Seòmar agus comataidhean

I appreciate the opportunity to speak about the legislative consent memorandum that was lodged by the Scottish Government on 27 August, which recommends that the Scottish Parliament gives its consent to clause 43 of Kim Leadbeater MP’s Terminally Ill Adults (End of Life) Bill.

Let me be clear that I am here due to the provision described in the LCM and my recommendation for it. It is not, in any way, a comment or opinion on Ms Leadbeater’s Bill, which is for the UK Parliament to decide upon. The committee will be aware that nothing in Kim Leadbeater’s bill has any effect on Liam McArthur’s bill in the Scottish Parliament, which is going through an entirely different process. The LCM process is part of our constitutional settlement, and that is what I am here to provide information on, namely the effect of clause 43 in Scotland and why I am recommending support.

Turning to the LCM, clause 43 of the Terminally Ill Adults (End of Life) Bill imposes a duty on the Secretary of State for Health and Social Care in the UK to make regulations to prohibit the publication, printing, distribution or designing of advertisements whose purpose or effect is to promote the England and Wales voluntary assisted dying service. The purpose of clause 43 is stated to be to prevent pressure from being put on vulnerable people or the undermining of national suicide prevention strategies through the unethical advertisement of the England and Wales service.

By consenting to that provision, the Scottish Parliament would be agreeing that the service introduced could not be promoted in Scotland. That is the wish of the UK Parliament, which I believe should determine if and where the English and Welsh assisted dying service is to be advertised. The Scottish Government’s view is that clause 43 is for a purpose that falls within the legislative competence of the Scottish Parliament, considering the schedule 5, section C7 reservation in the Scotland Act 1998, which covers the regulation of, among other things,

“misleading and comparative advertising, except regulation specifically in relation to food, tobacco and tobacco products”.

It does not reserve advertising generally. As such, we believe that the Scottish Parliament’s consent is required for clause 43, and that it should be given so that we do not find ourselves in a situation where the English and Welsh assisted dying service can be advertised in Scotland but not in England and Wales.

I hope that the committee finds that explanation and outline of the Scottish position helpful, and I am happy to answer the committee’s questions.

That is my expectation. As it is legislation in the United Kingdom Parliament, it is not an area that I have control over—it is for members of the UK Parliament to determine—but my expectation would be as Mr Harvie has outlined. We have lodged the LCM to ensure that we are in line with other parts of the UK on advertising and promotion as opposed to the production of factual information.

I have set out my position in that regard. The bill specifies a particular treatment pathway. I will rest there.

I recognise that the bill’s intention is to do that, and it is a shared objective. However, given what I said about the Government’s neutral position on the bill, I have to reserve my position on whether it could be such a mechanism. Through the committee’s work, a significant amount of evidence has been gathered, which I look forward to seeing a compilation of. We will, in part, take our position based on that, as well as other considerations.

We clearly and demonstrably have more work to do in relation to alcohol and drugs. Too many people are losing their lives or being harmed by their substance dependency, and we need to do more to support them.

Progress has been made, and I point to one area, above all else, that has changed during the national mission, which is the level of stigmatisation of people who seek to access services, particularly drug-related services. I say that on the basis of my interaction with families who have, sadly, lost a loved one to drug dependency and those who are currently seeing their family members battling that issue. I recognise that some of the evidence is anecdotal and not necessarily empirical, but it is clear to me from my conversations with those loved ones, particularly those who have lost family members, that had the services that are available now been available then, and had the stigma been reduced as it has been now, their loved ones would have been able to access services in a different way.

I recognise Mr Whittle’s point that there is clearly more work for us to do, and it is right that we consider the potential way forward that the bill gives us. A significant amount of work is on-going that is supporting and changing lives. I point to stigma as one particular area of improvement, because I am told consistently by family members that there has been a demonstrable shift due to the national mission.

We need to do more. As I referenced to Ms Mochan, we are demonstrably not at the end of the journey. We still have more work to do, which is what the Government is currently reviewing. We are not waiting until the end of the national mission; we are doing that work now. We are keeping the bill’s potential under consideration and are reserving our judgment on it while the committee does its work.

I hope that Mr Gulhane and the rest of the committee will forgive me for restating that we have taken a neutral position on the bill. We will return to our position on whether it could or should be amended—and, if it were, whether it would meet our expectations—after the committee has done its work and we have seen the totality of the evidence that has been provided.

I have already pointed to issues that have come through in evidence that, as I have set out in my written submission, cause me concern, but we will base our final judgment on the work that the committee does.

Yes, it is. It is important to set out at the outset that, although the Government is neutral on the bill at this stage, while we await your good work and the further evidence being collated and compiled, it is fair to say that we support the intention of the bill, which is to ensure that there is timeous access to support when people request it. There are measures in place to support that in a broad sense, through the medication assisted treatment standards and various other elements that are already in train, but the general principle of the bill that Mr Whittle sets out is also my understanding of it.

Yes, and those issues have come through in the evidence that has been provided by the likes of Public Health Scotland and the Royal College of General Practitioners. Some of those who have contributed evidence have suggested that an unintended consequence could be those rights becoming exclusionary for only those who are able to follow a particular path.

We are very clear, as Mr Whittle set out in his opening question, about the challenge for somebody who is in a situation where they have a substance dependency. They will probably have had varying degrees of interaction with statutory, community or voluntary services, and their decision to come forward to seek help is in itself a momentous one that we should support and embrace. However, we must make sure that a GIRFE—getting it right for everyone—approach is taken at that point. It should be person centred, and there should be a recognition that an abstinence-based approach at that initial stage of seeking help is not for everybody. There are other ways of getting people to a point of finding their own recovery, which could include going through residential rehab or various recovery treatment options. The MAT standards already provide for the timeliness of how that should be delivered, which is within hours of the first presentation.

The most recent quarterly data shows that the 90 per cent target is being exceeded at the moment. That is not to say that there is not more work to be done there—there is, because there are gaps in certain parts of the country—but the work that has been done through the national mission over recent years has certainly improved the picture on people accessing support and help when they ask for it, which is the point that Mr Whittle raises.

I do not think that there is a lot that I can add to that, given the Government’s position on the bill at this stage. I cannot comment on the specifics of the bill. All that I can set out is the wider work that we are doing at the minute, which I described to Ms Mochan in answer to her first question.

We need to ensure that we have coherent support in place for those with a drug or alcohol dependency. We must take further action, because the drug and alcohol-related harms in Scotland are far too high. Progress has been made, but my interest is in ensuring that we go further with the social infrastructure that is available and the destigmatising of access to support services. That needs to be done in a co-ordinated way that works for individuals and how they wish to access services. Demonstrably, certain interventions will not work for everybody, so we need to ensure that we have breadth of intervention as well as depth of availability. That is what the work that is currently under way is seeking to address.

I have seen that point being raised in other evidence sessions. For the reasons that Ms Zeballos set out in response to Ms Harper and were set out in my written statement to the committee, we have a concern about that issue. Some people who have given evidence have said that the approach could be exclusionary. I know for a fact that the last thing that the member in charge of the bill would want is for there to be any unintended consequences that would result in people feeling excluded or being practically excluded. It is important that we have due regard to that.

Ultimately, it is for the member in charge to discuss that matter more substantively, and the Government will take a more formal position once the committee has completed its work.

By its nature, it is difficult to establish that data set with certainty. Based on Mr Gulhane’s professional engagements, he will be familiar with why that is the case. People have various engagements with health professionals and others, which helps to provide a level of data, but other people do not, so such data is more difficult for us to substantiate.

In Glasgow, part of the Thistle’s success is that people are, for the first time, interacting with that service and the wider services that are offered in the centre, such as those relating to housing support, social work and education. We are capturing information that shows that many people who engage with the Thistle have never engaged with any statutory service before, and that intervention is giving them the opportunity to have a recovery pathway for the first time.

That illustrates how challenging it is to get the fuller and more accurate picture that Mr Gulhane is looking for. It is challenging to get accurate data, because of the complexity of human society and the fact that people will be at varying stages of recovery, with many, understandably, hiding their situation not only from statutory services but from their family members, loved ones and wider social groups.

Public Health Scotland reports on various elements that Mr Gulhane referenced, but getting the data is a challenge, as I am sure he will understand.