 The next item of business is a statement by Jean Freeman on the Scottish Government's response to the Sturrock review. The cabinet secretary will take questions at the end of her statement, so there should be no interventions or interruptions. I call on Jean Freeman for a 10-minute statement, please, cabinet secretary. I am grateful for this opportunity to update members on the findings of the fully independent review that I commissioned, led by John Sturrock QC, into allegations of a culture of bullying and harassment in NHS Highland. The independent review is published in full today, alongside the immediate response from the Scottish Government. Let me start by offering my sincere thanks to John Sturrock for his significant personal commitment to this undertaking, demonstrated by the thoroughness of the review and the substantive, detailed and thoughtful report that he has delivered. His report focuses in its conclusions and recommendations on repairing relationships and the practical steps and the leadership needed to restore trust and build a truly exemplary workplace culture in NHS Highland. Mr Sturrock has evidenced his conclusions from all those that he heard from, and I also want to put on record my sincere thanks to everyone who engaged with the review, especially to those who shared their own often very difficult personal experiences. I commissioned this review in November, as it concerned me greatly that a group of staff in NHS Highland felt that they had no option but to raise their concerns publicly. It was clear to me that, despite the steps, the interventions and the support that had been taken up to that point, very serious concerns remained and it was essential that those were heard. I was also keen to ensure that NHS Highland staff had the opportunity to access a safe space in which individual and collective concerns could be raised, and that that was provided through a review with a perspective that was independent of both government and the board. An impartial perspective that, in listening and understanding, would also focus on proposals that would secure and promote an open, transparent and inclusive workplace culture. I believe passionately in the NHS Scotland values of caring, compassion, dignity and respect, openness, honesty, responsibility, quality and teamwork. I know that staff in NHS Highland believe passionately in those values, too. Our collective belief in those values is critical to our capacity to deliver the safe, effective person-centred care that people deserve, but I also know that belief in those values has to be evidenced by behaviours that reflect the values. NHS Highland has very many, very caring, supportive, diligent and highly skilled staff, but this extensive review has identified a number of significant cultural issues that have contributed to both actual and perceived behaviours in NHS Highland that have not always reflected those values. That can neither be acceptable nor allowed to continue. So now we need to engage constructively with the findings, the conclusions and the recommendations of the review. We must also reflect, as John Starwick points out, that there are also a number of staff whose personal experience of working in NHS Highland is not one of a bullying culture and who have equally legitimate concerns that need to be heard and taken account of. Whatever else we may do, it is absolutely right that staff in NHS Highland are at the centre of that engagement and dialogue. That is the only way to secure the sustainable restoration of trust and shared purpose that is essential to a positive working culture. So I have made very clear to the board that I require them and the wider leadership of NHS Highland to carefully consider that report and actively engage with staff at every level to consider the conclusions and recommendations and how those can be positively applied. Now, whilst the review considered matters in Highland, it is clear to me that there are important issues raised here that require serious reflection across the health service more broadly. What the review articulates about how we work to build supportive workplace cultures, to engender and encourage behaviour that reflects our NHS values is absolutely of general application. That is not just an opportunity for NHS Highland, it is an opportunity for us all in NHS Scotland. I am well aware that concern about bullying and a desire to secure a positive culture is shared across our health service. As a result, I intend to bring together the leadership of our boards, including staff and union representatives, our royal colleges, and professional and regulatory bodies, to examine how collectively we can take forward measures to support and promote an open and honest working environment for all our staff. In particular, I will be asking the collective leadership what more we need to do to effectively deliver the behavioural and attitudinal improvement in leadership and management that sits at the heart of the Sturrock review. We will commend this important work in the summer by hosting a summit on wellbeing, engagement and employee experience in NHS Scotland. I am delighted that John Sturrock has agreed to join us for that first meeting. There are other steps that I intend we will take. The review highlights the opportunity to improve the relationship between boards and government. It highlights the dilemma that is not always satisfactorily resolved about when government supports and when government intervenes, and the need to move with some pace on the improvements already identified in the blueprint for good governance that was published earlier this year that aims to further strengthen a board's vital scrutiny and assurance work. That includes enhancing the recruitment, training and development of board members with greater consistency across NHS Scotland. I have also reflected on how we can ensure that all NHS Scotland staff across all boards and irrespective of their role have faith in the systems that we put in place to allow them to speak up, to raise concerns or to put forward ideas and be confident that they will be listened to and respected without anxiety about negative consequences. That is, in part, the work that is already under way to improve our workforce policies to ensure a people-centred focus that is consistent in its policy but also in its application across the NHS. On 30 April, as members know, we introduced legislation to this Parliament to allow the Scottish public service ombudsman to take on the role of the independent national whistleblowing officer for NHS Scotland. The SPSO will have the authority to investigate how whistleblowing cases have been handled, make recommendations and their reports before the Scottish Parliament, aiming to enhance public confidence and scrutiny in the system. We will now proceed with recruiting the new non-executive whistleblowing champions to every board so that we have them imposed by the end of this year. Those non-executive whistleblowing champions will provide assurance that boards are complying with NHS Scotland's policies on whistleblowing, and they will have the authority to escalate concerns directly to me where they feel that issues have not been appropriately addressed at board level. In the coming weeks, I will again visit NHS Highland to hear from myself how they are progressing the work from this review. I appreciate that this is indeed a substantive report and an important piece of work. I understand that members will wish to take time to reflect on its contents and on what I have said today. I also understand that members will be keen to hear how we make progress, and in particular the outcome of the work that I will lead with colleagues from across our health service, our royal colleges and our professional bodies, on our collaborative leadership to promote a culture that reflects NHS values. The concern and determination to take this opportunity to set the right course for our NHS is that I know that it is shared across this chamber, and the work to do so should be a shared endeavour. Following the summer recess, I will update the health and sport committee and will be happy to discuss our progress with them at that time if they would find that helpful. I will, of course, be happy to keep party spokespeople up-to-date and to discuss all of those matters with them. I am committed to doing all that we can to ensure that everyone in NHS Scotland feels valued, safe and supported. That matters greatly to every person who works in our health service, but it also matters greatly to every patient we serve. I commend this statement to Parliament. The cabinet secretary will now take questions on the issues raised in her statement. I will allow her in 20 minutes for that. Those who wish to ask a question, please press the request to speak buttons, and I call Edward Mountain. I would like to thank the cabinet secretary for advance sight of her statement, and more importantly I would like to thank John Sturrock for his detailed report. It was only the Scottish Government and casual observers who did not recognise that there was a serious problem in NHS Highland. John Brown's governance review published in May 2018 proved it, and when four senior clinicians made allegations of bullying in September 2018, and I called in the same month for an independent inquiry from the First Minister, the Government was still dithering. Finally, when we did get an inquiry and a very substantive one it is to, we learned, and I quote, that there was fear and intimidation amongst the staff, some who have suffered significantly and suffered serious harm. According to the report, it appears that the Scottish Government knew about the dysfunctional nature of NHS Highland in autumn 2017, and yet did nothing about it, waiting to see if others would. In my 40 years of professional experience, Presiding Officer, I have never read such a damning report on management, and in her statement I did not hear once from the cabinet secretary the word sorry. Let me start by welcoming the bladed actions of the cabinet secretary, but to move forward we need to resolve the past by healing. Let me give the cabinet secretary the opportunity on behalf of the Scottish Government to start off the process of rebuilding our health service by apologising to the staff, patients and people of the Highlands for this situation, which is in my mind attributable purely to poor executive management, and that is backed up by Mr Sturrock. I am grateful to Mr Mountain. I have already apologised to NHS staff in the Highlands and will do so again. I am more than happy to do that. I do think, though, that, in addition to the apology that NHS staff in Highlands and across our health service expect, we will judge us by how we respond to this very positive and substantive report that does not shirk from highlighting where there have been failings, but also argues very strongly that the approach that is now must be taken is one that is restorative and healing and aims to move it forward. In that regard, I think that we need to be careful all of us about the language that we use. I do not accept that the Scottish Government did not recognise the problem or that it did it, and I certainly do not accept that it did nothing about it. As Mr Sturrock highlights in my statement, there is a dilemma. From as early as 2017, senior officials from the Scottish Government were working with NHS Highlands, with the board and with others to try and improve the governance and the relationships there. There is a dilemma for any Government, not just this one, about when do you provide support and help and encouragement and when do you draw a line and say that that is not working, that we now need to intervene. That is what we did now. With hindsight, there may be a case that we should have done that earlier or that we should not have done it when we did it. The fact is that we are where we are, we have a substantive report now and now our job collectively is to work out exactly how we take that forward, not only in NHS Highlands but across our health service. I thank the cabinet secretary for advance sight of her statement and acknowledge the cabinet secretary's initiative in asking John Stadeck QC to review the claims of bullying within NHS Highland. NHS Highland is my home board area. I have dealt with the board for over 20 years in two parliaments from chief executives and board members to cleaners and patients. No amount of experience prepared me for the GMB organised event in the autumn of last year. Over 60 people attended, who spoke with one voice on the toxic culture of bullying within the organisation. Can the cabinet secretary outline what new system can be put in place for all those who lost jobs, who left jobs, who suffered mental health problems? We must never forget their experience. What assessment has the cabinet secretary made on the effect that this bullying has had on the credibility of NHS Highland and its ability to recruit and retain staff? Let us look to the future and the implementation of the review recommendations where staff in NHS Highland and beyond can start afreshing safety and security as respected, dedicated professionals free from the dark cloud of bullying. I am grateful to Mr Stewart for his comments and for his question and I absolutely recognise the long history that he has of positive engagement and strong interest in those matters. I completely understand how unprepared he would have been, as he said, for that GMB convened meeting. As I think we were too, Mr Stewart was hence the lengthening of the time that the review has taken for the numbers of people who wanted to speak to him and give evidence to him about their personal experience. He makes the point in his review about providing support for those who have experienced bullying or harassment and who have suffered in terms of their emotional and mental health as a consequence, and the board is actively looking at how it might do that and will actively consider what other steps it needs to take. The central thrust of John Stewart's report, as well as reflecting the views that were expressed to him and the evidence that he might have presented to him, was to recognise that the only way to move forward here is to heal first and heal by moving forward. He is very clear in his report on NHS Highland's board, and he understands absolutely that they are quoted today in saying that they must embrace all the recommendations of the report and act. They have begun that work now, and they have begun the work, too, to look at how they will engage directly with staff, because I was really keen that this report is not just for this chamber, but for NHS Highland, so they need to engage with their staff to understand whether or not staff want more than is in the report itself. The last point on recruitment and retention is impossible to have a scientific view of that, but it is one of the concerns raised by those who themselves had not experienced bullying and harassment about the impact, so we need to consider what we do about that, too. Can I ask for shorter questions and, indeed, answers, please, Cabinet Secretary, to try and get through all the questions? Gil Paterson, followed by Meryl Spriggs. Many thanks, Presiding Officer. Cabinet Secretary, I outline what commitments NHS Highlands has made on implementing the recommendations of the review and whether a timeline of implementation will be established. NHS Highlands are committed. They are hosting a suite of engagements with all their staff to ensure that the recommendations are implemented. In the coming days, they will set out their specific timeline. As I said, I will be visiting the board soon, but, in addition, I will also undertake, as John Sturrick recommends, a full review of progress that has been made after 12 months from the publication of the report. Miles Briggs, followed by Monica Lennon. Thank you, Presiding Officer. There is clearly a lot of learning from the Sturrick review for the wider Scottish NHS. What we have read in the report today, I think, clearly points toward NHS Highland, maybe just being the tip of an iceberg in terms of systemic bullying and institutionalised bullying, as outlined. The cabinet secretary says that she wants to be judged on how we respond. Will she commit to bringing forward a full debate on the report to Parliament on Government time at the earliest opportunity? I am happy to make that commitment, in addition to the commitment that I made about updating the Health and Sport Committee and discussing with party spokespeople. We need time to reflect on what is a 176-page report and to know a bit more about how Highland is responding to that, but in the wider debate, because it is a shared endeavour, I am very happy to commit to that. I am a mistake on my behalf. I am sorry, it would be Rhoda Grant, followed by John Finnie. I pay tribute to the GMB for bringing this serious issue to our attention, and the little I have read of the report and the time allowed is absolutely horrific. However, similar concerns have been expressed by other health boards, Lothian, Tayside, Borders, Narrow and Greater Glasgow and Clyde. If this is the culture of NHS Highland or the culture of the NHS in Scotland, fed by staff shortages and cuts putting enormous pressure on everyone within the NHS, what is the cabinet secretary going to do to tackle this to ensure that the NHS is adequately resourced in order to allow staff to work in an open and collaborative fashion? We are getting a wee bit along with the questions again, Keith Freeman. I do not accept that a significant proportion of the difficulty here is around the financial resourcing of our board, and I do not think that our boards justify that at all. What it talks about, though, is the quality of relationships. We can have as many policies as we want, but if the relationships inside a board or any organisation are not positive, healthy, open relationships, then policies will not resolve it. I have set out what I intend to do in the immediate term. I am open to other practical propositions, but the key thing for me is to hear also from our royal colleges, our regulatory bodies, our staff side representatives, which of course include our unions, and the leadership of our health boards across Scotland about what more they believe they can collectively contribute to creating that positive workplace culture. John Finnie, followed by Alex Cole-Hamilton. I thank the cabinet secretary twofold firstly for commissioning this work and secondly for early sight of the report. Of course, I thank Mr Sturrock for his very detailed work, which I have to be honest, I have not digested in detail. I have, however, seen, cabinet secretary, the recommendation in respect of Ergyll and Bute, and the suggestion of a separate review there that is importantly undertaken by an outside person. I wonder if you were in a position to outline any timeline for that. I am glad that Mr Finnie has pointed out to that separate review recommended by Mr Sturrock. I have asked the board of NHS Highland to consider what advice they may want to give me on that. My senior officials are also looking at how we can take that forward and who might lead that independent review. I am happy to update the member once we have concluded. Alex Cole-Hamilton, followed by Emma Harper. The report states that senior people in Scottish Government were aware for a considerable period of time that ought to have signalled the seriousness of matters. What changes will the cabinet secretary now instruct to processes so that future warning signs escalated to her Government will be dealt with from the outset? I am not convinced that it is changes to processes that can resolve that particular matter. Senior officials in the Scottish Government health directorate pay close attention to how our boards are operating in terms of their governance scrutiny and so on. We have a number of other ways of gathering information. We have the regular chairs meeting with me. We have the regular chief executives meeting. It is back to this dilemma about when does a Government move from supporting people to fulfil their responsibilities as leaders in a local board situation to intervening directly when that does not appear to be working? That is why I said that, as a Government, we need to reflect on that, except that it is a judgment every single time. We need to see if there is more that we can do to improve the consistency with which we make a judgment so that people understand the basis on which we might intervene more than simply the escalation framework, which of course has NHS Highland currently on level 4. Emma Harper, followed by Donald Cameron. I am aware that the Scottish Government is currently in the process of appointing a national whistleblowing officer. Will the cabinet secretary outline how the national whistleblowing officer will work with whistleblowing champions across health boards to ensure that a collaborative approach is taken to promote best practice? The independent national whistleblowing officer is what I referred to in my statement and the legislation to allow SPSO to take on that role is currently before Parliament. Prior to it going live, there will be a six-month training period and implementation period. We expect it to go live from the summer of 2020 by which time those non-exec whistleblowing champions will be in post. We intend that they are in post by the end of this calendar year and that they will then be for the independent national whistleblowing officer and those non-exec board champions to come to an agreement about when they will escalate any matters to me but also when they would escalate matters to the independent whistleblowing champion. The final point that I would make is that whistleblowing is a reflection of a culture that is not working. The key then is what more do we need to do to get the workplace culture to work whilst we have proper whistleblowing policies in place. Donald Cameron, followed by David Torrance. I also ask about Argyll and Bute, specifically. Paragraph 27.29 of the report of Mr Starrick states that he was concerned to hear from a number of sources about particular problems in some of the island communities and of a management culture located in Llock Gilpedd and Obern. He ends that chapter by saying that he has persuaded a specific review of management practices in Argyll and Bute that is necessary. Because the nature of some of the allegations implicates management at a very senior level, consideration should be given to this being conducted by someone from outside. What responses does the cabinet secretary make to that? As I have said, I completely accept that recommendation. I will give active consideration to how we might engage that review very quickly. I will hear from NHS Highland, who is, of course, under new leadership about what advice they might want to offer me, and then I will determine who independently will conduct that review. David Torrance, for a quick question, please, followed by Lewis Macdonald. Can the cabinet secretary outline how lines of communication between clinical and senior staff can be improved to ensure that all NHS staff feel supported at work? Jeane Freeman. There is, in all our boards, a clear governance arrangement that should allow, through the medical director and also the chief executive, constant communication between clinical leaders and others. Nonetheless, effective communication is a key feature within the report. In addition to looking at the arrangements and processes that currently exist within our boards, talking to those royal colleges, as I outlined earlier, will provide for me any additional advice that they want to give us about how their members represent in terms of the royal colleges, how that can be improved in individual boards or generally across the health service. Lewis Macdonald. Thank you very much. I look forward to the cabinet secretary coming to the Health and Sport Committee to address those issues, as she has indicated. In the meantime, can I ask her to reflect further on the committee's recommendation last year that an independent investigative and reporting line for NHS whistleblowers might well assist in the new structures that she is putting into place? I am happy to reflect on that and to see how, in addition to the whistleblowing helpline that exists, what more that might add and to respond directly to the committee in that regard. Quick last question, please. Clare Adamson. The cabinet secretary will be aware that, in 2017, a survey across NHS Scotland showed that 85 per cent of staff reported that they had not experienced bullying and harassment from colleagues. Every one of those experiences of bullying and harassment should be of concern and is something that is completely unacceptable. In light of the recommendations, can the cabinet secretary outline how those who have experienced bullying or harassment at work will be supported in coming forward with their experiences? I did not recognise a quick question there, however. Jeane Freeman. We already have policies in place, but what the Sturrock review identifies for us alongside is the importance of the work that we are undertaking to ensure that we have a once-for-scotland approach to a number of our workplace policies, including those in bullying and harassment, not just a policy but an application that is consistent across all our health boards. That gives us the opportunity to consider organisational cultures in all the boards and identify with the staff there. For example, the partnership forums that involve staff and union representatives, what more can be done in each board to ensure that those policies are implemented in a way that is speedy, open and allows staff to come forward and be listened to with respect and is safe in terms of no negative impact on them simply for raising their voices. That concludes questions on the Scottish Government's response to the Sturrock review. I apologise to Fulton MacGregor for being unable to take his question. We will move on to the next item of business.