 The next item of business is debate on motion 17281 in the name of Alex Cole-Hamilton on the treatment time guarantee. Can I ask those who wish to speak in the debate to press their best to speak buttons? I call on Alex Cole-Hamilton to speak to and move the motion for up to eight minutes please. Thank you, Deputy Presiding Officer, and I move the motion in my name. I would like to start by thanking the cabinet secretary for the time that she has given to meet with me personally on this exact subject matter. I know that she agrees with me on much of the problems that we identify in this motion. We cannot support her amendment tonight because I do think that it deletes much of the reference to the problem, but I do welcome the tone and in fact the existence of the apology that is contained within that. There is a law that this Parliament passed, which this Government has proceeded to break over 190,000 times since it received royal assent. All told, the legal bonds of the legally binding treatment time guarantee are routinely broken upwards of 200 times every single day. To put that in a local context, in NHS Lothian there are 34,000 people who have had to wait over 12 weeks this year. Greater Glasgow and Clyde is 32,000, and NHS Grampian is 27,000. There is no sanction for that. No ministers ever resign and nobody gets a fine. It is a legally binding guarantee in name only, but the human cost of that is measured out in anxiety, frustration, pain and suffering. It puts lives on hold, it puts potentially life-saving treatment just out of reach, and it visits with each of us in our constituency surgeries every single week. Every single one of those patients has been let down by the false hope offered by this Government and each tells a very similar story. A letter arrives shortly after diagnosis, advising them of their legal guarantee to have treatment begin within 12 weeks. For most people, that sounds manageable. 12 weeks is a season. You could get your diagnosis in early spring, and they will see you before your holidays in July. It might mean a bit longer on the pain medication than you hoped, but you can tough it out. Accordingly, you plan for your recovery. Everyone would. You plan for the time after your convalescence, where, hopefully, free of pain and disease, you can start to live your life again. You accept wedding invitations. You agree to host Christmas for the family. You book a holiday for six months from now, because, according to your letter, you will be well out of the woods by then. After about nine weeks, you begin to wonder why they have not booked you in yet. A knowing sense of doubt begins to creep over you. On perhaps the Monday of week 10, you phoned the surgical ward to ask about your surgery. That is when you get the bombshell. You are not going to be seen in two weeks time after all. In fact, more to the point, you are not likely to be seen for at least another 40 weeks in some cases. That must just be devastating to hear. You ask about your holiday. They say, do not leave the country. You ask about the wedding that you are planning to go to, and you are told that you would not risk it because you might get a cancellation. You ask about Christmas. They say that it is doubtful because, hopefully, with any luck, you will just be out of surgery by then. Aside from all the havoc that that causes you in terms of basic life administration, add to that the pain or immobility that you might be in. There might be anxiety, too, about the condition getting worse or even becoming life-threatening. There are many real-life examples that I could offer from West Edinburgh. I am sure that every member in the chamber could speak to a case in their constituency, but I want to single one person out. In December, I was contacted by Jane Ross. Jane has suffered several failures of the treatment time guarantee relating to urology at the West in general hospital in Edinburgh over the past three years. After developing bladder issues, she waited six months for a consultant appointment and then was referred for a test that took more than a year to be performed. The bladder, by this time, was so inflamed that it had shrunk to a fifth of its normal size. The pain was so severe that she had to control it by not drinking at all until around 4 pm in the afternoon, which allowed her to struggle through her part-time job. Dehydration started to affect her kidneys and gave her heart palpitations. It caused issues with her diabetes. In August last year, after his test results came back, she and her consultant agreed that she would need to have her bladder removed and her urosthomy performed. Like most people, she received a notification around her rights under the treatment time guarantee. She waited in a worsening state of physical health and suffering. All told, it took 36 weeks for her to have that operation. That wait was bad enough, but she had to lurch from week to agonising week, existing in this excruciating state under the misapprehension that treatment was just around the corner. I wanted to weep for her. It is one of the hardest cases that I have dealt with. This Government to its credit has put great store in the concept of realistic medicine. I am a fellow traveller here, absolutely. That basic precept is that we should give patients all the facts and options about their condition and credit them with the maturity and mental capacity to direct their care. That should not just be about end-of-life issues, that should be about every aspect of our journey through our national health service. People are not stupid, Presiding Officer. They know that our NHS is oversubscribed, that, in all likelihood, they may have to wait a protected period of time for treatment. That is not really the thing that bothers them. They accept those waits. They understand it. It is part and parcel of why our NHS is still deservedly the most well-regarded institution in our country. They just want people to be straight with them. They want doctors to be straight with them and they want politicians to be straight with them. To have someone from the outset tell you that it is going to be 40 or 50 weeks, you can plan accordingly around that. Some people may well decide to go private faced with that reality. That, in turn, might relieve pressure on other waiting lists, allowing people a shorter time before they are treated, by freeing up capacity and reducing those waits further. Whatever your world view, Presiding Officer, in this chamber, I would hope that we would all agree that we just cannot go on like this, giving people that element of false hope. I understand that aiming to stop breaking its own guarantee by 2021 may be an unavoidable reality for this Government, given workforce issues and capacity strain, our ageing population and the various issues that we are facing and the fires that we are fighting. I accept that. All I ask is that this Government stops sending out letters giving people false hope. Explain to them why their treatment has been set back and apologise to them for the discomfort that this causes. People are mature. They understand that our NHS is under pressure, but they still value it immensely. They give thanks every single day for those hard-working staff toiling for hours and days on end to make them well and to get through those waiting lists. We just need to be straight with people because they deserve to know where they stand. I move the motion in my name and I ask the chamber to support it tonight. Before I call the minister, I say that it is disappointing when people are not in at the beginning of a debate to which they wish to contribute, and I would expect a note from those in that position. I now call on Jeane Freeman to speak to and move amendment 17281.4. Thank you, Presiding Officer. I want to start by welcoming the debate on what is an important issue for patients across Scotland. There can surely be no doubt that I have been very clear from the outset that long waits are unacceptable and improving performance against waiting times is a key priority for me, one of three. Let me take this opportunity to again offer my unreserved apology to everyone who is currently experiencing or has experienced a delay anywhere in the health system. As I have said before, too many people are waiting too long for outpatient appointments and treatment. I know only too well the impact that that has not only on the patient, on their physical and mental health, but also on their families. I also know that knowing that is not enough. People quite rightly expect us to do something to change that, and my determination to do just that is exactly why I published the waiting times improvement plan in October last year, to substantially and sustainably improve waiting times, particularly for those waiting the longest and backed by significant additional financial investment. However, while we increase capacity in the NHS to deliver on that plan, for those people who have to wait longer than 12 weeks, health boards need to ensure that each and every person is given a realistic timeline from the very beginning of their journey and is kept up to date with any changes that affect that timeline. Around a year ago, my predecessor, Shona Robison, said that health boards should be advising patients of their likely weight and the reasons for delay, and we committed to reinforcing that through the revision of the charter of patients' rights and responsibilities, which is routinely reviewed every five years, with the latest review beginning in 2017. That revision of the charter has gone through a rigorous engagement process, including with stakeholders such as the patient advice and support service, and I am pleased today to advise members that the revised charter will be laid in Parliament before recess and applicable from autumn this year. We have also been working with our health boards and key stakeholders across the country to deliver on that commitment of giving clarity to patients on the length of time that they can expect before treatment, and the revised letter and guidance will be used nationally and will be issued to boards by the end of this week. Since the introduction of the waiting times guarantee, around nine out of 10 patients have been seen and treated within 12 weeks. That is over 1.7 million patients, and every bit of that achievement is down to the staff working in the health service. Recognising that matters, but it does not and it will not deflect from my determination to see improvement. Our work to improve performance is not confined to the treatment time guarantee but extends to mental health, our cancer targets and those attending A&E departments. Our A&E performance is the best anywhere in the UK and has been for more than four years. That is despite a significant and sustained increase in A&E attendancies, but there is more to do continuing our work with the Royal College of Emergency Medicine in Scotland, consistently implementing the six essential actions across Scotland with no variation and improving hospital flow and discharge. Since October, we have invested 26.7 million from the 850 million total to make immediate reductions in waiting times across a range of procedures and, importantly, focus board by board on the most pressing areas of longest wait. That varies board by board and it is important that the resources are targeted in that way. Last month, I announced a further 70 million for this year. That will increase, we will see additional recruitment of specialists and healthcare professionals, increase numbers of orthopedic and cataract procedures and an increase in the number of outpatient appointments and diagnostic procedures. All of it aimed at meeting the first waiting times milestone this autumn, but, although increasing activity is important, we need to build resilience into the system so that we have future sustainability. That comes by increasing capacity through the network of elective and diagnostic centres that we are creating and the work of the Scottish Access Collaborative, which brings together clinicians, healthcare professionals and others to ensure that the design of our patient care and our pathways are as streamlined and effective as they can be. NHS Scotland is recognised as a world leader in quality improvement. It is the central underpinning of our patient safety programme, so that must be embedded in the delivery of all our improvement programmes, including the waiting times improvement plan. Alongside all that I've outlined and much more beside runs our access QI work to increase our capacity to consistently improve patient pathways and patient experience and existing across all improvement programmes. Presiding Officer, I accept and have said before, here in this chamber and elsewhere, that our performance on waiting times must improve and that for every single person who is waiting longer than they should, that is a time for them that is anxious, that will involve pain and distress and is unacceptable, but just saying it isn't enough. That's why I'm disappointed that what we need to have and what we're not seeing are specific plans to improve our waiting times improvement plan. Our performance on waiting times must improve and I believe that our commitment to that is clearly evidenced by the many actions we and staff across the NHS are taking. All of it, the immediate activity, the long-term sustainable solutions, is focused on delivering the care that patients need within the timeframe that they rightly expect and in reaching a better balance between demand and capacity so that we are better placed with sustainable solutions now and for the future. With that, I move the amendment in my name. I now call on Miles Briggs to speak to you and move amendment 17281.1 for up to five minutes. Thank you, Deputy Presiding Officer. I'd like to start by thanking the Liberal Democrats for using their business to bring forward this important debate. No one can be in any doubt that since Nicola Sturgeon and the SNP Government introduced the patient treatment time guarantee in 2011, patients and their families have been let down. I also believe that it's important to look at the wider patient treatment targets that the Scottish Government is failing to meet and which I've outlined also in my amendment. Deputy Presiding Officer, this week is mental health awareness week. I welcome the positive campaigns to raise awareness and actively for his all-to-work to tackle stigma that still exists around mental health. However, the question that I'm asked again and again is what's the point that trying to encourage people to come forward when they're often going to be failed when they seek help. Alex Cole-Hamilton and Alison Johnson and I represent Lothian and they will, I'm sure, also be acutely aware of cases where unacceptable psychological waiting times and the CAMHS waiting times targets have failed our constituents. I'm sure that I'm not the only MSP who has had parents at my advice surgeries desperately trying to navigate the CAMHS system, telling me how they've been told that for children and young people the waiting time here in Lothian is over a year and for adults two years. I have to say that parents and families that I represent in Lothian are way beyond wanting apologies now from SNP ministers. They want action. After 12 years in office, they feel abandoned by the Government and the situation in Lothian is getting worse and worse. Mental health waiting times here in the capital are now beyond crisis level and the situation is showing no sign of improvement. I have parents in Lothian who have been told by GPs to go private to access support for their children and NHS Lothian do not clearly have the capacity. Children who are in desperate need of support being told to wait over a year or in some cases, as the Health and Sport Committee heard recently from parents, parents are being told that if a child was self-harming, they would likely to be seen earlier. This is Scotland's young people our future and they are being failed. Deputy Presiding Officer, as co-chair of the Parliament's cross-party group on cancer, I also hear regularly about the mental health impact on suspected cancers and what that brings to individuals, weeks and months of waiting and not knowing with sleepless nights and unimaginable stress. The latest cancer waiting times show only 82.9 per cent of patients in Scotland with an urgent referral for a suspicion of cancer starting treatment within 62 days. As Cancer Research UK stated, those figures show a service under huge strain with too many patients waiting too long. I accept that the 31-day target is being met. Will the member also explain to me how, in his amendment calling for additional resources for the NHS, we will be able to do that, given the Tory party's plans on tax cuts and the refusal to back a budget that included £850 million for waiting times and £250 million additional for mental health? That is what I hope that this debate will rise beyond. The Government has been given £2 billion in additional health resources, which is a fact. Today's debate should be a wake-up call for the cabinet secretary, not for her just to try to score cheap points, because she should know just how desperate the system is under her watch. Almost since the day the Government passed the treatment time guarantee, we have heard an excuse from SNP ministers. That has to end. Patients want and should be receiving timely treatment, and our NHS professionals want and should be able to provide the person-centred care that we all want to see, not constantly juggling patients in a desperate attempt to meet SNP targets. The cabinet secretary has mentioned and made much of the £850 million waiting time improvement plan, which was published in 2018. Early information on that improvement plan is being spent on points towards NHS boards accessing funds for new pieces of medical equipment and investigatory equipment. However, on the ground across health boards, there is not the staffing in place to utilise those pieces of equipment, the full capacity that they can provide and additional clinics are not being taken up, so where we will actually see that improvement is not being realised. Perhaps the only area where ministers have achieved some progress is the increased use of private capacity in Scotland. The plan sets out actions to ensure future delivery of waiting time standards and guarantees for patients across Scotland by the spring of 2021. However, SNP ministers have already publicly accepted that it has failed to deliver on those promises made to patients across Scotland. The waiting time improvement plan will reduce the number of inpatient day cases seen from 90 per cent target to 75 per cent target by October of 2019. It would seem that SNP ministers' answers to not being able to meet the target is to water it down even further. I believe that we need a national debate about the wider impact of targets on our health service. I meet with NHS professionals every week who feel that the target culture that is built up in our NHS is focusing resources on the wrong priorities, all at the same time as demoralising our NHS professionals who are often unable to meet those very targets. SNP waiting times promises made to patients across Scotland have been broken. That is what the minister is asking which one is. She has read out all the targets that she has broken. Patients feel that they are claimed by this Government, and it would be good if ministers listened to that fact. Albert Einstein said that, if you want different results, you have to do a different approach. I move amendment in my name. I now call Monica Lennon to speak to you and move amendment 17281.2 up to five minutes. Thank you to Alex Cole-Hamilton for securing this important debate, but also for a really excellent speech. I thank him for telling us about his constituent, Jane Ross. The treatment time guarantee is a law. It should have ensured that people receive treatment within 12 weeks, but the most recent figures tell us that the Scottish Government has broken its own law around 190,000 times since it was introduced in 2012 by Nicola Sturgeon when she was the first or when she was the health secretary. That is Nicola Sturgeon, who is now Scotland's First Minister and who recently said that she is not surprised about long waiting times. The current health secretary, Jane Freeman, has admitted that waiting times are too long, and I agree—I think that we all agree—that this is a broken promise too far. However, as the cabinet secretary's best response is really to continue breaking the law until at least 2021, the law, Presiding Officer, is not worth the paper that it has written on. If it were any other law in Scotland and if it were anyone else other than the Scottish Government breaking it, there would be consequences, but as things stand, there is no penalty if I have time. If you take an intervention, you do not get your time back, so I leave to the member to decide. I will take the intervention. I thank Monica Lennon for taking the intervention, just to clarify about the Patient Rights Scotland Act 2011, which was decided by and voted on by this Parliament that it was not legally enforceable by legal action. Does she disagree with the Parliament's decision on that? Monica Lennon. We will get to the points about what the law actually says, but the main point here is that we have just heard that 190,000 patients have been let down, and that is a disgrace. In a Scottish Labour business debate in May last year—I wish that I had more time for interventions, but we do not, Presiding Officer—in a Scottish Labour business debate in May of last year, we forced the Scottish Government into a commitment to amend the charter of patient rights and responsibilities to ensure that patients get an accurate waiting time estimate. A year later, when we drafted our amendment, no changes had been made to the charter, and it has been our concern that health boards have not been communicating well enough with patients. We hear what the cabinet secretary has said today by way of updates, but the Parliament and the country have been waiting long enough already, so I hope that she can convince us that we can believe her this time that action and real change will happen. These changes cannot happen at a snail's pace, and that is why the Scottish Labour amendment highlights our disappointment at the lack of progress in a year. I am sure that we are all thinking about constituents today who have been let down. Behind the figures are people in pain or distress waiting far too long for treatment. As Miles Briggs has said, this is mental health awareness week, so it is timely to acknowledge the emotional upsets and nervous anxiety that people can experience while waiting for treatment. Long and indefinite waits can have far-reaching consequences for people touching all areas of their lives. It is easy to see how people can be quickly plunged into financial difficulty or poverty because of ill health, and long waiting times can have terrible consequences for people who are low-paid, self-employed and those in insecure employment. The implications of illness and pain extend beyond individual and impact families, communities and workplaces. The workforce crisis in the NHS has many consequences, and too often it is the most vulnerable people who pay the price. Long waiting times is a recurring issue for my constituents. Last year, one woman in Hamilton waited more than 80 weeks for surgery on her wrists, and she is now worried about permanent long-term damage. My family has benefited hugely from the NHS in the past few years, and I will be forever grateful. My mum's GP probably saved her life, and she has been successfully treated for cancer, and this month we will be celebrating her 60th birthday and thank goodness for that. After her cancer treatment, she had to get a further operation, and she had to wait longer than 12 weeks. My mum had to wait 42 weeks, and this set her progress back. My mum is not looking for an apology, she does not want other people to have to wait this long in future. In conclusion, Scottish Labour strongly supports the Liberal Democrat motion, which rightly holds the Government to account over its failure to comply with its own law. We support the Conservative amendment, highlighting the other important NHS targets that have been missed, and we welcome Jane Freeman's apology to patients in her amendment, and to her agreement that patients should have expected waiting times in writing. However, we cannot support this amendment because it does not acknowledge the extent to which the Government has broken its own law, the plan to continue breaching it until 2021, or acknowledge that there is no redress. We call on the Government to honour its commitments and honour the people of Scotland. Thank you. Please move your amendment. I move the amendment in my name. Thank you. I am sorry that everybody is tight on time, that is what happens with these short debates and that is what the bureau has agreed, so you just have to live with it. Alison Johnstone, four minutes please. Thank you, Presiding Officer, and I too extend my thanks to our NHS staff who work tirelessly to improve our health too frequently in an extremely pressurised environment. I welcome the fact that we are debating the treatment time guarantee this afternoon. My own Green amendment was not selected, and in this instance is particularly frustrating, as neither the motion or the amendments outline the problem and the potential solution in a way that the Greens feel is of greatest benefit to patients. Alex Cole-Hamilton is right to describe the severity of the problem, but I do not agree that a letter to patients, which is the potential to make them feel like another statistic, is an adequate response. I appreciate the proposed action set out in the Cabinet Secretary's amendments, but regret that the context of Alex Cole-Hamilton's motion has been deleted entirely. I agree with the contents of Monica Lennon's amendments, and while I agree too with the amendment in Miles Briggs's name, I can't square his party's commitment to a great tax cut for the wealthiest with increased funding for the NHS. Shorter waiting times can reduce patient anxiety, improve patients' quality of life and improve clinical outcomes. We're all in agreement that the sooner a patient can access treatment, the better. That's why waiting times are important. However, as we know, there are considerable workforce pressures across NHS Scotland, which is treating patients with increasingly complex conditions and multi-morbidities, and of course Brexit will not help. The BMA has repeatedly raised concerns about the impact of Brexit on the health workforce, and I'm concerned that if we can't recruit sufficient numbers, the onus to improve waiting times will fall will be placed on the existing workforce. The Scottish Government's waiting times improvement plan states that it will encourage more capacity by working with staff side and employers to reduce sickness absent rates with a focus on staff health and wellbeing. Given that a recent BMA survey showed that 91 per cent of doctors who responded are already working over their allotted hours, I would argue that many NHS workers are already over capacity. Those working in the NHS must be able to take a day off due to their own ill health when they need one. It is hugely upsetting and disappointing for patients when the treatment time guarantee isn't adhered to, but we also have to make sure that we avoid making staff feel like they've failed when they're working incredibly hard. Opposition parties are right to criticise the Government, but it can't be beyond all of us to find a constructive way forward with constructive steps that can be taken to bolster our struggling health service. The Scottish Government needs to be honest about what level of service the NHS in Scotland can realistically provide in light of workforce pressures and current funding. Audit Scotland said in its 2018 report that the NHS in Scotland is not in a financially sustainable position. NHS boards are struggling to break even, relying increasingly on Scottish Government loans and one-off savings. It recommends that the Government, NHS boards and integration authorities work together to develop a clearer understanding of demand, capacity within primary and secondary care and publish clear and easy to understand information, including how much funding was provided, what it was spent on and what impact that had. I would urge the cabinet secretary to take this on board and hold a national conversation on the NHS, a far broader one than Miles Briggs outlined. What do we all expect from the NHS? How much are we all willing to pay to meet those expectations? Missed targets are a symptom of wider issues, and placing more pressure on boards and staff to meet those targets won't solve the problem. Let's ensure that health boards have the resources that they require. Let's ensure that there's a greater focus on preventative health agenda till less in that strain. That will help to enable us to meet the treatment time guarantee. Thank you, Presiding Officer. Thank you very much. Open debate, type 4 minutes, Mike Rumbles followed by Emma Harper. Mr Rumbles, please. In anticipation of this debate, I looked up the definition of the word guarantee in the dictionary. It says that it's a formal assurance, typically in writing, that certain conditions will be fulfilled. Another definition is that a guarantee is a legal term more comprehensive and of higher import than either a warranty or security. So what actually is it? It seems to me to be nothing more than an unfulfilled promise to the 27,000 patients in NHS Grampian who've had to wait longer than the 12 weeks for their treatment since this guarantee took effect. In the last quarter of last year alone, it was 42.5 per cent of all patients waiting for treatment in NHS Grampian. Now, I want to be clear here. I don't blame the hardworking staff who work for NHS Grampian for this sorry state of affairs. I don't blame the staff for the fact that NHS Grampian has regularly had the worst record for operations cancelled for non-clinical reasons or that it has the worst record in Scotland for treating child and adolescent mental health problems. Indeed, in other areas too, the record of Grampian health board in treating patients is less than spectacular. For the final quarter of last year, the board had the second worst record for treatment within the 31-day standard from decision to treat to first cancer treatment. With chronic pain treatment, 85 per cent of patients referred to a clinic in Grampian had received treatment in the final quarter of last year outwith the guaranteed time. Now, I could go on with a rather lengthy list of various treatments and illnesses where patients in NHS Grampian come out worse or almost worse than for any other health board area in the country. Deputy Presiding Officer, I'm not going to do that because you've given me just four minutes and I wouldn't have the time to do it. Now, we often talk about a postcode lottery for various treatments but it is worse than that for the 11 per cent of Scotland's population who happen to live in the Grampian health board area. I said that I didn't blame the hard-working staff for the situation. We find ourselves within Grampian NHS. I want to put the blame for the sorry state of affairs fairly and squarely at the door of the Scottish Government. Why? It's because Scottish ministers have, over the last 10 years, failed to provide £239 million of funding that should have come to Grampian health board over this period. Those are not my figures. Those are the figures provided by the Scottish Government and are available to everyone through the Scottish Parliament's information service. Unfortunately, I haven't got the time. I'd love to. The Scottish Government's own NRAC formula, a formula that still underfunds Grampian's population, has never—I say that again—has never been fully funded, unlike other health boards. The cumulative underfunding over the last 10 years has, without doubt, led to the worsening of patient care in the north-east. It's no good that the health secretary is saying that every time I raised this over the last three years that more and more money is coming to the NHS or the NRAC formula is closing. Actually, the NRAC formula this year is increasing again, and it still doesn't cover the money—the £239 million—that we've already lost. As far as Grampian NHS is concerned, the Scottish Government should address this funding shortfall to enable the staff at Grampian to receive the resources that they need to do their job to meet the treatment time guarantee. The people of the north-east demand action to put this right, and they want action now from the Scottish Government, and I'm glad that the ministers are here to listen to that. Thank you very much, Mr Rumbles. A wee correction. I didn't give you four minutes. It was the bureau and the Parliament then voted for the four minutes. I'm merely the policeman. I call Emma Harper to be followed by Edward Mountain. Thank you, Presiding Officer. Again, we're here in chamber discussing healthcare and our NHS, and as always from the outset, I want to put my thanks on record for our incredibly skilled and competent NHS staff across Scotland, many of whom are my former colleagues. Our NHS in Scotland delivers a wide range of complex specialist care and treatment for the people in Scotland, and services provided in NHS hospitals are extremely diverse and range from complex diagnostic procedures to life-changing and indeed life-saving surgeries, both planned and emergency. There are a wide range of waiting times targets to be measured—surgical, medical, outpatient, inpatient and mental health. I'm interested in the Lib Dem motion because I recognise that there are challenges with our NHS when it comes to waiting times, but it is under the SNP Scottish Government that the NHS in Scotland is outperforming the rest of the UK. The Patients Rights Act, which the motion refers, was introduced by the Scottish Government in 2011, and its principal aim was to enshrine in law that patients must be supported properly and their voices must be heard. Since October 2012, the Patients Rights Act has set out a 12-week treatment time guarantee for planned, inpatient and day cases. The 12-week target applies once the patient has been diagnosed and has agreed the treatment with their clinician. It's worth noting also that it is the responsibility of the health boards to ensure that eligible patients receive the treatment within 12 weeks. That may mean that, with the patient's consent, the health board arranges for a patient to be treated in another health board area. I am interested in addressing the points that Alec Cole-Hamilton raised about performing surgery at private clinics to free up time. That's not the answer. Surgical procedures that don't require high-dependency units—and I'm not going to take an intervention because we'll get four minutes because that's how you chose it—surgical procedures that do not require high-dependency units or intensive care unit beds such as day case herniorophy or arthroplasty—can be done privately. However, those are procedures that help to support staff learning and knowledge in patient care, airway management and observation of vital science as part of a clinical care pathway. It will take me longer to explain than the four minutes about how continuous professional development, addressing complications, which the NHS are the ones that have to deal with and the clinical care pathways that require a multidisciplinary team who all work with each other and know each other to support those pathways. So private hospital freeing up time isn't the answer. It may be one answer, but the whole issue is complicated and complex. However, I am pleased that the Scottish Government recognised that there have been challenges in meeting all waiting times across Scotland. It is important to ensure that no one is waiting too long for appointments and treatment. I was pleased when the health secretary published the £850 million waiting times improvement plan just last October 2018. That is not long ago, Presiding Officer. I think that we need to allow time for health boards and everybody to look at what they are doing to improve waiting times as the cabinet secretary introduced the plan last October. Jan Gardiner, the chief exec of the Golden Jubilee, welcomed the announcement and plan, citing that it provides direct funding for specialists to provide an additional 200 general surgery operations, 600 ophthalmic procedures and 1200 endoscopies and colonoscopies each year across Scotland—an action that will help to reduce waiting times. The strategy proposes that some patients, particularly those who are waiting for a routine check-up or test results, would be seen closer to home by a team of community healthcare professionals with close links to the hospital. The Government is committed to addressing the challenges that we have heard about this afternoon, and, as we have seen, the cabinet secretary is taking a proactive approach. In my short time, I want to focus on waiting times in NHS Highland. Let's be clear that the Government made a 12-week waiting time guarantee, and patients expect it. Clinicians want to deliver it, but, frankly, they do not have the resources to do so. I do appreciate that the cabinet secretary has said sorry, but sorry isn't going to be enough. We have seen, born out in the latest figures in NHS Highland, that, in the last quarter, for example, 45 per cent of patients waited more than 12 weeks for treatment. In the same quarter, 20 per cent of patients were not treated with in the 18 weeks that they were referred to. I do not think that NHS Highland is on the same page as the Scottish Government on targets. Indeed, I venture to say that they are in a different book. No, I will take an intervention for the cabinet secretary, but not from you, I am afraid. Patients feel let down and clinical staff feel the burden of responsibility. They shouldn't. They are not the ones to blame. The truth of this matter is that NHS Highland, like many health boards, is understaffed and overstreffed. Why? I can tell you. It's because this Government, with 12 years of management, has mismanaged the recruitment of our health staff. We don't have enough GPs, we don't have enough nurses and we don't even have enough radiologists. Indeed, huge pressure is placed on conditioners to deliver treatment time guarantees. Yes, I will take an intervention. I am always delighted— Cabinet secretary, thank you very much, Mr Mountain. In the initial additional funding that I talked about, NHS Highland received significant additional funding over £2 million for ophthalmology, general surgery, endoscopy and so on, and that would be additional funding that you voted against when you voted against our budget. So grateful if you could explain to me how you square that particular circle. Indeed, and it's always nice to hear the cabinet secretary make comments like that, so I can respond to them. So when it comes to ophthalmic treatment, how was that delivered? Not by NHS staffs but by private companies who were brought in because this Government hadn't got the staff in place to deliver them. Let me therefore take the cabinet secretary back to John Sturrock's report, which we discussed very briefly the other day, which was a report into bullying and harassment in NHS Highland, which has a terrible impact in his own words on the staff and their wellbeing. I am going to focus on just one passage, and let me make sure that I read it out right. It says that unrealistic or unachievable expectations can lead to managerial staff to pressurise clinical and other staff to improve performance. Thus, those policies may have an adverse impact on the people charged with delivering them, leading to dysfunction and a loss of morale that can then cascade down through the system. That's a damning indictment, cabinet secretary. I therefore believe that the way that this has been rolled out in NHS Highland and not delivered is not only bad for our health but bad for the health of the staff that were there. Solutions are desperately needed, and this Government has to improve on the recruitment levels to a point where staff have a realistic chance of achieving waiting times. I accept that the waiting time improvement plan that the cabinet secretary has announced is a step in the right direction. I also welcome the construction of a mobile theatre at Regmore hospital for the new elective care centre. It is indeed a good start, but we need more. Let us all be clear. We all cherish our NHS. We owe a huge debt of gratitude to our doctors and nurses, and we need to care more for those who care for us. Putting too much pressure on them to deliver waiting times that they are not resource to deliver is not good enough, and it needs to change. I thank Alex Cole-Hamilton and the Liberal Democrats for bringing forward this important motion today. It shines a light on a very serious issue in terms of the amount of time that patients are having to wait for treatment. The statistics tell us that the treatment time guarantee has been broken 190,000 times and there are 25,000 people still on waiting lists, but it is not just the statistics and the fact that the situation is not getting any better. It is the human stories behind those statistics. I like other MSPs who have been inundated with cases from constituents who have had difficult experiences. In particular, I want to highlight one gentleman who had a knee issue that took him eight months to get properly diagnosed and a treatment outlined. He was given a treatment time guarantee of January this year, but he was then told that it would be October before there would be any treatment, which caused him a great deal of stress. Then there was a ladyhood of hip issue, which was originally x-rayed in July 2018. It took until the end of the year to diagnose proper treatment or replacement. A treatment time guarantee was given of April 2019, but, again, the patient was advised that it would be October 2019 before that would be dealt with, at least October 2019. It is not only acceptable the length of time that people are having to wait. What those examples show is the failings in the system from the time that it takes to diagnose someone's issue through to them getting treatment. The story behind that is the impact that it has on the pain that they are having to suffer, the mental trauma that it causes, the difficulty that it has for their family, the disruption on their life, their ability to go out and work and participate in normal everyday activities. It is unacceptable. I have to say that it is a sad comment on the 20th anniversary of the Parliament. There has been a lot of commentary over the past couple of weeks, but we have passed a law in 2011. It has been broken 190,000 times, but not only that, it is the effect that that has had on individuals and communities throughout Scotland. People are entitled to better. I know that the cabinet secretary apologises. However, it is absolutely essential that people get effective notice of when they are going to get treatment. We need to see serious progress in the action plan to rectify the problem by 2021. What I am seeing on the ground is that that is not happening currently. To sum up, we have all experienced great advantages and benefits of the NHS. We see it in our own lives and in our family's lives. Unfortunately, what we are seeing on the ground is that people are having to wait anordinate amount of time not only for diagnosis but for treatment and it is causing real disruption to their lives. People expect better and we demand better from this Government. Thank you very much. Members are keeping their time so far. Mr Adam, do not break the habit. When we keep having these debates, we are all aware of the challenges that the NHS faces in these times. However, one of the most disappointing facts of the debate and others that come from the opposition is that I never hear any new ideas, solutions or options that they are going to do that will make any difference. The patient rights Scotland act created—I have too much to talk about, Mr Cole-Hamilton—a statutory treatment time guarantee of 12 weeks. Since then, more than 1.7 million inpatients have been benefited from the 12-week target since it was introduced. That is 90 per cent since it was introduced in 12 weeks. Although it is short of the targets, it is still a movement in the right direction. That will obviously be helped, as the cabinet secretary has already said, with the recently published £850 million waiting times improvement plan. However, let's look at the NHS in Scotland. Our Scottish Government is committed to delivering the investment and reform to ensure that the NHS is fit for the changing needs of the 21st century Scotland. There have been major improvements in public health under our SNP Government and the record high health funding. In 2019-20, health and sport resource spending will exceed £13.9 billion—up for billion—under the SNP. Patient satisfaction is at 86 per cent of those approval of inpatients who rate their experience positively. Positivity in debates like this is not something that I normally relate to the Opposition, but let's continue down that positive road. The success of this is all down, as everyone said, is down to those who work within the health service. That is the most important part, but the most important people in this debate are the patients themselves. As a constituency MSP in Paisley, when I get cases like this, my first thought is never, hold on there, I am going to write a strongly worded motion, take it to the chamber and I am going to show boat in front of the cameras. My first choice is to say, I will deal with this issue and get in touch with the health sport and represent the people of Paisley as I should. I think that when you look at this, you have to bring them back into the real world and away from the showbiz of the Lib Dems. If we look at the treatment time guarantee, the poorest quarter we have had was quarter four last year, which is 72.7 per cent. The cabinet secretary has apologised for this and assured that there is a robust plan to avoid this in the future. That is what Government is all about, saying the issue and making sure that you put a plan in place to do something about it. However, the waiting time improvement plan that came out on 23 October 2018 is ensuring that we will continue to have improved access to high-quality care. The immediate focus on the improvement plan is to reduce waiting time for patients whose treatment is urgent and the initial funding of the health boards will be to improve performance, recruitment and additional nursing staff, new equipment and staff over the very important weekend. We are also offering time over the weekends and evenings clinics to ensure that there is time for people to get involved. However, one of the important things about this is that the improvement plan includes £535 million in front-line spending and around £120 million in capital spent. As we look at the debate, the idea is for us to be positive about our NHS, positive about what is going on, but first and foremost, if anyone is going to come into this chamber, show me your ideals and tell me what you would do differently. Thank you for closing speeches, as I called David Stewart, close for Labour. Thank you very much, Presiding Officer. This has been an excellent debate on a vital issue, and I want to thank members from across the chamber for their insightful, ineligible and strongly felt contributions. I was particularly shocked from the contribution from George Adam, who said that he never showboats in the chamber. Well, that is news for me. I would like to thank the Liberal Democrats for using their initiative in securing this afternoon's debate. We all know that waiting times are difficult when a patient is suffering from a illness or an injury. Anytime between cause or diagnosis and treatment is unwanted. It, of course, prolongs the pain as well as adding additional stress to mental and physical wellbeing. Members this afternoon, such as Alex Cole-Hamilton, Monica Lennon, James Kelly, Alison Johnstone and Miles Briggs, have illustrated this perfectly by quoting dissatisfied constituents who felt let down by the system. A system that we have heard that was put in place by the Patients' Rights Scotland Act 2011 in place to guarantee a 12-week treatment time. That, of course, allowed hospitals and boards to manage expectations and for patients to have a known time frame. What we cannot forget, Presiding Officer, is that waiting times are not just simple facts and figures. Behind every delay in getting an operation or seeing a consultant, there is a person, often with anxieties, pain and stress. Let me also give you an example. I remember many years ago, when a 80-year-old Inverness writer, who is the late Beth MacArdal, came to see me, because she was told that she had to wait 11 months for a relatively simple cataract operation. She said, and I quote, It's vital that we, oxo-gentarians, are able to lead independent lives and still contribute to society. And I have to remember that many of us are still caring for a partner or family member. Without the basic support of maintaining adequate eyesight, we can rapidly become even more dependent on the NHS and care service that costs the state. Every statistic holds similar stories. In that individual case, although I cannot fault NHS Highland in trying to clear the backlog and reduce the waiting time, it is concerning that those procedures are often having to be outsourced to private companies and other boards at great cost. If we look back to Audit Scotland's report in 2018, there was a number of warning statistics that not one board were meeting all the key national performance targets. Only three more boards met the 62-day target for council referrals, and the number of people waiting lists continued to decrease and more people waited longer for outpatient and inpatient appointments. One of the key problems that are identified in the Audit Scotland report is the widespread difficulty meeting demand and the impact that is having on waiting times. Many members have said, Presiding Officer, and I would like to echo this, that front-line NHS staff work tirelessly to try to ensure that staffing issues, lack of resources and underfunding do not compromise patient care, but they do in the face of growing pressure. It is important to acknowledge that the hard work that is being put through and or tough circumstances by NHS staff across the board, but that should not stop us expressing concerns. I would also like to flag up the whole issues that I have done many times before in this chamber about the whole issue of life expectancy and the difference between those from deprived areas and more affluent areas. In conclusion, Presiding Officer, I am very conscious of the time. As we know, the NHS turned 70 last year and we are still having to fight to protect it. One of my heroes, Naib Evans, said, and I quote from him again, that discontent arises from the knowledge of the possible as contrasted with the actual. Those debates are frustrating because we can do so much better. The debate has shone a bright light into the dark areas of the NHS. We have a legally binding 12-week treatment time guarantee. Let's try and achieve it. Thank you, Deputy Presiding Officer, and I thank the Liberal Democrats for bringing forward this debate to the chamber today. I am a big believer in setting goals and targets. Before you begin any journey, it is really helpful to know where you are trying to get to. However, the problem here for the Scottish Government is that the 12-week target is not an aspiration. It is a legally binding guarantee that has been broken over 190,000 times. As Alex Cole-Hamilton said, apparently with no repercussions to the Scottish Government. One wonders, Deputy Presiding Officer, of what the definition is of legally binding legislation in the eyes of the Government. The Government has suggested that it will reach this legally binding guarantee in 2021, a full decade after the patient's rights act was passed. Frankly, I have to say that a reasonable goal for the Scottish Government would be to try and get the numbers of times the target is missed back to the level that it was when it first introduced it, because the numbers have continued to deteriorate. I have got to tell George Adam sharply since then. The Scottish Government cannot lay the blame on anybody else's door but their own, much as they may try. I do not think that they will hit the target in 2021. I think that everyone in this chamber knows that. I think that this is just a way of trying to kick the can down the road a bit further until they can come up with another line. The reason they have not and will not hit their target is quite simple. When one sets a goal, you need to plan the steps that will help to achieve that goal, as the cabinet secretary said in her address. Simply setting a goal will not make it happen. You might get a nice headline at the time, but the goal will not be achieved. Who in the Scottish Government is thinking about the implications on the front line of imposing such a goal? Who in the Scottish Government is looking at the actions that the Government would have to take to enable the NHS staff to achieve those goals? I think that the answer is quite painfully no one. The Scottish Government set a goal without understanding the implementative implications, imposed it on a health service and told them just to get on with it. The goal itself has been instrumental, I think, in creating an environment where it is impossible to meet the goal. By holding the NHS to those goals without giving them the tools, the technology and the resource to help achieve them, I think that the Scottish Government risks driving behaviour that is not necessarily in the best interests of patient care or, in fact, healthcare professionals. Truth is, increasingly missed hit 12-week waiting time guarantee is the accumulation of many areas of policy failure. As my colleague Miles Biggs highlighted, the 18-week mental health referrals is constantly breached. The 62-day cancer urgent referral standards is missed, the lack of competent workforce planning that Monica Lennon highlighted, and so on and so on all contribute to the SNP Government breaking its own legal commitment more and more each year. Finally, what gets me is that, as there is this indignation of the Scottish Government when we have the audacity to point out to them that they have failed to meet their own objectives, I think that that tells me everything that we need to know about the Government. It will accept the plaudits for setting the targets and legal policy, but it refuses to take the responsibility and the appropriate action when they are missed. 12 years, Deputy Presiding Officer. 12 years. It is about time that the SNP Government finally looked at itself in the mirror. Thank you very much, and I call Claire Hawke to close the Government minister five minutes, please. Thank you, Presiding Officer. As with healthcare systems across the world, our NHS in Scotland is facing increasing demand and challenges that require a long-term sustainable solution. This is a very complex landscape, which calls for open, transparent and constructive debate, which in some members' contributions today has been very positive, however in some it has been extremely lacking. We regret not being able to discuss further in the debate Alison Johnson's call for a national conversation, and we would certainly welcome further discussion on this issue. We also welcome her highlighting the impact of Brexit on our NHS. I certainly do not recognise some of the figures that Brian Whittle quoted or some of the statements that he made, and I am sorry that I am not important enough to intervene on Edward Mountain. We are very much a person-centred NHS and are committed to delivering high-quality healthcare to everyone every time, and the commitments that we have made as a Government will support the delivery of this ambition. However, we should not forget that our NHS delivers a first-class service. Although there are areas that need to improve, such as waiting times, I echo the cabinet secretary's comments earlier and acknowledge the admirable work that is done on a daily basis by our healthcare staff. Over and above the waiting times plan, we have also published three new delivery plans at the end of last year, which form the blueprint for the next phase of the mental health strategy. I do not have time. The delivery of our programme for government mental health commitments will see an additional total investment of more than £250 million over the next five years. The Government continues to provide support to boards—I have too much to say, I am sorry, improving their performance against waiting-time standards by investing £54 million to improve recruitment, retention and services. Under the Government since 2007, the Scottish Psychology Services workforce has increased by 67 per cent. On CAMHS, we acted quickly in response to the initial recommendation of the Children and Young People's Task Force by committing an additional £4 million to help to increase capacity within that workforce of around 80 additional CAMHS staff. As our understanding of mental health is deepening, our understanding of what we should do in support is changing as well. The answer lies in whole-systems approaches, which draws in support from across the public sector. Mental health is no longer a health only issue—it is an issue that cuts right across our public services. We need to make sure that everyone around those facing mental health challenges knows how to listen with a sympathetic ear. It is about trusting relationships and creating the environment for honest and supportive conversations about mental health. That is a stigma issue. Reducing and eliminating stigmas should be at the core of what we do. Doing so is necessary if we are going to achieve what we want to achieve. Additionally, to ensure that patients are treated in the most appropriate environment for them, we are also using technology to support improvement in primary to secondary clinical care advice provision. Early indications from initial pilots are that that is having a positive impact, and that will ultimately support the reduction of waiting times. The annual operating plans introduced last year have been developed to manage performance across the whole system, including financial and quality and safety performance. Those plans represent an agreement that sets out how NHS boards will deliver the expected levels of performance to provide the foundations for delivering the Scottish Government's priorities on waiting times improvements, investment in mental health and greater progress and pace in the integration of health and social care. We will use those plans to monitor performance regularly to ensure that NHS boards remain on track to deliver the agreed commitments and milestones. Those plans, once agreed, will be published on individual boards' websites over the summer. We will continue to work closely with our healthcare partners across Scotland to improve performance and to deliver our ambition of sustainable waiting times. Thank you very much. I call Alex Cole-Hamilton to close the Liberal Democrats, and I'm moving straight on to the next debate, so we don't waste time on your next debate. Mr Cole-Hamilton. Thank you, Deputy Presiding Officer. I'm grateful to everyone who contributed to today's debate. I'm sure that I'm not the only member in this chamber who noticed the cabinet secretary and the minister visibly crumple when George Adam got to his feet. A drift from their measured tone was his address. It's striking that the speech of a Government chief whip should be such an attack piece that demonstrates just how exposed this particular flank is to the Government. Nevertheless, I do thank the cabinet secretary and the minister for their measured tone and the way in which they've addressed this and taken it head-on. I particularly welcome the unreserved apology that the Government offers both in the remarks of the cabinet secretary and their amendment today to the patients—the tens—hundreds of thousands of patients affected by the breached treatment time guarantee. I also welcome the direction offered in her remarks around the fact that sports should be directed to be straight with people from the outset about being realistic in terms of the assessment of the time that they should be expected to wait. It isn't what happens now. We need to get this right. People are being hinted at the reality that that 12-week time may be missed, but when they get to line 2 and say, you have a guarantee that you will be seen within 12 weeks, people stop reading. People don't put that down. They don't necessarily notice the corollary that it says, but in many cases we may not be able to see you within that time. I also echo her thanks for our hard-working NHS staff. It's always easy to look at Opposition amendments that criticise any aspect of the health service and believe that that is some kind of inferred attack on our staff. It is not. It is not their fault that we are creating false hope in our patients about how long they could expect to wait, and anything to suggest otherwise diminishes the argument against. She also expressed disappointment that we are not coming forward with solutions. At the very heart of this lies the delays around which this centres. She asked her for a solution, so I will give you one. We need to take the bureaucratic systems of the NHS out of the dark ages. A patient came in to see me in my surgery, who had been referred for suspected oral cancer to the dental hospital. She gave me the letter of referral, which said that it had the astonishing admission at the top of the page, which said that it had been dictated in October 2017, and finally typed in December 2017, missing a full two months of delay for a potentially life-threatening treatment that she could have received earlier. Take our admin out of the 1970s. Do not leave letters lying around in dictaphone. I am grateful for Miles Briggs for tying this debate to the mental health week. He knows my party's position on this. If your child fell off her bike and broke her arm, she would be in plaster by the end of the day. However, if she came to you with anxiety or depression, she could join one of the longest waits in the entire NHS. In some cases, two years for first-line child and adolescent mental health services, we need to keep saying it because it is still a national outrage. Monica Lennon is absolutely right. That guarantee is not worth the paper that it is written on. She did a good job of making that point for her. It was, I think, very important to look at the link between those waits and poverty. In a lot of cases, people are incapacitated by the reason that they need surgery. They suddenly have to wait a year. That may be a year out of employment and potentially out of sick pay as well. I also just wanted to thank her for her personal remarks about her mother's experience and we wish her mother well and a very happy birthday when that comes. Alison Johnstone and I usually see eye to eye on health debates. We don't today, and I am disappointed by that. She has a problem with the suggestion that we need Government to write to patients individually apologising and explaining the delays to their treatment time guarantee. At this point in time, no accountability exists for this repeatedly missed legally binding treatment time guarantee. Fundamentally, we need to address that. I am afraid that I do not have time. Mike Rumbles was characteristically positive in his work for his constituents in speaking up for the north-east. He repeatedly raises the issue of the annuat reduction to Grampian. The impact that that has had on waiting times in that health board, but each of our health boards have similar tales to tell in terms of the problems particular to our regions that we experience. I am a harper trying to suggest that I was somehow suggesting that contracting in private healthcare was part of the solution. That is not what I was saying at all. I was saying that, given people the facts, allowing them to make different choices if they have the means to do so would actually help to stem the problem. It would relieve pressure on the NHS. My father needed a knee replacement surgery. He was told that he was going to have to wait 40 weeks. He said that he was in a lot of discomfort and said, well, I am going to do that. I said, but dad, you can afford to go private if you wanted to. He said, oh no, but I want to support the NHS, he said. I said dad, you are supporting the NHS by getting off the waiting list and allowing somebody into the system because you can afford to take that choice. It is about giving people the facts and allowing them to make different choices. Edward Mountain is right. Sorry is not enough and apology is not enough. We need to change behaviours. That starts by removing suggestions that someone will be seen within 12 weeks. We need to reform that inadequate correspondence. He is also correct to point to the psychological pressure that it puts on staff. Finally, I just want to address George Adam's attack speech. I found that very disappointing. There are some very serious issues here that affect constituents in every single constituency that is represented by this Parliament. He diminished his argument by doing so. This Parliament's job is to hold Government's feet to the fire. If we do not do that, if we are prevented from doing that, what is the point in having a Parliament? There are hundreds of thousands of patients who are looking to this chamber to be straight with them, to have their health boards be straight with them, about the time that they expect to wait, and we should answer that call. Thank you very much. That concludes that debate. I have a very brief pause while I let the front bench take the positions for the next debate.