 Welcome to the 33rd meeting of the Health, Social Care and Sport Committee in 2022. I have received apologies from David Torrance for today's meeting. The first item on our agenda is to decide whether to take item 3 in private today. Are members agreed? I agree. Thank you, colleagues. The next item on our agenda today is further consideration of the national care service Scotland bill. We have two evidence panels. Before we start, I want to thank everyone who took part in our informal evidence sessions last Monday in Aberdeen and yesterday in Dumfries. Members who participated in them would all agree that they were extremely helpful. We will make sure that some of the things that we heard in these informal sessions make its way into our scrutiny of the bill and, of course, a questioning of other witnesses and the minister, ultimately. The first panel will focus on data and information sharing aspects of the bill. We have two witnesses who are repairing it remotely, but we have four in person. Good morning to you all, whether remote or here in person. We have Darren Fitzhenneth, the Scottish Information Commissioner, Paula Fraser, the Development Officer for Voices of Experience Scotland, Ben Beth Lawton, Chief Digital Information Officer for the University of Strathclyde, and Ken MacDonald, the head of the ICO regions of the Information Commissioner's Office. Joining us online, we have Scott Held, the head of data-driven innovation for Public Health Scotland, and Dr Kenneth Mayan, the head of information and data protection, representing solar. First of all, I will come to David Fitzhennery first, because your office made a late submission. I think that it is as well to ask you about that first. In relation to the provisions in the bill that impact on the Scottish Parliament, corporate bodies, independent office holders, I wonder if I can come to you, first of all, just for you to raise your issues with that so that we can hear what they are. Yes, thank you for that, convener. It relates to section 15 and the provisions involved there relating to complaints and the ability to make regulations concerning complaints. The way in which it is currently drafted, in particular the reference in subsection 5 of section 15, is quite an expansive definition of the authorities in relation to which ministers are being given power to make regulations. In essence, it relates to many of the office holders, including myself. The powers being given are the powers to impose duties by Henry VIII powers, but also powers to remove functions from the bodies themselves. My concern is that there did not appear on the face of the legislation or in any of the documents to be a clear rationale as to why the Scottish Minister should have any power to alter the primary legislation relating to my office and my post in relation to that. I know that other office holders will have their own views and, in particular, the SPSO. From my perspective, there did not seem to be a clear rationale as to how freedom of information should be affected in relation to complaints. Certainly I would be concerned if there was any desire to remove the function of freedom of information in relation to the complaints process in this system, when it exists for the complaints processes in other systems. In the lack of a clear rationale or driver, certainly in the policy memorandum, I think the example given relates to the SPSO, which is where I think the focus lies. That being the case, my concern would be to include, if it is the SPSO that the intent is there to alter the legislation in relation to it, then I would suggest that it would be safer for those powers to be restricted to that office holder. As I said, I know that the SPSO will have their views on whether that would be appropriate in and of itself, but certainly in relation to me and my role to preserve the independence of it and to preserve the application of freedom of information in relation to all aspects of this. I would respectfully ask that the committee have regard to that in determining whether the current definitions are appropriate, given the extensive powers potentially available to ministers under it. I wonder if any colleagues want to come in on any of that or asking anything further. Sandesh. Can I just be absolutely clear here? Do you feel that the information commission needs to be taken completely out of the bill and should not have been included in the first place? That is purely in relation to section 15, which looks at the regulations for the dealing of complaints. On the face of it, I could not see why any regulations should require any alteration of the powers due to functions of the Scottish Information Commissioner within that. Therefore, in the absence of a clear rationale, it would be my submission that we should be removed certainly from the ambit of it. I think that there is a wider discussion as to whether it is appropriate for such powers to exist generally in relation to any of the office holder provisions, but as far as I am concerned, I do not see any clear applicability or suggestion as to how it may be used in relation to my office. You mean that Henry VIII powers would basically give you the option of doing anything that you want? That would give the ministers the ability to change the private legislation insofar as it relates to those complaints processes. During the pandemic, freedom of information was one of the areas in which emergency powers were used because of deployment of staff to other areas. I do not want to speculate, because you are saying that you do not know what the rationale is, but do you think that there is something in that that relates to this? I could not see it here to be honest, convener, because this provision purely relates to the dealing of complaints. It is regulations to make provision about the handling of complaints within that system, so it is bounded by that purpose. By being bounded by that purpose, I could not see what regulations would be relevant to freedom of information unless there was a desire to remove the ambit of freedom of information from such a system, and I would respectfully submit that that should not be done. There are exemptions and exceptions that apply to information if it is inappropriate to release it, and we apply those throughout to many authorities who have complaints procedures. We will make sure that we raise that with the minister and that we get clarity to your concerns and your questions. Thank you very much, convener, and good morning to the panel. We are going to start questioning this morning, focusing firstly on a single electronic record for health and social care. I think that this is an issue that has come up time and again in our scrutiny of the bill, but not only in our scrutiny of the bill, I think, more broadly in many of our inquiries and our work about the importance that many people feel a single record would bring, particularly in terms of people not having to repeat their story or their issues, time and again. I wonder if I can start by asking about the panel's views of the benefits or otherwise of a single electronic record. Is there sufficient data currently in the system to be able to deliver such a record? I am happy to go to each of the panels if that is possible. I do not know if we want to start with Beth Lawton. In terms of benefits, there are benefits right away from the individual citizen up to a public health level of holding a single health record or being able to access the data from a single place. That is probably key. We do not necessarily need to have one system that holds all the data for everyone, but we need to have a way that that data can be collated. As you say, there is not a repetition. The ability for a citizen only to have to present the same information once, not to go through it every time on their journey through the health and care system. I think that from a health population health issue, also from research, to be able to access that information on an individual from the beginning of their journey through the system to the end is really important. To have it held in one place. However, we have the beginnings of platforms in Scotland that can allow for that. For example, we have the national digital platform, so there would not necessarily be a need to start from scratch but to build on existing. I think that if I might also speak to some experience in setting up the integrated care system in Sussex, there is a danger that at the moment all the various entities involved with health and social care, be it the NHS, social work within councils or charities, they will all have their own systems. Some of those will be very difficult to unpick from the organisational system to move onto a central platform for everything, because those links would still need to be kept. So, from a digital perspective, my preference should I be asked would be more towards building a information aggregation point so that you can extract data from the systems, hold it centrally. As I said, the national digital platform might provide a basis for that, but to start building a system from scratch feels a little like the national programme for IT in NHS England, which is possibly not one that we want to recommend. I am here representing the UK Information Commissioner in our interests, particularly in data protection, so there are others that are better qualified to talk about the architecture of these systems. However, anything that improves the service to the individual, to the patient, to whether it is health or social care, we would support. As long as it is done proportionately, as long as it is done securely, and everything starts off from a perspective of privacy by design and default, in other words, the privacy of the patient or the service receiver is paramount and the system is built about that. It is a requirement now under the UK GDPR to start off from that premise. As long as it is developed with the patient in mind and also that you are interacting with patient representative organisations to get their views on where the dangers are and where the privacy risks are, then we would support the development of it. I come from the perspective of freedom of information, so my key interests in in this area would be more in relation to non-identifiable social care data. However, the more accurate records you have, if you have one version of the truth, if you have a consistent system, then that makes it easier to create and hopefully disseminate reliable, non-identifiable health and social care data that can be used to judge services, improve them and hold authorities to account. If the system helps and enables that, then again that is something that I would certainly not have a negative comment on. Hi. Many of our voices of experienced members have expressed frustration and anxiety at the repeating of the stories that could be mentioned earlier and are in favour of having a consistent integrated record, but even those that are in favour of that have concerns about it and about the IT system working properly and about records being consistently recorded by the different services and about having their own access to their records, which they have found repeatedly really difficult to do. Having to ask for it over and over again, maybe sometimes not receiving the information on their own records and they would want to have informed consent for particular parts of the record, but we also had a lot of members who have really deep concerns about any possibility of mental health records in particular being part of this consistent record because, obviously, at the moment it is closed and for many of our members they are very concerned about the possibility of those mental health records being available to everybody across the NHS and social care. Part of that is obviously to do with the stigma and judgment that many of the members have experienced from staff and the possibility that that data could end up more widely shared. They really are very worried and so many of the members are saying in terms of mental health records being shared that that absolutely should not happen because of those concerns. If I go to Scott Health first of all. Good evening, convener. I agree with the other panel members. We definitely see best a national care record as best said at the public health level. There are definitely advantages there and, with regard to service planning and how all that is organised, I agree with Beth and not sure that it would be one record or one system, but the ability to bring together data would be really, really important. I think that there is a need to think about the IT infrastructure a bit wise beneath all of this. One thing to say is that Scotland has lots of experience in record linkage and that is certainly an area that I think could come to the fore with joining the data across the system. A particular question about the data and do we have all the data available at the moment, I would argue that it is in fact meant at the moment, particularly in social care that I am not convinced that we have all the data that we would need at this stage to feed into any national care record. We also need to think about data standards and definitions so that we are all recording things in a consistent way. That will be really, really important. Just to touch on secondary uses of data, it is really important that people like Public Health Scotland are able to access the data held within the national care record so that we can do the work that we do around population health and service planning. If I can come to Kenneth Meehan. This is a double-edged sword. Any of the inquiries that have taken place into failures within the social care system have always said that one of the most important things professionals in this field can have is the chronology of a service user's interaction in significant life events. That is one of the most important things from a section of children and vulnerable adults. Clearly having a single record would assist in the chronology, and similar to what I have taken up from the previous panel member, yes, there would be efficiencies in avoiding the tell-its to us more than one time. The downside of that is that you cannot underestimate just how much effort would be involved in doing that. With my own organisation, we are currently replatforming the primary care system that we use to manage social work service users. Simply replatforming that one system is proving to be a massive project. If you are looking at integrating all the many, many different systems that will be in use across dozens, hundreds, probably of agencies, pulling that all together is a massive task. Once you have done it, you are left with a huge, enormous data set that would require a vast amount of management simply to ensure that the access rates that people have within it are appropriately federated. By picking up the point about access to mental health records, yes, some professionals absolutely would need to have visibility of that. Most of them would not. Even within a single organisation, the level of information that the child protection social worker needs to have access to is totally different from the amount of information that the home career who is going out to provide home services would need to have access to. There is a vast amount of complexity in doing that. If you look within the health service where you have had a centralised NHS for 70-something years, you still do not have the single integrated health record. I think that the idea that you would be able to integrate the social care records, particularly within the five-year timescale that was indicated in the policy memorandum, is not realistic. I think that there are a lot of dangers associated with going down that path. I wonder if we can pick up from that point that Dr Meakin makes around the bill itself and what is said in the bill and in the policy memorandum. There is obviously concern that has been raised that much of that will be dealt with in secondary legislation and that there is no clarity in the bill as to what the process will be in terms of gathering this data and then developing that platform, which Dr Meakin referred to there about an enormous amount of data having to be managed. I ask if panellists have concerns about this issue being dealt with in secondary legislation. Beth. Thank you. I think that yes, I have concerns because obviously when we are talking about building something like an enormous data source, we have to think about what you want to get out of the end of it and the danger is the way that the bill is written at the moment. The end stage that is being expressed is quite high-level, so to work out the nuts and bolts of how that would be. Information professionals that I work with would certainly be thinking what does our end state look like and then let's work back from that in order to design. At the moment there isn't enough detail in the primary legislation to be able to envisage that, so there's an awful lot of unknowns. I think that part of the concern in my area is not that we should or we shouldn't be doing it, it's just that the end state isn't clear enough for us to work out how that might be affected. It's more of the sense of clarity on the end point being left to secondary legislation that's a concern, not the direction of travel. Yes, when it comes to developing legislation with processing of personal data included in it, there's a requirement for the ICO, for the UK ICO to be consulted beforehand. This is under article 364. For each regulation that ministers are producing, they should be consulting with us and preferably at least 12 weeks before it comes to being laid in Parliament. That's so that we get the opportunity to properly scrutinise it from our perspective, from the data protection perspective, work with the officials to see where improvements may be needed. And there's also the requirement to be undertaking data protection impact assessments on processing, which involves this very sensitive type of information, special category information. And if there's any high risks that are identifiable that can't be mitigated, again we have to be consulted. So there are protections built in during the legislative and development processes from our perspective to work with the Government and the relevant bodies to try and make this as secure a system as possible. Did you want to come in on that specific, because you were signalling to me that you wanted to come in? Paul, mind if I bring in Emma? Thanks, convener. Good morning. It's just the issue of working back with them. So the primary legislation has basically said that the Scottish ministers, made by regulations, provide for a scheme that allows information to be shared in order that services can be provided. So in working back from that, we obviously need to make sure that all data is secure and what you're saying, Ken, is about co-design so that you are part of the process of developing any legislation that goes forward. So I think that's my understanding or trying to get at it. It's the whole co-designed process that comes from the primary legislation when we start looking at how we're going to manage people's data and then the security of their data as well. Is that to Beth, Flotin? It could be, yeah, that Beth or something, yeah. I suppose it wasn't on Beth's initial point about working back, but I'm happy to bring in Beth and then Ken from what you want to come in. So I'm sorry, I'm a little unclear on your question. I suppose the question is about the primary legislation will state what we want to achieve and then from that, we look at working back towards what the secondary legislation will need to be and that part of that is about co-design with the people that matter that know how a co-design process would then take forward. So the co-design part is relating to Ken's comment and the working back is related to yours, Beth. Yes, so I would absolutely agree with the co-design piece. As I said, it's really important to get an idea of what we're wanting. There will be so many parties who would have an interest in this and would need to be brought on board to make it successful because I think as well as building the technical capability, we need to build the culture around information sharing and that both on an organisational level and also build the data literacy because I think again some of the parties that we'll be looking at are not used to sharing information outside of their organisation. So I think in a way the mechanics will actually be easier than the cultural shift but the mechanics won't work unless we get that cultural and digital literacy piece. I mean in terms of co-design, our role is very much making sure that it's compliant with the data protection law and that is working closely. When we have been engaged with the government at the development of these initial high-level proposals and we would hope to be continuing to engage with them prior to any formal consultation as required under the law. But also in that general co-design area, as I referred to the DPIA, the Data Protection Impact Assessment, it's essential there to be engaging with all stakeholders, whether it's the current service providers but also the beneficiaries, the patients, the concerns that you've raised to make sure that they're properly and adequately dealt with in the final formulation of the regulations. I've got Scott Helg, who wants to come in, I think. I'll bring him in first and then come back to you, Scott. Can you just build on what the others have hoping to say? I think they'll need to have a sense of clarity on the end point but then also on the stages to deliver that end point, so working back and thinking through how do we get there. One of the really important points for me is that being clear on the data that we're looking to bring into the national care record does exist at the moment. I don't think that all the data will be there at the moment and we'll need to be worked on to develop that. I'm particularly thinking through what investment there might be, particularly in local authorities, around investment in IT to capture in a consistent way the data that would be required for that. I think that we've got well-established systems within the health service. I would say that it's less mature in local government, so it's definitely worked to do that. In the point that I made earlier about data standards and definitions, it will be really important so that when we're bringing things together across the country, we are being consistent. I would say that it's ambitious. I think that we should be excited by the ambition because it's an opportunity to really build on Scotland's data state in a way that we've not done before, but I think that getting that clarity on the end point and then working back just to understand how realistic it all is will be really, really important. Thanks. Can I bring in Paula? Members are really for being involved in the co-design stages, but they are very sceptical about how much involvement they'll actually get to have in that and are worried that they won't be represented well enough during the co-design stage, and they were also worried by how fast the bill came in without any co-design elements happening beforehand in their opinion. Thanks, convener. I suppose that the following question from that I think is realistic timescale, so the national care service should exist by the end of the Parliament, I think, is the intention. I think that what we've heard there is that there are big challenges in terms of being able to deliver this, not least as the data available, what will the infrastructure look like and how will we upskill people. I suppose that this is maybe a two-part question. One, do you think that the timescale is realistic for implementation? Two, are there concerns about the cost, because I've just heard that mentioned and I know that we'll come on to questions about finance, but are there concerns about how much that could cost in terms of delivering? Sorry, it does seem to be me on that. I think that it will take a considerable time to see the full value of a system like this. This is not something that goes in overnight. I would think that a minimum of five years, depending obviously on the resources available and finance will come into that, but you should be able to build in an agile fashion so incrementally, so you wouldn't necessarily go big bang and at the end of five, eight years have out grand unveiling, but that you would be building it incrementally and delivering those benefits in an incremental fashion. I think that it will be expensive and I think that it won't directly release all of that money, but it would be the indirect benefits that we would see from having that integrated data structure, that information in order to help us plan, in order for us to take a more proactive approach in managing health. In one of the previous committees Harry Burns was talking about solitogenesis, the idea of we're creating the right environments for health to flourish. Having that data to hand would enable that and enable us to take more proactive view of health and care in Scotland, which of itself, because the early intervention and the prevention would generate savings. I want to bring it back to the Government's other drives and digital strategy with regards to health, because I think that maybe we've got into the situation in our discussion this morning, is that the national care service pillar is the thing that's going to bring forward a sort of single interface that links records, but in fact there's a lot more going on in Government around this. It's not the national care service that's prompted this, this is something that the Government's been working on for a number of years, and it's something that comes up time and time again in this committee, not just in relation to the national care service, but in terms of every aspect of health and care that's having that. I noticed that Dr Mayan wants to come in, but a few of you have actually been in front of us before talking about this in general. Can we put it into that context? There was a wider strategy here, which wants that interface to work for all health and social care systems, not just as part of this bill. Yes, and I wonder, with the right architecture, we could actually be talking something more like the citizen data systems in Finland and Estonia, where every citizen has effectively a secure looker of their own information for them to interact with all Government bodies, be it health, be it social care, be it driving licences, banks. They grant access to that information, but it's independently verified. That could deliver a more holistic benefit for Scotland than having a health and care system in one place. We've mentioned some of the other things in there, so I can imagine that it might be constitutionally not be something that can be done, but certain terms in health, the idea of a single patient record, which I don't think anyone is really calling it, is more of a single interface, which gives access to all the systems that hold all the data and the relevant systems. It's not just in this bill. It's a wider strategy as well. Paula, you're nodding. Just that our members had mentioned a bit like the system that you're talking about in Finland. Members had mentioned that they would want to have something that's a bit more like a personal data store, that they're able to give consent on certain parts of it being viewed, but that it's a person-centred so that they are the ones that have access to that and don't have all of this asking freedom of information about their own records. That was really just what I wanted to mention. The personal data store idea is a good one, but I think that we have to be careful, given that we have regulatory functions here. There are social work interventions that are compulsory. The personal data store concept, I think that we have to be very careful when applying it in this particular area. I was once in response to the previous point on what is in the bill, as opposed to the policy memorandum, and I think that MacDonald mentioned the data protection impact assessment. Accompanying the bill only covers the framework and under the framework no personal data is exchanged whatsoever, and the data protection impact assessment doesn't tell us anything and doesn't give us any opportunity to engage around the wider privacy debate that those proposals should be engendering at this stage in the development of the plans. We can see that the long-term journey under the framework legislation will be to have the single unified health and social care record of some form, whether that's one great big data bucket or whether it's some form of federated interconnection between different systems in a debate for another day, but I still think that we need to be having a debate early on as to the wider privacy implications of how we do that, so that, picking up Ken's point, the privacy by design can be baked in at the outset and not done as different elements of this, and I appreciate the co-design process will highlight things moving forward. I think that we're missing the opportunity just now to have that wider privacy and data protection discussion around the wider proposals and the data protection impact assessment really doesn't address that kind of thing that it should. Can I bring in Scott Helb before I hand over to Gillian Mackay for another question on this? Scott? Yes, convener, it's a pleasure to find out about the kind of wider old data strategy, and I think that an important point is that there's an ambition to kind of modd how we do things in the health and care system, so modernising IT and modernising our ways of working. I can't comment on the costs and the data aspects of building this national care effort, but I think that it's important that, in the context of that, we also think about the economies of scale that we're looking at, and how we can't do things. I think that there's a real challenge there with that kind of balance between kind of carrying on and doing things, and we're doing it in a kind of funky, overlaping way, and managing something in a more joined-up way will be really, really important. Thank you, and maybe because it's mentioned to broadcasting that Scott's signal seems to, I certainly can't hear Scott very clearly, so maybe we can maybe take the video off next time we might get a clearer, better ability to hear you clearly, Scott. Sandesh, you have a question on this. Thank you. I'm an NHS GP, and I cannot access the NHS hospital data system. When I was doing psychiatry, as for adult psychiatry, I couldn't access the IT system for the children's, which was the other building. We have significant issues when it comes to accessing information within the NHS, when healthcare. We've been working on this for a very long time and spent an awful lot of money, and we do not have even access to each other's information, and that's actually a patient safety issue on a lot of occasions. So whilst I absolutely accept that this is very important that we have shared patient data, if we haven't got that right in the NHS for a long time, what confidence do you have that we're actually going to get anything that talks to each other within the next decade, because that hasn't happened in healthcare? I was going to start with Beth, but I know that Kenneth certainly wasn't in on this as well. Do you remember when we were talking about the national care service bill, and not this wider aspect, but we can always bring it back to the bill? It's very important that we understand that we've been working on it in the NHS, in healthcare, for a very long time. If we want to introduce something new to the national care service, which is this shared data, which is basically what we wanted to do in the NHS, but it hasn't happened in that context, what confidence do you have? I was going to start with Beth, and then if I could, Kenneth certainly was coming in on the next one. So you're right, it is something that the NHS struggles. My NHS experience is in England, rather than Scotland, by the way, but I think that the same premises arise. And there have been an over-reliance, I think, in the NHS on necessity, and because it was the only technology that was available on monolithic systems which purported to do everything and not share the information. There is a considerable movement happening now, and again, I speak for my NHS, England experience, not NHS Scotland experience, for increased interoperability and movement of data between systems, but it's not perfect yet. So the direction of travel is there, but I would agree that there is still a long way to go. In terms of this bill and setting up the infrastructure to support the implementation of this bill and the desired way of working as that flows through, I think we would have the opportunity to develop something from a much more scratch point and build that in from the beginning, so we would look at interoperability, we'd look at fire standards and the like, and build those in from the start rather than trying to retrofit them. So that would give us more of an opportunity, but I don't want to make claims that it will be easy. It would be very difficult. There are so many moving parts. Emma, you have some questions for our panellists, if you can direct them, that would be great. And panellists, if you want to come in on anything that you've been asked, even if you've not been named by the member, just signal to me that I'll bring you in. Thank you. I think maybe my question can be directed directly to Scott Heald. It's kind of on the back of what we're talking about, data and data security, and the public need to be absolutely, I suppose, aware and trust that their data will be managed in a way that doesn't reveal personal information, or especially if we're using it to monitor and collect how the national care service is working, and how records are exchanged, so that people don't have to repeat their story over and over. What do you think needs to take place to have the public trust where their information will be retained, and then only the specifics that are required will be shared? I suppose that we could go with Paula in the room, and then Scott as well. There is a lot of distrust from our members about how data is stored and how it is shared, although, as you have said, we have had a lot of members talking about even the current situation, as Sandesh mentioned, about records not being shared between different services and the trouble that that causes, but our members are worried about the confidentiality and the access to their own data as well. I'm not sure what it is that would give them confidence in the system, apart from what they've mentioned in terms of having that access and being able to look at different parts and say, I give informed consent to this area being shared with particular services, which would obviously be very complicated to do, but that is what members have been talking about, the idea of informed consent and feeling that their human rights are being respected, especially if it was in regards to mental health records. Some members are talking about certain areas that they might only have access to bullet points about their mental health record, for example, rather than all of the details, so those are the sort of suggestions. However, it's very difficult to say what would actually make members feel that they could trust that that was being done securely and that they were confident in the confidentiality of the records. I think that my videos have stretched out. I think that a key aspect of this will be engagement with public on all that people are trying to understand. I think that data is going to be set up for the people who are stored. It is a fundamental aspect of mental health records. It has to be the information governance framework that underpins all that has to be done at the start, so it's really clear how it's going to work and how it's going to impact. I think that it's just a little bit of a given that I've understood things from a perspective that I've explained by not dealing with a story, and all of those things will be one kind of benefit to how it should work, but also being really, really clear how that sensitive data will be handled and how it will be used. I think that, beyond the kind of many years of experience that we've got in Scotland, so a body like Public Health Scotland, we do have access to COVID-19. We've got really strict framework to learn how that's marching access to it. It's just something about having that narrative with the public and through groups that would be described in metaphysics, et cetera, to understand how it works. We would be having the information governance framework at the start of that, and that engagement with the public so that we're involving people at the start and how all of this is going to be set up and managed. A lot of that relates to existing work that we do in the kind of transparency here within data protection. Obviously, most of the players in this area are public authorities and in GDPR terms we're told that if you're a public authority consent probably isn't the way to go, simply because there's a power imbalance between the big public authority and the individual service user. Just because you're not using consent as your data protection legal basis doesn't mean you need to be transparent and open up front with people. Certainly in the local authority sphere we put a lot of effort into trying to tell people what it is that we will be doing with that information in relation to the different interactions that they have with us. That gets complicated because there is a really quite complicated ecosystem of information sharing out there. I know that there's proposals in the bill to facilitate information sharing. I'm not sure to take it a huge step further than where we are at the moment. The public bodies delivering services in this area identified that they can lawfully share the information with the people they need to share information with. We have those information sharing agreements. We've got information sharing agreements with Public Health Scotland as well. That's a pandemic, which helps to accelerate progress in that area. We already have a lot of that in place at the moment. There is a consultation in relation to social care data, but part of the problem with that consultation is that it almost creates an expectation in the minds of people reading that. If a service user reading that consultation paper would probably be left with the feeling that they should be able to have more control over their data than the legal framework gives, or indeed that the ability to deliver services requires. We have to be careful here as well. It would absolutely be transparent. We probably have in relation to those consultations that we have no idea at the moment what a national care service is going to look like. We don't know who is going to be the controller of that data moving forward. That is one of the fundamental difficulties that we have in engaging with the process at this time, as we are simply pinning the tail on a donkey, but the donkey hasn't been drawn yet. Thank you. Emma, do you want to come back in? Gillian, do you have a question on that? I might want to come in. It's just to pick up that there are existing processes out there, like badger notes for maternity, in which women who are pregnant can access their own information, their real time and their care record for their pregnancy. There are things that are happening right now. The clinical portal is another one that is part of what is being developed or a care record, for instance, or access to a care record, in which the patient doesn't necessarily get to see what the clinicians do. There is a working process that can be built on about that. I am understanding how we can use that as a way to measure how we implement a future safe, secure data care system. If anyone wants to come in on that. It was in relation that we have been discussing the access to the personal data at the moment, but it was mentioned earlier on in relation to getting the data in and exploring issues such as efficiency numbers, the non-identifiable care data that is coming in. There is an important point to be made about access to that as well, when we are looking at trust in a system and how well a system works for everybody, for the public, including patients. One concern that I have with the bill that is currently drafted is that, while the care boards would be made subject to freedom of information and therefore subject to those duties, the architecture in the bill allows for the contracting out of services, including the contracting out of some services that are currently being dealt with by local authorities. My concern is that, if that is done and if the freedom of information issue is not considered in relation to the providers of the care, as well as the overarching care boards, then there is a real risk that information rights could be lost in relation to access to that non-personal data in relation to that important non-identifiable social care data. That was an issue that was, the value of that was seen certainly during the pandemic, when people were hungry for that data to see how care homes were performing, to see how the system was holding up, to see whether loved ones were going to be safe or not. So, I do not think we should forget that and my concern is that as currently drafted the bill really seems to deal with freedom of information and those access rights as an afterthought to be picked up later by way of section 5 order, rather than considering it in the body of the bill itself. Due to the scale of change required, for example, the upgrading of legacy systems, Stirling Council has suggested a phase launch of the information sharing system. Does the panel have concerns about the capacity of some local authorities and potentially NHS, to be able to complete those in the timeframe suggested? Are there any other issues in terms of capacity and workforce available to do this that the panel would like to raise? It is a very real concern. I think that the incremental approach would probably be the most productive one. I think that we are all aware that there is, at the moment, a national shortage of qualified and experienced IT staff. My colleagues across industry and public sector in Scotland are all reporting the same thing, that there are not enough skilled staff to go around. That would be a significant problem in terms of bringing people in for a central project, but also within those various local authorities to not only keep their business as usual activities running, but to undertake significant enhancement. It is definitely a concern, but that said, to build incrementally, is a much more sustainable way of doing it if your resources are more limited or likely to change over time, because you can move things in terms of what is deliverable in the next sprint to deliver something positive need be. The approach being suggested is definitely one with exploring. Scotty Held wants to come in on this, and then Kenneth Meehan, if he can bring in Scott. I think that the experience of collecting data from social care has been very fragmented, but I think that there are opportunities to think about how we, I guess, modest the underlying instructor, will bring data into any national care worker. As Beth Sede has said, it is certainly a phased approach. I wonder whether there are opportunities for colleagues of scale, but I imagine that there will be something in the national team that will take the support of building incrementally in sprints. Further, the opportunity for national teams to work to provide additional capacity for a period to allow it to happen. That is an important point about the underlying IT system, particularly across the country. There is a lot of consistency, so it is certainly something that needs to be tackled around that, so we can crack the national care record whole scale. I do not underestimate the resource demands that are involved here, particularly the rest of the public sector. Budgets are increasingly constrained, vacancies are almost impossible to fill. That is more generally, even without getting into specific skills shortage that you might find in the IT sector. I think that the reality is that even if everybody involved in that decided that we wanted to have a big bang, it would end up becoming incremental simply because of the size of the super tank that you are trying to turn around here. There are a lot of moving parts. As the co-design develops, we should be remembering to involve the information elements of that as we are going along. However, this is a huge piece of work, and I think that I mentioned earlier that I do not think that the five-year timescale for the information elements of that is realistic. That would be a big task at normal times, at the moment, as I say, budgets being as constrained as they are, and staffing resources becoming increasingly scarce. I simply do not think that it would be achievable. Colleagues, we have touched on GDPR already, but a couple of colleagues wanted to comment on that, specifically on Sandesh. If you still have questions around that, I believe that you have some questions. I will go to Sandesh first. My question is directed to Kenneth Meachan. Solar expressed concerns about the impact of the proposed measures on the rights of data subjects. If you could expand a little bit on what you said in your submission, please. That was particularly in relation to people exercising their subject access rights using data protection legislation to see what information would be gold about that. There are some exemptions to that. You do not have an automatic rights to everything that is in your file, and there will certainly be information on taking the social work file as an example, but there will certainly be information about a lot of other individuals that you probably are not entitled to see. At the moment, if someone puts a request into a local authority that social workers who are familiar with the case are going through the file and identifying the parts where, yes, that should definitely be going out to the person because it is about them, or that it is about a third party, but I know that the individual service user already knows that, so I do not need to worry about redacting that chunk of it. However, decisions that are taken by people who are familiar with the individual, as you centralise the records, if you were to create the huge monolithic data tank of all service users in the care sector, it seems unlikely that those decisions and the interpretation of a request for information would be managed by somebody that has that knowledge of the case, and you would probably end up with a much more bureaucratic application of the rules. There is a similar part in terms of some social work records, particularly for people who have been in the care system. There is a sensitivity around information that needs to be handled with care, and very often the way that we do it would be to invite the person in for almost a counselling session. It is not just a case of, here is a pilot of records and you hand it over and that is it. It is a case of taking the person to do that just to make sure that you are not causing them harm in the course of them exercising their routes. Felly, you take the data away from the front-line staff the harder it is to make sure that you are getting that balance, right? All of us on the committee and most patients would be keen for the ultimate place to be the patient holds their own data, their own records. That would be an ideal scenario. Felly, on what you have said, what safeguards do you think need to be put into place because there are lots of things that you spoke about with the movement of this going to a more centralised location? I was wondering if I could ask you that, but also if I could ask you the same question about safeguards. We already have a lot of safeguards, and the UK GDPR and the data protection act already have a lot of safeguards built in there. That is reinforced by the fact that the organisations dealing with that have been dealing with that level of sensitive information for a long time. I am not saying that mistakes do not happen, but we will do and will continue to happen, unfortunately. The safeguard there is to be transparent with people and make sure that it is the right people who have access to it. I mentioned that if you have a huge centralised database, one of the most important safeguards that you are going to need is to make sure that you have all of the federated access. Just because you can access a system for one reason does not mean that you should have access to everything that is in there. You should have access to the information that is relevant to the function that you are carrying out. That is, going back to the resource issue in the previous question, actually managing that level of federated access after a number of staff involved in the care sector. Again, that is a big ask. However, if we are going to do it properly and we are going to have privacy by design and default, that needs to be baked into the process and we are going through the co-design process in terms of who is the actual controller of this information. When it has access to this information, we need to make sure that is factored in and that we have the appropriate resources to manage that problem. Disagree with anything that Kenny has said on that. It needs to be built in from the start. We do have to make sure that the staff dealing with the subject access request understand the individual, understand the relationships, understand the dangers that there can be to others when certain information is released. If we are talking about social care, there could be child protection issues, etc., that ready access to your record, as you are suggesting, would not protect the other individuals, the third parties. We have to bring people along in the process and that is the social workers, the data controllers have to be transparent with the service users. There has to be an understanding by the service users that there are these other issues, the legalities of access, etc. Our information commissioner, John Edwards, came into post just in January. He is taking a look at the way that we are dealing with certain sectors and putting a lot of emphasis on raising the awareness of those who have unmet needs, raising awareness of their rights. We are putting a lot of emphasis on that in our work now. I can see a role in during this co-design process that we have spoken about previously and our consultations with the Government as they bring the proposals forward. I can see a big role in us supporting the ways in which we can help the users to see that. I also hope that, Paula, we have engagement with you and colleagues and other organisations to help them there as well. I wonder as well, just to sustain with you there, Ken, just now. What about the role of the third sector and voluntary organisations, as well as externally housing, homelessness, etc. What role should they have in relation to the information sharing? Does the bill allow them to fulfil that role? Are there changes that might be needed around that? Are there any comments that you have in the voluntary sector as well and other services that are about housing and homelessness, etc. Most of that will come through in the detailed regulations that come through. Obviously, the third sector has a major role to play in the delivery of social work and other care services, so they cannot be ignored. I think that it is for the partners in that work to ensure that the organisations themselves are properly trained and properly aware of their data protection responsibilities, that they have good strong data sharing agreements between them so that they know what they can share and when they can share it and who they can share it to. It is again building in a strong framework, a strong infrastructure before the point of delivery, working with the partners, working with the patient and service users advocacy groups to make sure that we have an effective system of data exchange. On implementation, I suppose that I will bring it back to again a single interface, which I am guessing would be the goal that allows access to the systems and the information contained within those systems that people manage in someone's care, whether that being transitional from a clinical setting to a care setting being the goal. I want to bring from the perspective of those in the care sector right now, who told us yesterday when we were in Dumfries, that at the moment they are having to put multiple entries into different systems of the same information, or they are having to access multiple systems at the moment, and that is taken away from the time that they spend with their clients. I wonder if anyone in the panel has any views on that as to how we can help the workforce with the goal of having a single interface and how that could be manageable. I think that that is one of the reasons why this is coming up time and time again, is that the workforce is telling us that either Alexander is saying from my health perspective that it cannot access certain systems where there is actual data and information that they require to access, but also in social care they are saying that I am spending so much of my time having to log into different systems in order to report on things or to get information when it is taken away from the job that I am supposed to be doing. I know that I am rambling a little bit, but you get my point from the perspective of those on the ground. How do you see something being implemented to take down the red tape around that? I was nodding along because my previous role was in mental health in Sussex. Part of that was setting up the integrated care service there. We had exactly the same problems that you were talking about where social work would have entered their data on to council systems and mental health practitioners would enter on to NHS systems. Charities who were very active in the sector maybe had three standalone computers in a back office that did not connect to anything at all. I absolutely recognise what you are referring to there. I think that there is no easy answer. The ideal would be to have first of all common data standards so people are collecting the same data because what we find at the moment is that each organisation will have its own set of data that will all be slightly different and then to aggregate them becomes more difficult. If we could agree data standards and that culture of sharing because, again, typically in Sussex we found that one organisation would say, oh no, we can't share that information with you because of GDPR. Our staff were having to enter data on to two separate systems controlled by two entities. We have to build that culture of data sharing and the understanding of it. We have to build the common data definitions and then we can look at aggregating the data as part of the wider system that we were talking about. However, there is no quick fix based on three years' experience. I wonder if anyone else wants to come in on that. Dr Mayan, you have put in the chat box what you want to come in but I don't know if there is any relation to my question. I'll just go to you just to check. Was the answer to the previous one in relation to the third sector engagement? In terms of third sector engagement, again, it was during the pandemic, I think, the role of a lot of smaller third sector agencies in providing vital support came to the fore in a way that I hadn't previously, but it also highlighted the fact that there were some weaknesses in terms of information governance in that space. We have been working and developing that since then in terms of how can I put this? The bureaucratic parts of data protection—we have now agreed in Glasgow as a model that we are happy to share elsewhere—we have agreed that bureaucratic parts of data protection up front with the umbrella organisation, Glasgow Council for Voluntary Services, so they have gone off and got lawyred up because of that term and agreed a framework with the council under which all of their members can quite happily enter into specific data sharing agreements in relation to the small work that they are doing. We are happy that we have got the information governance address and that helps to facilitate the joint working in that area. In terms of current point in relation to joint services, there is a recognition that health and social care have been moving more closely together to the point that, in some areas of practice, it is recognised that you cannot do it in isolation. If you are dealing with addictions work in particular and some aspects of mental health work as well, it requires that you both have clinical and social care interventions to make that done properly. We recognise that by saying that this is an area in which we are jointly controlling that data so that it should not matter whose computer you are entering the data in. If you are entering into that area representing an organisation, that organisation is controlling the data. You should recognise that in what you are saying to your staff. I will only put that on that organisation's computer, even though I work for the council. I, as a council employee, am doing things with that data, so you should recognise that the council has a role there. We have been trying to do that and say that it is increasingly becoming the norm in fields like addictions and mental health, but more than one agency is controlling the data. Stephanie, do you have questions on ownership of data? That is probably a good time to bring you in on your questions on that. That is a really interesting one. I would like to hear a bit more about that, a bit more detail around that. However, if my understanding is right, there seems to be consensus around individuals owning and controlling their data. It is about consent, choice and setting limits. That has to be person-centred. I wonder if you feel that this should be stated on the face of the bill. If I could go to Paula first, thanks. I think that for our members it should be something that is stated on the face of the bill, but, for a lot of them, they are saying absolutely no mental health records being shared at all, whether they are not. There is the option of being able to access it themselves and it being person-centred, so I just have to state that there is that view as well from some of our members that they just do not want that to happen at all with mental health records. In general, from members wanting to have that put in there so that they know that it is absolutely guaranteed. I do not know if anybody else wants to come in on that one. I absolutely understand what Paul is saying, but I have concern about the language that might be used because person-centred may send the wrong signals. As Kenny mentioned before, there are times where we have to say that we cannot ask for your consent on this, we have a power imbalance, we are the local authority, you are needing our services and there is an imbalance. We have to be careful in that language. We also have to be careful, and there I say it when Beth said to her that we cannot share because of GDPR. I know it was not you were quoting people, not yourself. There is normally a way through the data protection legislative framework to allow sharing. It is a matter of going and seeking the right advice, and that is part of our role, an educative one. I will also maybe just smile and take exception at Kenny's description of the bureaucracy of data protection. I would call it good information governance, Kenny, and it is necessary, and it is key to the whole framework. I think that we do need to be really careful about, I guess, that balance in the health sector or the need for us to share data for things like service planning, understanding, and so on. It does come back to the phrasing earlier about having a dialogue with individuals about why it is useful to be used in those purposes. I think that that can't lie to a statement around people saying that they don't want the data to be shipped at. I think that it is risky because there are reasons why it is really, really important that they do share data and have that ability to understand what is happening in their situation. I appreciate the fact that people are concerned especially about mental health information being shared. However, that is also one of the key areas where we are talking about people having trauma and having to repeat their story over and over again. It is implicit, clearly, that they are able to share that information when that is something that is helpful to them. I am wondering about how we actually get that balance right, but for human rights I have respected too. Yes, definitely. Members have talked about the re-traumatising effect of having to tell their story over and over again. Interestingly, a lot of the time what they are mentioning there is within mental health services where the record has not been shared properly or it has not been recorded properly. That is where they are finding that they are having to retail the story rather than necessarily outwith mental health services. However, I do see what you are saying, but I am afraid that I do not have an answer. I really appreciate what you are saying there as well because I know that sharing details or too much information about traumatic experiences with someone that they are not happy about is also a traumatising experience. I do not know if any other panel members have any comments on how we look at actually getting that balance right. I am just wondering if there is any way of flagging up certain parts of information on the record. I do not know any of the scenarios well enough to give a proper example, but if we go back to the health scenario that we have referred to and is roughly parallel, we often see cases where people are disputing what the doctor has on the record and you will be aware of this, but it is essential that the doctor's initial diagnoses are retained. They want us to scrap it. We say, no, make a note that they dispute this because ultimately in the history of the patient it is essential to know what the initial diagnoses were and if they were correct and if they were wrong. It is not a direct parallel, but I am wondering if there is something in the mental health area where it is just the patient saying, I am not happy, I understand you might have to keep it, I understand you might have to share it, but please note my concerns and flag it up that way. I will bring you in before a couple of members want to come in specifically. Thank you. In relation to the point about control of the data, one of the important things is an area that can also cause trauma. You need to know whose job it is going to be to fix it when you get it wrong. We should not be naive enough to think that, however securely we build a system, there will not be mistakes at some point and things will unfortunately go wrong. That is when, unfortunately, there will have to be in touch with Ken's colleagues down in Wilmslow to notify them of data breaches. I think that that is something else that we need to bear in mind when we are designing this as well. I will give a couple of examples that I am aware of were that a local authority managed to lose a lot of data in relation to the housing of sex offenders in the community. The data found its way into the hands of the Sun newspaper when it was at the head of its hang-up pedophile from the nearest lamppost campaign. The data breach in that case involved the emergency rehousing of a lot of those offenders and that was a massive multi-agency task force. I had to be mobilised to deal with that as an issue. On a smaller scale, you have home carers who are going out to people's houses and have a piece of paper that has got the combination for the key safe on it. That piece of paper blew out the window of a van and the data breach response there was that we had sent tradesmen out to about 20 people's houses to change the combination of the key safe. That is the sort of thing where, again, it is really, really important for us to know who is going to be the controller of this data, because one of the important things that a controller has to do is make things right when it goes on. Thank you. A number of a couple of members want to come in on this in particular. Emma? Yes, just a quick thought about yesterday in Dumfries. One of the people around the table said that we should move away from talking about person-centred care and talking about relationship centred care, which is based on trust between your carer at home, your carer who you live in a care home, or whatever. I am just wondering about your thoughts on the language that we use. Of course, we want person-centred approach because it is very dependent on what data is shared and who is allowed access to your data, like the key safe in your house that Ken has talked about. I am interested in a brief thought about person-centred versus relationship centred care. I am not sure if I have got an answer to that. I mean, our members do talk a lot about person-centred care, but they also mentioned that often it is banded about, like you are saying, and it might not necessarily be doing what it is supposed to be doing. Relationship centred care might be a good description if you are talking about between the clinician and the patient, but as long as it is not taking away any of the rights of the patient, language is an important thing, but it is also quite a difficult thing to decide upon. I am not sure if I have got a good answer for that. Can I come to Evelyn? Do you have a question on that? We know that people want a shared record in whatever form that takes. The Scottish Government consultation showed that 86 per cent of people wanted it, and they wanted it to be shared across platforms, but in relation to co-design, you said that people were anxious about what that looked like, what that meant, would they have enough time? Would it be helpful for further guidance or from the Government about what that would look like to offer reassurance that there will be time to have these important conversations about control of data, mental health issues, whether and what might be shared and in what circumstances? It would be useful to know that there was going to be enough time to carry that out properly and have everybody consulted that should be consulted properly. Emma, we have a round monitoring and evaluation. You have some questions. I am just checking with members. Evelyn wants to come in on that as well. Is there anyone who wants to pick up on any of the aspects that we have mentioned before we round off this panel session? Can you please let me know? I will be really quick. We have talked a lot about data and personal data this morning, but there are part of now a couple of questions around the monitoring and evaluation of a national care service as it is taking forward. I am interested to know if you think that the bill does have suitable information as introduced about the monitoring and evaluation of care as it is delivered. Is there anything that should be added in, or will that work on the face of the framework legislation in order to introduce what we mean when we want the service monitored and evaluated? I am not sure who wants to go first. I think that going back to my earlier point in relation to freedom of information, that the openness and transparency that that can provide to the systems lets there be increased accountability, allows for the monitoring, particularly if it is tied in with information standards, so that what was mentioned earlier on about that consistent approach between bodies so that you can compare like with like between the different care boards, for example. While the care board level would be captured under freedom of information to enable that sort of analysis, what is not currently captured in the bill is the tier below. For example, you could get person A whose care is being provided still by a local authority or by some other public body on the care board, and they get access to specific information. Person B is in a care services provided by a contracted-out services, and they would not have the same rights to information. If we are looking at that consistency that is promised by the system, there is a risk that the actual architecture in relation to freedom of information rights will create inconsistencies. I am concerned that having a section 5 order to remedy that later on is asking for a period of time when the inequalities will be there. It is interesting to talk about the whole release of information, the sharing of information, the whole minutia of the regulations that allow freedom of information requests, and other monitoring and evaluation to then be out there and be shared so that we can compare on how a board is doing versus another one. I find that really interesting. We have talked a lot about self-directed support, and that works really well in some places and in others, so we need to be able to monitor that. Do you think that there should be something more detailed about data monitoring or monitoring and evaluation of the system, like unmet need for instance is something that does that need to be in the face of the bill? In terms of monitoring and evaluation, the piece that I am particularly interested in is the ability for the public to have that information so that they themselves are able to raise questions, concerns, have information, make informed decisions. That is where the freedom of information piece comes in. I am concerned that the bill is an opportunity to consider it as part of the process to build it in from the get-go, rather than to, while it is dealing with all these other data considerations, it is an opportunity to build it in, consider it in the system as a whole, rather than viewing it as an add-on. My concern is that, for the system to work properly, it is helpful for the Parliament, the committee, to have consideration of all those issues at the same time and build it in rather than, as I say, just dealing with it later on. Certainly, it is interesting how that would work with information standards and whether that in itself will help to create consistency across the various service providers. Emma, you have helped to cover my question. Just as an overall question, the governance structures, the way that information is stored, what is stored where and by who, probably, is not particularly clear for many people, does the panel think that that is the case and what work would they like to see undertaken as part of the construction of the NCS to ensure that everyone knows their rights and responsibilities going forward? I have referred to the legal responsibilities that the organisations have, the Government has and the partners will have. It is essential that they consult with us. It is an obligatory that they consult with us, and I would hope that we would be able to assist them in the pathway to getting it right. Does anyone else want to come in on that? Let me know. I have got Scott on-line who has asked to come in. It might not be on Gillian's question and might actually be on the last thing, but I will bring in Scott anyway. Yeah, thanks. Some point about what Gillian was saying about monitoring evaluation. I think that one of the real important things about the development of a national care record is taking through the uses of the data once it is established. I think that all the stuff that Gillian was talking about, about unmet need, looking at health and equality and building it at the start, how you are going to use the data once it is there, is going to be really important. I think that the fundamental part at the start is to talk through around how the data is going to be used. On that final question about multi-agency, I think that the answer is yes, it has to be multi-agency for lots of players in this space. On the specific question about it, is it clear at the moment? I think that it is safe to say, certainly from my perspective, that it is not clear, but I think that that is an important work that would have to happen at the start, where it kicks off about who is involved and what roles will be within that. Thank you. We have reached the end of our time with our first panel. I want to thank you all for your time this morning. We are going to suspend for 10 minutes for a break and allow our panels to change over, thank you. Welcome back. We now move to our second evidence session, which is focusing on the bill in relation to regulation and quality improvement. I welcome to the committee Rosemary Agnew, the ombudsman of Scottish Public Services ombudsman, or SPSO. Lindsay Clelland, the director of quality assurance for health improvement Scotland. Suzanne McGinnis, executive director of social work for the mental welfare commission for Scotland. Kevin Mitchell, executive director for scrutiny and assurance of the care inspectorate. I will come to Kevin first of all. The bill is drafted. What extent do you think that the bill could improve the regulation of care and support services? Thank you, convener, and thanks for the opportunity to give evidence today. The care inspectorate, we welcome the bill and particularly the aspiration to improve the quality and consistency of social work and social care services and thereby the outcomes and experiences of people, which is what it should all be about. We also welcome the underpinning principles of the national care service that is included in the bill. We recognise that it is a framework bill and that such does not have the detail that some perhaps are looking for, but we also understand that further detail will be forthcoming in due course, not least through draft regulations, consultation, co-design and co-production. However, in our experience, although we recognise the potential of the bill and the aspirations that are very laudable, in our experience structures or changes to structures won't deliver change or high quality seamless services for people, particularly those who need those services the most. Crucially important in our view will be how that legislation is interpreted, how it's implemented and implemented consistently, and what will also be equally crucially important is how the national care service is led, managed and resourced. We know from our scrutiny evidence that what it will need above all else is a strong shared vision, strong collaborative leadership, strong and effective partnership working, good multidisciplinary working, where relationships are key and have the potential to break down any artificial barriers that might exist, robust quality assurance and adequate resourcing. Again, going back to the original question, there is and we see the potential particularly for the most vulnerable. We welcome recognition of the importance in the bill to the independent scrutiny and assurance that aligns with a quality improvement approach. In that respect, we think that the care inspectorate is well placed to carry that out. We already do that across a wide range of social work and social care services for babies, children, young people, adults and older people, and a strong record of working across complex structures. We are confident that we can continue to do that and deliver independent scrutiny and assurance and support improvement effectively whatever the structure is in place. We certainly look forward to further discussions about how the detail of the bill and what its enabling powers are to be able to achieve all that. Social care is already a very highly regulated sector. You may be aware that we've been doing some local outreach work and we're doing free yesterday. It was put to me by somebody who was managing an independent care home about the burden of multiple inspections in terms of staff capacity. She put it to me that what she didn't want is another layer of inspections on top of it. You're involved in the review at the moment on the inspections. What would be your response to that? I assume that you're referring to the independent review of inspections scrutiny regulation led by Dame Sue Bruce. Yes, we very much welcome that and we look forward to engaging. We've already had a meeting with Dame Sue Bruce and Stuart Curry. We're very conscious of inspection when we go into any service. Clearly, it will be a distraction, but we take very seriously our responsibility to provide that independent assurance. However, we also take very seriously our duty to further improvement. It's a statutory duty to further improvement in social work and social care. When we go into inspection, we also are very clear that we will support improvement. We regard every single visit, every contact, every inspection as an opportunity to support improvement in the service. Yes, our statutory responsibility is to provide that independent assurance about the quality of care, the safety protection and wellbeing of people, sometimes the most vulnerable people, be they children, adults or older people. Again, when we go into the service, we will seek to deliver all of that and we are always regard our inspections as doing it with people rather than with two people. We will engage in professional dialogue, signposts and try to identify good practice. However, no matter how you package that, there are those who will sometimes feel that it's a burden. I think that sometimes the views of inspection might correlate to the outcome of the inspection because overwhelmingly services are good and very good. We don't often get complaints when we report the outcomes of those inspections as being very good. We are talking about the amount of inspections rather than any kind of outcomes. They were just saying that they were hoping that the national care service wouldn't be adding another layer on top of what they already got to do in that regard. I suspect, convener, what they might be alluding to, and I'm only guessing here, is that we would only seek to carry out inspections relative to an assessment of risk. We take an intelligent-slide risk-based approach to inspections. We clearly want to also look at services to identify good practice, so we've got to strike a balance there. During the pandemic, what developed was an enhanced role for oversight groups in health and social care partnerships. Those have been very helpful in many respects, and we lay very closely to the health and social care partnership oversight groups. However, we are also aware that we have been told on many occasions about potential overlaps and some inconsistencies in how they approach that role in different areas. Some services perceive the role of the oversight groups to be a secondary form of inspection rather than support improvements. I don't know if that is what people are mentioning. I don't want to speak in any way negatively about those oversight groups because they have done some really good work and we have worked very closely with them, but I know that some feel that rather than offering support and guidance, they come in and more or less repeat what we have done. I think that that might be the source of some tensions that have certainly been made known to us. I wouldn't like to say how widely that's a view that's held, but that view that you've put forward sounds similar to what others have put forward to us as well. I want to bring it back to the ministerial oversight aspect of the bill and how that might relate to the regulation of care and mental health services. Any thoughts? Suzanne, if I can come to you first on that. In terms of the bill itself, the commission welcomes any in all measures to improve the quality consistency of social work and social care. In terms of ministerial oversight of mental health services, we had submitted previously our views around the bill and it seems to be set out quite broadly and we would expect greater emphasis or made more explicit within the bill around parliamentary scrutiny of ministerial powers. In terms of mental health services, this is a really complex landscape as you'll be more than aware. We are currently working our way through the Scottish Mental Health Law Review. There's a lot in there that there's a clear crossover between what the NCS hopes to achieve and what the Scottish Mental Health Law Review hopes to achieve. We would ask that those two combine once we progress with national care service. Lindsay, do you want to come in? I could see you nodding. Another very specific issue relates to our last panel, Rosemary Agnew. The evidence that was given by the Scottish Information Commissioner, SPSO, was mentioned in the oral evidence for sure. I just want to know your feedback on that aspect of their submission with regard to the SPCB or the Scottish Parliament corporate body and the officers there. I'm going to start with an apology, but if I confuse you, it's because a lot of the information in the bill and the provision as drafted is quite conflicting in places and we've tried very hard to unpick it in specific ways. There are actually three issues relating to that ministerial powers. It's section 15 of the bill. The first one relates to being a parliamentary office holder, so we have concerns about the impact of the bill on office holders. I know that the SPCB has also written with their concerns and it's worth taking us back to the Public Service Reform Bill. When it was last proposed that the Government were able to make changes to parliamentary supported bodies by secondary legislation, which is what this is doing, it was accepted that it was not appropriate to simply use an affirmative procedure to do that. Instead, protections were added to the bill and then the Public Service Reform Act, as it became, to make it clear that secondary legislation would be for limited purposes only. The superaffirmative procedure specifically designed for this was introduced because that reflected the importance of the independence of the status of office holders, not just myself but the other parliamentary bodies. This has an added dimension for the SPSO because since that time the UN has endorsed something called the Venice Principles. It's a bit like the Paris Principles but it relates to Ombudsman and these principles ask states to ensure the independence of ombudsman schemes. Now whilst we fully support the purposes and the intention of the bill, as Kevin set out, we do have a concern that the ability to change our powers in this way would actually undermine our independence because it would have to go through some sort of procedure but it would make it secondary legislation to try and alter what is already complex legislation and we're not sure that that would be appropriate. Now there are also some very specific impacts of section 15 in relation to complaints and ministerial powers which I'm happy to cover here unless they're related to questions later. Now the second area where section 15 comes into play is in relation to our powers as a complaint standard authority. What I've tried to do is set out what the current situation is and what the bill might change. Now we were given complaint standard authority powers through an appropriate parliamentary process in 2010 so what this means is the SPSO sets complaints handling standards for bodies under our jurisdiction, we monitor complaints handling performance, we support and drive learning and improvement both in complaint handling and to get public bodies to use complaints to learn for themselves good and poor practice. Now we accept it's not ideal but we've seen significant improvements because of model complaints handling approaches. Now under our powers we expect a complaint process to meet model complaints requirements and the principles that have been laid before and approved by Parliament. Now currently all local authorities, health and social care partnerships, iJBs, health boards broadly apply that system. There are a few local differences but effectively the process is the same. Now the national care service will be established in the legislation as a function of Scottish ministers which means it's under the SPSO's jurisdiction so in theory it's also under our jurisdiction for model complaints handling. Now section 15 this is where come on to the what might transpire of the draft bill effect in effect is making ministers a model complaints standards authority so a complaint standards authority for the national care services and potentially social services because it gives them the equivalent power to issue complaints procedures for those areas. Now my view is this is incongruent with the powers that Parliament has already given the SPSO and I think it runs the risk of creating different systems for different parts of public services. Now it's difficult to say in detail what the impact would be but if we come right back to one of the fundamental aims which is to make this easier and simpler and a better service for complainers and for service users ideally we want a service that doesn't result in complaints but I don't think it would be helpful to further complicate an already complex landscape and then the final area where section 15 may come in it's it's in my primary powers they are linked to the body that is delivering the function so my powers apply because the body is delivering a function and it's in my jurisdiction. Now we think there could be an unintentional consequence here to reduce the accountability of some of my primary functions so this relates specifically to our ability to consider the merits of some decisions so under social work powers that we were given in 2017 and this was after significant consultation and through the super affirmative procedure we are able to look at the merits of professional decisions made by social workers and social services so but these powers are linked to the accountable body so the local authority we have the same for health so that's linked to the health board but if these functions were moved to the national care service without any saving provisions in the bill we think that it will end our powers in relation to the merits of decisions put simply we don't think we'd be able to challenge professional social work decisions in complaints because of the way the bits of the legislation interact together and I think this would just again be a very retrograde step in terms of the creation of an ombudsman that effectively is a one-stop shop and also again I think there is likely to be unintentional consequences of complexity for how and where complaints go now the Scottish government's confirmed that our understanding is is correct but we also have a concern that it might impact in a similar way for some health related complaints if any health functions are transferred and for whistleblowing complaints because since April 2021 we're also the independent national whistleblowing officer now we've not been able to assess exactly what the impact would be because we don't have as much of the detail now the Scottish government have said because you know we've been able to work positively with them that they would use their section 15 powers to reinstate the social work related powers but that seems a bit a bit the wrong order in my view the co-design that's going on at the moment it's a great way of of involving lived experience for designing the service and presumably some of that will relate to complaints but we think given our powers were confirmed through either primary legislation or the super affirmative process we are still concerned about the appropriateness of Scottish government being able to change primary legislation to suit what they want to see coming out of complaints what we would much rather do is be part of the co-design to see if we can't put the complaint systems we have you know make them better rather than introduce something completely new what you've said will inform our questioning of the minister on the specific issue so thank you very much can i move on to questions from Emma Harper on the national social work agency thank you convener good morning everybody there's a couple of bits of information in our papers about the establishment of a new national social work agency so i'm interested in what the panel's thoughts are on the creation of a centralized quality improvement body for like in the form of a national social work agency and is that something that you welcome or would you prefer to see some alternative approach and if so what would that be i suppose can we go to susan first the social work can i understand from my colleagues across the board are fully supportive of our national social work agency and it's really important for the social work profession to gain parity of professional recognition with integration partners across the board what that looks like whether that's an integrated national social work agency or a sand alone as long as it's there and we gain parity the commission itself is fully supportive of the national social work agency and i think we think that it offers an opportunity for social workers to operate in the way that we're trained and intended within communities relationship based practice and using a professional social work knowledge skills and values to best affect and that's a shift away from the current evolution towards gatekeepers in effect and i would add on to that as well in terms of the chief social work officer it would have been it would be helpful i think to see the role of the chief social work officer aligned with national social work agency and actually on the face of the bill not sure of anybody else what's the comment i see Kevin Mitchell thank you i'm not a social worker but i've worked very closely with social workers at both a strategic and operational level for almost all of my 45 years of public service whilst the detail is unclear that the care inspectorate recognises the potential benefits in what's proposed through creating a national social work agency particularly in terms of promoting the value of social work and supporting improvements in learning and development opportunities for social workers and indeed social work managers that in itself we feel could help attract more entrants to the profession and improve retention as well i think care although would have to be taken to ensure that there's no duplication of functions already undertaken by other bodies for example the Scottish social services council in terms of standards of education and training the care inspectorate also welcomes the tone on the bill about recognition of the unique task of social work which is very closely aligned to but not necessarily synonymous with social care social work and social workers make a unique contribution to any multidisciplinary approach to delivering health and social care services they have particular skills knowledge and experience and a strong values base of social justice which i don't think in my experience are always well understood they're often working with the most difficult and complex of cases balancing conflicting needs and views and making professional judgments in the most difficult circumstances around child and adult protection for example or managing high risk offenders so i suppose in totality children and adults don't live in isolation from each other they live in families and they live in communities and whilst there's arguments for and against the inclusion of social work services children's injustice in a national care service i think what's what's critically important is that those services are not disaggregated because we know from our scrutiny evidence that services delivered by adult social work services both in terms of drug and alcohol treatment or in terms of justice those services or not can impact on children and vice versa so whatever the decisions are made it will be important i think to to look very carefully before those are disaggregated and in terms of the national service i think again we whatever the structure that's put in place we would hope that social work and social care and the staff therein are are valued and that social work particularly are valued and represented at all levels of the national care service um with the national social work agency being in addition to and not instead of this representation enabled to consolidate progress uh and the number of agencies that work work together with social work okay um you talked about quality and education and and that's something that has come up in previous evidence session this might be a question for lindsay as well but we we heard yesterday in dunfries that some of our carers are they're doing peg tube feedings and they're you know they're actually really complex skills and skills that do need to be valued and as a former nurse educator i think it's really important that we measure and monitor and make sure that people are delivering this complex care that they're doing too so what we heard yesterday was that older skilled experienced care workers might retire early rather than undertake mandatory training is that something that you've heard about already or have you got experience about that because because you know is there maybe a plan that older experienced people that might not want to achieve the level that's been required that will they'll be able to continue to work in their capacity as they demonstrate a lot of these skills already i suppose if it can potentially come in more broadly i think that that point about the kind of balance of skill mix within the professions and across health and care professions is really really important and and the ongoing maintaining of skills and again ensuring that those those ongoing skills development and training is is delivered in an achievable way in that is meeting the needs of service providers and so it's going to be a really important balance to to be had in terms of of moving forward and i think that kind of wider considerations around workforce the resources and the skills that are needed across the health and care spectrum i suppose maybe picking on some of the broader considerations around quality improvement and some of if you like some of the key conditions for that and i think the important interplay between the kind of the professionals providing care and the systems and the structures that they're working in i think from our perspective it's just really important that that quality improvement framework is working to a consistent and connected framework across health and care where we have that kind of consistency of language and methodology and approach again to help to to ensure that but it's that integrated experience for for for people who are using services no matter what point of the care that they're on and i think certainly from from our experiences of the work that we've been doing in terms of improvement support across both both health and care and it's just vitally important that that we have individuals providing that improvement support who have kept the skills and experience to do it that it is being co-designed and that it's very much being tailored to to the needs and the specific issues that are looking to to be addressed. Yeah just going back i think to to one of the points you made we certainly recognise the staffing pressures across health and social work and social care at the moment and there isn't a day go back goes by where we're not faced with that in our day-to-day work. I think it's also important to acknowledge that across again health and social care sectors staff are the huge levels of professionalism commitment and dedication and it is true public service it's a vocation and those staff need to be valued they need to be recognised they need to be have reward packages that recognise what they do in terms of the the staffing pressures that we're probably all aware of we know that there's work on going to attract younger people into those professions to new entrants into those professions but to pick up a point that you made which i think is a really important point in both health and social care and indeed in social work you need to retain the high levels of experience of those individuals who have acquired that experience over sometimes a long number of years to train and mentor and support people coming into the profession so it's hugely important i couldn't speak to the demographics you know we could if necessary provide some information from a social work social care perspective perhaps if that was of interest to the committee but anecdotally we do know that there are these challenges and we do know and do hear of people leaving social work and social care perhaps earlier than then might have been expected but again we could only guess there could be a number of reasons for that it may be related to what people have gone through in the pandemic it may be related to a number of other things but there is no doubt that there has to be a considerable effort to recruit and retain high high quality staff because those staff are ultimately crucial in delivering high quality health social work and social care so that without those staff we wouldn't be able to deliver that care that everybody would hope to receive if ever we were unfortunate enough to need it ourselves final question yeah so going back to the national creation of a national social work agency it's in the policy memorandum on page three that the creation of a national social work agency that's part of the plan but it's not in the bill so does it need to be in the bill it seems pretty significant to me that if we're going to create a national social work agency if that's what is proposed that should it be in the bill on the face of the bill yeah i would absolutely agree that the national social work agency should be on the face of the of the bill as i say along with the clear role of leadership and accountability that the chief social work officer in each partnership area brings that leadership role cannot be cannot be under undervalued or in any way and there's also from the mental welfare commission's point of view the chief social work officer on the face of the bill along with the national social work agency whatever that's going to look like but from a mental health perspective there's adults within capacity and the chief social work officer acts as the proxy decision maker for people that are sadly unable to make or no longer able to make some decisions for themselves and i wouldn't want that to be lost and that the sheer significance of the role that local authority guardianships can play in people's lives and therefore it's really really important that the national social work agency along with that role sits on the face of the bill to make it explicit thank you that she had a question in this area yes i did it was directly to kevin if i may can you explain the explain the ken spectres opposition to the national social work agency if i've understood you correctly explain our opposition to it i don't think anything i said earlier unless i've got it wrong is was in any way suggesting other anything other than us seeing the potential benefits in in terms of enough i thought in the in the submission there was some opposition to it by mistaken and certainly certainly the collective views of the camspetry would be that whilst we don't have the detail and it's difficult to comment when you don't have the detail we certainly recognise the the potential benefits of promoting social work and i think the only qualification we would say is that in the creation of that if that were to pass it would just be important to ensure that there was congruence and not duplication with the roles of other bodies such as the Scottish social services council and i don't think in in highlighting that i don't think that that in itself is anything that would necessarily indicate a reason not to create a national social work it's just making sure that the roles and responsibilities are aligned to the new structure and with existing structures if those indeed remain so that services that are working together are not at odds with each other in terms of their individual roles and remits so again very clear that you know we think there are potential benefits and clearly as the consultation continues and there's co-design processes and further engagements with government officials no doubt as we've had already then we will be able to comment more on the detail but i certainly see that the opportunities that that might create for the reasons i gave earlier and now move on to talk about mental health support and protection a question slide by jillian micai jillian thanks good morning to the panel what risks are attached to separating different social work functions with some falling under the national care service and others remaining with local authorities could this create additional barriers and undermine the provision of a holistic person-centred social work service and i don't know who wants to go first in terms of risks of different social work functions sitting in various different structures i would say that the commission would strongly support a congruent and coherent structure the move together we cannot break things up if we break things up then we do we end up with more of the same and we're looking to seek to improve barriers in terms of social work functions if we have social workers for example being commissioned from local authority international care service into local care board that leaves the profession of social work in an exceptionally challenging position it would undermine and dilute the profession so therefore that's a key barrier into it if we're talking purely around the risks of the different social work functions there's obviously within that the social workers who are trained as mental health officers and ensuring that the mental health officer role sits alongside coleg social work colleagues as well so it moves it moves together under ncs so just to just add to that probably coming back to yourself again to Zann what opportunities do you think there are for the national care service to improve mental health support and protection there are there are opportunities with the national care service but as colleagues both here and in previous sessions have probably highlighted there's still a lack of detail we are currently working through as I said before that the Scottish mental health law review that's published and we are in the process of considering that and equally I'm waiting that the Scottish Government views around the recommendations in terms of opportunities we suggest that the national care service as we can move forward looks at the human rights enabling approach within the Scottish mental health which is outlined within the Scottish mental health law review in addition we would request cognisance of UNCRPD and international covenant of economic social and cultural rights for individuals across Scotland there's a clear crossover here between what is hoped to be achieved through the national care service and sections 25 to 27 of the current mental health act in Scotland around economic social and cultural rights right now sections 25 to 27 are certainly it would be polite of me to say that they're certainly not fully realised at this time in terms of individual rights who come under the mental health act the commission fully supports the early intervention and prevention which the NCFs again talking about opportunities could realise and in coming here today the royal college at psychiatry actually approached me and we're in agreement as with them and with the Scottish mental health law review in doing so I'm thinking about early intervention and prevention which is the heart of social work but equally we would call for the focus not to be lost for those individuals affected by severe and enduring mental health and who are at greatest risk there's a real balancing act here the NCS alignment as we progress forward aligning with the Scottish mental health law review and its recommendations could ensure and feel really everybody I think in terms of mental health world feels really strongly in ensuring mental health gains parity with physical health so in answer to your question quite simply yes there are opportunities here for the NCS and mental health how will you have some questions on this yeah it was really just to clarify you know were there hurdles that that you felt could be overcome to you know to get mental health within the bill or did you feel that we you know we wouldn't be able to to do that in terms of having mental health on the face of the bill yeah I think there's certainly and I think about my colleagues would would certainly agree in terms of the subsection 27 and 28 within the bill it talks about transfer of services and again looking at mental health law review and colleagues in royal college and the commission we can agree that there's wide range of powers there and there's concern over that in terms of what does that actually mean so we know that under schedule 3 that mental health act for example local authority duties are within the bill but it's really difficult to see what that means some of the concerns around it's a really complex landscape and I know that for example of royal college psychiatry are concerned about the transfer of you know lifting mental health services from NHS and to local care boards or specialist care boards and what that looks like and we'd call for a co-design of all stakeholders in order to ensure that mental health services sit in the right place there is no argument around having clear pathways for individuals around mental health and improving current pathways there's a raft of work going on as you'll be as you'll be aware so I don't know if that answers your question to some extent yeah I mean it does but but clearly some of the legislative stuff really needs to be worked through before we could you know be comfortable that people would be protected in and things would be happening as they should be I would absolutely agree with that being really really clear and again I draw your attention to a Scottish mental health law review there's a raft of background information there in terms of really honing down what is required and yeah I would absolutely call for clarity in detail on the face of the bill around what was meant by the transfer of mental health services and indeed the transfer of local authority duties under mental health legislation and capacity legislation and adult protection and so on thank you I'm going to stick with you because I think you had a question or two on joint inspections yeah we we actually took some evidence from people working in the field yesterday and they were talking about inspections and obviously we know it's such an important part that we do have that ability to go in and and see how services are performing and there was some talk about during the pandemic that were joint inspections I just would like a little bit more information about you know what were the benefits of that and in terms of this bill would it be beneficial to really look at who and how and why we're inspecting you know services I don't know who Kevin yet I'm happy to take that one just by way of context just to indicate to you if you're not already aware the care inspector has a long and strong track record of joint inspections working with healthcare improvement Scotland education Scotland his majesty's inspectorate of constabulary in scotland his majesty's inspectorate of prisons his majesty's inspectorate of prosecutions and indeed mental welfare commission we've worked successfully with three two of those bodies in fact his in fact three of them his healthcare improvement scotland hmycs the police inspectorate and education scotland for over 10 years we've also again a strong track record that i've alluded to of working across complex structures so again from a care inspectorate perspective we're confident that we can continue to deliver independence scrutiny and assurance that supports improvement effectively whatever structure is in place and whatever services are within or out with the scope of a national care service in terms of I think what you're asking specifically perhaps was what you're alluding to was during the pandemic we welcome in this bill the proposal that healthcare improvement Scotland may assist the care inspectorate in carrying out an inspection of a care service and I think that's under section 43 for a fee and we know from the financial memorandum that it's proposed to be a measure used in extremis used in exceptional circumstances only and I suppose that was arising from the pandemic when during the main period I think it was around April 2020 his healthcare improvement scotland agreed to request for the care inspectorate for mutual aid and support which initially focused on case holding but they began to join us with an inspection and up until April 2021 I think they joined us on about a third of all the inspections of care homes for adults that we undertook so just to reinforce whether it's in the context of the specific proposal of the bill in terms of section 43 and the exceptional circumstances or whether it's in general terms we certainly have a long history of joint inspections with a significant number of partner scrutiny bodies and we think that that would be something that we would envisage potentially requiring to be done more but that again much depends on what services are within or out with and I suppose it relates to the earlier conversation as well in terms of mental health services and community health services because for example adults in a care home still rely very heavily on community services, community health services, services delivered by a GP so there may well be discussions to be had about how those collective approaches might work in a new model of inspection and I suppose that's why we welcome the independent review of inspection scrutiny and regulation by Dame Sue Bruce which is looking I suspect specifically at that, not necessarily at us or Healthcare Improvement Scotland or the Scottish Social Services Council but actually to look at the existing scrutiny approaches to see how those may need to be developed in the context of a national care service going forward so again we we're very much up for those discussions and if we can help Government officials or indeed the committee in any way we're happy to do so. Lindsay? Yeah thank you so I think just to very much echo the comments that Kevin made in terms of the very strong working relationship that Healthcare Improvement Scotland and the Care Inspectorate have and indeed that we have with a range of other partner agencies so at Healthcare Improvement Scotland we undertake a range of assurance activities across both NHS and independent healthcare services and work in partnership with essentially the same organisations that Kevin has already listed there and I think we're again really keen to build on that collaboration so that we continue to ensure a consistent and connected external and internal assurance approach to very much support on-going improvements in care. I think it's really incumbent on all of the scrutiny and assurance bodies to continue to draw on the intelligence that's available to us and in terms of where we're targeting our assurance activities and also making sure that that's done in a co-ordinated way whether it's through joint activity or again being aware of where other organisations may be having a footprint so that we don't have services feeling like there's different organisations turning up on their doorstep within quick succession so that's something we're currently working very closely on and would continue to do and again I think we welcome the clarity that the bill is bringing about other areas in which we can continue to build on the collaborative work that we already have in place and I think really just the kind of final point is that really kind of the importance of ensuring that the scrutiny assurance and indeed improvement support for both health and social care services is very much joined up to reflect the complex pathways of care that people experience. The Mental Welfare Commission is neither an inspected nor a regulating body. We work with individuals to safeguard and promote persons human rights in the mental health and capacity context and on this particular point I'd ask you to look at the Scottish Mental Health Law Review which discusses inspection scrutiny in the context of obviously mental health and it makes recommendations for the commission particularly as an expansion or role there we're still considering it as a Scottish Government so there's we'll see what happens further on down the line and when colleagues there totally agree the commission would agree with working collaboratively provided from our point of view providing expertise in the field of mental health and as required for example at the moment through David Strang's recommendation we're currently chairing a recently developed group around mental health and learning disability and key to that is a co-ordination and communication across regulation and inspection bodies with key partners sitting round the table particularly in these fields I just wanted to highlight that point as well. I just one small thing just to get a bit of understanding just because it was raised with us in terms of sometimes has charge fees for their inspections and stuff it's just to get a wee bit of an understanding of where that comes from and if that would continue in the national care service. Just to clarify we don't charge fees for for our inspections I think that the point within the the face of the bill was the ability if we were asked to support the care inspectorate with inspection activity of care services the provision that we would be able to charge the care inspectorate for the cost of doing that if we take the example of when we provided support during the pandemic in relation to drawing on our expertise around infection prevention and control in care home inspections we did that by redeploying existing inspection staff drawing on their experience knowledge and skills to support that piece of work and we were able to do that at that point because some of our other inspection programmes had had been paused and again it would very much depend on the the nature of the ask if it was a kind of short term and piece of support that that was being requested again we would probably look to deploy staff and to pause or refaze existing work programmes I think where any considerations around the potential in terms of resource costs would be a consideration would be if it was something that was a longer term piece of support that would then require us to think about how we deliver that support in conjunction with the range of other inspection and assurance functions that we currently carry out. It's definitely you have questions on the role of the SPSO obviously we've dipped into that a little bit already with Rosemary in response to my questions around the information commissioners evidence earlier on but if you'd like to ask the questions that you have that would be great. So I think we've dipped into a big bit and I think Rosemary went into detailed answers earlier on with my questions around complaints. So just a couple of smaller points I'm not even sure if these are things that you'll really be able to answer straight off there but firstly chapter 3 the bill is about creating a charter and I'm wondering if you would expect that to be limited to principles or to include rights and responsibilities for example waiting times and complaints similar to what we've seen in the patients rights Scotland act so how would you kind of see that working and secondly wondering if ministers should have a duty to ensure advocacy services are available for those with disabilities or other needs in a similar way to what we had in the social security bill. So for Derek, that was Rosemary first and happy for others to come in. I think with the charter I was involved when they developed the charter for the social security agency and broadly I support the concept of charters because it's almost like an emotional or a social contract between a public body and a service user and it works both ways. I think in practice what we see is in a complaints handling environment we don't often have need to refer to the charters because the charters refer more to the overall principles of service. I would be mindful of including too much detail in terms of timescales or numbers and I use as an example the waiting time guarantee that's in health regulation that is almost like a hostage to fortune if you include too much detail and the landscape changes or other things structurally change but I think in terms of principles it's a very good approach and in terms of advocacy this is something that professionally I feel strongly about but personally I also feel very strongly about and in relation to advocacy we tend to think about groups of people needing advocacy and we use this general term advocacy for all sorts of things but actually it's about supporting people at a point of vulnerability and you can be it could be us it could be me tomorrow who something traumatic happens and I need support and I think the issues that I see with advocacy relate to there is inconsistent access to advocates depends on where you live on what the services you want an advocacy for and advocates also can perform different functions they can be there purely in a supportive role or they can be there representing somebody and I think what the principles that I would if I dare say advocate that we we think about are about the access and easy access to advocacy at the point of need whether it's to access complaints or whether it's simply to interact with the service what type of advocacy would be appropriate who puts the person in touch with an advocate because if you if you are trying to deal with something really traumatic in life the last thing you're going to be thinking about is where do I go for an advocate so I think there's responsibility on public bodies in this respect but I think we also have to think about the support and training that advocates receive because in a more professional context a well-trained advocate can make a huge difference for an individual but very often the people who are advocating are relatives, friends, charities who may not have that same background and I think some thought has to be given as to what we mean by advocacy and how we get people access to that advocacy in a consistent way if I could just answer that question in the context of complaints in relation to the charter and advocacy it was just supposed to be mindful that the care inspector already has a unique statutory responsibility for complaints about regulated care services distinct from social work or health or those services delivered in an integrated landscape and our review about the regulated care service complaints process is as it stands as it's working well we regard every complain as an opportunity to improve because that's what it's about it's an opportunity to improve the care that people receive and how complaints are dealt with by a provider can tell us a lot about that provider intelligence from complaints that we receive are critically important to our wider role of scrutiny and improvement support and we cannot and would not want to stress enough for the importance that we attach to that about retaining that link being able to quickly and effectively gather intelligence through dealing quickly and effectively with the complaints we deal I'm not sure if you'd be aware of this we deal with around 6000 complaints a year the number has risen steadily from 2011 from 2800 and the general increase may indicate that there's a greater awareness of our complaints process for regulated care services and greater awareness amongst people about standards of care that the another should expect to receive but relating that specifically to your question about a charter I'm old enough to remember the creation of the children's charter and the charter of rights proposed in the bill we think could be helpful to people who use services their families and carers to help them understand their rights their rights to receive care and support and to know their rights and what they should expect in terms of social work and social care including how to make a complaint so I think there's certainly mileage in that we acknowledge we do acknowledge that it's likely to be more challenging for people who use services in their families or carers to make a complaint about integrated services that may involve a number of health and social work and social care services working together and it may well be that that is what the bill is seeking to address we're not entirely clear on that but regardless it we think it's important that the route for making complaints our own complaints procedure is based on the complaint handling guidance from colleagues in the SPSO and its model complaint handling procedure so there is relevance to what was said earlier as well but in terms of the final point I think about advocacy we know that there's provision in the bill for regulations to be made for advocacy and we think it would be important to consider that specifically in relation to complaints particularly for those with communication difficulties so again I don't know if that's helpful Thank you, convener. It's just to follow on from a point that Rosemary made and we welcome section 13 of the bill in terms of advocacy and we'd submitted in our previous submission the clarifying definition and I think this follows on from what Rosemary's saying in terms of what we're talking there about an independent advocate and the definition is set out by the Scottish Independent Advocacy Alliance about giving people a right to voice, human rights respected, recognised and secured and equally NCS Bill could use this opportunity to fill gaps for specialist advocacy. I know that we're nowhere near yet in terms of where children and young people for example are going to be sitting but should it get to the point that we do have clarity around that we know through our work and I think next week we publish our children and young people's monitoring report in which we highlight the dearth of specialist children and young people's advocacy services for children that are detained in non-specialist wards so I would certainly have a call for using if we can use this bill to really make a difference in terms of the delivery of advocacy services and I think one of the key points that Rosemary makes equally is around well-trained advocates that can be really there to support people and navigate them through a really complex landscape. Thank you. Thank you, Stephanie. Um, Transos. Rosemary's apologies, didn't you come? I was just trying to be... I just wanted to pick up on a couple of the points. The first one was in relation to children and young people. We, I think, are all anticipating the UNCRC being incorporated into Scots law and I think one of the things within that is this right to your opinions being heard, children's rights in that. I think advocates will be a crucial part of that. The other point just picking up something that Kevin said about advocates in a complaints context, very often by the time something reaches a complaint you have emotion and stress and worry but there is always, I think, by the time particularly that it reaches a stage 2 or it reaches us, there's also a breakdown in relationships and I think advocates can play a vital role in helping to rebuild some of those because they can be both realistic with complainers but also they can perhaps, as Kevin said, help articulate some of the issues in a much more constructive way. I'm reflecting on some of the excellent work that we see patient advisory services doing in the NHS and very often when you're looking at a complaint that's being brought by a representative through a patient advisory services providing support, it's often easier for all parties to focus on the underlying real issues of it so I couldn't underestimate enough what my colleagues have said as well. We now want to talk about the transfer of services. Paul, you have questions on this, if you'd like to lead it. Thank you very much, convener. Yes, I wonder if I might explore the whole notion of social work being within scope of the NHS. Obviously, that wasn't included in Philly so I suppose my first question would be why do you believe or what are your thoughts on why that wasn't in the Philly review and secondly what would the potential impact be of transferring those services into the national care service and I'll maybe start with Suzanne, if that's possible. You mean the context of transferring the entirety of social work? I'm going to come on to talk, I suppose, about what a separation might look like but yes, if we were to transfer, as envisaged, criminal justice services, for example, what impact do you think that would have? I think there needs to be a consultation across the board in terms of criminal justice services and children's services indeed and it would be remiss to make any full comments on that in the absence of consultation through the mental welfare commission. However, there are cons and there are pros and I think it would be for the social work profession to be fragmented would be a risk if we don't come together but in the absence of detail in its entirety it's difficult for me to have a full informed view on that at this time. I appreciate that Karen Specter pointed to those services not being included in Philly so I wonder if you might comment in that context as well. Clearly, Philly's focus was on adult services but, as it came to pass, there was consideration of what children's services whether they should be part of a national care service or not. Clearly, consideration needs to be given to whether children's services and, indeed, justice services are the round. I suppose that all I would say is that we welcome the public consultation that's now taking place before any transfer of services. The bill, as it stands, as we understand it, proposes to give ministers power to transfer quite a broad range of services, social care, social work and community health functions. I think that all of that would seem to us to need careful consideration in terms of children's and justice. We know that there are arguments for and against, but, as I said earlier, we would caution against disaggregation of those social work services. I would just point to the example that I gave earlier that children and adults don't live in isolation from each other and services that are provided or not to children and young people whether they are from justice services or, indeed, from mental health or, indeed, drug and alcohol treatment services. Those have an impact on the children and, indeed, services provided or not to children have an impact on adults who are caring for them. There is a connectedness of social work across the lifespan and, indeed, to social care in the round, so I think that it needs very careful consideration. I suppose that the only other thing that I would point to in terms of requiring careful consideration in that context is the very particular arrangements around child protection and adult protection. We know that, at a strategic level, the chief officers play a key role in the strategic overview of child and adult protection, and many of them have now transformed into public protection, where they cover collectively the chief executives of health, social work and the local authority, take the strategic lead in both child and adult protection and, indeed, the management of high-risk offenders in the community. Again, none of that precludes any consideration being given to the responsibilities transferring, but I just think that all of that requires careful consideration. For example, in public protection committees, in our inspection, experience, the chair of those public protection groups at the most senior level is often done rotating between the chief executive of local authority, the health board, and, indeed, the police commander. Again, none of that, as I say, necessarily precludes being inclusion in a national case, but I think that all of that requires careful consideration. Of course, I will call on drug partnerships to fall into that consideration as well, but, above all else, we would advise against the disaggregation of social work, because I think that that could have potentially detrimental effects, whatever the structures might be. On some of Kevin's themes from a complaints perspective of what we see, where we see some of the issues between transitions from adult to child to adult, we see the complexity comes where there are different agencies involved. The argument for keeping services together and coherent, which Kevin has made, is one that is difficult to argue against when you look at where the issues currently arise. However, I was reflecting when preparing for this, I did prepare. We are in danger, I think, of focusing on service. At the heart of this is people. One of the dangers of focusing on which bit of the service do we put here, which bit do we put there? We perhaps are in danger of missing people's life journey. Their life journey and the number of times and ways that they will interact with a care service, with a mental health service, and perhaps if we look at it in terms of life journeys, it might make some of the congruence that Kevin is referring to a little more easy to comprehend, because I must admit that trying to put it purely in terms of service, you end up in your heads going round and round, I think. We are all listening to you and what you have said chimes in with what we heard particularly in our Aberdeen visit with Camp Hill when they were talking about residents and their care, reaching the point where they might have to reach in 60, 65 and have to transfer into services that they could not offer, because of the rage. Thanks for bringing that up. Lindsay, do you want to come in on that? I think that it's just to very much echo those points around the real importance of thinking about the journey of care and absolutely that connected approach, whether it's between acute services, community services, social care, so that we have that continuum. Again, wherever we do draw the structural lines, there's going to be interface issues that will need to be managed. Again, the focus needs to be on ensuring the leadership and the governance arrangements in place to work across any structural or organisational boundaries, essentially to the benefit of those who are accessing services. Probably one of the reasons that this national care service has been put forward is an idea to address some of the issues around services not being joined up and gaps appearing. It's good to bring it back to that. Paul, do you have any more questions? I want to return to the point about the fragmentation of the social work profession, because what we have heard and what I hear from social workers is that real concern, that if you take social workers out of the local authority context, you run the risk of, particularly in children and families services, there has been a real disconnect between, for example, education, who have a role within child protection as well and teams around the child and all those sorts of issues, and that you lose that link. Would people recognise that that is a significant risk? There is risk there, but there is equally the risk of fragmentation of social work as a profession and what that means. I think that Rosemary outlined it beautifully in terms of people's lives as a journey in social work. Don't look at people just within an adult context or a mental health context. Look at people in their holistic sense and across the age range. For a fragmentation of social work—you can see this with the caveat that we have not concluded our submissions around the consultations, but there is potential for the fragmentation of the social work profession and dilution. When we are talking about national social work agency earlier, is there a conflict there? I cannot fully answer that now, but potentially there could be as a profession. It is about holding people at the heart and that is what the social work profession does. Whether that is within a local authority—I understand that there is a much wider issue there in terms of local authority, national care service, etc., which I will not open up right now—there is a fragmentation of a profession that holds people in their holistic sense as opposed to just as a part. To have bits here and bits there, would that lose a sense of the profession and the way that it works for people across the piece? I would like to reinforce that point about transitions—transitions for children and transitions for adults into older people's services. You turn it into an older person and it is a stroke of midnight on your 65th birthday, so there is definitely—in terms of the NCS, I hope—finding a way to plug those gaps. I will also sit in the education committee, so we are looking at this stuff just now as well. Certainly, we have heard about situations in which a family has a justice social worker, who has an addiction social worker, who has a children's social worker, and about the fact that those different social workers are focused on different information, and then there is the kind of job of pulling all those threads back together again to look at the whole family holistically. If that presents an opportunity to streamline—I do not mean streamline, I suppose—to take a much more holistic approach where you perhaps have social workers who are working with the whole family, so rather than having three or four social workers, you have one or two who are looking at things around and applying their expertise and knowledge across it. I do not know if that is the case, or if there is a very specific training to each of those trends. It means that they would still all need to be separate, so I am just interested in what you would say about that. In terms of social work, social workers are trained in all of the disciplines from university, graduate, and will have had experience, certainly academically and most often practically, in each of the areas that children and young people, criminal justice and adult. I would refer back to my earlier response around social work and the evolution of social work, which has been submitted to this committee by other social work-specific agencies, as well as the Mental Welfare Commission, around the shift of social work away from the gatekeepers of budgets, eligibility criteria, the implementation of self-directed support, which has got to be one of the best pieces of legislation ever. I suppose that, just as an aside, in thinking about the implementation gap and the shift in cultures, that is key. We can have the best NCS bill in the world where everybody is input, but if we do not have the implementation gap sorted along with the shifting cultures, we will end up in the same place. I hope that the NCS will help to push that forward in terms of self-directed support. I would say that, hopefully, with the introduction of a national social work agency, of, depending on the outcome and the various consultations, that social work would be permitted to operate within its founding principles, knowledge, skills and values, in work with people in the holistic sense in communities and as individuals, across whatever the diagnosis or age. I must move on to apologising to Rose Mealy once she has come in. I keep on doing that to Rose Mealy. I apologise. I need a flag. You need to flag it. I just want to pick up on a couple of the things about structures and working together. There is a risk in any structure. There will be one that has positives in one sense, one that has positives in another, and it might be helpful to think of the legislation echoing something you said, Suzanne, about enabling. If we go right back to the user experience, it is about making it seamless at the point of delivery. It does not necessarily mean that one organisation does everything, but what is in the legislation has to enable it and reduce the barriers. I think that even within the current delivery system, the current regulatory system, there are probably things that can be done such as better information sharing, more enabling of working together that, if picked up well, would reduce some of the risk of perception of barriers at the point of delivery, but they all have to be equally well resourced, I would add. We need to move on to talk about Anne's law and the advocacy around that. Emma, for you. Thanks, convener. I have just a few questions about Anne's law. We know that one of the main drivers of introducing Anne's law was a recognition that families and friends were absolutely essential during the pandemic to support health and wellbeing of residents in care homes. We know that that might be a question for Suzanne because of the whole health and wellbeing aspects of the introduction of Anne's law. It is about visits to or by care home residents, so it does not mean that everybody goes in, it means that they can go out as well. I am just interested to hear your thoughts on whether the aspects in the bill about visits to or by care home residents is adequate in order to meet the needs to support the wellbeing of our residents. Throughout the Covid pandemic, the commission was inundated with concerns from families around the impact of visits in care homes or no visits. The commission's view is that everybody has a right to a family, a private family life, which includes visits to whether a care home is somebody's home once they get to that stage. We fully support Anne's law, both the visits in and out of the care home. Otherwise, if we do not have visits out of the care home, then we are talking about detention essentially, which is a whole other ballgame. We would also suggest that, for any reason that the NCS bill is paused or delayed, that Anne's law should be included in any relevant legislation in order to avoid any delay to this. We see that as fundamental for upholding people's rights and ensuring that people have the right to their family life. In the terms of advocacy and complaints, we have talked a little bit about it already. Is the bill adequate to be able to deal with that kind of support if there are any issues around—I suppose that we need to look at who is responsible, who is accountable? I know that there are issues around the legal liability and assurance. That was one of the issues that I had come up. It was a real challenge during lockdown about how care homes were really protecting not only one resident but all residents, for example. Is that something that needs to be further considered? I refer you to Kevin, as the care home regulator, and you would be the best place to answer that. I would not disagree with what has been said up to now by colleagues. That fundamentally goes back to what we talked about earlier, people. It is certainly connecting with people as a fundamental right and essential for wellbeing and good mental health. It is fair to say that the pandemic highlighted the need for a stronger voice for people, experiencing care in their families and did not withstand what is proposed in the bill. The Government has already published two new health and social care standards, which I am sure you are aware of, to put Anselol effectively into practical effect while the legislation is being prepared and considered. We are in no doubt that even the two standards, as they are, enable care homes to build on existing good practice and supporting meaningful contact. We know that there is a difficult balance sometimes to make between people's rights and choices and the risk to others, but I think the standards give that balance and the legislation seeks to enshrine that in law in terms of giving ministers power to require providers of care homes to comply with any directions that they make, particularly if they were something as serious as the pandemic again. Those would take account, no doubt, of public health requirements as well. On balance, we are supportive of the work that I think the bill proposes to embed open with care. We think that it is absolutely crucial for those visits to be regarded as not just visits into and out of the care home, because people in care homes are part of communities and the care homes are in communities. It was pleasing to see referred to in Thilia and elsewhere the investment that that should be regarded as investment in communities. Again, in terms of advocacy, we think that the charter will also give people confidence in their rights. Of course, as the regulator, we have a role and we have already been given a role whether that is pursuing through our existing complaints function or through other means. We will follow-up, as always, to make sure that those rights and compliance with the new standards and if the legislation is passed eventually the legislation are upheld. Should Anne's law be extended to other facilities such as hospitals, for instance, and I understand that infection control and prevention guidance is really important in specific areas, especially if there are other outbreaks in other places. Is that something that you have considered that whether we should extend it to hospitals? I think that, although there are similarities in your right to highlight, infection prevention and control is as important in care homes as it is in hospitals, but again we have to be careful that a care home is different. It is not a clinical environment and it is somebody's home. There is a risk that, if we do it the other way round, we potentially could over-mediclyse a care setting, but in terms of whether that would be appropriate for a hospital setting, I would probably defer to my colleague in healthcare from Scotland. As you said, there is obviously a range of important considerations around infection prevention and control, particularly in acute hospital environments and where there may be some people who are very vulnerable and uncompromised. NHS services have had to continue at various points throughout the pandemic to make adjustments to visiting, to take account of some of those considerations. For example, if there has been an outbreak in a particular ward and we are looking to restrict visiting in order to help to contain that outbreak, however, what is very much recognising is the importance of people being able to have contact with family and friends and the really vitally important role that that plays in somebody's overall health and wellbeing and indeed their recovery, particularly if somebody is having to be in hospital for a period of time. A lot of work has been done. Our community engagement directorate led a lot of work with health boards during the pandemic around virtual visiting and some of the technology and the support and the guidance to enable that to happen, so that patients were still able to have contact with their loved ones if it was not possible to have that face-to-face contact. That was both around getting the technology and the hardware that they needed to support a bit again around the general principles in embedding that ethos of supporting people to maintain that vital contact with family and friends. We should be finishing in about a couple of minutes, but if everyone's permission, I'm going to extend it by about 10 minutes because we still have one area of questioning to go. If I could go to Evelyn Tweed on monitoring of the national care system. I've rolled my questions into one large question. In evidence, we've heard that 72 per cent of respondents to the national care service consultation have agreed that ministers should be accountable for the delivery of social care. Can you give me your views on whether you're in agreement with this approach, what benefits you foresee with this approach or any risks that you would like to tell us about? I would like to go to Suzanne first and then anyone else who would like to come in. In terms of the monitoring and oversight of NCS, we need to establish agreed measures to monitor. We set out in our submission that the principles of the bill are too broad as are on the face of it appears the ministerial kind of powers held within there as well, albeit where it's only at the first stage. The principles therein are too broad to measure meaningfully, so in terms of what that would look like in reality, I don't think that you could come up with anything tangible. We would support and expect parliamentary scrutiny and reporting of the monitoring by the ministers to Parliament. The commission has got a statutory monitoring function under the Mental Health Act and we monitor reports around adults for the incapacity in children and young people. We're more than happy to discuss our kind of experience of monitoring in the mental health context once the reviews are concluded. It's important to note in terms of ministerial accountability, etc. What happens with the national care service will impact on the implementation of the Scottish mental health law review in terms of looking at ministers and looking at oversight in that monitoring responsibility. It's really important that those are joined up. We'd suggest a national care service oversight group, perhaps responsible for the oversight of delivery, we're talking about implementation gap, we're talking about shifting cultures. Is there something here for a body that oversees and is collaborative and cohesiveness that is needed to deliver? We know that there is public health data available for monitoring. The Scottish ministers are accessing that. Health boards have needs assessments. Data is available in communities and localities. The ministers have accountability and access to data. I suppose that what I'm trying to say is that it's very complex in terms of the various different strands. In terms of, as I say, I would expect that Parliament will be scrutiny overall of the monitoring by the Scottish ministers having responsibility, but their powers, etc., need to be clarified within the bill. I think as well that you'd asked about agreement benefits, risks. It is difficult to comment because there isn't a huge amount of detail. One of the things that in addition occurs to us is that monitoring, scrutiny and regulation are very closely joined. There's a lot of similarity between them. We've already engaged with Dame Sue Bruce on her current review. I think that there is a lot of argument to be said for what she finds and comes out of her review because scrutiny monitoring and oversight are slightly different things. From an SPSO point of view, we monitor the outcome of complaints handling, but it's unclear how that might apply in relation to the powers under section 15 to transfer services. In a different way, I'm probably saying the same thing, that there needs to be clarity about ministers role within the bill. That will probably help and inform and enable an appropriate accountability structure, once that is clearer. At the moment, I don't really have a lot of detail. To be honest, we're not entirely clear what was meant by monitoring the national care service. I probably suspect that that's multifaceted, as suggested by colleagues. Clearly, if services are directly provided or commissioned by the national care service, presumably that will require to be inspected and or regulated, it's difficult for us to provide detail on any changes that might be required. Again, one of the reasons we welcomed Sue Bruce's involvement in her review was that it's geared, we think, to providing some sense of that. All I would say in terms of our own approach is that, to reiterate the strong track record that we've got of working across complex structures and being flexible and responsive to changing landscape, we feel well-priced to do that irrespective of the structures that are put in place. Similarly, we've alluded to Dame Sue Bruce's inquiry a number of times today. I think that what is equally helpful, perhaps, is the recent announcement by the Minister for Mental Well-being and Social Care of a review of mental health scrutiny and assurance, which will feed into that work of Dame Sue Bruce and indeed the wider scrutiny and regulation to inform the national care service development, so we welcome that. Again, the only one other thing that remained unclear for us was in relation to section 3 of the bill, and that was responsibility for improvement support, and it said that ministers will put in place arrangements for the purpose of monitoring and improving the quality of services that the national care service provides. It's not clear to us what that impact would be on our own role in that respect. I've hopefully outlined how we link improvement support, both targeted and generic, to our scrutiny findings, and we would certainly welcome further discussions around that. But certainly we feel that we would be able to be flexible and responsive, as we have been previously irrespective of the structures that are put in place and what those structures provide for us. I think that it's really just to echo what colleagues have said and support all the points that have been made. From our perspective, it comes back to the clarity of roles and responsibilities being very cognisant, as Rosemary said, of the interplay between monitoring, scrutiny and regulatory activities and the various parts that they all have to play. I think that we lead that clear transparency and accountability. I'm focused on the impact and outcomes of quality of care that people are receiving. That will be the key consideration in terms of any of that oversight. Like Heaven, we're keen to continue to play our full part from both our assurance and our improvement functions in supporting the considerations that move forward. Thank you. A final question from Tess White. Tess, thank you. Sorry for being late this morning, I was at another committee. I have one question if I could address it to Rosemary and Kevin, please. So many are concerned that the bill for an NCS gives too much power, centralized power to ministers, and we've heard today it makes the Ombudsman function toothless, powerless, and as Rosemary said, can't do its job. So my question is, what are the conflicts of interest do you foresee? Thank you. What's a good question, thank you. I think fundamentally it's partly, I believe, to do with the drafting of the bill. I know that this might seem a bit left to field, but I want to go back to the thing of co-design. I've been reflecting on a really positive co-design experience that we had when we were working with the Scottish Government, and that was in relation to the establishment of the independent national whistleblowing officer function. We worked closely with the Government who led and hosted events for a whole range of stakeholders, but concurrently with that, the legislation was being developed and drafted. So there was an outline framework of the legislation, but what it meant was, by the time the legislation was drafted, it was informed by the co-design, but also it worked the other way and they informed each other. There were huge benefits to this, because it meant by the time the legislation came for parliamentary scrutiny, there was a very real example in the whistleblowing standards of what that might look like in practice. One of the concerns that I have at the moment is the timing of the co-design and the drafting of legislation. I think that we're in danger of losing the benefit of the two happening concurrently, if one happens ahead of the other. That, I think, will inform partly whether, as drafted, the powers of ministers—and I suppose that we're thinking about section 15 in particular—are what was intended, or whether those powers have been put in place to try and take on board anything that comes out of the co-design later. That's not clear at the moment. I don't feel it appropriate, as an apolitical body, to say anything about whether ministers have too much power or not. That, I think, is for Parliament to decide, but I do think that, as drafted, there is inconsistency about where powers sit and how they interact with each other. If I'm going to be taking the complaint's focus on this, I don't want it to appear like I'm being negative about what it might mean for the SPSO. That is fundamentally about what we have created in Scotland—an internationally respected ombudsman service. We're recognised as being, you know, as a public service ombudsman, as being innovative. We do a lot of good work, and I think it would be a retrograde step to undo any of that if we could draft legislation that enables the two to sit side by side coherently. At the moment, I'm not sure they do. Does anyone else want to come in? No, just Kevin. There's nothing much that I can really add to that. I don't think—as I said earlier today, we recognise that it's a framework bill, and as such, the detail that all of us would like to hear more about will come later through consultation, co-design and discussions with officials, no doubt. To be honest, I don't see any conflict for us as the independent regulator at the moment. Yes, we may have a role if this comes to pass in inspecting and regulating services that are commissioned by the national care service and thereby the Government. Again, I suppose that that would be similar to that commissioned by the NHS or akin to the NHS. Again, I suppose that we welcomed the emphasis and the strong emphasis on independent scrutiny by an independent scrutiny body such as ourselves. The only one—I'm aware that there have been discussions about intervention orders and I understand that there's been some concern expressed about possible overlap between the framework bill in relation to ministerial intervention and the care inspectorate's enforcement powers. To be honest, we welcomed the strengthening of our enforcement powers, and it might be wise to look more closely at this as more detail emerges, but my initial thoughts are that we had something similar in terms of emergency powers during the pandemic, and we were able to manage and work through those. Again, I suppose that the recurring theme and probably what I've said today is careful consideration as the detail emerges to identify any issues of that nature that may arise, but we remain recognising the potential benefits and, again, are happy to support in any way that we can if it's through our existing approaches or, indeed, through Sue Bruce's work or the independent review of mental health. Thank you to the panel and my colleagues for everything this morning at our next meeting. I wonder if I might bring something up with the committee. Is it in relation to this? It's in relation to work within the committee, so I wonder if we're going to have a discussion in private afterwards? I'd like to say something now if that was possible. Given that we're currently engaged in the national care service scrutiny, I thought that the reports yesterday around the two-tier national health service were quite alarming, and I thought that perhaps I would like to seek the advice of the committee on whether they thought that we should be clarifying some of that, as it very much links in with the work that we're doing, so we should be just to seek some clarity from the committee on that. Thank you, Carole. That is something that we can discuss in private because it relates to our work programme, rather than in public today. In particular, since I didn't have advance notice of what you were going to say, that would have been helpful. I am going to suspend. We're going to go into our private session where we can have detailed discussions on what we've heard today and any other issues that members want to bring up, but that concludes the public section of our meeting today.