 I want to conclude topical questions, and we turn now to a statement by Shona Robison on NHS Tayside. The cabinet secretary will of course take questions after our statement, so I would encourage all members who wish to ask a question to press their request to sweet buttons now. I would like to update the chamber on developments in NHS Tayside over the Easter recess. On Friday 6 April, I exercised powers under the National Health Service Scotland Act 1978 and instructed that Paul Gray, as chief executive of NHS Scotland, take immediate action to strengthen the leadership of NHS Tayside. The decision to exercise these powers was not one I took lightly and was the result of a series of issues that have come to light in relation to the management of NHS Tayside over recent months. As Parliament will be aware, since 2012-13, NHS Tayside has required brokerage funding from the Scottish Government to balance its annual financial position. The level of brokerage awarded each year has risen and the amount of brokerage outstanding now totals £45.3 million, excluding the repayment of endowment funds that will be added this year. In recognition of the need for action to tackle the rising deficit, NHS Tayside developed a five-year transformation programme, launched in 2015-16, with the twin aim of improving patient experience alongside achieving financial sustainability. To support this programme in May 2016, we have put in place arrangements to provide tailored support to NHS Tayside. By its very nature, the scale of change envisaged was not a quick fix. However, by the end of 2016-17, it was clear that the year-one milestones in their plan were not going to be delivered, and the board required a further £13.2 million of brokerage. In response in March 2017, we appointed Professor Sir Louis Ritchie to chair an assurance and advisory group, the AAG, to review the deliverability of the board's plans and the associated financial projections. On 27 June 2017, the AAG published its staging report confirming the financial picture being forecast by the board was unrealistic. It also highlighted issues in relation to the board's vision for the future, its service and workforce planning, its prescribing activities, as well as its leadership and governance processes. Upon receipt of the findings, we established a transformation support team, led by Caroline Lamb, chief executive of NHS Education for Scotland, to provide support and constructive challenge to the senior management of NHS Tayside. The transformation support team provided intensive input into the executive team from July to December 2017. The AAG's second progress report was submitted earlier this year and was sent to Parliament on 23 February. In the latest report, the expert team recognised that, while progress had been made, it was largely transactional, as opposed to transformational. Five days after the publication of that second progress report, an issue was uncovered by the Scottish Government officials and brought to my attention on how e-health funding had been recorded in the NHS Tayside accounts. We commissioned an independent investigation from Grant Thornton UK into the issue that has been shared with Parliament. The central problem that was highlighted was that the level of the board's deficit had been understated over a period of years. NHS Tayside's director of finance subsequently took the decision to retire and immediate steps were taken to strengthen the financial controls of all the organisations involved. That includes the withdrawal from e-health leads of the ability to make financial decisions and the review of internal controls in NHS national services Scotland. On 3 April, the then NHS Tayside chair highlighted claims to me that, on 24 January 2014, a decision was taken by the board of trustees responsible for endowment funds, which had resulted in a number of projects being retrospectively approved for charitable funding when they had already been approved for funding through core NHS resources. I immediately took action to have the accuracy of those claims independently verified. Following on from their work on e-health funding, Grant Thornton was commissioned to undertake a review of NHS Tayside's financial governance. That work has now been extended to cover the use of endowment funds. Given the significance of those issues, the review will now report to the Scottish Government. NHS Scotland chief executive Paul Gray wrote to all NHS board chairs on 5 April to seek their explicit assurance by the end of this month that all charitable funds have been used appropriately. The office of the Scottish Charities Regulator has recently opened a formal inquiry into the allegations of possible misconduct in the operation of Tayside's endowment fund. Once I have received assurances from all other health boards, I will share those assurances with Oscar, who have agreed to review them. Should they determine that spending of endowment funds by any board was inappropriate, then I expect it to be paid back swiftly and in full. In responding to such events, the maintenance of public confidence in the health service in Scotland is of paramount importance. The credibility of the board's updated reform plans, as well as public confidence in the board's leadership and in donating funds for the benefit of the health service, were significantly undermined by those events. The NHS Tayside chief executive's attendance at the endowment fund meetings in 2014, particularly in the January, when decisions were made on the use of charitable funds for retrospective expenditure raised serious concerns. Although the chair was not in post at that time of those decisions, the culmination of financial control issues, along with the limited progress that was highlighted by the AAG, led me to the conclusion that real change was going to require a new leadership team with a robust set of skills to restore public confidence in NHS Tayside. That is why I exercise my ministerial powers of intervention and ask Paul Gray, as chief executive of NHS Scotland, to strengthen management at NHS Tayside with immediate effect. The chair, Professor John Connell, tendered his resignation on 6 April, and I thank him for his service to the board over the past two and a half years. Leslie McLey is currently on sick leave and the role of accountable officer has been transferred to the new chief executive Malcolm Wright. It is not possible to comment further on Ms McLey's employment position at this time. It is crucially important that the new leadership team at NHS Tayside is strong and experienced, which is why I have appointed John Brown CBE as the new chair. Mr Brown already chairs a large health board and is a chartered management accountant with significant experience in leading change. I have also approved the appointment of Malcolm Wright OBE as chief executive. Mr Wright is a very experienced NHS chief executive and has already been involved in a number of successful board transformations. They have both started, as they mean to go on, with productive meetings already held with the rest of the board and with the chief executives of all three local authorities to underscore the importance of collaborative working in designing and delivering health and care services for the people of Tayside. Another priority has been to ensure that all staff in Tayside are cited on developments, with an all staff briefing issued immediately on the new leadership team taking up posts. In relation to the issue of endowment funds, an emergency board meeting held last week agreed to a proposal presented by Mr Brown and Mr Wright to repay in full the endowment money that had been retrospectively applied to programmes of work in 2014. Understandably stabilising the board will take some time, and I am committed to ensuring that the Scottish Government continues to support NHS Tayside with financial brokerage, with repayment currently suspended for a three-year period to provide breathing space for the board, to focus on achieving stability and to plan properly for change. I have also agreed that the brokerage will be increased to cover the repayment of endowment funds that have been inappropriately used. It is crucially important that the quality of patient services is protected and maintained throughout this challenging time. The staff of NHS Tayside have much to be proud of—a reputation for good, safe, person-centred and effective care, with many examples of innovation and good practice recognised across the country. I met the board alongside its new leadership on 9 April, and it is clear that there remains a real appetite within the board to drive forward positively, underpinned by clinically driven change initiatives. I have been clear with the new leadership that their priorities must be to steady the ship, provide clarity on where the organisation is going and to take the public and the staff of NHS Tayside with them throughout that process. I have every confidence in John Brown and Malcolm Wright that they will deliver that. I look forward to seeing NHS Tayside reach its full potential and becoming the organisation that staff and people of Tayside deserve. Alongside the work on going in NHS Tayside will also see the completion of the Grant Thornton review of Tayside's existing financial controls, including the use of endowment funds. Oscar will complete its consideration of the behaviour of the Tayside Endowment Fund Board of Trustees in the early 2014, along with its oversight of activities elsewhere in NHS Scotland, with any funding considered to be inappropriate being immediately returned to the endowment funds. I will ensure that all reports are made available to Parliament once completed and that all recommendations from those reports are implemented. I am happy to take questions. The public in Tayside and across Scotland have been rightly shocked and angered at the use of charitable funds by NHS Tayside to help pay for NHS board projects. In her statement, the cabinet secretary references the independent review by Grant Thornton on e-health funding between e-health NHS national services Scotland and NHS Tayside between 2012 and 2018, which raised many serious issues. The cabinet secretary, for some reason, has not mentioned the repeated failures of oversight in her own department over this period, which were clearly identified in the review. How will the cabinet secretary ensure that lessons are learnt from this, so that the cabinet secretary and her officials will in future provide the proper level of scrutiny and supervision that must be provided in relation to the use of taxpayers' money? In light of the concerns that other NHS boards might have also been using charitable funds in a similar way, does the cabinet secretary not agree that an independent broader inquiry into the extent of this practice across Scotland is now needed, one that is able to make clear recommendations about how to prevent this happening again in the future? Does the cabinet secretary not agree that that would be the best way to restore public confidence, which is now absolutely vital? The cabinet secretary also says that it is time to steady the ship. We have been raising those concerns for some time in Parliament, and it is quite clear that, for too long, NHS Tayside's leadership has been sinking under the leadership of this Government. Is it not now time to act and for this whole Parliament to have a role in supervising the finances of our health boards? The Parliament, of course, has a role. That is why we have an audit committee, which is looking into those matters, and that is quite right and proper. I have also said at the end of my statement that I will make available all of those reports to Parliament so that we can be open and transparent about those matters. I went through in some detail in my statement all of the support that has been given to NHS Tayside. I do not think that it is fair to say that the Scottish Government has not tried in its endeavours to support NHS Tayside. Over the years, we have given extensive support to that board. I laid that out in some detail in my statement, but it reached a position after all of that, particularly in the light of the e-health and the endowment funds issues arising. The conclusion that we reached was that what was required was a new leadership team at the top of NHS Tayside to take the organisation forward. That is not something that I did lightly, as I said in my statement. Miles Briggs also talked about the need for independent oversight of the issue of endowment funds. Oscar is independent. That is why we have asked him to look at all of the returns that will come from boards. At the moment, there is nothing to suggest that other boards or the endowment funds of other boards have been used in a way that NHS Tayside uses. However, Oscar looks at all of that. It is independent. As the charity regulator, it is the organisation that is best placed to oversee that. I should point out that endowment funds are also separate from ministers. Ministers have no role over the issues of endowment funds, so it is important that Oscar looks and has oversight into those funds. Once all of that is completed, we will make sure, as Oscar will, that all of that information is put into the public domain. I thank the cabinet secretary for prior sight of the statement. I note that she said in her statement that NHS Tayside needs new leadership and that her priority must be to study the ship, provide clarity and take the public and NHS staff with them. The leadership of our NHS cabinet secretary is you. You have let down NHS staff. You have failed too many patients. You have breached the trust of the public, and this has happened on your watch in your local health board. This is your mismanagement and your failure. The sad reality is that the public has lost confidence in this public cabinet secretary, and this cabinet secretary has lost control of her brief. Therefore, will the cabinet secretary do the decent thing and, at the very least, would draw herself from this investigation, if not would draw herself from this portfolio altogether? Anasarwar failed to mention that he agreed with the decision to remove the leadership team of NHS Tayside and replace them with a new leadership team. I think that he did not mention that fact, which is important, and I am glad that he supported my decision. In all of that, there was a question about the investigation. I do not know if he listened to my statement or, indeed, the answer that I gave to Miles Briggs. I think that I was very clear that Oscar is leading this investigation. If Anasarwar is suggesting that Oscar is not independent and is not capable of leading the investigation, I think that that is very unfortunate. Indeed, Oscar, as a charity regulator, is the best people to look at whether those funds, those endowment funds, have been appropriately used or not. That is how that process will be taken forward. The external audit of boards will also have a look at endowment funds, and that will also be taken forward. By the end of this month, we will have the returns from boards. By the end of May, Oscar will give us an initial view on those returns, and he will take any appropriate action thereafter. By the end of June, the external audits will have taken place with a particular look at endowment funds. I would have thought that, in anybody's eyes, that is a robust process with the independence of Oscar at its heart. Graham Dey, to be followed by Liz Smith. Graham Dey, can I ask the cabinet secretary if she agrees with me that the change of senior management must also lead to a cultural change at the top of the organisation, not least ensuring that the financial challenges that have been highlighted do not adversely affect the provision of services for patients in rural settings, such as those that I, John Swinney and Mary Gougeon represent? Graham Dey, I have been absolutely clear that the financial challenges facing NHS Tayside must not affect the quality of services that have been provided to patients. I have said that in a statement, I have said that previously, including to those in rural settings. That is why I have made a commitment to continue to provide brokerage to NHS Tayside, and it is why the repayment of brokerage is currently suspended to enable the board to focus on getting back on track. I think that that is important. I think that the new leadership team has already signalled that the quality of care will remain a key priority for the board. In both their words and their actions have already underlined the importance of a culture of honesty and openness and engagement with staff at all levels. I think that they have signalled a new culture and a new approach, and they should be given the time to get on with the job. Liz Smith, to be followed by Jenny Marra. Thank you, Presiding Officer. Cabinet Secretary, in reply to a constituent of mine, Oscar has stated that it did not become aware of the alleged issues regarding the use of NHS Tayside's assets until the media reports appeared on 4 April. Can I ask the cabinet secretary if, whether during the period 2014 to 2018, the Scottish Government had any communications whatsoever with Oscar about the use of NHS Tayside funds, given that a key role for Oscar is to review the charity's accounts? Liz Smith raises an important issue, and Oscar will be looking into all of this because bearing in mind that they are doing a specific investigation into the endowment issue of NHS Tayside, and it is right and proper that they do that. I can tell Liz Smith that in the return from NHS Tayside on 17 June 2014, from the Audit and Risk Committee, there were no significant issues raised that they were given a clean audit opinion. That issue was not escalated to the Scottish Government as a matter of concern at the time by either internal or external auditors. I think that there are issues there in terms of the reviews that are under way. I think that will help us to determine what further controls are required in the light of all of that. Liz Smith can be assured that that will be taken forward. In addition, I can tell her that the guidance that Oscar helped us to develop around the use of endowment funds back in 2013, Oscar has signalled its intention that it wants to review that guidance because it is concerned about a potential conflict of interest between people sitting on the board and sitting on trustees of endowment funds. I can assure Liz Smith that that will be taken forward with Oscar. I am concerned about governance on the board at NHS Tayside. In 2014, board members agreed to suspend the constitution to transfer charitable funds to core expenditure, breaking the trust of local people who give so generously. I welcome the decision to pay back the money, but we now need a full review of every board member at NHS Tayside to ensure that they have the requisite skills to prevent a breach like this ever happening again. Will the cabinet secretary outline a full appraisal and skills review of every board member at NHS Tayside? The first thing to say is, first of all, I welcome the fact that Jenny Marr welcomes the repayment of those funds. I think that that was an important early decision made by the new leadership team. It is also important to allow Oscar to do the proper investigation, and I reiterate that he is doing a full investigation into the endowment fund issue within NHS Tayside. He will look back to 2014 to the decisions that were made by the trustees and on what basis those decisions were made, so all of that will be looked at. On the wider issue of corporate governance and the skills of board members, that will be for the new chair and the chief executive to look at whether they have the right skillset across their board, and it is right and proper that they are given the support to do that. On a general point, there is work going on around a review of corporate governance that John Brown, the new chair of NHS Tayside, is leading. There is additional support being given nationally to non-executive members of boards, so that they are able to question, probe and ask the right questions in a way that they have confidence in doing. All of that will help us to strengthen corporate governance, but I have said in previous answers that, if there are any recommendations coming out of all the reviews that are currently on going that can further strengthen that governance, then Jenny Marra can be assured that that will be taken forward. Thank you. I completely agree with what the cabinet secretary said in her statement when she talked about the fact that the maintenance of public confidence in the health service and in the boards leadership is of paramount importance here. What assurance can the Scottish Government give that the appropriate measures have been taken to install a suitably high calibre of leadership to restore public confidence and trust in the board of NHS Tayside to manage the challenges that it faces going forward? I am confident that we have the people with the right skills that are needed by NHS Tayside at this moment in time. John Brown, as I said in my statement, is already chair of Scotland's largest health board and is also a qualified accountant. Anybody who knows him is also very good at leading change and he will do that within NHS Tayside. Malcolm Wright is an experienced chief executive who has already been involved in successful transformational change. He has been clear that quality of care is the priority for them, as well as getting back into financial balance. Restoring public confidence and trust is key, and although he has only been in place for a couple of weeks, it is fair to say that he has certainly hit the ground running and has been working closely with the staff side, as well as clinicians in order to begin to rebuild that confidence. I am also aware that they are offered to meet or, if not possible, to meet local members to give them a call. John Brown and Malcolm Wright were engaged in that over the past few days. It is right that we demand complete transparency regarding the financial decisions taken by the board as a situation like this cannot be allowed to happen again. It is right that a new leadership team takes over, but, as Audit Scotland pointed out last year, the majority of health boards had to use short-term measures to break even. I would like to understand how the cabinet secretary is going to address that at Root. Is she going to introduce longer-term planning for our IJBs? Is she going to tackle the significant use of agency staff that has been reported in NHS Tayside? Can I thank Alison Johnstone for her question? We are addressing the use of agency staff and a lot of work has been on-going to reduce agency staff spend. Fiona McQueen, as the chief nursing officer, has been leading that work. Alison Johnstone will be aware that additional funding for our front-line NHS boards will amount to £354 million, which is £208 million in real terms. NHS Tayside will see £13.7 million of increased investment and a share of the transformation monies. More money is going into the health service, but more demands are upon it. That is why reform also has to take place. Alison Johnstone makes a good point about integrated joint boards. We have been discussing with boards and councils about ways of being able to enter into longer financial planning beyond, obviously, the one-year that was required because of the budget processing that we have just gone through. There is also a financial framework that is being developed by the Scottish Government that will look over the five-year horizon, which will be able to not just plan the funding at a national level but also the shift in the balance of funding so that that can be visible over the next five years. That will be published in the next few weeks. Professor Connell was asked to resign in response to a scandal that had occurred before his tenure. What exactly is he expected to have achieved in the resolution of the situation to her satisfaction? What comfort can she extend to other board chairs concerned that they too may be used as scapegoats to protect this Government in the future? Will she rule out today any suggestion of abolishing and merging NHS Tayside with any other board, as proposed by senior back benches in her own party? Alex Cole-Hamilton said in my statement that I paid tribute to the work that John Connell had done for the past two and a half years. Of course, he recognised that he was not in post when the endowment issue arose in 2014. In fact, that period of times spanned previous health minister and my term of office as well, but no health ministers, I believe, could have picked up on something that internal and external auditors did not flag. That requires us to look at why those issues were not flagged by either internal or external auditors to the Scottish Government, because, obviously, we rely on those processes in order to be able to do something about it when they are. He asked specifically about the position of John Connell. It was an issue of a cumulative set of events. I laid out clearly in my statement all of the issues that led to the point of escalation to level 5, where ministerial intervention was taken, where we had reached the end of the road after huge amounts of effort and support being put into NHS Tayside. The only conclusion that we could reach was that new leadership was required in NHS Tayside and that required a new chair and a new chief executive to be able to take the organisation forward. In relation to the merging of boards, Alex Cole-Hamilton will be aware that we have been working to get more regional planning, that boards will work across boundaries but that form should follow function. The important thing here is realising the benefits of regional working and working across board boundaries rather than focusing on organisational change, which, frankly, would take up the efforts and the attention of senior leadership teams, whereas in Tayside, we need to be focused on getting the board back on track and restoring public confidence. There are still five more members who wish to get in. In fact, there are six now. My members wish to get in. Stuart Stevenson, please make your questions and answers quite short. Stuart Stevenson, to be followed by Bill Bowman. Does the cabinet secretary recall that intervening in Grampian NHS led to a very successful outcome on continuous improvement? Does she agree that the moving of the chief executive from NHS Grampian to Tayside should provide the reassurance that staff and patients need that this is a serious issue being taken seriously? I would. I met the board on 9 April, along with the new leadership team. Everything that I have seen and heard of the approach taken today gives me confidence that NHS Tayside will continue to make the provision of high-quality services for patients a priority, and that is very important that they do that. It is also important to say that work has been taken forward in Glasgow and Grampian to provide assurance that, because of John Brown and Malcolm Wright's focus on Tayside, there will be no impact on the work that is still on-going in Grampian and Glasgow in taking those boards forward. Bill Bowman, to be followed by Ash Denham. Regarding the on-going Grant Thornton review of NHS Tayside, will it or a further forensic investigation fully establish regarding the eHealth funds who approved the incorrect entries and, most importantly, who, both in NHS Tayside and in the cabinet secretary's own office, knew about the window dressing of the NHS Tayside financial statements for six years? As I said previously, all of the reviews, including the Grant Thornton review, will get to the bottom of all that and to make sure that there is full openness and transparency about the issue of eHealth moneys and the issue of endowment moneys, which is why we have brought that external process to bear, because we want to make sure that that is the case, and not least if there are areas that we need to change and tighten up on to avoid a situation like that happening again. Of course, that is the action that we will take. To ask the Scottish Government whether the independent investigation by Oscar will extend to other health boards. As I said earlier, the process by which the returns of boards will come to the Scottish Government and, indeed, Oscar, have written to the chairs of the endowment funds asking for those returns. Those will happen by 30 April. We hope that Oscar will be able to give an indication of any further issues that he wishes to look into in more detail by the end of May. In addition to that, the external audit will have a particular look at endowment funds. All that is taken in the round, particularly the role of Oscar, which is entirely independent of the Scottish Government, should give members assurance that those matters will be looked into fully. I apologise to the members who still wish to ask a question, but we have really run out of time and we have already taken substantial times out of the next debate, which we now move on to, which is a debate on motion 11643, in the name of Graeme Dey, on behalf of the Environment, Climate Change and Land Reform Committee. I will take a few moments for the ministers at least to change seats.