 The next item of business is a statement by Michael Matheson on update on point of order, Martin Whiff. I'm very grateful, Deputy Presiding Officer, and I apologise for taking the indulgence of the chamber over this, but under our standing orders, rule 13.2 deals with ministerial statements. Indeed, under the Scottish Ministerial Code, section 3.5 deals and states that ministers should ensure that important announcements of government policy are made in the first instance to the Parliament. This morning, at First Minister's question, the very positive news of an inquiry over the incidents that the statement will go on to deal with was confirmed. However, it was available in nationally published newspapers yesterday, along with a statement that was confirmed by the First Minister this morning that indeed it was discussed at the Scottish Government Cabinet meeting this week. I am disappointed that, again, we have had information that has been put out into the public domain before being announced to this Parliament, but in this particular case, because of the victims of this surgeon and these events, they should have had the right to hear a full and proper statement explaining what was happening rather than just snapshots and headlines of news, which I think is disingenuous to them, and I think that it is disrespectful to this chamber. I seek your guidance on what can be done about that matter. Mark Whittle, for prior notice of his point of order, says that guidance on announcements is intended to ensure that matters of importance do not enter the public domain before or without being communicated to the Parliament. I invite the Government to reflect on the concerns expressed by Mr Whittle, that information suggesting that he public inquiry into the case of Professor Elgi Mel was to take place appear to have been reported in the media prior to the First Minister's announcement in the chamber earlier today. With that, I am going to move on. Given the fact that we all know what is in the statement, would it not be in order for us to proceed straight to questions? I thank Mr Kerr for his… Allow me please to respond to the point of order rather than taking it upon yourselves to do so. As far as I am aware, the detail of what is in the statement has not been put in the public domain, and therefore I do not think that it serves any useful purpose to go straight to questions. I invite Michael Matheson to provide a statement on the update on Professor Elgi Mel NHS Tayside. The Cabinet Secretary will take questions on the issues raising the statement afterwards. Therefore, there should be no interventions or interruptions. I call on Michael Matheson, Cabinet Secretary, up to 10 minutes please. Thank you, Presiding Officer. There can be a few things more important than the safety of patients in our health service. One thing that is perhaps equally critical is the trust that we, as individuals and communities, can have in our healthcare. Patients must also have trust that where concerns are raised about their care and treatment, those will be investigated and the necessary actions taken. They must be able to trust that their concerns will be investigated, scrutinised and subject to robust governance and due diligence at the time and not several years later. When trust is broken and such weakness in governance identified, it is imperative that we do all we can to investigate why and do all we can to prevent others from having the same kind of distress and traumatic experience. The actions some years ago, by Mr Elgi Mel, a former surgeon in NHS Tayside, have been discussed at length in his chamber and I know that colleagues have a keen interest in the Government's next steps. Several reviews have taken place into his practice both at the time and in the years since, after concerns were expressed by a number of his former patients. The latest NHS Tayside review, due diligence review of documentation held relating to Elgi Mel laid bare the failings in NHS Tayside response to concerns about Mr Elgi Mel. It is clear from the review that these were not acted upon or followed up with the urgency and rigor that they deserve. Now, several years later, many former patients still live with the consequences and still have many unanswered questions. That is why today I am announcing our intention to commission a full public inquiry to seek answers to those questions. Mr Elgi Mel practised as a consultant neurosurgeon at NHS Tayside between 1995 and 2013. Concerns about his practice were first raised to NHS Tayside in 2011 and in 2012. As a result of a complaint received at the end of 2012, two further complaints received in 2013 and two significant clinical event analyses, NHS Tayside commissioned the Royal College of Surgeons in England to review his practice. Most complaints were received after Mr Elgi Mel had been suspended in 2013. Since then, several reviews have taken place into his practice. Members will know that one of my predecessors, as Health Secretary Jean Freeman commissioned in March 2021, an independent case note review on outstanding concerns of two former patients. This reported in May 2022 and made several recommendations for NHS Tayside, Scottish Government and NHS Scotland. In response, NHS Tayside commissioned the due diligence review in March of this year. This was considered by the board on Thursday 31 August 2023. I will say more about the detail of this review in a moment. In the months while this work was being undertaken, several former patients continued to raise concerns about their prior care and treatment. This was done directly with NHS Tayside through MSPs, with ministers and in the media. I have considered the concerns raised with me by several former patients and I have been struck by their bravery and their persistence, sometimes accompanied by significant distress and compounded by trauma. Nevertheless, I was not at first persuaded of their argument that only a full public inquiry would find the answers they sought about what happened to them and why. Knowing the length of time that could take and knowing that it would not necessarily consider each individual patient's circumstances, I was of the view that there were other, potentially faster and more individually responsive ways to seek to find the answers for what they were looking for. However, as I have already touched on, after considering the findings of the due diligence review, my view has significantly changed. I would like to offer some detail on the due diligence review process and what specifically it found that has informed my thinking. Earlier this year, NHS Tayside began to examine their own handling of those concerns. Last Thursday, their board considered that report. It outlines a number of failings that I believe can only be examined thoroughly by a full public inquiry. It also brings forward significant information that is not previously known to the Scottish Government. In the length of time since the first concerns were raised about Mr Elgiomal, that raises real concerns. Briefly, the due diligence review identified that NHS Tayside did not respond to the General Medical Council about Mr Elgiomal's request for voluntary erasure from the medical register and that there were no effective central board oversight or co-ordination of significant historical information or reviews into concerns. It identified multiple examples of reviews and investigations where there was no follow-up action recorded and no or inadequate scrutiny, assurance or supporting governance. It identified cases where, despite there being complaints, adverse events reported and legal claims, no formal review of cases have been documented or retained, that documents of potential relevance were subject to a destruction in accordance with routine retention periods, when putting a hold on such destruction would have been better supported subsequent review processes. It identified adverse events where no investigations can be identified and no reports of adverse events were formally recorded until several months following the incident and that communications and support for former patients was not consistently of the required standard. I have reflected on the concerns of former patients and MSPs since the findings were considered by the board of NHS Tayside and I am clear that the board's governance obligations were repeatedly not implemented in respect of concerns about Mr Eljamal. I consider that this now means that the commissioning of a full public inquiry under the terms of the Inquiries Act 2005 with the powers to compel witnesses is the only route to get to the bottom of who knew what and when and what contributed to the failures described by NHS Tayside. Let me say at this point that I know that this will inevitably be a lengthy process and that, as I said earlier, a full public inquiry will not necessarily answer the individual clinical questions for each former patient about their own particular circumstances. For that reason, I still do consider that an independent case review of patients' individual clinical cases, whether that is what individual patients want, remains necessary. This will allow a person-centred, trauma-informed review of each patient's own clinical case, addressing their individual needs and circumstances and attempting to offer answers in a bespoke and personalised way that an inquiry will not. There are former patients who are still living each day with the consequences of their treatment by Mr Eljamal, and addressing their personal needs in an individual clinical review that is conducted independently of NHS Tayside remains an important part of this process. I want this to begin as soon as possible and not to be delayed by the announcement of an intention to commission a public inquiry. For the sake of those patients directly affected, for the confidence of the community in Tayside and for the promotion of patients' safety more broadly across Scotland, I now believe that a full public inquiry is needed. I have now asked my officials to begin to make the necessary arrangements and I will continue to update Parliament as those arrangements progress. Thank you. The cabinet secretary will take questions on the issues raised in his statement. I intend to allow around 20 minutes for this, after which we will need to move on to the next item of business. I can advise the chamber quite tight for time over the course of the afternoon. I would invite members who have not already done so, but we wish to ask a question to press the request-to-speak buttons and I call first Liz Smith. Thank you. Presiding Officer, for the last 10 years in this Parliament, I have listened to some of the most harrowing stories that I have ever heard of intense and permanent medical and psychological pain, of families broken apart, and of heart-rending accounts of victims' attempts to get to the truth, only to be knocked back at every turn. The cabinet secretary has finally accepted that the only way to get to that truth is to commission a full independent inquiry. Unlike the former patients who deserve so much credit for their relentless campaigning, most especially Mrs Jules Rose and Mr Pat Kelly, I very much welcome this change of heart, but can I ask the cabinet secretary three things? Firstly, as well as the apologies that have rightly been made to individual patients for the harm that they have suffered, will the cabinet secretary also apologise on behalf of successive cabinet secretaries for health that the process has taken so many years, thereby just prolonging the agony for the victims of LJML? Secondly, does the cabinet secretary accept that there has not only been an utter failure on the part of NHS Tayside, as he has just described, but also the other health agencies to address serial complaints made about those in management who knew exactly what was going on, but who chose to keep quiet? Thirdly, in February 2013, as complaints mounted, we know that neurosurgeons at Ninewells complained to the Royal College of Surgeons that their workload was too great and that, as a result of what they said that were external pressures, they were forced to take on extra patients from Fife to try to cut waiting times. Can the cabinet secretary confirm if that external pressure to take on those extra patients came from the Scottish Government? I, from my recognition of Liz Smith's long-standing interest in pursuing the issue on behalf of her constituents. I recognise the significant impact that Mr LJML has had on individual patients both in terms of their physical and mental wellbeing as a result of his actions. On the specific points that Liz Smith raised, of course, I deeply regret that we are in a situation where we even require to have a public inquiry for such a matter. That is why I have come to the view, and she will be aware of my previous views on this matter, but why I have reflected on the circumstances and come to the view that I believe a full public inquiry is now required. I was particularly concerned that we were in a situation where, despite eight different reviews that have taken place over an extended period of time, we were still at a point where the Scottish Government was still learning new information from the health board as being an unacceptable state of affairs. That is why I have come to the view that we need to have a full detailed public inquiry. On the specific further points that Liz Smith made about other agencies and the issues around workload, those are clearly matters that will be considered by the public inquiry. At the end of that process, I hope that we will have a greater understanding about who made what decisions when and the impact that had on the delivery of services with an NHST side at that time. The announcement of a public inquiry, because a week ago the Scottish Government was not minded to grant the inquiry, so this U-turn is a tribute to the efforts of all those campaigners. I am very clear that the health board and Scottish ministers have failed in their duty to the people of Tayside, and they have failed in their duty to those patients operated on by Sam Eljamel. The issue was formally considered, as I understand it, by the health board in February 2014, despite concerns being raised well before that. What then followed were a litany of reviews and action plans, but little action. Will the cabinet secretary put in place an oversight board for NHS Tayside, given the failures in governance that he has acknowledged today? Will he tell us when Scottish ministers were first alerted to the problem, as whilst the issues may indeed be new to him, they were not new to Shona Robison, the former health secretary, who refused an inquiry, to Jeane Freeman, who initiated a case review, and then to be followed by Humza Yousaf himself, who also said no to a public inquiry? Finally, let me welcome the independent case review, and will he ensure that patients affected are supported through the process and consulted on the terms of the inquiry? The member will be aware that there is work on going just now with NHS Tayside and the recommendations that came from the Scottish Government review back in 2022. That work in oversight of that has been taken forward by the Scottish Government, by NHS Tayside, reporting to the progress that they are making against those recommendations to Scottish Government officials. There is continued oversight to make sure that they are making progress with the recommendations that are going forward. In relation to Jackie Baillie's point about the terms of reference, it is of course that the terms of reference can only be determined once we have a chair appointed for the public inquiry. I am very clear about the need for patients, affected patients, to be able to feed into the process in setting the terms of reference for the inquiry, and I will take that up with the chair once they are appointed. As we know, the Scottish Government has previously committed to establishing an independent commission that could engage directly with former patients in order to seek answers as quickly as possible, and I am pleased to see that that will continue. Can the cabinet secretary say any more about how this can complement the very welcome steps that are set out by the Scottish Government today? I have always been very clear since I came into post on considering this issue about how we can create a process that will help us to give affected patients the answers to their answered questions that they have. I have always been keen to make sure that whatever approach we take ensures that patients and their interests are at the very heart of that process. What we want to do is to make sure that, alongside the public inquiry, that we have a person-centred, trauma-informed process that allows former patients of Mr Jamal to have the opportunity to have a full clinical review if they feel they wish to have that and for that to be carried out independently of NHS Tayside. I have already commissioned our national clinical director to take forward this work and we are presently going through the process of looking to identify a lead clinician who can take that work forward for us. Hello and thank you. Let me start by welcoming this public inquiry for all those I met protesting outside they were asking for. It is clear that, across our NHS, senior hospital managers are increasingly interfering with the delivery of good quality clinical care. Complaints of substandard and dangerous practices are being ignored. Whistleblowers are subjected to bullying and intimidation. Lessons are not being learned. Does the Scottish Government agree that NHS managers should be regulated, such as doctors and nurses, by an independent body with the legal purpose to protect, promote and maintain the health and safety of the public? Given the urgency, rather than to pursue my private member's bill, I would be happy to work with the Scottish Government to take this forward. I declare my interests in seeing an NHS GP. The member will be aware that there is a full public inquiry taking place in England in relation to the Lucy Letby case, which is looking at issues relating to that case, which might result in recommendations on regulation of those who are managers within our national health service. We have already engaged with the Department of Health on that issue, and I am very open to that as being a possible option going forward, but I think that we should allow the inquiry to take forward its work first of all. I say gently to the member here that this is about more than just managers within NHS Tayside. This is also about the conduct of clinicians within NHS Tayside, and the process and the way in which clinicians within NHS Tayside have worked that has an impact on how patients have experienced the outcomes that they have. We must be mindful that this is not just about managers, but about the behaviour of clinicians, which is why we need to have a full public inquiry into this matter. I am very, very much welcome the decision by the Scottish Government to pursue this public inquiry, but it should never be forgotten that this is only as a result of the behaviour of LJML himself. In light of the horrendous effects that he has had through his malpractice, can the cabinet secretary advise what steps can be taken to compel him to appear before the inquiry? I am sure that colleagues in the chamber will be aware that there is presently a live police investigation into the harm caused to patients treated by Mr LJML. That is a live investigation, and I know that the Crown Office is already engaged in that process, but I will not comment any more on that. Clearly, the Public Inquiries Act gives powers to compel both documentation and individuals to appear before it. However, my understanding is that Mr LJML is out with Scottish and UK jurisdictions, and it would be dependent on him actually being willing to return if he is prepared to do so. However, that would be a matter for the inquiry to look at pursuing, but the inquiry will have the powers to be able to compel witnesses and documentation to consider what information it needs in order to carry out a thorough investigation. Michael Marra, to be followed by Collette Sinsen. Thank you, Presiding Officer. The cabinet secretary's assessment today of NHS Tayside's response in this regard is devastating. There are a plethora of recommendations across multiple reviews. I count eight in the most recent report that has not been responded to. I can confirm to the cabinet secretary at the meeting of the NHS Tayside board last week that no board member raised the fact that there has been such a neglect around the implementation of existing recommendations. Why can we have faith, as people who live in Dundee and Tayside, that those recommendations will be put in place? We need that oversight. Will he not consider putting it in place? I think that the member is correct that there have been eight reviews since 2013, taking forward, I believe, in relation to this matter. That is why, when the Dew Dillon's report was published last week, when I saw details of that, which resulted in new information being presented that we were not previously aware of, that raised serious concerns for me on the openness and transparency that there has been in the process to date within NHS Tayside. I mention to the member the recommendations that came from the review that was carried out in 2022, and there is oversight of that through the Scottish Government on the action plan that has been implemented by NHS Tayside on those matters, and to make sure that the actions are being progressed. It is important that we get to a point—I accept the underlying issue that the member is raising—that it is important that we get to a point where people have faith and trust within the local health board. I want to make sure that they will look at what further actions we can take in order to try to help to establish that going forward. However, I do not want to delay anything that will undermine the process of trying to get answers for patients and getting the public inquiry up and running as quickly as we reasonably can, but I will continue to look at what further measures are necessary in order to make sure that there is sufficient scrutiny of NHS Tayside. We know that many former patients have expressed concerns about how their trust in NHS Tayside has been harmed as a result of that case. Can the cabinet secretary see any more about how the steps outlined by the Scottish Government today can help to rebuild that public trust? One of the things that I think is important in recognising the findings of this review is that the medical director, I believe, in NHS Tayside, has carried out a very thorough investigation, exposing key aspects of where their organisation has failed. That is a significant step within the health board and itself in being prepared to face up to their failings and to accept the consequences that go alongside those. As I mentioned earlier on, I will continue to consider whether there are any further measures that we need to put in place in order to ensure that we continue to see progress being made by NHS Tayside and will help to engender confidence in their conduct in dealing with that issue. As I mentioned, it is important that we focus on making sure that we get the clinical review process in place for individual patients and that we continue to make progress in getting the public inquiry established. The cabinet secretary has made the right decision today. I think that the twin-track approach is the right one, but I am afraid that it has taken far too long. The patients have suffered throughout that. Physically they have suffered, mentally they have suffered, which he has referred to, but they have also got more angry as time has gone on, so faith and trust that the minister refers to has completely broken down. I hope that all those who know staff, who have no information, come forward now, now that they know that potential are going to be compelled to participate in the inquiry, that they release that information now so that the patients can have some comfort right now that they can know more about their cases and their suffering. Will the minister support that? Can I also say that it is important that we use this as an opportunity to try to learn for the rest of NHS Scotland? What I want to do is, through this process, to avoid finding ourselves in a situation where something similar could happen in our health board area, we need to make sure that the safeguards that we have in place, which have obviously changed since the time when Mr Eljamill was a surgeon in NHS Tayside, that they are sufficient and that they are robust, but also to make sure that we learn from this and that we ensure that this type of incident cannot happen again. That is one of the key reasons why I believe that it is now right for us to have a full public inquiry, but full disclosure, engagement of all those parties who have information, I would encourage them to do that now and I would encourage them to fully co-operate with the public inquiry once it is established. We cannot underestimate the importance of listening to the voices of former patients. Can the cabinet secretary provide any update as to the Scottish Government's latest engagement with patients and their representatives and the steps that can be taken to ensure that they are involved in the next steps set out by the cabinet secretary today? I met a group of the lead patients earlier on this morning in order to set out my intentions to establish a full public inquiry and to explain to them the processes that are put in place for individual clinical case reviews. I also took that opportunity to explain to them why I had changed my position from my previous engagement with them on what I thought was the most appropriate course of action and I explained to them why I had chosen to move towards a full public inquiry with the support of the First Minister and my cabinet colleagues. I can also assure the member that I will take up with the chair once appointed the need to make sure that patient representatives have an opportunity to feed in to the terms of reference to the public inquiry. It is a relief that we have at last got to the point of a public inquiry that so many have called for, but it should never have taken this long. I thank all those campaigners involved in getting us to this point. The cabinet secretary spoke of the need for that twin track to ensure that patients could get the answers that they need through person-centred trauma-informed process. What will he ensure is put in place so that, while those processes both take place, patients and former patients are not further traumatised as they have been and continue to be, some are currently being re-traumatised by being told to go through mediation and other processes? What can the cabinet secretary say to them now to ensure that this will continue to happen? Obviously, there is a process that has been put in place by NHS Tayside. As I have already indicated, my intentions are to establish a process that will allow patients who have clinical questions and issues that they want to be clinically reviewed to have an independent process of NHS Tayside to have their cases reviewed. That will be person-centred and trauma-informed in the way in which it operates. I hope that that would reassure the member. Their intention is to—where reviews do take place—is that it does not re-traumatise patients over the difficult circumstances that they have already gone through. That is very much in our minds on how we shape that process. I hope that, once we have it established, that patients will be able to give feedback on how effective that process has been. Stephen Kerr, to be followed by Evelyn Tween. Of course, Deputy Presiding Officer, I welcome the announcement that the cabinet secretary has brought to the chamber this afternoon. Once again, the evidence says that the voices of patients and healthcare professionals were ignored because the first time that matter was raised was as long ago as 2011. It is high time that we saw a change of culture in our public services, especially towards brave and principled people who blow the whistle. So, would the cabinet secretary agree that, in addition to the public inquiry, there ought to be a full review of whistleblowing practices with a view to the establishment of an independent office of the whistleblower for Scotland? We actually have an independent whistleblower who is based within the Scottish Public Service Ombudsman Service that is independent of the Scottish Government that has oversight of whistleblowing policy in Scotland. I think that we have already addressed the point that the member is making. I made this point to Sandish Gohani. That is that this is not just about managerial structural failures within NHS Tayside. It is also about clinical failures and the behaviour of clinicians that have had an impact on some of the information that has not been provided to patients and some of the information that has not been provided to the review processes that I have been taking forward. That is what I think is particularly important here. It is not just about managers not getting it right. It is also about clinicians getting it wrong as well. That is why the public inquiry is critical. Accountability has been highlighted as one of the key reasons behind calls for a public inquiry. Can the cabinet secretary say any more about how the Scottish Government envisages that the measures that are outlined today deliver on that call? It will give us an opportunity to have a very detailed investigation, not just into the actions of NHS Tayside but into some of the regulatory bodies that have responsibility for oversight of clinicians and also for inspections of our health board. I believe that that will help to identify where the failings have been and to make sure that we can learn the lessons for NHS Scotland as a whole for the future. Thank you very much, cabinet secretary. That concludes the sighting of business. There will be a brief pause. I forgot to mention when I asked my question a reference to my register of interests as a director of whistleblowers UK, which is a not-for-profit, which is set up to advocate for whistleblowers and to bring about positive changes in the law regarding whistleblowing. That is now on the record. There will be a brief pause while the front benches change.