Report on the Review of the Mental Health (Scotland) Act 1984

Chapter 35

THE STATE HOSPITAL

Statutory basis for provision and management of the State Hospital

1. The 1984 Act originally contained provision, in Part VIII, for the State Hospital. It imposed a duty on the Secretary of State to provide such hospitals as appeared to him to be necessary for persons subject to detention, who required treatment 'under conditions of security on account of their dangerous, violent or criminal propensities'. The only hospital so provided was the State Hospital at Carstairs. The Act provided for a Management Committee to manage the hospital, on behalf of, and subject to direction by, the Secretary of State.

2. Much of Part VIII of the 1984 Act was repealed by the State Hospitals (Scotland) Act 1994. This transferred the duty of the Secretary of State to provide high security hospitals from the Mental Health (Scotland) Act to the National Health Service (Scotland) Act 1978, which is the general statutory provision governing the provision of the NHS in Scotland. It also provided that the management of such a hospital could be devolved to a health board. Arrangements were then made to establish a Special Health Board which, from 1 April 1995, took over the management of the State Hospital from the State Hospital Management Committee⁴.

3. We understand that this change was prompted by a desire that the State Hospital operate on a similar footing to other parts of the NHS (although it is unusual for a health board in directly providing health care, rather than contracting with NHS Trusts to do so). We endorse this aim, and we were not made aware of any concern about the general statutory position of the State Hospital.

4. In 2000, the Scottish Health Advisory Service reviewed mental health services at the State Hospital. Their report raised a number of concerns about the culture within the hospital and took the view that the Hospital was not yet fully integrated within a national network of local hospital and community services, so as to ensure that a person has appropriate safe care at all stages of the rehabilitation process. The report also highlighted a number of positive developments, and pointed out that some of these difficulties were not within the power of the State Hospital to correct. The recommendations of the report did not identify any changes to the statutory basis of the State Hospital as being desirable⁵.

5. Some of the provisions in s91 of the Act in relation to the State Hospital Management Committee have not been repealed. We assume that these were retained for transitional purposes only, since that Committee now has no ongoing role. It would seem that, in a new Mental Health Act, these provisions would be unnecessary.

The Medical Sub-Committee

6. One issue which arose in the Ruddle⁶ case was the role of the Medical Sub-Committee at the State Hospital. This was originally constituted as a sub-committee of the State Hospital Management Committee, and carried out an expert advisory role within the Hospital, including reviewing the appropriateness of continued detention and treatment of State patients. The legislative basis for the committee disappeared when the Management Committee was replaced by the State Hospitals Board for Scotland, but the Medical Sub-Committee continued to perform an advisory role. In that capacity, it was influential in relation to decisions concerning Noel Ruddle, in the period prior to his successful appeal against detention.

7. The Mental Welfare Commission enquiry into the care and treatment of Noel Ruddle⁷ considered the role and responsibilities of the Medical Sub-Committee. It expressed some concern that its role in relation to restricted patients was unclear in some respects⁸, and recommended that the purpose and procedures of the Medical Sub-Committee should be reviewed, so that there is clarity as to the purpose and effect of its clinical, managerial and statutory involvement with patients⁹.

8. We understand that the State Hospitals Board and the Scottish Executive are reviewing the arrangements in the light of this report. Since the Medical Sub-Committee or any future replacement would appear not to need any specific statutory reference, we do not feel it is necessary for us to make any recommendations in this regard.

The information contained on this WWW site is Crown Copyright but may be reproduced without formal permission or charge for personal or in-house use. © 1997-2001. For general enquiries about this section email mentalhealthlawmailbox@scotland.gsi.gov.uk