Guest Post: Ross Finnie's submission to Sir Menzies Campbell's Home and Community Rule Commission

Ross Finnie was Scottish Liberal Democrat MSP to the West of Scotland from 1999-2011 and Rural Affairs Minister in the Scottish Cabinet from 1999-2007. He's shared his submission to the Campbell Commission with me. I've put an extract on Liberal Democrat Voice but I thought you might like to see the whole thing in all its glory.

Introduction

In order to provide some context to my submission I begin by stating my position on Home Rule, what I have understood Home Rule to mean and the policy positions of the Party which I have supported.  I have always supported Home Rule. I have always understood Home Rule to involve a new constitutional settlement giving equal status to England, Scotland, Wales and Northern Ireland and thereafter each nation would promote what each considered to be the most appropriate governance arrangements within a federal state. For Scotland that meant not just the establishment of a Scottish Parliament but the transfer of the maximum amount of legislative, administrative and financial powers consonant with being a nation within a federal state.

Like most Scottish Liberals, I supported the Party’s policy position as set out in Jenny Robinson’s 1976 pamphlet on Home Rule: Scottish Self-Government. I was one of the overwhelming majority who voted for the motion passed at the 1982 Conference in St Andrews calling for ” … the establishment of a Scottish Parliament, elected by proportional representation, within a Federal United Kingdom … .”  I was Chair of the Scottish Liberal Party when the policy pamphlet Scottish Self-Government was revised and updated by Jenny Robinson and Margo von Romberg prior to the 1983 General Election.

I was also one of many Party members who, long before Donald Dewar coined the phrase that Devolution was not an event but a process, believed that establishing a Scottish Parliament, as a priority, was a first step towards bringing about federal Home Rule. With the benefit of hindsight, I think that in our pursuit of a Scottish Parliament, Scottish Liberals and Scottish Liberal Democrats have seriously underplayed the critical advantages of federal Home Rule over Devolution, often deferring to a Devolution proposal and, as a consequence have failed to make the case for federal Home Rule. In support of that contention, I give my take on the recent history of Home Rule/Devolution to illustrate the Party’s apparent reluctance to press the federal Home Rule case.

In 1976 during the Lib-Lab Pact, George Mackie and Russell Johnston were tasked to improve what became the Scotland Act 1978 and they did. There is little if any evidence, however, of   a more federal Home Rule settlement ever being considered. Likewise, although the Scottish Constitutional Convention’s report of 1995 Scotland’s Parliament, Scotland’s Right formed the blueprint for the excellent Scotland Act 1988, Scottish Liberal Democrat submissions to the Convention, sought to build a consensus which had the unintended effect of playing down their federal Home Rule content. The result was that the Convention’s report effectively accepted the sovereignty of the Westminster Parliament and called for it to “ … move a special Declaration before passing the legislation creating the Scottish Parliament … that the Westminster Parliament will not remove or amend the Scottish Parliament without consulting directly the people of Scotland and the Scottish Parliament itself.”  A reasonable protection, perhaps, but one that would have been unnecessary under a federal Home Rule settlement.

Jim Wallace spotted the Devolution trend away from federal Home Rule when he established the Steel Commission in December 2003 with a remit “to consider [amongst other things] how to move forward to a fully federal structure for the United Kingdom … “  The report of the Steel Commission: Moving to Federalism- A New Settlement for Scotland was adopted as Party policy in 2006 and the 2007 manifesto, under its section on Governance, called for the development of the Steel Commission’s proposals and specifically “a new system of fiscal federalism”. The Party appeared to be back on a federal Home Rule track. Nicol Stephen’s attempts to move the debate forward on an all party basis, however, got subsumed by the drive of the then leader of the Labour Party, Wendy Alexander to take Devolution further and somehow take the steam out of the SNP. This led to the establishment of the Calman Commission in 2007 with a remit which restricted it to considering improvements to the Scotland Act 1988 thus precluding consideration of anything remotely resembling federal Home Rule.

The Party then proceeded to endorse the interim report of the Calman Commission at the 2009 Scottish Conference and the final report at the Federal Conference the same year with its proposals for substantial improvements to the Devolution settlement. Liberal Democrats in the Coalition Government then introduced the Scotland Bill, currently passing through the Westminster Parliament, incorporating and in many cases improving the Calman recommendations. In particular, the proposed financial powers for the Scottish Parliament represent the biggest transfer of fiscal powers from Westminster in the history of the UK. Welcome though the transfer of powers is, it is still a transfer to a Parliament that is subsidiary to the (now hybrid) Westminster Parliament. Scotland Bill or no Scotland Bill, Scottish Liberal Democrats are still a very long way from achieving federal Home Rule.

The conclusion I draw from the last thirty six years or so is that unless the Party sets out with a single-minded determination to achieve a federal Home Rule settlement, and is not fobbed off with further variants of Devolution it will continue to make no progress towards achieving that goal. Yet, as I write this submission, leading Scottish Liberal Democrats, Tavish Scott and Jeremy Purvis, have announced they are to play leading roles in the “Devo-Plus” campaign which whilst it would develop Devolution very much further than Calman or the present Scotland Bill will  still leave the need for federal Home Rule unmet.

The case for the UK

I will not dwell on the case for the UK but given the current independence debate in Scotland I think it is dangerous simply to assume the continuation of the UK. Both Steel (P48-50) and Calman (P63-64), particularly Steel, provide a well argued case in favour of the UK which I support. The UK enjoys a very high level of political and social cohesion. It is interesting that the SNP talks increasingly of retaining this important social union.  Underpinning the current social and political union, however, is the fact that despite the diversity of our respective nations we are all part of the UK. It is difficult to see how the same degree of cohesion could be maintained in the long-run if Scotland were to become Independent.

In my opinion, the present level of social cohesion is sustained by the UK’s ability to direct economic resources to where they are most needed and to make common provision for pensions and social security for individuals in most need. Given the high degree of economic integration within the UK, I can see no case for separate monetary policy for Scotland: a point apparently ceded by the SNP. In an increasingly interdependent world, the UK punches above its weight and enjoys more influence in the EU, UN and NATO than would an independent Scotland. A common policy on Foreign Affairs allows the UK to have united armed forces supported by a network of Embassies prosecuting the UK’s foreign policy and promoting UK trade. None of that is compatible with an Independent Scotland

The Steel Commission describes the UK as (P48) “one of the great success stories of the world” but the same Commission and later the Calman Commission pointed to serious flaws in the Devolution settlement including: the absence of an English dimension in a quasi-federal structure; a lack of constitutional equivalence as between the nations of the UK; and funding arrangements for the Devolved Parliament and Assemblies that lack accountability and control. I believe there is a powerful case for the UK but I also believe the present constitutional arrangements are unsustainable in the long-run.  

The case for a federal UK

I believe federal Home Rule offers the most logical basis for: modernising the UK’s antiquated and inadequate constitutional arrangements and thereby providing a stable platform for the future of the UK; giving equivalence of status amongst Scotland; England, Wales and Northern Ireland; allowing the respective nations to determine their own governance arrangements in a federal structure; and allowing each nation to have economic and fiscal powers consonant with that federal structure

A new written constitution

 Liberals and Liberal Democrats have consistently argued for the UK having a written constitution. It is not a topic that generates much public interest but in the context of the prospective referendum on independence it should. The threat of the UK’s current constitutional arrangements being undone by Scotland voting for Independence is real and, in my opinion, it is in everyone’s interest to consider not only whether our present constitutional arrangements are adequate in general terms but also whether they are adequate to resist the threat of Independence.

Scotland is a Nation: that is not in dispute. In common with many Liberal Democrats I make the same distinction, as was frequently made by Russell Johnston, between the nation as the symbolic community which provides one’s feeling of identity, nationalism as an emotional commitment to a nation becoming a nation state and the nation state as a political formation which rules over a given territory defined by its boundaries. A Nation, however, should not be subject to another Nation but that is the current position of Scotland, Wales and Northern Ireland within the UK.As the Steel Commission points out (p45) “Scotland is not afforded the same level of constitutional protection through the Scotland Act as is seen in many federal states… …  It is unusual in that it confers ultimate power to Westminster.” It may be unusual but it is the consequence of our constitutional arrangements and where sovereignty lies.

The Calman Commission, provides a useful summary of the UK’s constitutional conventions (p50):  sovereignty resides in the Queen in Parliament but in practice in the Cabinet comprising Ministers appointed by the Queen and legislation is made by the Queen in Parliament giving rise to the doctrine of Parliamentary sovereignty vesting with the UK Parliament The importance of this doctrine was stressed last year by Lord Hope, Deputy President of the Supreme Court, when addressing the  question of competence of the   Scottish Parliament: (Axa General Insurance and ors v The Lord Advocate and ors para 46) “The United Kingdom Parliament has vested in the Scottish Parliament the authority to make laws that are  within its devolved competence. It is nevertheless a body to which decision making powers have been delegated. And it does not enjoy the sovereignty of the Crown in Parliament that, as Lord Bingham Said … , is the bedrock of the British constitution. Sovereignty remains with the United Kingdom Parliament.”

Although Calman highlights the issue the Commission appears to be satisfied that the use of legislative consent motions (formerly the Sewell Convention) “is the way of reconciling the doctrine of Parliamentary sovereignty.” In my opinion legislative consent motions are a hopelessly inadequate response to a serious flaw in our current arrangements. It may be that in practice the UK has not legislated in areas of the Scottish Parliament’s competence without recourse to legislative consent motions but the fact remains it is an unsatisfactory and in my opinion unsustainable arrangement. The Scottish Liberal Party policy pamphlet, Scottish Self Government was more blunt: “Scottish Liberals have never accepted the artificial unionist state which was imposed on Scotland in 1707…”  Our policy “… is for a revised Treaty of Union which would create a new federal relationship between the countries of the United Kingdom.” 

 

I believe there is an urgent need for there to be a new written constitution that recognises the geographic and cultural diversity of the nations of the United Kingdom As a minimum, (based on Liberal Democrat Policy Paper 40 as developed by the Steel Commission) the constitution should:  

(i)            establish the federal institutions of the United Kingdom as being a UK Parliament as the

federal state parliament and the parliaments/assemblies of the respective nations as the national parliaments/assemblies each ranking pari passu one to another;

(ii)           set out the right to self-determination of the peoples of Scotland, England, Wales and Northern Ireland;

(iii)          set, the powers and limits of the federal institutions, the specific powers reserved to the UK Parliament, the powers that are subject to formal partnership working, the powers of the respective cabinets, judges, courts and the Head of State; and

(iv)         entrench the Human Rights Act and the independence of local government.

I recognise that at least three major political problems are raised by this proposal: the call for a written constitution; the suggestion that there needs to be an English Parliament; and the creation of an asymmetric federal structure. Clearly, it is not our place to frame a new constitution on our own far less is it our place to tell the English how they should be governed but that should not prevent us developing and proposing a federal settlement for the UK. As Murray Leith says in his chapter in The Little Yellow Book: “Simply put, the lack of a written constitution is a problem that the UK has not addressed, and it is one that the country must consider if it is to survive as a political entity in the 21^st Century. “

In practical terms, the “West Lothian Question” and all the English governance issues that are wrapped up in that phrase need to be resolved. Calls for more legislative and economic powers for the Scottish Parliament and the Welsh Assembly will only exacerbate the problem. The notion that the problem can be resolved by either restricting the voting rights of  Scottish, Welsh or Northern Irish MPs or further reducing their representation at Westminster whilst it remains the Sovereign Parliament is preposterous.

As regards an asymmetric federal structure, this was examined by the Steel Commission and it concluded (P45): “Asymmetric federalism is not unusual, both in terms of the varying size of the component units and variations in the levels of power and responsibility afforded to them. … there is clear evidence that asymmetric systems can work …”

It is imperative that the Commission works with our Liberal Democrat colleagues across the UK on its proposals on federal Home Rule. Our Liberal Democrat colleagues need to be fully engaged in the process and to understand that, in the Independence referendum debate, Liberal Democrats must be seen to campaigning for a constitutional settlement that meets the needs of the nations of Scotland, England, Wales and Northern Ireland for the 21^st Century and beyond and puts the case for the continuation of the UK beyond doubt.

Internal and external relationships    

Both Steel and Calman report that the workings between the Scottish and UK Governments and between the Scottish and UK Governments and the EU operate satisfactorily. That they operate satisfactorily is, in my experience, entirely down to the hard work and goodwill of certain individuals both ministers and civil servants because the institutional arrangements are profoundly unsatisfactory. I say this as a former Scottish cabinet minister who over eight years attended some thirty meetings of the EU Council of Minister on environment, agriculture and fisheries business and met with UK ministers and ministers from the other devolved administrations on nearly fifty occasions.

The problem arises quite simply because UK ministers are just that. They are appointed by the Queen, must be appointed to the Privy Council, their civil servants serve a UK minister and the policies they prosecute are deemed to be the policies of the UK Government. That is quite proper for policy areas that are reserved but for Justice, health, sport, education, culture, enterprise, transport, housing, local government, environment agriculture forestry and fisheries it is not. When I was at meetings at Westminster, unsurprisingly the UK minister assumed his/her policy position was the UK position and the papers presented in support of a position were prepared by that minister’s civil servants who made the same erroneous assumptions.

This position was only exacerbated in the run-up to a meeting of the EU Council of Ministers where trying to impress upon the UK minister the need to agree a UK line was initially not helped by the UK Representation in Europe (“UKRep”) instinctively supporting the line presented by the UK minister. In order to try and overcome this problem a system (initiated by my department) was put in place whereby: the civil servants of all administrations met and prepared papers on matters under discussion at the EU Council, ministers from the UK and devolved administrations then met to agree the UK line and the UK minister then delivered that line with ministers from the devolved administrations in attendance.

This was not an easy process. Some ministers and civil servants at Westminster with whom I worked got the devolution point, others didn’t and some were even resistant to it. The whole process was too dependent upon the understanding and goodwill of individuals and a change in personnel, either minister or civil servant, could set it back. Although the Memorandum of Understanding, the Joint Ministerial Committee (“JMC”), and informal bilateral concordats between UK departments and the devolved administrations were in existence throughout both Liberal Democrat/Labour Coalitions they were regarded as mechanisms for dispute resolution notwithstanding their terms. Donald Dewar and Jim Wallace as First Minister and Depute First Minister and their successors encouraged ministers to deal directly with their opposite numbers and avoid resorting to formal dispute resolution mechanisms,

When the SNP minority Government came to power in 2007 the JMC had not met since 2002. The SNP accused the Coalition of having failed to “stand up for Scotland.” The truth was that despite some very real difficulties the Coalition had sought to cooperate - not pick a fight.

The fact is, however, that the fundamental problems largely associated with ministers having jurisdiction over only English policy being invested with the authority as the UK minister remain. Almost all of these problems would be greatly simplified if not resolved if we had a proper federal settlement. The constitution would provide for a proper separation of responsibilities as between UK ministers and ministers of the nations and regions and a mechanism for agreeing the UK position for EU meetings.

Legislative powers and responsibilities

I believe the Scotland Act 1998 is a good piece of legislation. Founded on the principles and proposals that emanated from the Scottish Constitutional Convention, it established the Scottish Parliament with a reasonable range of legislative and administrative powers and set out the boundaries between reserved and devolved competences. The competences have been extended particularly in terms of transport and, if the Scotland Bill is enacted then, as I understand it, the Parliament’s powers will be extended further to include: the administration of elections; control over air weapons; control over the misuse of drugs; the setting of drink driving limits and speed limits; rights over the appointment to the BBC trust and the appointment of the Scottish Crown Estates Commissioner; shared responsibilities over Insolvency; and the regulation of health professionals would become reserved.

Even with these further transfers of powers there are still areas where I believe the Scottish Parliament should be given competence including:

(a)  Medical Contracts where because of the considerable divergence in the method of delivery and incidence of private providers between Scotland and England it would make more sense for medical contracts to provide terms and conditions and levels of remuneration that reflected the outcomes and means of delivery expected in Scotland; and

(b)  Animal Health policy which is developed within Scotland but the funding is reserved which is anomalous whereas the control of exotic diseases whilst operated at a UK level on a partnership basis because the UK is a single epidemiological area and the funding needs to be reserved with access to the contingency fund in case of emergencies.

                                                               

The Steel Commission called for (P67) a new constitutional category of Partnership Working. I think this a very neat solution for those areas where self-evidently there is a UK dimension but where nations and regions have a real interest the implementation of the policy. Some of the policy areas I consider as important candidates for Partnership Working include:

(a)  Transport Policy where the remaining transport powers call for coordination and should be a shared responsibility;

(b)  Energy Policy where Scotland needs to be able to promote renewable sources and must be able to share in the development of economic stimuli like carbon trading and the Renewables Obligations and influence the policy on grid strengthening and renewal;

(c)  Marine Policy which is largely regulated by the Marine and Coastal Access Act 2009  and the Marine (Scotland) Act 2010 but where there is a large measure of national interest in marine spatial planning, conservation and sea fisheries, a federal state interest in naval operations, merchant marine operations, offshore exploration, energy transmission and shared interests in marine conservation and protection;

(d)  Immigration which needs to be reserved but where account must be taken of differing economic and demographic needs of the nations and regions and where policies for dealing with asylum seekers must recognise the statutory framework operating within a nation or region;                                                                          

(e)  Strategic  planning of welfare  services which needs to take account of the very different levels of need identified within the nations and regions of the UK;

(f)   Crown Estate where until its anomalous position exercising rights over the sea bed without democratic accountability is resolved the directions between UK ministers and National ministers need to be shared. 

Steel and others have supported calls for a separate Scottish civil service. If we are to retain the UK, as I believe we should and we are promoting federalism, then there will be a federal state government and we will continue to have UKRep. Both of these institutions need to be supported by civil servants drawn from throughout the UK and I can see no reason why each part of the civil service should not continue to benefit from individuals transferring within the UK to the joint benefit of all concerned.

Economic Powers

Both Steel and Calman concluded that one of the major weaknesses of the current Devolution settlement is the lack of financial responsibility and accountability. Steel’s solution was to propose fiscal federalism whilst Calman proposed a considerable increase in the financial powers of the Scottish Parliament which, as noted in my Introduction, the Coalition Government at Westminster greatly improved at the instigation of the Liberal Democrats and incorporated into the Scotland Bill.

If, like me, you see federal Home Rule as the constitutional solution in legislative and administrative terms, then the logical extension of that argument is to see fiscal federalism is the economic solution. That has certainly been my understanding of the Scottish Liberal position over many years. It may not have been called “fiscal federalism” but that is what the policy amounted to, In 1982, Scottish Self-Government spoke of: “The independent right of the states to raise their own revenues … … the federal government would continue to control monetary policy … … all taxes, with the exception of Customs and Excise and possibly VAT, should be raised in Scotland … … a Joint Exchequer Board would agree Scotland’s contribution to the UK …”  As the Party’s economics spokesperson in the late ‘70s and early ‘80s I vividly recall supporting these policy positions.

More recently, Jeremy Purvis became the first Scottish Liberal Democrat to set out cogently the case for fiscal federalism in his pamphlet of that name and which formed an influential submission to the Steel Commission of which he was a member. I fully support the Steel Commission’s conclusion (P89) “that fiscal federalism will provide the best mixture of economic stability, financial and political accountability and scope for innovative action  … for the  economy”. Steel set out (P93-96) ”Principles of Fiscal Federalism for Scotland” with which I broadly agree and, more importantly, I think could be adapted to apply to the nations and regions of the UK in a broader federal settlement.

Equalisation and shared responsibilities in fiscal and monetary matters

Equalisation and intergovernmental transfers exist in all federal systems and so in establishing a system of fiscal federalism in the UK there would be a need for a Joint Exchequer Board (JEB) with two primary tasks: first to bring about an element of equalisation on the basis of need; and, second to ensure the effective coordination of the fiscal and monetary policies being pursued by the Federal Government and the respective Governments of the Nations and Regions.

In a system of fiscal federalism I can see no alternative to a new needs-base formula replacing the current Barnett Formula. The JEB would have the critical responsibility for ensuring a fair distribution throughout the UK taking account of indicators of need relating to, for example, income distribution, poverty, deprivation and the effect on the cost of essential service delivery of rurality and peripherality. In addition to the general responsibility for ensuring that the fiscal systems operate effectively with no overlap and that borrowing limits are strictly adhered to I think the JEB should assist in coordinating the operation of benefits such as housing benefit, tax credits and pension credits with the workings of council tax and income tax at a National level.

Tax base and tax rate

As the Steel Commission out it (P45) “The greatest fiscal autonomy for sub-central states comes from control over the tax base and the tax rate.”  Steel goes on (P96) to set out four principles that should guide any system. I think clarity and simplicity will be best achieved if the division of taxes is clean cut, if the application of borrowing rules for both capital and revenue are clear and unambiguous and if the system for equalisation is based on a transparent needs-based formula. Similarly, I think a clean cut of taxes will greatly reduce the chances of tax exportation but as with the danger of tax migration I think the key restraining factor will be in the design of the borrowing powers.

There has been concern expressed at the prospect of a Scottish Government leading a charge to the lowest (say) corporation tax rate and provoking unseemly competition within the UK at the expense of the most vulnerable. Johann Lamont, Leader of the Scottish Labour Party, is amongst the most recent to express such concerns. If one is considering reducing a tax rate then, self-evidently, you cut expenditure, increase another tax or fudge the issue by bridging the gap through borrowing. I regard the choice between raising/lowering expenditure and raising/lowering taxation as a legitimate political choice. I regard abusing borrowing limits as imprudent and unacceptable financial management and I develop this further at Borrowing Powers below.

    

The final principle Steel highlighted was efficiency and I think this is best achieved by developing further the responsibilities of HMRC such that it becomes the servant not only of the UK Government but also the nations of the federal state.

The Calman Commission considered in some detail whether any taxes might be devolved (P90-102). It found against devolving any tax that give the Scottish Parliament any real economic powers, only considered relatively minor taxes as suitable for control by the Scottish Parliament and opted for a substantial increase in the amount of revenue from income tax to be raised directly by the Scottish Parliament. I think the Nations and Regions of a Federal UK need to have the economic powers to set a fiscal framework that is appropriate to meet their needs whilst at the same time taking responsibility for raising the overwhelming proportion of the revenue required to meet their social needs. The Federal UK should be responsible for not only funding defence and national security but also providing the glue for the social cohesion of the Federal State by guaranteeing basic levels of pensions and social security and tackling poverty and deprivation

I believe, therefore, the Scottish Parliament (and other National Parliaments/Assemblies) should have the powers to raise as much as possible of its expenditure needs and should have responsibility for all taxes except those reserved to the Federal UK. The Scottish Parliament should have the power to alter the tax base and the tax rate for each devolved tax and should have the power to abolish any devolved tax or introduce a new tax subject to meeting objective criteria agreed with the JEB

At a Scottish/National level I would, therefore, give the Scottish Parliament control over:

(a)  Income and wealth  taxes: Income Tax, Corporation Tax, Capital Gains Tax, Inheritance Tax, all other taxes on income and wealth;

(b)  Property taxes: Council Tax, Non-domestic Rates, Stamp Duty, Land Tax;;

(c)  Environment taxes: Climate Change Levy, Aggregate Levy, Landfill Tax; and

(d)  Miscellaneous: Betting and Gaming Duties

In addition, I would provide for the Scottish Parliament to have automatically allocated to it:

(a)  The Geographic share of NS Oil revenues; and

(b)   Interest and dividends, Gross Operating Surplus (being mostly from Scottish Water), Rent and other current transfers and other taxes etc

This would leave as reserved or UK Federal taxes: National Insurance Contributions; VAT; Stamp Duty Reserve Tax; Alcohol, Tobacco, Fuel and Vehicle Excise Duties; Air Passenger Duty, and Insurance Premium Tax.

Borrowing Powers

Both Steel and Calman considered the very limited and short-term borrowing powers provided in S66 of the Scotland Act 1998 to be inadequate. Calman proposed (P112) an additional power to borrow to increase capital investment in any one year with the limit to be determined in a similar fashion to the Prudential limit operated by local authorities. The Scotland Bill proposes an extension in the borrowing powers setting a limit for short-term revenue borrowing at £500 million and granting new powers to Scottish Ministers to borrow to fund capital expenditure with a limit of £2.2 billion. From debates on the Bill at Westminster it is clear that the limit of £2.2 billion is considered by the Coalition Government to represent an acceptable risk for the UK finances that does not crowd out other priorities in the next spending review period. It appears that the limit could be increased depending on economic circumstances with the approval of the UK Parliament.

The borrowing powers required by the Scottish Parliament would require to be amended from those set out in the Scotland Bill (S37) to reflect the change to the tax base and the removal of the current block grant. The powers would need to address three areas: short-term timing differences; the effects of an economic downturn; and funding capital expenditure. The powers would have to be capable of relating to UK macro-economic policy, be operated with the JEB in accordance to its terms of reference and the mechanism for deciding the total quantum of permitted borrowing under each heading has to be set out in terms that are clear and transparent.

Drawing up rules to manage short-term cash deficiencies that arise from timing differences between planned income and expenditure should not be difficult as they are currently provided for. The second category, funding policies that smooth the economic cycle maintaining public service provision during an economic downturn, might prove more difficult. These rules would have to draw a clear distinction between a loss of revenue arising from a reduction in the buoyancy of a particular tax as the result of an economic downturn and a loss of revenue arising from a decision to lower the rate of a particular tax. (This is the issue referred to at para 2 of the section Tax base and tax rate above). The third category, financing capital projects, is again easier to define but the rules have to make clear how the limit is arrived at and how it fits into wider UK macro-economic policy. In drawing up borrowing rules the Steel Commission helpfully suggested P95 that “it would be necessary to develop “Golden Rules” governing the way in which the UK Government and the Scottish Government exercise their fiscal powers.”.

The problem with the current Golden Rules is that they are only a guideline for the operation of fiscal policy. The Golden Rule in the UK states that: “over the economic cycle, the Government will borrow only to invest and not to fund current spending”. In other words on average over the duration of an economic cycle the government should only borrow to pay for investment that benefits future generations. Day-to-day spending that benefits today's taxpayers should be paid for with today's taxes, not with leveraged investment. Over the cycle, therefore, the current budget (net of investment) must balance or be brought into surplus.

I think that the core of the 'golden rule' framework which is that, as a general rule, policy should be designed to maintain a stable allocation of public sector resources over the course of the business cycle has a great deal to commend it. I believe the core provides the basis of binding borrowing rules particularly if one takes account of the fact that “stability” is defined in terms of the following three ratios: (i) public sector net worth to national income; (ii) public current expenditure to national income; and (iii) public sector income to national income.

The difficulty is that everyone is well aware of how these very sound principles, expressed in terms of the Golden Rules or the Euro Borrowing Rules, have been rather easily over-ridden. In the UK, the over-ride was effected by changing the length of the economic cycle and in the EU by redefining the assets that qualify as security. I still think the principle should form the basis of UK federal borrowing rules but they would have to drawn up in such a way that any breach constituted an illegal act by the respective Government/Parliament and meant it was acting Ultra Vires.

Conclusion

As I hope is clear from my submission, I have not deviated from my long-held belief that only federal Home Rule offers a stable constitutional settlement that satisfies the legitimate governance aspirations of the Nations and Regions of the UK for the 21^st Century and beyond. I believe I have demonstrated that only federal Home Rule has the capacity to address both the constitutional and financial accountability shortcomings of the current Devolution settlement, the operational anomalies of the UK (predominantly English) Parliament at Westminster and the absence of a dedicated UK federal parliament that would facilitate fiscal federalism.

Your Commission has been asked, amongst other things, to build on the findings of the Steel Commission and I hope my submission will contribute to that process. As a matter of practical politics, however, your “Flyer” poses a number of questions including: how do we ensure home rule is a permanent solution? how do we ensure it is not dependent upon wholesale changes across the UK? and what are the hurdles to governance of England?

I cannot see how we even begin to move towards a permanent solution unless and until there is at least some consensus as to the nature of the problem. It is depressing that Cameron, Clegg et al (with the singular exceptions of Michael Moore and Jim Wallace) think the answer is more powers to Scotland under Devolution if the Scots say “No” to Independence.  A Scottish Government proposing to bring forward an Independence referendum is a threat to the continuation of the UK and the UK Government ought to be treating it as such. If the threat is to the UK, as it manifestly is, then the answer has to be framed to address that problem.

Because the de facto position is that the UK Government is the English Government and vice versa, I also cannot see how one can avoid engaging with the English to find a stable and long-term solution to the problem. Indeed, I think it is potentially dangerous to contemplate any further constitutional change unless it is at a UK level. As I have shown in this submission, positing a Scotland only solution proceeds on the wholly erroneous assumption that one can change the constitutional arrangements for Scotland without affecting the rest of the UK.

In my opinion, therefore, that aim has to be to establish the creation of a modern federal British State with Home Rule for all of its constituent parts as the long-term objective. A route map for the progressive untangling of the British equals English equals British conundrum has to be put in place. Any proposal to transfer further legislative or administrative powers to the Scottish Parliament should be framed on the basis that it ultimately would form part of a federal Home Rule Settlement that would apply equally to the other Nations and Regions of the UK. Likewise, any proposal for the transfer to the Scottish Parliament of financial powers in the form of fiscal federalism should be framed on the basis that this is the system that would ultimately apply throughout the UK.

Politicians show their good side at Breakthrough Breast Cancer debate

On Wednesday evening, Breakthrough Breast Cancer held a pre-election hustings on Women's Health in a Recession at the Scottish Storytelling Theatre in Edinburgh. Six politicians gathered to discuss issues from cancer treatment and detection to increasing breastfeeding rates. The photo shows the panel, from left to right:

Jackie Baillie (Labour), Ross Finnie (Liberal Democrat), Alison Johnstone (Greens), Audrey Birt, Director Breakthrough, Nicola Sturgeon (SNP), Nanette Milne (Conservative) and Margo MacDonald (Independent).

Beforehand, we'd chatted over coffee outside. I was blethering with Ross Finnie. He'd spent the whole weekend at Conference darkly warning that if he made any pledges that cost money, Jeremy Purvis would appear in a puff of smoke and tell him off. I told Ross that I was there as Jeremy's spy and would tell on him. You could tell he was petrified at the thought. Nicola Sturgeon then appeared and Ross introduced us. She said "Ah, are you Twitter Caron?".  We had a very enjoyable chat about Twitter. She said she really enjoys it - and you can actually tell. She's one of those politicians that get it's about a conversation not a broadcast. Later on, she said it was quite disconcerting to be answering a question in someone who was tweeting the answer as she said it. I guess someone is taking down her every word as she utters it in the Parliament, though, so it's not so different.

An amusing aside was that so many people, including Nicola and Jackie Baillie, had trouble getting hot water out of the flasks. I'd taken the coward's way out and gone for the coffee, which was much easier to operate.

We were told the Twitter hashtag at the start of the meeting, which made me think that there would be lots of people voraciously tweeting. When I checked out our little corner of the Twitterverse later, I discovered, to my slight embarrassment, that it was in fact just me. Twitter works best when there's more than one perspective on it and with the best will in the world, there's no way I could capture everything, and you tend to hear things that you are interested in more clearly. However, out of 34 tweets, only 2 of them could be construed in any way as party political and I did try to capture the best of everybody.

With just an hour, and six panellists, there was only time for 3 questions, which were discussed in some depth. First, though, each gave a 90 second summary of how their policies would impact on women's health in a recession

Jackie talked about the need for flexible childcare and a living wage, along with a 2 week cancer guarantee treatment time and the need for preventing rather than curing.

Ross spoke of need for early diagnosis and treatment and, not surprisingly for a Liberal Democrat, emphasised the need for services in the community, as close to people as possible.  He also spoke out opposing what had been said by the Scottish Breast Cancer Campaign, reported here in the Herald, about the breast screening programme. The SBCC thinks that women who don't necessarily need treatment are offered it when pre-cancerous cells, which may not necessarily develop into active disease, are detected in routine mammograms. Ross said that he could not countenance any diminution of the screening. There was a slight frisson of controversy when the SBCC Director later asked a question although she made it clear that that wasn't the time and place to have that discussion, but she'd be happy to talk to Ross at a different time. Maybe the untimely deaths of two close family members to this disease has coloured my opinion, but I just wonder if earlier diagnosis and treatment might have meant that Anna would still have a paternal grandmother and aunt to enrich her life. I lean towards Ross on this one.

Alison talked about the need for a holistic approach to health and in particular greater understanding of the environmental impact of chemicals we use in our daily lives as a matter of routine.

Nicola said that the SNP would protect the NHS budget, and would introduce a living wage and spoke of the need for much more to be done on lifestyle issues, particularly alcohol. I thought there might have been a bit more of a discussion on minimum pricing later on, but it wasn't mentioned again.

Nanette said the Tories would implement greater screening for those aged 40-74, £20 million for more health visitors and a Cancer Drugs fund.

Margo said she tended to agree with Alison's holistic approach and, although I can't remember the exact context, said Ross Finnie was a sweetie. He blushed.

As Jackie and Nicola both mentioned the living wage, it's worth adding in here that the raising of the tax threshold for those on low and middle incomes does much the same thing - and that will hopefully get to £10,000 by the end of the Parliament. That is a real achievement of the Liberal Democrats in the Westminster Government and it also applies to everyone, including pensioners, not just public sector workers.

The first real question was around how do we make sure that women look after their own health during austere times when they are more likely to be stretched looking after everyone else and probably suffering most from the effects of poverty. Everyone agreed about the need to make sure more women went for screening, picking up more Cancers and saving lives. Nicola said that getting treatment quickly was important, but that too many people are diagnosed too late to have any sort of a cure, so getting people educated about signs to watch out for, tailoring the message to different audiences, was really important.

The only real disagreement on the panellists was on the question of the idea of a Cancer Drugs Fund. The Tories were well in favour, saying that it was wrong to do things differently from the rest of the UK. Ross Finnie for the Liberal Democrats was equally adamantly opposed, saying that it was intellectually incoherent to undermine the Scottish Medicines Consortium. He said that if things needed changing, then the way to do it was to change the SMC's operating criteria. The others were various shades of maybe - Nicola talked
about the possibility of exceptional prescribing, and also said the issue raised ethical questions the bitggest of which was why just Cancer drugs? She said her postbag contained requests for Alzheimers drugs among other conditions & that more people were cured by methods other than drugs. Jackie Baillie said that she felt that the Jury was still out, as did Alison Johnstone. Margo was quite stark and realistic - saying that when resources were limited, we had to make hard choices about our priorities and that can be quite difficult to face up to.

Then it was my turn to ask a question. Regular readers here will know my interest in breastfeeding as a former breastfeeding counsellor. When I start to talk on this subject, donkeys across the land fear for their hind legs. I asked simply "What's your big idea to improve breastfeeding rates?" I will write a longer post analysing their replies and adding a few of my own ideas, but I'll just say here that I was impressed with the different perspectives each brought to the debate. Margo was down to earth and hilarious, talking about how she was something of a novelty in her Lanarkshire maternity hospital, being one of the rare breastfeeding mums and was often seen by visitors with nursing baby in one hand and cigarette in the other. Nanette spoke of difficulties arising because of mums being discharged from hospital mostly just hours after giving birth. Nicola talked about cultural barriers, and how important it was to make sure that people didn't feel lectured at or guilty for the choices they made. For Alison the key was better information and support, a point taken further by Jackie who spoke of the value of ordinary women supporting other ordinary women, without medicalising it, without uniforms. Ross, as the only man on the panel, spoke of the barriers put in the way by men and the need to tackle them. Both Jackie and Ross paid tribute to Elaine Smith who introduced the law which protects women who want to feed their babies in public places.  I remember it taking quite some doing to get the Government to support the Bill when it was brought in, and I'm glad everyone's now singing from the same hymn sheet.

There was then the opportunity for the audience to make some brief points before closing statements. Many people talked about lymphoedema. Margo talked about the importance of teaching massage techniques to carers and people who have the condition and Alison, who is an athletics coach said there were sports massage techniques which could help. Jackie said that when times were tough, people expected politicians to work together. If the panel can just get that through to Iain Gray and Alex Salmond, that'd be fabulous.

And look who I caught up with for a photo.

You don't often come out of a political debate in the run up to an election feeling all warm and fuzzy, that you've learned something and that the politicians are all totally engaged and interested, but this was an exception. Of course there are some major caveats - if they can't behave themselves at a cancer charity hustings, there really is no hope. I'm also sure that the fact that there were so many women, not just in the panel but in the room, had something to do with the civilised atmosphere. And most importantly, there was an unusually high level of consensus because there was no discussion of the really controversial issues. Free prescriptions weren't even mentioned, for example. However, all of the politicians came across extremely well, and Breakthrough's key messages were well discussed. A win win for everyone, I'd say.

You can judge for yourself with this short video Breakthrough have put up on their Facebook page.

Ross Finnie on Patients Rights Bill: What the Scottish Liberal Democrats would do

I have just had the quick chat I hoped for with Ross Finnie about the Patients Rights Bill due to be debated at Holyrood this afternoon. He told me why the Liberal Democrats are so opposed to it and what he would do in its place.

Ross started off by giving a bit of background about how we'd got to where we are with this Bill. He told me how the legislative process had started off with a consultation during which patients' groups had expressed a desire for something which brought patients' rights all together in one easily understood document, but they didn't want a lawyers' charter. The SNP Government ignored a lot of what they were saying and brought forward this very limited Bill with its clause 18, which makes it unenforcable.

He said to me that even then, this Bill had brought all the rights together, then it might have had some merit. However, he then went on to list 17 fairly fundamental rights which the Bill leaves out. These include things like the right to a GP, to mental health advocacy, to a second opinion. Even something as basic as requiring all health professionals to show due care and attention just isn't there.

I asked him what he would do if he were the Cabinet Secretary for Health. He said that he was impressed with what had happened in places like England and Australia where a Patients' Charter had been revised and updated in consultation with Patients' Groups. These documents were written in plain English and were easily accessible.

I actually went looking and found that the Australian version shows another glaring omission from the Bill - something as basic as the right to privacy and confidentiality.

Anyway, back to Ross. He told me that he'd make sure that the Charter was more than words on a page if he were the Cabinet Secretary by issuing it as a direction under the NHS Scotland Act 1978 requiring NHS boards to comply with it. I asked what that would mean for the patient. He said that rather than go through an expensive and lengthy legal process, a simple letter to the Cabinet Secretary showing how the Board was failing to comply with their direction would be an option if the complaints process failed to provide a satisfactory response.

I asked him about resolving complaints as I had often felt that better communication with patients and their families and a more genuine approach to complaints could resolve many issues satisfactorily at a much earlier stage.  Ross said that what most people actually wanted was an apology when things went wrong, and that was one thing that they were often denied as NHS institutions felt that to offer one would be to concede legal liability. He wants to see some sort of non litigious settlement procedure where people can have that sort of honest discussion.

He said that the only bit of the Bill which had "serious merit" was the Schedule at the end (which you can find here on page 12). "What Patients' Rights Groups want, " said Ross, "is not a half baked law, but high quality, patient centred care and good communication to be elevated. The Schedule should be the basis for action, not tacked on at the end."

He expressed his frustration that Labour, who have argued against the substance of this Bill from the start, saying how bad it was, have now inexplicably decided to support it.

My conversation with Ross confirms my earlier instinctive view that this Bill will ultimately offer as much benefit to patients as a chocolate teapot. In fact, it omits so many basic and fundamental rights that it could actually be counter-productive. As ever, it's the Liberal Democrats who look beyond the words and see how the law will work in practice.

What's not to love about the Patients' Rights Bill?

This afternoon, the Scottish Parliament will be debating the Patients' Rights Bill.  Surely this must be a good thing, to set out what patients can expect from their NHS. I mean, who could possibly object to Clause 1 (2) which says:

Health care is to—

(a) be patient focused: that is to say, anything done in relation to the patient must take

into account the patient’s needs,

(b) have regard to the importance of providing the optimum benefit to the patient’s

health and wellbeing,

(c) allow and encourage the patient to participate as fully as possible in decisions

relating to the patient’s health and wellbeing,

(d) have regard to the importance of providing such information and support as is

necessary to enable the patient to participate in accordance with paragraph (c) and

in relation to any related processes.

Well of course health care has to be patient centred and patients have to be fully aware of what's going on around them. I know how it used to be as I have personal experience of care not focusing on the patients' needs.  When my mother in law was diagnosed with terminal Cancer and given weeks to live many years ago, her consultant never told her. He told my husband and said he'd have a frank discussion with his mum about her situation - which he never did. She never talked about what the consultant had said to her and my husband never brought it up, each thinking the other knew and couldn't bear to discuss it.  Eventually his mum took control of the situation when she realised she wasn't really getting any better and insisted that the medics told her the full truth. A lot of time had been wasted, though.

And then we had the district nurse, who was a lovely woman, coming in every day being bright and jolly and encouraging his mum to eat and not really looking at where she was at. Tumours in the stomach don't generally give people a huge appetite. It took a very frank and occasionally fractious conversation with me for her to get her head round what she needed to do. She was just focused on patients getting better, but really didn't have much empathy and understanding of how to deal with it when that wasn't going to happen. She did get it a lot better after our conversation and made sure that we then had the Macmillan nurses as well as her who were beyond fantastic. Generally, though, I feel that if my mother-in-law's care had been truly patient focused, she wouldn't have had to go through the majority of her final weeks without her being able to make decisions about the real issues she was facing.

Anyway, I digress. I saw on Twitter last night that the Liberal Democrats in the Scottish Parliament are voting against this Bill. Given that we would naturally be in favour of people centred public services, and given my trust in Ross Finnie, our health spokesman, I guessed that there would be a good reason. So, I read the rest of the Bill and I started to see why.

We have all those wonderful principles in the initial clause which are almost immediately countermanded by Clause 2. Yes, we'll do all of those nice things, it says, but:

"In construing the right of a patient under section 1(1), the matters set out into Section 2 below must be taken into account"

(a) the rights of other patients under section 1(1),

(b) the desirability of action delivering health care being proportionate, and otherwise

appropriate, to the circumstances of each case,

(c) those specified in section 18(1)(a) and (b).

 Sorry, but the words in a and b seem to me to be a fairly substantial get out clause to me. And that's before you even get to clause 18 (2)  which is a really big sting in the tail:

Nothing in this Act shall give rise to:

any liability to pay damages; any right of action for specific implement; any right of action for interdict; any right of action for suspension;

So, you have a bill which basically says:

Dear Patient,

We think you should be treated within 12 weeks, and we think your care should be patient focused and all sorts of other good things. We'll give you a few rights, and then we'll give ourselves a get out clause so we can argue against delivering them, and then we'll make sure that although you might be able to complain, there is nothing you can do to enforce your rights.

Cheers,

The Government

Patients Rights Bill? Chocolate Teapot Bill, more like.

I also looked up the Scottish Government's FAQ on the Bill. I think that one of the areas where the NHS isn't delivering appropriate and fast enough treatment is in mental health. People just don't get the support they need quickly enough. Mental health services aren't excluded from the Bill, but there's a big but.

The treatment time guarantee will apply to mental health services where they are delivered as planned and elective care on an inpatient or day-case basis.

This is likely to have the biggest impact on child and adolescent mental health services, because they make more use of planned admissions than other mental health services, which are often used because of a crisis or emergency, where it would not be appropriate for patients to wait for treatment.

To me this seems like mental health services are only included where they involve some sort of hospital admission and not, for example, access to a Community Psychiatric Nurse. It stands to reason to me anyway that if people have the earlier community based intervention, then the need for emergency admission, or planned hospital admission is minimised. Why not have the guarantee where it can make the most difference?

There's a lot of emphasis in the Bill on Patients' Rights Officers, too. Tavish asked at FMQ earlier this year about whether we should really be spending £1.2 million on effectively more administrators at the same time as we're cutting nurses. I mean, it's all very well to have people walking around with clipboards and Excel spreadsheets pointing fingers if targets aren't met, but what are they going to do about it if operations aren't carried out in the 12 week guarantee time? Are they actually going to scrub up and get into the operating theatre? Wouldn't an extra nurse be better?

I'm hoping to grab a chat later with Ross Finnie, to talk about what he thinks should be done instead, and why he thinks this Bill is so bad that it deserves outright opposition rather than amendment. If that happens, you will be the first to know.

Lib Dem Finnie calls for probe into hospital malnutrition deaths

Scottish Liberal Democrat Health Spokesperson Ross Finnie has called for ministers to investigate whether malnutrition in hospital patients is being properly diagnosed after official figures sought by the Liberal Democrats showed that this was the cause of death for 450 people in hospital over the last five years.

Ross Finnie said:

"It is alarming that anyone in Scotland is dying of malnutrition in this day and age.

"Most victims are elderly people, many of whom have conditions that make eating difficult or need help with their meals.

"These figures raise the serious concern that in some hospitals, malnutrition is not being properly diagnosed.

"Ministers must investigate this issue as a matter of urgency."

I think he's right to ask the Government to make sure that there are procedures in place to check that patients, particularly the elderly, are eating as well as they can, and helping them if they can't, for example, feed themselves.

Sweet Dreams from the Scottish Liberal Democrats

Oh, I know I'm asking for trouble with a headline like that. You may mock, but there is a serious point to it all if the number of folk who are usually around on Twitter in the middle of the night is anything to go by.

I was lying in bed last night, uncharacteristically, and somewhat ironically, unable to sleep. The buzz of my blackberry alerted me to this.

Jim Tolson MSP for Dunfermline West asked the Scottish Government's Health Minister Shona Robison a series of questions relating to sleep disorders and prescriptions of drugs to aid sleep. The answers were worrying.

In 3 years, 130,000 people have consulted their doctor for help with some sort of sleeping disorder. For all those who feel that bad, I expect there are many more having trouble sleeping. In that time, the NHS has spent £1.1 million on sleeping drugs.

I have always needed my sleep. One night without eight hours I can just about manage. Two nights and I turn into the witch queen from hell. Three nights and anyone around me had better run for the hills. Fortunately, for most of my life, I've had no trouble getting to sleep, and once I'm there, you have no chance of waking me up unless you have a rather large stick of dynamite or a very cold, wet sponge. Even then, you're likely to get nothing more than a barrage of abuse for your trouble before I turn over and pull the duvet over my head. Sleep deprivation was one of the things I was really scared about when it came to having a baby. Happily, Anna and I slept in perfect harmony together, and although she didn't actually sleep through the night until she was around 2 and a half, it never really bothered me.

I have had periods in my life, mercifully brief, when sleep has eluded me and it's been utterly horrible and miserable. It affects you physically, because you just feel like lead and your head feels like cotton wool. It has to affect your judgment even if it's not dangerous. Having a chronic problem with insomnia must be indescribably awful.

There was an episode of the West Wing where President Barlet hadn't slept for five nights and a psychiatrist was brought in at great expense to try to get to the bottom of it. Thanks to my friends on Twitter, @draml, @allanmknox @thurible and @NickThornsby who reminded me of the title so I didn't have to get off my backside and look through my boxsets so I can show you this clip.



Liberal Democrat Health spokesman Ross Finnie has called for more investment in Sleep Clinics to tackle the problem which seems to be much more sensible than throwing drugs at it. He said:

"These are revealing statistics on a little-known affliction. Many thousands of people across Scotland are silently battling with sleep disorders, which can be physically and mentally debilitating.

"Insomnia ruins lives, while sleep apnoea and narcolepsy can be fatal.

"The vast majority of these GP consultations are for insomnia. Effective treatments are available at Scotland's sleep clinics but more must be done to improve access. Sleep clinics must be made a priority.

"By sending more people to sleep clinics we can keep them off sleep medicines and slash Scotland's prescriptions bill.

"I am worried that this could be the tip of the iceberg in terms of Scotland's sleep problems.

I'd say his solution was infinitely preferable to the Scottish Government sending Alex and Nicola round to sing a lullaby, particularly as we already know that the First Minister's singing voice isn't his greatest asset. Sorry. I couldn't resist. I have a feeling that this is kind of like that picture they keep publishing in Private Eye of Andrew Neil, which must have been going on for 20 years now.

Scottish Liberal Democrats highlight botched operations

Ok, if you're about to have an operation in a Scottish hospital, please don't panic. The chances are that the medical team operating on you are going to do their jobs with excellent professionalism and skill.

However, the Scottish Liberal Democrat Health Spokesman Ross Finnie has obtained figures that give cause for some concern. He is worried that patient safety is being compromised in some cases as Health Boards are pressured to meet targets on things like waiting times.

The figures released in a Parliamentary answer show that in the last 5 years, 3106 people have suffered some sort of organ damage through cuts being made in the wrong place, for example, out of a total of 5514 surgical errors such as leaving swabs inside a wound.

The first thing I asked myself when I saw this was "how many operations took place in Scotland during this period." Fortunately I didn't have to look very far, because the Scotsman had done it for me - 1.2 million operations took place during 2008. If you multiply that by five, that gives 6 million. On these figures, the risk of surgical error is tiny - 0.0919% of an error happening, 0.05% chance of organ damage.

So, while there's no reason for panic, the fact that over 5000 operations have resulted in some kind of error is a cause for concern. It's important that every instance is properly investigated and action taken to prevent these mistakes happening in the future. It's also important to work out whether these errors are being caused by too much pressure being put on staff and if so, then, I'm sorry, but patient safety has to come first.

It does seem to be that the chance of error is highest in the busiest places - Edinburgh, Glasgow and Fife being the top three. I wonder if there's some relevance in that the first two especially carry out some of the most demanding, specialist procedures which are riskier anyway. I'd like to see some more detailed figures, broken down further to see whether it's the routine operations for conditions where there are long waiting lists, or the specialist surgery that have the most chance of ending in an error. There's no excuse either way, but knowing that will help find a solution.

Our NHS is excellent and deserves its good reputation, but we can't let things like this pass without taking action.

All credit to Ross Finnie and his team for their work on this. Let's hope that the SNP Government takes notice.