 Welcome to this session of the Citizen Participation and Public Petitions Committee. First of all, I will just agree that we are going to take business and private agenda item 4, our colleagues are content with that. Our second agenda item this morning is the consideration of continued petitions. The first of those continued petitions is the review, petition number 1911, the review of human tissue Scotland Act 2006, as it relates to postmortems. This petition was lodged by Ann Stark, who believes is with us in the gallery this morning. Forgive me, my glasses aren't that good, but I'm aware that there are people at the other end of the room. Thank you for coming along this morning to observe our discussions. The petition calls on the Scottish Parliament to urge the Scottish Government to review the Human Tissues Scotland Act 2006 and the relevant guidance to ensure that all postmortems can only be carried out with the permission of the next of kin, do not routinely remove brains and offer tissues and samples to next of kin as a matter of course. This morning, we will be taking evidence remotely from witnesses as we are exploring the relevant issues as they relate to practice in England by which I think the committee has been intrigued in our previous considerations of the petition. I'm absolutely delighted that we are joined this morning by Dr James Adley, the senior coroner, Dr Simon Beardmore, a consultant radiologist, Ann Edwards, a coroner services manager and Dr Mark Sisson's consultant pathologist. I really thank you all very much for giving us your time this morning and joining us to discuss this petition because I think we are genuinely a committee intrigued to understand the different practice that exists in England and why that is something that would appear that, for the moment in Scotland, it is judged as being difficult to emulate. Having wished you all good morning, I'll move first to questions. Our clerks will be keeping a careful eye so that any one of you can indicate as and when you might wish to contribute. I suppose that I'm interested to understand because all of you are providing a postmortem scanning service in Lancashire, Blackburn and Darwin. This is a collaboration between the County Council, Lancashire Teaching Hospital NHS Trust and a private scanning provider, Digital Autopsy UK. All of this arrangement, I understand, has been in place since 2016 and was the first of its kind in the UK. I wonder, just by way of an introduction, if you could provide us with a bit of a background as to what prompted the establishment of this, was it simply a good idea, was it that there was similar public concern about the arrangements that were in place or was it professionals coming together who believed that it was possible to do things differently and in a way that you felt would better serve the public interest? So I'm very interested to understand if you can give us an understanding as to how you feel all this came about in the first instance. So who's going to kick off? I'm looking for one of our witnesses to volunteer, which of you would like to? Great. OK, thank you very much. I was the coroner in place at the time in 2016 and about two years before that, three years before that, we looked into the future and realised that the number of pathologists was decreasing rapidly and we would not have any form of post-mortem service. This is also coupled with the fact that there was research being developed, particularly coming out of the University of Leicester, that for quite a lot of post-mortems, this could be done by post-mortem scanning. It's not a panacea, but it does deal with a large number of cases. So we started looking at how to set up a service to achieve this. It's difficult to do. It's certainly the most complex piece of work I've ever done, and it requires Simon Beardmore and the local authority, all of us acting in concert to do it. Part of the driving force behind this is that if you have never been to a post-mortem, you basically have your body cavities opened, all your organs removed, they're examined and then put back in a plastic bag in the abdomen and the body reconstructed. Given the advances in CT scanning, I still think that that's a very invasive procedure. Quite a lot of faith communities would not accept it. Families are upset by it. Being able to offer a different service is, in my view, the way to go as technology develops. It required everyone acting together. Part of this was to provide a post-mortem scanning service based in a hospital next to the mortuary that had all of the personnel undertaking the tasks actually within the NHS. It is part of their job plan, so we don't have difficulties of ad hoc arrangements. This runs year in, year out. That was probably the most difficult. With this, whenever you come to set this up, the mechanics of it is not the problem. It is the past history of the pathologists having done post-mortems and this being a new technique. This is an imaging technique, not an invasive technique. I'm not quite sure if I'm helping anymore or you wish me to go in a different direction. No, that is very helpful. I'm intrigued just to go back to almost the start of what you said when you said there was a rapid reduction in the number of pathologists. I wonder just if you could elaborate on why that is and if that reduction continues apace or whether anything has been done anywhere to try and arrest that decline? If I could answer first from my perspective, but I think Mark Sysons would also have a valid viewpoint being a practicing pathologist. About 15, 20 years ago, the Royal College of Pathologists had to, it used to be a requirement of a pathologist's training to undertake post-mortems. What they were finding was that people were not going into the profession because they did not want to do post-mortems. They still needed pathologists to look at all the slides and the biopsies from the living. Consequently, there is now a split training regime where you do not require to train to undertake post-mortems. It's something you volunteer for. As a result, it tends to be the older pathologists who have this expertise and they're coming to the end of their working life. In terms of this, there is a fairly rapid reduction in the number of pathologists. It became incredibly acute over a short period of time in Lancashire. It's a problem almost anywhere, but even now we have about one Dr Sysons and one NHS pathologist for a population of 1.4 million. With that numbers, we couldn't even manage an external body examination service and let alone a post-mortem service. I pass you over to Dr Sysons to give you his... Thank you. Dr Sysons, good morning. I've just gone on to agree with what Dr Adley said there. The majority of trainee pathologists now do not want to get involved with coronial work. There's many reasons for that. The laboratory-based work they do is very busy. There's lots of demands on the system. There's a lot of cancer diagnoses going on in laboratories and there's time frames associated with that. Most trainee pathologists do not want to get involved in coronial work because it's done almost like private work. You have to do it in your own time. You have to do your normal laboratory work. The way that it's organised is that any coronial work is done extra to what you're expected to do in the laboratory. For those reasons, the majority of trainees are just not interested in becoming coronial post-mortem workers. Effectively, from what you've both said, there was a driving necessity to bring about this change in the arrangements that were in place. Every bit as much as clinicians and others were thinking that this was the right way forward. The previous arrangements were potentially dangerously unstable in terms of being able to provide a service from what you were saying. I'm interested to know on that basis what has, since 2016, to your knowledge, the practice that you have evolved rolled out to other parts of the United Kingdom outside of Scotland and the interim period since. Insofar as you were able to establish it, I suppose as a general introduction to the questions that will then follow, what were the main challenges in trying to bring what you have achieved about? I don't know who's going to volunteer to speak. All right, thank you, Dr Adley. If I start and then Dr Bairdmore comes in behind me, would that suit? That's fine. It's possibly helpful when these questions are being asked. If I come to you first and you maybe direct which of your colleagues you think would be most appropriate so that we're not operating in a vacuum, thank you. In terms of this, it was about the pathology service for coronas was about to cease to function around that time. The setup that we have here is quite different to a lot of other parts in the UK. When Dr Bairdmore and I set this up together, we took the view that when you CT scan somebody, this is an imaging process that you get a series of images on the screen. And there has been a lot of work comparing images against causes of death established at Postmortem. So there's that correlation between the two. What we decided was that when you have enough experience as a radiologist of seeing scans against dead people, you are able to say from that scan that this person has died of this disease. This is in much the same way as the pathologists have gained their experience of looking at diseased organs over the last 300 years. My view was that in most cases we didn't need a pathologist involved with these radiology images. It doesn't always give the answer postmortem scanning and you do need pathology there. It is still a very important part of coromial practice for those cases where you can't diagnose and certain other areas are coming back to you. But in terms of this, we had the problem that firstly there really weren't any pathologists. Secondly, I couldn't justify the pathologist being involved because they needed to treat the living. And thirdly, if it's an imaging modality it takes too long to train them to understand the images. So consequently you've got a shortage of pathologists to making things worse. The other problem you run into is that given the volume of scans, my population is about 1.4 million, we do 1,650 scans a year. If you add on the very low fees for a pathologist for doing this at £100 each time that they review the radiologist's report you're increasing your costs and slowing down the process. So for that reason I took the view that I would ask the radiologists to report on this. This is not what is done in a lot of areas where the radiologists work as they do in the NHS when they are assisting the living. They provide an opinion and then that is sent to a pathologist who looks at the opinion and says, yes, I think that's okay, or no, I don't think that's okay. I have a problem with this in the fact that they are reviewing what someone else has wrote and not having reviewed the scans themselves. So I would wonder why they're in it that point. They are very important for those cases where postmortem scanning does not produce a result. And this occurs, it depends how you scan. There are two types of scan. We took the view that we wanted the scan that would provide the greatest number of diagnoses because otherwise if you had to go on to a postmortem to find a cause of death the limiting factor was anthropologists. So the two types of scan are a plain scan where you just get put through a CT scanner as you would if you were in casualty or what we have, which is an enhanced scan which is where we've refused the coronary arteries with dye and sometimes we'll ventilate the lungs. Dr Beyrmore's better at this than I am. But that gives us a 94% diagnostic rate in interpreting this on the basis of the radiologist. If the radiologist is uncertain we can go back to the treating clinician who was treating the deceased at the time to ask them what is the cause of death because if you can provide them with negative findings they quite often will be able to give you more input into the cause of death. So with this, has this been rolled out across the UK? There isn't another service like this one that just runs on radiologists. The rest run on pathologists and radiologists. Is it rolled out across the UK? There are more centres doing it but I think it's still less than 10. Dr Beyrmore may be better. The challenges that you asked about for setting them up the biggest problem that we ran into was that the pathologists quite rightly have viewed that establishing the cause of death is their purview for the last 300 years and there is a consideration as to how they remain involved in the coronial process and whether or not they are part of the postmortem scanning service. That is a debate that probably needs to be had between the royal colleges and sorted out but given the fact that we're running out of pathologists it only seems to be going one way. I think I'll probably hand you over to Dr Beyrmore now. That's very helpful, thank you. Dr Beyrmore, good morning. Hi, good morning. I think that Australia has picked on most of the things that I was going to say, however, in terms of places around the country that are doing CT postmortem services or less that we train at, Oxford's are doing things and the private set-up is operating through Stokes, Sandwell and Birmingham way. Those are the ones that I know about. In terms of radiologists themselves we're quite adaptable. We can move from one sub-specialty to another and most radiologists that are trained in CT scanning can quite easily scan a base or report a scan in the dead as well as the living. From our point of view there's not too much training to actually go on and report the scans of the dead. We can turn scans around quite quickly as well. We can do probably one scan every half an hour and get a full report out to the coroner. We do one session a day, Monday to Friday, so we do eight scans per day and that creates about 1,500 scans per year which is probably a quicker turnaround service than what you'll get with a traditional invasive postmortem. The other thing we can do as radiologists is we can remote report so we don't have to be on site at the same time as where the body is. You could get yourself a group of radiologists together wherever in different countries if you like and they can report the scans remotely for you. As we said, a non-invasive scan is decorated for religious beliefs and for our loss of faith that don't like invasive postmortems. Are there any specific questions about radiology or the scan process you'd like to know? Fear not, I think we will have a number of questions. I was going to say just because this is all incredibly technical it may well be that in some of your answers your volunteering information which will then come up again in one or two of the questions that my colleagues might be going to ask but it's quite a complicated subject and we're very keen to understand it as best we, lesser mortals, can. I'm interested really therefore I think the conclusion I'm coming to there is that there is a variable practice but the common feature, no doubt, is that the number of pathologists is reducing wherever because of the way in which the service is structured and the voluntary nature of the actual electing to participate in postmortems and that's an interesting consideration. I'm going to bring in my colleague David Torrance because obviously one of the things we've been told by the Crown Office here in Scotland is that achieving the skill sets required to move to different technology would be incredibly difficult. David Torrance. Thank you, convener. Dr Adley, you mentioned earlier about training of pathologists and using radiologists and as the conveners already mentioned the Crown Office and the Procurate of Fiscal have identified skill shortages within the workforce in Scotland. Was there any need to up skill of pathologists in Lancashire-Barkwyn with a Darwin? In terms of up skilling the radiologists to read the scans that's a two week course because it's just an adaptation of what they already do. What you are looking for is how bodies change after death and that is a sort of special skill set but it doesn't take too long to learn because they already have all of the basic skills. So that is a straightforward course and it was taught to I think the 14 radiologists we use in Lancashire at the University of Leicester in two week courses with about three tranches. In terms of up skilling the pathologists that wasn't necessary because what we do is we'll give the pathologists the scan report and it will say what can we see on this series of images and it gives them information as to how they approach the post mortem and where they may wish to go. For example, if you've got somebody who's died suddenly and you've got a scan report that says we can't see any bleeds within the brain you may not need to go inside the head to examine it if you can find something else to the body that's caused the death. So in terms of up skilling the pathologists didn't need to be retrained at all they continued to do the job they've always done. Dr Adley, so in training there was no post mortem imaging training given to the pathologists at all. With this you can do this one of two weights. You can either train radiologists to look at the images which is relatively quick because they're skilled at doing it. If you want to run a service where the pathologists are looking at the scans that requires a considerable amount of retraining and effort. Pathologists are not skilled at looking at radiological images it's not within their skill set. If you wish to approach it in that way you can do so but I don't know anybody that's even considering that. There are very few pathologists that really scans. There's certainly Dr Guy Rutty in Leicester and I think there's somebody in Oxford but they're very much an unusual occurrence to find a pathologist that has done it. They usually have been in the process for a very long period of time and started at the beginning where they would do the scan but the system that we run and I think most of the other operations in the UK the other six or so that Dr Dierdmore mentioned the imaging is all reported by radiologists simply because of the speed and ease of training you can then give it to a pathologist but they're just going to read what can be seen on the scan. I don't think they'd require any more training. Dr Sysons could help you with this. Yes, if you'd like me to comment Yes, I think it's a long start considering training pathologists to interpret radiological images. I don't think there'd be any enthusiasm for that and I just don't think it's appropriate for pathologists to be involved in reporting x-rays. It's chalk and cheese really what the postmortem we do and the radiological postmortem images are two different things and it's not something that pathologists would want to get involved in. They'd be quite happy to read the report and of the radiologists and take that on board. Dr Beardmore Dr Beardmore, I understand you'd like to comment. The training for radiologists to report scans in the living is five years in this country. Once you've got the skill set report in a CT scan then it doesn't take too much to adapt you to reporting CT scans with the dead. We've already done the training for interpreting CT scans already and we did a three day course in Leicester to show us the changes that happened after death and then we were fine to report postmortem CT scans after that. If you were to train a pathologist to report a CT scan you'd be looking at it over the five years for them to get good at it. Can I go pick up on this point because radiologists are like Hens Tief in Scotland and NHS under is under huge pressure. Is there any way that pathologists could be trained on the postmortem scanning in a shorter time? Or could it be built into part of their course in the training? I don't think they've got the will power to do it. The pathologist I've spoken to has said would you be interested most of the time around and said no. So I think we're on the one start if we're trying to train pathologists up to insert with scans to go on this. Thank you for that. I've got one final question just with the pressures on before the postmortem and the present services. How much does PMCT scans reduce the pressures on you? They don't reduce any pressure on me. I've got some pressures from scanning the living already. What we've done is by training 14 others off we've spread the workload out between us so one radiologist has not taken a big hit so to speak. We do one session every two weeks which is not too omorous. But yeah, I know that there's pressures on scanning the living as there are pressures on scanning the dead. So that's across the board and with the 10% vacancy rate in radiologists in the UK as well. The only thing I can think of is that as radiologists we can turn the scans around a lot quicker than what the pathologists would have been able to turn the invasive postmortems so it's slightly more efficient from that point of view. Thank you. Just to go back a little bit on some of that territory as it occurs to me given that it's felt that it's a non-starter to look at the retraining that would be required for pathologists or even the desire amongst that community to do so you've alluded to the shortage of radiologists and perfectly candid. It's not a public secret or anything we are acutely short of radiologists here in Scotland and in relation for example to the 62 day cancer standard it's not being met by any of Scotland's health boards currently and really the waiting time for all of the key diagnostic tests including radiology is not being met anywhere in Scotland too. In December 2022 just 45.8% of patients waited less than 6 weeks for their diagnostic tests so I suppose and this isn't necessarily a question you can answer but I just wonder whether similar pressures were advanced in the arguments that took place some might say and government might say in response to the petition or any initiative that we might subsequently seek to promote that in the face of an acute shortage of radiologists their first priority should be towards the living and that this would be to divert and potentially undermine further our ability to satisfy or meet or even close the gap in terms of the provision that's currently being made was a similar sentiment advanced where you were setting up the service? It was a concern but not all radiologists report cancer scans for instance I'm a musculoskeeter radiologist so there's not the pressure on me to report cancer scans because I'm mainly dealing with bones and joints and similarly we've got quite a few interventional radiologists that are doing some reporting for us as well so yes there is the pressure and you've got to decide on where you want to portray your experience or where you want your radiologist to be reporting but not every radiologist is a cancer specialist so there are a couple of people that do report cancer scans that are doing postmortem CT but as I said by the fact that we've got foresee and I was trained up and spread the load between us to provide a service That's helpful and just by way of an understanding on my own part is the 62 I know it's Scotland's 62 day cancer standard is there a similar pressure in your area in respect of that discipline itself? Yes there is a pressure on to get scans turned around see frequent emails saying patients back in clinic we need a report the next day there are the same pressures on those as what you have in Scotland That's helpful to know because it then sets in context anything that we're discussing it means that our situation in that regard is not unique and yet the provision has been established elsewhere I'm going to pass it over to my colleague Fergus Ewing Good morning to our witnesses I wanted to ask about two matters first of all quality assurance and the efficacy of CT scan as opposed to conventional post mortems and secondly the cost aspects on the first question of quality assurance the petitioner claims that scanners are 99% accurate in establishing a cause of death however in a submission to the committee from the chief coroner this highlights guidance on the use of imaging post mortem this references a joint statement from the Royal College of Radiologists and the Royal College of Pathologists on post mortem cross sectional imaging the most recent version of this I'm told details the strengths and weaknesses of imaging in establishing the cause of death for example it details its accuracy in establishing deaths from trauma, stroke and heart disease but its limitations in diagnosing deaths from conditions like sepsis and poisoning so I guess I am I have excuse me, I'm sorry I'll just turn this phone off my apologies I have three with that introduction which I thought might be helpful just to set the background I have three questions and I'll pass to Dr Adley first as agreed how do the PMCTs compare with traditional post mortems in terms of accurately establishing a cause of death I'll just give the two others now so the second one is can the witnesses detail the main strengths and weaknesses of using imaging in post mortems and lastly what proportion of this could have their cause accurately established using imaging thank you alright in terms of this there's a number of questions in there and that's very interrelated in terms of the peer review with the different types of post mortem there is no peer review where one pathologist sorry if my top's charming in the background one second there's no pathologist that sits with another pathologist and goes through the same post mortem at the same time there is just no peer review there is also unless samples are taken no permanent record these things aren't photographed whereas with post mortem CT scan these scans remain for as long as they're kept is a digital image and we're required to keep ours for 15 years in terms of the quality assurance the I'll ask Dr Bay of Moran to come in after me there are different types of scans if you have a plane scan it is it relies upon for example for heart disease the amount of calcium that's deposited in the arteries that supply your heart and that gives you a score and tells you how likely you are to have died from coronary artery disease the technique we use is that we actually in the younger patients where clots in the heart are more likely put in a catheter so because we're doing a much more invasive approach relatively invasive approach but because we are imaging things with die catheters within the coronary arteries our diagnostic rates are considerably higher it is accepted as I said at the beginning that CT scanning is not a panacea there are certain things it does not do well sepsis is particularly one of these sepsis is a generalised infection running throughout the body so that you need to look at the organs poisoning if someone is being poisoned quite often you are either looking at a home office post mortem which is a completely different character but you may wish to instruct a post mortem performed by a pathologist directly you wouldn't go to CT scan to begin with so in terms of this there are academic articles that say in some circumstances CT is better for things like trauma in other soft tissue injuries it's not as good the question that I was running with at the time when I set this up was that it really doesn't matter which one is the better system if you haven't got any pathologists that dictates the choice that you make you may have a different situation in Scotland but if you have got one choice and it does the job nearly as well in most circumstances that's the choice that we made there are academic papers on this if you wish to be referred to them but in terms of producing courses of death we scan 1600 page deceased people a year we're probably the largest scanning outfit in England and Wales with this about 6% of ours go on to pathology it is very useful to have pathology there for things like suspected sepsis for when someone has had an operation it's also absolutely essential if you've got people who may have a genetic component to heart disease in which case you need biopsies to be able to send to specialist pathologists and also need for people who've suffered from industrial disease to be able to take biopsies in order that people can pursue claims so it's not really an either or you need both even if you're going to run a Pesmortem CT scan Dr Beyrmore yeah we're going to say we're giving courses of death in about 90 to 95% cases but it doesn't necessarily always mean that we're getting it right and we're running on the balance of probability which means we're going to be writing 51% of the cases but as long as we're 51 times out of 100 correct then we're still within the law so that's why we can give courses of death a greater rate than what some papers are saying that the accuracy of Pesmortem CT actually is you know as Dr Ely says we're good spething fractures it's very good coronary artery disease either by a non-invasive approach where we use calcium scoring or by a minimally invasive approach where we pop a cathastrine and put some dye down the coronary arteries both of those techniques are very useful and the majority of people that have dropped down dead without a cause of death are related to cardiac disease so we fulfilled a balance of probability and that's why we can give the causes of death we do so one of the radiologists mindsets that they've got to get around is when they report in the living they've got to be nearly 100% accurate in what they say whereas when they come to report in the dead that level of certainty is not required and therefore you can give a cause of death even if you're not 100% certain that's what's caused the patient to die Thank you I've got your assistance There's no doubt that the CTPM is very useful it relieves the burden of a lot of invasive PMs from my point of view I get involved with cases of industrial disease where you really need to take large samples of tissue mainly from the lungs which is the common cases I do or in young people dying from heart disease it's important that these people do have an autopsy or a limited autopsy to get samples of the tissues for experts and genetic testing I do come across cases where the CTPM is incorrect I think my main worry about CTPMs is that the pulmonary emboli which is a situation where blood clots travel from the leg veins or from the pelvic veins and block the arteries in the lungs causing sudden death the CTPM does miss some of these there's no doubt about that in my experience the cases I do it's the one thing I think that it's the one disappointing aspect from my point of view as a pathologist when I see pulmonary emboli which are not always detected on a CTPM scan but I think there are evolving techniques which can improve that but overall I think the CTPM service is very useful it solves the problem of invasive postmortives not being able to be done by pathologists and it means people aren't waiting for invasive autopsies to be completed I wonder if I could just ask one supplementary I think the witnesses will be aware that this petition before the Scottish Parliament was occasioned following the death of the petitioner's child suddenly and the petitioner's child underwent a postmortem and that was much more extensive in nature than the petitioner had originally thought it would be I mean obviously anyone's death involves grief and sadness for every family in bereavement and the postmortem issue is a very sensitive one and that's OTO so I don't need to tell any of the witnesses this you deal with this in your professional work but obviously the death of a child is particularly hurtful and causative of real long lasting perpetual, eternal, emotional harm and that's really why we're here and why we're taking evidence today so with that backdrop are there any particular strengths and weaknesses in relation to the use of a scan where it is the death of a child most especially an infant or a young child Shall I go first? Yes please, Dr Ridley Okay When you were talking about children that's a particularly problematic area children don't scan in the same way that adults do after death you need to put them through an MRI scanner rather than a CT scanner MRIs work on magnetism CT works on X-rays the problem is that the number of unexpected child deaths is extremely small the reason is that most child deaths are either expected because the child has a long-term illness and has been treated within the mainstream healthcare all alternatively it's completely unexpected and there is a criminal suspicion in which case it's going down the home office past Waterbury which leaves you with a very few cases in the middle where the death is not suspicious but is unexpected and the problem you then have is with the maintaining the skill set of the radiologists in doing enough of these to know that they're actually getting the right answer this is a very different situation in terms of numbers from scanning adults in terms of children who are older as in Mrs Stark's son in terms of these there is a particular concern in young adults who suddenly die because there's something called sudden adult death syndrome and it is just where it's a collection of heart diseases some of which may be genetic and unless you take a biopsy for this you will not be able to diagnose it and the problem is because it's genetic other family members may be at risk in order to deal with this more effectively we've just signed up for a pilot for limited postmortans to take samples necessary for genetic testing that do require an invasive postmortans however when you are dealing with these issues we usually ask the family about their views about postmortans because there is a range of views of how families approach some families are not bothered by some families are extremely distressed in particularly the faith communities in those cases there is a conversation between the coroner and the pathologist saying we'll scan them first there's nothing in the head that we can see could you have a look at the heart first and if you find a cause of death or it's abnormal it's markedly enlarged can you limit the postmortans to the areas that are most likely to produce a cause of death the difficulty here is that when you say to pathologists to limit their investigation if what they're expecting doesn't come back when they look down the slides on a microscope you've limited their investigation and you may not have found the cause of death so there's a whole series of unknowns with this when you are doing it in real time and you can't do these things you can't do the investigations fast enough in order to avoid hanging on to a deceased person's body for a long period of time whilst you conduct all these investigations so the answer's not straightforward sorry would Dr Birmore or Dr Sissons like to comment? I think in terms of pediatric postmortan scanning there are only specialist children centres in our country that actually do them and they're only done on a research basis and so as far as I know these children still go on to have in various of postmortans as well and the reason is as Dr Ali was saying there are so few deaths in children that somewhere like Preston won't get enough experience so we're confident we'll report those scans because we're not seeing enough of them so that's the main issue with death in children so by concentrating the expertise at the children's hospitals you may then eventually be able to build up some experience to be able to report CTs and MRs thank you my colleague Foisal Choudhury would just like to come in with a supplementary thank you convener yes doctor you just said that of course any death for any family is a sad time for the family but does the family have any opt out option like the faith community a lot of the time you find that they want to have the burial done as soon as possible but as you've said to the answer to our convener that there is a shortage of professionals so if you have to wait a very long time and what value is given to the family and how much information is given to the family when any organs are removed from the body to Dr Ashley sorry I'll be okay we have very good relationships with the faith community we have a system here where if it doesn't matter which religion you come from because if we only did it for the Muslim faith or the Jewish faith that would be discriminatory but if you have a very good reason for an expedited post-mortem for religious reasons or for possibly your family travelling in from abroad we will move you through the system much faster we're well aware of the faith concerns regarding post-mortems in respect of the body being a holy object the difficulty with this the faith community are very much behind the post-mortem CT scanning they've paid for additional body storage which was raised through the mosques the average time from anywhere in Lancashire from you dying post-mortem that's done by CT scan is about 3-4 days something like that in most cases a post-mortem in these cases isn't necessary if a post-mortem is necessary because there is no obvious cause of death we will have a conversation with the family and explain what we're doing because what we've discovered is that the faith community want two things they want the burial to occur as soon as possible but if that isn't possible what they need is information as to how long it's going to be so that we don't cause social difficulties for accommodating all the family members that come the tension really becomes when it's usually a young person who dies suddenly and they're under the age of 60 and you have got a concern that there is one of these genetic cardiac conditions now if you've got if it's a single child and there's nobody else around it's not going to affect anybody so we wouldn't do an invasive post-mortem but quite often families are quite large and you've got brothers sisters, cousins who maybe at risk of inheriting this disease that can be treated so in those cases I would I will have a conversation with one of the religious leaders I will explain why we are doing this and why it's necessary to stop the possibility of the next event occurring is another family member dropping dead it's not a decision I ever take lightly and each one is taken on its own accord if you'd like I can give you the contact details of the local Muslim burial societies that you can speak to them and how they find dealing with us but they were very supportive of CT scanning because it is faster to give you an idea we once put 18 bodies through the CT scanner in a single day the radiology department asked me never to do that ever again but it could be done you'd be lucky to get four postmortems in a day and the reports come in that evening the next morning because Dr Beyrmore is treating the living and if he gets called away we will wait but usually the delay is 14 hours no more usually it's the same day does that answer your question I'm not sure it does but it's never clear every case is different as you've said most of the time the family is in the fields that they're not getting the information they should be getting and there should be an opt out option as well which is not clear from anywhere that if the family is allowed to say that I don't want to go through all this difficulties okay, thank you for that I'm conscious just before I bring in my colleague Alexander Stewart I'm conscious on Edwards you've been sitting patiently with us this morning if I might bring you in with any general reflections on the comments and evidence that we've heard so far this morning yes, thank you, good morning so the local authority our role we have a statutory duty to resource the coroner in order for him to carry out his judicial function so my role I guess is the finances from a local authority point of view the CT scanning services cost neutral for us so it doesn't cost us any more than what the invasive post-mortem service did we have a number of key performance indicators that we use to monitor how it's doing and to give you some figures on that Dr Bailey's already referred to it but we had and I think Dr Baymore as well 94% of our scans in 23, 22, 23 had a cause of death so that left 6% that didn't and of our post-mortem was 92% were non-invasive so that's the highest non-invasive post-mortem rate in England which is high but yeah have you got any questions around the finance side of it in fact we actually do I was running ahead of myself when I was going to bring in my colleague Alexander Stewart because my other colleague Fergus Ewing who was on with us just a moment ago is going to ask some questions directly on the finance side of it I'll try not to be so long-winded this time but as a lawyer that's always a bit difficult could I ask how the costs of post-mortem CT service compared to traditional post-mortems and secondly may I ask can Edwards or other witnesses are the post-mortem CTs generally provided free of charge or is there typically an out-of-pocket payment and if so what is this usually set at thank you okay so to answer your first question so our CT scanning service was set up so that it was cost-neutral against the invasive post-mortem service so it cost us no more than what it did when we were doing invasive post-mortems we use a private contractor that provides us essentially with an end-to-end service so they provide us with the transport from our satellite mortars to our scanning facility in Preston that's all included in the price that is cost-neutral with the invasive post-mortem service what is the additional cost or is there a range of additional costs the way that ours is set up is in additional costs in what sense I guess I'm just asking if there is a payment that is asked to be made from the family in the case of the extra costs between the CT as opposed to the traditional invasive post-mortem there's no cost to the family this is a free of charge service provided by the local authority there are no costs thank you very much I'm now going to bring in my colleague Alexander Stewart who's going to ask some questions on tissue samples Alexander Doctor Adler, you did touch on earlier when we touched on samples and biopsies that are taken so we have already heard from the Royal College of Pathologists to talk about the potential challenges associated with tissue sample and any returns of those samples and can I ask you do you recognise the challenges that are described by the Royal College of Pathologists when it comes to the returning of samples themselves is that an area that you have had and continue to have or what are your views on that process okay I'm unfamiliar with the challenges if I explain what we do it might answer the question in a roundabout way what happens with samples is that any sample containing even a single cell the family asked what they want to be done with the sample when it's finished with so if it's a the family are given a number of choices and this will be asked by the coroner's officer that either the sample could be retained by the hospital for medical research and teaching or alternatively it can be returned to the family and their undertaker or alternatively they can elect for the sample to be disposed of by the hospital in a lawful and sensitive manner so those are the three choices what will happen is an invasive postmortem takes place because this doesn't apply with CT scanning but after an invasive postmortem the pathologist will fill out a document saying what they've taken in terms of organs, histology samples, blood and urine and then the coroner's officer will ask the family what would you like done with this and that will be fed back to the hospital where the postmortem took place who will then deal with the samples in that way we've not any problems with this it's very straightforward it works very well the only time it causes problems is when the family elect to have the samples put back in the body before it's returned because then the body has to be retained and for certain pathologists we have a backlog of a year before we can get a report quite often this can be managed that the funeral takes place in the funeral where the graves excavated down to the coffin and another casket put on top but in terms of the challenges raised by the College of Pathologists I don't know about these but we've got no problems with this system it works almost thoughtlessly and with very little administration that's very good to hear because I think that what was identified was a communications process and you've explained what you do and how that is managed to inform the relatives or next to kin or individuals who require information but I think that what the College found that there were sometimes barriers in some of that communication in making sure that individuals understood what was expected and what would occur with reference to some of the samples and I think that's the area that they've identified when they've given some evidence to us here and they've noted that Ann Edwards used to be my senior coroner's officer so she's got first-hand experience of conversations with families if you'd like to explain what the difficulties that were raised I'm certain she'd be able to answer your questions Thank you If I can maybe explain that to you Ann so that there was some discussion with reference to the complexity of communications and the process that was raised by potential barrier they felt that there was a barrier of offering relatives options for tissue sample handling and you've explained that you didn't see or Dr Ardhys explained that the way that was managed so have you encountered any challenges with communications and options of seeking informed consent No I mean in my experience sometimes families need some time which is absolutely fine the coroner's officer will contact them explain what samples have been taken go through the options and then give them some time you can go and explain it to them the following day I understand especially when whole organs are taken that's quite a big decision some families vary in what they want to know so for example if a brain has been taken we would explain to the family that that can take some time because of the process that has to go through pathologists can look at the slides some families don't want to know that some families are really interested in the process so we are guided by the family as to how much they want to know but we will always inform them exactly what has been and what their options are in relation to that once a pathologist has finished doing their test but I haven't in my experience encountered any issues with that Excellent Thank you very much for that Thank you for that in the written evidence that we received really the Royal College of Pathologists put up quite a strong almost I think the committee is not too strong a word to use the committee felt something of a smoke screen when we were trying to discuss this issue by saying that this would involve having to make a decision that tissues were no longer of use if the tissues were to be buried or cremated this would delay the process if it was not buried or cremated with the body then the options would need to be explained and understood and this could all be very complicated and it could lead to delays and the family not properly understanding matters I can see that in the context you referred to the Home Office we would obviously refer to the Procurator Fiscal that would be a completely different type of event but from what you've just articulated it seems as if an operational practice has been established where you are which has not led to some massive increase in cost and has worked perfectly satisfactorily to all those concerned that actually is quite an important counter-evidentiary piece of information from our point of view thank you very much for that then so I hope I haven't editorialised anything you said there but summed it up to that extent you touched there on brains and I suppose if I can just come back to finally a couple of general issues that arose out of the petition which haven't necessarily been covered in the commentary that we've had to date and the petitioner was asking in her petition that all post mortems can only be carried out with the permission of the next of kin and do not routinely remove brains and I just wondered what your view would be on those two propositions Dr Adley consent is families are always involved in the decision of what post mortem is taken place it will be explained by the coroner's officer if you start giving and I do appreciate I may sound paternalistic here the problem comes where quite a lot of the families that we deal with are fractured so you may be dealing with two or three different parts one of which will want a post mortem if you've got a situation where one family member doesn't want the post mortem another one does and it's a question of genetic testing for a heart disease that somebody else may die from giving the view answer to or giving the final choice to the family may cause all sorts of problems the same occurs where you've got to take biopsies for compensation for lung disease we don't find that with post mortem scanning there is anything like the same concerns because if you're I think it's under the age of 65 now most that will happen is that you have a very small incision under your left collar bone for introduction of a catheter other than that there will be no marks on the body what Mrs Stark has described happening to her son is a seems to be a standard post mortem practice which is extremely invasive the problem comes where you're going to make somebody and I don't know what your rules are if you're going to make the procurator fiscal responsible for establishing the cause of death you're going to have to have some provision that means that if the family refuse to have a post mortem undertaken they're not required to proceed I think the final area where I would raise concerns is it shouldn't apply to a home office post mortem because if it did a parent who is accused of killing their child could veto the ability of a home office post mortem to take place I'd hand over to Dr Sissons or anybody else who wanted to speak on this particular point Does anybody else want to contribute in relation to this point and sorry there was also the issue about brains just sorry routinely removed routinely removed with this I'll ask Dr Sissons to come in after me the Royal College of Pathologists have guidelines as to how a post mortem should be undertaken that it will set out what steps should be taken and in that examination of the brain is one of the standard investigations here if we've done a post mortem CT scan and we can see nothing in the head and there are certain conditions you can't pick up certain types of stroke but if there is nothing in the head we can assure the pathologist to some extent that there's nothing going on there and they should restrict their investigation to the other parts of the body so that's much more of a question that the Royal College of Pathologists in their guidance would need to answer as to why that is a routine procedure rather than coronas we actually have to specify not to do it rather than it being anything else Dr Sissons I think this is where CT PM scanning does help because in my experience if we've got a normal brain CT normal brain on the CTPM then I feel quite confident then that I could proceed with the invasive autopsy without examining the brain in most cases so I think I think you're right the Royal College of Pathologists best practice is that you should take the should always look at the brain but I think this is where CTPMs can really help minimise that make it not need it to be done on several occasions thank you very much that's very helpful again to our consideration that brings us to the end of the questions that we had to put and I am enormously grateful you're all very busy professionals clinicians and giving your time to us in the evidence that we've heard this morning I think it really will help the committee considerably as we consider the petition and how we might take some of the issues forward within it so I would like to thank you all very much for your participation on behalf of everybody here in the Scottish Parliament how very much it's been appreciated thank you all very much I'm going to move now to Monica Lennon MSP who is joining us this morning and has joined the committee when we've considered this petition on previous occasions and asked Monica having reflected before the committee obviously do themselves on what we've heard this morning which I think we can all say has been very interesting if there's anything you would like to add this morning Monica Lennon thank you convener and it's lovely to be back at the committee thank you for all your work on this and I think that was at an excellent panel it was very interesting I've been taking copious notes and stacked the petitioner and her husband Jerry are here today in the gallery and I'm sure that all of Anne's work in terms of really building research in Scotland and making these connections with colleagues elsewhere so I think in terms of reflections convener what struck me that we need to modernise and I think we need to keep pace and try to address some of the future challenges so it was really interesting to hear the work that colleagues have been pioneering in the Lancashire region in England and obviously there are other examples down south but there's some really good practice there and I think for us in Scotland both Scottish Parliament and Scottish Government there's a lot there that we can hopefully learn from really interesting to hear from Anne Edwards towards the end at this service which is being delivered in partnership with a number of different partners but working really closely with communities that came across strongly it's cost neutral which I think is an important point for all of us and as Fergus Ewing was asking there's no cost to the family members in terms of having the scans undertaken so again thinking about the workforce challenges both for pathology and radiology it feels to me that there's a framework there that we can certainly look at and that colleagues in Scottish Government wanted to look at they may want to have a different approach clearly there's a big role here for a private contractor they may wish to look at something different but remembering why we're here Richard Stark passed away almost four years ago he was 25 it's no age at all and he was very loved by his family Richard Stark started to understand and realise what can happen to each of us or to our loved ones when we die so there's big issues here around bodily autonomy around choice I did hear the colleagues say that families are all different and there can be challenges within families but it's about not just having information it's about informed consent it's about choice and dignity with the petition that Ann Stark has brought which I understand because I was looking on my phone there before I came in I think there's about 570 signatures on the petition that's gone up quite a lot in the last couple of days because there's been some publicity around the work that the committee is doing the more that we're having these conversations the more that people are wanting to get involved and I think the point was well made that some families might not be that bothered and just don't really want to know but for others it's going to be deeply distressing so it's important we bring this into the light a little bit I think as you know there's the different aspects to Ann's petition today rightly focus a lot on the experience of colleagues in England around the use of scanners but I think it reinforces to me that there are alternatives technologies advancing all the time we've heard for colleagues in radiology there's not a lot of work required to just refine people's skills we've got a fantastic workforce across the UK so that gives me a lot of hope so the issues again around human tissue and genetic testing that were just brought out towards the end there again we could spend all day talking about that and there's a really emotive issues and of course if there are opportunities to inform other family members that they may be at height and risk of a disease or a condition of course we want to get that information out there but as the petitioner has always said this needs to be proportionate routinely removing brains and doing a fully invasive postmortem that's not necessary and as we've heard a number of times a day from colleagues and I'm watching the clock now time is really important that's the biggest resource across the public sector and those teams that we've heard about today they're both dealing with the living and the deceased they've got incredibly important work to do and if we can be more efficient and more people centred in bringing people's human rights into this you know I'm here today because frankly my constituents Annan Gerry who's sitting behind me have had a horrific experience and the trauma that they've endured is bad enough to lose you know I loved one to lose a child but the trauma they've endured after Richard died I wouldn't want any family to go through that and that's why I'm so glad that this committee's been so diligent in the work that you've been doing but I thought today's evidence session did bring out some of the challenges of course no one expects this to be perfect or a panacea but it strikes me that in Scotland we've fallen a bit behind because there is really good practice happening particularly in Lancashire we need to learn from that and I hope that for Scotland and for the Scottish Government they'll really take that on board and just last last word because Ann is very persistent which I always encourage she has written out again to every MSP in the last few days and had a really tremendous response it's really resonating with colleagues because we all have constituents and it's really about our humanity and of course we want to be able to learn less and to apply that to future medicine and so on but this is a topic that's been neglected in Scotland the research is underdeveloped but we've got really good evidence and engagement with colleagues UK wide now so thank you to all the committee for your time Thank you very much Monica Lennon and like you that our guests in the gallery who have a direct concern with these issues have appreciated the session that we've held this morning and I think it certainly will help inform the committee as we go forward in a number of areas it seemed that there was an opportunity for clear progress others where it might be more complicated but in summation I wonder colleagues clearly we will want to reflect on the evidence further at a future committee meeting but I think we might at this stage anticipate that in considering the evidence at a future committee meeting we might then have the opportunity to put questions to the minister in relation to some of the issues that have been raised so if we can agree both those points then I think we would want to have a session with ministers and we can seek to try and secure that but also have the opportunity just to reflect further on the evidence we've heard before then too at this point then I will suspend the committee briefly to allow us to change thank you and welcome back to our proceedings we now move to the consideration of further petitions the next of which is petition number 1916 request a public inquiry into the management of the rest and be thankful project which has been lodged by councillors Douglas Fyland and Donald Kelly the petition calls on the Scottish Parliament to urge the Scottish Government to instigate the inquiry regarding the political and financial management of the A83 rest and be thankful project which is to provide a permanent solution for the route this is obviously a cause celebra with which the committee is familiar are having discussed this in various petitions over a considerable period of time as has no doubt Jackie Baillie who also joins the committee's proceedings this morning welcome to Ms Baillie we last considered this on the 9th of November and again we agreed to write to the Scottish Government and we've since received a response from Transport Scotland which indicated that potential route designs for a permanent solution are being progressed with an expectation that a preferred route option would be announced by spring 2023 I did read by way of a sort of a side a novel recently where somebody said stock home does spring very nicely to which the repost was yes but in July but I'm hoping that since we are getting nearer July it may well be that a Scottish spring is now defined as what we used to call the summer but here we are Transport Scotland's response also notes that the preferred medium term solution for improvements to the existing old military road which was announced in December 2022 which I remember visiting along with David Torrance a previous committee consideration of a petition a number of years ago we've also received a submission from the petitioners highlighting concerns that improvements to the old military road may delay progress in a permanent solution as I recall when you get to the end of the old military road you're confronted with quite a tricky topographical consideration that's very steep and windy as well as taking information on Transport Scotland's timetable for progressing a permanent solution and before I open up to wider comments I'm delighted to ask if Jackie Baillie could anything she would like to contribute at this stage probably perplexed as I am Ms Baillie at the definition of spring Good morning convener I am indeed perplexed at the definition of spring spring 2023 I think has now passed and we are ever hopeful but I am assuming that we are now entering summer now I recognise as do the petitioners there's a new minister in place there are tight budgets but you know the petitioners and indeed the entire area are keen to know whether there's been any slippage and what the timetable is for identifying a preferred solution and when that road will eventually be built so the local aspiration understandably is that it should be built by 2026 the last of Scottish government official of pined about this they were saying 2033 clearly there's a significant difference so we are keen to understand what's going on petitioners are keen for an indication of the timetable if there has been any slippage the magnitude of that slippage and they are slightly skeptical it has to be said that the investment in the old military road whilst welcome is going to be a sticking plaster approach because the permanent solution is not identified and progressed in good time so what we have is more money being spent on a project that has consumed vast amounts of public money over the years without a permanent solution being in place and let me in whilst I understand that the committee may not be entirely in favour of a public inquiry let me explain that the petitioners the core of this petition was their request for a public inquiry because they don't think there's value for money being achieved so we have a solution in place that's a temporary solution at the rest and be thankful which involves catch pits those catch pits started off being quoted as about 2-3 million is now over 100 million there's no permanent solution in place there's going to be investment in the old military road which is sticking plaster when is this ever going to end and we would like a date for one the preferred choice two when it's actually going to be permanent and completed and what the slippage is and I recognise that there is a new minister but I do think that this has gone on for long enough thank you miss Bailey I think that's reasonable I mean by a 2033 even you and I might have retired along with other members of the committee well I find that increasingly hard to do these days but I do still try I think in this occasion David Torrance do you have any suggestions we might make I mean it seems perfectly reasonable I think to try and find out where we stand given that we were given an understanding we would have heard something by now I think convener is someone along with yourself who has visited the area and seen the measures that were put in place I think we need to take this forward it's been gone far too long and there is still officially 14 days so I don't think that the report will be in that time we could certainly make reference to that in any submission that we make we don't want another broken promise after all can I make you suggest that we write to the minister for transport to seek an update on when the Scottish Government expects to announce a preferred route option for a permanent solution are we agreed are you agreeing Mr Young I was agreeing I was just going to ask that we ask for some supplementary information if I may I just read in the papers the petitioner submission of the 14th of March headed concerns voice to me if the old military road improvements work will this kick the permanent solution along grass I think that's been mentioned but I don't think it's been mentioned that the selection criteria of the medium-term solution is considered ensuring we have a two-way road which stays open when it rains and is free from traffic lights, road closures and convoys a fundamental requirement of the people who actually use the road and we would assume is the role for which transport Scotland exists so I just read that into the record because these are the petitioner's concerns and our job is in part to get not only a general response from the minister but also specific response to what appeared to me to be legitimate points that the petitioners have raised. Thank you very much, shall we agree? We are, thank you. Next petition we are considering is petition number 1930 which is to ensure customers are always given information on the cheapest possible fare in the new ScotRail contract. This was lodged by George Ecton calling in the Scottish Parliament to urge the Scottish Government to ensure that a requirement of future rail contracts is for customers to be given information on the cheapest possible fare of course and recognise the vital role of the existing ticket office's state in delivering on the same. We previously considered this on the 23 November and we agreed then to write to Scottish Government and Scottish rail holdings. Unfortunately, a response from Scottish rail holdings has not been forthcoming but we have received a response from Transport Scotland on behalf of the Scottish Government which you will have a copy of and in this response Transport Scotland highlighted that the interaction involved in reserved matters will form part of the Scottish Government's consumer duty scoping work with the Government considering whether Scottish rail holdings will be covered by the consumer duty legislation. Transport Scotland have also provided details of the on-going work to enhance smart ticketing across the public transport network which includes the establishment of the National Smart Ticketing Advisory Board. The response also indicates that the fair fares review may shortly be concluding if it is not already and will be followed by the launch of a public consultation on a draft vision for public transport. We have also received a brief submission from Petitioner in which he welcomes the consideration of Scottish rail holdings being covered by the consumer duty legislation while highlighting concerns about the advertising of fares and potential for digital exclusion for certain groups or individuals. Do members have any comments or suggestions for action? Alexander Stewart. I think that it is important to have further information back from the Scottish Government in relation to a number of issues. One of them would be the advice that has been received from the National Smart Ticketing Advisory Board as to how things are progressing there. The anticipated timetable for the public consultation on the draft vision for public transport and, as you have already indicated, what action is being taken to address issues of digital exclusion when purchasing rail tickets. It would be useful to have our hands to ascertain where we can take this forward, convener. David Torrance. Thank you, convener. I support everything that my colleague has said, but I wonder if we could also write to ScotRail to seek information on its evaluation of the options to upgrade the infrastructure which would support the use of contactless bank cars on the rail network. Thank you. I am happy with that. Colleagues content that we proceed on that basis, I believe we are. We will move to position number 1952 to instruct Scotland's NHS to perform specialist services for patients with automatic disfunction. Autonomic disfunction. Autonomic disfunction is quite different. This petition has been lodged by Jane Clark. It calls on the Scottish Parliament to urge the Scottish Government to instruct Scotland's NHS to form specialist services training resources and a clinical pathway for the diagnosis and treatment of patients exhibiting symptoms of autonomic nervous system dysfunction. The UK's recent submission disagrees with the Scottish Government stating that many patients do not have access to the best possible care and support and that POTS is not well recognised within the cardiology profession. The submission highlights that there are no established pathways to diagnose and treat POTS and adults across most health boards. Chest, heart and stroke Scotland's written submission notes that nearly 200,000 people in Scotland have long Covid and that 76% of long Covid patients had symptoms of disautonomia. However, it states that patients with disautonomia struggle to access medical support and people with POTS often wait years for a diagnosis. Chest, heart and stroke Scotland called for quicker and more coordinated diagnostic and treatment pathways for people with long Covid and the creation of a clinical pathway that integrates with existing sign guidelines. It also supports training for GPs and further scoping to ascertain the size of the need for special support for people with disautonomia. The written response from the National Services Scotland states that it would not anticipate being invited to commission a national specialist service, training resources or the development of a clinical pathway due to the broad range of local services and specialities involved for autonomic dysfunctions. That was all quite technical but important nonetheless. Colleagues, do you have any suggestions as to how we might respond to the written evidence that we've been received and read? On that, I wonder if we could write to the Scottish Government highlighting issues raised in the written submissions on BOTS, UK and Chest and Heart and Stroke Scotland. For our received feedback or evaluated, it's implementation support note. In particular, the implementation support note has increased knowledge of long Covid and POTS. Excuse me. How diagnostic and treatment pathways for people with long Covid are monitored and tracked to ensure appropriate care is provided in a quick and coordinated way to ensure that people are diagnosed with dysautonomia. We've both got problems with that, and whether it will request training for people with dysautonomia. Dysautonomia? Dysautonomia. OK. Thank you. Do any other colleagues of any additional suggestions they might like to make or are we content to proceed with that further request for information? I believe we are. Petition number 1957 home reports are more accountable. This is lodged by Catherine Donachey and calls on the Scottish Parliament to urge the Scottish Government to ensure that surveyors are legally responsible for the accuracy of information provided in the single survey and increase the liability and surveyors to pay repair bills where a home report fails to highlight existing faults and the condition of the property. We previously considered this on 7 December and at that time we thought we would seek views from a number of organisations. We subsequently received responses from the Scottish Law Commission, the built environment forum Scotland, the Royal Institute of Chartered Surveyors and the Law Society of Scotland and all of those responses were part of our pre-meeting papers for today. While BEFS saw no concern with the petitioner's suggestion that all home reports should include details for the Centre for Effective Dispute Resolution, the Royal Institute of Chartered Surveyors' response noted that it is not a specific third party resolution service as this would indicate bias. The responses from IRCS and the Law Society all noted an expectation that the Scottish Government will be carrying out a review of home reports in the near future. A move that BEFS would support. Do members have any comments or suggestions? Alexander Stewart. Thank you. It's important that we continue to take some more information with reference to this one. However, I would be suggesting that we write to the Scottish Government to seek information on the plans to review home reports, including any anticipated timescale for that review, because I think that that does indicate where we are with this process so far and that further information may be required. Although I think that in the evidence received, it's an expectation that the Scottish Government will conduct this review, so I think that we need to establish as much as anything that such a review is in prospect. Mr Ewing. Yes, I think that it's worthwhile to establish that, convener, but I would say that the very detailed responses that we've received from the built environment forum, the RICS, the Law Society, very clearly set out the parameters of a home report, which is not my experience as a slister. It's more than a basic valuation report, but it's far, far less than a detailed structure report, which would cost huge amounts of money. The limitations of the home report are clearly stated on it. I think that, in practice, most slisters are pretty good at advising clients about the limitations of a home report. Moreover, the surveyors do have to have liability insurance in place, they have to undergo professional training, and the system is pretty well understood and works pretty well in practice. If there was to be a blanket, strict liability imposed, which is what the petitioner wants, it would simply mean that the costs of the product, the home report would go up exponentially to pay for the additional professional liability insurance premiums that would automatically ensue from that. I say that not because I'm prejudicing the outcome of anything, but simply because I think it would be risky to raise expectations here of the petitioner, although I understand that individuals may have hard cases in their own experience, and I can't really comment on the individual circumstance. The point that you make, Mr Ewing, was the conundrum that was at the heart of the debate on the whole issue of home reports at the point when the Parliament sought to introduce them. Gosh, I think that in the first session I was here in 2007 to 2011, and I think that the home report was introduced during that session. Well, it existed long before that, but the issues have certainly been debated for quite a long time, but if there's to be a Scottish Government review, we should at least find out when it is and when they expect to hold it. Okay, are we agreed? I think we are. We then move to petition number 1967, which is to protect Loch Lomond's Atlantic awkward shoreline by implementing a high road option for the A82 upgrade between Tarbot and Inveraranon, which is a theme developed here. It's lodged by John Urquhart on behalf of Helensborough and District Access Trust and the Friends of Loch Lomond on the Trossacks. It calls on the Parliament to urge the Scottish Government to reconsider the process for selecting the preferred option for the planned upgrade of the A82 between Tarbot and Inveraranon and replace the design manual for roads and bridges, the TMRB-based assessment with more comprehensive Scottish transport appraisal guidance. Jackie Baillie has remained with us this morning in order to contribute to our deliberations on this petition again. We last considered it on the 21st of December, and at that time we agreed to write to Transport Scotland, Argyll and Bute Council, Loch Lomond and the Trossacks National Park Authority and the Loch Albar Chamber of Commerce. We have received responses from Loch Lomond and the Trossacks National Park Authority, Transport Scotland and Argyll and Bute Council, which are again all included in the papers before us as we consider matters further today. The response on the National Park Authority notes their concerns about the road design with the caveat that a formal view will be provided once Transport Scotland finalised the proposal. The National Park Authority also highlighted that without further consideration of the details it's not clear that the high road route would provide a more environmentally favourable option. Transport Scotland have provided a lengthy and quite technical submission detailing their assessment process and the community engagement that has taken place to date on the A82. In particular, I would draw members' attention to comments on the audit Scotland investigation into concerns relating to the application of STAG guidance. We've also received a late submission from the petitioner, which was circulated in his response to the submissions that we've received from Transport Scotland and the Loch Lomond and Trossacks National Park Authority. Once again, before I ask committee members if they have any thoughts on how we might proceed, may I invite Jackie Baillie to contribute to our deliberations? Thank you very much, convener. I also indicate that John Akart is in the public gallery, such as the interest in the petition and far for me to pick up the convener on something that he omitted to say, but I did invite members of the committee to come and have a look at the area in question. I did admittedly say that it was the summer, there's 14 days to go before the summer commences, but I do look forward to a response and a we-trip-up Loch Lomond side for the committee. Convener, whichever route is preferred, I think, whether it's the Transport Scotland suggestion of the low road, if we can call it, and the petitioner's suggestion of the high road, the issue is whether a stag appraisal has been carried out. This is significant amounts of investment and a stag is required when Scottish Government funding, support or approval needed to change the transport system is being considered. The wider consideration with a stag is it's not just that it's a transport project, it's what benefit it accrues to those living in or indeed visiting the national park. It requires a consideration of place, not just project and what local people want and, dare I say it, it's significance because it is within Scotland's first national park. Let me take the points in turn very briefly. Transport Scotland in their own submission agree that a full stag appraisal has not taken place. Instead, they've said their approach was underpinned by stag and DMRB principles and, with the greatest respect to Transport Scotland, that's not the same. It's taking things and maybe applying them, but it's not actually doing a full stag appraisal. They then consider that that is consistent with stag requirements but I have to say it is a bit like Transport Scotland marking its own homework. Questions have been raised by the petitioners about costings of tunnels, about exaggeration of costs, we've had cycle paths included where there was no need for a cycle path, we've had underestimating of costs of the disruption which all served to distort the conclusions reached by Transport Scotland. A stag appraisal would allow those errors to be corrected but much more importantly it would consider place issues as well. The impact on the economy and the life of people living in Tarbet and Ardlui for one but the impact on the national park which we should be treasuring and conserving. Let me turn briefly to the national parks response to you and can I just point out they shouldn't perhaps it's the fault of our process but they almost seem to be responding as a statutory consultee. Well this is much wider than planning their response as a statutory consultee. I think it is fair to say that they don't quite like either option. They don't like the option presented by Transport Scotland which would see big swathes of road going out over Loch Lomond which I think would be catastrophic. It's clear they also have concerns about the high road proposal but my submission to you is a stag appraisal process would help you work through that rather than the shortcut approach that has been taken by Transport Scotland. I think that this is too important not to get right. I recognise it's of critical importance to hauliers that need to use the road from the highlands and further afield but they equally I think would want to get this right so that they get a decent route and we also can serve our environmental heritage at Loch Lomond and the Trostecs national park. Thank you very much. You pointed out to us on the previous occasion that we have a reputation for liking to get out and about from a hollywood and we did in our response say that we may even manage to come and have a visit at some point so I think it's a little early to admonish us for not having quite managed already but I think in essence the recommendation about the stag board is quite significant. Does anyone want to comment or come forward with any recommendations? Mr Ewing? Jackie Baillie has always set out a strong case for that which she advocates. I'm just wondering, considering whether or not we should actually recommend the stag report we should just get a little bit more information and the reason I say that is that looking at the whole papers including national parks submission they reference and I won't repeat it here and Ms Baillie will know all this well but there's about 10 points they raise all of which seem to me to be likely to lead to very significant cost and difficulty and I'm not suggesting that we shouldn't recommend that it would be a stag report but I would just like to know how long it would take to get the stag report and what that process would involve without being obstructive to this in any way because the crossing of the West Island Railway twice, various tunnels very steep land contours triple SIs, water courses crossing the sloy power station pipes I mean I'm familiar with much of this area and it does seem to me to involve such a level of difficulty that the stag process might take a year or so and the reason I raise that is that I know that throughout the whole West Highlands not only in Jackie Baillie's constituency but the joining ones in Argyll, in Lachaber this is a road that has long been the subject of an overwhelming desire to see improvements for all concerners, I think everybody would agree so I'm not being obstructive to Jackie Baillie's proposal but if we're going to make this recommendation I think we should know is it going to take three months fine, is it going to take three years well if it is I'm not sure that that's something I would want to support and I don't know convener if it's appropriate to ask Ms Baillie for her comments on that because I haven't had a chance to discuss this with I'm usually content to invite Jackie Baillie if she wants to respond to that I think she indicated she might like to make a further comment I think that petitioners would contest the level of complication that is being suggested but I think the difficulty I have is a reality check that it looks like the national park in its response to you is likely to object to the existing root that is going to take time in and of itself and if that is the scenario that has been suggested and certainly I read from this submission then you could be talking ages in terms of planning before that process is concluded I think the stag is the accepted way forward I wouldn't want it to be held up unduly, I don't think anybody would but the reality is this is likely to be contested whichever root is picked Fair enough, thank you David Charnes Thank you convener, if we're going to visit Loch Lomond we're just as well going up the road a wee bit to the rest and we thank you and see Jackie Baillie's other area I would be delighted convener I think the stag report I wonder if we could write to minister for transport asking if we will do a full stag report on the second option and also raise with the minister the concerns raised by Loch Lomond and Trossach's National Party about the road design and transport of Scotland's preferred option and in doing that I wonder if we could seek an update of anticipated timetable for publishing the draft orders and associated environment impact and assessment report including plans for the public consultation Are we agreed? I mean I do think maybe we could I don't know whether it's possible but can we just look to see whether at any point it would be possible for those members of the committee that might like to visit the area to do so because it is obviously quite complicated and I think a physical appreciation again of all that is being discussed would probably assist That brings us to the end of item 2 We now move to item 3 A thank you Ms Bailey again for your participation and that brings us to item 3 on our agenda which is consideration of new petitions and before I introduce each new petition I do as always for those who might be following our proceedings elsewhere indicate that as a matter of practice we invite the Scottish Government and also the Scottish Parliament's independent policy advice resource spice to offer our comment on petitions and we do that because historically if we didn't do that that was usually what happened at the first meeting when we considered a new petition and so we bypassed that and so we are already considering the petition with a degree of information having been obtained So we will take the petition and we are joined this morning by Michael Marra who's been sitting quite contentedly for deliberations So in order to facilitate his day we will move to petition 2009 in the first instance which is to ensure fair access to Scottish universities for all residents in Scotland and the UK This is lodged by Caroline Gordon and it calls on the Scottish Parliament to urge the Scottish Government to ensure fair access to Scottish universities for residents in Scotland and the UK by reviewing university business models and Scottish Government funding arrangements The Scottish Government's response to the petition states that Scottish universities have autonomy in their admission policies and selection criteria meaning that the Scottish Government and ministers cannot intervene in universities business models The submission emphasises UCAS data published in January 23 which shows that a near record number of Scottish students secured a place at the University of Edinburgh The Scottish Government aims to have 20% of students entering university from Scotland most deprived backgrounds by 2030 The submission highlights that 9.1% of Edinburgh University's full-time first-degree entrance in 2021 came from Scotland's most deprived areas The petitioner has responded to the Scottish Government's submission stating that many capable young Scots are unable to attend due to chronic underfunding and poor Government policies She notes that freedom of information requests have shown an 84% increase in the number of Scottish domiciled applicants who are being refused entry to universities in Scotland since 2006 The petitioner concludes with a call for the Scottish Government to conduct a review of their funding arrangements for Scottish universities and remove the cap on places to provide equal opportunities for all young people regardless of their background As I said a moment ago we are joined by Michael Marra this morning and I would like to invite Michael Marra if he would like to say anything to the committee as we consider how we might proceed I begin by paying tribute to my constituent Caroline Gordon who joins us in the gallery today for lodging the petition now supported by many thousands of people and for our continued determination to seek answers from this area from the Scottish Government I also thank the committee for the opportunity to speak with you today For over 600 years our universities have educated some of Scotland's best and brightest for our scientists authors, poets the great people of Scotland who have lent so much to our history and our progress as a nation but today for many of our young people the basic promise of a Scottish education is being broken You work hard, you get the grades you get in that is the way it should be I raised my constituent's case and the First Minister's questions on 12 January a young man with outstanding grades to whom the doors of Edinburgh University were firmly shut there were no grades he could have achieved from 5As to 50As that could have prized those doors open and the policy of the Scottish Government locked him out and since then my office has been inundated with emails and phone calls from parents and young people across the country sharing similar testimony and this is not a case of one university it should be clear or one subject area this is palpable so my constituent and I are the strongest supporters of widening access to university in Scotland the Parliament has seen marked progress in that area in recent years but we come from a very low base where young Scottish people from the poorest backgrounds were far less likely to reach university than any other part of the UK we should be clear that we are still well behind the rest of the UK in that area and that much progress still requires to be made but the real issue of concern here in this petition is the dysfunction of the business model that is imposed by the Scottish Government on our universities and that includes the cap on Scottish University students but it's combined with 14 years of no increase in the amount of money paid per student to our universities so the alternative route that is being taken by many young Scots is to seek a place at an English university many will make a life outside Scotland will marry and flourish and my constituent and many other families will be hundreds of miles from their grandchildren and I think that's a very human element to this that we have to consider but I think that we can all identify with it but more broadly for our economy for the betterment of our society in Scotland these are losses that Scotland can ill afford so at best case I would say this is a case of unintended consequences of policy and I would certainly recognise that and it deserves better scrutiny in Parliament in terms of what may be happening as a result of policy the Government is not the stated intent but this committee may seek further information on and if I could be as so bold as suggest a couple of areas that may be of use to the committee in that regard maybe to seek evidence from University Scotland but also from individual universities to ascertain the scale of this issue whether certain universities or courses will be affected perhaps to develop a better understanding of the impact of the current policy on the number of young Scottish people being forced to leave Scotland to access higher education elsewhere the impact that that has on the country perhaps to ask the Scottish Government what analysis it has undertaken of the consequences of the current policy for Scottish applicants in general but to give an opportunity and I think importantly for those who are impacted to have their voices heard so thank you for the time today and for the consideration of the committee thank you very much Mr Marra and I know you've obviously been raising these issues in Parliament and with the First Minister I'm quite content I think with the proposals that you have made would the committee like to add any further suggestions David Torrance I'm just wondering if we could write to Commissioner for Fair Access seeking his views on the actions called for in the petition as well can we hear make sense too, are we content to pursue the suggestions made by Mr Marra also from David Torrance and that will give us some further information and we will consider the petition again in due course thank you very much your first appearance with the petitions committee thank you very much for joining us this morning moved to petition number 2007 which is to increase allotment provision for all and entitled universal credit claimants to a free plot this has been lodged by Caroline Weston it calls on Scottish Parliament to urge the Scottish Government to increase allotment provision so that current waiting lists are fulfilled and all universal credit claimants are offered a free plot at their nearest allotment site Members will be aware that legislation and allotments is contained in part 9 of the Community Empowerment Scotland Act 2015 the briefing we've received from SPICE highlights the post-legislative scrutiny undertaken by the local government housing and planning committee on this matter with the committee noting that local authorities do not have enough resources to simply create large numbers of new allotments to meet all demand in addition to the challenges of land availability for allotments the SPICE briefing also notes that in January 2023 there were over 478,000 people in receipt of universal credit in Scotland responding to the petition the Scottish Government recognises the on-going challenges faced by local governments in relation to allotment waiting lists and encourages local authorities to look at innovative ways to reduce allotment waiting lists the Government response also provides information on the funding it has allocated for community growing over the last decade in relation to universal credit the Scottish Government state there is no provision for it to provide an allotment to universal credit recipients in Scotland but does list a range of benefits managed and paid for by the Scottish Government for which universal credit is a passporting benefit do members have any suggestions or comments on what we might do in the light of the responses that we have received from SPICE and the Scottish Government David Towns? Thank you convener I think when you have 470,000 on universal credit I think what the petition is asking is impossible to do for local authorities across Scotland because normally there's actually a thousand people waiting for allotments who are willing to hire them so I think this is a very difficult situation and I'm quite happy to close the petition under real 15.7 of standard orders on the basis that allotments under provision are primary responsibility of local authorities Mr Stewart? I think that Mr Towns has indicated convener that there's a difficulty here and there certainly is I think that the idea of this petition is sound in some ways but it's not practical in others and I think that that is the problem that we face here that it would be virtually impossible we're all aware of the difficulties that local government are at the present time and even the allotment space that they have and land coverage that they keep is an issue and there is already some ways that the Scottish Government is funding to enable groups to do sound things within their community and I think that's also part of the equation so I would concur with David Towns that I think we do not see this progressing in the way the petitioner wants because it's not practical and it's not feasible in reality to achieve it Mr Ewing? I endorse what my colleagues have said and it's something that might be desirable in many cases but to create a universal right I think would impose an obligation on local authorities that is simply unenforceable and deliverable and you know we do it whilst always being mindful of supporting the petitioner as far as we can we have to be mindful I think that the financial reality is facing local authorities at the moment that they wouldn't thank us when they're under real pressure to deliver fundamental basic services at the moment across the board Thank you Well I think we agree I think we all can see the substance of the issue at heart I am struck still by the Scottish Government's suggestion that local authorities look at innovative ways to reduce allotment waiting lists I'm struggling to think what an innovative way of dealing with an allotment waiting list would be but not withstanding my puzzlement with that concept I tend to afraid I reluctantly am of the same view I mean the very clear advice of the Scottish Government is for the local authorities to deal with and as Spice pointed out that several hundreds of thousands of people that the petition would be seeking to give an entitlement to and I think that's impractical that while we understand the substance of the issue under rule 15.7 we will close this petition is that the view of the committee it is So I'm sorry, not necessarily the decision that the petitioner will look for but thank you for raising the issue and we have obviously put the concern on the record Petition number 2008 to provide funding for a separate mental health A&E for children lodged by Kirsty Solman the petition calls on the Scottish Parliament to urge the Scottish Government to provide funding to create a separate accident and emergency for children and young people presenting with mental health issues the Scottish Government's response to the petition details on going work to support people experiencing poor mental health it states that several mechanisms are in place to ensure emergency mental health care is accessible quickly and as close to home as possible an example provided is the mental health unscheduled care pathway which ensures that anyone presenting at A&E in a mental health crisis is properly assessed and cared for and care plans are put in place that may include support from crisis support organisations local mental health services or admission to the hospital where necessary now the redesign of urgent care programme ensures that each health board is providing access to a senior decision maker an SCDM 24 hours a day, 7 days a week for urgent mental health assessment or urgent referral to local mental health services the Scottish Government published the national CAMHS service specification CAMHS service specification outlining the provisions young people and their families can expect from the NHS which includes a 24-7 mental health crisis response service for children and young people now the petition's response to the Scottish Government highlights that there are only two wards for those in crisis with their mental health in the west of Scotland and questions the effectiveness of speaking to a child or parent over the phone to assess their mental state the petitioners also question the rationale behind the redesign urgent care programme stating that it does not have sufficient CAMHS staff available she also notes the lack of information on the locations of available hubs for children and adolescents struggling with their mental health the petitioner raises a number of challenges back to the Scottish Government in response to its submission details of which are available in the clerk's note and I wonder colleagues if we can agree that we will write to the Scottish Government requesting that it provides a clear view on the merits of what the petitioner is asking for and then responds to the points that have been raised by the petitioner in that recent submission to which I've just referred we are agreed with that thank you very much for the position that we are considering this morning so that brings to an end the public part of our meeting this morning and we now as agreed earlier move into private session thank you