 1. Alex Cole-Hamilton To ask the Scottish Government what action it is taking to ensure that NHS staff feel able to raise concerns about the service. All staff should have the confidence to speak up and know that their whistleblowing concerns will be treated seriously and investigated properly. NHS Scotland already has robust whistleblowing procedures in place, and we have continued in recent years to put in place additional supporting measures such as the national confidential alert line and non-executive board whistleblowing champions. Work is under way to establish an independent national whistleblowing officer for NHS Scotland, which will complement our existing policies and provide an independent and external level of review on the handling of whistleblowing cases. This will further contribute to better patient safety and also encourage an open and honest reporting culture. Alex Cole-Hamilton I thank the cabinet secretary for her answer. Year on year, the NHS staff survey has found that up to a quarter of staff don't think it's safe to speak up or challenge the way things are done if they have concerns about quality, negligence or wrongdoing. If they don't feel that they will be taken seriously or that their issues matter, that will have a severe impact on their morale. We have seen in other public services, most notably in Police Scotland, how damaging that can be. If staff knew that the confidential alert line, which the cabinet secretary describes, was a permanent fixture and not just funded on a rolling 12-month basis, does the cabinet secretary not believe that they would be more willing to use it? Alex Cole-Hamilton I agree with Alex Cole-Hamilton that the staff survey is an important way of us hearing from staff on the front line, their views and concerns. It is important that we act upon them. The current alert line provides a good service that doesn't just stand alone. It complements a range of whistleblowing mechanisms that have been developed in partnership. I outlined some of that in my earlier answer. We want to take further action, which is why we are working on the plans for the INO, which we are looking at the legislation at the moment developing that, that will provide further reassurance to staff. The independent national whistleblowing officer will have an important role in ensuring that, in addition to the whistleblowing procedures that are already in place, that that adds more robustness to the process. In terms of the funding, I am committed to ensuring that the alert line continues. We will want to ensure that it continues to meet the needs of staff. That may mean that it will develop over time, but it does not provide an important function. I hope that I can give the assurance to the member that I am certainly committed to its continuation. I am grateful to the cabinet secretary for that assurance. The chief executive of NHS Scotland, Paul Gray, said that staff wanting to raise issues have not done so. They fear the consequences or believe that it will be pointless because concerns will not be acted on. We cannot afford for that to be even the perception of such a corrosive culture within our NHS. Staff need to feel reassured that they are part of a listening transparent health service. One campaigner has called for a root and branch review of how the NHS reacts to justifiable criticism. Is this something that the Scottish Government has considered, given how much it appears to have already learned from the freedom to speak up review that occurred in England? I thought that Paul Gray was right to give a frank interview. He said that we have a number of mechanisms in place, with the alert line and very clear policies at a local level, working in partnership with the unions that are about providing a range of ways that staff can give their view. Sometimes, that would potentially involve issues with a line manager. Therefore, there are procedures in place that staff can report concerns outwith the line management structure. If we thought enough had been done, we would not be working to establish an independent national whistleblowing officer for Scotland. That, as I said earlier, will complement the existing policies and provide an independent and external level of review on the handling of whistleblowing cases. That will add another important dimension. However, if there is more that we can do to help to contribute towards a more honest and open reporting culture, we will look at what more can be done. It is very important that staff feel able to give their views and to raise any concerns—not least, it can be very important from a patient safety perspective. Ben Macpherson, to ask the Scottish Government what steps it is taking to ensure that there is an independent and external review system in place for the handling of whistleblowing cases in Scotland. As I said earlier, work is under way to establish an independent national whistleblowing officer that will provide a complementary service to existing policies and provide that important, independent and external review on the handling of whistleblowing cases. We have considered the range of views that are expressed in the consultation. We want to continue to work with our partners to make sure that staff are protected when raising concerns. As I said earlier, we want to encourage an open and honest reporting culture. It is clear from Paul Gray's statement that NHS staff still feel unable to speak up about concerns. What is the Scottish Government's position in relation to confidentiality clauses in staff contracts that may also be preventing employees speaking up in public? We have done a lot of work around confidentiality clauses. We have made it very clear to boards that they should only be used in very exceptional circumstances. If you look at the change of the use of confidentiality clauses over the years, there are far, far fewer now used. A lot of work was done when issues were raised previously and concerns were raised about the use of confidentiality clauses. That is something that I will continue to keep an eye on, and I am very happy to keep Donald Cameron informed. If he wants an update, I will, with some detail on that, and I am certainly happy to write to him. I thank Paul Gray for his intervention yesterday. I thought that it was very brave and honest intervention from him. I hope that he gets the understanding of the health secretary rather than the wrath of the health secretary as a result. The reality is that increased vacancies in our health service and cuts in our health service are only adding extra pressure to our already overstretched NHS staff—1 in 20 at any one time being on sick leave. Surely that would not be acceptable if that was the ratio in our Parliament, so it should not be acceptable in our health service. The NHS staff have a duty of care on patients. I believe that us as parliamentarians have a duty of care on NHS staff. What additional steps will the health secretary take to post Paul Gray's intervention yesterday? I think that any fair person listening to the answers that I gave earlier, if Anna Sarwar had been listening, I would have actually agreed that Paul Gray was quite right to put on the record his concerns. Rather than trustising or giving him my wrath, I support what he has said. Anna Sarwar perhaps should listen more carefully to the answers given. In what Paul Gray has said, in his position of leadership and in my position of leadership, I think that he has made it very clear that we take very seriously any staff members' views or concerns and how they are able to articulate it. That is why, over the course of the last few months and years, a whole range of opportunities have been put in place that enable staff to raise concerns, whether that is through the alert line or anonymously, or whether it is through the structures that are in our boards. All that has been done in partnership with the unions and we will continue to work in partnership with them. If we thought that, though enough had been done, we would not be moving towards establishing an independent national whistleblowing officer. That has been taken forward after consultation about the best way to do that. If there are any further mechanisms that we can do to develop, improve and open and transparent culture, we will do so. In relation to what Anna Sarwar said about vacancies, we have record levels of staff in our NHS and 11,000 additional staff in our NHS. Because we have more posts, sometimes that means that we have higher levels of vacancies because some of those posts are more challenging to fill. However, in paying tribute to every single person who works in our NHS and care services, as far as I am concerned, as Cabinet Secretary for Health and Wellbeing, I will do what I can to ensure that we develop an open and transparent culture, as Paul Gray will do in his leadership position. To ask the Scottish Government what powers it anticipates that independent national whistleblowing officer has, and when will it be introduced? We will use the findings of the analysis to further inform and refine proposals to ensure that the independent national whistleblowing officer is equipped to carry out the role effectively. We are clear that the INO should have the ability to provide independent challenge and oversight and should have the powers and functions that enable it to do so. We will introduce legislation to bring the role and functions into effect. That will complement policies already in place, as I said earlier, to promote support and encourage whistleblowing and further develop that important open and honest reporting culture in NHS Scotland. Of course, as that legislation goes through Parliament, all members from all sides of the House will have the ability to input into the passage of that legislation. Thank you, cabinet secretary, and that concludes topical questions.