 F decisive mind, the next item of business is debate on motion 1 to 856, in the name of Anas Sarwar on access to vital medicines. I would ask those who wish to speak, in the debate, to press request, to speak buttons, and I call on Anna Sarwar to speak to and move the motion for up to eight minutes. Presiding Officer, I have moved the motion in my name. I stand today to speak up for patients in Scotland who have no voice. For the patients with breast cancer or cystic fibrosis, who have been denied access to vital life-prolonging medicines due to bureaucracy. Failed by a system that has placed a value on their life and decided that the price tag is too high. Mums and dads, a son or daughter, a brother or sister, people who need this Parliament today to stand up for them, to make their voice heard in the hope that the Scottish Government listens and acts. Many of the patients that we are speaking of do not have much time. It is too late for many of them to benefit from these medicines. Yet what time they do have, they are using to campaign so that others do not find themselves in the same position. In the position of knowing that they have a terminal illness, of knowing that there are drugs available that will allow them to spend more time with their families, time they will not get without the drugs that they need. One of those drugs is Projeta, a breast cancer drug that prolongs your life for 16 months. 16 months more with your loved ones. Breast cancer now deserves our thanks for leading the campaign, and it has been helped by the bravery of patients. Today, we are their voice. Last week, John Ashworth, the Shadow Secretary of State for Health in England, and I met with breast cancer now and campaigners in Edinburgh. It is completely unacceptable that John's constituents in Leicester would be given access to Projeta to prolong their life, but my constituents in Glasgow are being denied it. Women in England, Wales and Northern Ireland can get Projeta on the national health service as a matter of course, but in Scotland they cannot. It has been rejected three times by the Scottish Medicines Consortium, as it is not considered cost effective, despite it being recognised as clinically effective. So, again, I ask what cost on life. The other drug referred to in our motion is the life-prolonging cystic fibrosis drug, or Cambi. It slows the decline in lung function by 42 per cent, which is the main cause of death from the condition. It also cuts the number of infections that require hospitalisation by more than 60 per cent. As we heard in the debate last week, the longer the delay in approving access to our Cambi, the greater the decline in lung function for cystic fibrosis sufferers. That is why the matter has to be treated urgently. Professor Gordon MacGregor, a cystic fibrosis consultant, spoke about his anger that he has the drugs to prolong his patient's life in his cabinet, but he does not have the permission to prescribe them. In some of those occasions, the pharmaceutical company has even given the drug for free on compassionate grounds, but the clinician still cannot prescribe them due to bureaucracy. Again, I would like to put on record my thanks to the cystic fibrosis trust, the patients and the campaigners. It should not take the courage of individuals to come forward and share their personal stories on the front page of a national newspaper, or, indeed, for some individuals, in the example of Anne McLean Chang, to crowdfund on Facebook to get the Scottish Government to take action and for them to get the vital drugs that they need. That is why the Government must implement in full and, without delay, the recommendations of the Montgomery review. That was published in December 2016. In particular, the Government must deliver the ability to negotiate on price during the approval process. It makes sense that if the drug has been accepted as being clinically effective, but discussions are on-going on cost effectiveness, that the Scottish Medicines Consortium and NHS National Services Scotland can negotiate with the pharmaceutical companies without asking them to reapply a process that can take months and months. It appears that the Government will support our motion today. That is welcome, but I must say to the cabinet secretary to write to me confirming what recommendations will be taken forward by the end of 2018, which is welcome, just shortly before the start of the debate, for her to write to Jackie Baillie and Alec Neil just today about issues that they have been campaigning on, and for her to write to the chair of the health and sport committee just yesterday on those vital issues. It only helps to emphasise the fact that it should not take campaigners on a front page. It should not take us having to bring motions to this Parliament to get action from this minister, get action from this Government, so that people can get access to life-saving or life-prolonging drugs. As I say, I welcome the fact that the minister is indicating that she will support our motion today, but will the cabinet secretary confirm that the ability to negotiate on price will begin now, as the motion states, not at some undefined point in the future in 2018? Every single day that is lost in that process is days that people are being denied access to medicines, so now has to mean now. Can she confirm to patients and clinicians when she expects projeter and or can be to be available to them? The Government amendment also states that the decisions on the new individual patient treatment request, the Pax 2 process, will not be based on cost. While that is welcome in words, in practice health boards are facing budgetary pressures, meaning that they have to cut up to £1 billion over the next four years. Therefore, will the Government guarantee two things? Firstly, that the new Pax 2 process will be faster in delivering access to medicines than the previous process. Secondly, that additional funds will be made available to health boards so that they can approve access to vital medicines to individual patients without knock-on pressures on existing services. I would also go further and ask that the Government consider a portfolio deal on cystic fibrosis medicines. Last week, the minister Eileen Campbell said that this wasn't possible as they couldn't spend money on drugs that weren't approved. Minister, it only starts costing money when the drug is approved and is being prescribed by clinicians. I want to end with the brave words of the campaigners. Breast cancer patient, Jen Hardy. Someone an hour and a half down the road can get projetta but I can't. We shouldn't have to think about cost because people in England and Wales don't need to. It is terrible not only for me but my family as well. I think about what 16 months would mean for me. It's a graduation, a wedding, knowing that your kids are doing okay. We need this drug now to stop women dying earlier than they should. Jen Hardy won't get projetta but she's campaigning for others to get projetta. Kelly Gallacher, who is 24—and I'll end on this, Presiding Officer—and has 20 cystic fibrosis. She's been told that she shouldn't expect to live beyond 31. In her letter to the First Minister, she says, I don't have time to wait. These drugs are available in other countries and, to me, it feels like they've been put on a shelf just out of my reach. I know they are there but I can't get to them. More people with cystic fibrosis will die unless something is done. We need these drugs now. Please don't let us die. For patients with breastcastor and cystic fibrosis, every day matters, so please support our motion and make today matter. I call Shona Robison to speak to you and move amendment 12856.3 for up to six minutes, please. Thank you, Deputy Presiding Officer. In recent years, this Parliament has driven significant change in the access to new medicines in Scotland—a system that, of course, is rightly independent of politicians. Those reforms for the availability of new medicines for rare, very rare and end-of-life conditions now sees the Scottish Medicines Consortium approve 79 per cent of submissions, up from 48 per cent between 2011 and 2013. Perhaps key to changes made in the health technology assessment process has been to give the SMC greater latitude to take into account patients' lived experience when assessing medicines. On Monday, I announced further change. From October, defined ultra-orphan medicines for the very rarest conditions will be made available on the NHS for at least three years, while information about their results is gathered. The SMC will also have flexibility to allow some orphan medicines to go through the ultra-orphan process where they consider this appropriate. My request that the Scottish Government's chief pharmaceutical officer has written to the SMC to ask them to determine whether or can be might be considered in this way. We have also changed the system for individual access to medicines that are not generally available on the NHS. From 1 June, under the new peer-approved clinical system, or PAX tier 2, the cost of a medicine is explicitly excluded from decision-making criteria when considering a clinician's request for individual access. In recent years, we have ensured that the rebate that comes to Scotland as part of the UK's pharmaceutical price regulation scheme, the PPRS, has been invested in accessing new medicines, and we will ensure that that continues. Anna Sarwar I thank the cabinet secretary for giving away that she mentions the PAX tier 2 process, where it explicitly says that cost will not be a consideration. Will she therefore make funds available to health boards who are under budgetary pressures to access those medicines so that they do not have to worry about the cost? Shona Robison First of all, it is important that clinical effectiveness is still demonstrated. We have made funds available through the new medicines fund that has been funded through the PPRS, and Anna Sarwar will be aware that that is under negotiation again, as we speak, and I will come back to that in a moment. In terms of improving the ways of negotiating with drug companies, a number of steps have already been taken to better pursue best value for the NHS in Scotland. The NHS and ABPI have agreed a new voluntary system to ensure that, for the first time, discounts offered to one part of the UK are made available at the same level in Scotland. We want to go further and help NHS Scotland to negotiate for patients in new ways. To do that, it is critical that the new UK PPRS scheme leaves greater scope for NHS Scotland to negotiate with companies about their applications for new medicines. Sadly, the existing PPRS scheme, which expires at the end of this year, places very tight constraints on Scotland's scope for additional negotiation, and that prevents opportunities for negotiation as we cannot convene the current PPRS terms that are agreed by the UK Government. We have now asked twice for Scotland to be a party to the upcoming PPRS negotiations with the industry to ensure that we can secure that scope for greater flexibility in negotiation. That so far has been refused. Our aim is to align the implementation of a new negotiation scheme and the implementation of the single national formula to the outcome in terms of the PPRS negotiations. We hope that those can be concluded as quickly as possible. As such, I am happy to accept Miles Briggs's amendment today as well as the Labour motion. I hope that we can rely on support across Parliament for Scotland to receive a fair deal and the flexibility that we need from the PPRS negotiations. Today's motion refers to two specific medicines for secondary breast cancer and for cystic fibrosis. The Parliament heard just last week of the terrible tool taken on people living with cystic fibrosis, and few of us will not have had a family member affected by cancer. The SNC, NHS Scotland and my officials have been working to help the companies that have developed, or can be in perjetta, apply to have their medicines considered flexibly by the SNC. I warmly welcome the undertaking offered by Roche that they will make a new application for perjetta. That is a positive step. I also hope that the makers of our can be will submit a fresh application too, because it is important that clinical effectiveness is established. That is the process, and every company has to go through that process. Scottish Government officials met with Vertex this week to discuss their proposals. I hope that they too will also engage fully and positively with assessments to ensure the clinical effectiveness of their medicines. The Parliament has helped to drive forward substantial reforms in this area, but we must also expect that some companies also reform some of their practices and come forward with far fairer prices and clear clinical evidence for assessment. Every other pharmaceutical company has to do that. There is little doubt that decisions around the availability of new medicines are among the most difficult issues that face Government. That is why the system is not in the hands of politicians. It is an independent system, but that system has reformed considerably. I think that any reasonable person would agree with that, and that has meant getting more drugs more quickly into the hands of more patients. We have made advances and we will not stop in our efforts to make further advances in order to achieve that end. I move the amendment in my name. I now call Miles Briggs to speak to you and move amendment 12856.1 for up to five minutes, please. Thank you, Deputy Presiding Officer. I am pleased to contribute to today's debate about access to life-prolonging medicines and thank the Labour Party for bringing it forward today, because I know that this is such an issue of such huge concern and importance to many patients and their families across Scotland today. Earlier this month, working with breast cancer now, I was pleased to host the summit here in Parliament to add access to projeta with breast cancer patients, manufacturers and representatives of the Scottish Government and all parties in this chamber. The summit heard moving and powerful testimony from breast cancer patients, like Jen Hardy from Edinburgh, who told us, I have lost out on 16 months of precious extra time with my beautiful family because I have been denied projeta. With every moment that goes by, more women are missing out. The drug company, the Scottish Government and the SMC need to keep working to make projeta available on Scotland's NHS. It's time to end this injustice. I'd like to start by commending breast cancer now and individuals like Jen and many others for leading such a high profile and passionate campaign. At that meeting, we heard from another one of my constituents who gave, for me, what has been the most beautiful and poignant words that I think I've heard spoken in the Parliament. The mum of two from Portobello said, in my case, the differences of the extra time include better mental health, reducing the overwhelming guilt of leaving my gorgeous children at such a young age. Instead, I can again relax and enjoy the time with them. I can also look forward to all the fun bits of being a mum, such as being the tooth fairy, being with them as they learn to read and hopefully love books as much as I do, discovering Legoland and all sorts of wonderful places and experiences. Perhaps even more important is knowing I'll also be there at the difficult times, maybe even reassuring them as a secondary school and teenage years approach. Deputy Presiding Officer, I hope that those words really demonstrate why we are debating this important issue today and why we must see urgent progress. While, of course, I welcome Rosh's confirmation that it will make a new bid to the SMC, Scottish campaigners and patients are understandably frustrated and angry at the delays that they face to access projector when it's been available on the NHS in England and Wales. Similarly, in the case of Ocambie, I was pleased to speak in last week's members' debate, led by my colleague Maurice Corry, where I highlighted constituent strong desire for access to Ocambie, which can, as we've heard, transform the quality of life for people with cystic fibrosis. Parents from across Scotland, including people like Jenny Landers in my own region, are to be congratulated again on their campaigning efforts, but it has been because of them that we are here today, making sure that we see this change. While today's debate focuses on projector and Ocambie, in the last few weeks, I have also been contacted by constituents and families who are campaigning for access on other specialist drugs for themselves and their loved ones that they consider to be absolutely vital. Families of children with rare diseases, such as 5Q spinal muscular atrophy, type 2 and 3, want the SMC to help them to provide medicines that could radically improve their lives. They desperately want a system that is responsive, transparent and fast. The Scottish Government, as the organisation that ultimately sets the rules around how the SMC operates, needs to show that it understands and can respond to patients' wishes. As Opposition MSPs, it is our job to press ministers on this and speak up on behalf of our constituents. Many elements of the Montgomery review are welcome, but there are growing frustrations that they may not go far enough and that the implementations of some are taking far too long. My amendment today adds to Anasawa's motion and reflects what patient groups feel in relation to the need to improve the patient access scheme assessment group. Current processes are failing and they are not able to assess, in the most adequate way, how highly innovative medicines. We all will no doubt see a great more of those coming forward in the next few years. Technology advances as genetic-specific drugs emerge into the market. Those are going to be small patient numbers that we must be able to provide access to. To conclude, it is clear that too many patients and families across Scotland face barriers to accessing new drugs. The Scottish National Party Government and Parliament need to make sure that that changes as soon as possible. Sadly, for too many cases that we will hear today, it is too late for patients and some families. I support Anasawa's motion and I move the amendment in my name. We all want patients to be able to access the treatments that they need without delay. It is unthinkable that patients' health is deteriorating while medicines that could help them are not being used. It is right that the Parliament works to ensure that medicines reach the people who need them. The best long-term solution is to improve the framework surrounding those decisions, as there will never be time in the chamber to properly consider individual medicines with the urgency that patients and all the organisations in individuals who have campaigned long and hard require and deserve. The amendment that I proposed was clear that all patients need to have confidence that there is a trusted and transparent system for regulating the approval of all new medicines. Today, Cancer Research UK has emphasised that the SMC plays a vital role in assessing the clinical and cost-effectiveness of new medicines independently of the Scottish Government. It is right that there should be an independent process. Ultimately, the efficacy of individual medicines must be evaluated by clinical experts. I support the motion before us today. Improvements have been needed to our overall frameworks for approving new medicines. The motion rightly highlights that the Government is already committed to improving aspects of negotiating with drug companies. I acknowledge, too, that we have seen some progress towards implementing the recommendations of the Montgomery review over the last year, which the Government's amendment details. I will support the Government's amendment on that basis, although I appreciate the real concerns that progress has not been fast enough or always clear enough. I also wholly support the position that pharmaceutical companies should offer NHS Scotland fair prices and properly engage with health technology assessments. I am glad that the manufacturers of Projetta are making progress on resubmitting to the SMC and I implore the manufacturers of Orkambi to do the same, because there is no time to be lost. I will also support the Conservative amendment that we remove unnecessary barriers to treatment, and I am open to some potential reform to the role of the patient access scheme assessment group, although I am not wholly convinced by some of the submissions made to the Montgomery review by pharmaceutical companies who want to see the assessment group develop their role from gatekeeper to enabler. I also have reservations about urging NHS national services Scotland, the SMC or the Government to move it into negotiations that are even less transparent than current processes. Decisions about procurement should always be taken as transparently as possible. If we are to urge the Scottish Government to take action beyond the SMC process, then we cannot rule out other legal routes to procure medicines. The campaign group Just Treatment wants to see the Scottish Government make use of its powers to pursue a crown-use licence in some cases, and I raised the possibility with the cabinet secretary recently. I appreciate that it may not be a quick solution, but it has the potential to lead to much-needed long-term change on drug pricing. We cannot ignore the fact that manufacturers have the latitude to change their stance on price, and I very much hope that Roche has reached a position that allows the SMC to approve perjetta for general use, and I would encourage Vertex to do the same. As Just Treatment has pointed out, although we cannot alter the efficacy of drugs to make them more cost-effective, the price is variable and the key driver of price will be the patent-backed monopoly that is held by manufacturers. Just Treatment has worked with absolutely inspiring campaigners such as Denise MacIver, who has spoken so honestly and openly about the difference that accessing perjetta in Scotland would make to their care and treatment. Last week, my colleague John Finnie highlighted the experience of his constituent, Hannah McDermid, who has grown up with cystic fibrosis and lives with two hours of physiotherapy a day to clear mucus from her chest and lungs. It is incredible that so many constituents have put so much into campaigning for access to treatment when their own health must be their priority and they manage really complex treatment regimes. They are inspiring us, but they should be able to focus entirely on their health and wellbeing. We must get access to medicine right in the first place so that nobody has to put time and energy, which they could be spending with their families, into leading campaigns for the treatment that they need. It is tough watching and reading about breast cancer patients and their ordeal. Who would not want to make policy changes when you learn about Jen Hardy from Edinburgh and her HER2-positive secondary breast cancer? She has been denied perjetta and the 16 months of life that she could give. When someone who is so exhausted with the effects of breast cancer considers moving home to another country to get treatment shows how much it matters to her, or the 31-year-old daughter of Jacqueline McEnany, who has cystic fibrosis and would benefit from Orkambie. This week, she attended the funeral of the last of her childhood friends with the condition. Orkambie can extend her life and improve her daily quality of life as well. Only thanks to the advances in medicine is this debate even possible. Previously, there would have been no hope, now there is. With that comes a new set of challenges. There is an expectation on the NHS and the state to do everything possible to save our friends and relatives from the pain and early death, if at all possible. We want new medicines and innovations to be used by the NHS to improve people's lives and to encourage greater innovation from industry and researchers. However, that cannot be done at any price or effectiveness, because that might have an effect on the treatment and services that are available in the NHS, which might be equally justified, if not more so. The SMC process is specifically designed to assess the flow of new medicines from pharmaceutical companies. Because drug discovery is not cheap, it is a difficult set of judgments to make. It has been recognised that the process for orphan and ultra-orphan conditions requires adjustment. Progress since the Montgomery review has, however, been slow. Even so, the ultra-orphan process has nothing to do with Perjeta. The Pax 2 tier 2 system should give patients better chances of accessing Perjeta on an individual basis, but why is there a need to use the Pax system process when it is routinely available in England? There is a lack of clarity on what is happening with the end-of-life drugs like Perjeta. How can Perjeta be cost-effective in England but not in Scotland? Leaving aside the cancer drugs fund, how was a special deal reached in England with Roche but not in Scotland? I hear what the health secretary says about the PPRS, but that does not explain why the Welsh Government has given the go-ahead or, in fact, in Northern Ireland we are seeing a managed arrangement towards the use of Perjeta, certainly. The principles that we want for the new PPRS deal is that, if the companies offer a deal to one part of the UK, that same deal should be offered to all parts. Willy Rennie agree with that? I agree with that, but that does not explain why we are in this situation just now, although Wales and Northern Ireland seem to be moving ahead alongside England, but Scotland seems to be incapable of doing so. Roche said at the time when it was rejected last year by the SNC. Unfortunately, inflexible pricing rules mean that the Scottish Government has been unable to accept our discount in full. I do not really understand what that means, and I would quite like an explanation from the health secretary when she sums up. Pharmaceutical companies, as she says in her amendment today, should offer the same prices right across the UK. I agree with that. It does not explain the situation that Roche is describing. We need to have proper clarity about that. We all in this chamber recognise that we want to solve that problem. We know the dilemma of trying to get sometimes expensive drugs through the system, but we need some clarity and we need some progress for the sake of the patients involved. It was only a week ago that we had a member's debate in this chamber on access to Orkambi. I have to say that the minister's response was disappointing, prescripted and offered little comfort to those for whom the drug could be life-saving. The cabinet secretary, I believe, has moved on from that, and that is very welcome. I would encourage her to go further, because that is not just about access to Orkambi, important though that is. It is about access to the next generation of drugs to treat cystic fibrosis, the drugs that are being trialled as we speak that will transform lives and the drugs that will follow them in a few months, treating the underlying causes of cystic fibrosis, not simply treating the symptoms. That is actually life-changing. According to clinicians, instead of someone with cystic fibrosis dying before they have reached the age of 31 years of age, they could live to their 70s, their 80s, they would have a normal life expectancy, and that is simply extraordinary. We have an opportunity and a duty to do something about that. Orkambi was licensed for use in 2015. The SMC recognised that it was an important therapy, but rejected it on cost grounds in 2016. Two years on from that, Orkambi is only available from the drugs company on compassionate grounds. Meanwhile, people with cystic fibrosis are dying. Time is something that cystic fibrosis sufferers do not have. A resubmission to the SMC would take six months. I am not convinced that the appraisal process recognises the contribution to the economy that someone living and working for an additional 30 to 40 years would make. The way that SMC measures cost and benefit does not even begin to fully capture that. Let me welcome the roll-out of the ultra-orphan medicine pathway. I think that it is great, but the truth is that it applies only to conditions affecting less than 100 people. There is a gap in the system, and that is how we treat orphan conditions. Orkambi is appropriate for about 300 cystic fibrosis sufferers, so it does not qualify as an ultra-orphan medicine. It is very clear that there is a gap between ultra-orphan medicines and the SMC process. I hear the cabinet secretary asking to make an exemption, and that is a start for Orkambi, but it does not address the underlying problem, and that is where I would like her to go further. The other point that I want to make is about a portfolio agreement. That is not just an agreement about Orkambi, we need that agreement about the next generation of medicines coming down the line. I know that this is new, and it does not fit the processes that the Scottish Government has, but let us not be hide bound by systems if they are not flexible. Let me correct the cabinet secretary as gently as I can. New treatments in a portfolio agreement have all to be licensed first. I would have the same safety concerns that she has, and I would not be recommending this if I did not think that it was appropriate. At the end of the day, this is about patients. Here are the countries that have agreed a portfolio deal. Austria, Denmark, Germany, Luxembourg, the Netherlands, Italy, Ireland, Greece, the United States, the Republic of Ireland and just this week, Sweden. Are all those countries wrong? Do we know better, let me finish. Assistive fibrosis sufferers are different in Scotland than in any of those other countries. Negotiate, I am happy to give away. Jackie Baillie has raised an important point, because the portfolio approach did include unlicensed medicines in that portfolio, the safety of which remains unproven. I am glad that she shares my concerns about that. That is a fundamental problem with the portfolio approach that really needs to be addressed. Ms Baillie, you need to conclude your remarks. I am suggesting that we can address it if we have those negotiations. All those other countries have. Negotiations on such an agreement are well underway in England. They have moved on to negotiate. I understand that agreement will be reached soon, perhaps even before the end of the summer. That will save the lives of cystic fibrosis sufferers in England. I cannot believe that the cabinet secretary wants to send a message today that we are suggesting that parents who want to save their children should somehow move to England to do so. I know—and I am very grateful—that the cabinet secretary in my last sentence is going to meet with my constituent Kelly Gallagher next week, but Kelly does not have time to wait. She needs or can be now. I call on Ash Denham to be followed by Annie Wells. As a constituency MSP for Edinburgh Eastern, I have met constituents for whom access to potentially life-altering medicines, either for themselves or for their children, is an incredibly pressing concern. I feel that the Scottish Government has acted to significantly improve access to medicines in recent years, but I know from the meetings and from the correspondence that I have received from constituents that accessing certain medicines and treatments has sometimes proved frustrating. In Scotland, new drugs are appraised in a clear way. The process is, of course, independent of ministers and Parliament and decisions are made by the Scottish Medicines Consortium. The system needs to be fair and consistent, but it also needs to be able to respond swiftly to clinical need. Pharmaceutical companies must play their part in the process by submitting a fair price ideally the first time. The Scottish Government has listened to feedback from patients and responded to the recommendations of the Montgomery report by working to implement a series of reforms to the system and new measures that make it easier for patients with rare conditions to access new medicines and treatments. The Government has announced just this week that it has widened the definition of ultra-orphan medicines to include medicines for rare orphan diseases so that patients with rare diseases can get faster access to new medicines and treatments. That means that if a medicine meets the definition and the Scottish Medicines Consortium considers it to be clinically effective, then patients will be able to access the new medicine on the NHS for at least three years while information on the wider effectiveness is gathered. That follows changes that have been made this month that give doctors the right to access licensed treatments that are not generally available on the NHS on a case-by-case basis, making it easier for patients to get access to the specialist medicines that they need. That peer-approved clinical system, tier 2, will act as a sort of safety valve within the system for clinicians and that non-routine access must not include cost effectiveness as part of that consideration. That is supplemented by the new national appeal panel and gives a more flexible pathway for clinicians and their patients. Those changes reflect the Government's understanding that more can and should be done in regard to exceptional cases. I think that that amounts to major improvements in access to new drugs that have the potential to improve the quality of patients' lives. Those changes by the Government are significant, but it is also vital that pharmaceutical companies play their part by bringing a fair price to the process. Ultra orphan medicines, as we know, are expensive, and the role of the Scottish Medicines Consortium is to ensure that best value medicines are available to the NHS in Scotland. I understand that, following encouragement from the Scottish Government, both pharmaceutical companies, Vertex and Roche have submitted new applications to the national health services Scotland. I hope that that will result on agreement being reached on fair prices that will enable patients in Scotland to access those medicines. I hope that those recent announcements go some way to reassuring both my constituents and patients across Scotland that the system is being reformed, it has been taken seriously and that access to the latest medicines for those that need them is being improved significantly. Thank you very much. I call Annie Wells to be followed by Kezia Dugdale. All speakers must keep the remarks under four minutes. Thank you, Presiding Officer, and to the Labour Party for bringing this extremely important topic to the chamber today. Imagine a situation whereby a family member or loved one could live longer if only they were given access to a medicine that you knew already existed. Imagine your frustration should they be denied that drug. In doing so, we are getting to the crux of why this debate is so important. We have seen in the media that the personal test means of patients who need these drugs. Last month, we saw a young woman right to the First Minister to beg for access to her can be, a drug that would improve her chances of living beyond the age of 31. A few weeks ago, as part of the breast cancer now campaign, I met a campaigner who desperately wants and needs Projeta to increase the time that she has left. The specialist drugs that are can be and Projeta are potentially life-changing drugs. A precision medicine that targets the root cause of cystic fibrosis has the potential to improve the lives of more than 336 people in Scotland by preserving and restoring full lung function. Projeta is a drug for people with HER2 positive breast cancer that is said to prolong the lives of women with incurable breast cancer by up to 16 months. That is why it is so important to discuss the availability of those drugs in Scotland. The Scottish Conservative Party has been consistent in calls for both drugs to be made available on the NHS. Miles Briggs hosted a cross-party talks on the availability of Projeta only this month. In May, Ruth Davidson raised the issue at FMQs, stating that some breast cancer sufferers had travelled to England to get access to the drug. In last week, my colleague Maurice Corry led a member's debate, which called for her can be, to be made available in Scotland. Cost, of course, will always be a factor in making such decisions, but what is clear is that the Scottish Government must provide clarity about what it intends to do going forward. There are underlying issues and reform that is needed. When it comes to negotiations, the SNC, of course, makes decisions independently of Government, but it is, after all, Government that sets the frame under which those decisions are made. That is why the Scottish Government must prioritise putting in place a negotiation system that will ensure greater access to those drugs. It has been 18 months since a promise was made by the Scottish Government to do so, and I would like to call on the cabinet secretary to provide a clear deadline as to when we can expect that to happen. Furthermore, as alluded to in Miles Briggs amendment, we must push for reform of the patient access scheme assessment group to make access to high-cost drugs easier for patients. In addition to those reforms, I would also like to echo the calls made by Miles Briggs for a cross-border arrangement to ensure that no one misses out on crucial care. There are medicines available in Scotland that are not available in England, which is why it is so vital for us to work together and share resources. To finish today, I would like to reiterate my support for this debate. The time has come for greater clarity surrounding new medicines, and we have seen in recent weeks just how pertinent the demand is for life-changing drugs to be made available in our NHS. It is our patients who are the ones who suffer with the lack of decision-making and complex discussions around cost, which, of course, have to be factored in. However, I call now on the Scottish Government to urgently put a new system of negotiation in place regarding those life-saving drugs. Only then will we see patients get the chance that they deserve to extend their lives and give relatives a source of comfort. Thank you very much. I call Kezia Dugdale to be followed by Claire Hockey. Thank you, Presiding Officer. I start by commending my colleague and friend in Asarwar on his persistent focus on access to medicine, a focus that has allowed us to devote Labour's debating time to it today. I wanted to share my experience of supporting constituents with cancer in the chamber today. I want to make three points, one about the wider situation facing the NHS, one about the Montgomery review and, in particular, the replacement for IPTRs, and then finally a comment about Jen Hardy and her battle for Perjetta. First of all, I say to the Cabinet Secretary for Health that, on my surgery on Friday, a woman came to see me about a family member who had been waiting over a year for an endoscopy within NHS Lothian. She never got the treatment that she needed and she died of stomach cancer earlier this year. The debate that we have today about access to medicine has to be seen in a wider context around the pressures on our NHS and, in particular, the failings that the Government consistently delivers around treatment time guarantees and that cancer is no exception to that record of failure. On the issue around the Montgomery review, I am pleased that the Government has accepted the recommendations to replace IPTRs with a new system, the Pax 2 system, which, in Asarwar, introduced to the chamber. I have had direct experience of trying to support two different constituents with an IPTR process. One of them was successful and one of them was not. The first one was a woman who walked into a constituency surgery a few years ago, who needed help to fill out all the paperwork associated with IPTR to access the drug Cadzyla for breast cancer. She was ultimately successful and she was only successful, I think, because of the sheer force and pressure put behind that campaign by breast cancer now at the time who did formidable work fighting for that drug. The second constituent that I tried to support with an IPTR was a woman with bowel cancer. One of the hardest things that I have ever had to do as an MSP in this chamber was to go and visit her in her house in Edinburgh and sit down and have a conversation with her about why she could not get the drug that she needed for her bowel cancer after devoting her entire career to the NHS. She was a pediatric nurse. Every waking moment of her adult life had been spent working in the national health service, and there I was sat in her living room trying to explain how it was fair that she could not get the drug that would have saved her life. She sadly passed away in February of this year and she never got that particular treatment that she needed. We also know from Miles Briggs and others about the situation facing Jen Hardy. Jen Hardy should be spending her final months with us, watching her daughter graduate, watching her get married, spending Christmases with her family, yet she is spending her time standing outside this building educating MSPs on a drug that would have given her 16 more months to live. The Government has been dragging its heels for such a long time over the issue of perjetta so long. In fact, we have been waiting longer than that drug would have given Jen Hardy in extra months with the people who desperately want her by their sight. If there is one thing that the cabinet secretary takes away from today, please stop dragging your heels. There are people who need those drugs now. Every one of us has had the experience of trying to support a cancer patient through one of the most difficult experiences of their lives and being hit by the system time and time again. A system that is failing them and a system that we could do much, much more to improve. That power lies in the health secretary's hands. I hope that she steps up and uses it. I refer members to my entry in the register of interests in that my registered mental health nurse and currently hold an honorary contract with NHS Greater Glasgow and Clyde. Like other members present, I too know of constituents and friends who have either had or are affected by breast cancer or cystic fibrosis. The impact of those illnesses does not only affect the patients themselves but also their family and friends who are supporting them. Like many across the chamber, I have heard of heartbreaking stories from constituents whose lives have been turned upside down by breast cancer and cystic fibrosis. It is for that reason that I fully applaud the tenacity of the campaigns that are led by breast cancer now and the cystic fibrosis trust in calling on authorities to widen access to medicines for such conditions. Their campaigning has helped to educate MSPs and the wider public on the merits of widening access to those drugs and for that we owe them a debt of gratitude. Presiding Officer, as we have heard, the Scottish Government has significantly improved access to new medicines in recent years. Figures show that between 2011 and 2013 the combined acceptance rate for orphan and cancer medicines was 48 per cent, whilst in the last three years under the new approach, the Scottish Medicines Consortium approved 79 per cent of such medicines. There can be no doubt that those drugs have changed lives. However, we can always improve and build upon our processes and learn from our own past experiences and evidence-based best practice from other nations. Following the recommendations that are laid out in the Montgomery report, I welcome the Government's commitment in reforming the systems that are currently in place and introducing changes that will enable medicines to get to the people who need them. Only yesterday, as we have heard, the Cabinet Secretary for Health and Sport announced that the Scottish Government is introducing a new definition of ultra-orphan medicines, which will give the Scottish Medicines Consortium the ability to treat some medicines for rare orphan diseases as ultra-orphan medicines. In effect, the changes will mean that if the medicine meets the new definition of an ultra-orphan medicine and the SMC consider it clinically effective, it will be available in the NHS for at least three years while information on its effectiveness is gathered. That is one of a number of steps being taken to ensure that access to vital medicines is widened. With those new rules for medicines, faster access to new treatment will become a reality. I wish to reiterate that medicine approval decisions are not taken by MSPs nor are they taken by Government. That is the role of the Scottish Medicines Consortium, which, as the Cabinet Secretary for Health and Sport said, rightly acts independently of ministers and Parliament. Nobody wants to be in a situation where certain medicines are rejected, and it is entirely appropriate that it is a decision that is carefully taken based on sound clinical evidence and by an independent body. Like others here, I welcome Roshi's announcement that they are to make a new submission to the SMC on Projeta, and I urge Vertex to do likewise for our can-be as quickly as possible. We cannot allow our health service to be held to ransom by pharmaceutical companies, and we must encourage them to offer fair and transparent prices for their products. Everyone here is in agreement that we want those drugs to be made available to the people of Scotland. However, there must be fairness in the costs of the drugs supplied. I therefore welcome the commitment made by the Association of the British Pharmaceutical Industry that its members will provide Scotland with the same discounts offered elsewhere in the UK for accessing medications. Parliament has spoken today with one clear voice in calling for all pharmaceutical companies to play their part and bring a fair price first-time to the drug's appraisal process. Quite rightly, people should not be losing out to profits. I am delighted to have the opportunity to take part in today's debate and pay tribute to the Labour Party for bringing this forward and anasawa for the campaign that it has brought. As we know, those serious issues—cystic fibrosis and breast cancer—are two completely separate conditions. However, they have a common thread that they are both attributed to genetics. That has reached a condition, and as we have seen, individuals who have those diseases have tried their best to do all that they can. Companies themselves have insistently had an uphill struggle in ensuring that they can successfully provide treatments for patients. However, thankfully to no small part, current knowledge and expertise have ensured that two drugs are now available for cystic fibrosis and HRT-positive breast cancer. Firstly, Ocamby is a different type of traditional treatment for cystic fibrosis because it is a precision medicine. The traditional medicines that have damaged occur, and the type of illness that they have seen, has progressed further. Following on the precision medicine, it targets the root cause, having the potential to ensure that the lung function is restored and that the decline subsides. Cystic fibrosis trusts have recognised that there are currently 336 people in Scotland who could benefit from having access to this drug, which is one-third of the 900 people across the country who are living with CF. Projeta is a newly developed drug for people with HRT-positive breast cancer, which has been created by the pharmacist to go society company, Roche. We have heard today how people in England—women in England and Wales—can get this drug, but people in Scotland cannot. Projeta gives the patients with cancer the opportunity to have their treatment increased. Projeta will give them the opportunity for 16 months. That is a lifeline to many patients. That gives them the opportunity to ensure that they spend more time with their families and loved ones. They need that access now, not later. Given the fact and the benefits that we know that Ocambi and Projeta are available, but they are not available to Scottish patients, patients cannot understand why they are seen or not seen as a priority. Why are they not being given this opportunity? Many are living and their life expectancy is shortened and they die because they do not have the drug. The Scottish Conservatives have made it quite clear on numerous occasions in this parliament that Ocambi should be available, and we have been discussing that since 2016. Indeed, Ocambi was made available on a debate last week, and I paid tribute to Maurice Corry MSP, who called for a portfolio approach on which medicines with cystic fibrosis become available for patients in the country to ensure that the manufacturer is licensed. The years of this type have already taken place across other parts of the country, and people want to know why it is cost and bureaucracy that are stopping this from happening. Doctors can move a patient on to new medicines if they believe that the access to the patient will ensure that they have a longer life expectancy, and we should be providing that. Ruth Davidson has made it quite clear, and she talked to Projeta at First Minister's Questions only last month. I paid tribute to my other colleague, Miles Briggs, who held a cross-party talks last month specifically on that topic. We have also talked about the Scottish Parliament looking at Projeta across a cross-border arrangement to ensure that no-one misses out on the crucial drugs that are taking place. It comes back to choice. Those are choices that have been made by the Scottish Government and Scottish ministers, so we must make the right choices—choose the choices for the people of Scotland. They deserve nothing less. Enough is enough. Thank you, Presiding Officer. I welcome the opportunity to take partners to be on access to new medicines. The movers of the resolution and all of us in the chamber want to achieve the best results for all sufferers of rare conditions in Scotland, who require orphan, ultra-orphan and end-of-life medication. For the sufferers and their families, the importance of the issue cannot be overstated. I join with other members in paying tribute to those who campaign tirelessly on the issue. As MSPs, we all have constituency cases where access to new medicines would make a transformational difference to the lives of individuals. Ensuring that robust, independent processes are in place to bring new drugs into use is therefore of critical importance. The Montgomery review, commissioned by the Scottish Government to look into the issue, made a number of recommendations, including on data sets, definitions, negotiations, new ultra-orphan pathways and arrangements on funding, which the Government has confirmed it will be implementing. The Montgomery review concludes that access to end-of-life orphan and ultra-orphan medicines has increased through steps taken by the Government, including the use of individual patient treatment requests and the peer-approved clinical system packs. Indeed, the percentage of new drugs that has been approved has increased from 48 per cent in the period 2011-13 to 79 per cent over the past three years, as a result of investment and reforms to approval processes. The Scottish Government put in place a new medicines fund to provide additional support to NHS boards to meet the cost of those drugs and commits to continue to use all the funding from the pharmacutical price regulation scheme rebate to support the NMF. The Scottish Medicines Consortium will introduce a new ultra-orphan pathway with an option to recommend a medicine on an interim basis. Doctors on behalf of patients can seek access to licensed treatments that are not generally available in the NHS in Scotland with a roll-out of packs. A new national appeal panel. I wonder whether he would agree with me that there is a gap between ultra-orphan medicines, which are covered by the new pathway, and the SMC process. For those orphan conditions, there is nothing that suits them just now. Would he agree that we should fix that? I think that everything needs to be looked at to make sure that there are no gaps. I know that the changes that I am outlining at the moment that the Government has done and is looking at will go a way to address that and should continue to do so. Doctors on behalf of patients can seek access to licensed treatments that are not generally available on the NHS in Scotland with a roll-out of packs. In a new national appeal panel, they will be introduced for individual requests to allow for medicines that are not approved by the SMC and greater cognisance of lived experience will be taken into account in decisions to fund new medicines. The issue of negotiation figures prominently in the Labour motion with calls for a new system negotiations to be implemented. The market for medicines, in particular new medicines, is particularly complex, as it does assessments of the recovery of research and development costs essential to ensure that the pipeline of new medicine development is not slowed. The process is also further complicated by the multi-layer processes that are involved in UK pricing negotiations. Indeed, the Scottish Government calls for the UK's PPRS to provide full transparency in pricing among the four UK Administrations is to be welcomed to ensure that NHS Scotland is fully engaged in this process and can leverage best pricing as a consequence. Given that ultra-urfing drugs are often very expensive, it is also vital that the pharmaceutical companies play their part in bringing a fair price first time to the process. In conclusion, the development and drug technology will continue apace, and that is to be welcomed by providing cure conditions that would have been possible until recently. The needs of sufferers who require access to the latest medicines is a priority, and ensuring that the process in place for approval delivers for them is of critical importance. Therefore, welcome steps that the Scottish Government continues to make to provide 50 new medicines and calls for all parties to get round the table to make progress on the specifics. When I move to closing speeches, I am afraid that we still have to restrict comments to four minutes. Brian Whittle Thank you, Presiding Officer. I am pleased to close this debate on behalf of the Scottish Conservative Party. I thank the Labour Party for giving us the opportunity to once again highlight for me what I meant to an anomaly in the process of approving drugs for general and rules, particularly when considering portfolio medicines. That is especially true in the cases of the drugs bargetta on our Canby. We have heard today how bargetta can prolong the lives of those who are suffering from terminal breast cancer by up to 16 months. We have heard how our Canby, unlike traditional medicines, for the treatment of cystic fibrosis, targets the root cause of the condition and has the potential to preserve or even restore long function, improving life expectancy and the quality of life of patients. When I am writing speeches in this chamber, I tend to shy away from quoting from constituents. In this case, I am going to make an exception, because their experiences and words highlight this issue far better than I ever could. Willie Rennie has already mentioned Ruth MacKillennie, who herself has a young son. Her mother wrote to me and asked that I speak on her behalf. I quote, From this early age, her daily regime of medication was huge, 60 tablets a day with added ones when required and intravenous antibiotics on occasion too. She has also had a daily physiotherapy from us twice a day and every kind of activity added to keep her fit and active, keeping her lungs in good shape. This must have cost us thousands of pounds over the years with dancing four or five times a week, singing and trumpet lessons. I have never regretted one penny of what we have spent on this wonderful, kind-hearted, intelligent young woman. Having completed a degree in performance music, she has gone on to work with children and young adults with autism, and now a piano teacher herself. She also has worked extremely hard on her fitness as an adult, which is the main reason she has got herself to 31 years old and we have mentioned 31 as a key age before. As I have said before, she is now a mum too, dedicating her energy to bringing up her four-year-old son, but now in a downward spiral with her health, having more hospital admissions in the last six months than ever before, and having struggled with her lungs and her bill with blockages and now regular currents and chest infections too. She goes on to say, Ruth is desperate to stay alive to see her son grow up, to take him to school, high school and beyond, which is what most of us as parents take for granted. I cannot therefore understand why there is a drug that could potentially transform her life, sitting on a shelf, while people say that the cost is not worth it for her and the many more wonderful, courageous, young cystic fibrosis warriors. We have battled for so long already, along with us. I am hoping and praying that today will be a landmark day to change their lives forever, giving them a gift of improved health and long life. Willie Rennie has already said that today, Ruth attended the funeral of her last surviving cystic fibrosis clinic friendic from Crosshouse hospital. He was 26 years old, five years younger than my constituent's daughter. Time is precious when we are talking about improving the quality of life, when we are talking about giving people time with their families, when we are talking about allowing people to continue to achieve like in the case of Ruth. Most debates in this place are about finding a way to gain a political inch from our opponents or dodge a bullet of intervention or get out of here unscathed having landed a blow. But not today. Today is not about politics. Today is about finding a way and quickly to resolve a situation that is eminently solvable. I fully recognise that it is not for politicians to make medical decisions and there is always a tension between what medicines are passed and those that are rejected. Can I say, cabinet secretary, please, get the parties around the table, find the solution, because this is most definitely within your power. Thank you very much and I call the cabinet secretary. Thank you, Presiding Officer. This has been a very good debate and some very powerful speeches. I certainly think that that has, I hope, united the chamber in a number of respects. I'll come back to that in a second. I want to try to deal with it as many issues that have been raised. Obviously, I won't be able to deal with all of them in the time allotted. I thought Annie Wells made a point that really answered the point made by Anasawa and others. Of course, there will be drugs north and south of the border that are not available either north and south of the border. That is because we have the different assessment processes, so there will be drugs available in Scotland that are not available in England. Those are the systems that we have, but they should all be based around the clinical evidence. I'll come back to that, because I thought that Jackie Baillie made an important point in that respect. Anasawa and others talked about the portfolio approach. Jackie Baillie mentioned that as well. Of course, the portfolio issue was not raised by Montgomery or anywhere else in terms of recommendations. Whether it is officials here in Scotland or officials in England, they all have concerns about a portfolio approach for two very important reasons. One is that it seeks to bypass the standard health technology assessment process. If we are all agreed—and I haven't heard anyone in the chamber this afternoon say—that clinical effectiveness processes have to be tested and met. Everyone has agreed that, and everyone has said that those medicines have to be licensed. The current portfolio approach then needs to be revisited by the manufacturers of our Cambie. That is a very powerful message for the chamber to send to Vertex and any other pharmaceutical companies, because the systems have to be reformed. I agree, but clinical effectiveness has to be established and the medicines have to be licensed for patient safety reasons. I think that Jackie Baillie said that. Jackie Baillie said that. I do, and let me quote from a Vertex statement made following their meeting with the Scottish Government on 18 June, because they say that that will accelerate access to our pipeline of potential new CF treatments after licence. Those tests that I want to see about the clinical safety of that drug would have been carried out. There is nothing to stop you from engaging in a portfolio agreement that would save lives. It is not for Government to do that, it is for the SMC to do that, but there were unlicensed medicines in that portfolio. If things have moved on from that, that is to be welcomed. Dialogue continues. There has been a lot of dialogue with Vertex, not just from Scottish Government officials but from national procurement. I hope from that last round of discussions that progress may be able to be made. I would certainly encourage all of that. Willie Rennie raised an issue. I want to be as clear as I possibly can because he asked why the perjetta deal was not available in Scotland. NHS England has come to a confidential commercial deal with Roche. The details of that cannot be shared between administrations for commercial confidence reasons, but unlike standard discounts, when they can be, that is why we need transparency and price parity written into the new PPRS. I cannot emphasise that enough. That is really important going forward, because that transparency does not allow me to tell Willie Rennie some of the detail that might be quite helpful. No, I am sorry, there is no time, cabinet secretary, to take an intervention. I will write to members about the specific issues that they raised, but I think that the message that we could all agree on in this debate is that we all want medicines to get into the hands of patients as quickly as possible. I want that. Obviously, those decisions are not made rightly by politicians, but we have improved the systems in order to deliver that aim. I would encourage Vertex to continue to have those discussions, to get a new submission to SMC, and to make sure that that is at a fair price as quickly as possible. I think that that would be well received. I call David Stewart to conclude the debate. This has been a productive debate with passionate and well informed contributions from across the chamber. One-level discussions on the licensing of medicines and negotiations with drug companies can become quite technical and abstract, but let us never forget that the outcomes of those debates have real-life impacts for the individuals who are affected. We have had passionate contributions and examples from across the chamber, such as from Malmood Salwar, Jackie Baillie, Kedsdagdale, Miles Briggs, Ash Denham and Brian Little. Orphan and ultra orphan medicines may only treat a few hundred people per year in Scotland. That does not mean that they should be overlooked. Every delay to improving the system in negotiations is another day that women with incurable HER2-positive breast cancer have to face less time with their loved ones. It is another day in which lives are lost because people with cystic fibrosis are denied access to the drug or can be. The Government this week has made some improvements regarding access to medicines with the PAX tier 2 system and the newly-announced Alcha Orphan pathway. Although that is a step in the right direction, action is still too slow. It has been two years since the Montgomery review, and many patients do not have access to these important life-sustaining drugs. Campaigners, Presiding Officer, are rightly frustrated at the lack of progress that has been made in Scotland in negotiations with manufacturers, Roche and Vertex about Perjetta and or Canby. That is especially so when a deal has been made to allow women in NHS access to Perjetta and England and Wales. The descriptor has been provisioned just a few miles across the border. It is a daily growing injustice. As my colleague Anna Sauer said in his excellent speech and I quote, Presiding Officer, women in England, Wales and Northern Ireland can get Perjetta on NHS is a matter, of course, but in Scotland they cannot. It has been rejected three times by the SNC as it is not considered cost effective. Despite being recognised as clinically effective, again I say what cost on lives. Miles Briggs, I think in an excellent speech, talked about the summit that he hosted on Perjetta and he should be welcome for the work that he has done on this. The message from campaigners is keep on working with the Scottish Government, SNG and industry. Stop this injustice, he said, and that patients, of course, value the last few months with their family and young children. Too many families, he said, face barriers to getting drugs. Alison Johnstone made some excellent points. I will particularly highlight her point about the Government getting a crime licence, which is a very important initiative, and the fact that we have patents backed monopolies on many occasions. We need to change, she said, the approval framework, which is vitally important. I think that Willie Rennie made some excellent points as well. He talked about the advance in medical science, which now gives hope to many people who, in the past, would have had very little hope. We, of course, need innovation in health, he said, but it cannot be done at any price or any effectiveness. Jackie Baillie made a very powerful speech, a very personal speech, about examples that she has come across. She said that there is an opportunity now to do something about it and mention the portfolio deals that many other countries like Sweden and the USA had carried out. Arshtemyn talked about the pressing concerns from her constituents with life-threatening conditions and that companies need to play their part in offering a fair price. Many other speakers like Annie Wells, I'm in key, clear, hockey, and Alexander Stewart made excellent contributions. In the very little time that I've got left, growing medical research is growing and developing apace. However, if assistance or approval are still too slow in response, if we continue to be reactive instead of proactive, the same problems will occur, again and again, as new drugs are developed and medical treatment new forward. New pathways and assistance may sound good, but we do not have the confidence of patients or this chamber unless they are shown to have real results. Therefore, I urge the Government to heed the call of campaigners and act now without delay to make Projeka on or can be available in the interest to those who need it now. Only then and then alone can we claim that true progress has been achieved. Thank you very much, and that concludes our debate on access to vital medicines. The next item of business is consideration of two business motions, motion 12877, setting out a business programme, and motion 12878 on the timetable for our bill at stage 2. If anyone objects, please say so now, and I can recall in Jovis Patrick to move the motions. Formally moved. Thank you very much. No one seems to object. Therefore, the question is that motions 12877 and 12878 be agreed. Are we all agreed? Thank you. The next item is consideration of five parliamentary bureau motions. Could I ask Jovis Patrick on behalf of the bureau to move motions 12879 to 12881 and motions 12896 and 12897? Moved on block. Thank you very much. There are seven questions today as a result of business. The first question is that amendment 12861.2, in the name of Jovis Patrick, which seeks to amend motion 12861, in the name of Rhoda Grant, on a review of Government FOI handling and record keeping, be agreed? Are we all agreed? Yes. Or not agreed? We will move to a vote. Members may cast their votes now. The result of the vote on amendment 12861.2, in the name of Jovis Patrick, is yes, 66, no, 59. There were no abstentions, and the amendment is therefore agreed. The next question is that amendment 12861.1, in the name of Edward Mountain, which seeks to amend the motion in the name of Rhoda Grant, is agreed? Are we all agreed? Yes. We are agreed. The next question is that motion 12861, in the name of Rhoda Grant, on a review of, as amended, on a review of Government FOI handling and record keeping, be agreed? Are we all agreed? Yes. We are agreed. The next question is that amendment 12856.3, in the name of Shona Robison, which seeks to amend motion 12856, in the name of Anas Sarwar, on access to vital medicines, be agreed? Are we all agreed? Yes. We are agreed. The next question is that amendment 12856.1, in the name of Miles Briggs, which seeks to amend the motion in the name of Anas Sarwar, be agreed? Are we all agreed? Yes. We are agreed. The next question is that motion 12856, in the name of Anas Sarwar, as amended, on access to vital medicines, be agreed? Are we all agreed? Yes. We are agreed. I propose to ask a single question on the five parliamentary bureau motions. If anyone objects, please say so now. No one objects. Therefore, the question is that motions 12879 to 12881 and motions 12896 and 12897, in the name of Joe Fitzpatrick, on behalf of the bureau, be agreed. Are we all agreed? We are agreed, and that concludes decision time. We'll move now to members' business, in the name of Adam Tomkins, on Welcome to Glasgow, a world city of music. We'll just take a few moments, pause, while members and ministers change seats.