Mae gweithdedig gwaith i gyfer sefyllfa 29 y syniadau 15 gynnydd. Ymgyrchu unig yn gwneud hynny, mae eich cyfnwys ysgol o ran ffodol sydd ymrwyngau yn gweithio ffordd cael ei chryddau fawr, ac mae eisiau bod yn ymddangosol cyffredinol i gweithgau holl gŵy i gael pwyntu ac adeiladau. Rechydig i fod y ffiantas Fendisyn Clawin wrth fedddai Dr Helen Smith i gael eich cyfnod. Mae'n edrych i gael o rhair hefyd i gael eu piwyr 3, oherwydd i'r llrygol i gael ei'r lawer Fy mengen nhw ac rôl ddim yn rameolyddio cy resilientol synsiwr r Garden isol, a或r i'r wiriau a hisds arall erin nhw'n fxfrigiaiddol. Rwyf sydd wedi am communications yng Nghymru gyda gwaith eich cael eff jederb First of all, thank you for inviting me to give evidence. I'm very grateful. Secondly, I need to make clear that I think any young person who dies in custody is a tremendous tragedy for the family and for Scotland as a whole. My sympathies go out. I don't know if you know but my father committed suicide and I have an absolute understanding of the misery and tragedy that can cause. The mental health review was commissioned, as you know, following the deaths of William Lindsay and Katie Allen, but specifically excluded our looking at those two cases. In reality, we did not look at any individual case as we felt that a case review wasn't within the terms of reference. What became clear in all our evidence—we did a considerable degree of work in a very short timeframe. We talked to families, we talked to children, we talked to young people in custody, we talked to young people in Grampian prison who had been in Pullmont. I visited two secure area centres to have a look and see the difference there. We did a huge clinical review, which Helen will be able to talk about more than I can. We did a considerable amount of work. There are areas of work that we were not able to complete because of the timeframes. For instance, one of the areas of concern for me was a matching up of the FAI determinations and recommendations with the recommendations from the Diplr, the death in prison review that happens. That is a piece of work that I would still like to complete. What came out were two clear areas. One was the inconsistency or patchiness of information that arrived in Pullmont with the child or young person. The second thing that became clear was that all the academic evidence that I have read more than I really want to know is that social isolation is one of the key indicators towards being at risk. Since we have in Scotland a culture of remand prisoners not being given the same opportunities as a convicted prisoner, for very good reason, nonetheless social isolation is a real issue. Those two issues came out. Let me be clear that we did a lot of things. We commissioned University of Glasgow to do the academic evidence review and their report is within our report. We formed three short-life working groups, the first one looking at information flows, the second one looking at everything clinical and wellbeing, and the third one looking at the death in prison learning audit review and the existing strategy for self-harm. All of those three working groups were initiated by a round table where we invited, frankly, the world and its brother to give us advice as to how to take this review forward. One of the other interesting things for me was how complex it was to find out all the other reviews that were going on at the same time or had recently been completed, who chaired them, who was chairing them and what their recommendations were and whether or not they had been fulfilled. One of my recommendations that you will read is for a centralised co-ordinating body run by Scottish Government that can actually say when you are starting a review or a task force or whatever else, here is the toolkit that you can use and this is where you can access the information that has gone ahead of you. I was constantly aware that I may be treading on toes all the time for people who had already completed a major piece of work. That is a quick, brief and helpful canter. We now move to questions, starting with Jenny Gorruth. I would like to start this morning by getting a better understanding of the mental health needs of young people when they first enter custody. I note in the report that you speak about the impact of adverse childhood experiences and you have spoken already this morning about social isolation. Have the mental health needs of young people changed over time in recent history, do you think? I really couldn't answer that, but I'm sure Dr Smith can. Morning. From my clinical viewpoint, there has been an increase in young people with neurodevelopmental disorders, particularly ASD and ADHD. Also, as you have pointed out, the ACEs and young people with traumatic backgrounds and trauma histories. I think that young people entering custody, when we looked at it in the secure care estate, which is where I do most of my work, there was a big increase in the number of young people with mental health difficulties. Whether they met criteria for a mental health diagnosis is maybe different, but I would suggest all the young people that come into custody would have difficulties of one. On average, we would be much more likely to experience some form of trauma in their lives. Oh, yes, definitely. The reduction in the number of children coming into prison has meant that those who do come in are likely to have more of a complex traumatised background. You mentioned inconsistent information in your opening statement. I was quite taken by that. During the inspection of HMP YOY Pullment, we found that the well-being opportunities afforded for young people were evidence-based, leading edge and impressive. However, the take-up of the remarkable opportunities remained consistently poor. Why do you think that was the case? It's a combination of reasons that we've looked at quite extensively. One of them is the young person's own wishes. They prefer and feel safer saying that they're staying in their room. Why do they feel safer? I can't experience that. Certainly, when you speak to young people about coming into prison, they feel very nervous. Then, when they're in and Pullment's very good at having a peer mentoring system, they talk to other prisoners there and they start to relax. However, I think that there is that fear of the unknown dealing with the trauma of coming into prison and they just want to stay in their room. They don't want to come out, so it's a difficult one. However, it's improved. Originally, the initial inspection report showed that 50% of the places weren't taken up, and now it's down to 30%. That's a progress. I'm not sure that I can add much to that. It may be some elements of their mental health, but I think that it's much more as Wendy is saying. In terms of those wellbeing opportunities, do those include educational opportunities? They certainly do. A range of educational opportunities are really excellent. Can I ask are those educational opportunities benchmarked against curriculum for excellence, because an eighth of curriculum for excellence is dedicated to health and wellbeing? It'd be interesting to find out if that's the case in Pullment at the moment, if that's been delivered across the past. Yes, it is. Thank you. I wonder before I bring some others in if I could ask you, Dr Smith, did I pick up correctly in you saying that everyone that came into Pullment had mental health issues? I think that it's very likely that a very high number of them will have mental health difficulties. Whether they have a diagnosable mental health disorder is very different. There's never an exception to that because we know that people go to Pullment for a number of reasons and with different backgrounds to how they arrive there. If you're suggesting that young people maybe who are remanded or have other difficulties, they can still have difficulties. That might be why they've impacted on their offending behaviour. They've usually had aces of one description or another, so it would be unlikely that there wouldn't be something for them, whether it's of the level that needs a mental health input is debatable. Is there an assessment when someone comes in at first to establish? For those that perhaps don't, is there a different path? That could be developed quite easily as a result of the trauma of being in a secure unit. As Wendy was saying, there's the payment scheme. There's the youth workers, which were very highly represented and thought of within the young people in Pullment. There's all the wellbeing services. There's peer support. There's lots of support if you don't need the mental health team. If I could just follow up on that line of questioning, Dr Smith, can you give us an assessment of whether you think that there is enough mental health, what the mental health services provision is like for young people with significant mental health problems? What do they need most and is it there for them? Are we talking now about in Pullment or secure care? There is good access to services, which is better access than it is in the community. They're seen within eight days on average, which is really quite good compared to the community. There is nursing input, there's psychology input, there's psychiatry input, so there's quite a wide range of disciplines there that can help support them. I think some of the other aspects of care interfere with nursing staff in particular being able to do what they would like to be doing. There's lots of medication that needs to be dispensed, and that takes up quite a long time in an establishment as large as Pullman, as you can imagine. That restricts some of the activities that can do with some of the interventions that were available. Also, before the review and the inspection, there was no psychology input for young people under the age of 18 in Pullment. That has now resolved and there is a psychologist available for them, so that gap in service has been filled. When they first come into Pullment, are you adequately informed of their needs and their medical background and their mental health history? That's very variable. In my experience, there's been some young people, particularly if they're sentenced, that come in with a lot of information. If young people are remanded, it can be very little information, so it's very variable. Is that something that you feel could be improved with more interaction? Definitely. Can I ask about the social isolation aspect, which you've mentioned in Features Highly? Can you maybe just explain how that can exacerbate young people who are experiencing syndrome or the fact that they're in there? What do you think could be done to alleviate that and what measures could be taken to avoid that for them? I think that that might be a joint answer. I'll maybe start off with the effect that it might have on their mental state. Obviously, if you're left alone with no activity, you're left alone with your thoughts, you can ruminate, you can become quite negative in your thinking, you're not having any form of distraction whatsoever from those negative thoughts, so it can really impact on your mental state and how you feel about things. In terms of resolving that, Wendy has made some recommendations. I've made a vast number of recommendations. My apologies. I've tried to reduce the recommendations to seven with suggestions underneath, but inevitably we end up with something like 81. I think that there are ways and means. The primary one is legislation, which implies that remand prisoners are not allowed or not required to work, and that term required means that when the member of staff says, come on, come out of your room, time to come out, come and mix, come and do things, great fun, go and pat the dogs, do whatever it is, and they go, no, I don't have to, I'm on remand, I don't have to, whereas in reality we need to remove that required to work and recognise that people should have some degree of coercion to come out of their room, take advantage of the opportunities, go to induction, do all of those things, so that's a legislation one. The second one from me is in cell technology. I think being, if you think of young people, you know, those of us who've got teenagers, they're welded to their phones. You know, you're taking that away from them, but also you're taking away their primary vehicle for communication, and so if you are distressed at night, currently you can ring a bell and somebody will come and give you a phone to phone Samaritans. That requires a level of sort of self help seeking behaviour, whereas in fact if you can just phone a helpline, phone your family, phone all the rest of it from your room without having to stigmatise yourself, I think that would be a huge benefit, and I would certainly say it's a quick win. Would that pose any, I mean I understand exactly what you're saying, but would that pose any risks as well? Not that I can say, I can't see any difference between using the phone because it follows exactly the same security guidelines as the normal phone on the wing. So supposing they phone their family and they get distressed, okay? So then you might say, well what could they do? Well at least they can phone the helpline, they can do all that, they can still ring the buzzer and ask for staff help, that's no different if they were distressed in their room without any access to help. Is that something that the Scottish Prison Service could do, or does that require any kind of legislation? It doesn't require any legislation, I think it needs support, support. You can imagine that the red tops are going to have difficulty with it. Yeah, yeah. Thank you. Hema Kaffir supplementary? Following up on that just for clarity, I think what you're talking about is the availability in cell to make phone calls as opposed to allowing young people to retain mobile devices in their cell. Absolutely, absolutely, yeah. Which I think absolutely would give rise to wider concerns in the prison book. They are cordless phones, but they have to dial in their pin number and then they can only dial the numbers that they've already been agreed they're allowed to use, so very safe. The other advantage of course is that staff can listen in to the ones that are happening in the middle of the night, which is when most people get very distressed and can think, all right, we need to go and help. I mean that's a model that's I think been piloted in prisons or some prisons south of the border. Has there been an assessment of the impact that that has had and indeed the cost implications of rolling that out across the estate and can you share with us the details? Sure, so the cost implications vary on the age of the prison where there is cabling already into the cell, the cost implications are neutral. So the cost of putting it in is offset by the profits made back to the company from the number of phone calls. The number of phone calls go up hugely inevitably, you know, rather than having to queue for a phone worrying about how your wife's labour is going, you can just go in your room and phone and you can be to it in private. And as a result, the company that installs them and it varies on the company actually makes sufficient money that it pays itself off after two years. So it's worth doing. What's interesting is I put it into a juvenile prison with 400 juveniles and thought, oh, how much is this going to cost us in reality at the end of a year? No phones were damaged. Our levels of violence went down 40 per cent and our levels of self-harm went down dramatically. So that's helpful. Thank you. I can also just begin by thanking you for your report, and it's extremely extensive and very detailed, so forgive me if I get some of that detail wrong, not all of it has been fully digested, but I'm quite interested in the provision of mental health services. I feel that in a sense there's a bit of a mixed picture. I think you talk in very complementary terms about the initial assessment that's made with the nurse and in terms of the TTEM programme having the right intent, but there's also elements where you talk about that being at times a tick box exercise and the lack of a strategic integration with the health board. Am I right to conclude that there's a mixed picture? Where do you feel the gaps are in terms of that mental health provision in particular? My feeling, and I'm going to hand it over to Helen again, it's a joint answer really, is that there is a lack of a mental health strategy across Scotland for prisoners and perhaps mental health strategy for young people. So the mental health approach that they will get in the community, insecure care, in any form of residential care and in Pullman, in my opinion, should be seamless and the same, so that it doesn't matter where they're coming from or what they're coming from or where they're going to, that continuity and seamless pathway of care is really important. In reality, it's fragmented in the sense that all the different health boards do their own thing. What we found in Pullman in particular was that the information transfer, say between secure care employment or community employment, wasn't rapid, so a child coming in on Friday afternoon they're unlikely to get the full information until they've done their research on Monday. Rather than being able to go click-click, we've got this person's health record, here we have it. Do you see what I mean? I absolutely do, and I think it certainly echoes some of the things I've heard from people within the education sector about their frustrations, about the integration with mental health services that they experience. I think that's a point well made, but the one thing that also strikes me is that some of the numbers that you talk about in your report are striking, such as 50 per cent of young people in Pullman having some sort of learning difficulty or disability, likewise a third having a head injury and so on and so forth, and a very significant number of care. My wonder is whether or not those are actually under-reported. I mean, there are people in the children's sector who have said to me that it's as much as 80 per cent of children have some experience of care, whether that's kinship care or more formally. Likewise, on learning disability, I'm somebody with a diagnosis of ADHD, and I've read academic literature which thinks that ADHD alone could account for 50 per cent of the young offenders population, which would make that 50 per cent figure an underestimate. Would you agree that those figures are potentially underestimated, and if so, by how much? The follow-on question to that is, do we need to have a much more proactive screening mechanism to detect those things? Does too much of that reporting rely on self-reporting, and do we need to be more proactive in terms of identifying those individuals? I think that's more you than me. In answer to your second question, yes, I do think that we need to be more proactive in screening for those difficulties that you're suggesting. One thing that, in my clinical practice that makes it very difficult is the transition of care, because the young people go from secure care to polemont to the community. They move around, and we all see the same young people, but I have to transition their care wherever they go if they're not in my area. That's not good care. It's not very safe in terms of transition of information, so looking and being more proactive, I think that we do need to look at that. That is probably within the remit of the CAMHS task force, the at-risk workstream, which is looking at some of these young people. Again, as Wendy was saying, there are so many reviews that overlap where that is dealt with, but we absolutely need to be much more proactive for those young people. Can I just ask one final question that touches on the answer that Dr Smith just gave? I'm going to do a bit of a shameless plug. In the amendment stage for management vendors, one of the things that I was exploring is whether or not we need to guarantee registration with the GP for people leaving the prison service. Do you think that that is a proposal that could help in terms of managing that continuity of care? I think so, yes. Whether it would be doable, yes, absolutely, but definitely. Certainly some people don't know where they're going when they're leaving prison on secure care, so it can be difficult to know where they're going to be placed, but absolutely there's been difficulties getting the GPs registered, so absolutely. A very brief supplementary point is probably picking up on the final point there from Dr Smith. You'll be aware of the task force that was started by Dr Dame Denise Coyer, and I know that you referred to that there, but I wonder if you found in your own work any potential areas of overlap. I know that the minister has already said last week that the Government and Coasler are currently looking at the recommendations on how to take that forward. I wonder if you've got any thoughts? From my point of view, I'm a great one in believing in equality of care, and there is a real disparity between the care people receive if they go to some of the secure units and if they go to Pullmont or if they're in the community. My specialty is Friends at Cams, and there's only one team in Glasgow that provide that service. There's no other provision across Scotland. There's the IVI project that do cross boundaries, but they are not multidisciplinary and can only do consultation at the moment. If you're a young person in Aberdeen, you do not get the same level of service as you would if you're in Glasgow. That goes for the secure care as well. I'm sure David Mitchell from Rossie will be telling you that there's a real equality in the care that is provided. In Glasgow, we provide an enhanced access service to Cams to young people who are admitted to secure care. NHS TASI do not do that in Rossie, so they do not get as much service as we provide in Glasgow. I think that there is scope to pull all that together to give a much more national picture, including Pullmont, and more nationwide support for these very difficult at-risk young people, but that would take more of a stay from people and a willingness to do that. We have touched already on the issue of interagency communication and working. We've heard that, first of all, there's a lack of information on the child that that information is variable, and also the information flow isn't rapid. Looking at the communication between agencies and the needs of young people who require multiple interventions, is it your judgment from what you've said—I suspect it is—that the agencies, whether it's the prison's courts, police, NHS, local authorities, take it you don't believe they work as well together as they could, so if you could confirm that, and in terms of the sharing information, what do you think needs to happen to improve that? Should there be, for example, some type of mandatory protocol with timeframes? What is it that you think would be the solution to make sure that, first of all, quality information is shared and that it's shared rapidly? Are there any data issues in that that could hinder such a thing? There are. If there's inevitably GDPR, it's a real issue, so there does need to be a consensus agreement between all the relevant agencies. Within that, there needs to be a framework that has a minimum data set that everybody signs up to, understanding what the minimum data requirements are, understanding what the standards of those minimum data sets are, so that you can actually do the assurance and accountability and say, are we meeting those standards of the minimum data set? I think that it can be done electronically. I don't think that it's an easy task. I don't think that every agency works with the best intent, but my overwhelming feeling is that it's very hard to make decisions unless you are fully informed. At the moment, sometimes people are fully informed, sometimes they're not, but what surprised me was people coming into polemont, some come in with such a comprehensive dossier of information, and some come in for whom there is a plethora of information out there, and none of it comes in with them. In reality, we need that consensus agreement as to what information we're going to provide, how it's going to be transmitted and what are the standards against which we're going to be measured against that. What mechanisms could be used to ensure that that happens? Would it have to be made mandatory? Would it have to have some kind of legislative underpinning to make it happen, or what needs to happen to go from where we are at the moment with that variance to what is happening as standard? Other countries use a consensus agreement, so it's not a legislation, but it is a kind of agreement that we will work together. If you look at the whole system's approach, there is that combined agreement that everybody will work together and share information. It works very well, so it doesn't have to be legislation. I think that legislation can help and can assist. Is that working anywhere at the moment, that consensus agreement? Has it been tried here? My understanding is that it is, but I would have to go back into the evidence review to confirm it. If you look through the evidence review, it's in there. There's a document talking about consensus agreements. Do you want to add anything? No, I don't think so. Daniel Dugge, for supplementary information. I just want to ask one brief and very specific point about information sharing. We know how overrepresented care experience children are. Is one of those bits of information proactively asking local authorities whether or not the individual has experience of care, because, as I understand it, that is self-reported at the moment. Would you agree with that? I would agree with that. Liam Kerr, on the line of questions that Shona Robison was taking on this consensus agreement, I think that what Shona may have been asking and I may have missed the answer, but who is going to drive that consensus agreement? Which agency says, we need a consensus agreement, everyone needs to sign up for it? On whom does the onus lie to put that in place from here? That's a good question, not one that I can answer for you. Right, thank you. Okay, Fulton. Thank you again. It's just fallen up from Shona's line of questioning. In probably quite a specific question around, do you think that there's a joined-up approach to addressing the needs of children and young people when they're making that transition from a secure unit, perhaps, to Pullman? I think that that's a very difficult question to answer, so I haven't got all the details to hand. My feeling was that there wasn't a joined-up approach. However, I do know that the Scottish Prison Service has been proactive with the secure care people in developing a standard operating procedure around that, so I think that there now is a joined-up approach, but there wasn't. Did you get a sense of how often such transitions were happening? No, not for me. Do you have a sense? No, it might be best to ask panel 2. I wonder if I could maybe ask you about the level of staff absence. I noticed in the report that the well-being opportunities were really good, impressive, cutting-edge, but there was a low take-up, and that was compounded a little bit by staff absence. Could you elaborate a little on that? Sure. I think that the Scottish Prison Service is undergoing significant and compelling pressure at the moment. The population rise means that staff are hugely under pressure, and what happens when staff under pressure—or one of the side effects—can be a high absence level. We have noted that in the last four prisons that we have inspected, there has been a very high absence rate. That was certainly true of Pullman as well. They tried to protect the well-being opportunities, so what you find was that Pullman was moving heaven and earth to try and get the kids out and up to the areas where they were doing all the activities, but there were times when that was impacted. Is that something that should be looked at in contingency plans, especially as there is a culture of not expecting anyone or a man to do anything? If we want to extend that, and at the same time the services that are available are not being taken up because of staff absences, then clearly it seems... I think that the number of places lost from staff absences was small. What happened was that certain specialisms would disappear. For instance, if the people who come in and do the nurturing with the dogs, if they came in because there are outside agencies coming in, then they would move staff around to make sure that that happened, but it could be that staff absences impacted on a group that was happening in the chaplaincy, and that would be lost. Again, to pose the question, is that something that there should be contingency plans for?  If they are working on a skeleton staff and the bare minimum, clearly there is going to be a... My understanding is that Scottish Prison Service does have a contingency for that, and they are using it. Are you satisfied with that? Is that sufficient? Would you suggest any improvements to it? No. I have talked extensively with Colin McConnell, who I think is giving evidence in the next session that might be able to answer your question better, about staff absences and about the population pressures and how those twin problems are actually having an impact on the prison service. I am fully aware that they have contingencies. Those contingencies are used. We saw those in action, so people are being called in on overtime. I think that it is called something else, but it is overtime at the end of the day. People are extending their shift, so it certainly was happening. Before I go on to my substantive question, I think that going back to someone who arrives, there is not an assessment until this is Dr Smith. To late days, would that be right? That is certainly faster than the community, but it still seems a very long time. When young people arrive into Poulmont, they are seen by the reception staff, and they are also seen privately by a mental health nurse. If you like a screening appointment then, and if needed, things will be taken forward, such as placed on talk to me or substance withdrawals, those sorts of things. If there is a further referral to mental health services, then it is eight days. Every young person who comes into Poulmont gets a screening appointment with a registered mental health nurse, which is excellent practice. The action is to refer to the assessment once the screening is there. That would be the action from the screening. It could be that the young person is placed on talk to me. It could be that they are given withdrawals for drug substance misuse, and it could be that they refer to for follow-up or further assessment by the mental health team. I ask because we know that the first 48 hours is a critical time. There has been a comment that there are too many reviews about some of the services, and I am particularly looking at the type of review that the Council of Europe data seemed to present quite an upbeat picture. However, understanding your request, chief inspector, you looked at the Scottish Centre for Criminal and Justice Research, and this positive finding was challenged. Particularly, issues were looked at around comparative analysis of prison suicide, differing definitions of suicide, the varying quantity of data for suicide, all of which meant that the rosy picture perhaps was not just as good as it seemed from the Council of Europe data. Could you comment on that? I can, actually. One of the things that I discovered was that the collection of data—the University of Glasgow evidence review—looked at one element of data. Even within their own review, they said that matching up how they collect the data and how they analyse it is very complex. The conclusion that we came to was that the Council of Europe collected data in a different way to the University of Glasgow. One of the things that I looked at was how they came to their statistics of 125 per 100,000, or whatever it was. It looked to me like they were looking at the number of people who were in prison. The Council of Europe data looked at the number of people who go through the prison system. I am no statistician. I gave up, and that is why my recommendation is that, given the very small numbers of suicide, the statistics can be misleading. Therefore, it is really important that we have an analytic team that looks at the veracity of it and how we compare to other jurisdictions. It is easy to say that we do worse than England or whatever, but the numbers they have are far, far larger. Somebody quoted to me the other day—I do not know how true it is. Iceland had one suicide last year, but they are the highest. The number of people who are in prison is very small, and the number of suicides is very small, and one person equates to a very high number. It is really important that we unpick that, because I can find no evidence to support either argument. I think that the numbers are too small to extrapolate. If we look at the numbers over 15 years, they go up and down like a sine wave. There does not seem to be a pattern of a rising trend. There does not seem to be a real concern when you look over 15 years. However, that is certain. Some statistics would argue that there are, and certainly the University of Glasgow argued that there are. Other statistics say that they are not. That is why, precisely, I have the review team recognised that some of the conclusions on suicide rates reached in the evidence review may be challenged. I would be one of those people who is challenging them. The review team is aware of the difficulties in interpreting potentially conflicting statistical data, including comparative suicide rates. It is conflicting. We therefore recommend that the Scottish Government undertakes further work to better understand Scotland's position relative to other jurisdictions and to look at the trends. Totally taking on the board your point about extrapolation, but clearly there is a challenge here. I think that is something that the committee would be very interested in, because we understand that having meaningful data in the right context is so important in trying to address the issue. Liam McArthur is supplementary. Thank you very much. I will take this into a slightly different area. When you mentioned in your opening remarks some of the work that you have done looking at the overlap between FAI processes and the Diplr processes, I would be interested in finding out a little bit more about that. We have heard concerns around the delays in taking forward FAIs and the concerns that that gives rise to in terms of learning lessons, as well as giving answers to family and friends who would clearly have questions outstanding. I also know that the parents of Katie Allen have expressed some anxiety and concern about even where FAIs take place. The recommendations are then not being followed through. I wonder whether that has informed or shaped the analysis that you were doing of that interaction. Two things. One is that we absolutely ran out of time and were unable to look at the FAI determinations. I think that that is a piece of work that I would love to do or have done. I would love to read to see whether those determinations and recommendations match up to the Diplr review that happens and whether or not they are followed through and acted upon. We did not have the time in the review to look at that. The fact that you wanted to do that is that concerns have been raised with you, similar to the ones that Katie Allen's parents have publicly raised about FAIs, not necessarily being followed through. That was not raised with us. What was raised with us was the timeframe, the length of time between the death and then the subsequent FAI. I know that I spoke to the Scottish Fatalities Investigation Unit. They also have that concern. They are trying to set a target of 12 months so that any death in custody is heard within the 12 months in order to overcome those difficulties. John Finch-Saunders Good morning, panel. Chief Inspector, since we have you here, can you maybe outline any potential challenges that you see in the coming months ahead more generally with the prison service, please? Good grief. That is a bit of a side blow. Yes, I certainly can. I think that the population rise, the unprecedented population rise at the moment is a huge pressure. I am a very simple soul. Either we have got approximately 700 extra people in prison at any given time, that is the equivalent of a large-sized prison. That is no joke to place that pressure on. I know that the Scottish Prison Service has no additional budget to manage those extra 700 people, which is a problem. I do not think that we necessarily have the space that we are having or that we are having to put two people into a room primarily designed for one. I think that the human rights people are going to be exercised about that. I understand that the unions are considering actions or actions short of a strike. I think that that is a pressure. I think that the Scottish Prison Service is facing a population pressure, a budget pressure, staffing pressure with the sickness, absence and the unions. I think that those are significant pressures. Thank you very much. Can I pick up two of those? That is not just the growing prison population, but the ageing prison population too. Does that bring challenges? It certainly is. One of the things that has become clear for me is that it is not just the rise in prison population but the complexity of the population. I think that the difference between 400 and 1400 legacy sex offenders in at the moment is a significant difference because their legacy sex offenders are of necessity older and therefore more likely to require social care. We have just inspected clonocal prison. I was impressed with some of the social care facilities and the reconstruction of the prison there to cope with that issue. Nonetheless, prisons are predominantly built for youngish fitish men. We are asking very much older people, a much larger older population, to be shawoned into that. The third part of that is that we have an increasing level of complaints about progression, people feeling that they cannot progress through the system and out. I think that that is a combination of pressure from the increasing numbers. If you have 700 extra people all competing for offending behaviour programmes, inevitably there is going to be some slow down in the system. I think that we, as a nation, are going to suffer a challenge on overcrowding and we are going to suffer a challenge on progression.  The ageing staff and the profile regarding retirals and the impact that has. Is that something that you have considered? Yes, absolutely. What I have noticed is that there is a bulge, a baby bulge if you like, which means that in about 18 months a significant number of staff are going to leave because they are due to retire. The combination of things is that when they retire, that is a bulge that has to be predicted in succession planning. I have talked to the Scottish Prison Service about that and I know that they are fully aware and dealing with that. However, there is a second half, the bit that does worry me, is that level of corporate knowledge and experience. Those are well-experienced staff that are going to be losing a bulk of them at the same time. That does worry me. Thank you very much indeed. Thank you, convener. Given what you have just said, do you feel that the presumption against short-term sentences would be beneficial and helpful if it goes through in terms of some of the concerns that you raised? I think that it is extremely helpful in dealing with recidivism. The evidence is that short-term sentences do not have the same powerful effect on recidivism as community orders, so I really welcome that presumption. For me, it is another example of Scotland being leading edge. However, when I looked at the statistics—please bear in mind that I am not a statistician, so I am always relying on other people—it seems to be that it is going to affect the churn or the turnover in prison but not have a huge effect or not the effect that I would like to see in reducing the prison population. If you compound that with the legacy sex offenders, the longer-term sentences for life sentences that people are getting and the impact of the HDC, what you have is an increased population that Paz is not going to significantly reduce. Liam Kerr. Thank you, convener. Good morning. I would like to give you the opportunity to elaborate on something that the committee has been very concerned about, which is remand. Indeed, you raised concerns about the area and the report. How long on average—which I accept is not a great benchmark—are young people spending on remand in the system? I would love to be able to tell you that, but I would be lying because I cannot remember my apologies and something that I should not know at the top of my head. Do you have any indication—do you have any sense of—is this a long time that we are talking about—a matter of weeks? Is it that people are coming in on remand for a few days and then off they go? It is an absolute variation. You have some young people coming in for a long time because of the heinousness of their offence. You have some people coming in for a few days, as you say, and you have some people coming in for a significant number of weeks. Because I do not know the average, I really cannot answer that. Do you know if anyone is capturing data on the reasons why remand is being used in the cases that you have just mentioned, and whether the use of remand is still appropriate? When I looked at the inspector of prosecution's report, one of the recommendations was that greater use should be used of early and effective interventions, and they collect the data and have a look at the reasons for remand. We did not. Perhaps on a similar note, are you aware—this committee put out a report on remand, as you will be aware, at roughly this time last year—I think it was June last year—of whether the Justice Committee's report has led to any concrete action that has fed into your conclusions? I am not aware. There are numerous reports. I look at the Health and Sport Committee, so many reports of my headspins, and, in reality, following up the recommendations was one of the items that I mentioned earlier, which was extremely hard to do, to find a centralised body where I could go and say that 17 reviews and reports have come up with the 4,000 recommendations and how many of them have been followed through. I would deeply appreciate that level of knowledge management being available. Final question on this. You conclude, or one of your conclusions, that we should maximise support for those held on remand, which I think the committee would have sympathy for. What does that look like? What does maximising support for those on remand look like? Okay. I think that there is a very simple rule that follows the numbers. When a young person is on remand and they access activities, those numbers are not collected. If you are convicted or sentenced and you attend activities or you go to appointments, etc, that data is readily available. The data on remands—how many times they come out of their room, how many visits they have had, what activities they have attended—that data is not readily available. My first thing is to do that needs analysis and say that we should collect that data and have a look. For instance, if you find that you have a young person who is not coming out of their room, particularly, or is not attending activities, that is a piece of data that can be looked at. You can then send the youth team in to work with them to say, let's get you out. You will feel better when you come out. There could also be brief mental health interventions that would be available for young people on remand, such as distress brief intervention or brief work with substances. There could be mental health interventions that were offered. Following on from Liam Kerr's questions, the use of remand in Scotland is roughly twice the rate that it is in England and Wales, either by incarceration rate or in terms of prison population, about 10 per cent of the prison population in England and Wales, about 20 per cent in Scotland. One thing that we can't really get to the bottom of, and I think that lies behind some of Liam Kerr's questions, is why that is the case. Given that you are coming to this with relatively fresh eyes, I don't necessarily expect this to be based on statistics, but do you have a sense of why we are in that situation in Scotland? I am not sure. I want my comments to be publicly recorded, so I don't have the facts behind that, and without facts I am unwilling to comment. That's an intriguing answer, and I look forward to following up in the future. I will just ask finally, are remand prisoners in a different section of employment from the longer term, or is there an issue given the pressures on space and the cell sharing of a mix that is not ideal? No, they are kept separately in employment, very comfortably so. And the sharing of cells, is that an issue? It's a really interesting one actually, because when we talk to young people, some of them feel the benefit of sharing a cell, particularly if it's someone else they know from the outside. Most of them prefer to be single cell, and most of them are in employment, so it works quite well. That really concludes all our questions. Is there anything that you would like to say in closing? I don't think that there's anything that I'd like to say, other than that I really would like the committee to urge the concept of a mental health strategy, which goes across Scotland. Just to mention that a lot of the problems that Pullman faces in terms of mental health provision, and I mean I've been quite rigorous in my responses when you read that they're not polite at times, you know they're very strong, but a lot of the problems that Pullman faces are those of recruitment. You know they're national problems, Scotland has a problem recruiting mental health staff, Scotland has a problem having a kind of combined mental health assessment approach, which is really really difficult. The lack of a national formulary, the lack of electronic prescribing, those are national problems and not just solely for Pullman. And the recruitment issue, is that a lack of people available or a lack of people prepared to go into the prison service? I think it's probably both. And perhaps some work with colleges and universities help more of an awareness campaign that there is definitely a gap in, if you like, the market there. I think the other side is to check whether we actually have sufficient spaces, so sufficient people get trained who want to go into the profession. Can I thank you both very much? That's been a very worthwhile evidence session. We're now going to spend briefly to allow for a change of witnesses. Agenda item 2 is the second panel of witnesses on our new inquiry. I refer members to papers 1 to 3. If I could just remind members that we have a very large panel today, so I'd be very grateful for succinct questions. Equally to the panel, if you don't feel obliged, if you don't need to respond to a question or have nothing to add, please just say so. And with that, we'll move straight to questions, starting with Jenny Goreith. Thank you, convener, and good morning to the panel. I'd just like to start with an opening question with regard to the mental health needs of children and young people. We heard from the previous panel, as you may have heard, about the impact of social isolation on mental health. We also heard a little bit about the impact of adverse childhood experiences, and I wonder if the panel might be able to share some of their thoughts around those areas. We can't. We've undertaken, as some of the other centres have as well, we've undertaken particular pieces of research around ACEs, given that we very strongly believe and see young people who are overrepresented with ACEs. The current framework accounts for about 10 adverse experiences. We've, in our research, had to add to that, so we've actually done research on 13 ACEs, and some young people have been admitted to secure care centres. Rossie and others will certainly exceed 10. The import of that is that young people can have adverse experiences and traumatic experiences and not actually have any mental health issues, I think that that's important to say as well. However, what we're doing about ACEs is that they are likely to influence fundamental biological processes, so the timing of these adverse events is important. What they engrave is what they call long-lasting epigenetic marks, which are non-genetic influences, so it's like whatever your hereditary load is, plus on top that will be the ACEs. As we know on neurological systems, so they do impact on behaviour, the impact on how our young people learn. I think that we spend a great deal of time in secure care and we've learnt to, when we're accommodating young people and when we're receiving young people, the actual lot of the time that we're doing is calming down what we call toxic shock, because those young people are so alert, hyper-vigilant at times because of the traumatic experience that they've encountered, and they're also significantly adversely affected by ACEs. I think that that has implications for any system admitting young people. If you have awareness of that, then you need to adapt your systems accordingly. What we've been spending a lot of time doing in the secure estate, and I know that Alison would contend that we don't have a secure estate, but as it's currently constructed, the secure estate in Scotland will spend a lot of time being trauma-informed so that our policies, our reception and admission processes are all informed by that very fact that those young people are very likely to be in survival modes or fight, flight, freeze, and we need our systems to be able to cope with that and to provide predictability, safety, consistency and begin then to use the relational care that we all offer to actually make progress with the young people. Sorry, long answer to what was a short question. I've been very remiss in not introducing the panel. I think that that would be helpful if I did that at the very beginning. In order, Alison Goff, director of the Good Shepherd Centre, Audrey Baird, executive director of education learning and development with Kibble education care centre, David Mitchell, head of operations, Rossie Young People's Trust, Carol Deary, head of services, Mary's-Kenmure, Colin MacDonald, chief executive and Leslie McDow, health and strategy and suicide prevention manager with the Scottish Prison Service. Alison, you were going to say. I was just going to continue where David can complete his opening comments. I think that what David has been explaining was backed up by a very recent survey that was undertaken by the Centre for Youth and Criminal Justice. That was a census of all children and young people who were in secure care at a certain point in 2018. That confirmed alongside lots of other studies that have been done in Scotland, including the work of the secure care national project, which was an independent review of secure care and explored the lives and backgrounds of children in secure care in Scotland. At first, the children from our least privileged Scottish communities are hugely overrepresented among the population of children and young people who come into secure care. The majority of children arrive with significant psychological distress, numerous adverse experiences in their background and often extreme abuse, neglect, trauma and exposure to significant levels of violence in their early years. During the course of that census, half of the children arriving at Good Shepherd Centre, for example, at that point, had expressed thoughts about ending their lives. A third of young people had actually attempted to end their lives in the year prior to coming into secure care. A high proportion of young people had been diagnosed with a mental illness either previously or were at that point receiving treatment. The exposure to interpersonal violence and involvement in interpersonal violence was a significant feature. That census also confirms several other recent studies that have been done UK-wide, including the work of Heidi Haill's Down in England, which was an exploration of all children in secured settings, whether YOIs, secure hospitals or secure children's homes down in England. We know that those are some of the most extremely vulnerable, challenged young people with very difficult backgrounds, so they will all have mental health and wellbeing needs, if not necessarily a mental illness. Just to go back to the question about mental health. You mentioned social isolation. I think that it is really different for secure care. We do not have young people on a man who do not do anything other than a full participation of all activities and education, et cetera. When it comes to any social isolation, there is a legal requirement based on us that we have to fill in documentation if a young person goes to their room. If we place the young person in the room, we have to give a reason why that is done. There is a very strict criteria. Social isolation is really something that is not used a lot in secure care. It is not to suggest that the poem is not therapeutic, but our emphasis on, as David said, is a trauma-informed approach. A trauma-informed approach is about relationships, it is about understanding the context of that child's life and understanding and the causation of some of that behaviour. When it comes to the mental health provision, we work very closely with Fcams and Cams. We also have a clinical psychologist who carries out an initial mental health screening and that formulates part of the care plan. It is slightly different for us in terms of what we access to the prison service. I was quite struck by your submission, because you say that a protocol on transferring from secure to permanent would be useful, as that would hopefully lead to a consistent approach for young people when transferring to the prison environment. We heard in the previous evidence session about an inconsistency in terms of how information is shared. I wonder if the SPS wants to perhaps respond to that point. I will make a general comment, and then more specifically Leslie can, if the committee wishes can pick up on the detail. We are on an improvement journey, but it would be crazy if me suggested that we have everything nailed down. In fact, improvements are being led by the Scottish Government in terms of the dialogue between secure care and the Scottish Prison Service for those planned movements from secure care into our care. Sometimes things happen that aren't planned or come at short notice, and I think that we are more vulnerable in those situations than I think that what is becoming a better understood and better mapped out set of arrangements for those movements that are planned. My concern would be in this discussion about where the vulnerabilities are for those movements that aren't planned or for some reason come around in short notice. Throughout 2019, we have been developing a safe operating procedure for planned and unplanned transfers from secure accommodation. If it is a planned transfer, the children and families directorate within the Scottish Government would notify HNP while I poamint that there was going to be a transfer. At that point, we would look to have an initial meeting about six months prior to that transfer, so SPS would meet with the secure accommodation and would be able to share information on that young person. About a month prior to the transition, SPS would meet with the secure accommodation, but our key partners, including NHS social work, would also be part of that discussion, so that prior to the individual coming into our care, we would have all the information available. Where it is unplanned, that is more difficult. However, it is more about an escalation. When we are made aware that a young person is coming, we are asking just the very fact that that person might be attending court that we are alerted to that, so there is the potential that that young person might come into our custody and that our governor and deputy governor would be made aware of it immediately. As at the earliest possible opportunity, a multidisciplinary case conference would be convened along with somebody from secure care, so that we could get all the information available at the earliest opportunity. Noticing David Mitchell's submission, he talks about the need for custodial settings to benefit from a trauma-informed care lens to admissions during custody and transitions. Is that something that you are considering at the moment? As part of our training development, we are looking at trauma-informed practices for staff within Polmont. We are looking to develop training and we are currently working with NHS Health Scotland. Would that be part of the admissions process? I noticed that you said that that is within Polmont, but as part of the admissions process, is that going to be considered? We would do that in partnership with NHS Scotland because, although we assess an individual when they come into Polmont, NHS Scotland is part of their initial mental health assessment when somebody comes in. Do education carry out an assessment as well, then? Not when the person first comes in, but if an individual was wanting to access education, then they would carry out an assessment. But they have to opt in. I noticed that you said that if they wanted to, they have to opt into it. It is not mandatory, is that right? It is for certain age groups, but if there were over 18, then it would not be mandatory to access education. John Hennop transition was an area that you want. Do you have anything else to say? Just a very small point on that, thank you convener. You mentioned in relation to the multidisciplinary team. We have heard potentially that education may be involved, social work is involved, health is involved. Is there anyone else involved at all? These would be our key partners, but it is not an exhaustive list. If there could be anybody that we felt it was appropriate to be part of that individual's care, it could be part of that case conference. Who might that be, please? I understand that it could be some of the other care providers. It might be families as well, if that was appropriate. Okay, thank you very much. Liam McArthur, you have got a supplementary? Just for definitional purposes, you talked about planned and unplanned transitions from the secure care sector to the prison sector. I mean, I am assuming that nothing is wholly unplanned as any transition is going to have a degree of planning attached to it. Can you maybe describe what an unplanned transition looks like, a planned one that is probably fairly self-evident? Our definition of unplanned is where a young person who is currently in secure care may be attending court. Our planned ones are where a person reaches an age that they would no longer be held in secure care, so we know that they would be coming to us. It may be that somebody who is attending court, the sheriff may determine that the person goes back to secure accommodation or they may determine that that person should be held in custody and fulfilment. On that, it can be very short. Before I ask my question, I want to say that I have visited three of the units here today, barring the good shepherd. I think that I am hugely impressed with the caring work that you do and the ethos in each unit, so I want to put that on record. Rwyf wedi'i ddechrau y ffordd, y limit ymgyrch weithgawr i ddweud o'i ddweud o'i ddweud o'i ddweud o'i ddweud o'i ddweud o'i ddweud, yn ei ddweud, ac yw'r hydrannu hwyddiwr, mewn sgwyddiant mewn sgwyddiant i ddweud o'i ddweud o'i ddweud o'i ddweud o'i ddweud? I have been involved in some discussions with Wendy about the need to look at some sort of hybrid model, as you say. One of the concerns that I have, and I'm sure that it is shared with my colleagues, is there is more emphasis put in age than there is in vulnerability in my opinion. What happens is that when a young person magically reaches the age of 18 I had a young man recently doing ddifwansaeth gyda amhae, fusdd 난wyd yn St Mary's, ac rwy'n i alu'r gwbl iaeth oherwydd i ddraeth i ddweud i'w ddweud. Rwy'n i'ch gael i'ch rhaid i ddweud, ac rwy'n i ddweud i ddweud i ddweud, felly rydyn ni ar gyfer y perth, fi gan oswn o'r nhw oedd yn yng Nghymru nad oes o ddweud i ddweud, fyddor cyfle i ddargarwg yng Nghymru. Ond mae'n gydrych yn ei ffrif ei wneud o wneud, rwy'n i chi'n gwneud, nad oes o swimfynol, aboard ond it was the demand for places at that particular, time but we suddenly saw our children, our young people being moved away from relation which they had often formed for a period of years, particularly if they were sentenced kids. And they were suddenly being taken away and put in a prison environment which is very different in terms of its structure. And I don't know the answer to that except to say that I sincerely hope that there pan maen nhw'n fawr oedd y Cymru i'n cyffinu i'u chrysiau i gynnar 56rwyth i'r cwylliant. ymgyrchu'r hun, i'w ganfraith, ac i'w gwirionedd. All ac mae hyn yn ei ddim yn eu gwybod i'w gan cyblygais yn cyfrifon iawn a'u cyfrifon iawn. Felly, ond ar gyfer y cyfrifon iawn, mesurau hynny o'r rhai fyrdd, gondol ei gweld nhw oeith y sefydliadau yma. Rwy'n credu i chi fod i gyrhunio i'r cyfrifon iawn. As well as Paul Mints numbers, we were going up for 16-18, we were travelling in secure places to take up to 18. I goed m carbon view and I'm happy to share that when that question comes up as to what that might be about. For me, certainly, I think that there is an urgency to look at the age limit in secure care, and even if it needs to go further than 18, it needs to go further than 18. If we can prevent our young people from being in a prison environment and being aeur wrth sefydlu aetheid ei chi chi'n ochon ar gyllidwr o gyllidol. Mae g speechless i ddweud eich myfyrdd yn ei weld i'r ffordd? Ysgrifennid gan gyllidol yn ei ddadr o ddatblygu, mae'n meddwl i'r urin yn eich cynnig gweld o gweldol i'r prifysgol i children gy recruiting ac gweldol i'r meddwl i'r arbyn y bydd the Scottish Prison Service is quite clear that, regardless of their mental health difficulties, children are being placed within a prison environment that is not suitable to meet their needs. We also have children with acute mental health needs that are currently being placed in secure locked placements that isn't meeting their needs either. What is needed is not necessarily just a hybrid model between the secure services and the Scottish Prison Services, but a hybrid model that looks at the therapeutic needs of young people that leads a trauma-informed approach. At the moment, Cibyl is in the process of developing such a service that takes much more of a holistic approach to meet young people's needs that are not within a locked environment. It is about intensive support using services in care, education, clinical input that may be required, interventions that are required for young people and children that are not within a locked environment. At the moment, we are looking at that. We are dealing with young people who have very complex mental health needs, young people who are receiving medication and require constant care, young people who present high risks to themselves and to others, young people who are receiving medical intervention, sometimes require hospitalisation, young people who demonstrate high risk behaviours that require a multi-agency response, and young people who have been mainly rejected by systems and who have a history of multi-placement breakdowns. It is really important that we are not placing some of these young people in locked environments, whether that be within prison or within a secure unit. Some of these young people need a therapeutic trauma-led approach to meeting their mental health needs. At the moment, Scotland, probably internationally, that type of facility does not exist. It is something that we really have to develop, and it is something that Cibyl is looking at at the moment, is looking to develop. We have done research. Because there are not any of these facilities that currently exist in Scotland for children, we have been going to facilities such as the Prince and Princess of Wales Hospice at Bellahouston Park in Glasgow. We have been going round to look at Maggie's centres, where they do not deal necessarily with children, but they create therapeutic, trauma-informed-led approaches to dealing with real, specific clinical issues that need a holistic approach in terms of education, care, psychiatry, psychology, all of those different areas, but not necessarily within a locked environment. A locked environment can actually re-traumatise some of these young people who suffer from these mental health difficulties. We are looking at things such as drug and alcohol misuse. We are looking at anger and irritability, depression, anxiety, sleep disorders. We are looking at suicidal ideation, thought disturbance and traumatic experiences that young people have experienced throughout their lives. Therefore, we need to look further than just looking at a hybrid model that is specific to locking a young person up, but we need to look at models that are not about locking young people up but that are actually meeting their needs within an open environment and provide that intensive support that they really need. I just really wanted to follow up on some of the things that Weddie Sinclair said. In particular, the point that she raised about the lack of consistency between health boards and the lack of strategic integration between the services that health boards provide and the services that are available in your context—I was just wondering if that is something that you recognised and what in your view can be done within the secure care sector to improve that integration? I think that I will take the opportunity to—I think that, as Dr Smith mentioned—the Glasgow secure care centres have access to a co-designed secure care pathway that meets the needs of young people in the three Glasgow secure care centres in that geographical area. We do not have that in Tayside. For those of you who read a bit about my background, I was a psychiatric nurse in five before I moved to social work and then, through various twists, found myself head of operations at Rossie Young People's Trust. Coming to Rossie Young People's Trust 12 years ago and having been a mental health officer in Dundee, which is a social worker with particular training in mental health, it was one of the areas that I thought that would impact on significantly. What has happened over the past is that we used to have a project called the Rossie Elms project, and Dundee used to also have some secure care beds, so this was a shared facility that gave us what we need and what we still need, which is consultant adolescent psychiatrist interested in our client group and undertaking in-reach work reviewing cases along with two project officers who happened to be, at the time, one was a social worker and one was a nurse. They were primary care workers, primary mental health care workers who operated in Rossie and the unit in Dundee. They were funded via intensive support monies, and when those monies came to an end in 2008—this was a service that evaluated very well—when the service came to an end in 2008, the consultant psychiatrist and the two primary mental health care workers were soon back into NHS Tayside. Since then, despite what colleagues have said about the levels of adversity, the levels of trauma, the levels of need prevalence relating to mental health that we have in secure care, we have only been able to access that service by a referral process, which is either done by members of our specialist intervention service, which includes a forensic psychologist with a general trained nurse, and we also have some specialist intervention workers or by our GP. What that does in effect—I want to be balanced in my account to committee today because I have read Mr David Strang's interim report on mental health services in NHS Tayside and he makes a brief mention of CAMHS within that. The balance bit is that I would say that where it works—there are examples of where it works—it works very well. Where it works well, we are getting that in reach. We are able to operate as a multidisciplinary team around the child. Where it does not work is clearly where we are referring in and we have very mixed response times to the needs of our young people. I just picked three cases before I came away yesterday. A young person referred on 22 August, a follow-up consultation by telephone in September, a telephone consultation on 18 December to advise us that they were still on the waiting list. The remaining dates are on the waiting list until their discharge date in April 2019. Unfortunately, what I have to report today is that, within an eight-month timeframe, that young person who had extensive mental health needs was not seen despite us referring into the service in which we believed we would get a service. We have another young person current who was referred for a medication review. She was admitted with a number of existing psychiatric drugs that need to be reviewed. Sometimes drugs that are provided in relation to ADHD require regular blood pressure checking, or drugs such as Araprypozoll or some of the mood stabilisers such as Lithium. Those all require regular bloodstaking to check toxicity levels and therapeutic values. A young person referred for a medication review in January 2019. We have not received the service and neither did we get any confirmation that the referral was received. There are very clearly geographical disparities. Certainly, where we are in Angus, we look with jealous regard to what is being created by Dothda Smith and the other centres down in Glasgow in relation to the secure care pathway. It is clearly a better system and it ensures that there are key points of contact for referrals. The waiting times are short. There is active in-reach by the consultant psychiatrist into the centres alongside CAMHS and forensic CAMHS staff. That is one of the key reasons why I was keen to come today to highlight to you exactly what that disparity looks like for some of our most vulnerable young people who are currently accommodated within Rossie. I will not ask anything further for that substantial answer, but can I just make the point that it sends a world away from an eight-week wait for services and something that, to my use, sounds wholly intolerable. I will hand it back. I would just like to clarify with Leslie Macdowell something that you said earlier. I think that I heard you say that a judge can determine whether somebody goes into custody or stays in secure care. If a judge is determining that, is that against any particular criteria and in any event, are there reasons why a particular decision is arrived at, captured and analysable? I can only speak to my experience where a young person has come into custody instead of going back to secure. In one instance, it was where a young man had committed an extremely violent act within the secure accommodation and therefore it was best placed within Pullman. On the second occasion, his social work requested that he went back to secure accommodation. However, there was not a place available, so the sheriff made the decision that he would come into custody. The sheriff's decision is that anyone is able to draw down that decision and say that that is why that decision was come to? I do not know, sorry. We have touched already on some of the issues about the interaction between the penal system and secure care. I guess that trying to pick up on what was said in the last session that you were present for is about the issue of protocols and information sharing. The transition process was described as being variable in terms of what information comes with the young person between agencies and at different stages, including between the penal system and secure care. I guess that what I want to hear from the panel is how soon would agencies begin to interact with where a vulnerable young person was due to be transferred from secure care to Pullman? What assessments are undertaken? How could that be improved? One of the suggestions in the previous panel on interagency communication was the idea of a consensus agreement. It would be helpful to hear from Eliza MacDowell on Colin MacDonald what your view of that is and whether you think that that is something that could be helpful in making sure that information is good, accurate and quick. We have an information sharing protocol between the Scottish Prison Service and the nine health boards that have responsibility for the delivery of healthcare and prisons, which gives us a framework by which we are able to agree which information can be shared and by which routes it is shared. That is certainly a very helpful tool for both the prison service and for health boards and for practitioners on the ground. Having something in place with secure accommodation, with social work that clearly sets out what information could be shared and with who would certainly be very helpful. What about beyond that? That is clearly a protocol between the prison service and the health boards, as you have said, but something that could be at quite an early stage of the young person's placement. Who might lead on something like a consensus agreement? Do you see yourselves leading on that to make it happen? Thanks for the opportunity to comment. First and foremost, we have to recognise that, although things have undoubtedly improved over recent months, as the chief inspector and Dr Smith have indicated, we have a long way to go yet before any of us could be satisfied with either the level of information sharing or, for that matter, the detail of it. Who is responsible? It may seem a sloping shoulders job, but it is not intended to be. I think that there is a broader policy issue here that has to be tackled. This is multi-agency, multi-specialism, and whether one individual agency could take that on is a matter of some discussion, if not debate, but be clear. The new SPS is right at the end of the pipe on this. We absolutely understand that as we are on many other issues associated with care or, for that matter, justice. We would most certainly be prepared to act as the generating point, the coalescing point and the driving force, if you like, if, indeed, other organisations and other agencies were comfortable with that. It is important to point out that, of course, there are commentators who might view the SPS as taking a responsibility for generating a protocol or a series of erasions like that. That might not be in the best interests of all parties, given that we are a large, nationally funded organisation. In the absence of any other clear volunteers or willing parties, off of that matter, a determination is being made, and certainly the Scottish Prison Service would be prepared to act as that coalescing body. Certainly, the Scottish Government did initiate in 2017 some meetings between Polmont and the secure care services providers. A meeting took place in Polmont, in which we looked at ways in which we can improve transitions for young people, and I believe that those discussions are still on-going. That is exactly the point that I was making earlier. It would be wrong for the committee to be left with the impression that no progress has been made, quite the opposite. I think that, again, to be fair to Scottish Government colleagues, they certainly have picked this up. The situation is much, much better now across the landscape than it was, but we absolutely recognise that, given the vulnerable group of young people that we are dealing with, there is much more that both needs to be done and we would want to see done. Thank you, convener. On that point, I will stick with Colin McConnell and Leslie Macdowell, if I may. We are looking at the report on Polmont earlier on. There are a number of recommendations that were made in that document and required action specifically relating to the SPS. The question then becomes, what is your view of the report and its conclusions, and do you accept all the action points that are on the SPS? If I may convene just to be clear, there were two reports published on Polmont. One was the chief inspector's inspection of Polmont, per se, and all the aspects that go along with the operation of Polmont. Then there is a wider commentary on reports on mental health provision at Polmont, but more generally across the system. Looking at the report that we were looking at this morning, it makes a number of recommendations on the SPS. Does the SPS accept the terms of that report and accept all the action points in that report? I can see where you are going with that question, but the report is not directed to me or the SPS. The report is directed to the cabinet secretary for justice. The cabinet secretary has been very clear that he welcomes the report and that he will be commenting to Parliament on the views of the report before recess. Let me perhaps rephrase the question, Mr McConnell, because you will forgive me, but that sounded like quite an evasive answer, if I may. I am looking at the key messages right here, and it says that an enhanced approach should be developed by the Scottish Prison Service for the talk-to-me strategy. For example, that is one of three. All I am asking is whether you accept the recommendations that are specifically directed at the SPS, and if so, will you be actioning them? I am sorry that you think that I am evasive, but I have to be clear to answer your question more directly, Mr Kerr. As I say, I am sorry that you think that I am being evasive, because I am absolutely stating a fact, and that is a report that is to the cabinet secretary who has already made clear that he will make a statement to Parliament before recess. That is the Government's position on it. As far as the SPS is concerned, we welcome any recommendation that can help us to improve our practice towards anybody that passes into our care, but I will leave it to the cabinet secretary to make a broader judgment on each of those recommendations in due course. I wonder if I could press you a little bit on staff absences just generally that was covered this morning. Do you have a comment on that? Yes. Staff absences in the SPS is troubling. We have near enough 4,500 people in our workforce. They suffer the same illnesses and afflictions as anybody else in the general population. Staff are not immune to being ill. In terms of the chief inspector's commentary about the relationship between population pressures and staff absences, undoubtedly there is a relationship, but I think that it would be unfortunate if the committee were to be left with the impression that staff absences in the prison service were simply driven by population pressures. I think that that is an impact, in fact, but not in itself the determining factor. However, because staff absences levels are high, that does impact on our general ability to deploy staff in and around the system. I heard quite rightly committee members asking the chief inspector about whether SPS has contingencies for such eventualities. We do. In fact, our calculations that underpin the number of staff that we have available in any prison establishment is informed by an assumption that staff will take annual leave, staff will be off sick, staff will have to go on training. I think that it is fair to say that the absence levels have gone above that allowance, so we are additionally covering those shortfalls with what we call excrasia payments, which the chief inspector referred to as overtime payments. I think that the chief inspector made it clear that the prison service will go that extra mile, but I think that she also referred to the aging population of prison staff as well. Is there anything that you would like to see that you can factor in that the committee could be looking at for the future to help the pressure? Yes, I would. I am really grateful that you have raised that. In some ways, I was left between when the chief inspector quite rightly outlined the sort of baby boom bulge that we undoubtedly have. The majority of our staff are sort of 40 and plus. That is young to me, but 40 plus to other folk. I only wish that the chief inspector was right in that they would be retiring soon. She has every reason to expect that that would be the case. Since the UK Government changed the pension rules probably about a decade ago now in terms of when public servants could retire, prison officers were disproportionately affected by that and currently have to work until the 67 in due course will have to work until the 68. Frankly, the thought of prison officers—we have discussed this morning some of the real complicated cases in terms of people who pass our way, whether it is from secure care or for that matter, direct into our care. Those, again, as the chief inspector and Dr Smith have referred to, are the changing nature of the prison population, becoming more complex, more challenging and, in itself, more aged. The prospect of 67, 68-year-old prison officers day and daily turning out on the landings to try and deliver a personalised service with, of course—let's not get away from it—is that prisons can be violent places, thankfully not all too often, but they can be. Therefore, 67 and 68-year-old prison officers having to deal with that is not a prospect that Scotland should welcome. So, yes, our prison officer cadre are getting older, but, by golly, they're not going to be able to retire because the UK Government has determined that they can't. The issue is not having actual bodies because they won't be there. It's the issue of their ability to do the job. It's a combination of issues and, again, it's just a matter of fact that, as we get older, we tend to suffer from more chronic conditions. Of course, if you just, in a sense, work with the imagery that I've set out for the committee, the prospect of older prison officers having to engage with sporadic violence—some of it extremely violent and confrontational—and the prospect of them being able to, in a sense, take that on a chin, recover from it quickly and get back to work is something that we should be really, really concerned about. Daniel McArthur is supplementary. I understand your reticence to not give a formal response to the report until the cabinet secretary's front. However, I think that there are some broad points. If I could characterise it as this, there's a broad point about strategic fit with your agency and others, which I think needs to be addressed. There's also one thing about maturity in terms of, when you look at things like TTM and the approach in terms of induction to appallment, there's good practice, but that's not necessarily bedded in. There's talk about tick boxes and then what happens thereafter. In terms of that broad characterisation, would you reflect that that's correct? Are there things that you can be doing to get going with that before you've heard from the cabinet secretary? I'll answer that in two ways. The first part of my answer, as I said to Mr Kerr, we welcome any direction that will take us to improve the services that we deliver to the people who pass in our care. Please take that as a given and that is SPS embracing. The positivity of the report at the end of the day, anything that can make our services better, we will embrace it and get on with it. In the meantime, a number of things have been happening, specifically appallment, to improve the general awareness and capability of our staff, as well as the availability of services to those who pass in our care. I say that to you in order to address specifically Mr Kerr's concerns that I was being defensive, quite the opposite. I'm being very clear about what the position is vis-à-vis SPS and the cabinet secretary's statement. Secondly, to give this committee an absolute assurance that we are a progressive organisation, we'll take every step that we can to improve the services that we deliver. Can I ask you about one specific step? One of the points that slightly surprised me was the point that I raised in the report, suggesting that staff desired greater training in specific mental health conditions. ADHD, ASD, borderline personality disorder were specifically named. I'm in a sense surprised that that training doesn't already happen, given the overrepresentation of some of those conditions within the prison population. Is that specific training for your staff in appallment, something that perhaps you could progress in advance of any statement of intervention? I'll let Lesley comment on that in a minute. Your question was really helpful in the sense that what reminds us around the committee is the complex challenge that we face in caring for some extraordinarily vulnerable and traumatised people who pass into our care, whether it's the secure community or indeed the Scottish Prison Service. What you've done, Mr Johnson, is set out the scale of the challenge that we face. The first thing that I wouldn't want to try and either create or pretend is that prison officers in Scotland can become experts in those issues. We simply don't have the capability or, for that matter, the recruitment approach to deliver that. We really do rely on our colleagues in the NHS but, more broadly, in other support services to help us to provide that wide range of services. Do we want to make sure that our staff are able to pick up on some of the signs, the indications that people have limitations or suffer or have needs? Of course. I think that what we will want to try and do is make sure that, when our staff are able to be sensitised to that, they are able to signpost quickly to the best sources of help that we can provide. Lesley, you might want to comment more specifically. On an ad hoc basis, some of the training has taken place in partnership with NHS, so some awareness around ADHD has taken place, but it would be to key staff. However, we have now secured mental health first aid training for young people, and key staff with employment will be receiving that training now. They are going through that training just now. We have also started working with NHS Health Scotland to develop a training package for our officers around mental health awareness. Exactly as Colin said, more about identifying the signs that somebody might be struggling or having a mental illness and then signposting them. The other thing is that the national mental health strategy for 2017-27 Scottish Government gave a commitment to review mental health training for front-line staff, as did the suicide prevention action plan. Again, we are working with NHS Health Scotland to participate in giving comment on some of that training. We have also said that we would be happy to pilot any training that came out from those two strategies. Can I just clarify that, when you are talking about mental health, are you including neurodevelopmental disorders and learning difficulties within that, or is mental health restricted to anxiety, depression and those sorts of issues? Yes, but there is another piece of work that has gone through the national prisoner health network advisory board. There has been research done on learning disability within prisons, as well as head injury. The draft report certainly gives a recommendation that prison officers are given training in learning disability and head injury, so we are awaiting the final report on that before we would action it. Can I just make a final comment? When you are looking at 50 per cent of the prison population as a low estimate, which is what we have just heard, having some sort of learning difficulty, I totally accept that your staff are not going to become mental health nurses or professionals. However, they have to have insight and information and expertise, but because such a high proportion of the people that you are working with have those conditions, I would just simply put it that it is a necessity for them to do their job. If I can comment, I 100 per cent agree and I would go further that your point is well made in that, of course, whilst we are focused here on particularly vulnerable and needy young people, you could broaden out that concern across the whole estate. That is not just a concern and a need about poman, which I entirely accept at your point, but people move on and people take those needs and vulnerabilities with them. In relation to the point that was being made in relation to staffing levels, as I recall, you were having a public quite legitimate go to the UK Government around pensions reform. I would be interested to know what the figures are of those aged 65, 66 and 67 who are operating on the wings and are potentially at risk of encountering violent situations and how that differs from the situation prior to pensions reform. Presumably, you manage your staffing in accordance with risk and in accordance with the skills and abilities of the staff. I do not have the figures, but if you want, I can write to you and give you that breakdown if that would be helpful. We have, at this moment in time, a relatively small proportion of the numbers of staff approaching the 67 or 65, 66, but that number will grow. That was my point about the chief inspector's observation, which is absolutely spot-on. The age profile of the staff because of the recruitment bulge previously is moving to the right, so that will become more of an issue for us. In relation to responding to staff capability and capacity, there is a requirement for prison officers to perform the full duties. We have limited opportunities or facilities to deploy fully trained, fully remunerated prison officers into non-front-line roles. We absolutely require the maximum capacity of our prison officer cadre to be deployable on a day-to-day basis. That is a concern for me as a CEO going forward. We potentially will encounter a situation as that group of staff move into their early, mid and late 60s, so that capacity will be seriously reduced. The moment prior to pension reform, what was the upper age limit of staff? 55. Staff were retiring at 55, maximum 60. I turn to the issue of FAIs. The chief inspector alluded to a concern that she did not have time to go into any great detail but expressed a hope that she would be able to do so in due course. We know that there are concerns around delays in FAIs. That is something that has been accepted by the cabinet secretary and, indeed, by the Lord Advocate. I think that what is almost as concerning is the concern that has certainly been raised by Katie Allans parents, that even where FAIs have taken place, those recommendations or some of the recommendations from those FAIs have not been taken forward. Is that a concern that has been raised with you? Are you aware of the details of those concerns? I am aware of the concerns. I think that what would be helpful if the specifics of those recommendations could be set out. I would be very willing to have a look at what it is that a sheriff has determined that we have not followed up on. Again, as I have said before, I give this committee an absolute assurance, as we do with the chief inspector's reports and recommendations or any other independent body. If a sheriff makes recommendations in his or her determination, then SPS will most certainly follow it through. If, indeed, we have not followed something through, then I would want to know about what it is. Between 2016 and 2018, there were 68 fatal accident inquiries that took place on deaths in custody. Of them, only two were their recommendations from a sheriff and others, only formal findings. I do not mean that he was relating more to the prison estate, but I do not know if that is a concern that has been expressed or is shared by those other witnesses. Yes. One of the things that is quite helpful for us within the security state, although there are secure care standards pending, I think, would be the best descriptor at the moment for them, but there are health and social care standards that actually apply here. One of the helpful things among those is, in the section, how good is your staff team, as there is the specific attention that reflects the vulnerability of the young people that we are working with. In essence, what it guides leaders and managers within secure care to do is to ensure not that you are just meeting the registerable minimals in terms of staffing with x-amount of young people, but that also guides us to make sure that we have the right people in the right place, at the right time, with the right knowledge. As a variety of systems in which we do that, most ostensibly, those are things like very clear mentoring systems so that people are actually performing some of those behaviours and picking up that knowledge as they go through their careers as residential care workers. They are also, throughout all the centres, very well established reflective supervision and appraisal systems that are actually checking that those things are in place. The care inspectorate's clear drive with that is that, from the young person's lens, they need consistent, predictable staff providing their care. If, as an agency, we are using too many seasonal staff or too many staff on part-time contracts or three of the set of six shifts, that is something that we keep a really close weathered eye on. We know that those young people need consistent care with predictable staff and with relational-based agencies that are also informed by trauma and attachment theory, which means that we work hard to get the right people in the right place at the right time with the right skills. Did you want to add to something else? David just said everything that I think that I was going to say. Collin and Collin. I would like to try to be helpful to Liam McArthur. In terms of your question about sheriff's determinations, where a sheriff, as I understand it—I am not legally qualified, but as I understand it, where a sheriff makes a formal determination and a recommendation associated with that, SPS is duty-bound to write back to the court in relation to that recommendation and confirm that we have followed it through. Again, I am not aware of any circumstances where we have not done that. Distinguished from formal findings, how would you expect to follow those three? Formal findings do not give any recommendation from the sheriff. However, we read all the FAIs. Even where there is comment, we may take an action, but we have not been formally requested to. There have only been two occasions in the past three years where the sheriff has formally given recommendations and we had to formally respond and act on them. Liam Kerr. That question again, please, Colin McConnell, right? You say you welcome any direction. There is one at number three of the key recommendations and the report that I am looking at, which says that a bespoke suicide and self-harm strategy should be developed by the Scottish Prison Service. My question is simply, do you agree with that statement and, if so, do you intend to do so? I am being boxed in here, but in order that Mr Kerr does not accuse me of being defensive again or avoiding the issue, the recommendation that, as it is set out, we would totally embrace that recommendation and would look to move forward on it to the satisfaction of the chief inspector in due course. Can I just ask, just to be absolutely clear, because I think that there is something I am missing here, Mr McConnell. When we were speaking earlier, is there a reason why you, as chief executive, will not comment on the report recommendations without having heard from the cabinet secretary? Specific things you have asked now, Liam Kerr, and Mr McConnell has given his response. I do not think that we are going to move any further than that on it, but could I, perhaps? I apologise to the rest of the panel, because this is a very big panel. Ideally, we would have had SPS separately and their assisted places in another panel. Time constraints have not allowed that, and we are very keen to hear from all of you. Just specifically, if not Mr McConnell, perhaps, Leslie McDowell, on the varying quality of data on suicide, the chief inspector has suggested that that would be best asked to you, given there is a variation between the Council of Europe suggesting that things were looking quite good and the Scottish Centre of Crime and Justice research saying that finding was challenged and alternative analysis indicating that Scotland may have one of the highest rates of suicide. She did qualify that quite rightly with the difficulty of extrapolating, given the small numbers. Could I ask, perhaps, Leslie McDowell, how you would address the specific thing of the varying quality of data on suicide, as it is so important that we get the best data to try to understand the extent of any potential problem? We do analyse the data that we have, but we would use the total number of people coming into custody over a year and not just on one specific day. We have brought an independent auditor to verify our figures, and what we can say is that, where they said that it was £125 per 100,000 for 2017, it was actually 41.4 and for 2018 it was 44.5 per 100,000 because that is using the annual number of people coming into custody and not on one day, which is where we think that figure has come from. Our rates of suicide tend to be fairly static, because the numbers are small, we look at it in a three-year rolling average rather than on an individual year. One death can make a percentage difference of 20 per cent, so we do it over three years, and it tends to then sit between eight and 11 over the last 10 years over a three-year rolling average. That is helpful. Specifically, on the differing definitions of suicide, is that something that you have come across that has been highlighted?  We will talk about apparent suicide, but the fatal accident inquiry determination will determine if it was. Do you think that that is sufficiently clear? That is a very sensible answer, so do you think that that is sufficiently clear that that is how you would address it to be absolutely sure? That is certainly how we have an external database that is accessible to the public, and within that we state that we wait on the formal findings, because experience has shown us that our thought of the reason that somebody died and what has come out from our determination has on occasions been different, so we wait on the formal finding. That is very helpful. I would like to ask about the funding and sustainability of secure care in Scotland. If you could maybe explain the structures of that, because I note from the submissions that St Mary's is different, and perhaps Carol, you could explain your funding structure and maybe incorporate the question of placements and referrals, et cetera, into that. Sorry, it is not definitely in the sense that that were part of the secure care framework. That happened when we had to go out to tender in 2009-11, and what happened was a secure care unit closed. From that point onward, we are in a contract with Scotland Excel, which requires that every year on year we have to put in a fee negotiation at lift for anything that we want to do with services for our young people, whether it be therapeutic, whether it be bringing in additional mental health services, whether it is paying staff, a pay increase. Sorry, how can you explain what fee negotiation at lift means? Sure, apologies, I am a projection or something like that. What happens is that the contract says that we are allowed to ask for a slight increase to our bed. We all have different bed rates across Scotland, and we are not allowed to know what each other's bed rate is. That is not permitted. So we have no idea—I have no idea, for instance, what Good Shepherd or anybody has. Every year, I put forward a presentation to Scotland Excel that says that, for instance, you will be aware that teachers have a significant pay increase. Unfortunately, when we negotiated our pay increase on our bed rate to cover this, it had already gone in by the time that that was agreed. What happens is that we have to go to a panel of people, and if we want, for instance—and I will be honest with this—we asked for a 3.2 per cent increase this year, and that was to cover additional therapeutic supports. It was to include a 3 per cent increase to staff, and it was to introduce one or two new posts that were going to enhance the outcomes of our kids. So every year on year, we go to these panels in total isolation from each other. We are asked various sets of questions, and then a decision is made whether or not we will get it. If we do not get it, then that can have serious consequences on our service to our kids. This year, we were not successful in getting it. We got a mandated offer of a less reduced percentage, which means that then I have to go in and cut the budget again. I think that I said this, and I hope that the committee appreciates it. It was as honest an answer as I could give, was that I had to then go in and look out where I could make savings, and I did so on some things around the building. Mary's is the oldest in the largest secure unit in Scotland, so by the very nature of that, it requires a lot more uplift in terms of maintenance and keeping it fit for purpose. I had to get in and tweak that so that I could keep my kids getting what I believe they needed to have a quality experience while they were with us in St Mary's. I am not so sure if the pressure continues to be that I cannot get the bed uplift that I want, that the next decision is going to have to either be around reducing staffing or it is going to have to be around reducing the quality of service. It is a very challenging model to be part of, and I can safely say that my colleagues feel that the fee negotiation is about all of our twistways. We will ask them for more, and it depends on the response to that. That is difficult because what has happened is that our care has been commoditised. Our salaries are not the greatest, because we have heard what our staff are often working with some of the most complex kids in Scotland. I try to put a budget forward. It is very balanced and keeps the kids at the centre of every decision, but getting that or not is up to other people, and that is very difficult. Finally, I was at a Scotland Excel conference, and I shared a table with people who tended car parts, toilet rolls and confectionary for the prison service. I am sitting there talking about the quality service to my kids, and there is something just not congruent with that being about kids. Can you explain a wee bit about the placement and referral and how that affects your funding and your service? Obviously, it is about our spot purchases. We get a call as we do many times when we get a referral to say that we have a bed available. We say yes or no, and we get that kid in. We often get that kid in with virtually no information or background information. It is an emergency placement. If the young person has went to remand, we are seeing an increase more on 16-year-olds to 18-year-olds going to Pullman, instead of coming to us, because the funding for remand is held at local authority level and not as it used to be until 1996, which was local government paid for remand. The beds are spot purchases, and we are a national service, which is for 32 local authorities. There was a significant decline in the number of beds that were being used in Scotland. Hence, the reason why we use cross-border placements was to keep us in business—I would not be sitting in front of you today, as St Mary said. It might be safe to say, but I will leave that to others. I think that definitely one unit would have closed, if not two. The cross-border placements allowed us to stay—I hate to use the word, but in business—to do that. We have recently seen a significant increase again in Scottish beds being referred for, but the difficulty is that a lot of the placements are taken by cross-border kids who gave a commitment to providing a bed for them. We certainly do not know about the rest of the panel, but I am not prepared to open the door and say thanks very much. There is still a child, and there is a child in Macare. There are challenges around—we do not know—if I said that it was only going to be Scottish young people, I could sit for two weeks without getting a referral from Scotland. That is a significant financial loss to St Mary's, because St Mary's only is, at this moment in time, a secure provision in Scotland, so it is more difficult. Thanks, Carol. That is helpful. Will anyone else like to explain how it works for you? I just wanted to make a couple of additional comments. When reading through the 299 pages of papers towards the committee hearing today, I was quite distressed at some of the language that was used when referring to us as secure care centres in terms of the business language that was used when referring to us as a market and almost equating children's lives to a supply and demand situation, which I find very difficult. We are all not-for-profit organisations with a long history of the delivery of residential school care for troubled children and children in need, and that is how we operate. We are underpinned by charitable values and missions in legislation, and we are governed by Oscar regulations, so I would hope that the committee bears that in mind in terms of some of the submissions that have come from other partners. Particularly in relation to health and mental health, other committee are aware that the way that it works in terms of the spot purchase contract framework that Carol described, the NHS are not partners within that. In terms of the commissioning of secure care services for Scotland's most vulnerable children, that is an agreement between the 32 local authorities. They commission our services via Scotland Accel as the purchasing agency of your like, who broke those arrangements between Scottish Government for young people who are placed on sentence and in certain other situations, and the 32 local authorities for children placed on remand, or children placed through the children's hearing system, which is the vast majority of Scottish children who come into secure care coming through the children's hearing system. It seems quite ironic, really, with all the emphasis on a trauma-informed approach, the implementation of the NES framework in terms of trauma skills and knowledge that we are all implementing across our secure care centres, GERFEC and the whole agenda around holistic approaches and corporate parenting for these children and young people that health are not part of that commissioning process. You then end up in a strange situation where each individual secure care centre is negotiating with the host NHS health board and negotiating in terms of the other 13 health boards, depending on where children are placed from. In terms of the level of service that is provided, there is no national agreement that sets out a framework that says that you must have the equivalent of 0.5 of a consultant psychiatrist or that you must have qualified clinical and forensic psychology or a CPN or somebody specialising in CBT or other forms of therapeutic intervention and treatment. That is something that secure care centres have developed themselves. It is the secure care sector that has led on that and has driven that. It has not come from the statutory services. We move on a little bit to procurement. Before we left the cross-border issue, that was your line of questioning, Fotun. Do you have anything to add? I know that John and Liam McArthur have both supplementaries. No, it was just on the referral process. Generally, we are talking about local authority referrals and likewise. Do you feel that referrals from local authorities are increasing or decreasing over the years for secure placements? Very much fluctuates throughout the years. At the moment, it is on increase in terms of Scottish referrals. Can you comment a wee bit on the children's hearing process? That is a declaration of interest. I worked in social work with children and families for 12 years and I was involved often in the referral to secure placements. I know that the children's hearing system had a very big role in it. Reflecting on my own experience, even when I started around 2004, the children's hearing panels were often quite keen to recommend secure placements, but that changed over time. I felt maybe 2007, 2008, 2009, that kind of time when directors of social work became more involved. Can you comment a wee bit on that? Certainly, the children's hearing system can make a secure care authorisation. Whether that secure care authorisation is taken up by the chief social work officer is another story. Quite often, young people that require that level of intensive support within secure care quite often do not reach a secure care centre and often are looked after within the community. Quite often, their behaviours can escalate within the community to quite high degree, and then it becomes an emergency situation where they have to then be placed within the secure care setting. In terms of thresholds, there is no commissioning model, so there is a commissioning model that is really around procurement. It is not a commissioning cycle and it certainly does not look at the commissioning of individual placements in terms of a hierarchy of need, if you like. What happens in the current situation, the secure care centres in Scotland have been pretty much full for several months now, which can lead to really distressing situations where local authority, social workers and placing officers are phoning round the secure care centres who are part of the national contract desperate for a placement for a vulnerable young person. There is no centralised mechanism for the management of that. Nobody is screening that. Nobody has a national overview of all of that data, so the same person could be phoning round about the same young person to all of the centres over the course of several days, but there is no mechanism for mapping that and looking at rising levels of need as the secure care centres themselves who are monitoring that. In just one further question, convener of supplementary supplementary. It talked a wee bit about the cross-border secure placements and I just wanted to explore that a wee bit. If you feel there has been a rise, a decline overall in perhaps Scottish children coming to placement as opposed to other parts of the UK and I say that because in my own experience again, I remember as a social worker having to travel, and I can't remember the name of it now, but having to travel down to a place in the north-east of England just outside Newcastle on several occasions because there was no placements in Scotland and it seems now to be the other way. Is there any comments on that? I think that one of the things that's really important to inform the committee was a massive, massive drive on looking at alternatives to secure care and we understand the reasons for that. Locking a child up should be a very difficult decision to make, so there should be, in children's hearing acts, you have to look at a lot of alternatives before you come to us. What we think has happened is that a lot of those alternatives in actual fact are meaning that young people are out in the community a lot longer and they're presenting much more complex to us. On the other side though, in England you have the use of secure care being used much earlier. The English social work local councils down there and local authorities tell us that they are in absolute awe of the secure units in Scotland, absolute awe. They've never seen anything like it, so there is a rise on the use of secure referrals to Scotland and this is my opinion because they're accessing a service that doesn't exist in England. While Scotland there is a decrease in referrals because of the alternatives to secure care, alternatives that have been pursued, what's happened is that alternatives aren't working, so we're seeing a rise again in Scottish referrals, but for me, certainly, as it may be, there's a consistent number of referrals from cross-border. I think that you were saying this morning that you had nine in two days or something. I could equally get maybe 20-25 referrals in a week from cross-border because they have absolutely nothing like this. In their words, not mine in Scotland, so I think that's one of the reasons why you see a rise in cross-border placements. Thanks, convener. I want to say that that was my main line of questioning, not supplementaries. That's why your supplementaries did take quite a time and actually brought you in to continue your main line of questioning, so you confused us wonderfully. Thank you. It's largely been covered by Fulton and, indeed, what Ms Deary said there, but I wonder if I must just clarify one point. As a former local authority councillor, there was a cell made in papers that talked about taking children back into the authority area. I would like to think that that was entirely driven by the needs of the child. I suspect that the bank balance was having a factor to play there, but I want to pick up on the point where you said that you're now finding that emergency admissions are people, perhaps, who are at a more advanced stage of complex needs than may have once been the case. Is that correct? That's my opinion. Young people who are coming in to secure care now are much more complex. When you look at their history, you can see that, had they perhaps had some interventions much earlier on, we would have seen less of that. In my opinion, the young people coming in to certainly to St Mary's are far, far more complex, far more challenging. In most cases, it's a lot more violent than what we've ever been used to. We're seeing some really incredible levels of violence. I don't know necessarily that anybody around this panel here beside me would say that they have an answer to that, but there is clearly a pattern developing and an increase in young people coming in to secure care who are much more challenging and complex in Scotland's Scottish referrals. Are you able to suggest that, perhaps, there are people who are being housed in residential accommodation within authorities who would be better placed in secure accommodation? Do I have any evidence? No, that's my view of a number of decades of experience in this work. I want to conclude by saying that I'm not saying that we shouldn't be pursuing alternatives to secure even though I'm ahead of a secure service. The vision for Scotland is that we have a Scotland that doesn't take the liberty away from young people, but when we do, we need to make sure that it's very therapeutic. I do believe that there are young people who are in residential placements across Scotland and who are on secure orders. We know recently—animal recently—of two young people who are placed in secure orders, who are out in the community for attempted murder and murder, and who were high court bailed. I think that there are concerns around the housing of those young people and trying every single thing to do before the legislation says we are the last resort. That's why the legislation calls us we are the last resort. There is much more emphasis on doing things in a community before coming to us. That's very good that the last resort is to put some in a secure accommodation regardless of their age. I'm concerned and rightly that the commendable work that all your institutions do, the business parlance does seem to take place when we're talking about procurement and the like. Are you concerned that there are people who should be in your care who are not for simply local authority funding? Yes. I think that that point in terms of the fact that local authorities can determine whether young people who are on remand are placed within Polmont or within secure care services. Obviously, the difference in cost between sending a young person to Polmont and sending a young person to one of the secure services is quite significant. In terms of that, that wasn't always the case. Previously, the Scottish Government funded remand placements, in which case then the local authorities didn't have that responsibility. However, when a local authority is faced with budgetary constraints, it has to take those things into consideration when it's got a young person that is on remand and whether it sends a young person to a secure unit, a 16-year-old or a 16-year-old child to a prism. That's a difficult decision to make, but added into that problem is the fact that when that young person has mental health difficulties, what decision is that local authority going to make? A young person that's 16 years of age who is actually still a child and has mental health difficulties, whether that local authority sends a young person to Polmont, where the staff-child ratio is, I believe, 12 to 1, or sends a young person to secure care services, where the ratio is 3 to 1, but more often 2 to 1. You were talking about the equivalent of the same sort of secure care services south of the border. Does that imply that the cross-border placement process is only working one way? Are we still seeing evidence of local authorities seeking to place in units south of the border? No, it's working one way. It's from cross-border to us in Scotland. What we also find is that young people in secure have an average day of 15 weeks, in cross-border it's nine months. In their transitions, leaving secure care are much more stringent, robust and effective, whereas a lot of our young people in secure end up in homeless accommodation. There are clear differences in how cross-border placements are utilised, as opposed to the Scottish ones. From that, you are saying that what is available by way of secure units in Scotland is far better than what is available. The process of transitioning through that is also better. I wanted to make the point that there are real differences at the moment in terms of the proportion of young people placed from England in the different secure care centres that are part of the national contract. The overall trend has been that there has been a significant increase in referrals and placement of Scottish young people with insecure care. At the Good Shepherd Centre, for example, we have a very small number of young people now in our secure care centre, whereas last year there were over half of the young people in secure care who were placed there from England. There is clearly a lot on the procurement processes. If there is anything that you haven't mentioned and you want to write in additionally to your submission, please feel free to do so. I would like to ask about the pathways and destinations of young people leaving secure care. I think that I might be right in thinking that the new legislation for looked after people doesn't extend to people leaving care, so can anyone comment on whether you think there is a satisfactory structure for this? Is we seriously letting our young people down? I think that there is a massive issue and effective and robust transitions. I think that one of the best ways that you have evidence is to give a real example. I have a young girl who we have carried out a two-year sentence who is about to leave early June. The only place that is being considered is a homeless hostel at 17 years of age. Anybody who tells me that that is an effective transition is not only letting that kid down but letting our country down, because our kids deserve better. They are the most vulnerable, yet time and time and time again. I would happily speak for everyone to do that point.  Is there anyone else who would like to comment? Just endorse the points that Carol has made. I think that that would be a shared view from from Rossie as well. I thank all the witnesses for attending. This has been very powerful and useful evidence session. I am now going to suspend briefly to allow the witnesses to leave. Our final agenda item is consideration of petition 1458. The petition is from Mr Peter Cherby, and I ask the committee to consider the merits of establishing a register of interests for members of the judiciary. I refer members to paper 4. Since we considered this petition last time, we have received additional information from Mr Cherby and also from Moiali. We have also received a letter from the Cabinet Secretary for Justice. We can invite comments from members on the correspondence, and whether they wish to make any recommendations or suggest further action. Thank you. It is very helpful to have all this information here, and there are a number of suggestions. I, for one, feel that I cannot understand what the problem would be with having a register. The more people tell me that there is no issue, the more I am convinced that there is a need for one. I think that the submission from Moiali is very helpful. There is a reference to a letter. That letter is 23 April 2014. That is now about all. We have also been provided with news coverage. I have to say that the idea that anyone connected with the Scottish judiciary would have any role whatsoever in the United Arab Emirates. I went on yesterday to human rights watch world report, which is a country by country breakdown. It is a country that is intolerant of criticism. It has played a leading role in the unlawful acts in Yemen. It is treatment of migrant workers. Women's rights are absolutely shocking. It permits domestic violence. I do not think that any reasonable examination of the role of a public official. When I get the separation of the judiciary, it would say that that is acceptable. I think that we need to do something. I am not content with the cabinet secretary's response. I think that it is just playing out the same line before that there is nothing to see here and move on. I do not think that the issue will move on until we have the openness and transparency that people rightly expect of public office. Daniel Johnson I would like to speak in support of what my colleague John Finnie has just said, that the Nolan principles are 25 years old this year. They are principles that I think have guided public life very well. In particular, three of those principles are one integrity whereby holders of public offices should not place themselves under any financial or other obligation to outside individuals or organisations that might seek to influence them in the performance of their official duties. Openness, which I think is self-explanatory, and honesty whereby holders of public offices have a duty to declare any private interest relating to their public duties and to take steps to resolve any conflicts arising in a way that protects the public interest. I think that that is pretty clear. I think that, although the cabinet secretary might well not view that there is a problem, that it is not to say that this is not a positive step to ensuring that we have an open, transparent and an all-am-above judiciary whose integrity is beyond question. I absolutely believe in the independence of the judiciary, but I think that in order to maintain that integrity and that independence, that step in terms of transparency has an awful off merit. I think that the committee should think about taking perhaps some further evidence, certainly hearing from Roy Alley, which is such a suggestion from the petitioner, but I think that that is something that we should progress and seek to move forward. Liam McArthur? I very much echo what Daniel Johnson has said. Much of what John Finlay has said, I think that in reference to the United Arab Emirates, while I might share many of his concerns, I think that the point about a register is illuminating that. If there is a justification in engaging in order to improve the way in which judicial procedures operate in a third country, then at least we all know what the purpose of that engagement is. I would very much concur with what has been said about the need for transparency, the underpinnings of the Nolan principles. I see from the court and tribunal service the details of the accountability report. I am not sure that that is a massive leap away from what is being sought through this petition, and therefore this may be a bit of a journey that they are on, but I would certainly agree that it would be worth the committee continuing to pursue that, to take further evidence from Moray Alley at that. That would seem illogical. Next step, as John Finlay suggested, the earlier evidence that she provided was in written form. It was a number of weeks ago and I think that it would probably benefit us all to hear what she has to say and cross-examine that a little further, but I would be very keen to keep this petition open for now. Liam Kerr? Just briefly to say, I am pretty much in the same place on this. I can see the argument why we would take this further and why we should hear more. I look at the response from the cabinet secretary and the reference to the previous cabinet secretaries saying, look, I do not think that there is anything to examine particularly here and I am just not persuaded having felt that or considered the force of argument in favour of exploring it further. I am not convinced that it is good enough to just say, look, there is nothing here, don't worry about it. For that reason, I think that we should be looking in more detail at this. Thanks, convener. Just to echo what others have said, I think that it looks like, you know, I think that John Finlay particularly made a very compelling argument about why we should do something further on this. I am not sure—some people have commented on the cabinet secretary's response and I am not sure that that was my take on what he was saying, that it was nothing to see here sort of thing, but even given that, I think that we really should be taking more evidence and information to work out where we go from here. I agree with what was said. Any other views? Right. Can I summarise, then, Moir Ali? I think that the cabinet committee was keen to hear from her submission or letter was dated 2014, but she did say that it was relevant that it would be good to get an update. The Nolan committee I think that we have expressed is 25 years old, so perhaps it is time that we take some evidence from perhaps Lord Callaway if he is prepared to give a view, the petitioner himself most certainly, and the cabinet secretary to give him an opportunity to respond more fully to the letter that he sent us. If there are any other witnesses, it would be September now that we would be looking to do this. We agreeable, that is