The evidence before the Inquiry from the public sector (including NHSL), and industry, indicated that a standard form of derogation for use throughout the NHS in Scotland would be beneficial. This would ensure that derogations are captured and recorded in a uniform way. This would result in consistent and uniform practices. It would also bring clarity to how and why a derogation is agreed and ensure that the approval of all parties is recorded in an appropriate and familiar way.

I would accordingly recommend that NHS Scotland Assure, in exercise of its guidance function, prepare and issue a suitable standard form for a derogation to be used by healthcare organisations throughout Scotland.

The precise structure of such a standard form would be for NHS Scotland Assure to determine, following consultation with stakeholders but, having regard to the evidence available in the report dated 10 June 2024 by the Inquiry's expert, Andrew Poplett, my expectation would be that it would be of the nature of a template for a readily accessible document held in a database or other digital file which records: the facility or operation which is the subject of the derogation and its current application; the provision being derogated from; the precise extent of the derogation; the reasons for the derogation; the predictable consequences of the derogation; and the mitigation put in place to ensure a degree of safety no less than if the relevant guidance had been followed. The standard form might incorporate or otherwise include a decision-making algorithm such as the questionsets prescribed for the HAI-SCRIBE process under SHFN 30.