 Can I open this meeting and welcome you to the 11th meeting of the Public Petitions Committee in 2017? Can you remind members and others in the room to switch phones and other devices to silent? I can also add that I understand that a minute's silence will be held in the Parliament at 11 o'clock today as a mark of respect for those who have been affected by the events in Manchester on Monday night. If we are still considering petitions at that time, I would intend to suspend the meeting for a brief period before 11 o'clock so that we are able to show our respect for all affected, particularly those who died or were injured and their friends and families. If we can move on to agenda item number one, petition 1408, updating of pernicious anemia of vitamin B12 deficiency, understanding and treatment. The first item on our agenda this morning is petition 1408 by Andrea MacArthur on updating of pernicious anemia of vitamin B12 deficiency, understanding and treatment. We are joined this morning by the Minister for Public Health and Sport, Aileen Campbell MSP. The minister is accompanied by Elizabeth Saddler, deputy director of planning and quality at the Scottish Government, and Dr Padmina Mishra, senior medical officer in the office of the chief medical officer. I thank you for joining us this morning. I understand that the minister would like to make an opening statement, and I shall allow time for that before we move to questions from the committee. Good morning, thank you, convener. Pernicious anemia can cause significant impact to daily lives of those with the condition. People can be unwell for some time, having experienced difficulties in obtaining diagnosis and appropriate treatment. That is why I would like to commend Mrs MacArthur for her determination and work to support all people living with the condition in Scotland. I recognise that the committee may ask questions of a more clinical nature, and for that reason, as you have outlined, convener, I am accompanied by Dr Mishra, one of the senior medical advisers in the CMO's office and Liz Saddler, deputy director of planning and quality. The petition was lodged in 2011, and at that time I understand that Mrs MacArthur hoped that the then guidelines available for GPs would be overhauled and updated. That has been achieved by the publication of the British Committee for Standards and Hematology guidelines, which were published in 2014. The petition made several requests, and I would like to outline how those have been met. One, a greater awareness of common sets of symptoms experienced by people suffering from deficiency in vitamin B12. The GP training curriculum includes investigation related to all types of anemia, including pernicious anemia, and as such, GPs are expected to be able to address the signs and symptoms of a patient presenting with pernicious anemia. The BSH guideline further supports healthcare professionals in the assessment and diagnosis of pernicious anemia. The second point was an overhaul of diagnostic test use, adopting the act of B12 and homocysteine and MMA tests to be used regularly. I understand that there is no definitive test for diagnosing vitamin B12 deficiency, and this is an area for experts in hematology and has been addressed in the guideline. The committee will understand that it is not appropriate for Scottish ministers or their policy officials to intervene or contradict the evidence-based guidance produced by specialists in this field. Her next point requested that patients displaying advanced symptoms be automatically offered trail injections of vitamin B12, and again, the BSH guideline stated that this could be considered. The petitioner also asked that foliate and ferritin be checked and other co-existings checked as well. The BSH guideline also provides advice on foliate deficiency, co-existing conditions and provision of folic acid. Lastly, the petitioner asked for patients to be able to self-inject vitamin B12 as and when they need it. All matters of treatment are for discussion and agreement between the individual and the clinician concerned. That is not and cannot be a matter for Scottish ministers to become involved in. In relation to self-injecting, I have been advised that it can be challenging to self-administer as this is an intramuscular injection and there are risks associated with it. As a result, some patients may not wish to do this. It is therefore needed to be a matter of discussion between the individual and the clinician that is concerned. Turning now specifically to the guidance, the BSH guidelines addressed the majority of the issues raised in the petition. However, at the time of publication, Scottish Government advisers felt that the guidelines were not in a suitable format for use in GP practices. That is that they were not in the format that GPs were familiar with, like the sign or nice guidelines. As a result, the Scottish Hematology Society was asked to prepare a draft summary document of the guidelines. An initial draft was prepared, however the SHS advised the committee that, owing to the level of work that is required to complete the document, it had taken the decision to withdraw from the process leaving the document in draft. Committee members will be well aware that it is not the role of the Scottish Government to publish clinical guidelines or summary documents derived from them. However, I wish to make it clear that the content of the BSH guideline was considered relevant and appropriate for adoption by Scottish clinicians and this remains extant. In addition, the National Institute for Health and Care Excellence produced a clinical knowledge summary on anemia, B12 and foliate deficiency in 2015. Those summaries are designed to be concise, accessible summaries of current evidence for primary care professionals and are also in a format that GPs are familiar with. Our position is that the requests of the petitioner have been met. In going forward, the chief scientist office within the Scottish Government with responsibility for the funding of clinical research in Scotland, we would welcome applications for research projects aimed at the diagnosis and treatment of people with pernicious anemia. The petitioner may wish to consider that route, aided by pernicious anemia society, to identify researchers willing to move that forward. I hope that that addresses the substantive points of the petition that illustrates the progress that has been made, and I am happy to take questions from the committee. As you said, the petition has been under consideration since 2011, as the committee has been waiting for the development of suitable clinical guidance. In the first instance, as you said, we were waiting for the publication of the British Society for Hematology's guidelines, which was published in 2014. More recently, we have been waiting for the Scottish Government to publish a summary of those guidelines, which the Scottish Hematology Society was asked to produce. I wonder if it would be helpful if you could explain why the summary document was commissioned, what it cost and what outcomes it hoped to achieve. The original, as I outlined in my opening remarks, was considered at the time that the guidance from the BSH was in a format that might not have been used to. There was no question about the content, no question about the guidelines themselves. The issue was around the format, and that was why there was a request to the NHS to produce a summary. That did not happen, and that has not been completed. It still remains in draft format, but since then, there has also been a knowledge summary produced by NICE, which is in the format that GPs are used to. There is a plethora of information there for GPs to access on that condition. When you say that, at the time, it was considered not to be appropriate, does that mean that now you think that the SH guidelines are appropriate? In fact, while you said that the question was about the format, at the time the advice was more than just the format, it was that the BSHA guidelines were not suitable for the Scottish practice setting. It raised concerns that the second-line testing that is recommended by the BSH guidelines is not standard in Scottish laboratories. It was a format, but there was something else as well. Do you agree with that, or has that opinion changed? It was around a format. There was never any question around the content. No, with respect, minister. It raised concerns that the second-line testing that is recommended by the BSH guidelines is not standard in Scottish laboratories, and that the format was an issue. There are two separate things. The other thing to remember is that the NICE have published guidelines, which have taken from the BSH guidelines. Those are complementary. Those do not contradict one another. The issue was around the way in which it was presented. There was never any question around the content of that or the guidance. I would suspect that that is not the evidence that we were giving before. I am asking if you have changed your opinion on that. The opinion has been the same that the guidelines that were developed by the British hematological society took two years to develop. Scottish clinicians never questioned those guidelines. That includes GPs. It was just that they were not used to reading their guidelines, the society's guidelines. They are much more used to reading guidelines that come at them more frequently from GMC and other areas. There has not been a change of opinion in the sense of what is recommended in the guidelines. It is that there is no definitive test available. You have to take the account of the person's clinical condition first and foremost. If required, try empirical treatment. Even if the tests are negative, because they could be negative. That is the issue. For me, it does not explain why, at the time, they were deemed not to be suitable. If it were just format, presumably that would be a relatively straightforward thing to do. If it did not really matter that much, you would not have asked the Scottish hematological society to do more work for you. If it did matter, I would have thought that you would have found somebody else to do the work that the hematological society was not able to do. I mean, if I can maybe ask a colleague to ask some. The important point is to recognise that NICE have produced a clinical knowledge summary in 2015, which is in a format that GPs can use. That does not contradict anything that is within the original BSH guidelines. There is a concise format for GPs to use. There is also the much more in-depth format that is produced with respect. I am saying that there is a format for GPs to use that has happened since the point in which the petition was launched. I think that we would need to test some of that because there does seem to be a contradiction between saying that there was a problem and now there is not a problem, but anyway, even if there were a problem, it is okay because NICE has produced information. Angus MacDonald. Thanks, convener. Good morning, minister. I am looking at the SHS's work. You have perhaps touched on this in your opening remarks. However, the submission dated 12 October 2016, from the Scottish Government, explained that, and I quote, "...has no plans to publish any draft in complete adaptation undertaken by SHS." Can you clarify to what extent the SHS's work is in complete? We have already told us why the Scottish Government said not to publish it, but what aspect of it was in complete? There has to be a set of processes that I have gone through. I know that Ms Lamont said that there would be a straightforward process. However, making a concise document out of something that is quite in-depth requires a lot of discipline and a lot of work and effort to make sure that there is nothing missed, nothing omitted and nothing in that may be over states a particular way in which you should approach a system. There has also been no consultation on the document and there has not been that level of peer review and research that has looked at the guidance, so it would not be appropriate, it would not be responsible for Government or anybody at this point in time to publish this summary document. Again, I would point back that, since then, NICE has published a knowledge summary there, which is in a format that GPs can use, which does not contradict in any way but complements the existing guidance from the BSH. Therefore, there is quite a significant amount of information that is on hand and ready to be used by GPs and clinicians across the country. Have you had any indication from GPs that they are not satisfied with the NICE advice? I am not even aware of any issues from GPs that have been raised on the BSH guidelines, either. Nothing has been raised with us from clinicians. What do you expect from the Scottish Government itself that said the problems with the BSH guidelines, not the GPs? That was to consider the Scottish Government's evidence to the committee, Angus? It is still helpful to know whether there is any feedback from the GPs and there does not seem to be. Brian Wittress. Mwneun i gwaith i'r ffordd. The Scottish Government explained in its submission on 26 November 2016 that it would share the draft version of the SHHS's summary document with the Public Petitions Committee only once the diagnostic screening group were satisfied with the draft. The committee received a copy of the summary draft document after it was approved by the diagnostic screening group. Can you clarify whether the group's view on the summary document has changed? If the group's view has not changed, can you again clarify in these circumstances why the Scottish Government will not publish it? The summary document has not been approved, so it is not going to be published. Perhaps I could add here. The summary document went to the diagnostic screening group, and that is the version that the committee has seen. The committee asked Mrs MacArthur if she had any comments on the draft, and she had a number of comments that she made to the SHC. They responded to those comments, and that was the point at which they withdrew from the process because they felt that they were being asked to change the content of the guidance, rather than just summarising the original guidance. The document was never finalised and has not been back to the diagnostic screening group again since the version that the committee has seen. Does that mean that the view on the summary document has actually changed in the diagnostic screening group? No, because the purpose of the document is a summary document of the original guidelines. It was not about changing the guidelines because everybody's clinical consensus is that the original guidelines remain valid. As the SHCs removed themselves from the process before they could finalise the document, we are not in a position as government to publish it. I am sorry—for my benefit. Does that mean that the summary document did not reflect the original document? It does reflect the original document, but it is not in a form that has been finalised. The SHCs did not formally sign it off and therefore did not give government a final version that could go to the diagnostic screening group. They withdrew before they did that. The SHCs document is not contradictory to the original BSH guidelines that were issued, and that was the process that was being asked to change that. There was never the request of the SHCs to change the format to ensure that it was accessible for GPUs. However, again, NICE has since produced a clinical knowledge summary so that there is a concise, usable, understandable format for GPUs that they are used to. The SHCs request of them was never to change anything in the guidelines that were set from the BSH. If there is nothing in the document that contradicts the NICE document, I still do not get why we cannot publish it. It is not being approved. It cannot be approved, then, if the SHCs are out. Is that what you are saying? It cannot be approved because the SHCs are not involved anymore. There is no need for it now. There is a nice clinical knowledge summary that presents the information to GPUs that they use. In response to Angus MacDonald's line of question, no GP has raised any concern over that. That follows on and flows from the BSH's original guidance, which, at that time, had been considered to be in a format that was not used—that the GP was not used to. What has happened since then is that NICE has produced a clinical knowledge summary and that there is plenty of information there for GPUs to use. Further more, there is much more authority attached to the NICE guidelines. The considerable work and effort that the SHCs have put in is no longer deemed as necessary as it perhaps had been at the time that the BSH published its guidelines. It is pretty much at the risk of repeating ourselves. Just to clarify that, regardless of what has happened over the publication or non-publication of documents, you and the GPs are satisfied that there is enough information in the NICE document and the BSH document to provide comprehensive guidelines. There is no sort of ambiguity about any of it. The NICE clinical knowledge summary and the BSH guidelines are nothing that contradicts either document. The NICE clinical knowledge summary is in a format that GPs are used to and we have had no GP contact, as far as I am aware, to raise any questions about or question the guidelines or request any additional information. We have not got any evidence to say how much it has increased or decreased by the guidelines, but what the guidelines suggest is that the diagnosis is not clear cut, so if it is required then clinicians can access the second line test. It is not universally available in Scotland, in Scottish laboratories, but it is available to them from elsewhere. Why is it not universally available in Scotland? The tests themselves are not dependable, so what you can surmise from a result, whether positive or negative, may not necessarily help with the management of a case, so it is difficult to interpret these tests and therefore more research is required to get things like standardisation of the test, cut-off points, what is actually a low level, what is a subclinical level, those are not available yet. For clinicians it is difficult and it is in the realm of not-GPs but specialists and researchers at present. Minister, what has been done about that? As I said in my opening remarks, the chief scientist's office is willing and able to take on research proposals from researchers, so there is an opportunity there to progress that if there is a suitable submission made to the CSO. Can I ask a reactival seeking submission? As opposed to saying if somebody's research proposal we would consider it, which I think is helpful, are you actively going out and asking seeking submissions for this work to be done? The submissions come from either patients, the public or the clinicians. It is not up to Governments to ask them to the CSO to look at research proposals. We have asked the CSO to look at it positively when a proposal in this area arrives. That is all we can do to encourage the CSO to keep an open mind in this area and make them aware that this is an area of need, but we cannot set up the proposals. It has to be a researcher that approaches them. I understand that, but very often in Government you actively go out and ask, you create a project and say that we want a researcher to do this job. Not clearly, the Government ministers are not good at the technical or clinical expertise to do that, but they say that we identify that there is a need and we will actively go now create an option and ask people to bid for that work. The national network management service has also pursued and established the establishment of a short-life working group for hematology. That will be able to pursue some of the issues raised in the petition, as well as the issues of research. There is the short-life working group on hematology and there is also the keenness for the CSO's office to be able to receive any submission around further research. Can you not be the other way round? You say that there is this job to be done and we are asking for bids for that. I am not understanding. I appreciate that there might be technicalities that I am not aware of, and clearly people make research bids all the time. However, if you recognise that there is a need for this work to be done, can you create a project that says, will you now bid to do this work? This is work that has been taken forward by the short-life working group, which we can consider all those elements. Aside from that, the chief scientist's office is also able to accept from researchers bids to pursue and progress other areas of research. There are two very clear routes forward to further enhance the research knowledge and capacity on this issue. I was going to ask Rona to come in at this point. Do you want to ask your question? It is really for Dr Amesra. You were saying that it is more or less up to the clinician's individual judgment at the moment because there is no standardised diagnostic testing. Is there any pattern emerging in how that is being done? Do you have any data that shows what is the most likely outcome of those decisions? There is not any data which is readily available. The British Hematology Society also acknowledged that you do not have randomised controlled trials in this area. What they recommended was a pragmatic approach. Because every individual patient starts from a different level, it is very difficult to compare from the beginning of their journey to the end. Some are treated, and it depends on patient preference. Some would like a lot of testing done, some would like just the treatment, some would like to wait and see. It is very difficult to find any data about it. If there is a need for the second line testing, the Government should take the lead on this and clearly fire off the gun to start the research on it. We have got the short life working group. It is unestablished. They have not come to the conclusion yet as to what they are doing. It is just in the process of being established and it has started. Is part of its remittal looking at this gap round second line testing? It intends to look at the management of vitamin B12 deficiency in the totality. That is the initial intention. Once they set the group out, they will decide their remitt. If there is a requirement and look at the gaps that require more guidance, more research work, that is the aim of it. They are keen to do some work in this area, but not exclusively on testing. It is the general management of vitamin B12 deficiency. The Government has set up the short life working group. The National Services Division has set that up. The National Service Division is a part of NHS NSS, National Services Scotland, and they run a series of managed networks across a range of disorders. They have a managed diagnostic network, and that group has set up the short life working group on hematology, which is looking at the B12 deficiency. It would be useful to get a note on the membership of that. I am assuming that the Government will have input into the remitt. We will be able to say that that would be an issue that would be worth giving. You have said that there is an area where you would like to see research. If we were saying actively that we want to encourage this research, that would be part of the remitt. We can get you that information and ensure that the network and the short life working group understand the particular interests of the committee. If the short life working group is partly in response to the recognition that his work is getting done, I am just interested in whether we can actually look at that. I am sorry, but I am trying to be helpful to say that we can let you know the group, the membership and ensure that they know the interests that your committee has. I am genuinely interested in the extent to which, as a Government, you have recognised his gap in the research on how you actively will ensure that research is taking place. I suppose that that could be included as part of the information that you provide us around the working group. The committee has asked the Scottish Government to consult with the petitioner on the development of the draft summary document from the outset. In this regard, the SHS commented when withdrawing from the process and I quote, the very considered responses that we receive from the petitioner in response to the draft guidelines indicate the limitations that our small society has in trying to produce specific Scottish guidelines. The committee understands from the petitioner's submissions that she is particularly concerned, and I apologise for my pronunciation here, about gastric parental cell antibody testing and does not agree with the way this issue is addressed in the BSHS guidelines. The Scottish Hematology Society does not appear to have the capacity to address those concerns, and the petitioner considers that she has not been listened to for this reason. I wonder whether she is willing to commit to her officials to meet with the petitioner to discuss her concerns about the testing procedures for panaceous anemia and the vitamin B12 deficiency. If the petitioner wishes to meet officials, we will happily arrange that. However, it would be worth recognising that we do not have the ability to change clinical guidelines or clinical guidance or the knowledge summaries because of the robust processes that they have gone through in order to create that evidence base and that peer research that has brought them to bear and that they are currently in use. While my officials would be entirely happy to make sure that we can engage with the petitioner to make sure that we understand fully her concerns or any outstanding concerns following the responses that we have had to each point of our petition, it is important to recognise that we are not in a position—or my officials are not in a position to change the guidelines, but certainly we can make sure that if there are avenues to ensure that the short-life working group understands our continued concerns, then we can happily do that. However, it is important to recognise the parameters and the restrictions that we have around changing guidelines that are being clinically looked at. The Scottish Government did, however, take a view that BSHA guidelines were inadequate and asked the Scottish Hematology Society, so I do not think that any suggesting that government ministers have to sit down and write out clinical guidance, but there must be capacity within the system on the request of the Scottish Government for things to be done. The Scottish Government did request that the Scottish Hematology Society do it, so I do not think that the issue is—we are not nobody pretending that you, as a Government minister, are capable of making clinical decisions nobody any year can, but the Government is capable of saying, we think that there is a gap here and can you look at it? That is really where I think a lot of this has emerged. In response to that, I just think that it was important to be clear that, while we are absolutely happy to engage with the petitioner and recognise the huge amount of work that she has put into it, it is important to put on record that that will not result in a change to the clinical guidelines that are already in existence. Again, I reiterate the point that there was never any doubt about the veracity or the accuracy or what the guidelines said. It was around the format of that. With respect, we have already heard that it was a bit more than that. It was also about the fact that the second line test is not available in Scotland and the Scottish Government itself recognised the need to do more than simply format it. However, I recognise what you have said about the nice advice. With respect, I think that you are downplaying the summary. The summary is important work. We recognise the work that has been done. The question that is still asked is how Government is proactive about recognising that the work that you yourself asked to be done was not completed and the work that you yourself recognised needs to be done with research on how that is now completed. Will the short-life working group have patient representation on it and would it be possible for that group to meet with the petitioner? We will explore with the officials where we can make sure that the petitioners' views and voices are heard and whether that is appropriate for the short-life working group. Again, we will reiterate that we will get back in contact with you around the membership of the short-life working group. Obviously, the petitioner will have heard the evidence and will be responding to that. We will make sure that the comments that she raises with us will be conveyed to you. I thank you very much for that. We recognise that this is not a petition that has been on-going for some time and that there are issues that are probably not one person in here. With a certain honourable exception, I really understand the clinical technicalities of all of this. I think that everyone recognises the role of the petitioner in pursuing the question. On how we take this forward, I do not know what suggestions the committee has. I certainly think that we would want to reflect on all of the information, including the short-life working group, the nice guidance and so on. I think that those would all be useful things for us to look at. We could then reflect on that and what the minister has said in this evidence session. There is no opportunity for the petitioner to respond, and then we can come to a view. I do not know if M.D. has any other comment or suggestions. I would just like to thank the minister for our evidence this morning. It certainly helped to clarify the situation in my mind. I think that there are a couple of salient points in the evidence that has been given this morning. One, the fact that the nice clinical knowledge summary has superseded any work by SHS. I think that another salient point is the fact that there has been no negative feedback from the GPs on the way the matter has been dealt with up till now. I am happy to reflect on the other evidence that has been given, but I think that those two salient points have to be stressed. I think that that is helpful. The niggling issue that I have is the fact that the Government initiated the body of work that the SHS produced some sort of draft guidelines, especially if it is collaborative evidence. There must be some way of bringing that out. I do not know how relevant that is. I do not know why, if it does not contradict anything that has been said under the nice clinical knowledge, that might be published as well. It seems to me that the more evidence around that we have, the better. The issue for the Scottish Immutology Society is that they felt that they did not have the capacity as a small organisation to do that. The question really is, is there any remaining work to be done, given the new guidance? Is it there for that? It was useful work, but we do not need to pursue it any further. Obviously, we would hope that through the short-life working group that that might be considered further. I think that the minister has clarified that she and the GPs are happy with the guidelines that have now been superseded by the SHS. I am content with that. I do not think that there is any need for alarm in that respect. I suggest in my lifetime that we reflect on the evidence to give the petition an opportunity to respond, but we also record our thanks to the minister, both for our evidence and for the update and the information that we have been given around the new guidance, or the nice information that is there. Obviously, I look forward to hearing more about the short-life working group. I thank you very much and those with you for attending, and I will suspend briefly. To order, we move to agenda item number 2 on new petitions. Petition 1646 on drinking water supplies in Scotland. We turn to agenda item 2, consideration of new petitions. We have two new petitions to consider this morning. The first is petition 1646 by Caroline Hayes on drinking water supplies in Scotland. We will hear evidence from the petitioner. She is accompanied by Leslie Dudgeon, who is the secretary of concrete and vicinity community council. I can also welcome Kate Forbes MSP for this agenda item. I welcome you both to the meeting. You have the opportunity to make a brief opening statement of up to five minutes, after which we will move to questions from the committee. Water is our most precious and important natural resource. It is vital to life, and Scotland has it in abundance. It is important for health, tourism, wildlife and sustainable economy. The Scottish Government has a responsibility for maintaining and improving the quality of all fresh water in Scotland. The drinking water quality regulator exists to enforce that the water is safe and pleasant to drink and has the trust of customers, also ensure that further issues that may affect drinking water quality in Scotland are adequately understood and that any knowledge gaps are filled through research. In bad knock and stressed bay, since the change in 2012 from Loch Aynach to the aquifers in Kinnacile, there has been a problem with the water supply that the DWQR has still not acknowledged. This could be the tip of the iceberg for the whole of Scotland. The DWQR has been aware of the taste and odour and skin irritations since 2012. No monitoring of Scottish waters was done until the full audit in 2016, which concluded that everything was normal and that there would be on-going discussions with NHS, DWQR and Scottish water, but none happened. Classified as a major event, DWQR resolved to closely monitor water quality during chloramination. That again has produced no results. After the dissatisfaction of locals due Henry MP with Scottish Water Commission an independent survey, with appalling results for Scottish water having for them to admit that the taste and odour was substandard, the health issues had been admitted from this survey, but after an open meeting with locals, they had to be addressed. It has taken five years. After this meeting with Dr Ken Oates, Moira Watson and DWQR, Peter Farrell's reinsurances are hollow by his reiterating that the water is of a high quality and over the past five years has consistently met strict standards. Because we know that this is not the case, Peter Farrell told us in January 2017 that we would like to apologise that the taste of water does not come up to standards expected and it has also taken us longer to make improvements that it should have. This same Peter Farrell says that our mantra is about putting customers at the heart of our business. Those standards are not being picked up, that no, the standards are not picking up the problems. Local doctors made their concerns to Public Health Board in 2012, again in 2015. Why is the DWQR not investigating or enforcing the standards? Where are the long-term studies of the effects of chloramination? There are none. Scottish Water has sent us this postcard. Scottish Water has now apologised and to resolve the taste and ode issues are adding ammonia to the chlorine. Chloramination, a water disinfectant incidentally 200 times less effective than chlorine at killing E. colo rotavirus acceptor, but it's cheap and it's far more difficult to remove but to what detriment to human health because of the disinfectant byproducts. They may simply be trading regulated DVPs for unregulated ones and I've got them but they're too difficult to pronounce. The NDMA, iron-onated DVPs and hydrazine, there are no risk assessments for the unregulated ones. There is also evidence of disinfectant byproduct exposure by inhalation during sharing but there have been no follow-up studies to confirm these risks. The Cranfield University studies concluded in the UK that only one group of DVPs are regulated, the TTHMs, maximum 100 micrograms per litre are the TAPs, further investigations are needed. There is limited sampling and more information on the occurrence of NDMA on health concerns is needed and for a number of chemicals the toxicity database is grossly inadequate or absent. DEFRA's concerns on iodinated DVPs' lack of data make sounds assessments of risk posed in drinking water impossible. In the US, the EPA on chloramines, there is not enough information and the importance on the effect of weakened immune systems in infants, the LDD, those having chemo at HOVA is incompatible and it's incompatibility for dialysis patients. Risk assessments based on incomplete data are not sound and with the interaction all the chemicals used within the industry there are no cumulative risk assessments and therefore this is not robust enough. The DWQR's job is to monitor these risks. There are efficient and sustainable alternative solutions for water treatment based on ion exchange, UV ceramic membrane and advanced oxidation which offer lower life cycle costs, greater efficiency and much lower environmental impact. Publicly owned companies have a responsibility while evidence may be lacking that many chemicals may pose no significant threat to public health. Removing them is an additional benefit of treatment for other purposes is advantageous. In the first part of your petition you called for the role of the DWQR to be reviewed and in the briefing that we have prepared for us sets out in detail the DWQR's role as described in its website. Have you got any comments in the description of the role measured against your experiences as a gap between what they report themselves to be responsible for and your experience of what they have done in your case? They are not monitoring, they are not sampling, they are not monitoring, they are not assessing the information and following up on it. They are not taking their job is to look at what happens within Scottish Water and to monitoring it, they are not doing that. Thank you very much for that. Angus Macdonald. You have perhaps covered this in your opening remarks and your answer to the convener's question, but the DWQR's own description of its role says that it exists to ensure three things, that drinking water is safe, that it is present to drink and that it has the trust of consumers. No, that is just what I was going to ask. Is it fair to say that? You know what is there for? It is like a, I do not know, chocolate fagad. Sorry. Okay. That is very succinct to you. Just for clarification though, you mentioned in your opening remarks that there has been no cumulative risk assessment. Okay. The Scottish Water industry puts lots of different chemicals. They put phosphates, which line the lead pipes. Okay. There are lots of places that I know around Aviemore that has lead pipes. The plumbers say that when they cut into them, this stuff lines the pipes. If you add the phosphate that they add for doing that, you add the ammonia, the chlorine, all the chemicals together, they are not, yeah, exactly why they are not doing that. Thank you. Good morning. Can I just ask a supplementary to Mr Wayne Donald's question there in terms of the implementation of any recommendation? Who has that responsibility? Implementation. If there are recommendations in terms of when the testing is done, if there are issues with the water, in your opinion, who has that responsibility? Or do you know who has the responsibility to ensure that recommendations are enforced? Well, the GWQR is overseen by the Scottish Government. The Scottish Government is there, the DWQR and CEPA. All those agencies should be working together. They do not seem to be working together. Sorry, I may not answer your question. No, I am very much sorry. I am not asking particular good questions. It is my understanding that CEPA does not have responsibility for private water. It is for public water. What I am trying to get to is that if there is an issue with the water, that is brought forward. DWQR is the ones that do the monitoring. Well, it is supposed to regulate the whole industry. And they are the ones that are supposed to have the power to implement or to ensure that those recommendations are implemented. That is really the question that I am asking. So, it is the responsibility that sits with DWQR. I think that they regulate themselves. Well, yes, nobody is regulating them, but the Scottish Government should be regulating them. That is what we are asking you guys to look at. That is kind of a convoluted way out of what I have got to that. I am not really sure. Somebody has to take responsibility for this. We have five years. We have been trying to bring this. We have had meetings. Scottish Water does not listen. They send out standard replies to doctors who get to the... Everything is fine. It is falling within the regulations. Everything is within the normal parameters. We are running everything lovely. It just keeps coming back. It keeps coming back. They say that to the doctors. They say that to the health professionals. In 2012, when the water was changed over, the doctor in Avemore went to the public health and they got in touch with Scottish Water, who sent them a stock standard reply. The same happened again in 2015. Scottish Water keeps telling us that there is no problems with the water. In your background to your petition, you say that, despite carrying out a full audit of the DWQR, you found no issue with the treatment that works in your area. Can you explain how that full audit came about? Was that a regular audit as part of its Scottish wide audit programme, or was it initiated at your request? No, it came because there were complaints. There was a major... The DWQR is saying that they are doing a full audit and there are no issues. Then you have Scottish Water sending this out to everyone saying that, if you are unhappy with your gut water, there is obviously a problem here and good news is changing. You have two agencies not working together. I think that this is what you asked. Between March and June 2016, 36 complaints were received by Scottish Water regarding water quality. They said that this was an incident. The summary was unpleasant taste, skin and irritations, but they are not monitoring this. They have not done any monitoring and that is their job. They said that the DWQR, the poor hole, they just say that we have a state of the art treatment plant. They keep fobbing us off that it is all working. It is not. They had to clean out the pipes. They cleaned out the pipes, the distribution pipes. They did it at night, but I happened to see the guy when he came. There was this black stuff that came out of the pipes. Where is that coming from? We have got loads of pictures. Any information that you have brought along will be circulated to my tea afterwards. Good morning, Leslie and Caroline. Our briefing pack tells us that chloramination, which is what Scottish Water is now doing to the water in your area, is widely used throughout the UK and that it plans to expand it for use throughout Scotland. Are you aware of any other problems throughout the UK or any other problems that you have? We know that there are probing problems in Fort William and that they have chloramination in Fort William. I know that they have had problems. I am trying to extend it beyond Scottish Water because, if it is throughout the UK, it will not be Scottish Water that is doing it through the water. In Wales, they do not have those problems because they do not put chloramines in the water. I am trying to suggest that it is particularly localised to your area. No, they put chloramines, but I do not think that— I think that there are 14 places in the UK that have chloramination in the water. A lot of those places do not know that they have it. Has that chloramination improved your water? No. We would have brought some here today, but we are not allowed to bring liquids. Because Scottish Water says that it does not have a significant taste or odour, unlike chlorine, which can be stronger. Well, that is not the case. I know that it tastes metallic now, but we also think that it is possible. We are not sure, but it could be the water source. I do have sensitive information here that I do not want. The press has been hounding us. I do not want the press to get hold of this. I would really like you guys to see this, because I think that it is really, really important. As I said to you before, all the materials that you provide for us, we will make sure that the committee has sight of those. Maurice Corry. Thanks, convener. Good morning, ladies. Our briefing refers to the DWR's 2015 annual report, and that provides statistics on compliance and what it refers to as contacts, I quote, from consumers who are dissatisfied with the quality of their supply. It says that there was 99.92 per cent compliance with the standards set out in legislation and the EU drinking water directive, and it reports that only 0.2 per cent of consumers reported concerns with the quality of their supply. What are your thoughts on those figures, ladies? Okay, if you look at the results, Scottish Water printed their results from 2012 to 2015. There's this huge, great big, the whole load of measurements, and a lot of them just go less than 2.7. You look through the results, and they, from the top to the bottom, they don't change. Okay? Which, that doesn't happen when you monitor something. A lot of the gaps are empty, and only twice in the whole of that time where they noticed that there was a smell of chlorine, and it's only twice within those 2012 to 2015 that they actually wrote in their notes. Okay, so if they don't put in their notes that it doesn't smell of chlorine, then of course they're going to fulfil the parameters because they're not putting the information down to be assessed. What was the first bit you said there was something else? No, those are thoughts on those figures. Basically, the low percentage of consumers are reported concerns, not 0.2 per cent. There was the official figure that they put out the report. Have you challenged them on that? No, I haven't challenged them, but we know from our experience that people do not complain because they are not listened to. They are absolutely fed up with not being listened to. You've got the other hand, you've got Scottish Water that I have had numerous meetings throughout the strath in all the different villages and had public meetings constantly and attended the Association of Community Councils in the National Park, and they're constantly meeting. If that was the case and there was no complaints, why would they be running all these meetings? They're running all these meetings to try and alleviate the problems that we're having in our communities. They came to a meeting. Leslie went to a meeting. Scottish Water was arguing with her husband coming up the stairs because they were going to be late, and the room was full of people. She said, it's okay, you're the first people here. Leslie, we were looking in the window and I could see loads of people in the room and I thought, how can I be the first people here? I can actually see people in front of me. It turned out afterwards that they were all Scottish Water employees. People are arriving, like me, thinking this is community that's all turned up to hear a meeting, and then you're thinking, well, wait a minute here, you don't know who's in the room because there's people there that are not in our community. They hold a meeting and they get everybody, they separated everybody, they said right. You write your questions down. You weren't allowed to sit in a room and listen to everybody else's opinion. Scottish Water got people to write on a piece of paper and say your concerns so they would individually answer your questions. We said to them, well, we don't know what other people are asking from other villages and what other concerns people are having. She said, well, we'll sum it all up for you at the end, but that's not a public meeting. A public meeting is when people in the public can go and speak out and then you can speak to other people and find out. That's why, in band of contrast being 2016, the water action group was set up. We could bring all the information from all the villages across the strath together and we start monitoring and write down all the complaints, the health complaints, and we go to the doctors and we go to the pharmacist and now we've managed to pull all this information together. Scottish Water can't turn around and say to us, we've got no complaints, we don't know about all this because we do know they know about it, but after five years they don't want to address it. We did our own survey to see whether we should come to see you. We can give you all of that information. Okay, that would be helpful to you. Angus MacDonald. Okay, thanks, convener. Just following up on the meetings that were held, according to our briefing on Scottish Water's web page, it says that five information events were held in May and June 2016. It was a follow-up information event and public meeting held in March 2017. From your comments just now, it's fair to say that you were less than impressed with a very difficult time in 2016 because I think now our residents have had enough. We're buying bottled water, we're having to get our springs reopened up again, we're paying for a product that none of us can use and I think people are now after five years, we're at the end of our tether, we need the water is the most vital of basics and if we can't get that, we have to look alternatively to where we can get drinking water. Okay, just for the record, did you both attend all these meetings? Yeah, no, I've attended most of them. Okay, and we know that the Scottish Water plan to hold a further event for residents in November, do you intend to go along to that one? Yes. Your petition calls for an independent research into the safe calamination of drinking water. A briefing identifies a variety of sources of evidence regarding the health effects of chloramine and drinking water. What is your response to the fact that these sources, the World Health Organization, United States Environment Protection Agency, the sensors of disease control and prevention and the international agency for research on cancer have referred to limited evidence, a lack of published evidence or inadequate evidence? Well, you've just said it, lack of evidence. We are under the EU directive, you are not, according to the EU directive, you are not allowed to put anything into the water that is potentially damaging to health. We've got photographs, we've got skin complaints, we've got loads of information that the water is affecting people's health. NHS is pretty, I mean, stressed quite a bit as everybody knows, listening to the news. I mean, if this is another tip of the iceberg where there's all these people attending hospitals and everything, I mean, surely this should be taken into account now. You said about that information. The Scottish Government, the Cranfield University, the study that I spoke about, they were commissioned by the Scottish Government and they came back saying that there wasn't enough information. Thanks very much, thank you for that information. Obviously, over the last few months, I have been aware of people's concerns to do with taste, odour and skin concerns. I wonder if you could sketch out for the committee the impact that you are aware of in terms of what people's concerns are. As you mentioned, talking about buying bottled water, for example, being one example. The bottled water has increased in our area because people can't drink it. In Avymor, we've got a wide tourist industry and people come for holidays and whatever. They have to explain to people in the restaurants and hotels that when they ask for tap water, we can give you it but you can't really drink it. That's having an effect on our tourism industry. Families who are on lower incomes are not, even though it's a lovely area, a lot of people who work in this industry in Avymor. They're not on really high wages, so a lot of their wages are now going on buying the bottled water. It's very, very difficult because we used to have, I would say, the best water supply when it came from the top of the mountain. For now to have the worst water supply, on the one show they did a taste testing and they took our water and they took Manchester's water and I think they took it to Perth, but I'm not sure about that. They got people to taste it and we watched it. Of course, they were all saying that this is the Highland Water and this is the water from Manchester and they were physically spitting it out when they were tasting the Highland Water because they couldn't believe what they were drinking. I don't know what we want to get. I went to the doctor. I spoke to Dr Yehatzi who's just retired from Avymor surgery and he said statistically with the children, it's a very transient, Avymor is a very transient young population so lots of people come in and go out, but he said statistically the kids are getting really badly affected by this and they know statistically and if a child has got eczema and his hands are all bandaged up and bleeding, this affects the whole family. They can't sleep and so the whole family is affected. Brief one, obviously since the water supply changed in 2012, there have been additional changes to the water supply whether that's flushing it out or adding in April this year the chloramination. What difference have you noticed in terms of what people's concerns are over that time? On the Facebook page, we have a Stratisbane ban not water action group that's on Facebook so that monitors the whole of the valley and that's been very good at keeping tabs on what's going on and there doesn't seem to be any change and can you see people put on on Tuesday that even boiling the water doesn't help with chloramination because it doesn't get rid of it? Scottish Water never told, lots of people in the strath have things to filter the water out but now it's chloramination, you can't do that, chloramination is a very stable product that's why they use it, it stays in the pipes for much longer but it's very difficult to remove it on it and you cannot remove it with a tabletop filter, you have to get specialist equipment but Scottish Water never told us that when it was introduced. In that case can I thank you very much for your evidence today and for a lot of issues there that we want to pursue further and it's really just a question of what we now do in relation to this petition. I think that fundamentally for me the question is who's testing the water and what the test protocols and who's analysing the results and recommending and who has the power to enforce the recommendations and whether there's any conflict of interest there and I think with that in mind we probably really should look at maybe asking DWQR, Scottish Water or SIPA to give evidence here because it is a recurring issue, I think, not just in the real world. I mean it would be important obviously to get Scottish Water the opportunity to respond anyway and maybe we'll see whether that would be an evidence session or not. I think we should write to the Scottish Government so that we can understand their role. We know the Parliament has a role in scrutinising the work of Scottish Water in their reports so I think we would be wanting to write to the Scottish Government, Scottish Water, the regulator, SIPA. That suggestion might be the Water Industry Commission for Scotland and I'm wondering whether there are groups that we should be asking about because I'm quite interested in the way in which they've consulted the idea that they have a public meeting but everybody's spoken to individually. It's quite unique in my experience. It's not quite unique, it is unique. Is it the new modern way of having a public meeting? All right, okay, so to avoid people shouting at you, you just deconstruct the meeting. Obviously, I don't know if there are particular questions that folk will you've already said, Brian, are there other questions that we would want to be flagging up with these organisations? Is a bad knock on stress by water action group? It seems to have taken a lot of time and maybe we should ask them to come. Angus? I think also given the concerns that have been raised regarding the health impacts, I don't know if we would be in order to write to the GPs and have them more, but certainly the health board in general to ask for their views. Something, there was a NHS research paper, synopsis, I don't know what this is, but the highlights the lack of convincing data from long term studies into the effects of public health of chloraminated water. Okay, it would be good if you could share that or a link to that with the clerks. I don't, we just... Okay, well we can trace it. But I think we should certainly write to the health board and ask for their views as well. And I suppose that I mean from the Scottish Government's point of view, I think it's to go back to the point that Rona makes, that this isn't, there are very specific issues that you're describing, but this committee has almost wanted to look at what are the national implications for that or the policy implications of that more generally. I suppose to have conducted an inquiry into your water supply, want to know the issues there that are not being addressed because of the jet that the petition itself specifically focuses on the role of the regulators. We really want to know what measurements there are, how do you respond to consumer concerns and those kinds of issues. I think that not many directives would be interesting to explore as well, but I find it hard to believe that a large public body would not be adhering to EU regulations and so we need to tease that one out because I think the petitioner said that there are certain things that can't be put into water under EU regulations and I'm pretty sure that Scottish water will be sticking to that, but we need to sort of find that out. The drinking water disinfectant byproducts, there's only one of them measured in Britain and that's a TTHM, which is actually reduced by using chloramines. They don't add because, well that's what I was saying about the cumulative, they don't add them all up and the EU directive says that you must have a total of all of those and they have to be under 100. It's a little funny thing that I don't something G per litre, but because only one of them is regulated, they can't add them all up because the only one of them is measured. I think that from the point of view of the committee, we recognize or hear what you have said about your concerns, we want to see in the general context, is there a structure in place that addresses those problems wherever they emerge? I think my sense is the committee thinks that it will be worthwhile A to get more evidence but also to have oral evidence, we might be discussed further at some point, but what that looks like once we've got initial responses from all the different groups of people that we've identified. I wonder if it would be in order to inform the ECCLR committee at this early stage, at least of today's transcript, given that they've got oversight of Scottish Water, SIPA and DWQR, just to make them aware of the situation and keep them in the loop with a guide, any further evidence that is taken? One of the discussions that we had at the conveners group when I was presenting on the public petition, the role of public petitions, was when we pass petitions over what is expected, but also how do we ensure that there is a kind of information exchange, so that they know what we are considering that might be relevant to individual committees, so that we can make sure that we do that. I think that it would be fair to say that we want to seek information and responses, but following that, we will be expecting to have further oral evidence to address the general issues around how we make sure that individual concerns and localised concerns are dealt with by having a regulatory framework that is robust. There are a lot of issues that have been flagged up today that we would be keen to address with the relevant agencies that you have identified, including the Scottish Water, the regulator and the Government. That is acceptable. In that case, I thank you very much for your attendance and will suspend briefly. The second new petition for consideration, which is petition 1647 by Angus O'Henley on protection for all employees in NHS Scotland. Mr O'Henley was unable to attend the meeting, but members have a copy of the petition and a note by the clerks. The petition calls for the creation of a specific statutory offence covering the assault of any employee within NHS Scotland whilst that employee is carrying out any patient service. The petition acknowledges the protection that is provided to certain employees under the Emergency Workers Scotland Act 2005, but considers that there is a gap in the legislation, which means that other employees within the NHS do not have the same protection. He says that this will often be front-line staff such as admin or reception staff, posters, cleaners—porters, my apologies—cleaners or auxiliary and trainee nurses. The clerks note refers to SPICE briefing, which advises that any such assault can already be prosecuted under existing criminal offences such as the common law offence of assault. Paragraph 5 to 7 of the clerks note provides further context in respect to the 2005 act. It notes that the petition refers only to assault and does not refer to obstruction or hindering, which are also offences under the 2005 act. Section 5 of the act does offer protection on hospital premises to anyone assisting doctors, nurses, midwives and ambulance staff without the requirement for this to be in an emergency situation. The SPICE briefing also refers to the protection of workers Scotland bill, which was introduced by Hugh Henry in 2010. While there was no disagreement that workers who serve the public deserve protection, there was no agreement about how best that might be achieved without duplicating existing legislation, and the bill fell at stage 1. Paragraph 17 to 21 of the clerks note covers sentencing and suggests that, by highlighting this issue, sentences might become tougher when taking account of any aggravating factors. I wonder if members have any comments or suggestions on the petition. Is the petitioner suggesting that the offence of assault or whatever within a medical environment or NHS environment should have a higher level of sentences? Is that what we are asking here? I think that my understanding is to underline the seriousness of it. If my recollection is right, the context for the original bill in 2000 or the original act in 2005 was a recognition, for example, that firefighters were being called out in emergency and were then being ambushed by young people, assaulting, throwing stones at them and so on, so that in emergency situations somebody was at risk and then, to be assaulted at that point, seemed something that the courts wanted to recognise as a very significant thing, as an aggravation. The debate that emerges after that is, is it just in emergency situations that are at risk? Are it just emergency workers that are just at risk? In fact, Henry's legislation was, to some extent, prompted by, I think, the Shelter Workers Union, where they recognised that people in retail can very often be in a put in a position where they are at risk as well. It feels to me that the legislative proposals have all been driven by the same thing, which is a recognition that people have gone about their business trying to do a particular job, a front-line job, trying to provide a service to then be assaulted or attacked is a significant thing that we want the courts to take into account. I think that always the argument has been when is the balance lies in terms of legislating for that. It would take an existing part of common law and replicate it as a new offence. It wouldn't extend any new protections because the laws of protection are there, but, as you say, it could highlight it. Is the same argument a lot of stalking legislation or—I haven't looked in detail at domestic abuse legislation, but it is to say that, yes, those things could be pursued as a breach of peace or an assault. However, if you place it in the context of a broader set of behaviours, you can then recognise that this has been an attack that is motivatable. Hate crime is the same thing. It tries to recognise context, motivation as well. I sense from the committee that we recognise that Mr Henley's petition is identifying an issue that we are sympathetic to. We recognise that it is not just doctors and nurses and so on, that there are a lot of people working in health services to do their best. The idea that they would be assaulted in a workplace is not something that is acceptable. I suppose that the question is whether the proposers that he identifies are the ones that would solve that problem. It might be that we would be worthwhile testing that a bit and asking for a response from people who might have an interest in the question. It seems that the petitioner is calling for this to apply to NHS employees, if we are as a guest. As you said earlier, you could extend it to assault at work, whatever that might be, whether you are a bus driver or a shop retail worker. It is not just the people who have a medical role in a hospital who are at risk when we all know of anecdotal evidence of people who are trying to manage the process of being abused, whether it is the receptionist at the GP surgery or somebody, the porter who is working in a hospital trying to do their best to become the focus of aggression. The question is not for me that distinction. We do want to recognise that the folk doing those jobs are equally deserving of protection. The question is whether the model that is suggested by the petitioner would work and would have the desired effect. You are not the situation of the ticket collector on the train. There is a law to protect any assault. I have seen it running factories. I have had people who have been assaulted and they have got the police in and they have been charged. Why cannot we use that law? I think that my question is that the assault of, as you have highlighted, the assault of a fireman attending an emergency or an ambulance attending an emergency. You have all heard anecdotal evidence of whether that constitutes a higher level of the same offence. I think that that is where I was looking at. I think that whether the practicalities of that would be interesting to hear from the Crown Office or whether the practicalities of that are. I think that we do recognise that the petitioner is highlighting an issue, but whether that is a practical solution to that. I suggest that we try to find out some more. We are not ruling it out completely. We want to test it against the views of the Scottish Government. You are right to talk about the Crown Office Procurator Fiscal Service. I am interested in what the unions in the health service have a view on that. I do not know whether the Law Society routinely comments on those questions, but I think that they quite often will have a view about whether adding legislation actually adds protection. I do not know what to do with what I am hearing from them. Anyone else? Whichever organisation, such as the Unions Royal College of Nursing, British Medical Association, NHS Scotland? I do not know what the health and safety executive would be if they have a view. If there are further suggestions of organisation, we might seek information from them. Definitely with a view to how it could be carried out. I think that in conclusion we recognise that there is an issue being highlighted here, whether the solution is a separate question, but it would be worthwhile examining that further. If we can then move on to the next item on the agenda, agenda item 3 on continued petitions. The next item on the agenda is two continued petitions, petition 1480 by Amanda Copill on Alzheimer's and dementia awareness, and petition 1533 by Geoff Adamson on behalf of Scotland against the care tax on abolition of non-residential social care charges for older and disabled people. I understand that the petition on Amanda Copill is in the public gallery, and I welcome her to today's consideration of the petition. Members would call that we took evidence from the Cabinet Secretary for Health and Sport to our last consideration of the petition. We discussed a number of issues, including the remit and timescale for the feasibility study. Members will see from the papers that that is likely to be completed in the summer, and I wonder if members have any comments or suggestions for action. The results of the feasibility study and the request that the Cabinet Secretary does have a meeting with the petitioner. We consider the results of the feasibility study that is carried out. It would be important for us to have an opportunity to look at the feasibility study. My sense is that people feel very strongly that there is an issue here. There is a question for us at some point whether we want to separate off the two petitions. Although they are dealing with the same area, they might be pursuing slightly different issues. I know myself that, in relation to the abolition of non-residential social care charges for older and disabled people, there is a question about, in the context of people's human rights, that you need access to services in order for you to be able to achieve your potential and to do things, and you are being charged for those. It prevents people from then do not access those services at a later stage that they need more support. It is counterintuitive. It is not focusing on preventative and early intervention, and it is creating more problems further down the line. There is some recognition that the feasibility study itself is important to people, but we want to be reassured about what the timescale for that is and what the expectations of that feasibility study would be. I know that, before, there was an issue about people saying that there are implications for costs, but it did not appear that there was no work done on what that might be. Are there any other comments that people might have? That is key to how we proceed with it, but I think that there is a strong argument for separating the two petitions. That might be something to look at at a later stage. The other thing is to check whether the Cabinet Secretary for Health and Sport would ask her officials to meet with the petitioner to discuss the feasibility study. I think that that would give people confidence that it was being those kinds of concerns, maybe from both lots of petitioners, that they were getting that opportunity to focus with the officials on what those concerns were. Obviously, those campaigns have been particularly effective in highlighting an injustice, and there has been some movement that would be important if that communication was continued, so perhaps we could agree to do that as well. Is that agreed? In that case, again, recognising the importance of the myriad issues that are in those two petitions is not something that we want to let go of at this point. We were very keen to see the outcome of the feasibility study, but we were particularly keen that that feasibility study was informed by the views and experience—the direct experience—of the petitions themselves. If we can move on to petition 1577 on adult cerebral palsy services. The next item on the agenda is petition 1577 by Rachel Wallace on adult cerebral palsy services. Members will recall that we took evidence from the Minister for Public Health and Sport at our last consideration of this petition. We have received a submission from the petitioner and members will also see that the clerks note provides some additional background information from SPICE. I want at this point if I can welcome murder-freezer MSP for this item. Members will recall that the minister and our officials considered that a national clinical pathway would not be appropriate for a condition such as cerebral palsy. They propose that developing practices at a local level is the way forward for now. The Scottish Government has been working with Bobas Scotland in this regard, and they will consider what learning can be sheared from that with health boards. We understand that capability Scotland is also conducting a national mapping exercise of therapy provision for cerebral palsy in Scotland. As those projects have only recently concluded, we are yet to have the Scottish Government's view on what action it will take in response to the findings of this work. The petitioner takes the view that the Scottish Government should take the lead at national level, whether that is in the form of a national clinical pathway or other framework, to ensure that adults with cerebral palsy can access to continuity and specialist care and services that they require. I wonder if members have any comments or suggestions for action. I wonder whether it might be useful for you to make some comments now to help us to inform what our views might be. I have a discussion with the petitioner on the evidence session that was held with the minister a few weeks ago. While there was some helpful things said in terms of that evidence, the petitioner's biggest concern is that we do not lose sight of the ambition to have a national clinical pathway. I think that what the minister said in her response was that they were looking at developing local pathways. I think that the petitioner's concern is that what that would lead to would be in effect a very mixed and patchy picture across the country where some health boards would do well and take this forward expeditiously. Other health boards might not. We know that health boards are suffering from, in many cases, financial issues, staff shortages and might not be seen as a priority. The petitioner was keen to reinforce a message that she wanted to see this taken forward on a national level and with national leadership from the Scottish Government, rather than just being left to the discretion of individual health boards to take this forward. I think that the work that has been on-going with Bobath Scotland and Capability Scotland has been helpful. I have been interested to see how that develops. To get some feedback from those exercises in due course would be very helpful. In terms of giving the impetus that the petitioner would like to see, we are keen that it is not lost sight of as a national clinical pathway. You can help us. It is referred to in the response from the petitioner that other comparable conditions would have national pathways. That is the thing that we are wrestling with. I am not quite clear, even from the evidence, why there would be resistance to that at national level and why there are other conditions where there would be any expectation of those pathways. I do not have enough medical knowledge to say how cerebral palsy fits in with the hierarchy of other conditions. However, if you take an example of motor neurone disease, where we have seen a great deal of impetus behind that over the past year and where the Scottish Government has provided a lead in making sure that local health boards are providing additional support for those who are suffering from MND, that is the parallel that you can see. If the Government determines that something needs to be addressed, it can give a lead to it and make sure that at a local level health boards deliver, rather than just being left to individual health boards to decide what action they are taking themselves. Is there a consistency across the country when, as children with cerebral palsy, there is an expectation of a particular kind of support right across the country, but it is a transition to adulthood that is causing the process? That is absolutely the point in that children's services, according to the petition in any way, are actually quite robust. Children with cerebral palsy are generally well cared for and get the attention that they require. The problem is with the transition to adulthood, where too many people seem to just fall off the edge of a cliff when it comes to the support that they require. Any comments from the committee on how we take it forward? Brian? I think that the baseline is that everybody is an individual and everybody will have separate needs, but that does not prevent there being a national framework in which there should be a fairly robust or similar approach to establishing what the individual needs would be. For me, that is incorrectly, if I am wrong, but that seems to me to be realistic. There should be a framework in place that enables individual treatment protocols to be established. I am reading the evidence that the petitioner has to seek out his own physiotherapy and identifying physiotherapists who would not be able to have the knowledge in order to deal with his condition, but that still does not reflect that there should be national guidance on it. It is something that we want to pursue a little further. From the committee, we might ask the Scottish Government for the findings from the pilot programme and the mapping exercise and to get a further assessment from the Scottish Government on the way forward, presumably informed by the bits of work that they have done, including whether it will produce national guidance for health boards. I suspect that the petitioner and for ourselves, the technicality of the language that he used to describe what that is, whether it is a pathway or whatever, is not as important as there being a national view of what it is reasonable for an adult with cerebral palsy to expect and to be able to access. Whether it is national or local, we need to sort of know the time frame, I think. If we can write to the Scottish Government in those terms and seek a time frame, my sense is that I do not know whether the findings—do we have a time scale for the pilot programme? No, it is already finished, so we can get that information. Is the national element that is putting something in place? I think that we fear to say that the committee has found that argument a convincing one. If you hear an argument against it, there may be a compelling argument, but it is not one that we feel as if we have heard and that we would be keen for the Scottish Government to give us information on the pilot programme, the mapping exercise and whether it will produce national guidance for the health boards. Precisely, for the point that Murdo Fraser makes, that people are making budgeting decisions, the context of national guidance becomes very important. If that is agreed, thank you very much. If we can move on then to petition 1581, Save Scotland's school libraries, which was lodged by Duncan Wright on behalf of Save Scotland's school libraries. The petition calls for a new national strategy for school libraries, which recognises the vital role of high-quality school libraries in supporting pupils' literacy and research skills. Members would recall that our previous consideration of this petition, the Deputy First Minister and Cabinet Secretary for Education and Skills, said that it had been persuaded by the petitioner's argument and that it is his intention to formulate such a strategy. The petitioner welcomes the Deputy First Minister's commitment, acknowledging that it, quote, fully supports the original aim of the petition. He seeks detail on how the strategy will be developed and delivered, who will be involved in any consultation, what the timescale is for the strategy to be in place and whether it is part of the strategy national standards will be established for schools across Scotland. The petitioner suggests that CULIPs should be involved in the development of the strategy and that it would be of great benefit to the future success of the strategy, if Mrs Winnie explained the rationale behind it to representatives of COSLA and ADES. I wonder if members have any comments or suggestions for action. Deputy First Minister's evidence to us was very positive and it has obviously been recognised here, so there is no issue with any of that, but it might be an idea to respond to the petitioner's request to request further detail on the strategy just to pick out certain elements of what was said during the evidence, but I do not think that there is any issue that anyone is unhappy with what is happening at the moment. I must be quite close to a point where we can draw a line under the list. That is the only question whether we close the petition now, given that the original request by the petitioner has been agreed or whether we would look for further information first, because I suppose that what the petitioner wants is some confidence that there is not just a strategy that might be developed at some point in the future, but there is now a timescale for it and, in fact, that the Government is addressing the concerns of COSLA and ADES who I think were more sceptical, but questions that clearly do not know the answer to, so I think that it might be worthwhile to write to the Deputy First Minister. I agree. Normally, convener, I would move to close the petition, but I think that, particularly given the Deputy First Minister's full support for the original aim of the petition and, of course, the fact that he has given a commitment to deliver a national strategy, but that is said, I think that the petitioner is right to seek a little bit further clarification, so I am happy to go with the other members on that. I agree to that, but I also think that, to reflect ourselves that this is an issue where we are very finely balanced whether we close it now, but I think that the expectation will be that having got the information from the Deputy First Minister that that would be something that we would be expecting to do, and recognising both the effectors of the petitioner, but also that the Deputy First Minister did move in the way that he did in a very positive way from the petitioner's point of view. If we can then move on to petition 1591 by Katrina MacDonald on behalf of SOS NHS, on the major redesign of healthcare services in Skai Lohalsh and South West Ross, I welcome Kate Forbes MSP and Rhoda Grant MSP, who are present for this petition. Members have a note by the clock, along with the most recent submissions from the Cabinet Secretary and the petitioner. The Cabinet Secretary's submission appears to indicate that she is confident that appropriate consideration has been given to any unintended consequences of the redesign and that she is content that due process has been followed. She also makes clear her expectations of the work required by NHS Highland to ensure full engagement with local stakeholders. However, the petitioners appear still to have concerns that they are not being listened to or fully engaged with, and that is perhaps a matter for the board to consider. Before I ask members for their comments or suggestions, I wonder if I can ask Rhoda Grant and Kate Forbes if they have a view on the progress that has been made or the response from the minister. I think that the most important line that you just mentioned was the introduction of Robison's letters about the expectations that are required. The issue here is matching up what has been promised, what is being expected and what people feel is really happening on the ground and the engagement with the community. It still remains a matter of concern for most people in the north end of the sky in particular about having confidence in the redesign and what that will mean for them. In particular, we have raised issues of concern in the past, but it is about care beds in the north end. Last time, I mentioned the closure of another care home, so there is growing pressure on care beds for elderly or palliative care and also for emergency care and emergency services provision in the north end. Those remain a concern, along with Ronald McDonald, who has previously submitted evidence around the mandatory national guidelines and taking into account the density of the population in the north end. I feel that my role is this morning to try and represent the views of those who have continued to write to me and raise their concerns with me around the provision of beds currently, the provision of emergency services currently and also the redesigned process of taking into account the density of the population. I should also add that there are other parts of the sky, so the south end, where at the moment the redesign suggests that the new hospital should be, who are content at the moment with the new hospital in their area, although I have also made clear that they too would like to see more services being committed to in the north end of sky. The question for the committee this morning is whether it is worth asking for more evidence or asking for the petitioners to come back and make their views known as a final point and whether the whole process of what is being expected, what has been promised, marries with what people sense on the ground? There is nothing that I would disagree with in what Kate has said. I would add just about the ambulance service, both patient transport and emergency ambulances. There are real concerns that people have to go to Broadford. Especially in an ageing population, public transport is not what it is in a city. It is pretty sparse. If people are not able to drive themselves, that becomes a big issue to access health services and indeed visit people. There are promises about better care in the community and the like, but nobody has seen the shape of that. Press reports are saying that NHS Highland is looking to make more major savings from their budget. If I was sitting there, I would be thinking, how are you going to deliver all the services with a budget that is contracting substantially? I tried to think what the committee can do to help with this. I just throw this out as a suggestion. I do not know if it would be possible for the committee to do a round table with the health board and the petitioners to see if some of the issues that are really concerning them could be answered. The committee is being passed back and forth, and we do not appear to have resolved very much for the petitioners. I do not know whether that would be a way forward that the committee would examine. Indeed, if it was something that the petitioners or the health board would be willing to participate in, it just feels to me that there is still that gap. I have said all the time that we need to get on and have a new hospital in the sky, because both hospitals are not fit for a purpose anymore. Any delay will mean that people not only have to travel to Broadford, but if they have to travel to Inverness, it will be even worse. We need that new hospital, but we need to make sure that the whole community is content with the services that they are receiving and that they know that they are going to be able to access healthcare without barriers in their way. I am interested in the committee's views on what we do. At one level, the Scottish Government has said that it is content that the due process has been followed, and people locally clearly do not agree with that. I am not sure whether a round table would resolve that question or what those individual anxieties are, but I would not want to misrepresent what the role of the committee is. It is not a scrutiny committee in the sense that it could establish X, Y and come to judgment on what has been done. We would not have that role, so we would not want unnecessarily to continue something in the expectations of a resolution that we cannot achieve for people. We have to be quite honest about what we can and cannot do. I am interested in the committee's views. There is a balance for us whether we close the petition on the basis that it is not going to be resolved through the petition process, or is there something useful that we can do that would illuminate some of the challenges that are there in terms of bringing the community together with the services that they are looking for and want to have confidence in? Brian? I alluded to what I was going to say. To me, it seems that we have the cabinet secretary content with the process that has gone through, but at the same time, we have not allied any concerns that we have with the petitioners and the population there. Somehow or other, it seems to me that there is a role to be played between communication between the two to try to find it from some middle ground. My question was, is that the role of the petitions committee? Is that one of what we actually do? At the end of the day, it is two opposing ideas from the same amount of evidence. I think that you make some valid points, convener, as does Brian Whittle. Initially, I had a great deal of sympathy for this petition and I have been keen to see the committee do all that it can in its power to assist the petitioners, given the quite valid concerns that clearly continue amongst the population in the sky, and perhaps not so much on the outside, but certainly in North Sky. However, given that the cabinet secretary has confirmed that she is content that the new process has been followed, as Kate Forbes mentioned, the north end of the sky is not so happy. Quite frankly, I do not see how that will change no matter how long we deliberate it here at the committee. I think that the process has been exhausted. I do not see any benefit in having the petitioners back in to give further evidence that Kate Forbes has suggested. I do not see the benefit of a round table, because it is basically just prolonging the situation where, clearly, the hospital has to be built as soon as possible. Given that there is never going to be—you are not going to get the whole of the community to be content—I would move that the petition be closed extremely reluctantly, because, as I said, I did understand the concerns. As I said, I think that we have exhausted the process, and I would move to close. I am interested in other people's comments. I suppose that what I would ask Rhoda and Kate is the question of the analysis done by Ronald MacDonald, in the sense that the process was not done properly, and the feeling that we have got back was that those specific, very definite points have not been responded to. Would it help—are people going to be more confident in the process if we ask the minister to directly address those points, or is your view that that that is discontinued? I see the force of what Angus MacDonald has said, but is that the one thing that we will look—we have given it a final shot here—that my sense from the petition is that they feel that those questions have just been ignored rather than addressed? I mean, they can be addressed by the minister, so he will actually check it or whatever, but I wonder if he thinks that that would help. I mean, I suppose that the petition initially is asking for some sort of review, and I have asked in the past what is the main concern. Is it a lack of confidence in the process? Is it the outcome of the process—in other words, where the hospital is—or is it thoroughly a general sense of downgrading of the services? Repeatedly, people have said to me that their main concern is a confidence in the process. If the petition were able to ask for the cabinet secretary to make sure that everything has been followed correctly in whatever form that would be, I think that that would be profitable. Can I ask the devil's advocate question? Do people complain about the process when they don't like the outcome? Even if we were to establish the progress, the process was right. If you're in the north of Skye and you're not happy, is it going to change anything? That's not to belittle or demean their concerns. Is it through looking at the process that you address the concerns or is there a next stage that allows those concerns to be addressed? It can't just be with the location of the hospital. It's all the things round about, such as transport, ambulance services and so on. There does seem to be unanswered questions. If we were to keep it open, it's worthwhile to have people back in for evidence, but a letter to the cabinet secretary asking to relate to the specific concerns around access to primary emergency care and highlighting those concerns to see what the response is. That would be my only reason for keeping it open, just to tie up those loose ends and not saying that it would give them the answer that they wanted, but at least we would ask those questions for them. Maurice Cawthorne? Yes. I entirely agree with what Rhoda has said, because from my experience on MUL, we had exactly the same position there. We managed to resolve it by specifically going in and talking about the reduction of access to primary and secondary emergency care, and that helped. I don't support closing it just now. I believe that we should just do this one more letter to the cabinet secretary to establish it, because it's about confidence in the north end of the island. I had this in the Ross of Mull. We got confidence back and we resolved the issue. The cabinet secretary confirmed it. In response to what you are saying, we should be seeing to the cabinet secretary or maybe to the health board as well what measures you are now putting in place to build confidence, because otherwise the process is stalled and nobody is benefiting from that. I think that over the past few months I have appreciated what the Petitions Committee has done in terms of going back and forth. I know that the petitioners have appreciated it, but it has felt at times that the same answer is coming back. If, in your letter, you were able to press the point for some tangible outcome that could instill confidence. If that is agreed, we would agree with that petition. I now suspend the meeting because the Parliament, as across the country, will take the opportunity to reflect on the events of the tragic events in Manchester. I want us to be able to participate in the minute silence at 11 o'clock. I will call the meeting back to order then, and we can move on to the penultimate petition on the agenda today, which is the petition 1603 on ensuring greater scrutiny, guidance and consultation on armed forces visits to schools in Scotland. I understand that one of the petitioners, Mary Campbell Jack, is in the gallery, and I want to welcome her to the meeting. Members will recall that our previous consideration of the petition was evidence from the Deputy First Minister, and we had the chance to consider the evidence that the petitioners have made a further submission, which we have in our papers. The petitioner's submission covers a range of issues, including the content of careers advice information and data that they have compiled about armed forces visits to special schools in Scotland. At this last point, the petitioners urged the committee to recommend that no such visits are made. The petitioners also urged the committee to recommend that a child rights and wellbeing impact assessment is applied to armed forces visits and that good quality data on armed forces visits to schools is requested. I wonder how members have any comments or suggestions to make on how we might take the petition forward. We are going to take some evidence from the armed forces themselves and visit the school until such times as we hear that evidence. We would need to think about how, in what format, that information would come, but that would be useful. I think that there are some of the questions that are raised by the petitioners, particularly around special schools data, wellbeing, impact and so on, that we could usefully test with them. I think again that it was a really positive session with the Deputy First Minister when he gave evidence the last time, but I do think that there are things that we could do just to follow that up because of some of the things that he committed to. I am very concerned about the freedom of information request that shows that 13 visits to special schools were made by the armed forces, so that might be something that we could certainly bring up when we hear some more evidence. One of the commitments that were made was that good quality data on armed forces visits to schools was requested, which was agreed to by the Deputy First Minister, but he also asked what data he thinks would help in that regard. I am not sure if we have provided that kind of information so that he can carry that out. That was an important commitment that he made. Are there specific things that you might suggest, Rona? What particular schools have been visited in postcode areas? We can get a picture if there is any pattern emerging from that. The petitioner also requests that a child rights and wellbeing impact assessment be applied to armed forces visits to schools. That is something else that we could possibly press, but that might come after we have had the briefing. The data point could be followed up now. I wonder if some of it is also about the purpose of the visits. I think that there is something that came out of the evidence with the Deputy First Minister. To some extent, he was addressing the question of careers visits, when we know that one of the concerns of the petitioners might be that there are softer visits, which are then used for recruitment purposes, when the other side of the argument would be that those are facilities or knowledge or information opportunities that they can bring into school, whether it is around health and fitness or whatever it might be. It is like pulling that out. The use of one in order to recruit for the other is at the heart of the petition. I think that the Welsh Government has implemented some things, and some of the things that I find on my work in the cross-party group, which is quite useful, is what they have done. I would like to see what they have come forward with on the Welsh Government, because that might give us some help. I presume that there is a spectrum of people who think that the armed forces are not going to schools at all. If there is a connection between the armed forces and an individual school, that should just go ahead. We want information and data to give us an idea of what the patterns are and where that balance is. Perhaps how the Welsh Government's response to the question would be useful in forming our views. I am not quite sure where we are with that. Is that something that is in hand? Was there something that they offered? I think that the question will be in what form it would be. At that briefing, the director of recruiting Scotland comes to that in the three armed services, and we do not want a generic report. That would give us some substance, because there are appointed seniors in that. I think that that is very helpful. Again, the committee is alive to the balance that we want to strike here. However, the biggest confidence that we can have in the process is that, if we know where the armed forces are going, why they are going there and what work is done around the question of whether there is an issue about special schools, the special schools themselves are so varied in their purpose and their cohort, then it may be different in different places. Historically, from a petitioner's point of view, it is getting the information that has been very difficult. If we can bring that forward to make it more open and transparent, that is a first step in dealing with the petition. I think that we would not want to deal with the petition further, or would defer further consideration of the petition until we have had that briefing on the armed forces to schools, provided by a representative of the armed forces. Again, Maurice Corry's point about who we would hope to be part of that would be useful. We can, in the meantime, forward to the Deputy First Minister our suggestions around the data. If that is agreed, we can then move on to the final petition today. The final item on the agenda this morning is the petition 1639 by Moryn Macmillan on Enterprise Agency boards. I welcome Rhoda Grant back for this item. Members will recall that we agreed to seek the petitioner's view on the ministerial statement by the Cabinet Secretary for Rural Economy and Connectivity, and we have now received her views. I wonder if members have any comments or suggestions for action. Do you want to say anything, Rhoda Grant? I know that you were lazing the petitioner on this. Yes, just a couple of things. Given the outcome of the review, people are pleased that the High Board has been retained, but it is not clear what is going to happen coming out of the review. We know that there is going to be an overarching cross-cutting board. We do not know fully the membership of that or its role, other than that it will not be statutory. I wonder if the petition may be kept open to see what happens with that. If it does impact—certainly some of the information that I am getting locally—that it will happen by the back door rather than up front and publicly. Another concern that people have been expressing to me—certainly it was something that the petitioner spoke to me about—was that, when the proposal was made originally, it was seen as the last part of High that remained. There were concerns that due to budget cuts, the reach of the High itself had diminished over the years, and what people wanted was the high of the past back. Given Brexit coming up, given the amount of money that flowed from Europe to the Highlands and Islands, there is a real concern that that will mean that the Highlands and Islands will suffer and that they need a strong voice in their corners. They are speaking to Government about allocation of resources to make sure that they understand peripherality in the way that Europe did, but neither of our Governments have ever done, regardless of what shade I am not making a political point. There is a role for high to be strengthened and represent the area, otherwise it could be a very difficult situation that we find ourselves in. I make those two comments. It might be that the committee wants to pass it on to the Rural Economy, to look more in-depth about in the role of high, or maybe just to hold the petition to see the outcome of the cross-cutting board before they decide ultimately what to do with the petition. I think that in terms of the actual petition, the petition has been successful in the sense that high has been saved. I personally am very supportive of a strong high with a strong social remit. I think that all enterprise boards should have a social remit. I think that it should be about people in plays, but it is particularly important in the Highlands and Islands. However, the question for us as a committee is whether that argument and that debate should be located in here, or whether the petition in a sense cannot be the vehicle for that. I do not think that my sense would be because it was very specific. There is nothing precluding anyone from bringing another petition to the committee on those questions. I do not know whether Angus has a view on what the Rural Affairs, as I still call it, committee is doing on the question. I am not on that committee, but I would agree wholeheartedly with you, convener. I was certainly delighted on the 20th of April, following the public petition committee's evidence session in the morning that the Government performed a vote fast that afternoon. It was the right thing to do. It was clearly pressure from members on all sides of the chamber that it decided to ditch the plans that it had. As I mentioned on the 20th of April, having had direct experience with the work of high and HIDB before it, the need to retain that board is imperative. That said, I think that the petition has done its job, as have the members who campaigned. As you say, convener, it is perhaps time for the petition to be closed. However, there is an opportunity for the petitioner to come back at a future date, should there be any, as Rhoda Grant mentioned, or referred to, backdoor actions there. I would hope that that would not be the case clearly, given that consensus broke out in the chamber on the 20th of April. I would move to close the petition. I think that we have gone as far as we can with the outcome. It was a good one. I echo what Angus said at the point of me repeating it. It seems that the petitioner, for me, has been successful. The question that Rhoda Grant is asking is the implementation around that. That is a different question to the one that has been asked in the petition. I think that, as a committee, we would be gravely disappointed if it looked as if it was something to buy time. It is going to do the same thing in a different way. Again, it would be across the parties and there would be grave disappointment if it was sleight of hand rather than a change in policy position. I agree that it is time to close. It has achieved its results. It is subject to the committee petitioner. However, the Parliament will keep a watching brief on that. I will pick up your point and maybe the rural affairs or whatever committee may come back in that form later on. Certainly, from the point of view of the evidence that we got from the petitioner, I think that it was very compelling and very powerful. Historically, what had been done in the islands by an agency had that kind of remit and responsibility. I have made an example before about generational change and the opportunities for young people now to stay in islands that were lost to my own parents generation. I would hope that that evidence that was given by the petitioner had an effect in here. It was a broader context rather than some kind of theoretical shifting round of the chairs around a table. We would be clear to the petitioner that we recognise those broader questions that have been highlighted. I think that there is always an opportunity for a petitioner to come back with a new petition that might address those concerns, if it was felt necessary. That is acceptable. We are agreeing as a committee that we are going to close the petition and understand the order rule 15.7. On the basis of the Scottish Government, it has decided to retain enterprise agency boards as part of its enterprise skills review, and it has addressed the specific concerns of the petition around HIE. If that is agreed. In that case, I thank Rhoda for her attendance.