Saร rotating, Ashwin Etinithwrt. A ch completes this year of the committee meeting before last, so we need to honour him with an appointment. God morning and welcome to the 7th meeting of the Health and Sport Committee in 2016. By the way, I asked those quoted this morning to use any their mobile phones as they can The first item on our agenda this morning is a declaration of interest, and I welcome Fiona McLeod as a new member of the committee before I invite Fiona McLeod to declare any relevant interest, I want to put on record my appreciation, and I'm sure to speak for the committee, and thanks to Bob Doris, who has left the committee. I'll feel a bit nervous this morning, but I'm on my shoulder throughout this time and the previous committee, so he's been my deputy convener for a number of years, so I feel a bit strange this morning. So Fiona can invite you to declare any relevant interests. Thank you, convener. I have no relevant interests to declare. I'm grateful to be back on the committee, even if it is just to cover Bob Doris' paternity leave. Thank you, Fiona. We now move to agenda item number two, which is the choice of deputy convener. The Parliament has agreed that only members of the Scottish National Party are eligible for nomination as deputy convener of the committee. That being the case, I invite nominations for the position of deputy convener. Thank you. We have no other nominations received, and I therefore ask the committee to agree that Fiona McLeod would be chosen as deputy convener of the committee. Are we all agreed? Yes. Thank you. Congratulations, Fiona, and welcome back to the committee. We look forward to working with you, albeit on a temporary basis. We now move on now to agenda item number three, and I invite members to agree to take consideration of the evidence and palliative care at agenda item number seven in private at this meeting and, indeed, if any future meetings of the need arises. Are we all agreed? Yes. Thank you. We now move to agenda item number four, which is the stage two, the two consideration of the health tobacco nicotine setting care Scotland bill. I welcome the minister, Maureen Watt, minister for public health. Good morning, minister. Dan Curran, bill policy manager. Craig White, divisional clinical lead. Lynn Nicol, quality team leader. Ilsa Garland, principal legal officer. Meryl Skiin, parliamentary council. I also welcome Mary Scanlon, who is here for this item of agenda. Welcome back to the health committee. Thank you. The member should note that, partway through the morning stage two, I will pause proceedings to enable the Government officials to chain over the change over at that point, and I will introduce the other officials at that point. Everybody should have a copy of the bill that is introduced after a list of amendments in the groupings of amendments. There will be one debate, as you all know now, on each group of amendments, and I will call the member who lodged the first amendment in that group to speak and move that amendment and to speak to other amendments in the group. Members who have not lodged amendments in the group but who wish to speak should indicate by catching my attention in the usual way. The debate on the group will be concluded by me, inviting the member who moved the first amendment in the group to wind up. Only committee members are allowed to vote, voting and any of the divisions is by a show of hands. The committee is required to indicate formally that it is considered and agreed each section of the schedule of the bill, so I will put a question on each section at the appropriate point. I move to the marshal list. I call amendment 3, in the name of the minister, group with amendment 4. The minister to move amendment 3 and speak to both amendments in the group. Thank you, convener. These amendments in my name relate to outcomes of incidents that trigger the duty of candor procedure. Amendment 3 addresses an issue that was raised by North Ayrshire Health and Social Care partnership in written evidence to the committee at stage 1. The duty of candor procedure can be triggered by an unexpected or unintended incident that results in the affected person needing treatment to prevent their death or injury. At the moment, the bill provides that treatment given to prevent death or injury would trigger the duty of candor procedure only where that treatment was given by a registered doctor. This amendment will change this so that the procedure would be activated by an incident that results in the affected person needing treatment by a registered health professional. The definition of registered health professional is wider, as it includes not only doctors but also nurses, midwives, paramedics and dentists as well as others. An unintended or unexpected incident in the course of treatment or care in health or social care settings could result in the intervention of any one of a number of health professionals in order to prevent death or injury. That amendment reflects that reality. Amendment 4 relates to outcomes of incidents that trigger the duty of candor procedure. One of those outcomes is that the affected person requires treatment to prevent certain injuries. Amendment 4 will add another category to the types of treatment that will trigger the duty of candor procedure. That added category, which is set out in section 21 for B, covers incidents that result in permanent lessening of one or more functions of the body and is described as severe harm. The effect of the amendment is that if, as a result of an incident, a person requires treatment to prevent severe harm, that will trigger the duty of candor procedure. I am glad to have the opportunity to bring forward this amendment, which does not reflect a change in the intended policy but corrects an omission in the bill as introduced. For those reasons, I would ask the committee to support amendments 3 and 4, and I move amendment 3. I do not see any other members wishing to comment or take part here. I presume that you do not need to say any more, minister. The question is, then, that amendment 3 be agreed. Are we all agreed? Yes. Thank you. I now call amendment 4 in the name of a minister who is already debated with amendment 3. Minister, do you move formally? I moved. Thank you. The question is, then, that amendment 4 be agreed to. Are we all agreed? Yes. Thank you. I call amendment 11 in the name of Rhoda Grant, grouped with amendment 12, Rhoda Grant, to move amendment 11 and speak to both amendments in the group. I move amendment 11 and speak to both amendment 11 and 12. The bill outlines a duty of candor in quite extreme circumstances, and I think that it was helpful to have the previous amendments because it just highlights how extreme those circumstances are. It also outlines a bureaucracy and reporting process for those very significant incidents. My amendments ensure that the duty of candor is required in not all circumstances. Patients must be at the heart of their own treatment, and they must know what is going on in order to have faith in the system. I moved away from a point where clinicians made decisions that they believed were in the best interests of the patients and put patients at the heart of that decision making, but we need to go further. I do not want to set up another bureaucracy, but I simply want to ensure that patients are informed and able to make decisions of themselves. When the incident is not of such extreme proportions, there should be at least informed of what has happened so that they can decide for themselves. A lot of professional organisations have a duty of candor stipulated by their own governing bodies, but we heard in evidence that this is not the case for all. Therefore, moving those amendments mean that patients are informed about their own treatment and any adverse circumstances. Any other members before I go to the minister? No? Minister. Thank you, convener. Amendments 11 and 12 would require unintended or unexpected incidents that do not or could not result in harm or injury to be reported to a person whose care has been affected. The result of this would be an unreasonable and unnecessary burden on health, social care and social work organisations. Furthermore, it departs from the principles that have led us to propose the duty of candor. The purpose of the statutory duty of candor for organisations is to require that organisations implement procedures where there has been an unintended or unexpected event resulting in death or harm or which could have resulted in death or harm, but for the treatment given by a healthcare professional. I believe that we should focus on cases where real harm has occurred or where there is a risk that real harm could occur, rather than creating statutory requirements on organisations in every case where no harm has occurred. Rhoda Grant's amendments would remove that focus and require that everything that happens, which is unintended or unexpected, to be judged to assess if care has been affected. Also, incidents should be reported to an affected individual whether or not there is a negative outcome of that event. I do not think that such a procedure would be helpful to those receiving care or treatment, nor to the staff who deliver our health, social care and social work services. The introduction of the statutory duty of candor must not become a box-ticking or form-filling exercise. I believe that the procedure proposed by those amendments is not proportionate. I also believe that such an additional procedure would result in the duty of candor for cases where real harm has occurred, becoming diluted and not having the desired impact on culture change, safety and learning. For these reasons, I would ask Rhoda Grant to withdraw amendment 11 and not move amendment 12. I do not understand what the minister is trying to say. She has stipulated the circumstances that a duty of candor comes in, so it is death or real harm. Those are extreme circumstances. My amendment is saying that, if an unexpected incident occurs in the provision of the health service, a care service or social work service to a person, and the reasonable opinion of the registered health professional is that that incident affected a person's care but did not result in death or extreme harm, then that person should be informed of what happened, given an account of the incident, told about what steps were taken to put it right and any other information that they require. It is very simple. Something has gone wrong. That is what has happened. That is what we have done. There is no added bureaucracy. There is no tick box exercise, and it seems to me extreme that the minister could be saying that people are not entitled to that very basic information about their own treatment. I will take the amendment away and have a look at it in light of the unintended consequences. I think that that was somewhat overstated by the minister, but I am really concerned that, if she does not believe that patients should have that information of their treatment, I do not know what kind of leadership that provides to health service professionals. The member is seeking to withdraw the amendment. Is there any other member object? No member objected. A member 11 is withdrawn. I now call amendment 17, in the name of Malcolm Chisholm, in a group on its own, Malcolm Chisholm, to move and speak to amendment. You convener, I am a strong supporter of the duty of candor but, Tim, obviously various concerns have been expressed by clinicians, and the particular concern that this amendment picks up is something that was expressed to those of us who visited Ardgauan hospice in Greenock back in September. The main purpose of our visit, obviously, was as part of our palliative care inquiry, but we also took the opportunity of asking the clinicians who worked there about the part of the bill. I think that, in summary, the concern was that some people might not want to be told. Obviously, in terms of their situation, that was particularly people who were in a hospice but, of course, it could well be other people as well. That is a matter that I raised as part of the evidence session on the 22nd of September. I thought that the comment by Peter Walsh of Action Against Medical Accidents was very interesting. It is on column 9 of the Official Report of 22 September. It would be helpful perhaps if I could read what he said. The point about some people, I am quoting now, is not wanting to know that a mistake has been made as a valid one. One must respect each individual's wishes. When the discussions took place in England about its version of the duty of Canada, we made that very point. The way that has been dealt with in England is that there is a requirement to tell the patient or service user or their family that there is something to report and to discuss. They can simply say, thanks, but I do not want to know. Let us say that my more dad has passed away and the family can say that we are moving on and we do not want to know another thing. That is their absolute right, but it is not the right of any individual, health professional or organisation to decide for them that they do not need the opportunity to know. That is the end of the quote. I think that the last part is absolutely fundamental to this, because clearly we are moving away from a paternalistic culture where health professionals decide whether someone is to be told or not, but I think that there can be no objection in principle to a health professional asking if somebody wants to know, because then the decision is entirely the matter, the concern and the decision of the relevant individual. That approach that is adopted in England is what I have tried to incorporate in my proposed amendment today. The details of it, if I can actually find it in the book, which I can at the moment, the numbers are all confusing me here. Basically, first section repeats what I have said, the responsible person must ask the relevant person and then the second section describes what has to happen in terms of a written record of the communication. That protects against any abuse of the requirement, but I think that there are quite a lot of clinicians and members of the public who would be concerned if people did not have the right to say that they did not want to know, so I move amendment 17. I was particularly struck by the evidence that was received about the procedure in England. Having grown up through a very paternalistic health service, I think that that is probably a good step in the right direction. The amendment in Malcolm Chisholm's name would require that responsible persons ask the person affected by an unintended or unexpected incident that causes harm whether or not they wish the duty of candor procedure to apply to them. I acknowledge that it may not always be in the best interests of the individual to be told about what has happened and organisations will be required to consider that carefully and ensure that they do not have a one-size-fits-all approach to disclosing information. Additionally, not everyone may wish to know the details of what has happened and, of course, that should always be an option. The Scottish Government's guidance development group will consider those issues as part of its remit in taking forward the implementation of the bill. While recognising that the procedure should, as far as possible, take into account the preferences of those affected by unintended or unexpected incidents, an undesirable effect of the amendment may be that where an affected person does not want to be told about an incident, the wider duty of candor procedure may not apply. We still would want reporting and learning to take place to prevent the same type of incident happening again. As members will be aware, under the bill, the duty of candor procedure is a series of steps to be taken by the responsible person. Section 22 of the bill leaves the detailed steps in that procedure to be taken forward in regulations. Under section 22A, the regulations may make provision about the notification to be given to the relevant person affected. Section 22E allows the regulations to provide detail on the account of the incident that is to be given. I intend that the regulations under section 22, setting out the duty of candor procedure, will reflect the aim of this amendment to the extent that the purpose is to provide an affected person with the opportunity to decline to be told about what went wrong. However, it is important that, in such cases, the wider duty of candor procedure continues to apply to the responsible person so that lessons can be learned from these incidents, even where someone does not want to know what happened. Therefore, having set out that intention, I would ask Malcolm Chisholm to withdraw amendment 17. I thank the minister for that explanation. I am still not entirely, to some extent, I am not sure if she really is objecting to the substance of this at all because she has said that she will actually make sure that it is delivered in regulation. I am not quite sure why what the objection is to having it in primary legislation. I accept what she is saying obviously about learning lessons from what has happened. I do not think that there is any there is no problem about someone just because someone does not want to know. It does not follow from that that lessons are not going to be learned, so I am not entirely clear that there is any fundamental objection to what I am proposing here. It becomes a judgment about what has got to be in regulations rather than in primary legislation. I do not really understand the rationale for that, so I think that I am quite happy to withdraw it currently, but at the present moment I would be minded to reintroduce it at stage 3 and perhaps build something in about ensuring that the lessons are learned just to cover that particular concern. However, I certainly do not see any reason why it should not be in primary legislation rather than in regulations. However, I am happy to withdraw it today, but I would be minded to reintroduce it perhaps in a modified or extended form at stage 3. Thank you. Malcolm Chisholm is seeking to withdraw amendment 17. Does any other member object? No, no member object. Amendment 17 is withdrawn. The question now is, as we call amendment 12, in the name of Rhoda Grant, already debated with amendment 11. Rhoda Grant, to move or not move? Not moved. Does any other member wish to move the amendment? No. To question section 22, be agreed to. Are we all agreed? Yes, yes. Thank you. Question is that sections 23 and 24, be agreed to. Are we all agreed? Yes. Thanks. I now call amendment 6, in the name of the minister, grouped with amendments 7, 8, 5, 9 and 10. Minister, to move amendment 6 and speak to all amendments in the group. Thank you, convener. Those amendments, in my name, make changes to the interpretation section of part 2 of the bill. Amendment 6 has the aim of assisting with the interpretation of provide. It adds a definition of provide to clarify that providing a health service, a care service or a social work service means carrying on or managing such a service. The term provide in relation to care services is already defined in other legislation in a similar way. It is helpful to define it in the bill, so it is clear that the term operates in the same way here. Amendments 7 and 8 relate to the care inspector's written evidence to the committee at stage 1, where they raised concerns that care service providers may choose to opt for a different business model, for example trading as an individual but employing others in order to avoid the duty of candor. Amendments 7 and 8 will ensure that, in respect of care services, self-employed individuals who employ others or have arrangements with others, where those others are directly involved in providing care will be brought within the definition of responsible person in the bill and, therefore, would be subject to the duty of candor. Amendment 5 is a technical amendment to correct the name of the act referred to in section 25 of the bill. Amendments 9 and 10 will amend the bill to give Scottish ministers the power to modify the definition of responsible person in section 251 of the bill. That will ensure that, in the event of the definitions given in section 25, do not cover a particular type of arrangement where it is envisaged, that type should be subject to the duty of candor. Secondary legislation can be laid to address that. Equally, the power will also enable Scottish ministers to exempt persons from the definition of a responsible person. Amendment 10 has the effect of making the power conferred by amendment 9, subject to the affirmative procedure, which we consider to be appropriate, given that it is a power to amend primary legislation. For the reasons that I have outlined, I would ask the committee to accept those amendments and I move amendment 6. Amendment 7, 8, 5 and 9, all in the name of the minister and all previously debated, invite the minister to move amendment 7, 8, 5 and 9. Does any member object to a single question being put on amendments 7, 8, 5 and 9? The question is that amendments 7, 8, 5 and 9 are agreed to. Are we all agreed? The question is that section 25 be agreed to. Are we all agreed? Amendment 18, in the name of Mary Scanlon, grouped with amendments 21, 22, 23 and 25. Mary Scanlon, to move amendment 18 and speak to all amendments in the group. Thank you, convener. I am very grateful for the committee's time to consider those amendments. I would also like to put on record my thanks to the clerks for assisting me with the amendments. Over the years, as an MSP, I have met many families. Families who are left with the guilt that they should have done more to protect their parents when they were in residential care. I spoke to one such lady last night, which is the real reason that I am here, and she has given me permission—sorry. It is quite an emotive issue—to use her name and her mother's name. Her name is Mrs Blann Bremner and her mother is Mrs Doreen McIntyre, who died in a care home in Inverness. Her root grant will be familiar with the Kingsmills care home some time ago. The family were concerned about the care and treatment of their mother and decided to install a tape recorder in her room. They were shocked when they played it back and I read it, and that is why I find it so upsetting. The Highland Senior Citizens Network, Dr Ian McNamara, quotes, having listened to the tapes, no one could be in any doubt that abuse of an older vulnerable adult had taken place. I appreciate times limited, convener, so I will be as brief as possible. Police Scotland were given the tape and they confirmed, and I quote, staff were behaving in an unprofessional manner and making inappropriate comments. They stated that insulting comments were made by care staff. They were highly inappropriate, derogatory, insensitive and fell significantly below the standards any reasonable person would expect for the care of a relative. However, they did not reach the threshold set by case law to proceed with a criminal investigation. Had the family installed a CCTV camera, convener, it would have been very different. I will give you an example when the lady asked for a hand. She kindly asked for a hand to help her. They gave her a round of applause and laughed and ridiculed her. The police stated that there was no evidence of assault by care staff and no evidence to meet the threshold for cruel treatment, which they stated is essentially a serious willful neglect offence. The police stated that the evidenced conduct of care staff at the Four Seasons care home required investigation by the relevant agency. The family went to the care inspectorate who responded to saying that they do not investigate alleged abuse. They went to social work and the social care manager told the family that they have to move on from the issue because legally nothing can be done and it will affect your health. The family are finding it more difficult to move on than the social work appreciated. The care home response was to send a letter that the two members of staff were suspended and no longer employed and that the Four Seasons care bears no admission of guilt as a consequence. I will come back to this in my next set of amendments. When I told the family of this legislation convener, I thought that it was an opportunity to look at what could be done. The legislation relating to willful neglect, I am afraid that they were not too impressed and they pointed out the difference between neglect and abuse. Neglect is to pay a little or no attention and to fail to care for or attend to properly. On the other hand, abuse is to hurt or injure by maltreatment, to assail with insulting or hurtful words, to use insulting or hurtful language and to speak insultingly or cruelly. Abuse, in my view, clearly describes the experience at this care home. It is not the first care home in Scotland where we have heard about this type of abuse. In my book, many of the problems arising from poor care standards are not simply neglect, it is abuse. I bring these amendments today to seek clarity around this issue, given that this is a unique opportunity to put something in place to help to protect elderly, frail and vulnerable people in Scotland. I thank Mary Scanlon for bringing this forward. My thinking is that there is professional conduct already with people who are registered to provide care. If they fail to do so, they can be held responsible. Indeed, people can have criminal charges brought against them, but certainly an organisation, whether it be social work or social care, in terms of the professional conduct and within their registration, these matters are usually dealt with. I am not sure that introducing this amendment through legislation will assist in taking that forward any more than the professional conduct that exists within the registration. I do not think that anyone listening to Mary Scanlon could help to be horrified about that experience. Sadly, it is all too common in some care homes. We have seen care homes being having their licence removed because of it. If I was the daughter of that person, I would not be happy if all that could happen to them was to have their professional registration removed. Such abuse really does need a legal sanction, so I would be minded to support Mary Scanlon's amendments. Richard Lyle? Can I talk to the points that Mary Scanlon has made? I would be concerned if any that happened in any care home, but can I also place a record that there are many many many care workers out there, many care homes, who deliver an excellent service? I remember a particular care home that my father-in-law was in. It was not a five-star hotel that he said he was in. He was in a seven-star hotel. Will I take the point that there may be situations that are deplorable and should be certainly put to law? I have to place a record that there are many care workers in this country who are delivering an excellent service and working very hard to help elderly people. No other members in the net milling. I hear what Richard Lyle says, and of course we would all agree with that. There is excellent care in many places, but nonetheless there are cases like Mary Scanlon has just told you. I remember Mary telling me about this some months ago, and it really is an appalling thing. I think that the law should be able to provide for this form of abuse in addition to willful neglect and the other parts of it. The care worker and care provider offences in part 3 of the bill are committed where there is ill treatment or willful neglect of individuals in receipt of care. The expressions of ill treatment and willful neglect are already, as the committee knows, established in law and cover a wide range of harmful behaviours, including what we would understand by the term abuse. As has been made clear previously, those offences are intended to deal with, among other things, the sorts of abuses that occurred during the breakdown of care at mid-staffage chair hospitals. On that basis, adding abuse would not broaden the range of behaviours that are covered by the offences, as we are content that such behaviour would already be caught by the bill. The term ill treatment is distinct from neglect and covers a range of behaviours including behaviour such as that described so graphically by Mary Scanlon. Additionally, those amendments would mean a departure from the wording of existing offences in relation to those receiving mental healthcare and treatment and in relation to adults within capacity. That has the potential to cause confusion and cast doubt over the width of those existing offences. Throughout the Government's processes of consultation and engagement on those provisions, there have been many comments on the wording of the offences and we have sought to reassure stakeholders that the terms ill treatment and willful neglect are familiar to the police and prosecution service. For those reasons, I would ask Mary Scanlon to withdraw amendment 18 and not to move the other amendments. Thank you, convener. I appreciate Dennis's point. The Scottish Social Services Council, obviously those care workers, would be registered. I say that one of them is still up until a few weeks ago working in the national health service at Rakemore hospital in Inverness. The example I gave was that they were suspended, they left, there was no investigation, the police could do nothing, care inspectorate could do nothing and social work could do nothing. Rhoda is absolutely right that there have been quite a few examples in and around Inverness and it is all too common. I should have said that at the point. I was so focused on that issue, but two, three or twenty poor care workers do not take away from the commitment that 99 per cent of our care workers have. They are not always the best paid richard either, so I should have put that on the record and like yourself. I have nothing but respect for well-managed excellent care homes and, thankfully, most of them are well-managed with excellent staff. I hope that I did not give the impression by using this example that it was every care home, but I totally and wholeheartedly agree with the points that you have made. I could not speak highly enough about what Richard is saying. I am a bit of an outsider here today, convener. I am not okay with all aspects of build treatment in the bill. I am not sure that the bill goes far enough, but, having said that, I am grateful for the response of the committee and the minister. I feel that the amendments that are needed are probing. I think that there are many people out there who are saying, how much better is this going to be? Will it ensure that people who do not have the commitment to caring that we would expect that they will not be in charge of my family? Having heard what I have heard today, convener, I will not move the amendments, but I may consider submitting them again at stage 3. Mary Scanlon is seeking to withdraw amendment 18. Does any member object? No member has acted. Amendment 18 is withdrawn. I now call amendment 19 in the name of Mary Scanlon, group with amendments 20, 24 and 26. Mary Scanlon, to move amendment 19 and to speak to all amendments in the group. That probably follows on from the very good point that Dennis Robertson made about the professional conduct and what happens. I have described the very poor experience of care standards and, of course, the tape-recorded evidence only related to two care staff. As I said, where a camera is installed in the room, the evidence would be so much clearer and the court case in prosecution would be so much different. Given that the staff were suspended and no longer employed by four seasons homes, they were instantly able to gain employment elsewhere in the care sector, and particularly given that we have a national shortage of care workers staff. One of the care workers got work at Readmore hospital working for NHS Highland, although the family has raised this with the NHS and I am not sure that he is still employed there. It was highlighted by the family and I also brought it to the attention of NHS Highland, but it was the ease of further employment, allowing opportunities to continue his unacceptable practices, which angered and continues to anger this family. My amendments today look at what can be done to protect others from care workers who do not live up to their job description. That is particularly relevant in this case, as well as when a prosecution has been successful. It was very difficult in this place. There was tape-recorded evidence, the police said that it was inappropriate, etc. There were no charges, there was no investigation, no one picked it up, the care workers just walked away and got jobs elsewhere. Amendments 19 and 24 in Mary Scanlon's name remove the option of ill treatment and willful neglect offences being tried under summary procedure would most likely result in fewer cases of neglect or ill treatment, making it to court as the Crown Office and the Procurator Fiscal Service would only proceed with the most serious cases of ill treatment or neglect, where solemn procedure would be appropriate. For the existing offences of willful neglect and ill treatment in mental health and adults within capacity legislation, nearly 80 per cent of the prosecution so far have been under summary procedure. Removing the option of summary procedure would severely limit the discretion of the Procurator Fiscal in dealing with less serious cases. Amendments 20 and 26 require Scottish ministers to make regulations preventing convicted care workers from working in care roles. I thank Mary Scanlon for giving me the opportunity to set out my intention to bring forward amendments at stage 3 that relate to the issue. First of all, to set out the background, there is already provision in the protection of vulnerable groups Scotland Act 27 that requires employers and regulators to refer individuals to disclosure Scotland for the purposes of considering them for listing as unsuitable to do regulated work where they have harmed a protected adult. In addition and more specifically in relation to the offences in part 3 of this bill, a court may, when convicting, refer a convicted individual to disclosure Scotland where the court thinks it may be appropriate for that individual to be considered for listening. Disclosure Scotland will then give consideration as to whether the individual should be listed as unsuitable to work with vulnerable adults. In terms of standard and enhanced disclosures under the Police Scotland 1997 and the PVG scheme, record disclosures under the 27 act, a conviction for ill treatment or willful neglect under part 3 of this bill would be disclosed to a prospective employer. Indeed, given the seriousness of those offences, I intend to bring forward amendments at stage 3 so that those offences will continue to be disclosed even when they would otherwise be spent convictions because of the passage of time. Therefore, I am satisfied that there are sufficient safeguards in place to ensure that unsuitable people would not be employed as care workers. For those reasons, I would ask Mary Scanlon to withdraw amendment 19 and not to move amendments 20, 24 and 26. I would be concerned if fewer cases were getting to court, because that is certainly not something that I would have intended. I am delighted with the tone and the response from the minister because I was hoping to get a good airing today. I think that this is an area that we are all concerned about. The fact that the minister is bringing forward amendments at stage 3, the fact that she is giving this part of the bill further consideration, I am very grateful for her response. I will be withdrawing the first amendment and not moving the rest of it. Mary Scanlon is seeking to withdraw amendment 19. Does any member object? No. No member has objected to amendment 19 being withdrawn, but it is withdrawn. We now call amendment 20 in the name of Mary Scanlon, which is already debated with amendment 19. Mary Scanlon to move or not move. Does any other member wish to move amendment 20? The question is that section 26 be agreed to. Are we all agreed? I now call amendment 21 in the name of Mary Scanlon, which is already debated with amendment 18. Mary Scanlon to move or not move. No other member wishing to move amendment 20. Is there another committee? We call amendment 22 in the name of Mary Scanlon, which is already debated with amendment 18. No other member wishing to move amendment 20. We call amendment 23 in the name of Mary Scanlon, which is already debated with amendment 18. Mary Scanlon to move or not move? Not move. Mary Scanlon is not moving. Any other member wish to move amendment? No. I now call amendment 24 in the name of Mary Scanlon already debated with amendment 19. Mary Scanlon to move or not move? Not move. Member is not moving. Any other member wish to move? No. The question is then that section 27 be agreed to. Are we all agreed? Yeah. Thank you. Thank you, convener. The question is that section the call amendment, Mary. The question is that section 28 be agreed to. Are we all agreed? Yeah. Thank you. I now call amendment 25 in the name of Mary Scanlon already debated with amendment 18. Mary Scanlon to move or not move? Not move. Mary Scanlon is not moving. Any other member wish to move the amendment? No. There isn't. The question then is that section 29 be agreed to. Are we all agreed? Yeah. The question is that sections 30 and 31 be agreed to. Are we all agreed? Yeah. Thank you. Well, I'm going to suspend it at this point and welcome you officials to join the minister. Okay? Thank you very much for those who attend. We continue with this session and I welcome you officials who are now accompanying the minister, Angela Bonymi, sensory impairment national delivery support adviser. David Wilson, legal directorate and Meryl Skeen, the parliamentary council from the Scottish Government health bill team. Welcome to you all. I now move to call amendment 1 in the name of the minister and I group on it. So, when minister to speak to the amendment. Thank you, convener, and I'll speak to amendment 1 in my name. The Scottish Government recognises that provision of communication equipment and the associated support required to use that equipment are key requirements of children and adults who have lost their voice or have difficulty speaking. Communication equipment can range from low tech, for example, picture symbol books to high tech such as dedicated voice output aids. Individuals who use communication equipment, service providers and organisations representing service users tell us that provision across Scotland is inconsistent, inequitable and does not always meet the needs of people with communication difficulties, particularly those requiring high tech devices. The majority of them told us in response to a call for written evidence that they support the need for the legislation that we are discussing today. The aim of amendment 1 is to provide a more explicit duty on Scottish ministers to provide or secure the provision of communication equipment and associated support, which will consequently raise the profile of the service, bringing it to the forefront of service delivery. By introducing the duty, it is expected that health boards who will discharge that duty on behalf of Scottish ministers will review their current service, systems and processes and consider the service as a priority. The breadth of the proposed duty is deliberate. It provides flexibility to determine who might receive communication equipment, what type of equipment might be provided and allows responsiveness to future technological developments. In addition, under the existing powers of the 1978 act, Scottish ministers will issue directions to health boards in the near future to help to support the discharge of the duty. Those directions will need to be carefully considered. They must contain the correct level of detail to address the operational issues and delivered person-centred care. We know that that is a cause for concern among a number of our stakeholders and we thank them for bringing them to our attention. The directions will be developed in consultation with stakeholders. Discussions are under way with the Royal College of Speech and Language Therapists to develop a Scottish Government-funded programme of operational improvement work. That will build on the recent right to speak strategy and lay strong foundations for the introduction of directions. I would also like to highlight the on-going work around voice banking, an important development in augmentative and alternative communication. The Scottish Government will fund the Ewan MacDonald Centre to pilot voice banking in three NHS sites from April of this year. We thank Gordon Aitman for bringing this research work to our attention and look forward to the findings of the pilot. The financial implications of this duty are expected to be cost-neutral, as it will not lead to an increase in demand, but any future directions are likely to incur modest financial costs for health boards and local authorities. To be clear, the more immediate operational improvement work with the Royal College of Speech and Language Therapists and the voice banking pilot are both being funded by the Scottish Government. Convener, loss of voice and the need for voice equipment affects a small number of people, but has a huge impact on their lives. Imagine if we in this room had difficulty communicating and could not convey our message. I therefore feel that legislating is the right thing to do and know that a number of people agree, so I move amendment 1 in my name. I think that the principle of this amendment is excellent, the provision of the communication equipment and the support that is required. I am glad to hear what the minister said about guidance to health boards, because I was quite concerned when I saw the number of suggested amendments coming in from the College of Speech and Language Therapists in response to the minister's amendment. Hopefully that has been taken care of. Another issue that was raised quite a bit that concerns me a bit is about funding. I cannot find it on my iPad, but because I put in a submission, I am quite concerned that there would be enough funding for the likely demand for this sort of equipment, and I was wondering if that could be looked at in detail. The principle of the amendment I am very happy with, but I think that there may be some detail to be sorted out, which presumably could be done later on in regulation or guidance. I am just wondering, taking forward this amendment minister, would this remove the duty on the Department of Work and Pensions through access to work for the provision of similar equipment? I personally rely on communication equipment all the time, and it is although I have my own voice, I rely on speech. I have activated equipment all the time, and I am just wondering, taking this forward, would this remove the requirement on DWP to provide such equipment for people in work? I think that it is really important that, when people are faced with a devastating illness, they know that they are going to lose their voice and not be able to communicate properly, to have something that they can hold as comfort to them, and to take some proactive action or to put in some mitigation of that. I think that that is really important. I am glad that this amendment is here, and I am glad also that the minister paid tribute to Gordon Aikman, who has brought this very much to the fore, and has probably given an awful lot of other people who would not have had this assistance access to it. I think that, certainly speaking for myself, voice banking is something that I was totally unaware of until that point, so I am grateful to him and to the minister for bringing it forward. I think that, in reply to Annette Milne, we have taken the view that less is more in terms of what we put into the face of the bill, rather than being so prescriptive about things because technology moves on. We do not know whether, in a couple of years, there may be something that technology has moved and replaces voice banking, for example, so we did not want to restrict ourselves in terms of that. In terms of the DWP, Mr Robertson, the answer to your question is no. It would not relieve the duty on the DWP. The DWP is complementary duties. In terms of funding and local authorities, the funding is the Scottish Government through the health boards, but that will be addressed as we develop the direction of travel with the legislation. The question is, then, that amendment 1 be agreed to. Are we all agreed? Yes. Thank you. Call of amendment 10, in the name of the minister. I am already debated with amendment 6. Minister, to move forward. Move. Thank you. The question is, then, that amendment 10 be agreed to. Are we all agreed? Yes. I call amendment 26, in the name of many Scanlan. I am already debated with amendment 19. Mary Scanlan, to move or not move? Not move. The member wishes to move an amendment. Does any other member wish to move an amendment? We go now to the question that section 32 be agreed to. Are we all agreed? Yes. Thank you. Question is that section 33 to 35 be agreed to. Are we all agreed? Yes. Question is that the long title be agreed to. Are we all agreed? Yes. That ends stage 2 consideration of the bill. Thank you minister and your colleagues that were with you this morning. We now suspend it over the moment we have moved to agenda. Well, let us clear the room a wee bit. Maybe just pause agenda item number five. We have two negative incidents before us today. The first incident is public bodies, joint working, integrating, joint board, establishment, Scotland amendment order 2016, SSI 2016 slash 2. There has been no motion to annul and the delegated powers and law reform committee have not made any comments on the incident. Do you have any comments from members? Is the committee therefore agreed to make no recommendation? Yes. Thank you. The second incident before us is the health boards membership and procedure, Scotland amendment regulations 2016, SSI 2016 slash 3. There has been no motion to annul and the delegated powers and law reform committee have not made any comments on the incident. Do you have any comments from members? No. I have not made any comments. Is the committee therefore agreed to make no recommendation? Yes. That is agreed. Thank you. Agenda item number six, which is palliative care. We are just ahead of schedule and I think that the cabinet secretary may have some travel problems, so we can suspend at this point, get a coffee, stretch your legs or whatever and but don't go far, so we can proceed quickly to our business when the cabinet secretary arrives. Thank you all. We now move to our sixth item on the agenda, which is an evidence session on the Scottish Government's strategic framework on palliative care and its response to the committee's report on palliative care. I welcome the cabinet secretary and the officials here this morning on an office in Cabinet Secretary for Health and Well-being. I welcome Janice Birl, senior policy implementation manager, and Craig White, divisional clinical lead share national advisory group for palliative and end-of-life care, all from the Scottish Government. Welcome to you all. Cabinet secretary, I was remiss last time in giving you an opportunity to make some opening remarks and you have that opportunity on this issue today before we move to questions. Thanks very much, convener, for giving me the opportunity to discuss what is a very important issue of palliative and end-of-life care. First of all, I would like to say a very much welcome the committee's report. We need to talk about palliative care. It is an important time for palliative and end-of-life care in Scotland at a time when we have seen unprecedented public discussion about end-of-life issues. I think that there is a conversation on which we need to build. I was particularly struck by the comprehensive way in which the committee assembled the evidence and were informed by the oral evidence presented to you. I would also like to commend the committee for taking the opportunity to meet with service users during the visits to Rachel House and Ardgaun hospice. I firmly believe that that is part of delivering person-centred health and social care. It is vital that we listen and learn from people who are using services. With more and more adults in Scotland living with long-term conditions involving specific palliative care needs and children with life shortening conditions living into adult who I fully recognise the need for robust and effective action to address changing needs. On 18 December last year, I had the privilege of launching the Scottish Government's strategic framework for action on palliative and end-of-life care at the Mary Curie hospice in Edinburgh. I was deeply grateful for the opportunity to speak with patients and staff there to hear directly about their individual experiences. I would also like to take the opportunity to pay tribute to the hard work of all the charities, members of the public, representatives of the health and social care sectors and the many others who helped to develop the framework. I am extremely pleased to be able to tell the committee that the strategic framework has received a positive response from around the world with positive recognition coming from members of the World Health Organization and the Altarum Institute in the United States. The vision set out in the framework is that, by 2021, everyone in Scotland will have access to good-quality palliative and end-of-life care, which is tailored to their own symptoms and life circumstances. We are committed to ensuring that people can access high-quality palliative and end-of-life care, regardless of their age, diagnosis, socioeconomic background or where they live. The new health and social care partnerships and the independent hospice care and voluntary sectors will have a central role in local areas across Scotland in meeting the growing and changing need that I referred to earlier. Only by focusing on local capacity and local solutions can we ensure that we deliver the best care and support for all those at the end of life and for their families and carers. I recognise that significant improvements have been made in the delivery of palliative and end-of-life care in recent years. The committee heard about those from Professor David Clark from the University of Glasgow, who is a world-leading authority on the subject. Scotland already has a good reputation for a palliative and end-of-life care. Indeed, there has been an increase in the number of doctors and nurses working in specialist palliative care services in Scotland. However, I fully understand that it is still a great deal that we can do to improve the provision of palliative and end-of-life care. I recognise that that is not going to be an easy task and will require a great deal of hard work and commitment of many individuals and organisations across health and social care, the independent hospice and care sector and voluntary sector. The framework outlines the Scottish Government's 10 commitments for action to support effective implementation over the next five years. We have also committed £3.5 million to support national improvements and to build capacity. The 10 commitments within the framework provide a clear direction for future improvement. Those commitments are designed to improve palliative and end-of-life care in ways that are sustainable and can be applied in many settings. Training in education is a key priority that we have already identified for targeted action. We have to ensure that medical, nursing and care staff are supported to recognise when time is becoming short and when sensitive conversations with people and their loved ones can make an enormous difference. I am happy to report that work on fulfilling this commitment has already begun. NHS Education Scotland is in the process of recruiting three regional practice education co-ordinators to work across the NHS and social care services to establish an integrated and collaborative approach to palliative and end-of-life care education provision across health and social care partnerships. Finally, we agree with the committee's findings that there is a need to improve the information that we have. That is why we have committed to improvements in the way that information is recorded, shared and accessed across the sectors. That will include capturing end-of-life care preferences on where people would like to be cared for when time becomes short. It is recognised that those preferences may change and on what it might be possible to provide will also change depending on someone's clinical condition. However, we need to be better in anticipating and recording care needs and to having that open discussion with people about what matters most to them. It will be important that staff across sectors are supported to improve the delivery of palliative and end-of-life care, and that, as part of the strategic framework, clinical and cost-effectiveness evaluations will also support. A review of hospice funding is being planned as part of the implementation process. I hope that that has been a run-through of some of the key elements of our response, and I am very happy at this stage, convener, to answer any questions that members may have. I was delighted with the Government's response to the health committee report, because I think that a lot of work went into that. It is good that there is mutual thinking along those lines. I am quite sorry that I will not be in Parliament to see the progress of that, but there will be a lot of work ahead. I would like to pursue the conversations, because at various meetings that I have been at over the past couple of years, and from witnesses and so on, is the fact that we still do not talk as a country, we do not talk about death, we do not talk about planning for death and about end-of-life care, palliative care. What I found concerning with Mary Curie's first research was the fact that healthcare professionals are not... I find it very difficult to talk with their patients about that. I can fully understand that. As a young doctor, we were thrown out of the deep end without any training at all to try and speak to patients about the fact that they were dying. It was not easy, and I am sure that a lot of mistakes were made because we had no training in it. I think that it is very important to try and change the culture around that early, so that once someone is diagnosed with an eternal condition, they have the forward plan openly and freely discussed with healthcare professionals. It was just around that. If you could give me any more detail of what the framework would do to drive the new culture of openness in the community. I think that part of it is the training and support for health and care professionals, and that is a key part of the framework. The wider conversation about how as a society we deal with these issues is the more challenging one. As a society, I think that we have found it difficult, perhaps a bit easier now than maybe a decade or a couple of decades ago, but nevertheless, it is still very challenging. Of course, that is why we have been looking at the extending the voices survey to Scotland-wide to be able to use opportunities like that, working with the Alliance, Scottish Health Council and others, to begin to keep that conversation going in the public arena about end-of-life and palliative care and dying generally, and the fact that people should be able to express their preferences, and that that is something to encourage for the family to talk about. None of that is easy. When it comes to you as an individual having that conversation, the theory is one thing and the practice is another. I think that support, particularly for perhaps newly qualified staff, is going to be very important. The anticipated care planning is very important here, because it gives a focus for the discussion. If there is an anticipated care plan, there is something to talk about with the person and the family. That, in some ways, can make it a lot easier, because there is something already there as a focal point. As the cabinet secretary mentioned, good progress is being made by NHS education for Scotland and the SSC. In fact, the interviews for those posts that were mentioned are taking place today. One of the advantages of NHS education for Scotland and SSC being involved is because of their existing involvement in the curriculum planning and the training across the different professions. We are also starting to see, since the framework was developed, some organisations sharing with Ness and the SSC their own local training needs analysis. For example, NHS Tayside just this past week has shared with us some surveys that they have been doing of medical and nursing staff asking them to rate their level of confidence in those issues so that that can inform the needs analysis that the three new post holders will be doing across the country. We have also heard in talking to stakeholders that initiatives such as Good Life, Good Death, Good Grief, which your inquiry report referenced, are important in designing future approaches around the public conversation, so taking the learning from Good Life, Good Death, Good Grief and scaling that up across the country so that we reach more people with that. In turn, it will mean that, when people have to have conversations, they will be less concerned by some of the barriers that have been reported. The plan for training and support is to start early on at an undergraduate level for nurses and doctors, particularly doctors. Once they are in post, it has to be an on-going training or support, I do not know which. My feeling is that it has to be introduced early and then progressed so that they continue to develop confidence in raising the issue. Early on with people, when you really can have a decent amount of anticipatory care plan? Yes, absolutely. On both those points, there is the early inclusion in the curricula and particularly in the practice-based aspects of health professions and social care professionals training. However, as you say, it is helping people who are in the professions to realise that those are conversations that do not just belong at recognition of end-of-life or deterioration, but that one wants to have those earlier as part of the care and support planning at work. I think that the need to talk about that is very, very important. I thought that the chief medical officer's annual report was very, very good in terms of the challenge that we have here. As a committee, we were flagging up education, training and so on. That will assist in some ways, but what we are dealing with here is a much deeper problem in the professions and in terms of pressure to do something even when it will make no difference. She highlighted that. If we are talking about pallidive care and end-of-life decisions about whether you take intensive treatments or having the opportunity to understand the consequences of all that, that is something that the committee touched on in terms of access to new drugs and particularly end-of-life and cancer. If some of the people remember, the clinician was at a gown hospital who did not just deal with cancer where it seems to be easier to talk about these things, because of the inevitability about it in a timescale, it can be applied. In terms of respiratory illness, it is the same case that having this discussion with people with respiratory illness—it is not cancer—would be seen by the clinician's point of view of abandoning and sending you home. We are dealing with things here that are a very deep set in the culture of the national health service. Education and training is all very well, but we need, as a chief medical officer, to suggest that we need something more than that. I think that her report was very good and quite challenging in some ways, reflecting some of the debates and discussions that are on-going. We are in a different place than we were years ago in that palliative care, and people can live a long time in a palliative care situation, and their needs will change, and their requirements will change through that time. I think that that is probably where the anticipated care plan is so important, because the discussion about someone's wishes should happen at a time that is not an end-of-life point, but a time where they are more able to have that discussion hopefully involving their family about what it is that their expectations would be through their care pathway, which might be over quite a long period of time, and at the end of that, what their end-of-life choices should be. Maybe having a focus and more priority given to that, as well as the importance of the right, whether it is medication or interventions, will always be clinical judgments. However, part of the debate that the chief medical officer has sparked off is whether there is sometimes an over-medicalisation of somebody's care, and sometimes the expectation of families and the person themselves will be whether they hear about a drug or something that could enhance the length of time that they have. Of course, it is a natural instinct for somebody to want to access that, and I think that that is where clinicians have to have that conversation about what the expectations would be, what it would do, what the likelihood would be, and any side effects, for example, because sometimes there are quite dramatic side effects, and in an end-of-life situation, that might not always be what is in the best interests of the person. Those are always very difficult discussions, which I think is why they are best had as early as possible in that process. One of the things that, as a committee, I know that you have heard evidence from before is the importance of considering that across a wide range of conditions, but it is not just something that relates to end-of-life. The chief medical officer asked for some of the clinicians and people who work in clinical lead roles, such as myself and colleagues, to advise her on some of the themes. We were able to give her advice on some of the issues relating to palliative care and your inquiry report, and she informed some of the thinking about the conversation that she wants to have with doctors on realistic medicine and how we build on the good work that is already taking place around putting people and families at the centre of conversations about anticipating future care needs, but also recognising, and it goes back to Nanette Milne's point, that that may raise issues around confidence and skills for doctors. So linking both of those issues together in the conversation that the chief medical officer initiated in her report. She is also highlighting that intensive care does not lead to better outcomes. She cited some American studies of stage 4 cancer where those who took intensive care are opted for intensive care, and those who took hospice at home had a better outcome. It would seem that we will only have to have that debate that will support education and training, that will encourage people, not the clinicians, to make that choice, but the individual and having that discussion with the individual about the options that they have, not just the new medicine, intensive treatment or whatever. I do not know if simply the education and training of the workforce is going to help to change that dynamic. Ultimately it will always come down to clinical judgment and discussion with the patient and their family. Sometimes people will choose a different option if they are fully aware of the side effects and what to expect. People will sometimes make those choices. I think that it is about having the full range of information about what those options will entail and having that discussion at an early enough stage so that a proper informed choice can be made. Some of the practices that we still have of perhaps panic and perhaps a fall down in pain control leading to a last-minute hospital admission at the end of life. There are those very practical issues that need to be overcome to make sure that at that stage people are able to still have their choice. If someone has chosen to have their end-of-life care at home, that is supported and sustained. As I have heard of cases where that was the active choice, but because there was a lack of confidence at the end of what to expect and perhaps issues around pain control that people ended up in a hospital setting when they should not have the pathway had been delivered as it should have been for the person to have their end-of-life care at home. Those are the things that we absolutely want to get in and about with the implementation of how we can ensure that someone's wishes are delivered, that there is a confidence there, not just from the professionals but the patient themselves, that they will be supported in their choice and that families—I cannot stress this enough, I think—have got to be involved in this discussion. In an end-of-life situation, families can sometimes become understandably quite upset and distressed. We have got to make sure that everybody is clear about what those choices are. Just in terms of anticipatory care planning, we are already working closely with the Living Well and Communities work, and there is a specific strand of work that is linked to anticipatory care planning. There have been two clinical appointments made to that work that is based and hosted within Healthcare Improvement Scotland. In line with the discussion just now, there is a wider piece of work looking at emergency care and treatment planning, and we are ensuring that the anticipatory care planning work is linked and has an oversight of the wider emergency care and treatment planning that is actually out for consultation just now, and I am happy to share with the committee the hyperlink to that piece of work. That is aiming to take on board at that crisis point when the discussions have been had at an earlier stage, but there is that emergency care and treatment plan in place. It links very much to the wider anticipatory care planning, but it is taking on board when times become a bit difficult. What are the care preferences at that point in time? I was trying to focus on the implications of some of the decisions that you made earlier on before the emergency situation. What likelihood is that that discussion will take place? What would that discussion look like or sound like at that point? Is there any consistency or guidelines across the board about what that should look like? Is that simply left to Dr Noe's best? In Lanarkshire, there is a consistent approach across the care home setting that has been piloted over recent years in anticipatory care planning. All but one care home in the Lanarkshire area uses the same anticipatory care plan, and there is data that demonstrates that inappropriate admissions to hospital has declined over the time. There is work on going in local areas to fit with the local infrastructure to make sure that the anticipatory care plan with a care lead is identified in discussion with the families that there is a clear plan in place. There is work that we are trying to spread and share. One of the issues that came up in the evidence is whether a death at home or close to home in a residential setting is a better death than in a hospital. We have not measured that in any sense, although we put it forward saying that more people are dying at home, so, therefore, that is better. Do we know about the quality of that death, the impact of that on that individual or the family? I do not think that we do. Craig will say something about this. I suppose that that is being based on people's preferences being delivered, but you are right about then actually looking at the quality of that experience and making sure that what we think is the better solution given that we know all the challenges that there are in busy hospital wards in terms of making sure that there is privacy and dignity, although that is what is delivered in most cases. Craig, do you want to say a bit about the quality of experience? As the committee will know from other sessions, it has had around spreading quality improvement initiatives, safety initiatives. We have learned through other work such as the Scottish patient safety programme about the best ways to spread reliable care processes to make healthcare safer. Therefore, we have looked at some of the learning from that around how, for example, we take the work that Janice mentioned in NHS Lanarkshire and we, through support that we will give to health and social care partnerships, how they can test and implement that within their local systems, and that will reduce the variation in relation to when and how the conversations take place. You are absolutely right. We then want to be able to measure that and your inquiry report, as you know, identified that there is an urgent need to look at measurement and describing the quality of care. We have been supporting some work in NHS Lothian around how to ask people about their experience of care and how to use the voices framework that was mentioned to ask bereaved relatives for their reflections on the quality of care. Importantly, as opposed to waiting for a survey once every year or two years, we are looking at how that data can be made available, again learning from the safety work to teams every day and every week, so that they can continuously improve the quality of care. There is still variation, but, as the cabinet secretary said, we want to try to accelerate the progress around the consistency of care process, so that, in keeping with the vision by 2021, everybody irrespective of condition will know when and how and with whom those conversations are going to take place. Robertson, what is a supplementary and then take load of grant? Thank you very much. It is really on the conversation. When we heard the evidence, I believe it was from Dr David Carroll from NHS Grampian, he said that having the conversation is fine, but you need to continue that conversation because patients and indeed sometimes families may well change their mind in terms of the type of care that they wish or indeed where they wish to maybe end their life, so this probably brings me to the HIS. In your response, you suggest that they are looking at their methodology of how they inspect what is going on at the moment. Do you anticipate a timeframe for that? I will let Craig answer on the timeframe. You are right though about a plan, an anticipated care plan, is not something that is done once and then that is frozen in time because people's needs will change and that may lead them to a different conclusion about what they want for their care and including the end of life care, so that has to be an on-going conversation that has to be co-ordinated so that everybody is clear about those wishes. Craig, in terms of the timeframe? I think that there are probably three elements to that. The first is in relation to our commitment to support healthcare improvement Scotland and others with the work that it is going to do around the commitments and improving the quality of palliative and end-of-life care. Janice and I met representatives of healthcare improvement Scotland last week, but Scottish Care, the Care Inspectorate and the two new clinicians that have been appointed to lead some of the anticipatory care planning work. Timescale-wise, that work is under way. We have asked them to submit a report describing how their existing work can support the commitments to palliative and end-of-life care but, importantly, link with other work that is on-going, such as the national care standards work and also the inspection process for strategic plans for health and social care partnerships, which Hes and the Care Inspectorate are working on. It is happening at the moment, and we are linking that with our on-going mechanisms to review the outcomes from that work. The guidance that health boards have been given for the local delivery plans, again, we have invited them to submit details on how the strategic framework is going to be implemented. We have tried very much to link that with all the existing programmes of work and the annual monitoring and governance mechanisms within the boards and within the partnerships. Rhoda Grant. Can I ask a quick supplementary on that as well? The difference between hospital and community palliative care, especially in an emergency situation, which we did not really take a lot of evidence on, but it seems to me that it is a different setup. Something happens very quickly. There is a huge intervention and people realise that staff cannot really help somebody. There needs to be a different kind of palliative care there, especially for families who are kind of willing this person to, you know, this person was healing hearty, you know, half an hour ago, and then suddenly, has any thought been given to how that happens, especially in a really busy ZITU emergency department or something like that? Yes, I mean, interestingly, I just recently was inquiring around what happens in an emergency department, and I was in the emergency department nine miles a few months ago and saw for myself that even in a busy A&E department, there is good practice around ensuring that there is a quiet area where there can be dignity and peace at the end of life, which, you know, you can imagine is quite challenging, but the boards have assured me that they make arrangements, even within a busy A&E department, where to move the person somewhere else would be stressful to the patient and their families. Therefore, obviously, it is not where you would want someone to have end-of-life care, but, if the clinical judgment is that it would be better than moving someone at that stage very, very much at the end of life, then there is a good guidance around how that's done in a dignified manner. As I say, I saw for myself in nine miles how that's done. Sorry. In terms of the commissioning guidance, one of our commitments is to provide health and social care partnerships with guidance around commissioning. As the committee may be aware, the partnerships will be responsible for commissioning palliative care in hospitals, as well as in community settings. We will be making sure that some of the issues that the cabinet secretary mentioned are clearly reflected in that guidance in order that the people who present to accident and emergency departments have high-quality palliative and end-of-life care. The work around transforming urgent care that, as you know, Sir Lewis Ritchie was leading is also relevant to this. Sir Lewis and I are meeting later today in order to discuss the issue that you have raised to make sure that some of that work can be informed when people present to urgent care services and when there is a need to look at the most appropriate care setting. I move on to my substantive question, which is about children. I visited Great Shaw house as part of the committee inquiry and it struck me that palliative care for children is quite different to palliative care for adults because they are quite often dealing with children from very small babies who have life-limiting conditions and might not see adulthood. I was wondering whether definitions would be different for them. On looking further ahead, as care gets better, as people learn more about those conditions, some of those children live into adulthood and there seems to be a gap. I notice from your report that you are talking about ages 0 to 25, but in some cases that can be up until the 30s, and where families have depended on children's hospice services, which gives them huge support. Sometimes they feel a bit cast out after that because the adult support for life-limiting conditions is not off the same, not even on the same Richter scale, to be honest. It is a recognition in our response that the needs of children and young people can be very different from those of adults. You touched on something quite important that many children and young people, through the development of medication technology, knew ways of supporting children and young people with life-limiting illnesses, are now living much longer than was previously the case. What we need to make sure is that things like transition period from children to adult services are as smooth as it possibly can be. The needs of children and young people are quite distinct. I think that that is, hopefully, recognised in our response and comes through. Craig, do you want to add a little bit on the question about definitions? I think that, within the wider evidence summary, there is a specific definition for children and young adults. In terms of the work that we have been doing with CHAS and officials have met, we have met a number of meetings with the transition team that has been appointed to CHAS. They are currently testing out different models of, particularly, respite care for a number of young adults who are used to coming together and meeting within CHAS and going forward. It is how best might they be supported. In recognition that one size does not fit all, it will be different models that will be tested out. That works on going. Around the provision for short breaks for individuals to support their families and themselves. The work that is testing out the different models is on going at the moment. One of the things in terms of definitions and the transitional issues is chair of the national advisory group. One of the things that I was keen to do when the framework was being presented was to seek assurances from experts, clinicians and, for example, the chief executive of the Children's Hospice Association, that both our framework and the evidence summary had accurately reflected the issues in relation to definition. The medical director of the hospice, the Children's Hospice, again confirming that the Government's commitment to 0 to 25 age group was very much in keeping with their service model. The point around anticipation and transition, we would expect, as people transition, who are living longer with the sorts of conditions that CHAS clinicians are seeing, that the commitments that we have made for adults would obviously benefit from those two, as they transition from the CHAS services and those services to adult services. Good morning, cabinet secretary. I have grat down to where the pall of care provided. I welcome your announcement in regard to the £3.5 million more allocated to this. It has been a concern of numerous people, and it has been raised several times about the impact of care from home visits being limited to 15 minutes. The committee recommended that you investigate this, and I note that your comments, local authorities, allocate care on the basis of an individual's assessment needs. Clear no-one should have 15 minutes or shorter visits where it is not appropriate, where an instance of medicine is being dispensed, etc. You have made an announcement in your papers coming back to the committee. You have said that the Scottish Government has developed a new joint inspection regime to ensure that people get the level of support through free personal care that they have been assessed as needing. The quality is no less that the people of Scotland deserve, and that you will implement inspections, including commissioning processes through councils that determine the volume and length of visits needed to develop safe, compassionate care services for Scotland's older people. Where I stay, I have a sheltered housing complex behind me, and I note on occasions when I'm going out or coming back into my home that various care workers are coming to visit clients in the area several times during the day, but it's different workers—some on foot, some on car—and it could be organised better. What inspections do you intend to ensure to develop and get away from this constant comment that people are only getting 15 minutes of care per day? There is a big area in itself. People should get the care package that they require depending on the needs, so it should be needs-led. A lot of work that you have outlined has gone on to try to improve quality and inspection around all those issues, including how councils commission services. We are moving into new territory in the world of integration. The health and care partnerships have had the shadow year move from 1 April into full integration, and that will make a big difference. For example, the joined-up nature of people working in multi-disciplinary teams gives us the opportunity to get away from someone's living room feeling like Salki Hall Street, with lots of different people coming in. Big improvements have already been made in that regard, but integration helps us to take that to the next level. It also, through the reform of primary care, gives an opportunity for the right professionals to be spending the right amount of time with someone. In an end-of-life or palliative care situation, you can see how important that will be, where their needs are more complex. Through the work that is on-going around the reform of primary care, freeing up the time of GPs to spend more time with more complex cases, making sure that the packages of care in its total sense that people receive are joined up, that they are multidisciplinary, and that communication is good. We minimise the different faces of the person, and we will see that there is more continuity of care. All of that is a big opportunity if we get integration and the new models of primary care. That, as well as the framework, which is very important in the implementation of this, is critical. So are all those other parts that are big changes that are in the process of happening, or that are coming. For palliative and end-of-life care, if we get that right, I think that it could make a huge difference to the quality of care that people receive right through their life to end-of-life. I certainly agree with you and through your convener that the many aspects that have come on in the last year or so are going to make, hopefully, a difference to people's lives and also to the care that they are going to receive. You are confident that the inspections that, whilst this is carried out by local authorities, we are confident that we can monitor what is happening locally. While inspections are moving more to a whole system approach, we are trying to reflect the work of inspectors as the services changed to be integrated. Rather than looking at, for example, just one element, if you look at the way older people's services are inspected, we are trying to do that across the whole range of older people's services to get a picture of what are older people's services, not just a bit on the hospital side, but the whole thing. The same could be said for palliative and end-of-life care. There is an opportunity to look at inspecting services across the whole system. I think that that makes more sense. That is really the whole direction of travel of inspection. We have secured agreement, in principle, from three at the moment health and social care partnerships to test out how our commitments can be implemented. Those are Glasgow City, East Ayrshire and Western Isles, with other discussions on going with some other health and social care partnerships. However, one of the things that we would want to do is, yes, inspection is important, but in terms of getting continuous quality improvement, we want the care staff to have access to information that can influence the day-to-day improvements. How many staff were involved with somebody's care? How long were they there for? What did they do? Did they meet their needs so that the teams have those data to look at as part of our approach to improvement? Inspection is part of that, but we have found, through other quality improvement work, that if we allow the teams to have those data, as part of our commitment to improving measurement, that they can start to identify variation. Perhaps there are more people than somebody wants to be involved in care, or they are not getting all the time that they might want, so that they can take the action there without waiting for an inspection further down. We empower the staff to improve as they go along. I am looking back to education and training, and we all know that, at that point, somebody who has been cared at home for will see carers' home health, carers' social work, every day of the week, three times a day. They are the people who provide the care. They see their doctor maybe once a fortnight, nurse similar terms. In terms of inspection, what are we inspecting? We are inspecting the basic principles of continuity of care. We are absolutely quality, but the cabinet secretary is right that it can be too busy at some points. However, almost more importantly, from personal experience, is how that person relates to that person who is going in and delivering personal care. There is also the other factor of the care workers who do not get the professional support that clinicians and nurses do in terms of resilience. Those carers who have not been trained in lifting and handling and so on, but have not had the training and education to understand maybe the palliative care, end-of-life care and what they are dealing with. They use their instincts and their own personal experience in that and provide empathy and whatever. They can be caring for those people for a long time, and there is an issue of attachment, which is recognised and nursing and clinicians, but there is no support when that person dies or whatever. I am just saying that workforce, to be the workforce that we need it to be, needs to be considered in this hierarchy of clinicians and nurses and whatever. The people who are delivering the care day in, day out are not those highly trained, highly paid people. I am hoping that the strategy reflects that and its education and training and support for those people who are delivering care. I agree with the work that Craig mentioned earlier about the triple SC, should help that, but we need to monitor that and make sure that, first of all, that level of care is also recognised. If someone has a wealth of experience in delivering palliative and end-of-life care as a care worker, I think we need to look at opportunities to recognise that in terms of their skill level, but also to support them because you are right, people do get attached. They have maybe seen that person every day. What support is there for the staff in an end-of-life situation? Absolutely. It was an issue that came up in the meeting that I referred to earlier with colleagues at Healthcare Improvement Scotland, the Care Inspectorate and Scottish Care, and there was an agreement last week that the work that we want to support in health and social care partnerships that Scottish Care, as a representative organisation, would be involved in that for the reasons that you said, so that the whole range of care workers are involved and the issues that matter to them in providing high-quality care are taken account of. To pick up on the convener's point around outcomes, absolutely the measurement framework that we want to develop needs to link with the health and wellbeing outcomes that are part of the integration work and legislation, but it also develops some specific indicators for palliative and end-of-life care that relate to quality outcomes. You will monitor the continuity principle. How many different people that person has had over a week or a month? We want the partnerships that we are going to support to test local work to develop and test out measures. Those meetings are happy to keep an eye on that and make sure that they are doing that as part of their monitoring. What we do not want to do is impose from the centre how or specifically what they measure, but, because that has been identified by Scottish Care at the meetings, it is already there on the list of things that we are looking to discuss with partnerships. I am pressing you to recognise that continuity of care is a priority and a principle that applies if that person was receiving end-of-life care or palliative care within the national health service. Why would that be a priority and a principle that is insisted upon and measured when that person is receiving end-of-life palliative care in any other setting? It is a fundamentally important aspect. Janice may remember about the voices work that I talked about. I am sure that it covers that point too, so we would have multiple points to monitor that. We can certainly keep the committee informed of that work as it has taken forward and tested out and we will make sure that we hone in on that and the feedback to committee around continuity of care. One of the models that I have seen is used is that a note of who is going to go in to see a person every day is sent out to the individual or their family or their carers. You could see it at a glance that it is the same people that are going in every day or is there a different person every day or is it the same three over a period of a week that goes in every day? That is a model that I am not sure if it is replicated across the country. At a glance, it is quite a simple mechanism to use. Anybody could see if the person does not have the capacity to understand that it is the same person that they think it might be. It is quite a good move. I personally think that it is possible, and the development of those workers and taking pride in being part of a pallid of care team that can go on in specific cases. I think that there is all sorts of potential there and opportunities to release potential where there are people out there carers who are very good at providing that, who do it now, but it might not be recognised. I am going to move quickly to Malcolm Tiddum. Dennis, do you want Malcolm Tiddum? Well, I will give you a supplementary and I will test the patience of the committee. I hear what the convener is saying and the responses, but surely what we are looking at if it is patient-centred, it will be the most appropriate people going in at that most appropriate time in that person's care. That will change and the continuum of that does change quite often. At one point, you could have somebody with a very good specialist nursing background, but if the person suddenly recovers, you might be back to social care. It is about making sure that the person's needs are kept on under review. If there is a requirement for more intense support, if someone's care needs change, that is what should happen. The convener was saying, and I would agree with that, is that where the basic care needs are being met, where it is possible that continuity of people involved in that is very important because relationships are formed and people get to trust folk. Those are very important in a very personal care situation where someone is quite vulnerable. We want to make sure that through the testing and the work that we hold on to that continuity of care as being a key aspect of how we measure that, we can take forward Janis Outline's one very simple way of being able to identify whether that has been the case or not. We will take that forward and I am happy to keep the committee informed. I move on to a couple of other points, but I want to focus on the health and social care partnerships. Some of that has been dealt with already. I was pleased that the first two commitments of the Scottish Government of the 10 were about health and social care partnerships, and we have heard something about the work of Healthcare Improvement Scotland. Those recommendations talk about providing expertise guidance and so on, but the remaining question that I would like to ask about is just to what extent it is on the radar now, because we know that health and social care partnerships have many commitments to deal with. I am sure that all that will happen in due course, but to what extent is it on the radar presently? For example, the Scottish partnership for palliative care recommended that all health and social care partnerships should have an identified lead for palliative and end-of-life care, and that the partnership should ensure that palliative care is included within their strategic and operational plans. I wonder to what extent you were looking at their plans at this moment of time in terms of their attention to palliative care. Obviously, the plans are all there for all this to happen in due course, but to what extent is it happening? Are they focused on that at the start of their existence, as it were? You raised an important point. The partnerships are required to produce a strategic commissioning plan by 1 April, covering all its functions, which includes the responsibility for palliative and end-of-life care in hospitals and communities. The legislation, if you remember, sets out the requirements for engagement as part of the strategic planning process so that the third sector, independent sector and all the right people, including local communities, should be able to be part of the engagement process around that. However, in terms of palliative and end-of-life care services, we will provide guidance specifically to support those partnerships with the development of the content of their strategic commissioning plans in relation to palliative and end-of-life care services. Officials, mainly Craig and Janice and others, but Janice and Cabeine the Key, are in the process of meeting each health and social care partnership now and have been and are continuing to discuss progress on palliative and end-of-life care, including other issues as well, but drawing that out as part of the items to be covered during those discussions. It is early days, but we have made it very clear and there is an expectation with partnerships that palliative and end-of-life care is something that we expect to see a focus on through the commissioning plans, that there is a plan laid out of how they are going to take that forward, what they are going to do, involvement of the third sector and the independent sector, so that there is a coherent plan bringing in all of the providers and they can then be able to articulate and lay out what those local plans look like. Craig, you have been more involved with the... Yes, so Janice and I are in daily contact with the integration team within the Scottish Government who are linking and having these meetings with all of the partnerships because we want to maintain the high levels of awareness that your inquiry and the framework have resulted in the local delivery plan guidance that I mentioned earlier that the chief operating officer of NHS Scotland has issued last week is encouraging NHS boards to have these conversations with partnerships in their areas to keep this high priority and look at how their future plans are going to address that. The chief social work adviser, Alan Baird, and I also attended a meeting with all the chief social work officers and I met with a health spokesperson of the society of local authority chief executives. Again, we are doing that to ensure that all the various different stakeholders and leadership groups that will influence the commissioning and the local plans are not only aware of the framework but have the opportunity to connect and have our contact details so that we can connect them with the third sector organisations and with the areas that perhaps are a bit further forward with some of that. Do you want your commitment to seek to ensure that our future requirements of e-health systems support the effective sharing of individual end-of-life anticipatory care planning conversations? I think that we had some discussion of that with some of our witnesses. The questions might be what is on the record and we did have some issues there just about how many different summaries. There seem to be emergency care summaries, palliative care summaries, key information system anticipatory care plans and so on, but I am not really sure where e-health has got to currently, but to what extent is that going to be possible for that to be widely shared and to have the necessary information on the record? I will let Kaye answer some of the detail, but essentially it will be the key people who will require access to information. For example, we talked earlier about someone ending up being admitted into an acute setting even with the best laid plans, sometimes things happen and someone may end up being admitted into an acute setting. It is very important that there is information available to the staff within that acute setting about the needs of the person, particularly if they are in an end-of-life situation. Kaye, do you want to say a little bit about where we have got to with the register and other stuff? I will perhaps mention two areas that I have been involved with and then if it is acceptable, Janice could describe some of the specific conversations that we have been having with the e-health colleagues about future systems. Following the agreement to dismantle the quality outcomes framework in relation to GPs from 1 April, we have reached agreement with the British Medical Association and GP practices that they will continue to maintain some of the disease registers that include palliative care, which are linked very much with the key information summary. I have also asked that some of the clinicians working in community and hospital settings identify some of the issues that they encounter, things that work well with the key information summary, but crucially as we design the future e-health systems areas that need improvement. That is work that Janice has been leading in relation to e-health, and perhaps you could comment a bit more on the future commissioning of the new systems. Yes, the key information summary at the moment, there is a piece of work being commissioned just to make sure in its current state that it is being used, it is being accessed, how best practice could be spread because we know that in certain areas in Scotland accessing the key information summary, the electronic key information summary is quite high and it is more challenging in others. There is a piece of work in NHS National Services Scotland, I have been invited and commissioned to do a specific piece of work to look at that rapidly, but beyond that a group has met already to start thinking through what the requirements might be about sharing the appropriate pieces of information across the health and care settings electronically so that someone can access electronically what is appropriate to be able to access an individual and their care preferences, some of the information that is captured on the anticipatory care plan and the electronic key information summary. That piece of work has already started as well, and colleagues in e-health are pulling together a multidisciplinary team that will include colleagues from health and social care integration to start teasing out what the requirements might be. Going forward in the future it might be that the key information is not the platform that is identified, it might be more than one platform that is already in existence where we are not clear what the outcome of this exercise will be, but that work has already started. We had a discussion about the register, to what extent is it very important to get more people on the register? There seem to be different views about that. It was unclear to us why perhaps so many people did not seem to get on the register, particularly for conditions other than cancer, but is that fairly crucial in terms of what you have been talking about or is it not really so central, as some people might think? I guess that it goes back to one of the issues that we were talking about earlier, in terms of having key elements of information available that allow conversations to take place, so that if a care preference or key parts of information about the person's condition or medication or circumstances are available quickly, clinical and care staff can have the sorts of conversations that they are not able to have if it is taking a lot of time to get the information or it is not there at all. Certainly what we have been told is that where the information is available, either on the register or accessible or updatable in secondary care settings, we do start to see an improvement in the conversations with people living with the sorts of conditions that we are covering. We did some work in Lothian that we found that at the start of the work it was taking medical staff up to an hour and a half to locate information in different systems. If perhaps the key information summary was not accessible or there were IT problems, we supported them with some improvement work and they reduced that to less than five minutes and reported a huge impact on the quality of care because they could then have an informed conversation with people because they were on a register or the information that had been uploaded. Is that the link between e-health and point-of-care that we really want to try and continue to support? If I could just ask one last question about funding, the cabinet secretary talked about our review of hospice funding. I think that we raised issues in our report about the funding of the children's hospice, but there is the more long-standing issue about the contribution that NHS boards make. I think that we found difficulty actually getting information about that and it may be that there isn't a common way of calculating that, so it may be that it's difficult to compare board with boards, but certainly the impression seems to be that some, if not a majority of boards, are not really contributing with 50 per cent that I think was agreed or required many years ago, so I just wondered what you can comment on the current situation and what the review might involve. First of all, there are a few issues. Obviously, the issue with CHAS and both Craig and Janice have had regular meetings with CHAS. I'm sure that you're aware of that, but it's at NHS Tayside that currently commissions services from CHAS on behalf of the 14 boards in Scotland. There have been a number of joint meetings between NHS Tayside and CHAS, and really what we would expect is that the review of that agreement and taking that forward will be concluded by the end of this financial year. We've had some positive updates around how those discussions between NHS Tayside and CHAS are going, so that's one issue. In terms of the hospice funding more generally, that's why I felt it was important to announce the review of hospice funding as part of the implementation to look at addressing the disparity between children and adult hospices, but also picking up on some of those wider issues around making sure that there is an equity of contribution there. The review that I expect to probably, well, certainly I would want to be concluded by the end of this year, certainly later than that, should pick up on all those issues. We're fortunate to have a hospice quality improvement forum where a lot of the chief executives from the adult independent hospices meet, and certainly through that group and discussions around our commitment to support clinical and health economic evaluations, we would want to address the issue in terms of the level of funding and certainly learning from your work, because it was very difficult to compare the position across different parts of the country because of the differences in the way data, including financial data, were collected. We've also asked Professor David Clark, who again you will know from his report to you and who worked with me and colleagues on the framework, but Professor Clark and his team are completing a mapping exercise for us at the moment in terms of specialist palliative care services across the country, which will be available in April. We want to link that with financial data so that we can have an accurate description of service, but we, with our health economic colleagues, look at evaluating models. Both Janice and I have visited a number of models of care, for example Strathcarran hospice was certainly one that I visited where they are collecting financial data around their hospice at home service. It is very much something that is part of our commitment to support health economic evaluation. We want to take forward and address some of the issues that you report highlighted. Do you think that that debate will encourage different models? I mean, I'm thinking, there's been some discussion, for instance, that empty wards in hospitals and the cost to boards if it increases to push that out may consider providing palliative care wards in general hospitals. We need to look at a whole range of models, but I suppose that I was thinking more that there's scope for some new thinking around the shift of focus on primary and community care. If you think about the community hub model that we've been talking about, bringing together a range of professionals, some of the models we look at at the clip manager, one that's already up and running, they do have some inpatient beds. Some of that may well be for palliative and end-of-life care. I know in the North West Highland they have an agreement with a care home where I think it's supported by GP and nurses to provide palliative and end-of-life care on those commissioned beds. There are various models and we need to, and there probably won't be one-size-fits-all. It will be perhaps a bit different in more remote and rural areas and it might be in a more urban setting. I think that we need a bigger range of choices and to make sure that there's a capacity that is there. We'll need more hospice at home, we may need more or probably will need more community-based end-of-life palliative care beds, particularly for when things happen that might not require someone to go into an acute bed but they require some additional support that might be difficult to deliver in the home environment. There will require to be an expansion of these types of services and I suppose there will probably be a range of models of what that will look like but we're definitely going to need more on that. I suppose I'm just flagging up the issue that increased contributions from health boards doesn't necessarily equal increased finance for specialist palliative care provided by hospices. I suppose that's because it's tended to be around that debate, isn't it? You know about you know the 50% that's not being met or you're not meeting 50% of what I consider my running cost but even if we get a greater focus from the health service and health boards it doesn't necessarily equal money going in there, it will be to represent a broader model. The hospice movement will always have a key role to play no matter what other services are developed. The hospice provision will always be a critical element. I suppose the point that I'm making is that we will need more provision and that will probably, there are models to be tested out and there won't be one size fits all but we will need greater capacity for probably in all settings to be honest. In one particular setting that was an unusual setting that I saw was a mental health ward within a hospital and it was hospital at home that actually delivered the specialist palliative care element of that care package and how the board captured that and actually fed that into their specialist palliative care spend. I'm not sure that that would actually filter its way through to that particular budget head. It was delivered, the care was delivered beautifully but how you actually captured the actual spend and that's where it gets quite complex because I think we said and the committee recognised that palliative care and specialist palliative care will be delivered across many settings and it's how you actually get those pockets and how they were funded and reported to us. I don't disagree. I'm just identifying maybe an anxiety within the hospice movement. We're embarking on change so one particular value of hospices have got that they're very well regarded in this area of delivery and I suppose that any progress that we make, the badge of even partnership are different models within a Nard Gown badge or a St Margaret's Hospice badge about that palliative care being delivered in the communities. It's pretty important and it would be pretty important to have that discussion with the hospices that you're going to be part of the future. You're not going to be your… Oh no, absolutely and I want to absolutely reassure them that their role in this is absolutely critical. What we need to look at though is how do we expand services and what are the options around different models, also harnessing some of the opportunities that are presenting themselves, like if we get the new primary care model right, that GPs will have more time to spend with patients who need their time perhaps in a palliative end-of-life care situation. You know, we need to look at it in the round, I suppose, is what I was trying to say. We're going to the measurement theme. We've been talking in fact just this week around how we support the hospices to better use the data that they collect so that they can describe the services that they provide, but crucially around palliative care being something that more people have access to, that we do that in a way that allows us to use the expertise that we have in Scotland around data linkage, so that if somebody is cared for by a hospice, we get the data around what care they are providing, but we can then start to link it with our other information systems. The committee will be aware of the Marie Curie work that was done based on English data around approximately 11,000 people in Scotland who might benefit from palliative care. In order for us to take that work forward in Scotland, we have to have the data linkage between hospices and the other systems, so this week we've identified a way that we can, again, with quite a high degree of urgency and pay, start to see how to link the data for the hospices and plug them into that more effectively. Fiona McLeod. Thank you. I'm aware of time moving on. I just wanted to briefly return. Rhoda Grant was talking about young adults and the support that would give them as they move through life. It was Janis Burrell that mentioned some respite available for young adults with long-term or lifelift limiting conditions but are living longer with them. I know that you're doing some pilot work with Marie Curie, with Chaz, and at Luchey House. I just wondered if you had timescales on when you'd be able to report on those pilots. I know that the first pilot was held just towards the end of last year. I've not seen any of the outputs from how that actually evaluated, but a group of young men went to Luchey House to trial out a short respite break there. I was at the meeting before the break happened, and I know that Luchey House was keen to tease out what was required and what they would have in place to help to support the short break. The transition teams that Chaz is linking across, I know that they've been looking to link in with some work in Highland and what they are doing around planning and mapping out how transition might look for young adults. The Chaz team is currently looking at their current cohort but also plans that they would have in place for youngsters coming up to that age and that they need to transition on. I think that that team is only being in place just over a year now, so they have done a huge amount of work in a short space of time. Is that something that you could keep the committee updated on? My recent visit to Luchey House, I have to say, I was very impressed by the level of care needs that they can manage. The environment is great and they do a lot of it. Activities provide a very good quality respite opportunity, but what struck me was a very high level of need that they can manage, which is not the case in many other respite places, so I was very impressed indeed. As there are no other questions from the committee, I thank the cabinet secretary and his colleagues for an interesting session. Thank you very much indeed. We are now going to private session, as previously agreed.