Official Report

The next item of business is a members’ business debate on motion S5M-16380, in the name of Iain Gray, on the 25th anniversary commemoration of the genocide against the Tutsi in Rwanda. The debate will be concluded without any question being put.

Motion debated,

That the Parliament notes the 25th anniversary commemoration of the genocide against the Tutsi in Rwanda, in which the lives of approximately one million people were lost in 100 days; notes the links that have developed between Rwanda and East Lothian, as well as other parts of Scotland, since then; remembers with the Rwandan people as they reflect on those dark days; commends Rwanda on its remarkable progress to reconciliation within the nation; notes its considerable development in social and economic terms since 1994; acknowledges the privilege of walking with Rwanda along its path of recovery as one of Scotland's key partners in international development, and trusts that the nation will continue to flourish in peace and hope in the decades ahead.

As we meet, Rwanda is observing 100 days of national mourning, which began on 7 April. That was the 25th anniversary of the day in 1994 when the genocide against the Tutsis began in Rwanda. In the following 100 days, around 1 million people were slaughtered, which is around 70 per cent of the Tutsi population. Appalling atrocities were committed by the armed forces and the Hutu Interahamwe militias, and by civilians against civilians, colleagues against colleagues and neighbours against neighbours. Most of that barely believable intensity of murder was perpetrated with nothing more than machetes.

The world knew that that was happening. At the time, I worked for Oxfam. I remember being told of the now famous letter that was sent to the president of the Adventist church by a group of its pastors who had taken refuge with thousands of their congregation members in their church. It began:

“We wish to inform you that tomorrow we will be killed with our families.”

They pleaded for his help, but the church president, Pastor Ntakirutimana, was a Hutu, and the next day the pastors were killed with their families. Pastor Ntakirutimana was later convicted of helping to organise the massacre.

With Oxfam, I campaigned and lobbied to get the international community to intervene, but it refused. The United Nations had a peacekeeping force in place in Rwanda. Its commander, General Dallaire, had told his superiors in the infamous genocide fax that genocide against the Tutsis was being planned. He was told to protect only foreign nationals and not to intervene in the murder of the Tutsi people. The UN force was then largely withdrawn. It is said that they burned their blue berets in shame as they left.

When the killing ended, fearing retribution, the Hutu population fled the country—at one point, 1 million people a day were crossing the border. In late August of that year, I spent some time with Oxfam’s emergency team in eastern Zaire and then a few days in Rwanda. In truth, I cannot find the words to explain what it is like to see a country empty of its people—one part dead and the rest having fled. However, I can say this: what remained was something of the evil done there only days before—a darkness that gripped you at every turn.

Rwanda emerged from the genocide devastated. Life expectancy had fallen to 29 years; there were 95,000 orphans. However, in the ensuing years, great progress has been made, and although 38 per cent of that country’s people still live in poverty, life expectancy is now 67 and, with economic growth averaging 7.5 per cent, it is one of the fastest growing economies in Africa.

Scottish charities such as Comfort International and Tearfund Scotland have played a part in that, and my East Lothian constituency has a special place in its heart for Rwanda, too. During the 2014 Commonwealth games, the Rwandan team was hosted by East Lothian, and those links have continued through sport and local schools—for example, Tranent Colts Football Club has sent delegations to do coaching and community-building work in Rwanda.

We can hardly imagine how difficult it is to heal the wounds of such events. It is true that some of the leaders of the genocide have been tried, convicted and imprisoned, but the guilt was widespread, and the Tutsi people of Rwanda still have to undertake acts of forgiveness and reconciliation that we can hardly understand every day of their lives.

All that we can do is try to learn the lessons. What are they? The first is that not all military interventions are bad. To this day, I burn with shame that my country failed to act to save those lives, because I know that it could have done so and I know that I failed to win the argument that it should.

Secondly, we must always remember genocide and the Holocaust, but we should be careful when we say, “Never again.” We let this happen in Rwanda and we let it happen, a year later, in Srebrenica in Bosnia. Instead of patting ourselves on the back for our empathy for the genocides of the past, we should ask ourselves, “On which genocides today are we turning our backs?”

The final lesson is that genocide ends with machetes and murder but that is not how it begins; it begins with the words of hate. The othering of the Tutsi people by Hutu extremists had gone on for a long time before 1994. A radio station, Radio Mille Collines, was specifically created to foster hatred of the Tutsi people, who it referred to as cockroaches, and was used ultimately to unleash and encourage the slaughter. This is the lesson that we must learn: we cannot, must not and will not tolerate the language of hatred, othering and dehumanisation anywhere, ever. Perhaps then we will earn the right to say, “Never again.”

Our message to the people of Rwanda should be this: we let you down in 1994, but you have our solidarity, our prayers and our love now in your 100 days of mourning, and we will try to do better in future.

Twenty-five years on from the slaughter that ripped Rwanda apart, it is right that we commemorate that genocide and reflect on its legacy for the Rwandan people and the international peacekeeping community, so I congratulate lain Gray on securing the debate and providing us all with the opportunity to do so.

On 7 April 1994, the majority Hutu of Rwanda turned on the Tutsi minority in a wave of calculated violence. The spark that lit the fuse of the already tense relationship between Hutus and Tutsis was the death of Rwandan president Juvénal Habyarimana, a Hutu, when his plane was shot down above Kigali airport the previous day. One hundred days later, when the killing finally stopped, the death toll stood at up to 1 million; it was comprised of Tutsis as well as moderate Hutus who had bravely opposed the bloodshed. Although we still do not know who was definitively responsible for the attack, it is undeniable that, within hours, a campaign of violence spread from the capital across Rwanda. Elite Government forces, supported by the Interahamwe—a Hutu militia—rounded up and executed Tutsi military and political leaders.

Road blocks were hastily erected to catch Rwandans with personal documentation identifying them as Tutsis—a distinction that was introduced in the 1930s by the Belgian colonial authorities to divide and rule. In rural areas, where Hutus and Tutsis had sometimes married and had children, Government propaganda in radio broadcasts and newspaper articles urged Hutus to pick up any weapon that they could find, such as machetes and clubs, to kill or maim their neighbours. Hutus were given incentives, such as money or food, or told that they could claim the land of the Tutsis they murdered. Some even stooped to destroying churches where Tutsis had taken refuge.

Sexual violence was also endemic, with the rape of up to 500,000 women, which accelerated the spread of AIDS and led to the stigmatisation of the offspring of those assaults as children of the killers. The scale of the slaughter was shocking. It was Africa’s largest genocide in modern times.

The horror did not end even after the Rwandan Patriotic Front captured Kigali, as the torrent of killings washed into the neighbouring Democratic Republic of Congo, where Hutu militias continued to operate, igniting years of strife in Africa’s great lakes region.

Shamefully, the Rwandan genocide was largely ignored by the international community, despite the United Nations having 2,500 troops in Rwanda. Years later, Kofi Annan, the head of UN peacekeeping operations, who later became UN secretary general, said:

“All of us must bitterly regret that we did not do more to prevent it.”

It is heartbreaking that the world’s largest peacekeeping force failed to intervene, just as it failed to do a year later in Srebrenica. Last month, President Emmanuel Macron of France ordered a two-year inquiry into his country’s role in the Rwandan genocide, given France’s significant role in French-speaking Africa. Perhaps that signifies that the international community is ready to take responsibility for failing to protect Rwandans. That is vital in order to ensure that lessons are learned to prevent future atrocities. Hearteningly, over the past 25 years, Rwanda has rebuilt its institutions and its economy. To bring perpetrators of the genocide to justice, the UN conducted more than 70 tribunals and Rwanda’s courts tried up to 20,000 individuals. Tutsis and Hutus, survivors and killers, now struggle to live side by side.

I am pleased that lain Gray’s motion refers to Scotland’s close relationship with Rwanda and our two countries’ efforts to move forward together. Despite Rwanda’s recovery, deprivation remains high and persistent, with 38 per cent of people living in poverty and 16 per cent in extreme poverty. Rwanda is now in the Commonwealth and is one of Scotland’s African partner countries, and the Scottish Government is funding a sustainable economic and agriculture development programme to improve the lives of 30,000 people in 207 villages across Rwanda. The programme aims to create alternative income generation and give access to savings and loans through self-help groups.

Agriculture is Rwanda’s economic mainstay, with 70 per cent of the population engaged in the sector, although farming methods are badly out of date. Farmers are also vulnerable to land degradation, soil erosion and climate shocks. The Scottish Government supports the use of environmentally friendly agricultural techniques to improve crop productivity and food security in Rwanda, and provides training on how to build energy-saving stoves and sources of renewable energy. That is particularly important in Rwanda, which is one of Africa’s most densely populated countries and where land availability is scarce.

While we reflect on the legacy of the brutal massacre of 25 years ago, Rwanda now looks forward. Whether through examining ways of preventing similar atrocities or working with international partners to support sustainable development and lift people out of poverty, there is a role for Scotland in Rwanda’s future.

I congratulate Iain Gray on not only his motion but his opening speech, which set the tone for the debate and offered a historical perspective on what happened in Rwanda.

As I said in the chamber last September, through Tearfund I had the privilege of visiting Rwanda and seeing some of the projects that are under way at the moment. Iain Gray was correct in what he said about our response to the genocide. Twenty-five years ago, I was a young solicitor here in Edinburgh. Some of us were at school, university or work while the genocide was on our televisions and we simply ignored it. A million people were killed within 100 days and we in the west, including the United Nations, stood back and let it happen. As Iain Gray pointed out, one of the things that we can reflect on as a Parliament and as politicians is what we will do if such events ever happen again. It is not enough for us simply to have debates and offer warm words; we need to intervene appropriately.

I will concentrate my remarks on what has happened in Rwanda since the genocide. One of the things that struck me on my visit to Rwanda nearly 25 years on from the genocide was the reconciliation that has taken place in that country. I was bowled over by the way in which people have been able to live again in neighbourhoods and villages. From the President and politicians to the media, the church and individuals, there has been an immense reconciliation.

I will never forget the Monday I talked to a man in a village under a beating sun. It emerged that he had murdered 30 or 40 people during the genocide. After spending time in prison, he had become a Christian and had come to reconcile himself with what he had done. The only place where he could go was back to his village, but he knew that most of the village would turn on him. However, in that village, he pointed to a lady and said, “I killed that lady’s husband and children, but when I came back to the village she was the first one to come over and welcome me.” Such reconciliation is beyond my understanding, and it puts into perspective a lot of what we talk about in the Parliament.

I, too, welcome the intervention of the Scottish Government through its working in partnership with organisations such as Tearfund. As we have heard, the statistics show that there is a long way to go, but good progress has been made. The Scottish Government has funded projects for things that we take for granted, such as water. The self-help groups that allow individuals in small communities to pool resources and money to bring the community back together are amazing. I remember visiting a project where a number of women have pooled resources to buy sewing machines to make items that they now sell to people in the local village and community and beyond.

Iain Gray is absolutely right; the message of the debate must be to say—as a country, as part of the European community and as part of the west—sorry to the people of Rwanda for turning our backs when they needed us most. We need to learn from that and move on, and I welcome the debate.

I thank lain Gray for securing the debate and providing us with an opportunity to commemorate all those who suffered and died during the atrocities that took place in Rwanda 25 years ago. I also welcome the insight that Iain provided from his time in Rwanda and Zaire with Oxfam, when he saw first hand the aftermath of the horrific events.

To mark the loss of approximately 1 million lives in 100 days 25 years ago, Rwanda is currently observing 100 days of mourning. Here, in the Scottish Parliament, we should also reflect on the terrible events of 1994 and remember the lives that were lost and the damage that was done. Around 70 per cent of the Tutsi population was slaughtered in those 100 days, and appalling atrocities were committed by militia, armed forces and—as we have heard—civilians.

An Amnesty International briefing highlights concerns relating to the current situation in Rwanda and the sad reality of a country that still faces political and human rights challenges, as is very much evident from the reports that Amnesty International has provided on the severe restrictions on freedom of expression and the reported persecution of political opponents.

We should also recognise the progress that has been made from what was a very divisive and bloody situation to where Rwanda is today. Following the genocide, Rwanda was socially and economically devastated, with gross domestic product growth of -50 per cent, life expectancy of only 29 years and 95,000 orphaned children. There is no denying that challenges remain, particularly in the high levels of poverty, food insecurity and malnutrition. However, 25 years on, significant progress has been made, with economic growth of 7.5 per cent in the 10 years to 2017 and life expectancy now at 67 years. It is a country in which 43 per cent of the population is under the age of 15, which can present many challenges, but can also provide huge potential.

I hope that Scotland continues to be a key partner to Rwanda and to provide support during its on-going process of recovery. I welcome the work of organisations such as Tearfund in delivering Scottish-funded programmes that have worked to heal communities, provide access to loans and develop new skills, in order to reduce poverty.

I will speak a little about Chantal Mrimi. Born in Zaire—as it was then called—to Tutsi parents who fled there from Rwanda as refugees, Chantal spent her childhood in segregation and extreme poverty. She was 18 years old when the 1994 genocide took place and her family spent months in hiding, particularly when the killing spilled over into Zaire’s refugee camps.

When Chantal and her family returned to Rwanda, the aftermath of the genocide was all around, and death was an everyday occurrence. The psychological impact of the genocide affected the entire population. In time, Chantal was able to secure a job working with the UN and, later, an opportunity to come to Fife on a temporary visa led to her emigrating to Scotland in 1999. Moving to Scotland allowed Chantal to address the trauma that she had experienced and to write a book about her story, the proceeds of which go to her education foundation in Rwanda. She is now employed by Fife Council and is an active community member, whom I have had the privilege of hearing speak.

Chantal also set up a project that lets Scots visit Rwanda, build links with its people and hear their stories. The project works to raise awareness of Rwanda’s history and to promote positive relationships between Scots and refugees. In recognition of her significant achievements, Chantal won woman of the year at the 2018 Scottish women’s awards.

Chantal’s story is an example of the individual links between Scotland and Rwanda, but it also serves as a powerful reminder of the capacity for individuals, communities and societies to recover and build bright futures. It reminds us that positivity and connectivity can come from even the worst atrocities.

It has been a powerful debate and I thank Iain Gray for securing it.

I, too, thank Iain Gray for bringing this important and difficult subject to the Parliament. I commend him for a powerful speech and thank him for sharing his insight and experience with us—as did Mr Balfour.

The Jewish lawyer and Polish refugee Raphael Lemkin coined the word “genocide” in 1943. It is a combination of Greek and Latin. The fact that it is a Jewish-Polish fusion of Greek and Latin shows how interrelated we humans are as a species. Mr Lemkin’s interest was prompted by his growing awareness of the Armenian genocide. He said:

“my worries about the murder of the innocent became more meaningful to me. I didn’t know all the answers but I felt that a law against this type of racial or religious murder must be adopted by the world.”

The international community formally adopted a definition of genocide in the 1948 convention, enshrining the message, “Never again,” in international law. We have heard that message in today’s debate and no doubt will hear it again.

Indeed, 1994 should have been a great year for the African continent, for those who value democracy, humanity, the right to self-determination and a new future. In May 1994, after three centuries of white rule, Nelson Mandela became South Africa’s first black president. At his inauguration, he said:

“Never, never again shall it be that this beautiful land will experience the oppression of one by another”.

Sadly, around that time, Rwanda saw the worst of humanity at play; I fear that the name of the country will forever be associated with the terrible genocide of 1994.

One of the many powerful things that Mr Gray said was that such genocide begins with the words of hate. My notes say “Hutu people” and “Tutsi people”, but in fact, they are just people—that is what we should call them. Of course, we should celebrate differences, but we are all one and the same. There were 1 million deaths during 100 days of bloodshed in April and July 1994 and, as Mr Balfour said, we knew about it.

We know that wholesale slaughter was not new to the world: there is a history of pogroms visited on Jewish communities; the Holocaust; the Holodomor in the Ukraine—killing by starvation, like the Irish famine; Armenia; Cambodia; Bosnia; and the treatment of indigenous peoples by colonialists, including Scots. In many respects, mankind has a shameful history.

I was drawn to an article in The Independent, written by Rachael Burns in December 2018, entitled, “Why the UN convention on genocide is still failing, 70 years on”. It picks up on some of the comments that have already been made. She says:

“First, the very application of the term ‘genocide’ is applied too slowly and cautiously when atrocities happen.”

That is because it is a question of who rather than what. There is no excuse for that, given how small the world is. She goes on:

“Second, the international community fails to act effectively against genocides. Third, too few perpetrators are actually convicted”.

When there are convictions, it is heartening to see.

The role of the international community is very important. When I speak in Parliament on matters connected to Palestine and elsewhere, I return to the topic of the UN’s role and the lack of respect for the UN. It is not a group of equals—the big boys have a veto. Might is not right in that context and the developed world must have respect for international law.

The 100 days of national mourning in Rwanda have begun and the legacy of the psychological impact on the communities must be dealt with. I believe that the human spirit is strong; we must be positive; and we must believe that things can get better. What role is there for each of us, as parliamentarians, to play as global citizens who shape the future of humanity? For instance, 1994 was also the year that the United States opened Guantanamo Bay detention camp and that the Provisional Irish Republican Army declared a ceasefire, which were significant events.

The future of our fragile planet and the lovely country and people of Rwanda—our sisters and brothers—must be at the forefront of our thoughts. We will not forget and we must learn and look to the future.

I, too, thank Iain Gray for securing today’s very important debate. I also thank him for his clearly personal and passionate speech, which laid out the reality of the impact of the events of those 100 days. In 2003, the United Nations General Assembly officially proclaimed 7 April the international day of reflection on the 1994 genocide against the Tutsis in Rwanda. I am grateful for the opportunity to speak about those atrocities 25 years on.

We must never forget just how awful the events of those days were or their impact on the people of Rwanda. However, we should also remember the knock-on effect that the horrors of what happened in Rwanda had on other areas in the region. After Rwanda’s genocidal Hutu regime was overthrown, more than 2 million Hutus are believed to have fled into what was then Zaire—now the Democratic Republic of the Congo—fearing reprisals against them by the new Tutsi-dominated Government. Among them were many of the militiamen who had been responsible for the genocide. They quickly allied themselves with the Government and began to attack the Democratic Republic of the Congo’s sizeable population of ethnic Tutsis, who had lived in the country for generations. It is widely believed in the east of the Democratic Republic of the Congo that the Rwandan genocide was the start of the region’s more recent problems.

An article that was written by the journalist, Maud Jullien for the 20th anniversary commemorations five years ago noted that the massacres of Hutus in the neighbouring Democratic Republic of the Congo have largely been forgotten. The article quoted a human rights activist in Goma who told Maud Jullien:

“people don't talk about it enough ... but the Rwandan genocide was like flicking over the first domino”.

I have never been to Rwanda, but I have been to South Sudan, north Uganda and Malawi and have seen the ripple effect from the genocide in Rwanda that was felt right across the region. I have also been to Sarajevo, Belgrade and Srebrenica. As Iain Gray and others have said, it was only one year after the events in Rwanda that we had the awful events in Srebrenica; that flicking over of the first domino was at approximately the same time. It does not seem to matter what part of the world we are in; the same thing can happen.

Iain Gray and John Finnie talked about the language of hate. Probably the most important lesson that we can take from that is that if we start to “other” people and to train people to behave in a certain way because the people that they are targeting are seen as being less than human, this is the outcome. If we take any lesson from this, it should be that it is vital that we be more respectful when we speak to people and that we should not talk about people as if they were a different species from us.

One of the great things that Rwanda has done is to ban the naming of people as Tutsis and Hutus—they are called Rwandans. People are taught in school that they are Rwandans and that they have not to be labelled as Tutsis and Hutus—that is vital.

We have seen it all through history: we saw it in the partition of India and Pakistan; we saw it in the Balkans; and we saw it in Rwanda. It is important that we take that lesson away from here today and treat people with the respect that they deserve.

To be fair to Rwanda, what they have done since then has been quite remarkable. As Jeremy Balfour said, to go through the reconciliation that they have gone through after the events that they had to go through, is quite something. It is the perfect example of humanity at its best.

Hopefully, out of those horrible events, something good will come, and Rwanda will be able to get itself to a place where everybody can forgive—if not forget—what happened during those terrible days. Perhaps we can learn a lesson from the horrible things that happened then as well.

I am pleased to take part in today’s debate and I congratulate Iain Gray on securing it.

As we have heard, Rwanda is a small country on the African continent and is surrounded by the Democratic Republic of the Congo, Uganda, Tanzania and Burundi. Twenty-five years on, we must remember the genocide that took place in Rwanda. I pay tribute to the tone of the debate in speeches by all speakers; Iain Gray set that tone, and I acknowledge that his was a personal and passionate speech, which I am sure we all learned from.

There is no doubt that the Hutus and Tutsis found themselves in a difficult, dangerous and disgraceful situation in the 1990s. Rwanda had had reasonably good support mechanisms in the past, and people had lived together and supported one another, even though there were differences between individuals and tribes.

The problems went back to the United Nations in the 1960s, when Rwanda was ruled by Belgium. During that time, the colonials thought more of the minority group than the majority, which might have started the process that ended up with the crash of the presidential plane in Kigali in 1994. No culprits were found and that was when the situation started. The crash set the tone for what took place. Within hours of the crash, the presidential guard, members of the Rwandan armed forces and Hutu militias set up roadblocks and barricades and began slaughtering people around the country. It started in the capital but quickly spread and, as we have heard, 1 million people were slaughtered in 100 days. The number of days is inconsequential in some respects, but the fact that the slaughter of that number of people could take place in 1994, which is not that far back in our memories, has had a huge impact on us all.

It is right that we remember the aftermath and the extreme nationalism of those dark days, but Rwanda has built on the difficulties that it once faced. The scars run deep, but great links have developed between Rwanda and Scotland, which we have heard about in the debate. I acknowledge that many organisations have played their part. We must also acknowledge the work that has been done in other parts of the continent, such as the structures that have been put in place in Malawi.

Although we can still focus on what happened 25 years ago, it is vitally important that Scotland plays its part in the rebuilding of Rwanda now. Scotland already has grass-roots connections through the Rwanda Scotland Alliance, and there is an honorary consul for Rwanda in Scotland. I pay tribute to the charities—such as Tearfund, which we heard about earlier—that put in a huge amount of effort to ensure that basics for life are given to the individuals who live and work in that environment.

We must continue to forge links with the country and ensure that the story of the development of civil and political rights in Rwanda since the civil war continues. The Scottish Government should continue to take any opportunity to work in partnership with Rwanda and to raise the issues loudly and clearly. Much has been achieved, but there is still much to be done.

We must never forget the genocide that took place. As other members have said, we turned our back on it, which was a major flaw.

I thank all members who have spoken in today’s debate on the 25th anniversary commemoration of the genocide against the Tutsis in Rwanda, which has been remarkably moving. I particularly thank Iain Gray for securing the debate and for his incredibly moving and powerful opening speech.

On 7 April, Rwanda began its period of 100 days of mourning to commemorate the 1994 genocide. “Kwibuka” means “to remember” in Kinyarwanda, and the word describes the annual commemoration of the 1994 genocide against the Tutsis in Rwanda, which is the time to remember those who died. Today in Parliament—and over the past three weeks across the world—we have come together to remember the genocide of 1994 in which, as other members have said, 1 million Tutsi people died.

On 13 April, I had the honour of joining the Rwandan high commissioner to the United Kingdom and members of the Rwandan diaspora here in Scotland—the Rwandan Scots community—at a service to commemorate the 25th anniversary. That gave me the opportunity to extend to Rwandans—those in Scotland as well as those in Rwanda—and to the Rwandan Government our deepest consideration at this time of commemoration and to reassure our Rwandan friends of our thoughts and prayers, as we committed together to remember those who died.

That commemoration service took place in Musselburgh and was hosted by East Lothian Council, reflecting the links that have developed in recent times between Rwanda and East Lothian and other parts of Scotland. As Iain Gray mentioned, Rwanda was first connected with East Lothian for the Glasgow Commonwealth games in 2014, through the “Support a second team” programme. The programme sought to use sport to foster and develop links and partnerships between Commonwealth regions, with East Lothian going on to host representatives from the Rwandan Commonwealth games team. It is a tribute to the people of East Lothian and Rwanda that those links have continued, so it was fitting that the commemoration service took place there, just a few weeks ago.

Over the 25 years since 1994, Scotland’s links with Rwanda have strengthened and deepened, as other speakers have mentioned. There are now many sectors, from education, health, civil society and faith groups to Government and business, that have connections to Rwanda and are creating more, and that is reflected in the Scottish Government’s international development programme. In 2008, the Scottish Government funded its first development project in Rwanda, and we are proud that in 2016, following a refresh of our international development strategy, Rwanda became one of four partner countries under the Scottish Government’s international development programme. Our Rwanda programme expanded and its diversity of projects now includes support for building the capacity of Rwandan coffee co-operatives, which we have recently expanded, and partnerships to support victims of sexual and gender-based violence and empower women to enjoy equal rights.

Also on gender equality, we have with Comic Relief supported projects in Rwanda under the “Levelling the field” girls’ leadership through sport programme, using football, basketball, cricket and other sports as tools for development and a connector between people and nations.

What all those projects have in common is Rwandans’ commitment to community, to developing Rwanda and to doing so with Rwandan solutions, underpinned by a clear belief in the future of the country that permeates throughout Rwandan society. It is that belief in the modern nation of Rwanda coming out of the awful genocide against the Tutsis in 1994 that is important to remember.

The wealth of connections and relationships that have built up over the past 25 years between Scotland and Rwanda has been rewarding for all. We have heard about some of those links and partnerships in other speeches. However, there is more to do and, as I said earlier, we in the Scottish Government are very proud to be in partnership with Rwanda in our international development programme. From conversations that I have had, I know of the enthusiasm that there is, not just in the international development sector but across other sectors, to continue to build our relationship with Rwanda.

Today, of course, we are having this debate on the 25th anniversary commemoration to look back and remember. I am sure that I speak for other members and, indeed, the whole Parliament when I say again, as I did on 13 April, that the Scottish Government extends to the Rwandan diaspora in Scotland, the people back in Rwanda and the Rwandan Government our deepest consideration at this time of commemoration. We do that while also looking forward, with the people of Rwanda, to a bright future. It is our wish that Rwanda will continue to flourish in peace and hope in the decades ahead. We stand in solidarity with our Rwandan friends as they remember the genocide against the Tutsis in 1994. We remember, we unite and we support them as they renew.

The next item of business is consideration of business motion S5M-17146, in the name of Graeme Dey on behalf of the Parliamentary Bureau, on the timetabling of the Health and Care (Staffing) (Scotland) Bill. Any member who wishes to speak against the motion should press their request-to-speak button now.

I call Patrick Harvie, as a member of the bureau, to move the motion. That was a wee surprise for you.

Motion moved,

That the Parliament agrees that, during stage 3 of the Health and Care (Staffing) (Scotland) Bill, debate on groups of amendments shall, subject to Rule 9.8.4A, be brought to a conclusion by the time limit indicated, those time limits being calculated from when the stage begins and excluding any periods when other business is under consideration or when a meeting of the Parliament is suspended (other than a suspension following the first division in the stage being called) or otherwise not in progress:

Groups 1 to 5: 55 minutes

Groups 6 to 10: 1 hour 45 minutes

Groups 11 to 13: 2 hours 25 minutes.—[Patrick Harvie]

Motion agreed to.

I will let members change seats before we resume.

The next item of business is stage 3 of the Health and Care (Staffing) (Scotland) Bill. For dealing with amendments, members should have the bill as amended at stage 2, the marshalled list and the groupings of amendments.

The division bell will sound and proceedings will be suspended for five minutes before the first division, and the period of voting for the first division will be 30 seconds. Thereafter, I will allow a voting period of one minute for the first division after a debate. Members who wish to speak in the debate on a group of amendments should press their request-to-speak buttons as soon as possible after I call the group.

Section 1—Guiding principles for health and care staffing

Members should refer to the marshalled list. Amendment 1, in the name of the cabinet secretary, is grouped with amendments 42 and 2 to 4.

I will speak to my amendments on the bill’s guiding principles.

Amendments 1 and 3 relate to amendments that were lodged by Alex Cole-Hamilton at stage 2. The duty to ensure appropriate staffing in proposed new section 12IA of the National Health Service (Scotland) Act 1978 sets out that

“every Health Board and the Agency”

have the duty

“to ensure at all times that suitably qualified and competent individuals ... are working in such numbers as are appropriate”

to ensure

“the health, wellbeing and safety of patients and ... the provision of safe and high-quality health care”.

In part 3 of the bill, there is an equivalent duty for

“any person who provides a care service”.

Sections 2 and 3 of the bill set out that every health board, in complying with proposed new section 12IA, and any person who provides a care service, in complying with section 6

“must have regard to the guiding principles”.

As such, the principles and general duty are intrinsically linked. Those who must follow the general duty must also have regard to the guiding principles.

As the bill is worded currently, a health board will be legally required to do the same thing twice. I want to avoid confusion for the people who are expected to understand and carry out the duties that are set out in the bill, so I gently suggest that we do not need to triplicate legal duties in order for them to take effect. I therefore ask members to support my amendments that aim to correct that matter.

Amendment 2 is a technical amendment that aims to correct section 1(1)(b) so that it refers to “those main purposes”, rather than to “the main purpose”. That will show that there are two main purposes of staffing for health and care services, following Monica Lennon’s insertion at stage 2 of section 1(1)(a)(ii), which refers to ensuring

“the best health care outcomes for service users.”

Amendment 4 is a technical amendment that clarifies that the definition of standards and outcomes for service users in section 10H of the 1978 act refers specifically to section 10H(1). That would be consistent with the specific reference to section 10H(1) in section 12IB(2)(b). I welcome Monica Lennon’s amendment 42.

I move amendment 1.

Amendment 42 seeks to clarify that one of the main purposes of health service staffing is to ensure the best health and care outcomes for service users. The aim of my amendments at stage 2 was to ensure that the guiding principles placed the necessary focus on achieving the best outcomes for service users, which is a position on which I am sure we can all agree. I have welcomed the further discussions that have taken place to enhance that principle. Amendment 42 will ensure that all health and care service providers, including, for example, housing support services, are taken into account.

I am grateful to the Scottish Government for meeting me after stage 2 to clarify the points that have been made. I signal the support of the Liberal Democrats for the amendments in the group.

Amendment 1 agreed to.

Amendment 42 moved—[Monica Lennon]—and agreed to.

Amendments 2 to 4 moved—[Jean Freeman]—and agreed to.

Section 3—Guiding principles in care service staffing and planning

Group 2 is on commissioning of care services. Amendment 5, in the name of the cabinet secretary, is grouped with amendments 43 and 44.

Section 3(1) imposes a duty on care service providers to

“have regard to the guiding principles”

when they carry out the duty in section 6. Section 3(2) is about the planning and commissioning aspects, and relates to when arrangements are being secured to allow a care service to be delivered operationally by another person. The guiding principles already apply, given that commissioners need to have regard to the principles under section 3(2)(a). Amendment 5 clarifies that commissioners are also obliged to have regard to the fact that care service providers need to take the guiding principles into account.

At stage 1, the committee heard from groups in the social care sector that were concerned that the bill places all its focus on care providers and does not adequately recognise the impact that commissioning decisions on funding resources have on staffing levels. I therefore lodged a stage 2 amendment seeking to place a duty on commissioners of care to ensure that providers are given appropriate resources under contract. That would have required them to take into account some of the factors that providers have to consider when setting staffing levels.

Following the raising of some concerns by the Government and local authorities, I agreed to further discussions on how the same principles could be agreed. The products of the discussions are amendments 43 and 44.

Amendment 43 would require local authorities and integration authorities to satisfy themselves, prior to agreeing a contract for care, that the contract for financial agreement will give providers

“adequate resources for the provision of ... appropriate”

staffing levels. In doing so, they will have to consider for themselves the same factors that care service providers are required to take into account under the duty that will be placed on them by section 6.

Amendment 43 also includes provision for local authorities and integration authorities, when determining whether providers are to be given adequate resources, to determine what the impact of entering the contract would be on the totality of resources—namely, the impact on the resources that would be available for other services.

It is my understanding that the provisions would mean that no local authority or integration authority should enter a contract or financial arrangement for provision of the care service when it believes that such an arrangement would leave it short of resources for delivery of other services for which it is responsible.

The draft of amendment 43 came from the Government. Therefore, before I move it, I ask the cabinet secretary what she understands the effect of the amendment will be.

Local authorities should consider proposed new sections 3(2B)(a) and 3(2B)(b) when planning or securing the provision of a care services.

Proposed new section 3(2B) would require local authorities, when determining what constitutes “adequate resources” under proposed new section 3(2A), to have regard to

“the factors listed in section 6(2)(a) to (e)”

of the bill, and to have regard to

“the effect of securing the contract, agreement or arrangements on the resources available for the provision of all other services (including care services) for which the local authority ... is responsible.“

That consideration would happen before finalising any contract, and the provision will not prohibit the local authority from entering into a particular contract. Both parties will enter into the contract having agreed the terms and conditions of that contract.

We have all recognised the complexity and difficulty of finding a suitable provision on this issue. Should Mr Stewart, on reflection, believe that amendment 43 does not offer the improvement that he is seeking, I will not object if he seeks to withdraw it. That said, I wish to draw members’ attention to the fact that the bill still provides that commissioners must have regard to the guiding principles and duties that the bill places on providers in their planning and commissioning of services.

Mr Stewart, would you like to come back in? It is unusual, but you may.

I thank the cabinet secretary for her answer. Under the bill, commissioners must have regard to the duties on care providers. I am reluctant to see that being undermined. With permission, Presiding Officer, I seek to withdraw amendments 43 and 44.

The amendments have not been moved, so there is no need to withdraw them. However, the point is noted.

I say to members that the way in which groups are normally managed, the person who moves the first amendment in the group gets the chance to speak. Other members then get one chance to speak on their amendments in the group, if any, and to all the other amendments in the group. The mover of the first amendment then gets to conclude. I am afraid that it is therefore not possible to have interaction such as we have just seen unless the cabinet secretary or somebody else requests to speak. However, I am flexible, so it was fine in this case.

I am just explaining the rules to make sure that you all know them.

I turn to—[Interruption.]

I call the cabinet secretary to indicate whether she wishes to press or to seek to withdraw amendment 5.

I will press amendment 5.

I have officials to keep me straight on the rules, too—as is quite clear.

Amendment 5 agreed to.

Amendments 43 and 44 not moved.

Group 3 is on reporting on staffing by care services. Amendment 6, in the name of the cabinet secretary, is grouped with amendments 45, 46, 39 and 39A to 39D. If amendment 6 is agreed to, I cannot call amendments 45 and 46, due to pre-emption.

I was pleased to have the support of all parties at stage 2 for effective reporting on the progress of our staffing approach. Effective planning of staffing will feed into and support workforce planning at local and national levels. I particularly welcome Monica Lennon’s focus on ensuring transparency around the challenges that will be faced when carrying out the duties in the bill.

Amendment 39 will insert in part 3 of the bill a new section that will place a duty on ministers to publish an annual report on staffing levels in care services, particularly on the numbers of specific health professionals working in such services.

I am pleased to support amendments 45, 46, 39A, 39C and 39D in Monica Lennon’s name, and 39B in Alison Johnstone’s name.

I note that amendment 46 would remove subsections (7) to (9) from section 3. On that basis, I am content that the reporting duty on local and integration authorities in section 3(6) remain in the bill. Therefore, when we have concluded the debate on this group of amendments, I will not press amendment 6, which is in my name. I move it now merely in order that we can get into that debate.

I move amendment 6.

The cabinet secretary has moved amendment 6, so I will ask her to seek to withdraw it later.

I call Monica Lennon to speak to amendment 45 and the other amendments in group 3.

Just keep me right, Presiding Officer.

At stage 2, I lodged amendments with the aim of establishing reporting requirements on local authorities in relation to the duties that the bill will place on them as commissioners of care. The amendments were intended to aid scrutiny of the new duties on staffing levels that the bill creates.

The cabinet secretary’s amendment 6 would move reporting duties on care service staffing levels into part 3 of the bill.

I welcome amendment 39 and the clarity that it gives on where information on care service staffing levels can be found. However, I remain of the opinion that some reporting should be required of local authorities and integration authorities because the bill still places specific duties on them. Therefore, I ask members not to support amendment 6, which is in the cabinet secretary’s name, and instead to consider my amendments 45 and 46.

Amendment 46 will clarify that local authorities need make available only information on how they have complied with their duties publicly. That recognises that local authorities are accountable to their local electorates.

Amendment 45 will remove the reporting duties on ministers covered by the cabinet secretary’s amendment 5; it will also remove detailed outcomes from reports, because that might not always be possible through commissioning structures.

I have lodged a number of other amendments that aim to strengthen amendment 39. Amendments 39A and 39D would ensure that the discharge of staff training requirements on providers under section 7 are also included in Scottish ministers’ reports. That is important because future staffing tools that are mandated for use by Scottish ministers are likely to come with additional training requirements, so their implementation should be captured in staffing reports.

At stage 2, the cabinet secretary made it clear that, given current commissioning structures, Scottish ministers do not directly contract with care providers and therefore cannot directly provide private providers with certain funding. Despite that unsatisfactory position, the cabinet secretary also stated at stage 2 that the Scottish Government has policy approaches that come with financial commitments; for example, the living wage. In such instances, it is a matter for the Scottish Government and those who are in receipt of funding, such as local authorities, between them to decide whether the money is correctly passed on.

Amendment 39C would require ministers’ reports to include information on the steps that they have taken to ensure that such money is passed on so that providers have access to funding to assist in discharging their duties under the bill.

I am grateful to the cabinet secretary for her comments and for providing clarity on amendment 6. I think that it was amendment 6. This is not straightforward, Presiding Officer.

I will be moving the amendments in my name.

Amendment 39B would require the Scottish ministers to set out how the information that will be contained in its annual reporting on care services will inform future workforce planning. At stage 2, I lodged an amendment that aimed to ensure that the Government would consider all relevant information available to it when it commissions training places for people who work in the care sector. We know that care homes now care for people with more complex illnesses than was previously the case, including people who require palliative care, and that there is a need for specialist input on aspects of care including nutrition and hydration.

My stage 2 amendment sought to ensure that, in relation to the care sector, which is facing significant challenges, and particularly at this time of focus on integration, we give the same consideration to ensuring that there are appropriate staff as we do in relation to the national health service. I did not press that amendment at stage 2 because of members’ concerns that it was too prescriptive, but I know that we all agree that it is absolutely essential that we have appropriate and safe staffing levels in the care sector.

Importantly, amendment 39B will ensure that Scottish ministers take account of the reporting on staffing in care services that will be established by amendment 39 when

“determining the future supply of ... registered nurses”

and other health and care professionals.

I will vote for amendments 45 and 46, in the name of Monica Lennon, because I agree that it is still a worthwhile and useful endeavour for local authorities and integration authorities to publish the proposed information.

I ask the cabinet secretary, having moved amendment 6 to allow debate on the group, to wind up on the group and to say whether she wants to press or withdraw the amendment.

I will not press it.

Amendment 6, by agreement, withdrawn.

Amendments 45 and 46 moved—[Monica Lennon]—and agreed to.

Section 4—NHS duties in relation to staffing

Group 4 is on the duty on health boards and care services to ensure appropriate staffing: staff wellbeing. Amendment 7, in the name of Alex Cole-Hamilton, is grouped with amendments 8, 9, 37 and 38.

It gives me pleasure to speak to the amendments in my name in this group and in support of the other amendments in the group. At stage 2, I was gratified when members of the Health and Sport Committee agreed to amendments in my name that expanded the scope of the bill and the definitions of safety that are used in it. Unsurprisingly, the bill was first drafted with the safety of patients in mind, and that should be the starting point for any such legislation. However, during the stage 1 evidence, the committee was told a compelling story about a situation on a mental health ward when the Royal College of Nursing phoned the duty charge nurse one night to ask whether the ward was safely staffed and the charge nurse said, “We’re safe for the patients but not for us.” The point is that the ward operated on an attack-response basis and there was insufficient staffing that night to allow staff to protect each other if something occurred.

So it was that I, with the help of the RCN, drafted amendments to increase the consideration of the safety of staff in the bill, and those amendments were agreed to at stage 2. I am grateful to the Government for bringing to my attention potential problems in relation to the devolution settlement, in that the amendments that were agreed to at stage 2 strayed into health and safety at work legislation, which is of course reserved. Working with the Government, I have constructed amendments 7 and 9 in my name, which absolutely retain the meaning of the original stage 2 amendments but recognise the nuances of the devolution settlement.

I offer the support of the Liberal Democrats for the other amendments in the group.

I move amendment 7.

I thank Mr Cole-Hamilton for taking the time to speak to me about the amendments that he inserted at stage 2. We share the view that the wellbeing of staff is of paramount importance, and I welcome his amendments 7, 9 and 37.

My amendments 8 and 38 are intended to remove the words “and services” from the general duties for health and care services. Those words were inserted at stage 2, but they are unnecessary as healthcare is already defined in proposed new section 12IG of the National Health Service (Scotland) Act 1978 as

“a service for or in connection with the prevention, diagnosis or treatment of illness”.

Further, the care service is already defined in section 9 as

“a service mentioned in section 47(1) of the Public Services Reform (Scotland) Act 2010”.

The words “and services” therefore create unnecessary duplication, so I ask members to support amendments 8 and 38.

Amendment 7 agreed to.

Amendment 8 moved—[Jeane Freeman]—and agreed to.

Amendment 9 moved—[Alex Cole-Hamilton]—and agreed to.

Group 5 is on the duty on health boards to ensure appropriate staffing: agency workers. Amendment 47, in the name of Anas Sarwar, is the only amendment in the group.

What amendment 47 seeks to do is pretty clear from its wording; it seeks to ensure value for money for our health boards and NHS Scotland more widely. We have seen agency staff being paid whole-time equivalent salaries that are four times as much as we pay NHS staff. Amendment 47 would at least set the principle of a cap so that such payments do not go above 150 per cent of a whole-time equivalent NHS salary. It would leave protection for emergency situations in which health boards have to employ people from agencies at salaries above that rate, but it would also ensure that there is a responsibility to publish the reasons why that has happened, the number of occasions on which it has happened and what the trends behind that are. There would also be a ministerial responsibility to update on why those situations have occurred.

We have had very positive interaction with the Government since lodging a similar amendment at stage 2, which I did not press in order that we could have further interaction with the cabinet secretary. I am pleased with how that interaction has gone and I hope that, given that we have accepted all the Government’s suggested amendments to our amendment, the cabinet secretary will support amendment 47.

I move amendment 47.

I am grateful to Mr Sarwar for working with me and my team since stage 2 on the amendment.

I am still of the belief that the bill as amended will drive the necessary changes in the way in which staffing decisions are made to reduce the use of agency staff. In developing and scrutinising the legislation, both the Government and Opposition members have considered the whole-system approach to staffing decisions. By that I mean that we have looked beyond the evidence-based staffing tools and methodologies and considered how decisions are taken at every level of the organisation.

There has also been a focus on how those decisions are fed back to the staff who have informed them. That is why I, Miles Briggs, David Stewart and others have put a significant amount of effort into working with our stakeholders to finalise the provisions on real-time assessment of staffing, escalation processes and appropriate clinical advice. It is that system of effective and informed governance that will drive the changes that we all wish to see. In ensuring that staffing decisions are taken based on workload and taking into account appropriate clinical evidence, we will move towards the appointment of a sustainable staffing establishment. It will also ensure that, if agency staff are used, that is as part of an appropriate risk-mitigation approach.

I absolutely appreciate the intention behind Mr Sarwar’s amendment 47 and I thank him again for taking the time to discuss it further with me. I think that there are some difficulties with the drafting of amendment 47 and that the requirements on boards could be considered to be ambiguous, but I believe that that can be clarified in the statutory guidance that will accompany the bill. In this instance, it is my view that the value of the intention outweighs those points of difficulty and I am therefore happy to support amendment 47.

I welcome all the content of the cabinet secretary’s response. I think that we both have the exact same intention and therefore I welcome her support for my amendment.

Amendment 47 agreed to.

Group 6 is on staffing assessment and risk escalation by health boards. Amendment 10, in the name of the cabinet secretary, is grouped with amendments 48 to 59, 11, 12, 60 to 62, 20 and 23.

I welcome all the amendments in this group lodged by Mr Briggs and Mr Stewart and I thank them for their collaborative work on the provisions. I also thank the members of the escalation working group, who have put a significant amount of effort into ensuring that the provisions work for all staff groups and across our healthcare system.

My amendments are fairly technical in nature. Amendment 10 inserts the word “safe” into section 12IAA(2)(a)(ii) so that it is consistent with the wording in the general duty for health following the addition of that wording by Mr Cole-Hamilton at stage 2.

Amendment 11 inserts reference to the new paragraph added through David Stewart’s amendment 59 into the list of those staff members who must be notified of every decision made in relation to risk so that all those who have been involved in attempting to reach a decision on the mitigation of a risk under this section should be notified of the final decision reached and should have the opportunity to record disagreement with that decision if they wish.

Similarly, amendment 12 inserts reference to the new paragraph to section 12IAB(2)(d)(iv), so that those who have provided clinical advice in any part of the procedures put in place under the section should be notified of the decision reached and, again, should have the opportunity to record disagreement with that decision if they wish.

Amendment 20 amends section 12IE, which is entitled “Reporting on staffing”, to include reference to section 12IABA, on the duty to have arrangements to address severe and recurrent risks, inserted by David Stewart’s amendment 62; section 12IABB, on the duty to seek clinical advice on staffing, inserted by Mr Briggs’s amendment 63; section 12IAD, on the duty to ensure adequate time is given to clinical leaders, inserted by my amendment 18; and section 12IAE, on the duty to ensure appropriate staffing and training of staff, which was inserted at stage 2 by Ms Johnstone. That will ensure that health boards and the agency must include information on their compliance with those duties in the reports that they are to provide to ministers on an annual basis.

Finally, amendment 23 sets out that ministers can issue guidance under section 12IF on the new duty to have arrangements to address severe and recurrent risks imposed by the new section 12IABA.

I move amendment 10.

I thank the cabinet secretary for the very helpful meetings that we had about planning these amendments to make sure that we have a stronger bill.

The Royal College of Nursing, representatives of which I welcome to the gallery, made it clear from the start of the bill process that the bill will be effective only if it deals with how to manage day-to-day staffing levels, not just with setting expected staffing establishments. For that reason, I was glad to see the introduction of provisions on risk assessment and escalation by the Government at stage 2.

My amendments 48 to 51 and 53 to 60 make only minor changes to those successful provisions from stage 2. The purpose of the amendments is purely technical; they are aimed at strengthening the risk assessment and escalation processes that have been established. To that end, I will speak to the amendments according to their purpose rather than in chronological order.

Amendment 48 ensures that any risk assessment procedures include a method by which staff members may notify responsible individuals of possible risk, closing a potential gap in the procedures that currently exist.

Amendments 49, 53 and 54 alter the precise definition of the individuals and management structures involved in the process so that non-clinical managers who bear responsibility for staffing levels can be included in the procedures. That said, the role of clinical experience and advice in staffing decisions cannot be overlooked. It is therefore protected by amendments 55 and 57, which put a requirement on decision-making individuals in the structure to seek and have regard to clinical advice.

Amendments 56 and 58 empower the individuals involved to take decisions on how to mitigate any risk that is identified and escalated. Amendment 59 allows for the escalation of any risk up the management chain as far as necessary and potentially up to board level.

Amendment 60 ensures that there is an opportunity and process for individuals to request a review of a decision on risk, should they be concerned or dissatisfied by the final outcome. Risk assessment notification procedures are only of use if staff are aware of them and they can be utilised. For that reason, amendment 51 requires health boards to proactively encourage and enable staff to make use of the procedures. In the same vein, I can confirm that we support amendments 52 and 61, lodged by Miles Briggs, which similarly ensure that staff are equipped to use the procedures.

Finally, amendment 62 seeks not to alter, but to add to the provisions that are already in place. As important as real-time risk assessment and escalation are, it is crucial that they are not used purely for firefighting on the ground. Health boards and those who scrutinise them should be able to have an overview of the risks to their staffing levels, especially if those risks are substantial and likely to recur. Where there are long-standing vacancies across a number of key posts in our health service, day-to-day assessment and mitigation will not be satisfactory or sufficient.

Therefore, amendment 62 establishes a requirement for health boards to keep a record of the most significant and potentially recurring risks, as well as to put in place a plan for how those will be managed. The majority of health boards should already have a similar process in place for risks to staffing. Amendment 62 merely makes the requirement clear and should provide a mechanism for linking the situations staff have to deal with on the ground to higher-level monitoring and planning.

Amendment 52 relates to amendment 105, which I lodged at stage 2. However, unlike that amendment, amendment 52 takes account of the fact that only those individuals with lead professional responsibility will be responsible for carrying out the staffing assessment procedures and so it sets out that those individuals are to be given the training and resources necessary to carry them out.

Similarly, amendment 61 provides that individuals with lead professional responsibility and other senior decision-makers are to be given the training, time and resources necessary to carry out the risk escalation procedures detailed in section 12IAB. I ask members to support both amendments 52 and 61.

As no other members wish to speak, I invite the cabinet secretary to wind up.

I have nothing further to add, Presiding Officer.

Amendment 10 agreed to.

Amendments 48 to 51 moved—[David Stewart]—and agreed to.

Amendment 52 moved—[Miles Briggs]—and agreed to.

Amendments 53 to 59 moved—[David Stewart]—and agreed to.

Amendments 11 and 12 moved—[Jeane Freeman]—and agreed to.

Group 7 is on clinical role and advice in health board governance. Amendment 63, in the name of Miles Briggs, is grouped with amendments 18, 18A and 18B.

Amendment 63 is an alternative to amendment 123, on the role of the designated person, which I lodged and then withdrew at stage 2.

I have had a number of discussions with the cabinet secretary to agree an alternative approach to ensure that the bill captures the crucial role of clinical advice in relation to the decisions that are made by boards under the various duties that are placed on them by the bill.

Rather than requiring health boards to designate a person, amendment 63 seeks to put them under a duty to put in place arrangements to ensure that clinical advice is sought in relation to staffing decisions and any arrangements that they put in place in relation to staffing, such as the development of a risk escalation process under section 12IAB of the 1978 act, and to have regard to that advice.

When a board makes a staffing decision that goes against clinical advice, that must be noted, and those who provided the advice must be informed. Boards must also identify any risks that might arise as a result of that decision and take appropriate action to mitigate them.

Amendment 63 also provides for an internal reporting procedure, which is an important element in relation to board transparency and accountability. Senior clinical professionals would report to the members of the board at least quarterly on the extent to which—in their view—the board was complying with its duties under the bill. The inclusion of the phrase “at least” would allow them to submit reports to the board at any time if they felt that it was not meeting those duties. I ask members to support this alternative approach.

I move amendment 63.

Again, I start by expressing my gratitude to Mr Briggs for working with me following the stage 2 proceedings. As he said, amendment 63 seeks to amend the bill by placing health boards under a duty to put in place arrangements to ensure that they seek clinical advice from senior clinical professionals, and to have regard to that advice in reaching any decision on staffing.

I agree with Mr Briggs on the importance of ensuring that the professional voice is heard. That is already woven throughout the bill, but I believe that amendment 63 strengthens the approach and is the appropriate way to ensure that health boards must seek that professional advice, while ensuring that the accountability for decisions remains with the board. I am therefore happy to support amendment 63.

Amendment 18 in my name will remove and replace proposed new section 12IAD of the 1978 act. I fully recognise the unique role of the senior charge nurse and agree that it is important that the role is protected. However, I do not believe that the existing wording of section 12IAD—which does not take account of the multidisciplinary teams or allow for flexibility with regard to the size of the team and the service delivery model—is the best way to achieve that.

It is not always appropriate to require health boards to make all senior charge nurses 100 per cent non-case load holding. One example of many would be on the Shetland Isles, where a number of community nursing teams are spread over the islands, with between two and eight members of staff in each. Two senior charge nurses currently provide clinical leadership across all those teams. As currently drafted, section 12IAD would not allow for that model and would require a senior nurse in each team to be 100 per cent non-case load holding. Each of those nurses would have to be backfilled. That approach is not sustainable and would not allow health boards to develop models of care that suit their local needs and their patients.

Because the definition of “caseload holding” is tied to the wider requirement to meet patient needs and not to the more specific requirement to provide direct patient care, I do not believe that it delivers the intention of ensuring that senior charge nurses have protected time to fulfil their clinical leadership role, and I imagine that it would be difficult for boards to identify senior nurses who were not required to meet patient needs. I am also aware of stakeholder concerns that a requirement for a fully non-case load holding senior nurse in every rostered location could have the unintended consequence of diverting resources away from other clinical team leaders.

For those reasons, it is essential that we replace the existing section 12IAD with a provision that works in all clinical settings. Therefore, I have worked with Ms Johnstone and stakeholders from a number of professional groups to develop an amendment that applies to not just senior charge nurses but whomever the appropriate clinical team leader is for a team of staff, be that a midwife, an allied health professional, a nurse or a doctor.

Amendment 18 seeks to recognise the unique roles and responsibilities of all clinical team leaders and to ensure that they receive adequate time to discharge their leadership responsibility and their other professional duties. It will provide flexibility for the appropriate amount of time to be allocated, depending on the local context, the size and nature of the team, and the healthcare setting. I ask members to support amendment 18.

I am content with Ms Johnstone’s amendments 18A and 18B to my amendment 18, and I welcome her support for it.

Amendments 18A and 18B have come about as a result of discussions with the Royal College of Nursing, allied health professionals, the Royal College of Midwives and the Government.

At stage 2, as members heard, I was successful in amending the bill to ensure that senior charge nurses will have the time that they need to carry out their important clinical leadership roles. The results of a freedom of information request from the Royal College of Nursing to NHS boards show that, of the 911 whole-time equivalent senior charge nurses that were identified in September 2017, only 115 were non-case load holding. I listened to what the cabinet secretary said, and I am sure that she will agree that there are many occasions when it is entirely appropriate for senior charge nurses to be non-case load holding. We must ensure that that is the case when that is appropriate.

I am pleased that we now have a proposal that all healthcare professionals are content with, but I was happy to push my stage 2 amendment, because nurses make up 42 per cent of the NHS workforce. My new amendments have been welcomed by nurses, midwives and allied health professionals. They seek to make absolutely sure that all lead professionals will have sufficient time and the resources that they require to carry out their leadership role and that that role is fully recognised.

Amendment 18A seeks to amend amendment 18 to ensure that clinical leaders have the resources that they require, as well as the time, to satisfactorily discharge their leadership responsibilities. Similarly, amendment 18B seeks to clarify that clinical leaders need sufficient time to “lead” the delivery of healthcare because, arguably, all healthcare professionals and staff “contribute to” its delivery.

Amendment 63 agreed to.

Group 8 is on the duty on health boards to ensure appropriate staffing: numbers and training of healthcare professionals. Amendment 13, in the name of Alison Johnstone, is grouped with amendments 15, 17 and 19.

Proposed new section 12IAC of the 1978 act will ensure that enough student places are offered to train a workforce that will better ensure that we deliver the healthcare that will meet Scotland’s changing needs. Amendment 13 seeks to acknowledge that there are factors that are outwith the Scottish ministers’ control, but still requires them to take “all reasonable steps” to ensure that there are sufficient numbers of registered healthcare professionals.

Amendment 15 seeks to add a stipulation that the Scottish ministers must take into account variation in staffing needs that are caused by differences in geographical areas. The healthcare needs of rural populations often differ greatly from those of more urban communities. Our rural and island NHS boards face particular challenges around recruitment and retention, and amendment 15 will ensure that the Scottish ministers have regard to rural-specific issues in their determinations.

Amendment 17 seeks to clarify what is expected of the Scottish ministers in reporting to Parliament on the provisions in question and setting out the extent to which ministers’ compliance with the duty to comply with section 12IAC has enabled health boards to comply with their duty to ensure appropriate staffing under section 12IA.

Section 12IAE places a duty on NHS boards to ensure that employees receive the time to carry out continuing professional development. NHS governance standards already state that employers will give time to staff for CPD but, as we are all too well aware, that time is often lost because of the demands on staff and their time. Amendment 19 will ensure that employees will receive sufficient time and resources to undertake training, but it will allow health boards to take a reasonable approach in determining what is appropriate training and resourcing.

I move amendment 13.

I welcome Ms Johnstone’s amendments, and I am grateful that we were able to work on them. In particular, I am pleased about the recognition of the open-ended nature of section 12IAE, which was inserted by her amendment at stage 2. Amendment 13 will ensure that health boards must ensure that appropriate time is provided for training, provided that continuity of staff and high-quality services are maintained. I offer my support for her amendments.

Amendment 13 agreed to.

Group 9 is on the application of duties in the bill to special health boards. Amendment 14, in the name of the cabinet secretary, is grouped with amendments 16 and 24 to 35.

New section 12IAC of the 1978 act, which places a duty on the Scottish ministers to ensure that sufficient numbers of staff are available to every geographical health board and the Common Services Agency to enable them to comply with the general duty, was inserted at stage 2 by Alison Johnstone. My amendments 14 and 16 will ensure that that duty also applies to clinical-facing special health boards, meaning the State Hospitals Board for Scotland, the Scottish Ambulance Service, NHS 24 and the national waiting times centre board.

Amendments 24 to 35 will ensure that the new sections that are being inserted through stage 3 amendments, along with new section 12IAE on the training of staff, will also apply to those special health boards.

I move amendment 14.

Amendment 14 agreed to.

Amendment 15 moved—[Alison Johnstone]—and agreed to.

Amendment 16 moved—[Jeane Freeman]—and agreed to.

Amendment 17 moved—[Alison Johnstone]—and agreed to.

Amendment 18 moved—[Jeane Freeman].

Amendments 18A and 18B moved—[Alison Johnstone]—and agreed to.

Amendment 18, as amended, agreed to.

Group 10 is on the duty to follow the common staffing method for healthcare. Amendment 64, in the name of Miles Briggs, is grouped with amendments 65 to 69, 21 and 22.

I have met the cabinet secretary to discuss the amendments that were made to the bill at stage 2, and her skills of persuasion have convinced me that further amendment of new section 12IB of the 1978 act is required to make it clear that setting the staffing establishment is not the only purpose of the common staffing method and to avoid any duplication that might cause confusion among those responsible for carrying out the method. I made it clear at stage 2 that it was never my intention to prevent the common staffing method from being used for other purposes, such as supporting the redesign of services.

With that in mind, amendments 64, 68 and 69 would remove new sections 12IB(1A) and 12IB(1B) of the 1978 act, which were placed in the bill by an amendment of mine at stage 2, and instead alter new section 12IB(2)(d) so that it states that, having followed the steps in the common staffing method, the health board is to decide “what changes (if any) are needed as a result to its staffing establishment, and to the way in which it provides health care.” A definition of the term “staffing establishment” is provided.

Amendment 65 clarifies that the measures for monitoring and improving the quality of healthcare that are published as standards and outcomes by the Scottish ministers under section 10H(1) of the 1978 act and that are to be taken account of as part of the common staffing method include any measures that are developed as part of a national care assurance framework.

Amendment 67 would make a minor change to the common staffing method. At stage 2, I lodged an amendment, which was agreed to by the committee, that added a new step in the common staffing method that requires health boards to take account of the experience of using the real-time assessment and risk escalation processes in new sections 12IAA and 12IAB of the 1978 act. It seems to me that the new linked duty in David Stewart’s amendment 62, which we have already debated, to have arrangements in place to address severe and recurrent risks, should also be included in that step in the common staffing method. Therefore, amendment 67 would add into the new step a reference to new section 12IABA.

I ask members to support all my amendments, and I move amendment 64.

I have only one minor amendment in the group. At stage 2, a number of additions and alterations were made to the bill in order to make explicit, and to protect, its multidisciplinary nature. Staff groups for which there is not yet a staffing tool had expressed concern that using the existing tools might draw resources away from other staff groups—an unintended consequence of not yet having multidisciplinary tools in place. At stage 2, therefore, I lodged an amendment that would require the impact on other staff groups to be taken into account in using the common staffing method to establish staffing levels.

Amendment 66 seeks only to alter the wording of that addition. The language of the bill refers to the tools that should be used for different types of “health care” rather than different types of professions, and amendment 66 would change the wording of my stage 2 addition to reflect that. The original purpose would remain the same: that the delivery of services for which a staffing tool did not yet exist should not be overlooked or understaffed by appropriate professionals so that statutory establishments could be met elsewhere.

I am pleased to offer my full support to Mr Briggs’s amendments 64, 68 and 69.

Amendment 22 is consequential to Mr Briggs’s amendment 68 in that it amends the words “staffing levels” in new section 12IF of the 1978 act—“Ministerial guidance on staffing”—to “staffing establishment” for the purpose of consistency.

Amendment 21 is a technical amendment to clarify that guidance may cover a step in the common staffing method that was inserted at stage 2.

I support Mr Briggs’s amendments 65 and 67 and Mr Stewart’s amendment 66, which provide helpful clarifications of the common staffing method that is set out in new section 12IB of the 1978 act.

As no other member wishes to speak to this group, I call Miles Briggs to wind up and to press or withdraw amendment 64.

I have nothing further to add, Presiding Officer.

I press amendment 64.

Amendment 64 agreed to.

Amendment 65 moved—[Miles Briggs]—and agreed to.

Amendment 66 moved—[David Stewart]—and agreed to.

Amendments 67 to 69 moved—[Miles Briggs]—and agreed to.

Amendments 20 to 23 moved—[Jeane Freeman]—and agreed to.

Section 5—Application of duties to certain Special Health Boards

Amendments 24 to 35 moved—[Jeane Freeman]—and agreed to.

Section 5A—Role of Healthcare Improvement Scotland in relation to staffing

Amendment 36 is grouped with amendment 70.

Amendment 36 is a technical amendment that adds to the list of duties, at new section 12IH of the 1978 act, that Healthcare Improvement Scotland “must monitor the discharge” of

“by every Health Board, relevant Special Health Board”

and the Common Services Agency. That will ensure that HIS will have oversight of the discharge by health boards of every aspect of the legislation. Having worked with Miles Briggs prior to today, I am also happy to support amendment 70, which is in his name.

I move amendment 36.

Since stage 2, I have had helpful discussions with the cabinet secretary around how Healthcare Improvement Scotland will review and develop staffing tools in the health service and what evidence and guidance it will take into account while doing so. I hope that amendment 70 reflects that and ensures that the development of staffing tools and methods continues to be based on the best available professional guidance and clinical evidence.

Therefore, I ask members to support amendment 70.

As no other member wishes to speak to this group, does the cabinet secretary wish to add any comments in winding up?

I have nothing further to add, Presiding Officer.

Amendment 36 agreed to.

Amendment 70 moved—[Miles Briggs]—and agreed to.

Section 6—Duty on care service providers to ensure appropriate staffing

Amendment 37 moved—[Alex Cole-Hamilton]—and agreed to.

Amendment 38 moved—[Jeane Freeman]—and agreed to.

Section 7—Training of staff

Amendment 71, in the name of Monica Lennon, is grouped with amendments 72 to 78.

In February, the fair work convention’s report “Fair Work in Scotland’s Social Care Sector 2019” found that the social care sector is not consistently delivering fair work and that its ability to do so is hindered by the current funding and commissioning structures. We know that the bill will not produce the additional caring staff that Scotland needs, but Scottish Labour believes that improving conditions in the sector would be a key step to addressing the social care challenges that Scotland currently faces.

Section 7 requires care providers to provide their staff with appropriate training for their jobs and suitable assistance in completing that training, and those provisions are an encouraging recognition of the need to support care service workers better. The guiding principles of staffing in section 1 contain the provision that staffing should

“be arranged while ... ensuring the wellbeing of staff”.

Amendments 71 to 78 in my name would add to those provisions along fair work principles. The bill does not contain any definition of “wellbeing”, but I would argue that my amendments go some way towards defining the standards required by wellbeing, as they would see care service workers properly reimbursed for costs that are incurred through the course of their work, be they uniform and clothing costs, travel costs for journeys between service visits, fees for necessary professional registrations or the costs of any training that workers must undergo. It is not acceptable that staff are still required to pay out of their own pocket for such items.

Amendment 75 would place on a statutory footing the Scottish Government’s current policy commitment to care service workers being paid a living wage, while amendment 77 defines such a living wage using language that is lifted straight out of the Scottish Government’s own Procurement Reform (Scotland) Act 2014. Amendment 76 and consequential amendment 78 would ensure that care service workers are given contracts with clearly defined hours, which would give them the security that a zero-hours contract could never offer.

The bill acknowledges that staffing is central to the delivery of “safe and high-quality” health and care services, and amendments 71 to 78 are in line with that principle. The social care that service users want and need cannot be delivered by staff who are overworked, stressed, struggling to get by and at risk of burn-out, and I know that the cabinet secretary understands and, indeed, agrees with that sentiment. I believe that the amendments would give Scottish workers in care services a guarantee of fair work.

Since I lodged the amendments last week, a number of organisations have expressed to me and colleagues their view that such standards should definitely be in place. However, I have appreciated the opportunity to talk to the cabinet secretary and her officials about these amendments, and I have taken on board their concerns that some of them fall outside the Parliament’s legislative competence. Moreover, the cabinet secretary has, in our discussions, confirmed that she is supportive of the principle that the amendments aim to meet, and I know that many others in the chamber concur with that view. I am not clear as to how my amendments substantially differ from the apparent workers’ rights provisions in sections 1 and 7, but I acknowledge the Scottish Government’s concern, and I do not want the debate to become about setting one legal opinion against another, given that there is so much in the bill that we can support and, indeed, which we have already supported.

The cabinet secretary has indicated to me that, as an alternative, she will ensure that guidance accompanying the bill will make clear that these fair work standards are to be followed in the delivery of care services. If the cabinet secretary is willing to make a clear commitment to the chamber today with regard to these standards and to producing alongside the bill guidance that follows these fair work practices in care commissioning and delivery, I will be content not to move my amendments. [Interruption.]

I was not sure whether the cabinet secretary was going to come in at that point. If I have her commitment, I will not press—

I suggest that Monica Lennon move amendment 71. If, in her response, the cabinet secretary agrees with the member, she can withdraw her amendment then.

I am happy to do so. I move amendment 71.

Colleagues will remember the case of my constituent George Ballantyne, who spent 150 nights in Liberton hospital after he was declared fit to go home. That was partly due to a deficiency in the availability of social care provision in Edinburgh. There is a crisis in social care in the nation’s capital and I am therefore compelled by Monica Lennon’s arguments. We need to do more to recognise fair work in the social care sector, and we need to make the profession attractive to people right from the early days of primary school so that they can direct their careers that way. Unless we start to make these kinds of changes, we will reap the whirlwind of that crisis in our social care sector.

As I have said, I am happy to support Monica Lennon’s amendments, but if she does not press amendment 71 or move the other amendments in the group, I, too, want the cabinet secretary to make a commitment to addressing this issue in guidance backing the bill.

I welcome the intention behind Monica Lennon’s amendments. As a Government, we have done what we can within the powers that we have to encourage every organisation, regardless of size, sector or location, to ensure that all staff receive a fair level of pay and, where possible, to pay the real living wage. We are committed to fair work. Payment of the real living wage and becoming accredited can make a difference to the lives of people working in Scotland; it benefits the economy and sends a positive signal to the wider community. I completely accept that it is also an important factor in the recruitment and retention of staff in this important sector.

As no other members wish to speak, I ask Monica Lennon to wind up.

I thank Alex Cole-Hamilton and the Scottish Liberal Democrats for their support on this matter. Indeed, I think that there has been support across the chamber.

Building on the constructive talks that I have had with the cabinet secretary and the remarks that she has just made, I welcome her strong commitment and strong assurance and I look forward to the guidance coming before the Health and Sport Committee. I am sure that colleagues on the committee will do a good job of ensuring that the guidance fully takes on board the points that were made in the amendments and I appreciate the cabinet secretary’s commitment on that.

Amendment 71, by agreement, withdrawn.

Amendments 72 to 78 not moved.

After section 7

Amendment 39 moved—[Jeane Freeman].

Amendment 39A moved—[Monica Lennon]—and agreed to.

Amendment 39B moved—[Alison Johnstone]—and agreed to.

Amendments 39C and 39D moved—[Monica Lennon]—and agreed to.

Amendment 39, as amended, agreed to.

Section 10—Functions of SCSWIS in relation to staffing methods

Group 13 is on staffing methods for care services. Amendment 79, in the name of David Stewart, is grouped with amendments 80 to 82, 40 and 41.

The amendments all relate to the staffing tools that might be developed for the care sector. Amendments 80 to 82, which Miles Briggs lodged, would ensure that professional and clinical guidance, as well as any accepted care indicators, could be taken into account in the development of such tools. That seems sensible and appropriate.

Amendment 79, which is in my name, would establish parity with health services under part 2. As we have discussed, it is crucial in health services that risks to staffing levels can be identified, appropriately escalated and mitigated. The same point applies to social care services.

I recognise that, unlike the health service, the social care sector is made up of a range of providers whose size and services vary. For that reason, it would be inappropriate to set out in primary legislation precise procedures on staffing risk for all providers to establish and follow, as has been done for the health service in part 2. The different staff and management structures across the care sector make it unlikely that it would be possible to craft even a general process that worked for everyone.

Amendment 79 includes the option to build risk management guidance into staffing tools that are developed for care services. Importantly, the amendment would allow flexibility in how risk management procedures were developed for different care services.

I move amendment 79.

Amendment 80 relates to my stage 2 amendment 122, which I did not move. As with staffing methods in health services, it is crucial for the professional voice to be at the core of staffing methods in care services. To recognise the diversity of the staff groups that provide care, amendment 80 sets out that a staffing method that is recommended for use by care service providers may take account of

“recommendations of senior care sector or health care professionals with qualifications and experience that are appropriate to the care services in question”.

As staffing methods are developed, that will ensure that consideration is given to who is best placed—be that a nurse, a care worker or an allied health professional—to provide advice on staffing decisions that are based on the method.

Amendments 81 and 82 relate to my stage 2 amendments 117 and 120. Given that not all care providers provide clinical care, it would not be appropriate to have clinical quality indicators for all care services. It is important to remember that the care setting is often someone’s home. Amendment 81 therefore provides that any staffing method that is developed and recommended for use in care services may take into account

“such indicators or measures relating to the quality of care as”

the Care Inspectorate

“considers appropriate”.

My amendment 70 provided that, in developing new or revised staffing tools for health settings, Healthcare Improvement Scotland must have regard to relevant evidence and professional guidance. Amendment 82 would create a parallel provision on the care side, so that the Care Inspectorate should also consider, when developing new staffing methods for care services in collaboration with stakeholders, whether appropriate evidence and professional guidance should be included in the method.

I ask members to support my amendments.

I thank David Stewart and Miles Briggs for working with me following stage 2 to produce their amendments as alternatives. I am happy to support amendment 79, in Mr Stewart’s name, and amendments 80 to 82, in Miles Briggs’s name.

Amendment 40 was lodged to introduce a regulation-making power to allow ministers to amend the list, in section 82A(5) of the Public Services Reform (Scotland) Act 2010, of what a staffing method for care services may include at the Care Inspectorate’s discretion. Amendment 41 was lodged to make that power subject to the affirmative procedure.

It would be inappropriate to specify absolute requirements for the development of staffing tools and methodologies for the care sector. Such tools and methodologies have not yet been developed, and I have consistently given the care sector the commitment that they will be developed by and for the sector. It should be up to those who are involved in developing methods to determine their content.

Amendment 40 was lodged to ensure that flexibility was maintained. I am pleased that, following our discussions at stage 2, members agree that flexibility is important and have not sought to be overly prescriptive in what must be included in a staffing methodology for the care sector. As I have already let the Delegated Powers and Law Reform Committee know, I therefore intend not to move amendments 40 and 41, as they are no longer required.

Amendment 79 agreed to.

Amendments 80 to 82 moved—[Miles Briggs]—and agreed to.

Amendment 40 not moved.

Section 11—Care services: consequential amendments

Amendment 41 not moved.

That ends consideration of amendments.

As members will be aware, I am required by standing orders to decide at this stage whether in my view any provision of the bill relates to a protected subject matter—that is, whether the bill affects the franchise for Scottish parliamentary elections. It is my view that the bill does not and therefore does not require a supermajority at stage 3. I know that Mr Swinney is fascinated to hear that.

Members will be delighted to hear that we have made very rapid progress through the bill. I will consult business managers and we will almost certainly move to bring forward decision time. We will suspend briefly before we resume for the stage 3 debate.

The next item of business is a debate on motion S5M-17127, in the name of Jeane Freeman, on stage 3 of the Health and Care (Staffing) (Scotland) Bill. I ask those who wish to speak in the debate to press their request-to-speak buttons.

The bill will put into legislation a system-wide approach to supporting and empowering staff across the health and care system to assess and respond to the workload associated with the delivery of high-quality patient care. I start the debate by thanking the organisations and members across the chamber who have so constructively contributed to the development and improvement of such important legislation.

The Health and Care (Staffing) (Scotland) Bill is grounded in, and builds on, the excellent approach to workload planning led by our nurses and midwives. This morning, I was fortunate to be at Forth Valley to see how that approach works to develop and improve safe care and quality care.

The development of the staffing methodology and specialty-specific tools has been innovative, evidence-based and, importantly, a professionally led approach. Scotland has led the way in developing those tools and methodologies for nursing and midwifery. Now we can become world leading by enshrining the approach in legislation and extending its core principles across our health and care system.

The legislation matters to our national health service and healthcare staff, but it also matters to patients and those who receive social care. We see the crucial link between safe staffing, the utilisation of the multiple skills of the multidisciplinary team and the quality and safety of the service received. It is a critical component of a safer healthcare system for the people of Scotland.

At the recent international forum on quality and safety in healthcare that was held in Glasgow, we welcomed leaders of healthcare systems from across the world. When we hear the head of Healthcare Denmark say,

“I have been following Scotland for the last ten years and have seen major changes and outstanding outcomes that we do not see anywhere else in the world at a system level”,

I think that our healthcare staff should be very proud of the work, effort and experience that they have applied to get us to this point.

When I opened the stage 1 debate, I talked about the opportunities that the bill offers us as a critical component in the safety and quality landscape. I very much appreciate the valuable work that the members of the Health and Sport Committee and health spokespeople from all parties have put into the bill at every stage. Although we may have disagreed at points, I know that we all had a shared intention: that the legislation should recognise the importance of dynamic workload assessment to inform professional judgment on skill mix, recognise the need to meet the demands of that workload and recognise the critical importance of the clinical and professional voice in all that. We all recognised the importance of an evidence-based approach, founded on the needs of the patient or service user, to contribute to our planning of the workforce locally and nationally.

I know that we all wanted legislation that would work for the whole system—across all health and care settings—and work for and be respectful of our key partners, be they professional bodies, local authorities or care providers. We agree that high-quality care is possible only when we recognise the importance of the multidisciplinary team and the valuable experience and expertise that each of the roles brings to that.

Together with Miles Briggs and David Stewart, we have made significant changes to the bill that set out that health boards must have in place clear processes to allow those on the front line to carry out real-time assessment of staffing needs and effectively mitigate risks.

The legislation will ensure that the voice of the professionals—be that the midwife and doctor on a busy labour ward, the nurse and the physiotherapist working together in the community, or the executive nurse or medical director at board level—will be heard and will influence staffing decisions. The legislation will promote a continuing culture of transparency and engagement with staff, helping to create and sustain the conditions that staff need to use their experience and expertise to drive continuous improvement in our health and care service, while always keeping the individual in receipt of that care at the centre of delivery.

Of course, a great deal more work is to come to ensure that the staffing method and tools for health settings are kept up to date with advances in the way that care is delivered, to develop the multidisciplinary tools and to work with and support the care sector and local authority, third sector and private care providers to take the core methodology and build an approach that works for them. There is learning from health that can be shared with the care sector in that regard; I am also sure that there will be learning from the care sector to share with health, which is exactly as it should be.

In passing the bill, I firmly believe that we will be supporting our health and care staff to meet the commitment that I know that they deliver on every single day; to apply their skills, expertise and compassion to deliver high-quality, safe care; and to find ways to improve how care is delivered, regardless of where it is delivered. I am very pleased to move the motion in my name.

I move,

That the Parliament agrees that the Health and Care (Staffing) (Scotland) Bill be passed.

This may sound a bit like an Oscar awards speech. I thank a number of organisations and people who have helped, including my Scottish Conservative research team, the Royal College of Nursing Scotland, the Allied Health Professions Federation Scotland, the Convention of Scottish Local Authorities, Scottish Care and all those health professionals who have contacted me. I also thank the Health and Sport Committee team, the Scottish Parliament’s legislation team and the Scottish Government’s Health and Care (Staffing) (Scotland) Bill team.

Scottish Conservatives believe that the most valuable resource in our national health service is its people, and we want the Health and Care (Staffing) (Scotland) Bill to do all that it can to help them with their lives and jobs. Therefore, the amendments that I lodged focused on several themes: a duty to seek clinical advice on staffing, improving real-time assessment and risk escalation procedures, and improving staffing methods for care services.

Scottish Conservatives believe that it is essential for the professional voice to be heard throughout the legislation, hence my amendment 63 on a duty to seek clinical advice on staffing. Now that that amendment has been agreed to, the professional voice will be heard in all areas of the bill, including the duty to ensure appropriate staffing, having arrangements in place to address severe and recurrent risks and ensuring that adequate time is given to NHS clinical leaders for the training that they need, with resources to enable that. The amendments will aid the bill’s whole-systems approach, which the cabinet secretary outlined. The bill needs to be as effective as possible, and ensuring that the professional voice is heard throughout it is a step forward in achieving that.

I also lodged amendments that looked to improve real-time assessment and risk escalation procedures. The amendments will ensure that staff with lead professional responsibility are trained and given sufficient time and resources to identify and mitigate risk. For other employees, the health board or agency will be under a duty to raise awareness of the escalation process and to encourage staff to identify and report risks that are caused by staffing inefficiencies. Real-time assessment is part of that.

Scottish Conservatives put forward numerous amendments that focused on staffing methods in care services. Throughout the Health and Sport Committee’s discussions and evidence gathering on the bill, it was clear that there are opportunities to develop tools in partnership with the care sector. That was an important part of how I wanted the bill to progress, so I am pleased that my amendments will ensure that the appropriate people and organisations are involved in developing tools in future.

During the Health and Sport Committee’s consideration of the bill, all members recognised that some care settings are people’s homes and that that requires a different focus and staffing complement. I am pleased that that has now been recognised, and I hope that we will see the progression of the tools as soon as possible, when guidance is brought forward. The bill provides the acute sector with opportunities now, and I hope that we progress the opportunities for the care sector as soon as possible.

As I said during the stage 1 debate,

“Scottish Conservatives recognise that our health and social care workforce faces a number of key challenges. With or without legislation, unless we urgently resolve the staff shortages across NHS Scotland, safe staffing levels will remain a dream instead of a reality.”—[Official Report, 6 December 2018; c 54.]

I hope that the Health and Care (Staffing) (Scotland) Bill will provide a critical contribution to driving the necessary improvements in cultural and organisational change that we need to meet the challenges and the expectations of health and social care staff across Scotland. We all agree on the principal objective of the bill, which is to provide improvements to deliver safe, effective and person-centred services and outcomes for people across Scotland. We now need the Scottish Government to ensure that it delivers that.

I congratulate the cabinet secretary and her officials, the Health and Sport Committee and the committee clerks, the legislation team and all the organisations that have put so much work into not just driving forward the bill but improving it. That is a great reflection on everyone. I also thank the many people in the public gallery who have followed the debate, particularly the Royal College of Nursing representatives.

Scottish Labour welcomes the bill as amended. It is vital that we have safe levels of health and social care staff, so we welcome all attempts to ensure that we get them. No one has claimed that the bill is a panacea. Our NHS workforce is working under serious pressure and workforce planning has been poor. Scotland’s fragile social care sector is facing a staffing and funding crisis. Scottish Labour continues to believe that the Scottish Government must urgently take action to address those on-going issues.

Alongside many stakeholders, Scottish Labour raised significant concerns about the bill at stage 1, so we are pleased that it has been substantially improved since then. I am pleased about the positive impact that Scottish Labour amendments will have for those working in the health and social care sector and ultimately for those who they care for.

It is important that NHS patients and people who are cared for by social care services are central to the bill. That belief is shared by staff, who commit their working lives to the health and wellbeing of others. My amendment 42 will ensure that the guiding principles of the bill focus on the outcomes for service users.

To have a positive impact, it is vital that workforce and workload planning are considered jointly. My amendments increase the public reporting requirements in the bill and, together with Alison Johnstone’s amendments, mean that the bill now takes into account workforce planning as well as workload planning.

I am glad that we have been successful in strengthening the links between the bill and national workforce planning.

On robust risk assessment and escalation procedures, David Stewart’s amendments will help to embed multidisciplinary principles into the planning of staffing levels. Anas Sarwar’s amendment 47 will ensure that, in principle, there will be a welcome cap on agency fees and that clearer information will be available on agency staff use.

Social care staff do valuable and rewarding work, but they often face difficult working conditions, with low pay and insecure work. My amendments 71 to 78 aimed to ensure that they would be paid at least the Scottish living wage, would have secure hours, would not be employed on zero-hours contracts, and would be reimbursed for travel, training and registration fees and uniform costs that are directly related to their work. I am pleased that the cabinet secretary agrees with me that social work terms and conditions must be drastically overhauled to improve the sustainability of the sector, and I am also pleased that they will now be included in guidance that will come before the committee.

Scottish Labour welcomes the Health and Care (Staffing) (Scotland) Bill and backs any opportunity to ensure safe staffing level for our vital health and care staff. The legislation is a step towards fixing the workforce crisis in our health and social care services, which sees staff being overworked and undervalued. However, I remain concerned that that crisis will not be resolved by the bill alone. In order to make real, sustainable change happen, our health and social care services need radical policy decisions that are backed up by investment.

I thank the numerous organisations that have provided briefings and support during stages 2 and 3 of the bill’s passage. I also thank members of the Royal College of Nursing, whose input during the process has been invaluable. As Monica Lennon said, representatives of the college are present in the gallery today. I also thank our allied health professionals and the Royal College of Midwives. Most important, however, is that I thank all the people who work in health and social care—from consultants to cleaners—for the work that they do every day.

Greens support the aims of the Health and Care (Staffing) (Scotland) Bill, and welcome the debate. As the Royal College of Nursing has said, it presents an opportunity to get the right number of staff, with the right skills, in the right place, so that patients and residents receive safe and effective care. There is a clear link between safe staffing levels and delivery of high-quality healthcare. A study by Anne Marie Rafferty, who is a professor of nursing policy, revealed that patients and nurses in hospitals in which there are favourable patient to nurse ratios had consistently better outcomes than those in hospitals with less favourable ratios.

Greens also support the guiding principles for health and care staffing, including respecting the dignity and rights of service users, ensuring the wellbeing of staff, and taking account of the views of staff and service users. We must do all that we can to support those who devote their working lives to caring for Scotland’s people. During the bill’s passage, we have carefully considered how the legislation will impact on them. That is key, because the evidence that has come from people who currently work in health and care services emphasises that the legislation is timely and necessary.

The RCN’s report “Safe and Effective Staffing: Nursing Against the Odds” revealed that 51 per cent of respondents reported a staffing shortfall in their previous shift, and 46 per cent said that they were not able to provide the quality of care that they would like to receive if they were patients.

Similarly, the British Medical Association conducted a survey of doctors, which showed that 62 per cent felt that rota gaps and lack of doctors were affecting their ability to deliver safe patient care.

In 2018, a report by Scottish Care revealed that 77 per cent of surveyed care homes had vacancies. Such stark figures stress that the protections that will be introduced by the bill will be vital to the delivery of safe and high-quality patient care.

We must continue to strive for real integration, and to give the care sector the attention that we give the NHS. Although they were either withdrawn or not moved, I welcomed Monica Lennon’s amendments 71 to 78, which aimed to improve conditions for people who work in the sector. They presented a welcome opportunity to raise important issues.

The most recent statistics show that 5.1 per cent of nursing and midwifery posts and 4.9 per cent of allied health professional posts are vacant. Although those figures represent an increase in staffing levels from the previous year, six territorial NHS boards reported a reduction in the number of qualified nursing and midwifery staff who were in post. There is also still considerable disparity between health boards that needs to be addressed.

As she did when she was Minister for Social Security, Jeane Freeman has worked hard to seek cross-party input and consensus, which I appreciate. We need a well-staffed NHS for patients and for the people who work in it. Workload and workforce are inextricably linked. Working in an overstretched and overstressful environment is not sustainable.

The bill alone will not create more health and care professionals. It will not address the fundamental shortages that are being experienced across the sector. However, it is a starting point. Work must continue in order that we ensure that Scotland has the health and care staff that it needs. I am certain, however, that the bill will play a key role in ensuring that our health and social care services are appropriately staffed, and that staff can deliver the best standards of patient care.

On the margins of this meeting, the cabinet secretary confided to me in private that she was looking for another consensus bill. I think that she has found it, so I congratulate her on her achievement. She worked very hard between stage 2 and stage 3 to reach accommodation on a range of tensions that existed at stage 2, which I think she has achieved.

I also pay tribute to Kirsty Williams, who is a Liberal Democrat member of the National Assembly for Wales who stewarded a similar bill through it. I leaned on her guidance in developing my understanding. I thank the clerks, the witnesses in the stage 1 process and, in particular, the members of the RCN, who started briefing members of our committee two and a half years ago on what they wanted to happen. I hope that they are pleased today. I thank Sarah Atherton, in particular. She is a friend and colleague of long standing, who was readily available to provide technical briefings on which we, as newcomers to aspects of this, relied heavily. I also thank the allied health professionals.

From the outset, it was clear that the bill needed to be slightly more than it was when it was originally drafted. It recognises the new strata in which we deliver health and social care. There is a multidisciplinary focus like never before. The integration of health and social care means that we need to think outside silos and to recognise that what applies to a clinical staff team might also apply to a social care staff team.

Alison Johnstone referred to the very scary survey of staff attitudes and beliefs, and to staff’s view that patient care had been compromised on their most recent shift. Obviously there will be a resource imperative, but the bill does something to give the staff the tools that they require to ensure that services are adequately staffed not just for the safety of patients, but for the safety of the staff cohort.

There is much about the bill that matters. It provides the facility to ensure that the voice of practitioners and nurses on the ground, who understand the wards that they occupy and their needs, is heard. Expertise matters in planning and understanding what a dynamic shift environment looks like. It is important to make sure that services are staffed accordingly, that there is planning for risk and that staff have faith in the process and faith that their views will be listened to. In normal times, that might be about ensuring that ideas from the grass roots about improving staffing are listened to, extrapolated from and taken forward across the NHS. At the more serious end of the spectrum, it is about ensuring that whistleblowers are treated well and dealt with appropriately.

The bill that we will pass into law today will mean that changes are felt in the quiet wards across the NHS, and in the noisy ones, too. Giving senior staff the time and space to get their heads around the planning and overview of the wards and areas of work in which they find themselves is one of the most significant and important changes that we are enacting. I congratulate Alison Johnstone on securing amendments on that. Those provisions will provide an important strategic overview, which will enhance staff safety and patient safety.

Allowing change to germinate from the grass roots works in any organisation: our NHS, social care structure and allied health professional structure are no different. The bill provides the opportunity for that to happen.

At first reading, it seemed that the bill was about a toolkit, but it is about so much more than that. It has been great to be part of its development, not least to hear about where it will take our workforce. More important, it has been a reminder of the importance and commitment of the workforce that it will serve. Those staff do so much for us; it is about time that we started doing something for them. In the pages of the bill, we achieve something of that.

We move to the open debate, in which just one member will speak.

I have enjoyed working on the Health and Care (Staffing) (Scotland) Bill since joining the Health and Sport Committee. The aim of the bill, as set out in the policy memorandum, is

“to provide a statutory basis for the provision of appropriate staffing in health and care settings, thereby enabling safe and high quality care and improved outcomes for service users”

—and all patients. The policy memorandum states:

“Provision of high quality care requires the right people, in the right place, with the right skills at the right time to ensure the best health and care outcomes for service users and people experiencing care.”

I fully agree with that and I know that the amendments that were lodged by the Government and by members of parties across the Parliament will allow that aim to be achieved.

It is clear that members have engaged in a process that has achieved cross-party agreement. We discussed staffing tools, continuous professional development, issues around case-holding and non-case holding senior charge nurses, and many other issues related to acute and community care, and the requirement for a multidisciplinary team approach to providing appropriate health and care staffing.

I am pleased that amendments 18,18A and 18B were agreed at stage 2. We had wide-ranging debate in the committee at stage 2. The cabinet secretary provided an excellent example of team working from Shetland, which requires the local team to be case-holding. I want to offer another example of that: senior charge nurses often provide direct patient care in the perioperative environment. For example, when surgery is extended or complications occur, the experience or expertise of the senior charge nurse might be required to provide the immediate care assistance that is needed when someone’s belly is open on the operating table.

I would like to thank everyone who provided evidence to the committee—whether it was written or provided at evidence sessions. It was all well-informed, and it helped committee members to come to informed conclusions. I also commend the committee clerks and the Scottish Parliament information centre team. Miles Briggs has mentioned all the people who provided the committee with information. I, too, am grateful to all the organisations that provided briefings that helped to inform debate. I have had lots of phone calls and direct advice from the Royal College of Nursing, chief nursing officers from NHS Dumfries and Galloway and NHS Ayrshire and Arran, and representatives from Scottish Care.

I was a new MSP for South Scotland when the First Minister announced the Scottish Government’s intention to enshrine safe staffing in law at the Royal College of Nursing congress in Glasgow in 2016. I was so new that only about a month before that I had been providing direct patient care. My work as a nurse educator and as a perioperative nurse, with 30 years’ clinical experience in America, England and Scotland, has helped to inform my scrutiny of the bill at the committee stage.

When I started nursing 30 years ago, we still had Nightingale wards, with rows of beds on either side. That certainly had some positives, particularly in relation to staffing. However, there were also negatives, including there being no personal space or privacy. Curtains are not walls and every voice and noise is heard in multi-occupancy rooms. There is also greater risk of hospital-acquired infection.

The bill enables a rigorous evidence-based approach to decision making on safe and effective staffing. It takes account of the health and care needs of patients and service users, assists in exercising of professional judgment and promotes a safe environment for patients and staff. Scotland is leading the UK with our groundbreaking evidence-based approach to nursing and midwifery workload and workforce planning.

The bill also puts in place a framework to support the systematic identification of the workload that is needed to improve outcomes and to deliver high-quality care. In introducing the bill, the Scottish Government, aided by experts from across health and social care, has understood the workload that is generated in any given setting and circumstance and, therefore, the skills that are required and the staff mix that will provide them.

I thank again all those who provided evidence to the committee. I also thank all those who work in health and social care across Scotland: they do a fantastic job every day.

This has been an excellent—albeit short and snappy—debate. There have been a lot of insightful and well-informed speeches from across the chamber. I am impressed to see how many SNP back benchers are here, because I understand that last night was their Christmas party. [Interruption.] I am very impressed by their dedication in turning up. I understand that there was a run on paracetamol at the local shop, but I will not go there.

As a member of the Health and Sport Committee, I took an active part in the questioning of all our witnesses, who included the cabinet secretary. [Interruption.] I am being heckled by the Deputy Presiding Officer behind me. However, to paraphrase the conclusion of the committee’s stage 1 report, nobody can object to the bill’s guiding principles of having the right people with the right skills in the right place at the right time to ensure the highest quality of care.

As Monica Lennon made clear, Labour supports the general principles of the bill. However, as Alison Johnstone and Alex Cole-Hamilton made clear, there were some areas of concern. Nonetheless, I believe that the cross-party consensus on the amendments strengthened the bill. As I said earlier, I thank the cabinet secretary—I hope that that does not damage her career—for her consensual and helpful role in ensuring that we have amendments that work for everyone.

In response to the committee’s stage 1 report, the cabinet secretary said:

“This Bill is about workload planning not workforce planning.”

Scottish Labour believes that health and social care policy should be focused on achieving the best outcomes for people and protecting staff wellbeing. As COSLA has argued, overreliance in the past on bureaucratic box-ticking exercises has not been helpful. I hope that we can avoid that.

We should also learn lessons from history. As I have raised before, the Francis inquiry report into bullying and whistleblowing in NHS England concluded that losing trained talent from the NHS led to inadequate staffing levels and poor quality of care. As the cabinet secretary knows well, there will be a statement on Thursday, to which Monica Lennon and I will contribute. I am sure that the Francis report will be picked up by the current report that the cabinet secretary has set up.

I am conscious of time and the fact that people are anxious to get away. I believe that all members in the chamber recognise the commitment and dedication of our hard-working front-line staff.

To make just a small amendment to correct my earlier comments, I think that I said “Christmas party”. I was, of course, a little bit early for that. However, it was a party nevertheless. Don’t let anyone say that I never correct the record when I am wrong.

As David Oliver, a consultant in geriatrics, said recently in the BMJ,

“Without adequate staffing in clinical roles NHS performance will decline, and services will become unsustainable. Morale will worsen, and staff will leave or choose to do less—a vicious circle. The workforce is surely the most pressing existential threat.”

In the short time that I have available, I make the key point that we cannot legislate staff into existence. However, I believe that the cross-party consensus on amendments has strengthened and improved the bill, which is the nature of this place—to ensure that legislation becomes better. There are much bigger issues that I do not have time to comment on, such as demand forecasting for future planning; the management of predictive training for front-line staff; the effect of Brexit—which will, in my view, be disastrous for NHS employment; the effect that the bullying culture in some areas may have on retention; and the strong rural element, which someone from the Highlands and Islands would of course argue.

The amended bill is a step in the right direction and Labour will support it. As Nye Bevan, the founder of the NHS, said,

“The NHS will last as long as there’s folk with faith left to fight for it.”

I am pleased to close this important and consensual debate on behalf of the Scottish Conservatives.

On first considering a bill entitled the Health and Care (Staffing) (Scotland) Bill—originally called the safe staffing bill—I believe that most people would instinctively think it to be entirely sensible. Of course ensuring that there are appropriate numbers of suitably trained staff in place is an entirely reasonable objective. However, as we heard in the speeches from across the chamber today, and from scrutiny of the bill in the Health and Sport Committee, crucial questions were raised as the bill developed. For example, in setting appropriate numbers of staff, it is important that the term “appropriate staff”—as well as what actions will be taken if the appropriate staffing levels are not met—is properly defined and unambiguous, so that NHS boards and the care sector know exactly what they are working to. Given the multidisciplinary nature of healthcare teams, we need to ask whether the bill is drafted in such a way as to include all facets of healthcare.

The Health and Sport Committee took evidence and questioned the cabinet secretary on the need to develop workforce planning tools and how to address that need. The technology that would be required to implement the bill as intended is not yet available and the workforce planning tools do not currently include all healthcare professions and disciplines—the evidence suggested that they are limited to nursing and midwifery. The tools are currently bolted on to the payroll platform. When I questioned the cabinet secretary in committee, she said that the required technology was under consideration, including the further development of workforce planning tools and, potentially, a platform for them to sit on. I would be grateful if the cabinet secretary, when summing up, will confirm that.

The specification of the required tools and the integrity of the platform on which they will sit should have been scoped out at the outset of the bill and, without a properly considered and implemented technical solution, the bill risks falling short of its intentions. If all that is not considered, it is in danger of being no more than window dressing and adding to a lengthy list of non-actionable targets.

As Miles Briggs and his amendments made clear, there is a need to strengthen the reporting requirements on health boards to ensure proper scrutiny, especially given the call for clinical advice to be sought on staffing bills as a prerequisite.

Underpinning the debate is the issue of staff retention and recruitment, which has been raised by several members. The Health and Care (Staffing) (Scotland) Bill cannot make the differences that are intended without the appropriate number of staff overall. It is obvious that the ability to ensure appropriate staffing at any one time will be impaired by a general shortage of staff. As David Stewart noted, the Royal College of Physicians stated that we

“cannot legislate doctors into existence.”

It is difficult to argue that the projected shortfall of doctors in Scotland will not have an impact on the potential of the bill.

Outcomes were mentioned by the cabinet secretary. In general, we are looking for improved services for patients and improved quality of working environments and improved work-life balance for NHS and care staff. That is why I was pleased to see Alison Johnstone’s amendment .

We spoke in committee about the importance of time for CPD for front-line staff. Without that, the implementation of the bill will not happen. We have always stated that looking after the health of our healthcare professionals is important in delivering a quality healthcare service, as it impacts absenteeism and staff retention.

The Scottish Conservatives will support the bill, but it should not be seen as a panacea. Its success will rely on progress being made in other areas, especially the swift development of appropriate technology and data analysis, the need to give professionals a strong voice in the staffing process and tackling the not insignificant challenges of retention and recruitment.

I thank members for their contributions to the debate. I am glad that Mr Stewart corrected the record, but members on the SNP benches are always up for a wee party, so I am sure that we will have had more than one.

I also thank David Stewart for making the important point that our role as parliamentarians in the chamber is to make the best laws that we can and to make legislation that is appropriate for the needs of our country. With this bill, that is exactly what we are doing.

As I said when I opened the debate, I am immensely proud of the work that is carried out by our health and care staff to ensure not just that the quality of care is consistent but that it is of a high quality and is improving. The bill will improve the experience of the patient and drive the improvement of outcomes. It recognises that it is people and citizens who deliver patient experience and care, and it provides a balanced, evidence-based approach to support patients, professionals and organisational outcomes.

As members noted and as I have made clear on many occasions, there is no single thing that we need to do to ensure safe, effective, person-centred care; rather, there are a number of important steps that we need to take. This legislation, which will sit alongside our Scottish patient safety programme and our excellence in care work, is the next important piece that will ensure that we continue to drive our commitment to safe and effective patient care.

There are a number of important steps that we need to take next. The important work of making this legislation come alive—to improve outcomes for the people of Scotland and to create conditions in which our staff can flourish—continues with the development of guidance as the next step in the journey. That guidance will be drafted in collaboration with all stakeholders and will, of course, be shared with our Health and Sport Committee. It is worth noting that regulations will be laid for every new staffing tool that is developed, which will be subject to affirmative procedure, thereby allowing further scrutiny by members across this chamber to ensure that they match the intention and the principles behind the bill.

I completely take Mr Whittle’s point about digital. A great deal of work is going on, in health, on digital platforms. I make the offer to the Health and Sport Committee to come forward, in due course, to explain and present all that work, so that it can see where we are.

It is appropriate for me to conclude with a number of thank yous for support for the bill, which has taken us to the point of having a significant and important piece of legislation to which I hope we are all about to agree. I thank the Allied Health Professions Federation Scotland, the Royal College of Midwives, the Royal College of Nursing, the BMA, the Academy of Medical Royal Colleges and Faculties in Scotland, COSLA, Unison, staff group representatives, Scottish Care and representatives of integration authorities. It is an indication of the importance of this legislation that all those organisations actively contributed, along with their members, to the bill that we have before us today.

I also thank the Health and Sport Committee, the Delegated Powers and Law Reform Committee and the Finance and Constitution Committee for their contributions to the development of the bill as it has gone through all the stages. Finally, I must thank the bill team, whose work has been extensive and driven by direct front-line experience and expertise. They have been unstinting, and I am certain that, without them, we would not be where we are at this moment.

Together with all of that, there is a shared commitment across the chamber to get this right for those who work in our health and social care sectors—they deserve nothing less, and nor do our patients and those who use our care services. I very much look forward to continuing this shared work with members across the chamber as we take the next steps to make this important legislation a reality.

The next item of business is consideration of business motion S5M-17152, in the name of Graeme Dey, on behalf of the Parliamentary Bureau, which sets out a revised business programme.

Motion moved,

That the Parliament agrees to the following revisions to the programme of business for Wednesday 8 May 2019—

delete

followed by Stage 3 Debate: Health and Care (Staffing) (Scotland) Bill

6.00 pm Decision Time

insert

5.00 pm Decision Time.—[Graeme Dey]

Motion agreed to.

I am minded to accept a motion without notice, under rule 11.2.4 of the standing orders, that decision time be brought forward to now.

Motion moved,

That, under Rule 11.2.4, Decision Time be brought forward to 4.32 pm.—[Graeme Dey]

Motion agreed to.

There is only one question to be put, which is that motion S5M-17127, in the name of Jeane Freeman, on the Health and Care (Staffing) (Scotland) Bill, be agreed to. As the question is on passing a bill, there will be a division.

For

Adam, George (Paisley) (SNP)
Adamson, Clare (Motherwell and Wishaw) (SNP)
Allan, Dr Alasdair (Na h-Eileanan an Iar) (SNP)
Arthur, Tom (Renfrewshire South) (SNP)
Baillie, Jackie (Dumbarton) (Lab)
Baker, Claire (Mid Scotland and Fife) (Lab)
Balfour, Jeremy (Lothian) (Con)
Beamish, Claudia (South Scotland) (Lab)
Beattie, Colin (Midlothian North and Musselburgh) (SNP)
Bibby, Neil (West Scotland) (Lab)
Bowman, Bill (North East Scotland) (Con)
Briggs, Miles (Lothian) (Con)
Brown, Keith (Clackmannanshire and Dunblane) (SNP)
Burnett, Alexander (Aberdeenshire West) (Con)
Cameron, Donald (Highlands and Islands) (Con)
Campbell, Aileen (Clydesdale) (SNP)
Carson, Finlay (Galloway and West Dumfries) (Con)
Chapman, Peter (North East Scotland) (Con)
Coffey, Willie (Kilmarnock and Irvine Valley) (SNP)
Cole-Hamilton, Alex (Edinburgh Western) (LD)
Constance, Angela (Almond Valley) (SNP)
Corry, Maurice (West Scotland) (Con)
Crawford, Bruce (Stirling) (SNP)
Cunningham, Roseanna (Perthshire South and Kinross-shire) (SNP)
Denham, Ash (Edinburgh Eastern) (SNP)
Dey, Graeme (Angus South) (SNP)
Doris, Bob (Glasgow Maryhill and Springburn) (SNP)
Dornan, James (Glasgow Cathcart) (SNP)
Dugdale, Kezia (Lothian) (Lab)
Ewing, Annabelle (Cowdenbeath) (SNP)
Ewing, Fergus (Inverness and Nairn) (SNP)
Fabiani, Linda (East Kilbride) (SNP)
Findlay, Neil (Lothian) (Lab)
Finnie, John (Highlands and Islands) (Green)
FitzPatrick, Joe (Dundee City West) (SNP)
Forbes, Kate (Skye, Lochaber and Badenoch) (SNP)
Fraser, Murdo (Mid Scotland and Fife) (Con)
Freeman, Jeane (Carrick, Cumnock and Doon Valley) (SNP)
Gibson, Kenneth (Cunninghame North) (SNP)
Gilruth, Jenny (Mid Fife and Glenrothes) (SNP)
Golden, Maurice (West Scotland) (Con)
Gougeon, Mairi (Angus North and Mearns) (SNP)
Grahame, Christine (Midlothian South, Tweeddale and Lauderdale) (SNP)
Gray, Iain (East Lothian) (Lab)
Greene, Jamie (West Scotland) (Con)
Greer, Ross (West Scotland) (Green)
Griffin, Mark (Central Scotland) (Lab)
Hamilton, Rachael (Ettrick, Roxburgh and Berwickshire) (Con)
Harper, Emma (South Scotland) (SNP)
Harris, Alison (Central Scotland) (Con)
Harvie, Patrick (Glasgow) (Green)
Haughey, Clare (Rutherglen) (SNP)
Hepburn, Jamie (Cumbernauld and Kilsyth) (SNP)
Hyslop, Fiona (Linlithgow) (SNP)
Halcro Johnston, Jamie (Highlands and Islands) (Con)
Johnstone, Alison (Lothian) (Green)
Kelly, James (Glasgow) (Lab)
Kerr, Liam (North East Scotland) (Con)
Kidd, Bill (Glasgow Anniesland) (SNP)
Lamont, Johann (Glasgow) (Lab)
Lennon, Monica (Central Scotland) (Lab)
Leonard, Richard (Central Scotland) (Lab)
Lindhurst, Gordon (Lothian) (Con)
Lochhead, Richard (Moray) (SNP)
Lockhart, Dean (Mid Scotland and Fife) (Con)
Lyle, Richard (Uddingston and Bellshill) (SNP)
MacDonald, Angus (Falkirk East) (SNP)
MacDonald, Gordon (Edinburgh Pentlands) (SNP)
Macdonald, Lewis (North East Scotland) (Lab)
MacGregor, Fulton (Coatbridge and Chryston) (SNP)
Mackay, Rona (Strathkelvin and Bearsden) (SNP)
Macpherson, Ben (Edinburgh Northern and Leith) (SNP)
Maguire, Ruth (Cunninghame South) (SNP)
Martin, Gillian (Aberdeenshire East) (SNP)
Mason, John (Glasgow Shettleston) (SNP)
Matheson, Michael (Falkirk West) (SNP)
McAlpine, Joan (South Scotland) (SNP)
McArthur, Liam (Orkney Islands) (LD)
McDonald, Mark (Aberdeen Donside) (Ind)
McKee, Ivan (Glasgow Provan) (SNP)
McKelvie, Christina (Hamilton, Larkhall and Stonehouse) (SNP)
McMillan, Stuart (Greenock and Inverclyde) (SNP)
McNeill, Pauline (Glasgow) (Lab)
Mitchell, Margaret (Central Scotland) (Con)
Mundell, Oliver (Dumfriesshire) (Con)
Neil, Alex (Airdrie and Shotts) (SNP)
Paterson, Gil (Clydebank and Milngavie) (SNP)
Rennie, Willie (North East Fife) (LD)
Robison, Shona (Dundee City East) (SNP)
Ross, Gail (Caithness, Sutherland and Ross) (SNP)
Rowley, Alex (Mid Scotland and Fife) (Lab)
Rumbles, Mike (North East Scotland) (LD)
Ruskell, Mark (Mid Scotland and Fife) (Green)
Sarwar, Anas (Glasgow) (Lab)
Scott, Tavish (Shetland Islands) (LD)
Simpson, Graham (Central Scotland) (Con)
Smith, Elaine (Central Scotland) (Lab)
Smith, Liz (Mid Scotland and Fife) (Con)
Smyth, Colin (South Scotland) (Lab)
Stevenson, Stewart (Banffshire and Buchan Coast) (SNP)
Stewart, David (Highlands and Islands) (Lab)
Stewart, Kevin (Aberdeen Central) (SNP)
Sturgeon, Nicola (Glasgow Southside) (SNP)
Swinney, John (Perthshire North) (SNP)
Todd, Maree (Highlands and Islands) (SNP)
Tomkins, Adam (Glasgow) (Con)
Torrance, David (Kirkcaldy) (SNP)
Watt, Maureen (Aberdeen South and North Kincardine) (SNP)
Wells, Annie (Glasgow) (Con)
Wheelhouse, Paul (South Scotland) (SNP)
White, Sandra (Glasgow Kelvin) (SNP)
Whittle, Brian (South Scotland) (Con)
Wightman, Andy (Lothian) (Green)

The result of the division is: For 113, Against 0, Abstentions 0.

Motion agreed to,

That the Parliament agrees that the Health and Care (Staffing) (Scotland) Bill be passed.