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Yes.

I would like to reiterate my thanks for the work that the committee has done in this area. Clearly, it is a very emotional area of healthcare and one that we really want to get right, so the questions that you have prompted in your evidence gathering have ensured that we have that covered in the work that we have been doing with the task and finish group and we are very appreciative of that.

Thank you for inviting me to provide evidence today. Addressing concerns about the new model of neonatal care is very important to me, so I am pleased to be here to talk about the petition. First, I will address a point made at the previous committee meeting and make it absolutely clear that no units are closing as part of the new model of neonatal care.

In 2023-24, around 4,500 babies were cared for in neonatal units. Just over 800 were admitted to intensive care. The majority of those babies need intensive care for only a short period—less than 48 hours. A small number need longer, highly specialised intensive care. For those babies, the complexity of that neonatal intensive care has increased, particularly for babies born at extremes of prematurity or with extremely low birth weights.

As the committee heard from Stephen Wardle of the British Association of Perinatal Medicine and Andrew Murray and Jim Crombie, the chairs of the best start perinatal sub-group, the clinical evidence shows that outcomes for the smallest and sickest babies are improved when they are born and cared for in a unit with a high throughput of cases, defined as at least 100 new, very low birth weight admissions per year and where support services are co-located.

That evidence underpinned the best start recommendation and also the professional guidance published by the British Association of Perinatal Medicine. As defined in the guidance and as highlighted by Stephen Wardle to the committee, local neonatal units will continue to provide a level of intensive care and be able to care for singleton births over 27 weeks’ gestation, with babies receiving care in one of the three intensive care units being transferred back to their local neonatal unit for on-going care as soon as possible. The best start report—“The Best Start: A Five-year Forward Plan”—was based on evidence and a range of expert clinical opinion. The options appraisal that followed, as you heard from Jim Crombie and Andrew Murray, was objective, followed evidence-based criteria and was undertaken by an expert group comprising clinicians with service users represented by Bliss Scotland.

I was disappointed to hear at the last committee meeting that colleagues raised again that NHS Lanarkshire was not present within the process. I have corrected that point many times previously, and I am grateful to Jim Crombie for further clarifying to the committee NHS Lanarkshire’s involvement in both the best start perinatal sub-group and the best start programme board. The members were appointed based on national roles that they represented, to provide an objective view to an evidence-based clinical approach. As the committee previously heard, having the right infrastructure in place is essential to support implementation of the new model and to optimise the parents’ experience.

When I announced those changes in 2023, I asked the regional chief executives to lead on detailed implementation plans that described how they would build capacity in the three units before commencing any changes. The Scottish Government also commissioned detailed capacity modelling to inform those plans. In addition, work is under way with the regional chief executives’ task and finish group to look at maternity capacity, financial modelling and cot capacity management. The best start report had family-centred care as one of its core principles. Among the earliest best start recommendations were the establishment of the neonatal expenses fund in 2018, now the young patients family fund, and the provision of accommodation on or near all neonatal units for the parents of the sickest babies. Other improvements include accessible psychological support services for parents, offered throughout their neonatal journey.

Since my appointment, I have been committed to listening to both families and clinicians from across Scotland, and I have seen at first hand the passion and commitment of the neonatal staff by visiting University hospital Wishaw, the Queen Elizabeth university hospital in Glasgow, and the new Royal infirmary of Edinburgh. I have also met with Wishaw neonatal campaigners and elected representatives on several occasions. I had the pleasure of presenting both Ninewells and Forth Valley neonatal units with their Bliss baby charter gold awards, recognising the care that those units provide and will continue to provide.

I also want to thank staff at Ninewells for their efforts in reassuring the local people that the new model is the right model. I want to put on record my thanks to all the neonatal nurses and consultants who do such a fantastic job in caring for babies and supporting families, and to thank Bliss for all its work for families at a time when they need that support the most, and their work to advocate for those families in national policy. I recognise that families will be concerned about the change, but I want to provide reassurance that this decision has been made in the best interests of the very smallest and sickest babies.

I thank the committee for listening carefully to the evidence of those involved in the process, and for taking time to visit Wishaw university hospital.

Of course.

That is a very good question, and it is one that we have also discussed. As you know better than I do, there are affirmative and negative procedures. If we were adding a new procedure, it would follow the affirmative process in the Parliament, which would allow this committee to consider it and there would be a parliamentary vote. However, the provision that requires people to provide documents to prove their age, for example, is not a policy change but a procedural change. Therefore, that falls into the negative procedure area. It is important that we get this right, which is why we have been quite clear about which procedures follow the negative or affirmative processes.

I thank the committee for giving me the opportunity to speak about the Non-surgical Procedures and Functions of Medical Reviewers (Scotland) Bill.

Part 1 of the bill was developed in response to rising concerns about the potential harm to members of the public who are seeking non-surgical procedures for cosmetic and wellbeing purposes. Its aim is to ensure that robust and proportionate regulation is in place so that anyone who chooses such procedures can do so safely. The legislation will regulate non-surgical procedures, such as procedures that pierce or penetrate the skin and which might require input from a healthcare professional, whether that is through a face-to-face consultation, the issuing of prescription medications or a medical intervention in the event of complications.

The bill contains the substantive provisions that will make the public safer by making it an offence, first, to provide such procedures to people who are under the age of 18 and, secondly, to provide procedures outwith permitted premises. Permitted premises will be safer settings by virtue of many of them being subject to oversight by Healthcare Improvement Scotland, and by being settings from which healthcare professionals provide or manage services. The involvement of healthcare professionals also supports safe and appropriate prescribing, and the bill will enable healthcare professionals to intervene in the event of complications. The settings will be hygienic and adequately staffed.

The provisions are key to protecting the public, especially young people, and they will give clients confidence in the services that they are receiving.

However, the bill must not simply capture a snapshot in time. It is vital that it can respond quickly to changes in what is a constantly evolving sector. That was a key piece of feedback from those who work in the sector. As introduced, the bill takes account of the fact that new procedures, new technologies and changes to the way in which procedures are performed will continue to occur in the sector, and they will need to be addressed in a timely manner to continue to assure safety.

Although I understand that the committee has questions about the powers that the bill takes, I would like to assure the committee today, as I have done in my letter, that those questions have been considered carefully. The Scottish Government set out its full policy intent in its recent public consultation and in the documents and impact assessments that accompanied the publication of the bill.

The regulation-making power in section 5 will enable ministers to keep provisions up to date in the future, as well as fulfilling those aspects of our intentions that we are not able to address in the bill because of our consideration of the effects of the United Kingdom Internal Market Act 2020.

I assure the committee that, where regulation-making powers are taken, they will be supported by engagement with relevant stakeholders and consultation where necessary to ensure that they remain proportionate and appropriate.

I welcome any questions that the committee might have.

I absolutely agree. I will pass to Owen Griffiths, who has been leading the discussions from the Scottish Government’s perspective.

That was considered. We do an options appraisal as we gain more information. However, section 5 is not purely focused on the UKIMA situation; it also takes into account that the industry is very fast moving and that procedures can change. We might need the requirement to amend schedule 1 but, from a safety perspective, there is also a need to provide for innovation in new techniques to perform the various procedures, so the bill needs to respond to a fast-changing environment.

I go back to my response to Roz McCall, which was that the bill can makes changes in key areas, such as age restrictions and the premises that are used, that are incredibly important from a public health perspective.

We have had a discussion about that. The bill as it stands provides the right controls around the powers that we are looking to introduce, because, as I have said, it is a very fast-changing environment. I will take your question away and look at the issue further, but as it stands, the bill contains the right safeguards, controls and flexibility so that we can respond quickly to any changes that are needed.

UKIMA is one area that relates to the bill, but I felt that it was important that we brought in legislation, given the level of consultation that we have carried out over several years on the safety of cosmetic procedures. It is about not simply the training but, from a healthcare perspective, ensuring that we have the right premises and proper regulation so that clients are assured of the hygiene and safety levels and the professionalism of the people who work in those premises.

We also think that it is very important to bring in legislation to ensure that young people under the age of 18 cannot legally get such treatment. That is a key driver of the bill. We have therefore focused very much on the age-related elements and the premises, while recognising that, ideally, we want to bring in training and professional qualifications—which we will do once we have achieved the discussions with the UK Government.