Seòmar agus comataidhean

Good morning, members. I have the majority of the amendments in the group, so I apologise for the time that I might take to talk through them.

My amendments 197 and 212 relate to the provision of information and guidance, and I have taken the proposals forward on behalf of the British Medical Association Scotland and the Royal College of General Practitioners Scotland. The amendments would require the establishment of an independent information service to provide information and support to people who may be eligible for assisted dying and who wish to pursue the option to help them to navigate the process. The service that the amendments look to establish would provide factual information about the full range of options that are available to patients, which would help them to make informed decisions and ensure that doctors who did not wish to or did not feel confident about providing information to patients about assisted dying had somewhere that they could direct patients to, in the knowledge that they would receive accurate and objective information. Patients who may meet the eligibility criteria would be able to access the information that they need without the requirement to go through their doctor, and would also have support to navigate the process.

The Nuffield Trust report, “Assisted dying in practice: International experiences and implications for health and social care”, looked at the implications of assisted dying legislation in 15 jurisdictions. It recommended that policy makers consider examples from other countries, such as

“establishing dedicated care navigator roles to provide information on assisted dying”

and about how service information can be accessed and how people can be connected with eligible clinicians, and to

“offer support to families, carers and health professionals.”

The report concludes that there is evidence that such roles help to improve access and understanding.

I appreciate amendment 44 in Liam McArthur’s name, but I do not think that it goes far enough. Although it focuses on the provision of information, it does not focus on the aspect of support, which I would also like to be included in the bill. It is not clear whether amendment 44 would cover personalised information for patients or whether it could also take the form of generic leaflets setting out information for eligibility to access assisted dying. I welcome the amendments in Ross Greer’s name that were passed on advocacy services and care navigation services, which are really important and almost supersede some of what I am trying to create. My amendments are important, especially in providing clarification for healthcare professionals.

I should have said earlier that I welcome Jackie Baillie’s amendments in the group. Given what I said about Ross Greer’s amendments in relation to advocacy services, I will not press amendment 197 or move amendment 212, but I intend to move all the others in the group.

Amendment 197, by agreement, withdrawn.

Amendment 198 moved—[Miles Briggs].

It would have to sit in the NHS. Given the nature of our health service and how it is structured with the different health boards, we want to ensure that Scotland-wide information is provided. It is important that if someone requests information from a clinician, the clinician can refer them to a service with nationally shared information.

Guidance should be developed in partnership with representative bodies. That is why BMA Scotland and RCGP Scotland have asked me to lodge the amendments. I hope that that clarifies that the information would be a national resource. It is important to ensure that we have clarity and that there is no variation.

My amendments 261, 262, 264, 265 and 266 are lodged on behalf of the Royal College of Nursing Scotland. RCN Scotland maintains a neutral position on assisted dying, but the amendments address two separate concerns that it currently has in relation to the bill.

The bill outlines several distinct roles involved in the provision of assisted dying, but it remains largely silent on where legal and professional accountability lies. Care for an individual and responsibility for the approved substance can be transferred between the roles on a number of occasions. In particular, the bill is silent on the legal effects of a co-ordinating doctor appointing an authorised health professional.

The amendments ask three key questions. First, should that be seen as a delegation of a task to the authorised health professional? Secondly, what responsibilities does the co-ordinating doctor retain at that point? Thirdly, does the bill make any reference to whether the authorised health professional is a doctor or a registered nurse or their respective responsibilities?

RCN Scotland members must be clear about those issues if they are to have confidence that they can be involved in the provision of assisted dying. RCN Scotland is of the view that outlining legal accountability in the bill would be challenging. Amendments 261, 262 and 264 propose, as an alternative, that the bill should require Scottish ministers to publish statutory guidance that clearly outlines where legal and professional accountability lies at each step of the assisted dying process.

Given the subject matter, the guidance should have the input of the Lord Advocate, as outlined in amendment 266. In developing the guidance, consultation with relevant trade unions and professional bodies is important and should be required. That is covered in amendment 265.

Amendment 264 would also require the Scottish ministers to set out guidance on how assisted dying services should be arranged by health boards, including, as discussed earlier, through the development of patient pathways. The committee has already considered amendments setting out a stand-alone assisted dying service, and RCN Scotland has proposed that requirement, as it shares the concern that has been expressed by others that adding assisted dying to the workload of existing underresourced teams would not be sustainable.

Along with RCN Scotland, I believe that the amendments would introduce essential legal clarity for health professionals who are involved in each stage of service delivery, and that they would ensure that, if the bill is passed, assisted dying can be delivered safely and sustainably across Scotland.

I move amendment 197.

The issue that we are discussing is important, because, over the past 10 years, we have seen the loss of a lot of those facilities, and many others are telling us that they are under threat. Local authorities have ownership of some of those properties, and I am interested in future capital assessments that might take place. The minister has outlined some of what that would look like, but how does Liz Smith envision that that will be captured in terms of the future investment that is needed?

I agree with what the minister says. When we look at where we are delivering in Scotland—in my local authority here in Edinburgh but also in Aberdeenshire and Glasgow—it is important that we see that flexibility around negotiation for teachers has actually delivered that capacity. It is really important that teachers are actively buying into and wanting to see this experience for their young people. I do not support the amendments in this group, because I think that they would complicate that picture even further.

I congratulate Liz Smith on the work that she has done on the bill and for being the first MSP to congratulate Steve Clarke and the national team—we are receiving email after email about it—although I thought that the convener would be the first to do so.

One of the interesting points that the committee noted when we visited the centres was that they were built in the 1940s—following the Education Act 1944 in England and Wales and the Education (Scotland) Act 1945—which was the last time that there was a focus on and significant investment in that area of education. The bill gives us an opportunity for us to have a reset in that regard, but in very different circumstances in terms of the sorts of facilities that we would expect. What work will be done with the centres, which are often run by private or charitable organisations, on what that investment might look like over that period? I hope that the bill will result in additional funds being given to the centres, but I also hope that, as part of the centres’ business models, other groups will come in and use them, which would create more cash flow for them to invest in their facilities.

Will the minister give way?

I do not have anything further to add. BMA Scotland, which I have been working with on a number of amendments, is very much in favour of ensuring that it has legal clarity as proposed, so I will press amendment 195.

Will the member take an intervention?