Gwelch yn maes iawn i mwyaf y prifedigau ar gyfer y bwrdd Cymru i Siwethaf, oedd ei ddigonau sydd yn gyfreithiwn i'w bwrdd Cymru ei gael ei teimlo i'w bwrdd Cymru, ac rydyn ni'n deud o ôl sahneis iddo negorol aethro i'r bwrdd Cymru. Rhyw Godifirr solic�니다 gan y cydweithio gyda'r llwyddiadau, maes iawn i fi ddigon. Rhyw Godifirr scoedd y cwrdd ar gyfer y bwrdd Cymru i fi ddigonwyr ar gyfer y bwrdd Cymru, After that, there will be a voting period of one minute for the first division after a debate. Members who wish to speak in the debate on any group of amendments should press their request to sweet buttons as soon as possible after I call the group. Members should now refer to the marshaled list. Amendment 1, in the name of the cabinet secretary, grouped with amendments 42, 2, 3 and 4. Cabinet secretary, to move amendment 1 and speak to all amendments in the group. Thank you, Presiding Officer. I will speak to my amendments on the bill's guiding principles. Amendments 1 and 3 relate to amendments lodged by Mr Cole Hamilton during stage 2. The duty to ensure appropriate staffing in section 12IA already sets out that for the NHS. It is the duty of every health board and the agency to ensure that, at all times, suitably qualified and competent individuals are working in such numbers as are appropriate for the health, wellbeing and safety of patients and the provision of safe and high quality healthcare. There is an equivalent duty for any person who provides a care service in part 3 of the bill. Sections 2 and 3 of the bill set out that every health board in complying with section 12IA and any person who provides a care service in complying with section 6 of the bill must have regard to the guiding principles. As such, the principles and the general duty are intrinsically linked. Those who must follow the general duty must also have regard to the guiding principles in doing so. However, as is currently worded, a health board will be legally required to do the same thing twice. I do not want to avoid confusion for those who are expected to understand and carried out the duties set out in the bill and I would gently suggest that we do not need to put something in legal duties in triplicate in order for them to take effect. I therefore ask members to support my amendments, which aim to correct that. Amendment 2 is a technical amendment that aims to correct section 11B so that it references those main purposes rather than the main purpose. That shows that there are now two main purposes of staffing for health and care services following Monica Lennon's insertion at stage 2 of subsection 1A2 to ensure the best healthcare outcomes for service users. Amendment 4 is another technical amendment clarifying that the reference and the definition of standards and outcomes for service users to section 10A of the National Health Service Scotland Act 1978 refers specifically to subsection 1 of that section. That would be consistent with the specific reference to section 10A1 in section 12IB2B of the bill. I welcome Ms Lennon's amendment 42 and move amendment 1 and the others in my name. Amendment 42 seeks to clarify that one of the main purposes of staffing for those services is to ensure the best health or care outcomes for service users. The aim of my original amendments at stage 2 was to ensure that the guiding principles placed in necessary focus on achieving the best outcomes for service users in a position that we can all agree on. I have welcomed further discussions that I have taken place to enhance that principle. Amendment 42 ensures that not just health service providers but all care service providers, for example housing support services, are taken into account. I am very grateful to the Scottish Government for meeting with me after stage 2 to clarify those points and to signal the support of those benches to those amendments. Amendment 42, in the name of Monica Lennon, is agreed to. Amendment 42, in the name of Monica Lennon, is already agreed to. I call amendments 2, 3 and 4, all in the name of the cabinet secretary. Previously debated, I could invite the cabinet secretary to move on block. Does anyone object to a single question that has been put on all three amendments? No one does. Therefore, the question is that amendments 2 to 4 are agreed. Are we all agreed? We are agreed. We turn now to group 2, the commissioning of care services. Amendment 5, in the name of the cabinet secretary, is grouped with amendments 43 and 44. Cabinet secretary, to move amendment 5 and speak to all amendments in the group. Section 31 imposes a duty on care service providers to have regard to the guiding principles when carrying out the section 6 duty. Section 32 is then about the planning and commissioning aspect and when arrangements are being secured to get the care service delivered operationally by another person. The guiding principles already apply under section 32A, since commissioners already have to have regard to them under that provision. Amendment 32 clarifies that commissioners are also obliged to have regard to the fact that care service providers have to take those guiding principles into account as well. With that in mind, I would ask members to support my amendment to correct the existing aspect of this bill, which I believe in this amendment provides clarity needed to assist those that we need to understand and implement the legislation. I am also happy, Presiding Officer, to indicate my support for David Stewart's amendments 44 and 43 and move amendment 5. I call David Stewart to speak to amendment 43, 44 and the other amendment in the group. Thank you, Presiding Officer. I am speaking to amendments 43 and 44 in my name. At stage 1 of the bill, the committee heard from groups within the social care sector who were concerned that the bill placed all the focus on care providers and did not adequately recognise the impact that commissioning decisions about funding resources have on staffing levels. At stage 2, I therefore lodged an amendment seeking to place a duty on commissioners of care to ensure that providers were given appropriate resources under contract. That would have required them to take into account some of the factors that providers had to consider in setting staffing levels. Following some concerns from the Government and local authorities, I agreed to further discussions on how the same principles could be agreed. The product of the discussion is amendment 43 and the corresponding amendment 44. Amendment 43 would require local authorities and integration authorities to satisfy themselves prior to agreeing a contract for care that the contract of financial agreement will give adequate resources to providers to the provision of appropriate staffing levels. In doing so, they would have to consider for themselves the same factors that care service providers are required to take into account under the duty placed on them by section 6. Amendment 43 also includes provision for local authorities and integration authorities when determining providers that are given adequate resources what the impact of entering the contract would be on the totality of the resources, namely any impact on resources available for other services. It is my understanding, Presiding Officer, that the provisions would mean that no local authority or integration authority should enter a contract or financial arrangement for the provision of the care service, where they believe that such an arrangement would leave them short of resources for the delivery of other services to which they are responsible. The draft of the amendment came from Government. Before I move amendment 44, I want to ask the cabinet secretary what she understands the effect of the amendment will be. If she wishes to add any remarks up by way of conclusion. Local authorities should consider both paragraphs A and B of subsection 2B when planning or securing the provision of a care service. Subsection 2B requires local authorities when determining what constitutes adequate resources under subsection 2A to have regard to the factors listed in section 6A to C and to have regard to the effect of securing the contract, agreement or arrangements on the resources available for the provision of all other services including care services for which the local authority is responsible. That consideration would happen before finalising any contract and that provision does not prohibit the local authority from entering a particular contract. Both parties will enter the contract having agreed the terms and conditions of that contract. I think that we have all recognised the complexity and difficulty of finding a suitable provision on this issue. Should Mr Stewart on reflection believe that amendment 43 does not offer the improvement that he was seeking, I will not object should he wish to withdraw the amendment. In saying that, I wish to draw attention to members that the bill still provides that commissioners must have regard to the guiding principles and duties the bill places on providers in their planning and commissioning of services. I look at Mr Stewart, we would like to come back in. That is unusual, but yes, Mr Stewart. I thank the cabinet secretary for her answer. Under the bills that currently stands, commissioners must have regard to the duties on care providers and I am reluctant to see that undermined for that reason. With permission, I would like to withdraw both amendments 43 and 44. The amendments have not been moved, so there is no need to withdraw them. However, the point is noted. I encourage members that the way that groups would normally be managed is that the first amendment in the group gets a chance to speak. You then get one chance to speak after that on your amendments and all the amendments and then the mover of the first amendment gets to conclude. I am afraid that it is not possible to have interaction like that unless the cabinet secretary or somebody else is supposed to press and ask for a request to speak. However, I am flexible, so in this case it was fine. I have just explained the rules to make sure that you all know. The cabinet secretary to press or withdraw her amendment. I wish to press, thank you. Thank you very much. I have officials to keep me straight in the rules as well, as is quite clear. The question is that amendment 5 be agreed to. Are we all agreed? It is agreed. As we have already agreed, David Stewart is not going to move 43. Correct. Amendment 44, in the name to move or not move, is not moved by Mr Stewart. We turn to group 3, and this is the reporting on staffing by care services. Could I call amendment 6 in the name of the cabinet secretary, grouped with other amendments as shown in the groupings? If amendment 6 is agreed to, I cannot call amendments 45 and 46 due to preemption, the cabinet secretary to move amendment 6 and speak to all amendments in the group. I was pleased to have the support of all parties at stage 2 for effective reporting on the progress of the staffing approach. Effective planning of staffing will feed into and support workforce planning at local and national level. I particularly welcome Ms Lennon's focus on ensuring transparency around the challenges that are faced when carrying out the duties in the bill. Amendment 39 inserts a new section into part 3 of the bill, placing a duty on ministers to publish an annual report on staffing levels in care services, in particular on the numbers of specific health professionals working in such services. I am pleased to support amendments 45, 46, 39A, 39C and 39D in Ms Lennon's name and 39B in Ms Johnson's name. I note that Ms Lennon's amendment 46 would remove subsection 7 to 9 of section 3, and on that basis I am content that the reporting duty on local and integration authorities in subsection 6 of section 3 remains in the bill. When we have concluded the section, I will not press amendment 6 in my name. I have merely moved amendment 6 in order that we can get into that debate. I will ask the cabinet secretary to withdraw it later, but having moved amendment 6, I now call Monica Lennon to speak to amendment 45 and the other amendment in this group. At stage 2, I brought forward amendments with the aim of establishing reporting requirements on local authorities in relation to the duties in this bill, places on them as commissioners of care. Those amendments were intended to aid scrutiny of the new duties that the bill created regarding staffing levels. The cabinet secretary's amendment today moved reporting duties on care service staffing levels into part 3 of the bill. I welcome amendment 39 and the clarity that it gives on where information on care service staffing levels may be found. However, I remain of the opinion that some reporting should be required of local authorities and integration authorities as the bill still places on them specific duties. I was therefore going to ask members not to support amendment 6 in the cabinet secretary's name and, instead, to consider my amendments 45 and 46. Amendment 46 clarifies local authorities need to only make information on how they have complied with their duties publicly available. It recognises that local authorities are accountable to their local electorates. Amendment 45 removes the reporting duties on ministers, covered by the cabinet secretary's amendment, as well as removing detailed outcomes from reports, as that might not always be possible through commissioning structures. In addition, in this group, I have a number of amendments that are aimed to strengthen amendment 39A and 39D that ensure that the discharge of staff training requirements on providers under section 7 are also included in Scottish ministers' reports. That is important, as future staffing tools, mandated for use by the Scottish ministers, are likely to come with additional training requirements and the implementation of those should be captured within staffing reports. Finally, at stage 2, the cabinet secretary made clear that, given current commissioning structures, Scottish ministers do not directly contract with care providers and cannot therefore directly provide providers with certain funding. Despite that unsatisfactory position at stage 2, the cabinet secretary also stated that the Scottish Government has policy approaches that come with financial commitments such as a living wage. In some instances, it is a matter between the Scottish Government and those in receipt of funding such as local authorities as to whether the money is correctly passed on. Amendment 39C therefore requires ministers' reports to include information on the steps that they have taken to ensure that such money is passed on and that providers have access to funding to assist in the discharge of their duties under the bill. I am grateful to the cabinet secretary for her comments and clarity around amendment 6. It is not straightforward, but I will move amendment 6 in my name. Amendment 39B would require Scottish ministers to set out how the information contained within its annual reporting on care services will inform future workforce planning. At stage 2, a lodged an amendment would aim to ensure that the Government considered all relevant information available to it when it commissioned training places for those who worked in the care sector. We know that care homes now care for people with more complex illnesses than previously, including those who require palliative care and that there is a need for specialist input on aspects of care such as nutrition and hydration. My original amendment sought to ensure that we gave the same consideration to the care sector, which is clearly facing significant challenges, particularly at this time of integration and the focus on integration, as we are giving to ensuring that there are appropriate staff in the NHS. I did not press that amendment at stage 2 due to members' concerns that it was too prescriptive. However, it is absolutely essential—I know that we all agree—that we have appropriate and safe staffing levels in the care sector. Importantly, amendment 39B will ensure that Scottish ministers take account of the reporting established by amendment 39 on staffing in care services when determining the future supply of registered nurses and other health and care professionals. In closing, I will be voting for amendments 45 and 46, in the name of Monica Lennon, as I agree that local and integration authorities publishing the proposed information is still a worthwhile and useful endeavour. Having moved amendment 6 to allow debate on the group, I ask the cabinet secretary to wind up and to say whether she is pressing or withdrawing amendment 6. I am not pressing. The member wishes to withdraw amendment 6. Is that agreed? That is agreed. I call amendment 45, in the name of Monica Lennon, already debated. Monica Lennon to move or not move. That is moved. The question is that amendment 45 be agreed to. Are we all agreed? We are agreed. I call amendment 46, in the name of Monica Lennon already debated. Monica Lennon to move or not move. That is moved. The question is that amendment 46 be agreed to. Are we all agreed? We are agreed. We are going to turn now to group 4, which is the duty on health boards and care services to ensure appropriate staffing and staff wellbeing. I call amendment 7, in the name of Alex Cole-Hamilton, grouped with amendments 8, 9, 37 and 38. Alex Cole-Hamilton to move amendment 7 and speak to all amendments in the group. Thank you very much, Presiding Officer. It gives me pleasure to move the amendments in my name in the group and speak in support of all other amendments. I was gratified at stage 2 when members on the health committee passed amendments in my name, which expanded the scope of this bill, the definitions of safety that we use in this bill. Not unsurprisingly, when this bill was first drafted, it was done so with the safety of patients in mind. That should be the first starting point for any such legislation. During the stage 1 evidence, we were told a story that was very compelling about the situation on a mental health ward when the RCN phoned a charge nurse on duty that night and asked if they were safely staffed. They said that we were safe for the patients, but we were not safe for us. The point is that they operated on an attack response basis and they had insufficient staffing that night to protect each other should something have occurred. The point was that I, with the help of RCN, drafted amendments to increase the consideration of the safety of staff in this bill. Amendments were passed at stage 2. I was grateful to the Government for bringing to my attention that there were potential problems with the devolution settlement in that the original amendments passed at stage 2 straight into health and safety at work legislation, which is reserved. In working with the Government, we have constructed amendments 7 and 9 in my name, which retain absolutely the meaning of those original stage 2 amendments but recognise the nuances of the devolution settlement. I also would like to offer the support of the Liberal Democrats to all other amendments in this group. I thank Mr Cole Hamilton for taking the time to speak to me about the amendments that he inserted at stage 2. We share the view that the wellbeing of staff is of paramount importance and I welcome his amendments of 7, 9 and 37. My own amendments 8 and 38 are intended to remove the words and services from the general duties for health and for care services. Those words were inserted at stage 2, but they are unnecessary, as healthcare is already defined in section 12-IG as a service or in connection with the prevention diagnosis or treatment of illness. Care service is already defined in section 9, as a service mentioned in section 47-1 of the Public Services Reform Scotland Act 2010. Those words therefore create unnecessary duplication and I would ask members to support the amendments in my name and move amendments 8 and 38. No other member has asked to speak. Does Alex Cole-Hampton wish to wind up and to press or withdraw? Nothing further to add. I'll press. The question is, does amendment 7 be agreed to? Are we all agreed? Yes. We are agreed. The question is, does amendment 8 be agreed to? Are we all agreed? Yes. We are agreed. Amendment 9, in the name of Alex Cole-Hampton, is already debated. Alex Cole-Hampton, to move or not move, moved. That is moved. The question is, does amendment 9 be agreed to? Are we all agreed? Yes. We are agreed. We turn now to group 5, which is the duty on health boards to ensure appropriate staffing agency workers. I call amendment 47, in the name of Anas Sarwar, in a group on its own, Anas Sarwar, to speak to and move amendment 47. I move the amendment in my name. What this amendment seeks to do is pretty clear in terms of the words, is to ensure value for money in terms of for our health boards and NHS Scotland more widely. We have seen experiences where we are paying whole-time equivalent four times as much for agency staff as we are for NHS staff. What this bill would do, or amendment, would do, would at least set a principle of that caption, not go above 150 per cent of what a whole-time equivalent NHS salary would be. That still leaves protections for when emergency situations are required when health boards would have to employ people on agencies above this rate, but it does insert responsibility to publish the reasons why that has happened, the number of occasions that has happened and what the trends behind it are. It also includes ministerial responsibility to update why those situations have occurred. We have had very positive interaction with the Government over the course of first table in this amendment at stage 2 when I did not push it at committee stage, so we could have further interaction with the Cabinet Secretary. I am pleased with how that interaction has gone, and I hope that, given that we have accepted all of the Government's suggested amendments to our amendment, the Cabinet Secretary will support it today. I am grateful to Mr Sawa for working with me and my team on this amendment following stage 2. My belief remains that the bill, as amended, will drive the necessary changes in the way in which staffing decisions are made to reduce the use of agency staff. In developing and scrutinising the legislation, both the Government and Opposition members have considered the whole-system approach to staffing decisions. By that, I mean that we have looked beyond the evidence-based staffing tools and methodologies and considered how decisions are taken at every level of the organisation. It has also been a focus on how those decisions are fed back to the staff who have informed them. That is why I, Miles Briggs, David Stewart and others have put a significant amount of effort into working with our stakeholders to finalise the provisions on real-time assessment of staffing, escalation processes and appropriate clinical advice. It is this system of effective and informed governance that will drive the changes that we all wish to see. By ensuring that staffing decisions are taken based on workload and taken into account appropriate clinical evidence, we will move towards the appointment of a sustainable staffing establishment. It will also ensure that, if agency staff are used, it is part of an appropriate risk mitigation approach. However, I can absolutely appreciate the intention behind Mr Sarwar's amendment and I thank him again for taking the time to discuss it further with me. I think that there are some difficulties with the drafting of the amendment and the requirements on boards that could be considered to be ambiguous. However, I believe that those can be clarified in the statutory guidance that will accompany the bill. In this instance, it is my view that the value of the intention outweighs those points and I am therefore happy to support the amendment. No other member has asked to speak. I therefore ask Mr Sarwar to wind up and to press or withdraw the amendment. Just to say that I welcome all the content of the cabinet secretary's response, I think that we both have the exact same intention and therefore I welcome her support for the amendment. I am happy to move. The question is that amendment 47 be agreed to. Are we all agreed? We are agreed. We turn to group 6, staffing assessment and risk escalation by health boards. Could I call amendment 10, in the name of the cabinet secretary, grouped with other amendments as shown in the groupings? Cabinet secretary, to move amendment 10 and to speak to all the amendments in the group. I welcome all the amendments lodged by Mr Briggs and Mr Stewart in this group and I want to thank them for their collaborative work on those provisions in particular. I would also like to thank the members of the escalation working group who have put a significant amount of effort into ensuring those provisions work for all staff groups and across our healthcare system. My own amendments are fairly technical in nature. Amendment 10 inserts a word safe into the subsection 12A2A2 so that it is consistent with the wording in the general duty for health following the addition of this wording by Mr Cole Hamilton at stage 2. Amendment 11 inserts reference to the new paragraph added through David Stewart's amendment 59 into the list of those staff members who must be notified of every decision made in relation to risk so that all those who have been involved in attempting to reach a decision on the mitigation of a risk under this section should be notified of the final decision reached and should have the opportunity to record disagreement with that decision if they wish. Similarly, amendment 12 inserts reference to new subsection into section 12A2A2D4 so that those who have provided clinical advice in any part of the procedures put in place under this section should be notified of the decision reached and again should have the opportunity to record disagreement with that decision if they wish. Amendment 20 inserts a word safe into the subsection 12A2A2 so that it is consistent with the general duty for health following the addition of the new paragraph added through David Stewart at stage 2. Amendment 12 inserts reference to the new paragraph added through David Stewart at stage 2. 63, 12 IAD, the duty to ensure adequate time given to clinical leaders being inserted by my own amendment 18, and 12 IAE, the duty to ensure appropriate staffing training of staff which was inserted at stage 2 by Ms Johnson. That will ensure that health boards and the agency must include information on their compliance with these duties in the reports that they are to provide to ministers on an annual basis. Finally, amendment 23 sets out that ministers can issue guidance under section 12 IF on the new duty to have arrangements to address severe and recurrent risks imposed by the new section 12 IABA. All that said, Presiding Officer, I move amendment 10 and the others in my name. Thank you very much. I called David Stewart to speak to amendment 48 and the other amendment in the group. Thank you, Presiding Officer, and I start by thanking the Cabinet Secretary for the very helpful meetings that we had about planning the amendments to ensure that we have a stronger bill. Presiding Officer, the Royal College of Nursing and I welcome them to the gallery today. I have made it clear from the start of the bill that it will only be effective if it deals with how to manage day-to-day staffing levels, not just with setting expected staffing establishments. For that reason, I was glad to see the introduction of provision for risk management and escalation by the Government at stage 2. Many of my amendments, namely 48 to 51 and 53 to 60, make only minor changes to the successful provisions from stage 2. The purpose of those amendments are purely technical in strengthening the risk assessment and escalation processes that have been established. To that end, Presiding Officer, I will speak to them group by purpose rather than Cronol Llywodraer. 48 ensures that any risk assessment procedure includes a method by which staff members may notify responsible individuals of the possible risk of closing a potential gap in procedures as they currently exist. Amendments 49, 53 and 54 alter the precise definition of the individuals and management structures involved in the process so that non-clinical managers who make and who bear responsibility for staffing levels can be included in the procedure. Having said that, the role of clinical experience in the advice and staffing decisions cannot be overlooked. It is therefore protected by amendment 55 and 57, which then put a requirement on decision-making individuals within the structure to seek and have regard to clinical advice. Amendments 56 and 58 empower the individuals who are involved to take decisions on how to mitigate any risk that is identified and escalated. Amendment 59 then allows for the escalation of any risk at the management chain as necessary potentially up to board level itself. Amendment 60 ensures that there is an opportunity in process by which individuals may request review of a decision on risk should they be concerned or dissatisfied by the final outcome. Obviously, risk assessment and notification procedures are only of use if staff are aware of them and that they can be utilised. For that reason, amendment 51 requires health boards to proactively encourage unenabled staff to make use of the procedures. In the same vein, I can confirm that we are supportive of amendment 52 and 61, lodged by Miles Briggs, which similarly ensures that staff are equipped to use the procedure. Finally, amendment 62 in my name seeks not to alter but to add to provisions that are ready in place. As much as real-time success and escalation are important, it is crucial that they are not used purely for an on-ground firefighting. Health boards and those who scrutinise them should be able to have an overview of the risks and their staffing levels, especially if those risks are substantial and are likely to reoccur. When we have long-standing vacancies across a number of key posts in our health services, day-to-day assessment and mitigation will not be satisfactory or sufficient. Amendment 62 therefore establishes a requirement for health boards to keep a record of the most significant and potentially reoccur in risks, as well as to put in place a plan for how they will be managed. The majority of health boards already have such a similar process in place for risk for staffing. The amendment really makes the requirement clear and should preside a mechanism for linking the situation that staff have to deal with on-the-ground to higher-level monitoring and planning. I move amendments 48 to 51, 53 to 60 and 62, all in my name. I thank you very much, and I call Miles Briggs, to speak to amendment 52 and the other amendments in this group. I move amendments in my name. Amendment 52 relates back to my stage 2 amendment 105. However, unlike that amendment, it takes account of the fact that only those individuals with lead professional responsibility will be responsible for carrying out the staffing assessment procedures, so it sets out that those individuals are to be given the training and resources necessary to carry out those procedures. Similarly, amendment 61 sets out that individuals with lead professional responsibility and other senior decision makers are to be given the training, time and resources necessary as well to carry out the risk escalation procedures, detailed in section 1 to IAB. I ask members to support both amendments in my name. Thank you very much, and there is no one else we should speak to. I call on the cabinet secretary to wind up and to pressure withdraw her own amendment. Nothing further, Presiding Officer, and I will press. Thank you very much. The question is that amendment 10 be agreed to. Are we all agreed? We are agreed. I call amendment 48, already moved by David Stewart. The question is that amendment 48 be agreed to. Are we all agreed? Yes. We are agreed. I call amendment 49, in the name of David Stewart, already debated. I think that it is already moved as well. The question is that amendment 49 be agreed to. Are we all agreed? Yes. We are agreed. I call amendment 50, in the name of David Stewart, already debated. Already moved. The question is that amendment 50 be agreed to. Are we all agreed? Yes. We are agreed. I call amendment 51, in the name of David Stewart, already debated. I have moved. The question is that amendment 51 be agreed to. Are we all agreed? Arly munnwgonol? Arly munnwgonol, 52 yn y mae Gw buriedol yn ddefteg. Arly munnwgonol, 52 Gefadol yn ddefteg. Arly munnwgonol, 53 yn ddeftat favourite arlaedd. Onw niam i chi Swetden turfodd? Onw niam i chi Swetden turfodd maen nhw bron drivern i chi Mai— Oprysieic geoes terribly na end Didol Cross, onw nada ni i chi siwg y parそれ. Amendment 56, in the name of David Stewart, to move or not move? Move, Presiding Officer. Thank you. The question is that amendment 56 be agreed to. Are we all agreed? We are agreed. Amendment 57, 58 and 59, in the name of David Stewart, to move or not move? Move, Presiding Officer. That is moved. I put the question amendments 57, 58 and 59 on block. Does any object on objects? Amendment 57, 58 and 59 be agreed to. Are we all agreed? Yes. We are agreed. Amendment 11, in the name of the cabinet secretary, to move formally. The question is that amendment 11 be agreed to. Are we all agreed? Yes. The question is that amendment 12 be agreed to. Are we all agreed? Yes. Amendment 60 in the name of David Stewart, to move or not move? The movement is, the question is whether the amendment has to be agreed to. That is the gerçek question that has to agreed to. TheEveryone— I see a few yes many questions, one with a counterorderal link but I know the line which lies out in a matter to address people who have been doctrine on the third amendment which has raised ideas, the first amendment which has been critived by inclusion workers, has placed an impact on others the fact that there is significant��af respect for people with adultlag amol, ond wrth y bydd iawn i tri ddonitiedig numf filedyddencer, drafodwch wedi gafodg gyweddaron cwr�u divine electronics, yani a gyda cynomu h habil o hyf Breathe, ond sef yn dech Dynasty themart wedi cael ei Nikki Gwyn Hyfford-Eau. 맛있wyr yma i gy afraidathol yn dengen lawer o'r unrhyw hнего raisedd Ysdegwchor mewn meddwl y ddialeildr Llywodraeth y Llywodraeth 8 a 8b, dim i mid a mas hefyd ac yma breakfast ar h degrees foundations of accessory. Felly,ああr MiGB A. is an alternative to the amendment 1 2 3, which I lodged and then withdrew at stage 2 on the role of the designated person. I have now had a number of discussions with the cabinet secretary to agree an alternative approach to ensure that the bill captures the crucial role to clinical advice in relation to decisions made by the board on the various duties placed on them by this bill. Amendment 63, rather than designating a person, places health boards under a duty to put arrangements in place to ensure that clinical advice is sought in relation to staffing decisions and any arrangements that they put in place in relation to staffing, such as the development of a risk escalation process under section 12 IAB and that they have this in regard to the any advice. Where a board makes a staffing decision that goes against clinical advice, this must be noted and those who provide advice informed. Boards must also identify any risk which may arise as a result of this decision and take appropriate action to mitigate them. There is also provision for an internal reporting procedure, which is an important element in relation to both board transparency and accountability. Senior clinical professionals would report to the members of the board at least quarterly on the extent to which, in their view, the board is complying with the duties placed on them by this bill. The inclusion of at least will allow them to submit reports to the board at any time if they feel that the board is not meeting the duties placed on them by the bill. I therefore ask members to support this alternative approach and I move amendment 63. Thank you very much. I call on the cabinet secretary to speak to amendment 18, another amendment in this group. Thank you, Presiding Officer. Can I start again by expressing my gratitude to Mr Briggs for working with me following the stage 2 proceedings amendment 63? As he says, he seeks to amend the bill by placing health boards under a duty to put arrangements in place to ensure that clinical advice is sought from senior clinical professionals by health boards and that they must have regard to this advice in reaching any decision on staffing. I agree with Mr Briggs on the importance of ensuring that the professional voice is heard and that this is already woven throughout the bill. However, I believe that amendment 63 strengthens this and is the appropriate way to ensure that health boards must seek that professional advice while ensuring that the accountability for decisions remains with the board. I am therefore happy to support amendment 63. Amendment 18 in my name removes and replaces section 12 IAD. I fully recognise the unique role of the senior charge in us and agree that it is important that this is protected. However, I do not believe that the existing wording of section 12 IAD, which does not take account of the multidisciplinary teams or allow for flexibility regarding the size of the team and the service delivery model, is the best way to achieve that. It is not always appropriate to require health boards to make all senior charge nurses 100 per cent non-caseload holding. One example of many would be on the Shetland Isles, where there are a number of community nursing teams spread over the islands that have between two and eight staff in each. There are currently two senior charge nurses providing clinical leadership across all of those teams. As currently drafted, section 12 IAD would not allow for this model and would require a senior nurse in each team to be 100 per cent non-caseload holding and for each of those nurses to be backfilled. That is not sustainable and would not allow health boards to develop models of care that suit their local needs and their patients. Because the definition of caseload holding is tied to the wider requirement to meet patient needs and not to the more specific requirement to provide direct patient care, I do not believe that it delivers the intention of ensuring that senior charge nurses have protected time to fulfil their clinical leadership role. I imagine that it would be very difficult for boards to identify senior nurses who were not required to meet patient needs. I am also aware of concerns among stakeholders that a requirement for a fully non-caseload holding senior nurse in every rostered location could have the unintended consequence of diverting resources away from other clinical team leaders. For those reasons, I believe that it is essential that we replace the existing section 12 IAD with a provision that works in all clinical settings. I have therefore worked with Ms Johnson and stakeholders from a number of professional groups to develop an amendment that applies not just to senior charge nurses but to whomever the appropriate clinical team leader is for a team of staff, be that a midwife, allied health professional, nurse or doctor. Amendment 18 recognises the unique roles and responsibilities of all clinical team leaders and ensures that they receive adequate time to discharge that responsibility and their other professional duties. That provides flexibility for the appropriate amount of time to be allocated depending on the local context, the size and nature of the team and healthcare setting. I ask members to support amendment 18. I am content with Ms Johnson's amendments to amendment 18, and I welcome her support for it. In a call, Alison Johnstone, to speak to amendment 18A and the other amendments in the group. Thank you. Amendments 18A and 18B have come about as a result of discussion with the Royal College of Nursing, allied health professionals, the Royal College of Midwives and the Government. At stage 2, as you have heard, I was successful in amending the bill to ensure that senior charge nurses had the time that they needed to carry out their important clinical leadership roles. The results of a freedom of information request to NHS boards from the Royal College of Nursing show that, of the 911 whole-time equivalent senior charge nurses identified in September 2017, only 115 were non-case load holding. I have listened to what the cabinet secretary has said, and I am sure that she will agree that there are many occasions when it is entirely appropriate for senior charge nurses to be non-case load holding, and we must make sure that that is the case where it is appropriate. I am pleased that we have now reached a proposal that all healthcare professionals are content with, but I was pleased to push my earlier amendment at stage 2, because nurses make up 42 per cent off the NHS workforce. My amendments have now been welcomed by nurses, midwives and allied health professionals, as we have heard, and they seek to make absolutely sure that all lead professionals have the sufficient time and the resources that they require to carry out that role and that their leadership role is fully recognised. amendment 18A seeks to amend amendment 18A. It would ensure that clinical leaders have the resources that they require, as well as the time to satisfactorily discharge their leadership responsibilities. Amendment 18B similarly seeks to amend amendment 18A and would clarify that clinical leaders need sufficient time to lead the delivery of healthcare, as arguably all healthcare professionals and staff contribute to its delivery. No other member wishes to speak or has asked to speak. I will call on Miles Briggs to wind up in this group and to press or withdraw amendment 63. I would like to press both amendments. Thank you very much. The question therefore is that amendment 63 be agreed to. Are we all agreed? We are agreed. I will return now to group 8, to the duty on health boards to ensure appropriate staffing, numbers and training of healthcare professionals. Could I call amendment 13, in the name of Alison Johnstone, grouped with amendments 15, 17 and 19? Alison Johnstone, to move amendment 13 and to speak to all amendments in the group. Section 12 IAC ensures that enough student places are offered to train a workforce that will better ensure that we deliver the healthcare that will meet Scotland's changing needs. Amendment 13 acknowledges that there are factors outwith ministers control, but still requires ministers to take all reasonable steps to ensure that there are sufficient numbers of registered healthcare professionals. Amendment 15 adds a stipulation that Scottish ministers must take into account variation in staffing needs caused by differences in geographical areas. The healthcare needs of rural populations often differ greatly from those of more urban communities. Our rural and island boards face particular challenges around recruitment and retention, and this amendment will ensure that Scottish ministers have regard to rural specific issues in their determinations. Amendment 17 clarifies what is expected of Scottish ministers in reporting to Parliament on those provisions in setting out the extent to which ministers compliance with the duty on supply in section 12 IAC has enabled health boards to comply with their own duty to ensure appropriate staffing under section 12 IA. Section 12 IAE places a duty on NHS boards to ensure that employees receive the time to carry out continuing professional development. NHS governance standards already state that employers will give time to staff for CPD, but, as we are all too well aware, that time is often lost because of the demands on staff and their time. Amendment 19 would ensure that employees will receive sufficient time and resources to undertake training, but will allow health boards to take a reasonable approach to determining what is appropriate training and resourcing. Thank you very much. Again, no one has asked to speak in the group, Cabinet Secretary. Thank you, Presiding Officer. I welcome the amendments from Ms Johnson. I am grateful to her that we were able to work on them. In particular, I am pleased with the recognition of the open-ended nature of section 12 IAE, which was inserted by her amendment at stage 2. However, now her amendment 13 will ensure that health boards must ensure appropriate time for training, subject to ensuring continuity of staff and high-quality services, and I offer my support to the amendments in her name. I am content with the debate that we have had, Presiding Officer, and I would like to move amendment 13. The question therefore is that amendment 13 be agreed to. Are we all agreed? We are agreed. We are going to turn now to group 9, application of duties and bills to special health boards. Could I call amendment 14 in the name of the cabinet secretary, grouped with the other amendments as shown in the grouping, and the cabinet secretary to move amendment 14 and to speak to all the amendments in the group? Thank you, Presiding Officer. Section 12 IAC, which places a duty on Scottish ministers to ensure sufficient numbers of staff are available to every geographical health board and the common services agency to enable them to comply with the general duty, was inserted at section 2 by Ms Johnson. My amendments 14 and 16 ensure that the duty also applies to clinical-facing special health boards, meaning the state hospital board for Scotland, the Scottish Ambulance Service NHS 24, and the national waiting time centre board. Amendments 24 to 35 ensure that the new sections, which are being inserted through stage 3 amendments, along with the section 12 IAE on the training of staff, also apply to those special health boards. With that said, I move amendment 14 and the others in my name. Thank you very much. There are no other requests to speak, so we are going to go straight to the question. The question is whether amendment 14 will be agreed to. Are we all agreed? Yes. We are agreed. Could I call amendment 15, already in the name of Alison Johnstone, already debated Alison Johnstone to move or not move? Move. That is moved. The question is whether amendment 15 will be agreed to. Are we all agreed? Yes. We are agreed. Could I call amendment 16, in the name of the cabinet secretary, to move? Move. Thank you. The question is whether amendment 16 will be agreed to. Are we all agreed? We are. I call amendment 17, in the name of Alison Johnstone, already debated Alison Johnstone to move or not move? Move. That is moved. The question is whether amendment 17 will be agreed to. Are we all agreed? Yes. We are. I call amendment 18, in the name of the cabinet secretary, to move formally. Move formally. Thank you. I now call amendment 18A, in the name of Alison Johnstone, already debated Alison Johnstone to move or not move? Move. That is moved. So the question is whether amendment 18A will be agreed to or are we all agreed? Yes. We are agreed. Could I call amendment 18B, in the name of Alison Johnstone, Alison Johnstone to move or not move? Move. That is moved. The question is whether amendment 18B will be agreed to. Are we all agreed? Yes. We are agreed. Cabinet secretary, to press or withdraw amendment 18, as amended? Press. Pressed. The question is whether amendment 18, as amended, be agreed to. Are we all agreed? Yes. We are agreed. I call amendment 19, in the name of Alison Johnstone, already debated. Alison Johnstone to move or not move? Move. That is moved. The question is whether amendment 19, be agreed to. Are we all agreed? Yes. We are agreed. We turn now to group 10, the duty to follow common staffing method for healthcare. Could I call amendment 64, in the name of Miles Briggs, grouped with amendments 65 to 69, 21 and 22. Miles Briggs to move amendment 64 and to speak to all amendments in the group. Thank you, Presiding Officer. Having met further with the cabinet secretary to discuss amendments placed in the bill during stage 2, her skills of persuasion has persuaded me that some further amendment is required in section 12ib to make it clear that setting the staffing establishment is not the only purpose of the common staffing method and to avoid any duplication that might cause confusion among those responsible for carrying out the method. I was clear at stage 2 that it was never my intention to prevent the common staffing method being used for other purposes, such as supporting the redesign of services. With that in mind, amendments 64, 68 and 69 remove subsections 12ib, 1A and 1B, which were placed in the bill as an amendment of mine at stage 2. Instead, alter the subsection 12ib to state that, having followed the steps in the common staffing method, the health board is to decide what changes, if any, are needed as a result of its staffing establishment and the way in which it provides healthcare. A definition of the term staffing establishment is provided. Amendment 65 clarifies that the measures for monitoring and improving the quality of healthcare that are published as standards and outcomes under section 10h1 by the Scottish ministers and which are to be taken account of as part of the common staffing method include any measures developed as part of the national care assurance framework. Amendment 67 makes a minor change to the common staffing method. At stage 2, I lodged an amendment passed by committee which added a new step in the common staffing method requiring health boards to take account of experience of using the real-time assessment and risk escalation processes in section 12IAA and 12IAB. It seems to me that the new link's duty to have arrangements in place to address severe and recurrent risks put forward by David Stewart in his amendment 62, which we have already debated today, should also be included in this step in the common staffing method. Amendment 67 therefore adds into this step as a reference in section 12IAAB. Therefore, I ask members to support all my amendments on amendment 64. Thank you very much. I call David Stewart to speak to amendment 66 and the other amendments in this group. Thank you, Presiding Officer. In this group, I have only one minor amendment. At stage 2, there were a number of additions and alterations to the bill in order to make explicit and protect its multidisciplinary nature. Staff groups of which there is not yet a staffing tool has expressed concern that use of the existing tools might draw resources away from other staff groups and unintended consequences of not yet having multidisciplinary tools in place. At stage 2, I therefore brought forward an amendment that would require the impact on other staff groups to be taken into account using the common staffing method in establishment staffing levels. Amendment 66, in my name today, seeks only to alter the wording of the addition. The language of the bill refers to tools that should be used for different types of healthcare, rather than for different types of professions. Amendment 66 therefore changes the wording of my stage 2 addition to reflect us. The original purpose remains the same. Nearly the delivery services of which the staffing tool does not yet exist should be overlooked and understaffed by appropriate professionals so that statutory establishments can be met elsewhere. Presiding Officer, I move amendment 66, in my name. Thank you very much. I call the cabinet secretary to speak to amendment 21. Can I start by saying that I am pleased to offer my full support to Mr Briggs amendments 64, 68 and 69? Amendment 22 is consequential to Mr Briggs amendment 68 in that it amends the word staffing levels in section 12if ministerial guidance on staffing to staffing establishment for the purposes of consistency. Amendment 21 is a technical amendment to clarify that guidance may cover a step in the common staffing method that was inserted at stage 2. I support Mr Briggs amendments 65 and 67 and Mr Stewart's amendment 66, which provide helpful clarifications to the common staffing method set out in 12ib and move the amendment in my name. Thank you very much. And again, no-one has asked to speak, so Miles Briggs to wind up in this group and to press or withdraw amendment 64. Nothing further to add, Presiding Officer, and I move amendment 64. Thank you very much. The question is that amendment 64 be agreed to. Are we all agreed? Yes. We are agreed. I call amendment 65, in the name of Miles Briggs, already debated. Miles Briggs to move or not moved. That is moved. The question is that amendment 65 be agreed to. Are we all agreed? Yes. We are agreed. I call amendment 66, in the name of David Stewart, already debated. David Stewart to move or not move. Move, Presiding Officer. Thank you very much. The question is that amendment 66 be agreed to. Are we all agreed? Yes. We are agreed. I call amendment 67, in the name of Miles Briggs, already debated. Miles Briggs to move or not move. Moved. Thank you. The question is that amendment 67, in the name of Miles Briggs, be agreed to. Are we all agreed? Yes. We are agreed. I call amendment 68, in the name of Miles Briggs, Miles Briggs to move or not move. Moved. That is moved. The question is that amendment 68 be agreed to. Rwy'n dechrau. Rwy'n dechrau. I call amendment 69, in the name of Miles Briggs, already debated. Miles Briggs, to move or not move. Thank you very much. The question is that amendment 69 be agreed to. Rwy'n dechrau. We are agreed. I call amendments 20 to 35, all in the name of the cabinet secretary, and all previously debated. Could I invite the cabinet secretary to move amendments 20 to 35 on block? Moved on block. Thank you very much. Does any member object of a single question be put on amendments 20 to 35? No, that's good. The question therefore is that amendments 20 to 35 are agreed to. Are we all agreed? Yes. We are agreed. And we turn now to group 11, the role of healthcare improvement Scotland. I call amendment 36, in the name of the cabinet secretary, grouped with amendment 70. Cabinet secretary, to move amendment 36 and speak to both amendments in the group. Thank you, Presiding Officer. My amendment 36 is a technical amendment that adds to the list at section 12 IH, which is the list of duties that healthcare improvement Scotland must monitor the discharge of by every health board, relevant special health board and common services agency. That ensures that his will have oversight of the discharge of every aspect of this legislation by health boards. Having worked with Mr Briggs ahead of today, I am also happy to support amendment 70 in his name and move amendment 36. Thank you very much. I call on Miles Briggs to speak to amendment 70 and the other amendment in this group. Thank you, Presiding Officer. I have since stage 2 had helpful discussions with the cabinet secretary around how staffing tools in the health service will be reviewed and developed by healthcare improvement Scotland and what evidence and guidance they will take into account whilst doing so. I therefore hope that my amendment 70 reflects that and ensures that the development of staffing tools and methods continues to be based on the best available professional guidance and clinical evidence. Therefore, on that basis, I ask members to support it today. Thank you very much. No one else wishes to speak in this group. Cabinet secretary, do you wish to end the comments to wind up? Nothing further, thank you. The question is that amendment 36 be agreed to. Are we agreed? We are agreed and I call amendment 70 in the name of Miles Briggs. Miles Briggs to move or not move. Moved. That is moved. The question is that the amendment 71 be agreed to. Are we all agreed? We are agreed. I call amendment 37 in the name of Alex Cole Hamilton, who was already debated, Alex Cole Hamilton to move or not move. Moved. That is moved. The question is that amendment 87 be agreed to. Are we all agreed? We are agreed. I call the amendment 38 in the name of the cabinet secretary to move formally. Move formally. Thank you. The question is that amendment 38 be agreed to. Are we all agreed? We turn now to group 12, care services, employment rights of staff, and a call amendment 71 in the name of Monica Lennon grouped with amendments 72 to 78. Monica Lennon to move amendment 71 and to speak to all amendments in the group. Thank you, Presiding Officer. In February this year, the Fair Work Convention's report into Fair Work in Scotland social care sector found that the social care sector was not consistently delivering fair work, and that its ability to do so was hindered by the current funding and commissioning structures. We know that the bill, as it stands, will not produce the additional caring staff that Scotland needs, but Scottish Labour believes that improving conditions within the sector would be a key step to addressing the social care challenges that Scotland currently faces. Section 7 of the bill requires care providers to provide their staff with appropriate training for their jobs and suitable assistance in completing that training. Those provisions are an encouraging recognition of the need to better support care service workers. The guiding principles of staffing found in section 1 of the bill contain the provision that staffing should be arranged to ensure the wellbeing of staff. Amendment 71 to 78 in my name would add to those provisions along the principles of fair work. There is no definition of wellbeing within the bill, but I would argue that my amendments go some way toward defining the standards that wellbeing requires. The amendments would see care service workers properly reimbursed for costs incurred through the course of their work, be it uniform and clothing costs, travel costs for journeys between service visits, fees for necessary professional registrations or the costs of any training workers must undergo. It is not acceptable that staff are still required to pay out of their own pockets for such items. Amendment 75 would place on a statutory footing the Scottish Government's current policy commitment for care service workers to be paid a living wage. Amendment 77 provides a definition for such a living wage using language lifted straight out of the Scottish Government's own procurement reform Scotland Act 2006. Amendment 76 and the consequential amendment 78 would ensure that care service workers are given contracts with clearly defined hours, giving them the security that a zero-air contract can never offer. The bill acknowledges that staffing is essential to the delivery of safe and high-quality health and care services. Those amendments are in line with that principle. The social care that service users want and need cannot be delivered by staff that are overworked, stressed, struggling to get by and at risk of burnout. I know that the cabinet secretary understands and agrees with that sentiment. I believe that my amendments would give Scottish workers and care services a guarantee of fair work. Since lodging the amendments last week, a number of organisations have expressed to me and colleagues that they think that such standards should definitely be in place. However, I have appreciated the opportunity to discuss with the cabinet secretary and her officials those amendments. I have taken on board the concerns that they have raised that some of those amendments fall outside the legislative competence of this Parliament. However, in our discussions, the cabinet secretary has confirmed that she is supportive of the principle that those amendments aim to achieve. I know that many others in this chamber also concur with that. I am not clear as to how my amendments would substantially differ from the apparent workers' rights within section 1 and 7 provisions. However, I acknowledge the Scottish Government's concern, and I do not want this debate to become about one legal opinion against another, because there is so much in this bill that we can and have already supported. As an alternative, the cabinet secretary has indicated to me that she will ensure that guidance accompanying the bill will make clear that those standards of fair work are to be followed in the delivery of care services. If the cabinet secretary is willing to make a clear commitment to the chamber today that those standards of fair work for social care and commit to guidance alongside the bill to follow those fair work practices in care, commissioning and delivery, I will be content not to move those amendments. I was not sure if the cabinet secretary was going to come in at that point there. At the moment, if I have that commitment, I am hoping to have it. I will not press the— Can I suggest to Mark Llywman that she move the amendment and then, if the cabinet secretary in a response agrees, you can withdraw the amendment? Yes. I am happy to do so. On that basis, I move the amendments in my name. Thank you very much, Presiding Officer. My colleagues will remember the case of my constituent, George Ballantyne, who spent 150 nights in the Liberton hospital after he was declared fit to go home. That was due in part to a deficiency in availability of social care provision in Edinburgh. There is a crisis in social care in this nation's capital, and, as such, I am compelled by Monica Lennon's arguments that we need to do more to recognise fair work in the social care sector. We need to make it an attractive profession for people to choose from the early days of primary school and direct their careers forthwith. Unless we start to make changes like this, we will reap the whirlwind in terms of that crisis in our social care sector. I am happy to support Monica Lennon's amendments. Obviously, if she does not move them, I too would like to see the commitment from the cabinet secretary to see the addressing guidance behind the bill. I call on the cabinet secretary. Thank you very much, Presiding Officer. Let me begin by welcoming the intention behind those amendments from Ms Lennon. As a Government, we have done what we can within the powers of this Parliament to encourage every organisation, regardless of size, sector or location, to ensure that all staff receive a fair level of pay and where possible pay the real living wage. We are committed to fair work, payment of the real living wage and becoming accredited can make a real difference to the lives of people working in Scotland. It benefits the economy and sends a positive signal to the wider community, and I completely accept that it is also an important factor in the recruitment and retention of staff in this very important sector. We have and continue to condemn the use of exploitative business practice and, as members are aware, our fair work action plan, developed with the STUC, was published in February of this year. However, for as long as employment law remains reserved to the UK Parliament, we are restricted in the next steps that many of us in this chamber would want to take. What that means is that the amendments from Ms Lennon are strictly out with the competence of this Parliament, and nonetheless, we have demonstrated that, regardless of that barrier, we will push for changes. I am grateful to Ms Lennon not only for bringing those amendments, but for indicating her intention not to press them, providing the assurance that I can give her is satisfactory. I believe that, if those amendments were passed, it would be inevitable that the entire piece of legislation would be referred to the UK Supreme Court because we have strayed into reserved areas. I know that there is no one in this chamber who absolutely supports what this legislation is intended to achieve for our staff in health and social care who would wish that to happen. I am more than content to offer Ms Lennon the assurance that the fair work principles that are set out in her amendments will be included in the guidance that supports the implementation of the legislation, that I will be returning to the health committee with that draft guidance to ensure that they have the opportunity to be consulted upon, as with other matters in relation to the guidance. I hope that that assurance is enough for Ms Lennon and that it would urge her not to press her amendments, but to work with me once we come to constructing the guidance. I thank Alex Cole-Hamilton and the Scottish Liberal Democrats for their support on the matter. I think that, across the chamber, there has been support. Building on the constructive talks that I have had with the cabinet secretary and the remarks that she has just made, I strongly welcome her strong commitment and strong assurance. I look forward to the guidance coming before the Health and Sport Committee, and I am sure that colleagues there will do a very good job to make sure that the guidance fully takes on board at the points that were made by the amendments. I appreciate the cabinet secretary's commitment on that. I am withdrawing the amendments in my hand. Thank you very much. The question is that the amendment is to be withdrawn. Are we agreed? We are agreed. I confirm with Ms Lennon that she does not wish to move amendments 72, 73, 74, 75, 76, 77 and 78. Not moved? Not moved. No other member wishes to move any of those amendments. Therefore, those amendments are not moved. Amendment 38, in the name of the cabinet secretary, is already debated with amendment 6. Amendment 39, in the name of the cabinet secretary, is already debated with amendment 6. Amendment 39, in the name of Monica Lennon, is already debated with amendment 6. That is moved. The question is that amendment 39A be agreed to. Are we all agreed? We are agreed. I call amendment 39B, in the name of Alison Johnstone, to move or not to move. The question is that amendment 39B be agreed to. Are we all agreed? We are agreed. I call amendment 39C, in the name of Monica Lennon, to move or not to move. That is moved. The question is that amendment 39C be agreed to. Are we all agreed? We are agreed. I call amendment 39D, in the name of Monica Lennon, to move or not to move. The question is that amendment 39D be agreed to. Are we all agreed? We are agreed. The cabinet secretary pressed or withdraw amendment 39 as amended. The question is that amendment 39 as amended be agreed to. Are we all agreed? We are agreed. We turn now to group 13, staffing methods for care services. I call amendment 79, in the name of David Stewart, grouped with amendments 80, 81, 82, 40 and 41. I call David Stewart to move amendment 79 and speak to all amendments in the group. Thank you, Presiding Officer. The amendments in this group all relate to the staffing tools that may be developed in the future for the care sector. If I may touch firstly and briefly on amendments 80 to 82, which have been lodged by Miles Briggs, which seek to ensure that the development of such tools take into account professional and clinical guidance, as well as any accepted care indicators, seems to me to be both sensible and appropriate. Amendment 79, in my name, seeks to establish some policy with health services and part 2 of the bill. As we have already discussed today in health services, it is crucial that risks to staffing levels can be identified, appropriately escalated and mitigated. The same also applies to social care services. I recognise that the social care sector, unlike the health service, is made up of a range of providers who vary in size and the type of service that they deliver. For this reason, it is not appropriate to set down in primary legislation precise procedures that all must establish and follow with regard to staffing risks, as has been done in part 2 of the bill. The different staffing management structures across the care sector make it unlikely, and it would be possible to craft a process, even in general terms, that would work for everyone. Amendment 79 therefore includes the option for risk management guidance to be built into staffing tools that are developed for care services. Importantly, the wording of the amendment allows for flexibility in how such risk management procedures could be developed for differing care services. I move amendment 79 in my name. Miles Briggs, to speak to amendment 80 and the other amendment in this group. Amendment 80 relates back to amendment 122, which I withdrew at stage 2. As is the case with staffing methods in health, I believe that it is crucial that the professional voice is at the core of staffing methods in care. In recognition of the diversity of staff groups providing care, amendment 80 therefore sets out that a staffing method recommended for use by the care service providers may take account of recommendations of senior care sector or healthcare professionals with qualifications and experience that are appropriate to the care service in question. As staffing methods are developed, that will ensure that consideration is given to who is best placed to provide advice on staffing decisions based on the method, be it a nurse, a care worker or an allied health professional. Amendments 81 and 82 relate to amendments 117 and 120 lodged in my name at stage 2. Given that not all care providers provide clinical care, it would not be appropriate to have clinical quality indicators for all care services. It is important to remember that care setting is often someone's home. Amendment 81 therefore sets out that any staffing method that is developed and recommended for use in care services may take into account such indicators or measures relating to the quality of care or as the care inspectorate considers appropriate. My amendment 70 sets out that, in developing new or revised staffing tools for health settings, healthcare improvement Scotland must have regard to relevant evidence and professional guidance. Amendment 82 creates a parallel provision on the care side so that the care inspectorate should also consider when developing new staffing methods for care services in collaboration with stakeholders whether appropriate evidence and professional guidance should be included in the method. I ask members to support my amendments in this group. I thank both David Stewart and Miles Briggs for working with me following the stage 2 proceedings to bring forward their alternative amendments. I am happy to support amendment 79 under amendments 80, 81 and 82 in the name of Miles Briggs. Amendment 40 would have introduced a regulation making power to allow ministers to amend the list in section 82A5 of what may be included in a staffing method for care services at the care inspectorate's discretion. Amendment 41 would have made that power subject to the affirmative procedure. It would not be appropriate to specify absolute requirements around the development of staffing tools and methodologies for the care sector. Those have not yet been developed and I have consistently given commitments to the care sector that they would be developed by the sector for the sector. It should be up to those involved in developing methods to determine the content. Amendment 40 was lodged to ensure that this flexibility was maintained. I am pleased that, following our discussions at stage 2, members agree that this flexibility is important and has not sought to be overly prescriptive in what must be included in a staffing methodology for the care sector. As I have already let the Delegated Powers and Law Reform Committee know, I therefore intend not to move amendments 40 and 41 as they are no longer required. Thank you very much. David Stewart will wind up in this group and press a withdrawal of amendment 79. Thank you, Presiding Officer. I press amendment 79, if nothing further is had. The question is that amendment 79 be agreed. Are we all agreed? We are agreed. Could I call amendment 80, in the name of Miles Briggs, already debated? Miles Briggs, to move or not move. That is moved. The question is that amendment 80 be agreed to. Are we all agreed? We are agreed. I call amendment 81, in the name of Miles Briggs, already debated. Miles Briggs, to move or not move. Move. Thank you. The question is that amendment 81 be agreed to. Are we all agreed? Yes. We are agreed. I call amendment 82, in the name of Miles Briggs, Miles Briggs, to move or not move. Formally moved. Thank you. The question is that amendment 82 be agreed to. Are we all agreed? Yes. We are agreed. I call amendment 40. Can I ask the cabinet secretary to confirm that she is not moving amendment 40? Not moving. Not moved. Can I also confirm that amendment 41, the cabinet secretary, does not wish to move amendment 41? Not moved. That is not moved. And that ends consideration of amendments. Now, at this stage, as members will be aware, I am required understanding orders to decide whether or not, in my view, any provision of this bill relates to a protected subject matter, that is, whether it affects the franchise for Scottish Parliament elections. In the case of this bill, my view is that it does not. Therefore, it does not require a supermajority at stage 3, which I know that Mr Swinney is fascinated to hear. Members will also be delighted to hear that we have made very rapid progress through this bill. The chances are that we are going to consult with business managers and almost certainly going to move to bring forward decision time. However, I suggest that we have a short suspension of five minutes, and we will resume here at 1548 for the stage 3 debate. Short suspension, thank you. May I call everyone to order, please? And the next item of business is debate on motion 17127, in the name of Jeane Freeman, on stage 3 of the health and care staffing Scotland bill. Can I ask those who wish to speak in the debate to press the request to speak buttons, and I call on Jeane Freeman to speak to and move the motion for seven minutes, please, cabinet secretary. The bill will put into legislation a system-wide approach to supporting and empowering staff across the health and care system to assess and respond to the workload associated with the delivery of high-quality patient care. I want to start this debate by thanking the organisations and members across the chamber who have so constructively contributed to the development and improvement of this important legislation. The health and care staffing Scotland bill is grounded in and builds on the excellent approach to workload planning led by our nurses and midwives. I was very fortunate this morning at Forth Valley to see how that approach works in terms of developing and improving both safe care but also quality care. The development of the staffing methodology and speciality-specific tools has been an innovative, evidence-based and, importantly, a professionally-led approach. Scotland has led the way in developing these tools and methodologies for nursing and midwifery, and now we can become world leading in enshrining that approach in legislation and by extending its core principles across our health and care system. Presiding Officer, this legislation matters to our national health service and to our healthcare staff, but critically it also matters to patients and those who receive social care. We see the crucial link between safe staffing, utilising the multiple skills of the multidisciplinary team to the quality and safety of the service received. It is a critical component of a safer healthcare system for the people of Scotland. At the recent international forum on quality and safety in healthcare held in Glasgow, we welcomed leaders of healthcare systems from across the world. When we hear the head of healthcare improvement Denmark say, and I quote, I have been following Scotland for the last 10 years and have seen major changes and outstanding outcomes that we do not see anywhere else in the world at a system level, I think that our healthcare staff should be very proud of the work and the effort and the experience that they have applied to get us to this point. When I opened the stage 1 debate, I talked about the opportunities offered to us by this bill as a critical component in the safety and quality landscape. I very much appreciate the valuable work that the members of the health and sport committee and health spokespeople from all parties have put into the bill at every stage. I know that, although we may have disagreed at points, we all had a shared intention that this legislation should recognise the importance of dynamic workload assessment to inform professional judgment on skill mix and the needs to meet the demands of that workload and the critical importance in all of that of the clinical and professional voice. We all recognise the importance of that evidence-based approach that is founded on the needs of the patient or service user to contribute to our planning of the workforce locally and nationally. I know that we all wanted to see legislation that would work for the whole system across all the healthcare and care settings and would work for and be respectful of our key partners, be they professional bodies, local authorities or care providers. We agree that high-quality care is only possible when we recognise the importance of the multidisciplinary team and the valuable experience and expertise that each of the roles brings to that. Together with Miles Briggs and David Stewart, we have made significant changes to the bill that set out that health boards have clear processes in place to allow those on the front line to carry out real-time assessment of staffing needs and effectively mitigate risks. The legislation that we will put in place will ensure that the voice of the professional be that the midwife and doctor on a busy labour ward, the nurse and the physiotherapist working together in the community or the executive nurse and medical director at board level will be heard and will influence staffing decisions. That legislation will promote a continuing culture of transparency and engagement with staff, helping to create and sustain the conditions that staff need to use their experience and expertise to drive continuous improvement in our health and care services, while also always keeping the individual in receipt of that care at the centre of delivery. Of course, there is a great deal more work to come to ensure that the staffing method and tools for health settings are kept up-to-date with the advances in the way that care is delivered, to develop the multidisciplinary tools and to work with and support the care sector, local authority, third sector and private care providers to take the core methodology and build an approach that works for them. In that, there is learning from health to share with the care sector, but I am sure, too, that there will be learning from the care sector to share with health, and that is exactly as it should be. In passing the bill, I firmly believe that we will be supporting our health and care staff to meet the commitment that I know they deliver on every single day, to apply their skills, their expertise and their compassion to deliver high-quality, safe care and to find ways to improve the way care is delivered, regardless of where it is delivered. I am very pleased to move the motion in my name. That may sound a bit like an Oscar awards speech to start with, because I would like to start by thanking a number of people and organisations who have helped my own Scottish Conservative research team, RCN Scotland, allied health professionals, Federation Scotland, COSLA and Scottish Care. All those health professionals who have contacted me, I would also like to put on record my thanks to the Health and Sport Committee team, the Scottish Parliament and the Scottish Government's health and care bills team. Scottish Conservatives believe that the most valuable resource in our NHS is its people. We want the health and care staffing bill to do all that it can to help them with their lives and jobs. My amendments are therefore focused on the following themes to seek clinical advice on staffing, improving real-time assessment and risk escalation procedures, and improving staffing methods of care services. Scottish Conservatives believe that it is essential for the provisions within the bill and, certainly, the professional voice within the bill to be heard throughout the legislation. That is therefore why my amendment 63 saw a duty to seek clinical advice. Those amendments, I believe, ensure that the professional voice will be heard on vital sections of the bill, including the duty to ensure appropriate staffing, having arrangements in place to address severe and recurrent risks, ensuring adequate time is therefore given to clinical leaders in our NHS for the training that they need, and that resources will follow that. I believe that the amendments will aid in the whole systems approach of the bill, as the cabinet secretary has outlined. The legislation needs to be as effective as it can possibly be in ensuring that the professional voice is heard throughout the bill. I believe that that is a step forward in achieving that. In terms of improving real-time assessment and risk escalation procedures, my amendments look towards how we can improve the real-time assessment of those procedures. The amendments therefore ensure that staff individuals with lead professional responsibility, for example, are trained and given the time and resources to identify and mitigate risk. For other employees, the health board or agency are under a duty to raise awareness of the escalation process and encourage staff to identify and report risks that are caused by staffing inefficiencies and real-time assessment being part of that. Scottish Conservatives put forward numerous amendments to the bill, which focused on staffing methods and care services. Throughout the evidence and discussions that we had during the health and sport committee around the bill, it was clear that there were real opportunities to develop tools in partnership with the care sector, for example. That was an important part of how I wanted to see the bill move forward. I am pleased that my amendments will ensure that the appropriate people and organisations are involved in therefore developing the tools in the future. It was also important for the whole health and sport committee to recognise during the bill's consideration that a care setting is obviously sometimes someone's home and therefore it will require a different focus and staffing complement. I am pleased that that is recognised. I hope that we will see the progression of those tools as soon as possible when guidance is brought forward. I believe that there are opportunities with the bill to provide the care sector with opportunities that the acute sector will now have as well. I hope that we progress those as soon as possible. As I said at stage 1, Scottish Conservatives recognise that our health and social care workforce faces a number of key challenges with or without legislation. Unless we urgently resolve the staff shortages across NHS Scotland, safe staffing levels will remain a dream instead of a reality. I hope therefore that the health and care staffing bill will provide a critical contribution to driving the necessary improvements around culture and organisational change and that we need to meet those challenges and the expectations of health and social care staff across Scotland. We all agree around the principles and objectives of the bill to provide improvements to deliver safe, effective, person-centred services and outcomes for people across Scotland. We need to now see the Scottish Government making sure that we deliver on those. I congratulate the cabinet secretary and her officials, the Health and Sport Committee and the committee clerks, the bill's team. Indeed, all the organisations that have put so much work into not just driving the bill forward but improving the bill are a great reflection on everyone here. I know that there are many people in the gallery who have followed the debate and, in particular, the RCNs. I thank you for being here today. Scottish Labour welcomes the bill as amended. Safe levels of staff for our health and social care staff is vital. We welcome all attempts to ensure that that happens. I do not think that anyone has claimed that the bill is a panacea. Our NHS workforce is working under serious pressure and workforce planning has been poor. Scotland's fragile social care sector is facing a staffing and a funding crisis, so Scottish Labour continues to believe that the Scottish Government must urgently take action to address those on-going issues. Scottish Labour, alongside many stakeholders, raised significant concerns about the bill at stage 1, and we are pleased that the bill has been substantially improved since then. I am pleased about the positive impact that Scottish Labour amendments will have for those working in the health and social care sector and, ultimately, those that they care for. It is important that NHS patients and people cared for by social care services are essential to the bill. That is a belief shared by staff who commit their working lives to the health and wellbeing of others. My amendment 42 ensures that the guiding principles of the bill focus on the outcomes for service users. To have a positive impact, it is vital that workforce and workload planning are considered jointly. My amendments increase the public reporting requirements of the bill and, together with Alison Johnstone's amendments, mean that the bill now takes into account workforce planning as well as workload planning. I am glad that we have been successful in strengthening the links between the bill and national workforce planning. On robust risk assessment and escalation procedures, David Stewart's amendments will help to embed multidisciplinary principles into the planning of staffing levels. My amendment 47 ensures that there is a welcome cap in principle on agency fees, including information that is available on agency staff use. Workers in our social care sector do valuable and rewarding work, but they often face difficult working conditions with low pay and insecure work. My amendments aim to ensure that social care staff would be paid at least the Scottish living wage, have secured hours and not be employed in zero-hour contracts and would be reimbursed for travel, training and registration fees in uniform costs directly related to their work. I am pleased that the cabinet secretary agrees with me that social work terms and conditions must be drastically overhauled to improve the sustainability of the sector. I am pleased that those will now be included in guidance that will come before committee. In conclusion, Scottish Labour welcomes the health and care staffing bill. Any opportunity to ensure safe staffing for our vital health and care staff is backed by Scottish Labour. We welcome the legislation as a step towards fixing the workforce crisis in our health and social care services. It sees staff overworked and undervalued. However, my concerns remain that Scotland's health and social care workforce crisis will not be resolved by the bill alone. Our health and social care services need radical policy decisions backed up by investment to make real and sustainable change. Presiding Officer, I thank the numerous organisations that have provided briefings and support during stages 2 and 3. I thank the Royal College of Nursing, who, as Monica Lennon has said, is present in the gallery today and whose input has been invaluable throughout the process. I also thank our allied health professionals and the Royal College of Midwives. More important, I thank all who work in health and social care for the work that they do every day, from consultant to cleaner. The Greens support the aims of the health and care staffing bill, and we welcome the debate. As the Royal College of Nursing has said, it presents an opportunity to get the right number of staff with the right skills in the right place so that patients and residents receive safe and effective care. There is a clear link between safe staffing levels and the delivery of high-quality healthcare. A study by Professor of Nursing Policy Ann Marie Rafferty revealed that patients and nurses in hospitals with favourable patient-nurs ratios had consistently better outcomes than those in hospitals with less favourable ratios. We are also supportive of the guiding principles for health and care staffing, such as respecting the dignity and the rights of service users, ensuring the wellbeing of staff and taking account of the views of staff and service users. We must do all that we can to support those who are devoting their working lives to caring for Scotland's people. We have carefully considered how the legislation will impact them. That is key, because evidence coming from those currently working in health and care services emphasises that the legislation is timely and is needed. The RCN's safe and effective staffing report revealed that 51 per cent of respondents reported a staffing shortfall on their last shift, and 46 per cent said that they were not able to provide the quality of care that they would like to receive themselves if they were a patient. Likewise, the BMA conducted a survey of doctors, which showed that 62 per cent felt that a lack of doctors and rotor gaps were affecting their ability to deliver safe patient care. A 2018 Scottish Care report revealed that 77 per cent of the care home surveyed had vacancies. Those stark figures stress that the protections introduced by the bill are vital to the delivery of safe and high-quality patient care. We need to continue to strive for real integration. We must give the care sector the attention that we give the NHS. While not pushed, I welcome Monica Lennon's amendments to improve conditions for those working in the sector, so I welcome opportunity to raise those important issues. The most recent statistics show that 5.1 per cent of nursing and midwifery posts and 4.9 per cent of allied health profession posts are vacant. While those figures represent an increase in staffing levels from the previous years, six territorial NHS boards reported a reduction in qualified nursing and midwifery staff in posts. There is still considerable disparity between health boards that need to be addressed. As she did when Cabinet Secretary for Social Security, Jean Freeman has worked hard to seek cross-party input and consensus, and I do appreciate that. We need a well-staffed NHS, both for patients and for those working in it. Workload and workforce are inextricably linked. Working in an overstretched, overstressful environment is not sustainable. Finally, the bill alone will not create more health and care professionals. It won't address the fundamental shortages being experienced across the sector. However, it is a starting point. Work must continue to make sure that Scotland has the health and care staff that it needs. I am certain, however, that it will play a key role in ensuring that our health and social care services are appropriately staffed and that staff can deliver the best standards of patient care. Call Alex Cole-Hamilton for four minutes, please. Thank you very much, Presiding Officer. In the margins of this meeting in private today, the cabinet secretary confided in me that she was looking for another consensus bill, and I think that she has found that. I congratulate her for the achievement. She worked very hard between stage 2 and this stage to reach accommodation on a range of tensions that existed at stage 2, and I think that she has achieved that. I would also like to pay tribute to Kirsty Williams, who is a Liberal Democrat Assembly member, who stewarded a very similar bill through the Welsh Assembly. It is her guidance that I have lent into in terms of the understanding of that. I too would like to thank the clerks and all the witnesses in the stage 1 process, and in particular the RCN, who started briefing members of our committee some two and a half years ago on what they would like to see happen today. I hope that they are pleased, particularly Sarah Atherton, who is a friend and colleague of long standing, who was readily available with some of the technical briefings that I think we all, as newcomers to some aspect of this, lent very heavily on. Those allied health professionals, too. From the outset, the bill needed to be slightly more than it was when it was originally drafted. It recognises the new strata in which we deliver both health and social care. There is a multidisciplinary focus, like never before, that the integration of health and social care means that we need to be thinking out of silos and recognise that what might apply to a clinical staff team might also apply to a social care staff team. Alison Johnstone referenced that very scary survey about the attitudes and beliefs of staff in terms of the views that they have about patient care being compromised on the very last shift that they did. Obviously, there will be a resource imperative around that as well, but the bill does something to giving the staff the tools that they require to ensure that they are adequately staffed, not just for the safety of their patients but also for the safety of each other and the staff cohort. There is much about this bill that matters. The voice of practitioners and nurses on the ground who understand the wards that they occupy and the very specific needs of those wards that they are heard gives them the facility to do that. Expertise matters in planning and understanding what a shift and dynamic shift environment looks like, making your staff—assure your staff—accordingly, but also that you are planning for risk as well and that staff have faith in the process, that their views will be listened to in normal times that might just be ensuring that, from the grassroots, ideas around improving staffing are listened to and taken forward and extrapolated across the NHS. However, at the more serious end of the spectrum, whistleblowers will be treated well and dealt with appropriately. That touches on that as well. The clauses of the bill that we passed into law today will see changes felt in the quiet wards across our NHS and the noisy ones, too. I think that giving senior staff the time and the space to get their head around the planning and the overview of the wards and the areas of work in which they find themselves is one of the most significant and most important changes that we have enacted in the bill. I congratulate Alison Johnstone for securing those amendments. I think that it will give that important strategic overview which will enhance staff safety and patient safety. Allowing change to germinate from the grassroots works in any organisation. The NHS and our social care structure and our allied healthcare professionals are no different, and this gives them the opportunity to do that. First reading was about a toolkit, but it is so much more than that. It has been great to be part of the process of its development, not least to hear about where it will take our workforce, but more importantly a reminder of the importance and the commitment of the workforce that it will serve, because it does so much for us. It is about time that we start doing something for them, and in the pages of the bill we achieve something of that. I move now to the open debate. We have one speaker, Emma Harper, for around four minutes, please. Thank you, Presiding Officer. The health and care staffing bill has been one bill that I have enjoyed working on since joining the health and support committee. The aim of the bill is set out in the policy memorandum to provide a statutory basis for the provision of appropriate staffing in health and care settings, thereby enabling staff to provide safe and high-quality care and improve outcomes for all patients and service users. The provision of high-quality care requires the right people in the right place, with the right skills at the right time, to ensure the best health and care outcomes for service users and people experiencing care. I fully agree with that, and I know that the amendments that are moved by the Government, as well as by colleagues across chamber, will allow the bill to be achieved. It is obvious that members have engaged in a process that has achieved cross-chamber agreement. We discussed staffing tools, continuous professional development, issues around caseholding and non-caseholding of senior charge nurses, and many other issues related to acute and community care, and the requirement of the involvement of a multidisciplinary team approach to provide appropriate health and care staffing. I am pleased that amendments 18, 18A and 18B were agreed. We had a wide debate at stage 2 in the committee. The cabinet secretary has provided an excellent example of team working in Shetland, which requires the local teams to be case holders as well. I would like to offer just one other example of that when senior charge nurses often provide direct patient care, such as in the perioperative environment, where surgeries are extended and complications occur, and you might need the experience or the expertise of senior charge nurses to be able to step in and provide the immediate care assistance that is needed when somebody's bellies open on the operating table. I thank everybody who provided evidence to the committee whether written or in the evidence sessions. It was all well informed and helped committee members to inform conclusions that committee clerks in support from the SPICE team should also be commended. Miles Briggs has mentioned all the people who provided evidence for us in the committee, so I am grateful to all the organisations who provided briefings for the bill that helped to inform the debate. I have had lots of phone calls, direct advice from the RCN and chief nursing officers at both NHS and Freeson Galloway and Ayrshire and Arran and representatives from Scottish Care. I was a new MSP for South Scotland when the First Minister announced the Scottish Government's intention to enshrine safe staffing into law at the Royal College of Nursing Congress in Glasgow in 2016. As a new MSP, I had been providing direct patient care just about a month before that actually. In my work as a nurse educator and as a peri-optive nurse with 30 years of experience in America, England and Scotland, it has helped to inform me in the scrutiny of the proposed bill at committee stage. One example that I have is that for 30 years ago we had 19 gael wards, where there were rows of beds up either side of the wards, which certainly had some positives when it was looking at staffing, but there were also negatives as well, which included no personal private space, curtains or not walls, every voice and every noise is heard when you are looking after patients in a multi-room occupancy. The bill enables a rigorous, evidence-based approach to decision making on staffing that is safe and effective. The bill takes account of the health and care needs of patients and service users, assists the exercise of professional judgment and promotes a safe environment for both patients and staff. Scotland is leading the UK in our ground-breaking, evidence-based approach to nursing and midwifery workload and workforce planning. The bill also puts in place a framework to support the systematic identification of the workload needed to improve outcomes and deliver high-quality care. In bringing forward the bill, the Scottish Government, aided by experts from across health and social care, has understood the workload that is generated by any given setting and circumstance, and therefore the skills that are required and the staff mix that will provide them. I thank all those who provided evidence in the committee and thank all the members of health and care across Scotland, because they do a fantastic job every day. I move now to the closing speeches. I call David Stewart for around four minutes, please. Thank you, Presiding Officer. This has been an excellent, albeit short and snappy, debate, and there have been a lot of insightful and well-informed speeches from across the chamber. I was, Presiding Officer, impressed to see how many SNP-backed benches were here, because I understand that last night was their Christmas party, so I am very impressed with their dedication in turning up. However, I do understand that there was a bit of a run-in parasita mill from the local shop, but I will not go there. As a member of the health and sport committee, I was present and took an active part in questioning of all our witnesses, which included the cabinet secretary at an earlier stage. I have been heckled by Presiding Officer behind me, but if I could paraphrase the conclusion of our stage 1 report, no one can object to the guiding principles of the bill having the right people with the right skills and the right place at the right time to ensure the highest quality of care. As Monica Lennon made clear, Labour supports the general principles of the bill, but, as Alison Johnstone and Alex Cole-Hamilton also made clear, there were some areas of concern, but I really believe that the cross-party consensus on amendments strengthened the bill. As I said earlier, I would like to thank the cabinet secretary and hope that that does not damage her career for her consensual and helpful role in ensuring that we have amendments that work for everyone. The cabinet secretary, in response to the health committee stage 1 report, said that the bill is about workload planning, not workforce planning. However, the Scottish Labour believes that health and social care policies should be focused on achieving the best outcomes for people and protecting staff wellbeing. As I have argued, as I have argued, the overlines in the past on pure traffic box to gain exercises have not been helpful. I hope that we can avoid that. We should also raise lessons from history and learn lessons from history. As I have raised before, the French report into bullying and bullying in NHS England concluded that losing trained talent from the NHS led to inadequate staffing levels and poor quality of care. As the cabinet secretary knows well, there will be a statement on Thursday of which Monica Lennon and I will be contributing to. I am sure that the French report will be picked up by the current report that the cabinet secretary has set up. Conscious of time, Presiding Officer, and people anxious to get away, but in conclusion, I believe that all members in this chamber today recognise the commitment and dedication of our hard-working front-line staff. Just to correct a small amendment to my earlier comments, I think that I said Christmas party, but of course I was a little bit early for that, but it was a party nevertheless. Do not let anyone say that I never correct the record, Presiding Officer, when I'm wrong. As David Oliver, a consultant in geriatrics, said in the BMJ recently, without adequate staffing and clinical roles, NHS performance will decline and services will come unsustainable. Moral will worsen and staff will leave or choose to do less, a vicious circle. The workforce is surely the most pressing existential threat. In the short time I've got available, I would make a key point that you cannot legislate staff into existence, but I do believe that the cross-party consensus on amendments has strengthened and improved the bill. That's the nature of this place to make sure that legislation is better. There are much bigger issues that I don't have time to comment on, Presiding Officer, such as demand forecasting for future planning, the management predictive training for front-line staff, the effect of Brexit, which is going to be disastrous in my view in NHS employment, the effect of the building culture in some areas may have retention, and, of course, there's a very strong rural element that someone from Hounds and Islands would, of course, argue. The amended bill is a step in the right direction, which Labour will support, and as Naib Bevan, the founder of NHS, said that the NHS will survive as long as there's folk left with faith to fight for it. I'm pleased to close this important and consensual debate on behalf of the Scottish Conservatives. When we are first considering a bill that is entitled health and care staffing, originally called safe staffing, I believe that most would instinctively think that it is entirely sensible. Of course, ensuring that there are appropriate numbers of suitably trained staff in place is an entirely reasonable objective. However, as we have heard today in the presentations from across the chamber and an on-going scrutiny of the bill in the health and support committee, there were some crucial questions that were raised as it was developed. For example, in setting appropriate numbers of staff, it's important that the meaning of the term appropriate staff is properly defined and is unambiguous. Also, what actions will we take if the appropriate staffing levels are not met? Again, that has got to be properly defined so that NHS boards and care sector know exactly what they are working to. Given the multi-disciplinary nature of healthcare teams, we need to ask if the bill is drafted in such a way as to include all facets of healthcare. The health and support committee took evidence in question to the cabinet secretary around the need to develop workforce tools and how we would address that. I think that the technology that is required to implement the bill as intended is still not available. Given that the workforce-supplied tools currently do not include all the healthcare professional and care disciplines, in fact, I think that the evidence was suggesting that it was limiting more to nursering and midwifery. When those tools are currently bolted on to the payroll platform, when I questioned the cabinet secretary in the committee, she did suggest that that technology required, including the further development of workforce planning tools and potentially developing a platform in which they sit was under consideration. I would be grateful if the cabinet secretary summing up would confirm that. I have to say that, although the specifications of the tools that are required in the integrity of the platform in which they sit should have been scoped out at the outset of the bill, but without a properly considered and implemented technical solution, the safe staffing bill risks falling short of its intentions. With all of that in mind, if all of that is not considered, the staffing bill is in danger of becoming no more than window dressing and adding to a lengthy list of non-actual and actionable targets. I think that there is that need, as Miles Briggs amendments have said, to strengthen the reporting requirements on health boards to ensure proper scrutiny, especially given the call for clinical advice to be sought as a prerequisite on staffing bills. Underpinning all of that, of course, is the issue of staffing retention and recruitment that has been raised across the chamber by several members. I think that the health care and staffing bill, in and of itself, cannot make the differences intended without the overall appropriate numbers of staff. It is obvious that the ability to ensure appropriate staffing at any one time will be impaired by general shortages of staff. As the Royal College of Physicians state and as Dave Stewart stated, we cannot legislate doctors into existence. With a projected shortfall of doctors in Scotland, it would be difficult to argue that that will not have an impact on the potential of the bill. Outcomes were highlighted by the cabinet secretary, and in general we are looking for improved services for patients and improved quality of working environment for NHS staff and care staff, and improved work-life balance for NHS and care staff. That is why I was very pleased to see Alison Johnstone's amendment in there. We spoke in committee on the importance of time for front-line staff for CPD without the implementation of the bill that will not happen. We have always stated that looking after the health care professionals is important in delivering a quality healthcare service, and it speaks to absenteeism and retention. In conclusion, the Scottish Conservatives will be supporting the bill, obviously, recognising that it should not be seen as a panacea rather that success will rely on progress being made in other areas as well, especially around the swift development of appropriate technology and data analysis. They need to give professionals a strong voice in the staffing process and tackling the insignificant challenges of retention and recruitment. I call Jane Freeman to wind up the debate for five minutes, please. Thank you, Presiding Officer, and I thank members for their contribution to this debate. I am glad that you corrected the record, but those benches were always up for a wee party, so I am sure that we will have more than one. I also thank him for making the very important point, which was that our role here in this chamber and as MSPs and as parliamentarians is to make the best law that we can and to make legislation that is appropriate to the needs of our country. I believe that, in this bill, that is exactly what we are doing. As I said when I opened this debate, I am immensely proud of the work carried out by our health and care staff to ensure not just that the quality of care is consistent, but that it is high quality care and improving care. This legislation will improve the experience of the patient, drive the improvement of outcomes and recognise that it is people and citizens delivering that patient experience and patient care. It provides a balanced, evidence-based approach to supporting patients, professionals and organisational outcomes. However, as members have noted and as I have made clear on many occasions, there is no single thing that we do to ensure safe, effective person-centred care, but a number of important steps that we need to take. This legislation is the next important piece that sits alongside our Scottish patient safety programme, our excellence in care work, in order to ensure that we continue to drive our commitment to ensure that we have safe and effective patient care. I need to mention a number of important steps that we need to take next. The important work of making this legislation come alive to improve outcomes for the people of Scotland and create conditions where our staff can flourish continues now for the development of guidance as the next step in the journey. That guidance will be drafted in collaboration with all stakeholders and will, of course, be shared with our health and sport committee. It is also worth noting that there will be regulations laid for every new staffing tool developed and that those will be developed and subject to affirmative procedure, thereby allowing further scrutiny by members across the chamber to ensure that they meet the intention and the principles behind this bill. It is also worth saying just before I conclude on this part to Mr Whittle that I completely take his point in terms of digital. There is a great deal of work going on in health on digital platforms and I make the offer to the health and sport committee to come forward in due course and explain and present all of that work so that you can see where we are. It is appropriate for me to conclude with a number of thank yous for support in this legislation and taking us to this point where we do have, I believe, a significant and important piece of legislation that we are, I hope, about to all agree on. I thank the Allied Health Professions Federation of Scotland, Royal College of Midwives, Royal College of Nursing, BMA, the medical royal colleges, COSLA, Unison, staff group representatives, Scottish Care and representatives of integration authorities. That is an indication of the importance of this legislation that all of those organisations actively contributed with members to what we have before us today. I also want to thank the health and sport committee, DPLR and finance committees, too, for the contribution that they have made in the development of this legislation as we have gone through all the stages. Finally, in my thank yous, I must thank the bill team for this piece of legislation whose work has been extensive, has been driven by direct front-line experience and expertise, has been unstinting, and without whom I am pretty certain we would not be where we are right at this moment. All of this takes us together with a shared commitment across this chamber to get this right for those who work in our health and social care sectors, they deserve nothing less, our patients deserve nothing less, those who use our care services deserve nothing less, and I very much look forward to continuing the shared work with members across this chamber as we take the next steps to make this important legislation a reality. Thank you very much. Thank you very much. That concludes our debate. The next item of business is consideration of business motion 17152, in the name of Graeme Dey, on behalf of the Bureau, setting out a revised business programme. I call on Graeme Dey to move this motion. Moved, Presiding Officer. Thank you very much. If no one wishes to speak on the motion, the question is that motion 17152 be agreed, are we agreed? Yes. We are agreed, and I am minded to accept a motion under rule 11.2.4 of standing orders that decision time be brought forward to now. Could I call on Graeme Dey to move such a motion? Moved, Presiding Officer. Thank you very much. The question is that decision time be brought forward to now. Are we agreed? Yes. We are agreed. So we turn to decision time, and there is only one question today. The question is that motion 17127, in the name of Jeane Freeman, on the health and care staffing Scotland Bill, be agreed? As that is a bill, we will move to division. Members may cast their votes now. The result of the vote on motion 17127, in the name of Jeane Freeman, is yes, 113, there were no votes against, there were no abstentions, the motion is agreed, and the health and care staffing Scotland Bill is agreed, is passed. That concludes decision time. I now close this meeting.