Seòmar agus comataidhean

I thank Emma Harper for that question, because she has illustrated what I was setting out in response to Sandesh Gulhane about the processes that are in play in all environments, in both health and social care, and what must be taken into consideration in order to understand what will be a safe staffing level for a particular shift.

Emma Harper rightly points to the fact that a number of factors will be dynamic and have to be flexible. In the example that she provided, the number of people who are intubated or in intensive care and requiring ventilation would change depending on the number of patients who are in that particular unit at that time. There is an understanding of that. The safe staffing legislation provides transparency around the tools that are used, the way in which the safe staffing level is determined, and ensuring that we comply with that across the NHS and social care estate. That is essentially what the legislation is designed to do.

As we are setting out the tools and seeing the act being implemented in local areas, and as we see the response that comes back from boards on how they are reviewing and ensuring that they have safe staffing levels, of course we keep under review areas such as those that have been suggested by the Royal College of Nursing. The process is dynamic and flexible—it is not a one-size-fits-all approach—so that we can deal with potential elements that need to be worked on as the legislation is implemented. We keep under review concerns such as those from the Royal College of Nursing that Mr Gulhane has raised.

I have engaged directly with the RCN, its leadership and its lay committee on many points since the decision was taken. With regard to the perceived delay, it was an issue on which I understood that there were very strong feelings from colleagues within the trade union movement, and I engaged with them to hear their perspective before I came to a decision. I took my time to come to that decision, because I recognised the strength of feeling on the matter, but also because of what I was being told and the advice that I was being given on ensuring that we safely implemented the commitment to reduce the working week.

There was no agreement in place about how we would arrive at the 36 hours. Given that the commitment in the pay deal was to get to 36 hours, I believe that I am implementing that deal by getting to 36 hours as of next April. I also believe that I am doing it in the responsible way, by having an implementation plan that takes place over the course of this year and that involves local area partnerships, the Scottish terms and conditions committee and the national trade union representative body. We will see draft plans coming through in May and confirmed plans from boards in October, and that will ensure that our approach to implementation guarantees that 36 hours will be arrived at in April of next year.

I absolutely understand what has been said, and I have engaged on the matter with almost all the relevant trade unions—I still have some to come—but, as I have said, this is Government delivering on the pay deal. We have not reneged. I understand the perception of the phasing of all of this and how people thought that it was going to be implemented, but there was no agreement as to how that would be done from Government. Therefore, I believe that we are delivering on the agreement that we set out in the pay deal two years ago.

Thank you for giving me the opportunity to speak to the committee. I will briefly set out the reasons for the amendments to the National Health Service (Common Staffing Method) (Scotland) Regulations.

The amendments, which are relatively technical in nature, largely take account of changes that are linked to the implementation of the reduced working week for agenda for change staff. The first half-hour reduction in the working week for those staff was implemented on 1 April last year. It is clearly important that the staffing tools that are provided for under the Health and Care (Staffing) (Scotland) Act 2019 are adjusted to reflect the new definition of whole-time equivalent working hours. Further amendments will be required at the point at which we deliver the 36-hour working week, on 1 April 2026.

I reiterate for the avoidance of any doubt that the Scottish Government is delivering on its commitment to implement the reduced working week by 1 April 2026. I look forward to staff feeling the full benefit of that change. A clear delivery plan is being set out to give confidence regarding its delivery.

As part of the Health and Care (Staffing) (Scotland) Act 2019, the common staffing method sets out a process, including the use of tools and the consideration of a range of other factors, to determine appropriate staffing levels. Those tools will need to be updated and supplemented periodically, and corresponding updates to secondary legislation will be required. The tools provide a useful source of information to support local decision making, and they form part of a wider set of systems and processes that were introduced by the 2019 act to support effective workforce planning.

To be clear, the intention is not to prescribe what staffing numbers are appropriate or to set recommended ratios at the national level. Such an approach would lack the flexibility to account for local circumstances and would fail to take account of the dynamic nature of healthcare services and the care that they are required to deliver. Instead, the approach is designed to support robust and transparent local decision making.

It is important to recognise that this is the first year following the commencement of the 2019 act and that, as more resources become available and learning takes place in the years to come, we will naturally see incremental improvements in the approach that is taken to compliance. That is not to say that some benefits are not already being felt. I am aware of work that is being done across the system to review staffing establishments as part of broader efforts to ensure that our services are fit for purpose and able to respond to the demands that we can reasonably anticipate. The act has added impetus to those efforts, and we will learn more about health boards’ experience of implementing the legislation when we receive their annual reports in the coming weeks.

I will re-engage with the Parliament later this year to give an update on the Scottish Government’s plans in the light of the evidence that continues to emerge. I will, of course, be happy to take questions from committee members.

No. I will bring in Christopher Thompson in a second. The tools are there to help to inform different parts of the system to ensure that staffing levels are appropriate. There is a duty on local boards to report to ministers on their staffing levels. Ministers must lay those reports and respond to them, which I will do later this year.

Christopher can correct me if I am wrong, but I do not believe that we have had any concerns expressed.

Of course. It has to be. That is why it is important that it is done at a local level, to respond to local need and the local environment, and to the various factors that Emma Harper will be familiar with, given her previous practice, in arriving at what will be required and what a risk assessment would arrive at as the best requirement for that particular shift, or for a longer period of time, depending on the environment that we are talking about. That is why it cannot be prescribed nationally. It has to be delivered locally, but we need the transparency that the legislation provides around how those decisions are taken, and when there has been challenge in the previous year, to arrive at a safe staffing level. The reports will come through in April to determine that, and the ministers will need to respond to those in the Parliament in due course.

They should be, yes, but to supplement that, I reiterate what Emma Harper has just put on the table and my response to Sandesh Gulhane—I cannot prejudge what will be in the reports. I will see the boards’ decisions and the risk assessments and other factors that they have used to determine what the staffing establishment should look like. When there have been issues, that needs to be clearly communicated in the reports that come through to ministers.

To add to Mr Whittle’s point, he will be aware that HIS now routinely inspects maternity and neonatal services. The first inspection is under way and we expect the reports on that in May.

In the light of what we are picking up through the boards’ reviews and other areas of learning, we will interact with boards that have a responsibility to make sure that they are honouring what they should be and providing safe staffing.

I will need to defer to Christopher on that.

We accept that there needs to be improvement, as I said in my written evidence. In the evidence from the people’s panel, we heard that, although the services exist, we need to explore, with regard to co-ordination and consistency, why they are not being referred to. We will work with the court service and other statutory organisations to ensure that there is awareness of the services that are available and that they are referring people to those pathways. Every encounter should be utilised as an opportunity to ensure that people are made aware of the support that is available to them and to encourage uptake of that support. We will explore that further and see what more can be done to ensure that the recommendation can be fulfilled.

Yes. I heard that evidence. I can reflect on the situation in my constituency; I know that the local support cafe is looking to work much more closely with the justice system so that there is a supportive element through somebody’s release from custody and they go into a supportive environment that means that they are supported in the community in a much better way. I know that that is being considered more widely. I heard that from the panel this morning, and we are absolutely looking to do better on it.