 Rydw i'n gyd gyda hi. Oedd y ddemnig y 30 oLaugh yng ngwych poem quáectfところ 5 yn tym going forward into the Health and Sport Committee, a geniu'r momentau itwpla'r Jewel to swap off mobile phones and they can most often interfere with sound systems but he' also asked those in the room to note that officials and members are using Darling devices instead of hard copies of the papers. The first item on the agenda this morning is a stage 2 consideration of the smoking prohibition to children in the Motor Vehicle Scotland Bill. Can I welcome member in charge of the bill and his officials and the minister and that official Jim Hume MSP, member in charge of the bill. Welcome, Stephen Fricker, assistant clerk, non-governmental bills unit and Louise Miller, solicitor, officer of the solicitor to the Scottish Parliament. Minister for Public Health, Siobhan MacGy, policy executive, tobacco control team, Scottish Government, Claire McDermott, bill team manager, tobacco control team, Scottish Government. David Wilson, solicitor, Scottish Government and Merrill scheme, Parliamentary Council, Scottish Government. Welcome to you all. Everyone should have with them a copy of the bill as introduced the Marshall list of amendments that was published on Friday and the groupings of the amendments which sets out the amendments in order in which they will be tabled. There will be one debate on each group amendments and I will call the member who lodged the first amendment in that group to speak and move that amendment and speak to all other amendments in the group. Members who have not lodged amendments in the group but wish to speak should indicate to me and catch my attention in the usual way. If they have not already spoken to the group, I will invite ministers and then Jim Hume and the member of charge to contribute to the debate just before I move to winding up speech. The debate on the group will be conducted, concluded by inviting the member to move the first amendment in the group to wind up. I will go to the amendments. I think that most people will know the procedure rather than go through. I call amendment 10 in the name of Malcolm Chisholm, grouped with amendments 11, 12, 13, 14 and 15. I will draw the member's attention to the preemption information shown in all the groupings. Malcolm Chisholm will move amendment 10 and speak to all amendments in the group. As it happens, amendment 10 is the central amendment in this group, although it should be grouped specifically with amendment 15, which defines driver, which is the central word in amendment 10. My starting point for this being a loyal committee member is the recommendation of the health committee report on the bill at paragraph 65. If I can just quote a little bit of that, the committee has persuaded on balance that making the driver and the smoker liable for the offence is the sensible approach. That would bring this bill into line with other duties on drivers, for example seatbelt legislation, be consistent with the approach south of the border and provide added incentives to protect children from the harm of second-hand smoking in private vehicles. I take the view like the committee that having the driver liable, as well as the smoker, would strengthen the central purpose of the bill, which is protecting children from second-hand smoke. That first amendment sets out the main thrust of all the amendments in this particular group. Amendment 11 deals with the exception sub-clause, which is sub-section 2, so, obviously, new section 1A will have the same exception. Amendment 12, well, no, actually, I'll do 14 first, because 14 deals with sub-section 5, extends the 1A offence to sub-section 5, which is the fine sub-section. Amendment 12 extends the new 1A offence to sub-section 4, which is to do with a defence in the case of section 4, and the bill is to do with reasonably believing that the persons in the car are all adults. Now, I understand that the cabinet secretary is going to try to remove that sub-clause, which obviously complicates the debate, but, certainly, when I put forward the amendment, it was to make sure that the new offence applied to sub-section 4, but I've also added a new defence, which is the final amendment in this group amendment 13. Again, if I can invoke the committee report at section 67, it refers to Ash Scotland and the Scottish Coalition on Tobacco, considered there should be a defence if the driver was unable to prevent another individual from smoking and the driver made all reasonable efforts to prevent the offence. They also noted that this would bring Scotland into line with similar provisions in Wales, England and Northern Ireland, and you'll see the words all reasonable precautions in amendment 13. So, while the central thrust of these amendments is to include the driver as someone who would be liable in the same way as the smoker, it also provided the specific defence for the driver, which seems to me only fair and reasonable. The amendments all hang together. I'll listen with interest to the views of the minister and, of course, other members of the committee before deciding whether to press them to a vote. I move amendment 10. Do any other members wish to take part in that debate on amendment 10 and the other amendments grouped 11, 12, 13, 14, 15? No other members? I then call the minister. Thank you, convener. I will speak to amendment 10 and the other amendments in the group, welcoming the opportunity to set out the Scottish Government's position on amendments 10, 11, 12, 13, 14 and 15 in Malcolm Chisholm's name. As it has been said, those amendments make it an offence for the driver of a car to knowingly permit another adult to smoke in the car when a child is present. I note that this was also highlighted as the preferred option in a number of submissions to the committee and discussed in the stage 1 report with a recommendation that this change be brought forward. We therefore carefully considered the need for this offence, particularly as reference was made to existing smoke-free legislation in the stage 1 report. Similar requirements exist in relation to workplace vehicles and public transportation in the Smoking, Health and Social Care Scotland Act 2005. I am also keen that consistency can be achieved with existing legislation, where there is a good reason to do so. That said, I am not convinced that adding an additional offence to make the driver vicariously liable for this offence provides further protection to children from the harms of second-hand smoke. I can understand why reference has been made to existing smoke-free legislation. However, it is worthy of note that this requirement was introduced in the context of work vehicles and therefore the offence would apply to individuals acting in a professional capacity. For example, in the instance of a passenger smoking in a taxi, it is right and proper that the driver of the taxi intervenes to prevent someone smoking. In such instances, they can rightly refuse to provide a service to the passenger in their professional capacity. This does not directly read across to private vehicles. The person driving is not acting in a professional capacity. I would advocate that all passengers should seek to protect children from second-hand smoke by asking others not to smoke in the vehicle with them. Applying an offence to the driver could be problematic. For example, it is reasonable to hold a young driver criminally responsible for the behaviour of his or her parents if they make a choice to smoke in front of a younger sibling. There has also been reference to seat belt legislation and the requirement for drivers to ensure that children under 14 who are passengers in their car wear a seat belt. However, that legislation does not make it the responsibility of the driver when another adult passenger in the car commits an offence by failing to wear a seat belt. That is effectively what such an amendment would do here. It would make an adult responsible for another adult's offence. There has also been reference to consistency with similar legislation already introduced in England and Wales. Those regulations have a number of differences from the bill introduced by Mr Hulme. For example, they do not require that the offence can only be committed by an adult over the age of 18, and so this amendment alone would not achieve consistency with the approach taken in other jurisdictions in the UK. As the committee knows, the Scottish Government consulted on this policy prior to bringing forward the health bill. That consultation invited respondents to suggest to whom the offence should apply. 62 respondents commented on those that the offence should apply to, but only eight of those, 13 per cent, suggested that it should be to the driver. I think that it is important that we send a clear and consistent message that all adults are responsible for their own behaviour when it comes to protecting the health of children from second-hand smoking cars. It is my belief that the person who is smoking should be responsible for committing that offence. There should be no confusion or uncertainty about who is ultimately responsible for an individual adult's decision to breach the law. I note that amendment 14 provides a statutory defence specific to the driver. Given that I do not think that the driver should be made vocariously responsible for this offence, it follows that I do not support the defence that attaches to it. However, I note that some submissions suggested that the offence should be applied to the driver in order to provide an alternative defence to the one provided in the bill. To my view, the defence that is provided by amendment 14 is problematic. Applying such a defence would require consideration of what those reasonable precautions or due diligence might be in practice. For those reasons, I would ask the committee to reject amendments 10 to 15 in Mr Chisholm's name. Jim Hulam. Thank you very much, convener, and good morning to the committee. I thank you for considering the bill at stage 2. I set out my views on driver liability in my letter to the committee on 5 October in response to its stage 1 report and, of course, during the stage 1 debate. I have not been persuaded by the arguments presented about providing consistency with the legislation elsewhere or about being consistent with the ban in smoking places. I have four key arguments against driver liability. One is that it has the potential to distract the driver from the road, which could lead to an accident. Also, introducing driver liability unhelpfully moves the focus away from the harmful effects to children of exposure to second-hand smoke in a confined space and therefore strays into the realms of a traffic offence. The driver is not in the same position as the owner of licensed premises. He or she is a private individual not running a business and is not necessarily in a position of authority in relation to other adults in the vehicle, in the way that perhaps a bus driver is, for example, in relation to their passengers. Primarily, I believe that this adds unnecessary complexity to a bill that is seeking to be as uncomplicated and easy to enforce as possible. I thank Malcolm Seism for his amendments, but I request that he perhaps consider withdrawing amendment 10 and not move the other amendments in the group. Malcolm Chisholm, to wind up pressure withdrawal. Well, thank you to the minister and to Jim Hume. Jim Hume certainly made some points there that I would want to reflect further on. In terms of what the minister said—well, I think that I need to have clarification. I probably won't get it. Today, on seatbelt legislation, the committee, in making up its report, thought that this would make it consistent with seatbelt legislation, but it included something that I and perhaps they will look at before stage 3. The minister said that it would be problematic in terms of the driver's ability to enforce his or her will, but, of course, that is the reason for the statutory defence, which is amendment 13, in my list. He said that it is 14. That doesn't really matter, it's a detail, but one of us must be wrong. Finally, he referred to a young driver being criminally responsible, but, of course, the point of amendment 15 is to make it clear that a driver means an adult, so a 17-year-old driver would not be criminally responsible under the amendments that I have put forward. Given the way in which the member responsible for the bill put forward some substantial arguments that I would want to reflect on, I would not seek to press these amendments today, although, obviously, I reserve the right to do so at stage 3. Members seeking to withdraw amendment 10. Any members object? No objection. Amendment 10 withdrawn. We now move to call amendment 11, in the name of Malcolm Chisholm, already debated with amendment 10. Malcolm Chisholm to move or not move? Not moved. Any member object? No member object. We then move to call amendment 1, in the name of the minister group, with amendments 2 and 3. Minister, to move amendment 1 and speak to all amendments in the group. Thank you, convener. The bill aims to exempt vehicles that are being used as a person's home. I support Jim Hume's intention to ensure that this offence does not apply in a person's home. However, I believe that the description living accommodation more closely reflects a vehicle that is being used as such. That could include vehicles such as motorhomes and caravans, but it is not limited to those examples. It is possible that other vehicles could be designed or adapted as living accommodation, such as vans with a bed, kitchen or toilet facilities. However, all of those installations may not be needed in order to consider a vehicle a person's home. Indeed, there may be other installations or designs that would lead an enforcement officer to believe that a vehicle is being used as a person's home. I believe that amendments 1 and 2 are in line with Jim Hume's policy intention to exempt part motorhomes, caravans and other vehicles designed or adapted to provide living accommodation. Amendment 3 removes the test, which effectively means that a vehicle must be part for not less than one night before it can be considered to be a person's home and thereby exempt from the offence in section 1 of the bill. I believe that that would be problematic to enforce. For this test to be applied, enforcement officers would need to be certain as to how long the vehicle had been part or intended to be part. Removing the test section does not change the policy intention to exempt vehicles being used as living accommodation. Vehicles that are part and being used as such will be exempt from the offence. Thank you minister. Any member who wishes to participate in the debate? No, Jim Hume. Thank you convener. I will keep it brief. Those are straightforward amendments. They provide a clearer definition of vehicles to be exempted, living accommodation more accurately reflects the policy intention. The removal of section 3 removes any difficulty for enforcement agencies in determining what constitutes not less than one night. Therefore, I am grateful to the minister for lodging these amendments, which I am fully supportive of and happy to support. Minister, I wish to respond and move to the vote. Or move to the vote. Just move to the vote, convener. Question is then that amendment 1 be agreed to. Are we all agreed? Yes. Call amendment 2 in the name of the minister who has already debated with amendment 1. Minister, to move formally. Moved. Thank you. Question is then that amendment 2 be agreed to. Are we all agreed? Yes Thank you. We now call amendment 3 in the name of the minister who has already debated with amendment 1. Minister to move formally. I formally move to. The question is then that amendment 3 be agreed to. Are we all agreed? Thanks. We now call amendment 4 in the name of the minister and a group on its own. Remind members that if amendment 4 is agreed to, you cannot call amendment 12, given the preemption that spoke about earlier. Ministers to move are ministers that move and speak to amendment 4. Thank you, convener. Amendment 4 removes the defence that the person smoking reasonably believed all other occupants of the vehicle to be adults. It is difficult to envisage what steps a person might take in order to prove that they reasonably believed all occupants to be 18 or over beyond asking for proof of age. Even if such a step were to be applied, it would be difficult to establish that such proof had been asked for or indeed supplied. In any case, such steps would appear to me to have a disproportionate impact. I recognise that the committee in their stage 1 report asked the Scottish Government to consider the alternative defences supplied and written evidence. I note that many of the suggestions relied upon asking the age of the child where there is any doubt, whilst I think that this would be prudent, the same problems occur in trying to prove that this had indeed taken place. It is worth noting that many of the written evidence submissions did not believe that there should be a defence of not knowing the age of the child. There are a number of offences that exist in statute where an adult commits an offence when acting in a way that harms the health of a child or indeed where failing to act harms a child. Reference has already been made by the committee in their consideration of the bill to the requirement for drivers to ensure that children under the age of 14 who are passengers in their car to wear a seat belt. There is no defence attached to this in respect of whether the driver could have known the child was under the age of 14. Neither does such an offence exist in relation to the offence of a person purchasing alcohol or tobacco on behalf of a young person under the age of 18. A similar offence has been included in the health, tobacco nicotine, etc. and Care Scotland bill, which is currently being considered by the committee, which will make it an offence for someone over the age of 18 to purchase a nicotine vapour product on behalf of a person under the age of 18. Again, such an offence provides no defence as to whether an adult could reasonably know the age of the child. I therefore see no reason why a defence of this nature should be applied to this offence. Adults must take responsibility, and if in doubt, they should not smoke in a car when a person who may be under 18 is present, so I move amendment 4. I am content to support the Scottish Government amendment to remove the defence and grateful for their consideration again. I presume that the minister does not require any time. Thank you. Then we move to the question that amendment 4 be agreed to. Are we all agreed? Thank you. We now go straight to amendment 13, in the name of Malcolm Chisholm. Already debated with amendment 10, Malcolm Chisholm to move or not move. No other member wishing to move. The question is then that section 1 be agreed to. Are we all agreed? Thank you. The question is that section 2 be agreed to. Are we all agreed? Thank you. Amendment 5, in the name of Jim Hume, is grouped with amendments 6, 7 and 8. Jim Hume, to move amendment 5 and speak to all amendments in the group. Thank you very much, convener. Before I speak to the amendments, I wish to, of course, record my thanks to the minister and her officials for the continuing spirit of partnership, which has enabled us all to get to this point. The schedule to the bill is introduced, allowed for the fixed penalty regime to be enforced solely by Police Scotland. During stage 1, it became clear that the penalty regime would be enforced solely by Police Scotland, but during stage 1, it became clear that there was a wide range of support for a joint enforcement regime between Police Scotland and local authorities. Both the Scottish Government and I have been persuaded by this argument. Amendment 5 replaces the schedule to the bill with a new schedule, which provides for joint enforcement between Police Scotland and local authorities, thus strengthening the bill. I have worked closely with the Scottish Government to revise the schedule to make it as similar as possible to schedule 1 to the Smoking Health and Social Care Scotland Act 2005. This will make enforcement simpler for the Police and local authorities as they are already familiar with the fixed penalty regime that applies under the 2005 act. In particular, the new schedule provides for fixed penalties to be paid to the local authority in the area of which the offence was alleged to have been committed or a person acting on its behalf, rather than to the clerk of court. Other references to the clerk of court and the schedule are replaced by the local authority throughout the amendment. Despite the fixed penalty regime being modelled on the 2005 act, paragraph 4 retains a fixed penalty for an offence that is £100 and allows a period of payment of 29 days, with no provision for an early payment discount. I am pleased that, to date, the Scottish Government accepted my position on this. There is provision for the Scottish ministers to amend the amount of the penalty by regulations. Amendment 6 inserts a new section to reflect the joint enforcement regime, granting entry and search powers to authorise officers of a local authority and to allow them to obtain the name and address of a person who they reasonably believe may be committing or has committed an offence under section 1 or to have information relating to such an offence. This is based on similar powers available to local authority officers under the 2005 act. Amendment 7, in the name of the minister, gives the ministers various ancillary powers to make regulations and sets out the procedures to which regulations made under the bill will be subject. Subsection 3 reflects the delegated powers and law reform committee's recommendation that regulations under paragraph 11b of the new schedule in relation to keeping off accounts be subject to the negative procedure. Amendment 8 is just a consequential amendment and I now move amendment 5. Thank you. Minister, do you speak to amendment 7 and other amendments in the group? Thank you, King Veiner. I will speak to amendment 7 in my name and the other amendments in the group. In the memorandum that the Scottish Government sent to the committee in March 2015, we made clear our support for amendment 5 in Jim Hume's name. It suggested that a joint approach to enforcement between local authorities and Police Scotland could be considered in respect of the bill. Environmental health officers have played a vital role in supporting the implementation of existing smoke-free legislation, which I am sure we can all agree has been a success. A primary aim of the bill is to protect the health of children by reducing their exposure to second-hand smoke. Protecting public health is fundamental to the role of environmental health officers in Scotland, and they would bring with them a wealth of experience. It makes sense that Police Scotland also has a role to play since it has powers to stop a moving vehicle, while local authorities could enforce the offence in respect of stationary vehicles. However, while enforcement of this offence will be important, the aims of the bill cannot be achieved by enforcement alone. This is about promoting a change in cultures and attitudes. We know that the harms caused by exposure to second-hand smoke are widely understood, and therefore the majority of adults choose not to smoke in their homes and cars when children are present. We developed our national campaign ticket right outside. That aims to raise awareness of the risks posed by second-hand smoke to children. We launched that campaign last year to a positive reception. The evaluation of the campaign showed that it had an impact on behaviour, but more needed to be done to drive home the message that is never safe to smoke in enclosed spaces with children. We relaunched the campaign last month with a stronger message that takes account of the evaluation's findings. It is my belief that the introduction of this offence will provide a deterrent and continue to promote this key message. We know that there has been a significant change in behaviours and attitudes since the introduction of smoke-free legislation in 2006. Enforcement in respect of that legislation was measured, and we would anticipate the same approach to the proposals in the bill. I am pleased that amendment 5 provides similar powers to local authorities in respect of enforcement at the administration of fixed penalty notices to those provided in the Smoking, Health and Social Care Act 2005. That will allow a consistent approach, albeit with a higher level of fine and no early payment reduction. I believe that those differences reflect a higher level of complexity in enforcing the offence. Having a similar approach will help to avoid difficulties associated with operating different enforcement regimes for different smoking-related offences. The committee asked the Scottish Government to consider additional costs to local authorities associated with enforcing the provisions in the bill. The financial memorandum accompanying the bill calculates the likely number of fixed penalty notices to be around £200 per annum. We would not expect that to rise as a result of local authority enforcement. The Scottish Government already provides £2.5 million to local authorities as part of their baseline grant to enforce current smoke-free legislation. My officials have met with COSLA and environmental health. Those discussions have raised the potential for modest one-off additional costs associated with training guidance and producing fixed penalty notices. I support amendment 6. Without powers to search and enter private vehicles, local authorities would be unable to enforce the offence effectively. It is therefore essential that such powers are provided. It is also right that those who are committing or have committed an offence and those who may have helpful information yet fail to provide local authority officers with their name and address without a reasonable excuse commit an offence, otherwise the legislation could be easily circumvented. Amendment 7 in my name reflects a replacement schedule inserted into the bill by amendment 5 in Jim Hume's name and which provides enforcement powers to local authorities. The change in procedure from affirmative to negative for regulation making powers under paragraph 11b pertaining to the keeping, preparation and publication of fixed penalty notices accounts reflects the recommendation made by the Delegated Powers and Law Reform Committee, so I would ask members to support amendment 7. I welcome these amendments, which give clarity to the role of the local authority in enforcing the legislation, because I think everyone is agreed that enforcement is one of the key issues with the proposed legislation, and there now appears to be agreement that there should be a joint enforcement approach between Police Scotland and local authority agents. The clarity that these amendments give around enforcement and the Government's stated intention to undertake a public information activity to raise awareness of the legislation will, I hope, result in the desired change in behaviour to protect children from the effects of smoke in the enclosed space of a motor vehicle. However, we indicated at stage 1 that it is our intention to introduce an amendment to ensure post-legislative scrutiny of the effectiveness of the measures to prohibit smoking in motor vehicles with children present. Scottish Conservatives will, at stage 3, be proposing a sunset clause to test the effectiveness of the legislation after it has been in place for a reasonable length of time, say, three years. I support amendments 5 and 6 and also amendments 7 and 8. Does the minister wish to respond? In terms of a sunset clause, we understand the desire to review whether the exposure to second smoke has been reduced and, indeed, the number of young people taking up smoking. That, of course, is continually monitored in relation to the figures in relation to people smoking and in terms of our taking it right outside campaign. We have monitored that since its introduction and continue to monitor it. That is why we refined the message in the relaunch of the campaign this year. I would argue that the measures are continually monitored in other ways. Jim Hume. Thank you very much, convener. I thank the net mill and the minister for the words. I personally have not been persuaded that we need a sunset clause at this stage. The evidence is clear from other countries throughout the world of the damage that second-hand smoke does to children and that legislation has led to the change in culture that the minister referred to. This is about promoting a change in culture. This is about protecting children from the dangers of second-hand smoke in cars in Scotland, which is well documented and scientifically based on. We know that there are 60,000 children every week in Scotland being exposed to second-hand smoke. I believe that the amendments that we have discussed are moving strength in the bill to do so. The question is that amendment 5 be agreed to or will be agreed to. The question is that schedule be agreed to or we all agreed to. I call amendment 6 in the name of Jim Hume, already debated with amendment 5. Jim Hume, do you move formally? Formally moved. Thank you. The question is then that amendment 6 be agreed to or we all agreed. Thanks. Call amendment 15 in the name of Malcolm Chisholm, already debated with amendment 10. Malcolm Chisholm to move or not move. Not move? Not move. Any other member wishing to move? Nope. Then we then move to the question that section 3 be agreed to, or we all agreed. Thank you. Ari Gwerth mwrdd y gallai mwy Sonyd bob anod ym unkelioen ganyl iau southweith silicone small na detgalioen gei gwreilu... Eiousniad ari—ŵs, neid iawn i gersonai arall yr yr anod ym unkelioen gwaith yn Gwreilrwy. Ari Gwerth mwrdd yr anod ym unkelioeni gwaith yn Gwreilrwy. Ond ym unkelioen gjoch iawn yn treh gweithio mwywarmotherne. Gwreilrwy gym直接ia erioed diad wedi sig yn anod vyNão, o bed sûroes i gônon i Gen Whoan o'r anod gymaevr... that, amendment eight, we agree to, are we all agreed? Thank you. I now call amendment nine in the name of the minister in a group on its own, minister to move and speak to amendment nine. Thank you convener. There can be no doubt that we all have a responsibility to protect children from tobacco smoke. That's why I relaunched the Take It Right Outside campaign last month. The campaign aims to raise awareness of the risks posed by second hand However, this is as important of a new law and I have therefore committed to run a national campaign to raise awareness of this new offence. It is vital that any campaign is aligned with the timing of the bill's commencement. This amendment will allow the Scottish ministers to commence the legislation when the campaign has been developed and launched. I have already made clear my commitment to implementing this important legislation as quickly as possible, but I reiterate that now for the avoidance of any doubt. I move amendment 9. As everyone knows, I smoke and I welcome this bill and I am sure that it will help to reduce and hopefully reduce smoke inhalation to children. In regards to the campaign minister, can I ask that our campaign is much better than what I have seen of the English campaign because it does not convey the message forcefully enough? Jim Hewman, do you wind up? No, sorry. Jim Hewman to speak and then we will go to the minister to respond to that. I am always happy to wind up, but that is usually the other people who are winding up to convener. I am very happy to support this amendment and welcome the minister's public commitment again today to ensure that the provisions will come into force as quickly as possible. At the time of drafting, I did not put the commencement date in the hands of the ministers. As I was not clear at that stage whether the Scottish Government would support the bill, but having received the Government's clear support and having worked together constructively, it is sensible to give ministers flexibility in terms of when the provisions come into force to coincide with the campaign. I have not seen the campaign that is being run in England, but I think that our taking it right outside message has been very forceful initial results show that. I think that the fact that we can show that smoke lingers for up to seven hours in a room that gets under doors and in windows shows that the picture of the lungs are all very forceful. I hope that the campaign that we run in relation to cars will be equally effective. I ask the committee to support this amendment. Thank you. Question is then that amendment 9 be agreed to. Are we all agreed? Question is then that section 5 be agreed to. Are we all agreed? Thank you. The question is that section 6 be agreed to. Are we all agreed? The question is that the long title be agreed to. Are we all agreed? Thank you. That ends stage 2 consideration of the bill. Members should note that the bill will now be reprinted as amended. Parliament has not yet determined when stage 3 will take place, but members can of course now lodge stage 3 amendments at any time with the legislation. Members will be informed when the deadline for amendments, once that has been determined. Thank you. Thank you, Jim Hewman, the minister and the team here this morning. We suspend briefly at this point. Thank you. We now move to our second item on the agenda, which is subordinate legislation with two negatives and two negative instruments before us. The first instrument is general dental council indemnity arrangements, dentists and dental care professional rules of council 2015 SI 20151758. There has been no motion to anul and the Delegated Powers and Law Reform Committee have not made any comments on the instrument. Do any members have any comments? I don't hear any. Can I take it therefore that the committee are agreed to make no recommendation? That's agreed. Thank you. The second instrument before us is natural mineral water, spring water and bottled drinking water Scotland amendment regulation 2015 SI 2015363. Again, there has been no motion to anul at the Delegated Powers and Law Reform Committee and they haven't made any comments on the instrument. Do any members have comments on the instrument? Any comments? Can I take it therefore that the committee are agreed to make no recommendations? Thank you. At this point, we should be going on to, but we're a bit ahead of time, but there is evidence session on transplantation and authorisation of removal organs. We propose that we move on from agenda item number five, make some progress on pallative care. That means that we will begin into private session at this point. Are members agreed to that? We will go into private session at this point and see if we can make progress with the pallative care report. Our agenda today, of course, is transplantation, authorisation, removal organs, etc. to Scotland bill. This is our first evidence session. Before I welcome our witnesses, as members will be aware, Richard Lyle and I were in Madrid yesterday with the Spanish National Transplantation Organisation, the ONT, and transplant coordinators. I want to extend my thanks to all those who we met, especially Dr Rafael Matisans, for his time and assistance with a visit. We both, I think that I can speak on both of my behalf. It was a very useful visit and a summary of our discussions will be provided to the committee in due course. I also want to thank all those members and the public who attended our informal meetings with us over the past two weeks. The members of the committee met transplant recipients, organ donor families and faith and belief groups over the past week or so. We, I am sure, and discussions with members, believed that those were very informative. We are very thankful for everyone who came along to those meetings and gave them time to engage with us, especially the transplant recipients and donor families, where there were some very serious experiences being shared. A note of the meeting with transplant recipients is now available on the website, and notes of other two meetings will be available in the coming days. Before I introduce the witnesses, Richard Lyle, do you have a declaration that you wish to make? Yes, convene. For openness and transparency, I should declare that one of the witnesses, Jordan Linden, actually works for me. Can I therefore go on to welcome our witnesses this morning, Dr Sue Robertson, member of BMA, Scottish Council, renal physician in Dumfries, BMA Scotland, Jordan Linden, MS, member of the Scottish Youth Parliament, chair of the Scottish Youth Parliament, Lindsay Patterson, policy manager of Royal College of Physicians, of Edinburgh and Dr James Cant, director of the British Heart Foundation Scotland. I also make the witnesses aware and welcome to the committee. I'm a tiger, the member in charge of this bill, and Anne will have the opportunity to ask questions at the end of the session. We're not expecting any opening statements, and we'll move to our first question, which is from Malcolm Chisholm. Thanks, convener. I wanted to hope that at the beginning of the conversation between the specialist nurse or whoever is having the conversation and the relatives in terms of whether an organ should be donated, because it does seem to me that that's very much at the centre of many of the debates and disagreements about the bill. My understanding is that, in terms of the bill, that will, I think, always take place, although there's the complication of a proxy, but others will probably ask about the proxy. Given that that is central, I noted that the BMA said, what we have been arguing for is a standard opt-out model whereby if an individual has not registered an objection and those close to the patient are not aware of any unregistered objection, the organs may be used for donation, whereas the Royal College of Physicians of Edinburgh says, changing the role of the family to one limited to being consulted on whether they are aware of any unregistered objection by the deceased, rather than asking for their views and consent, has the potential to be highly emotive and divisive. I'm really interested in what, because that conversation seems to me to be central to whatever system we have, so I'm really interested in the difference between those two points of view and, obviously, if the others have got views on that, I would be interested as well. Thank you very much for that question. I think that this is one of the key issues in this debate discussion about organ donation. We have a variety of fellows across different specialties, some of whom work in intensive care and some of whom would be renal care physicians, liver care physicians, so all different stages of the potential process in organ donation. Something that, through our conversations with fellows, has become apparent is that, at a time when it's very stressful, when, for example, there's been a traumatic accident, something that is totally unexpected, a family who are visiting a patient, potentially at the end of their life, will be, obviously, very upset. Conversations around organ donation have to be very sensitive. At a time when a family is potentially very stressed, everything is happening very quickly, that a clinician who is speaking to that family and who is caring for the patient would find it very difficult to try and go against the wishes of the family at that particularly distressing time. In practice, clinicians refer to the families, will speak to families, seek their consent for organ donation at the moment, and I think that that's viewed as a key part of the process. That time is a very distressing time, as we're all aware, and we also represent doctors from many different disciplines. The BMA has a slightly different approach to that situation, where we think that if the public debate has been had and the legislation has changed, then that gives the whole society an opportunity to discuss their views with their family and perhaps reminds people that they should discuss their views with their family. In that event, and in an opt-out system where somebody has the opportunity to opt out and their family would not even be approached in that situation, not only would that protect the views of somebody who wished to opt out of organ donation, it would also mean that if that person hadn't opted out, their family are likely to be aware of their views. If they hadn't got round to opting out but their family were aware that they did not wish their organs donated, then the family are given the option to inform the team at that time. I think that approaching the family at this time has to be done very delicately and has to be done by somebody who has as much knowledge of possible of this situation, but that it's actually potentially easier on the family. If you approach a member of your family and say, we're not aware that this person had any objections to their organs being donated, so therefore unless you know they had any objections, we would like to be able to progress this and help somebody to benefit from this sad situation. I think that the families would find that an easier conversation to have than the one that they have at present. Mr Lyndon. I don't think that I have anything in particular to say on that. I think that's something for our medical colleagues to answer. I don't think that I can. Thank you. I just begin by apologising for the state of my voice this morning. Bear with me, please. I think that my colleagues described two absolutely vital scenarios, and they're perhaps not necessarily contradictory. It could be that the initial scenario is one that we may have at the beginning of this process and over time we may move to a situation where it does become much more of an on-going narrative within families, within society. I think that what we have at the moment are a cadre of specialist nurses who have the absolute clinical and interpersonal skills to be able to have those conversations. I think that any system that we move towards must absolutely protect that particularly vital bond and relationship that they have with families, but enable them to have that conversation. I think that it's quite telling when we look at international comparisons that the countries that are doing this best are the ones where there is an absolute priority on those conversations being had within emergency departments, whenever there is a scenario where death is going to be certain, to make that much more part and parcel of the way in which families and patients are engaged with. That was all very helpful. Obviously, what we're trying to do is to reduce the family refusal rate, because that would obviously provide more organs. British Heart Foundation says that there is a yearning gap between the wishes of Scots and the follow-through to action, not helped by nearly a 50 per cent family refusal rate. What would I be interested in? Do we have any breakdown in terms of the percentage of refusal when someone is on the register or the percentage of the refusal when someone is not on the register? I don't have that information to hand, but I will get it if possible and get it to the committee. I think that that is quite an important point, because I imagine that everyone shares the objective of trying to reduce the refusal rate and get more organs for donation. There might be some people who have ethical objections, but a lot of people will take a pragmatic view, so it is really interesting just to know. I would kind of guess that you would assume that there would be a lower refusal rate for those on the register than those who are not, but it would be interesting to know that. Does anyone else wish to respond to Malcolm's question, as there are no figures here? There isn't any. Nenai, is it on the same theme or a different question? Rhoda, do you want to ask a supplementary question? I want to ask about—to my mind, it changes the nature of the conversation that is being had at a time when someone is a potential donor to asking for permission, so the ownership of the person's body passes on to their family, to asking for information from the family about the person's wishes, so the ownership remains with the person who is going to be the donor. Obviously, if the person has opted out, their family cannot then opt them in. At the moment, it is very difficult to opt out and that decision is left. The nature of the whole possession of that body and those donor organs is changed by the bill. That raises the question of what if a family were very much against organ donation? Do you foresee a situation in which a family being asked if they knew about their loved one's wishes said no, but I object—or religious reasons or whatever reasons—to that happening? I cannot foresee a situation in which a clinician would then go against a family's wishes if that was going to cause them real distress, as opposed to having a different conversation if you take it that bit further. I think that that is a very good point that you make. I think that the BMA in Scotland is very clear that if the person involved in that conversation felt that it would cause dreadful distress to the family to go ahead, then there should still be an allowance for them to not donate in that situation. When we are looking after patients, we are also looking after their families and we are very aware of that situation. There are some situations that we feel would cause the family undue distress. In that situation, we feel that legislation should allow us not to go forward. Anyone else? I think that I can be there and stop for a comment on how we can avoid that situation in the first place. I think that it comes down to avoiding the misunderstandings and having those conversations in the first place. James spoke about how that will change the discussion that we are having and how families and those involved can have that discussion. I think that that perhaps might touch on one of the questions later on or the potential for a discussion on the campaign that will be launched, because when people have the information that they need, they can perhaps address it and discuss it further that allow them to erode some of that potential. What within the current legislation prevents that discussion from taking place and how will this legislation ensure that there are more discussions? I think that from a young person's point of view, we are keen to see that any move would have publications on a campaign that was young person friendly that actually engaged with young people and the information that they could access was one that young people felt that they associated themselves with. Why would we need legislation to run an information campaign? I meant on the new proposal, if that was to happen. That would require legislation, but it is good to have discussion and to raise awareness of what we are looking at here is whether the current legislation needs to be strengthened. The question was, what prevents those discussions taking place now within the current legislation and how would more discussions and more organ donors result in a change in the legislation? There is no right about it that more information and more discussion is always welcomed in organ donation because the more people are stimulated to talk with their families about what their wishes are in the sad event of their death, the better. That should be going on anyway and we would encourage that that continues to go on and if anything becomes stronger. At the same time, we also think that a move to an opt-out system would mean a move for society eventually so that organ donation becomes the norm rather than the exception. We think that within that move there would be more organs available to transplant into patients who need them. We can come back to that, where the evidence across the world of the opt-out system has increased organ donation or not. At this point, the current legislation and whether we need legislation to have an information campaign—Lindsay Paterson, do you wish to? I think that the colleges view is very much that public education, public awareness are key components that need to be taken forward. That is aside from legislation, that families should be having conversations about potential organ donation and it means at a time when perhaps an unexpected accident has happened, something very tragic, then that people are aware at that point at a very stressful time. They know that they have had these discussions with their family members and I think that awareness raising among the public is vital to that. We have mentioned accidents a couple of times. Where do the majority of our organ donations come from now? Is it accidents? I do not have the statistics to hand, but we could easily get them. They are a mixture of reasons for sudden deaths, so you have accidents being won. For example, cerebral hemorrhage, that is the brain hemorrhage. What is the average age of a donor? Again, that is a number that I do not have. It would depend on what organ you are talking about for donation as well. I have a number of other questions in the net. I want to tell a little bit of clarification on the issue of appointment of proxies. When we met with the donor families, there seemed to be a feeling coming from them that they were concerned that this would actually complicate the system and could possibly delay organ donation to the extent that organs that would have been useful are no longer. That was one point. I have also heard it said that the fact that this is in the bill really is because it is in the Welsh bill and may not be necessary at all. I just wondered what the views of the witnesses are and if you could clarify that for me. I look on it as a role similar to an executor. I think that in some ways we perhaps have looked towards the Welsh example for some guidance there. I recognise the concerns that you raise about having a system that is sufficiently timely and is not overly bureaucratic, that does not encumber the process. What we have to do is strike a balance between clinical need and protection that would be applicable and relevant for particular sections in society that may have been estranged from their families. That would be something that would require some careful consideration and balancing as we move forward with this. I think that the Scottish Youth Parliament has got some important insights that they can offer as well in terms of exactly particular groups in society for whom this would be perhaps more important than for the rest of us. Max James, the Scottish Youth Parliament is supportive of the appointment of a proxy. That comes from the research that we did with young people, the survey, where 10% agreed a little and 70% completely agreed with the proposal to appoint a proxy. That was based on the fact that people are in diverse situations and it is our belief that a proxy gives more options to individuals and young people aged 16 or over more freedom to choose what happens to their body after death. If you do not mind me sharing, I will get a direct quote from a young person in the focus group who said, young people should be given options. They would know best who should help make the final decision after their death and it would be their decision to choose a proxy or not. We felt that the option to appoint a proxy for those aged 16 or 18 is in line with article 12 of the UNCRC that allows the views and wishes of a young person to be respected and taken into account. James spoke about particular groups. We believe that the option to appoint a proxy is especially necessary for those aged 16 or 18 who are in care and may not feel comfortable for their nearest relative or legal guardian to make the final decision about what happens to their body after their death. That is a belief that is shared with the Centre of Excellence for looked after children in Scotland, so that is the Scottish youth policy position on that. The British Medical Association does not object to the idea of proxy for exactly the reasons that you have just given. There are situations that we think it would be a very worthwhile thing but we are mindful that we should try and keep the system as simple as possible as you said and it does bring a complexity to the situation that is not there otherwise. I think that that part of the bill is certainly something that merits further discussion but I think that there is a place for a proxy in certain situations but it has to be that this can be done in a timely fashion for clinical need. It would be nice if there was a system that was similar to that in the other UK countries because we have a UK transplant population but I think for Scotland as a whole it needs to be simple as well as having the safeguards that you have described. The issue of proxies is something that our fellows had quite mixed views on but certainly a number of reservations. One was about the time element if an individual is able to point up to three proxies at the time taken to contact the proxies. I suppose that the reliability of the database that the proxy information would be kept on would always need to be kept up to date. Also in terms of the potential conflict between if a proxy had differing views to the views of the immediate family who are at the patient's bedside. So some reservations over those aspects. It's my understanding that proxy details would have to be provided on the register or pre-existent writing and be signed by the deceased person obviously beforehand. That's why I really just wonder how it would work and how would you think the system of appointing proxies should actually work. Just a brief comment in terms of I noted that the proposed legislation or the policy memorandum perhaps said that proxies would need to be informed beforehand or give consent to the fact that they were going to be listed as a proxy so it may be that somebody is unaware and I think that that would also add to the time problem which doesn't fully address your question but it's just an extra element of that that I think should be taken into consideration. Sorry, can I add just one more question? Yeah, just further you think that in the proposed system a soft-offed-out system that really proxies are necessary or would the system work quite well without you? I think that if the campaign is done well and the public education is excellent as it should be for any change in legislation such as this that is proposed then you would hope that proxy might not be required because the overarching aim here is to find out the wishes of that individual in the event of their death and so you would hope that with time that would not be needed but it might be a safeguard that people would feel is important for certain groups such as the younger members or people disaffected with their families. Just on this campaign again, I've got been up on it, you know I think we all accept, oh campaign, that's good, we're going to raise awareness. Also in some of the evidence that we've taken from people who are very successful, double the race of the nation, campaigns are divisive, they split doctors and communities, they split people and others and they don't always equal a better outcome. Have you looked at any evidence about the public campaign, education and awareness and found from that evidence that there's a sustainable benefit for increased donation? I think that what you probably won't find at any point here is anybody suggesting that soft opt out will be the magic bullet to cure this problem. I suspect that what you will have seen in Spain and what we've seen through international comparators is that it has to form part of a far wider campaign, it has to form part of a far wider emphasis on multidisciplinary and interlinked services and it's only when we have that working together that we can really hope to increase the number of organs that we have been made available and actually being facilitated for transplant use. What my research colleagues in BHF in London have not been able to find much evidence of or evidence at all is a situation where there's been a significant increase in transplant rates that hasn't actually featured soft opt out as a component of it. Now I accept that there is a mixed evidence base there but our organisation's belief is that soft opt out has to form an important part of a multifaceted approach that we would have to take. The Spanish soft opt out is a final reference to the family, a family object that doesn't go ahead. I think that goes back to the conversation that you had earlier with Dr Robertson but I think perhaps what moving the legal framework does is it subtly changes the implication, the de facto framework changes and I think that that probably has a very significant long-term effect on the type of conversations and societal expectations that go with it. But I think that you're absolutely right to point out the fact that I think Dr Robertson also was very keen to point this out as well, which is that we are dealing with people and families at the most distressed time in their lives and that compassion has to come through whatever system we have. Bob Doris. Thanks, convener. I'm going to pursue the role of the proxy a little bit more than I want to come back on to that conversation that takes place currently and how legislation would or wouldn't change that and I think those two things could actually be linked. Question that came into my head in relation to a proxy was one over any time delays that might be built into the system, which would be an unintended consequence but a negative to passing a billboard proxy was part of that. Does anyone have any concern in relation to how easy it would be to locate a proxy, for example, because the proxy is only there to give that informed view if they can be located? So has any thought been given to that and how long should we wait until we do that? Anyone? I think it's very difficult to be specific on that. We sometimes have to try and locate families in these situations because they happen without any warning, as Lindsay was saying, and sometimes it's very difficult to locate families in that situation too. With the way our society lives, we don't live necessarily in the same place that our families do. We may actually find it easier to locate a proxy for that person if there's somebody who is particularly close to them, if they're estranged from their family. So yes, the proxy issue is a concern because of the time delay but then locating a family can often involve delay too. I think that my previous answer to the net mill is that anything that would undermine or prevent a timely process is something that we would have to very seriously consider. This has to be a practical system and, as Jordan indicated earlier, there are particular groups within society for whom a proxy may be perhaps more important than others. It may be that we could consider that as a particular element of it in terms of, for example, looked after children. However, what we're looking to do here is establish a system that gets the correct balance between respecting individuals' wishes but at the same time having a more efficient transplant system. Anything that would in any way jeopardise the timeliness would be something that we would obviously have to look at. I'm just reiterating a number of the points that Dr Robertson made. Time is of the essence when making decisions about organ donation and often decisions have to be made in a number of hours. Contacting families, contacting proxies, there's, I suppose, no guarantee you're able to get hold of anyone in that timeframe. My concern would be trying to contact a number of different proxies and ensuring that a database was kept up-to-date. There's no guarantee that there would be details of a family to hand, but I suppose that it is a concern just because of such a tight time constraint trying to get in touch and get a hold of proxies in that time. That's very helpful. You raised the point about making sure that any database of proxies is kept up to date and also how, in some circumstances, it might be easier or not to locate the proxy as opposed to the family member. I suppose I would ask, should we not be trying to locate the proxy and the next-of-kin? Would there not be a duty to do both of those things? Could that build in delay perhaps? In relation to proxies and the idea of that active choice, should proxies stay valid? If I was to nominate a proxy today in 15 years' time, would I not bother to change that? Would that still be a valid thing to do? Should proxies only be there for one or two years, five years? I'd appreciate some views of that. I'll put a third one in, so I hope that you've taken notes. I'm keen to get your views on evidence in relation to that. What would happen if the proxy and the family member had quite strong disagreements over what the individual wanted? That's maybe what we'll come in from our next question in relation to that conversation with transplant coordinators and families or proxies. I know that there's a lot there, but I'd really appreciate you being able to put some of that on the record in terms of the time delay and whether proxies should stay there in finite number for one year, two years, three years and deathward conflicts might arise. If I could take a couple of those points, I think the point you make in terms of potentially time limiting a proxy would seem eminently sensible. In terms of the question of contacting both, in an ideal world, that might be what people would look to do, but I suppose that thinking about it from practical terms and again going back to the example given previously in terms of looking after children, one of the reasons that people may opt for a proxy may be because in the event of their death they may not want both proxy and family to be contacted, which again would be something that would have to be factored and then respected, but I think you're right to highlight the complexities of developing a system that has efficiency and equity within it and has that timely fashion too. Anyone else? I think that the first two points, Bob, are for my colleagues, but on the conflict question in terms of sharing the views of the young people that we spoke to, a significant number of participants agreed that the role of the family should be limited. 20 per cent said that they agreed a little and 60 per cent said that they agreed completely. That was one of the highest levels of agreement in the survey. In constructing my argument, it's to say that we fully should be aware of the difficulty and I think that James put it quite eloquently. The compassion that we have to have as human beings but also to recognise the time that the family members are going through, but the point that the Scottish Youth Partner is trying to make is that the young people who we spoke to expressed the need for a young person's decision to be final on that, and again, if you don't mind me sharing, a young person said that it should always be the decision of the deceased person rather than that of the family. I think that that comes down to the conflict thing for us is that young people's voices and views should be the final on that. Anyone else? Yes, Dr Robertson? I think most of it's been said already. I think ideally getting in touch with the proxy and the next of kin would be the ideal and I think we would hope that that would be done if at all possible. I think that even with a family, when we have a whole family that come in in the event of someone's illness or the event of them dying, then the families don't necessarily agree so there's always potential for disagreement and that is one of the things that the special nurses and organisation are trained to deal with to try and help the family come to some agreement about a way forward that they think that that individual would want in the event of their death and we go back to this being about the person who has died's wishes as to what would happen with their body in the event of their death. So proxy and next of kin ideally we would want both to be contacted. Time is difficult and we contact families often and we get a mobile phone that is on an answering machine so having a proxy and doesn't take that away. There is potential for disagreement always even just with a family and we have to mitigate against that and we have to deal with that in the situation and that's what we're trained to do. How long should you be a proxy? Yes, good point. I hadn't thought of that but I agree that there probably should be a time limited proxy but I couldn't tell you what the right length of time would be. I think some very interesting points have been made here. I think in terms of the time on the database there probably should be a time limit just to ensure that the people listed there is the correct details and people you would actually still want to be contacted. However, in terms of should family members be contacted at the same time as proxy? I think that we would say yes because our fellows still have a strong view that the family should be involved in this process and I think that if there was potential conflict between the views of the proxy and family at the bedside, I appreciate at the moment that family members may have different views. Where a proxy had perhaps a legal position where they were able to put forward a view, I think that that may cause distress to a family where they were placed in a legal sense and able to put forward a view. I think that some of our fellows are concerned that the conflict there may undermine confidence in the medical teams where there was a legal obligation to follow the views of a proxy, for example, over the family members. I hope that some of my colleagues and my community are telling us want to come in in relation to the proxy as well but I had said at the start of my questioning that I wanted to link this to that conversation that takes place when there is a possibility of having suitable organs for donation in relation to that. I wonder if you could tell me what you think the views are of transplant coordinators or the specialist nurses or the doctors who are having those conversations when the situation happens in terms of, at the moment, my understanding, I could be wrong, we have still to take evidence from that particular group. The sense of conversation is very much if they do not carry an organ donor card as well. If they did not carry an organ donor card, we would be really keen to use those organs to help a variety of other individuals who could really benefit from that. Flipping the whole thing around would be that this individual has not indicated an opt-out and would be keen to use those organs. I am just wondering how very different the conversation would actually be in practice if this legislation came through. Might it actually be very similar, but could an unintended consequence be an added layer of complexity during those conversations that the organ coordinators or the nurse specialist may or may not feel is appropriate or otherwise? Do you know what those on the ground are having those conversations? Not specifically the BMA, for example, but doctors on the ground that are having those conversations or nurse specialists on the ground that are having those conversations, have they raised any concerns in relation to that and is there a way to mitigate against that? Anyone? Yes, Dr Romaslaw? I am a kidney doctor, so I work with patients who are waiting for transplants. I do not have the conversation with any potential organ donors in my hospital, because I am looking after the patient who may or may not benefit from those organs. However, I think that in these situations, the specialists who are involved in the organ donor programme are very, very mindful that they do not wish to cause distress to the family. They are very well trained to try and alleviate the stresses involved in that conversation. I think that the conversation that might be had in the event of a change to an opt-out system would be not that different, but the nuance of it is easier. I think that it makes it easier for the family and so it may be easier to approach that family in that situation if organ donation becomes more of a normal thing to do rather than an exceptional thing to do. Do you mind if I ask if you have any other responses on that initial question from Bob? No, okay then, Bob. In my apologies to other witnesses for not giving you that opportunity and just coming straight in with a small supplementary, I am just wondering. Dr Robertson, do you intuitively think that based on you working with those who are waiting organ transplants, or is that what you think, based on conversations that you have had with the actual people on the ground that have to speak to those who have lost loved ones? I am just wondering where you forum that view from. That would be quite helpful. I have spoken to other doctors. I have not spoken to our transplant coordinator or our organ donation specialist nurse about it. I have spoken to other doctors because people have heard that I speak on behalf of the BMA on organ donation. Other doctors have asked me about the potential opt-out legislation. In our discussions, I have described what the new legislation would require. I have had no other doctor that has come back to me and that discussion has said that that is going to make it a more difficult conversation to have. In fact, they have said that sounds like it would be an easier conversation to have, but I have not spoken to the specialist nurses in organ donation. Are we actually saying that we have identified one of our senior hospitals? Someone who is on life support would be a good candidate for organ donation. Because this law is not in place, because that person does not carry a card, there is no discussion between the medical team and the transplant team. That discussion does not take place right now. Is that what we are saying? Yes, plenty. I am not a clinician, but my understanding is that the conversation would take place. The family would be asked if the individual opted in or if they had not made any views known, then the family would be asked if organ donation would be a possibility. My understanding is that a conversation would take place around that. It is just a question about whether the legislation—I think that Dr Cant's issue about changing a general attitude towards us and raising an expectation that that conversation would take place is a good point, but whether the legislation— The other point is just on time and relates to some of my earlier questions. A minority of our transplants are likely not to be road accidents anymore. They are older people and they are on life support. Why would it be possible in those circumstances to contact a proxy or confirm that person's point of view? The minority of cases is where the time-limiting factor would be in place. I am just wondering whether there has been a lot of presumption that the proxy might delay the process, but given that lots of transplants and the person will be on life support, it is not something that needs to be done in half an hour or two hours. I am just trying to put it in any context. Is that the case? Is it really time-limiting? Is the criticism of a proxy vote a strong argument because it is time-limiting or just the complexity or friction between the proxy and the family? In the situation that you describe where a patient is on life support and may have, for example, a life-threatening brain hemorrhage that their brain may be dying, but their body is being kept alive, you do then have more time, but what we would like to see is in all situations where there is a potential for organ donation that that can be allowed to happen and in some of those situations there will be much less time. There will be a section where there is time and there will be a section where there is no time. It does not apply right across the board. It is possible, in many instances, to have the time to reach the proxy to deal with the family in an appropriate way and spend time with them. This is not something that anybody will rush? Yes, of course. I think I have still got some questions on proxy from Mike and Rhoda. Thank you, convener. I am just wondering if I can get a bit of clarification on the need for a proxy. Just in my thinking about it, if I make the assumption that the bill passes and there is a public information campaign and people then think to themselves, perhaps for the first time, I now need to do something about this as a potential donor, so the either of the thought that I am not at all comfortable being a donor and they opt out, and that necessitates an active choice. The do nothing option is, the assumption is made that you will be a donor, and then you have this third option to appoint a proxy, and that again implies an active choice. You have to name and go through some process to name a proxy. But it occurs to me that the only scenario that that is likely to take place in is that if I wanted to be considered as a donor, but I thought there would be opposition from my family, and I want to ensure against my family blocking my wish, so I appoint a proxy. And I just wonder, first of all I would ask, you know, am I correcting my analysis, and secondly, is there perhaps a bit of a danger in looking at the Welsh situation and suggestion of a proxy, rather than just a further degree of opt-in? In other words, if I wish to put the matter beyond doubt, why has there been no consideration that I can have a positive opt-in, carry a donor card, and put the matter beyond discussion and doubt, and perhaps prevent all kinds of unnecessary and difficult discussions? That was a supplementary, and I'm going to take Rhodus, a supplementary as well, and you can deal with both at the same time, please, on proxy. Mine is not unlike that, because I believe that if someone has opted out, we've already established they don't need a proxy because that wish is taken into account, so there's no need. One imagines if they've opted in, neither do they need a proxy because they have made their own views known and that is recorded. So it seems to me that the time when a proxy is needed is when you're not on the register, which just doesn't work because you wouldn't have a proxy. I'm wondering if that could be dealt with better by encouraging people who were estranged from their next of kin to have a power of attorney. That would make that decision and indeed make other decisions. Are we maybe missing the opportunity here to say to people if your next of kin is not expressing your wishes or not around that you need to make provision on a much grander scale for what happens when you're not able to make those decisions and allow the register to speak for itself and the next of kin to speak when the register is silent? Any responses? Dr Kant? Yeah, I think that those are both very, very good points. I said initially to the net mill that I see this role as being a kin to an executor or power of attorney. So your suggestion that you actually go down the formal and established power of attorney road is potentially a very, very sensible one. I suppose what the other thing that was mentioned was almost a virtual proxy. Instead of registering and affirming your wishes with an individual person so that they couldn't be overturned by family or relatives, then what you would be doing is you'd actually perhaps be doing it within a system per se. I think both of these are very, very valid suggestions and could perhaps offer an important practical way through this. Anyone else? Nobody? Is there anybody to go back to the campaign again? Anybody got any concerns at all that a debate around this bill that focuses on proxy would actually damage the level of organ donation? I mean, I just recalled this morning that it was led on radio that this proxy, it wasn't about the autism of donation, it was about the division of overriding family wishes. Now, is there anybody of any concern at all that if this the debate around this issue and this organ donation could actually harm and reduce organ donation? Dr Canton? Yes, it is a short and simple answer. Anything which removes the focus of what we have as our ultimate aim has got to be a concern. I think that looking at this from a political and from a media point of view, this is a very juicy element of what is always a difficult and contentious issue. Coming back to what Dr Robertson said earlier, there is already often a significant amount of existing conflict within families at this very difficult time. Having a situation with a proxy would add a new agent, but it wouldn't add a new dynamic per se if the dynamic of conflict is already in existence in many cases. I think that the proxy element is an important failsafe, again going back to some of the people that Jordan mentioned earlier. There are certain elements within the community that we ought to be ensuring that they have an appropriate failsafe to make sure that their views can be respected. Now, whether that would be in a virtual sense by explicitly registering their wishes or whether it be through a proxy, I think is open to debate. However, I would very much share that concern that proxy became too much of the focus of this particular issue. Is that a concern that is shared by the panel or not? I think that we have already seen that this morning, as you mentioned, on the radio. I think that, as we said, the BMA is concerned about making this more complex than it needs to be a simple message. Yes, there is no dissent. The very patient, Dennis Roberts, thank you very much and good morning. I want to explore a wee bit of what Dr Robertson was saying earlier about family and the potential of conflict, even within a family. It is a very difficult time, because although the family may have some agreement with reference to organs, there may be some disagreement with reference to tissue. I am really referring to eyes and cornea. We have been focusing very much on the organ donation, but we have not really explored the tissue. I am just wondering if this is a difficult conversation that families do disagree with sometimes, because there may be saying yes to organs but no to tissue, or maybe vice versa sometimes. Do we have any figures at the moment that suggest that organs themselves are more likely to be donated but fewer people are signing up to, for instance, cornea donation? I do not have those figures. I could try and find them out for you, but I do not have them to hand. I am not sure whether they are available, but we could try and find them out. I think that one of the reasons that I am asking is that when we were having a discussion with families, families were saying, and one in particular said, yes, absolutely no problem with organs but never my eyes. Later, and it was a hindsight after they had met someone else, they had changed their mind. I wonder if there is any evidence, and I am just wondering if Dr Kant, through BHF, has got that type of evidence. I think that you raised a very important and telling point there, because if you look at the figures, we have such strong support for the principle of donation when we ask people in the calm of the hearing now. When we have the trauma of death is a situation where that calm reasoning inevitably comes under attack through emotion, and what you refer to there in terms of people differentiating between organs and tissues is the perfect example of where calm rational thinking perhaps succumbs to emotion. Again, that is one of the things that lends itself towards the notion of soft opt-out, because it perhaps changes the framework of conversation and thinking to move it back towards that slightly more calm and rational discussion that people will have in the hearing now, where they will express their support. If you think about the kind of scenario that families are faced with at that time, there is no worse time to try to have them seek to engage in that kind of conversation. I suppose that what we are looking to do is perhaps take some of that trauma and emotive element out of it by moving the debates further back. Anyone else? Dennis? I am just wondering if it is legislation that is required or if we need to adopt another system by which someone actually goes into hospital. Anyone who has been in hospital will have gone through an inevitable tick list, I will tell you, but whether or not one of the questions in that tick list should be, whilst you are here, if any circumstances—obviously—the death occurred maybe at that time, someone going in, it does not matter if it is for a minor procedure or not, I mean that things can go wrong periodically, but I am just wondering, should we maybe routinely, if someone is actually going into hospital, have that question asked? Therefore, that requires you have updated a register, you have got that person's either consent or not. At the time that they have been maybe admitted into hospital, should that be routinely maybe something that could be asked? The conversation is there. Dr Cant, then Dr Robertson? Yes, I think that that would absolutely be the way forward. Whether we move towards a soft opt-out or not, I think that what you described there would certainly encourage conversation on a family basis, on a societal basis, and if we did move towards a soft opt-out, I think that that would actually be a very important way of affirming the move. I remember the first time I went to the States as a 19-year-old and saw one of my friends driving licences over there and asked what that simple dot meant. That dot and that Colorado driving license indicated that they were a confirmed donor, and it was so much part and parcel. I think that what we need to be doing is looking at it in an all-encompassing fashion, trying to provoke and promote this conversation with people at every opportunity. I think that you are absolutely correct. Whether it be in terms of secondary care or whether it be a visit to the GP, I think that it is a conversation that we absolutely want to have. We are actually touching on people from as many different access points and avenues as possible. I perhaps have a slightly different spin on this. As somebody admits people to hospital as emergencies every week, most people who come into hospital, even for elective surgery, are quite frightened at that point. They are frightened of the unknown, or they are frightened that they might die, or they are frightened that something terrible will happen to them. I think that that would have to be a very carefully managed conversation if you are asking people at a very frightened and vulnerable time. What we want to do is ask people when they are not frightened, when they are not feeling vulnerable, when they are at their best, so for example the visit to the GP or when you are getting your driving licence. One of those times when you feel well and you feel that you are most robust is the time that that discussion should be had. I do not think that our society might be ready for that discussion on entrance to hospital yet. Maybe in the future we might be, but I think probably not yet, but that is a personal view and that is not to be any better. With reference to our younger people, at the moment, a young person at the age of 12 cannot have a donor card, but with the legislation that is being proposed at the moment, it is perhaps that they can still go for the donor card, but their wishes at the moment in the legislation would not be absolutely upheld, would they? I can offer a comment on the 12 to 15-year-olds in terms of what young people said to us, and that was that the option should remain for them to choose to opt in. That was 85% of the young people that we spoke to said that between 12 to 15, the option should remain for them to be able to opt in to that process if they choose. However, again, the majority believed that 16 is an appropriate age to be considered an adult for the purposes of organ donation. So, would you be supporting with the soft-out option that you can still opt in at all occasions at any time on a register? In terms of 12 to 15-year-olds, as I said, the young people that we consulted with said quite clearly 85% that they think that the option should remain for them to be able to opt in between 12 to 15. I think that I am looking at all age groups still being able to opt in. Or does that complicate things? I do not fully understand your question. I am saying basically should the opt-in still be available at all times, even if we go down the soft-out option here, that people can still register to opt in, well, basically still carry a donor card, because they want to have that sort of facility to try and ensure that their wishes are going to be adhered to. So people may still carry a donor card or could be on a driving licence or whatever, as Dr Kent suggested, the Colorado method. I am just wondering, do we need more than one system? Sorry, I understand now. In terms of the questions that we asked, that was not a question that we asked young people, but I think speaking from a young person's perspective, I certainly think that that would be a very helpful idea to have a dot or such on my driver's licence. I wouldn't be opposed to that as a young person myself. I think that's actually quite a good suggestion. Dr Kent. Speaking as a former young person, I actually think it's something that's really quite special and significant about our system just now, where we do allow really young people to make an affirmative statement on what they would like and what their wishes would be. I think it's empowering and I think it enables our young people from a very, very young age to demonstrate something about what they see as being their role and potential in society, even in the event of their death. So I would be loath to see that lost in any new system. Dr Roberts. I think that it also helps the parents in that situation too, because parents will say to you when they've lost a child that they knew that their child wished to donate their organs, and so they followed on their wishes, even though they found it really hard to do at the time. And I certainly haven't spoken to any parent who regrets that and they hold that very dear in that situation. It draws us again, although to the importance to when the conversation takes place, doesn't it? Because 94 Scots, according to the British Heart Foundation, say they support the principle of donation, yet only 41 per cent of them register. And if everybody who is registered went on to donate, that doesn't happen either. So I suppose even when you are a confirmed donor, this is what we are discussing here, how do we ensure that those confirmed donors are able to express their wishes through donation? I wonder how much of that would increase the donations that we have and the organs that we have available, and to what extent organ donation reflects refusal by the family? Or is it more important that doctors' clinicians are identifying donors right at the start of this process, would give us more donors at the end of the day, rather than any of these other measures? I think there is no doubt about it that we are getting better at identifying donors, but we are still losing some potential organs for transplantation because donors have not been identified. And we are working on that, and that work needs to continue. No matter what happens with the legislation, that work to improve the donation rate from suitable organ donors needs to continue. So I don't think that it's an either-or, but we still think that in order to try and improve the donation rates further, the soft opt-out system would add more organs for donation. But you can't tell me how many more. How many do we lose through family refusal? And we've spoken quite a bit about family refusal in that discussion. How many do we lose as compared to the focus on what organs are available? How are we identifying those organs? How are we ensuring that we can get those organs used? I'm just trying to get the focus here about that. Doctor Carrant? I'm afraid that I can't give you an exact or even a general figure as to how much of an increase we could have. What's concerning is the rate of family refusal. The figures that I have for 2014-15 were that 46 per cent of families refused donation because they didn't know what their relatives wishes were. What's also concerning is that during 2014-15 we saw a 7.7 per cent decrease in family authorisation. So the conversations are not taking place and the rate of family refusal is actually on the increase at this point in time. And it goes back to the point that I made earlier. I think the single most important thing that this legislation could do would be to change the framework to have the default position that there would be an assumption that people had opted into the system because otherwise we're relying upon conversations that aren't taking place currently or conversations that do take place in the calm of the here and now but which then don't translate into actions when we actually have the death of the person themselves. I'm not understanding that because we have confirmed the nations. You've just told us that people who have expressed a wish at the family refusal rate, you know, could be up to 46 per cent. So, you know, family refusal, what was the figure? No, what I said was that family refusal, it said that 46 per cent refused organ donation because they weren't aware of their relatives wishes. But there's only one conversation, ultimately, even if they expressed a wish, they signed a donor's card, they had a discussion, we've spoken about proxies to all of that. The important discussion is not around, you know, the dinner table, some Saturday night, whatever people have these conversations. The conversation is at that point in a clinical situation, at the point of death, irrespective of whether a person has expressed a donation, signed a donor's card or expressed a wish in the past, we've all conceded that the family will make the decision at that point. How does this legislation change all of that? How does it get as more organs? For me, it changes the dynamic of the conversation, it changes the dynamic of the system and it changes the expectation within Scottish society. It will not, on its own, be something that solves the problem here. It's something that has to take place on a multifaceted basis. It has to have a significant amount of public information that goes with it. I think that the fact that the legislation exists at all will in itself provoke a significant amount of public discussion. Controversy, as we've conceded, which we've produced. We are all in this room wishing to see an increased level of organ donation. We're just trying to examine whether the legislative process is a way to do it, if the family refusal rates are the problem or whether it's a conversation that takes place, or indeed, if practice was changed to identify as soon as possible in the system those potential donors and support that organisationally to ensure increased organs were available for organ donation. It's just a focus where, what would give us greatest benefit? I think that the one thing that we can absolutely guarantee is that what will increase will be controversy because this is such an emotive subject. It will always generate significant passion on both sides. In terms of the BHF evidence and policy position, on the balance of what we've seen in terms of international studies, it's our position that what we require is a multifaceted approach and soft opt-out is an integral part of that. Okay, I think I've got three bits and then we're going to, given time, we're going to wrap up at that, haven't we? A Bob and then Dennis has one, another quick question. Roda, is anyone else? Thank you. A couple of questions on maybe just stick with one at the moment of first time and then a last other one to my colleagues also want in. It's also worth saying that this feels a little bit like a Poisoned Chalice. I didn't catch radio this morning where there was a focus on proxy rather than the commitment. We all have to increase more organs to save lives or to improve the quality of lives, but the reality is that this committee has got the duty to thoroughly scrutinise robustly every aspect of this piece of legislation or do more job properly, but that feels a little bit like a Poisoned Chalice in doing that. So I wasn't obsessing about proxy, neither am I obsessing about authorised investigating persons, but I am about to ask questions on it because that's my job as a committee member, so it's worth pointing that out. So I'm interested in your view to know about who the authorised investigating persons should be because there might be a little lack of clarity in the bill in relation to who that person should be. It would appear that it wouldn't necessarily be the nurse specialist or the medic on the ground who would be having that conversation, but it would have a duty and obligation in law if the bill was passed to seek to identify and locate the proxy, if one existed, to seek and identify the next of kin and to make sure that all due process had been followed in an appropriate manner. Although not all organisations are time sensitive, they will appreciate again why I'd ask about whether that could lead to undue delays. I suppose that it would be reasonable to ask whether or not, as soon as you put something on a legal framework like that as well, whether there's a potential that people take a precautionary principle. For whatever reason, if there was a lack of clarity during that process, that the authorised investigating persons were going through that they would say, no, don't take these organs and could that be an unintended consequence? I'm not saying that it will be, but these are concerns that have been raised, so I'm just wondering in relation to where who the authorised investigating persons should be, what their role should be, whether that would be burdensome or whether putting it on a legal framework could create some unintended consequences. Any response? Dr Cameron, testing your vote to destruction, your voice to destruction? You certainly are. I can give you a limited response. In terms of BHF, we see specialist nurses as playing an absolutely vital role in this. I think you make an incredibly important point in terms of the balance between ensuring that anybody who's designated to fulfil this role feels legally and morally protected, but at the same time we have an efficient and timely process. That's a balance and I don't think it will be easy to achieve, but it's absolutely vital. As an organisation, we would actually look to NHS Scotland and colleagues working there for their expertise and how best to move this forward. We think they would be the best place to advise on this. Okay. Lindsay Patterson? I think that Dr Cairns raised some important points there. At the moment, we don't know specifically who would be responsible in this regard, because that will be set out in regulations. However, much of the role is outlined, particularly the investigative tasks that fall to the specialist nurse in organ donation. I suppose that theories would come up in terms of whether an additional burden is legal responsibility, what additional pressures would be involved with becoming the authorised investigating person, particularly in terms of the legal authorisation. I think that's where there may be some queries from that aspect. Dr Robinson? Whilst the BMA could see a clear advantage of having people in this role, it would need to be something that would be very carefully thought through. You would need to work out how many people you needed in these roles. Some of the roles are those of the specialist nurse in organ donation. The obvious people to do some of these roles would be those specialist nurses. However, to have an overarching legal requirement, it may be something that they are not at present fully skilled and appropriately trained to do. However, they would be the obvious people initially on the ground. You would have to make sure that whoever was doing this job, there was availability at any moment in any day of the week. That would need to be properly resourced, and they would need to be properly trained. It is an extra requirement that will require resource. What does the transplant team do? Do they not do that? I can see a role for the specialist nurses, but I also see that there is a clinical role to establish a point of debt, whatever. There might be the fiscal and the young death, there might be a violent death, and there might be all sorts of other things that would require a doctor rather than a nurse. I can see the softer role for communication, but I am just wondering what the transplant team do in all of this. You described the doctor who is trying to save the life. At some point, that is no longer viable. Somebody needs to come in and assess whether those organs are viable, the potential of that donor, there might be legal requirements, you need to be aware of that. Who does that now? At present, the transplant team do that. However, as described, it sounds as if there is a possibility of somebody who then makes a decision that the transplant team have done their job appropriately. I am not sure whether I have got the meaning of that slightly wrong. The transplant team are regulated, we are all covered by our, for example, the general medical council, the general nursing council regulations, so we all work within a legal framework. The transplant team are very careful to have due process, because they know that this is such a difficult issue. Whether you would need somebody extra as well as the transplant team, or whether you could designate the transplant team member as this person, that might certainly be a possibility, I think. I have got another copy of, who have I got on my list? It is Dennis, firstly, Rhoda, and then supplementary that one, okay. What I was going to ask is, is there a need for such a post? Given that, okay, this is new legislation, but the common law already exists, so if there was an issue about the legality now, it would be tested through the courts under the common law. I am wondering if this post is required, because the donor team would surely be looking at all those aspects as part of their day-to-day work. I see nods and agreement there. Yes, Dr Robertson. As I said in my answer to Mr Torres, I think that the transplant team do this job anyway, and I do not know if you need another person, another layer, but I am not a lawyer. Okay, okay. Dennis. Thank you, convener. We have already heard a few times today that the conversation is a very difficult one, and we know that there are team specialist nurses and donor coordinators. Are we aware of how many families say that they are prepared or accept the fact that donations are there because a loved one has expressed that wish? During the conversation with the specialist nurse or coordinator, when specific questions are being asked, which are extremely sensitive, are we aware of how many people walk away from that and say, no, I have changed my mind? It gets into the realms of extremely personal and difficult questions. Is it a situation that we need to try to ensure that that type of question—because you are probably aware of them—that people should be made aware of that at a much earlier stage when people actually sign up so that there is information out there? Because it does hit people like a brick wall when you are asked these questions by the coordinator just after a loved one has died, whether it be a child or a parent or a sibling or whatever. Dr Kant. I think that it is a really important point that you made there, Mr Robertson. I do not know that such statistics exist. Given the nature, it would be something that would be difficult to assess, but I think that the dynamic that you describe absolutely exists. I think that in many cases it can be a practical barrier to the process of gaining parental agreement. I think that the questions would be intrusive for many parents at any point in time, but given the particular traumatic situation that they find themselves in, that must just accentuate the case. Not just parents, but any loved one or wherever. It could be a husband, wife or whatever. It is quite intrusive. I am just saying that you think that people should be made aware that those are the type of questions that could be asked before they make decisions. Yes, I agree. We have an area in which we have not covered—could you cover that, Bob, in terms of capacity? Yes. We are just trying to make sure that we cover the full range of issues with the bill. There are issues in relation to adults with incapacity, so it would appear from the way that the bill is currently drafted that it would prevent a welfare attorney from either appointing or withdrawing the appointment of a proxy or objecting to removal of adult organs. A few submissions have raised concerns with that. I think that the General Medical Council and the Scottish Government have raised concerns that, effectively, the individual—of course, the adult with incapacity—could not opt out, but also that their appointed guardian would not have a legal basis for objecting to this also. I am just wondering in terms of getting the balance of rights. Correcting relation to any soft opt-out system of this would turn for a certain group of vulnerable people. It is not an opt-out system at all, and others are locked into that process, and if that is something that you have given consideration to. That is fine. We will have an opportunity to ask others. A brief comment, convener, would be that the caveat for us—I think about vulnerable young people who may have learning difficulties and disabilities—comes back to information again. If this legislation was to continue, it is absolutely essential that appropriate materials and an appropriate campaign with information are to allow young people who are vulnerable to make an empowered and informed decision. I think that that is the only thing that I can say on that. That was certainly a message that young people shared with us in the suffering. I think that the committee members now have completed their questioning. I invite Anne McTarget, MSP, member for the bill to ask some questions now. Well, thank you, convener, and thank you, members of the committee. I have got a few wee points. Convener, is that okay? Can I just race through them? Yes. You have got the three minutes. As long as that. Obviously, from the outset, the Scottish Government and I share the same ambition. Obviously, that is to increase more donors, more transplants and obviously to save more lives. Someone had raised the question earlier about, is this bill necessary, is this legislation necessary? Absolutely, yes, it is necessary. Otherwise, I most certainly wouldn't be sitting here putting myself through this and putting others through this. We do need to increase transplantation. It is not work today. Whatever we are doing is not working. The Scottish Government's transplantation plan 2020, we have fully backed that. The Government has done so well in trying to increase the transplantation. However, as I am sure that it was Dr Kant had mentioned, it fell by almost 7.5 per cent last year and that makes Scotland the worst performing in the UK. I am not happy with that figure and neither would many around this table. The deceased donor transplants in Scotland also fell by 13 per cent last year. However, the most worrying figure is that the first quarter figures for this year show that we are heading for an even bigger decrease in deceased donor rates of 10 per cent. Convener, what more do I say? I have loads more to say. However, international evidence has proven that someone had mentioned earlier about whether the bill is necessary. How do we know that it is going to work? We know that it is going to work because what has been done today has not worked. What will be done is that we have looked at international evidence and they have seen an increase between 25 per cent and 30 per cent. We do not have to circle around the world. We have used the basis of the Welsh Government's bill that is going to go in operation as of 1 December, as people will be well aware. They have also used international evidence. We have to do something different. Whatever we are doing just now is not working. International evidence shows us that 25 per cent to 30 per cent increase will happen if we move to a soft opt system. No, I cannot even say it now, convener. Is that three minutes? You have still got me. Yes, that was for the introductory remarks but you need to get to some questions. I will. Also, just really in the evidence that you have taken as well, the 856, they have given it, yes, 85.28 per cent of them believe that the bill will lead to an increase. Some of the other questions, I know, I will get around to you. The new pressures on the snods, could I ask again the panel members, the NHSBT have written evidence and have specifically said, can I explicitly ask for the panel members to explain what the snods currently do and what the NHSBT currently do? Okay. Can we have any response to that question? No. Can you inform me what a snod— Oh, sorry, sorry, sorry, sorry. A senior—oh, sorry, sorry, convener. That's entirely my fault. I'm up to hearing back with the Organtination Bill. It's a senior nurse of Organtination and the Claude's Art is a clinical lead in Organtination. Sorry, that's my apologies. I can't give you the full details of what the specialist nurse in Organtination does, but they are an integral part of the transplant team at every stage. A referring unit will refer to them directly and then they will come to that unit and they will co-ordinate everything from there on. So they're a very highly skilled group who have a lot of different skills to your standard nurse. They're very good at speaking to relatives and that's why that relative refusal rate is so disappointing and I'm sure to them incredibly disappointing. But they do a huge amount behind the scenes just making everything happen as it should happen in a timely fashion. If you wanted to know more about what they did, we could either interview one of them for you or we could get them to write their job description so that you know exactly what they do. They have an integral part at every level. We'll be taking some evidence on that anyway. Is there any other response to that initial question? Controversy was mentioned earlier. Can I ask the panel members and in particular the Scottish Youth Parliament member controversy. We've had bills go through here before and can I ask should we shy away from something that we think just now is controversial and can you think of any other bill or legislation that people may well have thought of as controversial at the time but now have changed their mind and it's as a good thing that it's now changed? Thanks very much for your question Ann. It's a nice non-technical question and snods and clods and all the various acronyms. I think there's two things in that two bills to be the legislation that may have been perceived to be controversial both of which I'm proud to say that the Scottish Youth Parliament grabbed and campaigned on one would be the equal marriage campaign when we launched our love equally campaign just over the back at the Scottish Parliament called for the consultation to come quicker. In fact consultation came much quicker and then obviously we have legislation and then obviously votes at 16 as well. Obviously this parliament unanimously voted for votes at 16 but it still remains an issue that we're continuing to fight the cause for at Westminster as well so that we can see young people casting their vote in all elections so that's two pieces of legislation on the more general point of campaigning on issues that are controversial is somebody who chairs the Scottish Youth Parliament who doesn't shy away from controversial subjects and I'd say absolutely not if it's controversial then I think it's important to ask why it's controversial and if it's because it causes conversation and I think that's a wholly good thing and I think it's conversation as colleagues on the panel have said already conversations are just a starting point to making a difference here in here in Scotland on that issue. Yes Ann. Thanks convener and another one of my questions is I've been taking notes from and I can hardly read them now so you'll have to bear with me a different type of conversation the culture the time there was a lot of time spent on on the proxies can I just say at this point convener this this bill is not the Ann McTaggart bill it will be the Scottish Parliament's bill and it will be for every member of this Scottish Parliament to be part of that and it is open for conversation just like we talk about conversations around families and through the issue of organ donation this will be a conversation and I think everyone should have a right to discuss what's within this bill for to make it the best bill ever possible for people. We do have the time limiting for the proxies somebody had mentioned earlier can I ask and it was Dr Robertson I'm sure what what evidence from the doctors can you reiterate some of the evidence that you've had from doctors what the difference may well be if they are going to have a conversation with a member that you definitely know does and it's actually secures their place on the register if they've definitely opted out there that would be happening or you know what is the conversations and how is that felt for the doctors whenever they do go to speak to families if the relative or the deceased one is on the register or off the register can you expand on that excuse me well at the moment the way the register works is you can you can register to give your organs in the event of your death but as we know although nine and ten people say they would wish to do that only four and ten have their names on the register for many different reasons so there's a big gap there in people who would like to give their organs but haven't registered the advantage of the opt out system is that if you don't want to give your organs you register that and your family aren't even approached so the people who don't wish to give their organs have their views respected in the event of their death and then we approach the family in a slightly different it's a different nuance to ask whether they were aware of any objections that hadn't been registered so I think that it makes it a less difficult conversation to have with that family in the event in that very stressful time and I think that it it's more likely to allow you to respect the wishes of that person who has died okay thank you convener and really that's ultimately what we all want from from this bill is for it to be an easier process for the families of the deceased persons and obviously to enable more organs to be donated okay that concludes this evidence session thank you all for your attendance and the evidence both oral and written thank you very much indeed we're going to suspend at this point we've got a very very short private session