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No—I accept that.

There is probably little for me to add, other than to say that I agree with Sarah Boyack. We have been talking about what things will be like a year from now; I am very confident that we will be out of the immediate grip of the pandemic by then, and we are making progress in absolutely the right direction. This and the last couple of weeks have felt extremely difficult, but we will get through this wave, as we have with other waves. However, the challenge is that the NHS’s recovery will take years. I do not think there is any Government, certainly across the United Kingdom, that would suggest otherwise.

Secondly—and, again, I agree with Sarah Boyack in raising the point—how people access their health service might well change, too. GP access is a good example. We want to restore face-to-face access to GPs where we can and as much as we possibly can, but we know now that that kind of access will be part of a hybrid model that will also include telephone and video consultation. We also have to ensure that our digital infrastructure keeps up, which I know is a particular issue in the NHS. If we are going to do this through digital means, we have to take on the point about digital exclusion that Sarah Boyack highlighted.

After all, we know that inequality exists, and more so in areas of deprivation. Thinking about the pandemic—and I will finish on this point—I do not think that there is any way that anybody can truthfully say that we were all in it together. We were not. There are people in communities that have been harder hit by the pandemic; for example, a look at the excess death figures shows that people in areas of deprivation are 2.5 times more likely to have died from Covid. Therefore, we cannot say that we were all in this together, and any work that the cabinet secretary and I do to build upon culture and the arts as part of mental and physical health and wellbeing solutions for the future has to be equitable. Indeed, that is something that those in the deep end project, who might be known to the committee, say to me very often: we have to make sure that we continue to direct resources into the communities that need them the most.

Thank you.

Good morning. I am absolutely fine with that approach and I welcome the opportunity to make some opening remarks. First, let me say that I hope that everyone on the committee is keeping safe and well.

Thank you for the opportunity to give evidence on two instruments under the Forensic Medical Services (Victims of Sexual Offences) Scotland Act 2021. When commenced on 1 April, the act will create a clear statutory basis for health boards to provide forensic medical examinations for victims of sexual crime. Health boards will also be required to provide consistent access to self-referral services. Self-referral will enable someone who is aged 16 or over to access healthcare and request a forensic medical examination without first having to make a report to the police.

First and foremost, I am extremely grateful to the survivors whose courage, bravery and honesty helped to inform the key principles of the act. I know that I can safely speak for my predecessor, Jeane Freeman, when I say that it was a moment of tremendous pride when the act was unanimously passed in December 2020.

I also thank the chief medical officer, Professor Sir Gregor Smith, for his leadership of the national task force for the improvement of these services, and I put on record my thanks to his predecessor, Dr Catherine Calderwood, for her efforts to improve forensic medical services across the country.

The task force has made significant progress against the five-year high-level work plan that was published in 2017, which was supported by a Scottish Government funding commitment of £11.7 million over four years. That investment has helped health boards to get ready for the commencement of the act. One of the most significant improvements is that victims no longer need to go to a police station for a forensic medical examination. Those now take place in an NHS healthcare setting known as a SARCS—a sexual assault response co-ordination service.

Healthcare Improvement Scotland has published national standards and quality indicators. There has been tangible improvement in health board performance against those. In the final quarter of 2021, 87 per cent of examinations were carried out by a female doctor, supported by a female forensically trained nurse. Nurse care co-ordinators are in post in every health board to help ensure the smooth pathway of onward care and support.

National clinical pathways for adults and for children and young people have been published and are followed by health boards. A national clinical IT system has been developed to ensure consistent recording and collation of data, and the system will go live on 1 April.

Task force officials are liaising closely with health boards to ensure that they are all ready to provide self-referral forensic medical services nationally from 1 April. Boards have been provided with detailed guidance and training, as well as additional funding to support implementation and readiness.

I turn first to the Forensic Medical Services (Self-Referral Evidence Retention Period) (Scotland) Regulations 2022. Section 8(1)(b) of the 2021 act enables the Scottish ministers to set, by regulation, the length of time for which health boards will be required to store evidence that is gathered during a self-referral examination. That is known as the retention period. Any evidence that is stored will be destroyed at the end of the period, unless the person examined has requested destruction of their evidence prior to that or has reported the matter to the police, in which case the police will request that the evidence be transferred to them.

The regulations, if approved, will set the retention period at 26 months. That period is based on the outcome of the Scottish Government’s public consultation and on evidence and best practice from across the UK and internationally. Just over half of the responses to the consultation agreed with that period, which seeks to strike the right balance between ensuring that evidence is held for a reasonable timescale and taking into account the practical considerations for health boards.

The Forensic Medical Services (Modification of Functions of Healthcare Improvement Scotland and Supplementary Provision) Regulations 2022, makes amendments to the National Health Service (Scotland) Act 1978 using the powers in sections 13 and 19 of the 2021 act. This technical instrument will give Healthcare Improvement Scotland functions similar to those that it currently holds in relation to wider health services. The functions include a general duty of furthering the improvement in the quality of services that are provided under the 2021 act and the provision of information to the public about the availability and quality of those services.

The instrument will also extend the inspection power of HIS to any service that is provided under the 2021 act. That serves as a backstop power that is likely to be used only in the event that a significant issue of continued concern has not been resolved through existing health board governance and assurance processes. However, the Government considers it prudent for it and HIS to have those powers in reserve, as is the case for other healthcare services.

In summary, the CMO’s task force has made significant progress over the past five years, and Scottish Government officials are working closely with health boards to ensure that they are ready for commencement of the 2021 act. This secondary legislation is an important anchor to that work and helps to underpin the continued improvements that we plan to deliver with our NHS partners.

As always, I am happy to take questions.

I thank Emma Harper for making those important points. She is absolutely right about why we have a 26-month period and not, for example, 24 months, which would seem a more natural time period. The reason why we avoid 12, 24 or 36 months, for example, is that those would be anniversaries of when the medical examination had to happen, which I imagine can be a traumatic period in a survivor’s journey. We avoid those anniversaries for good reason. That is the feedback that we got from the likes of Rape Crisis Scotland and others.

On Emma Harper’s point about consensus, it is important for me to say that, although the 26-month period was backed by the majority of respondents to the consultation—just over 50 per cent—there was not consensus on what the retention period should be among the remaining group of just over 49 per cent of respondents. Some thought that it should be shorter than 26 months and some thought that it should be longer. It would be remiss of me not to say that the survivor reference group favoured a longer retention period. However, we wrote to the reference group about the 26-month period and it has not pushed back on that.

I think and hope that the reference group understands our reasons for trying to balance important factors: retaining the evidence for a long enough period while ensuring that evidence is not held for a disproportionate amount of time, given the sensitivity of the data.

We looked at evidence from across the UK and found that in the London centres—the Havens—the average time between self-referral and police referral was three months. In other UK centres the average time between self-referral and police referral, for cases that go on to police referral, seems to be between three and six months. Therefore, 26 months seems adequate.

Good morning, convener; I hope that you and the committee members are keeping safe and well.

I thank you for the opportunity to speak to the committee about the proposed amendment to the Community Care (Personal Care and Nursing Care) (Scotland) Regulations 2002 (SSI 2002/303).

I am sure that members are aware that the draft amendment regulations that are before the committee make a routine annual increase to the rates for free personal and nursing care. Those payments help to cover the cost of services for self-funding adults in residential care. Historically, the payments have increased in line with inflation. However, emerging evidence—including from the Scottish care home census—clearly shows that the cost of providing care has increased.

To help redress that, last year we made an above-inflation increase of 7.5 per cent to the rates of payment, which was a significant increase on the inflation rate that was previously used.

We feel that it is again appropriate to make an above-inflation increase to the rates this year, and the amendment regulations that are before you propose a 10 per cent uplift for 2022-23. That will mean that the weekly payment rates for personal care for self-funders will rise from £193.50 to £212.85, and the nursing care component will rise from £87.10 to £95.80.

It is estimated that that increase will cost around £15 million in the next financial year, which will be fully funded by additional provisions within the local government settlement, as outlined in the recent 2022-23 Scottish budget.

The most recent official statistics show that more than 10,000 self-funders receive free personal and nursing care payments, and they should all benefit from those changes. I am happy to take questions from the committee.

As I said on 5 October and referenced in my opening statement, I have no objection to the policy principle. A lot of good can be done by tackling the advertising of less healthy food on a four-nations basis. However, it is incumbent on me, in my position in Government and, I suspect, important for all ���˿���, that we protect the devolution settlement. We are worried about there being some overreach. It should also be noted that certain stakeholders, including Food Standards Scotland and Obesity Action Scotland, have criticised the UK Government’s definition of “less healthy”. There are understandable differences but I stress again that I am not particularly opposed to the substance of the policy. My concern is the overreach into public health, which I think we all agree is a devolved matter.

That second question is really good. The first one is also good—I do not want to take that away from you—but the second one is important and vital for us to answer.

The first question is perhaps the slightly easier one to answer. Like any offence that is created, we will work closely with the Crown Office and Procurator Fiscal Service and Police Scotland on implementation. That will not be any different to how we deal with any new offence. We will take that forward in the usual way.

The second question is critically important. We cannot find—we are unable to find—any evidence of virginity testing taking place in Scotland. That is not the same as saying that that does not happen; we just not have been able to find any evidence of that.

The criminalisation of the practice intends to ensure a unified approach across all four nations. Therefore, although we could not find evidence of that practice—again, I stress that that does not mean that it is not happening—we would not want a situation to arise in which the other nations of the UK legislate that that is an offence, and Scotland is seen as a safe haven for virginity testing. Although we are unable to find evidence of it taking place, all of us—including the committee members—agree that virginity testing is a form of violence against women and girls. It is completely unacceptable if and where it is happening.

With regard to stakeholder engagement, the stakeholders were positive about legislating for the offence, given everything that I have said a moment ago. The only note of caution that was perhaps struck—which I would not overplay—was that we could be in danger of overcriminalising offences in a way that puts a focus on black, Asian and minority ethnic communities. The second point that a number of groups made was that it is fine to legislate, but we have to accompany that with education and working with those communities. We have to get into those communities to eliminate the practice, if it is going on in Scotland in any way, shape or form. The feedback from stakeholder engagement was really good.

If the bill passes in the House of Commons, we will absolutely do the work on that, perhaps on a four-nations basis, which would make sense if the legislation is across the four nations. We will look at the UK Government’s plans for that marketing and awareness raising and, if we agree with it, we will do it on a four-nations basis but—as is sometimes the case—if it does not quite match the messaging that we feel is appropriate, we will take forward our own awareness raising. There will be awareness raising and, as I keep emphasising, it is really important. We want to work with those communities so that they do not feel unnecessarily targeted. People in all ethnic minority communities would be the first to say that those practices are abhorrent and have no place in any society.

I do not think that the UK Government will necessarily accede to that, but discussions will continue. I should have said at the start of my remarks that I am grateful for the personal intervention of the Secretary of State for Health and Social Care. In my previous meetings and correspondence we were not getting very far, but he and I were able to sit down and thrash it out. I am pleased that he compromised in relation to the consent provisions that we were, reasonably, asking for. I will keep the discussions going, but, to be frank, I do not think that the UK Government will change its position.