 mae'r dioddolad na'n 18067fydd yn ddissifatig ar y Prifytig mor hwersreilol nhaid mor siarfaen, aeid mewn ddarllen gyda chi gweithio i gael i ffwrdd y magneton yn ddiffallol y mwyllgor. Anid o gweld i gael a'u frontennu i gael i ddifffr Thanksgiving, In my first speech in this Parliament, I spoke about how I believe that this Parliament has been at its very best when it has found common ground, when across this chamber members have come together to do what is right by their constituents and what is right for the country, whether that be in regard to land reform or indeed the smoking bill, parties united in common cause. This afternoon, members across this chamber from all parties once again have that opportunity to put our own party allegiance, our own political partisanship aside for the sake of our constituents. We all have the opportunity to stand shoulder to shoulder with patient groups across Scotland who are fighting to save valued local NHS services. None of us in this chamber, when we speak as individuals, do so as powerfully as the collective voice of this Parliament. That is why I strongly believe that we can and should speak with one voice when it comes to protecting and defending the services that our constituents rely on. I am happy to give way. I wonder if the member would say that we should never close any hospital or facility, because surely we should put more effort into preventative spend that would help people in the community before they go to hospital. I thank the member for that intervention. Of course, we should put more money into preventative spend, but it is interesting that John Mason had an opportunity to intervene to say that he believes that we should protect the hospital that protects his constituents, instead he chose to make a different point. As I was saying, it is also important that we stand up and represent the individuals, families and communities who have sent us to this place to represent them. I want to briefly talk about what constitutes a major service change, because it is certainly not clear or consistent. It is right that the removal of children's word is deemed as a major service change, but how can it be possible that the closure of a whole hospital is somehow deemed minor? The Scottish Government's amendment references the role of the Scottish Health Council on what constitutes a major service change, but the Scottish Health Council's guidance is clear and I quote, the decision on whether a service change should be regarded as major ultimately rests with Scottish ministers. Furthermore, the Scottish Government's own guidance states that the health board should, and I quote, seek advice from the Scottish Government health directorate on whether a service change is considered to be major and for those that are ministerial approval on the board's decision will be required. That is an important point. In our system, the Cabinet Secretary for Health is responsible for the health service, the buck stops with Shona Robison and the Cabinet Secretary is accountable to this Parliament. That is why it is vitally important that the Cabinet Secretary calls on the proposals so that all of us in this chamber who represent different communities and constituencies can ensure that all the various voices can be heard. I recognise that that was reflected in the Liberal Democrat amendment, which has not been called, and I support the sentiment in the proposed amendment. I believe that it set out the importance of democratic accountability and responsibility in our health service, which the Government and its amendment seek to avoid. Indeed, I would go further and say that it would be a democratic outrage, Presiding Officer, if we allowed health boards to proceed with the decisions without individual members, this Parliament or, indeed, this minister having a say. I want to say this. Ministers should be free to be able to say whether they support proposed changes or do not support supported changes. What is particularly frustrating for campaigners is that the cabinet secretary is saying nothing at all. Her position is spectacularly unclear. If the cabinet secretary opposes any of those changes, she should say so and therefore remove any concerns from local families and campaigners. However, if she supports, I am happy to give way. I am saying that those service change proposals that are major that come to me, I should say at the moment whether I support them or not when I have to make a decision on them. Is that not a bit silly? I think that what silly is actually the cabinet secretary's intervention. If the cabinet secretary, as she said, prior to the election opposes any of those service changes, she should be brave enough to say that she opposes them. However, conversely, if the shadow cabinet secretary supports any of those proposed changes, she should be brave enough to come to the Parliament and openly say so and make the case for why those changes would not impact on patient care. I urge the cabinet secretary that there are members of those campaign groups in the gallery today. They are watching this debate and perhaps she should reflect on that when she makes any further interventions. I do not believe that the voters would ever forgive any minister or indeed any elected member sidestepping their responsibility to step in and show their support for their local services. The cabinet secretary says that she is not happy to take another intervention where she can say that she will protect local services and which one she will keep. I am happy to take the intervention. I will make the decision of those major service change proposals that come to me. I will make those difficult decisions, but what I am not going to do is prejudge it. I have not seen the clinical evidence or the proposals that come to me. When they do, I will make a decision. That is the process that we have had long established in this place, and that is one that I will follow. I thank the cabinet secretary for that intervention, because it is actually very helpful. What she is saying is that she might support proposed closures to those services. What she is also saying is that those promises that were made before the election were not true. She has the ability to designate them as major service changes and called them in. Ultimate responsibility lies with you, cabinet secretary, but instead you are hiding behind faceless health boards. Use the powers that you have, not duck and dive and hide and say it was not me, because all of us, whatever our own party allegiances, owe our place in this chamber to the public. Every one of us is elected as their voice, speaking up and standing up for them. That is why we are urging support for Labour's motion to ensure that all the proposals that have come forward by the respective health boards are deemed major service changes and called in by the cabinet secretary for decision. We seek the support of Parliament to ensure that the cabinet secretary for health has a final decision on what are clearly major service changes, but also today to ensure that our constituents have their voice heard in this Parliament too. Moving on to the proposed changes, we now have it in black and white from the health boards, that the proposed downgrades or closures are maternity services at the Vale of Leven hospital, the children's ward at the Royal Alexandra hospital, maternity services at the Inverclyde hospital, orthopedics at the Monklands hospital in Airdrie, the Lightburn hospital in the east end of Glasgow, inpatient beds at the centre for integrative care based at Gartnavel hospital and cleff pallet services to be centralised away from Edinburgh. Other members will, I am sure, want to cover each proposal in more detail. Before moving on, I want to welcome to the chamber representatives of several of the local campaign groups, including Jerry McCann of the Save the Lightburn hospital campaign, Catherine Hughes of the CIC campaign, Yvonne MacLachie of the Cleft services campaign, Susan Archibald of the Vale of Leven saver services campaign and Caroline Davidson from the No campaign, that is the kids need our ward campaign from the RAH. Those people, Presiding Officer, are not interested in the day-to-day political squabbles. They are not interested in partisan politics. They just want—I am sorry that you are tutting that comment—that those are your constituents. Show some respect for your own constituents. I know that you do not respect this chamber, but at least show respect for the constituents that you are seeking to represent. Those are individuals who do not want us actually to squabble in this Parliament. They want our politicians to work together to protect their local services. Turning quickly to each service, the Lightburn hospital is a specialist unit providing rehabilitative care for older patients, including specialist units for stroke and post-trauma patients, plus a day hospital and outpatient clinics. The plan to close Lightburn hospital, for some reason, is not significant enough to merit a major change, a closure of a hospital. If the cabinet secretary wants to say it will be, that will be good. Happy to give away. I just made a statement that is factually incorrect. No decision has been made yet on whether Lightburn would constitute major service change. You are factually incorrect. You should be accurate with the things that you say in this chamber. I am happy to pass the board paper to the health secretary if she has not read it, in which the board paper makes clear that it regards it as a minor service change. If the health secretary disagrees with the health board, perhaps she should tell her and call it in. She has the ability to do that today. The centre for integrative care is currently an inpatient service that delivers holistic care to patients. I had the pleasure of visiting the centre last Friday and heard first hand from clinicians, nurses and patients about the difference that inpatient service makes to them and the impacts that they have if it is closed. Again, it has not deemed a major service change. The Monklands hospital with the plans to remove not just trauma orthopedics but all of inpatient orthopedics. A little under two weeks ago, I attended a public meeting in Courtbridge, where not a single SNP or health board representative turned up. If they had, they would have felt the unanimous strength of feeling and support of their local services. However, let's be clear about what those changes mean to Monklands. They are major service changes. In the words of Lanarkshire health board, this will be a major change in the configuration of several key acute specialities, including critical care, general surgery, orthopedics and rehabilitation. I'm happy to give way to the cabinet secretary. I hope we'll use the opportunity to see him be supporting the motion. Alex Neil. I'm not the cabinet secretary. You need to hear facts right, the ex-Cabinet secretary. I just say in relation to Monklands, can he explain to me, we're seeing earlier everybody should speak with one voice, but the Labour Party doesn't speak with one voice, because the Labour leader of North Lanarkshire council has publicly given unqualified total support to the health boards proposals. How is it that he's in favour of them and yet you're supposed to be speaking with one voice? You can't speak with one voice inside the Labour Party. Never mind with everybody else. First, I'd say that the SNP is not speaking with one voice. They're telling communities that their hospitals are safe, and in this chamber they're saying that they've not made a decision yet. That's not speaking with one voice, that's speaking with a forked tongue. We are very clear, the motion is very clear, we expect Monklands to be a major service change, we want it called in and we want it rejected. But again, the final decision will lie with the cabinet secretary. Inverclyde hospital. You've seen this before, Presiding Officer, the front page of the Greenock Telegraph, no less than the First Minister herself, shortly before the election, saying that guaranteed of maternity services is safe at Inverclyde hospital. Again, the cabinet secretary might want to say that that's not a decision made yet, I think that's pretty clear from the First Minister's comments, but again proposed for closure and not regarded as a major change. We mentioned the Royal Alexander hospital already. They can hardly be a more important debate or issue than the future of children's services at the REH, a children's service that treats 8,000 children every year. Indeed, given that those changes are already recognised as major changes, there is nothing standing in the way of members joining the colleagues and supporting our motion, which again demonstrates this Government's inconsistency of approach when it comes to NHS cuts. I'm sure that there will be at least one constituency MSP who, irrespective of party allegiance, will put aside party loyalty and stand on the side of their constituents. Today, I'm sure that that MSP will be a true champion of their local NHS. I hope that others will follow Jackie Baillie's example, who today will put her constituents first and vote to protect maternity services at the Vale of Leven. Again, despite previous promises, not designated a major service change. So in conclusion, Presiding Officer, I reach out across this chamber today to other constituency MSPs affected by those proposals. Today we have an opportunity to put aside our party allegiances and work together to protect our local NHS services. So I reach out to Ivan McKee—I'm not sure of Ivan's—even in the chamber to say that he has made commitments to fight to save the Lightburn hospital. If he is sincere in that commitment, I hope that he votes with us today. I hold out the hand of friendship to Stuart McMillan and say that we work with us to protect maternity services at the Inverclyde hospital. I say to George Adam and Tom Arthur—don't vote for an amendment today that takes out all mention of the RAH hospital and instead join with us today to save RAH pediatric services. I appeal to Bill Kidd. I know you're a whip. The chief whip no less, but your first responsibility is surely to your constituents. So please support your constituents by supporting our motion to save the CIC in patient services in your constituency. To Alex Neil, I know in your heart you'd like to support the motion, Alex. I know that inside you are a rebel at heart, so let that inner rebel in you come out today and work with us so that we can save orthopedic services at the Monklands hospital. Presiding Officer, our motion is clear. Labour is clear. We want these services designated as major service changes, called in by the cabinet secretary and rejected. Many MSPs in this chamber stood on the banner standing up for Scotland. Today they've got an opportunity. Will they stand up for the communities and will they stand up for our NHS? Cabinet Secretary Shona Robison, this provides a timely opportunity to acknowledge the commitment and dedication of health and social care staff across the whole of Scotland to reflect on our record of protecting and enhancing local services and to comment on the actions being taken to ensure that Scotland's NHS continues to be world-class. I would also want to welcome local people to the gallery. Turning to Labour's motion, I think that it would be helpful to state the facts as initially set out in response to Jackie Baillie's member's debate on the same issues on 13 September. Firstly, no final decisions have been made about the service change proposals that are mentioned. NHS Greater Glasgow and Clyde formalised their proposals at their board meeting in August and, as we would expect, are now in the process of engaging with the affected local communities, staff and other stakeholders so that they can carefully consider their views. I would encourage local people and their representatives to play a full part in that process and to note that the proposals may well change in the light of the results of that process. That will take the form of three months public engagement on the proposals relating to the Centre for Integrative Care, community maternity units and Lightburn hospital, running from September until November. That will help to inform the health board's on-going work with the independent Scottish health council, which includes coming to a view on which of those service changes should be considered major. The board will reconvene following that work, probably at its meeting plan for December, and will then agree the next steps. Should any of the final proposals be designated major, then the board must undertake formal public consultation of at least three months, and its final service change proposals will be subject to ministerial approval. The cabinet secretary is right. I am keen to take NHS services. The independent Scottish health council in its guidance clearly states that the ultimate responsibility lies with ministers. You can instruct them that those are major service changes and call them in. Why won't you? That is an established, robust process informed by the work of the Scottish health council. I want to know what they think when I come to make the decisions, and the board wants to know what they think when it comes to making their decisions. It was set up by statute in 2005 to provide independent oversight in the key area of patient focus and public engagement by this Parliament. The Labour motion quite inappropriately asked Parliament to cut across the vital work of the Scottish health council. It should be allowed to get on with its job and fulfil the duties that this Parliament has ascribed to it. What is the point of having the Scottish health council if we are not going to allow them to get on with their work? Returning to the service change proposals, in the case of the plans to... Yes, of course. Mr McMillan. Thank you very much for taking the intervention, cabinet secretary. Cabinet secretary, would you agree with me that in terms of the NHS Greater Glasgow and Clyde proposals for the IRH birthing unit that, with their consultation proposals thus far, they are not suggesting to have a public meeting? I have asked the health board to have a public meeting in Inverclyde so that the issues regarding the birthing unit could be fully addressed, but is that something that you would agree with? Cabinet secretary. The health board should have as much public engagement as is possible, including public meetings and other ways of engaging. I think that that is important. Returning to the service change proposals, in the case of the plans to transfer paediatric inpatient and day cases from the Royal Alexander hospital in Paisley to the new Royal hospital for children, NHS Greater Glasgow and Clyde will discuss the next steps that they are meeting in October. The board has already been clear that, should they move to proceed with those paediatric proposals, it would represent major service change and therefore would come to me for decision. In terms of the trauma orthopedic services at Muntlands hospital, NHS Lanarkshire, as supported by the academy of royal colleges and faculties in Scotland, has been clear that the interim changes are necessary in order to ensure the safety, quality and resilience of local services. I have been assured that the interim plans will not materially impact on the provision of any services at any of the three main hospitals in Lanarkshire. The health board has also repeatedly given assurances that it is committed to retaining three district general hospitals with full A and E departments as part of their longer-term plans. Those longer-term plans will constitute major change and, as such, are now subject to formal public consultation and those plans will come to me for decision. I would encourage all local stakeholders to play a full part in the consultation in order to help to shape the future of those local services. Thank you very much to the cabinet secretary for taking the intervention. Having just said what the cabinet secretary said about public consultation, I wonder if she can comment on the fact that orthopedics and trauma, which I would consider a major service change, is being removed, having a decision, having been taken during the recess with no public consultation. Cabinet secretary, you explained that that is an interim solution based on patient safety, but the longer-term plans are major service change, which has to come to me. It is very clear and straightforward. If any politician would stand in the face of being told that a service is not safe, I think that we all have to take some responsibility for the decisions and ignoring clinical advice. The interim proposal that is very clear is based on patient safety advice, and we have to listen very seriously to that. The Labour motion also refers to cleff pallet services at the Royal hospital for sick children in Edinburgh. Ministers are fully aware of the strength of feeling from those who oppose the recommendation to consolidate cleff surgery in Glasgow. There are very strong views on both sides, not just now. I want to be clear that the Government has been given an assurance that the proposed changes relate only to cleff surgery. Nonetheless, those remain proposals, and no decision has been made, as the Minister for Public Health and Sport made clear in the member's debate on this on 7 September. Not just now. Mr Johnson, please take your seat. Ministers will have the final say, and our decision will be informed by the plan visits that I am undertaken to both Edinburgh and Glasgow to visit the cleff surgery teams and to hear their views first-hand. I will give away. Mr Johnson, has the minister seen the same figures that I have seen, which would indicate that the surgical out comes in the Edinburgh unit are better than the ones that are achieved in the Glasgow unit? I will take into account all of the information that is why I am making the visits, and I will take into account all of the information that was presented to me before I make a decision. That is the right way to make decisions that are important to a lot of people. That is the right way to make decisions. Presiding Officer, the possibility that all of the service change proposals may change as a result of the public engagement underway and that some or indeed all may ultimately be subject to ministerial approval means that it would be inappropriate for me to discuss the specifics in any detail today and to say whether or not I support them. If I am making the final decision on them, then of course I will wait for the information and the evidence to be brought to me. However, I want to be clear that this Government remains committed to robust evidence-based policy making as set out in our national clinical strategy. Mr Sarwar, I am not keen on props. You should raise your game and respect the people in the public gallery, as you were saying earlier. Underpinning this is our long-term commitment to secure local services and develop specialised services when necessary. I am prepared to take difficult decisions where the evidence supports it. However, where change is advocated, we must ensure that local boards work with all stakeholders to make the case what we will not countenance is change being dictated to local communities as has happened in the past under your administration, Mr Sarwar. I would reiterate that local people can be assured that this Government will always focus our approach on providing as many services as locally as possible. Our record in government stands in stark contrast to that of the previous administration. Whether it was Nicola Sturgeon's coming to Parliament to save any departments in Monklands and Ayr, or whether it was protecting the damaging uncertainty of the previous administration, the Labour-led administration that Jackie Baillie served in when the Vale of Leven hospital was under serious threat of closure. The vision for the Vale has saved that local hospital. Indeed, we will make sure that those services that were lost under previous proposals that we make sure that services going forward are improved. Of course, the local hospital has seen a big improvement and a big increase in the number of patients using those local facilities. Finally, I know that the Opposition parties constantly call for increased investment in primary and community care and say that they support shifting the balance of care. We had the Tories saying that only last week. At the same time, they come and seek to oppose each and every proposed change, even when they are not proposed in acute services. We are going to have to collectively come to some decisions about whether politicians in this place are going to argue against any change anywhere that is ever happening in our NHS now or into the future. If that is the case, the shift in the balance of care and the increased investment in primary care called for by the Tories only last week will be made all the more difficult to achieve. I want to enclosing, to reiterate this Government's commitment to the delivery of high-quality, sustainable health and social care services. Where there are proposals for major service change in the NHS, they must be subject to formal public consultation and ultimately ministerial approval. I do not shirk my responsibility whatsoever in doing that, but local people can be assured that, in all such cases, ministers take all the available information and representations into account before coming to a final decision. I think that that is a proper and responsible way to run our health service and I move the amendment in my name. I am delighted to be here discussing health again on a Wednesday afternoon and I hope that it becomes a regular occurrence. I do not say that flippantly, following my own party's debate on health last week in this chamber, it is right that we subject the Government's record on health to frequent and effective scrutiny. It is right that the NHS is a running theme. We will be supporting Labour in their motion. I would accept that, technically, it is somewhat premature, because, as it stands, the proposals have not reached the point at which the Government requires to take a decision as to whether or not they are major service changes. However, there is clearly a wider public interest at stake here, which transcends that point on process, which is why we are happy to lend our support to the motion and call for the procedure to be expedited and for these specific proposals to be called in now. That wider public interest is manifested in the widespread concern over the various service changes in issue. It is obvious, in the levels of support, not yet, that the public campaign against those proposed closures has reached. Nearly 2,000 people have signed a petition against proposed changes to the Vale of Leven. Even over 6,000 have done the same against the proposed closure of Edinburgh's Clare pallet unit to name but a couple. It is our fundamental belief that, given the public concern and controversy surrounding those particular proposals, they should all be classified as major service changes so that the SNP Government takes responsibility for those decisions and can be held to account. We would all agree, I hope, that blanket opposition to any change in the NHS is impossible and indeed irresponsible. The NHS can never be static. The BMA warns today that the NHS is not sustainable in its current form and action needs to be taken now. We accept that tough decisions have to be taken even when they are not popular. A strong, responsible opposition recognises that. What is difficult to fathom is the approach of a Government that is content merely to do nothing. The Government continually reinforces the point about the need for the NHS to be more community-orientated. We hear that among its priorities for the coming year is to empower a truly community health service and to deliver the reforms that are needed for successful community health services. With that in mind, it is understandable why so many people will be puzzled that the Scottish Government's idea of delivering more community health services is to sit on its hands in the midst of controversial proposals, which, if enacted, will see communities lose services and not gain them. Just as we did in the debate last week, we urge the Government to take responsibility or, at the very least, take a view. It is only right that, in all those cases, where important services are at risk of closure, the SNP Government should step forward and make its position clear. Having dealt with correspondence on some of those issues, I know that people, many of whom are here today, want to know simply where this Government stands. Those particular proposals are so controversial, so serious, that it is not good enough for the Government to float indifferently above the fray. Let me take one example. We have asked countless questions about the Centre for Integrative Care and its future in general. Where does the Government stand? What consideration has been given to central funding? What discussions have been had? What is its position? The only answer that comes is that those are matters for the health board. The Government again washes its hands. I would argue that all of those proposals could be classified as major service changes using the Scottish Health Council's own guidelines. Of course, we know from those guidelines on major service changes that the decision ultimately rests with ministers. Not only that, but there is ample evidence on the ground to support them. For example, as I said during the debate about the Vale of Leven, closure of this service would force women in labour to travel an extra hour more from Dumbartonshire, from Argyll and Bute, to facilities in Glasgow and Paisley. That could constitute a change in accessibility of services and thus qualify as a major service change. Plans to close the Lightburn hospital would mean that elderly patients and stroke patients will have to travel to the Queen Elizabeth University hospital, putting pressure on that hospital. That could constitute having a consequence for other services and thus qualify as a major service change. There is a historical precedent for both Vale of Leven and Lightburn. Both were subject to proposed changes in 2008 and 2010, respectively, similar to the ones now. Both were deemed major service changes then, so why not now? I could go on. However, the facts support those proposals as major service changes. At any event, the Government can intervene further down the track. Again, there is historical precedent. Indeed, the Government mentions this in its own amendment. Ten years ago, the SNP Government was more than happy to intervene when it was proposed to close the Air and Marklins air and air units. As soon as the SNP took office in 2007, the current First Minister's health secretary immediately stepped in, overturned a decision and set up an independent review of the processes carried out by the health boards. If it can intervene then, it can intervene in the future. I thank the member for taking intervention. I wonder if he recalls that those proposals, which I did not agree with and spoke out against, were based on what the health board said were safety reasons. I cannot recall, because I was not in the Parliament at the time. The point that I am making is that Nicola Sturgeon intervened in that decision. She intervened again in 2010, in the face of the health board's recommendation to close Lightburn. She said that the Government has a policy of maintaining local access to healthcare services where it is appropriate to do so and where it is in the patient's best interests. Once again, if the Government can intervene then to save local services, it can intervene in the future. Last week, we highlighted the major staffing crisis in our NHS and social care services. We told the Scottish Government that there were still major gaps in general practice in nursing, midwrifery. We revealed a sparing locum cost in our NHS. We spoke out for Scotland's social care sector. We suggested solutions such as proposing to invest 10 per cent of NHS spending in general practice by 2020. I am in my last minute. The member, yes, thank you. You are in your last minute. Thank you. Because there is a clear link to be drawn between this week's debate and last, we know that one of the reasons given by NHS Greater Glasgow and Clyde for removal of facilities is down to a lack of staffing. We know that in other hospitals across Scotland, the shortage of staff directly affects the provision of services. I repeat the example that I gave in my maiden speech of my local hospital in the Highlands, where there have been no scanning facilities for pregnant mothers since 2013 because there has been no ultrasonographer. Short staffing has huge implications for local services and I have no hesitation in laying responsibility for that at the door of the SNP Government, as I did last week. Deputy Presiding Officer, it is clear to me that the Scottish Government must be held to account for those proposals. We believe that they represent major changes in service provision and should be called in for review now with final approval made by the cabinet secretary. For that reason, we will be supporting the motion. We now move to the open debate. Without embarrassing the members, there are three members who have not pressed the request to speak buttons. You cannot get called if your button has not been pressed. I now call Mary Todd. We follow the Banja Kebillian. Mary Todd, please. Thank you, Presiding Officer. First, I have to declare an interest. I am a pharmacist, registered with the General Pharmaceutical Council. Until my election in May, I was employed by NHS Highland. In their briefing for today's debate, the Royal College of Nursing Scotland states that to ensure the longer-term sustainability of services and to meet the needs of an ageing population in the future, health boards need to do things differently. Over the last year, RCN Scotland has been saying that urgent transformational change is needed. It goes on to say that to achieve this vision, politicians, professionals and the public must be prepared for transformational change, and all stakeholders involved with the changes will need to put vested interests to one side and work together to deliver the changes that are urgently needed. I hope that here in the chamber this afternoon we can achieve that in our debate. As I understand it, no decisions have been made in respect of the current service change proposals mentioned in Anna Sarwar's motion, so rather than address those directly, since they are still at an early consultation stage, I would like to take the opportunity to look more generally at the question of why we need to transform hospital care. The Scottish Government is committed to evidence-based policy making, as is set out in the national clinical strategy. There is now an overwhelming amount of evidence that complex operations are best performed in more specialist settings. There is increasing evidence that teams that are more specialised in doing more complex operations frequently get better outcomes for patients who tend to have fewer side effects and typically spend less time in hospital. We understand that we need to adapt to meet future demand, and in doing so we can make the best use of the skilled staff and the technology that we have. We have much more complete evidence about the connection between volumes and outcomes, so the more often a team does a procedure, the better results they get. This is pushing a need to plan for some procedures on a population level rather than at a health board level. Some procedures are becoming exceedingly high-tech, for example robotic surgery, so need to be concentrated on relatively fewer sites to make the best use of skilled staff and specialist equipment. Using telemedicine for virtual consultations, as we often do in the Highlands and Islands, reduces the burden of travel and will ensure that high-quality care can happen in remote and rural locations. I spoke to a surgeon a couple of weeks ago in Rakemore hospital who regularly holds telephone outpatient consultations and saves his patients several days of travel to outpatient appointments in from the islands. There are always pressures to stick with the status quo, but I think that it is wise for us to at least consider whether the current service configuration offers the best possible service provision. I wonder whether the member is aware that much of what she is saying in her well-delivered speech is actually the care report of 2005, which, in fact, was a precursor to the health boards making the wrong decisions to downgrade muntlands and air A and E. I do not think that it is being long held, wisdom makes it any less relevant. There are plenty of examples from history. Years ago, we had GPs performing emergency service in small community hospitals, a service that no-one would advocate now. I want to talk about the Golden Jubilee Foundation, where we and the Health and Sport Committee went to visit in the summer. I did not personally visit, but it is an example of a new model of service provision that has been extremely successful. The hospital has expanded year-on-year to meet the health demands of Scotland's population and is now responsible for delivering over 25 per cent of all-Scottish hip and knee replacements and up to 18 per cent of catara co-operations for the whole of the country. That is in addition to the thousands of patients with urgent and long-term conditions who are treated through the heart and lung unit, one of the largest in the UK and the only hospital in Scotland to carry out heart transplants. Innovation and participation in active research are core to its success, and some of the programmes that have developed there, such as the enhanced recovery service for orthopedics, have now been adopted all over Scotland and much of Europe. The outcomes are excellent, and with some of the lowest complication rates in the country, I boast in the UK's fastest door to balloon time for patients requiring primary percutaneous coronary intervention. As someone who represents a rural constituency where we often have to travel long distances for hospital care, I do also appreciate the provision of a hotel on site. It may seem a very trivial point, but if you have to travel for healthcare as we in the Highlands often do, making it easy for our nearest and dearest to travel to is helpful. Let me reiterate again why just so many health professionals and policy makers are prompting us to consider a change in our acute hospital services. It has the potential to significantly improve outcomes. That is the main driver. The new technology that we are using nowadays in modern medicine dictates the need to have centres for excellence for more complex interventions. As our population ages, as we have said many times before, there are increasing volumes of elective procedures for cataracts and joint replacements, and there are pressures in recruiting highly skilled staff. Finally, if we can find a way to deliver hospital care more efficiently, we can focus our attention on locally delivered primary and community health services, which will better meet the needs of our ageing population, with multiple long-term conditions and tackle health inequality. That is why the Royal College of Nursing is saying that Scotland must look at different ways of delivering service. Let us hear what the health boards have to say about service redesign. Let us consult with and listen to both the staff and the local population, and let us follow due process. I call Jackie Baillie to follow by Fulton Mcgregor, Ms Baillie. It is a tight six minutes. I am sorry. I do not think that anyone in this chamber can be in any doubt about the importance of the veil of leaving hospital to me or indeed to all of my constituents. It will therefore come as no surprise if I focus my contribution on the veil of leaving maternity unit. Maternity services are, in my view, the beating heart of any hospital. Nothing quite surpasses the cry of a newborn baby, the joy of a new life and a new family. The majority of women give birth without a great deal of intervention, other than perhaps pain relief. You do, of course, need specialist services, but, as ever, it is where the balance is struck. I will take on any Government of any political hue that threatens the veil of leaving hospital, and she knows that. She also knows that I supported the Scottish Government when they brought forward the vision for the veil of leaving hospital. It contained commitments to deliver a wide range of services at my local hospital, but the cabinet secretary also knows that staff numbers have dropped dramatically and a substantial number of clinics have been cancelled despite the vision being in place. Nevertheless, the vision remains an important commitment for local people in my community and one that I continue to support. However, it was so important that the community midwifery unit for the veil vision was pictured on the very front page. The exact wording of the commitment was that the community maternity unit will be sustained and promoted. That is the very same maternity unit that is up for closure today. The health board will say that it is because the numbers have dropped and indeed they have, but please look a little closer. The overall number of women from my area giving birth since 2009 to now has dropped by 8 per cent, but the numbers giving birth at the maternity unit has fallen by nearly 70 per cent. That tells me that the health board has not been serious about marketing the CMU. When I consulted GP practices, some did not even know about posters or leaflets, but the key to that is that bookings have been taken out of their hands and centralised by the health board at a telephone line. It is since then that the numbers have declined. They are closing the unit by stealth, entirely a problem manufactured by the health board to close the unit and the cabinet secretary must not be fooled by that. The health board has not committed to a full informal public consultation of my local community. Instead, what we are to have is an engagement strategy that is based on a consultation undertaken a decade ago. The health board cannot be serious. We need a full community consultation so that everybody has the opportunity to make their voices heard. The cabinet secretary pops through every door in my constituency in advance of the election on a leaflet and I quote what she said in it. I will not approve any move away from the vision for the Vale commitment. Three cheers to that, I say, because I want to believe the health secretary. My local community wants to believe the health secretary. Indeed, we all want to believe the health secretary will keep her promises. That takes me to why this, like the other cuts that are described here today, to maternity at Inverclyde, to Lightburn, the Centre for Integrated Care and the RH, are so important that they are designated as major service changes. Let me explain why this is so important and then I am happy to bring the cabinet secretary in. If they are designated as major service changes, they end up on her desk. That is important to me. It is important to my community, because the health board would not have the final say. It is important for accountability and democracy. I want the health board to be accountable to the cabinet secretary and, in turn, for her to be accountable to this Parliament. It is a fundamental matter of democracy, and I hope that she agrees. I would take an intervention. Cabinet secretary, as I said earlier, that may well end up being the case, because no decision has been made about whether it constitutes major change or not. However, I wonder if Jackie Baillie will recognise in her speech the work that I have asked the chief medical officer to undertake, which is why there is such a low midwife-led birth rate across the whole of Greater Glasgow and Clyde. Will she acknowledge that? Indeed, I would. I would invite the chief medical officer to look at the difference that has happened with the centralised booking service, because I think that that has been key to it. However, I very much welcome the intervention of the cabinet secretary on that point. In the past, I know that cabinet secretaries have operated on the basis that, if they did not cross their desk and they did not need to see it, somebody else made the decision, they could turn around and blame the health board. I am afraid that that is not good enough any more. It is the case that the decision on whether a service change should be regarded as major is ultimately a matter for Scottish ministers. Of course, there should be discussions with the health council and the health board, but please, cabinet secretary, do not hide behind them. The cabinet secretary has had discussions with Greater Glasgow and Clyde, I know that, and agreed with their arrangements for consultation. The health board paper says, and I quote, in our view, the changes to the community maternity units do not meet the criteria for major service change. Does the cabinet secretary agree with that statement? I am happy to take a yes-no intervention on that point. You cannot, because you are in your last minute and you have got 30 seconds. Well, that genuinely is a shame, and I hope that the cabinet secretary will pick that up. Unless the cabinet secretary wants to do it, I will give you time in. I am happy to do that. I will be guided by what the Scottish Health Council and the board say, but I will ultimately make the decision about whether or not that is subject to ministerial decision. I thank the cabinet secretary for that response. I hope that she does make a major service change, because let me say as gently as I can. It would simply be unacceptable if the matter was left to the health board, because as night follows day, that will be the death knell for the Vale of Leven's maternity unit, and she knows that. I am sorry that you must conclude then. Thank you very much. I now call Fult McGregor to be followed by Brian Whittle, who I see is not in his place, but no doubt he will sprint in in time or somebody will tell him. I would like to take this initial opportunity to declare that I have been appointed as a parliamentary liaison officer to the Cabinet Secretary for Health and Sport. I am sure that I am not the only one in the chamber today. He finds it slightly ironic that 10 years almost to the day, since Labour voted to close the Muntlands accident emergency department and downgraded it to a grade 2 hospital, it now put forward a motion claiming that this Government is downgrading services there. As has already been said, it was the SNP Government who reversed that appalling decision taken by Labour, a reversal that has saved countless lives in my constituency and beyond. Every SNP health secretary, Nicola Sturgeon, Alex Neil and Shona Robinson, has unequivocally guaranteed that Muntlands hospital will retain A and E services and its grade 1 status is safe. Indeed, that guarantee was once again given in this chamber only a few weeks ago when I asked the health secretary if Muntlands accident emergency was safe from closure, which of course she confirmed. The Labour Party seemed to have decided that the Muntlands should be used as a political tool in their almost desperate attempts to keep control of North Lanarkshire Council next year, but it is my colleague Alex Neil who has already pointed out that it is only some of the Labour Party and that is here at Holyrood, because the Labour leader of North Lanarkshire Council, Jim Loog, has given his full backing to the plans. I am sure that he would have appreciated some discussion on that. Why has the Muntlands been mentioned in the motion and why are we talking about the services there? NHS Lanarkshire recently proposed to temporarily move orthopedic and trauma services from Muntlands while a consultation takes place on the permanent future of those services. As we have already heard, there may be some argument that in hindsight it may have been better for NHS Lanarkshire to have consulted on this move, but the simple fact remains that those services are being moved because healthcare improvement Scotland and the general medical council, amongst many others, have identified significant risks and demanded that changes be made to improve patient safety. Those changes are being made temporarily with concern for patients' lives and wellbeing as a priority. I welcome the long-term plan of having all specialists orthopedic services in one centre of excellence in Lanarkshire and I fully support Alex Neil's amendment 1510.1, calling for Muntlands to be in this very centre, and I will be fighting for that. It is also important to note that, while there is to be a temporary transfer of orthopedic services to Hermeyr's, from a service delivery point of view, patients who require this service will still attend Muntlands in the first instance. The reality for people of Coatbridge and surrounding areas is that, despite those temporary changes, if Muntlands is your A and E, that is where you will go to. Only 2 per cent of all those attending the Muntlands accident emergency unit will need to then visit another hospital under those temporary arrangements. The vast majority of orthopedic patients will still have the initial treatment and follow-up care managed locally. What people who I speak to really care about is often how does that affect them, so let me make it crystal clear. If you live in Coatbridge or in Airdrie and you need to go to A and E, it is Muntlands A and E that you go to. I should also say that those changes are welcomed by a number of professionals, including Dr Ian Wallace, who is a medical director at NHS Lanarkshire. He highlights that, following a number of independent reviews—I am going to be struggling for time, as Mr Leonard has to forget later—a temporary transfer of 2 per cent of the most complex trauma cases is the only viable option to ensure that services remain safe and sustainable in the interim period. Dr James Burns, medical director for the acute division, has acknowledged that trauma and orthopedic services in Lanarkshire have been under pressure for some time and that there is a real need to make the changes to services right now. There has been an on-going level of risk to patient safety, which the NHS board is keen to address before we move into the coming winter period. Presiding Officer, looking to the future, the news of a £400 million investment for a new hospital in the Muntlands area by 2023 is indeed welcomed. The investment will mean that we can provide strong and appropriate local health services that meet the high standards that are required to treat the changing demographic of the area. That new hospital will ensure that the people served by Muntlands hospital will receive the high standard of care that they not only expect but deserve. Now that is investment in local services. Furthermore, in the past five years there has been £65 million invested in Muntlands, including the funding of the new critical care unit, the new pathology unit, the Lanarkshire Beats and Centre, a refurb of the mental health unit and operating theatres. There has also been £1.5 million investment in a consultant led rapid assessment and treatment area in the emergency department and to extend the same day surgery. Now that is investment in local services for local people. The SNP is committed to making the Muntlands hospital the very best it can be. We think big for our local area and services and are not content to score cheap political points. The two towns, mainly affected by Muntlands, now have four SNP representatives between Westminster and Holyrood, and there is a reason why the people of Muntlands now back the SNP. They know that their hospital is safe with us. Presiding Officer, by the time this Parliament term is ending, the people of Coatbridge and beyond will be able to see for themselves the construction of a new hospital under way, recognising my aim and the aim of this party for my constituency to be the very best it can and realise its full potential. Presiding Officer, I will always fight for the Muntlands. Over the last few months, I have been working with my colleagues in the area to ensure that we get a hospital that is capable of delivering the best services for the people that it serves. I have engaged with the NHS board and other elected representatives, including Elaine Smith, and secured an additional NHS-led public meeting on 10 October, on this matter. I would urge everyone with an interest to come together, get involved in the consultation and attend the meeting. No, you are stopping, I am sorry. I think that I may have missed, but did you declare your PLO at the beginning of that speech, which was your first speech? My apologies to the chamber. I now call Brian Whittle, followed by Ash Denham. Thank you, Deputy Presiding Officer. I am pleased to speak in today's debate and thank Labour for putting health on the agenda again after the Scottish Conservatives health debate last week. The pressures on our NHS and its staff are many and ever-present. The pressure to continue to deliver a world-class service while being squeezed from both sides with ever-more complex procedures and treatments within ever-closely scrutinised budgets. The pressure of an increasingly unhealthy nation—we cannot and shouldn't shy away from that—and the pressures of staff shortages and continuing issues around recruitment. The pressures of an ageing population, and I am rather pleased that I may get a few more years in my dotage to annoy the children. In considering today's motion and the protection of local services, we should discuss this in the context of an overall health strategy and the services provided at local, area and national level. As the service provided by the NHS continues to develop, it is important that a long-term strategy at least keeps pace. There is no doubt advantage in having centres of excellence for those once-in-a-lifetime procedures, such as transplants, hip or knee replacements. It makes sense to have the best surgeons and healthcare professionals in their field fully utilised. However, more acute services such as A&E, pediatrics, trauma orthopedic and some daycare services and maternity units should be much more readily accessible. It is right and proper that local MSPs and we as an opposition question the Government and its reluctance to take a position on those cases raised today, which are of significant material change in services to take the responsibility and be held accountable for their actions and decisions that affect those communities so fundamentally. It is not good enough to hide behind, it is not me gov. That speaks to the motion protecting local services. That does not mean looking at secondary care in isolation. Those must be considered in the context of overall medical services on offer at the local level. Perhaps it is time to think much more strategically and creatively. Perhaps it is time to introduce budgetary terms of longer than a year to allow proper consideration for the implementation of longer-term strategies. Longer budgetary terms would certainly be conducive to a more cohesive preventable disease strategy. It would also speak to staff planning and recruitment. Procurement becomes a more manageable process. If you want efficiency, longer-term budgets give you more options. We have discussed creating GP community hubs as a good way to allow GPs to engage and interact with their communities more effectively with a multi-disciplinary offer. Specialists in areas such as mental health, physiotherapy, nutrition, pharmacy and even exercise prescription could all be on site, and I am very much like the last one. However, how about creating community hubs around pharmacies as an area worth exploring? Pharmacies are often better positioned in communities, especially in the more deprived areas. Even more fundamental, if we were to improve the health of our nation and release some of the burden on our NHS, we should be focusing preschool. Intervention at that age is often mooted and understood as crucial, yet little is really done. With the proposed 30 hours of free child healthcare for three and four-year-olds, although Scottish Conservatives would like that age group to be younger for the more significant interventions, it should be possible, with a bit of will power, to engage with the childcare professionals to deliver a national-structured active play programme that tackles the foundation of health inequality and the attainment gap. After all, some children are already two years behind by the time they reach the school age. Deputy Presiding Officer, I guess what I am saying in my own convoluted... Hi. I said that without moving my lips. Deputy Presiding Officer, I guess what I am saying in my own convoluted and imminent fashion is that protecting local NHS services does not necessarily mean preserving them as they now are. Local services are multifaceted and specific changes to those services impact on each and any decision must be reflective of that. NHS boards must have autonomy to make their decisions within Government policy headlines. Having said that, we must be aware that they risk fixating on implementing cost cuts in the short term and ignoring the potential long-term cost, which is exactly why those specific decisions are fundamentally changing their local NHS service provisions that deserve to be examined at ministerial level. The buck stops with the Government, even if the SNP tries to wriggle out of that responsibility. Deputy Presiding Officer, in conclusion, the success of the NHS does not lie with the people who work with it directly only. Everyone in Scotland contributes to the survival of our NHS. We see that today both with Labour's motion and the reasons behind it. When the public hear that their local services are in jeopardy, they rally round and they fight to protect their local NHS services, and that is why the Scottish Conservatives will support today's motion. Thank you. Ash Denham, to follow by Neil Bibby. Again, I repeat, members, if they do not talk across the chamber please, Ash Denham to follow by Neil Bibby. It is a tight six minutes to all speakers and some of the later ones may have their time cut a little. I am sorry. Ash Denham, please. We are in very challenging times. The Scottish block grant is 5 per cent lower in real terms than it was five years ago. The Fraser of Allander institute has recently predicted that the budget could be cut to up to 6 per cent. That is a staggering £1.6 billion over the next five years. The institute states that the Scottish budget has faced unprecedented cuts since 2010. That represents a full decade of significant cuts to the Scottish budget. If that was not bad enough, due to the impact of inflation, any financial commitments made by this Government, such as the one to increase NHS revenue budget by £500 million in real terms, will be even more expensive. It will be the same story with repayments associated with revenue finance capital investment programmes such as PFI, which already represent a significant portion of health spending. That is the backdrop on which the achievement of this Government must be considered. Perhaps she could explain why the Scottish National Party Government has not passed on the money in the block grant specifically designed for the NHS. Perhaps the member may wish to concern himself more with the pockets of meltdown that are predicted to affect the Conservative-run NHS in England. Achievements such as the increase in the overall NHS budget to a record high of £13 billion this year, record numbers of staff across the board from nurses to GPs to consultants to paramedics. Unlike England, no compulsory redundancies in NHS Scotland banned five nurses on higher pay, retained bursary support for nursing and midwifery students. I could go on, but I fear that I would run out of time. The NHS really is demonstrably safe in our hands, so I would urge the Labour Party to consider that the real reason for the cuts to Scottish budget is Tory austerity and unite with those benches against the real cause and stand up for Scotland's public services instead of disparaging them. The motion for debate before us today concerns changes to services and in that list of hospitals put forward by Labour, one affects my constituents, and that is the proposal to change— Excuse me, Clif Sudden. Can you just say to a member that sedentary interventions are annoying me if you want to make an intervention on your feet? I will say that. And that is the proposal to change the provision of cleft lip and palate surgery. My interest in this is due to many constituents contacting me about the possible loss of service in Edinburgh. Furthermore, the service is currently provided from the Edinburgh Royal Hospital for Six Children. That hospital has now reached the end of its life and it is being replaced with a state-of-the-art brand new hospital, due for completion in early 2018, cited next to the Edinburgh Royal Infirmary, which is in my constituency. I am very keen to ensure that my constituents continue to receive the very best in care. At the moment, the provision in Edinburgh at the Royal Hospital for Six Children is of the highest standard. It is led by Dr Felicity Mahendale, a world-class surgeon who is a leader in her field. Next year, she takes up a four-year presidency of the International Cleft Association, and she will also host beating off some quite stiff competition from Kyoto and Brisbane, the 14th International Cleft Congress, to be held here in Edinburgh in 2021. The proposal by the National Specialist Services Committee and recently approved by NHS board chief executives is to move away from a single surgical service over two surgical sites to a single surgical service on one site. The new service is proposed to be run from Glasgow. Part of the surgical goals for Cleft pallet is that the patient must reach speech standards, and those are assessed at age five according to UK protocols. The Edinburgh team scored very highly on those, consistently scoring in speech standard one over the past standard of 50 per cent, and in 2016 scoring an impressive 90 per cent. In contrast, the other team has on two occasions in the last four years failed to meet the past standard and in 2015 scored as low as just 36 per cent. Speech standard 2A, which is distinct in that it cannot be affected by speech therapy, shows a similar story over the last four years. The Edinburgh results for the last year being 95 per cent and Glasgow's only 68 per cent, which in fact fails the past mark in this instance of 70 per cent. The Glasgow service, unfortunately, has not met the past mark at all in the past four years. Therefore, the clinical evidence I feel does support the retention of services in Edinburgh. The Edinburgh service with its multidisciplinary team is one of the best in the UK and it is recognised as being of international standard. The proposed change would mean an impact on families from the east of Scotland who would lose the best in care outcomes and it would also create a deficit in the eastern part of the country. I have much sympathy for the fact that patients and their families will have longer travel times by car from Aberdeen and Inverness in the north, right down to Melrose in the south, but by public transport these journey times from Fife, from the borders, from East Lothian and from Edinburgh are significantly more and in many cases will be double what they would have been to Edinburgh. I do already have a meeting set up with the cabinet secretary to discuss this issue and I hope that she will listen to the concerns of my constituents and retain the Edinburgh cleft pallet service. Thank you, Presiding Officer. I welcome the opportunity once again to speak up for the many NHS patients and staff that I represent. Patients and staff who are rightly concerned about plans to cut key local health services in the west of Scotland, including the REH's children's ward in Paisley, and maternity services at the Inverclyde royal hospital. Presiding Officer, I have lost count of the number of times I have spoken in this chamber about the children's ward at the REH and the need to protect it. There has been a cloud of uncertainty over its future for far too long and we know that the health board's plans are to transfer 8,000 pediatric cases from the REH to Glasgow, and that would represent the closure of the children's ward as we know it. I have said before and I will say it again that the cabinet secretary should be under no illusions about the importance of the REH's children's ward to local families. Families like the ones that I met at a public meeting organised by the Kids Need Our Ward campaign last week. As the health secretary has repeatedly refused invitations to visit Paisley and speak with those families, I want to relay directly some of what has been said by my constituents to her this afternoon. One Paisley mum said that my daughter was in ward 15 for two weeks when she was six. The ward is very family-focused and the staff are brilliant. Being close to home meant that I could receive support from family, which meant that I was able to go home for a short time each evening. That could not have happened if it had been in Glasgow. Paisley desperately needs that ward to stay open. Other grateful parents said that ward 15 saved our little boy when he was admitted at 11 weeks old. Being able to stay with him throughout the week and also having the support of family who lived close to the hospital was invaluable. Without ward 15, we may not have our energetic four-year-old now. Sandra Webster, a founding member of the No campaign, described how her son had to use the ward once a month for minor operations. She said that I cannot describe the upheaval both financially and personally if we had to travel to the Queen Elizabeth University hospital. Having the ward in the REH makes our lives so much easier. The health secretary needs to listen to the children, the staff, the parents and the grandparents who want to see the REH children's ward protected. Listen to common sense and also listen to the communities in Renfrewshire and beyond that use that ward. The cabinet secretary has said that she will listen to representations. Shona Robins will be aware that she has already received thousands of petition signatures calling for her to stop those plans once and for all. I can tell the health secretary that there are thousands more that will be arriving with her shortly. Virtually no one in the local area believes that those cuts to the REH children's ward should go ahead and they should not go ahead. As I said in a speech in this chamber, two weeks ago concerns over centralisation of NHS services are not just about children's services but maternity services to closing the birthing unit at Inverclyde royal hospital would mean that women are no longer able to give birth at their local hospital close to home, family and friends. I think that most people would consider that type of closure to be a major service change and one that would be a major blow to people in Inverclyde. That is why it should be designated as such so that the final decision on birthing facilities at the IRH are taken by the health secretary. It would be good to know when the health secretary will take the decision on whether she will take her decision on those proposals. People in Inverclyde will rightly expect the SNP Government to take responsibility. Let's not forget, as Anas Sarwar said, that the First Minister was on the front page of the Greenock Telegraph last year promising that there are no plans to centralise services out of Inverclyde. The reality is that the future of our local hospitals depends on keeping those key services. Those decisions do not just have short-term consequences and consequences for people directly affected. The centralisation of services is leaving people across West Scotland concerned that questions will inevitably arise over the long-term sustainability of their hospitals. The SNP denied the proposals that existed before the election and said that it would protect local NHS services. However, the Government's amendment today mentions the St John's children's word, but it fails even to mention the RAH children's word or the IRH birthing unit. That cannot possibly be reassuring to worried local families that they are not even mentioned in your amendment. If local SNP politicians who represent that area support that amendment over our motion, they will be putting their party's interests ahead of their communities. Our motion today makes it clear that all those cuts should be designated as major service changes and we believe that they should be rejected by the health secretary. We know that the health secretary has the power to act. The Scottish Health Council's guidance is clear and I quote the decision on whether a service change should be regarded as a major ultimately risk with Scottish ministers. It is time for the SNP Government and the health secretary to listen. It is time to stop hiding behind the health boards facing financial black holes because of underfunding from our Government. It is time to stop hiding behind the Scottish Health Council and get off the fence. It is time to stop sitting back and watch while those cuts happen and local services are being axed. The SNP said that it would protect local NHS services. The question now is very simple. Are they going to or not? I hope that members from across the chamber will do the right thing, stand up for their services, their constituents rely on and support the motion at 5 o'clock. I am pleased to have the opportunity to speak in this afternoon's debate and I would like to draw members' attention to my declaration of interest. I am a registered nurse and I am a member of the Royal College of Nursing. It is because of my 30 years of experience as a nurse in the perioperative department—that is the operating room—and as a nurse educator that I wanted to speak in this debate today. I think that everyone in this chamber can find common agreement in recognising that people absolutely value the NHS services that are local and convenient to them as well as absolutely value the contribution of all NHS staff who work round the clock to provide the safest patient care in a world-class health system that is our NHS Scotland. As a former Stranraer lass, I am familiar with the concerns of family and friends as well as constituents that I have spoken to who make the 150-mile round trips for routine appointments in Dumfries and Moore. Some of those challenges are already being addressed by utilising modern video conferencing technology, as Marie Todd mentioned, for diabetes clinics, urological clinics and respiratory clinics. Equally, my professional experience is that multi-disciplinary teams working across many specialties are vital to getting the best evidence-based outcomes for patients. The RCN states that ensuring long-term sustainability of services means that health boards need to do things differently. I agree with the RCN that it should be consulted as an active participant in any service redesign. That means delivering services locally while putting the right teams together. Providing orthopedic trauma care, for example, is not simply a question of having existing competent nurses, orthopedic surgeons and other team members, physiotherapists, occupational therapists, radiographers, radiologists and other team members in place. There is a lot more to it. Orthotrauma requires specialised equipment and tools. Literally, the nuts and bolts, wires, plates and screws and power tools needed to realign or rebuild fractured bones are all sizes and gauges of nuts and bolts and wires. Service redesign, not downgrading, is about addressing shifting medical needs to address the health of our age and population. It is not easy to facilitate and provide all the advanced knowledge and technical requirements to assure optimal safe care. Given all those considerations, any health board has to consider all the available options in order to put the sort of teams that I have described together in the most effective way, but boards must do so with regard to the national clinical strategy. That provides a long-term commitment to delivering local services wherever possible, but also recognises that there will be a need for complex treatments to be delivered in specialist centres where the right teams, as I have outlined and as other members have outlined, can be brought together with the volume of patients to ensure good clinical practice, which meets our very demanding national patient safety programme. The point that I wish to make very clearly is that the practical experience of delivering modern healthcare is a constant effort to get that balance right. Reviewing service provision has part of that effort. Having said that, I would not wish colleagues to take that point critical, although I believe that it is, as a defence in what the motion describes as the downgrading of valued local services. It is anything but. Instead, it is an attempt to relate my front-line experience of NHS service provision to this debate and explain why health boards will be reviewing how they provide services. Clearly, the fact that the service changes are considered by boards does not mean that they will be implemented or accepted by ministers should they be designated as major service changes. Boards have made previous recommendations which SNP ministers have not accepted, such as closing Monkland's A&E or Lightburn hospital, as has been mentioned already, both of which ministers rejected already. My own practical experience of service delivery is that we engage in the best evidence-based practice to obtain the best outcomes that focus on safe, effective, person-centred, timely and cost-effective care. It is that experience that leads me to expect that such issues must be fully considered in any health board service review. The service review is a process that has currently been undertaken that has not even finished yet. The Government cannot interfere while the process is on-going. I encourage colleagues to remember that the SNP has made massive commitments to resourcing our NHS, which will see funding rise to a record high of nearly £13 billion this year, with primary care receiving an increasing share of NHS budget in each year of this Parliament. That is a commitment that my Labour colleagues would not match in their manifesto that their NHS spending plans were lower than the Tories. I encourage everyone with an interest in the services being reviewed in those three health board areas so that they can participate in those consultations. Where any of those results and proposals for major service change that will be subject to ministerial scrutiny, I am confident that the Government will weigh up the arguments carefully in reaching a decision. I support the amendment in the cabinet secretary's name. I declare an interest as a councillor here in Edinburgh City Council, and I also have family members who are employed by the health service. It was my privilege last week to take part in the health debate and to raise the porting issue of GP numbers and the effect that we were doxing on patients in Malorians and across Scotland. If we were to get that right, the pressure on hospitals would be reduced. It would be easy again to talk about doctor numbers, doctor morale, but I want to move on in regard to the debate and look at something that is as important to patient care. That is high-level decisions that are made by the Scottish Government and local health boards. Clearly, the relationship between government and health boards is vital and important, and too often, each other seeks to blame each other for the decisions that are made. However, there needs to be a close working relationship. Here in Malorians, we are in the first few months of an integrated health and social care board. The model chosen here is a joint work in between Edinburgh City Council and NHS Llorian. I think that most people think that it is the right way forward and can work well. However, what we have discovered just again this week is that there is no budget set for this new board. Neither the council nor NHS Llorian have been able to set a budget. The city was raised at the Governance Risk and Best Value Committee on Monday afternoon at the council, and it was made clear, certainly from the city council, that the reason they have not set their budget is due to the Scottish Government not being clear on what funding they will get. That seems to me unacceptable, and I would ask the cabinet secretary to intervene to make sure that both the council and Llorian health boards can set a budget even at this stage, as we are a third of the way through the financial year. We are all aware that the health service has to change. Why? Because our population is changing. We have seen the number of people who are elderly increasing, and that will continue as the BMA pointed out in my briefing paper to us in the next 10, 15, 20 years. However, as the health service changes, we need to keep to our core foundation, and that is helping people in need. Let me give an example of a service that has been changed here in Llorians as something that I think is illustrative of what is happening in other parts of Scotland. Landfine is a specialist service that has helped those affected by neuro-disabling conditions, those who have got severe conditions, who need help and respite care. The service offered individuals help with their conditions, taking them to hospital maybe once, twice a year to give them extra treatment and extra care, plus respite to those who looked after them. The redesign of the system started in 2010. It was based on taking from 33 hospital beds down to 10. It has been felt by many of my constituents who have contacted me that despite the assurances at the start of the redesign that it would not be financially driven, it is being financially driven and people are being forgotten about in the process. The service started its redesign six years ago. Six years ago, a full outreach team was meant to be in place and up and running by now. However, as of today's date, there is still nobody employed to help in this redesigned service. We have cut beds, no redesigned service and people wondering where they go to. The service is meant to move to the new royal Edinburgh, which is due to open in 2020. Yet many of the services that those people rely on are based on the Ashley Ainsley, the smart centre and other professional help that is given there. What will happen when it moves? Where will those services go? How will people access what they require? Those questions remain unanswered and are leaving many vulnerable people concerned and scared that they will not get what they require. Deputy Presiding Officer, as a Parliament, as a nation, we need to make difficult choices going forward in the decades and years ahead. Those choices must be informed at what is best for the patient and those who are vulnerable in our society. I fear that too often decisions are made around board rooms that are not driven by the patient but are driven by other factors, and that needs to change. In the short time that I have available today, there are a few principal concerns that I would like to raise about the proposed service changes. There has been a lack of robust, meaningful public consultation, that the pace of change is too fast and that our community services may not be ready to handle the impact of those service changes, those closures. I appreciate that there can be long-term benefits when we shift the balance of care away from the acute sector. Like others across the chamber, I am not opposed to developing more specialist services if they deliver clinical benefits to patients, and there was much of what Marie Todd said that I could agree with, but there are fundamental questions about access to be answered. I am not sure that we are ready for changes to local services on this scale. We need to ensure that we have solid, well-supported community services, flexible enough to handle the impact of any closures, although that is not to say that I support those closures. However, we need to know that the clinical benefits for patients are proven, not just assumed, before pressing ahead with service changes. That demands robust discussion around future service delivery. To be fair, the Government's amendment points out the strong efforts that are made to keep impatient paediatric services at St John's, just as the Royal College of Paediatrics and Child Health recommended. I am glad that NHS Lothian is acting on this expert advice and protecting local services for young people and their families. However, we need to have far more discussion about the wide range of service changes and closures that are proposed across the west coast, because, as anas Sarwar's motion makes clear, there is widespread public concern over those proposals. Too many patients, their families and staff members feel that they have not been listened to, and for too many that has gone on for far, far too long. Just a few weeks ago, we had a debate on the centralisation of cleft lip and pallet surgery. My colleague Alison Johnson pointed out that one of the national specialist service committees' own papers on the proposals acknowledged that there were lessons to be learned from the consultation process. Involvement of service users, staff and the wider public has to be real and meaningful, and it has to help to shape the outcomes. Have we really seen this level of public engagement around those service changes? I do not believe that we have, and I am sick of so many issues that affect my constituents coming back to problems related to poor levels of consultation. I am concerned that NHS Greater Glasgow and Clyde is discussing significant changes to maternity services in August, when we know that the national review of maternity and neonatal care was in its final stages. The concluding report was not yet submitted to ministers. Whatever the outcome of the review, it would have been reasonable to delay those plans to change maternity services until it has been completed. Its findings published and an informed public discussion have begun. In maternity care, we know that supporting patient choice is incredibly important. I am sure that we all want a full range of options to be locally available. If women can no longer choose to give birth in community maternity units in the veil of leaving and under Clyde, more will be booked into hospitals in Glasgow. We risk pushing women into giving birth in environments that they have not chosen to be in. Some might be able to have a midwife-led birth at the Royal Ags Andrews community midwife unit, but for those of my constituents in the veil of leaving, as Jackie Baillie has covered very well already, that is certainly not a local service. NHS Greater Glasgow and Clyde's board papers state that the main compelling arguments for change are based on staffing issues. Surely we should respond by providing better support to our local services. The same paper suggests that dedicated home birth team, which currently covers Glasgow, could simply extend their services to the whole of Greater Glasgow and Clyde. If staffing issues are the principal concern, how can we be confident that the home birth team is well resourced enough for such a rapid expansion? Ending paediatric inpatient services at the Royal Ags Andrews is estimated, as Neil Bibby mentioned, to affect over 8,000 episodes of care. The board's papers indicate that access to the children's hostel in Glasgow is a significant concern, and will be a significant concern, for patients in the Royal Ags Andrews' current catchment area. I know from the level of correspondence that I have received from constituents, some of whom are in the public gallery today, that this is of huge concern. It cannot be taken for granted that outpatient treatment is feasible in the centre for integrative care proposals. Many of those who use the centre experience chronic pain, chronic fatigue and other conditions that make everyday travel difficult. NHS Greater Glasgow and Clyde has stated that the overnight accommodation will be available in exceptional circumstances, but we do not know what that means. We all value our NHS. I hope that the Government can see the concerns that have been raised and see why many across the chamber will be supporting the Louber motion today. Ivan McKee, followed by Elaine Smith. No more than six minutes, please. Thank you, Presiding Officer. Lightburn hospital in my constituency is a key part of the local community. It provides inpatient, outpatient and day hospital services and is a base for the local Parkinson's group. In August, Greater Glasgow and Clyde health board presented proposals to closer. As members will no doubt be aware, this is not the first time that Lightburn has been threatened. In 2010, the health board made similar proposals. Indeed, those proposals were discussed at a meeting of the Glasgow City Council in November 2010, and the Labour councillors supported that closure plan in order to save the sum of £500,000. As we all know, the health board failed to make the case, and those plans were overruled by the then Cabinet Secretary for Health, Nicola Sturgeon, in 2011. The health board at a meeting in August this year, 16 August, which I attended, where they presented the paper making their case that they believed for the closure of Lightburn. I attended that meeting along with the Save Lightburn campaign, and Jeremy McCann from the campaign is in the gallery today. I have also met separately along with the Save Lightburn campaign and representatives of Parkinson's UK with the directors of the health board to examine their case for closure in more detail. In my opinion, the board fails to make a case for the closure of Lightburn based on what it has presented. The data that it presents is misleading and incomplete, and there is no data presented to back up the board's key claims around improved outcomes, a key part of the board's argument for closure. Outpatient services are to move from Lightburn to a proposed new health hub in the east end, but with no timescale for its construction. The health board directs questions about that hub to the IJB, a case of integration being used as a vehicle to shift rather than share responsibility. There is no clarity as to what measures will be put in place to cover the period between the proposed closure of Lightburn and the hoped for construction of the new facility. In the meantime, the Lightburn site has suffered significant under-investment. Recently, parts were boarded up signalling that the site and the patients that it serves are not valued. Lightburn serves a community with a high proportion of elderly residents in low-car ownership, and recovery rates are better when patients are closer to family and friends with frequent visits. The plan to relocate rehabilitation in-patient services to the other end of the city presents visitors with many transport challenges. The Government aims to tackle health inequalities, partly through shifting resources to the most deprived communities. The health board's plan does precisely the opposite. It would move resources from an area that contains three of the four most deprived areas in Scotland. I made all those points in the debate two weeks ago, and today I want to examine further plans for continuing community health services in the end of Glasgow. The Scottish Government has rightly put integration of health and social care at the heart of its programme to improve health outcomes. It has transferred the lion's share of funds from health boards to integrated joint boards, the IJBs. The Glasgow IJB is taking over responsibility for the provision of community health services across the city. Unlike the health board, where seven of the 27 members are only elected representatives, fully half of the members of the IJB are Glasgow city councillors, it is the IJB that has to consider how community health services should be provided in the city. In August of this year, the IJB considered this very subject. The answer was to invest £32 million in a new community health hub in the east end. Here, I can help the IJB by offering them some free advice. The IJB could use their new found powers and the funds that have been allocated to invest in and develop an existing site that already provides community health services to the people of the east end. In short, the IJB could site the new community health hub at Lightburn alongside the existing services there. Jackie Baillie Members will be aware that IJBs are complaining about being underfunded by health boards. Has he just shifted responsibility away from the Scottish Government on to IJBs instead of defending Lightburn? Ivan McKee If Jackie Baillie had been listening to what I had said through the first three minutes of my speech, I talked precisely about defending Lightburn and working with the Save Lightburn campaign. I have written to local organisations and I am committed to working to save Lightburn. If you read the IJB paper, the IJB has talked about investing £32 million in a new community health hub in the IJBs. I have got a lion's share of the funding that goes to the health service across Scotland. You should read the document and see what it says. Who is on the IJB that would make that decision? The chair of the IJB is Councillor Archie Graham. Four other Labour councillors, including Bailey Elaine McDougal, who represents the east centre ward adjacent to Lightburn hospital. The money is there and it is in the paper. The public engagement on Lightburn's future has now started and I have written to local community groups and community councils to urge them to take part. I believe that the health service proposals for Lightburn to be flawed. The answer to shift and the focus of service delivery from acute to the community is not to close a community hospital and move patients to a large acute hospital some distance away. The answer to tackling health inequalities is not to shift resources from the most deprived communities to the centre. The answer to improving outcomes for patients is not to move them away from friends and family, reducing rather than improving their outcomes. The answer to improving health service provision for the people of the east end of Glasgow is not this health board proposal. I call on the IJB to step up to the plate to invest in the Lightburn site, the money they are going to invest, the money they are going to invest in their own paper, the money they are going to invest in their own paper to choose to invest in the Lightburn site to continue to provide services locally in the community in line with this Government's national clinical strategy. Elaine Smith, to be followed by Graham Simpson. Labour's motion reflects the number of major service changes proposed across the NHS in Scotland. I have personally expressed concern about the proposals for the CIC at the Petitions Committee and I have written to ministers with a particular focus on the closure of the CIC clinic in Cotebridge. However, our time limits today mean that I need to focus on the cuts to orthopedics and trauma at Monklands. A decade ago, NHS Lanarkshire carried out a review of acute service delivery under the banner, a picture of health, based on the care report. Several of the options in that review involved downgrading Monklands hospital, and if I could just remind the cabinet secretary, that was based on alleged safety of services 10 years ago. None of those options proposed completely closing the hospital or, indeed, to A&E. Nonetheless, the attack on our local health services in Monklands was completely unacceptable to local people, as evidenced in extensive consultations, and it was unacceptable to local politicians, including me. The decision was devolved to the health board, but the Government has a duty and a responsibility to sign off major service changes, so the Labour-Liberal Coalition signed off that change wrongly, in my opinion, and frankly suffered the electoral consequences of that. I spoke out against my own party on this, I put down a motion on the future of Monklands as my last one before the election, and then I put down another as my first one after I was sworn in following the election. I have no doubt that the SNP's election campaign to save Monklands helped them to victory in 2007. Indeed, it was printed on the ballot papers beside their candidates' names. One of the downgrading options at that time—Option D—specifically proposed to remove orthopedics and trauma. That was meant to have been rejected when the newly elected SNP Government demanded a rethink by NHS Lanarkshire, resulting in the status quo for Monklands. It was rejected those proposals 10 years ago. It has not really been the status quo. The loss of pediatrics has then been added to over the past decade by a loss of gynaecology and dermatology, and heart attack patients are now treated at Hairmayers. Now what we see is a return to the downgrading of a decade ago, with removal of orthopedics and trauma again based on alleged safety of services, as the cabinet secretary pointed out in her opening remarks. That all looks very much like death by 1,000 cuts to me. There is an opportunity right now to call in the current cuts proposals to properly consult and to rethink again. As for the proposal to build a new Monklands hospital in seven years' time, that investment would of course be welcome, but maybe the minister can clear up some questions. Where in our Government's budget planning is the £400 million, what does she say to the health professionals who say that a new acute hospital would constantly double that amount and where is it going to be built? If there is a cost identified, the detail of that must surely be known. In fact, Fulton MacGregor seems to know it in today's advertiser, so maybe that could be shared with the rest of us. The promise of a new hospital cannot be used as a smokescreen to cover up the current threat of the downgrading of orthopedic and trauma. So let's have a look at what the facts are about the current threat. Orthopedic and patient trauma are being taken away from Monklands hospital to be delivered instead at Whishaw and Hairmayers hospitals at least an hour away on public transport, with no new transport arrangements proposed for a patient, for example, with limited mobility. That is going to be for at least seven years, apparently. That decision was taken during the summer recess with no prior public consultation and the staff were issued with their redundancy notices. Due to that, Richard Leonard and I organised the public meeting to try and get public engagement with the health board. I would actually expect them to come to a meeting organised by MSPs, but they chose not to attend the meeting and they cited lack of consultants at short notice. I did not ask for a consultant, I asked for one of their board members and or a senior official. However, it is important to hear the views of medical professionals, particularly those who have experience of working in Monklands. Orthopedic surgeon Sathur Sajam, who has worked at the Monklands for 30 years, calls the plan, ill-advised ill-thought-out badly planned and totally unnecessary. He goes on to say, the argument that Mr Callum Campbell and the Lanarkshire health board put out continually, saying that there will be no disruption to the care of the elderly and the young, following the closure of the orthopedic trauma unit at Monklands hospital, is, in my opinion, frankly ludicrous. Having spoke to other staff privately, I know that we could hear similar from more of them if they weren't worried about speaking out. Some consultants have actually spoken out. Six at Whishaw, who said that it's impractical to shunt patients about Lanarkshire and ambulances, and seven orthopedic surgeons at Monklands have made the case for it to stay at Monklands. The SNP Government can and should step in to stop this major service change, and I believe that they have a duty to do so. At the very least, the plans must be halted until a full consultation on that specific issue is carried out. A meeting is a start, but the people of Monklands deserve to know the full facts. At what point does the downgrading of Monklands hospital end? Do the Government really think that people are going to accept promises of jam tomorrow, which are frankly designed to try and disguise cuts today? At what point do SNP constituency members put the people they serve first and demand that their Government steps in to stop those cuts? I did that a decade ago. I stood by my principles and I did that, and they should do it now. We know that the issue featured heavily in the recent Co-Bridge and North Glenboyg by-election, with Labour's Alex McVeigh elected on a promise to oppose cuts to Monklands. That sent a clear message that people care about their vital local health services and increasing numbers are joining the campaign to save Monklands hospital, the least they can expect is for the Government to call this in, and some of them are in the gallery today from that campaign. I've got no doubt that People Power can and will win this battle to save services, and we on the Labour benches will be standing firmly with them to stop those cuts. I hope that other elected representatives will do so too. Graham Simpson, to be followed by Claire Hawke. Thank you. This is an important debate. I have to thank Labour for bringing it, and it follows on from our own debate on health last week. We all use the NHS. Most of us have great experiences of it, and we're grateful to the staff who provide such fantastic service. It's easy for politicians to either say what a great job we're doing if you're in government or say that the governing party is letting the public down. The truth is usually somewhere in between. Some good things are happening in the NHS in Scotland. I'm attending the opening of a new health centre in East Kilbride next week, the one my family uses, and there'll be a new Monklands hospital in the region that I represent. However, there are problems, and we need to be honest about those. Let me start with some general figures. The Royal College of GPs say that Scotland is 830 GPs short of the number needed, following a 2.4 per cent fall between 2013 and 2015. Now, that's serious. I was contacted by a local GP this week. He told me, and these are his words, secondary care problems snowball back to primary care. Waiting times are increasing. I was informed two weeks ago, this is him speaking, that the routine waiting time for outpatient gastroenterology at the new Victoria is now 30 weeks. Waiting time for a community physiotherapy appointment in my area is now 12 weeks. After a busy day, often 10 hours plus, I, like many other GPs, couldn't face a shift in out of hours. There are shortages and closures as a result. That's from a doctor. This does not paint a rosy picture. Staff shortages mean costs increase and add to stress levels among those left. They're changing the way we deliver our health service. I mentioned Monklands, part of Labour's motion and heavily mentioned today already. A new hospital is to be welcomed. Let's be clear about that, but there have been big concerns locally over the changes to trauma and orthopedics. A Lanarkshire health board briefing says that the most complex trauma cases that require surgery are being moved from Monklands to hair mires and wish or general hospitals. As Shona Robison said, this is an interim move, but proposals are underway to take them solely to one site, probably wish or. My own sense, as someone who lives at the other side of Lanarkshire, is Monklands, is probably the best place to have it. It is the easiest place to get to. I welcome the tone of the member's contribution so far, but just to be clear, what the health board is saying is that the trauma centre should be in wish or because pediatrics is there, but that the elective centre, orthopedic centre, would not be in wish or, and my preference obviously will be, and I think it will be, in the new Monklands hospital when it's built in 2023. Graham Simpson? I would agree with that for the reason that I've stated. I think that it's a more practical option and it'll be a brand new hospital. So, the health board have stated that risks have been identified within NHS Lanarkshire's trauma and orthopedic services that could affect patient safety. They've said and I quote, we have an immediate pressure to make interim changes now so that the service is safe and sustainable for patients in Lanarkshire. These are serious words so that the service is safe. How has it been allowed to get to this stage? Ten years, ten years of, I want to make progress, ten years of SNP government. Staffing issues have been in the pipeline for some time, but sufficient action has not been taken. Now, let me be clear. I understand and I agree with the move to have specialisms delivered more centrally. It makes absolute sense for the professionals and for the patients. Changing the way we deliver GP services that you don't always have to see, the family doctor, that also makes sense. But the proposals in Lanarkshire are perceived as a downgrading of Monklands, even though we'll retain three fully functioning A&E departments. Irrespective of what is planned, we need to know how we got here. The reason is that after a decade of having the SNP in charge of Scotland's health services, we have those staff shortages. Here's what consultant orthopedic surgeon Alberto Gregory has to say, direct quote, there's a shortage out there. We can't recruit. Part of that is people who don't want to work in small units and part of it is there is a national shortage. The present status quo is not sustainable. It's not safe. So far Shona Robison is hidden behind the health board, but she has to take some responsibility. She's in charge. I don't want to step in on every decision made locally, but those are big ones and she must step up to the plate. After 10 years in charge, the time for blaming others has to end. Claire Hawke, to be followed by Alex Cole-Hamilton. Thank you, Presiding Officer. As one of the three healthcare professionals recently elected to this Parliament, and one of the two nurses in this chamber today, it's particularly important to me to speak in this debate on the future of healthcare services. The Government's vision is that by 2020, everyone will be able to live longer, healthier lives at home or in a similar setting. To ensure quality and consistent care, the health service must be smart and efficient in order to meet the increasingly complex health needs of an ageing population. The national care strategy, the blueprint for health and social care in Scotland, takes this population change into account. Its emphasis on the shift to multidisciplinary working and the use of advances in research and technology is designed to support the needs of this generation and of generations to come. I am not a stranger to periods of transformational change. I have been a mental health nurse for over 30 years. In that time, there have been huge changes, not only in the way that we view mental illness, but also in the way that we care for and treat people suffering from mental illness. I would go as far as to say that we have witnessed a revolution in mental health care. When I began my nurse training, the majority of patients with mental illness were cared for in large institutions. Those asylums, many of which were built in the late 1800s or early 20th century, were quite frankly no longer fit for purpose. Often physically disconnected from modern life and society, patients were isolated from their communities, isolated from their families and isolated from their existing networks of support. In many cases, this isolation was for years at a time. It was not unheard of for someone to have been admitted to hospital for an illness, which would now be treated in primary care by GPs and they would never return home. Often wards were home to in excess of 40 or 50 patients with little personal space or privacy. Long-term patients spent years of their lives in these institutions and I personally cared for many men and women who had been in hospital for over 30 years, forgotten about by society and estranged from their friends and families. The staff and the other patients were their only social contact. The hospitals became communities of their own where work activities were supported and encouraged, social events organised and held and shops provided not just sweets and drinks but clothing and shoes. There was little reason to leave the hospital grounds and, for many, there was little prospect of returning to a life outside of hospital. However, in the 1980s and early 1990s, we began to see a change in how mental health services were delivered. Multidisciplinary community mental health teams were formed, no longer with community psychiatric nurses of whom there were only a few working in isolation. Psychiatrists, psychologists, occupational therapists and pharmacists all adapted to new ways of working in new settings. Ideas of where mental health care should be delivered began to change, and in most cases that change was to a community setting where most people wanted to receive care and treatment. The majority of the large institutions were closed and newer, smaller and more modern facilities were built to provide care for the most acutely unwell patients. Long-term care was no longer the norm. If you needed to be admitted to a mental health facility, it was for a short period of time as possible rather than being committed to care for the rest of your life. The public came to expect to be able to access mental health services while remaining at home. As well as the community mental health teams, support services were delivered by third sector partners. Thus, the social needs and mental health needs of those who required additional support to live their lives were addressed. Out-of-hours mental health services began to develop with telephone triage and access to mental health assessment and care outside of normal working hours. Again, services helped people to stay at home rather than being admitted to hospital. In the early 2000s, crisis services began to be developed across the country. The seven-day a week teams provided crisis management and support to some of the most unwell and vulnerable in our society. They provide intensive home treatment, often visiting several times a day to ensure that a patient is safe and that they are able to remain at home. Specialist community teams were also developed. Teams that could provide expert care and treatment in areas such as eating disorders, perinatal mental health and early intervention in psychosis. All the service teams that I have described are now accepted as the norm in mental health care. Across my career, there has been a profound change in the way that we care for patients, carers and their families. That change has helped to reduce the stigma around mental illness and encouraged people to access care and treatment at an earlier stage. We talk about mental illness instead of shying away from it. That is to be welcomed, but none of that would have happened without service redesign. At the time that these changes were difficult, service users, carers, staff and the public were worried and concerned about bed and hospital closures. Worried services would not meet their expectations and worried about safety. However, now no one would argue for a return to old ways of working. We accept that the model of mental health delivery is much more modern, evidence-based and rights-respecting than it was in the past. If we are to change the focus of healthcare away from the existing models and existing hospital settings to community settings, as we did in mental health, then we have to review services. We have to be open to discussion about how things can be done differently, what can be done more efficiently and what is best for patients. Service redesign should not automatically be viewed as negative. Changes to services can be challenging, but challenges can also come with opportunities—oportunities to make real and positive changes to real people's lives. We move to the last of the closing speeches. Alex Cole-Hamilton, up to five minutes, please. Thank you, Deputy Presiding Officer. I would like to start by congratulating the Scottish Labour Party on bringing this motion to the chamber today. In particular, I would like to thank Anas Sarwar on his kind remarks around the Liberal Democrat amendment. We will certainly be embracing that spirit of cross-party consensus to which he referred. Deputy Presiding Officer, this debate is not about exercising top-heavy parliamentary control far from it. As a Liberal and as a passionate exponent of subsidiarity, I would not rise in support of a motion that is sought to give either ministers or Parliament the whip hand to ride roughshod over the set careful plans of clinicians and managers opposing any rationalisation or redesign on a whim, but on decisions of this magnitude when proposals threaten much-loved and well-used local facilities and that, in turn, induces dozens upon dozens of constituents to seek appointments in my constituency surgery, in your constituency surgery. Then we have a duty to raise it in this chamber and in the corridors of government to give stakeholders their day in court and to test the reasoning of those clinicians and managers who designed that change. On the doorsteps, on in surgeries and in mailbags, we are, as parliamentarians, asked to account for these day-to-day decisions taken by health boards, yet I for one am not content to hide behind the health board in reply. I too want answers that go beyond the sort of vague opaque world of funding pressures or optimisation. Every day decisions are made to rationalise and optimise. Well-paid people, experts in their fields, take decisions and that is absolutely right, and the vast majority of those things are the right thing to do. Yet sometimes, however, the bottom line or what appears to make sense is not met with the expected public response. For example, in huge amounts of research went into the design and commission of the Queen Elizabeth Children's Hospital on the site of the Old Southern General, a colourful state-of-the-art single occupancy rooms were constructed through much fanfare until the kids arrived. I was a youth worker of 19 years. I could have told those commissioners that children who are vulnerable do not like to be left alone, and as we have seen, a rowback of some of those provisions. My point is that what looks good on paper and is backed up by research sometimes requires a direct input of the end-user to sign it off. If that is not in the chamber for Scottish patients, if they do not have us as parliamentarians to voice their concerns and to have that input, then I do not know where that interface can lie. We have heard compelling evidence of specifics, such as Royal Alexandra Children's Hospital, the Vale of Leven maternity wards, but in my own interests, the constituents and patients who have come to my surgeries overwhelmingly voiced the issues of cleft palate and craniofacial department in Edinburgh. Felicity Mahandelay, the surgeon, leads a world-beating team. As we have heard from Ash Denham, he is set to play host to the field's international congress in 2021. We know how good she is. We have heard about that in this debate, but only because 6,000 campaigners had to raise freedom of information requests as part of the consultation process to prove how good she is. I think that that speaks volumes of how the lack of opacity and how untransparent the process is. To move her to Glasgow was on the grounds that not to do so would be sub-optimal, could run the risk of losing her from the Scottish profession altogether, not just sub-optimal, but a criminal waste of talent. I find it astonishing that the only time that this parliament has had the opportunity to debate these planned closions, where in Mars Briggs's debate two weeks ago, and in this opposition debate today. I do not think that that is how Parliament should scrutinise these decisions. We still have challenging decisions before us. Health boards will make decisions down the line that we cannot even comprehend. We have heard of how the paediatric ward at St John's has been saved and that has been referenced in the Government amendment. Recent closions and staffing pressures paint a very worrying picture about the future viability of that service. I want to know, because it is the hospital of choice of many of my constituents, that if that viability raises its head again that this chamber will have the opportunity to question the cabinet secretary and to scrutinise the arguments for its retention or its closure. This is not about rejecting all organisational redesign, it is about an opportunity for the cabinet secretary to enlist his champions for that redesign, or if the weight of argument and intervention from this chamber compels her to think again then so be it. However, I welcome the opportunity that the Labour Party has given us today and the Liberal Democrats will support the motion. I now move to the closing speeches. I call on Miles Briggs. No more than six minutes, Mr Briggs. Thank you, Deputy Presiding Officer. I am pleased to close today's debate for the Scottish Conservatives, which I think has been useful in allowing members from all sides of the chamber to voice the genuine concerns that they have of constituents about service changes and downgrades in their own areas. I grew up in rural Perthshire. Anytime I or anyone in my family needed care, we could rely on the highly valued hospital that was Perth Royal Infirmary. I am pleased to say that, growing up, I personally did not need to call on their service very often. However, the same cannot be said for my sister, who ffared much worse with broken arms and other fractures over the years, the life experience of growing up in the countryside. Thinking about today's debate, I considered just how valued Perth Royal Infirmary was to our family and how grateful the whole community across Perthshire and Kinroshire always have been for the NHS staff who provide these services to the local community, the vast majority of which live locally. I am therefore very sad and to learn of how many of Perth Royal Infirmary's key services have been lost to the local community in recent years. In fact, since this SNP Government came to power, Perth Royal Infirmary, which serves one of Scotland's fastest growing population areas, has seen the continuous removal of services such as the maternity ward, pediatrics, pathology, weekend surgery, emergency surgery and, most recently, the GP out-of-hours services, with all those being centralised to Ninewell hospital in Dundee. In each case, SNP ministers and health board officials have stated that each proposal does not constitute major changes to services. However, it is pretty clear that, for anyone looking at Perth Royal Infirmary today, the stage removal of enclosure of services that have taken place over a number of years has ultimately led to the end of PRI as an acute district general hospital. Like with all of the key hospital services mentioned in the Labour motion today, too often the Scottish Government has been satisfied to hide behind NHS health board decisions and support the downgrading enclosure of services, the unintended or perhaps intended consequence being the highly centralised health service that we are seeing being developed in Scotland today. I am looking to services currently under threat in my own Lothian region. I very much welcome the positive case made by both Alex Cole-Hamilton and Ash Denham to retain Cliff pallet surgery unit services here in Edinburgh. I am pleased that, on this issue, SNP members have started to speak out against those proposals. I want to take the opportunity again to call on the Scottish Government not to approve the centralisation of the surgery unit, which we debated in my member's debate on the subject in the chamber recently. I welcome the fact that the cabinet secretary has announced that she is due to visit both the Edinburgh and Glasgow teams over the next few weeks, and I hope that those visits will help to persuade her that the two-site model, which works well across many locations across Scotland and the United Kingdom, is in the best interest of Cliff pallet patients here in Scotland. While we can talk in facts and figures about those cases, the reality is that, especially for children's surgical services, there are disrupted families, husbands and wives having to live in separate places and children not seeing one of their parents for maybe weeks at a time because they are getting treatment tens of hundreds of miles away from where they live. You were too quick for me, Mr Johnson. Miles Briggs. I very much agree with those points. I think that this is what is key to this whole debate, that our NHS belongs to the people we serve in Scotland, and the Scottish Government needs to start working for that as well. The Scottish Government amendments also mentions the fact that St John's Hospital in Livingstone and highlights the fact that it is currently providing cleft pallet surgery. However, as I have highlighted to the chamber previously, the cleft services that are currently located at St John's are delivered by the Edinburgh cleft surgery unit. I am sorry to say that today I am not sure if ministers have grasped the facts around the proposed centralisation of cleft lip and pallet surgery in Scotland. Although I do not have time to raise those specific concerns, I have written to the cabinet secretary today to further highlight those. We need to see a continued focus by the Scottish Government on recruiting the consultants needed to keep key paediatric services at hospitals like St John's in the Royal Alexander, not the decision simply to centralise those services. One of the themes that emerged during today's debate is the lack of confidence many of our constituents have in the consultation process organised around health board service changes. Jackie Baillie made a really passionate speech, highlighting the fact that constituents offer fear that the consultations do not take into account their views or are skewered towards approving decisions that they think have already been made. I have to say to Scottish ministers that the idea of a consultation is to listen to the people who are responding to you. Ministers talk about patient-focused healthcare and services being close to patients as possible. However, the reality that we are seeing is the constant centralisation of services, which once lost or never returned. As Ross Greer and Donald Cameron have said, increasingly it is starting to feel that the centralisation of our health services or the consolidation of services is also being driven by staff shortages in the NHS. The failure by the Scottish Government to deliver an NHS workforce plan should not be the reason for the closure of vital local services. Patients and communities want to know what services they will have provided locally and the confidence that those services will be properly maintained and made to be sustainable. Increasingly, communities feel that they are facing a constant threat of the valued services that they hold so dear being removed. The Scottish National Party Government was elected on a manifesto commitment to keep services local and improve the availability of those services. It is clear from today's debate that they are increasingly failing to keep that pledge to communities across Scotland. What is not in question today is the level of priority afforded to the safe stewardship of the NHS by the people of Scotland. There are no public services that are valued higher. I want to put on record that, once again, the Government is sincere appreciation for the instinting professionalism and commitment shown by those who work so tirelessly in our health and social care services. It is on that note that it is appropriate to remind ourselves, as Marie Todd did and Claire Hawley did, of what one staff body, the RCN, said in their briefing, to ensure the longer-term sustainability of services and to be able to meet the needs of its local, ageing population in the future. Health boards need to do things differently. They go on. Politicians, professionals and the public must be prepared for transformational change and all stakeholders involved with the changes proposed will need to put vested interests to one side and work together to deliver the changes that are so urgently needed. It is behind that rallying call from the RCM that I genuinely think that we should unite behind, regardless of political party, as opposed to the imploring of unity by Anas Sarwar, behind what was, I think, a responsible narrative that was big on grandstanding but short on detail and facts. As the cabinet secretary pointed out in her remarks, there is a clear, robust process that should be followed, which gives opportunity for engagement and that no decisions have been made about service changes. That process was set up by statute in 2005 to provide independent oversight in the key area of patient focus and engagement. It is that process that Donald Cameron's comments seek to cut across. His speech seemed to, on one hand, accept that it was premature to prejudge the process but, on the other hand, sought to ask the cabinet secretary to expedite that process. He simply cannot have it both ways. He then went on to say that blanket opposition to any change is impossible and that tough decisions need to be taken. While I accept that these discussions are emotive, they are of huge importance and that it is absolutely right for opposition parties to hold this Government to account, the opposition also needs to realise that they need coherence to their arguments and be responsible with the marshalling of the facts. The fact is that it is this Government and the cabinet secretary have made clear about our responsibilities in taking decisions but also on using the evidence, both clinical and local. The minister for giving way accuses me of grandstanding. I say that I am here standing and representing my constituents. I wish constituency members like Bill Kidd, John Mason, Alec Neill, Tim Arthur, Stuart McMillan and George Adam, who are discussing their constituent services today, chose to stay in their seats and not speak. I have heard many members from the— Just from the record, this debate was well oversubscribed, which is why many of us were selected to speak. It is not a point of order, Mr Neill. I actually heard a number of backbench SNP contributions today, who made huge contributions and articulated incredibly well the needs and desires of their constituents. Again, that follows on from the grandstanding that Anas Sarwar took when he rose to his feet earlier on today. I want to talk about Elaine Smith. I am sorry, Mr Finlay, that she was not in the debate, and I am sure that others will want to interject in my comments later on. On Elaine Smith's point, I have no doubt her commitment to Monklands hospital, unlike the rest of her party nearly 10 years ago. However, she did fail to recognise the £65 million spent on Monklands over the last five years on a new critical care unit, on upgrading operating theatres, a new Lanarkshire Beats and Satellite Radiotherapy Centre, a new pathology unit and extensive refurbishment of the mental health unit. Clear commitment to a hospital from this SNP Government. Further more, I will just for clarity and then I will let her in. I understand that, while NHS Lanarkshire could not make the meeting, it was asked to attend at incredibly short notice that it has also offered to work with her on an alternative date. Elaine Smith. Many thanks, but unfortunately it is a drop-in. I have just found out that it is not a public meeting, and I do not think that that is acceptable. However, would the minister recognise that, in arguing against those proposals, both myself and my colleague Karen Whitefield got commitment to things like the Beats and Satellite Radiotherapy Centre, so I recognise that those things are now at Monklands hospital? Elaine Campbell. I will point in any way at all. She failed to recognise entirely the commitment that this Government has put in terms of saving Monklands A&E and further enhancing the services that are provided at the hospital. Ross Greer made a number of valid points, I thought, that will need to be addressed in the engagement process under way. I think that the general issue that he raised about communication and clarity of that communication is a good one that I think stands for all of our public bodies and not just the NHS. Ive McKee also raised the issues of deprivation and the inequalities of the constituency that he represents, and the additional barriers that that creates in terms of access to services that must be borne in mind when designing those services. Neil Bibby and I know that we will disagree on a number of issues in today's debate, but I think that on that theme of listening and engagement, I do not think that anyone can have failed to be moved by the accounts that he read from the families who have incredibly strong views about the future of the hospital in their area, and, of course, those views must shape and hone the decision making process. Likewise, Clare Hockey excellently articulated, with a great deal of authority, the wider changes that we need to see in healthcare, especially in mental health, and will of course be taken forward by my colleague Maureen Watt. Presiding Officer, there have also been some mention today of ensuring that the NHS has enough resources, and Ash Denham set out the challenging backdrop that this debate occurs in. Let me remind the Opposition that this Government, which has ensured that health spending in Scotland during 2016-17 has risen to a record level of close to £13 billion. That is despite Westminster having cut Scotland's fiscal budget by 10.6 per cent in real terms between 2010-11 and 2019-20. We have increased the front-line health budget by 8.2 per cent in real terms between 2010-11 and 2016-17, and we will continue to provide real terms protection. In 2016-17, territorial health boards have seen a 5.5 per cent increase in budget levels, and that funding includes investment of an additional £250 million to support the integration of health and social care. Despite Brian Whittle's inaccurate claims, let me clear this up for him. Every perry of health resource consequentials has been passed on in full since 2010-11, plus an extra £54 million in last year. We will, of course, increase the NHS revenue budget by £500 million more than inflation—nearly £2 billion—in the lifetime of this Parliament. I think that with that record of increased numbers of staff, increased numbers of front-line staff, increased investment that we have a clear plan for the NHS, and we will continue to engage with the population. Opposition needs to understand that it needs to have its facts right before it comes and stands hand in this chamber. I now call on Colin Smyth to wind up the debate. Around nine minutes, please, Mr Smyth, but no later than one minute to five. Thank you very much, Presiding Officer. I refer members to my register of interests, which shows that I was employed by Parkinson's UK when I was elected in May, although disemployment has ceased now. In today's debate, we have heard the voices of thousands of concerned families right across Scotland. Member after member has stood up for their constituents and sent a very clear message to the Scottish Government. It is time to listen. We heard the voices of people in West Dunbartonshire when Jackie Baillie spoke passionately on their behalf to expose the attempt to cut by stealth maternity services at the Vale of Leven hospital. We heard the voices of people in Renfisher and in Inverclyde when Neil Bibby spoke up for his constituents and continued his fight to save the children's ward at the Royal Alexandra hospital and maternity services at Inverclyde hospital. We heard the voices of people in Lanarkshire when Elaine Smyth once again championed Monkland hospital, highlighting community concerns over plans to act inpatient orthopedics at Monkland. We heard the voices of people in Glasgow when Anas Sarwar spoke of the impact on the availability of care for some of our older, most vulnerable residents if the closure of Lightburn hospital goes ahead. However, what we also heard in this debate this afternoon is the fact that those concerns cut across party lines. It was not just Labour members who spoke passionately about their communities. Donald Campbell, Brian Whittle and Alex Cole-Hamilton rightly asked why the cabinet secretary does not even seem to have yet a view on whether the plans before us today are major service changes. Daniel Johnson, Ash Denham and Miles Briggs raised concerns on behalf of their constituents over plans to centralise cleff pallid services away from Edinburgh. Ross Greer rightly highlighted the concerns of his west of Scotland constituents over the lack of public engagement and the plan changes in his area. It is clear that the concerns that are raised in the chamber today unite members across party lines, as Anas Sarwar called for. More importantly, it is clear that those concerns represent the views of a growing number of people in the communities that we are here to represent. Earlier today, along with a number of members, I had the pleasure of meeting representatives from the No Campaign, the Royal Alexander hospital, the saver services campaign at the Vale of Leven hospital, the campaign against the downgrading of the centre for integrative care at Gatnaval, the cleff services campaign and those campaigns to protect services at Monklands, and the Save the Lightburn hospital campaign. Gerry McCann, the chair of the East Glasgow Parkinson's support group, told me how the closure of Lightburn would impact on people with Parkinson's. A condition that I know is so debilitating for those who live with it every day, but also how that closure would impact on those with heart failure, dementia and those who have suffered strokes—some of the frailest people in our area with some of the poorest health in Scotland. He told me what the campaign led against the closure of Lightburn in 2011, but he cannot understand why the proposed closure of the last inpatient facility in the east end of Glasgow in 2011 was deemed a major service change then, but so far not now, even though the evidence of a major change is already clear. Those campaigners took the time to come to Parliament today to share their stories with us, and what a disgrace then that the wording of the SNP amendment before members today pretends those communities and those concerns do not exist. Like a scene from George Orwell's 1984, the cabinet secretary's new speak amendment airbrushes out any reference whatsoever to the word concerns. It does not even mention the services that we are here to debate today. I can tell the cabinet secretary that those communities are concerns, and they want this Government to face up to its responsibilities. As several members have highlighted, and as it says clearly in the Scottish Health Council's guidance, the decision on whether a service change should be regarded as major rests with Scottish ministers. I know that the proposals that we are debating today are major service changes. The patients' groups here today know that they are major service changes, so as Neil Bibby asks, it would be good to know when the cabinet secretary will take the decision and whether she will take the decision on those services. That is the least the Scottish Government needs to do, because ultimately the reason for many of those plans being considered is, as Jeremy Balfour highlighted, a direct result of the funding challenges facing health boards today. When I made my first speech on health in this chamber in June, I said that we needed to have an honest debate about the future funding of the NHS. We all accept that we have an ageing population and an increased number of people with complex care needs. Despite a growing demand for services, local health boards are still being hit by significant health savings targets that cannot be achieved without impacting on services. This year, my local health board, NHS Dumfries and Galloway, has to make so-called savings of £30 million. Greater Glasgow and Clyde is £69 million. Lanarkshire is £45 million. Those cuts are driving the changes that we are debating here today. They come at a time when the NHS is struggling to recruit and retain staff, exasperated by a number of unfilled trainee and specialist posts. One in four of our GP practices report a vacancy, and we have a ticking time bomb of GPs queuing up to retire. In my own health board area in Dumfries and Galloway, the number of GPs has fallen from 134 in 2012 to 118 in 2016. Just today, I received a letter from NHS Dumfries and Galloway highlighting the fact that they cannot recruit two out of three GPs needed to maintain the high-street GP practice in Moffat. Those vacancies will be covered by locums in the short term, and then the NHS plans to merge practices and close down their outreach surgeries held in the villages of One Lockhead and Crawford to manage that crisis on the GP recruitment. As the letter says, there are an increasing number of GP practices that are simply unable to continue to provide services. The Royal College of GPs has predicted that by 2020, Scotland will have a shortfall of 830 GPs just to return to 2009 levels. Cabinet Secretary, if that is not a GP crisis, then I certainly do not know what it is. It is not just in GP numbers that we have that crisis. There are more than 350 consultant vacancies with nearly half vacant for more than six months. Two and a half thousand nursing and midwifery vacancies include more than 300 mental health nurse posts unfilled. The consequence of high vacancy rates and training posts going unfilled across the NHS is an increase in the burdens on existing medical staff, adding to an already unsustainable workload and, as we have heard today, the closure of facilities across Scotland. Despite that, the SNP put forward an amendment that, after 10 years on powers, simply says, there is no problem here, nothing to see here, simply move on. It is an amendment that treats communities with content by failing to even acknowledge that there are local concerns right across Scotland. It is an amendment that even fails to mention the very services that we are debating today, with many of the SNP members who represent the areas that are affected posted missing and SNP members from as far away as they can get drafted in to talk about anything other than the motion that is before the members today. However, I would simply say this to members in the chamber. It is the motion that we will be voting on today, the communities and the areas that are mentioned in that motion that you will have to make a decision on today. I have also mentioned, cabinet secretary, the areas that are covered in the motion, unlike your amendment. I would urge members across the chamber to stand up for the communities that they represent, recognise the concerns of those communities and support the motion before us today. That concludes our debate on protect local energy services. The next item of business is consideration— Point of order, Rhoda Grant. Could I ask the Presiding Officer how many members had requested to speak in this afternoon's debate and were not called? Thank you for that point of order, Ms Grant. I will find out and I will return to you after decision time. It is not a point of order, but I will find out from Ms Grant. The next item of business is consideration of business motion 1737 in the name of Joe Fitzpatrick on behalf of the parliamentary bureau setting of the business programme. Members will be aware that a new business motion has been lodged to accommodate a finance committee debate next week. I would ask any member who wishes to speak against the motion to press their request-to-speak button now. I call on Joe Fitzpatrick to move motion number 1737. Formally moved. Thank you. No member has asked to speak against the motion. I will put the question to the chamber. The question is that motion 1737 in the name of Joe Fitzpatrick be agreed. Are we all agreed? We are all agreed. The next item of business is consideration of four parliamentary bureau motions. I ask Joe Fitzpatrick to move on block motion 1691 on the variation of standing orders and motions 1694, 1695 and 1696 on the approval of SSIs. Moved on block. Those questions will be put at decision time to which we now come. There are three questions to be put as a result of today's business. The first question is that amendment 1677.1 in the name of Shona Robison, which seeks to amend motion number 1677 in the name of Anas Sarwar on protect local NHS services, be agreed. Are we all agreed? We are not agreed. Parliament will move to a vote and members may cast their votes now. The result of the vote on amendment number 1677.1 in the name of Shona Robison is as follows. Yes, 62, no, 64. There were no abstentions. The amendment is therefore not agreed. The next question is that motion 1677 in the name of Anas Sarwar on protect local NHS services, be agreed. Are we all agreed? We are not agreed. We should move to a vote and members may cast their votes now. The result of the vote on motion number 1677 in the name of Anas Sarwar is yes, 64. No, 0. There were 62 abstentions. The motion is therefore agreed. Any points of order will be after decision time. I propose to ask a single question on parliamentary bureau motions 1691, 1694, 1695 and 1696. If any member objects to a single question being put, please say so now. I therefore put the question that the four motions be agreed. Are we all agreed? We are all agreed. I seek your clarification, Presiding Officer. Today, Parliament has clearly stated its will that the proposed NHS service changes and downgrades should be called in for ministerial decision. Will the health secretary then take this opportunity to say that she will accept the will of Parliament, recognise the mandate that she has been given and call on these changes to NHS services? It is a point for the Government that the Government can respond at its own time. If it is a point through the chair for me to respond, resolutions of the Parliament are not binding. If the Government wishes to respond an act in the will of Parliament, that is up to the Government. That is not a question for the Government to respond to on the member to not through the chair, please. That concludes decision time. We move now to Members' Business. If we can change seats, please.