 The next item of business is topical questions and we start with question number one from Monica Lennon. To ask the Scottish Government what its response is to reports that two patients have died in the Queen Elizabeth university hospital after contracting a fungal infection. What advice has been issued to NHS boards on the matter? Cabinet Secretary, Jean Freeman. I hope that you will bear with me. I want to just go through some clear factual points in response to this answer, which I'm sure members would appreciate. In November, the bacteria Cryptococcus was identified in one patient. That patient was discharged for palliative care and sadly subsequently died in late December, but Cryptococcus was not a contributing factor in their death. In December, a post-mortem of a child who had passed away confirmed that Cryptococcus was both present and a contributing factor in their death. I know I speak for the whole chamber when I say for both families our thoughts and sympathies go to them. The identification of two cases acts as the trigger for additional infection control measures by the board. That was undertaken. That includes the provision of prophylaxis antifungal medication to the relevant group of vulnerable patients and the provision of additional HEPA filter machines to ensure clean and clear air and air monitoring. In visiting the Queen Elizabeth University hospital this morning, I had detailed briefing and the opportunity to speak directly with the medical director, the senior nurse, senior board members and a family. From the external advice that the board has sought, including from Health Protection Scotland and from the clinical advice that is available directly to me, I am confident that the board has taken all the steps that it should to ensure and maintain patient safety. To provide further independent assurance, I have also asked the healthcare environment inspectorate to fully review the incident and to make recommendations on any further steps that should be taken. I thank the cabinet secretary for her response. I also extend our sympathies to the families of the patients who died. We now know that one of the patients, indeed a child, has died. Sadly, we have now learned that that contributes to the fact, and I think that people will be quite shocked and upset to hear that. The cabinet secretary says that she is confident in NHS Greater Glasgow and Clyde, but she must recognise that over the weekend there was a complete lack of clarity from the health board in response to very legitimate media inquiries. I have to say that we had no update from the Government at a very worrying time. We have had some further information about the outbreak of this back in November, but it is not quite clear when the Scottish Government was first made aware, so perhaps the cabinet secretary could confirm that, because yesterday we learned that an outpatient and his wife wrote to the former health secretary about the pigeon infestations last March, but the Government is saying that this week they cannot find that letter. This is a very serious public health concern. Two people who contracted the infection are sadly now dead, and the public needs to have full confidence that this Government has a grip on the situation. Can the cabinet secretary confirm if she was made aware of this issue at the Queen of Azuboth when she took over as health secretary last year, and if not when exactly was she first notified and what did she do? I am grateful to Ms Lennon for her additional points. Can I be clear on a number of matters? What I said was that I am confident that the board has taken all steps that it should do to ensure and maintain patient safety in the light of the incident. The query with respect to no update from the Government—I hope that I am making it clear to members that I treat such matters exceptionally seriously, but I want to work on the basis of factual information, so I have come to give that factual information today. The Government was first informed of the Cryptococcus infection in two patients on 21 December. That was the right time for the Government to be informed, because it was the post-mortem following the death of the child that identified the second case. As I said, that second case is the trigger then for additional infection control action, and therefore we were rightly informed. However, in order to progress, so we maintained an update, but in order to progress and understand the factual situation, we have to first of all be sure about patient safety. We then have to be sure and take the time to identify the source and the manner of spread of the bacteria. That takes time, because plates have to be cooked—I cannot think of another word if you forgive me—and incubated. Thank you very much to my health minister—that is very helpful. We have to be incubated in order to ensure that you have the right form of cryptococcus, so that you are taking the right steps and so on and so forth. In terms of the letter, Scottish Government has always had—so not just this Government, all previous Governments—a very robust system of recording all communication to ministers and cabinet secretaries, whether those come in writing by email via social media. We undertook a thorough search of that system, the MAC system, using a number of different ways of spelling people's names, of using different keywords over the past few days and have found no record of the letter. In addition, Ms Robinson's constituency office also undertook a search of its system and found no record. Although the letter predates my appointment as cabinet secretary, my constituency office also undertook that search. We have found no record of the letter, but we have made it clear that, if the authors of the letter want to advise us of what they said, then I am very happy to deal with that seriously and to respond directly to them. In the absence of that information, that is not something that I can do. I think that the people of Scotland will feel that it is absolutely extraordinary that, in a modern hospital, Scotland's flagship—and apparently superhospital no less—we have a situation where pigeons and infections can kill patients. The health board, quite frankly, has struggled to get its facts straight over the weekend. Even in times of reporting concerns have been known about for two years, and two people are dead. We do not know what health secretaries have been doing. That is the latest in a catalogue of public health concerns, not just at the Queen Elizabeth, but also at NHS Greater Glasgow and Clyde. We have had the closure of two cancer wars at the Royal Hospital for Children over a bacteria outbreak, and there has been the temporary closure of the Cowlayers facility, which led to over 1,000 operations being cancelled. The public are right to be concerned about patient safety. If this unthinkable and deadly infection can happen at the flagship Queen Elizabeth, what is to stop it happening at other hospitals? Can the cabinet secretary comment further on what steps she is taking to support the families of the deceased and what she is going to prevent this from happening at any other hospital ever again? Let us be clear, because it really is important that we deal in factual and accurate information here. The concerns that were raised two years ago, as I understand them, were very different from the incidents that happened in this case that has led to one patient dying as a consequence of cryptococcus infection. The concerns two years ago were acted on by the board. They put in a number of additional anti-pigeon or anti-bird measures, including spikes and a version of hawk prevention and other means. Those concerns were dealt with at that time. That is a new instance. If I can explain to members in investigating the source of the bacteria and infection, the estates staff at the hospital and on the board, including the director of estates, traced it to one plant room on the 12th floor, the roof top of the building, where, invisible to the naked eye, was a very, very small break in the wall of the plant room. In that small break, pigeons had entered the plant room, and excrement was found there. That was found by smoke detection, because, as I say, invisible to the naked eye. What they continue to work on is how the bacteria from that excrement could enter a closed ventilation system, and that work continues, and we will continue to be updated on it. However, Ms Lennon is right in as much as there is concern—concerned by the board, concerned by me, but much more importantly concerned by the people of Glasgow and Wider—about what appear to be a number of instances in the fabric of the Queen Elizabeth university hospital, which are less than satisfactory. Today, in the discussion that I had this morning, I have agreed a review with external expert advice that will look at the design of the building, the commissioning of the work, the construction of the building, the handover of the building, and the maintenance of the building in order to ensure that we identify where issues were raised that should have been addressed and where maintenance programmes now should be perhaps more robust and more frequent or whatever that recommendation will come from. In addition, there will be independent expert advice sought for that review and independent expert advice to me on the progress of that review and its recommendations. I intend, by the end of this week, to make available to members of this chamber and to publish the remit of that review and the expert advice that will be sought in the various technical areas that it is required. It is right that we consider whether or not in its totality the fabric of the Queen Elizabeth university hospital is for purpose as we require it and that if there are lessons from that, we take those and apply those across the rest of our health system in Scotland, in particular where we have the commissioning of new builds. We had quite lengthy questions and concomitantly detailed answers, but I have at least five members who would like to ask further questions. If we can be brief, we will try to get through some of them at least. Alex Neil will be followed by Annie Wells. I very much welcome the cabinet secretary's statement and, in particular, the review, which I also hope looks at the issues around the closure of the children's cancer ward in the Queen Elizabeth university hospital. It is also very welcome that the proper procedures that appear to have been carried out, but a great deal of anxiety has been unnecessarily created by the way in which the communications externally have been handled by Greater Glasgow and Clyde health board. Had that information been made available more timuously, I am sure that much of the anxiety that has been created in recent days could have been avoided. I ask the cabinet secretary if she will make sure that the health board learns the lessons of the need in such circumstances for effective and timuous communications and transparency as part and parcel of the strategy of handling outbreaks of this kind. I take Mr Neil's point absolutely. I discussed internal and external communications. I should have said in answer to Ms Lennon that the board immediately discussed and had conversations with the families of the two individuals who had died. There is on-going communication between clinical staff and the families affected in the areas of the hospital right now. I have taken the opportunity to discuss both external and internal communications with the board this morning, and I understand and expect to see a number of improvements in those areas in addition to other improvements that they have made themselves. We need to understand, too, that in order to be sure of your facts, you cannot always work exactly to the timetable of the new cycle. There will be times when either I or a health board are not able to answer exactly at that point questions from our friends in the media, but I think that it is a fair point that, in terms of external communications, improvements have been sought and I am confident that improvements will be made. Annie Wells will be followed by Anas Alwar. I, too, wish to express my sympathies to the families involved. I thank the cabinet secretary for her answers to the previous questions. What other concerns, if any, has been raised to the cabinet secretary with regard to the major problems at the Queen Elizabeth? Can the cabinet secretary ensure full transparency when it comes to the publication of the review? We know that there have been a number of issues at the Queen Elizabeth University hospital, covering water hygiene, external cladding, the ventilation system, glazing failures and the most recent incident in terms of the ingress in the plant room and the ventilation system. All of those are the areas. Others, including the impacts of access to healthcare and so on, I will expect the review with that external advice to be looking at. It needs that external advice, because some of what we will be talking about will certainly be beyond my expertise in its technicality. The review's recommendations will be public and I will respond to the chamber in terms of our response to those recommendations. By the end of this week, I hope to be able to make public to all members the remit of the review, the nature of the external advice thought, the nature of the additional independent advice that will come to me, an idea of timescale—although we have to see what those experts tell us—and then I absolutely undertake to keep this Parliament updated and that the recommendations from the review will be made public and I will respond in this chamber to those. Given the series of events that have taken place at the Queen Elizabeth University hospital, I welcome the review announced by the cabinet secretary today. Can she give a guarantee that it will be a genuinely independent review, i.e. that those people involved in commissioning doing the work and delivering the hospital won't be part of investigating what has gone wrong at the hospital? Will the review commit to looking at the history of the reports from the consultative microbiologists at the hospital, which I believe have been raising concerns about the safety and security of the hospital for a number of years? Yes, I can give that commitment. Obviously, those individuals who will have been involved at various steps along the way will be providing information to the review and perhaps comment an opinion, but we need to discuss with those who will be charged with the review exactly how they want to undertake it, but they will have that very important independence and expert advice available to it. Can the health secretary advise on the current hospital-acquired infection rate for NHS greater Glasgow and Clyde and how that compares to the rest of Scotland? Since 2007, 85 per cent fall in the cases of C. difficile infection in over 65-year-olds and 94 per cent fall in levels of MRSA in line with the national average. The national point prevalence survey record of the Queen Elizabeth University hospital has it as an overall rate of hospital-acquired infection of 4 per cent compared to the rate for Scotland, which is 4.9 per cent. Of course, we should not ignore the successful track record of our patient safety programme. However, that is a hospital that deals with very sick individuals in acute circumstances. In those circumstances, in this hospital and elsewhere, then infection arises. The key is to understand what you need to do to improve patient safety and to get to the source of that infection. We know from today that I have been advised that there has been a fungal infection, not connected to the one that we are discussing. There has been further information given to me. More information is to come. Again, I am very happy to keep the chamber updated on that. It affects two patients, both of whom are being treated. The source of that infection is being pursued. Additional safety measures have been put in place, including air sampling, enhanced cleaning and, as I said, it is unrelated to the infection caused by pigeon excrement. However, as I explained, I will come back and update members on that in due course. Thank you very much. I apologise to James Kelly. We don't have any more time for questions on that subject. Question 2, Bruce Crawford. Thank you, Presiding Officer. To ask the Scottish Government what its response is to the Prime Minister's latest statement and how she plans to proceed with Brexit withdrawal agreement. Presiding Officer, firstly, it is clear from yesterday's statement that the Prime Minister has simply not taken on board the crushing scale of the 230 votes defeat in the House of Commons. Yesterday, the Prime Minister could have ruled out no deal. She didn't. She could have called for an extension of article 50. She didn't. Instead, still failing to understand the EU's position, she intends to return for further negotiations armed with plan A. Given the Prime Minister's approach to engagement with the Scottish Government to date, her offer of an enhanced role for devolved Administrations like lacks credibility. Indeed, this morning, the UK Government cancelled a meeting of the joint ministerial committee that deals with EU negotiations, which was due to take place on Thursday, a decision that flies in the face of the Prime Minister's rhetoric. However, the Scottish Government will continue to do everything that we can to protect Scotland's interests, and the First Minister is due to meet the Prime Minister in the coming days. The Prime Minister should now focus on securing an extension to article 50, during which arrangements can be made for a second referendum, which includes the option to remain within the EU. I would also like to congratulate the 3 million campaign and members of this Parliament who voted in December to call on the UK to scrap the settled status fee. All members, of course, accept the Conservatives. The UK Government should never have introduced it in the first place, but this U-turn is welcome. However, it does not change the fact that EU citizens should not have to apply to retain rights that they already have. Thank you, cabinet secretary. Last week, the First Minister wrote to the Prime Minister calling for a meeting of the GMC for urgent and meaningful discussions to agree a way forward, which would command the majority in the House of Commons and, crucially, have the confidence and support of devolved Administrations. Obviously, the cabinet secretary just told us the information about the GMC, so what does the Scottish Government now see as the best way forward of resolving the current impasse? The joint minister of committee is not meeting on Thursday as part of the European negotiations, and neither I understand the meeting in the next few days. Neither is that at a joint ministerial committee plenary level, although I understand that the First Minister of Wales will also meet. It is important that there is some consensus on the way forward, but in the absence of consensus empowerment, the best resolution would be a second EU referendum. The Prime Minister's statement refers to improved discussion and consultation with Westminster, the Parliament and the devolved Governments. However, yesterday's statement made clear that it is simply to set future negotiating terms on our current deal that has been rejected by 230 votes. Her offer for talk to set out in her statement is just about implementing the political declaration setting out the framework for the future relationship between the EU and the UK, not about changing the political declaration terms in future arrangement. It is important that there is greater engagement, but it has to be meaningfully about trying to address what could command a majority position. That is why, obviously, the debates that will take place in Westminster over the next week are important, and there will be opportunities for members there to put forward different suggestions. Bruce Crawford The cabinet secretary has already mentioned the scrapping of the UK's proposed EU settled status fee. Will she agree with me that the disgraceful policy should, frankly, never have been in place to begin with, that no citizen should be expected to pay to secure the rights that they already had ever entitled to because they had made their home in the United Kingdom? Cabinet Secretary? I welcome the scrapping of the settled status fee. The pay-to-stay was never appropriate in the first place, but I think that the anxiety, the sheer anxiety that so many EU citizens have faced and, indeed, continue to face with this application system is of real worry, particularly in a country where we need to ensure that we can attract those from the EU and beyond to help in our work places and in our universities and in our care sector and in our health sector. I think that it is a very serious point that, in terms of what the UK does in the future, it should address the concerns of the UK's application system. One is that the pilot that was launched yesterday has many, many questions about it, but what kind of message does it say to people if you are actually asking them to apply for something that they already have? I think that this Parliament can come together. I think that, even on the other benches, as far as the Conservatives are concerned, if we want to address the real issues in terms of population and migration in Scotland, I think that this Parliament coming together can make a difference. We made a difference in the discussions on Ben Macpherson in particular. We made a difference in terms of the arguments in relation to the scrapping of the fee, and I think that we can do more in this area if we as a Parliament come together and work together and put forward common-sense proposals. Adam Tomkins The cabinet secretary does not want a no-deal Brexit, and I am with her on that. So can I ask what detailed, concrete, positive proposals for a deal to resolve this crisis has the cabinet secretary's party brought to the discussions with the Prime Minister in the last week? Well, the member will be aware that we have spent the last two and a quarter years arguing for a compromise position, a single market membership and customs union membership, and that you are starting to see an opportunity for other parties coming to that. However, the clock is ticking, and that is why we have to stop the clock. Unless we rule out the no-deal, the no-deal is the default position. In terms of where we go forward, we have to ensure that the opportunity is there to ensure that we can remain. If we scrap freedom of movement, whether it is under this deal that the Prime Minister has or a no-deal, that will be absolutely catastrophic for Scotland. In terms of what has been put forward to date, we have been diligent. We have been patient in putting forward our proposals, and our First Minister again will be able to engage with the Prime Minister. However, we are now at this very last minute, having spent 15 months for the UK to try and get a resolution on the hard-border risk in relation to Ireland and Northern Ireland. 15 months and no progress. What makes her think that, with the EU's position as it is standing full square behind the Irish position, how does she think that she is going to get some movement in the next few weeks? As I said, that is facing down a ticking clock, and we need to stop the clock. We need to make sure that there are opportunities for a common sense proposal, because the consequences are very, very dire indeed. Thank you very much, and that concludes topical questions. We are going to move on to our next item of business, which is a debate on motion 15493, in the name of Michael Matheson, on a city deal and regional economic partnership. I would ask all members who wish to contribute to this debate to press their request to speak butons as soon as possible.