 The next item of business is a statement from Humza Yousaf on NHS Endowment funds. The cabinet secretary will take questions on his statement afterwards, so there should be no interventions or interruptions. I call on the cabinet secretary around 10 minutes, please. Thank you very much, Deputy Presiding Officer. I am grateful for the opportunity to provide an update to members on the independent review of governance of NHS Endowment funds in 2019. The then cabinet secretary for health and sport commissioned the review to consider and provide recommendations on changes that could be enacted to strengthen governance arrangements for NHS Endowment funds. The review is being published today, and in my statement I will summarise the key findings and recommendations, alongside our next steps. Before I do, it is important to provide some context in the need for the review and for the resulting recommendations. In terms of background, members will be aware that NHS Endowment funds are charities. There are 16 such NHS-linked charities in Scotland, each registered with Oscar, the charity regulator. The underlying legislation is contained within the NHS Scotland Act 1978. That gives power to a health board to, and I quote, to accept, hold and administer any property on trust for the purposes relating to any service that is in their function to make arrangements for administer or provide or to their function with respect to research. Each charity is therefore a trust, and in line with the 1978 act, the charity trustee of each NHS-linked charity is the related NHS board, acting as a single corporate trustee. That means that board members of the NHS board also act as trustees of the related charity. The decision to commission the review, as members will remember, was prompted by a report from Oscar in February 2019 following the inquiry on the use of endowment funds by NHS Tayside. Oscar found that, while charitable assets were used only for the purposes of the charity, which are the same as those of the health board, there was inadequate separation of the interests of the charity and of the NHS board in decision making. Oscar considered that an issue inherent in the structure of the charity with health boards as corporate trustees and recommended a review of the governance arrangements of the endowment funds and also of the 1978 act in that respect. Before I turn to the findings and recommendations of the review, let me place on record my sincere thanks to the chair, Julie Hutchinson, to the project team, to the reference group and the specialist subgroups, and to all those who are involved in the time and care that has gone into the review. I would also like to pick up on the point that was made by the chair of the review, more of a reflection rather than a recommendation. In her words, the report shines a light on a particular group of charities in Scotland that deserve to be better known. That is reflected in comments from one donor who observed that people may not know that they can raise and donate funds to their local NHS charity and that beneficiaries may not know that charitable funds have provided something from which they have benefited. That review considers governance arrangements and, in doing so, it highlights the importance of the work of those charities and provides us with very helpful recommendations to support that work in the future. I turn to the findings and recommendations. The review found, as did Oscar, that an inherent conflict of interest exists in the structure of the funds. First and foremost, that is seen in the dual role of NHS board members who are also officers of the corporate trustee of the related NHS charity. In those dual roles, they are required to make decisions both on how to direct charitable funds and on managing board finances in order to deliver the required services and to meet the statutory requirement of financial break-even at year end. Let me be clear that it was not the finding of Oscar or, indeed, of the review that there was widespread issues in the decisions that were made on use of charitable funds. Rather, it is the case, as reflected in their findings, that the current situation puts health boards in a difficult position and open to criticism when making spending decisions on behalf of NHS charities. It is also the case that, under the current legislation, the statutory purpose of the health board and the related charity are the same. As a result, the same item of expenditure could, validly, be incurred by the health board or by the related NHS charity. Although there is no legal requirement to do so, to address that overlap, health boards have established practices to separate out core spending and non-core spending. Those items are to be publicly funded by the health board and enhancements to be funded by linked charities. However, there is no legally binding governing document for those NHS charities. There is a lack of separation between the health boards and related NHS charities that need to be addressed. The review makes a number of recommendations, 28 in total, to do that and to improve the overall governance arrangements of those NHS charities. The most significant of the recommendations is replacing the existing corporate trustee with a charitable board that would compromise an independent chair and a majority of independent members. That means that a chair and a majority of members are not drawn from the executive or non-executive membership of the related NHS board. The review also recommends publicly available legally governing documents for each endowment fund and the introduction of limited liability for board members of endowment funds. It makes further recommendations on recruitment and training of trustees and on communication, including on-going interactions between the health board and the charity. I turn to our response to those recommendations and to the review and how we will take forward the recommendations in the review. I accept the recommendations of the review absolutely in principle, but there is some work to be done on precisely how we take forward those recommendations to ensure appropriate consultation, to ensure no unintended consequences of course and to support our NHS boards through implementation. The legislation governing the NHS charities dates back to the 1970s as the review rightly sets out times have moved on and so must we. There are significant sums held in those funds and it is not just the money that we must protect, but of course the intent behind those funds. Since the establishment, many people have donated to those funds. Often friends and family members of loved ones who have received care from the related health board or, indeed, the recipients of that care themselves. They have donated in order to give back to support the people and services that supported them in their hour of need and to improve the experience for others in the future. That has never been more true than now with unprecedented levels of donations to NHS charities seen throughout the course of the pandemic. As the chair of the review reflects, those charities are uniquely placed to play a creative and much-needed role in supporting how we cope and recover from Covid-19. Trustees are required to consider the interests of the charities separately and distinctly from those of the health board. I fully accept that we need to ensure that structures and governance arrangements safeguard our endowment funds and support those responsible to act in the best interests in the charities at all times. I also accept that the current legislation simply does not adequately provide for this and that taking forward the recommendations from the review to separate the people and the purpose of the charity would address the inherent conflict of interest that I have spoken about extensively in this statement. As the review sets out, the creation of an independent board would provide trustees whose focus is no longer split between the health board and the charity and allow the charity to shape its own strategy, linked yet separate to that of the health board. Fully adopting the recommendations will require legislative change and it will first require the precise mechanisms for that change to be determined. It will also involve significant work for our health boards. That will not necessarily be the quickest process, but we will ensure that it moves forward with pace. It will require consultation with stakeholders, including Oskar, NHS boards and those who donate to our NHS charities. It will also require support for our NHS boards in taking forward this change when it comes. Deputy Presiding Officer, while changes will take time, I want to emphasise to members today my commitment to improving the governance structures and frameworks for our NHS charities. I will urgently explore what can be done now before legislation is passed by this Parliament and what more can be done at this stage to improve governance and accountability on these important matters. That is a commitment that is shared and that we will progress with our NHS boards and with Oskar. The cabinet secretary will now take questions on the issues that are raised in his statement. I intend to allow around 20 minutes for questions after which we will move to the next item of business. It would be helpful if members who wish to ask a question could press their request-to-speak buttons now as soon as possible or place an R in the chat function if they are joining us online. I call Craig Hoy. Mr Hoy, just a second, your microphone does not seem to be on. Thank you, Deputy Presiding Officer. I thank the cabinet secretary for advance sight of his statement. We welcomed the publication of this review today. The review was first announced in 2019, with the aim of looking into how health boards use funds donated to NHS endowments following a scandal at NHS Tayside the year before. To quote the statement, there are significant sums held in those funds. It is not just the money that we must protect but the intent behind those funds. Given that, can the cabinet secretary give us concrete assurances that all accounts of the charities will be made public, including income and detailed expenditures? Going forward, will he guarantee that any changes to NHS board endowments will have transparency at their heart? That is a very fair question from Craig Hoy. I hope that, in relation to my statement, I was able to give some details of what boards are doing right now and just to emphasise that there are a few safeguards. One is that all trustees are required to act in the best interests of the charity. They are also required to publish an annual report and accounts, and within that set out spending plans and future strategy. Those are publicly available, and they are open to scrutiny. Given how much interest there is in that, I will certainly impress upon the chairs and chief executives of boards when I meet them and I meet them very regularly and when I meet them next. Just how important it is that, if there are any changes made in advance of legislation, then those are communicated publicly. I think that that is a reasonable expectation. I thank the cabinet secretary for advance sight of the statement. Today's statement should be welcomed and Scottish Labour will take time to consider the range of recommendations made in today's report. The cabinet secretary rightly states that this process will not be a quick one, but could he advise the chamber when he expects to have completed consultations with relevant stakeholders and have brought draft legislation to the chamber? Indeed, will he give more detail on who he expects to consult as part of the process? Will it include patients and members of patients' families and those with a genuine interest in making the NHS trust work on behalf of local communities? Answer to Karen Watkins' last question absolutely, consultation should be with donors, with patients, with the families of patients, as well as with the NHS boards themselves. On her first and substantial question, I could not give her a date today, it would be wrong for me to suggest that I could. She used the phrase that when could she expect the Government to bring forward draft legislation? It might be that we are able to make the changes that we are looking to make with other legislation that we are considering, such as the reforms to charity law that we are considering already as a Government. It might be that we are able to make that change. I could not say for an absolute sure at this stage, so it might be that we are able to do that. If we are, that speeds up the process if we are able to have the relevant consultation in advance of that legislation. What I can promise, Ms Watkins, is that we will do that as quickly as we possibly can, because I understand just how important an issue that this is for all those concerned. Stuart McMillan joins us remotely. Thank you, Presiding Officer. Following on from Kate Hoy's question, can the cabinet secretary outline how taking forward a statutory corporation route for endowment funds would actually stop the repeat of the issues with the Tayside fund? Forgive me, I could not quite hear Stuart McMillan entirely, but I think that he was asking about the statutory corporation, which is one of the recommendations of the review. In that respect, yes, I think that it would help with the issues, particularly around conflict of interest. That is actually one of the areas that I wish to take a bit of time to see whether that is one of the recommendations that we can take forward, but could we take it forward or achieve the outcomes of that recommendation through another route? For example, could it be that the new NHS charity boards are set up as skills, for example, as opposed to the SLA statutory corporation? There are pluses and benefits of both routes, but ultimately, at its absolute core, what that recommendation does is help us in relation to that inherent conflict of interest that I expressed in my opening remarks. Thank you, Deputy Presiding Officer. Until recently, I was actually on the board of NHS Grampians. I have seen, first-hand, the amount of valuable work done by the endowment funds. Does the cabinet secretary have any estimates on how much the changes and icturable costs the endowment funds, which will, of course, mean less for the charity to spend on patients and staff? I am thinking that would the chair and board members be paid, for example? Also, thinking about new members of staff that may be going on to work for the charity, would they be included in the NHS terms and conditions, for example? Cabinet Secretary. Douglas Lumson is right to raise all of those issues, and that is why we have to take a bit of time to work through them. I would not want any NHS endowment fund to be reduced because of the changes that we are making. Therefore, as a Government, we will look to see how we can absorb those costs and make sure that funding is given to health boards to be able to absorb those costs, as opposed to having to take those costs out of endowment funds. That is not why people are given to endowment funds and NHS endowment funds. I think that that is a very reasonable point. However, in terms of the second part of Douglas Lumson's questions, I could not, at this stage, give him absolute definitive answers, but that is exactly why we want to consult with all the relevant stakeholders. Michelle Thomson, to be followed by Paul O'Kane. Serious governance flaws stem back to 1978 and the UK Government legislation of that time that enshrined the conflict of interest. I note the comments from the cabinet secretary that fully adopting the recommendation could require legislative change and it will first require the precise mechanism for that change to be determined. A couple of questions, can he give any further guidance on that further legislation and perhaps challenges around it? Furthermore, is he issuing some interim guidance just now to boards regarding that conflict of interest, or is he relying on the OSCR report? I think that they are both very important questions. On the first part of my question, I will not repeat or rehearse what I said to Carol Mocken, but we will look to see if there is any other legislative avenue that we can possibly use to move this forward at pace, as opposed to introduce completely separate primary legislation. On the second part of my question, it should be said that, since those issues were first surfaced in relation to NHS Tayside, it would be absolutely the case that NHS boards have looked at their own governance processes and accountability processes and have made positive changes. It is also important to note—I am sure that no member has that impression, but it is really important to note from the OSCR report that initially the NHS Tayside issue was not widespread issues with the conduct of trustees. The picture that has emerged from our analysis is generally positive and encouraging, and I hope that that will reassure existing and potential supporters of the charities. By and large, the NHS Endowment Charity in Scotland has appropriate charters, operating instructions, policies and terms of references in place. Those documents exist. Of course, where they need updated, on the back of the review, my expectation would be that NHS chairs and boards would look thoroughly at the review and make the appropriate changes, if necessary. Public confidence in NHS charities is vitally important, and we must learn the lessons of what happened at NHS Tayside. I recognise that the review by Julie Hutchison is a key part of this. I am sure that we were all inspired in the first lockdown by the fundraising efforts of Captain Sir Tom Muir, and NHS Scotland boards received a share of £4.4 million of that fundraising. It shows the importance of endowment funds, because, although the public may not know much about them, they have likely contributed to supporting them, I would want to see the money well spent. I welcome the cabinet secretary's intention to accept the recommendation to create independent boards of trustees to govern each charity, but does the cabinet secretary agree with me that those boards must be more representative of patients and family carers, and what steps will he take to ensure that boards are representative of the communities that he serves? On the first point raised by Paul O'Kane, what it does say to me and suggests to me is that people still have confidence in our NHS endowment charities, and that is why they have donated in record sums. I know that they are inspired by the likes of the late Sir Tom Muir, but others as well. On the substantial point that he raises, it is an issue that I have raised with NHS boards. They all have, as you would imagine, equality policies that they follow, but if I can be frank with Paul O'Kane, I would like to see progress being made quicker and faster. Although our boards absolutely have equalities at the heart, not just in terms of racial equality, which has been an interest I know of this Parliament of most recent, but representation right across the board of protected characteristics. There are policies in place. I am challenging boards to make sure that they are more representative. I think that he is right when it comes to the new boards that are created for charities. They must be representative, but we do not need to wait for those charity boards to be set up to see what we can do with our current structures absolutely in place. In short, we can do more and probably go faster in this regard. As the cabinet secretary has noted, huge sums have been donated to NHS charities during the pandemic. We also know that our boards are under intense pressure, including financial pressure. What safeguards are in place to ensure that the funds are used as they were intended to be? Of course, funding of the NHS is at record levels and we will continue to ensure that our NHS is funded adequately given the pressures that it is currently under. In terms of the safeguards, I spoke to some of those when answering questions from Craig Hoy earlier. It should be said that, as I mentioned in my statement, all trustees are required to act in the best interest of the charity. That is the first and primary safeguard, but they are also required to publish an annual report and accounts. That has to set out in detail their spending plans. Of course, those are publicly available and open to scrutiny. Those are the safeguards that currently exist. On the back of the review, my expectation most certainly would be that every single NHS board looks in detail at the review. If it has to update its procedures, governance and structures, it should absolutely do that. We have heard several times today that, in 2019, NHS Tayside was forced to give money back to the endowment funds following allegations of mismanagement. Can the cabinet secretary confirm that no other Scottish health board has been required to return money to the endowment fund on the same terms? It is certainly not that I am aware of. Given the pressure on the NHS board for remobilisation, is the cabinet secretary confident that the timescales for recommendations that have been taken forward can be met? It is a very fair question to ask. Of course, we all know and we debate regularly in this Parliament just how under-pressure NHS boards are, but I think that this is an issue of extreme importance and therefore I expect urgency to be attached to the recommendations, given that this, as a number of members have said, is about public confidence. Yes, while they remobilise, I would expect there to be some pace and urgency around those recommendations. I will do my best, because of course this will involve legislative change. I will certainly do my best to ensure that there is that pace and urgency from the Government, too. Apologies, Deputy Presiding Officer, and cabinet secretary, for being late. I have experienced what all Glasgow's regions are at the moment in severe delays on ScotRail. These charities have given valuable equipment that I personally have benefited from in hospitals and thank all those who have donated to them. One of the recommendations is that each NHS link charity should put in a place a code of conduct to provide guidance and set expectations on board behaviours. Can I ask the cabinet secretary what is the timescale for putting those code of conducts in place? Who will review them before they are implemented? Will they vary from health board to health board? It goes back to my answer to my colleague Douglas Lumsden and others that we will obviously need to take a bit of time to work through those to consult with the appropriate individuals, but there are already, of course, in our current public appointments, including our NHS boards, codes of conduct that we expect those members to abide by. We will make sure that they are absolutely robust. In terms of who we have been to consult with, I have already referenced a number of answers to a number of members that we will want to talk to as wide a group as possible, but perhaps I left out clinicians, which is an important reminder that, of course, it is really, really important that those who are working in our health service, such as Dr Gohani himself, are consulted upon in relation to all of those matters, including a code of conduct. Gillian Mackay, to be followed by Emma Roddick. One of the recommendations of the review is that NHS-linked charities should put in place induction training for all charity trustees, as well as consider the need for on-going training and support. Such training and support will be an important step towards widening access and ensuring a more diverse membership of NHS-linked charity boards. I appreciate the cabinet secretary's earlier answers to Paul O'Kane and Douglas Lumsden, but what measures, such as paying, trustees and implementing training, will the cabinet secretary employ to ensure that our boards are more representative of lower socioeconomic backgrounds, ethnic minority backgrounds and disabled people? While I cannot, as I have said to others, give our absolute specifics, because we will take some time to review the recommendations, I think that the points that Gillian Mackay raises are exceptionally important, because we know that for a number of people, particularly in our diverse groups in society, the fact that there is not the appropriate training, there is not the appropriate capacity building, there are perhaps financial disincentums for them to get involved in boards such as NHS-linked charity boards. Those are all important issues and issues that I will take time to reflect on, because, as Paul O'Kane and others have said, our board should be as reflective of the societies that it represents. Finally, Emma Roddick joins us remotely. Can the cabinet secretary outline what steps have been taken to improve the management of those funds in advance of today's recommendations that have been taken forward? I could probably be relatively brief, because I think that I probably answered the question from a couple of people that, since the issue first surfaced, a number of boards, obviously all boards, looked at their own internal processes and governance around the issue. Changes have been made, but the most important safeguard that we probably got in place is that those spending plans are published and open to scrutiny, which I think is really important. However, a range of steps and the measures that have been taken by boards, since the NHS Taste edition in particular, did surface my expectation now, if I can give some reassurance to Ms Roddick. My expectation now would be that, since the review was published, the NHS boards would look at it urgently and see whether their process, its governance, needs to be updated and to do so at pace. Cabinet Secretary, that concludes questions on the statement. I will allow a little time for front-benches to change round.