The Health and Social Care Alliance Scotland (the ALLIANCE) welcomes the opportunity to respond to the Adults with Incapacity Amendment Act (the AWI Amendment Act) consultation.
We consider this a valuable opportunity to comment on the proposals and the importance of reform to mental health legislation. It is positive that the proposals align with the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) and incorporate some of the recommendations of the Scottish Mental Health Law Review (SMHLR).
However, whilst we acknowledge the fact that the Scottish Government have stated that this is an initial step towards longer term and larger changes in the law, we do not think that the proposed amendments go far enough to truly introduce positive change for people subject to the Act.
The ALLIANCE have concerns about the amendments approach being taken. Instead, we recommend that the Scottish Government legislate for a rights based system of supported decision making that will replace guardianship and which is in line with the UNCRPD.
We do not believe that the proposed new principles can be fully realised without a new supported decision-making framework that is robustly resourced, implemented and independently scrutinised to support them.
A university project, which is raising awareness of the shocking rise of osteoporosis in adults across the UK, is to provide specialist education for care home workers and community champions.
On World Osteoporosis Day (20th October ‘24) Queen Margaret University (QMU), Edinburgh announced that it is expanding its vital work to ensure osteoporosis is viewed as a public health priority.
The University team will be encouraging staff from care homes, and people living with the condition, to become better educated about the common bone disease which affects over 3 million people in the UK.
Osteoporosis is a common bone disease that weakens bones, making them fragile and more likely to break. Developing slowly over several years, it’s often only diagnosed when a fall or sudden impact causes a bone to fracture.
Affecting over 250,000 in Scotland and accounting for around 527,000 fractures per year in the UK, QMU’s Lydia Osteoporosis Project is passionate about raising awareness to help halt the rising numbers of people affected by the condition.
Although it is frequently perceived as a condition primarily affecting postmenopausal women (affecting 1 in 2 women over 50), evidence indicates that osteoporosis affects approximately 1 in 5 men over the age of 50.
Given its often ‘silent’ progression until fractures occur, it frequently evades diagnosis until it reaches an advanced stage.
Dr Karen Matthews, who leads the Lydia Osteoporosis Project at QMU, explained: “Osteoporosis silently undermines bone strength over time. Often, it remains undetected until a simple fall or sudden impact results in a debilitating fracture.
“Typically, individuals with osteoporosis experience fractures in their wrists, hips, or spinal bones. It can even lead to a broken rib or partial spinal bone collapse triggered by a mere cough or sneeze.
“Older people can develop the characteristic stooped posture as their spinal bones weaken and are unable to bear their body weight.”
Due to our increasing aging population, osteoporosis is now increasingly prevalent, with a high incidence of people with the condition living in a care home setting, as well as in the community.
Dr Matthews explained: “It is not always obvious that someone has osteoporosis, as it can essentially be a hidden disease. But it is critical that staff in care homes and health care settings develop a better understanding of the condition so they can prevent any unnecessary bone fractures when moving or handling patients.
“Care homes workers who may be moving people in and out of beds, chairs, wheelchairs etc., or even helping them wash or change, need to be aware of the condition, to avoid handling which may cause people’s weakened bones to fracture accidentally.
“Staff in care homes, healthcare professions and the public can all benefit from improved knowledge about preventing osteoporosis through lifestyle choices, physical activity, and a balanced, bone-healthy diet, as well as how to prevent unnecessary fractures.”
Dr Matthews emphasised: “We cannot underestimate the importance of care home staff when it comes to the care and welfare of our elderly population. We must invest in their education and professional development so they are equipped with the skills and knowledge to give the best care to their residents.
“That’s why Queen Margaret University will be offering a number of free modules as scholarships to individuals working in the care home sector. We want to develop a community of Lydia Osteoporosis Champions who can help to raise awareness of this important condition within the sector.”
The QMU team is also keen to develop champions in the community who can work to reduce the incidence of osteoporosis within the population by promoting good bone health and preventative behaviours such as weight bearing exercise and healthy eating.
Dr Matthews concluded: “Osteoporosis is now such a significant health problem in today’s society that it needs to be viewed and addressed as a public health priority.
“Education and research are key to raising awareness. That’s why we are ensuring it’s taught as part of our undergraduate and postgraduate healthcare professional courses at QMU, and in our PgDip Advancing Care Home Practice (Person-Centred Practice).
“But we also need to reach people who are already in healthcare roles to spread awareness of knowledge across healthcare settings. Partnerships with staff in care homes and other healthcare settings are going to be crucial to our development of Lydia Osteoporosis Champions.
“Ultimately this will improve person-centred care of people living with osteoporosis across our care home sector, and reduce the prevalence of this worrying condition in Scotland and the UK.”
It’s Male Breast Cancer Awareness Week and breast cancer charity Walk the Walk is celebrating seven years of raising awareness that Men Get Breast Cancer Too.
Following the success of the Men Get Breast Cancer Too campaign, charities across the UK now regularly feature men as an integral part of their awareness campaigns and include the following important information:
Male breast cancer affects between 370 – 400 men a year in the UK
Over 80 men a year die from breast cancer due to not knowing men can get this type of cancer, and not doing regular checks
Breast cancer usually affects men aged 50 and over, but it can be found in men of any age
The diagnosis of breast cancer in men, as well as the treatment, is very similar to that for women
Mark Winter(59) from Eastbourne is part of the Men Get Breast Cancer Too campaign and was diagnosed with breast cancer in May 2020: “My message to men is to not only check ‘below’, but to check ‘above’ too and don’t be frightened if you find something.
“Proportionally, more men die of breast cancer because they’ve ignored the problem and not done anything about it. My own diagnosis was a hell of a shock, but that phone call I made to my doctor’s was probably the best one of my life.”
During menopause women can experience a range of psychological and physical symptoms.
Psychological symptoms can include anxiety, irritability and low mood. Knowing the signs can help you navigate this life transition with more confidence.
A partnership between NHS 24, Police Scotland, and the Scottish Ambulance Service (SAS) ensures anyone who needs urgent mental health support will be directed to the most appropriate service for their needs.
Termed the ‘Mental Health Pathway,’ the collaboration between the three services means that people phoning 999 with non-emergency mental health concerns are now referred to NHS 24’s Mental Health Hub.
This is staffed by Psychological Wellbeing Practitioners and Mental Health Nurses who are highly trained to help patients in mental distress. The Mental Health Hub is designed to support people who need urgent mental health support, where emergency intervention is not required.
The Hub can also be accessed by phoning 111. As well as helping people with their immediate care needs, specialist staff can also refer people to local services. They’ll then get further assessment and treatment if needed. Although most people can be helped immediately and supported with self-care techniques.
Dr Ron Cook is NHS 24’s Medical Director. He details the aims of the Mental Health Pathway and why it became essential for NHS 24, Police Scotland, and Scottish Ambulance Service to work together to provide more effective urgent mental health support for patients:“It is imperative that anyone in mental health crisis or distress can quickly and easily connect with professionals who are experts in that field. Within office hours, patients seeking help with their mental health should contact their own GP.
“However, during the out of hours period, such as evenings and weekends, it is common for patients to be unsure of where to access mental health support. Many will often reach out for help by dialling 999, which may not be the most appropriate care route for them.
“The Mental Health Pathway was set up to streamline the process for anyone needing urgent assistance with their mental health, and aims to make all callers feel supported, understood, and cared for.
“This project has led to a better experience for individuals experiencing mental illness or distress, but also has the added impact of reducing the deployment of frontline services in non-emergencies and easing the demand on emergency services.”
The Mental Health Pathway was developed as a response to actions from the Scottish Government’s Mental Health Strategy 2017-2027, which aims to improve mental health services and outcomes for people in Scotland by providing a comprehensive and integrated approach to mental health.
NHS 24, Police Scotland, and SAS’ partnership went live operationally in 2020, and since then, the project has undergone various evaluation phases and gradual roll-out to thoroughly test processes to ensure patient safety.
2024 has marked a significant milestone for the Mental Health Pathway as over 91% of Police Scotland staff are now trained in the transfer process, with work ongoing to train 100% of applicable staff, secure the pathway as business as usual, and ensure all Police Scotland and SAS staff have awareness of and confidence in transferring mental health callers appropriately.
Anna is a Senior Charge Nurse in NHS 24’s Mental Health Hub, she explains the benefits to patients: “It is great that patients now come directly through to us if they need urgent assistance with their mental health, as it means that they are not waiting for lengthy periods at A&E which may not be the most suitable place for their needs at that time.
“It is so important that we are providing safe and effective care for all patients, and the development of the Mental Health Pathway means that people are getting the help they need at the right time by right person.”
The collaboration between NHS 24, Police Scotland, and SAS not only has a positive impact on patients. The Mental Health Pathway has also meant that police and ambulance staff are no longer deployed unnecessarily to calls regarding mental health unless there is an immediate threat to life.
This change has meant that staff from these services now have more time to perform their core roles.
Notably, Police Scotland data has recorded that 17,413 officer hours were saved over a ten-month period and 99% of their staff confirmed they felt confident making referrals and using the Mental Health Pathway following their training.
Chief Superintendent Matt Paden leads Police Scotland’s Mental Health Taskforce, he said: “Our work around policing’s response to mental health seeks to reset the parameters of policing’s contribution to a system wide response to ensure people get the compassion, help, and support they need and deserve from those best able to provide it.
“Our colleagues in the Mental Health Taskforce and C3 Division have worked closely with partners in NHS 24 and Scottish Ambulance Service to deliver the Mental Health Pathway over a period of years.
“Their important work demonstrates the benefits of referring those in mental health crisis to services best able to meet their needs. This can provide better outcomes for individuals and communities, better value to the public and enable officers to tackle threat, harm and risk and prevent crime.
“Further development and evaluation will continue, but I am grateful to all of those involved in the successful implementation and delivery of the Mental Health Pathway.”
Catherine Totten, Head of Service for Mental Health and Dementia at the Scottish Ambulance Service (SAS) said: “SAS supports people in mental health crisis and distress 24 hours a day, 365 days of the year, and we are committed to improving the outcomes and experience for these service users.
“The Mental Health Pathway allows us to directly transfer non-emergency callers to mental health trained clinicians in the NHS 24 mental health hub, ensuring those in crisis receive the right care at the right time.”
A new strategy is being published to radically cut the number of single-use medical devices in the health service
Move to scrap single-use MedTech as Health and Social Care Secretary launches waste blitz
Tens of millions of disposable items are binned after just one use
MedTech companies incentivised to produce sustainable products – pumping millions back to NHS frontline and cash into economy
The government is launching a major crackdown on waste in the NHS to save millions of pounds a year, helping to divert more resources to frontline care.
A new strategy – the Design for Life Roadmap – is being published to radically cut the number of single-use medical devices in the health service and reduce our reliance on foreign imports.
Disposable medical devices substantially contribute to the 156,000 tonnes of clinical waste that the NHS produces every year in England alone. The roadmap paves the way to slashing this waste and maximising reuse, remanufacture and recycling in the NHS.
Doing so will create thousands more UK jobs and help transform the country into a life sciences superpower. As it stands, millions of devices like walking aids and surgical instruments are thrown away after just one use.
Harmonic shears – surgical devices which seal patients’ wounds using ultrasound waves – each cost more than £500 and around 90% of them are binned after a single use. Innovative companies are already purchasing these used devices and safely remanufacturing them at a lower price.
The government will encourage more of this kind of innovation to safely remanufacture a wider range of products and drive costs down, including by changing procurement rules to incentivise reusable products and rolling out examples where hospitals are already leading the way on cutting wasteful spending and practices.
Approximately £10 billion each year is spent on medical technology like this in the NHS, but too much of it is imported via vulnerable routes that risk disrupting patient care.
A Circular Economy Taskforce has already been created to foster more highly skilled green jobs and smarter use of our resources. An economy wide shift to a circular economy could add £75 billion to the economy and create 500,000 jobs by 2030.
Health and Social Care Secretary Wes Streeting said: “The NHS is broken. It is the mission of this government to get it back on its feet, and we can’t afford a single penny going to waste.
“Because the NHS deals in the billions, too often it doesn’t think about the millions. That has to change. This government inherited a £22 billion blackhole in the public finances, so we will have a laser-like focus on getting better value for taxpayers’ money.
“Every year, millions of expensive medical devices are chucked in the bin after being used just once. We are going to work closely with our medical technology industry, to eliminate waste and support homegrown medtech and equipment.”
The below case studies illustrate the potential savings:
Mid Yorkshire Trust uses 330,000 single use tourniquets in a year, but a single reusable tourniquet can be used 10,000 times. In a one-year trial, reusable alternatives saved £20,000 in procurement costs and 0.75 metric tonnes of plastic waste.
In Northampton Hospitals NHS Trust, a single Ophthalmology department saved 1,000 pairs of disposable scissors and £12,000 in a year by switching to reusable pairs. Single-use scissors are often used in surgical settings. NHS procurement data shows that several million pairs of single-use scissors were purchased by the NHS in a single year (2022-23). That is the equivalent of hundreds of pairs of scissors thrown away every hour.
Leeds Teaching Hospitals Trust saved £76,610 in costs purchasing 604 remanufactured Electrophysiology (EP) Catheters, and generated a further £22,923 for selling used devices for collection. If the same approach were to be scaled up across the UK, the NHS could save millions of pounds per year on EP catheters alone, just a few product lines among hundreds of thousands.
Harmonic shears are complex devices for performing surgical procedures and cost more than £500 each, yet around 90% are binned after a single use. Leeds University Teaching Hospitals Trust has demonstrated that companies can safely remanufacture them, giving up to 50% cost savings.
The Design for Life programme will reduce this kind of waste and achieve an NHS-wide move to sustainable alternatives– also supporting the government’s net zero goals.
A new roadmap sets out 30 actions to achieve this shift – including how the government will work with companies to encourage the production of more sustainable products, along with training for NHS staff on how to use them.
Taking this approach will mean more money can be spent in the UK, driving growth, creating more engineering, life sciences and research jobs – all while securing savings for the NHS budget.
Many of these products include precious metals such as platinum and titanium which are in high demand but go to landfill when they could be recovered and sold. A reduction in the amount of disposed single-use devices will also reduce the country’s carbon footprint and plastic pollution.
The government will encourage industry figures to innovate by making sure benefits of reusable MedTech are part of how the NHS chooses the products it buys.
Baroness Merron visited University College London Hospital yesterday (Tuesday, 15 October). The hospital is a member of the Circular Economy Healthcare Alliance, which advocates for sustainable practices within the NHS.
Health Minister Baroness Gillian Merron said: “Design for Life doesn’t just deliver on the Health Mission, to build an NHS fit for the future, it also delivers on our Growth Mission to make the UK a life science superpower and our commitment to get the NHS to net zero by 2045.“
She toured a mock operating theatre and was shown various sustainable products its NHS staff use – from simple products like gowns and scissors to sophisticated, expensive products like harmonic shears.
Professor Sir Stephen Powis, National Medical Director of NHS England, said: “While the NHS is treating record numbers of patients, we know there is much more to do to ensure taxpayers get value for money.
“The NHS made a record £7.25bn worth of efficiency savings last year and is targeting a further £9bn of savings for 2024/25. But we are rightly still looking for ways to get our money’s worth for every penny we spend.”
