Legislation In Scotland Research Articles

Reference by the Attorney General for Northern Ireland – Abortion Services (Safe Access Zones) (Northern Ireland) Bill [2022]: The proportionality of safe access zone legislation

In an unanimous judgment given by Lord Reed on 7 December 2022, the Supreme Court of the United Kingdom (UKSC) held that clause 5(2)(a) of the Abortion Services (Safe Access Zone) (Northern Ireland) Bill is a proportionate interference with the rights of those who wish to express opposition to abortion services in Northern Ireland. This clause would make it an offence to do an act within the safe access zone with the intention of or being reckless as to the possibility of directly or indirectly influencing a protected person. In this comment, I analyse the reasoning of the UKSC. I consider, first, the clarifications offered by the UKSC on issues related to the proportionality assessment itself. I then turn my attention to the application of the proportionality test by the UKSC to the facts of the reference. I conclude that the reasoning of the UKSC in Reference by the Attorney General for Northern Ireland – Abortion Services (Safe Access Zones) (Northern Ireland) Bill is sound. The UKSC’s decision is relevant to plans to introduce similar legislation in Scotland and to any future human rights based challenges to the English and Welsh Public Order Bill, which will create a similar offence to the one in clause 5(2)(a) of the Northern Ireland Bill when it becomes law later this year. Moreover, the decision is significant because the UKSC had not previously considered the proportionality of safe access zone legislation. The Abortion Services (Safe Access Zone) (Northern Ireland) Bill has now received Royal Assent.

Mortality among those certified under lunacy legislation in Scotland during World War I.

Mortality in asylum populations increased during World War I. This paper seeks to analyse the mortality data from Scotland, where governmental statistics allow comparison between different lunacy institutions, poorhouses and prisons, as well as people certified under lunacy legislation but living in the community. Detailed study is made of two Lothian asylums, the Royal Edinburgh Asylum and the Midlothian and Peebles District Asylum, and the 1918 influenza pandemic is considered in the asylum context. Similarities and differences between the situation in Scotland and that in England and Wales are discussed, and parallels are drawn with the Covid-19 pandemic in Scotland.

237.4: Diversity in Organ Donation in Scotland - Improving Awareness in Black and Ethnic Minority Groups

There is a continued imbalance between the need for organ transplants in Black and Minority Ethnic (BAME)communities in Scotland and the availability of suitable organs with the right blood and tissue type resulting in healthcare inequalities. Currently over 31% of transplant waiting lists in the UK are represented by BAME patients, only 7% of deceased donation are from BAME patients, 75% of opt outs are BAME patients with 70% of BAME families refusing to consent to donation of their deceased relatives. Kidney Research UK along with the Scottish Government and NHS Blood and Transplant have championed the cause of equality of access to information for all faith and cultural groups and their communities to have an understanding of what organ donation means to them. With the change of legislation in Scotland (March 2021) it was even more imperative that people from all backgrounds were made aware that their faith and beliefs can be recorded on the organ donor register. Despite the pandemic, innovative solutions were found on how best to ensure information could be shared not only with local communities but include education for health care staff. The project used the digital platform to host a total of 13 webinars separately with the Muslim, Hindu and Sikh communities and one with Interfaith Scotland. Webinars have been held with medical students and the British Medical Association and Café Scientifique. Participation in webinars for nursing staff, staff working in NHSBT and doctors in training have also helped to inform healthcare workers about faith and cultural needs of diverse communities. Engagement with local media such as community radio (Awaz FM and Radio Ramadan) and digital magazines such as Asian Voice have aided the dissemination of information. These initiatives have resulted in positive outcomes with quantity and tone of media coverage, number of events and followers. people at local cultural events, schools and religious places. We have revised Faith leaflets for the Muslim, Hindu and Sikh faiths with contributions from not just faith leaders but members of the community to ensure accuracy, comprehensibility and accessibility. We are continuing to engage with MSPs from ethnic backgrounds via online meetings to encourage conversations about donation not just amongst their constituents but also in Parliament.While it is difficult to actually quantify the tangible impact on organ donor registrations, continued engagement since 2015 in Scotland with commitment from NHSBT (hosting Scotland s very first Faith seminar in June 2015) has resulted in an increase in BAME opt ins from 5.8% to 7.8% in 2019-2020 In summary we have harnessed the reach, impact and value of digital and social media platforms to continue this vital piece of work during a pandemic.

Beliefs and Attitudes of British Residents about the Welfare of Fur-Farmed Species and the Import and Sale of Fur Products in the UK.

Simple SummaryFur farming has become increasingly controversial in the western world. Fur-farmed species such as mink contracting and transmitting COVID-19 have put a further spotlight on the industry. The United Kingdom (UK) and other nations have banned fur farming due to welfare concerns. Despite this, due to European Union (EU) membership, the UK has continued to import and sell fur from two million animals each year. The UK left the EU in 2020 and the British government is now considering a ban on the import and sale of fur. This paper reviews public polls on British attitudes to the fur industry conducted between 1997 and 2021. The polls reveal consistently high majority opposition to the fur industry. The paper then reports the results of a new questionnaire to explore in further depth the views of UK residents on the fur industry and attitudes to a ban. A large majority (86%) believed fur-farmed animals do not experience a good life. A similar majority (83%) believed it was unacceptable for the UK government to ban fur farming and continue to import and sell fur from producers overseas. Over three quarters (78%) supported a legal ban on the import and sale of fur in the UK.Around 100 million animals are killed annually for the global fur trade, with 85% reared on fur farms and 15% trapped in the wild. Fur farming is banned across the United Kingdom (UK) under the Fur Farming (Prohibition) Act 2000 in England and Wales and parallel legislation in Scotland and Northern Ireland. Despite the farming bans, the import and sale of fur products to the UK have continued, largely due to European Union (EU) membership. The UK left the EU in 2020 and the British government is exploring a potential ban on the import and sale of fur post-Brexit. This paper reviews public surveys on attitudes to fur farming in the UK from 1997 to 2021. It then reports the results of an online questionnaire to investigate in greater depth the beliefs of UK residents (n = 326) about the welfare of animals used in fur production, knowledge of the legal context of the fur trade and attitudes toward a ban on the import and sale of fur in the UK. A large majority (86%) of respondents believed that fur-farmed animals do not experience a good life. Over four-fifths (83%) disagreed that it is morally acceptable for the UK government to ban fur farming and yet continue to import and sell fur from producers overseas, with over three-quarters (78%) supporting a legal ban on the import and sale of fur in the UK.

Young People's Rights and Mental Health During a Pandemic: An Analysis of the Impact of Emergency Legislation in Scotland.

Emerging evidence indicates that the COVID-19 pandemic and government measures put in place in response to this have had a detrimental impact on young people's mental health. A children's human rights-based approach was taken to examine the impact of the legislative and policy measures that were implemented in Scotland in response to the pandemic on children's rights related to their mental health. Key concerns were identified around children's rights to access mental health services and information, participation in decision-making and non-discrimination of vulnerable groups. Although the analysis focussed on Scotland, recommendations to protect these rights are likely to be relevant to other countries following similar approaches as lockdown restrictions are eased, or in the event that stricter local or national measures are required again to curb rising infection rates or subsequent wave(s).

SIDMA as a criterion for psychiatric compulsion: An analysis of compulsory treatment orders in Scotland

Scottish mental health legislation includes a unique criterion for the use of compulsion in the delivery of mental health care and treatment. Under the Mental Health (Care and Treatment) (Scotland) Act, 2003, patients must exhibit ‘significantly impaired decision-making ability’ (SIDMA) in order to be eligible for psychiatric detention or involuntary psychiatric treatment outside the forensic context. The SIDMA requirement represents a distinctive strategy in ongoing international efforts to rethink the conditions under which psychiatric compulsion is permissible. We reconstruct the history of the Scottish SIDMA requirement, analyse its differences from so-called ‘fusion law,’ and then examine how the SIDMA standard actually functions in practice. We analyse 100 reports that accompany applications for Compulsory Treatment Orders (CTOs). Based on this analysis, we provide a profile of the patient population that is found to exhibit SIDMA, identify the grounds upon which SIDMA is attributed to individual patients, and offer an assessment of the quality of the documentation of SIDMA. We demonstrate that there are systemic areas of poor practice in the reporting of SIDMA, with only 12% of CTOs satisfying the minimum standard of formal completeness endorsed by the Mental Welfare Commission. We consider what lessons might be drawn both for the ongoing review of mental health legislation in Scotland, and for law reform initiatives in other jurisdictions.

Fatal accident inquiries into 83 deaths in Scottish prison custody: 2010-2013.

The only non-legal reference in Lord Cullen's Review of fatal accident inquiry (FAI) Legislation in Scotland (2009) was my audit of FAIs into 97 deaths in prison custody in Scotland, 1999-2003: recommending that waiting time from prisoner death to end of FAI should be less than 1 year for 90% of FAIs, and epidemiological rules for FAIs to have a written determination versus formal findings. Audit of FAIs into 83 deaths in Scottish prison custody in the period 2010-2013. Assessement of waiting times from prisoner death to end of FAI; dissemination of written determinations; self-inflicted death rate per 1000 prisoner-years; cause of natural deaths; and yellow card submissions. Detailed cross-checking was nec37essary between Scottish Prison Service and courts' websites and the Scottish Fatalities Investigation Unit. Of 83 FAIs into deaths in Scottish prison custody, 2010-2013, 37 (45%) were long-awaited (ongoing >2 years after the prisoner's death); 16 (19%, 95% CI 11-28%) beyond 3 years. Of 37 long-awaited FAIs, 27 made written determinations but only 12 of these (44%) were published. Self-inflicted deaths numbered 36: 1.1 per 1000 prisoner-years (95% CI 0.75-1.48). Of 47 deaths from natural causes, cardiovascular disease accounted for 23 (49%, 95% CI 34-63%); liver disease was implicated in 10 of 47. To support pharmacovigilance, submissions were made to Medicines and Healthcare Regulatory Agency for eight deaths (10%, 95% CI 4-19%). FAIs into prisoner deaths in Scotland are too long-awaited given that four (5%) identified precautions that could have prevented death.

The impact of the point-of-sale tobacco display ban on young people in Scotland: before-and-after study

Background Tobacco displays at point of sale have been shown to increase young people’s pro-smoking attitudes, susceptibility to smoking and smoking initiation. In Scotland, legislation that prohibited tobacco point-of-sale displays was implemented in large stores (i.e. those > 280 m2) in April 2013 and in small retailers in April 2015. Objective To assess the impact of the point-of-sale tobacco display ban on young people’s exposure to tobacco advertising, their attitudes to smoking and smoking susceptibility, and their risk of smoking initiation. Design Multimodal before-and-after study design using mixed methods to collect data at baseline (2013) and then longitudinally for 4 years. Setting Four main study communities in the central belt of mainland Scotland, UK, purposively selected to reflect two levels of urbanity (urban vs. small town) and two levels of deprivation (high vs. medium/low). Four matched communities. Participants In the main study communities, 94 tobacco retail outlets. All Secondary 2 (aged 13 years) and Secondary 4 (aged 15 years) pupils in 2013 and 2014 together with all Secondary 1 to Secondary 6 (aged 12–17 years) pupils in 2015–17. This included 6612 pupils who completed 14,344 questionnaires over 5 years. Three hundred and eighty-two participants in 80 focus groups who were recruited from Secondary 2 and Secondary 4 in 2013–17. In matched communities, 24 retail panel members in 2013–17. Main outcome measures Tobacco product and tobacco storage visibility, density of retail outlets (the number of retailers in a pre-defined area such as a residential neighbourhood), tobacco product exposure, brand awareness, perceived accessibility of tobacco, pro-smoking attitudes, pro-smoking norms, smoking susceptibility and smoking initiation. Data platform and methods The study had four components – a mapping and spatial analysis of retail outlets; a tobacco marketing audit, including retail panel interviews in matched communities; school surveys; and focus group discussions with secondary school pupils. Limitations The study was based on a small number of communities and did not include communities in remote areas. Results Compliance with the point-of-sale legislation in Scotland was high. This led to a large reduction in the visibility of tobacco products in retail outlets. However, when the results were stratified by socioeconomic status, declines in retailer density, weighted by total product visibility, were restricted to the least disadvantaged tertile of participants. Nevertheless, the implementation of the legislation was associated with a reduction in risk of both smoking susceptibility and smoking initiation in young people, as well as a reduction in the perceived accessibility of tobacco and in pro-smoking attitudes after both the partial and the comprehensive bans were introduced. Conclusions The Scottish point-of-sale legislation has been successful in reducing the overall visibility of tobacco products and is associated with improvements in attitudinal and behavioural outcomes in young people. However, cues that tobacco is for sale are still highly visible, particularly in retail outlets in areas of deprivation. In addition, the increase in retailer density that was observed after 2015 increased inequalities in product visibility. There was also evidence that the emergence of e-cigarettes may have disrupted the full impact of the legislation. Future work Our research indicates that further research is needed to examine the longitudinal relationships between tobacco outlet availability and product visibility inequalities; and the impact of e-cigarettes and standardised packaging on smoking initiation and prevalence. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 1. See the NIHR Journals Library website for further project information.

\u2018If I donate my organs it\u2019s a gift, if you take them it\u2019s theft\u2019: a qualitative study of planned donor decisions under opt-out legislation

BackgroundThere is a worldwide shortage of donor organs for transplantation. To overcome this, several countries have introduced an opt-out donor consent system. This system, soon planned for Scotland and England means individuals are automatically deemed to consent for organ donation unless they register an opt-out decision. This study was designed to explore the reasons underpinning donor choices for people who plan to actively opt-in to the register, take no action and be on the register via deemed consent, opt-out, and those who are unsure of their decision.MethodsThis study reports the analysis of free-text responses obtained from a large survey of intentions towards opt-out legislation in Scotland, England and Northern Ireland (n = 1202). Of the n = 1202 participants who completed the questionnaire, n = 923 provided a free text response explaining their views. Thematic analysis was used to explore the reasons why participants plan to: opt-in (n = 646), follow deemed consent (n = 205), opt-out (n = 32) and those who were not sure (n = 40).ResultsA key theme for people planning to opt-in is that it ensures one’s donor choice is explicitly clear and unequivocal. Some regarded deemed consent as unclear and open to ambiguity, thus actively opting-in was viewed as a way of protecting against family uncertainty and interference. For the deemed consent group, a key theme is that it represents a simple effortless choice. This is important from both a pragmatic time-saving point of view and because it protects ambivalent participants from making a challenging emotive choice about organ donation. Key themes for those planning to opt-out relate to fears around medical mistrust and bodily integrity. Notably, both participants who plan to opt-out and opt-in perceived presumed consent as “authoritarian” and a method of increasing Government control of organs. In response, registering an active decision protected their freedom of choice.ConclusionsThe findings highlight the importance of registering deliberate active consent for people who choose opt-in, due to concerns over possible family refusal under deemed consent. These findings could inform the development of communication campaigns that encourage family communication before the implementation of opt-out legislation.

Impact of legislation to reduce the drink-drive limit on road traffic accidents and alcohol consumption in Scotland: a natural experiment study

Background It is widely recognised that drink driving is a leading cause of road traffic accidents (RTAs). There is evidence that changing the drink-drive limit from a blood alcohol concentration of 0.08 to 0.05 g/dl is effective in reducing RTAs. Scotland changed the blood alcohol concentration limit to 0.05 g/dl on 5 December 2014. Aims To assess whether or not the numbers and rates of RTAs and per capita alcohol consumption in Scotland were reduced because of the 2014 drink-drive legislation. To assess whether or not the 2014 change in legislation provided good value for money. Design A natural experimental, quantitative study. The control group was England and Wales, that is, the other countries in Great Britain, where the drink-drive legislation remained unchanged. Setting Great Britain. Participants The entire population of Scotland, England and Wales for the period of January 2013–December 2016. Intervention The change to drink-drive legislation in Scotland. Outcome measures The counts and rates of RTAs; and per capita alcohol consumption. Methods For the numbers and rates of RTAs (both traffic flow and population denominators were used), and separately for the intervention and control trial groups, negative binomial regression models were fitted to panel data sets to test for a change in outcome level after the new 2014 legislation was in place. To obtain a ‘difference-in-differences’ (DiD)-type measure of effect, an interaction term between the intervention group indicator and the binary covariate for indicating pre and post change in legislation (‘pseudo’-change for the control group) was assessed. For off- and on-trade per capita alcohol sales, and separately for the intervention and control trial group, seasonal autoregressive integrated moving average error models were fitted to the relevant time series. Results The change to drink-drive legislation was associated with a 2% relative decrease in RTAs in Scotland [relative risk (RR) 0.98, 95% CI 0.91 to 1.04; p = 0.53]. However, the pseudo-change in legislation was associated with a 5% decrease in RTAs in England and Wales (RR 0.95, 95% CI 0.90 to 1.00; p = 0.05). For RTA rates, with traffic flow as the denominator, the DiD-type estimate indicated a 7% increase in rates for Scotland relative to England and Wales (unadjusted RR 1.07, 95% CI 0.98 to 1.17; p = 0.1). The change to drink-drive legislation was associated with a 0.3% relative decrease in per capita off-trade sales (–0.3%, 95% CI –1.7% to 1.1%; p = 0.71) and a 0.7% decrease in per capita on-trade sales (–0.7%, 95% CI –0.8% to –0.5%; p < 0.001). Conclusion The change to drink-drive legislation in Scotland in December 2014 did not have the expected effect of reducing RTAs in the country, and nor did it change alcohol drinking levels in Scotland. This main finding for RTAs was unexpected and the research has shown that a lack of enforcement is the most likely reason for legislation failure. Future work Investigations into how the public interpret and act on changes in drink-drive legislation would be welcome, as would research into whether or not previous change in drink-drive legislation effects on RTAs in other jurisdictions are associated with the level of enforcement that took place. Trial registration Current Controlled Trials ISRCTN38602189. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 7, No. 12. See the NIHR Journals Library website for further project information.

Enhanced agency rights for older Scottish children with additional support needs: a philosophical review

ABSTRACTThis paper considers some possible pitfalls in recent legislation in Scotland that has enhanced agency rights for older children with additional support needs (ASN). It does so with particular reference to philosophical literature on children’s rights. Though the UNCRC increasingly animates education law, policy and practice in Scotland and elsewhere, some philosophers, including O’Neill and MacIntyre, have raised pertinent questions about whether or not a rights-based approach is the best way of ensuring that all children receive the care, support and education they need to flourish. Discussion concentrates on four possible objections to the human rights tradition generally and the new legislation concerning the rights of older children with ASN in Scotland specifically. It is concluded that: (1) future policy, practice, law and research on child well-being should prioritise capabilities over rights and; (2) the concept of capability might be a helpful one through which to analyse the extent to which children with ASN in Scotland really do have enhanced agency rights in practice.

An evaluation of the effects of lowering blood alcohol concentration limits for drivers on the rates of road traffic accidents and alcohol consumption: a natural experiment

SummaryBackgroundDrink driving is an important risk factor for road traffic accidents (RTAs), which cause high levels of morbidity and mortality globally. Lowering the permitted blood alcohol concentration (BAC) for drivers is a common public health intervention that is enacted in countries and jurisdictions across the world. In Scotland, on Dec 5, 2014, the BAC limit for drivers was reduced from 0·08 g/dL to 0·05 g/dL. We therefore aimed to evaluate the effects of this change on RTAs and alcohol consumption.MethodsIn this natural experiment, we used an observational, comparative interrupted time-series design by use of data on RTAs and alcohol consumption in Scotland (the interventional group) and England and Wales (the control group). We obtained weekly counts of RTAs from police accident records and we estimated weekly off-trade (eg, in supermarkets and convenience stores) and 4-weekly on-trade (eg, in bars and restaurants) alcohol consumption from market research data. We also used data from automated traffic counters as denominators to calculate RTA rates. We estimated the effect of the intervention on RTAs by use of negative binomial panel regression and on alcohol consumption outcomes by use of seasonal autoregressive integrated moving average models. Our primary outcome was weekly rates of RTAs in Scotland, England, and Wales. This study is registered with ISRCTN, number ISRCTN38602189.FindingsWe assessed the weekly rate of RTAs and alcohol consumption between Jan 1, 2013, and Dec 31, 2016, before and after the BAC limit came into effect on Dec 5, 2014. After the reduction in BAC limits for drivers in Scotland, we found no significant change in weekly RTA rates after adjustment for seasonality and underlying temporal trend (rate ratio 1·01, 95% CI 0·94–1·08; p=0.77) or after adjustment for seasonality, the underlying temporal trend, and the driver characteristics of age, sex, and socioeconomic deprivation (1·00, 0·96–1·06; p=0·73). Relative to RTAs in England and Wales, where the reduction in BAC limit for drivers did not occur, we found a 7% increase in weekly RTA rates in Scotland after this reduction in BAC limit for drivers (1·07, 1·02–1·13; p=0·007 in the fully-adjusted model). Similar findings were observed for serious or fatal RTAs and single-vehicle night-time RTAs. The change in legislation in Scotland was associated with no change in alcohol consumption, measured by per-capita off-trade sales (−0·3%, −1·7 to 1·1; p=0·71), but a 0·7% decrease in alcohol consumption measured by per-capita on-trade sales (−0·7%, −0·8 to −0·5; p<0·0001).InterpretationLowering the driving BAC limit to 0·05 g/dL from 0·08 g/dL in Scotland was not associated with a reduction in RTAs, but this change was associated with a small reduction in per-capita alcohol consumption from on-trade alcohol sales. One plausible explanation is that the legislative change was not suitably enforced—for example with random breath testing measures. Our findings suggest that changing the legal BAC limit for drivers in isolation does not improve RTA outcomes. These findings have significant policy implications internationally as several countries and jurisdictions consider a similar reduction in the BAC limit for drivers.FundingNational Institute for Health Research Public Health Research Programme.

The hidden health care costs of power of attorney legislation in Scotland: what needs to be done?

Current power of attorney legislation in many European countries seeks to protect the rights of adult patients who lack capacity by ensuring that discharge from hospital to an alternative care setting only occurs when there is legal authority to do so, via a named guardian or power of attorney. In Scotland, a clause introduced in 2007 allows some patients who lack capacity to be transferred from hospital to a community care service provided all relevant parties are agreed that this is in keeping with the legislation (the ‘least restrictive option’) and the patient does not resist the move. However, there is variation in the understanding and use of this clause by local authorities across Scotland, often resulting in avoidable hospital delays, which are costly and cause ‘bed blocking’. This essay illustrates the costs of hospital delays due to current power of attorney legislation in Scotland and highlights the need for the systematic monitoring of power of attorney data and related hospital delays, and for alternative legislation to be considered in the future.

Night-time confinement and the practice of realistic medicine.

SummaryNight-time confinement is the practice of routinely locking patients in their rooms at night unless there is a contrary clinical indication. It is used in high-secure psychiatric hospitals. This article argues in favour of this practice on the basis of realistic medicine, an individual human rights based approach, the principles of mental health legislation in Scotland and England and cost effectiveness. This is not an academic debate. There is a real danger that those advocating against night-time confinement, if successful, will at best make little difference to the lives of our patients as they sleep, and at worst may hugely impoverish their lives because of reduced daytime activities.Declaration of interestL.T. is Medical Director at The State Hospital. Night-time confinement is used within this setting.

Beyond the legislation- investing in sustainable transformation

Introduction: From April 2015, landmark legislation in Scotland established 31 new integrated health and social care organisations[1]. The Public Bodies (Joint Working) (Scotland) Act (2014) required NHS Boards and Local Authorities to establish one of two organisational models by April 2016. Each integration authority, with their health, social care and housing providers, community partners, patients, carers and service-users, developed a strategic plan and is using an integrated budget to commission the range of integrated services and community support to improve local population health. This paper discusses the critical capacity building support required to enable progress towards integrated care at scale. Description: Each new Integration Authority oversees an integrated budget of more than 60% of the health and social care resources, including all adult social care, adult primary and community health care, and some aspects of adult hospital care. Local progress is being measured through nine health and wellbeing outcomes supported by a suite of 23 indicators that track activity, resources and care experience. Targeted population: Local integration of adult community health and social care services with the option to include children’s health and social care services, criminal justice social work and housing support. Highlights: Capacity building to enable progress in implementing integrated care includes: Additional local analytical capacity to inform commissioning decisions and to make progress in linking health and social care data. Ringfenced funding of £300 million to enable investment in preventative supports and new models of anticipatory care and person centred care in the community. Technology Enabled care programme that has enabled over 25,000 more citizens to live safely in their own home, monitor their health at home and /or access specialised services remotely. A collaborative leadership programme and action learning to support practitioners to build new relationships and design new models of integrated care. Community intermediate care and advanced practice models that have enabled older people to spend around 3 million more days at home than would have been expected based on previous institutional care rates. Transferable lessons: Introducing new models of integrated care has been enabled by a new GP contract and development of enhanced interdisciplinary practice in primary care, supported by education and leadership programmes on people centred integrated care, including a new Masters programme. Progress on data sharing has been slower and a fully integrated electronic record remains elusive. Conclusions: Implementation of integrated care at scale is a long game requiring enabling supports across all dimensions of integration. Legislation, structural and financial integration have built a strong foundation for transformation but continuing support for leadership, workforce redesign, professional and functional integration remain priorities if we are to make integration 'business as usual'.

The short-term impact of the alcohol act on alcohol-related deaths and hospital admissions in Scotland: a natural experiment.

Background and aimThe introduction of the Alcohol Act in Scotland on 1 October 2011, which included a ban on multi‐buy promotions, was probably associated with a fall in off‐trade alcohol sales in the year after its implementation. The aim of this study was to test if the same legislation was associated with reduced levels of alcohol‐related deaths and hospital admissions in the 3‐year period after its introduction.DesignA natural experiment design using time–series data to assess the impact of the Alcohol Act legislation in Scotland. Comparisons were made with unexposed populations in the rest of Great Britain.SettingScotland with comparable data obtained for geographical control groups in other parts of Great Britain.ParticipantsFor alcohol‐related deaths, a total of 17 732 in Scotland and 88 001 in England and Wales throughout 169 4‐week periods between January 2001 and December 2013 and for alcohol‐related hospital admissions, a total of 121 314 in Scotland and 696 892 in England throughout 182 4‐week periods between January 2001 and December 2014.MeasurementsDeaths and hospital admissions in Scotland and control groups that were wholly attributable to alcohol for consecutive 4‐week periods between January 2001 and December 2014. Data were obtained by age, sex and area‐based socio‐economic position.FindingsThere was no evidence to suggest that the Alcohol Act was associated with changes in the overall rate of alcohol‐related deaths [incidence rate ratio (IRR) = 0.99, 95% confidence interval (CI) = 0.91–1.07)] or hospital admissions (IRR = 0.98, 95% CI = 0.95–1.02) in Scotland. In control group analyses, the pseudo intervention variable was not associated with a change in alcohol‐related death rates in England/Wales (IRR = 0.99, 95% CI = 0.95–1.02), but was associated with an increase in alcohol‐related hospital admission rates in England (IRR = 1.05, 95% CI = 1.03–1.07). In combined models, the interaction analysis did not provide support for a ‘net effect’ of the legislation on alcohol‐related deaths in Scotland compared with England/Wales (IRR 0.99, 95% CI = 0.95–1.04), but suggested a net reduction in hospital admissions for Scotland compared with England (IRR = 0.93, 95% CI = 0.87–0.98).ConclusionThe implementation of the Alcohol Act in Scotland has not been associated clearly with a reduction in alcohol‐related deaths or hospital admissions in the 3‐year period after it was implemented in October 2011.

Growing in Glasgow: Innovative practices and emerging policy pathways for urban agriculture

Driven by shared concerns about climate change, social justice and health and wellbeing, Urban Agriculture (UA) is an emergent global movement. In this paper, we present an exploratory case study of UA practice on the Southside of Glasgow, UK that traced the emergence and development of four UA projects. Data from the four projects revealed a diversity of practices, including temporary gardening projects organised by local volunteers, a community and market garden operated by a charity, a food shop and vegetable distribution service run by a social enterprise, and a permanent growing space for charities and schools provided by local government. UA practitioners in Glasgow have sought to re-purpose vacant and derelict land, build social cohesion, contribute to environmental and food sustainability and provide participation space for marginalised groups. Reflecting on future avenues for research on UA in Glasgow, we have identified two broad policy pathways that are emerging both at the local level and through national legislation in Scotland to harness local urban food growing and support UA. We conclude by pointing to a need to preserve the self-organising spirit of UA in Scotland as new legislation comes into force.

Are Retail Outlets Complying with National Legislation to Protect Children from Exposure to Tobacco Displays at Point of Sale? Results from the First Compliance Study in the UK.

BackgroundFrom April 6th 2015, all small shops in the UK were required to cover up tobacco products at point of sale (POS) to protect children from exposure. As part of a larger 5-year study to measure the impact of the legislation in Scotland, an audit was conducted to assess level and nature of compliance with the ban immediately following its introduction.Materials and MethodsA discreet observational audit was conducted 7–14 days post implementation which took measures of physical changes made to cover products, server/assistant practices, tobacco signage and advertising, and communication of price information. The audit was conducted in all small retail outlets (n = 83) selling tobacco in four communities in Scotland selected to represent different levels of urbanisation and social deprivation. Data were analysed descriptively.ResultsCompliance with the legislation was high, with 98% of shops removing tobacco from permanent display and non-compliance was restricted almost entirely to minor contraventions. The refurbishment of shops with new or adapted tobacco storage units resulted in the removal of nearly all commercial brand messages and images from POS, dropping from 51% to 4%. The majority of shops stored their tobacco in public-facing storage units (81%). Most shops also displayed at least one generic tobacco message (88%).ConclusionsCompliance with Scottish prohibitions on display of tobacco products in small retail outlets was high immediately after the legislation implementation date. However, although tobacco branding is no longer visible in retail outlets, tobacco storage units with generic tobacco messages are still prominent. This points towards a need to monitor how the space vacated by tobacco products is utilised and to better understand how the continuing presence of tobacco storage units influences people’s awareness and understanding of tobacco and smoking. Countries with existing POS bans and who are considering such bans should pay particular attention to regulations regarding the use of generic signage and where within the retail setting tobacco stocks can be stored.

De-Throning King Midas: The New Law of Land Registration in Scotland

For a period of almost 40 years, the legislation in Scotland on land registration shared many features with the equivalent legislation in England and Wales. With the passing of new legislation in 2012, however, Scotland has moved decisively away from the English model towards the model found in Germany and in some Torrens systems. The Land Registration etc (Scotland) Act 2012 adopts a rule of deferred indefeasibility. At the same time, it abandons the principle of title by registration, with its attendant bijuralism, in favour of a rule which confers title only on those whom, in the long run, the system intends to protect – principally those presenting for registration deeds which are valid, or those whose deeds are invalid only on account of an error on the register which was unknown to them. The new Act was the culmination of a root-and-branch review of the law of land registration by the Scottish Law Commission. This paper explores the reasons for the changes and seeks to evaluate their effect.

Criminalizing songs and symbols in Scottish Football: how anti-sectarian legislation has created a new ‘sectarian’ divide in Scotland

Since the 1990s, the regulation of football fans has increasingly shifted from the policing of actions to the policing of words. With this in mind, this article looks at the impact of the anti-sectarian ‘industry’ in Scotland. In particular, it looks at the impact that legislation in Scotland, that criminalized football fans’ songs and chants, has had on Glasgow Celtic, and especially Glasgow Rangers, supporters. The article is based on participatory action research with football supporters in Glasgow who were opposing the Offensive Behaviour at Football Bill, in 2011. Through this work, two issues became necessary to address; firstly, the impact of the anti-sectarian ‘industry’ in Scotland, which has grown precisely at a time when sectarianism appears to be declining, and secondly, the emergence of a new tension, divide or form of intolerance, which is developing amongst fans (particularly Glasgow Rangers fans), that has been created by this anti-sectarian industry.