Meeting of the Parliament

Meeting date: Thursday, May 2, 2019

Official Report 1014KB pdf

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Health and Care (Staffing) (Scotland) Bill

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.

15:58  

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.

16:02  

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.

16:06  

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.

16:10  

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.

16:14  

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.

16:19  

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.”

16:23  

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.

16:28  

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.