Meeting of the Parliament

Meeting date: Tuesday, October 1, 2019

Official Report 925KB pdf

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Topical Question Time

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St John’s Hospital (Children’s Ward)

To ask the Scottish Government how it will support the paediatric programme board to ensure that the return to a 24/7 service at the children’s ward at St John’s hospital happens as quickly and safely as possible. (S5T-01814)

As I know the member will agree, the key factor in the full reinstatement of the service to 24/7 at the children’s ward at St John’s hospital is patient safety.

Since the Royal College of Paediatrics and Child Health review in 2016, NHS Lothian has recruited an additional 16 staff but, at the same time—as happens across our national health service—three staff have left to take up posts elsewhere, and a further three are on reduced hours or extended maternity leave. The current staffing means that 32 of the 40 out-of-hours shifts that are needed to reach 24/7 delivery can be covered, so more recruitment is needed. I remain committed to a full 24/7 service and continue to actively support the board’s efforts to achieve that.

West Lothian parents are deeply disappointed, not least because they face yet another winter travelling to Edinburgh with their wee ones at the weekend when they could and should be cared for locally, but they are determined to see the Scottish Government and NHS Lothian deliver on their commitments. Will the cabinet secretary commit to meet parents to say what is now different about the plan that she has outlined and when we can expect to have a 24/7 service at the children’s ward?

I am grateful to the member for that additional question. I absolutely understand the disappointment that is felt by parents in West Lothian. For families with a sick child, having to travel to Edinburgh is an additional worry and an additional burden when they had hoped that this would be the winter when they did not have to undertake that additional journey. Of course I would be very happy to meet the families concerned, and I would be grateful to Ms Constance for any support that she can offer in arranging that.

I have asked repeatedly about support for and scrutiny of the paediatric programme board in delivering a 24/7 children’s ward service. In the light of the challenges that are faced in paediatric in-patient services across the Lothians, does the cabinet secretary agree that, given that we have a first-class children’s ward, providing more services in West Lothian could not only help to anchor a 24/7 service at St John’s but benefit the region as a whole?

I very much agree with what the member has just said. She has made the important point that, in St John’s, we have a first-class and undoubtedly much-loved children’s ward. I am well aware of the population growth in the area that St John’s serves and the nature of that growth—there are many families with young children. I fully expect NHS Lothian to consider the Lothian-wide delivery of paediatric services in hospital and in the community, and that means giving active consideration to the design and delivery of services. I have asked the chief medical officer to engage directly with NHS Lothian on that and to look across the entire estate at how, not just for this winter and the coming months but in the longer term, we can make sure that both areas of the estate are actively and properly resourced and used to meet the needs of the populations they serve.

A number of members have supplementaries.

Following the cabinet secretary’s promise in January that a 24/7 service would be reinstated in October, families will indeed be bitterly disappointed that they have been let down yet again. It has not been a good year for NHS Lothian. Can the cabinet secretary guarantee that the paediatric service at St John’s will be fully reinstated by the end of 2019?

I am grateful to Ms Lennon for that question. For the record, I say that, when I made my statement in January, I made it very clear that it was not a promise but a commitment, because I am not personally in charge of staff recruitment. Of course, I have asked NHS Lothian to overrecruit to ensure that it can take account of things such as long-term sickness, all of which play a big part in the rota.

At this point, without further detailed discussion with NHS Lothian about other opportunities such as advanced nurse practitioner training, which Ms Lennon will recall is a significant part of what makes a sustainable rota, I know that NHS Lothian has recruited to what it describes as hybrid consultant posts—posts in which consultants work both in Edinburgh and at St John’s. There may be more to do there and there may be more to do in the use of existing staff who are prepared to take on additional hours—in a sustainable, long-term way, not in a short-term way—as well as in recruitment.

The chief nursing officer, the chief medical officer and I will look in considerable detail at NHS Lothian’s specific plans in addition to what we already know about what it intends to do, and we will then discuss what more we require it to do. On the basis of that, I will feel more confident about being able to indicate exactly when I think that NHS Lothian will be able to reach full 24/7 provision in the children’s ward at St John’s.

I restate that my commitment is absolute to getting to a 24/7 provision in the children’s ward at St John’s and—to take up Ms Constance’s point—to maximising the use of St John’s for paediatric services.

When will the cabinet secretary be able to come back to the chamber and give members an update and, more important, give parents an update as to when the service will be available? Will she work with NHS Lothian and her colleagues in the Scottish Government to look at the transport issues that parents face when trying to get back to West Lothian, particularly on a Sunday night, when there is a limited number of public transport options? What provision can be made for parents so that they can visit their children and then be able to get back to their homes?

On the question of transport, my understanding is that NHS Lothian offered additional support to families who had to travel into Edinburgh sick kids hospital and then return home. If that is not the case, I am happy to look at that again or to look at what more NHS Lothian might do and raise that issue directly with it.

On when I will be able to come back to the chamber and update members, that is a difficult question for me to respond to directly. However, I make a commitment to update members at the start of November on the progress that we have made in October.

I hope that the cabinet secretary can see this copy of the West Lothian Courier, from February 2012, with the headline, “Staff Crisis in Kids Ward”. This shambles has gone on for seven years and it is still not resolved. The cabinet secretary said that the paediatric board met at the end of August and made a decision then that it would not reopen on a 24/7 basis in October. Why has it taken from the end of August until the end of September—a month later—to make that decision public?

Is it just a coincidence that NHS Lothian had to reply to a letter that I sent it about this issue last week? Is that why a Government question was set up for Angela Constance so that the cabinet secretary could give the answer that was given? Is it any wonder that the public have little faith in NHS Lothian or in the cabinet secretary when we see a shambles at St John’s and an even greater shambles at the sick kids hospital?

I completely understand Mr Findlay’s anger about this matter. However, it is not the case that there was a sudden flurry of Government activity because he wrote a letter.

Aye, right!

The programme board made that decision at the end of August but we questioned that decision and looked at it further.

It is a stitch-up.

Mr Findlay may be cynical and sceptical about that but it does not alter the facts of the matter. Members would expect me to query—

It has been seven years.

Order.

Members would expect me to query a board if it tells me that it cannot do something when I have made a commitment that I need it to do that. Of course I went back and queried that, otherwise I would be failing in my responsibilities as a cabinet secretary.

You are not meeting your responsibilities.

Mr Findlay, please.

I do not think, Presiding Officer, that it is overly helpful when I am trying to be clear in the chamber for a member to insist on continuing to shout at me. I am trying to make sure that members are kept up to date. I do not know how well Mr Findlay knows Ms Constance but trust me when I say that setting up Ms Constance to do anything is a very unlikely circumstance.

She asked a question for the Government.

She asked a question, quite legitimately, as the constituency MSP, just as Mr Findlay has a legitimate locus in the matter. There is no conspiracy or attempt to keep matters from the Parliament—that is not my way and it has not been the case here. More important is that it is not my way to keep information from the families who are directly affected. That is why we have been clear on the issue and why I will take up Ms Constance’s offer to meet the families that I met previously to hear from them what they need me to do now.

Given the well-publicised difficulties and challenges facing the sick kids hospital in Edinburgh, will the cabinet secretary outline what support has been given to nearby hospitals that are treating patients who have been diverted from St John’s? The cabinet secretary said that the issue of staff leaving their posts has contributed to the delay. What steps are being taken to ensure that staff wellbeing is prioritised at St John’s?

As Ms Johnstone is aware, a number of steps are being taken at the existing sick kids hospital at Sciennes, as the staff and services are continuing there while we ensure that the new site is safe and fit for purpose. That includes additional support to staff as well as matters relating to the building and facilities and so on. In addition, as I said in answer to Ms Constance, we are looking at a Lothian-wide paediatric service that maximises the use of all the resources at the board’s disposal. Indeed, when I visited the staff at the sick kids hospital last Monday, I heard from one of the senior paediatric consultants, who wished to ensure that the capacity, resource and quality of service at St John’s are maximised.

The offer to staff at St John’s in relation to mental health and wellbeing is as I would expect NHS Lothian, and any other board, to provide. However, if Ms Johnstone wishes, I will make a specific inquiry as to whether any additional steps are being taken and advise her of that.

In January, the cabinet secretary said:

“I will ensure that, month by month, we make the progress that we need to make by October.”—[Official Report, 29 January 2019; c 11.]

What lessons have been learned from the experience, given that, as Neil Findlay outlined, we have had years and years of understaffing problems at St John’s that have not been successfully resolved? The cabinet secretary is not able to give a commitment on the timescale today. What will she do to ensure that the issues are fixed? In her answer to the first question, the cabinet secretary mentioned the number of staff moving on. That seems to me to be totally unsurprising—these days, surely we have to expect that and plan additional staff capacity to give the hospital the numbers that the hard-pressed staff who are there already and the patients urgently need.

Ms Boyack is absolutely right that planning a sustainable rota involves fitting in questions that can be anticipated, such as staff leaving, holiday entitlement and sickness absence. However, it is not possible to plan for long-term sickness absence that does not begin that way or for long-term maternity leave that does not begin that way. It is not possible to plan for a situation in which staff have made commitments to a particular service and then decide that they wish to take up opportunities elsewhere. That is entirely reasonable and they are entitled to do it—it may be for personal reasons or because of domestic circumstances.

That is why I have asked and continue to ask NHS Lothian not to recruit to the numbers that it thinks that it actually needs for a 24/7 service but to overrecruit, if sufficient numbers come forward in a recruitment exercise. That is the approach that we are taking. We track the situation month by month and we will continue to do so to meet the commitment that I have made.

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“Thematic Inspection of the Scottish Police Authority” (Response)

To ask the Scottish Government what its response is to the HMICS report into the Scottish Police Authority, including the finding that it has “no clear vision, strategy or plan in place”. (S5T-01821)

The SPA has developed, and is in the process of implementing, a significant programme of improvement, and the thematic inspection by Her Majesty’s inspectorate of constabulary in Scotland has found evidence of genuine progress on that over the past 18 to 24 months. That includes the appointment of experienced and talented individuals to the SPA’s board and Police Scotland’s leadership team. However, I recognise—as does the SPA—that that improvement journey must continue. The report helpfully highlights key areas of focus for the future, a number of which the SPA has already begun to address.

In June 2017, the Scottish Police Authority and Police Scotland published their 10-year policing strategy, “Policing 2026: Serving a Changing Scotland”, which set out a long-term plan for building a sustainable, modern and flexible police force. At the start of next year, that strategy will have to be refreshed to take account of the new strategic police priorities that set the overarching framework for policing in Scotland. The Scottish Government consultation on those priorities closes on Friday.

While I was listening to the cabinet secretary’s response, I started to wonder whether he had been reading a different report from the one that I read, because the verdict in that one was damning. It said that there were serious flaws in governance, in that the chair and a number of board members had been acting well outwith their core non-executive roles. There was also said to have been a “lack of rigour” in the SPA’s holding the chief constable to account, and a conflict of interests at its core.

Why there has been a complete failure on the part of the Government to highlight and manage the serious problems that have been detailed in the HMICS report? Will the cabinet secretary set out a clear plan with a timeline for addressing its specific recommendations?

Given the picture that James Kelly has painted of the report, I genuinely question whether he has fully read it himself. In my opening remarks, I said that I recognise that the SPA has improvements to make—having read the HMICS report, I have no doubt about that. For the sake of brevity, I will not read out reams of quotes from it, but I highlight that the inspector said:

“The current SPA Chair and Board members bring a wealth of experience and skills from a range of professional backgrounds that can usefully be brought to bear on the governance of policing.”

Mr Kelly’s substantive point about executive and non-executive powers involves a good and serious question that it is appropriate to ask. That is why, in my immediate response to the HMICS report last week, I said that the Scottish Government has agreed with the SPA to look at its organisational, governance and accountability frameworks. I will keep James Kelly, other members of the Justice Committee and other justice spokespeople up to date on the timescales associated with that review.

In setting the culture and tone of an organisation, leadership rules are important. Bearing in mind his first response, does the cabinet secretary agree that it is unacceptable for the chair and a number of board members to act outwith their non-executive roles? Will he immediately set out a timeline for the review of such roles, to ensure that the chair and board members carry out their work appropriately?

As I have already said, I will give James Kelly details of the review that the SPA has agreed to carry out, which will look at the executive versus the non-executive space. Of course, the SPA board operates within the “On Board” principles. In fairness, I think that every one of us would recognise that the SPA has a unique role in that it performs scrutiny of the chief constable and also looks forensically at the delivery of certain policing functions.

It is also worth my saying that although I take very seriously what James Kelly has requested, and the Government will carry out that review, there is a fine line here. The SPA was created to be a buffer between operational policing and the Government, and it is right that that is so. I am happy to work jointly with the SPA to undertake such a review, but I certainly will not be stepping into a space where James Kelly might accuse me of interfering at the same time as telling me to involve myself. I am sure that he would be the first person to tell me that I was interfering.

Lastly, even the SPA’s harshest critics recognise the tireless hard work that the chair, Susan Deacon—who I am sure is well known to James Kelly—has done in that space. The SPA must and will improve, but it is in a remarkably better place under her leadership than it had been previously.

A large part of the controversy surrounding the SPA was to do with meetings being held in private with no chance of public scrutiny. Can the cabinet secretary tell us the SPA’s current policy on meetings being held in private?

Again, the member is right to make that point. Previously, there was criticism of the SPA for holding the meetings in private. However, I think that it is absolutely right to say that Susan Deacon, under her leadership, has brought much more openness and transparency to the SPA. In fact, that is recognised in HMICS’s report. The inspector says that the SPA

“has made a number of changes and improvements over the last 18—24 months to improve the overall system of governance, including a revised Committee structure, a new Governance Framework, Standing Orders and Scheme of Delegation.”

The member’s specific question about the SPA is a matter to raise directly with it, but I certainly know from my conversations with Susan Deacon that, where the SPA can be open, public and transparent, it will be—with the understanding, which we all have, that some sensitive matters need to be discussed in private.

The cabinet secretary will be aware of the passage in the report that says:

“Some local authorities remain concerned that national policy decisions, and their impact locally, are not the subject of effective engagement and consultation and that there is a disconnect between local scrutiny and the SPA Board.”

Given that local engagement and maintaining local relationships is a key feature of the SPA, what steps will he take to resolve that very important matter?

The chair of the SPA, the chief constable and I have regular meetings, and we are all committed to that local accountability and to further devolution of policing to local communities. I am sure that the member has heard the chief constable say on many occasions that policing is only done with the consent of the people, so having people involved is hugely important.

I see John Finnie pointing to the report. The issue around governance is highlighted on page 5, where the chief inspector says that the SPA

“has improved its visibility and engagement with local authorities”,

but also, crucially—this is the member’s point—that it

“has recognised the need to improve its overall approach”.

I will, of course, take away what the report says. Some of the recommendations are for Government. Equally, however, most of them are for the SPA. The point about local accountability is an important one that is not lost on any of the triumvirate that are involved in policing.

Although most of the recommendations in the report are, as the cabinet secretary said, for the Scottish Police Authority to take forward, will the Scottish Government commit to considering its role in delivery, including providing on-going support to the authority as it addresses the issues? Does the cabinet secretary agree that it is important to recognise the findings in the Justice Committee’s post-legislative scrutiny report, which says that more equal access to specialist support and national capacity is a success story and that it has particularly benefited victims of crime such as domestic and sexual abuse?

Yes. Shona Robison makes a hugely important point. Those who represent particular victims of those terrible crimes, particularly rape and sexual offences, while of course calling for further improvement—they are right to do so—have said publicly and on the record that the investigations of those terrible crimes nationally, under Police Scotland, are in a better place compared with the position previously, under the legacy forces.

However, none of that takes away from the fact that the report makes for sobering reading—I do not doubt that. The recommendations that are for the Government will be taken forward, and of course the SPA will reflect on the majority of the recommendations, which are for it. I will continue to keep the Justice Committee updated on our progress.

This feels like groundhog day. How, more than six years into the existence of the SPA and almost two years into the tenure of Susan Deacon, can there still be fundamental conflicts of interests and so much confusion about who does what and where the boundaries lie?

I think that even Liam McArthur would have to accept that the SPA, as an organisation, has a unique function in statute. Although it is, I stress, still abiding by the “On Board” principles, it has a unique function in relation to scrutiny of the police and its dual role in supporting policing.

I say to Liam McArthur that I listened intently to his speech in the debate about police and fire reform that took place in the chamber a few weeks ago, and I will quote from it directly so that I am not misquoting. He said:

“Susan Deacon, for whom I have the utmost respect, is due considerable credit for many of the reforms that she has introduced since she took over as the chair of the SPA.”—[Official Report, 12 September 2019; c 79.]

I think that all of us can recognise—as Liam McArthur clearly has, based on that quote—that Susan Deacon has done an excellent job in driving forward some really impressive change in the SPA.

Liam McArthur’s wider point is around what else has to be done. There are very clear recommendations, as we heard in James Kelly’s question, around the executive and non-executive space. We will do a review of that and other governance issues, and I promise to keep Liam McArthur and the rest of the Justice Committee informed of progress.

A recurring theme that has been identified is the limited ability of the SPA board to recognise issues of public interest and to hold Police Scotland to account when it comes to community policing. How will the Scottish Government increase the effectiveness of the SPA board to recognise those issues of community policing, and how will it move the issue forward?

Again, we will look at the recommendations carefully—clearly, the local element is hugely important to all of us. The feedback on local policing is very positive, and that is not just my view. I read with interest a letter in the Greenock Telegraph on Monday 12 August from Councillor David Wilson, who is a Conservative councillor, not a Scottish National Party councillor. He said that he can only comment on the quite unanimous feedback from constituents that they feel more secure than they did in the past and often comment on the visibility of our police.

That is a really positive comment from someone who is on the ground—in this case, in Greenock.

I think that we are making positive progress in relation to policing at a local level, but that is not to take away from what HMICS has said and from what Gordon Lindhurst and others have said around the local element. Therefore, we will take forward those recommendations and I will keep members who have an interest in the matter updated on our progress.