 Welcome to the 18th meeting in 2014 of the Health and Sport Committee. As usual at this point, I would ask everyone in the room to switch off mobile phones and other wireless devices as they can interfere with the sound system and sometimes the stubby meeting. To that, of course, is that members and officials are using tablet devices and, of course, this is instead of the hard copy of the papers. Our first item on the agenda today is supporting the legislation and we have one affirmative instrument before us today, which is the health and care associate professionals indemnity arrangements order 2014 draft. As usual with affirmative instruments, we will have an evidence-taking session with the Cabinet Secretary and his officials on the instrument. Once we have had all of our questions answered, we will have the formal debate on the motion. Can I now welcome Cabinet Secretary and his officials, Alex Neil, Cabinet Secretary for Health and Well-being. Please have you here, Cabinet Secretary, Jason Birch, senior policy manager regulatory unit health directorate, and Alicia Elsa. Sorry, I'm having a great day here. Principal legal officer, food, health and community care, Scottish Government, welcome to you all. Can I ask the cabinet secretary to make a few opening remarks? Thank you very much indeed, convener. Present in Scotland, England, Wales and Northern Ireland, there is no consistency across the nine-stature to healthcare regulatory bodies in legislation or guidance on the need for health professionals to have insurance or indemnity in place. The Scottish Government and the health departments in the three other nations believe that this is unacceptable for individuals not to have access to compensation where they suffer harm through negligence on the part of a healthcare professional. To rectify the situation, this order will require all statutorily regulated healthcare professionals who are practising to have insurance or indemnity in place as a condition of registration with their respective regulator. Unless regulated healthcare professionals can demonstrate that such arrangements are in place, they will be unable to practice. The development of this order follows an independent four nations review led by Finlay Scott, the former chief executive of the general medical council, which was reported in June 2010. The key recommendation of the Finlay Scott review was that there should be statutory duty on registrants to have insurance or indemnity in respect of liabilities which may be incurred in carrying out work as a registered healthcare professional. The four health departments accepted the report and its main recommendations in December 2010 and undertook to introduce legislative changes at the next opportunity. The order also implements article 4 2d of the 2011 European Union Directive on patient rights and cross-border healthcare. That requires member states to ensure that systems of professional liability insurance or a guarantee or similar agreement that is equivalent or essentially comparable as regards its purpose and which is appropriate to the nature and extent of the risk are in place for treatment provided on its territory. It is important to note that the vast majority of regulated healthcare professionals are in receipt of cover by virtue of their employer's vicarious liability or via a professional body which offers an indemnity arrangement as a benefit of membership. However, it should be noted that it will be for individual healthcare professionals to assure themselves that appropriate cover is in place for all the work they undertake. In conclusion, convener, the Scottish Government is committed to ensuring that people have access to appropriate redress in the unlikely event that they are negligently harmed during the course of their care. Everyone should have this right and I am happy to answer any questions to the best of our ability. I thank the cabinet secretary for those opening remarks and we have a question from Rhoda Grant. Thank you, convener. It is my understanding to ensure that everybody has indemnity insurance that will be a condition of their registration to provide evidence of that indemnity insurance. Is that right? If somebody is taking a career break and not practising that could become a barrier to then re-registering, which means that once people are trained, if they are taking a career break, say, for instance, bringing up family or the like, it is one cost keeping up your registration. It is another cost entirely keeping up an indemnity insurance that you are not using. Will there be special measures in place to cater for them? It is also to handle the detail, but the principle here is that it is for practising healthcare professionals. If you are practising to require the indemnity insurance, my understanding is, as the lawyer will confirm, that this is correct, my understanding from the briefing is that a woman who has taken, say, five or ten years out in order to have a family during that period when she is not practising would not be required to indemnify herself. Yes, cabinet secretary is correct that the terms of the order relate to registered professionals who are practising as such. In cases where they are not practising, my understanding is that they would not be required to keep up their insurance for that period. Will they still be able to keep up their registration? Yes, I think that there are different categories at play there, yes. Richard Lyle. Yes, thank you. Good morning, cabinet secretary. I welcome this order, but I notice that the provision relates to the regulation of the majority of healthcare professionals is reserved to UK Parliament. What percentage of professionals would this order through the Scottish Government cover? I will cover all the 32 professions to operate in the National Health Service in Scotland, and they are covered by the nine regulatory bodies that I have referred to. It would include nurses, midwives, doctors, ophthalmic practitioners, dentists, the whole range. I cannot think of any professional group working in the national health service that would not be covered and it is not listed as part of the 32 professions covered by this order. That is correct. There are seven professional groups that have devolved responsibility to the Scottish Parliament. We can supply details of those if that would be helpful. Richard Simpson. Yes. Just to pursue the licensing, if they are registered but not licensed, then they cannot practice. This is doctors, they won't be able to practice. I presume that your previous remarks will cover that. If they are registered and then decide to practice again, decide to license again, then they will have to pay the indemnity. Yes. The wording, as you are probably aware, the order makes amendments to different pieces of legislation already in place. The wording for different professional bodies is slightly different. For example, in relation to medical practitioners, it is in relation to those who hold to a licence to practice and who practice as such. That is where the requirement to have indemnity applies. If I could ask you just a further question. At the moment, if you are practicing within a hospital setting, the hospital covers your indemnity. If you are for example a GP working on a local basis, where the health board is employing you, who covers your indemnity at that point? My understanding is that the GPs are all covered by themselves because they are independent practitioners. They are not part of a national health service policy because they are independent but they do have to cover themselves. The ones that I am talking about, I understand that for the independent contractors but there is a group of professionals, dentists and doctors and there may be others who are employed by the health board directly. They are not independent contractors in the general sense of the term. They are directly employed. They are salaried doctors. Will they actually be covered by the NHS or will they have to pay for this themselves? Four per cent of GPs in the national health service in Scotland are salaried GPs. They are employees of the national health service and my understanding is that they would be covered by the national health service because we cover our employees. My understanding is that if they are employed by the health board then there would be an insurance arrangement through that. I am not absolutely certain. We could check. The other thing is that there are double check on GPs. There are increasingly complex arrangements for employment. Some people will be employed by the health board but through an agency. Again, is the agency then responsible for ensuring that there is an indemnity or is it the practitioner themselves or will it be the health board who are actually purchasing services from the agency? My understanding is and Ilza will correct me from wrong. My understanding is that the very clear duty of where you are not employed by the national health service is the duty of the doctor, the practitioner to ensure that they are indemnified. Is that right? In terms of the order, in terms of the new arrangements it will be up to the practitioner to ensure that they have indemnity in place and that will be a condition of their licence or registration however it is termed for that particular professional body where they are working for somebody else. My understanding is that normally there is insurance in place through their employer but in each case it will be for them to check in that particular circumstance because in any case where they are practising they will require to have insurance in place. My last question which is following the same trend is that after we had a grants question about career gaps you can be in a career gap and still be being sued for a piece of negligence earlier on. So will the requirements for the particular form of indemnity require that practitioner to carry indemnity beyond the point? Because if you are no longer part of say the medical defence union then medical and dental defence union of Scotland anyway will you still be covered or not? My understanding and again Ilza can correct me if I am wrong my understanding is in that situation what matters is the date when the alleged harm took place and was the doctor indemnified at that stage. If the doctor is indemnified and legal action goes on for two or three years thereafter indemnification does cover the cost of that action right through to conclusion is my understanding. Certainly that is how I imagine it would happen as with any sort of insurance policy that even if a time of an event had occurred when you were covered then I assume it is similar to a car accident or something that had occurred and you may be no longer have the car but the liability for the insurer continues that is certainly how I would understand how it would operate. That is my understanding. We have a number of staff also employed jointly by the NHS they may be employed with health and social care integration coming along they will be employed by the NHS but they may also be employed by the local authority or they may be employed by the new authority if it is an employing authority will that all be covered will they all be covered by as they are under the NHS at the moment? Initially the integrated boards would not employ any directly any medical staff but of course through time the organisation allows them to do that and very clearly there would then need to be an arrangement between the health board and the integrated authority about who covers the indemnity but it still is the fact that under the legislation the practitioner, the health professional will still have to be indemnified. Thank you very much. Gil Paterson Practising professionals who will now be responsible to provide insurance for themselves will health boards or the Government have oversight of those people who would need to register in fact that they have secured that insurance? If anybody is carrying out any work for the national health service the national health service will obviously make sure that they are indemnified. If somebody is in private practice it is entirely their responsibility and we have no regulatory authority over that at all. Colin My question is on the retrospective aspect that Richard Simpson brought up. Thanks Colin. Bob Thank you. It is similar to what Richard Simpson was saying but from a different angle it has been consulted on with stakeholder groups which would include the NHS and other health professional organisations and practitioners. I suppose what I am asking about is any insurance scheme is only as good as the policy that you take out so does the Scottish Government have any control over the quality of indemnity scheme that is taking out? Are there one or two large providers who specialise in this kind of thing and that healthcare professionals would sign up to practice imprivately or are they just within their rights to shop around and find the best deal the same way some people would do for other forms of insurance policy so does the Scottish Government have any control over that? The boards are responsible for ensuring that their employees are indemnified because the boards are an employer not me as a minister so it is entirely in law the responsibility of the board to ensure that people are indemnified now obviously the board is entitled to shop around and get the best deal and different boards use indemnification through different organisations, different companies but the regulation of the indemnifiers of the insurance is a reserved matter and is part of the financial services a regulatory regime rather than per se part of the healthcare regime in other words a health board will only indemnify a commission an insurance or indemnification policy from a licence and hopefully respected and respectable insurance company I have to say that is what I thought would happen in relation to NHS boards I would hope and expect that they would be very robust in how they would take out the indemnity policies for all staff working in the NHS there was more thinking about the private sector so other areas of healthcare provision where it is possible for them to shop about to reduce the margins that they have and you wouldn't have any control as cabinet secretary in relation to say that does cut the mustard in terms to the policy you sign up because in theory you could have a private healthcare professional with a policy which they must have by law and we hope that this never happens but there is a significant issue with practice there are claims against it and the policy is not as robust as you would think hopefully this would never happen but I am just trying to think about the Scottish Government wouldn't have any control over that it would be financial services provision at a UK level that would look at that I think it is fair to say that the regulatory bodies themselves have a close eye on this as well to make sure that those who are operating in the private sector are adequately and properly indemnified it's not the role of the Scottish Government because we don't control the private sector but I'm absolutely sure the regulatory bodies will monitor that to ensure that clearly that the policies that are taken out are of an adequate amount to cover any possible claim given the final bit of assurance that I need there the final question I think, Cunner, would be I suppose it would be within the right of any regulatory body or registration scheme to deregister a practitioner if they thought they didn't have appropriate indemnity so that would be a check and balance within the system I would have thought two things if there is a private practitioner who has not indemnified themselves and done it deliberately just because they forgot to renew their policy but if there was evidence for example they'd done it deliberately I would have thought that would fall foul of the regulatory bodies and indeed their ability to continue in the profession might even be called into question I mean obviously the most obvious example is the general medical council if you are a private practitioner you are a private cosmetic cosmetic surgeon and of course we have had some very high high level cases of where cosmetic surgery has gone wrong seriously wrong if the cosmetic surgeon has not been indemnified and in law has to be indemnified I would have thought that surgeon would certainly take the risk of being struck off I would have thought That's helpful Richard Lyle One of the points that Richard Simpson was making earlier on about doctors employed doctors working independently what about out of ours doctors who basically work for the NHS for a fee and may only work a couple of days or even just come for one night and then are never seen again My understanding is that they will be indemnified either through their board or through NHS 24 Excellent That concludes committee questions Thank you We now move on to agenda item number two which is the formal debate on the affirmative SSI which we have just taken evidence Can I remind the committee at this point as you usually do that members should not put any further questions to the minister during this session it is a formal debate and officials may not speak in the debate Can I invite the minister to move motion S4M 10156 Formally moved Thank you cabinet secretary Do any members wish to contribute to the debate No Cabinet secretary don't expect there's a need to sum up that debate It might be useful just to point out assuming there are this is an affirmative resolution but there are difficulties with it in the chamber that it's anticipated the private council will formally endorse this legislation at its meeting on the 16th of July and the legislation will then become effective as of the 17th of July this year Thank you cabinet secretary for putting that information on the record The question is then that the health care and associated professionals indemnity arrangements order 2014 Draft B approved Are we all agreed? Thank you cabinet secretary and your colleagues with you this morning We suspended at this point and quickly set up for our first panel Thanks for that I've eventually got set up here and we now move to format our item number 3 which is to take evidence on stage 1 of the Food Scotland Bill We have the around table session here this morning and and as usual I will give two to the panel members this is an opportunity for committee members to listen to comments on that so I'll always prefer them in this situation so I'll ask for patience from my colleagues I think we'll go directly to questions if that's okay and we if the panel members could introduce themselves as they speak and that might get us more time for the discussion Is that agreed by everybody? We're happy with that Thank you, Rhoda Grant for our first question Please Some of the evidence we've received while we've been looking at Food Standard Scotland is that the new organisation should take a lead in looking at nutrition and the like tackling obesity in Scotland I suppose, do people think is that what the role of the new agency should be is there any other aspects that fail that the new agency should take on and would it be resource to take on those new duties and would it require more resource to do so? Sorry, three questions Anyone want to take that one? Yes please I'm Peter Morgan I'm director of the Rout Institute at the University of Aberdeen I think the new Food Standards Agency or Food Standards Scotland could be a very good vehicle for taking on the role of leading in nutritional issues relating to diet and health I think the Food Standards Agency when it was set up across the UK was developed with the intention of providing leadership in that area of public confidence in doing so that was seen as a place where the public could go to get sound advice around nutrition and health as it's now been split up I think there is more confusion so certainly within Scotland I think that it is a role which the Food Standards Scotland could play however I think that for it to continue in that function it needs to get access to some of the knowledge that was present in the Food Standards Agency UK which of course have been lost websites have been lost for example which provide information to the consumers that would have to be restored and I guess that's a resourcing issue so I imagine that to set it up properly there would be a resourcing issue in terms of providing the infrastructure to provide that information to the public so I do think that the Food Standards Scotland could be a good vehicle to providing diet and health information to the public I think that there is then the broader issue of whether in fact it should take on a role which it perhaps didn't have before which was perhaps advice around obesity and this is a difficult one because obesity is one of those things which bridges is a complex issue and isn't solely diet related but I think that there is it would be helpful for the New Food Standards Scotland to have related issues towards obesity recognising however that obesity and some aspects of obesity would have to remain within the health department where of course there are clinical relationships as well so my view is that yes I think that the Food Standards Scotland could take a lead role in relation to diet and nutrition in terms of advice I reserve my judgement about coordinating research if I can comment on that later Anyone else Marion Bain I'm the medical director of NHS National Services Scotland and probably most relevant to this debate one of our areas is health protection Scotland but actually I just wanted to follow on from Peter Morgan's point about the possibility to have more of an impact on some of the health related issues in Scotland especially obesity I think that it is important to recognise that the NHS already has a major role in that and in particular special boards NHS Health Scotland so I think that it would be a question of being clear about what the relative responsibilities were and how to build on the best of all of the different organisations Anyone else Please Ramin Cymar, consultant public health in Lanarkshire I think that it would support both the comments made and would say that yes that the Food Standards Scotland would be a good position to lead on that role of public health nutrition and should work along with boards and local authorities in strengthening what's already taking place and support the partnership so just support that Yes, I think the really important thing if the Food Standards Scotland is going to have a role in any kind of public advice it must be seen as independent I think that's an absolutely crucial issue that it must keep its independence particularly from industry and even from government in a sense it's going to have to be seen as an independent organisation so however the bill works the bill must work to maintain that independence I know the organisation itself Tilly is funded from government and so on but to have that independence so the public can trust it that has to be borne in mind in rolling forward the bill and making sure that it has that very strong link with the public rather than official bodies and so on in terms of public perception Any of the other panel members it didn't take us too long to get the independence question but that's what happens in the Scottish Parliament but it was a theme of last week's discussion of funding the body and the nature of the funding and the evidence last week it does raise questions I think also the make-up of the board as well would anybody like to comment on that in terms of the make-up of the board the funding mechanisms as they are and I took from the evidence last week it may be wrong that the core funding but particularly in issues of research they're going to be bidding for funds and you know how do you create independence for the body when they're funded in such a way and how strong can the board be while it represents the consumers any response on that Yes, I think the make-up of the board is going to be crucially important the individuals on the board have to be seen in themselves as trustworthy individuals who are not going to be afraid to speak out on issues even if perhaps they're going against government policy and you know that's sometimes very difficult when you're in that kind of position but I think that has to be seen by the public as the essential nature of the body that it has that degree of independence clearly it is going to be looking for research funding and if I could put in a historical comment here when the Food Standards Agency itself was set up it lost research funding that was already in the system there was a change to the system then I think the Food Standards Agency at UK lost out on research funding which was a great pity and I would hope that whatever goes forward in terms of the way the new body works that it does have an adequate research budget I know that's very difficult to define what it is but it must have that as one of its high priorities to commission research and also to keep links with other funding bodies so that it can influence them if necessary perhaps indirectly in terms of pushing funding towards issues of great public health importance which are capable of resolution in real time but there are many issues out there and I'm speaking to the microbiologists for example we have made progress with campelobacter in terms of research in understanding it better unless we understand it even more we won't make much more progress in controlling what is the commonest cause of bacterial food poisoning in Scotland Yes please Professor Morgan I think the issue of independence raises a number of different issues there's independence as a body which is separate then from the original food standards to UK previously of course it was part of the overall system by becoming independent it essentially has to be able to stand on its own two feet but I think it's important to recognise it needs to work in partnership with other bodies and those links are the crucial things that need to be sorted out so it can't work in isolation of the food standards to UK and I don't think it can work independently totally of the public health England however it does need to have its own identity and its own understanding how it's going to go forward in terms of research you is right that there was a great loss of research money when the food standardization to UK was disbanded the money for nutrition research certainly disappeared I think there's still elements of money for food safety research is where does the new money come from and I think that we have to be clear about that the way I understand this situation is that previously the food standards in the UK had a pot of money for research which is quite a sizable pot and as I say that disappeared equally the food standards in Scotland had a small sum of money which was targeted towards research which was for Scottish focused issues I would see that needing to be maintained however the wider research funding opportunity which of course comes from other government sources like RESAS the Rural and Environmental Science and Analytical Services division that is a different budget and we need to be clear that is a different budget and I don't think it would be a good idea to raid that budget to put it into the food standard in Scotland because the function of that the RESAS budget is different than the food standard in Scotland budget in other words if there is research money required for food standard in Scotland then I think we need to consider where that money is going to come from and I think there is a debate in my own mind what sort of research food standards in Scotland should do so for example I think that if you have a body giving advice and it's a legislative body I'm not so sure it's a great idea for it to be the one commissioning the research I think it needs a budget to do short term research to answer but in terms of strategic research needs I would keep that budget independent panel members I'm giving praise to the panel members Robbie Beattie, Association of Public Analyst one part would be to look at your budget I mean the third of the budget is looking at the operations so that's the third of it is it serving industry or is it serving the public as a consumer champion or not so there may be conflicts in there in the structure we've been looking at cutting plants and meat plants, is it helping industry or is it helping the consumer No other panel members Bob Doris Talking about the independence of Food Standards Scotland I wonder about the powers it has as well and I was looking through the bill under a general powers provision there which says Food Standards Scotland may do anything which it considers necessary to or expedient for the purposes of or in connection with its functions and they are laid out within the bill One of the things to think up from our witness from which last week was that the FSA my understanding was that Food Standards Scotland won't be able to have statutory access to food testing regime results from industry and there was a belief that that would be very helpful so when industry does do testing that's information that should routinely be passed so over to whether it's the FSA at a UK level which is now going of course to the new Food Standards Scotland I'm just wondering if there's an opportunity to put on the record whether they agreed with that in terms of first of all I suppose the general powers question given there about the balance of powers within the bill and I've got other questions perhaps later if there's time in relation to that but the specific thing we got last week was the power to compel industry, large supermarkets producers for their own food testing and how come move if possible any takers a general comment that the more information the body has the better it will be to discharge its function I think there is obviously an issue about relationship with industry and getting information in that way I think I sit on the fence on that one in terms of having overall riding powers to get information of that kind but in principle yes it would be useful to have that sort of information in terms of preventing outbreaks and having information up front I think that would be very useful and I think also that would boost confidence among the public in terms of the monitoring that takes place and the information that is available in terms of auditing and improving driving standards I think that would be yes I mean on testing that a fair amount of testing is done on a fairly random sort of basis and I think one has to look very carefully at whether you're doing the right kind of testing on the right kind of foods and so on because most of the results are going to be negative and my personal experience has been that that kind of testing is of value but it's of relative limited value in giving good public health protection there are other issues which are probably more important in terms of how well businesses are run and a lot of the course that falls down to local authority enforcement officers doing their inspections and so on and there are fundamental philosophical issues about the role of testing testing is essential it is necessary but it has to be focused and done almost in terms of looking at something where you think there might be a problem focusing on that rather than doing having a general testing program which can be quite expensive but give you quite small returns and I think that's something where clearly professional judgment is crucially important in terms of who's doing the testing on what and so on Robby Beattie it's things about allowing industry to do its own testing Cadbury's got caught short because they were putting salmonella in chocolate to look after their own shop we do risk having problems as well similarly with the horse meat industry was looking after themselves but only looking for what they wanted to look for and didn't find horse meat so you have to have an independent body willing to take that challenge on and look for the horizon scan the unknowns as it were if you lie on industry they'll just give you what you want to hear Any other panellists on that one sorry Mr Hamilton Billy Hamilton, Glasgow City Council business regulation manager environmental health Julie used to pick up in the broader question about powers and to fly off a little bit of a tangent I've got a rather unpopular view in relation to the enforcement role and all of this and I think that I would like to see a slightly more aggressive role taken to be honest again being an enforcement person perhaps is in my blood but I think that there's an aspect of going back to nutrition and obesity issue that I feel that there's a need for a perhaps a more interventionist approach we have quite a lot of initiatives which go on which we engage with fairly peripherally which encourage and support in relation to healthy reading but I don't feel that it's a great sort of frustration to me that there is no final step that can be taken to push the issues like the more and we have for instance a scheme in Scotland which promotes or advises the public in relation to food safety compliance I just wonder whether there's maybe more Scotland there is a move in the bill to make that a mandatory scheme I just wonder whether there's maybe more scope to broaden that into a broader compliance issue or a broader performance issue with businesses nutritional performance and the kinds of food that they sell and to be working out some kind of profile for businesses some of your evidence about food sales in and around schools and young people it would do, I don't want to pre-empt any discussion on that but I think that leads me on to that way of thinking to be honest and the frustration that I feel that my colleagues feel that the evidence is there obviously that you cannot get that actually helpful Mr Hamilton because I was going to come on to that I think just very briefly in relation to the general powers provision and in terms of testing with industry I would hope it could be partnership is rather than just confrontational because as the witnesses have said there's no point in testing things you know are safe but you know supermarkets and large producers that are ethical and their practices would be keen to work with FSA to identify the higher risk areas to put an inspection regime around that and that would be a good thing to see so it doesn't always have to be confrontational hopefully there's a partnership way forward but in terms of enforcement powers that would have been my other question which Mr Hamilton has helpfully allowed me to come on to so I thank him for that one of the things looking at the policy memorandum that I brought up last week was where food is seized but is the vendors are guilty of food fraud if you like there's no power to seize that but not to destroy that and it could in theory go back into the food chain the bill does appear to put a stop to that and just looking at some of the more general powers convener the duty to compel the reporting of breaches outlets and Mr Hamilton was talking about maybe a cluster of more powers so I think this would be a good opportunity for witnesses to put on record any additional powers that they would like to see within the bill but also if I could just give a caveat convener I'd imagine some breaches are small businesses trying to do their best that are not complying and I wouldn't want to see those driven out of business but to be supported to perform better but what powers on Mr Hamilton started to give some suggestions what additional powers people would like to see within the bill particularly in terms of enforcement Last Mr Hamilton is that the case if you seize food for one reason or another that's been labelled incorrectly or whatever but do you give them it back? General speaking we don't seize food on the basis that it's not what it says powers really extend food where it's deemed to be potentially unfit so there's only a safety imperative for that, the bill is introducing a food standards power which mirrors that exactly which is very welcome and I'm assuming that the powers will be the same, we'd go to a sheriff and get the authorization to destroy the food One of the original questions that Bob has raised is any response from the finalists on that the challenge to strengthen the bill no guarantees of course Bob said it, yes Mr Hamilton Thank you I think again being an enforcement person it's only natural that I would say yes there should be more enforcement powers I certainly respect the view that there's always potential for inappropriate use of powers but I think that if anything there's a suggestion that some of the powers are adequately so I certainly take that point on board but I think that there is certainly a case for the mandation for instance of the food hygiene information scheme which is as I mentioned welcome then information is already available to the public through the Food and Information Act anyway and I think that a more meaningful scheme in other words one which is mandatory for business would be helpful I know that there are certain doubts about how helpful it would be relatively inexpensive when we are going ahead and as I said I would quite like to see the scope of that scheme being expanded on the issue of powers I mean there's an additional issue which is quite close to my profession's heart and that is the subject of food premises licensing which powers already exist within the Food Safety Act but I'd be crucified if I didn't mention that you know on behalf of my colleagues there is still quite a strong appetite for that in Scotland primarily to prevent the emergence of unsuitable businesses just as a matter of course I agree absolutely with all that has just been said about the mandatory display of the scores on the doors as it were which has gone forward in Wales and the way there was going to be some problems with that but as far as I understand they haven't amounted to very much so I very much in favour of that power being exercised at this stage rather than leaving it to ministers to come forward with that at an appropriate time because I think that would be very much in a public interest Richard Simpson I'll just clarify that Bobby B.T. here You just have to put something in because if there's a perhaps a move towards looking at industry testing you could look at the 80-20 rule you could have 80% of your problems coming up to 20% of your estate you've got E.coli outbreaks in Fife you know it's related to be a small restaurant your outbreaks of E.coli in Wishaw small butchers you've got Glasgow so you've got lots and lots of problems coming out of small areas so you were expecting industry to self-police so you'd be okay for your test scores your as does and such like but who's going to look after the small guys that are causing a lot of the problems and killing people Just on that point it's not my main question convener but as I understand it from our discussions in Aberdeen when the committee visited the proposal is not to have a five point scoring system as they have in Wales because how do you judge what's a three what's a four and what do the public understand by that you've got to have three levels which are that a health improvement notice will be issued and whether that should be displayed and how quickly it should be displayed how long should the individual have the opportunity to rectify the situation before they're required to display it so I'd like a comment on that and then the two other levels are yes you've passed the health inspection so you're regarded as a hygienic premise and then we've got a thousand at the moment who have the gold standard a sort of exceptional standard and that seems to me quite a good system but I just wonder if we could get a comment just to follow that point on the health improvement side how quickly should it be published Mr Hamilton Thank you the issue of the scheme in Scotland is quite as you described very well it's quite a simple scheme compared to that in England and it's less problematic in reality in the footage information scheme there are two statuses one is improvement required which the very small minority of premises are deemed to be improvement required the vast majority are pass and in other words they are considered to be a satisfactory standard I'm sure that my colleagues would love to make this much more complicated and more impenetrable for the public but in reality it's very simple and straightforward it's completely flawed in the sense that it's not mandatory and I would be looking for the scheme to be carried forward as it is not to contrary to what I've already said and I'd like to see the scope of it rather enlarged so whether we are saying that business is clean and it's well operated but the fact that it's serving deeply unhealthy food in the main is an avenue for us in the area I don't know if that answers your question entirely because it's how long should they have before they have to comply with the health improvement or display the notice which will have an effect on their business I think that the key thing is to be aware of the fact that the displayer of the information is for public information it's not an enforcement tool we have an enforcement mechanism which would require the business to comply within a given period of time if it was presenting on a risk it would be closed immediately however if it was there were some matters that were of a serious nature it would probably be subject to a notice which would allow 14 days to rectify these issues the scheme itself to display would be I would imagine would be much instantaneous there would be a requirement to display straight away if the business can sort things out straight away then they would be allowed to change the display No one else Richard My main question is really about research and I understand from the discussions this morning and other discussions about the UK Food Standards Agency funding and being split and being underfunded and we also heard from in Aberdeen that research there are a number of Scottish unions involved in the research without being the main one but the Scottish research is complemented by big units at Norwich and Cambridge as I understand it and moreover research funding comes from councils like the BBRC and from Welcome and from other groups the Scudimo report said that the FSA Scotland and the Scottish Government must urgently identify the scientific capacity and capability required to deliver official controls in future so that decisions can be made about what needed to be available in Scotland what needed to be available elsewhere should then be used to inform more strategic investment decisions that was recommendation 33 and we heard from Jim Wildgus at the evidence session last week that there are 15 UK scientific advisory committees so could the witnesses give me an outline of where actually we are and where we're going to go with a new research body we've already heard about the rural fund and that should be separate but how are we going to have scientific advisory committees and systems because of the splits that have occurred in England and in addition to that what would happen if we were independent in independent country what would actually then happen in terms of all these aspects of research and relationship to the current complementary system and the final bit convener is that Dr Wildgus made it very clear that the Food Standards Advisory Committee would also cease to exist and I wonder what the implications of that are for Scotland that's a respective of the question about post-September okay well I think the first thing to tackle is the issue of advisory committees um that if the Food Standards Agency in Scotland becomes a separate body then it's effectively dislocated itself from what went before but in many I guess in many ways that's happened as a result of the Food Standards Agency being fragmented in England so to speak so there are advisory committees which are set up for various different activities advisory committees on nutrition novel foods and pathogens, toxicology and various others I do not see any advantage in duplicating those committees they are already existing on the basis of bringing in the best people across the whole UK to give advice to set up a separate set of bodies would just be duplication to know positive benefit and you'd probably be using the same people who were already on the existing committees so I think the best thing we should try and do is to harness the information and advisory usually advisory committees already exist the issue is then how do we do that because previously under the Food Standards Agency in the old Food Standards Agency Food Standards Agency Scotland was part of the parent body therefore you had all of the relationships built in now that it's become fragmented I think we need to revisit the mechanisms through which a new independent body would be able to influence and get advice out of those committees I don't think it's impossible but it would require us to go and look at how the mechanisms to make sure they were fit for purpose I can't imagine any reason why they shouldn't that shouldn't be possible because I think that certainly from the advisory committees I know of they don't see themselves working solely for one body they're just giving advice and there's no reason why that advice should not be given to Scotland as opposed to as well as England I think it's the mechanisms that are important so in other words if advice around nutrition is currently being the secretariat for that is in Public Health England then a conversation would need to go between Food Standards Scotland and Public Health England about how Scotland gets proper representation of advice so I think that's the first point I would not duplicate committees because at the end of the day all advice is about synthesising information from the maximum number of sources and any one committee if it's the right committee should come to a good consensus on behalf of everybody In terms of research I think that there are many many places in research in these different topics whether it's nutrition or food safety and these committees, advisory committees will filter that research whether we need to do more research independently in a Food Standards Scotland I am not so convinced I think there's plenty research going on and the only question in my mind is whether Food Standards Agency or Food Standards Scotland need to do specific things to answer specific policy needs I think there's sufficient research going on in other areas that would allow the committees, the advisory committees to pull together the information they need so unequally as I said before I'm not convinced that the body which is the advisory committee and also the enforcing body should be the same body that commissions research I think there's a conflict there which I think is best kept separate so I don't think there's an issue about how well the new body can get advice I think that the mechanisms are potentially there, certainly the advisory bodies are there, the mechanisms need to be examined to make sure they do what we want them to do and I think in terms of research there's plenty research going on no doubt, I mean many of my colleagues would argue well we've lost Food Standards Agency Food Standards Agency in the UK their research budget has never been replaced but nevertheless there's a lot of work going on within the UK across Europe and the advisory bodies pull that information together for the benefit of the advice through the Food Standards Scotland as an independent body Could I echo what Peter just said about advisory committees and talk perhaps about the one particularly interested in me, the advisory committee Microbial Safety Food which existed before the Food Standards Agency itself was set up and it's worked I think extremely well in producing essentially a consensus view about what a problem is and what the best solutions are and these can get embedded in legislation at the moment its chair is somebody who used to work in Scotland who's now a Professor at Liverpool so she knows the situation very well and I think what Peter says about maintaining in a sense a formal link between that sort of committee and what happens in Scotland is really important so that they don't ignore any special Scottish problems there are one or two I'll come on to one in a moment but it is really important that that kind of link is maintained so that there is a Scottish voice heard on that committee or a Scottish representative somebody who knows what the Scottish scene is on that committee if at all possible and I don't see any reason like Peter why that couldn't be done the negotiations might be quite complex and difficult as I understand those negotiations always are between different government departments because they're always looking after their own patch but I think if that's done sensibly and with the right kind of aiming view which is clearly to protect public health I don't see any problem about that as far as the research is concerned again I think maybe I'm slightly different Peter here but I think it's really really important for the Scottish Food Body to have a research budget of its own and we may well have for example to respond to a particular situation in Scotland which may not be cause for example from a microbial point of view by an organism that only exists in Scotland but we may have a particular need in Scotland to look at a particular problem I think we don't have our own research budget it might be quite difficult to take that forward timidly sometimes these things have to be done really quite quickly to get to grips with a problem to find out what that problem was for example when we had the wish or outbreak in 1996 work was commissioned on the back of that and had been commissioned before in similar outbreaks although they were looking at particular Scottish issues and required Scottish input to do the research the results of that research applied internationally they didn't just apply in the UK they were of international importance but I think it really would be important for the body to have a research budget on which it could call to do that kind of research and to commission its own research in terms of informing its own policy if I could come back to the Scottish Food Advisory Committee I was a foundation member of that committee and one of the advantages of that committee was that it sort of held head office to account in a way because we saw ourselves as independent members of that committee we were part of the food standards agency but we could ask questions that perhaps the head office in Aberdeen didn't well I'll say no more but I think we could raise issues and stimulate policy development and one of the great advantages of the Scottish Food Advisory Committee was that we met in public and we met in all parts of Scotland we went from Shetland to Dumfries and I think that was a very useful way of communicating with the public it might have been quite expensive but I think committee members felt that that was a really important way of talking to people in public about issues, hearing what their views were and being helped to account as well because there were question and answer sessions if that body is not to be replicated I think it's really important that the the border of the new body does the same thing that it has frequent interactions with the public as well as having the appropriate interactions with people in the Scottish Government I just want to make a point of clarification I agree with Hugh that the Food Standards Scotland would have to have some budget for research to respond to time use and important projects for policy what I'm really arguing is I don't think the body should be involved in co-ordinating or taking a lead role in directing research in the general area Was a doctor well goose last week raised the issue about being very careful about this and are you aware or have you been involved in any work that will ensure we continue to link into these scientific committees what has been done to ensure that your concern is met The committees I'm aware of and I know people who sit on those committees there is still an opportunity for members of Food Standards Scotland to sit as observers on those committees but the thing is I think that if we want to use those committees for what they can actively do which is to respond to questions which Scotland may wish to have answered or to get advice out the committees then I think the linkages need to be re-examined because they were set up under the old Food Standards Agency UK and really haven't been re-examined in the context of the new world so I think they if we want to make sure we have formal arrangements where we can utilise the committees firstly to perhaps examine issues which are important to the Scottish Food Standards Scotland as well as to get outputs from those committees then we need to examine those linkages Gives an opportunity to set up a separate Scottish committee so is that contradictory to all of that what would that committee do I don't think I think if we're talking about advisory committees for around specific issues relating to scientific research then I see no point in duplicating those committees because we're using the experts across the UK already if we're talking about a committee which may be a committee which was functioned a bit like SFAC then that's a slightly different issue where if they're taking an overall view within Scotland then that perhaps isn't, that's still possible but it's not the same as the advisory committees relating to research Dis, please Yes, could I come in and agree with that absolutely the scientific advisory committees are the crucial ones that we want to have those formal links into the SFAC is a slightly different issue because that really wasn't engaged in research that was engaged in public communication looking at issues in a broad sort of way slightly outside the box but all the people on that committee were selected because they brought different strengths to that committee across the piece in terms of food and I think that's the sort of body I would like to see exist in one way or another just to get those people round a table meeting at frequent intervals to advise the body to advise the board who will be busy with other things running the organisation and so on to make sure that nothing is being missed and that concerns that are being properly addressed but that wouldn't be a scientific advisory committee on microbial safety food which has quite a different role which does extensive in-depth studies about a particular problem and it may well one important reason which hasn't been mentioned as to why it's really important for the Scottish body to have input into that would be that that committee looks in depth at particular issues and there may be an issue which might be seen as more important in Scotland than in the rest of the UK for example and it's useful for Scotland to have that voice to persuade the the larger body to conduct an in-depth study using resources which might be beyond the Scottish body to have to employ to do that kind of study Bob, you're on this theme and then I'll let you back in Richard then because I'm aware of it only very narrow in that case then in terms of committees in the bill it gives it gives a permissive power to forum committees not a prescriptive power in other words my reading of the bill is the expectation would be where the FSS feels the need to forum a committee it is free to do so rather than prescriptively saying here are set committees and seem to be working on the basis that knowledge transfer across the UK across Europe or across the globe is you find your expertise it's just to make sure that because we're talking about various committees at a UK and Scottish level whether the witnesses are content for it to be a permissive power within the bill rather than a prescriptive power such as the nuts and bolts of the bill really convener because we're talking specifically about committees if there's nodding heads that's fine that's fine that's fine that's fine that's fine that's fine that's fine when we talk about accurate research in particularly in the clutch of health protection Scotland they talked about seeing further opportunities and I wonder they didn't actually specify in the paper what those opportunities might be because I find that really quite interesting so have you had further thoughts about what those opportunities would be mean I think from health protection Scotland's point of view a recognition that there are a number of areas I don't think that cuts across anything that's been said earlier. A lot of these things need to be done nationally and internationally. I'm not a specific expert in the area, but the sorts of things that my colleagues were talking about were things like bacterial counts and food and stuff like that. I'm sure that others on the panel would be able to reflect that more accurately. But it was more the point that we didn't want to lose that. There are still a lot of areas that need significant research in order to protect the public's health better, and we would want to make sure that that wasn't endangered in any way. Yes, please. In terms of unique challenges for Scotland, identifying those, I mean, the Pennington referred to the sort of food safety issues in terms of particular things that might emerge within Scotland, but also in terms of obesity or food poverty or other things that might come up. Those are some of the things that we were referring to when we looked at further opportunities for research. Dr Simpson raised the point about Scudamore Recomendation 33, which is talking about official controls. I saw that as a red flag to the Government and the FSA to deliver official control laboratories because the network in Scotland is creaking. They are looking to join scientific services of the four official control labs. That was a point, and that is still to be addressed. That feeds into how we have national reference laboratories. If Scotland has its own FSA, will it have its own national reference laboratories or will it be going to use the ones in England? That is still to be understood. That would feed up to the European reference laboratory. I found it hard to reconcile the two views in the public analyst paper. The budget has more than halved in the last 10 or 12 years for the public analysts, and you were recommending a centralised national public analyst system as opposed to local authority controlling it. The local authorities were saying that they wanted to keep the individual bodies, so I found that quite difficult. Professor Pennington made the point that testing will produce a lot of negative results and that we need to focus on them. I am trying to get my head round how much we should be doing on that and whether we should have a national system or whether we should rely on the UK national reference laboratories or whether we need our own for everything. Local testing is useful, but a national scale allows you to buy larger pieces of equipment to look at the DNA sequencing and all the new techniques that are coming through. IZ Talk is looking at authenticity and provenance, but that is not anything that we can fund on a local authority level. Certainly, sampling is halved, as you mentioned, and that is exposing difficulties for the laboratories. Their funding is drying up. What they are needing to do now is diversify and they are trying to scrap around and get some money. What you do not want is an emergency, and then there is nobody there to respond to that emergency. There has to be a continual supply to keep the capacity up, keep the expertise up, and as soon as there is an emergency they can respond. That is one rationale for having a national service keep it ticking over. The food standard agency are trying to prime and put some moneys in from co-ordinated food sampling, but if you look at food, we are talking about food, but the agency is all looking at feed. My local authorities, none of them would actually submit any samples and they would not even take the free money from the agency to submit samples because the trade and standard service do not have the capacity to deliver the samples. There is that input on one side, and then you have the number of local authority officers on the ground to take samples reducing as well. That is now being diluted. There is a lot of competing pressures there. To compete with multinational companies, I have mentioned that they are the big huge ones, such as Nestle, Cadbury and all those big guys, a small local authority lab is going to be David and Goliath to try and make sure that you can keep on top of that. Any other comments in the back of that? Yes, please. I thank you on the point of view again with support that it should be a proportionate risk-based approach in terms of availability of testing, especially when you are dealing with outbreaks when there needs to be a rapid response in order to prevent impact or negative impact. I think that access to specialist testing is absolutely crucial in order to make sure that we can take that risk-based approach in a very rapid way, as it is expected. Yes, please. From the microbiological point of view, we already have reference labs in Scotland that have had for a long time for organisms like E. coli 157, which do work well. They are out with the food standards agency. It is important that the new body keeps a sharp eye on the funding of those laboratories, because they provide a national service. I always have a slight B in my bonnet about them not just providing a reference service in terms of looking at organisms that have been isolated in hospital laboratories and so on, but they also have a research function of their own. It is quite wrong for a reference laboratory not to have some research function as well. The point is to be well made about the increased cost for providing those services by DNA sequencing and so on. Although the cost of that is coming down, it does not come down to the level where you can ignore it as a substantial cost. I would expect that the new body, as soon as it starts, would be looking at that to make sure that there is an appropriate service being provided across Scotland. If they do not think so, they should say so to the appropriate bodies. Eileen McLeod research funding, which, of course, we know is based on excellence, and certainly Scottish research is well-renowned for its excellence. We will continue to attract research funding and participate in international research collaborations, regardless of what happens post-referendum on independence in September. I wondered what opportunities that panel members see for the new body to be able to lever in other sources of research funding, such as the EU's new horizon 2020 programme, and I know that one of the grand societal challenges that the horizon 2020 is seeking to address is around how we tackle sustainable, how we ensure that there is sustainable food and feed security and safety, and whether we see the Food Standards Scotland having a crucial role to play in identifying areas for future research around diet, nutrition and obesity. We are working in partnership with our key partners—academia—on the industry side and with other research institutes. However, the key issue is around the other sources of EU funding that we could obviously use to lever in. I agree with you entirely. Scotland is one of the best places to do research in the world and always punches above its weight. I think that it exploits funding from the European Union very well. I can see great opportunities for it coming through in the horizon 2020 funding. I see that the leader for that research is going to primarily come from the academics, but I certainly see that, although I would not argue that the new body should be co-ordinating research, I think that it should have a definite role in trying to influence what research it would like to see done. That is where I think that we would need to have some forum in which the Food Standards Scotland could have an influence on saying what sort of research it would like to see being taken up. That will influence the academics in terms of what funding they may seek within Europe or anywhere else. Of course, if you have got support from industry or from government for research, that makes the research applications even more compelling. I see that that is the way it will work. If the Food Standards Scotland can bring forward its ideas and bring them through some forum where it can have an influence on research direction, whether that is in Scotland or beyond, I think that that would be very good. It will certainly be very helpful for the academics in terms of focusing them into what they see as the key priorities. Anyone else? The functions of the board. We have had comments from our Society of Edinburgh about the actual size of the board that the suggested minimum of three is not enough. I just wondered around the table what views are about the size of the board for FSS and who should be on it. In our chair, the committee, the Royal Society, came up with our recommendations. We felt quite strongly that the minimum of size was a bit on the small side for the board. Not to have it too large, but clearly it is not necessarily going to be representative, but there will be a fundamental representative nature to it of people coming from completely different areas of expertise and background knowledge and representing consumer interests. We thought that three was really going to be a little bit on the small side to get those interests represented on the board in terms of what the board members could contribute to the way that the organisation runs. It was really to have that breadth, because clearly what we are talking about is an incredible array of problems. Some of them are much more simple to resolve, but I would say that some of the microbiological ones we have done quite well like some of our enteritis, where we have a vaccination programme on the chickens, which works quite well. However, if you talk about some of the other bugs that I am interested in, we know better often than we were 10 years ago in terms of the level of human infection, and some of those infections are very serious. Of course, we have these incredible problems with nutrition as well with poor diets, inadequate diets, as well as superabundance of food. Those are problems that do have some connections, but many of them don't have much of a straightforward connection in terms of the answers to the problems. That is why I think we felt philosophically that a larger board would be much, much wiser to have than a smaller one. Representing those particular areas of expertise, clearly plus the personal qualities of the individuals that they have had to already shown that they are able to fight for their corner—let's put it like that crudely—in terms of the influence on nutritional policy. Looking at one of the issues that was certainly important when I was on the Scottish Food Advisory Committee, I was looking at how do you persuade the public that what everybody knows is a good thing? The public even knows it, but they are not doing anything about it. That is a common interest in terms of obesity. Everybody knows that being overweight is not good for your health, and everybody knows that washing your hands is a good thing. How do you persuade people not to eat too much and wash their hands at the same time? That can be very difficult. Again, you need somebody on the committee or members on the committee who have some wisdom about how you communicate those things to the public in an effective way that delivers. Otherwise, the body will just be a talking shop. There should be any industry representation? I do not think that industry is all bad, but I think that this is the issue about the credibility of the body itself. If it is seen to be too close to industry, even if it is getting close for the best reasons, I think that many parts of industry do not want to have food problems associated with their products. I have talked to heads of big supermarkets who have talked to me about a problem that has existed just before a board meeting that is being held in public about an outbreak that they have had, and they are desperate because they do not want their brand to be destroyed or damaged by that kind of thing. They have a vested interest, not necessarily in protecting the public health but in protecting their own business, but to have industry members who are clearly associated with industry, I do not think that that would be a particularly good idea. That is not to say that we might not have people on the board and senior officers who had substantial industry experience but not current. To what you have just said, does that not go counter to having industry looking after its own testing if they are desperate to try and hide what they may have uncovered themselves to protect their brand? I am slightly more catholic in my views. I certainly agree with you about the side of the board. It has to be bit greater than three, because I think that we need to have appropriate representation of the key elements of what goes on in the new body, but it must not be too large that it cannot take decisions. In terms of representation, I certainly feel very strongly that, although the food industry gets lambasted for a lot of problems around health, it is also, in my view, the vehicle to getting better public health. I think that it is important that we engage them to achieve that. I do not think that a single member from the industry is going to be able to subvert the whole board. In my view, I think that we should be engaging industry and having a member on the committee or on the board, because I think that it will be a positive statement of the industry of what they can have an influence but not necessarily a soul say. I agree with what is being said, and it certainly makes sense. I agree that three would be too small a number. We do not want to be too big because then it becomes unmanagable, and that would be from personal experience of being on boards as well. I thought about going back to our early discussions about the opportunities for the broader public health, so going beyond the health protection issues into the nutrition and obesity agenda for Scotland and linking it to health inequalities and the potential to make a big difference there through some of the work that might be focused on. That would suggest that you should have someone on that board with a strong public health background and who can bring that to the agenda in terms of not just being able to see the obvious opportunities but some of the less obvious ones to improve Scotland's health and to reduce inequalities. I think that we do not talk about it very much because it does not fill us with any great pride, but the Glasgow effect, somebody with some experience of that kind of very complicated issue, I would like to see somebody on the board with that particular expertise, and that really is a sort of public health person who sees across the piece and sees how difficult these issues are and clearly relates to other health issues as well. I think that we've heard already that the new body should have a very strong relationship with health because clearly many of these issues overlap into health things like alcohol policy. I think that the Royal Society did mention that we should look at whether the new body should have input. It's bound to have an input in terms of fraud because of the fraudulent sell of things like vodka and so on. I would agree that the public health industry is absolutely crucial and focusing on that particular Scottish problem, which is what I call Glasgow. I know it's unfair to Glasgow. I did live in Glasgow for 10 years, but I know what the problem is and it's still there and it's still at large. I turn to Willie Hamilton and Professor Hugh Pennington. That's the cover and part of this, but if there were food fraud, what would be the sanctions? Would you like to see more sanctions in regard to food law offences, Mr Hamilton? Yes. I don't want to paint myself as a rather draconian enforcer here again, but I've been pressing a number of years for a slightly more user-friendly regime, including fixed penalties, basically. It's a quick and easy method of approaching enforcement. When you mentioned food fraud, the only recourse that we have is relatively low-grade. A lot of it is very low-grade. It's prosecution and we have big, big problems with prosecution, because the court system doesn't support it. We suffer more than most in terms of the critical mass that enables the court system to work in our favour. Prosecution is really not a great option. A minister defines fixed penalty notices as calling what you will would be certainly a boon to us. I'm familiar with the arguments against it in terms of, you know, how it could be seen as fundraising, but I believe that the bill is going to deal with that issue by any funds raised would go into a central pot anyway, so it wouldn't be a money-making exercise for councils or it wouldn't seem to be that. I think that's certainly the way to go. It shouldn't be a draconian, it should be preventative. The majority of the food fraud that we encounter, certainly in Glasgow, surrounds the substitution of meat and fish. It's done at a relatively low scale. It's done primarily to save money. It's food fraud, of course, but it's not in the same league as some of the horse meat issues that we saw last year. I don't think that it would certainly justify pursuing cases of the court and criminalising individuals. Small butchers, very often in the ethnic community, restaurants where they substitute beef or lamb, for instance, or a whiting for whiting is more likely. There is a need for a more streamlined, non-criminal science in the region, which would certainly benefit us all to be truthful, including the industry to a great extent. The industry calls for the level playing field that we can deliver that better with a slightly more flexible system. Can I come in and say I had an experience of a butcher who killed some people with his bad meat, but he was also selling what he said was Welsh lamb, but it was actually New Zealand mutton. He wasn't prosecuted. That was just an incidental thing. I would agree very strongly that we do need a much better way of sorting out this problem, which is probably quite common. It's not like the horse meat thing in the sense that it would immediately come up if he started testing on the basis of intelligence. It's a small thing, but it may be quite common. Although, of course, one must remember the Shattlen fish thing, which was on a ground scale, but clearly that really needed forensic accountants rather than anybody else to bring the prosecution. Again, basically the situation, in your experience, is what the average find that someone finds if they have found something to be wrong in their premises? I'm probably not the best person to ask in the sense that, in my authority, our policy is largely to avoid prosecution simply because it's become incredibly ineffective. We have one case, just as an example, one case pending just now for food hygiene offences. It's been well over two years. We haven't heard a thing about it in several months. It may not even come to court now. It may have just disappeared into a hole in the ground. It's not seen as an effective method of enforcing food law and protecting public health. I understand that the public seeks or would require or request it to happen, but it's not really in our best interest. I don't think that it's really in the public's best interest for it to be the main thrust of our actions. I'm sorry, I don't know what the average find would be though these days. Will you welcome any changes that would save the frustrations that you sometimes feel? Very much so. I think that there are certainly items within the bill that will deliver that. Thank you, convener. It's just very brief on that interesting line of questions by my colleague Richard Lyle. Mr Hamilton has given very useful evidence in relation to the need for the fixed penalty notices that are contained within the bill. He's given a fairly strong reason for why they go to a central pot rather than back to local authority, so there's no conflict there. My question is probably for Mr Hamilton, because you're involved in the enforcement side of things in terms of the use of fixed penalty notices, which I know very a little about, I have to admit, but I'd imagine that if you have a family business, it's a fish and chip shop, you're substituting whiting for harduck, you only have one outlet, and there's a fixed penalty notice on you. The burden of that fixed penalty notice would be far greater than saying that if you had a chain of 20 stores across west central Scotland and you may only have been caught in one of your stores, can fixed penalty notices take account of the scale of your business network or will it disproportionately, if you like, affect smaller retailers, producers and outlets? I'm just wondering if that's something that's been done before. It's always dangerous when they're asking a question when you don't have a clue what the answer is going to be, but just in terms of making sure it's proportionate on industry. To be honest, there are existing schemes at the moment, or legislation like the Environmental Protection Act, which enable us to serve notice, as I mean local authorities, and there is very little consideration to be truthful given to the capability of businesses to cope with the actual costs involved. I would certainly argue that if there were to be a fixed penalty regime or anything of that sort introduced in the food law, it would have to be very robust. I think that local authorities would have to exercise or be called to account to exercise transparency, accountability and proportionality, and there would need to be quite a clear co-de-practice covering the means by which it would do, the notices would be served. Perhaps there would be a sliding scale in terms of the degree of the final level of the fines, I would suggest, but I'd certainly take in board. There is potential, therefore, to be disproportionately puritter. I'm not saying that there shouldn't be a fixed penalty regime to try to work out how the impact will be across various businesses. That's very helpful. There is a review going through Europe just now, which has used the jargon, the 882 2004 review of official controls funding of, and at one stage they're talking about having a minimum of 1 million euros for the business, whether you take action or not. We're talking about the number of employees in the business. You have to say that it was 20 employees. Would that be if you had two people in the kitchen and they don't comply or if it's a hotel, you include all the cleaners? I presume that the lawyers have looked at the bill and made sure that they're not going to cut across what's coming out of Europe, or there will be additional penalties and offences coming out of Europe through the review of 882 2004. That's the thing going on me, so thank you very much for giving me that information. Back to this challenge, I mean that I've been out and about and heard some evidence. We've had an evidence session last week, an evidence session this week, and there's lots of opportunities in the bill. I'm still uncertain about what the outcomes will be when I hear the evidence that says, well, just as I heard there, that lots of powers and regulations come out of Europe. That's still going to change. Powers of inspection lie with local authorities, if that's going to change. In fact, I heard yesterday a meeting locally that local authorities and health and care partnerships are worrying now about who will be carrying the health message, whether it be the health service or whether it be local authorities. We heard evidence last week that the labelling regime where we've already got powers has not been used, but it could be slightly different. I think I asked the question last week what's the point? Will this help us tackle—what would the outcomes be? Will it help us tackle obesity? Will it give us a new focus on E. coli and the other Scottish problems that we have? Tell me that this will make things better someday. The proof of the pudding will be in the eating. It will depend entirely on how well the body works. It's essentially going to be very similar to what we've got already. It will have a few extra powers here and there. It will be able to take a few more extra powers here and there as well. At the end of the day, it's going to be down to how well it works. I think that the composition of the board is going to be very important—to get the right people on that board, getting that message across, sounding the drum whenever it is necessary. Of course, there are other big issues that are not addressed in the bill, which couldn't be addressed in the bill, such as local authority funding. The enforcement is done by local authorities. The new body will have a role in making sure that local authorities are doing their work properly, but it will be dependent quite a lot—in fact, to a enormous degree—on how other people are comporting themselves. I think that it is—I'd like to just get that written into the record—that this is a crucially important issue. Of course, it's the same with the public analyst as well. We do need to have a whole system across the country that's fit for purpose. The body itself will have a big role in keeping that going. That's why it's important that the body itself will have very good, robust relationships with the Scottish Government in the sense that, if it sees a problem, it can appraise Government of that problem, even if it's not a problem at which it can do anything about itself. However, for example, we need to make sure that we have got the right enforcement structure in Scotland and that we have got the local authorities appropriately funded with the appropriate numbers of staff. If I could just finish by saying that I gave evidence to a Welsh Assembly committee in the back of the public inquiry that I added in the south Wales EECOL outbreak. I raised the question about local authorities and enforcement, because there were problems with that, but there were problems in other areas as well. There were problems with the meat hygiene service. There were problems right throughout the system. There were problems with procurement by the education authorities in terms of the food that they were buying. I would say that there are major opportunities for the board, but there are also major hazards. If it doesn't have the right board calling the shots in the right sort of way, it doesn't have the right level of funding and it doesn't have the right level of support from Government, we're not going to be as good as we are at the moment. I can leave it on that, certainly negative, but positive note in the sense that there is a way forward. We all agree that, to have the opportunity, we need a board. We are, I think, all agreed on that, aren't we? I think that we've come to the end of our session, but there is an opportunity. There are areas that you feel that we've also got your written evidence, but there are areas that you feel that we could have touched on this morning that you want to leave us with a last thought. You have the opportunity now. Obviously, if you're on the way back home and something comes into your mind that you feel that the committee needed to take into consideration, then please follow the committee's work and email as it doesn't need to be as informal as this. What may be the last word? I've just let you have fallen up front. What you were saying there, you're asking the new food body to do more with less, because if you look at the budget, you're depending on FSA UK to put some money back up to Aberdeen, so there's a lot of imponderables there and you're asking it to do more, so that's the challenge, how can you do more with less? Is that possible or do you need to fund this body adequately to do the job? We'll examine that in the future sessions. Thank you all for your attendance at the time that you've given this morning. It's very much appreciated. Thank you. Suspend at this point while we wind this on. I think that we have agreed by silence at least that we're all agreed that we'll introduce ourselves as we come in and ask questions and, as normal with the round table, it says that I will give the floor to our panellists here today. Richard, could I have the first question from you, Richard Simpson? The 2003 act was the first one where Scotland actually led the way in the United Kingdom all previous mental health acts were created at the UK Parliament and then essentially shartenised, so the introduction of the Milan principles was clearly very very important at that time and I think my question would be whether the revision which we're now proposing is appropriate and whether they particularly things like the compulsory treatment orders and the community aspect of that has worked and whether we really need revisions and I know we've had evidence from people but what do they feel about the manner support and the revisions that are proposed to come in? We would, sorry, I'm Caroline Roberts. I knew you were just about to ask me. I'm Caroline Roberts. I'm the head of policy and campaigns at SAMH, which is the Scottish Association for Mental Health. I think that the mental health act as you say was groundbreaking in Scotland when it was first introduced and it has human rights at its heart, it has a number of really welcome provisions. In terms of where we are now, we're looking at the new bill being introduced I believe later on this month. The draft that we have seen so far, we had a number of concerns about elements of McManus that were not included. We felt that McManus was a very comprehensive and a very thorough review and as you know it's taken some time to get to the point where we're actually seeing a response in the shape of this new bill. We have submitted a very thorough response to the bill but a few areas that I would highlight of concern were around the medical reports, the consultation draft that we saw suggested that it would be possible to detain someone on the basis of only one report. We were very concerned about that. We would like to see some different changes than those that are proposed being made to named persons. The Scottish Government stated an intention that no one should have a named person if they did not actually choose to do one but that is not the effect of the actual bill. We have a number of other concerns about the absence of advocacy, which is one of the areas that was a real strength of the original bill given that the right to advocacy. I don't think that that has been fully realised and we're disappointed not to see more of that in the new bill. Obviously, we'll wait to see the revised version that will come out, but those are a few of the concerns that we had initially. Do you want to else? Voices of experience. I am wanting to add to that. Thank you, Carolyn. Obviously, we were in agreement with all of the issues that Carolyn's raised. I think I'd just like to add that we had been looking for, and as indeed was raised by McManus, an onus on an individual to drive forward the completion of the advanced statement provision, meaning that they would suggest somebody from the care team that had the responsibility for that. I think that that's a really good idea in terms of the recent talks about where incapacity is being challenged, the idea that you're meant to look for and make every opportunity to have supported decision making as opposed to taking decisions away from the service user. I'm the director for mental health in NHS Ayrshire-Nam, but I'm here as a front-line RCN member. Our concerns relate to nurses' holding powers and the proposal to change the length of time. We don't agree with it in terms of reciprocity and the fact that the act was based on rights. We see that it's infringing on rights. There is, as we see it, no need to change and extend the time for holding. The nurses' holding powers is two hours. If a doctor arrives before the end of the two hours, there's a further hour with which nurses can still detain. So then to change the act and say that we can, as a nurse, have the power to detain someone even when there's a doctor present. I don't think that it's placing on service the reciprocity that's based on the act itself. It becomes a workforce issue, as opposed to saying, well, actually, what is more important that someone is doing than attaining to someone who we are considering detention? So, by the very dint of that, it means that they are unwell and we should prioritise that. So we didn't agree in relation to that as RCN members. In the mental health nurse forum, Scotland also discussed it as a senior group of mental health nurses, and they don't agree with that provision. There is no need to change it, and none of us understand where it came from or what the driver for that change is. Chris O'Sullivan from the Mental Health Foundation. We agree with all of those points, in fact, and we've echoed those in our submission. The two things that I came to concentrate on today were about equity inequalities and about mainstreaming mental health, and I think both of those things deserve to be explored in the process of discussing the bill, and potentially in terms of opening up further the discussion in the bill process. I think the draft bill that was discussed was extremely technical, or appeared extremely technical on the face of it to many stakeholders, and as Richard Simpson rightly pointed out, in the process of creating the 2003 act, Scotland took regard of the differences in mental health in Scotland and the work that had been done on the various national programme activities. It would be fair to say, I think, from our perspective that the paradigm has shifted again in Scotland in that 10 years, and the discussion of a new bill and a potential new piece of mental health law deserves to be examined in the light of the ways that those paradigms have shifted. We would like to see the discussions on the bill particularly focus on those groups who are subject to inequalities, some of the ways in which the bill's provisions and the existing act provisions are applied to people from inequality groups, asylum seekers and refugees, for example, young people, and where does their right to things like advocacy and other stuff work, and we would also like to see the bill revisit sections 25 to 31, which deal with the obligations on local authorities to promote recovery and access to other services like employability and education, all of which are bound up in issues around welfare reform and other things which I'm sure will come up today, but which deserve an airing in the way that local authorities are able to mainstream their work on mental health in the context of single outcome agreements and other activities which are all new since the 2003 act. Ms, please. Shabene Begham, Scottish Independent Advocacy Alliance, we were really concerned about the lack of mention of independent advocacy in the new bill. We feel that that was one of the strengths of the original legislation, that it was the first piece of legislation in the UK to give people a right of access to independent advocacy, and we think that what actually happens in practice throughout Scotland doesn't actually reflect the rights that people have in the legislation. Access to advocacy has been really, really patchy over the last few years. Certain groups still don't have the levels of access that they should do. We've produced various pieces of research, and most recently the Mental Welfare Commission published some research yesterday that said that people with dementia still didn't have access to advocacy. Lots of people still don't know about advocacy. They talked about units that hadn't had any kind of input from advocacy for the last six months. We're really concerned about those sorts of developments, and as other people have said, advocacy safeguards people's rights. It makes sure that people have access to the right kind of support and care and treatment, and we think that this was a missed opportunity. There needed to be something that strengthened people's right to access independent advocacy, and also to remind local authorities and health courts about their duties to make sure that there is appropriate levels of access. People with learning difficulties, older people, people with dementia, children and young people are the gaps in provision that we see all the time. We're in the process of producing some new research, and one of the target groups in that research has been mental health service users, and the number of times that it's quite disheartening and quite depressing really, because the number of people who say, I wish somebody had told me about advocacy years ago because it would have made a huge difference to my life, and I might not be in the situation that I'm in, recognising the role of advocacy in terms of prevention, in terms of avoiding situations becoming more difficult and more complex, and also helping people on the road to recovery so that, when advocacy is involved, people have a stronger sense of control, they have more choices, they have the ability to make better decisions, and hopefully avoid situations from escalating, so we're really concerned that the bill doesn't recognise the importance of advocacy. On behalf of the British Psychological Society, can we say that we strongly support the principles of the new bill, but can I reflect some of the previous comments? It clearly is tightly drafted and it looks as though it's meeting a legislative framework, rather than looking at, understandably, a legislative framework, but rather than reflecting some of the developments and changes that we've seen over the last 10 years in terms of how mental health is now delivered in Scotland, so we would very much like to see this reflected in the new bill in terms of expanding the mandated treatment available to people within this type of situation. For example, input to families in terms of psychological care, where that's appropriate. Interestingly, developments in England in terms of the mental health bill there have expanded the role of other clinicians in terms of providing specialist reports, and the role of responsible clinician has now developed. The British Psychological Society has supported psychologists, appropriately qualified psychologists to take on that role, and appropriately qualified nurses are also taking on that role in England. We particularly note the suggestion that one report could be used, and we echo the concerns from other consultation responses about that. Again, we appreciate there may be resource issues, but again, perhaps this is the opportunity for the bill to look more widely in terms of who can take on rules of providing a second opinion. For example, there are issues that are more clearly psychological, for example, in learning disability, in areas where there may be neuropsychological difficulty. There are areas that would sit well with the expertise of psychologists, so we would be very keen that that would be looked at. I am not sure that I completely agree with Carol on extending the role of the nurse into what would prove to be an MHL role, and the MHL role provides a safeguard, so I am not sure that we would support nurses who are taking on the same role as they do down in England. That is a legitimate view, but what will be helpful is that there will be information coming from England about how that is working, who has taken on those roles, and whether, in fact, those safeguards are there. I think that it is to be investigated and evaluated. It is simply a comment, and of course I cannot speak on behalf of nurses. I would not dream of it. That has been a very useful introduction. I should have declared a couple of interests as a fellow of the College of Psychiatry, but I also have a chair in psychology at the University of Stirling. I think that the named person thing is very interesting. I wonder whether others would like to comment on that, because I think that the roles are definitely changing of individuals. If you go back 40 years to a nurses role, it was quite different to what it is now, and the range of roles has become quite different. It is the same with psychologists in 1979. You could not see a psychologist without being referred by a psychiatrist. I did some research that showed that that was a complete nonsense, and the system then changed. Should the bill be drawn in such a way to allow that possibility, that the extension of roles, the extended roles for perhaps a limited number of nurses with particular qualifications, but also psychologists and others, to provide a second report if we retain the second report, which would be another way of tackling it. I wonder whether others have a view on that. What a view? No one? Mr Barron? Sorry, I am surprised. I absolutely support the role of extended nurses. In Ayrshire, we have advanced nurse practitioners in Crosshouse hospital who do away with the need for psychiatrists overnight. We have on-call consultants, but we do not have junior doctors, so I absolutely agree with that. However, there is a bit about having that step away in that protective element that I think we need very careful consideration within the bill. I get the point about specialist or advanced practice and what we can do, but I would be cautious, because currently what we have is a rights-based legislation that protects individuals. Potential of nurses and doctors being too close in one team and what we can do is a risk that needs active consideration. Can I just say that, if the second report was to replace the general practitioner, we are well aware that the general practitioner provision for the second report has not worked particularly well. Therefore, to substitute another professional in that role is fine. I think that what Derek is talking about is the absolute need to have a second report and an MHOs safeguarder and not confuse the two, not to use the MHOs report as the second report in any circumstance, because that should be the sort of inviolate bit of the legislation. I am Karen Addie from the Royal College of Psychiatrists. I am not a practising psychiatrist, so I should point that out. However, I know that there are huge problems with getting the second report from the GPs. That is a particular issue in rural areas and in areas in which they are short on junior doctors particularly. What Derek was saying about getting junior doctors on call overnight, we have big recruitment problems in psychiatry and we have gaps in particular bits of the country and in particular specialties. I think that that needs looking at. If I could just make a final comment about a second independent report. The British Psychological Society has supported psychologists in England with extra training and mentoring around those rules. I would propose that the Scottish Government could seek information and intelligence about the development of those rules. As I say, I am reflecting some of the resource considerations that have been flagged up. Part of the core role of a psychologist is to be able to assess, to be able to produce a report that would be helpful to a tribunal within these circumstances. I think that it could be beneficial for the process. That would be my thinking about this. I was going to make a point that might broaden that discussion out slightly. It relates to the point that I was making about mainstreaming mental health across a wide range of competencies and about anti-stigma work as well. In the olden days it became solely the duty of psychiatrists and laterally MHOs to deal with mental health in a legislatively defined manner. Now, as we sit in 2014, there are a whole wide range of legislatively designed roles which compel people to act on people's mental health. For example, the role of practitioners in self-directed support from the recent legislation passed. I guess we would want to see the widest possible workforce involvement and understanding of the complexity of mental health. The broadest range of practitioners from a whole range of different professional backgrounds were able to act within the sphere of professional responsibility in a way that promoted rights and encouraged people's self-advocacy in the best possible outcomes for their recovery. If that means that, in the context of mental health legislation, there are options to widen the range of workforce roles that have a statutory responsibility, then that, we think, would probably be a good thing to see alongside a wider recognition of the impact on mental health at a whole wide range of professions having different areas of communities and policy. The follow-up on the issue around professional roles, I think, that are two points. I would, first of all, support Derek Barron's point about the role of the mental health officer, which is fundamental and provides real safeguards. We have concerns about the number of trainee mental health officers who have been following in recent years. That is an important point, and I would welcome the committee to give some consideration to that. On the other point about the two reports and who ought to be able to provide the second report, what will be important, as we consider the bill, is to define the purpose of the second report. That will drive who ought to be able to provide that. At the moment, what we have focused on is a GP report. The reason that we are quite positive about GP participation is that it is reasonable to expect that many GPs will have a relationship with the individual. They may be able to provide some wider information beyond the person's immediate state about their experiences, their previous conditions, perhaps their family circumstances. Those things are all very relevant, so we are keen that GPs retain a role. I understand that there are practical difficulties often in getting them to participate. I would be concerned about making changes to a process that has such positives purely on the basis of resources and availability. I would prefer that we at least make efforts to address those resource-driven issues before we change the system. There are something like 1,200 compulsory treatment orders every year and around 4,000 practising GPs. I do not think that those issues ought to be insurmountable. It does focus on the crisis. The committee spends a lot of time discussing preventative initiatives and so on. I was shocked to see some of the evidence of the papers off at the weekend about waiting times for psychological therapies. The difference is that, in some cases, between Glasgow doing it seven weeks, 17 weeks in Fort Fally and just within the 18 weeks, and March this year, 2,700 or so on this paper, who were waiting beyond 18 weeks, there seems to be, of course, looking at the point of crisis, but surely part of this must be looking at how we slow down and how we reduce people getting to crisis. We have not mentioned children yet and we have had some evidence in the past here about the number of children that we know are presenting that social work is suffering from emotional abuse, which is in the thousands, and the lack of access that they have for specialist support. I think that my name is Brian Donnelly. I am here representing Young Scotland in Mind, which is a forum of mainly voluntary sector organisations working with children and young people. It probably is a very relevant time to raise some of the issues as this affects children and young people. There is a whole host, to be perfectly honest, that is absent in relation to children and young people. Our members, in terms of even feedback on the proposals in the bill, do not feel that it talks to them or addresses the issues for children and young people at all, waiting times for children and young people, like others, but it is especially poor. There are issues around defining an adult as someone over 16. The United Nations Convention on the Rights of the Child says that a child up to the age of 18, and on the back of the new children and young people's bill, if you are looked after and accommodated, you can get a service up to your 25. Between the ages of 16 and 18 is historically poor in any service, but we are looking at a particularly vulnerable group here, especially children that have been looked after. They are disproportionately affected by poor mental health, and almost half of them leave care with a diagnosed mental health condition. Those are the people who fall through the cracks and come into the adult services at the point of crisis later on. There is a real lack of community-based engagement with the third sector, preventative work. A lot of sporadic things are going on, but it is not usually joined up with some of the bigger budgets or the bigger services that are there. Sadly, the draft of the bill that we have looked at does not do a great deal to address that, because our membership feels that the needs and issues that affect children and young people are absent from it. They are not an add-on group, they are not an equalities group. They are themselves, an entire population. They are affected by parental mental health, and the biggest indicator of their mental health and wellbeing can be particularly of their mothers' mental health, but there is a considerable gap there. The third sector has lots of ideas in relation to this and is looking for partnerships and wants to see more community-based work, would like to see more work being done, having CAMHS linked to schools and information around things like self-harm that just do not exist in schools. We have surveyed our membership on that, and those are significant issues, so without trying to grab all of that, that is just skimming the surface. However, prevention—the opportunities to take a more preventative approach would be very well supported and echoed by the children's sector. Can I just add something again on psychiatric recruitment to that? I have had an update from our child and adolescent psychiatry faculty in the last couple of days. Recruitment of psychiatric trainees to higher specialist training—that is the last two years before they become a consultant—is becoming an increasing problem across all psychiatric specialties and doctors in general in Scotland. However, as anticipated, there will be an increasing shortfall on consultant numbers. Those people are seeing the most ill and the most severe psychiatric illnesses, but there are going to be gaps in that psychiatric workforce. Out of vacancies recently, there were six ST4 vacancies advertised in child and adolescent psychiatry, and only one was filled. Three vacancies in 4th valley for consultant jobs, and last week all three candidates withdrew. There are expectations around legislation and beefing up the services and reducing the waiting times, but there will definitely be problems in the psychiatric workforce. I do not want to depress anybody any further. Can I just pick up on some of the comments that Brian made about CAMHS's links in schools? Paradoxically, there are cuts to educational psychology. Psychologists who are linked to schools are currently linked to schools. Their workforce planning predicts that over the next four or five years, maybe a quarter of them will retire. Local authority budgets, of course, are strained and under threat, and posts are not filled. Again, I am sure that people are aware that postgraduate funding for educational psychology has been completely withdrawn. It is the opposite problem that Karen has delineated. People want to become educational psychologists. It is an enormously popular career route for people, but there are bottlenecks in our system. These are people who work with some very disadvantaged children. CAMHS links, of course, but let us think about an integrated and joined up system in terms of the support that educational psychologists can provide to these very vulnerable groups. Thanks very much. I would like to make a couple of points about young people's mental health. Certainly, there is some knowledge that we have acquired over the past few years, both in Scotland and in the wider UK. Across the UK, we had a programme called Right Here, which worked with 16 to 24s in five centres across the UK, recognising that there was a gap in both service provision and in citizenship around mental health for 16 to 24s. That programme has developed some interesting recommendations, which I am sure will have an opportunity to feed in evidence to the committee later on. One of the things that our work with young people has really shown us is something that came up in the Christie review about co-design and the importance of involving people and the value and imagination that young people bring to both defining their problems and innovating solutions that perhaps the adults in their lives and those of us, in positions of power, perhaps do not get so much. I would really hope to see that the committee would take evidence from young people and others. One project that I would bring to your mind, NHS Greater Glasgow and Clyde, invited us to work with young Scott in helping them to work with young people to see how they could involve digital in their young people's mental health strategy because they recognised that young people were operating pretty much seamlessly online and offline and that they had a reasonable demand for their mental health services to include online dimensions and also were mindful of the fact that young people engaged in all sorts of strategies, both positive and negative, to help them manage their distress earlier than the point that they might need CAMHS, which reflects more widely in the sense that we need to ensure that there are options available for all population groups to self-manage distress and find their way to support downstream of the specialist services like CAMHS, which are so bottlenecked. The community situation is not good, but I would like to keep people's minds on the top of the pyramid where specialist services tend to see our young people sent down to England in particular circumstances. I think that that is something that we should be keeping our eye on as well. Thank you for bringing it up and a reminder that it is particularly in areas like forensic adolescent beds and CAMHS stroke learning disability. There is no inpatient provision for those in Scotland and they tend to get shipped out across the border at great cost, not just in terms of financial costs but in human costs to their families and those that are trying to support them. It is also quite difficult to get them back once you have sent them. I wonder if perhaps I could bring up another population group for the committee's attention, another group that is not one of the specific inequality groups but is a large population in Scotland and that is people with long-term conditions. Having a long-term condition is greatly associated with the greater risk of poor mental health or mental health problems, so 30 per cent of people with diabetes develop depression. You are twice as likely to have depression if you have coronary heart disease and if you have coronary heart disease and depression you are twice as likely to die of your coronary heart disease, which itself makes a compelling argument for addressing the mental health of people with long-term conditions. The Kings Fund did a very interesting study in 2011 on the economic costs and they discovered from their economic modelling that mental health problems raise the total health care costs by 45 per cent for each person with a long-term condition and a co-morbid mental health problem, which equates to around £1 of every £8 being spent on long-term conditions, being spent on the mental health aspect of long-term conditions. We feel that there is a need to recognise and engage that more in Scotland. A lot of work has been done by us, the Royal College of GPs and a range of other areas in terms of peer support for managing the long-term conditions and mental health problems. There are some good studies going on about mental health support in cancer and other areas, but this is an area of great potential for addressing some of Scotland's challenges, both in terms of long-term conditions and in terms of the kind of complexity and multi-mobility, which is so often behind health inequalities that we know are so acute in this country. It is useful to put on the record that we are listening to what you are saying about workforce planning, vacancies and recruitment. It is a complicated web and I think that all of us, as committee members, I am sure that I am speaking for all of us who have taken that on board, but the solutions are quite often going back towards preventative or not exacerbating mental health issues as they come in. I do a lot of work with the continent's management service in the NHS, Greater Glasgow and Clyde. A lot of the older population first present with mental health issues because they become housebound because of continent's issues and other issues kick in. Whatever the trigger is, there is always a trigger for one aspect of the population, so I know that there is some positive work around that in Greater Glasgow and Clyde, but sometimes where mental health issues kick in, there is a variety of partnership work. For example, the Notre Dame Centre in Glasgow does some excellent work with kinship care children in particular. It could be better funded, but the dose of good work around that last week, I was looking at a new link worker service around GP practices, the deep end project, about taking some of that softer empathy skills needed in healthcare away from front line GPs to others. The reason why I mentioned both of those things is that neither of those initiatives are straightforward referral clinical processes for mental health. There seems to be a patchwork quilt of good practice out there, whether it is for young people, whether it is for older people, whether it is for those suffering the effects of welfare reform. It is a huge issue to ask any Government or any local authority or health board to coordinate that together in some kind of coherent way. I guess I am looking for a steer in relation to we can talk about a mental health strategy, but when the solutions are very often local and unique to each local area, how do we share best practice across the country or could you give me some other things we could be doing? I think I would find that helpful as an MSP. Lots of hands there, Bob, so Brian, anything, Dr Allan? I think one of the things that we have to do, the points, very well made. People from a social care background have a different focus. Children that maybe experience abuse or neglect or violence at home get a social care service that can be about prevention, it can be about managing risk, but it is not always about managing the impact of that trauma on their life and as that goes on through their life. The challenge that particularly faces young people is that we will not be the first person to say this, but the thinking is that in silos, adult mental health over here, community stuff over here and children and young people are completely different. It has got different money, it has got different ministerial responsibility and there has to be a way of looking locally at what people have got mapping out and putting it around so that if you work in a school and self-harm is an issue, you should know where to look, what is going to point you in the direction of what voluntary sector services out there in my area that can come in and work in partnership with us in this rather than just a tried and tested medical and professional routes. We do, it is said a million times and I know it is an easy answer, but funding and thinking tends to come very top down with a very narrow focus and we need not be scared to throw that open and start talking about what communities have got and look at community assets and mapping right across the whole social care. Children in school now, the curriculum for excellence, health and wellbeing is a core part of the curriculum, it is the responsibility of all teachers. The new children and young people's bill is asking all paid professionals to share concerns about welfare, not just about wellbeing for children and young people, that is a significant change in what professors are going to have to act on. It is not just about risk anymore, it can be about their mum was hospitalised at the weekend or they are not getting fed, these professors are going to have to share these concerns. It has to be joined up otherwise we will just keep doing the same stuff over and over again. Dr Allan. Can I say, I do not have a complete answer to the challenge that you said, but I am hoping that the integration of health and social care will start to provide us with some answers. The point is well made that, as the population ages, co-morbidity and complexity will be what we are all dealing with and co-morbid physical and mental health problems, they do coalesce together. The King's Fund and Lord Layard have been eloquent about the costs and difficulties. For example, it is extremely difficult to engage somebody in managing a long term health condition if they are also anxious and depressed, so ignoring it is not an option. The other thing is managing these chronic conditions is about managing them. There is not a pill that is going to sort anything out. It is about the kind of lifestyle choices that people find very difficult to make when they are poor and they are up against it. It is about more exercise, stopping smoking, drinking a lot less, those kinds of things. The way I look at it is it is a kind of stepped care model. There is a huge amount that can be done in the community and there are some fantastic projects around that. There are levels of complexity. You would not expect a kind of tertiary care service to deliver the kind of broad interventions. Again, maybe to clarify an interest, NHS Greater Glasgow and Clyde has invested quite a lot of money in terms of psychology support for the acute services. There are more psychologists working in obesity than in addiction problems in Glasgow, which is quite something, I think. The problems associated with obesity are huge in the west of Scotland. The model is psychological. All the treatment is not given by psychologists, but the model is psychological. They have outreach work within the community, but there are also more complex cases that are seen within a hospital, perhaps the kind of people who may progress to surgery. It is levels of care that I think we are thinking about, but the bulk is always going to be dealt with within a community setting using a range of providers who are close to where the client or patient is. Visitors arriving. You asked for some solutions, Mr Dorris. I do not think that solutions are immediately apparent, but I have some thoughts. First offer at the level of government and legislation, and we believe that there should be a mental health impact assessment of policy and practice. What is the impact on mental health? We can demonstrate and the evidence supports the fact that there is a mental health dimension to most public policy decisions, and understanding that and framing that through legislation and guidance can be very, very helpful in enabling workforce groups and the people implementing that legislation on the ground in local authorities to make the time to include mental health. Downstream of that, assuming that there is a mental health dimension of any inequality or health interaction, in fact most public service interactions is very useful at a ground level, and your continent service example is a perfect example of a service which is not mental health, but when it recognises its ability to both encounter and engage with mental health has the potential for great benefits on that. I believe that all public service employees in Scotland should be minimally equipped to compassionately deal with disclosures of distress, so any public servant in Scotland should be able to recognise the signs that somebody might be experiencing distress, have a conversation about that with them in a confident and comfortable manner, and help them if they want to to make the first step on addressing that and be that in a continent service, a welfare advice service, a noise abatement team or whatever, that should be a professional competence of people on the ground. I also think and link to that that peer support has a great role to play, we've considered where that fits in mental health and there's a good evidence base for that and we've done some work in transplanting peer support from mental health to both long-term conditions and also now to carers as well, but there's an element of that in professions as well and helping people to professionally use their own experiences and be comfortable in doing that is a potential avenue forward. Complexity I completely agree with Dr Allan is where it's at, we are no longer able to conceive of a situation where people come to a GP, a social worker or any other public service interaction with one problem that requires one appointment and one appointment for each thing because people exist in a web of complexity which usually includes mental health, long-term conditions and other social issues and we need to gear both our policy environment and our practice environment to engaging with complexity and helping people to unpick that and there is some promising practice which enables that to happen both from things like deep end and from things like the PCAM complexity assessment tool which is being developed in Edinburgh and Stirling and Trial at the moment and indeed some of the approaches to engaging with distress and trauma and other things which are in the current mental health strategy which we hope will show promise over the next few years. Echoing somewhat what Dr Allan has already said, integration is allegedly the answer, that's the whole purpose of integration of what we aim to do and try to do it because right now we've got different organisations doing different things and sometimes the same things doing it twice. Just in my own North Ayrshire shadow integration board we had a discussion that the health service is spending on learning disabilities and having out of various placements and what our local authority colleagues are spending in terms of learning disability, the potential to bring it together and to do it possibly better and cheaper which means we've got more money for other things actually increases what we're doing so part of the answer I don't mean to be glub is integration, otherwise why are we doing integration so it's not going to be a magic wand it's going to take us a time to get there but that's the purpose of it and if that's not the purpose then we're wasting our time because we're going to work together and things and on our shadow integration board we have got the third sector, we have got voluntary organisations, we have got carers groups and we have got users groups so around that what we aim to do is what is it we need locally and how do we tailor that to what is the local needs which might be children, it might be older adults, it might be any care group in the middle, it's that totality of it so part of the solution without being glub is integration to answer. I think it was that Brian's point easier said than done I mean that even you know leaving out local authorities, leaving out adult services, children's services, community services all with the same professionals are working at Silo's as Brian said. The mental health, Silo but then you've got the children, Silo and then you've got the children's mental health when Israel it's so it's a challenging board to a single director which we do all of those Silo's actually meet at one point who's responsible for it and then responsible to elected members responsible to the population, responsible to the health board it all meets an integration who is right now doesn't meet in a single place so if you've got one person who's accounted before it it is a little bit easier to say well actually you have to balance your responsibilities. What we haven't got is what Chris described as a mental health impact assessment. We're not measured in those outcomes but we can quite easily identify all the inputs in all of the salaries. I didn't expect anyone to have all the answers I wanted to tease out some of the good things that are going on where we have to go further. It's a long time since we've looked at single outcome agreements. Is there a mental health outcome indicator within single outcome agreements because that will then progress on to local plans in terms of integration and the like? Chris, do you want to respond to that? Yeah I mean on the ground we've worked with several local authorities now back in the beginning of single outcome agreements we were asked by Glasgow City Council to help them to engage some of their departments that weren't explicitly about mental health and the delivery of mental health outcomes both in terms of what they were obliged to do under sections 25 to 31 of the act and in terms of their obligations under the single outcome agreement to reduce suicide and improve subjective wellbeing and we developed a programme of work which we did with Glasgow and subsequently we did with the three Ayrshire local authorities in now with Highland on what's called our mainstream in mental health programme and what we've done in that is for each area we interview service leads about where mental health fits in with their work and encourage them to connect their single outcome obligations both the explicit ones in relation to mental health around suicide and well-being but also their implicit ones which are many and varied and create a space for them to come together to discuss that to realise what their role in mental health is and to create a mini action plan for developing that and it comes up with some very interesting discussions when you have the guy who runs the lighting strategy saying what's what's lighting got to do with mental health and you say well why are you doing this lighting strategy and he goes well we want to connect communities and get people to be able to walk safely at night what does that do for them makes them feel more comfortable where they are well what does that do for your mental health oh you know or the guy in in Ayrshire who ran the team around the team who does the house renovations when someone's in hospital and he said to said to us we're not mental we're not mental why are we here and and they thought they were coming to a mental health training to learn about mental illness and and I said to him why do you why do you do what you do well we we change people's houses for them when they're ill so when they come out hospital they're better but but we're like we're better than some councils because some councils they just do the bedroom in the kitchen whereas we do the garden why do you do the garden so that people can get outside and keep in touch with their neighbours so they don't lose touch oh and by the end of the day they were talking about using their own time to go and work with some people with mental health problems to build a garden in the community in that bit of Ayrshire and that everybody in the community can involve so oftentimes we find on a practitioner level it's about flicking the switch realising that mental health is not the psychiatrist's job but a competence that we all have and at a strategic level getting a service lead to recognise that his obligations under a single outcome agreement have lots and lots of mental health relevance and not just in the suicide and well-being section I know Caroline wanted to come in encouraging Caroline to come in at this point where you've been prompted Caroline go on I think on the point about single outcome agreement specifically when we have looked at them with a view to finding out how much they incorporate mental health what we find is that as Chris has said it tends to be very much driven by areas where there are heat targets so we've seen that there are indicators within single outcome agreements about suicide about psychological therapies these are good and important things and it's one of the reasons why we think targets are helpful because it gets issues on to people's agenda but it's not really reflecting mental health and it's more broad sense Scotland has actually done a great deal of good work in developing mental health data and we have a lot of information now on mental health on outcomes on what's happening and there are in particular a set of both adult and children's mental health indicators which can be used to set outcomes so that there is a lot of work that we could do there and I would also agree that in response to the initial challenge the answer does lie I think with integration and so we do have a very promising opportunity in front of us as we integrate health and social care although I would point out that the third sector doesn't report to a director within that directorate so it's not quite as straightforward it is however a very good opportunity and I think our concern is to ensure that when we are creating these new bodies and these new structures that we try to ensure that the individual is still at the heart of them we do have a concern that we're going to create new structures new processes which can make it very easy to lose sight of the person who is at the heart of all of that so there's a real opportunity to do better joint work and to integrate but I do think it needs a great deal of care to make sure that we don't simply further lose individuals in structures voice please everybody's brought it back to the point I was going to make originally two things to help with mr Doris's original comments commitment one we're one of the lead partners for commitment one and it's going to do a mapping of services across the piece across scotland mental health services it includes voluntary sector contributions and it's a wee bit wider this time than just you know your part of the course statutory delivered services a second point was going to be about all the good work that's going on about person-centred care and the collaborative that's been set up across health and social care to get that into the system and at the very first one of those I went to nationally the people around the room were just saying let's look to mental health to take a lead in this because quite often we've already engaged across health and social care to drive a patient pathway as it were finally I suppose they've come down to the idea that what you need is person-centred outcomes for the individual and that's back to Caroline's final point no matter what's in the outcomes agreements let's not forget that what we're looking for is outcomes that the person wants for their own life and that's that's the whole life that's not just a mental health life we've noticed on my briefing here it's just we're supposed to the next question is that what happens when issues are identified like the mental welfare commission identified that there was an increase in detentions by seven percent so we've got the information we know it's not what what makes a difference at that point it's a sad point that I suppose that it's reactive but even in that reactive sense what happens how do how do how do we how do we engage with government and the agencies that are responsible to question that increase of seventy seven percent detentions what happens at that point yes Derek I think the figures remain to be if we can swear it's that or other figures for example we talked earlier about nurses holding powers actually are there to ask a question in the why question that you've just asked it's absolutely right because actually I'd like to see more nurses holding powers used I'd like to see that figure go up because that gives people protection under the act so an increase in detentions isn't necessarily a bad thing because with it it brings a protection and a statutory responsibility of what we in service must do to protect the individual part of which is advocacy part of which is having a name to looking over the shoulder of the health professional to say is this right is it wrong that brings a protection with it so that figure to me asked the question let's understand the why and I think in response to that the particular figure that you're quoting I think is about an increase in the rate of emergency detentions and I think that that's a good example of how we can use the kind of excellent data that the mental welfare commission produces to make improvements so the reason that we would be concerned about an increase in emergency detentions is that they don't have the kind of protections that a short term detention certificate would have under a short term detention you have a mental health officer involved you have a lot more protection so I think that reflects the importance of that data being being gathered so that we can look at why is that happening and I noticed on the figure you're referring to there was it was much less likely that there would be an emergency certificate used where there was an intensive home treatment team available so that tells us something about the kind of services that we need in order to make a difference and I think that that is useful for NHS boards and in doing their planning I would certainly hope those figures are considered and I think I think we've come to the end of the session to be another session just after this and we've got all of the written evidence we've had a broad session here this morning I think that that reflected much of that written evidence there is the opportunity you know if you feel the absolute need to to say well I need to put this point on the record and and I'll give you that opportunity to do that briefly now if you wish to do so on the way home if you think of something that I wish to have said that as you often do then let us know it doesn't need to be as formal as this we're quite happy for the class to receive any additional comments about the session and points that you may wish to have raised email us do anyone yes yes somebody gave me a platform today and there's there's there's one issue that I think we haven't had a chance to touch on that it would that I think we and others would be grateful if the committee was mindful of and that's the implementation of self-directed support in relation to mental health and a lot of us are working on this and finding that the implementation of self-directed support for people with mental health problems has been somewhat complicated and we would like to see that issue paid close attention to over the over the coming months as the evidence around implementation increases we've seen some examples of poor implementation some examples of good implementation and some concern from service users and service provider organisations which at some point in the future will need to be aired you taking out opportunity to to put that on the record and give you the reassurance if you write to the committee with issues and concerns there then we will maintain an ongoing interest in that matter yes please just to back up what Chris has said one of our concerns is that with self-directed support there's a number of companies that are being set up that are going to charge people directly for advocacy support so that we're moving away they're trying to encourage moving away from local authorities and health boards funding advocacy directly what they want to do is charge individuals for advocacy support and that charge would be a percentage of their social care package so therefore perpetuating the inequality and difficulties for people who might need complicated support because of their situations we're really concerned about that yep certainly we as I say we welcome it we're very early into the process but if these issues are appearing as early as this then the committee would wish to do all that could to bring attention to the Scottish government Brian I'll be very very quick just a reminder I suppose that under the new children and young people's bill all ministers are obliged to give due regard to children's rights in any policy or legislation that affects children and young people so that is relevant to children and young people whose own health and wellbeing is affected but also decisions you make about the treatment the care of their parents has a direct impact on them and under this as signatories of the UNCRC you have to give due regard to the impact on a child's rights so that affects children the children of prisoners as well as the children of people who are hospitalised and the children's rights impact assessment that may have to go with that but just to throw that in there at the end I will write in about this I'm sure you saw the reports in the papers about NHS dementia care and how poor it can be I'd like to write in about the kind of psychological support and developments that can be inputted into this type of care for improvement the relative disparity there are only 37 psychologists employed in older adult services in Scotland there are a workforce of 700 can I say it's incredibly popular specialty for psychologists to work in but there are no jobs for them and I feel very strongly about care of older adults as I get older and also about care of people who are dementing so I will write in about that welcome that it's something I think that the committee will want to look at anyway given our past work and our inquiry into older care thank you Derek you can have the last work just very well just because Dr Allen brought up the report yesterday just pointing out that the East Ayrshire community hospital was held up as an example an excellent example of how to integrate the building and outside spaces in the care of older adults who have dementia and I thought since it's on the record I might as well plug the good work in East Ayrshire community hospital it's an important point that you may not just for your own service but to recognise that there is much going on that is good in the national health service but certainly that report this week was very very disappointing indeed thank you all for your precious time this morning here to spend at this point and we'll set up for our agenda today it should only take a moment but the annual report is we've got to be agreed it's in the usual standard format for all committees it's a simple record of what the committee has done over the parliamentary year and just a statement of fact actually so I'm looking for the committee's agreement to publish the annual report as set out are we any comments or do we have general agreement as as to the publication yes no that's fine just to draw attention once more to our work on access to new medicines review the committee's done for myself everything and there's worthwhile but I think the work we've done on that in partnership with government and other stakeholders has been really really positive it's an annual report it's just an excuse to to mention it quite privately do you mean just in terms of it's in terms of where it sits in the report and maybe an extra it might worth giving a bit more bit more prominence but to be fair convener it really was just to put in the public record no that's fine are we okay with that I have the committee's agreement there yes thank you thank you thank you and now closing meeting and we have a welcome opportunity to to invite the representatives of the nursing and midwifery council to make