Human rights in the UK: Universal Periodic Review, 2017 – Scottish Government position

11. Promoting health

The Healthcare Quality Strategy for NHS Scotland ^[123] contains three quality ambitions of safe, effective and person-centred care. The Patient Rights (Scotland) Act 2011 ^[124] gives all patients certain rights concerning the healthcare they receive, including a right to raise concerns or complaints, and requires Scottish Ministers to publish a Charter of Patient Rights and Responsibilities. The Scottish Government's 2020 Vision ^[125] is that everyone is able to live longer healthier lives at home, or in a homely setting, and that by 2020 Scotland will have a healthcare system where, amongst other things, health and social care are integrated; there is a focus on prevention, anticipation and supported self-management; and, whatever the setting, care will be provided to the highest standards of quality and safety, with the person at the centre of all decisions.

Access to services

Anyone who is living in Scotland legally and for a specific purpose is able to register with a GP practice to receive NHS general medical services. This includes asylum seekers, refugees, migrant workers, Gypsy/Travellers, students and those joining their families. Asylum seekers who have made an application to the Home Office are entitled to the full-range of NHS care and services while in Scotland, regardless of the status of their application.

A national standard has been introduced to ensure 48-hour access, or advance booking, to an appropriate member of the GP practice team during core hours, through either a face-to-face or a telephone consultation. Most NHS services, including those provided by GP practices, local pharmacies, hospitals or clinics and emergency services, are provided free of charge. There is also a right to free NHS eye examinations and free NHS dental examinations. Health Boards are expected to design and put in place service models that best reflect local circumstances, and are responsible for ensuring that primary medical services in Scotland recognise cultural diversity and respond to the healthcare needs of all ethnic groups and communities.

Healthcare staff have a duty to ensure that information and services are accessible to all, for instance through arranging interpretation or advocacy services for those who need them. The Scottish Government's national strategy on sensory impairment, See Hear (April 2014), ^[126] sets out a commitment that adults and children should expect a seamless provision of assessment, care and support, and the same access to public services including healthcare, employment, education, leisure, and social care as everyone else. NHS Health Scotland is working with NHS Boards across Scotland to support improvements in the provision of British Sign Language ( BSL) interpreting services in health settings. These and other actions the Scottish Government is taking to improve access to health services for people whose first or preferred language is BSL will be included in Scotland's first BSL National Plan, which will be published in October 2017 as required by the British Sign Language (Scotland) Act 2015. ^[127]

The Scottish Government is committed to building on the work already delivered on augmentative and alternative communication ( AAC) in Scotland through A Right to Speak (2012) ^[128] and Now Hear Me (2015). ^[129] In April 2016, Part 4 of the Health (Tobacco, Nicotine etc. and Care) (Scotland) Act 2016 ^[130] received Royal Assent. This legislative duty on the provision of communication equipment and support gives children and adults across all age ranges and care groups, who have lost their voice or who are at risk of losing their voice or who have difficulty speaking, a statutory right to access the communication equipment and support they need. ^[131]

The Scottish Care Experience Survey Programme is a suite of national surveys which aim to provide local and national information on the quality of health and care services from the perspective of those using them. ^[132] Information on protected characteristics is routinely collected through national surveys conducted by the Scottish Government, and administrative systems used in the delivery of health care also capture a range of equality information. Both the Scottish Government ^[133] and NHS Health Scotland ^[134] publish evidence summaries for each equality characteristic.

Autism

In 2011, the Scottish Government launched the Scottish Strategy for Autism , ^[135] which focuses on reducing the inequalities faced by people who have autism. It has been reframed into an Outcomes Approach ^[136] with four key outcomes that aim to ensure that people with autism should be afforded the same rights as all citizens.

Learning disabilities

In 2013, the Scottish Government launched the Keys to Life strategy, ^[137] which has been reframed into an Implementation Framework ^[138] with four key outcomes that aim to ensure that people with learning disabilities should be afforded the same rights as all citizens.

Health inequalities

The Scottish Government recognises the need for a shift in emphasis from dealing with the consequences of health inequalities to tackling the underlying causes - ending poverty, promoting fair wages, supporting families and improving physical and social environments. Scottish Government measures such as investment in affordable housing, free school meals and continuing commitments to free prescriptions, concessionary travel and free personal care, are the right approach, coupled with decisive action to address alcohol consumption, reduce smoking rates, encourage active living and healthy eating, and investment to improve mental health services.

The Scottish Government is currently funding the Links Worker pilot programmes in Dundee and Glasgow, which see a dedicated individual working in GP surgeries, helping patients on a one-to-one basis with non-medical problems that are making them feel unwell. The Scottish Government will increase the number of community Links Workers in disadvantaged areas to 250 over the next five years, with 40 to be recruited by September 2017, to ensure that anyone who needs psychosocial support receives it.

The Scottish Government is expanding access to Family Nurse Partnership ( FNP), an intensive, preventive, one-to-one home visiting programme for young, first time mothers and their children from early pregnancy until the child reaches the age of two. FNP aims to break the cycle of disadvantage by working directly with young mothers and their children to improve their health and wellbeing. It is now in 10 NHS health board areas and supports almost two-thirds of the first time, young mother population at any one time. There are high levels of engagement and retention.

Mental health

The Scottish Government has a Ministerial post dedicated to mental health and over five years is investing an additional £150 million in mental health. A new strategy for mental health, which will set out a vision for the next 10 years and how to transform services, will focus on themes including prevention and early intervention, responses in primary care settings, improving the physical health of those with mental health problems, and improving access to mental health services. The Scottish Government remains committed to meeting its target of 90% of those referred for specialist Child and Adolescent Mental Health Services ( CAMHS) starting treatment within 18 weeks, and is continuing to work with NHS boards to help them to make the necessary improvements. The Scottish Government is implementing the Mental Health (Scotland) Act 2015 and will promote independent advocacy and advance statements, alongside a rights-based approach in the statutory guidance on the use of mental health legislation.

The aim of the NHS/ SPS multi-disciplinary Mental Health Team is to provide mental health care within prisons equivalent to the care provided for people in the community but designed to meet the recognised increased mental health needs of prisoners. Following the transfer of responsibility for healthcare from SPS to NHS Health Boards in November 2011, clinical treatment and support for prisoners with mental health problems sits with NHS. SPS still has a role to play in providing support and activities for prisoners with mental illness and mental health issues, and an environment that encourages prisoners with mental health issues to engage with staff and services. SPS has funded training for Residential Officers in managing prisoners with challenging behaviours and personality disorders, and NHS Psychiatry operates an in-reach service across establishments in Scotland with a mixture of forensic psychiatrists and general adult psychiatrists in attendance. Several third sector agencies also provide additional services and support for prisoners with mental health issues. On 29 November 2016, SPS launched its new Suicide Prevention Strategy, Talk to Me , ^[139] which replaces ACT2Care . The new strategy is intended to enable the whole prison community to work together to identify vulnerable individuals, share information and encourage those 'at risk' to accept help and support.

Suicide prevention

Data published in 2016 show that the suicide rate in Scotland fell by 18% in the period 2001-05 to 2011-15.

The Scottish Government Suicide Prevention Strategy 2013-2016 ^[140] was developed on the basis of the growing evidence base about factors that can be related to death by suicide. One of the strategy's five key themes is 'Developing the Evidence base', and the Scottish Government has committed to fund sources of research data that help to inform suicide prevention action, including the Scottish Suicide Information Database and the UK Confidential Inquiry into Suicide and Homicide by People with Mental Illness. The Scottish Government also funds NHS Health Scotland's National Suicide Prevention Programme, which includes a range of communications and actions to raise awareness of suicide and to encourage people to talk about their concerns or to ask if a friend or family member is feeling suicidal.

With partner agencies, the Scottish Government has developed a proposed Distress Brief Intervention ( DBI) to be piloted in four areas from 2017. This is aimed at intervening early with people who are in distress and potentially at risk of self-harm or suicide but who do not need urgent medical treatment. An evaluation report on the impact of DBI is expected in 2021.

Adults with incapacity

The Adults with Incapacity (Scotland) Act 2000 contains provisions covering the personal welfare and financial affairs of adults who lack capacity to make some or all decisions on their own behalf, and provides safeguards through the roles and functions of the statutory bodies involved. The 2000 Act sets out arrangements for guardianship orders and intervention orders made by the Sheriff Court, which provide legal authority for someone to act on behalf of the person with impaired capacity, to safeguard and promote their interests. Authority to make welfare decisions can include placement in care settings if specified. The 2000 Act allows for a person with capacity to grant a power of attorney to someone they trust in the event of loss of capacity and, if they are given health care decision-making powers, they can give consent for medical treatment. Where there is no proxy, a doctor is authorised to provide medical treatment in that specific instance, subject to certain safeguards. ^[141]

Following the Scottish Law Commission's review of the 2000 Act on compliance with Article 5 of ECHR, specifically in relation to deprivation of liberty in hospital and care home settings, the Scottish Government consulted on the Commission's recommendations and published an analysis of the responses. ^[142] Work in the longer term is being undertaken with stakeholders on these and wider issues around guardianship, and consideration of circumstances in which supported decision making can be promoted. Further public consultation will follow towards the end of 2017.