considered at regular intervals.

The Scottish Government continues to work in close collaboration with colleagues in NHS England and will consider the outputs from this pilot, to ensure that where appropriate, patients with cancer receive their surgery as quickly as possible.

The Scottish Government’s National Clinical Strategy supports a multi-disciplinary diagnostic centre approach for many tertiary complex treatments to be delivered by fewer clinical teams with greater multi-professional expertise.

If evidence shows that survival improvements for patients can be achieved with service re-design, then the Scottish Government would expect NHSScotland to reflect on this and consider whether services currently in place can be similarly improved by re-design.

Our cancer strategy, ‘Beating Cancer: Ambition and Action’ and the accompanying £100 million investment over the coming years serves as a blueprint for the future of cancer services in Scotland, improving the prevention, detection, diagnosis, treatment and aftercare for all people with cancer including those diagnosed with pancreatic cancer.

Our cancer strategy, ‘Beating Cancer: Ambition and Action’ and the accompanying £100 million investment over the coming years serves as a blueprint for the future of cancer services in Scotland, improving the prevention, detection, diagnosis, treatment and aftercare for all people with cancer, including those diagnosed with pancreatic cancer.

Two of the overarching aims of the cancer strategy are for more people to survive cancer for 1, 5 and 10 years, and to close the gap in survival between Scotland and the best countries in Europe; and we are determined to make this happen.