 Fel fawr, wrth gwrs, a ch которуюi i'rறpent y Fforth Metw y gynwyllteth hankwamelig yn 2019, wrth i gau myfydliadau, gallwch yn eu rhan i'n ddiddordeb yn fwrdd ddechrau ffoeidliad ym mwyntaf a'r bydd hyn yn seilent i ddweud yn dechrau cymddechidol ar gyfer sosial meddwl eu broses. Mae'n trefiau ei wneud o'r ffotograffu oherwydd i wneud o'r prwyhiddiad. Dwi wedi ei wneud i'r pliwyd posts bryddo a oedd ymolaf ac yw Alex Cole Hamilton am David Torrance. We are joined today by Bob Dorris, a substitute member for David Torrance. Welcome. The first item of the agenda is continued consideration of stage 2 of the health and care staff in Scotland bill. I welcome once again Cabinet Secretary Jeane Freeman, who is again accompanied by Diane Murray, Louise Kay, Julie Davidson and Jonathan Brown. Welcome officials to the table. I also welcome Monica Lennon, who I know will be moving amendments. In due course, we will have Mike Rumbles to move amendments. I also welcome to Fiona McLean, who is accompanying the minister. Everyone should have with them a copy of the bill that has introduced the martial list of amendments published on Thursday and the groupings of amendments that set them out in the order in which they will be debated. I am glad to welcome members of the public to join us today. I will briefly explain the procedure. Once again, there will be a debate on each group of amendments. I will call the member who lodges the first amendment in that group to speak to and move that amendment and to speak to all the other amendments in the group. I will then call any other members who have lodged amendments in that group. A member who has not lodged the amendments may also contribute to simply catch my eye in the usual way. I will invite the Cabinet Secretary to contribute to the debate, which she has not already done so just before I move to winding up, and I will then move to the winding up speech by the mover of the initial amendment. Following debate on each group, the mover of the amendment should indicate whether they wish to press the amendment to a vote or to withdraw. I will then put the question on that amendment if they do wish to press ahead. If a member wishes to withdraw, that must be agreed by other members, so if any member present objects the amendment will immediately be put to the vote. If a member does not wish to move an amendment, they should say not moved. It is open to any other member of the committee to move that amendment. If no one does so, I will immediately move to the next amendment on the martial list. It is a reminder that only committee members and substitute members may vote. Voting in any division is by show of hands, and I would ask members to indicate their intention clearly and keep their hand up until their vote has been recorded. The committee is required also to formally approve each section of the bill on completion of amendments in that section, so I will also put a question on that at the appropriate point. The intention is, if we can, to finish consideration of stage 2 of the bill. Clearly, if we are unable to do so, we will return to it after the February recess, but I would indicate at this stage that we have approximately three hours set aside for completion of these proceedings today, and I hope that we can get through it. On that basis, we should move straight away to amendment 18, in the name of the Cabinet Secretary for Justice, which is grouped with amendments 93 and 22, on the common staffic method, purpose and frequency of use, and I call the Cabinet Secretary to move amendment 18. Thank you, convener, and good morning to you and to members. Amendments 18 and 22 relate to the frequency of use of the common staffic method in section 12ib. The common staffing method includes the use of staffing level and professional judgment tools and consideration of the results that they produce. Section 12ib3c provides Scottish ministers with the power to prescribe the frequency of use of the staffing level and professional judgment tools as part of the common staffing method. It does not allow ministers to prescribe the frequency of use of the common staffing method as a whole. The data output produced as a result of using those tools should only be used as part of the common staffing method and should not be used in isolation. Vice versa, the common staffing method should not be used without using the tools and the data output from them. It is therefore the Scottish Government's intention that the whole common staffing method as set out in section 12ib should be used at a specified frequency and not just the tools. Upon reflection, therefore, the Scottish Government considers that the power in 12ib3c is too narrow to achieve that intention since it relates only to the frequency of use of the tools and not the wider common staffing method. Accordingly, amendment 22 removes section 12ib3c, while amendment 18 sets out a replacement power for Scottish ministers to prescribe in regulations the frequency at which the common staffing method as a whole and not just the tools is to be used. It is also worth underlining that this will be a minimum frequency. Health boards will have the discretion to use the common staffing method more often if they wish. As well as providing clarity that Scottish ministers can specify the frequency with which the whole common staffing method should be used and not just the tools, those amendments should also remove any possible suggestion that the output of the tools can be used separately from the common staffing method or that the common staffing method can be followed without using the data from the output of the tools. Turning now to Mr Briggs amendment 93, which seeks to set out the purpose of the common staffing method, is to set staffing establishments. Although the common staffing method is used to set staffing establishments, it is not its only purpose. It is designed to be used more widely. Indeed, the bill already reflects its wider use as a method to support service redesign. It is set out as a specific step in 12IB2D. If we were to say that the common staffing method was purely about setting a staffing establishment on an annual basis, then the opportunity created by this legislation is being missed and we would just be making the voluntary use of the existing tools a statutory requirement. Throughout the consultation on the legislation, we were told that it needs to go beyond just looking at how the establishment is set. The common staffing method set out in the legislation does just that and restricting it to that in terms of establishment only really undermines the purpose of the legislation. However, although I do not believe that amendment 93 accurately conveys the range of uses for which the common staffing method can bring benefits, it is worth noting that those other uses lead to the setting of an establishment figure and would therefore be captured within the purpose set out in amendment 93. Therefore, I will not oppose it, although I would ask Mr Briggs to confirm that his intention behind this amendment is to cover not only the routine regular staffing establishment setting process, but also its use to provide an establishment figure as a result of other triggers such as the need to redesign a service. With that, convener, I move amendment 18. Thank you, convener, and good morning to everybody. My amendment 93 looks to designate the common staffing method as the process by which the establishment figure is set. In the bill that is drafted, the common staffing method is the only process used to set staffing levels. The staffing tool and professional judgment tool are required to be run as the first step of the common staffing method. If current practice is followed, the two tools will be run in almost all cases on an annual or biannual basis. In some specific settings, such as neonatal, for example, the staffing tool will be run on a daily basis if current practice continues. Given the steps that the common staffing method requires, it is a way to set a staffing establishment figure. That is what I have been looking to try to incorporate. It is not a real-time process to monitor staffing safety or quality. I have heard what the cabinet secretary says and I think that the amendment could still complement the overall bill going forward. I thank the minister for clarifying the position of amendment 18, particularly around the frequency. It is in my mind anyway that we are moving more towards integration, and that is part of it. That is my concern. Some of the amendments that have come forward have some clarity on that particular amendment. I just asked Miles Briggs about, and I know that the minister says that she is minded to accept that amendment. We are looking at service redesign and flexibility, which is what the bill is all about. Will Miles Briggs do any way possible that the amendment that you are putting forward would stop the flexibility in the service redesign? That is my concern in regard to the amendment. I indicate that, if Mr Briggs wishes to respond to that, he would have to make an intervention either on Sandra White or on the minister in due course. In terms of the wider context of health and social care integration, I think that that is what is important behind the bill, which I think that all committee members are committed to. What I have been looking forward in this amendment is to look at how we can strengthen the bill as drafted around common staffing methods. That is currently the only process that is used in establishing staffing levels. Would you take an intervention? Yes. That is a point that I want to clarify in myself and, hopefully, for others also. You quite rightly said that it is the long term, and it is very difficult to get that. I did ask about service redesign and flexibility. Would the amendment stop the service redesign that has been proposed and the flexibility of staffing that you have not answered to me? I do not believe that it would. It would not stop. Thank you very much. I think that that concludes Ms White's contribution. Can I invite the cabinet secretary to wind up? Thank you, convener. I have very little to add. I am grateful for Mr Briggs's confirmation that he does not intend that his amendment would restrict or prevent service redesign. With that assurance, I press amendment 18, and I will not stand in the way of Mr Briggs's amendment. Thank you very much. That is clear. Can I? The question then is that amendment 18 be agreed. Are we all agreed? Can I call amendment 93 in the name of Miles Briggs? It is already debated with amendment 18. Miles Briggs to move or not move? Moved. Moved. The question then is that amendment 93 be agreed to. Are we all agreed? Thank you very much. Move on to the next group. Common staffing methods, steps and factors in method. Can I start by calling amendment 94 in the name of Miles Briggs group with the amendments that are shown in the groupings? Miles Briggs to move amendment 94 and speak to all amendments in the group. I move all amendments 94, 95, 97, 99, 100 and 101. The purpose of those is to remove the hierarchy within the common staffing method so that tools, patient, acuity and dependency and the clinical advice of nurses of appropriate seniority are given equal weight. The current common staffing method is based on average workload for each specialty across Scotland. It is supplemented by considering the specifics of local context, including the age profile of staff, local recruitment challenges, quality indicators and professional judgment. As drafted, the use of a staffing level tool and the professional judgment tool are the first step, taking into account current staffing levels, local context and so on must be taken into account next. Then, patient need and appropriate clinical advice are taken into account. That means that within the common staffing method, the tools hold more weight than patient need and the clinical advice of nurses of appropriate seniority. As such, common staffing method is not truly triangulated. The process set out by the common staffing method should give equal weight to the use of staffing tools, patient acuity and dependency and the clinical advice of nurses of appropriate seniority. When the committee took evidence on that, we are looking specifically at a piece of work around ultimate focus on outcomes to be achieved. I believe that those amendments helped to complement the bill in that. Thank you very much. Can I ask the cabinet secretary to speak to amendment 19 and other amendments in this group? Thank you, convener. In starting, I would speak to amendments in particular amendment 20. I addressed this amendment in part last week, and I do not intend to repeat everything that I said then. I would like to point out, however, that in developing this amendment, I listened to the views of the RCN, that the leadership role of the senior charge on us should be recognised. This is something that was covered by the leading better care review back in 2008, which set out that, in recognition of their leadership role, senior charge nurses should not be completely caseload holding. The leadership role of the senior charge on us is something that we will continue to work on, and the workload planning tools and common staffing method provide an evidence-based way to do so. I do not, however, feel that it is appropriate that nurses have been singled out for preferential treatment in a bill that is not only about nursing, and having looked further at Alison Johnstone's amendment 91, which was passed last week, I am not convinced that that does what she intended it to do, and I have some serious concerns about the way that is worded, and the impact that it could potentially have on patient care, and we will return to that later in the process. My amendment 20 aims to recognise the unique roles and responsibilities that are placed on all clinical team leaders by setting out an additional step in the common staffing method, which requires health boards to consider the role and professional duties of lead clinical professionals. As such, this amendment takes account of the multidisciplinary nature of the services that we aim to provide, as it would, for example, mean that, in a rehabilitation ward, if the team leader was a physiotherapist, then that person would be allowed appropriate time to fulfil their leadership role. It will also mean that midwives are afforded the same support for their leadership role as nurses. That is important, perhaps even more so, given the passing of amendment 91, to ensure that all staff groups are supported in their leadership role. The Scottish Executive Nurse Directors Group is also supportive of this approach, which they believe clearly articulates the role of the clinical leader in the common staffing method. With that in mind, I would ask the committee to support this amendment. Amendment 19 sets out that, as part of the common staffing methods, health boards and the agency must take into account the different skills and levels of experience of its employees. That aims to address concerns raised by some of our stakeholders that the product of the workload tools does not define the level of skill and experience required to deliver the workload. In amending the bill in this way, I intend to ensure that health boards and the agency are not only looking at how they can put in place the correct number of staff, but that those staff have the skills and experience necessary to provide the kind of safe and high-quality service that I am keen to see across our NHS. Amendment 21 sets out that not only comments by patients but also comments by individuals who have a personal interest in the patient's healthcare—for example, family members and carers—should be taken into account as part of the common staffing method, insofar as those comments relate to the duty to ensure appropriate staffing. That recognises the fact that, for various reasons, patients are not always able to speak for themselves, but that does not mean that their needs and wishes should not be heard and responded to. I am not completely clear what the intention of amendment 96 from Mr Stewart is. From my reading, it could purely be about underlining the importance of multidisciplinary services. It could be about avoiding unintended consequences of covering one staff group by a workload planning tool on other staff groups. It could be about recognising that some aspects of care could be carried out by more than one profession. I would agree with all of those and they have been considered in the drafting of the bill, so I would welcome Mr Stewart's clarification on the intention of his amendment 96. Finally, to the amendments lodged by Mr Briggs. I see no issues with many of those amendments, although some appear to be based in my view on a misunderstanding that there is some kind of hierarchy in the common staffing method, which, for clarity, is not the case. All steps in the method must be carried out and they are all given equal weight. With that being said, it does absolutely no harm to change the order in which those things appear and so, if Mr Briggs wishes to do so, I will not stand in the way. The amendments that give me some cause for concern, however, are 94, 95 and 102. In relation to amendments 94 and 95, I am concerned by the lack of clarity on what is meant by peer-reviewed evidence and professional and improvement organisations. What is the definition of peer-reviewed evidence and why would there necessarily be any certainty that anything reviewed by health peers should always be something that should be taken into account? In the health field, there would be numerous trials or pieces of work that some might class as evidence upon which clinicians disagree. Is it the case that all of those should be taken into account? Similarly, what are professional and improvement organisations? Those questions are exactly the ones that will be asked by the working group set up to develop a tool and they are best placed to determine what is relevant for that tool. When his review of the effectiveness of the tools and the common staffing method, as is set out in amendment 17, it will take into account the most up-to-date and relevant evidence and guidance, as is its professional duty. I do not feel that it is appropriate for legislation to require a senior charge nurse, for example, to have to carry out a review of available evidence every time he or she runs the common staffing method. My preference would be to include something in guidance in order to allow for greater clarity and greater flexibility. I would be happy to work with Mr Briggs to see if we could develop an amendment for stage 3 if he feels strongly that he wants something included in primary legislation, although I do not believe that that is necessary. With that in mind, I would ask Mr Briggs not to press amendments 94 and 95. In relation to amendment 102, that is, I believe, based on a proposal from the RCN who is keen to see excellence in care referenced in the bill in some way. If I am correct in that assumption, that amendment is completely unnecessary, as section 12ib2b already sets out that account must be taken of, and I quote, insofar as it is relevant, any measures for monitoring and improving the quality of healthcare that are published as standards and outcomes under section 10h1 by the Scottish ministers, which excellence in care will be. I therefore cannot see what this amendment adds. If Mr Briggs feels that the current provisions do not achieve what is required, then, as with amendments 94 and 95, I would be happy to work with him to develop an amendment for stage 3, which achieves that. As it stands, I would be very hesitant to support this amendment, and I ask the member not to move it. Thank you very much, cabinet secretary. I now call on David Stewart to speak to amendment 96 and other amendments in the group. Thank you, convener, and good morning to everyone. I speak to and move amendment 96 in my name. As with many other amendments in this group, my amendment seeks to add to the list of considerations that must be taken account of when determining staffing levels. At stage 1, the committee heard evidence from a number of stakeholders about concerns that the bill could have the unintended consequence of drawing resources into supply of professions covered by the existing tools at the expense of other healthcare professions not yet covered by the tool. Obviously, that would not be of the benefit to delivery of quality services or improving outcomes for patients and service users, which is why amendment 96 requires account to be taken of the potential impact of other staff and professions in determining appropriate staffing levels. Other amendments brought by the cabinet secretary and Alex Cole-Hamilton, not directly in this group, seek to embed a multidisciplinary approach to the development and review of tools. That is very welcome. However, I also submit that amendment 96 is needed in addition to those amendments, referencing multidisciplinary working approaches to ensure that all professions are considered from day 1 of implementation of the bill and not just when the tools come up for review. Amendment 96 does not detract from the multidisciplinary amendments, rather it makes explicit their ultimate aim and is complementary to them. I hope that those comments cover the questions that the cabinet secretary said in her opening remarks. Thank you very much. If there are no other members, I am a harbour. Thank you, convener. I just want to clarify that if we are going to pursue common staffing methods that many of the tools have not been created yet and that care homes do not have nurses working in care homes, about a third of our care homes have nursing staff, but many care homes do not have nurses working. Those are social care that has been provided. Those are people's homes, so there are not nursing assessment requirements unless people are unwell for whatever reason. I am just really interested in how moving those amendments may restrict or allow the bill to put in on the face of the bill the requirement to manage common staffing methods in a restrictive way when tools have not been developed yet for a multidisciplinary team approach. Specifically in care homes is my concern because many nurses are not working in care homes. Thank you very much. I call on Miles Briggs to wind up and to press or withdraw. Thank you, convener. In terms of my amendments, both 94 and 95, it was looking to set out as part of the common staffing method that health boards or agency take into account not only measures for monitoring and improving the quality of healthcare, but also standards and outcomes. Under section 10h1 by Scottish ministers that we looked towards actually peer-led evidence as well as part of that. I have listened to what the cabinet secretary has to say today and I would be happy to, in terms of those three amendments, look towards stage 3 and how we can hopefully come to a cross-party agreement on that. I am happy not to move those three amendments. Amendment 94, Miles Briggs wishes to withdraw. Is that agreed? Thank you very much. Amendment 95, Miles Briggs, to move or not move? Not moved. Not moved. The amendment is therefore not moved. Are we all agreed? Thank you very much. Can I call amendment 19 in the name of the cabinet secretary? Already debated with amendment 94. The question is that amendment 19 be agreed to. Are we all agreed? Thank you very much. I call amendment 20 in the name of the cabinet secretary. The question is that amendment 20 be agreed to. Are we all agreed? I call amendment 96 in the name of David Stewart, already debated with amendment 94. David Stewart to move or not move? It is. Moved. The question is that amendment 96 be agreed to. Are we all agreed? Thank you very much. Can I call amendment 97 in the name of Miles Briggs, already debated with amendment 94, the amendment is therefore not moved. The question is that amendment 97 be agreed to. Are we all agreed? The amendment is agreed. Can I call amendment 98 in the name of Miles Briggs, already debated with amendment 94? Are we all agreed? Erweigwadol ers Cymru yn mynd ddatblygu Eymreigwadol. Mae'r Se experiadwyr hefyd agorfaethungwyannau yng Nghymru速y 되는데ol gan eich complexes. Is iddieraidd gemwysadau ni am dda. Mirror Os ydych chi'n ddewf yn gweithio i ddhefnog通aff amgiittyidd. Mae fömant yn ddawdwi'r mwylo diningach am ei ddigon fydd, ergoi ymgyrsadau gwir особonu. Erweigwadol eitthwyd yn rhaid mewn gwFonda circondwyr mwylo diningach erwydwyr mwylo diningach i ddewf yn ddewb. Erweigwadol Adam Par i d Minute amendment 100, code amendment 103 amendment 104 amendment 5, Foreign Minister amendment 106 amendment 154 amendment 13, aeth o gam i ddefnyddio? Mynd aa f Certainly in the United States President by this amendment 103. The authority before 127 amendment 136, and I hope to say btw, when I came front that I wasじot following the discussion onィ'sідd new years legal. That's obviously what I tried to say to this amendment. The first amendment that I wrote in this building to delay was to 세�t threat Call amendment 20 be agreed to, are we all agreed? The other members agreed. Call amendment 102 in the name of miles briggs that is already demated with 94 miles briggs to move or not move. Not moved. That amendment is not moved, members are content. Thank you very much amendment 102 is not moved. We are therefore move on to the next grouping, which is common staffing method, types of healthcare and employees covered. Can I call amendment 23, in the name of the cabinet secretary, a group with amendments as shown in the group, and cabinet secretary to move amendment 23? Those are minor technical amendments to the healthcare settings covered by the duty on health boards and the agency to use the common staffing method. The purpose of amendments 23 and 25 to 29 is to clarify that, where multiple types of employees or locations are covered by a healthcare setting in the table in 12 IC1, the requirement to follow the common staffing method applies where one or more of the employee types or locations are present and not just where all those listed are present. The effect of amendment 23 will be to ensure that, for example, for a neonatal provision that can be delivered by registered nurses, registered midwives or a combination of the two, that the duty to use the common staffing method comes into effect when some of the employee types are present in a particular ward, not just when all those listed are present. Amendments 24 and 31 bring the definition of adult inpatient and small wards provision in line with the nursing and midwifery workload and workforce planning programme guidance for the use of these specific staffing level tools. Amendments 30 removes the perioperative provision entry from 12 IC. A review of the perioperative staffing level tool, which would be used as part of the common staffing method in perioperative healthcare settings, has identified issues that are currently being investigated. Because of that, the tool is currently unavailable for use by health boards and as such it would be unable to comply with the duty to use this common staffing method in perioperative settings. Amendments 34 and 35 clarify that medical students and student nurses and midwives are not included in the staffing establishment for the purposes of the common staffing method. This exclusion can be extended to other types of students in the future, if necessary, as more staffing groups such as allied health professionals are brought within the common staffing method. I spoke last week about the importance of taking a multidisciplinary approach and in doing so recognise the important role that allied health professionals play in achieving outcomes for service users. That is a point that those professionals highlighted during stage 1 evidence sessions and which was noted by the committee. Amendments 36 arises from productive engagement with the Allied Health Professionals Federation. It clarifies that allied health professionals are an example of the type of employee that can be covered by the common staffing method. That means that, when new tools are developed in the future, which cover allied health professionals, the duty to use the common staffing method can be extended to cover them. Amendments 46 expands the definition of employee in section 12-IG to include those employed by a local authority under the lead agency model of integration. That means that those local authority employees will be captured under the common staffing method, which is necessary to ensure its correct operation in lead agency settings. Amendments 32, 33 and 45 are minor technical corrections to ensure that the legislation operates as intended. Throughout the bill, individual is used to describe a natural person and person to describe a legal person. However, section 12-IC2 sets out the types of healthcare to which the duty to use the common staffing method applies, and the definition of appropriate clinical advice in 12-IG uses the term person to describe a natural person. Amendments 32, 33 and 45 therefore change references from person to individual to provide clarity that they refer to a natural person and to provide consistency throughout the bill. Amendment 23 The Deputy Presiding Officer Thank you very much. There would appear to be no other members who wish to contribute. Cabinet Secretary, is there anything that you wish to say in winding up on this group of amendments? No, thank you, convener. Thank you very much. The question is that amendment 23 be agreed to. Are we all agreed? Yes. Amendments 24 to 36 inclusive are all in the name of the cabinet secretary and have all been debated. Can I invite the minister to move amendments 24 to 36 on block? Move on block. Thank you very much. Does any member object to a single question being put on amendments 24 to 36 inclusive? If not, the question is that amendments 24 to 36 are agreed to. Are we all agreed? Thank you very much. I move on to the next group, which is regarding common staffing method training and consultation of staff. I call first amendment 103 in the name of Miles Briggs, which is grouped with amendments 6, 104, 105 and 106. Thank you, convener. With regard to those amendments, I am looking to put a duty on NHS boards not only to support them, but that boards will support not just encourage staff to share their views on the NHS boards compliance with the legislation going forward. As drafted, NHS boards are only required to encourage employees to give views on their staffing arrangements. The requirement covers only those areas that use the common staffing method. Employees of NHS boards will have valuable experience of staffing issues as well as views on whether the care that they are able to provide is safe and of high quality. The duty on NHS boards should therefore be strengthened so that they must actively seek the views of their employees and support them to make their views known. That could, for example, mean that NHS boards are ensuring that their reasonable systems are in place to collect the views of employees. A strengthened duty of engaging employees would mean that those working in areas covered by the common staffing method would have a significant opportunity to comment on and potentially shape NHS board processes for discharging the duties on them under the legislation. The operation of the legislation in practice could be further strengthened if the provisions for staffing engagement at 121dA and B and the provisions for reporting back to staff in 121dE were not solely focused on the use of the common staffing method but also took into consideration the guiding principles for staffing and the duty to ensure appropriate staffing. If amendments were accepted in the need for the NHS boards to establish protocols to identify monitoring and assess risk supporting staff to give their views on the protocol should also then be included. My amendment 104 looks to ensure that nurses of appropriate seniority receive training in the common staffing method. The bill continues provision for NHS employees to be trained in using the common staffing method as well as having adequate time to use it. Education in how the use of the common staffing method and having the time to use it are hugely important, I believe, to the outcomes of this bill. It should therefore be made explicit that NHS boards will make training on the common staffing method available to nurses of appropriate seniority across all settings. I welcome Mike Rumbles and invite him to speak to amendment 6 in the name of Alec Cole-Hamilton and other amendments in this group. Thank you very much, convener. It's a pleasure to be here. As I say, unfortunately, Alex can't be with us. As a member of the health committee, I think that he's visiting hospital at the moment. He's asked me to appear and move his amendment for him, which I now do, but I'd like to just comment on it on his behalf. This amendment simply adds to the bill. It doesn't take anything away from it. It just, in his view, improves the bill. If we take into account and use any such views that it received to identify best practice and areas for improvement in relation to such staffing arrangements, that is supported by the Royal College of Nursing. I think that it would add greatly to the intention behind this section of the bill. Thank you very much. I invite the cabinet secretary to respond to those amendments. Thank you, convener. I have no concerns with amendment 103, and I am happy to accept amendment 6, which I think is a helpful addition to the duty on boards in section 12-ID. I would maintain that amendment 104 is unnecessary, as section 12-IDC, as drafted, already requires all those staff who use the common staffing method to be trained. I appreciate what amendment 105 and 106 seek to do in connection with the real-time staffing assessment procedures, but, in technical terms, they are placed in the wrong part of the bill. The real-time staffing assessment procedures apply to all employees in a health board, however, those amendments will only apply to employees covered by the common staffing method, because section 12-ID, where those amendments are inserted, only applies to employees engaged in the common staffing method, not to all employees of a health board. I would assume that Mr Briggs's intention is to cover all employees. In addition, the opening words of section 12-ID explicitly make compliance with the duty to use the common staffing method in section 12-ID, dependent on fulfilling the duties listed in 12-ID. Given the differing coverage of the sections, it does not make sense to make compliance in law by health boards with section 12-IB dependent on new procedures relating to the real-time staffing assessment procedures, which are not linked to the common staffing method. The correct link for any requirements relating to those new assessment and escalation procedures is with those new sections, 12-IDAA and 12-IDAAB, which the committee agreed to last week. That is precisely because of their wider application to all of a board's employees. I would therefore ask Mr Briggs not to press those amendments 105 and 106 and, instead, to bring forward alternative amendments at stage 3, amending the technically correct section of the bill, and I would be happy to work with him on that. Thank you very much, cabinet secretary. Can I call on Miles Briggs to wind up and press or withdraw? Thank you, convener, and I welcome the cabinet secretary's agreement to support my amendments. I think that as we head to stage 3, there is clearly going to be a lot of housekeeping to clean up this bill, so I am happy not to press 105 and 106 at this stage. I am sorry, convener, for not being mentioned. Yes. Sorry, thank you very much. It was another point of clarification. I think that the minister actually picked up on what I was intending to say, but I will go again anyway. When you were given your quotations at the beginning, you constantly mentioned nursing staff, and that was where I was a bit concerned. I think that the minister has clarified it in regard to staffing levels. I am a wee bit concerned that it has leaned more to us nursing staff than anyone else. Would you consider withdrawing those amendments to have a chat with the committee or even the minister, per se, going forward to stage 3? I do have some concerns in regards to how prescriptive it is. I hope that I am helpful in that respect. In terms of where we are all agreed, the multidisciplinary nature of the bill and in terms of health and social care integration, there are two very different sectors that we are trying to make legislation work for. My understanding is that the cabinet secretary is content with my amendments 103 and 104 going forward, but I am happy to not move 105 and 106 under the understanding that we will bring forward an amendment at stage 3, which we can hopefully all agree on. The question is that amendment 103 be agreed to. Are we all agreed? I call amendment 6 in the name of Alex Cole-Hamilton, already debated with amendment 103. Mike Rumbles to move or not move. The question is that amendment 6 be agreed to. Are we all agreed? I call amendment 104 in the name of Miles Briggs, already debated with amendment 103. Miles Briggs to move or not move. The question is that amendment 104 be agreed to. Are we all agreed? We are at that amendment. Is it agreed? I call amendment 105 in the name of Miles Briggs to move or not move. Not moved. Not moved. Amendment 105 is not moved. I call amendment 106 in the name of Miles Briggs, already debated with amendment 103. Miles Briggs to move or not move. Not moved. amendment 106 not moved. Amendment 107, in the name of David Stewart, already debated with amendment 17, David Stewart to move or not move. Thank you, convener, it not moved. I've had a discussion with the cabinet secretary in a half day that she's taken on board the spirit of the amendment. Thank you very much. Amendment 107 is therefore not moved. Amendment 123, in the name of Miles Briggs, already debated with amendment 17. Miles Briggs to move or not move. Amendment 123, already debated with amendment 17, that was debated last week. Amendment 123 is moved. The question is that amendment 123 be agreed, are we all agreed? We are not agreed. We will therefore move to a division on amendment 123. Can I see all those in favour? Sorry, I'm jumping sheets of paper here. That's quite all right. Therefore, the amendment 123 is not moved by Miles Briggs. Is the committee agreed that that should not be moved? Thank you very much that this agreed. We therefore moved on to the next grouping. Can I remind members in debates on groupings before I call, if members wish to contribute to the general debate, other than when moving an amendment, they should indicate before I call the cabinet secretary and I can therefore take their contribution separately before the cabinet secretary. Of course, it's always open to members to intervene on others and indeed on the minister, but if members wish to make their own comments, I would encourage them to do that. This is the grouping that is being reported on staffing by health boards and the Scottish ministers. I call amendment 37 in the name of the cabinet secretary to move amendment 37 and speak to all amendments in the group. Amendment 37 and 38 will strengthen the duty on health boards to report on how they have carried out their new duties under the bill. That includes reporting on section 2, which Monica Lennon's amendment 85 passed last week also inserted a reporting duty on. Boards will have to provide a report detailing how they have complied with the general duty to ensure appropriate staffing, the common staffing method, real-time assessment of staffing, escalation of staffing concerns and with the duties on training and consultation of staff. Boards will have to submit those reports to ministers and publish them within one month of the end of the financial year. Amendment 40 will create an additional duty on ministers to inform Parliament about how those reports provided by health boards have been taken into account or will be taken into account when setting national staffing policy for NHS services. I know the committee heard evidence from stakeholders who wish to see a firmer link to workforce planning. I believe that that approach recognises that the bill is not about strategic national level workforce planning but that the information generated by the implementation of both the duty to ensure appropriate staffing and the common staffing method within health boards is one of the factors that will be considered in such national planning. By setting out a clear reporting process, my intention is that that would create a transparency around the decisions that are taken by boards and allow scrutiny of how that is reflected in their workforce projections. Similarly, creating transparency around the information that has been provided to ministers allows scrutiny of how that information is then reflected by the Scottish Government in national workforce planning. I do not think that there is anything covered by Monica Lennon's amendments that is not already addressed by my amendments. Ms Lennon's amendment 109 sets out a similar reporting duty on Scottish ministers. However, it does not cover the new real-time staffing and risk escalation duties that amendment 17 places on health boards and it does not contain the link to how the information is used to wider workforce planning. I ask the committee therefore to resist this amendment. I see Merit in the intention behind amendment 108 requiring health boards and the agency to report on risks and challenges. It is something that I had intended. Guidance would set out that boards must include in their reports, so I would be happy to make it explicit as part of 12IF at stage 3. I therefore ask Ms Lennon not to move amendments 108 or 109, and I move amendment 37. Thank you very much. I invite Monica Lennon to speak to amendment 108 and to speak to other amendments in this group. Similar to amendments to section 2 and 3 of the bill in an earlier group, those amendments aim to improve scrutiny of health boards' compliance with the bill. Amendment 108 does that by requiring health boards to specify in the information that they provide to Scottish ministers any particular risk or challenge they have faced in their compliance with their duties, namely their duty to provide appropriate staff, taking into account the guiding principles, their duty to follow any common staffing methods and their duty to provide appropriate and adequate training to staff. The purpose of including reporting on risks is to allow opportunity for the identification of any systemic or systematic issues that might hinder staffing levels, both at a health board level and at a national level. My amendment 109 requires Scottish ministers to gather the information that they receive from health boards and respond to it publicly. The amendment also requires that public report from ministers to address the risks that are faced by health boards with regard to their staffing duties. The aim of amendment 109 is to encourage scrutiny of the decisions taken by Scottish Government with regard to national workforce planning and the staffing of our health service. I note that amendments moved by Alison Johnstone last week also sought to establish the link between this bill and national workforce planning. I was supportive of those amendments and believe that amendment 108 and 109 strengthen this connection further by ensuring that Scottish ministers are kept accountable for mitigating risks faced by health boards in any area of national policy, be it supplier-trained professionals, as Alison Johnstone's amendments required, or pay levels, terms and conditions, accessibility of workplaces, for example, in rural areas. I welcome the cabinet secretary's comments and recognise that amendment 40, in the name of the cabinet secretary, also seeks to provide a connection with national workforce planning, which is welcome. However, I believe that the specific reference to risk in amendment 109 is stronger, and I recommend that to the committee. Thank you very much. If there are no other members who wish to contribute to this debate, I invite the cabinet secretary to wind up. Thank you very much, convener. I would simply say in relation to my amendment 40 or Ms Lennon's amendment 109. Let me repeat. Amendment 109 from Ms Lennon does not cover the new real-time staffing and risk escalation duties that amendment 17 places on health boards and does not contain the link to how the information is used for wider workforce planning. That, I believe, makes it a weaker amendment, and I would ask the committee to support my amendment 40. Thank you very much, cabinet secretary. The question is that amendment 37, in the name of the cabinet secretary, be agreed to. Are we all agreed? Thank you very much. Call amendment 38, in the name of the cabinet secretary. Already debated with amendment 37. Thank you very much. The question is that amendment 38 be agreed to. Are we all agreed? That amendment is agreed. Can I call amendment 39, in the name of the cabinet secretary. Already debated with amendment 17 last week. Thank you very much. The question is that amendment 39 be agreed to. Are we all agreed? That's agreed. Can call amendment 40, in the name of the cabinet secretary. Already debated with amendment 37. Thank you very much. The question is that amendment 40 be agreed to. Are we all agreed? Yes. I call amendment 108, in the name of Monica Lennon. Already debated with amendment 37. Monica Lennon to move or not move. Question is that amendment 108 be agreed to. Are we all agreed? We are not all agreed. Can I therefore see first of all votes in favour of amendment 108 in the name of Monica Lennon? Can I see votes against? The result of that vote was four votes in favour and four votes against. I will therefore use my casting vote in favour of the amendment. Can I call amendment 109, in the name of Monica Lennon. Already debated with amendment 37. Monica Lennon to move or not move. The question is that amendment 109 be agreed to. Are we all agreed? We are not all agreed. Therefore again there will be a division. Can I see all those in favour of amendment 109 and all those against? That division again is four in favour and four against. I will therefore use my casting vote in favour of amendment 109. Amendment 109 is therefore agreed. Can I call amendment 41, in the name of the cabinet secretary. Already debated with amendment 17. Question is that amendment 41 be agreed to. Are we all agreed? We are agreed. Amendment 41 is agreed. We move to the next grouping. Ministerial guidance on staffing by health boards. Can I call amendment 42, in the name of the cabinet secretary, which is grouped with amendments 43, 44 and 47. Thank you, convener. Amendments 42, 43, 44 and 47 relate to the guidance that ministers can produce under section 12IF of the bill covering the new staffing duties on health boards and the common services agency. Section 12IF of the bill sets out that health boards and the agency must have regard to any guidance issued by ministers when carrying out their duties under sections 12IA to 12IE. Section 12IF 3 lists those with whom ministers must consult before issuing those guidance. Amendments 42, 43 and 44 make changes to this list, while amendment 47 is consequential on amendment 42. Amendment 42 clarifies that ministers must consult with every relevant special health board, while amendment 47 sets out that relevant special health board means those to whom those duties apply as a result of section 5. That means that ministers will not be required to consult with non-clinical special health boards as they are not covered by the bill. It is important that trade unions and professional bodies representing staff working in all the bodies to whom duties in the bill apply are able to offer their views on the guidance. Amendment 43 means that, as well as health boards and the common services agency, ministers must consult with representatives of employees working in relevant special health boards, integration authorities to whom healthcare functions are delegated through the Public Bodies Joint Working Scotland Act 2014 and Healthcare Improvement Scotland. Amendment 44 adds professional regulatory bodies for employees of health boards, the common services agency, relevant special health boards, integration authorities to whom healthcare functions are delegated through the Public Bodies Joint Working Scotland Act 2014 and his, to the list of those with whom Scottish ministers must consult before issuing those guidance. That will cover the relevant statutory regulators such as the general medical council, the nursing and midwifery council and the health and care professions council, and ensure that they are consulted on guidance that may impact on the professional groups that they regulate and move amendment 42. Thank you very much. If there are no other members who wish to contribute on this group, cabinet secretary, is there anything further you wish to add? No, thank you, convener. Thank you very much. The question is that amendment 42, in the name of the cabinet secretary, be agreed to. Are we all agreed? Thank you very much. I would now call amendments 44, 45, 46 and 47, all in the name of the cabinet secretary, all previously debated, and invite the minister to move amendments 43 to 47 on block. Thank you very much. Does any member object to a single question being put on amendments 43 to 47? If not, the question is that amendments 43 to 47 are agreed. Are we all agreed? Thank you very much. The question is that section 4 of the bill be agreed. Are we all agreed? Thank you very much. I move on now to section 5 and the next grouping on the bill. I call amendments 48 to 65, all in the name of the cabinet secretary and all previously debated. Can I invite the cabinet secretary to move amendments 48 to 65 on block? Move on block. Does any member object to a single question being put on amendments 48 to 65? If no member objects, the question is that amendments 48 to 65 are agreed to. Are we all agreed? Thank you very much. The question is that section 5 be agreed to. Are we all agreed? Thank you very much. To the next grouping. This is on the role of healthcare improvement Scotland in relation to staffing. I call amendment 66 in the name of the cabinet secretary group with amendment 66, a cabinet secretary, to move amendment 66. Thank you, convener. I committed in the stage 1 debate to lodge an amendment to make the role of healthcare improvement Scotland clear. Amendment 66 extends his role to existing quality insurance and improvement role by inserting new sections into the national health service Scotland act 1978, setting out that his will be responsible for monitoring the discharge by every relevant special health board, meaning a special health board that provides clinical healthcare services to patients and the common services agency of their duties under all parts of the bill. This amendment has the full support of his and has been drafted in consultation with that body. New section 12 IH places the duty on his to monitor the compliance of boards and the agency with the staffing duties introduced by the bill, including the new real-time assessment and risk escalation duties under amendment 17. New section 12 IJ places a duty on his to monitor the effectiveness of the common staffing method and the way in which boards in the agency are using it. His must, additionally, as and when they consider appropriate, carry out discrete reviews of the CSM with a view to publishing and submitting to ministers a report recommending changes to it if required. Ministers may then, by the regulations already provided for under section 12 IB 4 of the bill, amend the common staffing method. His must have regard to the guiding principles in carrying out a review, and he must consult with a range of stakeholders as listed in subsection 3 of 12 IJ in doing so. Ministers also have the power to direct his to carry out such a review of the common staffing method. Further to this section 12 IK sets out that his may also develop and recommend to ministers new or revised staffing-level tools and professional judgment tools for use as part of the CSM in relation to any kind of healthcare provision. Ministers may then, by regulations already provided for under section 12 IB 3 of the bill, prescribe the use of said tools as part of the common staffing method. In developing any new or revised tools, his must collaborate with those bodies mentioned previously and must again have regard to the guiding principles. Similarly, ministers may direct his to develop a new or revised staffing tool or professional judgment tool. In recognition of the view of stakeholders and in particular the Allied Health Professions Federation, there is a need to look at the development of multi-disciplinary tools going forward. Section 12 IL places a duty on his when developing a new or revised staffing-level or professional judgment tool to consider whether it should apply to more than one professional discipline. It also gives his a power to recommend to ministers that an existing tool should be multi-disciplinary. His will be under a duty to monitor the effectiveness of any staffing-level tool or professional judgment tool that has been prescribed by ministers under section 12 IB 3. That would include any new or revised tool. Sections 12IN and 12IM aim to ensure that his is given access to the support and, crucially, to the data that is necessary to carry out their new functions under the bill. Section 12IM requires health boards, relevant special health boards and the agency to give his such assistance as it requires in performing its functions under sections 12IH to 12IL. Section 12IN gives his a power in pursuence of its functions under sections 12IH to 12IL to serve a notice on a health board, relevant special health board or the agency requiring it to provide his with information about any matter specified in the notice by a specified date. Ministers will also have a power under section 12IO to issue statutory guidance to his and to the boards about these new provisions. Finally, but importantly, the existing powers of his to inspect NHS services are extended to include the enforcement of these new functions by amendment section 10I of the 1978 act. His are fully aware of this amendment and are happy with the provisions set out in it. In relation to amendment 66A, I would note that this amendment is in my view unnecessary, as ministers can already direct his to carry out a review of the common staffing method under section 12IJ4 or to develop a new or revised level tool or professional judgment tool under section 12IK5. That could include a direction that his look at particular matters, including staff absences and bed occupancy levels. However, I do not feel that this amendment does any particular harm and I will therefore not stand in Mr Briggs' way if he wishes to press it. I move amendment 66. Thank you very much, cabinet secretary. I call Miles Briggs to move amendment 66A and speak to 66A. Thank you, convener. From stage 1, I welcome the fact that the cabinet secretary has brought this forward. I think that we are both trying to achieve the same thing in our amendments here. I specifically was looking to a lame ministers to prescribe what could be included because I think that our original discussions around a multidisciplinary approach is very different to multidisciplinary tools. Given the different workforces, how we take that forward is important. I am happy to press my amendment and hope that, at stage 3, we will finally get something in the bill that is workable. Thank you very much. If there are no other members who wish to speak, can I ask the cabinet secretary to wind up on amendment 66? Nothing further to add. Miles Briggs will wind up on amendment 66A and press or withdraw. Nothing further to add and press. In that case, the question is that amendment 66A be agreed to. Are we all agreed? We are agreed, cabinet secretary, to press or withdraw amendment 66. Thank you very much. The question is that amendment 66 be agreed to. Are we all agreed? Thank you very much. I now call amendment 110 in the name of David Stewart. Already debated with amendment 84, David Stewart, to move or not move. Not moving, following a helpful discussion of the cabinet secretary. Thank you very much. I now call therefore the question. Amendment 110 is not moved with the agreement of the committee. Thank you very much and then we move on to section 6 and the next grouping, which is in relation to the duty of care service providers to ensure appropriate staffing. I will call amendment 7 in the name of Alex Cole-Hamilton, which was grouped with amendments 111, 112 and 67. Can I call Mike Rumbles to move amendment 7 and speak to all amendments in the group? Thank you very much, convener. As I say, I am here on behalf of Alex Cole-Hamilton's amendments, but I also like obviously to speak to the cabinet secretary's amendment 67 as well. All of these amendments are intended to improve the bill, and whichever way we go, it will be an improvement. Alex Cole-Hamilton's amendments are more comprehensive, if I can put it that way, and more effective than the minister's amendment in this case. The reasons are as follows. We are looking at any person who provides a care service must ensure that, at all times, suitably qualified and competent individuals are working in the care service and such numbers are appropriate for the health, wellbeing and safety of service users, and Alex Cole-Hamilton's amendment says, and staff. I think that that is really important. It is about the health, wellbeing and safety of service users and staff. This amendment is particularly supported by the Royal College of Nursing as well. Take it together with the other two amendments 111 and 112 in the next subsection, the provision of safe and high quality care and services. Taking these three amendments together, they are far more comprehensive than looking at the minister's choice in section 67 when she says, adding a subsection C in so far as it affects either of those matters in AOB, the wellbeing of staff, whereas Alex Cole-Hamilton's amendments cover health, wellbeing and safety. I do not need to add any more than that to say that I think that they are far more comprehensive. They build on the importance of this section and I think that I would hope for unanimous support for it. Thank you very much and I call on the cabinet secretary to speak to amendment 67 and other amendments in the group. Thank you convener. I appreciate the valid aim of amendment 7 to ensure that staff wellbeing is considered in ensuring adequate numbers of staff. However, as I said last week in relation to amendment 3, we must be mindful that employment and health and safety law are reserved matters and not for this Parliament. I also stated for amendment 3 but will restate again for clarity that an almost identical provision to this proposed amendment already exists in health and safety legislation and we would not want to replicate in the bill any duty that already exists in primary legislation. With this legislation we seek to ensure safe high-quality services. Success will create a virtuous circle of better outcomes for patients together with improved wellbeing for the staff. Evidence does demonstrate that one can affect the other. We have already have ensuring the wellbeing of staff as a guiding principle and throughout the bill, for the sake of clarity, we express concern and institute provisions to ensure their health and safety. I am not averse to the aims of amendment 7. However, I will move amendment 67 as a replacement, which I believe will answer the request of the committee in the stage 1 report to include staff wellbeing in the duty on care service providers to ensure appropriate staffing. As with amendment 15 in the health context, which was, unfortunately, not passed last week, amendment 67 will keep the primary focus of the legislation on the welfare of service users while considering staff wellbeing in terms of how it impacts on the service itself. In relation to amendments 111 and 112, section 6 of the bill provides that any person who provides a care service must ensure that, at all times, suitably qualified and competent individuals are working in their service in such numbers as are appropriate for the health, wellbeing and safety of their service users and provision of high-quality care. Amendment 111 would state that any person who provides a care service must ensure that such numbers must be working as are appropriate for the provision of safe and high-quality care. I have no concerns, therefore, with amendment 111, given the clear aims of the bill to secure safe and high-quality care. Amendment 112 would state that such numbers must be working as are appropriate for the provision of high-quality care and services. Although that does duplicate what is already provided, as the care is the service, I will not stand in the member's way if they wish to accept this amendment. I therefore ask the committee to support amendment 67, but not to support amendment 7. Thank you very much, cabinet secretary. I see Brian Whittle and George Adam. Thank you, cabinet secretary. I think that you have highlighted the fact that the primary concern here is to look after the concerns of the patients here at all times and their wellbeing, but my concern is that, in doing so, we should also consistently look after our healthcare professionals. I am assuming, cabinet secretary, that that is something that you would agree with. I am not sure, especially if amendment 67 is the case here, because I think that one goes in hand with the other. Looking after the healthcare professionals is key to looking after the health of patients. I am not saying that— You wish to intervene on Mr Whittle if you choose. I am not going to disagreement with Mr Whittle. I have already said that I am not going to stand in the way of amendments 111 and 112. I am also making the point that elsewhere in the bill we have clear provisions that show our commitment to the health, wellbeing and safety of staff. My primary point is that the focus of the legislation is on the quality of the provision to those who receive it, and there is multiple evidence—indeed, that virtue is circular—that I spoke about. In order to do that, you have to ensure the health, wellbeing and safety of staff. I kind of think that we might be dancing in the head of a pin here. I do not have a problem with 111 and 112. My concern is around amendment 7, which I believe replicates legislation that is not necessarily in our power to do so. Mr Whittle, have you completed? Thank you very much. Firstly, can I just talk about the positive side? I think that 111 and 112, I can support and obviously 67, but with 7, I have an issue, and it is similar to the issue that I brought up last week in the cabinet secretary's brought up as well. Although we welcome what it tries to do, there is a problem with the potential competency of the actual amendment in itself and so much that it does start moving on to reserved issues with health and safety. I mentioned this last week, and I mention it again, because I have some concerns with that. Possibly that is something that we need to be very mindful of when we take that forward. Okay, thank you very much. If there are no other members, I will call my grumbles to wind up and to press a restore. Thank you very much, convener. I am surprised to find such a red herring, suddenly appear in this debate. It is a red herring, the health and safety legislation. I think that the minister—sorry, the cabinet secretary—might not be so well advised on this issue, because it does not trespass on health and safety law. If it did, then you couldn't have what's in the bill already, which is the wellbeing and safety of service users. You can't draw the distinction to say that the health and safety of service users isn't to do with health and safety, and then say, because it's the staff, that it is health and safety. It isn't. Mike Rumbles for taking intervention. I think that perhaps you're mixing it up slightly. Obviously, it's a health and wellbeing, but we're talking about legislation, which is reserved, and I think that's where the point is. No, no, I'm sorry. I think that the member misunderstands the point that I'm making. The point that I'm making is that the minister, the cabinet secretary, has brought forward this legislation. If it contravened health and safety legislation for service users, the safety of service users, it couldn't be in here. So the point that I'm making—I haven't given it away already on this point—we are including staff, the people who work in the organisation, as well as the people who use the organisation. Health and safety legislation applies to everybody who uses a facility, whether they are members of staff or not. The detail of health and safety law is in health and safety legislation. That does not contraven health and safety legislation. If it was, if it did, this would be incompetent in the bill. So I'd like to put the rest at red hiring. Order, please. Thank you very much. Mike Rumbles, are you pressing amendment 7? I am indeed pressing the amendment because it certainly improves the bill dramatically. Thank you very much. The question is that amendment 7 be agreed to. Are we all agreed? We are not all agreed. Will there be a division? Can I see those in favour of amendment 7? Can I see those against? That division is 4, and I will use my casting vote in favour of that amendment. Amendment 7 is therefore agreed. I call amendment 111, in the name of Alex Cole-Hamilton, already debated with amendment 7, Mike Rumbles to move or not move. Amendment 111, the question is that amendment 111 be agreed to. Are we all agreed? Call amendment 112, in the name of Alex Cole-Hamilton, already debated with amendment 7, Mike Rumbles to move or not move. The question is that amendment 112 be agreed to. Are we all agreed? Can I call amendment 67, in the name of the cabinet secretary, already debated with amendment 7? The question is that amendment 67 be agreed to. Are we all agreed? We are all agreed. Amendment 67 is therefore agreed. The question is that section 6 be agreed to. Are we all agreed? Thank you very much. Move on to the next grouping of amendments in relation to care services, risk management procedure. Call amendment 113, in the name of David Stewart, in a group on its own. David Stewart to move and speak to amendment 113. Thank you, convener. This amendment in my name seeks to ensure that care sector providers have in place appropriate processes for assessment and managing risk associated with staffing levels, as my previous amendment starts to do for health services. Having spoken to stakeholders in the sector, including Scottish Care, I have submitted a slightly pared down amendment compared to my related amendment in part 2. Risk management escalation procedures are there partly to protect staff and employees who will have to find solutions to staffing challenges in the real time by giving them clear guidance and steps that they can take. However, it was suggested that, prescribing the steps that must be taken by employees, could have the unintended consequences of placing significant responsibilities and bureaucratic burden on the ready stretched and hardworking employees. That is why amendment 113 places responsibility on providers to set out risk management procedures but allows flexibility for local contexts. Risk management procedures must be policy as standard and this amendment seeks to standardise this as much as possible with regard to staffing the sector. I give way to Sandra White. I thank the member very much. I have also consulted various organisations and had various feedbacks. I presume that everyone got that from COSLA, including my own area in Glasgow, the social work department. It puts an added burden on two care services, particularly ones that are smaller care services. It is another layer of bureaucracy that is at the moment going through consultation in care services. They feel that this coming in at this moment may jeopardise any agreement that is made with care services. They also say that it seems to not really give any elaboration of how good care service could be if this amendment is put forward. They think that it is an additional burden in regard to legislation and scrutiny. I would ask David Stewart to take that particular point on board coming from COSLA and from service users within my constituency in Glasgow and coming from Glasgow City Council, head of social work department. I thank him for bringing it forward, because it is good to have a debate on that particular one, but I would ask, as I did previously, if you have spoken to the minister, to say that that would be great if you would not press this particular amendment. I thank the convener, Sandra White, for her contribution. Obviously, I respect COSLA and all the players in the care sector. Obviously, I have had discussions with a number of them. I do think that this is an important amendment, but I am happy to listen to the points that the cabinet secretary may make on this particular amendment. Thank you very much. Are other members wishing to contribute? If not, can I invite the cabinet secretary to respond to this? I am mindful that the risk escalation procedure that I have proposed for health settings has been developed through very detailed work with representatives of nurses, midwives, medics and allied health professions. Given the importance of that, I would be very reluctant to apply a similar process to care service providers without working closely with them to ensure that it is proportionate and effective. I have no issues with the intention of Mr Stewart's amendment, but, in terms of scope, the way in which it is drafted would cover the full range of care providers. That means that all those who fall within section 47.1 of the Public Services Reform Scotland act 2010, including childminders, there are over 5,000 childminders as an example in Scotland who mainly work individually. As word did, this amendment would require each to have an escalation policy. I am sure that that is not Mr Stewart's intention, and I am sure that the committee would agree that that would be disproportionate. I would suggest that Mr Stewart withdraw the amendment to not press it so that we can work together to bring forward a replacement at stage 3, which is drafted in such a way as to meet his intention but not be so wide in its scope. Thank you very much. Can I ask David Stewart to wind up and press or withdraw? In light of the contributions that are being made by the Cabinet Secretary, I am happy to go away and think again about this particular amendment, particularly with my colleagues at COSLA, and in light of that, I am not pressing this amendment. Thank you very much. Amendment 113 is withdrawn with the agreement of the committee. Thank you very much. We will move on to the next grouping, care services training of staff. Again, I call amendment 114, in the name of David Stewart, in a group on its own. Thank you, convener. Amendment 114 in my name seeks to ensure that, should the Scottish ministers mandate the use of staffing tool by care services, that they take responsibility for adequately resourcing the training that is required. Social care providers' margins are tight and full-time staff is limited, so it is important that the resources are there to reimburse staff for training that they are obliged to undergo. Similarly, care providers should not be forced to pay for additional training time out of squeezed resources. As we have seen with the implementation of the living wage for social care workers and overnight carers, new policy and standards for the Scottish Government must be backed up by resources if they can make a difference at the ground level. The financial memorandum does make some reference to funding the training associated with implementing the use of the tools. This amendment merely makes the obligation on the Scottish ministers to fund the training explicit in the bill. That will be important, should costs run by more than was originally estimated in the financial memorandum. Thank you very much, convener. Once again, I thank you, David Stewart, for that also. I think that it clarifies some points in regard to obviously funding as well. I have also, as I said previously, spoken to COSLA and various others as well. I am sure that everyone has had COSLA's letter back to them. I mean it basically asks COSLA and others to ask that this is further considered by commissioners at this moment in time, as obviously the commissionary authority are the ones that fund this as well. They would like to go through the process fully, COSLA with the commissioners and through the bill also, and I would ask that this is taken to consideration. I think that they are willing to work as they always do, and I would ask if the member would not press this particular one, and perhaps the cabinet secretary may have something to say in that particular one as well. Thank you very much, Emma Harper. Thank you, convener. It is just a quick question that David Stewart will be able to answer in his summing up. Is this assuming that all training is provided away from the place of service provision? In my experience, a lot of training is provided and delivered at the bedside, at the place of care, at the place of residence, so it is creating a very narrow approach that does not really enable training to be, I guess, more widely appreciated in the diversity that it is provided. Thank you, convener. Again, I appreciate what Mr Stewart is intending to achieve with this amendment. I think that we all agree that it is entirely right that care staff are properly trained. I believe that that is recognised in section 7. However, the suggested amendment, the proposed amendment, is, in my view, fundamentally flawed in that the Scottish Government does not directly fund or contract with care service providers. They are private providers who are contracted by local authorities, integration authorities and health boards. Indeed, when the Scottish Government has a policy approach, as it has in terms of the real living wage, those funds are provided to those who then contract with care service providers. Should they not pass that on, that is something between the Scottish Government and those to whom we provide the funds, such as local authorities. However, we do not have that direct contracting arrangement with care service providers. We have set out in the financial memorandum our expectation to fund the initial training for using a staffing method. However, I cannot see how the Scottish Government could ensure that everyday training costs for private providers and for every kind of training, not just training in the use of any new staffing methods, are resourced and allocated on a year-in, year-out basis. That would be entirely contrary to the existing funding framework and the way that funding for care service providers operates. On that basis, I would ask members not to support this amendment. David Stewart, to wind up and press or withdraw. Thank you, convener. I think that this is a very important issue. Having fully funded training is essential. I would point out, as far as the living wage is concerned, that we have seen in practice the Scottish Government policy that some carers are not getting the living wage, so clearly there is a problem in the system. However, I think that we generally all agreed the overall principle about that. I am happy not to pursue this on the basis that I can come back at stage 3 and perhaps have some further contributions from providers and from the Scottish Government. On that basis, I will not press. Amendment 114 is withdrawn with the consent of the committee. Thank you very much. The question, then, is that section 7 be agreed to. Are we all agreed? Now, with a number of amendments in section 8, can I call amendments 68, 69, 70 and 71, all in the name of the cabinet secretary, all previously debated, and invite cabinet secretary to move amendments 68 to 71 on block. Does any member object to these being put as a single question? If not, the question is that amendments 68 to 71 inclusive are agreed. Are we all agreed? We are all agreed. Those amendments are therefore agreed. The question is that section 8 be agreed to. Are we all agreed? That is agreed. The question is that section 9 be agreed to. Are we all agreed? That is agreed. Thank you very much. We move on to section 10, the next group covers staffing methods for care services development and review. Can I call amendment 115 in the name of Miles Briggs, a group with amendments as shown in the group? Miles Briggs, to move amendment 115 and speak to amendments in the group. Thank you, convener. Amendment 115 amends section 28A1, the development of staffing methods, changing the function for the care inspectorate, from a power to develop and recommend a staffing method for care homes and other care services that are specified by Scottish ministers to an obligation to do so. It is important to know that any new tools I believe need to be developed and tested in collaboration across the sector. That is what I was looking to achieve with amendment 115. With regard to the overall bill around social care, I think that we need to look at stage 3 how we can take forward the bill that will work for them. I am happy to hear any comments on the amendment from across the committee. Thank you very much. Can I call on the cabinet secretary to speak to amendment 72 and to speak to other amendments in the group? Excuse me, convener. I wish to give members the assurances that the Government wishes to see the development of a staffing method and tool for care homes for older people, as we have stated in the policy memorandum. The care inspectorate is ready to support its development. However, I would ask members not to support amendment 115, as the approach outlined in the bill will only be successful with the co-operation and active participation of the sector. It needs to be collaborative and cannot be an imposed solution, which the word must suggest in this amendment. That is absolutely crucial for the success of this part of the bill, and on that basis I would ask Mr Briggs not to press amendment 115. Members may have gained the impression that the care inspectorate has abandoned staffing numbers in care homes. The care inspectorate has changed its approach rather than rely on a historic ratio. It is requiring providers to carry out assessments of individual dependency, aggregating that and determining on a regular and dynamic basis what implication that has for their staffing profile and numbers. This is an approach that anticipates what will be required as the tools develop and should be welcomed. I have nothing to say on amendment 116. Turning to my own amendments in the group, section 10 of the bill inserts a new section 82A into the Public Services Reform Scotland Act 2010, empowering the care inspectorate to develop staffing methods for care services, working together with the persons listed in subsection 2 of section 82A. Following conversations with relevant stakeholders, amendment 72 adds the social services council to that list, while amendment 73 adds every health board. Amendment 74 fulfills a request of the Delegated Powers and Law Reform Committee that all guidance in this legislation issued by Scottish ministers is published. As you are aware, at present, there are no tools of staffing methods in use for care. For when such tools and methods are developed, amendment 79 would give the care inspectorate the power to review and redevelop them. In doing so, SCSWIS must collaborate, have regard to ministerial guidance and develop staffing tools in the same way as if developing a new staffing method. Ministers will also be able to direct the care inspectorate to redevelop a staffing method if necessary. In addition, section 82BB in amendment 79 will require the care inspectorate in developing, reviewing and recommending a staffing tool to consider if the tool should be multidisciplinary, making consistent provision to the new functions for healthcare improvement Scotland. Amendment 76 is consequential to amendment 79 and would enable ministers to require, through regulations, the use of any redeveloped staffing method recommended by the care inspectorate. I am happy to support amendment 79A from Monica Lennon. Finally, in relation to Ms Johnson's amendment 125, I would ask for clarification on several issues. It is not clear if the intention is that this section should be restricted to reporting on the supply to care service providers or to apply more widely. I do not believe that that is clear from the amendment itself. If this is only intended to apply to care service providers, then I am not clear who Ms Johnson has in mind when she refers to medical practitioners. That would generally be understood to apply only to registered doctors. However, that is presumably not who Ms Johnson has in mind in relation to care. I would also point out that care homes are private sector services and that Scottish ministers have no locus in employment or recruitment in the private sector, so I am not clear how Ms Johnson believes that her amendment would work in practice. I find the lack of clarity on certain points in the amendment, which would then, if passed, become primary legislation troubling and would therefore struggle to accept it. I would be happy to work with Ms Johnson on an amendment for stage 3, if she would be willing, and I therefore ask her not to move the amendment. In conclusion, convener, I ask members to support the committee to support amendments in my name. Thank you very much, cabinet secretary. Can I call on Monica Lennon to speak to amendment 79A and other amendments in the group? Thank you, convener. Amendment 79A relates to the powers of the care inspectorate. It ensures that they can review not only the use of a staffing tool but also whether providers are complying with the general duty to provide appropriate staff levels under section 6. The purpose of the amendment is to clarify that the remit of the care inspectorate is to consider staffing levels is not limited by the existence or otherwise of a staffing tool. Current inspections by the care inspectorate consider staffing levels already as policy. The amendment should not therefore create any additional burdens or obligations on providers or in the wider social care sector. I welcome the cabinet secretary's support for amendment 79A. Thank you very much. I welcome Alison Johnstone to speak to amendment 125 and other amendments in the group. Amendment 125 is similar to amendment 90 for health services, which was agreed by the committee last week in part 2 of the bill. Amendment 2 recognises that workforce and workload are inextricably linked, and it aims to ensure that the Government is considering all the relevant information available to it when it can commission training places for those who work in this sector 2. We know that care homes are now caring for people with far greater and more complex illnesses, including palliative and end-of-life needs. That means increased challenges around caring for people with dementia, frailty, mobility problems and that there is a real need for specialist input around nutrition and hydration. It is significant that 65 per cent of care home residents are now assessed as requiring nursing care. In 2007, only 10 per cent of residents had a physical disability or chronic illness. That figure is now at 38 per cent. In the same period, we have seen a 44 per cent increase in men over 95 living in care homes, and we have seen a 15 per cent increase in women over the age of 95 living in care homes. The care home workforce data tells us that 77 per cent of services have staff vacancies. My amendment would seek to ensure that the same due consideration as we are giving to making sure that we have appropriate staff in the NHS is given to this sector, which is clearly facing significant challenge. I am open to working with the cabinet secretary to progressing a form of words for stage 3 that would meet everyone's approval if that is helpful. I am interested in seeing how that would develop. I am looking at Miles Briggs amendment. I am concerned that any imposition of any tools that have been developed that are nurse-focused would not work for a multidisciplinary team approach. There are many care homes that have nursing places, but it is a residential care home that is people's homes. As I have mentioned before, I am keen to look at the collaboration and multidisciplinary team approach. Currently, nurses in the NHS go to care homes to provide nursing assessment and care and service provision in a nursing way. However, I am keen to not put anything on the face of the bill that might mean restricts any way that flexibility in working team development, multidisciplinary team collaboration, because that is key to looking at how we develop care in the future. Thank you very much, Sander White. Similar to Emma Harper, it has probably already been said under Miles Briggs amendment 115. The big thing for me is changing the May 2 must. That is too prescriptive. I would ask Miles to think about that particular one. Obviously, I am coming back on from COSLA and the other experienced one. Just to put on the record, David Williams, who I mentioned, is not just a social care in Glasgow, but a health and social care Scotland chief officer group. I wanted to put that on record. If I could also say sorry to Alison Johnstone in that respect, I did have concerns in the previous amendment, and I did raise that as well. I am pleased that Alison is looking at that. It is amendment 125 that needs to be looked at, but I also feel that it is not just nursing staff. You mentioned certain numbers of people who need nursing care in care homes, but equally there are people in care homes who do not necessarily need a nurse there constantly all the time. We have to look at the fact that it is a bit of flexibility, but I am pleased that you said previously that you would be happy to work with the cabinet secretary and perhaps the committee going forward to stage 3, because I think that it is something that needs a wee bit more clarity in regards to the amendment that you are proposing. I just want to agree with my colleagues and add some extra parts that Scottish Care brought up during this, particularly with amendment 115. They said that they needed flexibility in the appropriate set of tools, not a nursing acute tool imposed on them. It is quite interesting because they are the ones that are dealing day in, day out in our care homes. They also mentioned the fact that, if I am summarising some of the things that they said, it was a failure to understand care homes are non-clinical environments. It is a bit of a mistake that we have had, even in this debate here today. We have had a bit of a misunderstanding with that as well. They have a concern as well that it is a creation of a tick box list of clinical issues, paying no regard to new outcomes and focusing, effectively taking away from what we all believe is having a person's central values at the very core of everything that we do here. When you look at some of the things that have been brought up by those involved in the sector, you can see why 115 is probably a difficulty for us at this stage. Again, it could be something that could be worked on, and possibly between now and stage 3. However, we have to make sure that all of that is a joint working collaborative approach, as Emma Harper said, and ensure that people are working in the sector. It is not just about the nursing staff, it is also about everyone who works in the sector, and that is one of the most important parts of that. Thank you very much. Bob Doris. I briefly could hear that it is in relation to Alison Johnson's amendment, which I thought she raised in a very reasonable manner. There is something in there about getting the correct staffing mix in care homes. I was inspired to speak in relation to palliative care, which is something that I am particularly interested in. Just in relation to the skills mix, because sometimes non-nursing staff in care homes are worth their absolute weight in gold, and different care homes have different models of care for palliative and end-of-life care, and it is just that slight nervousness about being prescriptive about staffing levels and what the various disciplines would be. However, I do appreciate that we would want to capture the demands on care homes in the various skills mixes that exist in order to make sure that suitable professionals have been trained to come through into the system for workforce planning going forward. There is definitely something in Alison Johnson's amendment, which might not be in the form it is just now, but I think that it is worthwhile and should be explored further. Thank you very much. If there are no other members who wish to contribute or respond, I will invite Miles Briggs to wind up and press a withdrawal amendment 115. Thank you, convener. In terms of all the remarks that have been expressed across committee, I think that it is important as we head to stage 3 to look towards what we are trying to achieve. I will put on record in terms of COSLA's submission that they did not support inclusion of social care workforce in the bill, because it is important to maybe highlight. In terms of my amendment, having spoken to the cabinet secretary this morning, I am happy not to press it at this stage and look towards stage 3. Thank you very much. The amendment 115 is not pressed as withdrawn with the committee. Can I call amendment 116 in the name of Miles Briggs? Already debated with 115 Miles Briggs to move or not move? Not moved. Again, not moved with consent of the committee. Thank you very much. We therefore move on to the next group, which is in relation to staffing methods for care services, content and frequency of use. This is the last group in the proceedings on the bill, although we have a number of questions to put thereafter. I call amendment 117 in the name of Miles Briggs, grouped with other amendments as shown in the groupings. Thank you, convener. Amendment 117 specifically looks to add to assist with the development of staffing methods for care services. Care Inspectorate will also be developing these indicators of clinical quality for care home services for adults. However, there must be a commitment, I believe, to a tool being developed by the sector that it is not too restrictive and can fit with a person-centred outcome-focused approach that social care wishes as we move towards integration. That is what amendment 122 looks to entail. I wanted to look at the development of a potential for staffing method for nursing homes, as Bob Doris has outlined, in terms of workforce planning in the future for further engagement and collaboration, which will be needed to help to build collective support to develop new tools in the future, given that there are no tools currently in existence. Any new tool would therefore look to pay special attention to the environment of various care homes. I call the cabinet secretary to speak to amendments 75 and other amendments in the group. I will speak to amendments 117 and 118 first. I understand the desire for the Care Inspectorate to develop and use indicators of clinical quality for care home services for adults, however, that would require any tool developed in care to be partially or wholly focused on clinical measures. That does not fit with the person-centred, non-medicalised and outcomes-focused approach to social care that is our aspiration through integration. I wonder whether amendment 117 was intended to say clinical and quality, rather than clinical quality, and it may be that we could work further on that to make that clear if that was indeed Mr Briggs's attention. I have committed to the staffing method that is being developed by the sector, and I believe that otherwise those other amendments are too restrictive due to making assumptions about what the tool would be. With that in mind, I would ask the committee not to support amendments 117 and 118. As I have alluded to, the existing common staffing method and tools for health were developed with the nursing midwifery and, in the case of the emergency care tool, medical professions. The people representing those professions were not told that the method or tools that they developed must take particular things into account. It was for them to decide on their professional judgment what was appropriate. If amendment 119 is passed, the same opportunities will not have been afforded to the care sector. I think that it would be difficult in those circumstances for us to argue that that sector was being treated with the equity and respect that I know we would all wish it to be treated with in order to ensure that we successfully deliver integrated health and social care. That amendment would change the wording at 8285, from me to must, thereby prejudicing what has to be in any staffing method that may develop. In doing so, it would contradict the reassurances that I have given to the sector that any staffing methods developed for care settings would be developed by the sector for the sector. I take the point that in the early stages, COSLA did not wish social care to be included in the bill following significant discussions and a willingness on their part to reconsider their view. It is now fair to say that COSLA, with some of the important assurances about the role in delivering social care, we respect their judgment and their experience along with the care sector that COSLA would now be supportive in working with us on developing just such a tool with the care inspectorate. Should amendment 119 be moved and passed, then I would bring an amendment at stage 3 to ensure flexibility in the provisions in the staffing method. As I mentioned previously in relation to amendments 94 and 95, I am concerned by the lack of clarity on what is meant by professional and improvement organisations in amendment 120. My preference, as with amendments 94 and 95, would be to include something in guidance in order to allow for greater clarity and greater flexibility. Written evidence to the committee from Motoneuron Disease Scotland and others highlighted the position of carers and their families and emphasised the importance of their voice. Amendment 75 clarifies that taking into account their comments on the general appropriate staffing duty is one of the elements that may be included in any staffing method developed by the care inspectorate under section 82A. Amendment 121, lodged by Mr Stewart, requires that ministers ensure that adequate resources are allocated to the care inspectorate to enable them to develop staffing methods for care services. The financial memorandum already clearly sets out the financial support for the care inspectorate. I am of the view that this is not something for primary legislation, it is something for the normal executive duties of government and for scrutiny by members from across the Parliament as part of the budget process, not for scrutiny by the courts, which is what a statutory duty can lead us to. On that basis, I would ask Mr Stewart not to press amendment 121. Amendments 77 and 78 relate to the frequency of use of any staffing methods for care services that are prescribed through regulations made under section 82B. That covers similar grounds to amendments 18 and 22, which I addressed earlier, on the frequency of use for the common staffing method in the NHS. Section 82B provides Scottish ministers with the power to prescribe the use of a staffing method that has been developed by the care inspectorate. 82B2C sets out that those regulations may specify the frequency of use of staffing-level tools. It does not allow ministers to prescribe the frequency of use of a staffing method as a whole. Whilst a staffing method and tool for care settings has yet to be developed, the expectation is that a method and tool would not be run separately. That is reflected in the requirement in section 82A4 for any staffing method developed by the care inspectorate to include the use of staffing-level tools. It is therefore the Scottish Government's intention that the staffing method and not just the tools should be used at a specified frequency. Accordingly, amendment 78 removes section 82B2C, while amendment 77 sets out a replacement power for Scottish ministers to prescribe in regulations the frequency at which the staffing method as a whole, not just the tools, is to be used. As with the health provisions, as well as providing clarity that Scottish ministers can specify the frequency with which a staffing method for care services should be used and not just the tools, those amendments would also remove any possible suggestion that a tool can be used separately from a staffing method or that a staffing method can be followed without using a tool. In relation to amendment 122, that is, I believe, based on a proposal from the RCN who are keen to see that the views of a senior nurse be sought if a staffing method and tool is developed for care homes for adults. As I have already said, a tool or a method has yet to be developed for this sector, and this amendment makes assumptions about the aspects of care that will be covered by a staffing method. That amendment is unlikely to be supported by the sector in my view, as it is too restrictive, and I would ask the committee to reject amendment 122. With that, convener, I ask the members to support the amendments in my name. Thank you very much. I call David Stewart to speak to amendment 121 and other amendments in the group. Thank you, convener. Amendment 121, in my name in the group, is similar to my earlier amendment 114 with regard to the resourcing of training for the use of new staffing tools. Amendment 121 places an obligation in the Scottish Government to full resource and fund the development of tools for the social care sector should be considered when they are required. In the financial memorandum for the bill, there is reference to the cost of developing the tools with £200,000 per annum over three years for contributions to the development from the sector. Is it knowledge that development of tools for the sector could be complicated and it is possible that the time and cost required are more than estimated? Should the case be the case, organisations in the sector should be appropriate and reimbursed, and amendment 121 makes the obligation on the Scottish ministers explicit in the bill. Thank you very much. I think that Sandra White indicated. Thank you very much, convener. If I can just speak to some of the amendments in the group. Obviously, Miles Big's amendment 117 and 118, the evidence that I have been given, and I have looked at it and spoke to it before also. Since amendment 117 is restrictive by stating that the care inspectorate must develop indicators of a clinical quality for care home for adults, I believe that by focusing on clinical measures, it does not fit in with the person-centred approach to delivering health and social care, which, throughout the debates and contributions, does depend on integration. That is what the bill should be doing. Equally, amendment 118 looks at that particular possibility too. People should be spoken to and collaborated working. I feel that I could not support amendment 117 and 118 in that regard. Dave Stewart has explained that 121 is similar to 114, which I spoke to also, and the cabinet secretary also mentioned that the Scottish Government does not give moneys to care homes. Some of them are private care homes as well, and it has to go through the commission in that respect. It has to go through individual local authorities too, so it has reservations in 121, which is similar to 114, which I know that Dave Stewart did withdraw. The most substantive one, I think, is amendment 122. It basically requires nursing homes to have a staffing pool in seats of use of a registered nurse. I agree with what the cabinet secretary has said. It is a multidisciplinary staffing team that is used in care homes. We heard evidence before that we have various abilities and nurses who are older nurses who have more experience in multidisciplinary nursing. What I have been told, and I will say this about, is that this is from the social work departments. It says that one element of the multidisciplinary staffing team appears to look as though it is preferential treatment and everyone should be treated the same. In the spirit of integration, you would hope that the tools would be developed in a collaborative way. That is something that we need to look at. We are looking at multidisciplinary, we are looking at integration and we need to look at a collective support of tools that would work in that respect. Being so prescriptive in amendment 122, I do not think that it lines to this, and I would like to be able to speak to it more and perhaps speak to Miles Briggs as well and whoever else. David Stewart's amendment is a similar amendment to making sure that there are adequate resources and funds available for training across the sector, which is an important aim that I would contend. I wonder if one of the underlying issues is not a permanent member of the committee. The wider issue that we are trying to get at is a consistency in the quality of training opportunities that are delivered across the sector irrespective of whether it is a local authority or whether it is a procure service through the third sector. If that is the desired aim, perhaps that particular amendment is not the best way to achieve that, but it certainly raises that as a very important issue. I will listen to the rest of the debate carefully. I will respond about amendment 122. I find it quite interesting that we would require registered nurses that might have no affiliation with a care home to come in and decide how a staffing method would be used or implemented. In support of what Bob Doris says about palliative care, there are many wide-ranging experienced people across many care home settings that are able to provide support and care. Some of the care homes in my area have only eight beds and some have 50 odd. There is a big wide variety of care delivery, and I do not think that we should be prescribing or dictating or making it not flexible when we are trying to collaborate and look at health and social care integration as a multidisciplinary team approach. We have got some great work being done by paramedics in my area as well. I call Miles Harper to wind up on—sorry, Miles Briggs. It is a first. It sometimes feels like we do seem— Miles Briggs, please wind up and press a restore one-once-in. I have heard the points that have been raised with regard to my amendment, specifically in terms of one-on-eight. It was looking to where there is a real lack of consistent data on quality care, and I think that that is something for stage 3. We should be working with the sector to collaborate on to move forward, specifically as well. I think that it is important, and I have had conversations with the cabinet secretary with regard to the pooling of professionals, and I think that that is another area where the care sector can move forward. I think that that is something at stage 3. I do, in terms of Dave Stewart's amendment, think that it is actually quite an important one for the bill and the points that have been raised around this. At the end of the bill, there will be costs for the sector to meet and how that is actually taken forward for different aspects, both in terms of private and publicly funded care home places. I do not think that that is clear. I think that there is an opportunity in terms of stage 3 to bring all those aspects together, and I hope that, cross-party-wise, we can achieve that. Thank you very much. Do you wish to press or withdraw amendment 117? Not moved. That is not moved. I call amendment 118, in the name of Miles Briggs, already debated with 117 to move or not move? Not moved. Question. With the agreement of the committee, can I call now amendment 72, in the name of the cabinet secretary, already debated with amendment 115? Moved. The question is that amendment 72 be agreed to. Are we all agreed? Yes. We are agreed. Call amendment 73, in the name of the cabinet secretary, already debated with amendment 115. The question is that amendment 73 be agreed to. Are we all agreed? Yes. Call amendment 74, in the name of the cabinet secretary, already debated with amendment 115. Moved. The question is that amendment 74 be agreed to. Are we all agreed? Yes. Call amendment 119, in the name of Miles Briggs, already debated with amendment 117. Miles Briggs to move or not move? Not moved. Thank you very much. That's not moved with the consent of the committee. Call amendment 75, in the name of the cabinet secretary, already debated with amendment 117. Moved. Thank you very much. The question is that amendment 75 be agreed to. Are we all agreed? Call amendment 120, in the name of Miles Briggs, already debated with amendment 117. Miles Briggs to move or not move? With an understanding that we will be able to look at this at stage 3, not moved. Amendment 120, with the agreement of the committee, is not moved. Call amendment 121, in the name of David Stewart, already debated with amendment 117. David Stewart to move or not move? I think that in order to make this an improved amendment, and I agree with the points that Miles Briggs says, I will not press this amendment. With the agreement of the committee, that is not moved. Call amendment 76, in the name of the cabinet secretary, already debated with amendment 115. Moved. The question is that amendment 76 be agreed to. Are we all agreed? We are agreed. Call amendment 77, in the name of the cabinet secretary, already debated with amendment 117. Thank you very much. The question is that amendment 77 be agreed to. Are we all agreed? We are agreed. Call amendment 78, in the name of the cabinet secretary, already debated with amendment 117. Moved. The question is that amendment 78 be agreed to. Are we all agreed? Call amendment 122, in the name of Miles Briggs, already debated with amendment 117. Miles Briggs to move or not move? Again, for the opportunity to improve at stage 3, not moved. Not moved. With the committee's agreement, that amendment is not moved. Call amendment 79, in the name of the cabinet secretary, already debated with amendment 115. Moved. And I call amendment 79A, in the name of Monica Lennon, already debated with amendment 79, to move or not move. Thank you very much. The question is that amendment 79A be agreed to. Are we all agreed? Are we all agreed? Yes. We are all agreed. Cabinet secretary, to press or withdraw amendment 79. Press. Thank you very much. The question is that amendment 79A be agreed to. Are we all agreed? Call amendment 125, in the name of Alison Johnstone, already debated with amendment 115. Alison Johnstone to move or not move. Convener, I do believe that in a truly integrated health and social care sector, health and care sector, we shouldn't be commissioning places solely for one part of that sector. I believe that clinical care is absolutely essential very often to that person-centred care that we all seek. I do not think that that is an either or. Given the comments from colleagues this morning and from the cabinet secretary, I will not push this morning but look forward to working with colleagues to bring back an amendment at stage 3. With the consent of the committee, that amendment is not moved. Is that agreed? The question therefore is that section 10 be agreed to. Are we all agreed? Question is that sections 11 to 14 be agreed to. Are we all agreed? Finally, the question is that the long title of the bill be agreed to. Are we all agreed? Thank you very much colleagues. That ends stage 2 consideration of the bill. Thank you to the cabinet secretary and her officials and to members who have joined us for that item. We will now suspend for five minutes and then we will resume in private session to consider the rest of the committee's business. Thank you very much.