Scottish Parliament, 6 November 2008

305 contributions from 69 members. The official report.

Official Report 6 November 2008

Scrutiny Improvement

Alex Fergusson (None, Galloway and Upper Nithsdale)

Good morning. The first item of business is a statement by John Swinney on scrutiny improvement—changes to structures.

John Swinney (Scottish National Party, North Tayside)

This Government's purpose is very clear: we want to create a more successful country with opportunities for all of Scotland to flourish through increasing sustainable economic growth.

In the current economic climate, it is more important than ever that all public services actively contribute towards that purpose. An example of how the Scottish Government, in partnership with local authorities and agencies, is focusing on that is the wide-ranging package of improvements announced last week to help Scotland's planning system support increased sustainable economic growth. This morning, I will set out a range of measures to ensure that scrutiny supports and encourages public bodies to improve the services that they provide to the citizens of Scotland.

The drive to reform scrutiny extends far beyond this Administration. I am grateful to the previous Administration for setting up the independent review of regulation, audit, inspection and complaints handling of public services in Scotland under Professor Lorne Crerar, whose report was debated in the chamber last October. Members endorsed the review's main recommendations and there was cross-party agreement on the need to create a robust but proportionate scrutiny system.

Parliament and bodies accountable to Parliament form a crucial part of that system. I whole-heartedly welcome the interest shown by the Scottish Parliamentary Corporate Body in our plans and the Parliament's bold initiative to draw on the lessons of Crerar and important work by the Finance Committee and the Audit Committee in reviewing the bodies under its wing.

Developing policy to implement the Crerar review was a specific element of our concordat with local government. We have worked very closely with local government on this matter and members and officials of local authorities have been involved in all the key groups. I also thank the other bodies, including the scrutiny bodies, that have worked with us on this issue since January.

That said, I am determined to take us beyond principles to tangible action. We are making bold choices—the right choices—to deliver an effective and proportionate scrutiny system for Scotland.

Over the past 20 years or so, the public sector has grown in a piecemeal fashion. We are simplifying the vast range of delivery bodies; indeed, we have reduced the number of such organisations by seven. We also have a wide array of organisations that scrutinise service delivery. Although partnership working can go some way in jointly organising scrutiny, it cannot and should not be the only solution.

Our reform of the scrutiny system is a key strand of this Government's desire for a more simplified and coherent approach to public service delivery, including a much clearer role for public bodies. In doing that, we are streamlining decision making and increasing transparency; stopping activity that no longer contributes to the public purpose; and applying much tougher tests to the creation of new bodies. Moreover, just as we have formed a new relationship with local government, this Administration is redefining its relationship with Scotland's public organisations by moving to an outcome-based approach aligned with the national performance framework.

The Government wants to create not only a system of external scrutiny and complaints handing that emphasises excellence in delivery, but a culture of self-improvement within the delivery bodies, which, after all, know the people who use their services. Of course, some level of proportionate external scrutiny will always be necessary to provide independent assurance that services are well managed, safe and fit for purpose and that public money is being used properly.

In June, I committed ministers to a target of reducing scrutiny bodies by 25 per cent, which matches our broader commitment on public bodies. Today, I will set out not only how that commitment will be achieved but how we are making progress on changing how scrutiny is carried out through the work of the Accounts Commission and the action groups that we set up in January.

Since Professor Crerar published his review, much has been done. Back in March, I asked the Accounts Commission to find ways of reducing the burdens on local authorities through the better planning and scheduling of service inspections. I have recently received the commission's first progress report and it is clearly identifying real opportunities for co-ordinating work to reduce the burden of scrutiny on councils and to improve its impact and effectiveness. The Accounts Commission will continue to report regularly to ensure that real change is delivered on the ground.

In January, I announced the creation of five action groups to produce practical ways of implementing the Crerar recommendations. Four of the five groups have now reported and the fifth will report shortly. Although a formal response to those reports will be published in the near future, I can announce that we are accepting a number of key measures.

For a start, we endorse the vision of simple, user-friendly and broadly consistent complaints procedures across public services, with the Scottish Public Services Ombudsman working with the public sector on designing and implementing them. We agree that local government complaints systems should be a priority for that new approach and that scrutiny bodies should work together and with councils to develop a proportionate and intelligence-led approach to scrutiny based on robust risk assessments. We will move to formalise the independence of bodies that scrutinise services to give the public assurance that their reports and findings are free not only from the influence of those delivering the services, but from political interference.

The key drivers behind the move to simplify the scrutiny landscape are obvious. First, we want to tackle the complexity of organisational structures. Working across structural boundaries can absorb a lot of time that could be spent on speaking directly and listening to and addressing the needs of citizens. Secondly, we want to achieve more outcome-focused, efficient and streamlined public services that provide better value for the public pound.

The changes affect 11 bodies with more than 950 staff and budgets amounting to £59 million. Under the plans, those 11 bodies will be reduced to five. To create a clearer system for handling complaints about public services, the Government would prefer to transfer functions in two areas—complaints about the water industry and complaints from prisoners—to the Scottish Public Services Ombudsman. One result of the streamlining of complaints handling would be the abolition of Waterwatch Scotland, whose complaints functions we would like to transfer to the SPSO. Consumer Focus Scotland, which already promotes customers' views on a range of public services, would represent water customers.

With regard to the Scottish Prisoner Complaints Commission, we would prefer to put its functions on a statutory footing for the first time and to make them part of the SPSO's revised functions. Both proposals are in line with the complaints action group's recommendation that the number of standalone complaints-handling bodies should be reduced to simplify the process and landscape for users.

However, as the SPSO is a parliamentary body, I recognise that it is not in the Government's gift to transfer functions to it. The Parliament's ad hoc committee, which will be convened by Trish Godman, will rightly want to consider the functions of the SPSO and other parliamentary bodies. We will put our proposals to the committee to allow members to consider how well they might fit with their wider considerations.

We are developing a more integrated role for the prison visiting committees that better reflects modern offender management structures and we are exploring the prospect of linking their functions with those of Her Majesty's prisons inspectorate for Scotland.

We will abolish the Scottish charity appeals panel and consult on where its functions might best sit. Although it is important for charities to have an accessible and cost-effective way of appealing the Office of the Scottish Charity Regulator's decisions, the fact that only a very small number of appeals has been received suggests that that need not be provided by a specialist standalone body. We will publish a consultation paper on future options, but I assure the third sector that the SCAP will remain until a suitable recipient has been found for its work.

We intend to make major improvements to the scrutiny of health, social care and social work services. In future, there will be a single scrutiny body for health services; a single body for care and social work; and a single body concentrating on education and learning for children and other learners.

The new health scrutiny body will bring together the existing functions of NHS Quality Improvement Scotland and the Mental Welfare Commission; take on the scrutiny of independent health care, which at the moment is conducted by the Scottish Commission for the Regulation of Care; and have new responsibilities for reviewing and inspecting performance on health care-acquired infections. The Cabinet Secretary for Health and Wellbeing will make an announcement shortly on that very subject. The new body will ensure greater consistency of scrutiny.

The new health scrutiny body will not only ensure greater consistency of scrutiny, but will give the public a better understanding of standards of performance and delivery across a highly integrated universal public service. It will also put more of an emphasis on the health needs of vulnerable people, including older people, people with mental health problems and people with learning disabilities.

The single scrutiny body for care and social work will take on the functions of the Social Work Inspection Agency, the functions of the care commission—without its independent health care function—and Her Majesty's Inspectorate of Education's current responsibilities for the inspection of child protection and the integration of children's services.

The new body will consider the links in what should be a chain of support, from how the local authority performs its strategic social work functions right through to how services are delivered to individual citizens. HMIE will maintain its focus on raising educational standards, stimulating improvement and promoting self-evaluation while continuing to ensure that education services work with other services to support the development and wellbeing of all children in Scotland.

The health and social care proposals present a much simplified landscape that will focus on the needs of the individual service user, not the bureaucracies of organisational structures.

The changes that I have outlined affect the scrutiny bodies that report to Government. Parliament has its own commissioners and scrutiny bodies. We have undertaken positive dialogue with the Scottish Parliamentary Corporate Body, and I fully recognise that Parliament should play a leading role in considering its contribution towards improving scrutiny. I am pleased that the Parliament will be invited to consider the proposal to establish an ad hoc committee to consider its relationships with its bodies and how those can be improved, and I look forward to contributing towards its deliberations. Of course, all decisions on legislative change, irrespective of who sponsors the bodies, are clearly for the Parliament as a whole.

We intend to deliver the package of structural reform by 2011. I expect the changes that require legislation to be reflected in legislation that will be introduced next year, either in the public services reform (Scotland) bill, which is due to be introduced early next year, or in other legislation that is relevant to the policy area.

Whatever structural approach we adopt short of having a single scrutiny body—that proposal received little support when we debated the Crerar review last year—scrutiny bodies will need to work together across organisational boundaries to ensure that the needs of individuals and families are met. The work that the Accounts Commission is doing will play an important part in breaking down any barriers that exist.

Finally, there is a further change that will contribute towards our commitment to cut the number of public bodies by 25 per cent. The Mental Health Tribunal for Scotland Administration, which is currently an executive agency, will be merged into the core Scottish Government. That change will help in moving towards a new structure for the tribunal system in Scotland in the light of the Leggatt report and other reports.

The changes that I have outlined will benefit those who deliver services. Crucially, time will be freed up for the delivery and improvement of public services, which will benefit people who use them. Service providers will be responsible for the robust self-evaluation of their activities. A smaller number of scrutiny bodies should support that self-evaluation, but those scrutiny bodies should retain independence and the right to assess the effectiveness of how services are delivered and their quality. Complaints procedures will be simpler and more consistent throughout Scotland. Complaints will be handled better, at a more local level and in a more consistent way, and there will be fewer stages between when the complaint is made and its resolution.

We will work closely with scrutiny organisations to implement the reforms to ensure that they deliver clear benefits. In the short term, there may be some transitional costs as we move towards having a smaller number of scrutiny bodies, but those costs will be offset against savings over time. The savings will contribute to the efficiency gains that are required under the efficient government initiative from the bodies that are directly affected by the changes, and they will be available to support the improvement of services.

The size of the workforce involved in what has been a disproportionate external scrutiny system will diminish as we move to self-evaluation. We maintain our commitment to having no compulsory redundancies. The reduction in the workforce will be achieved through redeployment, natural wastage and, potentially, limited voluntary severance. We will also consider a staged transfer of resources closer to the delivery of services. We will engage with staff, trade unions, local government and other stakeholders to ensure that the changes are well designed and implemented.

Members of the public expect assurances that their services are efficient and fit for purpose, but they want teachers, care workers and other public sector workers to get on with delivering services rather than constantly preparing for the next inspector. I am committed to delivering a real reduction in scrutiny as part of the simplification of public service delivery. The package of measures that we have set in train today is a substantial start.

I am grateful to all our partners for the work that they have done to date. We need to be bold in taking forward the measures to deliver tangible change on the ground for the people of our country.

Alex Fergusson (None, Galloway and Upper Nithsdale)

The cabinet secretary will take questions on issues that were raised in his statement. Around 30 minutes are available for such questions. Not a huge number of members want to ask questions, so there is a little—I repeat: a little—flexibility in times.

I call Andy Kerr to ask the first question.

Andy Kerr (Labour, East Kilbride)

Thank you for that kind invitation, Presiding Officer.

I thank the cabinet secretary for the advance copy of his statement, much of the content of which I welcome, and for his acknowledgement of the work that was done by the previous Administration. I am sure that further details about the proposals will arise during parliamentary consideration of them and the work of the ad hoc committee. As the process develops, it will be interesting to find out whether the cabinet secretary's proposals comply with the recommendations on accountability and governance in paragraphs 10.10 and 10.11 of the Crerar review report, including recommendations 22 to 25. I am not sure that there is the clarity that we would expect at this point for us to examine the proposals.

One key Crerar principle is focusing on the public. How will the cabinet secretary ensure that the public become central and involved in the new form of scrutiny so that that clear principle is followed?

The Crerar report states:

"the scrutiny bodies appear to have different levels of independence from government and ... accountability across the scrutiny sector is neither transparent nor consistent."

With agencies, non-departmental public bodies and, of course, the SPSO retaining scrutiny functions, is the cabinet secretary convinced that he has addressed Professor Crerar's concern about that?

On local government, I note with interest the ideas about complaints systems at a local level. Is the cabinet secretary proposing a uniform and standard system at the local level to allow transparency across local authority areas, or will he allow individual local authorities to have their own systems that are in line with certain principles which are set out by him and the Parliament?

On unintended consequences, the Scottish health council performs a critical role, which is being subsumed within a bigger organisation. What assurance can the cabinet secretary give that that organisation's role, influence and importance will not be diminished?

Finally, how do the cabinet secretary's proposals fit with our next debate, on patients' rights proposals? There are linkages in that respect that have not been addressed in the statement or the associated documentation.

John Swinney (Scottish National Party, North Tayside)

Mr Kerr mentions that supplementary information that goes into more detail than it was possible for me to go into in my 15-minute statement has been made available. I should have added that.

Mr Kerr has pointed to a number of key issues. I assure him that we are coming from the same place. Simplifying the system of scrutiny to ensure that the interests of members of the public are absolutely central is at the heart of what the Government aims to do. Because of the system's complexity, it can often be difficult for interests of members of the public to be viewed as central. Organisational infrastructures rather than the concerns, or rather the legitimate interests, of members of the public can often predominate. I assure Mr Kerr that the interests of members of the public are central to the Government's approach, whether we are talking about organisations' accountability and governance arrangements, how we establish bodies, how bodies should relate to the Government or their freedom to express their views about the performance of public services. It is in nobody's interest to have organisations that are in any way hamstrung in their ability to express their views on service performance.

On complaints at local authority level, I referred in my statement to enabling the Scottish Public Services Ombudsman to have a more active role in supporting the establishment of more consistent complaints systems that would meet clearer standards throughout the country. As Mr Kerr knows, local authorities are independently constituted bodies, so it would be for them to design the complaints-handling processes. However, I hope that we create a climate in which authorities feel well supported by the Scottish Public Services Ombudsman in securing that.

Mr Kerr made two points about unintended consequences. I am not sure that I follow his concern about the Scottish health council, but I will write to him on that if I feel that any issues need to be explored. On the connection to the next debate this morning, on patients' rights, I return to my first point that it is absolutely critical that we put the member of the public at the centre of the reform and our considerations. The debate on patients' rights strikes me as a perfect illustration of how the Government intends to do that.

Derek Brownlee (Conservative, South of Scotland)

I, too, thank the cabinet secretary for the advance copy of his statement and the supporting document, which is helpful. For a brief moment, we thought that we had an inadvertent leak from the Government and got terribly excited about that, but we found nothing untoward in the document, which was most upsetting. The Conservatives welcome the broad thrust of the announcement, although we reserve the right to consider the detail when it is produced. We look forward to engaging on the implications of the Crerar recommendations on the parliamentary ombudsmen and commissioners.

The cabinet secretary mentioned the five action groups and said that the report from the fifth one is still to come. He also talked about a variety of statements that his colleagues will make. Can we assume that, with the exception of the fifth action group report and the content of those ministerial statements, we now in effect have the Government's broad approach to the Crerar report? Will he comment in more detail on the Government's assessment of the cost savings that will arise from the move to more proportionate scrutiny? Has any quantification been made of the benefits to service users and the organisations that are scrutinised?

John Swinney (Scottish National Party, North Tayside)

I am amazed by the prospect of inadvertent leaks that can excite the Conservative party on a Thursday morning.

My statement and the subsequent announcements that the Government will make are the components of the Government's response to the Crerar report. As I said, the previous Administration established the Crerar review, which we welcomed and supported when in opposition. We have made progress on the recommendations. I acknowledge that, across the board, the Parliament needs to be comfortable on all the questions that we are exploring. The debate last year on the Crerar review, in essence, allowed Parliament to express its general views on the report and to give the Government guidance on how much parliamentary comfort there would be with our approach. That style lies at the heart of how the Government wants to take further action in relation to the Crerar review. I hope that we can work across the Parliament in doing that and in the legislative process for the forthcoming public services reform (Scotland) bill.

I cannot give Mr Brownlee an estimate of the cost savings, because it is difficult to quantify the benefits or the savings in management and staff time in local authorities. Frankly, authorities have been overburdened by inspectors turning up one after the other. The Accounts Commission has done a good job, in consort with Audit Scotland, in bringing together regulatory bodies to plan better the inspections that are undertaken at the corporate level in local authorities. We are seeing the fruits of that work in the way in which the process is organised—it is having a significant influence on the design of the best-value 2 approach, which will build on the best-value regime that was introduced into local government in the past. There will be cost savings. Savings will arise from the functions of the bodies to which I have referred, but there will also be consequential savings to local authorities, as the burden of inspection will be made more proportionate as a consequence of my announcements.

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

The cabinet secretary highlighted the fact that the Government asked the Accounts Commission to find ways in which to reduce the burden on local authorities through better planning and scheduling of service inspections. However, will the cabinet secretary confirm that all the 3,599 targets in the single outcome agreements with our local authorities have been signed off without any audit? How does that square with scrutiny improvement?

John Swinney (Scottish National Party, North Tayside)

The outcome agreements are focused on providing the clearest possible illustration to members of the public in individual localities of what they should expect their local authorities to achieve as a consequence of service planning, service delivery and public expenditure in each area. The single outcome agreements crystallise very clearly what local authorities aim to do in individual localities and they are a significant improvement in transparency and openness. They are public documents that are available for scrutiny. Members of the public can examine the contents of the single outcome agreements to determine whether authorities have made progress in achieving the aims and objectives. Mr Rumbles should be assured that there is a much greater degree of transparency and scrutiny.

A significant amount of audit activity is undertaken routinely in every local authority in the country. Mr Rumbles will see that the work that is done in the best-value 2 regime will continue to build on the clear lessons and benefits of the best-value system that the previous Administration introduced. As a consequence, public service will improve into the bargain.

Brian Adam (Scottish National Party, Aberdeen North)

Will the cabinet secretary spell out a little further how the proposals sit alongside the wider simplification programme on which the Government has embarked?

John Swinney (Scottish National Party, North Tayside)

Earlier this year, the First Minister made a statement to Parliament that set out the Government's approach on the simplification of public bodies. The various steps that were set out in that statement are now being delivered actively. The public service reform (Scotland) bill, which will be introduced to Parliament in the spring, will give further details and Parliament will have the opportunity to consider those propositions. In our agenda, the improvement in scrutiny sits comfortably with the improvement in the organisation of public bodies.

Jackie Baillie (Labour, Dumbarton)

I generally welcome the cabinet secretary's statement, which is a positive step in the right direction. However, I have three specific points about the new health scrutiny body. First, I return to Andy Kerr's point about the status of the new bodies, because I am not clear that we got an answer on that. The supplementary information does not tell me whether the bodies are to be agencies, non-departmental public bodies or a mixture. I am sure that the cabinet secretary will agree that it is essential that the bodies are independent of ministers and free from political interference.

My second point is about the health scrutiny body's role in the inspection of performance on health care-acquired infections. Will the body operate and report on a hospital-by-hospital basis? Will it deal with health care-acquired infections in care homes? That is an area of substantial and growing concern and I am worried about overlap with the other new body that the Government is to set up, which will be an amalgamation of the care commission and the SWIA.

Finally, I have a question about self-evaluation. Although I understand absolutely the merit in that approach, and although Professor Crerar commended it in his report, equally I am clear that self-evaluation is not enough. Argyll and Clyde NHS Board had two successive self-evaluations of its compliance with its HAI targets. It failed twice and no action was taken at a hospital level. We know the results of that. Does the cabinet secretary agree that self-assessment needs to be backed by monitoring and that strong action is needed at the hospital level to correct the systems failure that resulted in so many patients dying of Clostridium difficile at the Vale of Leven hospital?

John Swinney (Scottish National Party, North Tayside)

The status of the new bodies is not confirmed in the statement and there will be further discussion about that point. It is a material point for consideration in the parliamentary process. I commented that we want to ensure that the bodies are free from political interference, so I hope that that gives Jackie Baillie some comfort on the Government's thinking about their status.

Whether there will be hospital-by-hospital reporting will be considered as the Cabinet Secretary for Health and Wellbeing sets out her points in greater detail. We must ensure that the regime is applied effectively across hospitals and care homes.

Jackie Baillie's last point gets to the nub of the issue. It is a serious issue. On the one hand, there will be, and we all know of, examples of unacceptable performance in the public service; on the other hand, there will be examples of supremely effective public service performance. The Parliament will be asked to consider whether it is appropriate to apply the same regime to the elements of the public services that perform poorly and the parts that perform exceptionally. That is where proportionate scrutiny comes into focus.

I accept that that is a question for the Parliament to consider, which is why I have gone to such lengths to ensure that we have a broad spectrum of agreement about the point. I hope that, in the course of considering the issues, we will be able to reassure members. I instinctively think it inappropriate to use a one-size-fits-all inspection regime when we know that some elements of the public services are performing well and, therefore, do not require to be inspected as frequently as others. I readily concede that there is a danger of deterioration in performance within public service organisations, so we need a mechanism that can identify that deterioration and intervene to protect the public interest.

I hope that that is helpful in explaining some of the Government's thinking. The Parliament must be engaged on the issue to ensure that we are comfortable about moving to a more proportionate regime that is driven by self-evaluation rather than comprehensive, one-size-fits-all inspection and scrutiny.

Gavin Brown (Conservative, Lothians)

I, too, broadly welcome much of the cabinet secretary's statement, quite near the end of which he said that complaints would be handled better, more locally and more consistently. From what he said, I can see how they will be handled more consistently, but it is not immediately obvious to me how they will be handled more locally. Will he elaborate on that point?

John Swinney (Scottish National Party, North Tayside)

I am sure that we all agree that, if the Scottish Public Services Ombudsman has to address a complaint, we have reached a pretty unacceptable point in the relationship between a member of the public and a public body. The impetus of what I announced is to put in place the responsibility that lay at the heart of the Crerar report: ensuring that organisations take responsibility for addressing examples of poor performance long before a member of the public feels the need to go to the ombudsman.

If organisations had a more consistent approach towards local handling of complaints about poor performance and were more engaged in addressing the concerns of members of the public and finding solutions locally, perhaps there would not be significant increases in the ombudsman's caseload and perhaps some of the complaints would not be so intractable or difficult to resolve once they got to the ombudsman. The key lesson of the Crerar report was that, if complaints can be handled quickly at a local level by the people who deliver the services, we will improve the position for members of the public and reduce the time and energy that the public services must devote to resolving complaints but should devote to ensuring better-quality public services.

Nigel Don (Scottish National Party, North East Scotland)

What solutions does the minister envisage for charities that need to appeal OSCR decisions, given that he has decided to eliminate the Scottish charity appeals panel?

John Swinney (Scottish National Party, North Tayside)

We have taken the view that the Scottish charity appeals panel is not required simply because it has not had to consider any cases so far and we feel that there is an opportunity to handle its work more efficiently. The Minister for Community Safety will consult on that. I would not want to prejudge the outcome of that consultation, but the third sector and charity sector will be able to participate fully in it.

Tom McCabe (Labour, Hamilton South)

I welcome the cabinet secretary's statement and his emphasis on a consumer-focused approach. Many people have talked that talk; let us hope that we are more successful in achieving it this time.

I note the proposal for a single scrutiny body for health. Will the cabinet secretary expand on his proposals for complaint handling within the health service? In my experience, it is unbelievably difficult for members of the public to pursue meaningful complaints about the health service. Often, they try to pursue them after emotionally trying experiences. They find that very difficult and, all too often, give up because of the complexities of the system that they encounter. It is vital that one outcome of the cabinet secretary's proposals be that members of the public find it easier to pursue a complaint—not out of vindictiveness but to ensure that others do not, in future, experience what they have experienced. Will he give us a bit more information on how his proposals will assist in that effort?

John Swinney (Scottish National Party, North Tayside)

Mr McCabe was the minister who initiated the Crerar review and did a great deal to advance many of the issues that the Government is now taking forward. I warmly welcome the work that he undertook. It sparked the debate and, through the Crerar report, gave the Government a resource that could advance the scrutiny agenda when it came to office.

I agree with his view that the individual must be at the centre of the process. If somebody has had an unfortunate and unacceptable experience, the public services must adequately address and respond to their complaint. In my experience, it is difficult for such a complaint to find a straightforward route through the system, and I reassure Mr McCabe that the individual's interests will be at the heart of the process.

I repeat the point that I made to Mr Kerr on the debate that will follow this item of business. We are putting greater emphasis on patients' rights and on ensuring that patients are satisfactorily supported through the challenges that they face. The interests of members of the public who may have had bad experiences will be at the heart of the proposals that we introduce as we design the new bodies and encourage the creation of a new ethos within them. As they are established, the bodies will take those considerations forward.

Andrew Welsh (Scottish National Party, Angus)

Having sought over three decades to bring greater public and parliamentary accountability to quangos, I congratulate the minister on his statement and actions. In light of the decision to abolish Waterwatch Scotland, how will he ensure effective customer representation in the water industry, particularly in rural areas?

John Swinney (Scottish National Party, North Tayside)

There is a clear distinction between handling complaints about the water industry—the Government has decided that that task should be transferred to the SPSO, subject to parliamentary consent—and the articulation of the consumer interest, which we want to be part of the work of Consumer Focus Scotland, which is already involved in the articulation and representation of consumers' concerns across Scotland on what they can expect from the public services.

Mr Welsh has raised a serious point. He and I represent adjoining constituencies with similar communities, so the importance of ensuring that people in rural areas can express their views and aspirations about public services is something about which I am deeply concerned. The issues that Mr Welsh raised will be at the heart of the arrangements and remit for Consumer Focus Scotland that we will encourage.

Alex Fergusson (None, Galloway and Upper Nithsdale)

I am grateful to members for endeavouring to take up the full 30 minutes that was available. We have not quite made it, but we move to the next item of business. I will allow a wee while for members to change seats.

Patients' Rights Bill

Alex Fergusson (None, Galloway and Upper Nithsdale)

The next item of business is a debate on patients' rights.

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

It gives me great pleasure to set out the Scottish Government's proposals for a patients' rights bill for users of the national health service in Scotland. The mutual NHS described in our "Better Health, Better Care: Action Plan", published in December 2007, is one in which patients and staff value each others' experience, knowledge and skills. A truly mutual NHS will be one in which patients have more control over their own health and in which decisions about how our NHS is run are shared by all: patients, staff and planners. At the heart of our vision of a mutual NHS is a set of principles that include dignity and respect, equality, fairness and autonomy—principles that mirror equality and human rights legislation.

On 22 September, I launched a public consultation, which will run until 16 January 2009, seeking the views of the people of Scotland on the possible content of a patients' rights bill. It is intended that such a bill, if enacted by Parliament, will underpin our vision of a mutual NHS. The consultation document sets out our thoughts on why patients' rights and, indeed, responsibilities are important; what rights should be included in the bill; and what difference this will make to patients. The consultation also describes proposals for improving the effectiveness and independence of redress—what patients can do if things go wrong. The bill's aim is to reinforce and strengthen our commitment to place patients at the centre of the NHS in Scotland.

As members will be aware, there are already a number of existing patients' rights and entitlements, but those are not always widely understood or exercised by patients. To be useful to patients, it is essential that a patients' rights bill is easily understood, clearly communicated and simple to enforce. It will therefore include provision for a charter of mutual rights, which will set out how patients' rights will be delivered in practice and will provide a clear framework and guidance for staff. Those rights and their associated responsibilities are relevant to all aspects of health and health care, and to patients, carers, families, local communities and NHS staff. It is intended that they will apply wherever and whenever NHS care is provided.

The consultation suggests that the bill should include patients' entitlements and responsibilities in relation to: equity of access to NHS care; respect, dignity and consideration for the individual, both for patients and for staff who work in our NHS; safe and effective care and treatment; clear and appropriate communication; information about services and care and treatment options; patients' participation in decisions about their individual health, as well as decisions about their health services; privacy and confidentiality of personal information; and independent support and redress.

As I speak to patients and their families across Scotland—I am sure that this experience is shared by other members of the Parliament—they tell me that access to swift and safe treatment remains a key issue, if not the key issue, for them. That is why we propose that a central part of a patients' rights bill will be a legally binding waiting time guarantee that is easily understood by patients and their families. Clearly, when a patient has been told that they require surgery, waiting for admission to hospital can be a time of anxiety and stress. That is why we have decided that that important part of the patient pathway should have a legally binding waiting time guarantee of 12 weeks. The new, legally binding 12-week guarantee will sit within the overall 18-week referral-to-treatment standard that will apply across Scotland by 2011. It means that if someone is diagnosed within, say, two weeks, their overall waiting time should be no more than 14 weeks. On the other hand, in the small number of complicated cases where diagnosis and decision about treatment may take longer than 18 weeks, a patient will still know that, once diagnosis is confirmed, a long-stop guarantee of treatment within 12 weeks will apply. This will mean that patients will be fully aware of what the waiting time will be following diagnosis and will have certainty that it will be delivered. Of course, within that timeframe and within any waiting time guarantee, clinicians will continue to have the flexibility and freedom to set the clinical priority that is most appropriate for their patients, particularly those requiring urgent treatment.

The new proposal is all about providing clarity and certainty to patients. Should an NHS board be unable to meet the proposed waiting time guarantee, it will be required to take steps to ensure that swift treatment is provided elsewhere—for example, in another NHS board area, at the Golden Jubilee national hospital, or elsewhere in the United Kingdom.

To help us deliver on the waiting time guarantee, the Government has decided to commit an additional £270 million over the next three years to allow boards to take action and redesign services in a way that allows the ambitious new target to be met.

Mary Scanlon (Conservative, Highlands and Islands)

Will that include using spare capacity in the private sector to meet the waiting time guarantee?

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

Boards are already able to use existing capacity in the private sector to meet waiting time guarantees if they are unable to do so from within their own capacity. There is nothing in the proposed patients' rights bill that would seek to change that position.

In addition to the provisions on waiting times, the bill will do a number of other things. It will acknowledge that Scotland is a socially and culturally diverse society and that patients' rights apply across that diversity, and it will require health services to provide accessible and appropriate services that are responsive to the individual needs, background and circumstances of people's lives. People have the right to the support that they need to access health services—for example, access to an interpreter or to patient transport. Patients also have a right to expect health care services to be provided with care, skill and competence in a safe environment. We know that, while the care provided in NHS Scotland is already of a high standard, we can always get better. That is why we have set up the Scottish patient safety alliance. The alliance supports staff to improve steadily the reliability and safety of health care services and ensure, crucially, that we learn from incidents that have safety implications where and when they occur.

A patients' rights bill will underline the critical importance of communicating with patients in a clear, accessible and appropriate way. We know from reports from the Scottish Public Services Ombudsman that communication can and sometimes does break down at any stage of the patient journey. Patients should have a right to the support of a family member, interpreter, advocate or other independent supporter to help them understand the implications of the options available to them and help them express their views.

Jamie Stone (Liberal Democrat, Caithness, Sutherland and Easter Ross)

How will that tie in with the issue of remoteness and distance, which can be crucial in determining whether family members can join in and help?

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

That is an important point. As I have said on previous occasions in the chamber, patients should have the same rights in the health service regardless of where in Scotland they live. That should apply as much to advocacy and support as to the range of other rights that I have mentioned.

By April next year, we intend to introduce a health information and support service that will bring together quality-assured local and national information from the NHS, the voluntary and other sectors. Patients and their families will be able to access the information online, by telephone and in their local high street. Every household in Scotland will receive an easily understood report about their rights and responsibilities, local NHS services and how well their NHS board is performing and engaging with the community. If the proposed bill is enacted, all NHS boards will also be required to designate independent patients' rights officers to help patients to understand and access their rights.

Most people who seek redress after something has gone wrong want an explanation or apology and an assurance that lessons have been learned, but there are times when financial compensation is appropriate. At present, generally patients can receive compensation only when they can establish negligence through a legal process. A no-fault compensation scheme could be simpler than existing processes and could support the development of the concept of a mutual NHS, as well as a positive feedback and learning culture, without the need for recourse to the courts. As a Government, we consider that no-fault compensation is the way forward for the NHS in Scotland, but we recognise that further work is needed on the practical implications and possible costs of such a scheme. We will consider the responses to the consultation before making any firm decision on future arrangements.

The proposals that I have outlined are by no means exhaustive. In the coming months, following full consideration of the responses to the consultation exercise and further debate in the Parliament, we plan to introduce legislation in the form of a patients' rights bill. I believe that such a bill will have an impact on every part of the NHS in Scotland. The Government's aim is to deliver a truly mutual NHS that respects the rights of both patients and NHS staff and allows them to work in partnership to deliver a world class service. I believe that that is in line with the founding principles of the NHS when it was introduced 60 years ago and that it is right for the future of patients in Scotland.

Cathy Jamieson (Labour, Carrick, Cumnock and Doon Valley)

I welcome the opportunity provided by this morning's debate. There will surely be plenty of political point scoring elsewhere today so, perhaps unusually, I will set that aside. Instead, I will explore concerns about the proposals and make constructive and helpful suggestions on what further work could be done to ensure that the legislation that is introduced will be worth while.

My starting point is that I am generally supportive of a rights-based approach. In any public service, people should know what is to be provided and what level of service they ought to expect. They should also be able to be involved in decisions that affect them and, of course, they should be able to seek redress when things go wrong. However, having worked for many years for a rights and advocacy organisation and developed a charter of rights for children in care, I can also foresee where difficulties will lie. We must avoid passing legislation that makes no difference to the patient or, worse still, simply creates new layers and levels of costly bureaucracy. That said, I am generally sympathetic to the cabinet secretary's aim of a mutual health service that encourages people to feel that it is genuinely their service.

However, there is a difference between taking ownership of how the health service is run and being involved in our own health care. For many patients, the last thing that they want when they desperately need treatment is to be concerned with the structures of the NHS, its complaints procedures and how they can seek redress at that point in time, but they will want a real say in the options that are available to them for treatment.

One point in the consultation document that the cabinet secretary mentioned is the proposal for a charter of mutual rights. Can she explain in more detail—perhaps later in the debate—how that is intended to work in practice? Will the charter simply be the list of existing rights that are outlined in the document, with the addition of the waiting time guarantee, or will it be something broader? Will it encompass rights across a wider range of health provisions? Will it be legally enforceable as part of the process of ensuring that patients have rights under which they can seek redress? That is an important point because, in my view, a charter that is simply a list under which there is no redress would not be worth anything other than, literally, the paper on which it was written.

Although the proposals on the waiting time guarantee build on what the previous Administration did and include much that we can support, we have some concerns about whether legislation is the only way to ensure that the waiting time guarantee is met. It is likely that redress will be sought in only a few cases, so we need to consider the issue of proportionality. Do we need legislation on the waiting time guarantee or are there other ways in which it could be enforced? We will need to discuss that issue during the course of the bill. Another concern is that a range of patients would not necessarily be covered, including those with mental health problems, who I am sure members will mention during the course of the debate.

Giving patients the right to go elsewhere in the UK or Europe sounds good in principle, but may not work in practice for all, so we need to explore that proposal in a bit more detail. People with family commitments, those from vulnerable groups and elderly people may feel unable to exercise such a right. For some vulnerable people, the prospect of a hospital admission is frightening enough without the thought of being away from family and friends or travelling into the unknown. We need to ensure that it is not simply the affluent and the articulate who are able to exercise such a right, with others perhaps taking the view, "I'll just leave it for now, thank you very much, and wait my turn on the list." The consultation document makes much of access to independent support and redress. As Tom McCabe and others pointed out to the Cabinet Secretary for Finance and Sustainable Growth during this morning's statement, patients already have a number of ways to complain, but it can be quite difficult for people to negotiate their way through those in deciding whether they should complain to their local NHS board, seek support from independent advice, approach the SPSO or seek legal redress. We need to hear a bit more about how the proposals that John Swinney outlined this morning will fit with the bill. I look forward to hearing more on that.

The consultation paper suggests that boards should be proactive in introducing the patients' rights officers to which Nicola Sturgeon referred, but those need to be adequately funded if they are to be meaningful. Will there be statutory provision for patients' rights officers? Will there be funding to ensure that they are available? From my experience of dealing with children's rights, I know that non-statutory posts tend to be the first to be hit when funding is tight or difficult decisions need to be made. The paper also mentions new approaches, including local resolution, but provides little detail on what those should be. I believe that there is an opportunity to explore more fully how mediation could be offered and used, but we need to understand who will provide such mediation, what training will be given and how it will be funded.

As the consultation paper states—and as the cabinet secretary has repeated—people often want just an apology or explanation but there will be some cases in which financial compensation is appropriate. I generally welcome the proposal for no-fault compensation, although I recognise that it would involve some difficulties, which were outlined by a report back in March 2003 that considered that and other issues in the health service. Rather than simply wait for the outcome of the consultation, the cabinet secretary should consider setting up an expert group to consider the previous work in detail, identify the issues and begin to consider proposals to put the idea into practice. Unless such proposals are made as part of or in the context of the proposed patients' rights bill, we will have a pretty thin bill, which will focus only on the waiting time guarantee and the means of legal redress and will not take a wider view on no-fault compensation.

Mutual responsibility is important. All members agree that staff should not be physically or verbally abused. I want to ensure that the cabinet secretary intends to continue to work with the trade unions on the issue.

The cabinet secretary talked about patients' dignity. The Royal College of Nursing is calling for consideration of patients' dignity to be an essential part of all policy making, to ensure that in all decisions consideration is given to whether the proposed course of action would add to patient dignity.

Breakthrough Breast Cancer identified concern about what it would mean to make patients legally responsible for

"seeking and using information appropriately to support their own health".

We need to pursue in more detail that statement in the consultation paper. What exactly does it mean? Similarly, what would the proposal to give patients responsibility for heeding lifestyle advice mean in practice? Who would decide what lifestyle advice was appropriate and whether it had been heeded appropriately? I sound a note of caution: it might be harder for patients in vulnerable and disadvantaged groups to take on board lifestyle advice that the rest of us perhaps take for granted.

The Long-Term Conditions Alliance Scotland has called for consideration of and reference to transitions from children's services to adult services and from adult services to elderly care services. During such transitions people can be at their most vulnerable. The matter is worthy of consideration. The alliance also asked how the bill's provisions would be incorporated into training and how its effect would be monitored, which is particularly important in light of John Swinney's statement this morning.

The debate gives us a useful opportunity to consider patients' rights. A key issue is how we make the Government's aims work in practice. It is not yet clear to me how the Government's wish to

"create a clear legal framework of rights for patients"

fits with its desire to

"avoid encouraging a culture of blame or litigation."

We need to understand the Government's intentions in more detail. There is understandable concern that hard-pressed health boards might be forced into taking cash from the front line to put the new arrangements in place, so I will want to give close consideration to the bill's financial memorandum.

The debate is important and I hope that we will hear more from the cabinet secretary. All members want patients to be at the centre of the NHS in Scotland. We all want to ensure that everyone gets the appropriate treatment at the appropriate time.

Mary Scanlon (Conservative, Highlands and Islands)

The debate is useful. I was interested in Cathy Jamieson's comments on the unintended consequences of the Government's proposals and I will consider other unintended consequences.

The Conservative Party introduced the first patients charter, in 1991. The charter was revised in 1995 and was revised again, by the Labour Party, in the late 1990s. Patients' rights and responsibilities are not new; what is new is the legal recourse that would be enshrined in the proposed bill—if members can find that in the consultation paper. Where there are rights, which we welcome, there must also be responsibilities. Jackson Carlaw will talk about patients' responsibilities.

The Scottish National Party's manifesto contained a commitment to introduce not only a patients' rights bill but an NHS redress bill, which would

"give patients an alternative to pursuing a medical negligence claim by introducing a right to redress without having to go through a lengthy legal battle."

The NHS redress bill was intended to

"replace the current NHS clinical negligence scheme with a no-fault system of compensation".

Conservatives are committed to a lighter touch in legislating, so we could accept two bills that were rolled into one. However, we question whether legislation is needed at all, as does the Labour Party.

The consultation document contains 79 paragraphs, but only paragraphs 68 and 69 mention no-fault compensation. If the consultation exercise does not invite people to give their views on no-fault compensation, no one can be expected to do so—ask no questions and you will get no answers. The paper says:

"It is possible that there may be cases in which financial compensation should be paid without the need to go through such a legal process ... We therefore favour no- fault compensation as the way forward for the NHS in Scotland".

However, I sense another SNP U-turn. A proposal that might have sounded good in the manifesto and at the hustings is disappearing when the reality check kicks in.

The proposed patients' rights bill must be underpinned by a clear definition of patients' rights in every sector. It cannot be right to introduce waiting time guarantees in relation to some conditions but not others. In that regard, I use again the examples of mental health services, infertility treatment, drug and alcohol services and physiotherapy. Many general practitioners do not bother to refer patients to physiotherapists because the waiting lists are too long and they think that patients can pay for private treatment.

It is proposed that patients will be able to seek redress if the waiting time guarantee cannot be met. According to paragraph 60:

"feedback will be actively encouraged. This will be used to explore the best approach to quick and effective means to resolve any problems patients may encounter when using health services, and to ensure effective redress where patient rights are not met. The feedback will also be used to make changes and improvements in the way services are delivered".

I thought that that was already happening. Where is the mention of legal redress? I worked until 8 pm last night and I had to ask a few colleagues whether I had missed something. Is the proposed legal guarantee simply an assurance on feedback and resolution, as paragraph 60 suggests? What legal implications will there be if the waiting time guarantee is not met? I would have thought that patients have a right not to become infected during a stay in hospital, but it is not clear what legal redress a patient in such a situation would have. Could they sue? If a patient died as a result of an infection, would the family have more right to sue the health service than is currently the case? Will the proposed new arrangements bring benefits for patients?

Christine Grahame (Scottish National Party, South of Scotland)

Will the member give way?

Mary Scanlon (Conservative, Highlands and Islands)

Not now.

What would happen if a clinician refused to prescribe a cancer drug that a patient wanted?

I want to talk about patients' involvement in decisions about their care. Like the RCN, we all want patients to be treated with respect and to be accorded dignity. None of us wants to hear about cases such as the ones that were described on "Good Morning Scotland" today. It says in the consultation paper that patients' views

"will be given the same level of consideration as clinical opinion when coming to decisions about their care and treatment."

A patient might decide not to have further treatment, despite the best clinical judgment. As it says in paragraph 53 of the consultation paper, the bill will enshrine a patient's right to

"withdraw consent or refuse further treatment, even if previous consent has been given to the treatment or procedure".

A huge amount of clarification is needed in that regard. If a patient died because they had refused further treatment, would their death fall into the category of voluntary suicide? If a clinician supported a patient's right to have no further treatment and the withdrawal of treatment led to the patient's death, could it be argued that there had been a case of assisted dying? I ask the question with the best of intentions, because the issue has been raised in the Parliament. More clarity about the Government's intentions and greater scrutiny of the proposed bill's unintended consequences are needed in relation to paragraph 53 and other aspects of the consultation paper.

My final point is that, in considering rights and responsibilities, we must remember the rights of NHS staff. Our national health service may be the caring profession, but it is not always too caring about the management of its own staff. I ask that all NHS staff be treated with respect and dignity by their employer, particularly in relation to employment rights, human relations and personnel management. Far too many staff are suspended in the long term without any proper support, dignity, respect or hope of getting back to work.

Ross Finnie (Liberal Democrat, West of Scotland)

The cabinet secretary stated at the outset that she would make the case for a patients' rights bill, and she helpfully set out some of the guiding principles that would underpin such a bill. She made particular reference to reinforcing and strengthening patients' rights and raised the important question of additional clarity. She referred to the charter, which is set out in the consultation document, and talked about entitlements and responsibilities. She then spoke about the new legally binding waiting time guarantee, access to information and no-fault compensation.

However, I was disappointed that the cabinet secretary did not devote any time to the issue that Cathy Jamieson referred to: the tension between having a clear legal framework of rights and possibly entering into a culture of blame and resort to litigation. I believe fundamentally that if we are to make the case for having patients' rights in a bill, we need the Government's view on how that tension is to be resolved.

Liberal Democrats have no difficulty in agreeing with the Government—as I suspect most members will—that the NHS needs to embrace more explicitly the principles of mutuality. Equally, my party has no difficulty in supporting, for example, the RCN's call to put patient dignity at the heart of health policies, all of which should be dignity proofed. I also have no difficulty with the call by Breakthrough Breast Cancer for patients to be provided with sufficient information

"to keep them informed at every stage of treatment and also in the decision making about their care specifically in terms of who will treat them and where."

The case put by the Long-Term Conditions Alliance Scotland about the need for patients' rights during transition, from child to adult or adult to older people's services, is also well made. Patients have the right to know how and at what level or standard care should be delivered. I share Mary Scanlon's view that staff also have the right to know what is expected of them in delivering care to that level and standard and that the NHS, in its capacity as both an employer and provider, must set out how it will give effect to the rights of patients and staff within the policy framework of the Government of the day.

As I said, I discern no disagreement among members about the need for patients' and staff rights and obligations to be stated more expressly. However, neither do I discern unanimity about how best that is to be achieved. In particular, the case has not been made for incorporating several of the elements in law.

Liberal Democrats draw a distinction—which we regard as important and not merely one of semantics—between, on the one hand, rights granted to patients of the NHS by this Parliament and enforceable in law and, on the other, entitlements granted to patients by the NHS, perhaps by means of a charter, and enforceable through executive action by the NHS.

That is an extraordinarily important distinction, which is why I was disappointed that the cabinet secretary chose to tell us only about the elements of these important rights about which I have heard not a single disagreement. I am not a betting man, but I am almost prepared to wager that I will not hear dissenting voices about the range and extent of these rights as the debate progresses—I will be astonished if I do. What is not clear is what exactly we need to do.

I do not think that it is necessary or appropriate for all of the rights and obligations in the extensive list that the cabinet secretary articulated earlier to be placed on the NHS, enshrined in statute and therefore enforceable in law. As the BMA points out

"The NHS already has a Patients' Charter which has been commended by other countries. Why do we need to enshrine that in law?"

I can see a case for improving and extending the charter, but I still think that the BMA makes a fair point. Indeed, it illustrates its point well, saying:

"If we are looking at legally binding waiting times we need a system that takes into account the whole range of services, not just the ones that are easy to count. You can't easily measure treatment in some areas and we hope this does not create winners and losers. It will be interesting to see how they propose to make this legally binding."

I welcome the debate in the same way as I welcomed the consultation paper. However, it is clear that, although a degree of unanimity is emerging on the range and extent of rights that should be accorded to patients and on the fact that they probably need to be strengthened further, the case has not been made for enshrining the majority of them in statute and therefore giving them the full force and effect of the law. If we are to progress further, we need to devote much more time to that issue.

We must consider three elements: the range of rights; how best they might be given enforcement; and which of the rights might properly be dealt with outwith the framework of the law and which—if any remain—might properly incorporated in legislation. That is the Liberal Democrat plea to the Parliament: we need to be satisfied about those questions before we proceed to a bill.

Christine Grahame (Scottish National Party, South of Scotland)

As a former lawyer, I thought that the speeches by Ross Finnie and Cathy Jamieson were very thoughtful, and there are issues to explore. If we are going to enshrine rights in statute, we must consider whether they are enforceable and not just of paper value.

There is much that we will agree on: the announcement on waiting time guarantees; recognition of the diversity of our population; the issue of suitable transport raised by Jamie Stone, which is particularly important in rural and remote areas; and the significance of communication with people. Issues of communication are often at the beginning of problems that unravel in the health service.

The no-fault compensation scheme will be complicated. I was listening to the comments on that, and with my background I can see that there may be issues with its interaction with common-law rights in negligence cases. No-fault compensation will not always be appropriate; some cases will require to be taken to court to test the liability and degree of negligence and perhaps to change what happens generally in our NHS.

In that regard, some of Mary Scanlon's points on infection were off the mark because the common law of negligence will still exist. If somebody goes into hospital and does not receive the professional care that they ought to, the test of the law will still be there. There will still be the common law, although people may have the option of going down the statutory route. We require to explore that, as was mentioned earlier.

Mary Scanlon (Conservative, Highlands and Islands)

My question was: what difference will the bill make to the current situation?

Christine Grahame (Scottish National Party, South of Scotland)

As I understand it, patients will have statutory rights and options, but there will still be the common law. If someone went down the route of no-fault compensation, they might have to take the option of not proceeding to court—they could not do both. However, the issues are complex, which is why we must tease them out at this stage of the debate and at stage 1 of any bill that comes before, I presume, the Health and Sport Committee. Some rights might supplant others, and there will be a choice because some rights will be additional to common-law rights.

I want to focus on complaints in the NHS, which is an issue that often crosses my desk and the desks of other members. I completely support Cathy Jamieson's point about complexity. This is about those people who are not articulate or determined. Professionals are all very articulate and can, I am sure, assert their rights in the NHS, but that is not true of the elderly lady who has Alzheimer's, the person who has a mental health problem, someone who has learning disabilities, or someone who is just shy. For a variety of reasons, all those people will not find it easy to complain.

It is not just about the process and the system. People must think that they are entitled to make a complaint without fear of retribution from staff. There might not be retribution, but patients might feel that there could be some comeback, like them not getting a cup of tea brought to their bedside if they complain, so they lie there and say nothing. I have issues such as that.

One bad case in a hospital is one bad case too many. Recently, the papers reported the case of an elderly lady with Alzheimer's who was left in a chair from which she fell and broke her hip; the press are saying that she came home in a much worse state. It is alleged that, because she has Alzheimer's and could not communicate with staff, she was not given proper treatment and, as a consequence, her whole life has been made miserable, as has that of her husband, who is in his late 80s.

There was another recent case of a woman of 64 who was given a needless hysterectomy when she had terminal cancer because there was a 15-day delay in her receiving a magnetic resonance imaging scan to determine whether an operation was necessary. That complaint was upheld by the Scottish public services ombudsman. The consultant gynaecological oncological surgeon who advised the ombudsman said that the case was "quite disgraceful".

Those are unusual cases, but they should never have happened. When Richard Simpson and I recently went on a fact-finding mission for the Health and Sport Committee, we met a young woman who self-harms who told us that she does not go to accident and emergency because of the way she is treated. People there give her the impression that she is wasting their time because it is her own fault. That woman has all sorts of issues, but she will not refer herself to A and E. If that is happening, it is quite simply wrong.

In the current year, NHS Scotland has received more than 7,000 complaints, which is much the same as the number in previous years. Of those, 66 per cent were about staffing and treatment, which is a huge percentage, and 60 per cent of them were upheld. We are looking at a figure of something like 4,000 complaints being upheld in whole or in part. Those are the complaints that completed the journey, and while they might not all involve cases as dramatic and horrendous as some of the examples that I gave, they are too many.

I would welcome it if we could to get to the stage where anyone sitting in a hospital ward, for whatever reason, who cannot take the lid off their cup of tea because they do not have strength in their hands knows that someone will come and help them, or knows that, if they are not helped, they can say something about it without feeling that they are making themselves more vulnerable.

That said, if patients have rights, they also have obligations, for example to keep their appointment or to tell the hospital if they cannot keep their appointment so that they do not waste time. Our society is under an obligation to treat our national health service staff with respect. I am talking not just about the consultant who comes round with his happy band of eager students and automatically gets respect; I am talking about everyone who might pass the end of the bed, including the cleaner, the porter and the lady who brings the jelly and ice cream for the patient's sore throat. They all deserve respect, and I hope that the NHS's culture will change in an atmosphere of mutual respect. That is the point I want to make most of all.

In some respects, I agree with Ross Finnie: legislation can be a heavy tool and is not always necessary. More than anything, what the NHS needs is a culture change on both sides of what should not be a divide, so that patients feel that they are being cared for as individuals, not just as an elderly person, a pregnant lady or someone with mental health problems, and the staff feel that they are there not just to earn their wage but because they have a vocation that society values in all kinds of ways that are not measured by a pay packet.

Cathie Craigie (Labour, Cumbernauld and Kilsyth)

I welcome the opportunity to discuss patients' rights today. As our health service develops to better meet all our needs, it is right that we take the opportunity to explore how best health care services can serve independent and individual patient needs. That is what people should expect from the health service 60 years on, and we are right to have the debate.

I am sure that we would all agree that it is vital that we remain committed to the founding principles and values that underpin our national health service to ensure that it remains a national service. However, we must move with the times to ensure that our health service meets the needs of the people that it serves, and that it does so by meeting patients' expectations and using modern technology and communication techniques to ensure that patients are guaranteed a patient-friendly and customer-friendly experience in all their dealings with the health service. We live in times when people want to have more say in how their services are delivered, whatever those services might be. Patients deserve and want more say over how their local services are designed and run, and if politicians want to respond to that, we must put the money up front to deliver it.

People tell me that their most important priority for the health service is to improve the patient journey, and to strive always to improve final outcomes for people. I am sure that the opinions of people in Cumbernauld and Kilsyth are no different from those of people throughout Scotland. People are saying clearly that we should work to improve patients' rights, but that the resources to do so should not come from existing health service budgets; there should be additional resources. I hope that the money that the cabinet secretary announced will be enough to meet that need.

Members know that I support the principles of patients' rights, as I am sure we all do, and we can only ensure that we meet individual needs through supporting all health care sectors throughout Scotland. Health visitors, community nurses, pharmacists and other allied professionals all have a vital role to play in delivering the best and, perhaps, most personal care and support to patients. I urge the Scottish Government to ensure that any charter enshrining patients' rights in Scotland enables full use of the thousands of talented and well-trained staff that the NHS has, and from whom patients benefit every day. We do not want to see money taken away from front-line patient services to pay costly legal fees; that would not be the priority of the people I represent. Therefore, the cabinet secretary must make it clear how the provisions of the proposed patients' rights bill will be incorporated into the training and education of all health care staff.

More than a year ago, the cabinet secretary pledged that the Scottish Government would consult on patients' rights, including legally binding waiting times, with a view to legislating on the guarantees in the later years of the current parliamentary session. We have all seen the consultation document, but from the discussions I have had, and from the debate this morning, it seems that we are not much further forward. It will be interesting to see what the outcomes of the consultation bring, and whether we really need legislation. Some of the things in the consultation document have already been done and we would expect any caring professional to deliver in the way described.

I move on to how my constituents might be affected. We have a national health service, and people expect to have access to services at the same level throughout Scotland regardless of where they live. My constituency is within the boundaries of NHS Lanarkshire and, for many years, people from Cumbernauld and Kilsyth have been able to access services delivered by NHS Lanarkshire, NHS Greater Glasgow and Clyde and NHS Forth Valley. On behalf of my constituents, I want a guarantee that we will continue to be able to choose where we are treated. If my constituents need acute health care, will they be guaranteed access to Glasgow hospitals? Will my constituents have access to the new Larbert hospital? That was the case and I want a guarantee that it will continue to be the case.

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

Will the member take an intervention?

Cathie Craigie (Labour, Cumbernauld and Kilsyth)

I am happy to take an intervention if the cabinet secretary wants to make the position clear.

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

I make it absolutely clear that nothing in the proposed patients' rights bill would change any of the rights that patients already have. It is important to stress that point.

Cathie Craigie (Labour, Cumbernauld and Kilsyth)

I am happy to hear that clarification. Nevertheless, I assure the cabinet secretary that changes have been made, whether by design or because of budgetary restrictions.

What will happen to the rights of my constituents who have, in the past, been able to access obesity services in Glasgow hospitals? At the moment, people are being denied access to those services because they live outwith the Glasgow boundary. That is not delivering a national health service, in my opinion or in the opinion of my constituents who are not being treated with dignity and respect and who urgently need to be treated at the clinic in Glasgow. We must ensure that that practice does not creep in in other areas.

The consultation document talks about treating people with dignity and respect. It also talks about providing clear access to the services that people need. We have all been sent a briefing paper this week from the Royal National Institute for Deaf People Scotland, which sets out the specific issues that people who are deaf or hard of hearing face every day. They have difficulties in accessing health services and in ensuring that communications come to them in a clear and understandable form. They have difficulties even when they are sitting in waiting rooms. The normal practice is for the health care front-line service managers or receptionists to call out people's names, but if someone is deaf they cannot listen out for that call—they have to rely on someone being with them or the staff in their local health centre knowing to alert them when they are called to see their doctor. It is important that all NHS staff are trained to communicate with people who have all levels of additional communication needs. A priority in any changes that we make should be to ensure that local general practitioner services are aware of the needs of people from the deaf community.

Another area—

Trish Godman (Labour, West Renfrewshire)

You should be finishing now, Ms Craigie.

Cathie Craigie (Labour, Cumbernauld and Kilsyth)

The cabinet secretary is aware of the differing waiting times for treatment by audiologists. I hope that that will be addressed.

I hope that people will engage with the consultation document and that the cabinet secretary and the Government will listen. It is important that we get the services right, so that everyone's needs are met and we do not waste money on costly legal fees.

Michael Matheson (Scottish National Party, Falkirk West)

I am sure that all members are rightly proud of our NHS and the dedication that its staff demonstrate daily and hourly in ensuring that it serves the people of Scotland as effectively as possible. In the past 18 months, the Government has ensured that the underlying principle of the NHS being free at the point of delivery has been extended further with the abolition of prescription charges, the ending paying for parking at hospitals and the move away from private finance initiatives and the difficulties that they can cause in the NHS setting. The idea of a patients' rights bill sits well with the philosophy behind what the Government has set out to achieve in the past 18 months.

However, over the past 18 months—in particular, since I joined the Health and Sport Committee—I have, in dealing with a number of the health professional bodies, been struck by how often the rights of patients are largely overlooked in those bodies' eagerness to promote themselves. Given the vested interests of the different professional organisations in our NHS, I understand that they have important issues to address, but when I am in dialogue with them, I often feel that they do not recognise that the NHS not only exists for the people of Scotland but belongs to them. It is not an extension of any one professional body or collection of professional bodies, and it does not belong to any political party—the Government of the day is merely the custodian of the NHS. There is an issue around the vested interests within the NHS and the way in which the professional bodies within it conduct themselves at times. Enshrining patients' rights more visibly in the law could help to address that.

A good recent example of vested interests making their voices heard by the Parliament is the way in which the NHS boards have been desperate to ensure that the Health and Sport Committee and the Government are aware that they oppose the idea of having elected representatives on elected health boards. It must be the first time all the health boards have been singing from the same hymn sheet in the evidence that they have submitted. However, when I have discussed with my constituents the possibility of their being able to elect representatives to their health board, they have been keen on the idea. It is therefore important that we are prepared to enshrine the rights of patients in law in order to keep in check some of the professional self-interest that can arise within the NHS.

I agree with Cathie Craigie that the NHS must move on because society has moved on. The days have largely gone of a doctor or nurse telling someone what treatment they are going to receive and how things are going to be done and the patient just accepting that, although there is a generational issue—I do not mean to be ageist—in that younger people are probably more assertive in ensuring that their rights are exercised. Christine Grahame does not appear to agree with me, but that is my experience. We believe in the principle of having a written constitution for our country, and a bill that enshrines patients' rights within the NHS is entirely consistent with that.

Like other members, I receive complaints from my constituents that tend to focus on the lack of communication in the NHS and, at times, the lack of respect that is shown to patients and their families. They also focus on the failure of parties within the NHS to take their concerns and views seriously when they are expressed. I agree with Christine Grahame that one of the biggest challenges that we will face in ensuring that a patients' rights bill is effective will be in changing the culture in the NHS.

When the Freedom of Information (Scotland) Bill was passed, it was noted that one of the biggest challenges that we would face in ensuring that people could assert their rights effectively under that legislation was in changing the culture within public organisations. In that context, the role of the patients' rights officer, to which the cabinet secretary referred, will be important. The fact that those officers will be independent is welcome. However, the people who will play an even bigger role are the NHS staff, who must ensure that patients are informed of their entitlements and rights, and must act accordingly. It will be important, when the legislation is introduced, to have a considerable lead-in time to ensure that those cultural issues can be addressed.

I turn briefly to the decision that was announced earlier this week by the Secretary of State for Health regarding top-ups. One of the founding principles of the NHS was that everyone should be treated equally and should have equal access to treatment. The Scottish Government is consulting on the issue, but I must say that, if we are to maintain the principle of all patients being treated equally and fairly, we need to ensure that we do not get into a situation in which a patient is receiving treatment X in one bed while the patient in the next bed is also getting treatment X but with something added because they have a bit more money. That would undermine the philosophy behind not only patients' rights legislation but our NHS.

I firmly believe that enshrining something in law might not necessarily make a great change the day after the bill is passed, but it will ensure that people have the legal rights that they are entitled to and will become more aware of them as a result. Accordingly, I will support the bill when it comes before the Parliament.

Jackie Baillie (Labour, Dumbarton)

There is much to agree with in the aim of ensuring that the rights of patients are uppermost in the minds not only of the health service but of us all. Like others, I support the principle of a mutual NHS, co-owned by the Scottish people and NHS staff, and I sign up to the principles that the cabinet secretary outlined. However, she also said something that I have heard before, which is that patients should be at the centre of the NHS. Those words have been said by successive Governments and ministers, and give shape to an aspiration that we all share. However, what that means in practice—in ordinary, everyday life—can fall far short of our expectations.

I am grateful, as I am sure we all are, that the majority of patients experience excellent services and care from our NHS. We need to acknowledge the hard work of NHS staff at all levels in delivering that. However, for some, the experience is less than optimal. The test, for me, is how the principles that were set out by the cabinet secretary today, and which will feature in the proposed bill, will work in reality. There are three tests of that. Will the proposed bill improve the quality of service? Will it improve relationships? Will it ultimately improve the experience for patients?

Like Cathy Jamieson, I would welcome clarity about which elements of the proposals will be legally enforceable and subject to no-fault compensation. Will it be the charter of rights as a whole, or will it relate exclusively to the new waiting time guarantee? What will be in the charter? Mary Scanlon is right to highlight some of the difficulties that the NHS has experienced, not least among which is the incidence of Clostridium difficile. Will that feature, or will the charter simply be a high-level set of rights balanced by responsibilities?

I understand that any legislation is capable of being challenged in the courts. However, given the cabinet secretary's view about avoiding the need to go to court in the first place, is there consistency of approach in ensuring that no-fault compensation applies to that wider area of the charter? I would welcome genuine clarification of that point.

I am not persuaded about legally binding guarantees. We have achieved significant improvements in waiting time guarantees over the years without the need for legal redress. Successive ministers have driven down waiting times, and I believe that this minister will do her utmost to do exactly the same. However, the cabinet secretary's signalling of priorities might carry more weight in the NHS system than a loosely defined legal guarantee would. I am worried that there might be unintended consequences, despite the positive intention that I acknowledge underpins the bill proposals.

The creation of a framework of rights is something that many in this chamber would instinctively support, but Cathy Jamieson and Ross Finnie were right to ask how that new open framework and mutual relationship will sit with the introduction of a culture of compensation. Will it lead to more litigation? Is it a charter for lawyers? People are worried about the administrative burden. Will it remove money from front-line services? We all know the tight financial position of some health boards, to which that diversion of resources might not be welcome at this point.

Christine Grahame (Scottish National Party, South of Scotland)

Does the member agree that the introduction of a no-fault compensation scheme would considerably reduce the amount of money that is spent by the NHS on court actions, many of which are settled at the door of the court?

Jackie Baillie (Labour, Dumbarton)

I hope that that would be the effect but, obviously, we do not have a financial memorandum. We look forward to scrutinising that. I am merely listing some of the criticisms that have been made and which need to be explored, and I am sure that the cabinet secretary will do so.

More important than those reservations, however, are my original questions. Will the proposed bill improve the quality of service? Will it improve relationships? Will it ultimately improve the experience for patients? I fear that the answers to those questions are, at the moment, unclear.

Patients say to me that they want to be treated safely, quickly and as locally as possible. They are ill, and they do not want to spend time complaining and arguing; they simply want to be made better. Christine Grahame was right to say that many people are unable to complain because they are vulnerable or distressed, because they need assistance to complain or because they are too frightened. I welcome the proposal to have a patients' rights office, but I wonder whether the cabinet secretary has given consideration to expanding independent advocacy services more generally. That would have the same effect, but would be more welcome in terms of coverage on the ground.

The involvement of patients is central to improving the quality of services in the NHS and their experience of those services. If patients are to be involved, they need information and support and they need to know what choices they have—choices about where they are treated, choices about the shape and design of services and so on—and be able to exercise those choices when they have all the available information.

The cabinet secretary will be aware that Greater Glasgow and Clyde NHS Board is consulting on service change at the Vale of Leven hospital. I am interested in her view of the weight that will be accorded to the various views that will come forward. What will be the balance between, for example, the views of clinicians and the views of the local community?

Cathie Craigie raised an interesting point about the fact that the default patterns of service provision that are in place—for understandable reasons—limit people's ability to exercise choice. Can the cabinet secretary indicate whether she will review that?

Many of the speeches in this debate, including my own, have contained more questions than answers. Michael Matheson was right, not on his point about age—he and I are slightly younger than other members of the Health and Sport Committee, and I would not dare to suggest that Christine Grahame and others are significantly older—but about vested interests and the need to create a better balance in that regard. In that context, patients' rights matter absolutely. We need a better balance between the rights of patients and the rights of those who are perceived to have vested interests. The best way of ensuring that those rights are given real meaning remains unresolved, however. I am not yet convinced that legislation would be the best way of doing that, nor am I convinced that introducing a compensation culture would necessarily be an advantage. However, principles that we can all support have been mentioned in the debate. I hope that, in doing so, we take forward a new era of patients' rights in Scotland.

Ian McKee (Scottish National Party, Lothians)

Members will know—perhaps to the point of boredom—about my background in the health service. However, I have not previously discussed my mercifully short contact with the health service as a patient. My only admission to hospital is still a cause of some embarrassment many years later, as I am the only male I know of to be admitted as a patient to a maternity hospital. I will not go into the reasons why: suffice it to say that the satisfaction survey that I was given to complete at the end of my stay seemed to be irrelevant in certain important respects.

More recently, I embarked on the hazardous adventure of partnering my mother-in-law at a Scottish country dancing class—sadly, unfortified by alcohol. The result was a ruptured Achilles tendon and an urgent visit to the local orthopaedic department, where the doctor asked, "Do you want me to sew the ends together, or do you want to be treated conservatively?" I responded by asking, "What would you do in my place?" A cunning look appeared on his face, and he said, "I would assess the evidence and decide accordingly." That story illustrates the gap between the theory of what patients want and the true situation. Correctly, we emphasise the right of a patient to be involved in treatment decisions. I had that right, but when it came to the crunch I simply wanted the best advice from an experienced practitioner. Because I am a doctor, I was able not only to perform a computer search regarding the treatment of my injury, but also to weigh up the merits of one approach versus another. However, not every patient has a medical degree.

In my case, the specialist could tick all the boxes regarding patient empowerment, but was that the help that I really needed? There is an increasing divergence between how the health service is run in England and how it is run in Scotland. In England the model is increasingly to see the patient as purely a consumer. What is important is that the patient is offered choice—choice as to where treatment is offered and, in many instances, whether it should be provided by the NHS or by the private sector.

I disagree with that emphasis for many reasons, but today I will concentrate on one of them. How does the individual, who is often suffering from the effects of an illness, know enough about all the factors to make an informed choice? There is a danger that in this matter, too, political correctness will stand in the way of satisfying real need. In Scotland, we increasingly regard the patient not only as a consumer of the NHS but as a person who also jointly owns the service. In the words of the Long-Term Conditions Alliance Scotland, a patients' rights bill should achieve a

"cultural change away from the traditional model of people as passive recipients of NHS services".

I could not agree more, but as other members have said, with ownership comes responsibilities. Most people prefer us to concentrate our energy and resources on improving local NHS services rather than offering token choice or giving more profit to the private sector. However, individuals have a responsibility to take steps that help to utilise precious resources to the full. It is not unknown for some hospital outpatient clinics to have a no-show rate of 40 per cent or more, and all general practitioners will tell you how many appointments have been missed in the past month. How can we get waiting times down further if resources are wasted on such a scale?

Medicines are another significant cost to the NHS, yet many are not taken according to instructions and some are not taken at all. If we are all partners in a mutually owned health service, it is up to us all to do our level best to run the service efficiently. If we all gave up smoking, ate more sensibly and took more exercise, we might not need the service so frequently.

Although it is important that the patient has a right to a speedy and efficient complaints procedure when things go wrong, it is also right that all of us, as actual or potential patients, should have a say in how the service is run. We need to be treated with respect, not only as patients but as the people who pay the wages of staff in the service, buy the equipment that they use and pay for the new hospitals in which they work.

Let me tell another story. Some years ago, I looked after an old lady in her final illness. Her grateful daughter came to thank me for the care that I had given and, as she left, she slipped a large parcel out of her shopping bag and shyly presented it to me saying, "I am sure you'll know what to do with this, doctor." I took the gift and replied, "Oh, there's no need for that. I was only doing my job", only to find, after she had gone, that the parcel contained almost all the medication that I had prescribed for her mother in the past year, totally unused. It is not just up to patients to see that the health service runs efficiently.

I finish by replying to the cogent point that Ross Finnie, my colleague on the Health and Sport Committee, made in his opening speech. Should the rights that we are talking about be enshrined in law or should they be part of an extended national health service charter? That is a good question that we need to discuss more, but the point that I would like to make to Ross is that, from my experience of the national health service, an awful lot of patients sadly no longer trust it to investigate and look into the problems that arise and which could be dealt with under a charter. My feeling now, although I am happy to listen to further argument and discussion, is that a bill of rights for patients will help to redress the balance and allow our patients to be confident that they are receiving the service that they deserve and for which they pay.

Jamie Stone (Liberal Democrat, Caithness, Sutherland and Easter Ross)

I have listened to the debate with great interest and it has been extremely informative for a layman such as me, who is no medical expert. I thank the Cabinet Secretary for Health and Wellbeing for outlining, in detail, the intent of the proposed bill and the way she sees developments going, although I do not necessarily agree with her any more than my colleague Ross Finnie does.

I will pick up on one comment that was made by the cabinet secretary, which I thought was useful and struck a chord with me. She referred to patients wanting

"an assurance that lessons have been learned".

We must surely encounter that in all our dealings with constituents who have problems with the health service. Many of them say to us, "It's not about me—I want to ensure that it doesn't happen to somebody else." In going back to those constituents, it can be difficult to provide such an assurance. If we can empower people in that direction, that will be all well and good.

Cathy Jamieson set out the arguments that have been repeated again and again on whether we should go down the legal route. She is right that we need to see the financial memorandum to the bill to see what will happen. As Cathie Craigie asked, will it be about taking money away from front-line services and paying for legal fees? None of us in any party could possibly agree to that. That will be the acid test.

Mary Scanlon made a thoughtful speech in which she rightly gave us the history of the patients charter, which was introduced by the then Conservative Government. She also pointed out that only two paragraphs in the consultation document mention no-fault compensation.

Mary Scanlon also touched on the rights of NHS staff and the issue of consent to future treatment. I have a constituency case, which I will not discuss in detail, whereby an elderly lady has been receiving treatment for cancer. The treatment is, in the clinician's view, the most appropriate treatment. Of course, there comes an end point to the treatment. She has two sons who disagree totally with that and have involved me—and, I am sure, list members from the Highlands—in a letter-writing fiasco, if I can put it that way, which has become far removed from what is best for the patient and is more about particular individuals having a grievance against the health service. When matters reach that point, they become grotesque in the extreme. I therefore think that consent to future treatment is an issue on which we must keep a very close eye.

Christine Grahame rightly referred to the common-law rights that currently exist. Echoing Mary Scanlon to a degree, she also mentioned patients' rights and their obligations to staff—Dr Ian McKee referred to the number of appointments that are not kept. Christine Grahame also mentioned ice cream and jelly. I do not expect that to be mentioned in a bill, but it is true that the porters, the cleaners and the people who scrub the toilets deserve recognition every bit as much as the man with "Dr" before his name.

I have already referred to Cathie Craigie talking about money going to front-line services rather than to legal fees. In Michael Matheson's far-reaching speech, he made the point—not one that I particularly agree with—about the importance of staff informing patients of their rights.

Jackie Baillie asked about what will be in the charter and whether C diff will be included. That will be the acid test of what the charter is all about. She also asked about the best way of ensuring that those rights are observed and protected.

Ian McKee's speech, which was one of the best speeches that I have heard for a long time in the chamber, was amusing and thought provoking. He brings to our attention the question whether it is just political correctness to say that patients have the right to discuss decisions with the doctor or to overturn them. Nicola Sturgeon, among others, made the point that a patient goes for treatment in order to be made well. I, for one, tend to respect the doctor or consultant's opinion. I admit that I know nothing about medicine, so God knows why I am speaking in the debate, but there we are—I have bags of common sense.

I will never forget Dr McKee's reference to being admitted to a maternity hospital. He might like to tell us in the privacy of the coffee lounge what that was all about. I am sorry that he hurt himself doing Scottish country dancing. He illustrated what lies at the core of the debate.

I return to Ross Finnie's comments. The issue is how we ensure that the rights of patients and staff can be dealt with and honoured without going to law. As I and others have said, it would be very bad if any NHS money, which is so precious and is about making people well, was spent on paying legal fees. That would be grotesque in the extreme.

I turn to my constituency. As members will appreciate from my intervention on the cabinet secretary, the issue of distance and access is crucial to my constituents and people in other Highland or remote parts of Scotland. Coming from where I do, when I consider what is meant by patients' rights and what is proposed, it seems to me that the test should be whether people will have easy access and their loved ones and family will be able to visit them when they are ill in hospital.

Jackson Carlaw (Conservative, West of Scotland)

This has been an interesting short debate on the consultation on which the Scottish Government has embarked. In opening for the Conservatives, Mary Scanlon asked some important questions about where the proposed bill sits in relation to the set of commitments for action in the 2007 SNP manifesto. Is it an amalgam of the two bills that were envisaged? Why, as Mary Scanlon pointed out, is so little or nothing about redress to be asked of so many in such a wide consultation on such a profound measure?

The consultation invites contributions under a number of headings, all of which have been well aired in the debate. This is as good an opportunity as any to throw in my own tuppenceworth on a matter that is regularly raised with me and of which I have personal experience. I suppose that, although trivial, it falls within the respect remit. It is to do with the use of names. So many people tell me, following a stay in hospital, that the instant use of given names rather than plain Mr or Mrs is a ghastly indignity and a characteristic that is shared by the NHS and pushy, unsolicited telephone salespeople.

Why has the convention become established? Why, when many people instinctively feel that the use of their given name is based on a shared confidence, affection or acquaintance, are their wishes assumed or cast aside? Why should they lose control of this basic dignity as though they were back in primary 1, being told that what will be will be—or is that the point? Does the unauthorised use of given names emphasise the institutional nature of the establishment to which they have been admitted?

I know from experience that the practice is haphazard because the correct given name is rarely sought. Although I have been called Jackson from birth and that has always been my given name, my first name is actually David. I continue to use it on all official documents and it is a comfort to know that, when an individual assures my mother, friends or colleagues that they are David's personal friend and confidante, that person is clearly up to no good. However, it is as David that I have been known when in the bosom of the NHS during my admissions to general wards in the past decade. As it happens, I would gladly have volunteered to be called Jackson, because I am not bothered about being called Mr Carlaw, but I was not asked, so in a small anarchic way I let it be and was called David throughout my stay.

However, the approach can add to the trauma of others, particularly the elderly, many of whom find themselves in the same position as me, being called by their first name rather than their given name. An elderly friend, who is now deceased, was called Joan all her life, but she suddenly found herself being called Florence at a confused stage of her life when she was admitted to hospital, as if all the world called her that all her days. In another case, I was told that, as the only name on the file was the person's first name and it did not mention their given name, that was how they would be addressed.

The modern convention of assumed familiarity is certainly prevalent, but it is not necessarily dignified. It might be profoundly important to an individual according to how they define respect. Should the approach be defined in law? Hardly.

Mary Scanlon mentioned the Conservatives' patients charter of 1991 and others mentioned the Labour Government's 1998 follow-up to that. Those charters did not establish rights and responsibilities within a legal framework. Although the consultation's constant theme is the detailing of patients' rights, accompanying that are stated patients' responsibilities.

Under "Access", it states:

"Patients will be responsible for:

attending agreed appointments."

Under "Respect", it states:

"Patients will be responsible for:

treating staff with dignity and respect; and not physically or verbally abusing staff."

Under "Safety", it states:

"Patients will be responsible for:

complying with advice on medication and treatment; and raising legitimate concerns about the safety of their care."

Under "Communication", it states:

"Patients will be responsible for:

providing information about their history, current treatment medication and alternative therapies directly or through their family, carer or other nominated supporter; informing their healthcare provider of any changes in their condition; and taking part actively and constructively in discussion and decisions about their health and health care."

Under "Information", it states:

"Patients will be responsible for:

seeking and using information appropriately to support their own health, for example to enable self-care for minor conditions; and ensuring that they have the information to understand what they need to know about their care, and to provide consent to treatment."

Under "Participation", it states:

"Patients will be responsible for

asking for further information if there is any uncertainty about their care; giving informed consent or not; and participating constructively in decisions about healthcare and service where they wish to do so."

Under "Privacy", it states:

"Patients will be responsible for:

providing the information that is appropriate and relevant to treatment of their condition."

Under "Independent Support and Redress", it states:

"Patients will be responsible for:

offering feedback on their health services in a positive way as far as possible."

I quoted those responsibilities at length simply to illustrate that, if we strip out the rights, we are left with the most comprehensive and stringent set of patients' responsibilities—indeed, we are left with a pretty draconian patients' responsibilities bill I have noted regularly in recent debates that the NHS is not an insurance policy in the normal sense. I have talked about leaving the house doors and windows open, being burgled and then finding that the insurance company is not inclined to pay. I have noted that, in the final analysis, no penalty exists within the NHS, so I suppose that I should welcome the responsibilities, but what do they mean? If a patient does not follow

"advice about ... suggested lifestyle changes",

fails to provide "information about their history" or is unable to provide knowingly

"information that is appropriate and relevant to treatment of their condition",

what will happen? How will that be reconciled with the desire to tackle inequalities? Will the patient be sued by the health board or denied further NHS treatment? Will there be a new sanction in law? That is surely inconceivable, but if there is not, what will be the legal and practical purpose of a bill that seeks to establish legal frameworks? In contrast, the existing charters can be updated without the need for primary legislation.

I applaud Cathy Jamieson's cogent analysis of the value of legislation with regard to the package of rights—on which I have not dwelt—over and above the existing charters. I sat spellbound—that is the word that I wrote down, anyway—as Ross Finnie encapsulated those arguments as well.

It is as well that there is a consultation, for there is much to consult about. We await the responses with interest and we will scrutinise the Government's subsequent proposals with care. Legislation begets unintended consequences and we will look to establish what they might be.

Richard Simpson (Labour, Mid Scotland and Fife)

The debate has been consensual as far as the concept of patients' rights is concerned, but it has not been consensual on whether the argument for legislation on the matter has been appropriately and fully made.

David Carlaw went on at considerable length about names. That might have caused some amusement, but it conveyed two things. First, the question of names is a matter of dignity, and, secondly, it is a matter of hierarchy and power within institutions. Names are important in that regard, so his point was well made.

Mary Scanlon made a number of important points. If we introduce statutory waiting time guarantees and legal obligations, the unintended consequences will be substantial. She addressed mental health and referred to infertility and addiction, and Cathie Craigie mentioned audiology and deafness. If the bill is to take a non-discriminatory approach—it will be challenged by the Health and Sport Committee on that issue—it must ensure that all patients have equal rights, regardless of their condition. That will be a major challenge for the Government. I know that it is considering the mental health issue, but there is serious discrimination against mental health patients. If statutory guarantees are imposed for one set of conditions, health boards will apply money to meet those guarantees at the expense of other patients. That is already happening. It is a major challenge for the Parliament to ensure that we do not have discrimination.

A number of members mentioned the unintended consequences, which are potentially legion. I will give an example. A GP refers a patient to a consultant, who then refers them to a physiotherapist and asks to see the patient at the end of the physiotherapist's intervention. In that case, the treatment guarantees will apply. However, if the patient is referred directly to the physiotherapist, there will be no guarantees even though the condition might be the same. Furthermore, if the consultant does not ask to see the patient at the end of the physiotherapy treatment, the guarantees will not apply.

We are dealing not with simple issues but with the complexities that will be inevitable if statutory guarantees are introduced. I remain unconvinced on the issue. We will see whether the arguments are made more effectively in committee and in the consultation responses, but I do not believe that they were made effectively today.

I offer the chamber another example. England has just announced that, within two hours of a coronary heart disease event, 90 per cent of all patients will get a primary intervention. With our geographical spread, such a target would be a lot harder to achieve—90 per cent would probably not be achievable. If such treatment is required within two hours, will we give patients a guarantee? If we do not give that guarantee, are we saying that they are not entitled to that treatment when it should be available?

An absolutely fundamental issue that has not been raised today is that, for a lot of patients, managing a long-term condition is more—or as—important as treating an acute condition. Therefore it is the patient pathway, to which some speakers referred, that is important. As the Labour Party said in our manifesto and in subsequent discussions, we need personal contracts with individual patients so that they agree to what is practical and possible for them. The alternative, which has been explored by some speakers today, is that we end up in a situation in which we might have draconian patients' responsibilities, as Jackson Carlaw said. I will return to that in a minute.

Christine Grahame (Scottish National Party, South of Scotland)

I hear what the member says about the responsibilities that might be put on a patient, but I think that he will agree that those responsibilities would not be the same for each individual but would depend on their capacity to engage with such responsibilities.

Richard Simpson (Labour, Mid Scotland and Fife)

I would agree entirely, if what Christine Grahame suggests is what really happens. However, there are doctors out there who say that one should not treat patients who smoke if their condition is a consequence of their smoking. I disagree profoundly with that approach, but I promise Christine Grahame that there are doctors who believe that. Unless one defines such responsibilities, there could be difficulties.

Independent support, to which several speakers referred, is important and I very much welcome what has been said. Christine Grahame talked about the complaints system, with 4,000 out of the 7,000 complaints submitted being upheld. Having a system of no-fault compensation in the proposed bill is alluded to in the consultation but not dealt with in any detail. As Mary Scanlon remarked, such a system would be fundamental in changing the culture. As a doctor, I can tell members that at present, if a doctor does something that might not be appropriate and the patient makes a complaint, the Medical Defence Union will often tell the doctor not to say anything, because the matter might become a legal case. There is a culture of not saying things when, as Jamie Stone said, often patients just want a reasonable explanation of what went wrong and an assurance that it will not go wrong again. Although my party does not have a position on the issue, my personal opinion is that no-fault compensation could be very helpful.

Mary Scanlon (Conservative, Highlands and Islands)

Given that you are a medical professional, I ask you respectfully for your views on the unintended consequences of a patient being entitled to withdraw consent and refuse further treatment.

Alasdair Morgan (Scottish National Party, South of Scotland)

Members should make their remarks through the chair.

Richard Simpson (Labour, Mid Scotland and Fife)

I do not want to get into that question today, but I will refer to consent and its withdrawal. If the bill is enacted, we will have to relate it to the Adults with Incapacity (Scotland) Act 2000 and consider the situation carefully.

We all want genuine choice for patients, but as Cathie Craigie said, that has to be approached carefully. If patients are offered the opportunity to go to one hospital but wish to go to another because they prefer the surgeon or the reports on hospital-acquired infections from that hospital, or because they have relatives nearby who might support them, will they lose their guarantees? The matter is difficult and complex.

We need a culture in which patients who raise concerns about their treatment are welcomed and not treated as a problem. I have cases that relate to hospital-acquired infection. In one case, a patient who intervened because the staff had not washed their hands was treated unpleasantly. That culture has to change. Although the cabinet secretary cannot change it, the Parliament, together with the cabinet secretary, can make it clear that we want to change the culture.

I do not have time to address all the remaining issues so I will finish by saying that there has to be a balance between a charter—rights that the Parliament indicates are appropriate for patients—and a legal framework. That is the main point to come out of the debate.

Medicine is not a product like a car with a guarantee that one can hold over another individual if things go wrong. Medicine is very complex and the choices that have to be made between one treatment and another might not depend entirely on a strong evidence base. Ian McKee's illustration of being offered alternative treatments for his Achilles tendon was valid. To ask patients to make such a choice is wrong; one should discuss with the patient the benefits and risks of each treatment and then, in partnership with the patient, agree what treatment to use. We in this Parliament should foster that concept of partnership. If we pitch one set of rights against another, it might lead to unintended consequences that will not help to improve the quality of care for patients.

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

I begin by genuinely thanking all members for their contributions to today's quality debate in which some serious points have been made.

The issues that have been raised are undoubtedly those that will require full explanation in the course of the consultation. I will avoid as far as possible in my summing up the temptation to take fixed positions on all the points that have been raised because at the heart of this debate are not only serious, practical questions but serious philosophical questions. It is right that the Parliament airs those issues and works through them during the consultation and thereafter.

I said that I would not take fixed positions on all issues raised today, but I will take fixed positions on some. To my esteemed colleague Christine Grahame I confirm that the bill will not enact the right to ice cream and jelly in every hospital; I believe that they should be provided as a matter of course anyway. To Ian McKee, I say that the bill, if enacted, will certainly not enshrine his right—or that of any man—be admitted to a maternity hospital anywhere in Scotland. I am sorry if that brings great disappointment, but I am sure that my colleague will live with it.

In the few minutes available to me, I will respond to some of the comments that have been made and then I will address what I believe to be the key philosophical question at the heart of the debate, which has been referred to by many members.

I very much welcome the broad support that Cathy Jamieson expressed for the intention and objective of the bill. I also welcome her constructive criticisms and suggestions about how we could improve our proposals. As with all members' suggestions, they will be reflected on properly during the consultation.

Cathy Jamieson also raised issues around the proposed waiting time guarantee. She said, rightly, that any legislation, particularly in an area such as the one that we are discussing, must be appropriate and proportionate. I believe that what we propose is both: it focuses on a vital stage of the patient journey; and it would avoid the possibility of lengthy waits in exceptional circumstances.

Cathy Jamieson, Mary Scanlon, Cathie Craigie and others raised an important point: because the existing waiting time guarantees do not apply to all patients and treatments, giving a legal guarantee to some patients would create an inequity. Of course, that inequity exists in the current waiting time guarantees, which is why the Government is considering which further groups of patients can be brought within those guarantees. Cathie Craigie will be interested to know that we have already taken the decision to bring audiology services within the guarantees and, as Richard Simpson said, we are looking at the possibility of including mental health services. No doubt, our consideration will go beyond those areas in due course.

Cathy Jamieson also spoke about the complexity of the complaints system, and I agree with her. That is why we have proposed independent patient rights officers, and I believe that it is important to give such posts statutory force.

No-fault compensation was raised by a range of members, including Cathy Jamieson and Mary Scanlon. I reiterate the Government's commitment to the principle of no-fault compensation; I also reiterate my recognition of the considerable practical, legal and financial considerations that have to be addressed in the debate. If we can address those issues, I will be happy to consider including in the bill proposals for no-fault compensation. However, because of the complexity of the issue, we may need to conduct a separate exercise. I was struck by Cathy Jamieson's suggestion that we establish an expert group, not least because I have been giving consideration to that. I will reflect further on her comment.

I will touch briefly on the issue of responsibilities. It is right that we stress responsibilities as well as rights. However, to be candid, it is much more difficult to place patients' responsibilities in law than it is to place patients' rights in law. Like Richard Simpson, I disagree profoundly with the view that a patient who drinks or smokes against advice should not be given the same rights to treatment as any other patient. There is merit in a personal contract approach to enshrining responsibilities as well as rights.

Mary Scanlon raised the extremely important issue of NHS staff. We can never do enough to ensure that our staff are properly respected. NHS Scotland has a system of partnership working and a staff governance standard that are world leading in many respects, but we should always do as much as possible to ensure that the rights of staff are respected.

I turn to the central issue that was raised by Cathy Jamieson, Mary Scanlon and, principally, Ross Finnie. I refer to the apparent tension between putting in place a legal framework and avoiding—as we all seek to do—a culture of blame in the NHS. I have reflected hard on the matter and will, no doubt, continue to do so. That culture of blame often comes from a lack of clarity and understanding of what a patient's rights are, how they can ensure that those rights are delivered, and what they should do to get appropriate redress when things go wrong. The intention behind the patients' rights bill is to ensure that there is no dubiety about what those rights are. It should be backed up by a charter of mutual rights that makes clear how rights will be delivered in practice. As with any statutory right, the ultimate sanction is access to courts; as Christine Grahame said, any statutory rights would be in addition to the common-law rights that patients already have. A legal framework that works effectively will reduce the necessity for patients to seek redress, because giving patients' rights statutory force will help to ensure that they are delivered properly in the first place.

Cathy Jamieson (Labour, Carrick, Cumnock and Doon Valley)

Will the cabinet secretary assure us that mediation will be considered as part of the process?

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

I am happy to do so. The essence of what I am saying is that I believe that putting rights in statute will help us to change effectively the dynamic of the relationship between the patient and the NHS. Michael Matheson was absolutely right when he said that this is about changing the culture. Such a change in culture will allow a patients' rights bill to pass the test that Jackie Baillie set of improving quality, relationships and experience. If we combine it with a no-fault compensation system, there is a real possibility of reducing the likelihood of patients accessing the courts. That is the philosophical debate at the heart of the issue that we will continue to pursue in the consultation.

Finally, I will address the issue of patient choice. Jackie Baillie was right to say that there are established patterns of service delivery, which is as it should be. Patients will almost always exercise the choice to be treated as locally as possible—that is why it is important to retain local services, where possible. However, patients can already choose where to be treated. It is reasonable to ask whether that right should be enshrined in statute—the issue should be considered in our discussions. Richard Simpson was right to point to the patient pathway and the importance of treating long-term conditions as well as acute conditions. I am pleased to see that the Long-Term Conditions Alliance Scotland has welcomed the approach to patients' rights that we have taken.

I have enjoyed today's debate, which has been illuminating and informative. I look forward to that constructive approach continuing when we confront some of the complex issues with which we are dealing, as all Parliaments have a duty to do, and reach conclusions that are in patients' interests.

Question Time — Scottish Executive — General Questions

Alex Fergusson (None, Galloway and Upper Nithsdale)

I remind members who were not in the chamber for questions last week of the instructions that they should have received from their business managers. Questions should be sharply focused and should take the form of a question, rather than a statement or speech. I expect ministers to respond accordingly.

Cathy Jamieson (Labour, Carrick, Cumnock and Doon Valley)

To ask the Scottish Executive what further improvements are planned for the A76. (S3O-4704)

Stewart Stevenson (Scottish National Party, Banff and Buchan)

Transport Scotland's strategic transport projects review is examining the longer-term needs of Scotland's nationally strategic transport network. That includes consideration of the A76 as part of the transport corridor between Glasgow and north-west England.

Cathy Jamieson (Labour, Carrick, Cumnock and Doon Valley)

The minister will be aware that many of my constituents are concerned about the lack of an adequate footpath between Cumnock and New Cumnock alongside the A76. Will he assure us that the matter will be re-examined as part of the strategic transport projects review, especially in light of the fact that an e-petition on the issue was submitted to Parliament this morning?

Stewart Stevenson (Scottish National Party, Banff and Buchan)

I have made 278 ministerial journeys on foot, accounting for some 65 hours of my ministerial time, since coming into office, so the member should be assured that I want to do everything possible to ensure that there is safe and adequate footpath provision not only in the south-west of Scotland but across the country. I will give further careful consideration to the issue.

Alasdair Morgan (Scottish National Party, South of Scotland)

In his initial answer, the minister referred—as does Transport Scotland—to the M74 and the A76 as a corridor, which strikes some of us as a curious concept. In light of those comments, to what extent is he considering improving the A70 to divert heavy vehicles from the northern part of the A76 to the M74, which would take pressure off the southern part of the A76?

Stewart Stevenson (Scottish National Party, Banff and Buchan)

The strategic transport projects review is considering surface transport across Scotland. It is looking at hubs—our main centres of population—corridors linking those centres and corridors extending out from those centres to more remote parts of Scotland. Examination of the various roads in the south-west will, of course, include consideration of the kind of alternative routing to which the member refers.

John Scott (Conservative, Ayr)

To ask the Scottish Executive what discussions have taken place, or are planned, between Scottish ministers and the European Commission about the forthcoming review of Council regulation (EC) No 1/2005 on the welfare of animals during transportation. (S3O-4675)

Richard Lochhead (Scottish National Party, Moray)

Formal discussions between the Scottish ministers and the European Commission about the forthcoming review of the Council regulation on the protection of animals during transport and related operations have yet to take place. The Commission has consulted on options, rather than proposals. We have expressed concern to the Commission about the potential impact of the review on Scotland's livestock sector. We anticipate that the Commission will issue proposals next year. In the meantime, Scottish Government officials are working closely with officials from the Department for Environment, Food and Rural Affairs to ensure that we are in a position to resist any proposals that are against Scotland's interests.

John Scott (Conservative, Ayr)

I am sure that the minister is aware that there are serious concerns about the consistent lack of enforcement of existing welfare regulations, which causes an estimated 100,000 horses to suffer unnecessarily each year as they are packed into trucks and driven thousands of miles across Europe to slaughter. Will the minister condemn that cruel practice and undertake to write formally to the European Commission on behalf of the Scottish Government in support of a strengthening of welfare regulations, as advocated by World Horse Welfare, to end the inhumane transport of horses into and across the European Union?

Richard Lochhead (Scottish National Party, Moray)

I am aware of the member's concerns, which I know he has raised elsewhere in Parliament. I will be happy to express to the European Commission Parliament's desire to ensure that existing regulations are enforced adequately, as happens here in Scotland. Such enforcement should be replicated throughout Europe. I will seek opportunities to raise the issue with the European Commission.

Gavin Brown (Conservative, Lothians)

To ask the Scottish Executive what assessment it has made of the impact of recent events in the financial sector on economic growth in Scotland. (S3O-4677)

John Swinney (Scottish National Party, North Tayside)

The Scottish Government monitors developments in the global economy and assesses their potential impact on the Scottish economy on a regular basis. The assessments of recent events in the financial sector and of the wider impact on the economy have informed the Scottish Government's economic recovery plan.

Gavin Brown (Conservative, Lothians)

One part of the Government's economic recovery plan refers to planning. Why, in the draft budget, is the planning budget reduced from £8.9 million this year to £2.2 million in the next financial year?

John Swinney (Scottish National Party, North Tayside)

The answer is simple: capital expenditure has been undertaken in this financial year to introduce the e-planning system, which was a one-off item of expenditure, to allow us to benefit from greater efficiency in the planning system. I should have said "electronic planning", as opposed to "e-planning" for short. Once the money has been spent on installing the infrastructure, we will benefit from efficiencies without having to count the cost every year. I am sure that Mr Brown will approve of that prudential investment.

Brian Adam (Scottish National Party, Aberdeen North)

Can the minister provide guarantees that, should another bid for HBOS be forthcoming, the Scottish Government will fully engage with it and do all that it can to protect Scottish jobs, maintain decision-making functions in Scotland and ensure that Scottish consumers benefit from a competitive banking sector?

John Swinney (Scottish National Party, North Tayside)

Mr Adam charts a number of the aspirations and motivations of the Government in dealing with the HBOS situation. We have been anxious to retain in Scotland significant corporate decision-making jobs, with effective decision-making power remaining here in Scotland. We have been anxious to secure a competitive banking market, which is essential for a vibrant and healthy contribution to the Scottish economy from small and medium-sized enterprises. Those are all key aspirations of the Government.

We have made it clear—the First Minister has made it very clear—that the Government will engage with any bids that come forward equally, as we have engaged with Lloyds TSB. As an Administration, we have a duty to do all that we can to protect employment and decision making in Scotland. That will be our approach towards any bidder who comes forward for HBOS.

Elizabeth Smith (Conservative, Mid Scotland and Fife)

To ask the Scottish Executive whether it can provide details of the likely timescale for publication of the results of the recent consultation process on SQA exam reform. (S3O-4682)

Fiona Hyslop (Scottish National Party, Lothians)

The consultation on the next generation of national qualifications in Scotland closed on 31 October. Individual responses will be published on the Scottish Government website by 28 November 2008. The independent research company Ipsos MORI is analysing the responses and a range of other evidence, and is due to report in late January 2009. Following consideration by the Scottish Government, an announcement on the way forward will be made in spring 2009.

The expanded curriculum for excellence management board, whose membership now includes teacher and headteacher associations, met last Friday, 31 October. Following its advice, I took an early decision and announced on Friday that the standard grade replacement and other new qualifications will be introduced in 2014. I wrote to the Education, Lifelong Learning and Culture Committee to inform it of that on Friday.

Elizabeth Smith (Conservative, Mid Scotland and Fife)

In light of that answer and of the cabinet secretary's announcement of a one-year delay to the implementation of the new structure of the Scottish Qualifications Authority, is it still the Government's intention to introduce a Scottish baccalaureate in science and languages and, if so, what will the timescale be?

Fiona Hyslop (Scottish National Party, Lothians)

The curriculum for excellence is already being implemented across Scotland. Many schools are implementing the curriculum for excellence structure from secondary 1 this year, and all schools are expected to do so by 2010. The extra time for implementation automatically means that the timing of the examinations has been moved to 2014.

Because the Scottish baccalaureate involves existing highers and advanced highers, the timetable for its introduction will continue according to the original proposal, so the first students will benefit from it in August 2010.

Ian McKee (Scottish National Party, Lothians)

To ask the Scottish Executive whether it considers that the nation's cultural identity is enhanced by the permanent presence in Scotland of a vibrant, robust and competitive television programme-making industry. (S3O-4745)

Linda Fabiani (Scottish National Party, Central Scotland)

Yes. As highlighted in the Scottish Broadcasting Commission report "Platform for Success", broadcasting is important to the economic, cultural and democratic health of the nation. The report recognises that more high-quality creative content can be produced in Scotland given the right environment. That will provide the basis from which Scotland can develop a dynamic and successful production industry, creating world-class content for worldwide audiences.

Ian McKee (Scottish National Party, Lothians)

Bearing in mind the close links between television production and the health of the wider creative community, as well as the importance of local and national news programmes in informing citizens about issues of common interest, does the minister agree that an appropriate model must be found to maintain and expand high-quality television content from both BBC Scotland and STV, as the commercial broadcaster in Scotland?

Linda Fabiani (Scottish National Party, Central Scotland)

Yes. As was highlighted in the commission's report, plurality of services is extremely important to viewers, both for news services and more generally. The commission's research highlighted a desire on the part of the public for a Scottish network to service the whole of Scotland, and for all the public service broadcasters, including the BBC and ITV/STV, to ensure that their news services provide suitable coverage for all parts of the United Kingdom. The Scottish Government has indicated that it supports those recommendations. We will respond fully to the Broadcasting Commission by the end of the year.

Ted Brocklebank (Conservative, Mid Scotland and Fife)

The minister will have noted yesterday's comments by Ed Richards, the head of the Office of Communications—Ofcom—that STV programmes such as "Scotland Today" might be axed because of the financial crisis facing ITV. Does the minister believe that there should be current affairs competition for the BBC in Scotland? I accept that broadcasting is a reserved function, but does the minister see merit in top-slicing the licence fee to allow ITV to provide that competition?

Linda Fabiani (Scottish National Party, Central Scotland)

The matter is obviously being discussed by the Conservative party at the moment. As is outlined in Ofcom's public service broadcasting review consultation, a number of issues will need to be considered, particularly the provision of local and national news on ITV/STV. The Scottish Government is considering its response to the Ofcom consultation, and we will respond by 4 December. I urge members throughout the Parliament also to respond to Ofcom to ensure that all concerns are taken into account.

Alex Johnstone (Conservative, North East Scotland)

To ask the Scottish Executive what plans it has to improve further the junction of the A90 with the A937 at Laurencekirk. (S3O-4681)

Stewart Stevenson (Scottish National Party, Banff and Buchan)

Transport Scotland's strategic transport projects review is examining the longer-term needs of Scotland's nationally strategic transport network, which includes consideration of the A90 as part of the transport corridor between Dundee and Aberdeen.

Alex Johnstone (Conservative, North East Scotland)

Does the minister acknowledge the fact that when the temporary measures were put in place at the junction, it was understood locally that they would be temporary, and that there would be a quick move towards the development of a grade-separated junction at the site? What progress was made by the previous Government towards that aim? Will that aim feature among the present Government's priorities?

Stewart Stevenson (Scottish National Party, Banff and Buchan)

The member will be aware that the previous Liberal Minister for Transport made improvements in 2005, which have resulted in a reduction in the number of accidents at the junction. We inherited no planning for further work. In light of the remark that the Liberals' finance spokesman, Jeremy Purvis, made last week, that

"Efficiency savings in the infrastructure programme have been identified,"—[Official Report, 30 October 2008; c 11852.]

we would not have expected any further investment from the Liberals, had they remained in a position of influence on the matter.

Tavish Scott (Liberal Democrat, Shetland Islands)

What has that got to do with the question, Presiding Officer?

Alex Fergusson (None, Galloway and Upper Nithsdale)

I am indeed left wondering what that had to do with the question.

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

This is a very serious issue. The minister wrote to me saying that only "2 slight injury accidents" have taken place on the A90 at Laurencekirk in the past three years, whereas figures released by Grampian Police under the law on freedom of information—which is more than I got from the Minister for Transport, Infrastructure and Climate Change—show that there have been 35 collisions and 21 injuries at Laurencekirk. Does the minister agree that those are alarming figures? Will he reconsider his decision not to meet me, Jill Campbell and other local campaigners to see for himself just how dangerous the road around Laurencekirk is?

Stewart Stevenson (Scottish National Party, Banff and Buchan)

As the member is aware, I am a regular user of the A90 and I am familiar with the area—indeed, it seems quite clear that I am somewhat more familiar with it than he is. My answer related to the junction that he asked me about; the freedom of information request that he mentioned referred to a substantially greater area of the A90. As this is a matter of concern to us all, it is being treated very seriously.

Of course, the Liberals have trouble with numbers. Last week, Jeremy Purvis said that ministers in this Administration

"will be 40 per cent wealthier"—[Official Report, 30 October 2008; c 11851.]

than those in Ireland. Actually, the Irish make twice as much money as we do.

Alex Fergusson (None, Galloway and Upper Nithsdale)

That remark is off the subject, minister.

Stewart Stevenson (Scottish National Party, Banff and Buchan)

Numbers from Liberals on the subject of roads or on anything else are not to be trusted.

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

On a point of order, Presiding Officer. Given that people have died at this junction and that there have been serious injuries of which the minister is not aware, is it appropriate for him to make petty political points on this serious issue, which has received broad cross-party support?

Alex Fergusson (None, Galloway and Upper Nithsdale)

I remind the minister of what I said at the beginning of question time: I expect answers to stick strictly to the subject matter of the question.

George (Labour, Lothians)

To ask the Scottish Executive what plans it has to revisit legislation on charities. (S3O-4699)

Fergus Ewing (Scottish National Party, Inverness East, Nairn and Lochaber)

We are making good progress on implementing the Charities and Trustee Investment (Scotland) Act 2005, which includes mechanisms for regular review.

George (Labour, Lothians)

Is the minister aware of the comments of Lucy McTernan, the acting director of the Scottish Council for Voluntary Organisations, who said that the Office of the Scottish Charity Regulator's recent decisions on private schools

"could undermine the public perception of charities"?

Does he agree with me—and, indeed, with Christine Grahame—that private schools are bastions of privilege that help to perpetuate class divisions? Finally, does he accept the suggestion from Stephen Maxwell, a very respected and well-known nationalist, who, writing in Third Force News, said:

"it is time for the Scottish Parliament through its Communities Committee to review the implementation of its own charities legislation"?

Fergus Ewing (Scottish National Party, Inverness East, Nairn and Lochaber)

The charities legislation, which was introduced by the previous Labour-Liberal Administration, received broad cross-party support. For an organisation to qualify as a charity, it must demonstrate that it provides a public benefit, and that criterion was employed by the independent charities regulator in reaching the decision that was announced on 28 October. Some private schools passed the test on the grounds that they satisfied the public benefit test, in particular by providing assistance to those who are unable to pay fees to attend those schools; other schools did not.

I note in passing that Lord Foulkes's personal details, which can be found on the Scottish Parliament website, show that he attended Haberdashers' Aske's school, which is a notable and significant private school. Members will therefore be interested to learn that along with the actor who played Borat and the comedian David Baddiel, Lord Foulkes is a notable old Haberdasher.

Alex Fergusson (None, Galloway and Upper Nithsdale)

I am not sure how that relates to the question. [ Laughter. ] I would prefer your answer to relate to the question, minister.

Fergus Ewing (Scottish National Party, Inverness East, Nairn and Lochaber)

I was simply going to suggest that those who have benefited from a system should perhaps not decry others who take up opportunities to do so.

George (Labour, Lothians)

On a point of order, Presiding Officer.

Alex Fergusson (None, Galloway and Upper Nithsdale)

I hope that it is a point of order, Lord Foulkes.

George (Labour, Lothians)

Surely, if the minister's suggestion were followed, you and he would also have to declare an interest.

Alex Fergusson (None, Galloway and Upper Nithsdale)

That is not a point of order.

David Stewart (Labour, Highlands and Islands)

To ask the Scottish Executive what discussions have taken place with Highland Council and Highlands and Islands Enterprise regarding possible events in the Highlands and Islands during the homecoming Scotland 2009 celebrations. (S3O-4726)

Jim Mather (Scottish National Party, Argyll and Bute)

The homecoming team is in constant contact with the Highland Council and Highlands and Islands Enterprise, both of which, along with other organisations in the north, are important partners in the event. To strengthen those partnerships, a member of the homecoming team works out of the HIE office in Inverness two days each week. The very close working relationships that have been built up have resulted in the planning of a number of homecoming events across the Highlands and Islands to celebrate homecoming Scotland next year.

David Stewart (Labour, Highlands and Islands)

Does the minister share my view that the year of homecoming provides opportunities for the diaspora to visit Scotland and provide a major boost to tourism in the Highlands and Islands and beyond? Will he support my campaign for the Tate gallery to lend Gainsborough's portrait of the famous Highland family, the Baillies, to the Inverness art gallery to provide a focal point for Highland events in 2009?

Jim Mather (Scottish National Party, Argyll and Bute)

Of course I support that campaign. We should also encourage everyone in the Highlands to show Highland hospitality in their letters, e-mails and phone calls. In their Christmas cards to people furth of the Highlands and Scotland, they should invite them to next year's year of homecoming. The gathering in Edinburgh next year should involve work with the clan societies; people should be told to come to Edinburgh and, having done so, to go north and west.

Christine Grahame (Scottish National Party, South of Scotland)

And south.

Alex Fergusson (None, Galloway and Upper Nithsdale)

Thank you for that sedentary intervention, in which I declare an interest.

First Minister's Question Time

Alex Salmond (Scottish National Party, Gordon)

Later today, among other things, I will have meetings to take forward the Government's programme for Scotland.

The question provides an opportunity for all of us to welcome the huge election victory of President-elect Obama and all that that victory means for the world in promoting an atmosphere of hope and expectation as opposed to the politics of fear and despondency. [Applause.]

Iain Gray (Labour, East Lothian)

Throughout Scotland, local authorities are struggling with the budgets that the Scottish Government has given them. Let us look at Fife Council, for example. Home care charges are up from £4 a week to £11 an hour; £51 is now being charged for a home alarm whereas, previously, everyone who needed it got one free; and charges of £7 for shopping deliveries have been introduced for the first time and that service is no longer free. Is that what the First Minister meant when he said that he had given local government the flexibility in funding to meet the priorities of our people?

Alex Salmond (Scottish National Party, Gordon)

I wonder why the leader of the Labour Party chooses Fife as his example. If Fife is the example, let us welcome the 10 per cent increase in the education budget there and Fife Council being one of the councils in Scotland that is moving ahead with employing new teachers in this academic year. [ Interruption. ] I see that Lord George Foulkes is again disgruntled. Let us make him even more disgruntled by mentioning the fact that Glasgow City Council, North Lanarkshire Council, Clackmannanshire Council, Dundee City Council, North Ayrshire Council, East Dunbartonshire Council, East Renfrewshire Council, Inverclyde Council, Midlothian Council and South Lanarkshire Council are Labour-led councils that have home care charges.

Iain Gray (Labour, East Lothian)

It is true that other councils levy home care charges. In Glasgow, for example, the average charge is around £10 a week—not £11 an hour—and that is for home care and shopping services. This is about change—abrupt overnight change for the worse when the Scottish National Party takes power.

Rose Ritchie of Cardenden uses a wheelchair because a spinal condition has left her unable to lift her head. With some support, she manages to live alone; her community alarm is—literally—her lifeline. However, the SNP has changed that. On her tight budget, she simply cannot afford the new bill of £51, so the SNP Fife Council has set its debtor team on to her. Will the First Minister take some responsibility for the plight of Rose Ritchie and others like her in Fife and tell his council to call off the bailiffs?

Alex Salmond (Scottish National Party, Gordon)

I am glad that Iain Gray talks about responsibility, because that has been totally lacking in the Labour campaign in Glenrothes. We should consider, for example, what the Labour candidate said the other night at The Courier hustings. He said that he had tried to reassure people, but that he did not know what the criteria were. If he had taken the opportunity to find out what the criteria were, he would know that 1,000 people who were paying charges under the Labour Party are now no longer paying charges under the SNP-Liberal Administration. It is true that 8 per cent of people are paying charges at the full rate as a result of an income assessment that is based on their ability to pay, but exactly the same position prevails in many Labour councils in Scotland. I wonder whether, in future by-elections, the Labour Party will want to feature those examples, in which its councils are in charge of home care charges that are based on the ability to pay.

Iain Gray (Labour, East Lothian)

Earlier in this exchange, the First Minister mentioned events in the election in America. I have to say that the First Minister is no Barack Obama. [ Interruption. ]

Alex Fergusson (None, Galloway and Upper Nithsdale)

Order.

Iain Gray (Labour, East Lothian)

Indeed, the First Minister is less about the audacity of hope and more about the effrontery of hype. One thing is certain sure: with the power that Barack Obama has taken on comes enormous responsibility. Always with power comes responsibility for those who are big enough to accept it. The SNP leader of Fife Council has taken responsibility. He stands by his cuts. He said this week on the "Today" programme:

"I've no problem taking responsibility for everything the council has done".

That must include the council's cuts. Will the First Minister now accept his responsibility for the SNP cuts in Fife and throughout Scotland?

Alex Salmond (Scottish National Party, Gordon)

It is certainly true that I am no Barack Obama; the problem for Iain Gray is that he is no Jack McConnell. The campaign in Fife has included a range of accusations that have been levelled at the SNP council. The Labour Party in its campaign has said that there have been education cuts in Fife, despite the fact that the Fife education budget has increased by 10 per cent. The Labour candidate for Glenrothes says that there are education cuts in Fife. That is absolutely true. I have here a letter that he wrote to councillors in Fife complaining about the slashing of his school budget, before the last election, when the Labour Party was in charge in Fife. As we examine the items one by one, there is no doubt whatever in Scotland about which party is pursuing the politics of hope and expectation and which party pursues the politics of fear and despondency.

Iain Gray (Labour, East Lothian)

That is exactly the effrontery that the First Minister deploys. In Fife, £300,000 has been cut from the budget for classroom assistants, £500,000 has been cut from the budget for teachers, and £460,000 has been cut from the budget for transport for disabled pupils. The cuts in Fife are unfair and unjust; they are being made to services for the elderly and the disabled and in Fife schools, too. Will the First Minister stand alongside his council and his candidate and say that he, too, has no problem with the council's cuts? Is he with Peter Grant, or is he with Rose Ritchie? Today, he cannot be both. Whose side is he really on?

Alex Salmond (Scottish National Party, Gordon)

The problem for Iain Gray is that the budget for education in Fife has increased by 10 per cent in the current year. There is no doubt about that—the figures are there. I accept that the previous Labour council reduced the education budget, as the Labour candidate helpfully pointed out when he was a headmaster rather than a Labour candidate.

On the generality of local government funding in Scotland, we hear repeated complaints from Labour members who are unable to accept that the historic concordat has proven that the local government settlement in Scotland is the most generous for a generation. I was interested to note the following words in a Finance Committee Official Report:

"I would always acknowledge the costs of providing services in local government. This is set against the backdrop of the Government providing local authorities with a record level of resources."—[Official Report, Finance Committee, 16 September 2008; c 700.]

That was said by Jackie Baillie. I know that she is a non-person and is no longer in Iain Gray's team, but if she acknowledges that there are record resources to local government across Scotland, why does Iain Gray not?

Annabel Goldie (Conservative, West of Scotland)

To ask the First Minister when he will next meet the Secretary of State for Scotland. (S3F-1143)

Alex Salmond (Scottish National Party, Gordon)

I will meet the Secretary of State for Scotland this Sunday at the service of remembrance at St Giles cathedral.

Annabel Goldie (Conservative, West of Scotland)

This week, it was confirmed that the national health service in England should not withdraw treatment from patients who choose to pay privately for additional drugs. Will the First Minister confirm that that facility will now be available to NHS patients in Scotland?

Alex Salmond (Scottish National Party, Gordon)

We are looking carefully at the report that was released in England. We will be able to announce our response to it shortly, but that measure is certainly something that we are considering. A review is in place and we will make an announcement shortly.

Annabel Goldie (Conservative, West of Scotland)

The First Minister rightly misses no opportunity to laud Scotland's virtues, but it is unacceptable complacency if he fails to address negative impacts with the same urgency. Health care in England is now more flexible and, therefore, arguably better. Why should some NHS patients be forced, particularly at a time of grave ill health, to make a choice between staying in Scotland or selling up and going to live in England to benefit from that improvement? How is that, to quote the First Minister's words from only a few moments ago,

"the politics of hope and expectation"?

What is he going to do about it?

Alex Salmond (Scottish National Party, Gordon)

The burden of argument has been that the Scottish system of determining drug availability through the Scottish Medicines Consortium is generally recognised as more flexible than, and superior to, the one that prevails down south. We are always willing to learn lessons and take advice based on the most recent information, which is exactly why we are studying the report that was released this week. If we can improve the Scottish situation on the basis of advice that is taken elsewhere, we will do so, because it is our obligation to the national health service and the people in Scotland. However, Annabel Goldie is wide of the mark if she does not acknowledge that the present Scottish system for determining the availability of medicines—which will always be a difficult and agonising issue—is generally considered to be substantially superior to the one that prevails south of the border.

Tavish Scott (Liberal Democrat, Shetland Islands)

To ask the First Minister what issues will be discussed at the next meeting of the Cabinet. (S3F-1144)

Alex Salmond (Scottish National Party, Gordon)

The next meeting of the Cabinet will discuss issues of importance to the people of Scotland.

Tavish Scott (Liberal Democrat, Shetland Islands)

I join the First Minister and other members who have congratulated President-elect Obama—a very liberal Democrat.

This week, Unite the Union told me that there is now no doubt that we face losing thousands of banking jobs in Scotland. Only minutes after its meeting with the First Minister, Lloyds TSB told the City that it would cut 20,000 jobs. What levers does his Government have to influence HBOS shareholders to keep Scotland's bank Scottish?

Alex Salmond (Scottish National Party, Gordon)

The Parliament made a substantial statement of concern about these issues last Thursday. I recall that Tavish Scott and I voted in the same manner. That vote enunciated by a substantial majority a parliamentary view of the concern that is rightly felt about jobs, decision making and competition in the Scottish banking sector. There have been some well-reported developments over the past week. The Scottish Government's view is that if any bid for HBOS were to emerge beyond the one that is on the table from Lloyds TSB, it would be our duty to evaluate it in exactly the way in which we are evaluating the Lloyds TSB one: on the basis of its impact on jobs in Scotland, decision making in Scotland and competition in the Scottish economy. That seems to me to summarise the interests of Scotland.

Tavish Scott (Liberal Democrat, Shetland Islands)

The First Minister inherited a position in which the Scottish Government is hardwired into the Scottish financial services industry. That needs to be exploited. There is now a fight to find an alternative way forward for HBOS. How is it acceptable that the bankers' first instinct is to pay one another £60,000 a month to advise one another on the mess that they made? The taxpayer is now a £1 billion shareholder in our banks, and we want our money to do more than lose 20,000 jobs, send other jobs overseas and close down branches on the high street. Will the First Minister tell bankers that, when the taxpayer has to cough up billions to bail them out, we expect them to listen to the interests of customers and small businesses, not tell us to leave them alone?

Alex Salmond (Scottish National Party, Gordon)

There is broad agreement that a variety of practices in the financial sector, which have been well noted and well reported, should come to an end. That seems a reasonable position for all of us to adopt.

On the guts of the issue, I take it that Tavish Scott agrees that the Government should have discussions with Lloyds TSB on what is in the best interests of Scotland—I know that he does because he supported that position. I take it that he agrees that, if another offer comes on the table, it should be assessed and evaluated against exactly the same criteria. That is also in the interests of Scotland. In turn, I think that every single one of us should acknowledge that people's concerns about employment and jobs are entirely legitimate—they arise from an entirely reasonable assessment of the situation. The concerns about decision making in Scotland are also legitimate, as are, as the Office of Fair Trading report indicated only last Friday, the concerns about the impact on competition.

In terms of pursuing the public and national interest in Scotland, as Tavish Scott well knows, we do not have authority over the financial sector at present—would that we did. Nonetheless, within the powers that we do have, we shall represent the interests of the Scottish people to private organisations, the United Kingdom Government and any other interested party and we will keep those paramount in how we approach this situation.

Jackie Baillie (Labour, Dumbarton)

The First Minister will recall the devastating loss of life at the Vale of Leven hospital due to Clostridium difficile. Since then, constituents have come forward to report that relatives have died of C diff when it was not diagnosed and that, in other cases, patients have been discharged carrying the infection, yet tests gave them the all-clear. Is the First Minister aware of a study that was published in The Lancet that suggests that up to a quarter of C diff cases have been misdiagnosed? Will he ensure that the central recommendation of that study, which is that double tests be undertaken in all cases of suspected C diff, is implemented in every Scottish hospital to help to reduce the mortality rate for C diff?

Alex Salmond (Scottish National Party, Gordon)

The general concern about diagnosis and death certificates is well noted. If there are specific matters affecting Jackie Baillie's constituents in terms of the recent understandings, she should approach the Cabinet Secretary for Health and Wellbeing, who will give her specific concerns a very willing hearing.

John Lamont (Conservative, Roxburgh and Berwickshire)

The First Minister will be aware of the devastating job cuts that have been announced in Hawick this week. On Monday, we were told that Hawick Knitwear Ltd would cut 15 per cent of its workforce due to the economic climate and, last night, it was announced that Hawick Cashmere would cut further jobs due to a company restructuring. That news comes on the back of the decision by Pringle of Scotland earlier this year to stop production in Hawick, which has left that proud town reeling. What action does the Scottish Government plan to take to protect the skilled workforce in the Borders and, in particular, to save the textile industry from cheap overseas imports?

Alex Salmond (Scottish National Party, Gordon)

As the member will know, John Swinney has already intervened in the Pringle situation and he indicates a willingness to visit and intervene in the latest development, which is a blow to jobs in the Borders. Equally, the Scottish Enterprise partnership action for continuing employment team will be put on the case in order to develop skills and find alternative employment. The member can be satisfied that the Scottish Government will be fully engaged in addressing the employment position that is developing across the country as a result of the general economic climate.

Christine Grahame (Scottish National Party, South of Scotland)

To ask the First Minister what discussions the Scottish Government has had with HM Treasury about ensuring that an estimated £46 million of local authority investment, along with charity deposits, are recovered from Icelandic banks. (S3F-1150)

Alex Salmond (Scottish National Party, Gordon)

The Scottish Government is working with the United Kingdom Government and Scottish local authorities to secure and retain all the assets that local government and other Scottish depositors have placed in Icelandic banks in good faith.

The Cabinet Secretary for Finance and Sustainable Growth is in regular contact with the UK Government and the Convention of Scottish Local Authorities to ensure that everything possible is being done to recover those assets. He wrote to the Chancellor of the Exchequer on 9 October outlining the strong concerns in Scotland about the developing situation. He met with the Secretary of State for Scotland, the Treasury and COSLA representatives on 15 October. On 31 October, he again wrote to the chancellor outlining the agreement reached that Scottish local government be represented at future meetings between the Treasury and the Local Government Association on the situation as it develops. He has offered to meet the chancellor to review progress and discuss the wider developments in financial services and the economy. To date, no response has been received.

Christine Grahame (Scottish National Party, South of Scotland)

Does the First Minister agree that it would be indefensible if HM Treasury, which has used our money to bail out banks—and we have heard what they have used that money for in some cases—is not prepared, in the event that the Secretary of State for Scotland's persuasive powers fail him during his trip to Iceland, to underwrite those potential losses to local authorities and charities? Does the First Minister agree that, together with hikes in energy bills, such losses will put unacceptable pressures not just on our local authorities but on household budgets? I am sure that he is hearing that concern on the doorsteps of Glenrothes.

Alex Salmond (Scottish National Party, Gordon)

I think that, in the current situation, the guarantees that have been indicated for retail depositors should be extended to wholesale depositors. Given that we know that there were some early indications of the position as it developed, and given that bodies such as the Audit Commission south of the border were among the organisations that have been hit, I do not think that it is reasonable to hold individual councils responsible.

On the wider concern about heating bills, I absolutely agree. The biggest concern that I detect for homes in Scotland is the heating bills that are thumping through people's letterboxes that show increases of 30, 40 and 50 per cent. In that light, it is welcome that the additional £10 million for the central heating programme that was announced by the Cabinet Secretary for Health and Wellbeing will ensure that record numbers of installations of new heating systems will be pursued throughout Scotland and in Fife.

Alison McInnes (Liberal Democrat, North East Scotland)

I welcome the discussions that the First Minister and his team have had with the Treasury. Is he aware that the Minister for Local Government, John Healey MP, has given an assurance to the Local Government Association that any English local authorities facing severe short-term difficulties will be offered assistance? Will the Scottish Government give the same assurance to our local authorities? Has the Cabinet Secretary for Finance and Sustainable Growth indicated to COSLA that he is willing to consider ways to help any Scottish council that faces cash-flow difficulties arising from such deposits not being returned at contract times?

Alex Salmond (Scottish National Party, Gordon)

The cabinet secretary is in constant contact with COSLA on that issue. Indeed, COSLA and the cabinet secretary are at one in their approach to the issue. However, I know that Alison McInnes would not like to divert attention from the fact that financial regulation is a UK Government responsibility. We would not want to remove from the Treasury the obligations that it most certainly has in that regard.

Lewis Macdonald (Labour, Aberdeen Central)

Does the First Minister recall the Government's approval in December of Aberdeen City Council's much delayed schools renewal programme on the basis of £120 million in funding from an Icelandic bank that has since gone into administration? If it is confirmed in the next few days that new private finance providers are required to get the job finished, will the Government offer whatever financial guarantees may be necessary to bring such financiers on board?

Alex Salmond (Scottish National Party, Gordon)

The Cabinet Secretary for Finance and Sustainable Growth is already in correspondence with Aberdeen City Council and is looking at the situation as it develops. Although the local member said that the schools project had been much delayed, I know that he welcomed the fact that the current administration on Aberdeen City Council pursued the project. I know that we will be at one in ensuring that that project—and the non-profit distribution model schools that it brings into being—comes to fruition, to the great benefit of the folk of Aberdeen and north-east Scotland.

David McLetchie (Conservative, Edinburgh Pentlands)

Does the First Minister agree with the comments of his colleague Keith Brown, who told the chamber last week that the United Kingdom Government was guilty of "despicable bullying of Iceland", or does he think that the steps that were taken were justifiable in order to protect the deposits of Scottish savers, including local authorities and charities?

Alex Salmond (Scottish National Party, Gordon)

The detail that has emerged about the early discussions that took place some time ago between the Icelandic Government and UK Government officials at the highest level indicates that there was rather more warning of the developing situation than we were perhaps led to believe at first. I think that it is right and proper that action is taken to protect the interests of Scottish and UK depositors. I am not altogether convinced that it is the wisest thing to do to give people the impression that they are being branded as terrorists or as part of a terrorist organisation. Negotiations, which I understand are now proving fruitful and beneficial, are not best conducted in that way, by name calling or by depicting people as something that they obviously are not.

Cathy Jamieson (Labour, Carrick, Cumnock and Doon Valley)

To ask the First Minister what further actions the Scottish Government will take to ensure that repossession is used only as a last resort by lenders when home owners are having mortgage repayment difficulties. (S3F-1160)

Alex Salmond (Scottish National Party, Gordon)

The Mortgage Rights (Scotland) Act 2001 provides significant protection for those at risk of repossession. Owners have the right to ask the sheriff to give them time to pay off arrears and lenders are obliged to comply fully with Financial Services Authority regulations.

In addition, Government officials met the Council of Mortgage Lenders on 23 October. The CML confirmed that its new guidance on repossession, which was issued that day, applies to all United Kingdom members, and emphasised that lenders should consider all alternative options to repossession when dealing with home owners in mortgage difficulties.

This Administration believes that home owners in Scotland have protections that are better than the protections in the rest of the UK, given that the Government has made available extra money to support families who are struggling to meet their mortgage payments—that is not in place in England and Wales. As part of our action plan on the economy, we are of course keeping the situation under review.

Cathy Jamieson (Labour, Carrick, Cumnock and Doon Valley)

There might be disagreement about whether protections in Scotland exceed those south of the border. A number of commentators have suggested quite the opposite. Will the First Minister therefore agree to consider the introduction of pre-court protocols in Scotland and to report back to the Parliament on the matter? Given that the Parliament legislated in 2004 to regulate the private rented sector, will he urgently consider using the powers that are available to this Parliament to regulate so-called sale-and-leaseback landlords?

Alex Salmond (Scottish National Party, Gordon)

Cathy Jamieson will acknowledge that the Deputy First Minister made an initiative on the matter in the past few days. The Deputy First Minister is looking for the UK Government to implement as soon as possible the recommendations of the Office of Fair Trading report on sale and rent back in the private sector.

As Cathy Jamieson well knows from experience, the legal system in Scotland is substantially different from the system in England and Wales. Before we go down the route of thinking that pre-court protocols are a panacea, we should consider the words of Judge Robert Jordan, the chairman of the Civil Justice Council, which drafted the "Pre-action protocol for possession claims based on mortgage or home purchase plan arrears in respect of residential property". On 22 October, he said:

"The protocol does not change the courts' limited powers to deal with these cases."

The Scottish Government is by all means willing to listen to suggestions and examine further improvements that can be made. However, we and home owners in Scotland should take comfort that practical arrangements are in place in Scotland, not least the new home owners support fund, which has a budget of £25 million over the next two years. The fund is in place now to help people who cannot access support elsewhere to stay in their homes. No such scheme is in place elsewhere in the UK, despite some soundings to that effect, so my remark that the position on public support is in many respects better in Scotland than it is elsewhere in the UK was well justified.

Brian Adam (Scottish National Party, Aberdeen North)

What representation has the Scottish Government made to the UK Government in relation to the OFT report, "Sale and rent back", which calls for regulation by the FSA to ensure that home owners who face financial difficulties are protected from rogue companies?

Alex Fergusson (None, Galloway and Upper Nithsdale)

The question has almost been answered, but the First Minister may make a brief comment.

Alex Salmond (Scottish National Party, Gordon)

The issue is worthy of further explanation, because it is important to the people of Scotland. People who are under pressure from threatened repossession are worried about sale-and-rent-back schemes in the private sector.

The OFT report specifically called for the compulsory regulation of sale-and-rent-back schemes and for the Department for Work and Pensions to provide

"greater clarity on the eligibility of sale and rent back tenants for housing benefit."

Members will acknowledge that the recommendations touch on what are currently UK Government responsibilities. Therefore, it is entirely appropriate that the Deputy First Minister should this week have written to the UK Minister for Trade, Investment and Consumer Affairs, to see that the recommendations, which I am sure are supported by members of all parties, are fully and properly implemented.

Bill Aitken (Conservative, Glasgow)

To ask the First Minister whether the Scottish Government, in liaison with the United Kingdom Government, has plans to redefine the role of the Lord Advocate. (S3F-1147)

Alex Salmond (Scottish National Party, Gordon)

We have had no discussions with the UK Government on redefining the role of the Lord Advocate. Our national conversation—to which I know Bill Aitken is on the cusp of submitting a contribution—is considering all aspects of our constitutional arrangements, but we have no immediate plans to change the role of the Lord Advocate.

Bill Aitken (Conservative, Glasgow)

The First Minister should never anticipate my actions, but he will be aware of the problems caused by the volume of appeals on so-called devolution issues. Many may be spurious, but a great many are related to the currently defined role of the Lord Advocate in relation to convention rights legislation. Is there not a case for seeking, through the UK Government, an amendment to the Scotland Act 1998 to exclude the acts of the Lord Advocate from section 57(2) or to redefine the Lord Advocate's role between the prosecution function and that of the Government's legal adviser, which would seem to be one way of obviating what is becoming an increasing problem?

Alex Salmond (Scottish National Party, Gordon)

I do not anticipate what Bill Aitken is going to do but, when we came to office and one of our first actions was to agree that the Lord Advocate and Solicitor General would no longer routinely attend the cabinet, emphasising the separation of the political and judicial, I am pretty certain that Bill Aitken welcomed that move.

Bill Aitken should also be aware that the Lord Advocate has indicated on several occasions that she is open to the constructive consideration of the future of the role. For example, in the KPMG annual law lecture last February, she said:

"I think it is perfectly valid and proper for people to debate the proper role of Law Officers. I also believe it is important, though, for that debate to be informed not only by history but, crucially, by the needs of a modern 21st Century ... Scotland."

With that in mind, Bill Aitken invites me to consider amendments to the Scotland Act 1998. I must confess that I am considering amendments to the Scotland Act 1998, although the amendments that I have in mind may be more all-encompassing than those that Bill Aitken has in mind. However, there is a degree of consideration and flexibility, and if we pursue that in good faith and while acting jointly, I am sure that Bill and I will come to the right conclusions.

Question Time — Scottish Executive — Health and Wellbeing

Alasdair Morgan (Scottish National Party, South of Scotland)

Good afternoon. The first item of business is questions on health and wellbeing. I remind members that the Presiding Officer stated last week that they should keep their questions brief and in the form of a question, rather than a statement, and that multiple questions should not be asked. If members fail to adhere to that advice, we may have to stop them.

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

My officials have meetings with the British Dental Association planned for 10 November and 19 November. The Minister for Public Health last met the BDA on 9 September at its offices in Stirling.

Brian Adam (Scottish National Party, Aberdeen North)

I note that we have in recent times seen an improvement in the number of people who have registered with dentists. However, given that there are wide discrepancies among areas—only 38 per cent of people in my patch are registered, whereas 71 per cent of people in Glasgow are registered—what steps does the cabinet secretary plan to take to encourage the BDA and its members to return to delivering NHS dentistry across Scotland and not just in some areas?

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

Brian Adam is right to point out that the latest statistics show that, across Scotland, we have the highest number of registrations with dentists for both adults and children since registrations were introduced in October 1990. That is extremely good news and I know that everyone in the chamber will welcome it.

Brian Adam is also right that some areas of the country have registration rates that are unacceptably low—I include the Grampian NHS Board area in that. Work is continuing to improve registration rates. It is important that we continue to work at two levels. First, we must work at Government level, which is why we pay a range of allowances to encourage NHS commitment from dentists. The Minister for Public Health also announced earlier in the year an agreement to provide financial assistance to dentists who do not meet the NHS commitment criteria but who, nevertheless, treat large numbers of NHS patients. Of course, dentists can access the Scottish dental access initiative.

Secondly, it is important that action is taken at health board level. NHS Grampian is on target to open six new dental premises across Grampian in the next 12 months, each of which will have between one and four surgeries. The Government has made available £6 million to NHS Grampian under the primary and community care modernisation programme for next year and the year after. A priority for that funding is the development of new dental centres.

I hope that Brian Adam accepts that a range of work is under way. We will continue that work until we get dental registrations to a level that we all want—not just on average across the country but in every area.

Mary Scanlon (Conservative, Highlands and Islands)

In evidence to the Health and Sport Committee during the budget process, the British Dental Association said that it would need £600 million to provide greater access to NHS dentistry—in other words, £245 million more than it receives at present. What is the cabinet secretary's response to that request?

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

I saw the evidence that the BDA submitted to the Health and Sport Committee. No doubt some of it will form the basis of future discussions that we will have with the BDA. I am not entirely clear about what the basis of the BDA's calculation is. I think it might have been making some comparisons between independent dental practitioners and salaried dentists, which are not always valid comparisons.

There has been substantial additional funding for dentistry in recent years. It was started under the previous Administration and, I am pleased to say, has continued under this Administration. Increases in the fees that are paid to dentists are subject to the Doctors and Dentists Review Body recommendations, which we implemented fully last year. We will respond to the recommendations for next year when we get them in due course.

As I said in response to Brian Adam's question, we make substantial funding available to dentists through the various allowances that are in place to promote and encourage dentists to do as much NHS work as possible.

Alasdair Morgan (Scottish National Party, South of Scotland)

Question 2 was not lodged.

Derek Brownlee (Conservative, South of Scotland)

To ask the Scottish Government what factors explain the recently announced increase in the percentage of the population registered with an NHS dentist. (S3O-4684)

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

Several factors are at play. First, the number of national health service dentists increased by 4.1 per cent in the year to March 2008. Secondly, through the Scottish dental access initiative, we are funding the establishment and expansion of additional dental surgeries. Thirdly, the extension of the registration period to 36 months has strengthened the relationship between patients and dentists. Fourthly, payments that are linked to the level of NHS commitment mean that dentists are incentivised to maintain their patient registrations.

All those factors contribute to the increase in registrations as we begin to reverse the long-term decline in NHS dentistry. Nevertheless, as I said in response to question 1, the level of registrations is still unacceptably low in some parts of Scotland. I expect all NHS boards to continue to put plans in place to improve access further for their populations.

Derek Brownlee (Conservative, South of Scotland)

Is the third factor not the overwhelming one? The previous Government extended the period in which a patient could go without visiting an NHS dentist from 18 months to 36 months before being deregistered. That means no deregistrations between July last year and April next year. Before that change, 650,000 patients were deregistered for non-attendance each year. The increase in registrations in the past year was only 445,000. Does not that indicate an underlying trend that is still negative? If the change in the registration period had not happened, would the minister be announcing a fall rather than an increase in the number of registered patients?

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

It is not like Derek Brownlee to take the glass-half-empty approach to life. He is usually much more optimistic than that, and than some of his colleagues sometimes are. In my first response to his question, I openly acknowledged that lengthening the registration period to 36 months was undoubtedly a factor in the increased number of registrations. However, nobody who studies dental health in any depth could conclude anything other than that other factors are at play, too. Surely Derek Brownlee is not suggesting that a 4 per cent increase in the number of dentists has had no impact on registrations. I also presume that he does not suggest that funding new dental surgeries and the payments that we make to dentists to encourage them to register more NHS patients have no impact on the number of registrations. All those factors play a positive part in reversing the long-term decline that I spoke about. Yes—the 36-month period is one of the factors, but the bottom line is that more people are registered with a dentist than are being deregistered. That must be a good thing.

As Derek Brownlee knows, the dental action plan that the previous Administration published contained a commitment to making registration a continuing rather than time-limited system, with defined responsibilities for patients and dentists. That commitment raises a range of practical issues, which we are exploring. We will make further announcements in due course.

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

Is the cabinet secretary aware that, despite the initiatives in the Grampian NHS Board area that she mentioned, adult constituents of mine still cannot register with an NHS dentist? The number on the waiting list has risen by 2,000. Surely the solution is to enter negotiations with the BDA and to make it attractive for dentists who have gone private to return to the national health service to tackle the backlog of adults who are waiting to register.

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

I absolutely recognise the picture of Grampian that Mike Rumbles paints. I openly acknowledged that in response to Brian Adam's question. That trend is historic. If Mike Rumbles has magic solutions to the problem, I am keen to hear them—believe me. However, the reality is that no shortcut exists. The solutions are those that we are pursuing. They are bearing fruit, as I said in my other answers, but there is much work still to do. Some of NHS Grampian's plans, such as opening new dental premises and encouraging independent dentists to take on more NHS patients, will have a positive impact.

It might have escaped Mike Rumbles's notice—although I suspect that it has not—that we are taking measures to encourage dentists who do private work to do more NHS work. That is what the range of allowances is about and that is why we have entered into an agreement through the BDA to provide financial assistance to dentists who do not meet the full commitment criteria but who nevertheless treat NHS patients. A range of other incentives are in place. On top of that, NHS boards can employ salaried dentists.

I absolutely acknowledge the urgency of the situation. As long as any patient in Scotland cannot register with a dentist, my job—and our job—is not done and we need to continue to work even harder.

Karen Whitefield (Labour, Airdrie and Shotts)

To ask the Scottish Executive what investment it is making in the development of social rented housing. (S3O-4727)

Stewart Maxwell (Scottish National Party, West of Scotland)

The Scottish Government is investing in social rented housing in a number of ways. Our main investment will be through the affordable housing investment programme, under which we plan to invest a total of £493 million in 2008-09 in the development of affordable housing. In addition, we recently announced the acceleration of £100 million AHIP moneys. That will see an extra £30 million being spent in 2008-09, most of which will be invested in social rented housing.

Under its rural homes for rent pilot scheme, the Scottish Government will also fund additional new-build affordable housing for rent in rural Scotland. Grant funding will be targeted at landowners in pressured rural housing markets where registered social landlords have been constrained in meeting local housing and homelessness need.

We have also recently agreed with the Convention of Scottish Local Authorities details of the criteria that will be used in allocating the £25 million that we announced to encourage council house building.

Karen Whitefield (Labour, Airdrie and Shotts)

Having spoken to a number of housing associations, I understand that the Government is keen for additional housing investment to be spent on shared equity properties. In the current situation, in which many people are reluctant to take out additional loans, does the minister feel that that priority is appropriate? Would it not be better to direct all the money at homes for rent?

Stewart Maxwell (Scottish National Party, West of Scotland)

This is not an either/or situation. Investment is required in both social rented homes and low-cost home ownership. The vast majority of this Government expenditure is on social rented homes. The extra investment is being spent on securing new land for housing, buying off-the-shelf units from private builders, and accelerating projects that would have taken place further down the track. Clearly, the bulk of the money that is being invested is going into social rented homes.

We have to recognise the fact that not only did Homes for Scotland, other sectors of the building industry and many others call for extra investment in this area, the vast majority of people want to own their own home. There is a demand for that. Shared equity is an obvious solution in trying to assist people on to the housing ladder.

The Government does not take a position whereby we encourage one type of housing tenure over another. The fact remains that, where we can help people, and where it is affordable for us to do that and it is the right choice for people, it is entirely reasonable and correct for the Government to support people through shared equity schemes. I repeat what I said: the vast bulk of spend through the affordable housing investment programme is in social rented housing.

Jamie McGrigor (Conservative, Highlands and Islands)

The building of affordable houses is vital for social rented housing. Will the minister revert to the previous rules for housing association grants, under which far higher levels of grant were given to associations than is the case under the new rules? Does he accept that the new rules are seriously inhibiting the building sector, housing associations and, above all, families that need homes?

Stewart Maxwell (Scottish National Party, West of Scotland)

I am sorry, but I do not accept the premise of Jamie McGrigor's question. The fact is that if we had carried on in the same vein, we would have spent more money on building fewer houses, which would have been neither a reasonable option nor a sensible option.

Certain individuals have put about a lot of misinformation on the housing association grant. The HAG levels that we introduced in April are a target and not a cap. Negotiations take place around the country on HAG levels for individual projects. We have always accepted, and continue to accept, that HAG levels can vary, particularly in remote and rural areas and island communities where added costs are to be found. As I said, HAG negotiations are undertaken on that basis.

Bill Butler (Labour, Glasgow Anniesland)

To ask the Scottish Executive when it next plans to meet with the chief executives of national health service boards. (S3O-4694)

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

The chief executive of NHS Scotland meets the chief executives of NHS boards on a monthly basis to discuss a wide range of issues. The next meeting is scheduled for 19 November. I meet with chief executives on an individual basis regularly, for example, at their annual review meetings. Of course, I have regular meetings with NHS chairs.

Bill Butler (Labour, Glasgow Anniesland)

The cabinet secretary will be aware of the National Deaf Children's Society's campaign to gather data on the number of deaf children in Scotland. When she next meets the chief executives of NHS boards, will she discuss the progress of the NHS-delivered universal newborn hearing screening programme that was introduced in Scotland in 2005? Specifically, will she consider collecting information from NHS boards on the number of children who have to date, through that programme, been diagnosed with a hearing loss, so that such a data collection mechanism could form the basis of a national register of children who have hearing loss, which would inform future service developments and allow the impact of the hearing screening programme to be monitored? Does she accept that such a register would help colleagues in the education and social care sectors to plan and deliver effective interventions in the early years of a deaf child's life?

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

I thank Bill Butler for raising a serious issue and will do him the justice of giving his proposal serious consideration. I pay tribute to the National Deaf Children's Society and the work that it does on a range of issues, especially its collection of data on the number and circumstances of deaf children in Scotland, which Bill Butler mentioned.

I will be more than happy to mention the issues that Bill Butler raised around the universal screening of newborns programme in my discussions with NHS boards. I will certainly give due consideration to his specific call for a register and will revert to him when I have had the opportunity to do so.

Ian McKee (Scottish National Party, Lothians)

In its meetings with the chief executives of NHS boards, will the Scottish Executive question in detail their plans for tailoring health service resources to the differing clinical needs of the people who live in their areas?

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

Indeed. I might be wrong, but I assume that Ian McKee refers to the need to ensure that we can target resources appropriately on areas of deprivation and inequality which—as members will be aware from "Equally Well", the report of the ministerial task force on inequalities—is a Government priority. I am sure that that is a priority that is shared by members of all parties.

I welcome the contribution that the Health and Sport Committee recently made to that debate by considering how, in our discussions on the general practitioner contract, we can deal with some of the issues around the contract that might not allow us to target resources effectively on people in deprived communities. I am happy to give Ian McKee and others an undertaking that health inequalities, which are shameful and unacceptable in a country that is as rich as Scotland is, will remain at the top of the Government's priority list.

Cathie Craigie (Labour, Cumbernauld and Kilsyth)

At her next meeting with NHS chief executives, will the cabinet secretary mention provision of cross-boundary services? My concerns relate particularly to the stance to obesity services that seems to be taken in Glasgow. In the past, people from the Lanarkshire area were able to receive such services in Glasgow, but it appears that people from Lanarkshire are now being treated differently from people who reside within the Glasgow boundary.

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

I know that that is an issue that Cathie Craigie raised on the margins of this morning's debate on patients' rights. I will be more than happy to look into the circumstances to which she has drawn attention, on which I think she might already have corresponded with me. Although there is a general issue, which I will be happy to look into, I understand that, particularly with obesity services, there are issues of clinical decisions and recommendations at stake. I will be more than happy to have further discussion with Cathie Craigie on the specifics of her constituency cases and to come back to her in due course.

Jamie Stone (Liberal Democrat, Caithness, Sutherland and Easter Ross)

When the cabinet secretary meets the chief executive of Highland NHS Board, I presume that they will discuss the recent publicity surrounding the scary cuts in funding for that organisation. Will she take the opportunity of that meeting to look extremely favourably on NHS Highland's bid for finance for a four-surgery dental unit in Thurso?

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

I have already mentioned the resources that are being made available to NHS Grampian from the primary and community care modernisation fund for next year and the year after. Dental premises will be that fund's priority in those two years. I do not have with me the figure for NHS Highland's allocation, but it has been given such an allocation, so I certainly expect it to use it to upgrade and modernise its dental premises.

The next time I meet representatives of NHS Highland, I will be delighted to tell them that, in addition to the record resources that it has already been allocated by this Government for this financial year, it will get an additional £5 million out of the £90 million over and above base allocations that we are making available this year to help drive down waiting times for patients, which is a key priority.

Kenneth Gibson (Scottish National Party, Cunninghame North)

To ask the Scottish Government how patients in Ayrshire and Arran will benefit from having a directly elected NHS board. (S3O-4738)

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

Having a directly elected element on an NHS board will introduce greater awareness of local issues and opinions at the very heart of a board's decision-making process, which I believe will benefit all patients.

Kenneth Gibson (Scottish National Party, Cunninghame North)

Does the cabinet secretary agree that democratically accountable health boards are fundamental to an effective health service and to delivering for patients? Will she confirm that had elected health boards been in place a couple of years ago, some unfortunate proposals, such as the suggested closure of vital accident and emergency units, would not have required her direct intervention?

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

I am a great believer in democracy, and I know that it is being exercised in at least one part of Scotland today, which is why there are not more members in the chamber. I agree with Kenny Gibson that introducing democratic accountability into health boards is an important step forward. It is right in principle, and will lead to better decision making.

As I have said previously, I have never argued—and will never argue—that having directly elected people on health boards will remove the need for health boards occasionally to take decisions that are difficult and indeed unpopular. However, I believe that having directly elected people on health boards will ensure that understanding of local issues is enhanced, which will improve the decision-making process and the decisions that flow from it.

Cathy Jamieson (Labour, Carrick, Cumnock and Doon Valley)

I am glad to hear the cabinet secretary place her faith in the democratic process. Of course, that does not come cheap. Ayrshire and Arran NHS Board's estimate of the cost to it of around £800,000 every four years is causing it some concern. In the context of its being required to achieve £11 million per annum of cash-releasing efficiency savings, it has described that as "a significant amount", which it believes could better be spent on services for patients. Does the cabinet secretary believe that NHS Ayrshire and Arran has accurately estimated the cost of the elections to health boards? If so, will she ensure that that money comes as an additional sum rather than being taken from front-line services?

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

I encourage Cathy Jamieson and, indeed, representatives of NHS Ayrshire and Arran—or any other health board—to read the terms of the Health Boards (Membership and Elections) (Scotland) Bill. If it is passed, the bill will commit only to piloting elections to health boards. The cost of pilot elections to health boards is estimated at £2.86 million. I have made it clear that that money will be funded centrally from the health directorate's budget.

Any decision on roll-out of health board elections will be taken by Parliament, based on the findings of the pilot elections. Therefore, decisions on spending on that are probably one, if not two, comprehensive spending reviews away. I believe that that money should be funded centrally rather than from health board budgets, as Cathy Jamieson knows, although I cannot commit future Governments to any course of action. However, I dare say that that issue will be to the fore in people's minds when they scrutinise roll-out.

Bashir Ahmad (Scottish National Party, Glasgow)

To ask the Scottish Government when the Cabinet Secretary for Health and Wellbeing last met officials of the board of NHS Greater Glasgow and Clyde. (S3O-4730)

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

I regularly meet all NHS chairs to discuss matters of importance to health and the NHS in Scotland. The most recent meeting was on 27 October. I also met the senior team of NHS Greater Glasgow and Clyde on 18 August this year when I chaired the board's annual review. The board's performance on key national health targets including health improvement, efficiency, waiting times and service changes was discussed.

Bashir Ahmad (Scottish National Party, Glasgow)

Last week, NHS Greater Glasgow and Clyde decided against removing health visitors from local general practitioner practices. Does the cabinet secretary welcome the health board's announcement, and does she agree that the original proposal was ill-advised? How will the future role of health visitors be promoted and protected throughout the country?