 The next item of business is an urgent question. Miles Briggs. To ask the Scottish Government what its response is to reports that under-reporting of any waiting times has taken place across NHS Lothian, and how will it ensure that people responsible are held to account? Shona Robison. The findings from NHS Lothian's final internal audit report, which I received over the weekend, are very concerning. As the member will know, I have instructed an independent investigation to be carried out by the academy of medical royal colleges led by Professor Derek Bell. I think that it is important to await the outcome of this independent review and its recommendations. In the meantime, I welcome the interim actions taken to ensure practices in NHS Lothian are brought into line with ISD's guidelines to ensure accuracy going forward. My officials will continue to work closely with the board to ensure that recommendations are fully implemented as soon as possible. Miles Briggs. I thank the cabinet secretary for that answer, but when was the cabinet secretary first made aware that NHS Lothian waiting times had been unreported across other A&E facilities within the health board area, not just at St John's? Given that it is only a few years since NHS Lothian was involved in another waiting time scandal, when it was found to be marking patients as unavailable to artificially reduce the number of breaches of waiting times guarantees, can the cabinet secretary say whether she has the confidence that NHS Lothian has the leadership to make sure that these sorts of things never happen again? Shona Robison Let me give Miles Briggs and the chamber a little bit of background. On Wednesday 11 October, a member of staff from St John's hospital wrote to the chief executive of NHS Lothian and to me outlining allegations of bullying, intimidation and altering of waiting times in St John's A&E department. I was very concerned about that and asked that an investigation was immediately put under way by NHS Lothian to find out whether there was the veracity of those concerns and to look into the matter in detail. What then became apparent from the internal investigation was that the concerns were not just restricted to St John's but were an issue across the acute sites within NHS Lothian. Essentially, what was happening was not adhering to national guidance. The national guidance is very clear about how the four-hour target, for example, should be recorded. Those were not being followed within NHS Lothian and, rather, local operating procedures were being followed instead. That has now changed, obviously. As I said in my initial answer, we are expecting and making sure that NHS Lothian is now following the national guidance. I also felt that it was important to go beyond the internal look and to make sure that there was an external look at the issues in more detail. We will look at some of the issues that Miles Briggs is hinting towards, around where were those instructions emanating from and what was the governance around that. Those are all issues that the external review will look into. I would expect to have that report early in the new year and, of course, we will publish the findings of that in due course thereafter. I think that we should await that report and then we will be able to see what further action is required at that stage. Miles Briggs. In this case, it is quite clear that local guidelines have been put in place against what should have been taking place. What is important is that NHS Lothian's problem is exposed, but maybe it is not just here in Lothian and Edinburgh. What assessment has the Scottish Government made of how waiting times are being recorded in every health board across Scotland? In order to reassure patients across our country, can she guarantee today that no other health board is also locally producing such guidelines to underreport any waiting times? Shona Robison. Of course, I have contacted chief executives of other health boards to make sure that they can assure themselves and assure us that the national guidelines are being applied in their boards. We have no evidence that national guidance is not being followed in those other boards. It is important to recognise that the issues that are being raised in Lothian are a very strong performance by our accident and emergency departments across Scotland. Certainly, the work that has been carried out by the unscheduled care team has led to a sustained improvement of our accident and emergency departments. As they face winter pressures, we should make sure that we send out a very clear message of support for all our hard-working staff in our emergency departments across Scotland, who will face winter pressures that are beginning to emerge in our health system as they are elsewhere. I can reassure Miles Briggs that we will not just look at the internal review but the external review, as I have said, will answer some of the wider questions about NHS Lothian in that regard. As I say, I am very happy to make sure that that is published once I have received it. A few members have pressed their buttons to ask a question. I will try and get through them all. Thank you, Deputy Presiding Officer. Those findings will be of huge concern to patients and staff. While performance continues to decline impacting on patients and staff, the one positive has been the ability to rely on detailed and perceived accurate statistical analysis. The fear will now be that this is not an isolated case but a deliberate attempt to game the statistics, meaning even poorer performance than previously feared. Given that, will the cabinet secretary today, given undertaking that she will instigate an urgent nationwide independent review of reporting procedures and undertake to come back to this Parliament with the outcomes of that review, also outlining what additional resources will also be provided so that we meet our expected patient treatment standards. Our overworked, undervalued and underresourced NHS staff and Scotland's patients deserve nothing less. Shona Robison I think that what our staff and patients deserve is that due recognition of the huge efforts that our A&E departments have put in over the weeks, months and years to dramatically improve the performance within our A&E departments in Scotland. It would be quite wrong to assert that what has happened in Lothian is an issue anywhere else in the rest of Scotland. There is no evidence that any other A&E departments are not following the national guidance. Chief executives have been clear about that and have been clear with us. In terms of making sure that the interests of patients are at the heart of that, and the external review being led by Professor Derek Bell will be looking at whether any patients have been impacted by the issues that have been brought to light within Lothian. That will be part of the work that Derek Bell and his team are undergoing. We have also made Scotland aware of the issue and will now discuss the findings of the full internal report with them and in the light of the on-going external review by the academy. Derek Bell, I should add, has also been very involved in the work of the unscheduled care team in making the improvements across our A&E departments in Scotland. This time, more than any, as we are approaching winter, I would hope that members will get behind our A&E departments, because they are facing winter pressures, as they will be across the whole of the islands. I want to put on record my thanks to the hard work and efforts that each and every one of them puts in to keep us safe during winter. I welcome that Professor Derek Bell, who I note is also president of the Royal College of Physicians, will be carrying out the review of the allegations. Can the cabinet secretary outline what the remit of the review will be and can she confirm that it will report as quickly as possible? Shona Robison and I could ask members to be aware that we are still in session and to keep our conversations down. The remit of the external team is to make sure that they leave no stone unturned in looking into what has happened within NHS Lothian. Importantly, where the governance was around this and to look at whether there was any impact on patients during this time. It is also important to say that, of course, we have made sure that, going forward, NHS Lothian and all its acute sites are now adhering to the national guidance. As I said, I am expecting that independent review to report early in the new year. The findings will be published in due course thereafter. If there are any wider lessons to be learned for the rest of the system from that report, then, of course, those will be applied. Alex Cole-Hamilton, followed by Colin Smyth. Reports in the press suggest that revelations about NHS Lothian's reporting of A&E waiting times came from a whistleblower. Given that confidence in the mechanisms around whistleblowing in the NHS are not high, will the cabinet secretary instruct this independent review to expand its focus to other health boards, perhaps issuing a confidential staff survey to other A&E departments, so that we can ascertain whether the problem is more widespread? Shona Robison. I confirmed to Alex Cole-Hamilton that, indeed, the whistleblower was in contact with me directly as the whistleblower was in contact with the chief executive. The whistleblower has been kept informed of the process going forward. It shows that, where people raise concerns, they are listened to and, importantly, acted upon. That sends out a very important message to the staff within the NHS that, should they raise concerns, whether it is through the whistleblowing helpline or, indeed, directly with me as the cabinet secretary, those issues and concerns are acted upon promptly and swiftly and with determination to get to the bottom of what has gone on. It should also be noted that, of course, we are strengthening the whistleblowing processes. Just this week, we have announced the work around the independent role with the national officer where whistleblowing concerns can be raised. It is important that we make sure that the message goes out to staff that, if they have any concerns in whatever setting within our health service, they should be reporting those and, importantly, they will be acted upon. If we speed up a wee bit, I will manage to get the last three questions in. Colin Smyth, followed by Alison Johnstone. Can the cabinet secretary say whether this underreportant of accident emergency waiting times by NHS Lothian would have been picked up by the Scottish Government had it not been for a whistleblower? If not, will the Scottish Government be reviewing its own procedures for gathering, monitoring and scrutinising waiting time data to ensure that the Government does not have to rely on a whistleblower to make sure that its own figures are correct? Shona Robison As I said my earlier answer, if there are any lessons to be learned around how we make sure that we monitor any changes and fluctuations that need further investigation, then I think that Colin Smyth makes an important point and that will be picked up by Derek Bell and the external review. In terms of what the impact has been within NHS Lothian, we need to wait for the external review to give us an indication of what impact that has in terms of its reporting figures, so we can see that the scale of that. I think that just to give further reassurance that that will not have had a huge impact on the overall national performance of our A&E departments, which continue to perform very well. As we go into winter, I think that it is very important that we give our support to our A&E staff and understand the winter pressures that they will be under over the next few weeks. The cabinet secretary provides assurance that the review will investigate any suggestions of bullying and harassment and whether staff have adequate time for CPD and ensuring that they are familiar with best practice. While we wait for the arrival of the national whistle-blowing officer, what additional support will be put in place for whistleblowers? Shona Robison As part of the internal and external review, it is important that staff are interviewed in a way that they feel confident in being able to raise any issues. Of course, that is a process that is on-going to make sure that all the issues that have gone on in terms of what staff have felt and any concerns that staff may have, we absolutely fully have the opportunity to raise those in a confidential environment, and that is important. My officials are supporting that process and making sure that the work that Derek Bell and his team are getting on with has the full support in order to take that forward as quickly as possible. As I said to other members, to re-issue any recommendations that are emerging from that external report will be implemented not just in NHS Lothian but appropriately elsewhere. That concludes the urgent question, and we now move on to decision time. There is one question to be put as a result of today's business. The question is that motion 9241, in the name of Johann Lamont on petition PE1517, on polypropylene mesh medical devices, be agreed? Are we all agreed? The motion is therefore agreed. That concludes decision time. We will now move on to members' business, and I will give members a few minutes to vacate the chamber.