RCPsych in Scotland at the Scottish Political Parties
Spring Conferences March 2014
Summary
Scottish Conservative Party Conference, Edinburgh International Conference
Centre, Friday 14th – Sunday 16th March 2014, attended by Rebecca Middlemiss,
Policy Administrator.
This was a quiet conference overall with very few exhibitors or fringe meetings. David
Cameron spoke mainly about the need for a no vote in the Referendum on Scottish
Independence and the strength of the UK together. He outlined the achievements that
the coalition government has made including the most generous child tax credits ever,
the biggest ever cash rise in the state pension and looking after the poorest people in
society and tackling adversity. He reiterated the importance of a sense of family, place
and history in the UK as a whole and how this ties in with Scottish values including pride
and resolve.
In both David Cameron and Ruth Davidson’s speeches there was a commitment to
further devolution of powers should there be a no vote in the referendum. This
commitment clearly signalling that for those who are disenchanted with the status quo,
but not willing to vote yes, there is change possible. He stated clearly the risk element
of voters choices in that “there will be no going back, no second chances”.
Ruth Davidson delivered a plea to Scottish people by pointing out that Scottish values
are reflected in the Conservative party and their values. Ms Davidson confirmed that the
party would end free prescriptions and use the money to fund 1,000 extra nurses, with
pensioners, the young, the pregnant or the poor remaining exempt. She promised an
overhaul of the education system, more power for parents to choose schools, more
rigorous exams for the brightest, sacking underperforming teachers and action over
‘failing schools’.
Fringe Meeting - My Life, My Death, My Choice
This fringe aimed to explore issues around the Assisted Suicide (Scotland) Bill currently
being considered by the Scottish Parliament and provide more information on the many
different aspects of this debate.
Speakers were Jackson Carlaw MSP, Tim McGuire from Humanist Society, Jane Devine,
journalist and Reverend Scott McKenna from the Church of Scotland.
Jackson Carlaw stated he had not supported the Bill the last time but will support this
version since a recent experience of a relative dying.
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Tim McGuire gave the Humanist perspective whereby there should be a choice of how to
live and how to die. He acknowledged that there is a high suicide rate but that he
believes this Bill concerns those who are suffering intolerably from a physical condition.
He discussed evidence from Oregon which has legislation in place to assist dying in those
who are mentally ill. The occurrence of hastening of death is around 40 per year on
average from 15 years of data. The financial implications of treatment are the least
popular used reason for the choice to hasten death. One third of people who apply for
the right to end their lives don’t take the medication following approval. Humanists think
that it is reasonable and common sense to allow the right to die and that the people of
Scotland will support this in the same way they have supported same sex marriage.
Jane Devine believed safeguards that were issues in the previously drafted version have
been addressed in this one. Devine discussed the Diane Pretty case and that the result
in that case was that the legal system had seemed intolerably cruel. The implementation
of Self Directed Support on 1 April gives choice and control over care and as individuals
will have the choice over how to live, this should also extend to whether they live. Many
people may not choose it but may get comfort from the choice being there.
Scott McKenna stated his opinion that the Church and the BMA have been slow to
change and are not representative of the feeling on the ground about this issue. He
discussed the church and their view that thou shalt not kill unlawfully, but gave
examples of where this is not absolute including the example of a ‘just’ war. The church
is also permissive of abortion in certain cases, for example in rape cases. At the moment
if people are wealthy enough or well enough they can go to Dignitas but this option is
not available to many. He also stated that this debate is about compassion and that he is
a supporter of good palliative care. Evidence from other countries is that there is no
reduction in funding for palliative care as a result of having a right to die. The church
sees this as an issue of autonomy and community which complement each other.
Individual choices are made as part of a community and are a sign of society maturing.
Several issues were raised in the discussion including the Royal Pharmaceutical Society
stating they will remain neutral and have developed a framework to manage end of life
care. The issue of mental illness and those in psychiatric care was raised and the
problem with the stigma of suicide. There was a discussion on living wills and do not
resuscitate orders.
There was also a discussion over the provision in the Bill which excludes doctors and
nurses who know the person concerned being involved in any assessment.
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Scottish Liberal Democrat Conference, Aberdeen Exhibition and Conference
Centre, Friday 28th March – Sunday 30th March 2014, attended by Rebecca
Middlemiss, Policy Administrator
Chaired by Jim Hume MSP, speaker Dr Tom MacEwan, Clinical Director of Older Peoples’
Service, NHS Grampian.
Jim Hume praised the good work of the College and of psychiatrists in general, he
applauded the focus on older people at the Fringe.
Tom gave a very well received presentation about older people’s mental health, the
importance of accurate diagnosis of dementia, recognition of older people with functional
mental illness and the prevalence of this. A general point was made that the needs of
older people with functional mental illness are being neglected and that there is a
gradual dismantling of older peoples services adding to this. He gave a description of his
own service including the composition of professionals in the team and how many
referrals they get. He went on to give examples from case studies illustrating that
patients referred for dementia diagnosis can sometimes have had issues with poly
pharmacy. Tom praised the very good work in Aberdeen of Penumbra and Alzheimer’s
Scotland.
Depression and anxiety are very common and part of the role of a psychiatrist is to
understand and help people with an emphasis on fully understanding a patient’s social
milieu. There is good work being done in Grampian where in addition to an older peoples’
service in psychiatry they have an Old Age psychiatrist in the general hospital in
Aberdeen.
There was an interesting question and discussion session following the presentation by
Tom. It was noted that many people with dementia have depression as well. There was a
point made about veterans and that many have unresolved issues. Those with dementia
can sometimes have memories of traumatic events refreshed and this is hugely under
diagnosed. There was discussion around the importance of understanding reliving
trauma and knowing the whole person being treated.
There was a question on national standards and models of care in hospitals and the
community. Tom advised there is RCPsych guidance on what a health service should look
like. He discussed HEAT targets and problems with measures, which in his view can be
problematic. There are also problems with diagnosis post diagnostic support, specifically
access to the 8 pillars model.
There was a question on voluntary sector representation in RCPsych in the light of a
decline in care packages people being stuck in hospitals. Tom confirmed the College is
flagposting and highlighting this issue. It is recognised that being in hospital isn’t good
for mental health and is often not the right place for people with dementia.
There was a question on integration and what is the College doing to prepare. In
Aberdeenshire the Chief Operating Officer has been appointed. It was discussed that the
success of integration will depend on good leadership.
Representatives of the Royal Pharmaceutical Society raised poly pharmacy and the need
to include pharmacists in discussions around this issue. There are poly pharmacy
guidelines and every ward meeting has a pharmacist present.
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This was a busier and livelier conference than the Conservatives and the exhibition area
was busy.
The main speeches by Nick Clegg MP and Willie Rennie MSP were largely focussed on the
referendum with a commitment to further devolution putting the Liberal Democrats in
line with the other unionist parties.
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The Scottish Labour Conference in Perth on 21-23 March 2014 was attended by
Karen Addie, Rebecca Middlemiss, Dr Alastair Cook (Friday) and Dr Ajay
Mirakhur (Saturday).
The College in Scotland took part as an exhibitor over three days of the Conference and
in that time staff and members spoke to a wide variety of delegates, MSPs, charities and
third sector organisations. The “Help is at Hand” information leaflets and the Scottish
briefing papers were popular with delegates and many commented on how useful they
found the mental health information from the College. It was particularly helpful to have
an informal discussion with the Scottish Consortium for Learning Disability given that the
College in Scotland is currently discussing the possibility of setting up a Mental Health
Alliance with other key stakeholders.
Dr Mirakhur meeting Lewis MacDonald MSP.
On Friday 21 March Dr Cook and Karen Addie met with Richard Simpson MSP, Shadow
Minister for Public Health.
There was some discussion about devolution and working in a Scottish branch of a UK
organisation. Dr Cook raised with him the health inequalities issue and how mental
health services can make a difference to improve outcomes for patients.
On the topic of health and social care integration, Dr Simpson suggested it would all
come down to budgets and confirmed that the Government will have reserve powers to
intervene if no agreement is reached on budgets between health and social care.
Dr Simpson raised the issue of dementia and care homes and in particular problems of
prescribing antipsychotics. Dr Simpson acknowledged the best care homes are really
good but he is not convinced the care inspectorate can look in enough depth at all
homes, especially on the use of drugs. He stated that if Labour win the next Scottish
election they will create a new independent inspectorate.
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Dr Cook spoke about the mental health journey from acute hospital care to community
care and this could now be applied to older people’s services. Richard advised speaking
to the Association of Directors of Social Work.
There was a short discussion about distress and aggression in older people and how this
is a major issue for psychiatrists working with this group.
Dr Cook went on to say the Scottish Government is carrying out a one-day census of
who is in all inpatient beds across Scotland.
In relation to Borderline Personality Disorder Dr Simpson was interested in what work is
going on in prisons with this group? Dr Cook said the College would provide information
to him on this. The overall impression was that healthcare in prisons had improved but
Dr Simpson was not convinced that the work done by the Commission on Women
Offenders had resulted in a better situation. There was a short discussion on the
important role of medium secure units.
Dr Simpson raised the issue of Alcohol Related Brain Damage and said his alcohol Bill
would be re-introduced after the Easter recess.
Finally, Dr Cook informed Richard of the recent meeting of mental health organisations
hosted by the College and the plans to establish a “Mental Health Alliance” to work
jointly on some campaigns and look to getting key messages about mental health
included in the political party manifestos for 2016 Scottish elections.
Dr Cook with Margaret McDougall MSP at the College stand
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Labour Fringe Meeting on the future of social care in Scotland attended by Rebecca
Middlemiss, Policy Administrator
Speakers included Richard Simpson MSP, Annie Gunnar-Logan and Pam Duncan.
Annie Gunnar-Logan stated that 1 April 2014 is the date for implementation of the Self
Directed Support Act and this will influence Health and Social Care partnerships and how
they shape up with a focus on structures rather than philosophies. It is hoped the Act
will encourage embedding new partnerships and a new common view with legislative
impetus coming through at local levels. The policy direction and social care development
have been positive.
There was some discussion of integration of health and social care, procurement and the
problem of competitively tendering for services. There is a massive downward financial
pressure, and competitive tendering has led to problems with pay and conditions for the
workforce. Self Directed Support is becoming entangled with cuts and rationing, this may
give it a bad name.
Pam Duncan challenged perceptions of disability and emphasised the need for rights of
individuals to be protected as well as access to practical support. The social care system
is in crisis with some support packages being cut by 40% and a 12% rise in charges over
the past 3 years. This has led to 47% of disabled people living in poverty.
The issue with transitions from one local authority to another was highlighted; there are
differing standards and criteria. Society should value social care as a structure for human
rights and equality.
Richard Simpson MSP (Shadow Minister for Public Health) stated that 40% of the
Scottish budget is spent on health and social care is being squeezed. He discussed the
success of the joint futures programme which was set up to try to address crushing
poverty and severe mental health problems. He pointed out that there is no living wage
in the Procurement Bill. Scottish Labour will be issuing a call for evidence and
commentary on their new health review. There is a problem with the complaints system
as the Patients Rights Act doesn’t apply to social care.
Fringe Meeting Friday 21 March on Social Care (Organised by UNISON) attended by
Karen Addie, Policy Manager
Karen Addie attended a Fringe event on “Time to Care” a report commissioned by Unison
on standards in home care. The Fringe meeting looked at the rising costs of social care
since the Council tax was frozen by SNP and how demographic changes are contributing
to the problem of caring for frail elderly people. Fundamental changes are needed to the
system and Unison remain unconvinced that integration will bring the desired changes
quickly. The focus of the Public Bodies (Scotland) Bill so far appears to be on governance
not care.
There was some discussion about bed blocking and standards/skills of carers and their
status. Neil Findlay MSP said that there was no bed blocking in West Lothian as health
and social care already worked really well together and people were not in hospital for
longer than they needed to be.
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The meeting then covered the working conditions of those providing care and included
discussions on minimum wages and zero hour contracts. There were some questions
from the audience about the 15 minute care visits and clarification that it goes up in
units of 15 minutes so if someone needs an hour of care that is what they should get.
People should be encouraged to be as independent as they possibly can be whilst their
care needs are met. Travelling time between care visits, especially in rural areas can be
a problem. There is anxiety that money from health will be used to fund care provided
by private companies. Friday’s exhibition ended with a visit to the stand by none other
than Ed Milliband!
Here he is taking a “memory and dementia” leaflet from Rebecca Middlemiss, our Policy
Administrator.
Saturday 22 March
Fringe meeting on the Assisted Suicide Bill attended by Karen Addie, Policy Manager.
Speakers included Mary Fee MSP, Bob Scott (Head of Campaign My Life My Death My
Choice) and Jane Devine (Journalist)
Mary Fee MSP introduced a Fringe event on Assisted suicide and said she supported the
Bill because she believed it offered the right protections to ensure it wouldn’t be
misused.
The meeting discussed the fact that people would have to be able to carry out the actual
act themselves and this legal protection was to ensure that anyone helping them
couldn’t then be prosecuted. It would not encourage “suicide tourism” as people would
have to be registered with a GP in Scotland in order to be protected by the Act. People
would also have to have mental capacity and there are essential safeguards in the Bill so
that two medical practitioners (who don’t have a caring role for the person involved)
have to agree separately on this issue. There will be strict time limits and the person will
have to carry out the act within a certain time frame or it will become unlawful.
The meeting discussed the Diane Pretty case and the public support for this Bill. An exGP said that research has showed that doctors in some cases upped drugs at the end of
life in order to give someone an “easier” death. Since Shipman, and the GMC changes
regarding this, it has become more difficult for doctors to do this, for example, many GPs
no longer routinely carry injectable morphine.
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The panel were all in agreement this Bill would bring clarity to a very complex issue and
it should not be seen as a replacement for good palliative care but as a complement to
that. Gail Grant from the BMA said that members of the BMA debate this annually and
have always opposed it. The Royal College of GPs have surveyed their members in
Scotland and have agreed to take a neutral stance on it. The pharmacists in Scotland are
also neutral.
An audience member asked about people with mental illness who have capacity and
would they fit the criteria. There was some debate about “alienation of reason”. The exGP thought it very unlikely someone in this position would fit the criteria and the period
of reflection necessary may enable someone to address their depressive illness for
example.
The meeting moved on to talk about quality of palliative care and there was lots of
agreement among the audience that this can be poor. Some members of the panel
thought this Act may improve the palliative care.
It was confirmed that you couldn’t use the Act to carry out suicide at the point of being
given a diagnosis of a terminal illness.
Staff and Dr Mirakhur attended the “Healthier Nation” session of the main conference on
Saturday 22 March.
Neil Findlay MSP, Health spokesperson for the Scottish Labour Party spoke about the
advances in medicine since the 1940s and the changing demographic challenges. People
are living longer but if they live in a poor community they are more likely to suffer from
health inequalities and die at a younger age than those from more affluent areas. There
will be half a million pensioners in Scotland by 2035 and there are ongoing problems in
the system at the moment caused by bed blocking and poor standards in home care.
Scottish Labour are committed to having a national conversation about care and how
best to plan and deliver services to meet demographic changes. In order to tackle
health inequalities it would be necessary to take action on income; early years and the
inverse care law. It would need reallocation of resources in order to meet the costs of
this.
Neil Findlay also visited our stand on Sunday 23 rd March and spoke to the staff. The main
themes were health inequalities and integration. We also spoke about care of the elderly
and standards of home care.
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