 I think we just need to make a restart, I think. Good morning and welcome to the first meeting in 2016 of the health and sport committee. I would ask everyone in the room at this point as I normally do to switch off mobile phones as they can interfere with the sound system, but you will also notice that some of us using tablet devices instead of our hard copies of a paper. We have received apologies this morning from Rhoda Grant, who is unable to attend. Our first item on the agenda today, of course, is our first evidence session on the burial and cremation Scotland Bill. Bills, I should point out, at this time by their nature have to be very precise in their meaning and their language that they use. As such, there may be some language and terminology used this morning, which some people might find upsetting. I wish to apologise in advance of that if that does occur. It is not our intention to cause any offence, but it is the language and terminology of the bill that we are working with. I would like to welcome this morning to the committee Willie Reid. We are expecting Cheryl McHannan, and we welcome Cheryl when she comes. Anne McMurray is still with the Neonatal Death Charity Scotland sands. Willie, you are prepared to make an open statement to get us under way here this morning and understand. Please do that then, and then we will take some questions. Thank you very much for having me along here today. Just to give you a brief history on where I stand on that, I am an affected parent, and my daughter died sadly in 1988 and was cremated at Morton Hall. I am not going into the full details of the surroundings to that, but more to what has happened since the story broke about the baby ashes scandal. The big thing that I found was the political side from it. Right at the start, I personally wrote to Mr McCaskill, the then Justice Secretary, who got no reply from him, to the First Minister, Mr Salmond. It took seven months for us to get a voice here in the Parliament from the Government level. At that point, Mr Salmond—I was calling for a public inquiry—although Dame Angelini was doing the Morton Hall report on behalf of Edinburgh Council, Mr Salmond commissioned Lord Bonomy to carry out an infant cremations commission. The downside to that was there was a political fight between the Government and Lord Bonomy about having parents on that committee, and none were. I thought at that point that Lord Bonomy suggested that the emotion of it would be too great, and I just found that to be the kind of thoughts of how things were when years had gone by, as opposed to what happens in modern day. The next thing that was after Lord Bonomy reported with the 64 recommendations was that the bill was announced and that the HMI cremations was announced as well. That was an appointment that was announced in shining light, shall we say, when the post was advertised. It came out like a two-walk bulb. It was only a part-time poster on 90 days. There are 27 crematoria in Scotland. How can they be snap inspected and inspected with such a low or part-time role? However, Mr Salmond has been appointed to that and appears to be doing a fantastic job. The bill has then been sent out and draft. My big concern from it is that I worked within the cremation procedures sub-committee on that in the Scottish Government national committee. However, the death of a baby or the loss of a baby starts right at the beginning, normally within a hospital, then goes on to undertakers and then on to cremation authorities. My personal experience was that I never spoke to anyone at a crematorium. Everything was done through undertakers. They were the ones who gave me a forum. I was a 22-year-old young lad who, two days before, had lost my baby and was asked to sign that forum. At that point, I was told that I didn't get ashes from babies. However, 25 years later, on site of the forum, there was a tick in the back saying that disperse the remains. Why would I have wanted the remains to be disperse if they were never there? My big point about that is that the funeral directors have a big part to play in that, and they do not appear within the legislation. They are the ones who are the first contact that needs to be licensed and regulated as part of the bill. How do we do that? I do not know the right way. However, the extension to the Her Majesty's Inspectorate of Cremations role could incorporate that. It would be easy to say that it is licensed at local authority, but, given the nature of what it is, it would have to be licensed and regulated nationally, so that every undertaker in the land carries out the same procedures, whether it is an adult cremation, a baby cremation or whatever. That would be a hard job for an inspector to go around and inspect on his own, and to understand the austerity measures that were in it at the present. One suggestion that I would like to put forward was to bring in something akin to custody visitors that they have in police custody centres and prison visitors and those people who would, in the large bay, voluntary to go around and inspect and look at what undertakers are up to in the report to the HMI. The big thing about the bill is that it has to go forward so that it just will not allow the procedures of the past to continue, but it has to ensure that they cannot continue. There has to be some sort of censure to those who are contravening it. For example, if I get caught speeding and I am going to get £60 fine in three penalty points, if I carry an knife in public, I am liable to an imprisonment of five years if I commit murder then in life. There is nothing in the bill that suggests that, if anyone contravenes any of the procedures that are in there, what the censures are. The other big thing that we have to ensure is that, as the bill is worded and written out, when there are contraventions, the investigation and the subsequent censures have to be robust, they have to be swift and they have to be fair, more especially to the parents. We are now getting into the fourth year of the scandal since it broke at Mortonhall. I am still being played as a legal football between the Lawyers of Edinburgh Council and the Lawyers of Representing Parents. I hope that that will not happen, but should that happen to any affected parent in the future, I do not think that it is right that the length of time that we have been involved in this should be the time that they are expected to in the future. The effect of losing someone dying, we all are going to die at some stage. However, a baby's death is slightly different because the mother and the father are looking forward throughout a pregnancy for the arrival of that child. It does not matter at what time or a gestation that the baby is born or lost, joy turns to instant pain. That in itself takes a long time to get over. To revisit this 25 years later has been the most horrendous thing that I have had to deal with in my life and I am sure that I speak on behalf of other parents who feel the same. Ultimately, the bill has to ensure that it cannot and will not ever happen again. I agree with Willie, in the sense that for parents who were affected—I am a bereaved parent, but I was not affected by the Ashley Scandal, thankfully—for this whole process, it is giving them renewed grief, so they are right back to the very day that this happened to them. For me, I wonder what concerns the committee would have for those parents and what support and mechanisms can we put in place to ensure that they get the right support to get through this renewed grief and trauma that this has caused. We are going to move to some questions now and then around the bill. I am sure that I will be picking up some of the points that have been made already. I am Bob Doris for our first question. I thank Willie Reid and Annick Murray for not just your opening statement, Willie, but for preparing to give evidence here today. I just wanted to mirror back a couple of things that you said, Mr Reid, so that you know that we are listening. You are very keen to see when there is a breach of what should happen, that there is effective enforcement and that there are sanctions in place and that there are consequences and people are held to account. How that happens is another thing altogether, but I was listening carefully to that. I was listening carefully to the idea of consistency to make sure that we know it does not matter what local authority is and what crematory is involved and that we have that consistency. I am initially going to restrict myself to some of the provisions in the bill, because part of the process is that we will help to shape the bill as it goes through Parliament, but we have to be sure that the parts of the bill that you are supportive of, as well as other things that you would like to see improved, are part of the process. I am going to pick up a couple of bits of the bill that I would like to find out if you are supportive of that, and that is the reason for asking that question, because we have to prepare a stage 1 report to order us to make recommendations to the Scottish Government. I am looking to deliver my briefing for today's session. One of the things that is contained within the bill at section 38 is that it is now expected that Ashes will normally be recovered in the vast majority of cases, but where that does not occur, the inspector of crematoriums will investigate. It understands that there may be concerns about what that means in practice, but is that a positive step forward? I am going to roll that together just with a second thing. It is expected that, if there are not Ashes as a result of a cremation, there will be an investigation of some description. Also at section 55—I apologise, I want to be very specific about the different parts of the bill, although that is okay with you—there will also be a register of disposal of remains, which is a duty on each health authority to maintain a register of recording the disposal of remains when pregnancy loss occurs. For that, we are talking about normally before 24 weeks. Obviously, the healthcare system is not as good as it could be in relation to how it deals with pregnancy loss before 24 weeks. There has to be a register for that, and there has to be an investigation in each instance whenever there is a cremation that no remains are found. As we go through the bill, we have to assure ourselves the bits of the bill that are fit for purpose and the bits that need proofs have deliberately picked two very specific bits. I hope that that is helpful for you. Some comments on either of those two things would be very welcome by the committee. Certainly, for the investigation, it is very much welcomed that the cremation authority has to inform the HMI cremations of any failure to recover Ashes. I think that Dame Angelini's Morton Hall report, with the technical support that was given to her, states that Ashes could normally be recovered after 16 weeks. The definition of Ashes has been changed, and that is highlighted in the bill. I would like to think that, should the procedures that are adopted from the national committee, if every local authority or cremation authority abides by that, there should be Ashes at every stage. As for the registration of the remains, I would ask Anne to comment on that, because that is something that I am not overly familiar with and did not really look into practical. I think that we welcome the registration of pre-24-week babies. I would also like to add that, in the majority of cases, those babies would still, if they were cremated, be able to obtain Ashes. It would only be in the very early losses from 12 weeks below that they would normally not have an individual cremation. Therefore, although there would be Ashes from a communal cremation, parents would not be able to get individual Ashes, because they would not be able to identify those, but there would still be Ashes, which would then be scattered in a sacred place in the crematorium. Now, we move to Richard Lyle. Can I say that your opening statement was very powerful? I am sure that many of the committee has taken board what you have already said, but if I can turn to, I will bring Anne in if possible. One of the submissions that we got, a parent stated that their daughter died at 23 weeks of gestation. The cremation was organised by a local maternity hospital. At the time, she was given not given the option of burial via the hospital or privately. Minutes after her death, she was handed a cremation form to sign. She had been sedated shortly beforehand. The procedure was not shown in the forms, and they were not explained to her. No point were the forms ever explained, as I said. In your submission on behalf of Sands, you welcome many parts of the bill. You disagree with the proposal on the bill to create a single application form to cover all cremations for both adults, children and babies who would die. You suggest that it should be separate forms and cover it in regard to the point of who should be involved, who should be explaining what is happening, should it be the undertaker, should it be the hospital. If I could ask both of you, and as I said, if I may be touching on points that are very sore, who do you think should have the form be multi-purpose, or should it be separate forms for each case? If you could explain what you mean and by your submission, and maybe Wally could tell us where you think the forms should be with, either the hospital undertaker or who else? I think that the most part would probably be more than likely to be the hospital, because that is where the parent is more likely to be when that event occurs. With regard to being separate forms, it really pertains to the very early losses, because for some parents who have had a termination for fetal abnormality, for those who choose to have a termination for whatever other reason, they might not want to have a form that says baby on it, and it might be more distressing for them, so that was really the main reason for the separate forms. It is unlikely that parents would go directly to a funeral director, because as I say, the event normally happens within the hospital, and therefore it would be the hospital that would deal with the parents initially. However, it is important that parents are given the choice to speak to a funeral director, and that the hospital should not always take ownership of that process, and that is what sometimes happens. Parents are then not given the choices. I think that with the set-up of the sub-committees, and we are looking at training and procedures, in that committee, we are looking at making sure that the staff that deal with parents have as much information as they can, that they can pass on to parents so that they can make an informed choice about what will happen to their baby. I am worried about the point that Ann was making about undertakers. If things may have changed, I mean that we are now almost 28 years since the loss of my daughter. However, it was the hospital that guided me to the undertaker. I gave all the details of what happened and undertaker filled out that form. My mother passed away just eight months ago, and I did not see an undertaker about her cremation. Right again, I was an undertaker quite happily filling away the form. We had more experience this time, and I checked over everything before I signed it. However, when you have just lost a baby, as I explained to you, the joyous occasion that is approaching is taken away for forums to be put under. I think that there is maybe an onus in the hospital. Maybe the hospital chaplaincy, and then on to the undertakers. However, I do not think that this forum should dress with just undertakers in the bereaved. Or, if there is, there maybe has to be a 48-hour 72-hour cooling period to then go back and say, here are your options, whether it is cremation, whether it is burial or whatever else. 72 hours later, this is what we are going to go ahead with. Are you content with that? Then a countersignature on the forum would probably be better than what was there before. There is the option that parents have a timescale to be able to change their mind about what the decision that they have made. I think that it is about three days or four days. I think that that is something that would well be incorporated into the bill. Then every undertaker, every hospital unit has to then abide by that, because at the moment I would say that we are just a guideline and a guidance as opposed to a part of that. Is it more about the communication here? It may well be. We are dealing with a traumatic situation. Some people will be able to cope with that. In the reflection, asking the right questions, the communication is better than you would have been able to do that. Was it willful that this neglected a forum and reduced it to a forum? There is a paternalistic approach from whoever is in there to try and alleviate some of that bureaucracy from the person who is dealing with a traumatic event. How is it more about the communication and helping people through that process? Or every question on a forum or the language, whether it is considered a baby, can there be a standard, I am asking, about how we should be dealing with it, because everybody will be very different in terms of their coping? You are saying that, but on years gone by, my experience was that it was a case of, that is not so good that you have lost a baby. If you go having a learning crack on your life, that was society's view of it back then. Society has changed now. If I am going to be reflective of my life, I was the man, I had to organise a funeral, and I had to do this and do the next thing. It took about 20 years for me to realise, do you know what? I did not do the right thing and it came back to bite me, but that is another matter. At the time, the forms have to be correct, they have to be, because, as I say, there was a tick in the box of my daughter's for me that said the disposal of the remains in the garden of remembrance, but the undertaker told me that there was no ashes. Was that willful? I would suggest that it was. I think that, again, there needs to be some sort of training programmes for everybody across the board, not just health professionals, but funeral directors and Mkrimistoria staff, to ensure that they give a consistent message to parents when they are arranging a funeral of their baby. I do believe that people do not set out to willfully mislead us. They think that they are doing the best for us, but hindsight is a wonderful thing. Honesty is much more acceptable than being led down a different route, because all of us would have made different decisions if we had been given the correct information at the time, and allowing parents to have that space to reflect on the decisions that they have made and the opportunity to change that decision. Dennis Robertson, with regard to the bill, there are suggestions in the hospital area, for instance. Do you have a view as to who should provide the appropriate information in order that the parent and parents could make a decision with regard to the baby that has died? Or, indeed, maybe a stillbirth prior to the baby being born? Do you have a particular view as to who should provide that information? Probably, it would need to be an experienced staff member, and a lot of the hospitals now are using senior midwives who have a particular interest in bereavement, and therefore they would have most of the information that they need to have to pass on to the parents. However, as Willie Sayed said, the hospital chaplans could be involved in that as well. Again, there is only one paid bereavement midwife in the whole of Scotland. There are others who are doing the job but are not recognised as that, and I think that that might be another issue, but it should be something that could be looked at. There is also part of the bill in terms of, if there is a disagreement, say, with the parents as to what should happen, it is suggesting that if you cannot come to an agreement, then the courts should make that decision. Do you think that there is another way forward, or do you agree with what is being proposed in the bill? I think that I agree with what is being proposed in the bill, but it would have to be something pretty traumatic for it to get to that stage. However, if there becomes then a legal battle or even a battle of bills between the cremation authority and the parents, a swift court judgment would not be the best way forward. Do you know of using that on? It is hard to imagine that it would get to that stage, I suppose, because I have to take that on the account. Malcom. Thank you very much for your statements at the beginning and the questions. It was very helpful for us. Willie Rennie said that he wanted to say a bit more in relation to funeral directors when he talked about inspection, so that would be one way of dealing with it. What are the concerns that you have about them? You have described some of them, but should there be anything in the bill, specifically apart from inspection, should there be any requirements of funeral directors that could be put in the bill? I could go out and start an undertaker's business tomorrow with no training, no licence, no nothing. Get a couple of herces together and they're at arm. I suppose, like any business, you're always going to get your rogue traders. However, I think that all undertakers should be licensed nationally. They should be regulated so that they all carry out not just the service but the procedures that they're building up to, whether it's a cremation or a burial, nationally. As I said earlier on, if they contravene that, there has to be some sort of censure available when they do it. They are the first point of contact for a funeral, but particularly with a baby. As I said, they were the ones who fed me down this, there are no ashes. I never spoke to them at a crematorium. I never spoke to the hospital about it. It was undertakers who completely nutterly fed me that. My knowledge is that a lot of their small family undertakers are being taken over by the bigger businesses throughout the country. I think that the bigger the companies are, the more profit they are going to be looking for. However, I'm not particularly interested in what profits they make. What I'm interested in is the way that they treat families, the way that the forms are filled out, and the fact that there should be some sort of corroboration to what they're doing with those forms. 72-hour lay-off period or period to reflect on what we're doing, that should be there. A second signature by the parent who is organising the funeral, so it's not just one signature at that time. I think that a lot of us have concerns that there is no regulation for funeral directors, or no regulatory body. Some of them are affiliated to their own bodies, but there are independent funeral directors out there as well. For us, we would want to see a consistent approach, that they all have the same training in their background, and the approach that they have when dealing especially with vulnerable parents. You lose other family members and yes, it's traumatic, but the loss of a baby is unthinkable for everyone. It's something that you learn to live with. It's not something that you ever get over, but you learn to live with it. Any death is bad, but the death of a baby, people's instincts, are completely awry, and they really need somebody to be very compassionate and caring when they're giving information to make sure that the wishes that they really do want are adhered to. When a lot of discussion has been about the ashes, and it's very important in the bill, what the bill says about ashes, but I wonder if, as I understand it, there will still be some provision while the ashes will be recovered whenever possible. Do you feel that the provisions are strong enough or could there still be worries that ashes could have been recovered but weren't? Is there anything more that could be done to ensure that they always are recovered whenever possible? I think that the bill does state that ashes, as everything, remains after the last excluding metals. As we've said already, they should be able to recover ashes from every cremation of a baby, no matter what gestation, apart from those very early losses where they are in a communal cremation. Plus, it does say that, if there are no ashes, that will be investigated as to the reason why there are no ashes in that instance. For me, I feel that it does cover that. Parents can be reassured that, in 99.9 per cent of the time, there will be ashes from that cremation of their baby. I think that, just to bring to the point when I was sitting on the Procedures Committee for the National Committee, one of the phrases that it was going about was to minimise the loss of ashes. What I suggested was to put into guidance that was put out to all local authorities. It wasn't, it was to maximise the recovery of ashes. I think that it's all about putting the positive spin on to what's required, as opposed to the negative of what we don't want. In the guidance that I certainly know has been issued to all crematorium authorities, it has been to maximise the recovery of ashes in every case. Is there any other members who wish to ask a question? Any other members who have not asked a question wish to come in at this point? No, Bob Doris for Richard Lyle. I hope that there is not a bit of repetition here in saying this, but I shouldn't be clearing my head about a couple of things. That's okay. Firstly, maybe just in terms of the idea of regulation of funeral directors, I have put my head around how that would work, but I think you made your point quite clearly in relation to that, but also in terms of where ashes are not recovered. That's what it's not just about identifying where that happens, but what are the processes that lead to the fact that ashes are not recovered and if those aren't satisfactory, how do you make them satisfactory in the future? It's about driving change in that process, so I get that and I'm listening to that. I think that we have to go back and ask questions about that as well. However, where I wanted to specifically come back in was the idea of the role of the funeral director, because let's work on the basis. I hope that most funeral directors have compassion and are sensitive. Unfortunately, I recently had two of the funeral directors from my mother passed away in December and I would paraphrase that relationship with the funeral director saying to her family, what would you like to happen, and then they sought to make that happen. Yes, through a forum, but the importance of the forum for me wasn't what the forum looked like, it was that I understood what was happening and I was very clear about what was happening. I can only imagine how much more difficult that is when it's a baby or an unborn child that you're having to go through that process with, which is why I'm coming back to that point again about the idea of a cool-off period or a single point of contact, whether it's at hospital or at a funeral director that takes you through that process. A cool-off period where you have that initial conversation, maybe you look at a forum, maybe you don't, about what's happening as a cremation, whether there's a likely to be ashes, what the process is around that. Horrific is that's going to be when you've just lost a child. To have that conversation a second time could be doubly distressing, I suppose. Actually, I'm not making a point at the question, I'm hoping to ask, is it worth risking that additional distress at the very short term when you're in grief anyway to make sure that you've got absolute clarity and absolute certainty in the process? Maybe at a time when a lot of grieving parents can't cope with it or don't think they can cope with it, so is there a tension there between putting something in place? Maybe there's not maybe we should just do it, but is there a tension between putting something in place when you go back to a grieving family a few days later when maybe they were struggling initially and the funeral director or a single point of contact can help manage them through that process? Going back a second time may have unintended consequences, is there a balance between that? If we were to recommend what you're suggesting we would have to make sure there were unintended consequences, but I like the idea. I think the best way to explain this to you is the current bills we have date back to 1905 and 1935 or 1937, so what we need to do with this bill is not just see what's right today but see what's right in 50 years time. Now, as I said in an opening statement how the death of a baby was seen by society 30 years ago, 25 years ago is completely different to the way things are today and I think we've got to give humans a bit of credit that yeah, where there is distress that that distress may be required to do the right thing. What's become apparent of this is because in Edinburgh alone at Mortonhall there was 153 cases, I believe. 153 times funeral directors and cremation authorities got it wrong, so in 50 years time we want that still to be none, because I believe in the last year there's been recovery of ashes in every single baby cremation in Scotland. We don't have to go back through and over the whole form again, but I think it's just a checking balance. It can be a phone call, pop into the funeral director's office and say, this is what we're doing, are you content with that? Are there any changes you want to do or make if there isn't recount or signage to say that everything's fine? I hear where you're coming from, but I'd rather that potential grief that you're talking about was there and then at that time than in 25 years time down the line. It would be difficult, but again if people have the right training they'll be able to approach parents in a way that they would not be as upset as a just a blank, right? We need to go over this form again. There are ways of speaking to the parents and asking them. We just want to make sure that your wishes are what they are, that you haven't changed your mind that you were given. And they're told at the beginning that they have a cool-off period, that they have a period of time that they can reflect and that if they want to change their mind they can do so. And at that point they could say, we'll come back to you in a few days time just to check that that's still your wishes. So there are ways that you can be gentle with parents without making them. They're not going to feel any worse than they do, actually. I find that the comments are made very persuasive. I just wanted to be absolutely sure for clarity for the evidence that we are getting, so I found that helpful, thank you. Should the role of the funeral directors then be set out clearly in the bill? I think so, yes. Again, we're looking at today and what went wrong yesterday, but we're willing to look at tomorrow because in 10, 15 years' time, this will have been a story that will be sent away into history. Bad pennies can turn up more than once in a lifetime. And I just feel that at the moment the beam is on, the funeral industry at the moment because of this scandal. If we take that beam away and the beam is now that act, then your role trader could be back in 10 years' time going back to the old practices and procedures. I mean, just to give to that, we're four years down the line from this ash scandal coming out and it's what I was saying to you about censure and punishment. There's been nobody putting a court of law of any sort in this country over what went on thus far. Now, I know Dame Angeline needs still having her national investigation, but I'll go to my grave and never knowing what happened to my daughter's ashes. The person who was responsible for doing that is walking about scot-free. I'm not suggesting that we're looking for somebody to go to the jail right now for it, but if we don't make sure that act is watertight now in 50 years' time, we could be back with this scandal all over again. Richard Lyon. Can I say to Mr Reid that when death comes to anyone's door and every family's door, it's a traumatic experience and sadly most of us have been through that way, loved ones, and I don't take away the point that you've made about your daughter. I certainly agree with you. Can I turn to the point that you made earlier? You welcomed the factor of the appointment of the inspectorate, but then went on and said that it was only 90 days. You then suggested that we should have local visitors who could possibly appointed people who could visit undertakers or whatever. Would you like to expand on that? And also, prior to possibly another question, I'd like to ask is what is not in the bill, what do you think should be, what is the rest of the bill? The HMI is one person, and he's got the task at the moment of inspecting 27 Crematoria, because the procedures have been changed and they have to be seen to be abiding by that. Obviously, if there's any investigations coming out, he's a one-man band, so to speak. If the undertakers were regulated and licensed, they would need to be inspected as well, and that would probably be too much of a job. I have no idea how many undertakers there are in Scotland, but I can guarantee that it would be an awful lot more than 27, like we have in Crematoria. I think that what I'm trying to get at is that it's easy enough to write to somebody and say, right, I'm coming to inspect your register, because if I can go back a wee bit, when the story broke, I went to the local undertaker who carried out my daughter's funeral and they didn't have records. They should have records, so that's probably the first thing. Even if it's just something dating time of Funeral, who organised the funeral, they should be keeping a register as well as a Crematorium. It's just a case of ad hoc inspections by, as I say, these could be volunteers who are only getting expenses or giving some sort of minimum remuneration countrywide that can just go in and go into an undertaker and say, right, let me see what your last ten funerals have been. It's snap inspections, they're not giving any warnings or whatever, and it's just so that someone is keeping them on their toes. If they know that, that's there, then the likelihood of them not doing the right thing would be very much minimised. Allowing me to convene, would these be appointed by the inspector? Many years ago, councils used to talk about prisons earlier, prison visitors, but that doesn't happen now. We've changed that system to my knowledge. The sub-inspectors, let's say, would they be appointed by the inspector, or would they be appointed by the local council? What would yours be, if you could give me that? They'd have to be independent of the council, because ultimately the council would be the Cremation Authority, so they'd have to be independent in some way, but I don't think that I would have an issue of them being appointed and vetted for whatever with the HMI. That's the answer that I was looking for. Dennis Robertson, with regard to the records, do you think that the bill should specify very clearly that all records for burials and cremations should be kept electronically and probably enable a transition period for anything that's currently recorded on paper to go electronically for ease of access and for, obviously, future records? We're in the 21st century. Do you believe that it should be an electronic register? I do, because, having now, 25 years later, I've seen the records that are held by Edinburgh Council and my daughter's cremation, and there's a register, and then all the forms are now into microficiants, so they're actually quite difficult to read and whatever else. I think that that was one of the recommendations from Lord Bonomy, but there was a national computerised record that everyone showed. Do you think that the bill should specify that? I would have no qualms with the bill specifying that, and putting it on to the cremation authorities, they must have it for them to run as an authority. Ease of access to the register should always be free of charge? Very much so. The bill said that the records must be kept of every burial and cremation, which wouldn't identify a woman who has experience of paying the laws before 24 weeks. Is there any concerns that arise from you? It's got to be available for the public, but, like anything else, I think that once it goes on to a computerised record, I'm no lawyer, but the data protection would then come in to play on that. I would imagine that names and dates are birthed by the redacted, however the procedures of the cremation and what happened should be available. If it's an official body, like a Government body, that redaction could be removed, but when it's open to the public, I don't think that the public needs to know the name and date of birth. With adults, I don't suppose that it's a big problem, but with babies it's a little more sensitive. I wouldn't have thought that it was a matter of public record, but it's available if you, as the parent, want to check those records. Also, the fact that there is that anonymity for those parents whose baby was born before 24 weeks, as to how much information is given on that as well. However, it's important that those records are kept and that they are available for those parents who want to check. However, it would be available to the public as far as the bill says that it would be available to the public, but the woman wouldn't be identified. Any other questions from the committee? Thanks, convener. This is my last question, I promise. Again, it all seems to come back to being sure what's happening within the process. Yes, having trust in the funeral directors and cremation authorities in crematoria, but having a check-in balance in place to make sure that they're doing what they say they'll do. I think that Mr Wood gave the example about if someone was to go in and do a spot check and tell us about your last 10 cremations or burials or whatever that process would be. It's not your job to justify your alternative solution, but I'd like to ask a general question on that. I suppose that a funeral director or a cremation authority could say that there's the forms and the forms could be filled in perfectly, but the forms could have been filled in perfectly 30 years ago, but it doesn't mean that people knew what they were signing up to or they were complicit in how the forms were filled in. I could imagine again the only real way of making sure that the process was dealt with sensitively is that vexed issue of going back to the parents and asking them how they felt the process was. That brings me back to my last question, I suppose, about what parent really wants. How can I possibly know if I've not been in that situation three months after their buried or had their baby cremated or six months or nine months or whenever I knock at the door on a telephone call or an email saying, can we just have a little chat with you about it? I can see issues with that. That's not a reason not to do it. It's a reason to think carefully about how we make sure that we're talking to parents, so maybe just some thoughts in after. Rather than the detail of the suggestion that Mr Rood made, because that would be unfair on you, it's not for us to interrogate that. It's to scrutinise the bill, but what's not in the bill, I suppose, is how we go back to parents after they've been through that horrible experience in the process of cremations and burials to see that they thought they were dealt with sensitively, appropriately and had clarity and assurance on what was happening in the process. I suspect that that's not in the bill. How could we put it into the bill and should we put it into the bill? I don't know the answer, but, again, I think that last year, both you and I lost our mothers. After my mother died, I think it was maybe about a month to six weeks later, the crematorium wrote to me and said that he wanted the name in the book of remembrance and how did things go. I think that one way of adopting that would be part of the initial conversation right at the beginning to say, you know, we've had your cooling off period, here you are, you've come back, this is what you want in your cremation service. Would you object to us coming and speaking to you in 12 weeks' time just to, you know, or the HMI coming and speaking to you in 12 weeks' time just to ensure that everything went to your satisfaction? I would think that you'll get some parents would say no, but I think that the majority would be quite comfortable with that if they knew, you know, again, how that's given over. It's not a weird Scottish Government and we're determined to come and see you in 12 weeks, you know, but in a more sensible way, I don't think that would be an issue. I'm in two minds about that. I'm all for looking out, see if things have been done. I think it would probably need to be longer than 12 weeks, but if it was part of the initial conversation and then it's another tick box on the forum to say, yes, this parent would be comfortable with people. They would have the option if somebody contacted them to say, well, actually, I've changed my mind. I don't want to make a comment. I'm in two minds. I think it's another tick box and another exercise. Those are the thoughts that I had in my head as well, so thank you for putting that on the record. I think that there were just a couple of wee things that we'd like to get for clarity. I'm looking for page 6 on the briefing in terms of the bill. We've looked at records as they apply to the funeral directors and retailers, and the bill explains that health authorities must keep records of what a woman decides to do when they're pregnant and they're lost, and in many cases that's where the initial record would be, as well as what happens in the health authority is asked to bury or cremate those remains and the information would be anonymous. There might be a comment about that approach that I think it's been alluded to earlier. Should anyone check that the health authorities are keeping records, who would do that? How would we be able to monitor that record keeping within the health service? I think that in the majority of cases that parents are dealt with by the health professionals in the first instance. With regard to the keeping records, it will be on their health records, that information, so it's there already. The onus is on the health professional to ensure that they update those records when they've spoken to parents. So it shouldn't be said that you can just be part of somebody's medical record then? I think that that information should be there. Obviously it's there that you've had a stillbirth or a baby who's died before 24 weeks or whatever the situation is. There should be some sort of information that they have spoken to them about funeral arrangements or passed them on to the funeral director or whatever the action was. That would prevent us from having some overall check and monitoring of the system. I'm looking around here, but medical records are something that's not shared generally. It's private, so you wouldn't be able to ensure that the public could be aware that the practice that the bill quotes to establish could be monitored by the public, like some of the other measures. But if the hospital will have contracts with funeral directors if they're going to make the arrangements on behalf of the parents, surely there must be a record trail of that? I'm looking to you, who have experienced that. If you try to examine some of those records, would the records be there? The bill said that they should be in the future, so we presume that they're not regularly established now. Is there something that we can explore? I mean, if the hospital has a contract with a funeral director to enter or cremate babies on behalf of the parents because that was the parents' wishes, they didn't want to be involved in that, then there should be some sort of mechanism in place where those records are there. It would be very strange for hospitals not to keep such records, but I haven't experienced that. It's maybe worth something that you guys want to check out. There's no right answer to these, but that's as good as an answer we're going to get, maybe we will all ask those questions. I suppose that the other one in terms of if the bill says that what should happen when record-keeping a woman loses a baby in the first 24 weeks of pregnancy, and this is the catch-all that the bill says that a woman decides, within a week of losing her baby, that decision must be recorded and signed, but nothing will happen for the further seven days. I suppose the earlier comments is that sufficient. On the other side of that, we know from our caseloads whether it's children or indeed adults, that there are big cultural pressures in some of our communities. We receive regular case work about the length it takes to get a funeral, etc. Now, if this becomes standard, that's at least the fortnight before we're into another month. I don't know whether you support this as a standard or whether it becomes a requirement that can cause some cultural problems with certain defined communities. If someone has a particular culture that they wouldn't be adhering to that, they wouldn't be taking the choices of waiting a week or waiting another week to make that decision. The decision would be made that that's their culture and that's what they want to happen, and that that child would be buried or cremated within a certain period of time. Whether it's right or wrong for that parent, but if that's their culture and that's what they believe, they will just do that. I think that, in that sense, the option has to be there for that culture. To say yet, your culture says that you go ahead with that, however, what's in the act gives you that option of waiting. I don't know how that could do best. Written into the bill, I'm sure that it would have to be accommodated, but I think that doing the right thing does that take precedence over a culture? I don't know the answer to that. No, it's not a question that we can't answer because it may not apply to our given situation, but if you have a bill that says that even if the decision is recorded, then it would be another waiting period of time, which I think Anne had mentioned, which is very important in terms of that. That would be the rules of law. It's maybe something that we can explore for that. I don't know. The question that I'm going to ask is, because I don't know the procedures, but surely the waiting time to get a cremation carried out regardless of culture isn't going to be instantaneous anyway, you may well. I would imagine with the death of, especially in the near-natal death of a baby, there's going to be a post-mortem. Any funeral isn't going to take place until after any post-mortem. It may not matter, and it may not apply. Any other questions? Willie, Anne, thank you very much for your time here this morning. We're sorry that Cheryl hasn't been able to come, but obviously we've got Cheryl's written evidence, which we'll take into account when we complete our initial report. As we come to the end of this session, thank you very much indeed. I just wanted to say that, as you started off this morning by apologising for some of the terminology that was used in the bill that we might be upset or offended by, I did ask that there should be something for any parent who wants to read that bill, that there should be something on it in a similar vein that they may find some of the terminology, but it has to be there for legal reasons. You've just put it on the record and that's a good final word, but Willie's terminology is going to have a final word. I know that more parents are coming to see committee members tomorrow in private, but to finish off, I think that the Government needs to get this right. Failure to get it right and it isn't watertight is just going to give a trauma that I never want any other person to go through. Babies are going to die, we are all going to die, but we've definitely got to avoid this double grief that we've went through. I just want to impress the committee to ensure that what we do is done right and for the best of intentions. We now move to agenda item number two, which is a decision on whether the committee will consider its future work programme in private at future meetings. I can have the committee's agreement that we follow that custom in practice. Thank you. Agenda item number three is subordinate legislation. We have one negative instrument before us today. The instrument is Food Information Minister's miscellaneous amendment, Scotland Regulations 2015, SSI 2015 410. There has been no motion to annul and the Delegated Powers and Law Reform Committee has not made any comments on the instrument. Do we have any comment from members? We haven't. Is the committee, therefore, agreed to make no recommendation? Thank you, that is agreed. Agenda item number four is subordinate legislation. This time, we have one affirmative instrument. As usual, with an affirmative instrument, we will have an evidence-taking session with the cabinet secretary and the officials on the instrument. Once we have had all those questions answered, we will then move to the formal debate on the motion. The instrument that we are looking at today is a general dental council fitness to practice, etc. Order 2015 draft. I welcome, formally, the cabinet secretary for health and wellbeing in sport, Shona Robison, and our officials Elsa Garland, principal legal officer, legal director and Jason Birch, senior policy manager, regulatory unit, health directorate, all from the Scottish Government. Does the cabinet secretary wish to make some remarks? The Scottish Government and the health departments in the three other nations are committed to legislative change and healthcare regulation to enhance public protection, and that is why changes are being made to the general dental council's legislation through this order, which is made under the health act 1999. Within the last three years, the GDC has seen a 110 per cent increase in its fitness to practice caseload, putting a significant strain on their resources. In order to ensure public protection, the GDC needs to be able to expedite the fitness to practice complaints that it receives. It is also clearly vital to prevent the GDC developing an unmanageable backlog of cases. Currently, the GDC's legislation can make it difficult to act swiftly when a complaint is received that a registrant's practice presents a risk to patient safety. To maintain patient safety, generate efficiencies and ensure confidence in dental regulation, changes are required in the GDC fitness to practice processes at the investigation stage. Therefore, this order will make five key amendments to the GDC's legislation governing its processes. The first is to enable the GDC to make rules to allow for decision making functions currently exercised by its investigating committee to instead be exercised by officers of the GDC known as case examiners. Currently, if a complaint is taken forward, the GDC must convene an investigating committee, but by using case examiners, a full investigating committee will not be needed for each case, leading to the swifter resolution of cases. As case examiners will deal with a higher volume of cases than the investigation committees, there is the potential for greater consistency in decision making and further enhancing patient safety. Secondly, the proposals enable the investigating committee and case examiners to address concerns about a registrant's practice by agreeing appropriate undertakings with that registrant instead of immediately referring to a practice committee. For example, if a case involved an allegation that a registrant's health was affecting their fitness to practice, an undertaking could address any public safety risks avoiding costs and saving time. However, the GDC's policy is that rules will ensure that a registrant must not be invited to comply with undertakings if there is a realistic prospect of a registrant being erased from the register at a practice committee. Thirdly, the GDC will have the power to make rules so that the registrar can review a decision that an allegation should not be referred to the case examiners or to the investigating committee. That power also extends to review of a decision that an allegation should not be referred from the investigating committee or case examiners to a practice committee. The GDC's policy is that their rules will provide a review that can only be undertaken by the registrar if the original decision was materially flawed or if new information has come to light, which might have altered that decision and a review is in the public interest. Such a review can only occur within two years of the original decision to close the case. Fourthly, a power will be introduced to enable the investigating committee, which will be extended to case examiners through rules, to review their determination to issue a warning. At present, a registrant can only appeal the issue of a warning by judicial review, which is a lengthy and costly process. Finally, it is proposed that registrants will be able to be referred to an interim orders committee at any time during the fitness to practice process. The amendment removes ambiguity in the current legislation and ensures that those who are potentially unsafe to practice have their registration restricted while inquiries and investigations are made. Those proposed changes are estimated to deliver approximately £2.5 million in annual savings for the GDC, which will no doubt help to reduce future pressure on registrant fees. It is also worth noting that the General Medical Council, the General Optical Council and the Nursing and Midwifery Council already use case examiners. All three regulators have seen positive benefits from their introduction on the speed of completing cases and ensuring public protection. The detail governing the operation of the proposals will require the GDC to amend the procedural rules governing their fitness to practice procedures. The GDC has consulted on its proposed rules changes and the negative procedure instrument will be laid in the Scottish Parliament this year. The Scottish Government considers that the best way to improve consistency, create greater efficiency and simplify professional healthcare regulation would be to introduce a single UK bill covering all professional groups, which builds on the work of the law commissions. I have written to the Department of Health on five separate occasions to ask for confirmation that such a bill is to be progressed. I understand that I will now finally receive a response in the near future. I am happy at this stage, convener, to answer any questions that members may have. Thanks to the cabinet secretary for those opening statements. Members, any questions? I see Dennis Robertson. Again, what training will the case examiners have? What is in place to ensure that they have the competence to meet the standards that you have laid down? The case examiners will be given full training by the GDC. We have been assured on that point. There will be a case review team that monitors their performance as the work progresses. What length of experience will case examiners have before they can become a case examiner? Of the case examiners, there will be one registrant and one layperson. In terms of the detail of that, that will be the GDC's guidance, which will be put into the rules in due course. We do not have the absolute detail, but it will be substantial, and we have been reassured. Will the change bring the GDC into line with the GMC and the other regulatory bodies that you have already mentioned? How long has it since the other bodies changed their regulations? It will bring more of a consistency of approach. The other regulators have moved in that direction for the same reason in order to have a more efficient process. I hope that it has been over a number of years that the GMC has had that for quite some time. I am not sure about the exact dates, but it has operated well for quite some time. I thought that it had been for some time, so I was asking you to check. If it has operated well, I think that it is a very good idea for all those professional bodies to come into line as far as regulations concern. Across the country, I have to say. I am sure that everybody supports that. It is interesting from the point of view of what we and the UK formally regulate. The process is absolutely identical to, for example, for a dentist and dental technician. In terms of the wording of the order, is that identical with the equivalent UK order? Yes, it is. The regulations are UK-wide for all groups that are regulated by the General Dental Council. The regulations are UK-wide, but that has to be approved by us for certain of the groups. Is that the procedure? Yes, and that will be the same for Welsh and Northern Irish assemblies. There are four groups that are regulated by the GDC, dental nurses, dental orthodontic therapists, clinical, dental technicians and dental technicians, because they are regulated since the Scotland Act 1998, and the approval of Scottish Parliament is required for any legislation that includes that. That is how it is done. It is not formally a legislative consent, but it is like that. Is that what you are saying? You have agreed that it should be done at the UK level, but we have to lay separate regulations. The regulations are consistent UK-wide. It is just because they mention those four groups that the Scottish Parliament needs to be content for the registration. Is that more like a legislative consent? In essence, yes. It is very similar to that. No, that is interesting. I thought that we had to lay separately. No, it is just one set of regulations UK-wide. No other questions? No other questions. We move to agenda item number five, which is a formal debate on the affirmative SSI, on which we have just taken evidence. Can I remind you all that that member should not put questions to the minister during this formal debate? Officials cannot take part in the debate. I invite the minister to move motion S4M14970. Do any members wish to participate in the debate? No members wish to participate in the debate. Minister, I do not presume that you wish to add anything, but if you do, you know. I therefore put the question on the motion. The question is that the motion S4M14970 be approved. Are we all agreed? Thank you. We just suspended at this point in a pause to change the panel. Thank you very much. The sixth item on our agenda today is our second and final evidence session on the DAAF budget 2016-17. Can I welcome again for this session the Cabinet Secretary for Health and Wellbeing Sport and her officials, Paul Gray, chief executive NHS Scotland and director general health and social care. Welcome. Dr Catherine Calderwood, chief medical officer, John Matheson, director of health, finance, e-health and analytics, all of the Scottish government. Welcome to you all this morning and a good new year to you all in our first session. We are moving directly to questions, which the first question is from Malcolm Chisholm. I think that we have a particular interest in the integration authorities and the funding of them, so everybody was obviously pleased about the announcement of the £250 million for social care, but I suppose that questions have been asked about how that will work in practice. I suppose that the first question is how can you be sure that that £250 million will actually be spent on social care? I am aware that you have raised the issue already in the chamber and I was able to give a brief response to you to reassure you that we are very clear of our intentions that that £250 million needs to be able to make a significant step change and improvement to the delivery of social care. We are very clear with boards that, first of all, that resource will be allocated to the IJBs. Obviously, Highland, the lead agency model, is slightly different, but in terms of the other 31 IJBs, discussions are on-going, as you will be aware, between John Swinney and COSLA in terms of the detail of the deal, but we are clear that we want that resource to deliver as much additional benefit as possible for social care. The benefit to the health service is also very important and that is why this move has wide support. Although we have already invested the £100 million over three years to tackle the lead discharge, the size of injection of resource into social care has the ability to deliver a real change in terms of the progress in eradicating the lead discharge, but also to build some new models of delivery of social care to anticipate the growing demographic changes that we have and to make sure that, through the new world of integration, we have resources at a level that can begin to meet better and meet the demands that are out there. I suppose that we are in a phase at the moment where negotiations are still on-going. What I am happy to do is to keep the committee informed once those are concluded in terms of some of the mechanics around how that resource will be delivered. I can say that, from my position as the cabinet secretary for health, I am very clear that we must see that resource work to create a step change in the delivery of social care. I suppose that it is related to the Audit Scotland report, which you will be familiar with. The recent one about integration said that there is a risk that if NHS boards and councils seek to protect services that remain fully under their control, integration authorities may face a disproportionate reduction in their funding despite the focus on outcomes that all partners should have. I suppose that it is just trying to think and practice how that will work so that we can accept that the £250 million will go to the IJBs. Since we do not know what the main sums are, have not yet been agreed between NHS boards and local authorities about how much is to go into the IJBs. Audit Scotland has reflected that concern in its report, which is encapsulated by that quote in terms of there may be a tendency not to give as much money as they should to the IJBs. It is just difficult to see that you can be confident that there will be the additional investment that you clearly want in social care. I do not know how you can ensure that it happens. We hope that it will happen, but I do not know how you can ensure that it will happen, particularly from the local authority side, I suppose. I will bear in mind that we are only in the shadow year of IJBs. Essentially they will have their first full year of operation come next April. The answer is to make sure that there is visibility and transparency for both local authorities and boards around the resources that go into the integrated joint boards. The outcomes are that, with integration and the legislation and requirements, there is a responsibility to clearly set out—not least to the public—that those two key organisations serve in their localities to set out to the public what those plans are and what the outcomes will be from the resources that they are investing and what the priorities are for the collective resources that will be invested. To be held to account for the delivery of those outcomes, as a Scottish Government, we have a responsibility to performance manage the NHS and make sure that they play their part in that. There is also an onus on local government to be seen to be playing their part as well. It is established by statute. There are certain requirements through that statute around the production of reports and so on. There are a number of levers that can be used, but my expectation is that there is far more to be gained by both organisations making that work for their local populations. We need to make sure that both are held to account for the delivery of that significant resource. I am sure that others will want to pursue that. I can ask one other question about NRAC, because I was very concerned to see the extent to which certain health boards that seem to have been moving towards parity are now moving away. Obviously, I have a particular interest in Lothian, but I am sure that Dennis, beside me, will have an interesting grampion. Lothian, for example, will be 30 million from parity based on the allocations for next year. That is the total sum of money that you set aside for NRAC parity next year. How do you see that? That creates particular problems for boards such as Lothian. What is your plan now for NRAC parity? Does that mean that it will take longer than you thought? Why would you not consider trying to at least bring all the boards within the 1 per cent, which I think was your original target? I do not think that 30 million will bring all the boards within 1 per cent of parity. Obviously, NRAC is a process over a number of years. There are three main gainers from NRAC in 2016-17, but the two big gainers are Lothian and Grampian, which will receive more resource than they have budgeted for. As I understand, the uplift to Lothian is at 6.4 per cent and Grampian at 6.6 per cent. There are significant gainers in 2016-17 through the NRAC formula. In terms of the 1 per cent, that would bring Lothian, for example, to just 1.4 per cent. Just slightly above the 1 per cent, but nevertheless, I think that it is fair to say that Lothian and Grampian have received resources beyond what they had budgeted to receive in 2016-17. John, do you want to say a little bit more? Just to have a couple of further comments. Over the last five years, we have got a cumulative total of 619 million into moving boards towards NRAC parity. The principle that was established at the very beginning when we started this process was that we would do it in a way that did not destabilise the boards that were on the other side of parity and a particular focus there on Greater Glasgow and Clyde, which is the one board that is obviously in that position. We are trying to do it in a measured way. The move to within 1 per cent and Lothian and Grampian will be 1.4 or 1.5 per cent after that adjustment. We accelerated that from what was due to happen in 2016-17 and we brought it forward into 2015-16. Lothian were anticipating within their financial planning 12 million, they have got 14 million, Grampian were anticipating around 10 million and they have got 15 million, so they have got more than they were anticipating in their plan. We are trying to do it in a measured way and we are trying to do it in a way that does not destabilise the other boards in Scotland, particularly Glasgow, and 619 million investors over the past five years. We accept the point that Lothian and Grampian are the two boards that are still around about 1 per cent away from parity and the focus will be going forward on those two boards. Cabinet secretary will know that I have an interest in relation to the funding available for GPs and I have pursued that matter locally in Glasgow as well. I welcome, first of all, that looking at the draft budget that we have before is that there is a 3.6 per cent increase in the general medical services budget for GPs and that represents a 1.9 per cent real terms increase. It is also worth putting on the record that that does not include another £45 million that has been allocated to the new primary care fund that can be accessed by GPs and health practices for new ways of working. We end up with a substantial increase in funds. I think that we can get to something like 10 per cent if we add that together. Sometimes there is a feeling that some of the issues surrounding GPs' practices is as much about recruitment and retention as it is about the funds available and new ways of working. I have a particular interest in urban areas and deprived areas, but other MSPs will have their own issues across Scotland. There is a good uplift for GPs' services. I think that what we are keen to know is what influence the Scottish Government can have on that in relation to taking some of the burden off some GPs' practices that are facing challenges that the cabinet secretary will be aware of and how that feeds into recruitment and retention issues. What we have tried to do through this budget is to prioritise areas of investment, which is not without its challenges, but hopefully the committee will see whether it is the £250 million for social care or the additional investment in primary care and elective centres and so on that we have tried to prioritise those areas of spend and align them very much with the direction of travel for the NHS and health and care services generally. In terms of primary care, there is a significant uplift in the general medical services, but the primary care fund, which includes the £25 million of new funding, is making a £45 million investment in 2016-17. It is worth noting that there are other significant budgets that lie elsewhere, which also impact on primary care and will help to realise a new vision for primary care. If you look at the Scottish Ambulance Service investment, a good chunk of that is about working more closely with primary care, and the health visitors investment will have a significant impact on primary care, as will the social care budget. We need to make sure that all that works to realise that new vision and that we are able to make primary care an attractive proposition for the GPs of the future, so that we can encourage medical students to choose general practice as their preferred specialism and that we also, through the significant changes that will be made to the contract, will help to underpin a new contract. That work is coming to fruition for the transition contract through 2016-17, which is ready for the new contract from 2017. I really want us to seize the opportunity to have tackling health inequalities as very much a focus of that new contract and that the allocation formula needs to reflect that as well. We are in the midst of negotiations and discussions around that, which have not been concluded as yet, but I hope that the significant investment in primary care will help to bring all of that to a positive conclusion and that that will in turn address the recruitment and retention issues, will help to deliver a more effective primary care service and particularly will help to address some of the health inequalities that still exist within your constituency and many other constituencies. That is helpful and I do not want to push you too much when there are negotiations on going in relation to what you said. As an urban MSP, I can accept that there are areas of deprivation in remote and rural areas that have their own specific problems, but obviously in areas that I represent where there is significant urban deprivation, I am delighted to hear that there is more thought given to tackling those health inequalities that extend from that deprivation, but we have to have the GPs that want to work in those practices on one of the ways to buy in for a new generation of GPs is that they see themselves as very close partners in relation to health and social care integration, because with that £250 million and other moneys, that is where the real meaty uplift is. Can you give us some reassurances that GPs and GPs' practices are central to that health and social care integration? Sometimes we are not too good at talking up what the opportunities are in relation to general practice going forward, and that in itself can dissuade a lot of young medics from choosing general practice as an option. What would you say to those that are seeking to consider going for, thinking about going on a training rotation to be a GP just now? Do they have a significant role to play in relation to health and social care integration? That is where the meaty uplift of cash certainly is. Absolutely. Of course, the RCGP and other bodies, the RCN and others, have frequently called for investment in social care, because I think that they recognise that all of it hangs together in terms of community services and having the ability to pull those resources together for their patients, whether it is someone needing a care package or avoiding admission to hospital, being able to maintain people at home with chronic conditions. It is all part of the same picture. We need to make sure that the frameworks and structures that lie behind all of this can help to deliver that new vision. There have been challenges in making sure that, for example, GPs are represented around the table of IGPs, and that is work in progress, to be honest. However, we are very keen to make sure that that voice is not just heard, but is central to being able to be part of the decision-making about how resources are allocated, how services are delivered and developed. That is crucial. The vision that we think to in the next five to 10 years has to be a significant acceleration of the shifting of the balance of care—something that I have talked about at the committee on a number of occasions—but we need to accelerate the pace of that. The resources around the budget put down a marker that is where we need to head. The resources are following that, and we need to see that accelerated. That is our commitment. The final question in relation to that. You mentioned shifting the balance of care. I mentioned before at the committee about the £200 million in relation to the six new surgical centres that the Scottish Government is seeking to develop across Scotland because of an ageing population and we need to do those elective surgeries for whether that is hip replacements or cataracts or whatever. That falls in budget terms into the acute sector. It can appear if it is sucking resources towards the acute sector now, just coincidentally, my father-in-law is in the golden jubilee for a hip replacement this morning. I hope that he does not mind me saying that. I did not clear it with him first, but he is. It allows him to stay at home and to continue to get on with what he is doing. Sometimes I do not think that we are very good at identifying which spend is purely acute and which spend is an investment to keep people in the community for longer at home or in a homeless setting. When we do our budget scrutiny and we look at that £200 million, should we view that as a dragging of more money to the acute sector? How should we view it? Some have done that, but I would see it differently. How would the Scottish Government seek to view that expenditure? I hope that it goes well for him this morning. The golden jubilee is in good hands. I guess that we will bear in mind that £200 million is over five years, so if you compare that with a £250 million injection to social care in 1617 alone, I think that it is pretty clear that there is a significant shift in the balance of care. However, we also need to make acute services more effective and efficient. If you look at the demands that are coming down the line, you have just articulated them around hips, knees and eyes. You could argue that those are preventive measures. I think that they are if we are avoiding people falling because their eyesight is failing, because they are not getting their cataracts sorted early enough and so on and so forth. However, there is also something around the more effective delivery of acute services per se. That is going to require us to be able to avoid as many interruptions to plan procedures, which happen at the moment because emergencies come in. That separation between elective and emergency procedures will mean a more effective and efficient flow of patients through procedures with less cancellations and being able to meet the demands of the future. The shift in the balance of care is absolutely key and important. We also need to make sure that our acute services operate in the most effective and efficient manner that they can. The golden jubilee model has proven itself to be a very effective and efficient way of doing high-volume procedures and what we want to do is to replicate that model throughout Scotland. I think that that is a good investment to make. I think that the committee would welcome that. I think that we have made a comment on the pressure that targets place in the disorption of target. We are allocating money to make more efficiently and to make better use of that, as opposed to the least that we can do to tackle that area. However, there is another issue that you might want to respond to. The committee has asked about the continual use of some of the targets in its recent report. Of course, it keeps Bob's poor father-in-law at home for a week or so, but having that operation today or a fortnight from today is not going to make much difference to him, I do not suppose. You mentioned it in my last time. It is a hard bit of something that you have to do, but there is an issue there. The targets that we have and the target regime that we have are not replicated in some of the other areas that you have mentioned about the deprivation, the reductions in inequalities and so on. We have seen that with more than £100 million that was put into A&E when the crisis was running there. Those of us who support the progress and the journey that you are on are sometimes stumped with some of the spending announcements that we make in the short term to deal with A&E when, in the longer term, planning those resources. We raised the issue about the £200 million and the A&E services, which are around £300 million over a period of time that we have conceded, with some of the people last week who have been given a responsibility to transform how we provide health and social care. Those who are heading up the indicated joint boards, they told us last week that they have not agreed their budgets with the health service. We now know that we do not know exactly how that will be fed into them or whether that will be a real opportunity for them. If those organisations are going to be the standard bearers of this step change, should they not know what their budgets are in January for April? How do you plan in that environment? How do we give them the best assistance? First of all, to reassure you, they will all have their budgets in place and their plans in place well before they hit the ground running in April. I suppose that some of it is, you know, this is new territory, it is new ways of working, sometimes that can be difficult. It is no surprise to you, convener, and I am sure that those partnerships that were already quite strong have gone on and got on with the job in other areas where that relationship maybe was not as well developed, it has maybe been more challenging and I suppose that is the case. However, if you look, for example, at what has been delivered in places like Glasgow City, for example, a relationship between the council and the health board that perhaps was not traditionally one of the strongest, has managed to deliver one of the best results in terms of the reduction in those delayed discharges for the over 75s by a remarkable amount. That is because of a number of things, but for example, the power and responsibility being devolved to the operational managers of both organisations so that they can get on and resolve issues and just get on with the job without having to go back and get sign off by 10 different committees and so on and so forth. Also that within Glasgow, the ward staff within hospitals can directly commission social care and I am told that has made a huge difference in the speed of getting people discharged. They are also developing a range of services to avoid admission to hospital in the first place, so they are more developed around the step-up facilities within the city of Glasgow. The reason that I am citing that is that it shows what can be done. It is almost able to name the cases that are delayed within the city of Glasgow, which shows how few cases are compared to previously. Other partnerships are not there yet in that territory, but they need to be. If we can get all partnerships to be in that same territory and perhaps learn some of the lessons that have been deployed within the city of Glasgow, which I know is sometimes a challenge to look at what is happening elsewhere, I think that we can make a huge change. The integration boards are really only as good as what they deliver and that has to be a change and improvement to the services that people receive. You mentioned targets. I have said here before that as part of the discussion around the national conversation, as part of the discussion around the national clinical strategy, which Catherine has been working hard on, along with Jason Leitch and others. We are up for a discussion about what are the right targets. Interestingly, I would probably disagree around the unscheduled care, because the investment in unscheduled care has meant that this winter, for example, touch wood so far has been a big improvement on what we saw last winter. From a patient safety perspective, it is much safer for people within A&E departments to be treated within the four-hour target, which is why it was set. If you speak to the Royal College of Emergency Medicine, it will tell you that the four-hour target, if you were to pick a target, will defend that very strongly, because it is a bit of a barometer of what is happening in the rest of the hospital. We should discuss targets in the round. Out of all the targets, the investment in unscheduled care has meant that the flow through the whole hospital has forced other parts of the hospital to get on with discharging patients and has helped to create a culture of not holding on to patients to get beds freed up, to get patients out, to get them home. That has meant that the joining up with council colleagues has had a direct impact on the front door of the hospital, because people of the beds have been freed up much earlier. We have to look at the whole system rather than just one part of it. I agree with that. Anyone who sat in this committee over the last five years agrees with that. We probably argue that the solution that the A&E department lies out with A&E departments, although it assists them. Who knows if we could be physicians and say that the absence of snow and ice helps A&E departments to meet their targets this year? There are many factors that are involved in that, but some of the evidence that we are having with all of—I can understand that—is a good marker, as you described. A good marker is that £250 million has been directed at it. There is no doubt about that. If that is the start of something in a journey, then that is very good indeed. However, what people are concerned about at that level—the separation between the health service and social care, although we all see them as integrated and not integrated in a whole—is that developing, as it has been suggested, not working with but with parallel systems? There is a danger in that. Some of the Glasgow work shows some of that. It is circumventing doctors' practices or hospital doctors' practices and things like that rather than integration to solve some of their problems. If that develops in the way that we are getting parallel running, as some people are concerned about, how do we avoid that? How do we get that integration that we need to deliver in the money going to the places where it should be going when, at this stage, whether we like it or not, they have not agreed their budgets? Ultimately, it is down to accountability, visibility and transparency. All of that has to be laid out. The partnerships have to be able to show how they have agreed their priorities, what those priorities are, how they have invested, what new services they have delivered and developed and what the outcomes have been for their populations. All of that will be laid bare in terms of the reports that those partnerships will need to make through their IJBs. Of course, it is not just the two organisations as well as the local authority and the NHS. There are the third sector partners, the private sector and the role around the table. That is important in terms of delivery partners, but I suppose that access is really around the interface between the NHS and the local authority. The reason that we had to legislate, as you know, convener, was because the pace of joint working was not cutting it, it was not delivering what we needed to deliver. Within the legislation, there are levers to help to ensure that things are delivered. At the end of the day, as I said by citing Glasgow, we are already beginning to see the fruits of that. Would all of that have happened without integration? I do not think that it would. I think that it is forced partners to really think about things in a different way, to have a collective responsibility for the resources that they spend within their locality, to think in more innovative ways. Part of it is about trust as well. For example, trusting the operational managers to get on with the job of delivering the services that have been agreed are going to be delivered. I think that if I were to pick out one thing around the Glasgow success that perhaps is a lesson for others, it is about trusting the front line to get on with the job, rather than continually having to refer back to the parent host organisations. That requires an element of risk there and it requires trust, but it has meant that operational managers within the city of Glasgow have been able to sort some of the inevitable glitches, issues that arise, have been able to identify what those are, agree what the solution is and get on and sort it. When I met the operational managers within Glasgow from both organisations, they felt quite empowered to do that in a way that they had not been previously. I am not saying that it is not a magic wand by any man who means, but it appears to me to have been a significant factor in the success of getting those delayed discharge figures down in Glasgow in a way that is a bit of a stand-out. We have had great examples, haven't we? Highland has been on a five-year journey, and we have had great examples given in evidence about the pockets of good practice, but it has not been an outbreak, it has not been infectious. We have had to legislate to make it happen, so we have lots of examples. We are, as a committee, trying to provide some budget scrutiny in and around specific pockets of money that has been directed to tackle in different areas. At the same time, we also know as a committee looking at social care that unless we get that aspect in local government delivering and working effectively, we cannot achieve one without the other. There is a big power gap between—I mean, it is sitting there in front of us in terms of the Cabinet Secretary for Health and all of the people here who are health boards—you know, it is health, they have that place at the table, and you have local government who are facing cuts and pressures and increased pressures on it. It is not an equal balance, and we are putting a lot of expectation on that part of the system to deliver effectively for us. There is a power gap between those two. It is not equal at all. It is now one system, and it has to be one system. It has to see itself as one system. Five years ago, would we have invested £40 billion a year into another part of the system? As we are probably not. We do not even know if it is going in that part of the system. Well, it will. I can assure you that it will. We have been very clear with boards that money will go to IJBs, and it will sit within those IJBs. That is quite ground-breaking. It is a significant resource. You can imagine that health boards are new territory for them as well. It is challenging. It is different, and it will mean thinking about things in a different way. It is not about that so-and-so's money. It has got to be a very different thought process around that collective resource and making it work more effectively. The £250 million is a significant injection, but what they need to look at is the global resource that they are now collectively responsible for and making it work more effectively to deliver a better service for patients and service users within their area. Dennis Robes, can I say that Malcolm Wright in Grampian did put on record that he welcomed the additional monies that were coming to Grampian? There is a fantastic capital spend going on in Grampian as well. I think that there is a lot of good news stories that we can actually take forward from Grampian. I welcome the additional monies for mental health, and I am just wondering if you could explain a little about how that money could be spent within the mental health programme. In addition, what monies are going to be spent within the digital technology to enable distance examinations of patients to prevent them from having to travel? If I look at rural areas within my own constituency—and obviously in places like Orkney—that might require a specialism that they can speak to a consultant in Aberdeen, what investment is there? You touched on the preventative spend in terms of the elective surgeries that are going on. Do we have an idea how much more—what we are actually saving by having cataracts done in terms of trips and falls? On the last point, first, that modelling has been done, and certainly we could probably get you some additional information from the work that John Conaghan has done around investing. If you prevent falls, for example, by effective preventative measures—which I think that you could argue is a cataract operation—what does that save in terms of other parts of the system? There has been work carried out on that. I will answer the mental health issue, and then John Matheson can come in on the digital. On mental health, the top line around investment over the next five years will be £150 million of additional investment over that period. That builds on the investment that was already announced by Jamie Hepburn around the £100 million with the focus on children and adolescent mental health services, bringing down waiting times there, increased access to specialist services and psychological services, plus an investment in the field of primary care in mental health. We know, for example, that many GP appointments are taken up with people who have mental health issues. If we can provide more options for GPs to be able to refer to them, there is good compelling evidence that we can help to avoid perhaps some further, more severe and enduring mental health issues further along the line. Work is going on around what that might look like. The additional £50 million was a consequence of the consequentials that were received through the health budget from the UK Government. We took the decision to allocate £50 million to mental health, and we will be looking and discussing what the priorities for that should be over the next five years. I know that there has been a significant interest in this place around investment in mental health, not least from yourself and others. We are determined to make sure that we get that right. It is getting the balance right of investment in specialist services, but the requirement for that is why I was keen to see some investment in primary care, but to try to prevent some more enduring mental health challenges further down the line if we can have prevention and early intervention. I am happy as we develop those plans to keep the committee informed about the thinking of where that additional resource will be invested. John, do you want to talk about the digital investment? I think that just three examples here. The first one is that we have put some recurring resource into this area. We have put £10 million into this area in terms of technology-enabled care, and we are looking at how we can support people to live in their homes, but we are also picking up on your point about video conferencing. Rather than people coming down and travelling a long distance for a 20-minute-day outpatient follow-up to be able to do it through a VC link. Following on from that, we have allocated to individual boards the Highlands and Islands travel scheme funding, which is about £15 million. That is intended to allow boards to look at whether they can reduce the amount of air travel that they have for patients and invest money in enhancing video conferencing facilities. Those are two examples. We are also doing some very powerful work with European colleagues on learning from best practice and sharing our best practice with them and looking at what is happening in Scandinavia in terms of the distance healthcare and how healthcare is provided and also in Alaska. The final example that I would give is that we have eight innovation centres that have been taken forward within Scotland. One of them is the Digital Health and Care Institute, which will be based at the Eurocentral at Maxham, just outside Motherwell. They are looking at developing a simulation laboratory, a ward and a domestic environment to allow SMEs to come in and take their products forward to market using a real-life environment. European examples, innovation examples and how we can use the Highlands and Islands travel scheme and the technology-enabled care money are something that we are keen to proceed and proceed with at pace because the ability to take that forward with the way technology is moving forward is greatly enhanced over the next few years. Welcome. Do you have a supplementary on the mental health? I was wondering to ask about capital, but somebody else might have. I was so keen in it later that I thought that it was mental health, so I will move on to the next one, which is the net mill. A couple of comments first for me. I was very pleased to hear what you said about the empowerment of front-line staff and the success of that in the Glasgow area, because I think that to give key front-line people responsibility for what they are actually doing is one of the key issues in getting things right. I will refer back to the funding. I hear what you say about tackling health inequalities, which is clearly very important, but I worry that someone from Grampian, given the long time that it has taken to bring NHS Grampian near parity under the NRAC formula, I do worry a little bit that we might suffer again in a new funding formula situation, which we are more likely to put money away from Grampian and into the central area of Scotland, where I agree that my A is needed. That is a comment. I really wanted to say that the RCN that I see in its written evidence to us expresses a continuing concern about the presentation of the budget and the lack of any direct linkage between spending, priorities and outcomes, and the lack of scrutiny of in-year allocation of resources. It cites the six new elective treatment centres as part of that. The BMA has also said to me that the treatment centres seem to just suddenly appear on the horizon. They were not sure how or why and what the rationale was. Could you give us any sort of elucidation of that? First, we have talked about Grampian receiving more of an allocation than it had budgeted for, and they seem pretty content with that. When we talked earlier about the allocation formula, it was more in relation to the GP contract. Those things are obviously open for debate, but we need to find a more systematic way of tackling health inequalities. I want to move away from the initiative here and the initiative there approach. We have to make sure that it is built into the way that we do business. One of the most effective tools is primary care intervention because of the community nature of the services. If we can get that right through the new GP contract, we are on to something quite significant. There will be a debate around that. We are in the midst of early negotiations, so there is not too much detail that can be said about that. However, I am keen that we take the opportunity to have a step change in the way that we are able to tackle health inequalities in our most deprived communities. On the issue of outcomes and in-year allocation, it will hopefully not have escaped your notice that we have listened to what the committee said about that. Instead of the 65 budget lines or whatever there was to boards, we are bundling that resource and they will have far more flexibility in the way that they manage that resource. They will still require to deliver outcomes and we are working on an outcomes framework with boards. Paul, can we say a bit more about that in a second? It is with a view to having for boards to be able to deliver those outcomes in a more flexible way and make better use of the resources and avoid more of the in-year allocation that I know the committee had comment on. On the elective centres and the RCN comment and others, the elective centres model has been well tested through the golden jubilee model. What we wanted to do was to take the learning from that and to look at what the best models would be to ensure that we have the right level of diagnostic and treatment capacity within the NHS. The national clinical strategy, which Catherine might want to say a bit more about, is an opportunity to discuss those matters further. However, if something works and it is shown to work and we know that the split between elective and emergency goes back to the care report, it is not particularly new. It is about making it happen. The rationale for the six was that each area of Scotland had access to enough capacity that would make a difference to the way that acute services operate to meet the growing demands for the future and that there was a geographical spread of that. We know that there have been challenges in areas further from the golden jubilee, and there are issues around that. We felt that it was important that we took the learning from that and applied it and came up with the model. There is still work going on about what will be where in terms of what procedures. There is still scope for discussion and engagement, and the best place to do that would be through the national clinical strategy. On the outcomes framework, if you think of effectively three parts of local delivery plans and outcomes framework and the clinical strategy, you see how we are trying to give a strategic framework within which the NHS and its delivery partners can operate. The point about putting the outcomes framework alongside the local delivery plan as part of that process is that we still want to be sure that boards are operating within financial balance. We want to be certain that they are meeting the standards that we have set subject to the discussion that this committee and others are having. Instead of having, as the cabinet secretary says, 65 separate lines of accounting, where you probably spend as much time accounting for what you have spent as you do on delivering what you ought to deliver, we can set a frame of outcomes for the boards, which also take account of the fact that there is now a significant set of outcomes to be delivered by statute through the integrated joint boards. It seems to us more coherent to have it done that way than to do it through a series of separate little points of accountability. Catherine Calder would also say a little about where we are headed on the national clinical strategy, but I think that the point is to ensure that clinical decision making remains central to the delivery of national health services. Of course, there has to be proper financial management and administration, but leadership and clinical decision making are central to the delivery of safe, person-centred and effective services to patients. Perhaps the CMO could say something about the clinical strategy. I will start with the elective centre example. The Golden Jubilee currently performs 25 per cent of hip and knee replacements, the major joint replacements for the whole of Scotland, so Mr Doris's father-in-law is in a place with a very high volume. If you look at the national hip registry, which Scotland has run for many years, the outcomes for those hip replacements are the best in the country. Infection rate, operative complications, readmission rate are way above the line for being very, very good. We have a model of a high-volume centre doing very, very high-quality work with, of course, the best outcomes, which is what we are aiming for. That is a driver behind some of the national clinical strategy work. If we look at the converse, we then have redo surgery and that will take knee replacements, again high volume. There is always a volume of people who will need another knee or another hip because it wears out. We have then smaller numbers but they are done spread out across the country and we know that that is not the best, it does not produce the best outcome. If a surgeon does more of those, particularly the complicated ones, the outcome for the patient is better. The national clinical strategy is building on some of the medical evidence that we have for volume but you are then able to deliver your rehabilitation closer to home. That is where our integration and the primary care part and hospital at home etc. comes into play. We are asking those questions very much in that national clinical strategy. If we line up what we know, operative procedures are probably easier to benchmark because they have known complication rate and known redo surgery rate. If you take a particular volume that we know gives a better outcome for the patient, why are not we delivering that all over Scotland? We are asking once for Scotland's type questions. It might be six times for Scotland for these elective work but we are starting in that strategy to say that we know that where there is evidence, why are we not moving towards a system where those outcomes for patients are lined up as the very top line. There is always interpretation and there are financial issues to all of that but can we then have a pragmatic solution where the value for money is important but the clinical drivers are always key behind. We have to remember the rurality and travel time and for certain people a long distance to travel might be for them. If it is every week for chemotherapy maybe that is the wrong thing for elderly patients but you are looking for a solution that will be clinically focused and patient focused. I think that our strategy is going to ask some uncomfortable questions and it is going to have some uncomfortable conversations with the medical and nursing professionals as well because people hold on to their patch and if you are keen on doing a procedure, you may not want that procedure to be done somewhere else if you are doing a low volume. Those are not going to rest easy in everybody's committee meetings but I think that if we keep saying that if that is the best outcome for the patient then we have to go get past those difficult situations. I have to say that I do not disagree with anything that has just been said. I think that it makes an awful lot of sense. Is there therefore some sort of communication difficulty? To have an organisation like the RCN and the BMA, we did not know about that. I think that nothing against these elective treatment centres. I do not know that they would have either but I just wonder that it seems to just suddenly appear as far as they are concerned and I wonder if that is right or if there is a failure of communications number, I do not know. I have an on-going dialogue with the BMA and the RCN and others and we discuss a whole multitude of issues. I would like to think that there is a pretty broad consensus of the need to build in the right capacity in the right places. For doctors and nurses and other health professionals in Tayside, Grampian and Lothian, and of course, Highland and Rhaigmore would be one as well, I think that there is a welcoming of the concept. Where there is room for discussion still is about what is going to be done where. It was really about establishing the principle that we think that this is a good model and that we want to do more of it. We think that these are the places that would benefit from that additional capacity and separation from emergency procedures. We are now in the position through the national clinical strategy of discussing what we want to do because we might not want to do hips, knees and eyes at every centre. Some centres might become the centre for X, Y or Z. I think that those are the areas that we need to discuss. I anticipate what the demand is going to be for the procedures into the future and making sure that we have the right capacity in the right places to help to meet that demand. As some of those difficult discussions have been around issues such as how we sustain consultant-led A&E services at the number that we are currently doing so. I think that going back in memory, one of the issues about what was derogative described as a centralisation system is better described by Dr Calderwood as getting good quality outcomes by people who are doing thousands of knee operations a year and their chances are better. However, was there worry in terms of A&E and the impact when you withdraw some of the services from some of the local hospitals, then you diminish your opportunity to provide a seven-day 24-hour consultant-led A&E service at some of these hospitals? Obviously, the national clinical strategy has not been published yet and it will be in due course. However, the model is more around being able to sustain our district general hospitals with a range of core services, if you like, that you would expect to see in your local hospital, which would include your front door, your hospital, your A&E services. There obviously has to be a level of service that lies behind that in order to deliver a safe and sustainable service. That would be our core services. What we are talking about here is those services that are more specialist in nature or where there is a clear evidence that doing very low volumes of them is probably not the safest. If you look at vascular services, for example, there is good evidence around vascular services that the outcomes for patients are better where there are specialist centres. It is looking at that distinction of what are general core services that people could expect to receive at their local hospital and what are the more specialist services where you may have one in a lifetime, but it is better that the outcomes for patients, in terms of patient safety, show that they are better delivered in a centre, a regional centre or a national centre. None of that is fixed in tablets of stone. These are debates to be had, but there is an emerging clinical evidence base for that. It is not things that are plucked out of thin air. It is what is based around the clinical evidence and getting that distinction between what local hospitals will continue to provide, which will be the services that most people receive most of the time compared to those once, twice and a lifetime services, which are not the services that people would expect to receive every day. Does it make it more possible for seven-day working with development? I would say so. Again, if you look at how those services could be configured, I think it does. Obviously, there are challenges to be overcome around making sure that we get the right definition of what we mean by seven-day services. What we are not doing is what they have done down in England and given a perception that everything can be done in 24-7. That is just not realistic. Just because you could do a procedure in the middle of the night, it does not mean that it is the right or the safest thing to do. What we are talking about is making sure that the services that you would expect to be delivered over seven days are done so in a safe and consistent manner and that the ones for Scotland approach is taken to make sure that diagnostics are available, for example, at the weekend. We know that, if they are, you can then have more of a chance of getting someone discharged more quickly. It all is part of the same picture of more efficient, effective services. In some parts of the country, they have already developed, for example, in Glasgow, the diagnostic procedures over the weekend. Do you want to say a good example? If we could maybe tell back to the budget implications of some of that seven-day services, has it been factored in the budget that has progressed? Is that part of the 200? It is part of the £13 billion. The sustainable seven-day working group has been working for some time around what is required to deliver safe, sustainable services over seven days. They have produced an interim report. That has all been factored in to making sure that boards in their allocations and, indeed, their outcome framework, which Paul touched on earlier on, are delivering the services in the right places in the right way that they need to in order to deliver the right services over seven days. It is not all singing, all dancing, 24-7 for everything. That is not what we mean by seven-day services. It is about making sure that there are safe, consistent services, particularly over the weekends and evenings that need to be provided, particularly in the area of diagnostics. The national clinical strategy will also talk about doing things differently. We talk about the example of the virtual fracture clinic in Glasgow, which has reduced the number of patient returning to be seen by an orthopedic surgeon by 38 per cent. Instead of everybody who is seen through A and E having their x-ray done, they all just used to come back because there was not a consultant there at 24-7. Instead, the consultant looks—this is some of the digital technology—access as they film virtually, not with the patient at all and nurse films the patient to check if there are details needing to be checked with symptoms. 38 per cent of the patients no longer come back, and that has freed up 10 per cent of each consultant orthopedic surgeon in GRI's time. You are using that time in their week in a different way to provide a more consistent service throughout the week. In fact, some of the ways of working, if you work differently, the seven days is not, in fact, needing additional resource. You can do it and still have a saving. I suppose that we are talking about reexamining what because you will maybe not be surprised to hear that there has not been an outbreak of virtual fracture clinics all over Scotland. We need the orthopedic people to talk to each other. It has spread outside Glasgow, in fact, not at the moment across all of Glasgow. I think that this conversation very much needs to happen. Initially, orthopedic surgeons said that this is a disaster and we will not see the patients. We will miss all those fractures that will be all sorts of adverse outcomes and, of course, there are not if it is done in a very robust way. Some of this is about the culture change and about reassuring people at working differently. It can be better for the patients, but it does not lead to less good outcomes for their fractures in the future. Richard Lyle, you worked at a hospital during the new year. You look up the signs and you see all the different services that are being provided. Last year, our budget for health reached £12 billion. This year, our budget, and I compliment you on it, that your budget is going to reach £13 billion. The territorial boards and the special boards are going to get nearly over £500 million more, plus other factors, but can I get a slightly off message for a second? This is one-third of your budget that is spent on health, but since I have the opportunity and I cannot pass it up, we will shortly be doing a discussion on the penrose inquiry. This is as we all know the blood products disaster that has resulted in people possibly going to make substantial claims on budgets. Is it on the individual health budget of a board or is it against the health system that Mr Gray or Mr Matheson might want to enlighten me? Are we ensured for that? My view is that it possibly could reach in between, and I might be picking figures out of the air that people may dispute, something like £50 million or more for Scotland alone. I do not see it in this budget at all, and I am sure that it will not be, but suddenly we will pick this money out of the air. Where is it going to come from? Can I be enlightened in regards to that? I will let John Jones say a word about litigation and how the NHS handles that more generally in a second. On the positive side, just before Christmas received the report from the group that was set up in Welsh's chairmanship to review and make recommendations around the financial provisions for people who have been affected through contaminated blood and blood products. That series of recommendations are quite far-reaching. They would substantially enhance both the payments that were made to people at stage 1 of illness, but they would also substantially enhance the on-going payments for people who have the highest health needs and other supports for widows. There are supports in terms of one-off hardship payments and so on. As a package, it is a very substantial package. Resources have been set aside within the budget to meet the needs of those affected. At the moment, I am considering those recommendations, and I will make an announcement in due course about those. Just to put on the record, as I have done previously, I am determined to make sure that some of the hardships that I have been told about very directly from those affected and their families that we provide a better level of support to people in Scotland. Obviously, what happens elsewhere is that I am not responsible for it, but I am determined to make those improvements here in Scotland. In terms of litigation and court cases, there already have been some around this area, but John, do you want to say a word? Just a couple of things. We have a general clinical negligence in the student scheme, and that is primarily used for obstetric and gyny cases, which tend to be the prime examples to come through that. That money is allocated to boards and they pay a premium to recognise that. In almost eight years of my role, I have moved from the traditional position where there was a lump sum payment made and they moved to a position whereby there is now a reduced lump sum made for housing adaptations and transport adaptations, and then there is an annual payment made for the lifetime of the individual who has been affected. However, the key factor there, as well as dealing with the cost of the legal claim, is to learn lessons from a clinical practice to make sure that the situation that it caused, the tragic events in which the NHS has been negligent—we have accepted that we have been negligent—that we have reduced the chances of those happening again. In terms of the infected blood patients, we have been making some payments to date in parallel with England. As the cabinet secretary has said, we have recognised on a central basis—not in terms of the board allocations—that a central sum will be set aside to recognise the cost of that going forward. How much is that central sum? We have not concluded the negotiations. I am looking at the recommendations. Obviously, if I accept the recommendations, the resources will be made available to meet those recommendations, but John Matheson has made an important point. There has already been around £30 million paid to Skipton. The two funds are done on a UK basis, and we pay our share for Scottish recipients into that fund. Lastly, if you allow me to convene the point that I was trying to make, thank you very much. I know that you have been working hard on the issues that I had in the last couple of years. I will be assured that people can be assured that any funding that is required will be made available. I recognise the work that you have done, Richard, on this area. I have the campaigners. When I was first on this committee, it was one of the earliest issues that we looked at. It has been a long-standing issue. The recommendations of the group have come together on the basis of compromise. I am not going to sit here and say that everybody is happy with them, but they have been borne out of pragmatic discussions that have taken place in them, led by people affected. Those are the recommendations that have emerged. As I say, they are with me now. If those recommendations are accepted, we will absolutely make sure that the resources are there to meet them. Thank you, convener. Thank you. Malcolm Chisholm. Any members who have not asked a question wish to come back. You have been on, though. I will let you back in. Malcolm Chisholm. I just wanted to get to the bottom of the capital budget, which is of course very interesting because of all the things that have been happening. First of all, there is a big increase in it, but a large part of that is the £215 million up-front capital to provide cover for the NPD projects. I suppose that you cannot really say definitely, but would you still be hopeful that that money will not be required and that changes can be made to those projects to take them off the balance sheet? Is that an unrealistic hope at this stage? It is difficult to say, because John Swinney is leading on this. He is in very close discussion with the Treasury. Obviously, that has been triggered through ONS and Eurostat, and he is still in the midst of all that. Obviously, the decision that was made on the Aberdeen peripheral route has significant implications. John, do you want to say a little bit about the rationale of the cover? I think that there are two different aspects here. There were two things conjoined at the beginning. One was the NPD projects, such as the Aberdeen peripheral bypass, and the second one was the hub projects. There was concern about a number of the hub projects being caught up in this. We have now had clarity from the Office of National Statistics that the hub contract is acceptable to them, and they were able to proceed with projects such as the Greenock and Inverclyde health centres and other projects that were held up on that. The NPD position has given us a view on the Aberdeen project, and it has not specifically given a view on any of the health projects, but the expectation and current shape of the contract is that their view would be similar to the Aberdeen one, so we would need capital cover. That is what we are prudently covering at the moment. We will continue to pursue, on a Scottish Government-based working with Scottish Futures Trust, whether there are any adaptations that we can do to the NPD contract that would make it compliant and revert back to a similar situation to hub. This is a prudent position at this point in time, and this will enable the five NPD projects, six children's and precent Galloway, the Blood Transfusion Centre, Ayrshire and Arden and the Balfour hospital placed up in Orkney to proceed. In terms of the hub projects, we do not really need to go into the details of the changes that have been made, but are there any budgetary implications from the changes that have been made to the hub projects, or are they not? They are not. They are not, okay. Even apart from the NPD cover, the £250 million, there seems to be an increase in the capital budget, which we would welcome. I do not know if you can say more about that, but that has been something that has run in the past that the capital budget has not been increased, and I suppose that a lot of that is because it has been funded through the NPD method, so I am not objecting when I ask why there is still an increase there on the capital budget. If you add the natural increase plus the cover, it is a substantial increase in the capital budget. The other question is what are the implications of that for other parts of the capital programme more generally, either health or the Scottish Government more generally, or are we able to have a bigger increase in the capital programme because of our new borrowing powers? It is not specifically connected to the new borrowing powers. If we put the £215 million for an NPD to one side, the other major areas of increase have been an additional £50 million coming into capital. What that has enabled us to do is to remove the resource, because as you mentioned, Mr Chisholm, the capital position has generally been tight across the Scottish Government, and health is no different from that. As part of our financial modelling for 1617, we were anticipating how we would transfer £47.5 million from resource to capital to give us an adequate capital budget to take forward to do the work on backlog maintenance and the work on non-NPD projects. The additional £50 million that we have got as part of the draft budget settlement has enabled us to remove that resource to capital transfer and has enabled us to proceed with the £250 million into social care. In addition to that, we have an additional £23.5 million for the diagnostic and the treatment centres. That will be partly spent on that but will also be spent on investing in taking forward the cancer plan. The next one that I have on my list is Dennis Roberts and then Bob Doris. Thank you, convener. Is there a budget allocation for the community pharmacies to take on minor ailments in order to prevent people going to their GPs, for instance? If so, what some of money is that? Is there money in raising the awareness in terms of educating or the public in terms of using community pharmacies in a better way than maybe we will currently do at the moment? Well, there obviously is an allocation around the pharmacy contract and that is part of an on-going negotiation at the moment as well as the other contractors will be. However, as part of the primary care fund, there is an element within that, you may recall, to increase the number of pharmacists attached to primary care premises. Doing a lot of the medicines reconciliation work, really trying to help to relieve some of the workload of GPs but also bringing their specialist skills to manage medicines within the patient population within that locality in a better, more effective way. The role of community pharmacy more generally within the vision for primary care is very important as we take forward the concept of the multidisciplinary team, the community hub model, where patients are going to see the most appropriate health professional. In many cases, that will be the community pharmacist. We know that there is a lot of interest within people studying pharmacy who want to do more of the clinical pharmacy role and we want to create those opportunities for them to do so. That will mean far more patient facing work. Again, it is part of that new multidisciplinary model that community pharmacists which are very accessible in terms of seven-day working as well. They are open, they are accessible, they are well located, often have a significant role to play. The budget supports that, but it also provides additional resources through the primary care fund to really be pushing at the boundaries of that and making sure that we are both ensuring that community pharmacy has a continuing role but also that we have the skills of those pharmacists attached to GP practices in order to reduce the workload of GPs and as part of making primary care a more attractive proposition. Are you able to determine how well it is being used in terms of patients using the pharmacist as opposed to going to their GP practice? We can certainly get you more information on that but, yes, the evidence is that patients like using their community pharmacist for a start. They get a good service through the minor ailments service and through the chronic medication. It is particularly for people with chronic conditions and for the elderly population. It is a good, well-regarded service. It is very cost-efficient. We want to build on that and to make that more of the mainstream way that people receive their community health services so that there will be a more systematic way of accessing community health services that will mean that you do not always see a doctor. In fact, you will see the most appropriate health professional. That is the territory that we are in at the moment with the test sites that are going to be developed over the next few months. We are really pushing the boundaries of what that multidisciplinary working look like and what it will deliver in terms of better outcomes. I will ask a little bit about the spending plans for sport. I am looking at the draft budget plans before us. I can see that it is a flat cash commitment in terms of revenue for sport that is staying at £45.8 million, which is a small real-terms decrease in its funding. I understand the budget pressures across Government, but health is done particularly well in relation to the budget that has been set by the Scottish Government. It would be quite good to get some information on how that revenue budget for sport might be used, but in doing so, could I also draw your attention to two other budget lines from the health budget, which would include a 7.9 per cent increase in health improvement and health inequalities in the health of revenue side of things and a 69.8 per cent increase in the mental health improvement and service delivery budget in the health spend. The reason I put those two figures on the record as an example is that we have those figures for sport, but do we have to think in tight financial times when we look at early intervention and preventive spend? Do we have to look at a connectivity between that health budget to get people more physically active and sporty rather than just looking at that £45.8 million? How would you envidge that being spent and what connectivity is there between sport and physical activity with the core health budget as well? It has been a tough budget in that the special boards have had a relatively tougher settlement and departmental allocations have obviously reduced because I thought that it was right, particularly in that budget, to make a very clear statement of the priorities and we will have to therefore make sure that those other budgets, whereas it might be tough that we have to also help those organisations and bodies, such as Sport Scotland, to agree their priorities. Obviously, that is done in terms of the letter that will be set out in terms of what we would expect Sport Scotland to deliver in 2016-17 for their budget. Priorities in that will be things like maintaining, for example, the work that Sport Scotland has done with Education Scotland around the PE provision. If you think about the massive increase in the delivery of the two hours and the two periods, which I think has worked its way through into a stabilisation of the physical activity levels of kids in Scotland, you know that throughout that week, as a minimum, at least they are getting more activity within the school day, through the PE provision and the active schools network that Sport Scotland also delivers. Within that, we will be working with Sport Scotland to agree what the priorities are. Obviously, their capital budget has reduced because of the delivery of the national performance centre and the Parasport centre. Although Sport Scotland receives lottery monies and will be able to utilise the lottery monies to help to continue to invest in sport, you are right to point to the interface between other budgets, such as the health improvement budgets such as the education budget and the mental health budget. There is the opportunity to do more about early intervention and collaboration between using some of those resources in a more effective manner. There is some work that has been done, around the physical activity brief intervention that primary care is in a good place to deliver, where the evidence certainly shows us that the more physically active people are, the better it is for their health and wellbeing. How do we build that into part of the work within community health services? It is about not just treating illness but helping to keep people well. The work with third sector organisations is critical to that. There is far more scope to do more there. We have been scratching at the surface of some of that. As we take forward new models of delivery for community health services, I would like to see a stronger link-up with third sector organisations so that health professionals can be more routinely referring people to exercise classes, third sector organisations, providing walking groups and things like that. That does happen, but I think that it could happen more systematically. We have had an interest in the sport in terms of the Commonwealth Games legacy. We had a quiz here earlier, and nobody could answer it. What was the total cost to the Commonwealth Games? Oh, no, you should know! I did not intentionally put you on the spot. Five to five. It is not unreasonable that they are looking for a legacy from that, which would increase activity in previous discussions. The committee agreed with you that it in your words, a strong and sustainable coaching and volunteering base would help us to deliver that. We focused on that inquiry about identifying that base, sustaining that base, replacing that base, understanding where it is, what it is doing and where the gaps are. Can we have some assurance that, despite the tight budget that we are using, all the resources that might be in place to ensure that that already weak link, because we have not had much movement and growth in volunteers and we do not understand where the gaps are and things like that, that aspect of the cut in the sport budget will not impact on that area? Well, legacy is very important, but it builds on what is already, without a doubt, the kind of mainstay of how sport is delivered in Scotland. That is around 10,000 volunteers that support sport across Scotland, without which the local clubs would not exist. The legacy from the Commonwealth Games is sought to build on what is already a fairly well-advanced infrastructure there, but to try and reach people and communities that were not taking part in any physical activity or exercise or sport. It is probably more of a slow burn, to be honest, and we knew that there was not going to be a kind of eureka moment where everybody suddenly took up exercise and sport. It was going to be over a longer period of time. I think that part of the solution here is creating easier opportunities. I think that the school day is very, very important. I have always thought so, which is why I drove forward when I was a sports minister the link up with education to deliver a more rounded opportunity in the school day through PE and active schools and sport. For sport Scotland's role to have changed over that period of time, they do not just see themselves as a sport delivery organisation, they see themselves as a physical activity and PE supporting organisation as well. That has been a big change for sport Scotland. Getting those early habits through the school day right will be a really important legacy as those children get to their teenage years and then into adulthood. I think that there is scope within, if we think a bit more imaginatively, around some of the shifting of the balance of care to community services. You could imagine the community hubs, for example, where they will deliver primary care services, and they will deliver all the services that you want to see and make sure that people are kept out of hospital and all that. However, there is scope for some really good work with third sector organisations around those hubs, where there is a more systematic mainstream usage by primary care health professionals and others of those third sector assets, whether it is the local walking group or perhaps patient-led groups, however formal or informal they are, that can help to deliver more physical activity within the community. Will that happen on its own? Probably not. We would need to try and push that through the new models within primary care to get primary care professionals to see that as being an important part and opportunity for them when they have patients in front of them. I suppose that I am asking whether there is anything in the budget to establish what capacity we have in volunteers, because we looked at it at that time. European comparisons showed that there was a poor comparison with other European companies about the number of people who were volunteering. We both recognise that the greater the volunteer base, the greater opportunity and access that there will be derived from that. We identify 15,000 people as games volunteers. Has any work been done to establish how many of them remain volunteers delivering sport in the community? That is part of the on-going assessment that is part of the reporting on the legacy of the games, which was obviously happening at set periods. Part of that is an analysis of how many volunteers have remained active. Of course, there was a lot of work done to keep in contact with those volunteers. Remember that there were the data sharing aspects at the beginning, so that other organisations could approach and encourage those volunteers to keep active, not just in sport but in whatever walk of life. That work continues and will be evaluated at key points right the way through to the final evaluation that was to take place of games legacy. There was an NUS initiative and there was also an initiative proposed by yourself about the recognition of volunteers. Has any of that moved on? I think so, but probably the best thing, because that is a wee bit hazy, convener. From my previous role, I could get you the latest on that, if that would be helpful. There is only one other thing in sport that links in with deprivation and the lack of support for some children. When we looked at it at that time, 25 per cent of children leaving primary school in Scotland could not swim. That is probably higher in some of our communities, because that is communities that have not got that support, either through volunteers or others. Again, I suppose that that reduction—that hard budget in sport—should not react to some of these issues. You would think that we could be supporting that. It is all down to the priorities that we agree with Sport Scotland. Clearly, they will have to deliver a level of performance sport, which is part of their job. Obviously, with the Commonwealth Games, fast approaching and the Gold Coast, there will be preparations being put in place for that. Sport Scotland's role has changed to see itself as more of the community work that it carries out, the value of the work that it does in schools, the value of participation, and that is a key plank of its work. What we have to do in working with it through the priorities being set for the 16-17 budget is to agree what those priorities are. I will feed back to Jamie Hepburn. I appreciate that, but, just as we heard earlier, the analysis of the city of Asia and what works, if we do not know where the volunteers are, we have not established the only measure that we use as a household survey. If we do not know where the gaps are, if we do not know where the absence of volunteers are, how do we nurture that workforce that is going to be delivered for us? The committee agreed that there was an absence of going to that type of analysis, that rigorous analysis, that gives us a two-comparsing of what we are doing and the levels of volunteers, how we are taking them through coaching, what level they are at and all that sort of thing, if some academic work is done around that. I will certainly back and reflect on that. We have a couple of quick things to do before we leave in private, as previously agreed.