Patient Rights (Scotland) Bill: Stage 3

– in the Scottish Parliament at on 24 February 2011.

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Photo of Trish Godman Trish Godman Labour

The next item of business is stage 3 proceedings on the Patient Rights (Scotland) Bill. Members should have the bill as amended at stage 2, which is Scottish Parliament bill 42A, the marshalled list, and the groupings, which the Presiding Officer has agreed. The division bell will sound and proceedings will be suspended for five minutes for the first division this afternoon. The voting period for the first division will be 30 seconds. Thereafter, I will allow a voting period of one minute for a division after a debate. Members should refer to the marshalled list of amendments if they are in any doubt.

Section 21—Patient Rights Charter

Group 1 is on a charter of patient rights and responsibilities. Amendment 1, in the name of Richard Simpson, is grouped with amendments 1A, 2, 3, 5, 6, 9 to 11, 25 and 32.

Photo of Richard Simpson Richard Simpson Labour

I will speak to amendments 1, 2, 3, 5, 6, 9 to 11, 25 and 32.

Amendment 1 removes section Z1 as inserted into the bill at stage 2 and replaces it with a requirement on the Scottish ministers to publish a charter of patient rights and responsibilities within six months of the section coming into force. The charter must set out a summary of the rights and responsibilities, extant at the date of publication, of patients and relevant persons. The charter may also include a summary of the duties on relevant national health service bodies, a summary of the behaviour that is expected from patients and relevant persons, and any other information that the minister considers to be relevant, such as waiting time periods.

Relevant persons are defined as persons who have a personal interest in the health care of a patient, such as a relative or carer, and such other persons as the Scottish ministers consider to be appropriate. The charter cannot create new rights and responsibilities, or alter existing ones in any way. It must be published in such a manner and form as ministers think appropriate. Before publishing the charter, ministers must consult those whom they think appropriate and must also lay a copy of the charter before the Parliament.

Ministers must tell the relevant national health service bodies about the publication of the charter. Relevant NHS bodies must make the charter available without charge and, in doing so, must take into account the particular needs of those who will be using the charter when they consider the form that it will take.

Amendment 2, on the review and revision of the charter, states that it must be reviewed at least once every five years to ensure that the rights and responsibilities contained within it are still accurate, and to assess how effective the charter is at raising awareness of the rights and responsibilities of patients and relevant persons. When a review is carried out, ministers must also consider the effectiveness of the distribution and publication arrangements for the charter and they must improve those processes where appropriate. When carrying out a review of the charter, the Scottish ministers must consult those whom they think appropriate.

Following a review, ministers must revise the charter if they consider that it does not accurately summarise the rights and responsibilities of patients, or if they consider that it is not effectively raising awareness of the rights and responsibilities of patients and relevant persons. Ministers may also revise the charter at any other time that they consider to be appropriate. When ministers revise the charter, they must publish it as so revised and notify each relevant NHS body of that publication. Before publishing the revised charter, ministers must consult such persons as they consider to be appropriate and they must lay a copy of the revised charter before the Parliament.

Amendment 3 deletes section 1(2)(e) of the bill, which says that health care is to

“have regard to and respect for the rights and responsibilities conferred on patients by the Charter to be made by the Scottish Ministers” that was referred to under what was previously section (Z1)(1).

Amendments 5 and 6 remove the reference to the charter having to be upheld by relevant NHS bodies and having to be upheld in turn by any person with whom the relevant NHS body enters into a contract agreement or arrangements to provide health services.

Amendments 9 and 10 remove the reference to the charter from sections 5(1) and 5(2) of the bill, which are about the duty of NHS bodies to have regard to any guidance that the Scottish ministers issue and the duty of the ministers to consult such persons as they consider to be appropriate before providing such guidance.

Amendment 11 removes the power of the Scottish ministers in section 5(3) to give directions about the practical application of the charter.

Amendment 25 specifies that the patient advice and support service, in promoting awareness and understanding of the rights and responsibilities of patients, should, in particular,

“promote awareness of the Charter” of patient rights and responsibilities. I accept that the wording might be subject to slight criticism—it is a little cumbersome—but it gets the point across.

Amendment 32 is consequential on amendment 1. It inserts a provision that means that reference to “the Charter” under the bill is a reference to the

“Charter of Patient Rights and Responsibilities published under” the section that amendment 1 inserts.

The affect of amendment 1 will be that the charter will be an information document, summarising the various rights and responsibilities of NHS users. It will not be a Scottish statutory instrument, so it cannot itself confer rights and responsibilities. The charter is designed to bring together a user-friendly summary of the rights, responsibilities and entitlements of patients and other relevant persons such as carers or relatives and other family members. The charter will be drawn up after consultation with relevant people and organisations, and it will be laid before the Parliament when it is finalised.

Under amendment 2, the charter must be reviewed every five years, or more often if appropriate, in order to take account of significant change. When it is reviewed, ministers must consider how effective the arrangements for the publication of the charter are. They must consult those whom they consider appropriate. After review, the charter might have to be revised and, if it is revised, ministers must consult relevant people.

Amendment 3 is consequential on amendments 1 and 2, with section Z1 being removed from the bill. Amendment 1 means that the charter will no longer confer any rights or responsibilities on patients, and it would therefore be inappropriate for section 1(2)(e) to remain in the bill.

I commend the amendments in this group to the Parliament, and I move amendment 1.

Photo of Irene Oldfather Irene Oldfather Labour

Amendment 1A seeks to extend the reach of Richard Simpson’s amendment 1 so as specifically to include those who lack capacity under the Adults with Incapacity (Scotland) Act 2000. In drafting the amendment I consulted the bill team about whether people who lacked capacity would already be directly covered by amendment 1, and the advice that I was given was that there is nothing particular in that amendment in that regard, so it would therefore be helpful to add my amendment to strengthen their rights.

Rights are meaningful and are able to be claimed only if one has knowledge and understanding of them. People who lack capacity, for whatever reason, share a common thread: the barriers and difficulties that they face in relation to communication and understanding. It is therefore incumbent on us to ensure that appropriate steps are taken to communicate their rights to them.

When the cross-party group on Alzheimer’s reviewed the experiences of patients with illness in accident and emergency units, I was struck by one carer’s comments about her mother’s situation. She said that when her mother arrived at A and E, it was akin to being parachuted into a foreign country and surrounded by unfamiliar faces and people, who spoke to her in a language that she simply did not understand. We have an obligation and duty to give people information in a way that is understandable to them. If we do not do so, we discriminate against them, albeit inadvertently. I hope that members will support my amendment.

I move amendment 1A.

Photo of Ross Finnie Ross Finnie Liberal Democrat

I am very supportive of the amendments in Richard Simpson’s name, and I am deeply grateful to Irene Oldfather for advising the Parliament that she sought advice before lodging her amendment, and for telling us that she was advised that the wording as proposed in amendment 1 would not cover or extend to adults with incapacity.

Members ought to reflect for a moment on that advice, which I take in good faith—I am not challenging Irene Oldfather’s position. For the benefit of members, I will read out what the proposed new section, as drafted by Richard Simpson, says:

“a relevant NHS body must take account of the particular needs of the persons to whom the Charter is to be made available as to the form of the Charter”.

If, in the ordinary use of the English language, those words mean that we exclude and discriminate against adults with incapacity, there is something seriously wrong with the way in which we are framing our legislation. For the purpose of this afternoon, I will not get into a silly debate. If Irene Oldfather has been advised that it is important and imperative that that extension is made, I will go along with that. If a more clearly worded amendment is needed to ensure that the particular needs of the persons for whom the charter is to be made are addressed and that the bill is not capable of being construed as discriminating against adults with incapacity, I accept Irene Oldfather’s proposition that we have a problem. However, we might also have a problem with people who draft statutes telling us that these words do not mean what they say.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

I welcome Dr Richard Simpson’s amendments to remove section Z1 on a patient charter, which was inserted into the bill at stage 2, and instead to introduce a duty to publish a charter of patient rights and responsibilities in a way that avoids some of the potential pitfalls of section Z1 and, therefore, the bill as amended at stage 2.

As I made clear at stage 2, although I supported the principle behind the amendments to introduce a patient charter, the drafting of the amendments was problematic for several reasons. For example, if the bill were to remain as it is, ministers would have to make an order listing all the statutory rights and responsibilities that patients have. Such an order would have to be subject to negative procedure and would need to be continually updated and brought before the Parliament every time it was amended. In addition, if the charter is to cover reserved as well as devolved legislation, there may be an issue whether that is within the devolved competence of the Scottish ministers.

That is why I am pleased to support Richard Simpson’s amendments, which provide that ministers must publish a charter of patient rights and responsibilities that must contain all the rights and responsibilities that patients have. As we have heard, the charter may also contain information, such as the behaviour that is expected from patients and information about waiting times. Because the charter will not be a statutory instrument, it will be possible to design it in the way that is most practical and useful for patients. The group of amendments also provides for mechanisms for consultation with appropriate people on the contents of the charter and for the charter to be reviewed and improved if appropriate.

I also support the technical amendments in the group. As Richard Simpson pointed out, those amendments are consequential on amendments 1 and 2. They reflect the fact that the charter, as amended today, will be a versatile information document rather than a statutory instrument. The Scottish Government is happy to support those amendments.

I turn to amendment 1A, in the name of Irene Oldfather. She has made a powerful case for her amendment and I support the principle and intention behind it. Nevertheless—this comment may help Ross Finnie—I believe that the amendment is not, in itself, strictly necessary. It inserts an extra example into a list of examples of needs that NHS bodies must take into account when making the charter available to patients. The list of examples in amendment 1 is not meant to be exhaustive and would include adults with incapacity. That said, I cannot see any problem with adding an extra example to the list; indeed, that may well strengthen the bill in the way that Irene Oldfather has described. In the light of that, the Government is prepared to support amendment 1A.

Photo of Trish Godman Trish Godman Labour

Before I call Richard Simpson to wind up the debate, I remind members that this is stage 3 of a bill. It is important legislation and there are far too many private conversations taking place in the chamber.

Photo of Richard Simpson Richard Simpson Labour

I acknowledge the cabinet secretary’s support for this group of amendments, especially amendment 1.

On amendment 1A, despite the fact—as Ross Finnie points out—that amendment 1 seems to cover all the bases, the specifying of that example is welcome. Dementia will be one of the main health challenges that we face and we know that there are existing problems with the management of patients within the system. Although amendment 1A is perhaps gilding the lily, such gilding is not inappropriate and I will, therefore, support amendment 1A.

Photo of Irene Oldfather Irene Oldfather Labour

I am grateful for the support that has been expressed across the chamber. My amendment reflects the advice that I was given. I have to say, however, that the word “discrimination” was mine and not that of the bill team.

I think that the minister and the cabinet secretary have accepted that, in identifying adults with incapacity, we take a step further along the line towards assisting them better. In supporting this amendment we not only take the practical step forward of assisting people who lack capacity to understand their rights, we also take a step on the long road towards destigmatising people who lack capacity. We are saying to them that they are a vital and integral part of our society and that, here in their Parliament, we are giving them a voice and are standing up for them and recognising their needs. That is all very important.

Amendment 1A agreed to.

Amendment 1 agreed to.

After Section 21

Amendment 2 moved—[Dr Simpson]—and agreed to.

Section 1—Patient rights

Amendment 3 moved—[Dr Simpson]—and agreed to.

Photo of Trish Godman Trish Godman Labour

Group 2 is on patient feedback, comments, concerns or complaints. Amendment 4, in the name of Richard Simpson, is grouped with amendments 16 to 22 and 26.

Photo of Richard Simpson Richard Simpson Labour

I will speak to amendments 4, 16 to 22 and 26.

We are in the process of devising a comprehensive NHS system of complaints and, as the cabinet secretary said, although a complaints system has already been in existence, this will be the first time that it is placed squarely within primary legislation.

Some of the amendments are technical, and are designed simply to improve the quality of this section, which was debated at stage 2.

Amendment 4 is a technical amendment to correct a grammatical error.

Amendment 16 ensures consistency of language throughout the bill in terms of complaints, feedback and so on, in line with changes.

Amendment 17 widens the scope of the section to refer to feedback, comments and concerns as opposed to simply concerns and feedback, as currently drafted.

Amendment 18 removes the reference to patient rights officers and replaces it with a reference to the provider of the patient advice and support service, in order to take account of the deletion at stage 2 of section 17, which referred to patient rights officers.

Amendment 19 widens the scope of the section to include feedback, comments, concerns and complaints, as opposed to concerns and feedback, as is currently drafted, and also removes the reference to the patient rights officer and replaces it with a reference to the provider of the patient advice and support service.

Amendment 20 ensures consistency of the language that is used throughout the bill, in terms of complaints, feedback and so on, in line with the changes that were made at stage 2.

Amendment 21 clarifies the stage 2 amendment about the identification of best practice, and should be read together with sections 11(1) and 11(2), which set out the relevant NHS bodies and, in turn, the service providers, which are to use feedback, comments, complaints and concerns that are received to identify best practice.

Amendments 22 and 26 ensure consistency of language throughout the bill in terms of complaints, feedback and so on, in line with the changes that were made at stage 2.

Essentially, the amendments ensure consistency of language, broaden the scope of the bill, remove the references to the patient rights officers and replace them with references to providers of the patient advice and support service, and place the appropriate duties on the relevant NHS bodies with regard to the use of comments, concerns, complaints or, indeed, positive feedback.

I move amendment 4.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

The amendments in this group, as Richard Simpson has indicated, are largely technical in nature. They tidy up or clarify amendments that we agreed at stage 2. I do not think that I need to add anything to the comments that Richard Simpson has already made. I need say only that I am content to support amendments 4, 16 to 22 and 26.

Amendment 4 agreed to.

Section 3—Duty to uphold certain rights and principles

Amendments 5 and 6 moved—[Dr Simpson]—and agreed to.

Section 5—Health care principles and Charter: guidance and directions

Amendments 9, 10 and 11 moved—[Dr Simpson]—and agreed to.

Section 6—Treatment time guarantee

Photo of Alasdair Morgan Alasdair Morgan Scottish National Party

Group 3 is on the treatment time guarantee and its relationship with existing duties. Amendment 12, in the name of the minister, is the only amendment in the group.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

I listened carefully during previous stages of the bill to concerns that members expressed about a perceived—I stress the word perceived—negative impact that a legal treatment time guarantee could have on other access targets. Concerns were expressed that focusing in primary legislation on that particular stage of the patient journey may suggest that targets around other stages of the patient journey were somehow less important.

Amendment 12 seeks to address that specific point. It sets out that the treatment time guarantee is in addition to, not prejudicial to and not instead of current and future access targets. The amendment clarifies that health boards will still be expected to deliver on other waiting time targets. For example, they will still be expected to deliver on the 18-week referral-to-treatment time target—indeed, the 12-week target is intended to sit within that—the four-hour accident and emergency target, cancer targets, child and adolescent mental health targets and the new health improvement, efficiency, access and treatment target for psychological therapies.

Amendment 12 helps to put the treatment time guarantee into that overall context, so I urge members to support it.

I move amendment 12.

Photo of Richard Simpson Richard Simpson Labour

The minister has outlined the effects of amendment 12. It is important for the Parliament, in supporting this section of the bill, to recognise how far we have come since 1999.

This section of the bill will now ensure that, once a patient has begun the specialist part of the clinical journey, they will not be sidelined so that another patient can be promoted to meet the guarantee, within any tolerances set by the health minister at the time.

At times in the past, an unintended consequence of targets has been that once a guarantee was broken, new patients would be favoured. Now that we understand fully the purpose of the treatment time guarantee, I hope that the Royal College of Nursing and the British Medical Association, which have opposed the treatment time guarantee section of the bill, will understand that it is a long stop that is highly beneficial to patients.

It is interesting to speculate, for example, how the treatment time guarantee might have affected the patient in my constituency who was reported this week in the cancer statistics as having waited 178 days for melanoma treatment from a maxillofacial unit. I suspect that if the treatment time guarantee had been in place, that waiting time would have been considerably shorter.

I am pleased to support amendment 12.

Amendment 12 agreed to.

Section 9—Treatment time guarantee: guidance and directions

Photo of Alasdair Morgan Alasdair Morgan Scottish National Party

Group 4 is on the suspension of the treatment time guarantee. Amendment 13, in the name of the minister, is grouped with amendments 14, 15 and 33.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

The Subordinate Legislation Committee raised concerns that the Parliament had no role or scrutiny function in relation to the suspension of the treatment time guarantee. I have given its concerns careful consideration.

I hope that members accept that it is clear that, should exceptional circumstances arise that require the suspension of the treatment time guarantee, action will need to be taken quickly, and that it is likely to be only in exceptional circumstances that any Government or minister would propose the suspension of the guarantee. Nevertheless, although that set of circumstances makes scrutiny by the Parliament difficult, I agree that the Subordinate Legislation Committee raises a valid point, so we have worked hard to find a way to address its concerns while still being able to take into account the need to be in a position to react quickly in exceptional circumstances.

I have lodged an amendment that will provide a role for the Parliament on the suspension of the treatment time guarantee if the suspension is to exceed 30 days. The amendment will provide that any request for a suspension of more than 30 days will require the agreement of the Parliament through an emergency order. However, it will still allow ministers to suspend the guarantee by direction for a period not in excess of 30 days.

I hope that members will accept that we have tried to meet the concerns of the Subordinate Legislation Committee in a way that still gives ministers the flexibility that would inevitably be required in any set of circumstances that would lead to the suspension of the guarantee.

I hope that members will be able to support this group of amendments.

I move amendment 13.

Photo of Richard Simpson Richard Simpson Labour

I support this group of amendments. If we had had a serious pandemic and the bill had been in place, exactly this provision would have been required to give the minister the necessary flexibility. Admitting patients when our intensive care units are already loaded with pandemic flu patients would be a serious problem and we would be in danger of breaching the legislation. I welcome the amendments.

Amendment 13 agreed to.

After section 9

Amendment 14 moved—[Nicola Sturgeon]—and agreed to.

Section 10—Treatment time guarantee: key terms

Amendment 15 moved—[Nicola Sturgeon]—and agreed to.

Section 12—Encouragement of patient feedback etc

Amendments 16 to 19 moved—[Dr Simpson]—and agreed to.

Section 11—Arrangements for handling and responding to patient feedback etc

Amendments 20 to 22 moved—[Dr Simpson]—and agreed to.

Section 14—Patient advice and support service: establishment and funding

Photo of Alasdair Morgan Alasdair Morgan Scottish National Party

We come to group 5, on the patient advice and support service. Amendment 23, in the name of the minister, is grouped with amendments 24 and 27 to 29.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

This is an area about which we had some discussion in the Health and Sport Committee at stage 2. Certain views were expressed about the patient advice and support service. The amendments that I will move aim to address the concerns that were expressed and to clarify the role and scope of the proposed service.

We all appreciate that in order to maximise the effectiveness of the patient advice and support service, which I think we all agree with in principle, the service must be aware of and work with other advice and support services. It should also build on and learn from the valuable experiences of the current independent advice and support service.

Amendment 23 seeks to emphasise the important relationship between the patient advice and support service and other organisations such as Citizens Advice Scotland, as does amendment 27.

Amendment 27 also serves to reinstate a reference to advocacy services that was inadvertently dropped at stage 2, which I am sure was not the committee’s intention.

Amendment 24 will exclude the new healthcare improvement Scotland from providing the patient advice and support service. That is in keeping with the views that were expressed not just at stage 2, but at stage 1, that patients value a service that is genuinely independent of the NHS. I certainly think that the strength of a well-functioning patient advice and support service is that it is independent of the NHS.

Amendment 29 acknowledges that the service will not be prohibited from providing advice on matters other than those relating to the health service. That was always the original intention, but many members expressed the view at stage 2 that they would like that to be clarified. Many people who access a service such as this have not only health-related queries but problems relating to housing or benefits, which might also affect their health. The holistic nature of this service was supported at stage 2.

On amendment 28, in the name of Mary Scanlon, I understand that many have construed the original provision much more narrowly than was intended and, as a result, I am content to support the amendment, which proposes the removal of the provision.

I move amendment 23.

Photo of Mary Scanlon Mary Scanlon Conservative

Amendment 28 was suggested by the Law Society of Scotland’s mental health and disability committee. It considered that the wording of section 15(4) is too narrow, in that it sets out an obligation only to provide advice and guidance to patients on their rights as contained in the bill by defining

“a reference to the rights of patients” under section 15(2) as a reference to rights that exist only under the bill. However, patients have many other significant rights beyond those contained in this bill. As it stands, the bill places no obligation on the patient advice and support service to inform a patient of or provide advice or guidance on those other rights. The restrictive nature and wording of section 15(4) is considered to be a significant weakness in the bill. If the limitation in this section were not removed, any advice that was given could be fundamentally flawed in that it would imply that patients’ only rights are those under the bill. In effect, patients would be deprived of their other rights. There must be an obligation to provide patients with advice and guidance on all rights, whether contained in the bill or set out in other statutes or common law.

I acknowledge that the cabinet secretary supports amendment 28.

Photo of Richard Simpson Richard Simpson Labour

I support the Government amendments to section 16 because they will allow us to achieve our common objective of establishing a system independent of the health board, readily available to the patient and integrated with other advice systems linked directly or indirectly to advocacy. Previous amendments on this matter referred to citizens advice bureaux, which have provided an excellent service since their commencement. Although it would not be appropriate to name one organisation in connection with the proposed patient advice and support service, I point out that CABx embody a holistic approach that is appreciated by patients.

I also welcome Mary Scanlon’s amendment 28, as it will underpin patients’ confidence in a system of support that will identify need and assist in a holistic way.

Amendment 23 agreed to.

Amendment 24 moved—[Nicola Sturgeon]—and agreed to.

Section 15—Patient advice and support service

Amendments 25 and 26 moved—[Dr Simpson]—and agreed to.

Amendment 27 moved—[Nicola Sturgeon]—and agreed to.

Amendment 28 moved—[Mary Scanlon]—and agreed to.

Amendment 29 moved—[Nicola Sturgeon]—and agreed to.

Section 18—Protections and limitations

Photo of Alasdair Morgan Alasdair Morgan Scottish National Party

Group 6 is on protections and limitations. Amendment 30, in the name of the minister, is the only amendment in the group.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

Amendment 30 is a technical amendment that seeks to make it explicit that the limitations and protections applying to the bill will also apply to any orders, regulations and directions made under it. Committee members and others made it clear that they did not want to end up with lawyers at every bedside; I do not think that that was ever going to be the case but, nevertheless, with the other changes to the bill, this amendment makes it absolutely clear that that will not happen.

I move amendment 30 and hope that members will support it.

Amendment 30 agreed to.

After section 18A

Photo of Alasdair Morgan Alasdair Morgan Scottish National Party

Group 7 is on payments to or in respect of certain persons infected with hepatitis C. Amendment 31, in the name of the minister, is grouped with amendments 34 and 35.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

Members will appreciate that amendments 31, 34 and 35 introduce a separate issue to the bill. I will explain why we took the opportunity to lodge them.

Amendment 31 proposes changes to section 28 of the Smoking, Health and Social Care (Scotland) Act 2005. Members will recall that that section allows the Scottish ministers to make a scheme for the making of payments to certain persons infected with hepatitis C as a result of NHS treatment with blood or blood products. The scheme that the Scottish ministers have adopted under that provision is operated by the Skipton Fund, and it operates on a United Kingdom-wide basis.

New support provisions for that group of persons were announced for England on 10 January 2011. The Scottish ministers have discussed the issue with patient representatives, and are deciding what arrangements should be put in place in Scotland. An announcement on that will be made shortly. If we decide to announce similar arrangements in due course, a new group of eligible persons—that is, relatives of patients who died prior to August 2003—will be introduced. The amendments to the 2005 act need to be agreed to before support can be provided to any newly eligible persons.

As I have said, we have still to announce our final policy intentions, but it is nevertheless prudent that we amend the 2005 act now. If the amendments are agreed to, they will mean that any future policy decisions that we take to make payments to newly eligible groups can be implemented without having to wait for another legislative opportunity to amend the 2005 act. Obviously, the first such opportunity after this one would be in the next session at the earliest—it would be much later this year. Therefore, agreeing to the amendments will avoid what could be a considerable delay before any newly eligible claimants could apply for support.

I hope that members will support the amendments. I took the opportunity to brief the Opposition spokespeople prior to lodging the amendments so that they understood the intention. I know that the issue of those infected with hepatitis C as a result of NHS treatment has been debated in Parliament on many occasions in the past, and I hope that members will see the need for the amendments and will give them their whole-hearted support.

I move amendment 31.

Photo of Jackie Baillie Jackie Baillie Labour

I am happy to say that Labour members support amendments 31, 34 and 35, in the cabinet secretary’s name, and we thank her for the briefing in advance of the debate.

I recognise that the bill might not be the most appropriate legislative vehicle, but it has the benefit of being quick, and timing is all in politics.

It is right that those infected with hepatitis C as a result of treatment by the NHS with blood or blood products should be compensated. However, if she is able to do so, will the cabinet secretary detail the likely funding impact that that will have over a number of years and whether that funding is being identified within the health budget?

Photo of Ross Finnie Ross Finnie Liberal Democrat

I rise to indicate Liberal Democrat support for the amendments. I, too, express my gratitude to the cabinet secretary for the briefing on the subject.

Like Jackie Baillie, I think that it is right and proper that the earliest opportunity should be taken to introduce the provisions following the changes that have been announced. I understand the propriety of the cabinet secretary requiring to have a legislative framework before she can make an announcement but, like Jackie Baillie, I earnestly hope that the proposals have been made on the premise that, all being well, the cabinet secretary will be able to come to the chamber and make an announcement that she will utilise the provisions, which I am sure members will approve today.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

I thank Jackie Baillie and Ross Finnie for their support for the amendments.

I appreciate that, through the amendments, I am asking for enabling powers that we need in order to make payments to any group that is not currently eligible. As I said in my earlier remarks, I have not yet announced our policy intention. I should say that we were not as fully consulted as I would have liked us to have been prior to the Department of Health’s announcement, and we have made our views on that known.

I want to do two things before announcing our policy intention. First, I want to ensure that we have the right legislative framework in place, as Ross Finnie said. Secondly, I want to take the views of patient representatives. Without referring to any particular group or individual, I think that it is fair to say that there are differences of opinion about the adequacy of what has been announced south of the border. We want to take time to consider carefully the implications and what the right move is for the Scottish Government. I will announce our intentions on the issue as soon as possible.

To respond to Jackie Baillie’s question, I say that there will be financial implications, although I cannot say exactly what they will be in advance of deciding on the package. However, we might be talking about a financial implication of up to £10 million in the first year of implementation. Obviously, that money will have to be found from within existing budgets. Whatever we decide to implement, we will take care to ensure that it is fully funded.

Amendment 31 agreed to.

Section 19—Interpretation

Amendment 32 moved—[Dr Richard Simpson]—and agreed to.

Section 21—Orders, regulations and directions

Amendment 33 moved—[Nicola Sturgeon]—and agreed to.

Section 22—Short title and commencement

Amendment 34 moved—[Nicola Sturgeon]—and agreed to.

Schedule—Health care principles

Photo of Alasdair Morgan Alasdair Morgan Scottish National Party

Group 8 is on health care principles. Amendment 7, in the name of Richard Simpson, is grouped with amendment 8.

Photo of Richard Simpson Richard Simpson Labour

Principle 9A uses the term “unnecessary harm”, but it is not completely clear what that might mean. In the quality strategy, the safe quality ambition uses the phrase “avoidable harm”. Amendment 7 would make the principle consistent with the strategy and avoid misinterpretation.

Amendment 8 relates to the principle that patients should be

“cared for in an appropriate, clean and safe environment”.

That can apply only when it can be reasonably achieved. What is “appropriate, clean and safe” will vary depending on the circumstances and the location of treatment. The change that amendment 8 proposes should not be interpreted as a softening of Parliament’s unanimous desire to ensure that hospitals are clean at all times, but it is important to be realistic. There are many circumstances in which patients will have to be treated in an environment that is less than fully clean. Amendment 8 will allow that to happen.

I move amendment 7.

Photo of Ross Finnie Ross Finnie Liberal Democrat

I have no problems at all with amendment 7, but I have a problem with amendment 8. The schedule to the bill is headed “Health care principles”—it is not a detailed manual of how health care is to be delivered in every circumstance in every hospital, by every roadside, on every pathway and in any other circumstance that we might care to think of. In the context of the problems that we have had in relation to cleanliness, I found it profoundly helpful to have as a principle that patients are to be cared for

“in an appropriate, clean and safe environment at all times.”

I have the same problem that I had the first time I entered into the debate, which is that, to me, the word “appropriate” conveys a clear sense that what is appropriate or not appropriate might well be different in a hospital and by a roadside. Therefore, there is no need to enter the caveats that appear in amendment 8, under which we would talk not about an environment that is clean and safe at all times but about one that is

“as clean and safe as is reasonably possible”.

That waters down the principle. I do not see why we should dilute principles. I can well understand the practical implications but, if we are setting principles, let us not water them down. Therefore, I oppose amendment 8.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

I confirm my support for the underlying principle and intention of the amendments at stage 2 that inserted health care principles 9A and 9B into the bill’s schedule. However, I explained at that time that I had concerns that the scope of principles 9A and 9B was too wide and might lead to unintended consequences for the national health service. The bill currently talks about having a

“clean and safe environment at all times.”

Although I absolutely agree with Ross Finnie that we all have that aspiration, that terminology does not take account of certain circumstances in which people might require NHS treatment. The example that I used at committee is the one that I will use again today. Somebody who is in a road accident and requires to be treated at the side of the road is not being treated in a “clean and safe environment”, but they are being treated in the best environment that can be provided at that time. That is the type of example that we are talking about.

I am pleased that Dr Simpson agreed as much and that he recognises, as we all do, that there are circumstances in which the urgency of a medical intervention takes priority over the environment in which treatment is taking place. He committed to working with us to amend the wording of those principles, which has given rise to these amendments.

Although I understand where Ross Finnie is coming from, I disagree with his view that the amendments in any way dilute our commitment to clean and safe hospitals and treatment environments for all patients. One thing that I hope the Government has achieved, with—to be gracious, as I always am—the support of everybody on all sides of the chamber, is to put the cleanliness of our hospitals much higher up the agenda than it has ever been. Even if there were to be any softening on that on the part of any Government—and there is not on the part of this Government—our new health care environment inspectorate would see to it that that was not allowed to happen in practice. We have raised standards here, and the impact of that can be seen in the hospital infection rates, which are declining and will, I hope, continue to do so.

We should ensure that we pass the bill in a practical manner. Amendments 7 and 8 achieve that. The Government will support them, and I urge other members to do so.

Photo of Richard Simpson Richard Simpson Labour

It depends on how Ross Finnie reads the existing wording and where the word “appropriate” applies. If it applies to the general environment rather than to the two words that follow, there could be some room for debate. Although I hear where Ross Finnie is coming from, I do not agree with his conclusion.

The cabinet secretary is right to give the example of a road traffic accident. However, anyone who has been in an accident and emergency ward will have seen that, on occasions, treatments in that situation have to be undertaken that are anything but as clean as everyone would wish them to be, simply because of the need for urgency and speed at that time.

As I said in introducing the amendment, it in no way absolves staff from trying to achieve maximum safety and cleanliness at all times. Indeed, that is clearly stressed in the amendment as it is drafted. To suggest that staff would not wish that to be the case is inappropriate, but to ring them with a requirement for absolute cleanliness at all times would also be inappropriate. I welcome the cabinet secretary’s support for these further amendments, which will make the principle appropriate and proportionate.

Amendment 7 agreed to.

Amendment 8 moved—[Richard Simpson].

Photo of Alasdair Morgan Alasdair Morgan Scottish National Party

The question is, that amendment 8 be agreed to. Are we agreed?

Members: No.

There will be a division. As it is the first division, I will suspend Parliament for five minutes.

15:43 Meeting suspended.

15:48 On resuming—

We come to the division on amendment 8.

Division number 1 Patient Rights (Scotland) Bill: Stage 3

Photo of Alasdair Morgan Alasdair Morgan Scottish National Party

The result of the division is: For 100, Against 15, Abstentions 0.

Amendment 8 agreed to.

Long Title

Amendment 35 moved—[Nicola Sturgeon]—and agreed to.

That ends consideration of amendments.