Last year the Scottish government said it would consider bringing forward new legislation on an "opt-out" system for organ donation despite MSPs rejecting a Labour member's bill on the topic.

MSPs voted by 59 to 56 to reject taking forward Anne McTaggart's Transplantation Bill, external.

Holyrood's health committee backed the aim, but not the detail of the bill.

The government amendment accepted by MSPs said there were "merits" to such a system and pledged a consultation.

Image source, SPL

The amendment, lodged by public health minister Maureen Watt voiced "serious concerns" about the "practical impact of the specific details" of the bill as it stood, and prevented it from proceeding to the next stage of consideration.

However, Ms Watt did say a "workable" opt-out system should be considered, calling on the government to "commence work in preparation for a detailed consultation" during the next parliament.

The SNP offered members a free vote on the issue, and 11 administration MSPs voted against the government amendment, which won out only with the votes of Conservative and Liberal Democrat members.

• Look back at the Transplantation Bill debate on our Holyrood Live page

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Labour MSP Mark Griffin says the committee has his proposal for a member's bill for a soft opt-out for organ donation and his argument for why a further consultation is unnecessary. 

Mr Griffin says his father, when he was twelve, was diagnosed with a heart condition and waited ten years for a heart transplant.

He says his father was not strong enough to make it through the transplant and died.

Labour MSP Mark Griffin has a draft proposal for the Transplantation (Authorisation of Removal of Organs etc.) (Scotland) Bill. 

The proposal was lodged on 19 December 2016. 

The proposal is for a Bill— to amend the law on human transplantation, including by authorising (in certain circumstances) the posthumous removal of organs and tissue from an adult who had not given express consent.

The proposal is the same as the one lodged by Anne McTaggart MSP on 26 June 2014, details of which are outlined below. 

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In the last session of the Parliament, Anne McTaggart MSP consulted on the same draft proposal. That proposal was lodged on 26 June 2014 and consulted on until 25 September 2014.

The consultation document is available from this link., external

 Anne McTaggart’s consultation sought views on changing the system of organ and tissue donation registration from an opt-in system to a ‘soft optout’ system in Scotland. 

The basis of the proposed soft opt-out system would be that organs and tissues could be removed posthumously from an adult who had not registered or expressed an objection during their lifetime.

 n contrast, the current opt-in system of organ and tissue donation encourages those wishing to become a donor to register on the NHS Organ Donation Register.

Image source, SPL

Last Summer the Evening Times reported that  Labour MSP Mark Griffin, whose dad died after waiting ten years for a heart transplant, was to re-launch a bill to change Scotland's donor registration system, external.

Mr Griffin set out his plans to bring back a private members bill to introduce an opt-out system of organ donation.

In the last Parliament the bill received cross-party support but was narrowly rejected in a tight vote at Holyrood.

The SNP government pledged to legislate itself but has not given a timescale for any potential change in the law. 

A planned consulation is looking at a number of options to increase donor numbers.

The committee will now take evidence on the Transplantation (Authorisation of Removal of Organs etc.) (Scotland) Bill from the following Scottish Parliament representatives:

Mark Griffin, Member in charge of the Draft Proposal

Andrew Mylne, Clerk Team Leader, Non-Government Bills Unit

Committee convener Neil Findlay asks about cuts to services and the impact of it to the NHS.

Dame Denise says that the issue is about how we use our funding and that the NHS will have to live with the reality that funding is going to be tight whatever is done.

She says that problems are not about cuts to services but rather about changing serivces and shifting resources.

She says that focussing on cuts could "drive ourselves down a negative rabbit hole".

"We can do much better with the money we have at the moment" she says.

Conservative MSP Miles Briggs asks about senior management in the Scottish NHS, asking if the right people are in place to take forward a period of major reform in the health service.

Robbie Pearson replies that the context is changing in NHS Scotland as governance is more complicated than it used to be. He says that the skills for the future will be more focused on influence and negotiation rather than command and control.

This will require a different approach to leadership, he says.

Dame Denise says that we need to look at how we train leaders across the whole public sector, adding that leadership skills in future will require knowledge of transformational change and strategic planning that doesn't necessarily require a clinical background. 

She adds that growing managers from within Scotland will be the way forward. 

Dr Brian Robson adds that management in the health service is very complex and that the relationship between management and clinicians is crucial for good performance. 

Alison Johnstone goes on to ask about staffing and leadership levels in the NHS.

Robbie Pearson replies that HIS undertake quality of care reviews on these issues that take in workforce, leadership and several other dimensions of quality that need to be measured.

He says that this work is already underway.

Dr Brian Robson, Healthcare Improvement Scotland's Medical Director, adds that workforce is not just about numbers; saying that the mix, training and experience of staff needs to be taken into account. 

Green MSP Alison Johnstone asks how often HIS standards are updated and what happens if a health board fails.

Robbie Pearson from HIS says standards are important and they are being updated.

The new standards will be used by the inspectorate, he says.

Mr Pearson says there is process for updating standards.

He says if a board is not meeting the standards HIS is requirements and recommendations.

There are unannounced follow up inspections says Mr Pearson.

The HIS chief still unsatisfied it can be escalated to the Scottish government.

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Ruth Glassborow from Healthcare Improvement Scotland says it is important to supply the practical support for hospitals.

Ms Glassborow cites the case of delirium in hospitals and describes the practical tools that were put in place and the support provided to clinicians.

Conservative MSP Donald Cameron says that HIS has to deal with complaints about the NHS despite having limited enforcement powers and ultimately reporting to government.

He asks if, given this situation, the witnesses feel that Scotland needs a "truly independent" health regulator comparable to the Care Quality Commission (CQC), external in England.

Robbie Pearson replies that he would be "very cautious" about changing the current arrangements where there are officers in the Scottish NHS who are directly accountable to parliament.  

To change this, he argues, it would be necessary to introduce a regulatory regime and a different set of accountabilites and sanctions to the whole process of NHS oversight. 

"Inspection alone will not drive improvements" he says, adding that the current arrangement of HIS gives "something unique" to the Scottish oversight model as it takes more aspects of healthcare provision into account when evaluating performance and quality. 

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Dr Brian Robson from Healthcare Improvement Scotland says HIS takes advice from across the world.

Dr Robson says "regulation has a role if done correctly", but if done from the outside it does not improve care. 

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Healthcare Improvement Scotland chair Dame Denise Coia says it is really important that there is independence from central and local government.

Dame Denise says HIS must also be independent from a lot of vested interests .

She says: "You really have to work at independence." 

The HIS chair says the organisation has to be apolitical and compassionate.

Liberal Democrat Alex Cole-Hamilton says that evidence taken by the committee last week suggested that, despite £2.3 million funding, the Scottish Health Council had only taken the views of 1100 people in the last year. 

He says that this points to a crucial conduit for patients being "stifled at best". 

HIS chief executive Robbie Pearson replies that the 1100 number was in relation to one initiative taken by the health council. He tells the committee that the Scottish Health Council engaged with just short of 13,000 people in 2016. 

He adds that there would have been "tens of thousands more" than that who were engaged with on social media and the internet.  

Committee convener Neil Findlay says that he is shocked it has taken a week to clear up the misunderstanding around the number of people helped by the health council. 

Image source, Scottish Health Council

The Scottish Health Council, external was established by the Scottish Executive in April 2005 to promote Patient Focus and Public Involvement in the NHS in Scotland. By ensuring that NHS Boards listen and take account of people's views, it says it can achieve a "mutual NHS" - where the NHS works in partnership with patients, carers and the public.

It wants to see an NHS which has a patient-centred approach to care, based on an understanding of patients' needs, life circumstances and experiences; and which ensures that patients, carers and the public are able to influence the planning and delivery of NHS services.

The Scottish Health Council is a committee of Healthcare Improvement Scotland, external but has a distinct identity. The Committee, external is responsible for agreeing the overall strategic direction of the organisation.

It's National Office, external is based in Glasgow and we have a local office, external in each of the 14 territorial NHS Boards across Scotland.

Image source, SPL

Mr Bibby says there is widespread concern about the patient's voice being heard and he asks if HIS is the right organisation to take this forward.

Healthcare Improvement Scotland chief executive Robbie Pearson says he thinks HIS is the right organisation to make the patient's voice heard.

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Healthcare Improvement Scotland chief executive Robbie Pearson says he is accountable for the overall performance of the Scottish Health Council.

Mr Pearson says there is a clear governance and accountability line.

Labour MSP Neil Bibby asks if this is "not like marking your own homework".

Mr Pearson says HIS can do someting quite unique and tells the whole story of health care, including the citizen's voice. 

Mr Bibby asks if HIS is satisfied with the citizen's voice being heard enough.

Healthcare Improvement Scotland chair Dame Denise Coia says no, abosolutely not, adding there is a "long, long way to go".