 The next item of business today is a statement by Jeane Freeman on NHS Tayside board. The Cabinet Secretary will take questions at the end of her statement, so if any members wish to ask a question, I would urge you to press your request to speak button as soon as possible. I call on the Cabinet Secretary. Thank you very much, Presiding Officer. I would like to update the chamber on developments in the governance of NHS Tayside since the changes to its leadership earlier this year. In April this year, following clear concerns over the board's service delivery and management of resources, including the board's use of endowment funds, John Brown and Malcolm Wright were appointed as acting chair and chief executive of NHS Tayside. John Brown and Malcolm Wright are two of the most senior experienced leaders in the NHS in Scotland, and their remit was to strengthen the governance and leadership of the board and improve public and stakeholder confidence. Their first step was to meet with directors, non-executives and clinical leaders to clearly set out their joint and shared aims for improvement and to listen to and respond to concerns about the challenges facing the board and how each could contribute to addressing those and taking the board forward. The principles that they set out on that first day of visible leadership, of openness and honesty, combined with challenge and accountability, have continued to define the priorities pursued over the past five months. The top priority for the new leadership team has been to get a full picture of the situation that they were dealing with right across the organisation, to identify priority areas that require immediate action and to make best use of the assets and resources at their disposal to remedy those. In that, they recognise the enormous contribution that the staff of NHS Tayside make each and every day. Their approach has been underpinned by a need for deep-seated cultural and structural matters to be addressed if delivering reform in the board is to be both effective and sustainable. That is not just about what people do, but about how they do it. The chair and the chief executive reviewed all of the findings of external reviews and reports carried out over the previous 18 months and identified five priority areas for focused action, providing clear direction, supporting operational leadership, driving service change, improving financial and service performance and ensuring effective regulation and compliance. An important action by the chair has been to commission an independent governance review covering the role of the board, the capability and capacity of board members to deliver against that role and the effectiveness of the information systems and administrative arrangements that are necessary to support the board. Given its importance to the NHS, an independent review of information governance and cyber security arrangements has also been completed and the Institute of Internal Auditors has reviewed the effectiveness of audit arrangements in Tayside. The chief executive has taken decisive action to strengthen his executive leadership team in key areas, including finance and human resources, as well as rolling out a system that supports staff to make decisions at the most appropriate level. That work has been complemented by the development of a comprehensive performance management system to make performance visible and the lines of accountability clear. Oversight of this work is the responsibility of the performance and resources committee that was introduced to put scrutiny of performance and finance in the same arena. A new clinically led operational management system has been put in place that puts clinical leaders in the driving seat with devolved budget responsibility. Crucially, that is accompanied by a development programme to ensure that they are supported in fulfilling those roles. Clinical leaders are supported by dedicated operational managers, which creates a collective responsibility for improving patient care. The establishment of a clinical alliance group has also provided a forum to encourage whole system approaches and the design of innovative solutions that tackle both immediate challenges and longer-term reform. The newly appointed strategic director of workforce has set in train a safe, affordable workforce process with a devolution of workforce changes to a local level. In terms of prescribing, highlighted in Sir Lewis Ritchie's report, as the other key cost driver in Tayside, a continued and unwavering focus on driving out unwarranted variation and waste is being complemented by a public health-led approach aimed at addressing the systemic factors that drive prescribing behaviours and expectations. All of that is necessary to deliver the kind of sustainable reform envisaged by our chief medical officer in her realistic medicine programme. Partnership working is being promoted at every level within the organisation, bringing us back to the point that I started with, the importance of openness, honesty and engagement from the internal infrastructure of partnership working to the strengthening of engagement with external stakeholders, including many colleagues in the chamber today. The new leadership team has been at the forefront of the board's response to important issues that have emerged over the last few months, including the recently commissioned independent inquiry into mental health services across the board area. In relation to the management of endowment funds, we have already taken action to further strengthen the governance around this issue to mitigate any risk posed by dual membership. Once the charity's regulator, Oscar, completes his independent inquiry into the management of endowment funds in Tayside, the chair and chief executive will also lead on any further action that may be required. The work of the chair in engaging with non-executive directors has led some to choose to stand down as the new leadership team has become embedded, having helped to support the transition to the new arrangements. I was advised on Wednesday 12 September that three non-executives had intimated their wish to resign from their positions. Both Mr Cross and Mr Hay had initially considered resigning in April of this year when action was taken to change the leadership of NHS Tayside. Following discussion with the acting chair, both decided to remain to assist the new chair and chief executive and to help to provide continuity and assist with the review of governance for NHS Tayside. Both have now decided that this is the right time to resign from their role so that fresh non-executive input can be brought on to the board. I am genuinely grateful to them for their commitment and the positive role they have played in providing stability to the board in recent months. A further non-executive, Mr Hussain, has indicated that he will resign following his current period of sick leave. He has written to me on 31 August that I received it on 3 September on a number of matters that I immediately followed up on and have been assured by the chair that those matters raised by Mr Hussain are being properly dealt with. I am aware that other board members are also considering their future plans in light of the significant work that has been undertaken around the governance of the board and the clarity that that has provided on the role of board members in providing challenge and scrutiny and in taking responsibility for doing that. The board will consider a full report of its governance mechanisms at its meeting on 25 October. I am in regular contact with John Brown, met him this week, and I have received assurance that the work of the board will continue to meet its responsibilities. He has also confirmed that Trudy McLeigh, one of the recent non-executive appointments to NHS Tayside, has agreed to be the board's new whistleblowing champion, and I have passed on my thanks to her for taking on that important role. I expect new non-executive appointments to be made early in the new year following a full, value-based appointments process that is regulated by the commissioner for ethical standards in public life for Scotland. In conclusion, I will continue to support the new leadership in NHS Tayside building for the future. In addition to agreeing to suspend the repayment of brokerage for three years, I have also agreed to provide additional funding, including support to give clinicians the time to make the commitment to clinically-led challenge change a reality. I am clear that the need for organisation-wide culture change and sustainable recovery in NHS Tayside will require sustained and agile intervention and leadership of the highest calibre. I want to put on record my thanks to John Brown and Malcolm Wright for their effective and focused work so far, and to the staff of NHS Tayside, who have engaged with and supported the approach and work that is necessary to ensure the good and effective governance that is essential to delivering quality, safe healthcare. Thank you very much. The cabinet secretary will now take questions. I want to start by sending the message to our NHS staff in Tayside just how much we value them and the work that they do. I know from the many emails, phone calls, letters and conversations that I have had with friends of mine who work for NHS Tayside just how low staff morale has fallen in the organisation in recent months and years, and that does nothing for staffing and patient care. From the cabinet secretary's statement, Mr Hussein has written to the cabinet secretary to identify a number of matters that she says she has felt the need to immediately follow up. What are those matters, cabinet secretary? Can I also ask the cabinet secretary, given the now imperative need to recruit a long-term leadership team for NHS Tayside, and given the crisis in leadership that we have seen over many years now, will the cabinet secretary also agree today for the Health and Sport Committee of this Parliament to be given an additional scrutiny role of the future appointments? Thank you very much. I thank Mr Briggs for that question and for the support that he has offered to NHS Tayside staff. In terms of the matters that Mr Hussein raised with me, they covered doctors in training, prescribing, senior management pay, use of public funds, CAMHS issues and transformation. All of those matters have been followed up. I will write to Mr Hussein with respect to my response on all of those, but they are all being followed up by the board. In terms of dosage, the chief executive of NHS Tayside discussed the issue that Mr Hussein raised with our CMO and our chief pharmacist, and a fact-finding review has been conducted by Health Improvement Scotland, which will be followed up by a more wide-ranging review by the Royal College of Physicians in London, which has been commissioned by NHS Tayside. In terms of the scrutiny role that you asked for, I believe that the values-based recruitment that we undertake successfully in some of our boards are being rolled out for the current round of chief executive appointments is one that provides a significant degree of scrutiny and challenge. Of course, at the end of that process, there are other steps in terms of a chief executive that has to be gone through to ensure that they are a fit person to be the accountable officer before any such recommendations come to me. In terms of the chair, there is a comparable process that is gone through. I believe that that is right for our board appointments at that very senior leadership level. I am very happy to keep the Health and Sport Committee appraised of how we are progressing on that matter, but I think that we have, within our arrangements, currently an appropriate and robust level of scrutiny, challenge and check, to make sure, particularly through that values-based recruitment, that we secure the best possible senior leadership for our health service in Scotland. I thank the cabinet secretary for a prior site of our statement. There is a crisis in public confidence with NHS Tayside following a series of issues, including financial mismanagement, leading to brokerage loans, reading of the charity annoument fund, a chief executive and chair forced to resign, the issues that cast view leading to an independent mental health inquiry, and a failure to suspend a consultant after repeated concerns were raised. The cabinet secretary made passing reference to the now formal whistleblowing champion, Munwar Hussein. I have seen the letter that Mr Hussein sent to the cabinet secretary. In it, he says, that, on 27 June 2018, I received a direct email from an ex-doctor in training who had managed to get my email address, noting that they had left the NHS due to issues of systematic bullying and negative cliques, and highlighting that issue for others within the organisation. Further, there were claims that people were raising issues, but those were not being acted upon by managers, including allegations in the email that a previous trainee took their own life, and the stress was unbearable for some. A serious set of allegations, including a claim that a trainee took their own life due to stress. He goes on to say that he asked for this to be raised at a board meeting but was told that he could not. He attempted twice to meet the strategic director of workforce in August, but both times the meetings were cancelled. He did eventually raise the matter at a staff governance committee, but felt in his words that this is viewed as an on-going issue that is tolerated. Why does the cabinet secretary feel reassured that this is being adequately dealt with when the person whose job it was to ensure it was does not believe that it is so much so that he resigned? I am grateful to Mr Sarwar for that supplementary question. There are undoubtedly challenges for NHS Tayside. I would not underestimate those in any respect. There are challenges across our health service. We have rehearsed some of them in this chamber before, and I undoubtedly will rehearse some of them again. I take all concerns that are raised with me directly or by any other means very seriously indeed. In the specific instance that Mr Sarwar quotes in terms of the junior doctor, the ex-doctor in training raising those issues, the appropriate place for the whistleblowing champion to raise those matters is indeed in the staff governance committee and not in the wider public board meeting. That was why it was not appropriate to raise it in that public forum when you are talking about individuals in those circumstances. The GMC report on the quality of junior doctor training in mental health services will be at the next staff governance committee for NHS Tayside, and the specific allegations that were reported via that whistleblowing are currently under investigation. The chamber should rest assured—I will give them my absolute assurance—that I will continue to monitor how those matters progress, but it is on the basis of the board responding appropriately in my opinion to what the whistleblowing issues have been raised with them. I have the assurance that they are being dealt with, and I will continue to monitor how the board deals with those and what end results there will be. I am happy to continue to advise colleagues across the chamber of progress as it is made. I thank the cabinet secretary for early sight of her statement and I would like to put on record my thanks to staff in NHS Tayside for all that they do. In its report on NHS governance, the Parliament's health and sport committee recommended that there should be staff involvement in the process of appointing whistleblowing championships for boards. The cabinet secretary's response to the report mentions a consultation on new whistleblowing standards. How will those standards address the situation that the whistleblowing champions in NHS Tayside have found themselves in, concerns being escalated but not clearly being acted upon? How will those standards set out standards for staff involvement? In that response, the cabinet secretary noted that legislation would be introduced in the autumn to establish an independent national whistleblowing officer for NHS Scotland to go live by the end of September 2019. Is that still on track? Is that time frame acceptable? What can be done to expedite that and support whistleblowers further now? Thank you to Ms Johnson for her questions and to her too for her support for NHS staff in Tayside. In terms of the involvement of staff, of course, this board, as with other boards, has a partnership forum, which directly involves representatives of staff from across the board and matters that go to the board are discussed in that partnership forum. The partnership forum is represented through the employee director who sits on the board. I understand that, from the information that members have in terms of Mr Hussein's letter, if they have sight of that to me or the media coverage in the Sunday post just this past Sunday, there is a claim that whistleblowing concerns were escalated but not clearly acted upon. From the information that I have received from the board and part of which I have made available today to Mr Hussein, I am perfectly willing to make that available more widely to other members about how the board is dealing with that. I do not share the view that those whistleblowing issues have been escalated but not acted upon. That is precisely what I seek assurance on, that not only have they been escalated but that they are being acted upon. I believe that I have that assurance. I have already stated that I will continue to keep a close eye on how these matters progress as the board goes through its proper processes. As I have said, I am very content to keep members up-to-date with that progress as it is made. On the other matter that Ms Johnson has raised about whether or not we are on track, we are on track in regard to that appointment and to that timescale. Alex Cole-Hamilton will be followed by Emma Harper. I thank the cabinet secretary for advance sight of her statement. I am going to depart from my prepared question based on the revelations placed before Parliament by Anas Sarwar. On a failure of whistleblowing systems this serious, can we really expect the board to mark its own homework on that? As such, does she agree with me that it is time to bring, and it is in our national interest, to bring that into the light? Will she today instruct a full independent public inquiry into whistleblowing practices in north Tayside? Well, Mr Cole-Hamilton wants the independent inquiry into the whole Tayside and not just one bit of it, and I do not believe that that is necessary. We have a very serious set of claims by a member of NHS Tayside's board, which was communicated to me by an email on 3 September. That member then indicated his intention to resign following his current period of ill health absence on 11 September. The board has acted on those concerns. I have, as I have said, seen the actions that they have taken prior to Mr Hussain being in touch with me, and I have made a commitment that I will keep a very close eye on how those matters progress and will keep this chamber up to date on that. The board is absolutely not marking its own homework. I understand Members' concern about that, and I share it, but I think that we need to be very careful here of the language that we use. I have already advised that Tayside itself has asked the Royal College of Physicians in London to undertake a review on dosage matters. The GMC will be involved in terms of the allegation of doctors in training, the single doctor that raised that issue via that whistleblowing matter. In terms of the issue around senior management pay and the public reporting of pay and expenses, a paper is going to the board in October that proposes that not only do they publish those pay scales but they also publish expenses. There are a number of other matters at CAMHS. The issue on CAMHS was precisely issues that have been discussed across the chamber on many occasions on which members are acting. The Government is acting and the board itself is acting. I refute the notion that any other board, on matters as serious as this, is marking its own homework. That is absolutely not the case. I will, as I have already committed, return to members via another statement if that is what they wish, or by other means keeping them updated on the progress of the specific issues that have been raised, but in the wider context of the significant steps that both the acting chair and the acting chief executive are taking with senior staff and others in Tayside to improve the scrutiny, the challenge and the governance of that board. Given the importance of the role of non-executive board members, how can health boards and the Scottish Government ensure that people with the right skills are recruited to those posts? The way in which we go about recruiting non-executive members to those posts is to other important posts in other public bodies. In the health service, we use what we describe as value-based recruitment. The intention behind that is to try, in the process of a recruitment exercise, to allow an individual who is applying to display more than one dimension of their capability and capacity, in other words, to look at the values that they bring, as well as their experience of particular task. Non-executive board members in our health service are of absolutely critical importance. There are issues here in Tayside, but we can see them more widely afield elsewhere in the UK, where the absence of effective scrutiny and challenge by non-executive members in boards leads to poor decisions being made, at the very least. It is important that non-executive board members not only understand the information that they are being given, that they are given the right information that allows them to exercise that function, but that, in challenging, they pursue their challenges. The recruitment process that we now have in place, I believe, will offer us the opportunity to have an even more robust view of the individuals who are coming forward to what is a very responsible role and one in which we absolutely need a lot of their time, a lot of their energy and a lot of their expertise. That is the way by which we recruit, interview, select and determine the role of our non-executive board members. However, there is one final step that is very important for chairs to take, and that is the annual review of how individual board members are performing in that role. That review is quite robust. We have a further discussion coming up this Monday between myself and the chairs of all our boards about how we can ensure that that is consistently applied across all the boards, because that goes to inform any future appointment of a member to the health board concerned or to any other board in the health service. Liz Smith, to be followed by Liz MacDonald. Cabinet Secretary, you mentioned earlier that on 27 June, in an answer to an earlier question, that was when you received first information about this or the Scottish Government did. Can I just confirm whether that was the previous health secretary who received that information or whether it was you yourself? I think that what Ms Smith is referring to is a point that Mr Sarwar made, and that is when Mr Hussain says that he raised the matter in terms of the board. In terms of being in touch with me, his letter to me is dated 31 August. He sent it to me by email on 3 September, and that is the first point that I was aware of the specific concerns that he was raising. At that point on 3 September, when he sent me that letter, he was raising those matters with me and asking for what he described as a period of special leave because of his health. There is no such thing as a special leave, but he was advised to seek his GPs involvement in that. He has since then been on sick leave, but on 11 September he intimated his intention to resign when his period of sick leave is over. Lewis MacDonald, to be followed by Sandra White. Thank you very much. Members have referred to the health and sports committee report on the governance of the NHS in Scotland, which among other things highlights the importance of monitoring and assessing whether changes in support for those who are whistleblowing in NHS bodies, whether those changes are effective. I note also from the cabinet secretary's response that there is no intention to hold the Dignity at Work survey in 2018, which is one of the means by which the NHS is able to assess staff views of support that is available to them. What else does she have in mind in order to ensure that staff who find themselves in the position where they feel bullied or harassed are under pressure as a consequence of whistleblowing or other issues, how is that going to be monitored? Cabinet Secretary. I am grateful to Mr MacDonald for raising that and indeed to the committee for his governance report, which I have read in great detail. We have responded to it and I believe that I am due to meet the committee myself to go through some of those matters in some detail because it is a very important series of issues that are being raised and for the steps that we might take. In terms of the Dignity at Work survey, I believe that we have already dealt with that in this chamber in terms of the level of response to that. The iMatter survey, where NHS Tayside, is more than comparable with the health service across the piece in terms of staff responses, at around about 63 to 65 per cent rate of response or engagement from NHS staff in Tayside, with a number of areas where, in terms of the overall grid about how people view their position, NHS Tayside is doing at the top level in some of those areas. However, there are other areas where it needs to improve. The staff governance committee and the partnership forum in NHS Tayside should be actively engaged in looking at those areas in terms of how they look to improve that, in particular the areas that Mr McDonald has raised. As members will know, each board is subject to an annual ministerial review on its performance. This year, in terms of NHS Tayside, I will be conducting that review personally. That is one of the areas that I will be looking to see what progress they have made and how that is received by staff when I meet the clinical forum and the partnership forum when I am at NHS Tayside for that review. Thank you very much, Presiding Officer. I have not caught sight of any emails that Anna Sarwar had or anyone else, but I note the mention of openness and honesty and the whistleblowing in the opening statement from the cabinet secretary. I wonder whether, with dignity work in other areas that we have mentioned in the health committee, can the cabinet secretary expand on exactly what will happen regarding the whistleblowing, the honesty and openness that has been put forward to ensure that it is safe and acceptable for staff to speak out about any confidence, particularly in any areas that should be highlighted. As I indicated in my statement, there is a new whistleblowing champion at board level in NHS Tayside, and we have already covered the other initiatives that are taking in terms of national whistleblowing. However, I want to put on record what I said in my statement and deserve some reputation. What we are looking to do in NHS Tayside is to secure significant cultural and structural reform. That cultural reform is critical in any board, and I will be looking across all the boards to ensure that they are behaving in a manner that I believe is appropriate in terms of how they engage with staff, how they involve staff and how welcoming they make it for staff at any level and at any part of a health board's operation, to raise concerns that they have and to have confidence that those concerns will be listened to seriously, will be acted on and they will be advised as to what has happened. In some instances, there will be concerns raised that prove to be ill-founded, not raised in a malicious way, but simply when the facts are looked at, there is no particular foundation for them. Nonetheless, if a member of staff has a view that something is of concern, it should be treated very seriously. All those matters will be looked at and we will look across the other boards to ensure that they are operating in the manner that I believe is essential for them to actively and fully make best use of that most significant resource that they have, which is our staff who work in the health service. Every single one of the ministerial reviews of boards that will be conducted by myself and my two ministerial colleagues for this year will focus on that as well as on a range of other matters. Bill Bowman, to be followed by David Torres. Last year, it was revealed that NHS Tayside had a severe problem with workplace bullying. Respondents to a questionnaire highlighted that they did not trust their managers enough to tell them. This current whistleblower development, and it has been quite a shocking list to hear today, also involves a lack of trust in management's capability to take things seriously. The actions that you have spoken about in terms of NHS boards overall are one thing, but the NHS Tayside actions have not worked out so far for the staff there. What will you do specifically for NHS Tayside staff who are obviously very mistrusting of the management to stop this thing happening again? I am grateful to Mr Bowman for raising that. He raises a very serious matter, which is where NHS staff—or staff in any organisation, but, from my point of view, NHS staff raise concerns and say that they do not trust in management to take their concerns seriously, or they fear that, in raising concerns, in some way there may be some repercussion on them for doing so. In addition to the steps that I have outlined today, when I undertake the ministerial review of NHS Tayside, I will make a particular point. In normal practice, those ministerial reviews for Mr Bowman and others involve meeting the clinical forum, which is a mix of clinical staff of all grades about how they feel matters are being pursued within their health board, meeting the partnership forum, which involves, as I said, unions and others representing staff, RCN and others representing staff. In that particular instance, I will make a particular point of seeking a way by which I can have a wider discussion with staff in NHS Tayside about some of those particular matters and that I will do that without the benefit of NHS board officials beside me, but obviously with my own officials there with me. In order to see if I can get, if you like, under the skin of what some of this is about, so that we can then be assured or otherwise take other steps if needed in terms of how the new leadership, the current leadership, of NHS Tayside is addressing those matters and taking them forward. David Torrance, to be followed by Jenny Marra. Can the cabinet secretary give assurances that all staff at NHS Tayside will continue to be kept informed of any developments? I believe that I can with the knowledge that I have. I know that, for example, the current acting chair, John Brown, regularly issues staff notices to keep members appraised of what is happening, including a very recent notice that I believe was issued either yesterday or the day before with respect to those board resignations and giving staff assurance that the matters that were raised by Mr Hussain are being dealt with and looked at in detail by his chief executive and that senior team and also giving assurance more widely to a wider community that, nonetheless, with those resignations, the board is still able to meet its core statutory responsibilities and its responsibilities more widely in terms of integration of health and social care. Jenny Marra, in her response to Miles Briggs, the cabinet secretary made reference to an issue of dosage that is being reviewed. Can she provide the chamber with details on the conditions that that dosage review pertains to? She also outlined, in the same response, some details around the appointment process of a new chief executive, but I am looking for confirmation that the recruitment process has started because we need a stable and seamless transition in December for the long term. Can the cabinet secretary give her views on the forecast outturn of an £18.7 million deficit this year in Tayside, taking the Tayside's debt to the Government to nearly £65 million? How does she plan to get on top of that and give patients in Tayside the confidence that this financial mess is being sorted out? There are a lot of questions there, cabinet secretary. Perhaps I will not go into too much detail on all of them. There are too many questions for the end of the statement, cabinet secretary. I do my best. On the dosage review and the specific conditions, I have that information before me. I am quite happy to seek that information and will advise Ms Marra of that in due course. On the process for recruiting the chief executive, the preliminary process has begun. It is unlikely, even if we had started that in August or earlier, that we would have a chief executive in post in time, because those matters take some time to go through. Generally speaking, if you are looking for high-quality leaders, they will have another role that they are leaving, and you have to negotiate their leaving period. I am pleased that Mr Brown has agreed to continue as the acting chair until the new chief executive is in post. I would hope that, in the early part of 2019, we will also begin a process to recruit a permanent chair for the four-year period to NHS Tayside. On the final point of the finances, we take active engagement with our boards across the financial year in terms of their financial position. To all boards, I have made it very clear that in looking to address their financial challenges, we need to be assured that they are making the best use of those resources, but what will not be acceptable is that they take capacity out of their health board in terms of delivery, because of the knock-on impact that has directly two patients. My chief finance officer in the directorate and in the health service is actively engaged with NHS Tayside and its board. As members will recall, NHS Tayside is at the highest escalation level for health boards in Scotland, and that means that there is detailed and rigorous reporting and scrutiny of all the decisions that they are making, in particular, in this instance of the decisions on finance. Thank you very much, and that concludes our statement. We will move on to a debate on finance reduction. We will just take a few moments for the members and ministers to change seats.