I will speak to amendment 20 in particular. I addressed that amendment last week, and I do not intend to repeat everything that I said then. However, I would like to point out that, in developing amendment 20, I listened to the Royal College of Nursing view that the leadership role of the senior charge nurse should be recognised. That was covered by the 2008 report “Leading Better Care: Report of the Senior Charge Nurse Review and Clinical Quality Indicators Project”, which set out that, in recognition of their leadership role, senior charge nurses should not be completely case load holding. We will continue to work on the leadership role of the senior charge nurse, and the workload planning tools and common staffing method provide an evidence-based way to do so.
It is not appropriate that nurses have been singled out for preferential treatment in a bill that is not only about nursing. I have looked further at amendment 91, in the name of Alison Johnstone, which was passed last week, and I am not convinced that it does what she intended it to do. I have serious concerns about the way in which it is worded and the impact that it could have on patient care, and I will return to that issue later in the process.
Amendment 20 aims to recognise the unique roles and responsibilities that are placed on all clinical team leaders and sets out an additional step in the common staffing method that requires health boards to consider the role and professional duties of lead clinical professionals. It takes account of the multidisciplinary nature of the services that we aim to provide. For example, in a rehabilitation ward where the team leader is a physiotherapist, that person will be allowed appropriate time to fulfil their leadership role. It will also mean that midwives are afforded the same support as nurses for their leadership role. Given the passing of amendment 91, that is all the more important to ensure that all staff groups are supported in their leadership role. The Scottish executive nurse directors group is also supportive of that approach, which it believes clearly articulates the role of the clinical leader in the common staffing method. With that in mind, I ask the committee to support amendment 20.
Amendment 19 sets out that, as part of the common staffing method, health boards and the agency must take into account the different skills and levels of experience of its employees. It aims to address the concern that has been raised by some of our stakeholders that the workload tools do not result in a definition of the level of skill and experience that are required to deliver the workload. By amending the bill in this way, I intend to ensure that health boards and the agency not only look at how to put in the correct number of staff but ensure that those staff have the skills and experience that are necessary to provide the safe and high-quality service that I am keen to see across our national health service.
Amendment 21 sets out that, as part of the common staffing method, comments by individuals who have a personal interest in the patient’s healthcare, such as family members and carers, should be taken into account, as well as those of the patient himself or herself, in so far as those comments relate to the duty to ensure appropriate staffing. That recognises that, for various reasons, patients are not always able to speak for themselves, although that does not mean that their wishes should not be heard and responded to.
I am not clear about the intention of amendment 96, in the name of David Stewart. From my reading of it, it could be about underlining the importance of multidisciplinary services, avoiding the unintended consequences of covering one staff group by a workload planning tool for other staff groups, or recognising that some aspects of care could be carried out by more than one profession. I agree with all of those and they have been considered in the drafting of the bill, so I would welcome Mr Stewart’s clarification of the intention of amendment 96.
I see no issues with many of the amendments that have been lodged by Mr Briggs, although some appear to be based on a misunderstanding that there is some kind of hierarchy in the common staffing method which, for clarity, I say is not the case. All steps in the method must be carried out and all are given equal weight. However, it does no harm to change the order in which the steps appear so, if Mr Briggs wishes to do that, I will not stand in his way.
The amendments that give me cause for concern are amendments 94, 95 and 102. In relation to amendments 94 and 95, I am concerned by the lack of clarity on what is meant by “peer-reviewed evidence” and “professional and improvement organisations”. What is the definition of “peer-reviewed evidence” and would there necessarily be any certainty that something that is reviewed by a health “peer” should always be taken into account? In the health field, there could be numerous trials or pieces of work that some people might class as evidence but on which clinicians disagree. Is it the case that all such work should be taken into account? Similarly, what is a “professional and improvement organisation”? Those are exactly the questions that will be asked by the working group that is set up to develop a tool and it is the working group that will be best placed to determine what is relevant for that tool.
When Healthcare Improvement Scotland reviews the effectiveness of the tools and the common staffing method, as set out in amendment 17, it will take into account the most up-to-date and relevant evidence and guidance, as is its professional duty. I do not feel that it is appropriate for legislation to require that a senior charge nurse, for example, carry out a review of available evidence every time he or she runs the common staffing method. My preference is to include something in guidance, in order to allow for greater clarity and flexibility. However, I would be happy to work with Mr Briggs to see whether we could develop an amendment for stage 3, if he feels strongly that he wants to include something in primary legislation, although I do not believe that that is necessary. I therefore ask Mr Briggs not to press amendment 94 or move amendment 95.
I believe that amendment 102 is based on a proposal by the RCN, which is keen to see excellence in care referenced in the bill in some way. If my assumption is correct, amendment 102 is completely unnecessary, as proposed new section 12IB(2)(b) of the 1978 act sets out that account must be taken of,
“in so far as relevant, any measures for monitoring and improving the quality of health care which are published as standards and outcomes under section 10H(1) by the Scottish Ministers”.
Excellence in care will be one such measure. Therefore, I cannot see what the amendment adds. If Mr Briggs feels that the current provisions do not achieve what is required then—as is the case with amendments 94 and 95—I will be happy to work with him to develop an amendment for stage 3 that does. As it stands, I am hesitant to support amendment 102 and I ask the member not to move it.