 Gweltaf ei wneud i ddweud, ac maen nhw ymwneud iddyn nhw y for older and disabled people. The petition 1480 is by Amanda Copill on Alzheimer's and dementia awareness and petition 1533 by Geoff Adamson on behalf of Scotland Against Care Tax on the abolition of non-residential social care charges for older and disabled people. I'm delighted that we are joined this morning by the Cabinet Secretary for Health and Sport and their officials. They would have limited time this morning and the intention is to move straight to questions from the committee if that's acceptable. If I can maybe start on behalf of the committee, Cabinet Secretary, in your submission to the committee dated 2 November 2016, you explained that the Scottish Government is conducting a feasibility study into expanding free personal care and nursing care to people with dementia under 65. I understand that it is due to be completed in summer this year, and the committee would welcome a copy of the study when it is published. You will also recall that you have previously given evidence in petition 1480 by Amanda Copill to the session 4 Public Petitions Committee on 6 October 2015. At that meeting, you explained that, quote, we are absolutely trying to avoid lists of conditions because we will always miss one, and that will be the condition that will form the basis of the next one. It would seem from the details that we have in the feasibility study that you are focusing on dementia. The petitioners for petition 1533 argue that the scope of the study should be extended to include people with disabilities. I wonder if you can explain why you have decided to focus on a specific condition while acknowledging that this approach will be criticised? No, just for clarification, the feasibility study, first of all, thank you for the opportunity to give evidence this morning, but the feasibility study will look at the feasibility of extending free personal care to all those under 65. I do not know if you are aware during the members' debate on 6 December last year. This issue was explored, and members were asking that we should be looking at all conditions. As I have said previously, I think it would be difficult to look at one condition. I think that it is difficult to look at one condition. In consideration of the views of members during that debate, and the challenges and difficulties of looking at one condition, and how challengeable that would be, and basic fairness, we have agreed that the scope of the feasibility study will look at all those under 65. Hopefully that will give you the clarity that you are looking for. You have opened it up beyond dimension then. Thank you very much for that. Moris? Good morning. Calls have been made to establish a cross-party working group to consider what a fair social charging system would look like and what would it cost. Can you update the committee on whether discussions on this have taken place, and what has been the outcome? I think that we need to do this in an orderly manner in that the feasibility study will give us a lot of important information for us then to be able to make some informed choices about the way forward. At the point that we get the feasibility study, I think that that would be the point at which to have discussions with members of other parties. I would be very happy to do that. I think that I gave that commitment during the members' debate, and I would be happy to give that commitment again today, because then we will have something to talk around, rather than talking around before we actually have that information in front of us. I think that that would be the best process, but I am very happy to confirm that once we have that feasibility study, I am happy to engage with members from other parties. Can you confirm whether any stakeholders are represented in the feasibility study, and whether it is on track to be completed by summer of this year? Yes, it is on track. The feasibility study has been taken forward by Scottish Government officials and analysts, with talking to local authorities and making sure that we get the right information. However, I am happy to ask my officials to meet with stakeholders that want to discuss this further and to keep them informed of the work that we are undertaking. Again, once the feasibility study is published, I am very happy for that to be brought to the committee. As you have asked, convener, the committee gets a copy of that. I am very happy to confirm that. I am very happy to confirm that stakeholders could get a copy sent to them if they want to discuss it further once they have seen it. I am very happy to do that. Can I ask on the cross-party group? It is like the different proposal to have a meeting with folk who are interested to look at the report, but the suggestion of a cross-party working group and perhaps the stakeholders are well looking at the feasibility study and seeing what the challenges have implemented. Is that something that you would at least consider? I am happy to consider that. I hope that the information that we get in the summer will give us some clearer options of the way forward. Obviously, it has to be deliverable. The options have to be affordable and they have to be fair and consistent. What we need to have first of all is the information in which to be able to make some informed decisions about what is possible. Whether that is an initial meeting cross-party to look at that, if there is then a view that we should continue those cross-party discussions, I am not going to rule that out. I would be happy to consider that further. In terms of those stakeholders or indeed the petitioners at this stage, they should simply be contacting your officials in terms of feeding into the feasibility study. You have explained in previous evidence that there are various models that could be implemented in making the charging regime fair. One approach that you have mentioned is to reconsider the threshold at which people start to pay charges. You have explained that the income threshold that determines when people will begin to pay charges will rise from 16.5 per cent to 25 per cent. The petitioners for petition 1 are to consider the concern that a blanket increase in the social care charging threshold will not reflect the relative cost of living in different parts of Scotland. What is your view on whether applying blanket thresholds promotes a fair charging system? First of all, we have taken action around the threshold. We did raise the threshold from 16.5 per cent to 25 per cent above the pension credit guarantee or the income support personal allowance and disability premium allowances. We did that because we felt that in making charging fairer, which is our aim, that actually starting with those on the lowest incomes was the fairest thing to do. That is why we took that step to raise the threshold. We also, of course, have taken other action in terms of those who are members of the armed forces, having their war pensions disregarded in terms of income assessment. Of course, there was already the position of those who are in the final six months of their life in making sure that local authorities are not charging where someone has a terminal illness. I think that there have been steps taken already, but in terms of the issues raised around whether or not there should be differing thresholds in different parts of Scotland, I think that we would want to make sure that we also listen to stakeholders who tell us that they want greater consistency in charging policies across the country. That has been raised with me by a number of members within Parliament over the years and recently as well. I think that moving to different charging thresholds in different parts of the country would seem to me to be counter to the idea of greater consistency. I think that in taking forward the feasibility study and the information that it gives us in the summer, I think that trying to achieve greater consistency would hopefully be one of the principles rather than less consistency across Scotland. Having different charging thresholds in different parts of Scotland would lead to greater inconsistency. Members on balance are asking me for greater consistency rather than less consistency. In the debate on 6 December last year, you explained that COSLA has implemented a new standard financial assessment tool and should reduce the variation in local authorities' charging regimes. The petitioners for section 1533 have been critical of the ability of the tool to meet the aim and argue that there is evidence that variation continues. Some local authorities have increased their social care charges despite the tool being in place. What assessment has been done of the impact of the tool and its effectiveness at meeting the aim? COSLA's standard financial assessment tool is in the first year of operation. COSLA has said that it will monitor its impact, and we would expect it to do that. I want to see greater consistency and fairness in the system, as Sysys said earlier in answer to the previous question. While we do have powers to require local authorities to charge or not charge for any particular aspect of social care, the partnership agreement that we have with local government means that local authorities should retain that local accountability. They are very keen that that is the case. I think that where we are just now making progress on fairer charging, that is where we would want to remain. Although the power does exist for government to mandate these things, I think that the way we have worked with local government in trying to reach agreement has been to tackle these things in a different way. That is why the standard financial assessment tool is important. I can say to the member that I will continue to discuss with COSLA the monitoring of that and the implementation of that. We do need greater consistency and we need to see local authorities using that financial assessment tool to achieve that. Rona Mackay? Yes, good morning. I have previously explained that if the variation in charging regimes does not improve, you might consider using legislative powers to ensure that that happens. At what point would you consider introducing that legislation and how would you use that approach to diminish the variation in charging? As you say, that power has existed for a number of years now. However, I think that the approach that we have taken has been one of partnership and what we have attempted to do is to achieve greater consistency. COSLA has worked with us on that in terms of the assessment tool. Of course, we have taken the action around raising the threshold, around terminal illness, armed forces veterans receiving the full value of their war pension. It has been an incremental approach in terms of improving and making charging fairer. I would see that continuing and I would hope that the feasibility study that we get in the summer will help to be able to reach a consensus on the way forward, including a consensus with local government on the way forward. That would be my preference, certainly, than having to tackle this in a different way. For me, that is the better route forward. Would that be an absolute last resort? It remains there. It has always been there. That power was brought in when free personal care for the elderly was brought into legislation. That power was there as a backstop. We would want to avoid doing that if we could work with local government to get a fairer charging position. We have already made progress. I have outlined some of that, the thresholds, armed forces, veterans and those in the last six months of life. There is more to be done. I would expect to do that in partnership with local government, and they would be very much involved in the feasibility study that will be published in the summer. Angus McDonough. Thanks, convener. Good morning, cabinet secretary. You have mentioned the standard financial assessment, so falling on from that and your commitment to work with local authorities. The petitioners for PE1533 raise some concerns about the democratic accountability of social care charging. In their view, the integration of health and social care has made it less clear which body is responsible for setting policy in this area. What is your view on this and how should councils and IJBs be working together on this issue in practice and communicating clearly with members of the public who use social care services? The integration of health and social care has, as you know, established a new relationship between IJBs and the work between health and local government and other partners around the table. We would expect that, when considering the provision of social care services, that all of those partners should be in dialogue and that those discussions would be taken into account when reaching decisions on social care charging. However, ultimately, the framework for setting of charges remains clear, and that is that social care charges are set by the local authority taking into account the guidance produced by COSLA that we were discussing earlier and the other guidance that they have produced. The guidance makes clear a number of things, but, importantly, the need to ensure that people have good and clear information about available services and the types of charges that might apply. It recommends that all councils provide charging information in a standard format on their council website and that information about benefit entitlements should also be available. Ultimately, it is for local authorities to decide. I guess that, in terms of the democrat accountability, if local authorities make decisions that local people don't like, it is for local people to make their views known about that. Obviously, there is an opportunity to do that through the ballot box if a local authority has produced a policy around charging that local people don't favour. That is where, ultimately, the democratic accountability is exercised. I hope that that explains, in terms of the new integrated landscape, that local authorities still retain the authority around charging. That is fine, cabinet secretary. Dr Cappell has raised concerns about the six-month end-of-life guidelines, arguing that it is often difficult for practitioners to assess whether someone is in the final six months of their life. You have previously explained that once a DS-1500 form has been completed, the person will not be chased by the local authority. It is our prognosis that continues beyond six months. Can you explain what written guidance there is to support this policy? Are you aware of any complaints that this is not being followed? That is a very important issue. COSLA's charging guidance recommends that local authorities use their discretion to extend the waiver of charges beyond six months. We would expect all local authorities to follow that. I am not aware of any evidence that this is not being followed. If members have any evidence, I would be very happy to look into any instances where the guidance is not being followed. If need be, work with COSLA to clarify their guidance, because it is important that no-one in the last stages of their terminal illness is charged for the personal care that they receive at home. If there is any evidence to the contrary, I would be keen to see that, and I would certainly take action accordingly. It is important that we continue to monitor that, but if there is any evidence, I would want to see that. The committee does have any evidence. We will forward it to you. First, on the question of disability-related expenditure, you will be aware that, in England, it is a legal requirement to take account of any additional expenditure related to a person's disability. That is not the case in Scotland. It would seem that the majority of local authorities in Scotland make no allowance for additional costs. That is an issue in terms of people's ability to fulfil their potentials, to work with them, if that is simply not recognising the charging regime. Is that something that you would look at? I think that we would want to continue to discuss with local authorities what is disregarded and what is taken into account as we take those issues forward. There is variation in terms of the practice across these islands. In terms of the income that is disregarded and then the buffer on top of that is designed to try and make sure that the income that people are left with is adequate to not just pay care charges but to meet other needs as well. I guess that is something that we would want to keep under review. Do you want to say anything about the difference? Is there anything, David? Obviously, the disability benefits that people get should be taken into account, their relative needs and we will be getting additional powers in relation to some of those things. Specifically, in England, it is a legal requirement to take into account to have a proper assessment of what are the things that are added because of the specific disability. Rather than a general disability, you take that box and that is therefore the charging regime. Specifically, assessing the person and the basis of what the extra expenditure that comes with your particular disability and for some people it can be very significant. More of a need space. Is it something that you would at least look at? I think it is something we could take into consideration and explore further. David, your point about the fact that we are getting some welfare benefits devolved enables us to have a look at all of those things and perhaps take a different approach, but it is certainly something we will give some further consideration to. I suppose that the other issue that is behind us in terms of the first petition, which is the question of you have dementia and you are under 65 and you do not have access to certain supports that are very clear in your feasibility study, is looking at the second petition, which is really about whether, at the point of access to services, they should be free at the point of need. That is not something the feasibility study is looking at, as I understand it, but I wonder whether, or what is your view on what I find quite a compelling argument, which is that this is a human rights issue, that we should all be entitled to achieve a potential, that we should have the supports that allow us to access work, education or whatever it might be, and that we currently have a care regime or a funding regime that denies people that right. That disability-related expenditure is part of that, but if we have a system of support and care that is not very closely connected to people's individual needs, do you see the argument around it being a human rights issue? I think that someone being able to live life to the full and being supported to do that is a basic right, so I would agree with you to that extent. I think that we have also recognised that in some of the policies that have been taken forward. If we step outside charging for a setting, then we look at things like self-directed support or the independent living fund, which has been continued in Scotland and like elsewhere, I think those are examples of resources that are being used to very much enable people to live their life they want to live, be able to continue to work, for example, and ILF, of course, supports people to remain independent at home and indeed to hold down their job and to go about their daily lives. And the SDS, again, is on the principle of personalised support that the person can live life as they would wish to, rather than perhaps being restricted by fitting into the services that are available. That is all on the basis of empowerment, personalised care and being able to live an independent life. I think to that extent I have sympathy with what you are saying. In terms of taking forward the fairer charging policy, it is with a view to maximising people's independence, the quality of care they receive and also making sure that they are not accepting support because of charges that they may, and I think that is where we want to assess things like unmet need, for example, which the feasibility study will look at, because there may well be people out there who currently are not accepting support because of the charging regime and that is a concern, because obviously that means that they might not be living, not just living life to the full, but they may actually have severe difficulty in their day-to-day lives because of that. Those are the things that we need to look at. I think that there is an issue, and I note what you say about independent living funding. You have continued it for those who are already in it, but there are no new applicants to independent living funding. There will be resources available for new applicants to ILF. I think that it was £5 million. There will be the ability for new applicants to apply, but the focus has been on establishing the infrastructure around that, and that has taken some time in making sure that the processes and application processes are there. I think that there is an opportunity as well as we get some of the welfare benefits devolved to join the dots a bit more effectively around the supports that are available, whether that is mainstream care support through local authority, a third sector providers, whether it is SDS, ILF, and indeed some of the other benefits that will be devolved. I think that there is an opportunity over time, certainly, to bring more of a coherence to those and focus a bit more on what is it that the person needs to be able to live a fully independent life. I suppose that the human rights approach would mean that the answer was that it is too expensive, it would not be an answer, it would be an unacceptable answer, and that is something that I think the campaign is exploring, and certainly a number of us would be exploring this question. You wouldn't say, well, universal education is too expensive, so we will just educate our boys. I think that that is really the kind of issue around there. The final question I have is really around what your understanding of the definition of care is, but some of the evidence that we have got on the minds of support that people require is not just physical care, but there are other things that allow you to be an active citizen to work and so on, which would not be a very narrow definition of care. Are you concerned that local authorities have very significant budget constraints on what they are doing, but are you concerned that perhaps generally we have a definition of care which does not recognise this question about people's entitlement to be able to achieve their full potential and, in fact, to inhibit what they are doing because we are quite a narrow definition of what care is? I think because of the free personal nursing care policy it was necessary to define what was meant by that in terms of entitlement. Given that we are living in a situation where finances are not infinite and, therefore, there has been a focus on the support needs around personal care and the prioritisation, I guess, of people's needs and those who have the greatest needs getting the support, particularly around dignity and being able to remain living at home without that personal care input. Many people would not be able to or, indeed, family and carers would have to provide all of that support without external support and that would put huge pressure on them. We will always need definitions, I think. Personal care has been given that level of priority because it has been recognised. It is, by nature, personal and it is about the personal needs, the washing, the dressing getting up, help to go to bed, all of those things that are really about dignity. Whether or not it needs to be redefined, I think I would be cautious around that because we do live within a finite resource. The focus of our attention at the moment is on what we can do around the personal care needs of those who are under 65. I would quite like to keep a focus on that and to try to see if we can resolve that issue in a fairer way before looking at the definition of personal care more generally. Okay. Thanks very much for any final questions from the committee. I mean, I think that in terms of the petitioners, this clearly is something that is not going to resolve simply by a feasibility study, but that is something that obviously is going to provide a lot of information, but the very strong and compelling case that has been made round under 65s but also this question of the variation across the country, what is defined as need, comparisons perhaps around disability-related expansion, all those kinds of questions and stuff that we maybe want to look at further, but we appreciate very much the evidence that you have given thus far. I wonder if the committee has a view on what we do now, and I think we maybe want to take the opportunity to reflect on what the cabinet secretary has said. There will be clearly a critical milestone when the feasibility study itself is published and perhaps we can look at it further as a committee based once we have got to that point. Does that seem reasonable? We will take the opportunity to reflect on the cabinet secretary's evidence, and obviously the petitioners will have a view on this as well. We can perhaps a further meeting to decide a course of action, but in the meantime, I thank you very much for your attendance. That has been very useful and can I suspend briefly? We can call a meeting back to order, and we are now moving to petition 1577 on adult cerebral palsy services. Can I welcome Murdo Fraser to the meeting for this item? The next item on the agenda is petition 1577 by Rachel Wallace on adult cerebral palsy services. We are joined this morning by the Minister for Public Health and Sport and her officials, Dr Gregor Smith, Deputy Chief Medical Officer and Elizabeth Porterfield, Head of Strategic Planning and Clinical Priorities. Can I welcome you to the meeting this morning? We have a bit of time, so I wonder if you want to make an opening statement, then we would be happy to hear from you. I understood that the committee had wanted to go straight into questions. However, I thank you for the opportunity to respond to Rachel's petition. I got the opportunity and privilege to meet with Rachel last week, along with her MSP Murdo Fraser, and I got a chance to explore some of the issues that she had concerns about. I think that it's a tribute to her for articulating those concerns and trying to make a difference and trying to make improvements for others who suffer from cerebral palsy across the country. We undertook to explore further some of the issues that she raised around physiotherapy access and the main point that she had been trying to articulate around a national clinical pathway. I think that those will be some of the questions that you'll want to prove us a wee bit about today, particularly around our work, on-going work with Bobath Scotland about the local pilot in Western Bartonshire, which we think, and hope, will go a long way to reassure Rachel about the action that we're taking to address the concerns that she's raised. We have also undertaken to work with Rachel on a range of different activities to ensure that we can provide her with a bit more reassurance and comfort that the action that we're taking addresses her concerns. I'll also instruct my officials to explore a bit more fully with NHS boards across the country about their provision and how they're helping people with cerebral palsy to cope with that transition. I think that that's an issue that I think that a lot of people with disabilities or conditions face. Those tough transitions from children's services into adult services, and I think that that's something that we should explore, not just in terms of NHS Tayside where Rachel lives but across the whole country. I think that that will complement the work that's already being undertaken by Capability Scotland in their mapping exercise and the work that Bobath Scotland is taking with the pilot. I think that together we'll get evidence, information that will allow us to take forward a framework that provides reassurance to Rachel, provides a hope reassurance to the committee and will keep the committee updated with the progress that we make to make the differences that Rachel is keen for us to make across the country. Okay, thanks for that. Obviously you'll be aware that this petition was carried over from session 4, Public Petitions Committee, and as you say, you're funding a pilot project being led by Bobath Scotland in conjunction with the Western Bancers Health and Social Care Partnership. Scottish Government has described this project as, quote, an alternative supported pathway for adults with cerebral palsy. I think that the suggestion appears to be that Scottish Government will not consider the needs for a national clinical pathway until this pilot programme is completed. I wonder if you could explain the scope of the pilot for the record, obviously, and why it's described as an alternative supported pathway for adults with cerebral palsy in circumstances where there does not appear to be an established clinical pathway? I might ask Gregor to explain more fully for your benefit around the processes for a national clinical pathway, but certainly in a broader sense, national pathways are delivered for more specialist conditions that require fewer interventions from clinicians and fewer and less providers. Because of the range of ways that this condition can manifest itself and because it relies very much on a variety of providers both across health and social care, that means that there is much more merit in having a more local and bespoke way of ensuring that people get the care that they need. That's why we're keen to get the learning from the Bobath pilot in Weston-Bartonshire, understand the learning that has been amassed during the 18-month period of this pilot, work alongside the work that's on-going from Capability Scotland in their mapping exercise, and then I think what we'll be able to do is develop a framework that will allow us to have some national principles that will enable there to be a bit more consistency felt across the country. That's why we won't be proceeding with a national clinical pathway because the way in which this particular condition manifests itself doesn't necessarily allow itself to easily be translated into that course of action. That's why we want to make sure that local activities are as good and as strong and robust as they can be and that's why we're proceeding with this pilot to amass that evidence so that we can then proceed with that evidence backing to ensure that local services are delivered in an appropriate and timely way. Gregor, would you like to expand on that? Good morning, everyone. We've got a couple of decades of experience of developing pathways now, both at a local level and a national level, and a better understanding of what conditions lay themselves to be very open to the development of pathways in either of those manners. When the description is made here of an alternative pathway, I think it's an alternative approach that would be a better description. It's done when we've developed a clinical pathway. If you go back to the first pathway work that I was involved in in the early 2000s, what tended to happen was a group of clinicians, experts, we would get together in a room and they would examine the evidence for a particular approach to care, look at the contributions from each of those professionals in terms of a pathway and develop a pathway with supporting data to assess the quality of care along that. That approach probably has become very much less used now. What we have is a very different approach where much more use of co-created pathways is working with patients in the public to develop a pathway. The alternative sense that Bob Arthur described this pathway is what they wanted to do in terms of the development of the pathway was to development very much and use it up. Working very closely with people who have experience of cerebral palsy looking to see exactly what their needs were and develop the pathway using evidence around about their needs. That's why the term alternative pathway has been given here. As the minister has already explained for a condition like cerebral palsy there's a number of different influencing factors when the approach to developing a pathway is considered. One is about what kind of evidence base exists for that pathway already. Is there a consensus around that evidence base? Is there the data to support the development of a pathway? Is it a high volume specialty? Is it a particularly specialist type of service that would be needed? Considerations taken as to whether that's necessary on a national basis or at a local level. I'm certainly convinced by the argument that in the case of cerebral palsy what's required is a stronger evidence base developed from the ground up that informs the national framework for services so that local pathways can be developed for people to receive care at that local basis. Does it feel illogical to me to say that this is too complex to have a national pathway? Because it's a complex condition that doesn't have a national pathway and it has to be started at a very local level which presumably will be very local. I don't understand certainly from the petitioner's point of view her description of having a whole series of people around about her as a youngster moves into adulthood and she has to find out all of these supports for herself. It feels pretty basic to have a system in place where she would have somewhere to go where those services would be identified so the definition of something being too complex to have a national pathway doesn't feel to me to make sense and even if it were the case I'm not getting the logic of then saying you're there for this repilot in one particular area that's going to tell you everything about the condition right across the country. I've suggested that it's the complexity I think it was the minister who said that it was too complex but what I think I said was that the condition manifests itself in a different number of different ways and that means then that there needs to be a cognisance of that and which is why, as Gregor said if we have local pathways that will allow us to take a much more holistic picture of the individual patient their individual needs ensure that they have the appropriate transitions in place and that local services are delivered around that patient in a way that allows them to seamlessly move in Rachel's case from children's services into adult services so that was why I said that there was at this current point in time no plans to develop a national clinical pathway but actually the Bobath work is important, it's not just a local pilot it is something that's going to develop and enhance our understanding of the condition, the way in which services are provided and delivered and how we can then upscale that and make sure that there are principles across the country that are understood so that people don't, as Rachel has herself described have that feeling of falling through the cracks at that point of transition and that's why I've also undertaken I will undertake to ensure that we engage with every single NHS board across the country to make sure that there's appropriate provision in place to ensure that those people don't fall through the cracks because that's not what any of us wishes to see happening and actually there should be in place already ways in which people are helped to move seamlessly from their children's services into adult services and that's why, again, if we have much more rigor a much better and clearer understanding of how services are delivered which is what the Bobath pilot will offer us then I think that that will move us towards what I think and I hope that Rachel does want is to make sure that that transition is seamless and that people feel supported I'm still not clear that you say it has to be done locally because it's complex you can't just have a national provision or a national pathway but we don't have we aren't developing local services we aren't developing local pathways we have a pilot a pilot to help us understand what we need to do to enhance provision across the country in a local sense but have those national principles that we all understand will be useful and critical so that provision is much more seamless so is there a possibility that the pilot will lead to a national pathway you're not excluding it as a possibility if it's a pilot is this something that might happen so one of the characteristics of national pathways from a clinical perspective tend to be if there's a really narrow range of providers who can give care to patients maybe one or two providers at a national level who would actually be delivering that care that would be something that would be very tangible for a national pathway what we're talking about in this case for the cerebral palsy pilot is the requirement to develop in that planning phase the robust evidence that suggests these are the services and the approach that are at a local level by multiple providers in order that patients receive the best care possible it's the best way that I can try to describe this so national frameworks national pathways tend to be for a very narrow provider range one or two providers throughout Scotland who are only capable of providing that care but a framework which underpins local pathway development allowing local care according to the needs of that population is very much what the go bath pilot will provide the evidence for I hope that makes sense in your meeting with the petitioner there was a suggestion in terms of how long this is going to take it will take 10 years is that a prayer to develop a clinical pathway and framework for adults with cerebral palsy it may take 10 years would you agree that that's far too long and are you going to put a timetable on developing this work I think at the time in our discussion with Rachel we I think there had been a misunderstanding about that 10 years that wasn't the case and we tried to give reassurance that to develop improvements around cerebral palsy won't take 10 years and the go bath pilot is 18 months and that will help us then develop a framework along with other work that's happening across other neurological conditions for instance Huntington's that will help us to pull that together to ensure that we can develop the changes that I think Rachel said that she would like to see so no, it won't take 10 years okay, I think Rona Mackay will be helpful to come at this point thank you, good morning this might be a question for Elizabeth Porterfield we know that there are other national clinical pathways in Scotland for other conditions such as motor neuron disease I wonder if you could tell me roughly what it would cost to set up a national pathway and if it has any bearing on what you're planning to do here no I honestly don't know how much it would cost but I do know that there would be as Gregor has described several layers and areas of work that would need to be progressed by people with cerebral palsy involving them as well as the specialists and the non-specialists on all the managers this is possible to do this is what the Bobath pilot has been looking at how you do that locally with all the providers because although there may be and I use the words with quotes around it, specialist needs within a general service if you like physiotherapy, they are all trained to provide physiotherapy for a variety and range of conditions and etc for people defining that for someone with cerebral palsy obviously needs to be looked at for the individual so yes we can do that but the costs would be the time costs of the people that need to get together to do that which would be variable but there isn't a specific cost attached to it and it has not at all entered into anything around this we agree we need to do this that's why we funded the pilot to see how this can be done within the partnership context because of integration because the needs are not all about healthcare services there's also the issues around the join up with social care and IJBs are responsible for commissioning these local services which is why this needs to be done locally can you remind us how much the funding for the pilot costs £73,000 so far okay thank you Dr Smith I think all I would want to say is that I don't recognise cost as being a consideration in terms of the thinking about what qualifies for a national pathway and what needs work to develop local pathways but it's not one of the considerations that people factor in and I think it's very important I think with what the discussion I had with Rachel as well a lot of what she described was that she felt that there was as is often the case in many areas of social policy and health policy that if things had been identified earlier if services and that transition had been smoother then perhaps that wouldn't have been as costly or that she wouldn't have needed to have had more costlier services because some of the things would have been prevented that she's encountering now so I think that's a real lesson as well that services delivered in a holistic way around the person that they are empowered to be in control of what services are delivered to them that they are able to articulate clearly and feel that they're being responded to by local services so that they can avoid the more costly consequences of something not being identified and dealt with costly in terms of their own personal health but also costly in terms of the public purse the whole reason for developing this alternative pathway is also to embed that approach of early intervention and prevention which is the right thing to do for the person but it's also the right thing to do for the way we marshal public funds Thank you, that's helpful, thank you I think the point is that there is no transition I mean, in experiencing the petitioner there was no transition, it wasn't that it wasn't terribly well organised, there was no transition That's why we've got this pilot in place to try and identify ways in which that can be dealt with adequately but also what we don't have is what we want to make sure is that we have a better understanding of what other NHS boards are doing and whether this is particular to Rachel or whether this is something that we need to address much more quickly which I think will then mean that the evidence that we're getting and the research that we're getting from the pilot will allow us to speed up some of that across the country and what the health boards are doing across the country is working in parallel with the bull bath Capability Scotland understand that although I've not been involved in that work they're doing a mapping exercise as well and they'll be identifying areas that need to be addressed which will complement the learning from the bull bath pilot and also other work from other neurological conditions such as Huntingdon's Association which are also developing a framework to help people which I understand as well other neurological conditions are welcoming and want to build on and develop further so it doesn't just cater for Huntingdon's but it develops for a suite of other conditions as well so I think what we're doing at this point of time is gathering that evidence gathering that research and making sure that we can proceed in a much stronger way and give that reassurance to Rachel that she needs Sorry If I can perhaps expand on this from a clinical perspective it's utterly critical that work on transitions is led at a local level utterly critical because the experience of transitions in other chronic diseases whether that be asthma or epilepsy or whatever other childhood illnesses transitioning into adult care it's about how local services configure themselves, develop the relationships between clinicians and with the patients They must be shaped by national understanding of the issues around a particular condition surely I'm not suggesting that everybody within a particular geographical area their asthma is very specific to their local conditions so there must be a national perspective on how you would manage any condition which then would inform the very local issues That's different from a national pathway a guidance or a national framework which helps to support that local work a national pathway would take us into a whole different spectrum of the approach to the way that we manage that condition There's key principles across transition for any issue whether that's any condition as well and that key principle is about those relationships and ensuring that services are delivered timiously to that individual and making sure that they feel empowered in that case, unfortunately, that doesn't seem to have happened and she's explained to us With respect, I think that she would suggest it's not just herself but for people with her condition that she would suggest that that was an issue but anyway, if we can progress Ryan Whittle Ms Wallace is calling on the Scottish Government to consult with stakeholders on the development of a clinical pathway She's particularly keen for professionals in the NHS who are involved in supporting and delivering services for adults with cerebral palsy and I wonder if this is something that you're prepared to do Absolutely, I was keen to engage with people who have lived in real life experience on issues like this and again we've made that offer as well to work and continue to work with Rachel herself to ensure that she has the confidence that the action that we are taking is addressing the concerns that she's raised at this petition Also the work that Bobath Scotland are doing in Western Bartonshire has very deep engagement with people and with the condition and also clinicians in that area and the whole range of service providers in Western Bartonshire So I'm absolutely keen to always engage with people with real life lived experience because that's the way in which we can enhance services The petitioner notes to her written submission that she has experienced difficulty using self-directed support to pay for specialist physiotherapy This is one example that she uses to highlight why in her view a national clinical pathway for cerebral palsy is merited Are you familiar with this problem and why there may be confusion about what types of services self-directed support can be used for? Well I think we're very clear that the self-directed support guidance and the guidance that accompanies self-directed support legislation states that direct payments can be used and spent in a way that provides that it meets approved outcomes and should be an empowering thing for people with particular conditions Again the discussion that we had with Rachel we undertook to do further work in case that's not understood in a national sense and we have also worked with COSLA to make sure that we can develop much more consistency around the way in which self-directed support is applied in a more general sense across the country because self-directed support is to make sure that people feel empowered and in control of their condition and in control of the way in which they can get help Thank you convener I've been mourning just to put on record my thanks to the minister and to the officials the opportunity to meet with the petitioner yourself a couple of weeks ago prior to that with officials that was very helpful the exchanges that we've just heard I think my experience of talking to Rachel I think her biggest issue was her inability to find anybody within the NHS who had the correct knowledge and expertise to try and address her issues it was different when she was a child when she made the transition to adulthood it just seemed to be nothing available and no one to even point her in the right direction which really is what led to the petition being taken forward and she was left having to source specialists for example in physiotherapy herself and in some cases travel quite large distances to get the specialist treatment that she needed there's two issues that have come up which I'm quite keen to focus on the first is this question of the local pathway that you're talking about the petitioner was very clear she felt there was need for a national clinical pathway I think my concern about going down a local route is if you're then leaving it up to health boards to develop this themselves what confidence is there that they will actually take this up given Rachel's experience so far in Tayside which I'm sure is not atypical of what might be happening elsewhere in the country and I think the whole point of having a petition that was based around establishing a national clinical pathway was to try and ensure that there was some uniformity of care and support for CP sufferers right across the country and the second point which is the one that the convener has touched on already is the question of timing because I think we'd want to know that there's some degree of urgency going to be put behind this what we've heard from your self-minister has been encouraging in terms of the work going on but we don't want to be coming back in five years time finding that very little has happened absolutely because people will be going through transitions now and we don't want to hear more stories like Rachel's experience so I agree that there needs to be pace injected into this. We're coming to the end of that pilot so we'll be able to then move forward on ensuring that there's a better national understanding that there are ways in which we can build a framework that has that national prominence for local NHS boards or local providers to understand but again it goes back to the points that Gregor made around that local clinical path when needing to be based on the cognisance of the individual's condition and the local support that can be brought around them so it needs to be, you're right though we need to drive this in a national sense too and I think that part of that is also about making sure people have a better understanding of the condition that there's much more general awareness of the condition too so that Rachel doesn't feel that she's having to go over what her condition means for her and that she has to explain that condition to people that she thinks and feels and believes should already have a knowledge of what she may be going through and I think one of the points that she made was that she wasn't able to speak to anyone who was able to tell her what other related conditions she might she should anticipate as part of her cerebral palsy so I think on that point to make sure that there's greater awareness raising I think that they'll be able to develop a framework based on the Bobath pilot I think that Bobath Scotland have just launched a new website as well which although it's for children we want to explore ways in which we can develop that to be applicable to everybody and adults with cerebral palsy as well and we'll continue to work with Rachel on all of these things to give her the confidence that the pace is injected into this work of having to re-submit a petition in five years' time Just to get clarity on this question of the local pathways we're talking about and how what is the role of the Scottish Government and NHS nationally in making sure that these are actually delivered by local health boards? Local ownership is really important in this pathway development because you rely on local clinicians, local coordinators that are really championing that and some of the problems that missworks experience in terms of that co-ordination at a local level the signposting, the availability of services the visibility of those services to local clinicians one of the best ways of trying to resolve that is by that local ownership and development and certainly that can be influenced in a variety of ways through the kind of influence of if you like the national medical directors and national nurse directors group who can be examined as to where they are in terms of that development and how they assure themselves of the service through the local clinical governance structures there's also a really strong role here for some of the groups like capability Scotland to really to be holding the local boards to account alongside Scottish Government in terms of the services that they the kind of members and the people they represent experience as well We also have the national advisory committee on neurological conditions as well and I think there may be a role for them to make sure that there's national oversight of the way in which local provision is delivered and that the service planning subgroup is part of that as well so that gives us another opportunity to have a national understanding of that local delivery as well I think ultimately our aim is to improve the service that people with cerebral palsy experience and there's a variety of ways that you can go to do that If we use the example of another area of clinical practice for instance respiratory medicine the pathway work with respiratory medicine started back about 2000 between 2006 and 2008 and gradually across the country we saw huge improvements in terms of the way particularly patients with a condition called COPD experienced care the formation of the national airways group which represented all those if you like all those pathway groups coming together sharing good practice learning from each other has meant that they're able to kind of take things on there's never a national pathway for respiratory medicine but what happened was that those pathways developed cognisant of local needs, local services owned by local services and has taken forward the respiratory care there I just have one final question although I think it's quite remarkable a suggestion that capability Scotland as a charity should have a job to hold a board to account given it very often commissioning work from an individual charity that feels like a very uneven battle to me can I ask you are there lessons emerging out of the Bobath's work at local level about which local services care would encompass including health and social care beyond physiotherapy are there early lessons emerging just now that might be a cross-sharing with social concern about this question I think what Dr Smith said at the start there was around the number of ways in which boards can be held to account and I also under in the response to Murdo Fraser did mention the national advisory committee as well so I think it's a bit disingenuous to suggest that we were only and solely looking for capability Scotland to be holding boards to account It would be remarkable if a charity was able to hold a board to account I think there is an issue about anyone holding a board to account so that would be an interesting lesson to learn from that perhaps there are early lessons from the Bobath pilot which has been on-going now for around 18 months and they have been concentrating on working with the workforce making sure there's a better understanding of the condition around the workforce and understanding where the gaps of provision are so they've been working to ensure that knowledge is understood about the transitions for people with cerebral palsy their phase 2 has been looking at practical improvements that they can make and what interventions need to be undertaken to ensure that the transition is smooth and that outcomes are improved and we'll be shortly to get the finalised pilot and we can share that full learning with the committee if that would be of interest to you OK, unless there are any further questions Brian I know you can go over this before chair but I do understand the necessity for delivery of services locally using local services what I'm struggling with is connecting the dots up between having a pilot for a local pathway and as you've said yourself each local authority will have a disparate pathway to follow and using that to develop local pathways across Scotland without having at least a framework for a national pathway so I get this is not unusual for the way in which you develop policy and practice that you would have a pilot to test what works, to test what is possible and to understand barriers to see what more you need to do what are the unintended things that might crop up through that process and then to distill that learning and then to share that learning in a national sense with those key principles so that's why there's a pilot that's why there has been this engagement with Bobath Scotland that they with the expertise they have on this condition have been the ones that have been commissioned to provide us in government to bring about the research the evidence, the understanding of the condition what needs to happen what needs to be improved and then how we can then share that with other boards so that they can then apply those key principles to their own local clinical pathways to ensure that provision is improved for people across the country with cerebral palsy To me, you're describing a national pathway there I think as he's off in the case Mr Whittle, sometimes the terminology gets mistaken and it's really easy to do that but you mentioned the term the national framework and I think that's really important because what the evidence from a variety of different sources including what is current practice across the boards will be able to inform is that sense of a national framework that informs best practice in pathway development rather than a national pathway which is something completely separate national pathway would be a way of delivering care to patients from only one or two providers on a national basis Okay, Morish, reflect Morning minister Would it not be sensible bearing in mind what Mr Whittle has just said to run a parallel project say in Aberdeen or somewhere else in another local authority area even maybe a third one statistically that is more sensible than relying on one and particularly in my local area there is a lot of rural part of it and therefore we're not looking at the conurbations so much there should be a balance I believe to get the right result I think that might be one option I'm also kind of aware that you've asked me to inject pace into this as well so the other thing is that this is based on people, individuals understanding as well as working with the clinicians this is about working with individuals with cerebral palsy and the expertise and knowledge that Bobath has more generally aside from this pilot so I think together we'll be able to get to a place where we do have an ability to provide something a framework in a national sense which takes the understanding the rurality, the complexity of Scotland's geography the cities, the urban areas as well the islands too so that we can understand the condition as best we can that we can improve it in a national sense but I'm kind of conscious that I don't think the committee would want me to then undertake more pilots at the risk of delaying those improvements to be seen across the country Sorry, it's just a pity that it hadn't started off say with three different areas as the pilot rather than just one specific area on the local authority area Elizabeth, would you like to comment on the reasons why Western Bartonshire was picked? It was entirely working with Bobath because we wanted to look at this and we have worked with them and that was their suggestion so this is how we agreed to go forward there wasn't a proposal to do it in two or three areas I wanted to look at the possibilities because integration the joint boards, the community of partnerships all help and they are the commissioners of these services now so we have to look at it that way I take your point though Mr Corey around perhaps we might have looked at doing it elsewhere but the partner in this case was Bobath and this was where they proposed to do it so it's as simple as that I'm afraid Both Bath Scotland do have national understanding in depth understanding of the condition they work with many people across the whole of the country as well so there is that on the side the individual outcomes of Western Bartonshire pilot that understanding that they have and the expertise that they have in a national sense as well which will all work together towards ensuring that we get a framework that's deliverable across the whole of the country also the mapping exercise undertaken by Capability Scotland that is looking to see where provision may need enhanced our own undertaking to further enhance that and also the work that the Huntington Association is doing around frameworks for that condition which other neurological conditions have said that they would like to use to enhance services for their particular illnesses as well so I think that piecing all of that together puts us in a strong position to then deliver a national framework that understands the geography of Scotland that understands the desire that we all share to improve services across the country for people that are suffering from cerebral palsy and addresses the issues that Rachel has raised in her petition around transition, around access to issues like physiotherapy that sense of powerlessness that she felt as someone experienced in that condition and I anticipate that this will make the improvements and I hope it gives her comfort because we will continue to work with her and test that against her expectations I'm just concerned the final point that you've slightly been I wouldn't say led by the nose and I'm not decrying them at all the work they do but it just means that it takes away from this national picture that's my concern I thought you might go after a bigger part I though have told and highlighted the fact that Bobath have a national presence have expertise in this condition far more than probably any of us round the committee table and that we are also undertaken to ensure that and test with NHS boards about what they're doing and whether it's appropriate around their transition programmes and how they're helping people to overcome some of those barriers across all NHS boards across the country and of course there's the other work that we are funding Scottish Huntington's Association to develop their framework which other neurological conditions have said that they would be keen to use to enhance provision for their own particular condition Thank you The only thing that I would say is that there's a bit of a chicken in the egg but presumably you actively chose Bobath to do your pilot and we'd have a conversation with him about defining what that pilot would be but we will also await the findings of that with interest I think that in terms of time we have come to the end of this particular petition and I thank the minister and officials for being here to reflect on the evidence that we've heard and maybe to test what you've heard, what you've heard here against what the petitioner might respond and others might respond to that and so we will take an opportunity at a further meeting to decide what further action we want to take I don't know if there's any particular murder phrase that we'd want to highlight in terms of that or the rest of the committee but I think there's plenty of food for thought there I think that that's been a helpful session and there's a lot of information that's come out in the course of the last half hour so it's quite useful to sort of take that away and digest it and to get the petitioner's view on where we go from here OK, on that case I think we're agreeing then that we're going to reflect the evidence from the minister and decide at that point what further action we're going to take but again, thank you very much for your attendance today I think it has been a very useful session and I'm sure that alongside that those processes that you've undertaken in your deliberations that you have an idea of the timescales for when the pilot comes to an end and learning from that so that that might help with your understanding of how to take this forward I think we're particularly happy with your clear view that this will not take 10 years and that will probably reassure everybody with that, and I thank you very much and can I suspend briefly OK, if we can call a meeting back to order we now move to agenda item 2 on a new petition and we're taking evidence in petition 1637 ship to ship oil transfers and transport accountability and can I welcome Kate Forbes and John Finnie Hewer in attendance for this particular petition this petition is by Greg Fullerton on behalf of Cromarty Rising this is a new petition that we're considering for the first time we will take evidence from the petitioner who was joined by Duncan Bowers and Lorraine Thomson can I invite Mr Fullerton to make a brief opening statement of up to five minutes after which members will have an opportunity to ask questions thanks very much thanks for inviting us here today this petition reflects our experience with a recent proposal to undertake ship to ship transfers of crude oil on the Inner Murray Firth it becomes a decade after a similar proposal was rejected on the basis of environmental impacts on the Firth of Firth so we asked the committee why has this issue not been resolved in the intervening years with North Sea ports and infrastructure in need of support these proposed transfers at sea anchorages bring no new jobs and threaten existing ones there is no benefit for the areas affected businesses and communities in the industrial environment need clarity to be able to make investment decisions for the future Lord Donaldson's landmark safer ships cleaner seas reports which followed on from a catalogue of oil spills around the UK coast it was recommended that such transfers should only take place at two locations in the UK namely Southwold and Lyme Bay there were no sites in Scotland ship to ship transfers of crude oil and Scottish waters it should be subject to both a strategic environmental assessment as well as a sustainability appraisal which considers economic impact we ask why these strategic assessments have not been undertaken in Scotland in our experience of the recent Cromarty Firth port authority application there are now 27 Highland and Murray community councils in opposition there are several high profile NGOs in opposition and over 100,000 people have now signed a petition opposing it in the case of the Firth the 4th three councils representing 900,000 people opposed it and the issue was raised in the Scottish Parliament so how can the Scottish Parliament act to use its powers to reflect the will of the people to protect our environment and businesses that depend on it the matter of ship to ship oil transfer of course is not devolved however environmental protection most certainly is devolved this leads to significant process anomalies in our view we are not here to argue for ship to ship to be resolved to devolve sorry we simply seek that the Parliament uses its powers to protect our environment so how can Marine Scotland's sepa protect our environment in our designated areas and our wildlife in this situation when there are no more than consultees or advisors in the process moreover how can we ensure our environment is protected in the event that our environmental agencies disagree with the views of the maritime and coastguard agency who are the awarding body implementation of the habitat regulations in relation to ship to ship oil transfer currently requires authority in the discipline area by those qualified in each subject matter so currently the maritime and coastguard agency who have expertise as mariners are the competent authority and can override or overrule our environmental experts so what legislative levers are currently available in Scotland to enable the Scottish Government to contest decisions made which may have significant detrimental impacts to the Scottish environment the recent application has highlighted a number of inadequacies and uncertainties with regard to environmental impact this is not just limited to the impact of an oil spill which would be a catastrophe for marine life and businesses alike there are also significant operational concerns in relation to ballast water treatment acoustic disturbance underwater discharging of carcinogenic volatile organic compounds into the atmosphere in the case of an oil spill occurring the modelling is based on a worse case scenario of the discharge of 1 tonne of crude oil even though the tankers that are going to be carrying out these transfers can carry up to 180,000 tonnes the environmental impact is therefore grossly underestimated one of the most shocking elements is the potential for euthanasia of whales and dolphins following life stranding due to an oil spill in order to simplify this petition we've made a technical submission to SEPA on the ballast water hazards and we asked the petitions committee to obtain SEPA's responses guidance we asked how the Scottish Government can enforce its own code of practice on non-native species to allow ballast water discharge that is taken by a body external to Scotland acting contrary to SEPA's advice and we asked further whether the planned euthanasia of European protected species is lawful or indeed ethical when it could be avoided completely in the case of the Murray Firth application there is not enough certainty in the process to say beyond all reasonable scientific doubt that there will be no impact on the integrity of the Murray Firth special area of conservation this is a fundamental requirement and it is not unique to this case with process uncertainty therefore how can we allow another Scottish transport to put forward such an application the other part of our petition of course deals with port accountability and again using the Cromarty Firth Port Authority as an example Cromarty Rising who we three represent have written to individual board members the chamber, the chairman of the board and the chief executive with regard to their recent application there has been no meaningful engagement Transport Scotland has stated that it is up to each trust port to ensure it complies with its own legislation is the committee comfortable that an unelected self-appointed organisation looking after a public asset should be able to police themselves Transport Scotland has no remit of course in disputes and if stakeholders feel aggrieved their only further recourse is to take legal action which is both costly and time consuming and we know this this is wrong trust ports manage valuable assets that belong to the people of Scotland they are managed on behalf of the people and they ultimately and not to themselves at the very least there must be independent oversight trust ports are responsible to their stakeholders they can receive indirect public funding via the Scottish Enterprise Network and all profits should be reinvested in their ports their ability to do that should not be diluted by private joint sector joint ventures or using penetration pricing strategies to direct detriment of local stakeholder competitors and other Scottish ports we finished to say is it desirable or indeed within the spirit of the harbours bill that Scottish trust ports should deliberately set themselves up in direct competition to their local stakeholder businesses and finally do the committee agree that there is a need for oversight of our trust ports thank you very much for that opening statement about existing ship-to-ship oil transfer licence in Scotland our understanding is that licence exists for ScapaFlo, NIG and Sillamvo and our background information indicates that there have been no major incidents at ScapaFlo since 1980 the 86 transfers took place at NIG terminal between 2009 and 2014 without incidents and in respect to Sillamvo we understand that in 2009 there were two minor spills in respect but the investigation confirmed no adverse effects or damage to the environment what I'm interested in is whether you oppose all ship-to-ship transfers or are there specific locations and or infrastructure that provide appropriate facilities for this activity I think that's the crucial part of it you need the infrastructure to be able to undertake these transfers safely at NIG we have absolutely no issue whatsoever with ship-to-ship transfers that are taking place there they have been done safely as you say for the last 30 years tied up at a jetty with the supporting infrastructure there there are 40 people employed by Wood Group to support the process of ship-to-ship transfers and the former operations of the NIG oil terminal if this is going to be moved to sea you're in an open sea situation the Cromarty Firth Port Authority have no intention whatsoever of using that shore support that is there they are able to offer the service at a cost which will be something around a third of anywhere else in the UK and that comes back to my point about penetration pricing strategies they are going to make it so cheap that it will attract the business in and it is within a couple of kilometres of a very rocky shoreline so if anything goes wrong there with no emergency tug on hand there will be harbour tugs on hand then as far as we are concerned it is a disaster waiting to happen I think the other issue is that this current application which has brought us here there's going to be an 800% increase in the quantity of oil transferred that the application is for so part of it is about infrastructure then an appropriate site but are your concerns also about this activity being carried out in the environmental sense of environments and if so what are the characteristics of these environments that you're specifically concerned about I think the whole issue probably comes back to the fact that there should have been a strategic environmental assessment carried out if we are going to undertake this process in Scottish waters we should have thought about this before we started doing it willy and illy and it should have been done on a UK boat basis as well obviously but I think we've come to the situation that in the Cromarty Firth it's within the middle of a special area of conservation for bottlenose dolphins and it's also a special protection area for birds and we think it's wholly inappropriate that this process should be undertaken in this location when it can be undertaken very safely at the alternative location at Nig so it's about having that foresight and strategic thought into where we want to allow these transfers to occur which gives the general public clarity but it also gives the ports clarity as to where it may be acceptable to carry out and just for a date's guide for the premier's human just to absolutely confirm that that strategic environmental assessment is within the domain of the Scottish Government we believe so so it is possible to have a UK-wide policy where other sets of considerations within the devolved powers to address that we've got examples of that around nuclear power and so on so this is an area where the strategic environmental assessment could be acted upon in order to address this question we believe so that's very helpful thanks very much Angus MacDonald okay thanks convener at the start I should declare that as a councillor at Falkirk Council in 2006-07 I was actively opposed to the proposal by 4th Ports and I'm on record at the time of opposing the plans the petition considers the issue from the perspective of using environmental legislation to prevent ship-to-ship oil transfers and we understand that in respect of some of the areas where ship-to-ship transfers may be proposed there's existing legislation for environmental protection but that the licences as we've heard for such transfers are a matter for the UK Government clearly you've already said that that's your understanding but would you not agree that we know that the Scottish Government has regularly called for the devolution of the licensing powers would you not agree that it would be a lot easier for the Scottish Government if it didn't just have to rely on the environmental regulatory powers that it has and had full powers over the licensing that would help to expedite the whole situation? I would agree fully with that it would be much easier if it was a devolved matter but the fact of the matter isn't a devolved matter and we believe that the Scottish environment would be put at risk by a licence being granted particularly in the Cromarty Firth but not limited to that the 1st of 4th application could come back in Maritime and Coast Guard to make that decision but I think the point is that the Scottish Parliament does have power over the environment is one of your responsibilities and I think we've got to look at what levers or legislation are available to ensure that our valuable environment and wildlife is protected okay, thank you Ryan Whittle I could turn to another aspect if you petition you call for reform of trust ports it would be helpful if you could provide some information about the current status of these ports the information we have sets out that they are independent statutory bodies run by independent boards for the benefit of stakeholders I'm just wondering if that's your understanding and if so, do you know that it's up to each individual trust port to name their own stakeholders so in the case of the Cromarty Firth it is businesses that use the port it is customers of the port it is communities surrounding the port and specifically in Cromarty Firth it is the environment as a stakeholder obviously the environment can't speak for itself but the communities surrounding the port can speak for themselves and as we've stated there are 27 community councils that surround the Cromarty Firth port authority area in direct opposition there is one in favour we do not we see there's something of a democratic deficit there when the port authority plough on with their plans in the face of massive public opposition the governance of trust ports as you rightly said it's an independent statutory body however the harbours bill 2015 invoked a repeal of sections 10 and 12 of the port act which basically means that Scottish trust ports are no longer under any pressure from Scottish ministers to be a commercial venture as they were required under the 91 act so basically we have a trust port set up for the benefit of its stakeholders who has now set up a private company with private investors which means 80 per cent of the profits will then return to the private stakeholder rather than all the profits being invested back in the port and our contention is that the trust ports whilst they operate in an environmental commercial environment and they've got no direct public funding they do receive indirect public funding from Highlands and Islands Enterprise etc so our main concern is we have a trust board that is supposed to represent and be there for the stakeholders and community and we have a private company that's been set up by this trust board who has two private stakeholders having 50 per cent and there for 50 per cent of the profits instead of all of the profits will be divided now we would like the Scottish Government to sort of clarify how a Scottish trust port that's set up for the stakeholders and basically is supposed to be independently managed can then set up a private company and for that private company to then be in direct competition with the local businesses sitting on the trust board you've kind of answered the first question that I was going to ask which was probably quite a naive one was why is this happening and I think you've probably answered it is to do with financial to do with money absolutely yeah okay so can I turn to this accountability of the trust port boards and you said in your opening statement I'm wondering what you could suggest at this stage given where we are to overcome this and you said maybe independent oversight is what we're looking for can you maybe expand on that what independent oversight you think is appropriate firstly I think there has to be some governance which basically allows ministers to clearly see that whatever profits are coming back from private companies albeit that they've got to operate in a commercial environment that basically we've not got any asset stripping through these private companies they are set up for the benefit of the community and the benefit of the stakeholders but if you can just for a minute picture a local company who is doing stevedoring services or whatever and then the trust port comes along and sets up in direct opposition to it it hardly looks as if it's acting in the best interests of the community so at some point when they are setting this company up questions need to be asked by Scottish ministers is this appropriate that they are in direct competition particularly when it's a trust port I think the other thing we'd like to see is financial clarity this is a public asset these are not private companies they are set up by acts of parliament to look after a public asset and there needs to be complete financial transparency which there is not at the moment and when something goes wrong when we are just one of several stakeholder groups that are in dispute with our local trust port there is no recourse there is no one to turn to the transport Scotland cannot intervene the Parliament cannot intervene there is no body there's no ombudsman there if you like independent body that can look at an issue like this and take a balanced view so our only option is to take legal action okay, thank you Morris Corry I'm very mind all that's just been said from my previous two colleagues comments given a blank piece of paper and a blue sky objective how would you see the changes to trust port boards being affected what would you ideally want to see on those trust ports and how would they be representative of what you're talking about board members appointed through the public appointments as any other public figure would be at the moment the boards the ports appoint their own boards there's no transparent say, there's no public scrutiny there at all whatsoever and I think we'd like to see the stakeholder groups better represented if you look at the Cromarty first one for example at the moment five out of eight or seven of five out of eight of the members I think it's five out of eight it's more than half of the members anyway are from an oil industry background there is no one there that represents communities there is no one there that represents competing businesses and there is no one on that board environment right so you're basically saying somebody a representative on the board from each of these sectors I think there should be a better representation and I think it should there should be more public transparency in the way people are appointed right okay thank you good morning and it's to say that I don't know if the committee is aware that there is indeed a live case about the whole issue of sports that has been to my understanding still live at Tainshire of Court which would involve but it shouldn't intrude in the deliberations of this committee can I ask the petitioners about the issue of and it's not to presume that there's not a misunderstanding of this but the port of Cromarty first is different the port of Cromarty and indeed Invergordon and Nyg is different from the area, the geographic area of this proposal can you outline that a bit please absolutely so Invergordon sits at the head of the Cromarty Firth along the western extent the proposal to undertake ship to ship transfers sits at the mouth of the Cromarty Firth pretty much opposite the village of Cromarty also on the other side opposite Nairn and the whole Murray coast so it is not really the villages of the Cromarty Firth that are affected or it's not only them that could be affected it is also the whole Murray coastline the ship transfers sit bang in the middle of that geographic area it's a late person I'd call it the sea it's such a reasonable yeah and can I ask what your understanding is of the community engagement by the port of Cromarty for the port authority the initial engagement wasn't with the communities around the area of the proposal no the first the communities knew about this proposal was an advert a statutory advert that was seen in the Inverness courier the week before Christmas completely accidentally the community council was not consulted in any way, shape or form until it was raised internally within the village of Cromarty and our community council had to contact the port authority the port authority on several occasions have refused to come along to an open public meeting and discuss this issue openly they have come to a closed meeting of the community council which had to be unminuted take from that what you want and all the way along we have as I say we have written to the board each individual member of the board we have written to the chairman and we have written to the chief executive and never had replies to any of our questions and if I may just to reinforce a question about the outset it is not the position of Cromarty arising that they have or there has ever been a concern about the relative safety of the procedure being undertaken at Nig Harbour no absolutely not they can carry that on all day long can I then ask most likely to be Mr Bowers I do not understand the mechanics of all this but the modelling around any spillage we have heard is about a ton and we have heard to maybe for the committee's benefit say something that I have heard you say at other meetings about the number of seconds it would take to close down valves and what the implications of that would be on spills is a couple of things and it comes back to a point we raised earlier we went back and looked at the Orkney Isles licence application in 2014 and a risk assessment was done by an all spill service provider and they estimated that from ship to ship transfers there you could lose the entire ship so they put a figure of 300,000 tonnes would be the worst case scenario and that was actually signed for and accepted by SIPA and by SNH officers in June 2014 then six months later the maximum spill volume was changed to one ton by the regulator and we think that's an enormous difference between what the Scottish agencies think and what the regulator thinks and what's the speed of transfer because it's on the open sea there are ship side by side anchor or not there's no clear figures in the application but if you take the volume and the time it works out about two tonnes per second they will be pumping between the ships remind us that what we're dealing with is the general issues that come from a specific application so this is obviously the information but we're not investigating an individual authority but we're learning lessons from it in terms of what the Scottish Government might do I understand and finally fairly recently there was a committee the time involved with me deliberated over a decision of Aberdeen Harbour trust and on a very sensitive environmental issue which the committee approved are you aware of that at all? no the petition summary identifies that this position is calling on the Scottish Government to look at how environmental legislation could be strengthened with in terms of your experience through this process what kind of devolved powers would you want to see exercised more fully? I think that would be the beginning point for everything marine do you want to say on the yeah the Marine Scotland consequential orders 2010 actually empower the Scottish ministers to which has been agreed and I think it was 2015 that any reserved matters by public authorities must be dealt with the same as public authorities would deal with them for a devolved matter in other words the 2010 regulations and we've got the Scottish regulations at the moment we can't look at a reserved matter however under our Marine Scotland act there are regulations that ensure that public authorities whether it's a reserved matter or not must conform to what is contained in our national marine plan and therefore it is Scotland's way of ensuring that when these bodies consider for example this application they must take license of our marine plan and therefore our marine plan says we are projecting the environmental species we don't want invasive species from ships through ballast water and they have got to take all that so even though it's a reserved power the order that has been passed enforces that the UK government agencies must apply the same scrutiny as the Scottish government organisations but it is in such a diluted way that to look for it in the legislation it's lost and we need to be able to get to the point where that is highlighted because in actual fact what we have is we have a competent authority in England who is making a decision about a Scottish marine protected area but the Scottish government is the body who actually issues the environmental protection of species licence so we've actually got two competent authorities and I'm saying yes we'll give agreement but we could have our Scottish government saying no we're not going to issue a licence now as part of the 2010 regulations there is provision for co-ordination where there are two competent authorities and I think that whole area of co-ordination needs to be explored and needs to be developed to get a completely fully devolved version of the regulations I assume that if it was fully devolved you might find there was conflict within government which might be easier to manage really briefly in terms of engagement by public bodies so CEPA, SNH very briefly could you sketch out for the committee what their views were CEPA objected SNH had felt they couldn't object because they are only operating in an advisory capacity but they had a very lengthy eight page response to the application that raised significant, very significant concerns and Marine Scotland put in no response whatsoever Thank you very much I think that we've come to the end of our questions so thank you very much for your evidence I think that that has been very useful in this clearly area that the committee would want to explore I suggest the initial starting when we would write to the Scottish Government to see the reviews on the action called for in the petition that we contact the relevant stakeholders Marine Coastal Coast Guard Agency Scottish Natural Heritage UK Harbour Masters Association the specific point about CEPA and Marine Scotland Marine Scotland, are there any other actions that people would like to suggest? I would just like to understand whether or not the Scottish Government has authority through environmental legislation to prevent ship-to-ship transfer or transfer of weight to test that to see what that is I'm thinking of the parallel around nuclear power stations where establishing a nuclear power station is a matter for the Scottish Government but the Scottish Government has made quite clear that it would use planning legislation to block it so it's whether that is an equivalent relationship where you say environmental damage is such that simply won't happen and there are also a series of questions around the harbour authorities themselves what you might want to explore further with the Scottish Government so we here agree with them we're agreeing to write to the Scottish Government and that will be something that the Petitions Committee will come back to but in the meantime, thank you for your attendance and can I suspend briefly? To order and we move to agenda item 3 on dealing with current petitions under which there is no evidence and we're dealing with agenda petition 1408 by Andrea MacArthur on updating of punishes anemia vitamin B12 deficiency understanding and treatment members have a note by the clerk the Scottish Government and the petitioner members will see from the submissions that the petitioner is seeking a new method of diagnosing and treating punishes anemia since she lodged the petition the British Society of Hematology has published new guidelines initially the Scottish Government took the view that the format of the BSH's guidelines is inappropriate for use in the practice setting and that its recommendations for second line testing is not standard in Scottish laboratories for this reason the Scottish Hematology Society was given the task of summarising the BSH's guidelines for use in Scotland the Scottish Hematology Society has completed this task the petitioner has expressed concern with the contents of the guidelines and the draft summary document in this context the Scottish Hematology Society is not able to contribute any further to the process citing its limited resources the Scottish Government does not seem willing to publish the draft summary document that the BSH's guidelines will suffice it is not clear why this is the case and the petitioner is dissatisfied with the lack of progress on this issue and the Scottish Government's engagement with her throughout the process and I wonder if members have any views on what action we might take on this petition the common and the likeness I think that that would be useful because there is a lot here that perhaps we are not getting to the heart of some of it is very technical it does seem odd that the BSH's guidelines were not appropriate and now are there might be something very simple explanation for that that would be worthwhile pursuing with the minister do we know why the Scottish Hematology Society's work is not being published was there a reason given for that or was that the lack of resources I don't think we know that and I think they have now stepped back and I suspect my sense would be that they are having ownership of these guidelines and having to deal with questions and you know the kind of back forward around that and maybe they feel that they are not in a position to be able to I think they were trying to provide a service is my sense and they are now they are at the centre of it Is the Government's decision not to make this report public is it well as far as I understand that they have they don't seem to be willing to publish the draft summary document and it might be worthwhile exploring that and it would give us an opportunity again for the petitioners perhaps to and it's already given us lots of evidence but in terms of a focus for the session with the minister that might be useful Is that it? Yes that's agreed Is there anything else we want to do? I think probably that feels to me to be the best opportunity and also we have this briefing but again we may be looked to if there's any more information about why we've got to where we are that would help our deliberations and perhaps to ask the minister ahead of the meeting if there's some clarification around that Okay that's agreed we can move on to petition 1591 The final petition for consideration this morning is petition 1591 by Catriona MacDonald on behalf of SOAs NHS on major redesign of healthcare services in Skylochalsh and South West Ross and I welcome Kate Forbes and Rhoda Grant for this agenda item Members have a note with a clerk and the submissions from the Cabinet Secretary for Health and Sport and the petitioners Members will recall that our previous consideration of this petition in December we agreed to write to the cabinet secretary inviting her to respond to the points raised in the critique provided by the petitioners and to address concerns on patient transport provision In the context of the decision making process the cabinet secretary is quite clear in her view that she cannot reasonably add anything to what she's already communicated in previous submissions to the committee She notes that with regard to patient transport provision the Scottish Ambulance Service has confirmed that it has two service vehicles to cover the region both with stretcher capabilities and covered by three full time posts She indicates her understanding that the service will work with NHS Highlands and other partners to deliver services that support the public and local communities The petitioners consider that the cabinet secretary has failed to answer specific key questions and has ignored the quote fundamental issues set out in the critique that was submitted on 8 December last year They identify five areas that they feel have not been sufficiently addressed A response to the critique the mandatory guidance in the Scottish Capital Investment Manual and the Treasury Green Book on the costs and risks of the possible locations for the new hospital the role of the Scottish Health Council and concerns highlighted by elected representatives I wonder if members have any views on what action we might take on this petition Angus? Thanks I mean clearly from the cabinet secretary's letter she says in it that she remains content that independence scrutiny would not significantly contribute to the local consideration of options She goes on to say with regard to the Scottish Ambulance Service that NHS Highland will continue to work with the service and other partners to deliver services that support the public and the local communities in Skye and Lochalsch Given the cabinet secretary's assurances and also her statement that the decision to approve the health board's proposals has been made there is little more that this committee can do other than write to the cabinet secretary along the lines that you have suggested convener to allow NHS Highland and local stakeholders to move forward on the issue together I don't know whether Kate Forbes or Rhoda Grant from their perspective would want to perhaps help us in our deliberations Rhoda? There is still real concern within the community and indeed things that are happening recently isn't providing any comfort to them at all We hear about there being two ambulance vehicles supported by threefold time staff well threefold time staff for two ambulances you don't really need to do the maths There's press reports last week from the ambulance staff who are now being balloted for industrial action saying they're falling asleep at the wheel What happens is quite often those ambulance staff are not just sending people to Broadford or Petrie hospital they're taking them to Inverness If they're in Inverness and a 999 call comes they have to attend it as being the closest vehicle to that so they can be off island it's not without reason that both ambulances could be off island Now if those staff report fatigued in Inverness they're not allowed to travel home so there's a huge disincentive for them to report fatigued when they're in Inverness so they are on duty until they can find a window of opportunity to get back home leading to many of them reporting falling asleep at the wheel trying to get home so that's the kind of situation and when that service is being put forward as comfort for this new setup you can just imagine why the community don't feel particularly comforted and neither do they see the services I think I've said before to this committee we've waited a long time for the new hospital in Skye and you know while it's not ideal and I understand what people are saying further delay is going to impact on patient care it already is procedures are taking now being moved back to Inverness that could take place in Skye but you know there are big issues about how patient care will be dealt with and what care is going to be available where people have been used to having their own hospital and what patient transport because one of the issues with the emergency ambulance service and why they're balloting is that they feel that they're being used as a patient transport service rather than an emergency service so there is not enough resilience in the other services GPs, out-of-hours you know RASI I think came up at the last committee where there is no health cover out with the hours of nine to five there is no qualified health professional on that island again there help comes from portray at the moment it would have to come from Broadford under the new setup so there are a lot of unanswered questions here and I can understand you know but rather than hold back the building of the hospital which I think has to go ahead I think we need a lot of security around what is going to be there in the north end of the sky in RASI and indeed what support is there from the other services like GP services, out-of-hours NHS 24, Scottish ambulance service and the like that is really it gives no comfort to the community at all Kate? For the sake of the committee I wonder if it's helpful to break down the three different strands of concern that are here the first is the current healthcare provision the second has been the decision making process to get to the point we're at now and the third is the location of the new hospital and in terms of current healthcare provision I think I would echo everything that Rhoda has said particularly on the emergency and out-of-hours I'd also add to that my own concerns with palliative and elderly care so there are reports that I have not been able to verify today in the west health and free press that the only 13 beds that are available in north sky in terms of elderly care at the haven which is apparently due to close in three months so in terms of provision in north sky these things whether it's ambulance or beds closing or the fact that award had to close in Petrie hospital because of staff being unavailable all cause quite tangible fear in the north of sky which is where there is the population density so care beds, transport and emergency and out-of-hours care but in terms of the decision making process which is really what the petitioner is picking up in her response is the concern that the mandatory guidelines in the Scottish Capital Investment Manual haven't been followed now I think that's the issue that the committee needs to decide on today in terms of how they take that forward and the third thing is the location of the new hospital the cabinet secretary said that there will always be disagreement about where the new hospital is located if it's in Broadford or in Petrie the questions are whether there is sufficient health services in the north and south end of sky in terms of dealing with transport in terms of offering enough care beds palliative care and whether there's enough stakeholder engagement in north and south end of sky to ensure that there's a confidence in the service redesign going forward I echo Rhoda's points on the first point which is current healthcare provision which is causing genuine concern in the north end particularly around care beds and ambulances the petitioner picks up on the decision making process and the mandatory nature of the SCIM and then thirdly the location of the new hospital has got to be to have more clearly and more substantial promises of services in terms of care beds in the north and south end That's helpful Can I suggest that one of the things that we would want to ask the cabinet secretary to reflect on is the consequence of the decision of where the hospital is going to be what the provision looks like across the island not just the ambulance issues but a matter of concern of the unintended consequences that you actually are centralising services which the past could have been delivered within Sky and the whole question of ambulance and the conflating of that with patient transport service so we will be looking for reassurances around that the argument on process presumably is a consequence of an objection to the conclusion so the reason the petitioner has raised the issue of process is because they're not happy with the conclusion that hospitals to be cited so we have to identify what the cabinet secretary's anger says is absolutely clear that process has been followed and others are saying well no it hasn't been that always feels to me that that would be decided you know in a judicial matter I might be wrong but that feels to me how do you make that decision we can certainly ask the cabinet secretary to clarify the points again that have been raised and others are asking us to focus on that but to get reassurance around the consequences of that and I think the point has also been made in our reflections before it's clearly that while the cabinet secretary says well I'm absolutely clear I've done the right thing and this is the decision if people locally are unhappy what responsibility does the Scottish Government got to bring people together and to give them those reassurances and that might be something we'd want to the cabinet secretary to reflect on because we've legally done the right thing within Sky area there's still a fracturing of relationships and no confidence in the health board and not a proper understanding of the consequences and we wonder whether maybe the Scottish Government would see the head of role in trying to pull that back together again and an expectation from us maybe that we would get a report on that if that feels is the cabinet secretary aware of all the points that Kate and Rhoda have made I mean the decision was a decision based despite everything that was said and these views put forward I'm assuming that what you're saying is that these are not insurmountable they may have been used as arguments for the sighting of the hospital but once the hospital is sighted you still have to address the question of ambulance driver fatigue the transport side of it and current services there are other examples in Mone City where everybody agrees the hospital should be built there are now consequences to that which might not have been envisaged which then have to be dealt with in terms of provision I mean I don't know whether that's your suggestion Kate Last time I had a meeting I asked the question of whether the main concern was current healthcare provision decision making process of location of the new hospital and the current healthcare provision so if you feel confident that the services will remain locally and if you feel confident that you are not going to be disadvantaged about the location of the new hospital then there's far more confidence in the redesign and that's why I think the critical thing at the moment is to ensure that there is confidence that somebody in staffing will not be risking their lives because of where they live that's what it boils down to and the recent changes in terms of the unfortunate situation of having to close beds in Portree hospital due to staff being off as well as new reports of the care homes that are there closing and the very serious issues with the ambulance service are just making confidence fall even further Can I suggest that we write to the cabinet secretary in those terms on the specific issues around the consequence of the decision what reassurance can give around provision but also that we feel there is an issue here about there has been a fragmenting of confidence in the process and while the Scottish Government is confident in their view we wouldn't know the technicality of that we do think they have a job in trying to bring people together would that be reasonable and then we can perhaps get a report back from the Scottish Government in that regard If that's the case can I thank everybody for their attendance particularly Rhoda Grant and Kate Forbes and can I close this meeting