108.Memorandum from the Royal College
of Speech and Language Therapists (MIB 895)
The RCSLT welcomes the opportunity to comments
made on this draft Bill. Speech and Language Therapists (SLTs)
are the only registered profession qualified to assess peoples'
communication capacity including the use of augmentative and alternative
communication methods across all age and care groups.
Our comments are as follows:
1. We welcome the broad aims expressed in
the overview, and the attempt for the Bill to provide a clear
informal system to ensure people are able to maintain their maximum
level of autonomy.
The consultation process could be strengthened
by sending reminders to key stakeholders a week before the end
of the consultation periodNICE do this.
Also, is it possible to manage consultations
so that they are not occurring during mid July and August or to
extend the consultation period till mid September? We have had
few responses because of SLTs on holiday or using this time to
review their services.
3. THE OBJECTIVES
The objectives of the bill seem reasonably clear
however, because it is written within a legal framework is still
not easily accessible. It seems sufficient and workable, in that
no identifiable gaps (other than those noted belowsection
5 and 6) have as yet been noted. Further analysis, discussion
and more detailed information about how the Bill is to be operationalised,
the requirements for decision makers etc is needed to then consider
if it is really sufficient and workable.
Are we correct in assuming implementation of
the Bill will be covered in "section 30 Codes of practice".
The draft codes of practice from the Adults with IncapacityScotland
could be useful when developing these codes. We assume that these
codes would be consulted on. The NICE guidelines of schizophrenia,
and the National Service frameworks for "mental health"
and "older people" would also be a useful source of
4. OVERVIEW OF
The single definition of capacity is welcome
but it is not clear from the Bill who would carry out this assessment,
especially in the assessment of capacity depending on the level
and complexity of the decision to be made. It would be important
to establish that any person(s) making an assessment and judgement
about capacity is suitably qualified to do so.
There may need to be guidance stating the type
of decisions that could be made from an assessment of capacity,
so that the patient is not subject to unnecessary repeated assessments.
This would need to be carried out by a person suitable qualified
to assess the communicative demands for the decision to be made
as well as the abilities of the client. It would be useful to
know what is intended for the statutory and best interest checklists
when they will be available? However, we appreciate that this
might be within the codes of practice, yet to be developed.
5. THE BILL:
PART 1 SECTION
We understand the section to mean "If an
adult lacked capacity, treatment could be carried out if it was
considered (by the person with general authority) to be in the
best interest of the adult and after working through statutory
checklists and consulting with others interested in the welfare
of the patient".
There could also be a number of interested others
who could be involved. Consultation would depend on the decision
maker's knowledge and understanding of the different disciplines,
their roles, accessibility. For example for an adult with dementia
and dysphagia (feeding and swallowing difficulties) and SLT would
be the only person able to assess both the changes in communication/cognition
and the feeding/swallowing difficulties the patient was experiencing,
and the medical, ethical and legal aspects to decision making
for feeding in the late stages of dementia are complex.
Our concern therefore is that some professionals
might be excluded because of the lack of knowledge of the decision
Where there is no formal decision making mechanism
is in place, it would beimportant to secure a multidisciplinary
approach to inform the decision making of the person with general
We would suggest that an explicit statutory
checklist is developed to include:
(a) a summary of the process for decision
(b) information about the role /contributions
of the different professionals who might be involved.
Information to assist with this checklist might
be found in NICE guidelines for schizophrenia, and the National
Service frameworks for "mental health" and "older
people", and the Health Professional Council Standards of
7. LASTING POWER
PART 1 SECTIONS
8 AND 10
The points noted above would also apply to these
sections, since an attorney would be expected to make decisions
about health matters after discussing the issues with "all
relevant people". A concern then is how would they know who
the relevant people are unless that information is made available
The meaning of the word "instrument"
is not clear (section 8.2, and later sections).