 chi am ni'n drefnio i wych iawn? Felly, mae'n�af nhw'n wneud am y cyfnod rhagiau nid o bobl sydd gyda chi gweld fyffordd ar gyfer y cyfnod mae'n teimlo i weld i'n ffrwng mwyaf i gael ar y cyfnod werthuaeth. The next item of business is a debate on motion 1190, in the name of Humza Yousaf, on a caring nation recovering, remobilising and renewing health and social care in Scotland. Could I invite members who wish to participate in the debate to press their request and speak button now or placing R in the chat function if they are joining us online? I call on Humza Yousaf to speak to and move the motion for around 11 minutes. I apologise to Mr Carlaw for the unfortunate positioning of my crutches. We would not have added or wanted to add to our waiting list given the significant challenges that we already have. I am delighted to be opening the debate on behalf of the Government. Of course, I have not moved the motion in my name. We are living in extremely challenging times. We are living through a global pandemic that has brought an extremely significant challenge for health and care services right across the world. Right now, our NHS and social care systems are under more pressure than they have ever been at any point in the pandemic. In fact, the NHS is undergoing the biggest shock of its 73-year history. Today, there are more than 1,000 Covid patients in our hospital. That number has more than doubled in the past two weeks. To provide wider context over the past 80 months, our hospitals have dealt with more than 31,546 Covid admissions, enough to fill well over half of Hamden Park, and more than 2,455 have been admitted into ICU. Those numbers are not just staggering in terms of scale, but also tragic in terms of the human impact that they have had on so many. I know that my thoughts and the thoughts of the entire chamber go to every single family and community that has been bereaved by the impact of Covid. At the same time, we have seen that our NHS continues to deliver emergency and urgent care, for example cancer, as well as standing up the biggest ever vaccination, testing and contact tracing programmes ever seen. I suspect that we will ever see in this country. Through the first two waves of the pandemic, we responded by standing down non-urgent procedures, pausing some important aspects of our health service such as some screening programmes and, critically, demand for primary care and A and E were significantly reduced as people stayed at home or, sadly, were reluctant to seek advice on their symptoms. That is not over, far from it. That third wave has already brought pressures to a new level. Covid numbers are high again. In the last couple of weeks, they have been at record numbers. We are still dealing with urgent and emergency procedures. We are restarting paused services as quickly as possible, while still running the test and protect and vaccination programme. On top of that, we are seeing record levels of presentations to A and E, just as one statistic to demonstrate how that challenge has materialised. Over the last week of August, more than 27,000 people presented at A and E. Last time, we saw 1,000 people in hospital with Covid, which was last December. There were just over 19,000 presentations. We have seen a 40 per cent increase, currently placing even more pressure on our NHS. Acute bed capacity across our health boards is sitting at as high as 98 per cent in some cases, so there just simply is not the headroom that we had at the beginning of the pandemic. Important infection prevention and control measures mean that it is taking longer to assess people, to move them to discharge or admission. All of that, coupled with increased length of stay in hospital due to people presenting at hospital later and sicker, means that our hospitals are fuller than they have ever been, and with a wide range of ailments, not just Covid. By definition, the workforce has been under sustained and unprecedented stress. It is not immune to that, nor are they immune to Covid. The 11 communities, such as the rest of us, with high prevalence, come staff absence across both health and social care settings. For social care, that means that it can take longer to discharge people who are ready to leave hospital, but it cannot be accommodated in care settings due to staff pressure already adding to pressure on beds. No one single part of the health and social care system operates on its own. We are all aware of that. They are entirely interconnected and interdependent upon each other. That is apparent, and that is why we are tackling the challenge that we face on all fronts with a comprehensive programme of investment, not just targeted to one part of the health service but taking a whole systems approach across GP services, NHS 24, the ambulance service, our acute sector and, of course, social care too. Of course, I will. Willie Rennie. Tumis is going to come on to the justification for the centralisation of social care, but that will be the third bureaucratic reorganisation since this Parliament was created. The others have not worked. What makes them think that this time another reorganisation is going to make a difference? I am going to the past battles around Police Scotland, but I think on that the Liberal Democrats have been thoroughly defeated in terms of the national care service. What I would say is that what we would like to do is improve and, of course, increase the terms and conditions for social care staff right across the country. We can do that by ending the postcode lottery of social care by ensuring that that is accountable to ministers. We will speak, I am sure, at length in this chamber on many occasions about the national care service. Are colleagues across health and social care? He was speaking about waiting times and waiting lists. I am going to ask him how many people in Scotland are currently on waiting lists for treatment and how long does he estimate or how long has the model estimated that it will take to get that backlog under control? I will come on to the detail of waiting lists. That is, as he knows, extremely significant. Of course, he also knows that that is a challenge that is being faced by Governments right across the UK, but he is right to ask how long that will take to resolve. There are two things that I would say to Stephen Kerr on that matter. First of all, I am afraid that we are still adding to that backlog because we are in the midst of a global pandemic. The pandemic has not ended, so, by very definition, we are still facing those challenges and pressures. Our NHS recovery plan, backed by over £1 billion investment, sets out in detail how we will recover those challenging backlogs. If you do not mind—since it is Mr Ewing, my goodness, I will give away what he has deemed. I am very generous of the cabinet secretary and thank you for giving way. The cabinet secretary has given details of the heavy burden on NHS services throughout the country, partly, perhaps largely, as a result of the Covid pandemic. Plainly, with COP26 close on us, we will see arriving in Scotland and focusing in Glasgow several tens of thousands of people and concerns, perhaps, about importation of new strains of the virus. Can the cabinet secretary assure the House that the Scottish Government has given the fullest consideration and carried out a detailed assessment of what possible contingent consequences there may be with regard to the arrival in Scotland of such a large number of people at a time when we are having concerns about mass events? I can give those assurances to Fergus Ewing. We are working with the UK Government. We are working with the United Nations. We are working with all stakeholders to try to make the event as safe as possible, but I cannot stand here and not honesty and tell them that it will be a risk-free event. We will do our best to mitigate that risk as best we possibly can. If I can continue, I want to give some detail of some of the funding that we have provided in the year. We are not simply waiting for the pandemic to be over to take actions to help our care and health service. Additional funding of £30 million has been given to Scottish Ambulance Service and NHS 24, £12 million to support acute care that will help in opening additional bed capacity, £23 million for the new design of urgent care that reduces demand at A&E, providing more support within the community, £155 million for primary care, including restoring face-to-face treatment and additional support for NHS 24 and the Scottish Ambulance Service, and £120 million for mental health services that will focus on prevention and early intervention, as well as, of course, helping to clear the challenging CAMHS backlogs. Some of the immediate actions that we have taken to support social care pressures include funding support to advertise vacant posts on a dedicated social care webpage, targeted communication with further and higher education, healthcare, nursing students and social work students to encourage applications to join the workforce. That is in addition to us providing funding to ensure that social care staff are paid at least the real living wage. We will do all that we can to support and reward those who work in health and social care. We have already implemented a 4 per cent increase for agenda for change staff. That is the biggest single-year rise in the lifetime of this Parliament. Our recovery plan sets out, as I said in response to Mr Kerr, how we will deal with the significant challenges that we are facing. Of course, that backlog is significant. I know that there were challenges with that pre-pandemic, but I think that it would be absolutely fair to say that those have been significantly exacerbated by the shock of that pandemic. Our plan, backed by a bill—yes, I have not given way to a labour member, but I am happy to do so. Paul Sweeney. I thank the council for giving way. He notes, of course, the significant pressures under the health services facing under the current situation. However, he may have noticed today the particular case of Brian Sneddon in today's daily record in relation to ambulance services. Brian suffered a stroke last week but was in his house for over two hours, and eventually his son's cousin had to drive him to the hospital. Because he did not get treatment within four hours after suffering a stroke, he now faces a much more complex journey to rehabilitation. That then induces further long-term costs and pressures on the NHS. I urge the cabinet secretary to look specifically at ambulance responses to urgent cases around stroke victims and where that can be avoided, because I do not think that there is much that the cabinet secretary can say to swage the suffering of Brian and his family as a result of the complexities that he now faces, but that is particularly problematic, and we really need to get on top of it quickly. I can reimbush you about 12 and a half minutes. We are quite tight for time. I was going to say that you are generous. In response to the very serious story and case that Mr Sweeney raises, I did see the details of it. First of all, I give my sympathy to Mr Sneddon, but it is not my sympathy that he is right that he needs action. I have just detailed some of the work that we are doing to fund and invest in the Scottish Ambulance Service. What I cannot do—I know that Mr Sweeney understands this—is that I cannot wave a magic wand to make the effects of the pandemic that we are currently living through disappear, but what I can promise him is that I am speaking to the Scottish Ambulance Service with great regularity to see what more we can do, not just to invest in the Ambulance Service, but just as I have said, if we can improve the flow into A and E, that can also help ambulances to be discharged to get to people sooner and quicker. I thank Mr Sweeney for raising the important case of Mr Sneddon. Our recovery plan, of course, gives great detail of how we intend to work through the challenges to remobilise, to renew and to recover our NHS. We will increase inpatient capacity by 20 per cent, outpatient capacity by 10 per cent. We will recruit an additional 1,500 staff to work in our network of national treatment centres right up and down the country. I will leave it to my colleague Kevin Stewart to give more detail of the national care service, which I know is of great interest. However, I wanted to end my speech by saying that we all know just how challenging the past 18 months have been for everybody, but we would all agree that our staff in our national health service and social care have been heroic in their efforts. That is why a common thread throughout the NHS recovery plan is ensuring that we invest in the wellbeing of our NHS and social care staff. We have committed an £8 million package of support, including in that £2 million of support that is targeted at social care and primary care. We will continue to work closely with the NHS, with trade unions and others, to see what additional support we can offer. I will conclude by saying that all of us will be agreed that the NHS and social care staff have made a heroic effort over the past 18 months to do so every day, but particularly over the past 18 months. I want to end by thanking them all and by giving them an absolute guarantee and a promise that this Scottish Government, and I suspect that all of the chamber will ensure that they are recognised and supported for what will still be a challenging period ahead. I am happy to move the motion of my name. Thank you, cabinet secretary. We are quite tight for time this afternoon. I do want to encourage members to make and take interventions, but I would encourage them to make them briefly. I will try to reimburse members for that time. I now call on Craig Hoy to speak to and move amendment 1190.3. Mr Hoy, around seven minutes. Thank you, Deputy Presiding Officer. Covid-19 has been linked to nearly 11,000 Scottish deaths. One in three of those deaths has tragically taken place in our care homes, and our thoughts go out to the families of all those who have died during the pandemic. The cost of cancelled operations, delayed diagnosis and the failure of many patients to be able to access healthcare will be significant, but ministers must accept that many of those problems predate the pandemic. Before I turn to proposals for the creation of a national care service, a brief review of the challenges facing our national health service will prove sobering. In our A and E units, more than a quarter of patients are still not seen within four hours. 115,000 patients are waiting to be seen for key diagnostic tests. The 12-week treatment time guarantee is at its third lowest level of performance since records began. A fifth of patients are waiting too long for mental health treatment. Drug deaths have tripled under the SNP Government and waiting times for residential rehab regularly exceed a year. BMA Scotland chairman, Dr Lewis Morrison, says that doctors are exhausted. Many are simply considering leaving the NHS altogether. The Royal College of Emergency Medicine says that there is genuine concern that hospitals will not be able to cope this winter. Deputy Presiding Officer, Covid has contributed to those challenges, but Covid is not ultimately the root cause. Years of this Government's poor workforce planning are finally taking their toll on our NHS. The First Minister told Parliament last week that the creation of a national care service is not, I quote, the most significant public service reform since the creation of the national health service. The builder who botched your extension is now asking if they can build you a new house, all while a public health typhoon is blowing. According to the Fili review, the creation of a national care service will put adult social care on unequal footing with our NHS, but a brief look at our NHS in this present crisis raises serious questions about whether that is the right time to embark on such significant reform of adult social care. The Scottish Conservatives readily concede that social care in Scotland needs reform and investment, and we will look closely at the Government's final proposals. However, the question is how far this process should go and how fast. Hardworking staff are exhausted. The system is under a mainstream. There are long-term demographic structural staffing, commissioning, funding and delivery challenges. Last year, 197 warnings were issued by the Care Inspectorate over staff shortages in care homes. In 5, 395 people are waiting an average of 77 days for care at home packages. Rather than looking to fix the urgent failings in the system, ministers now propose to bite off far more than they can chew with a widespread reform programme. Despite the current crisis in care, the Scottish Government now proposes to consolidate adult social care, social work, children's services, justice social work, alcohol and drug services, and areas of mental health in one service under direct ministerial control. Those reforms focus on structures for tomorrow and ignore the crisis in social care today. While I welcome Kevin Stewart's commitment to further consultation, I wonder whether he really is genuinely listening. For if he is, he must already hear the alarm bells ringing on the scope of the proposed service. I will give way. Thank you, Mr Hoy, for giving way. I challenge Mr Hoy and other members to go and talk to folk who have lived experience. Covid has shone a light on social care. Folks are not happy with the current situation. They want to see change. Please talk to the stakeholders and not just those who are normally listened to in this place. I very much recognise that families and those with lived experiences have raised legitimate concerns about social care, but I do not think that they have asked for a major structural review in order to fix it. Deputy Presiding Officer Alison Evanson rightly asks why local government services were, at the very last minute, wrapped into plans for the national care service. She says that if there is nothing to hide, it should be a fairly straightforward question to answer. Unless you missed it, where was the consultation on the decision to significantly expand the scope of the freely recommendations? Despite repeated disasters in Government IT procurement—no, I need to make some progress—and despite repeated disasters in Government IT procurement, the plan glibly proposes a wholesale data sharing system across all care settings, including an interface with NHS medical records. That is despite the fact that the two commonly used GP record systems, EMS and Vision, do not presently speak to one another. Almost all large-scale SNP commission public sector data systems have hit serious cost overruns, yet the minister appears confident that this huge IT project can be achieved in this Parliament. Ministers must do more to explain why a centralised service under direct ministerial control will lead to any better outcomes. The lessons from Police Scotland tell us that centralisation undermines local delivery and needs to poor and sometimes tragic consequences, as we saw sadly only last week. Those plans amount to an attack on local authorities and local accountability. By proposing to scrap health and social care partnerships and integrated joint boards, ministers are finally admitting that their previous attempts to deliver greater integration have failed. Why is the SNP so confident that making Scottish ministers accountable for social care while driving local delivery through new community health and social care boards will lead to any meaningful positive impact on social care outcomes? In fact, centralisation ignores the clear need for services to be designed and delivered as close as possible to the people who use them. Centralising children's services runs the risk of placing vulnerable children far away from the local agencies and the local communities who understand their past problems and their present needs. How can that lead to better outcomes? On staffing, pay and the absence of structured career development in social care, we are moving to a system of national pay bargaining to tackle the recruitment, retention and career development crisis in our care system. The Royal College of Nursing says that the reform process overlooks the nursing contribution in social care. What of future capital investment? Fears are growing that centralisation will lead to creeping nationalisation, undermining future investment by the private sector. Deputy Presiding Officer, the proposals for national care service go way beyond the plan set out in the Fili review. That is yet another blatant and unjustified power grab by the Scottish Government. After years of hollowing out councils finances, the SNP is now mounting a direct assault on local authorities. It proposes to scrap local accountability by imposing a system of direct ministerial control. So far, the Scottish Government has failed to outline exactly how much those vast reforms will cost. In conclusion, we have very real concerns about the present operation of the NHS and the future operation of any national care service. Those reforms are all about structure, not about improving patient care, and they fail to address today's growing crisis in Scotland's social care sector. That is why I move the amendment in my name. It is absolutely right that we should express our deepest gratitude to those who are working in health and social care for all that they have done, not just during the pandemic but equally before the pandemic. They risk their lives to keep us safe, but I do not just want to thank them, because if the applause on a Thursday night is to mean anything, then the Government needs to step up to the plate now and truly appreciate and support what they do. Instead of the complacency displayed by the cabinet secretary and the First Minister, the people of Scotland need and deserve action, and they need it now because, make no mistake, the NHS is in crisis now. The NHS recovery plan has been criticised by a number of professional bodies, including the BMA, who described it as unrealistic, with a number of worrying gaps, especially on how to tackle staff shortages. It is one thing to be criticised by the opposition, but it is another entirely to be criticised by clinicians, and that demonstrates to me that the Government is simply not listening. The problems that are experienced by the NHS are happening now in real time. However, let's be honest, this is built on 14 years of the SNP's mismanagement and neglect of our NHS. It was frankly astonishing to hear that the First Minister blamed staffing shortages on Brexit when she was the one, as health minister, who cut training places for nurses and doctors. Let's also not forget that it was Nicola Sturgeon who failed to pass on all of the funding to the health service given to her by the UK Government in her first two years as health minister, which means that the NHS now is £1 billion worse off as a result of that under the SNP. The lack of awareness, Presiding Officer, of the SNP is simply extraordinary. Given that track record—I'll want to make some progress—how can the SNP Government expect us to take them seriously? There is a crisis unfolding under their watch. Ambulance waiting times are on average six hours for urgent and critical cases. Some have waited as much as 30 hours and the condition has deteriorated to such an extent that it becomes life-threatening. The Red Cross, for goodness sake, is having to provide support and assistance to ambulance crews and patients waiting in queues outside the Queen Elizabeth University hospital. Waiting times for diagnostics are up. Waiting times for treatment are up. There are currently 600,000 people on waiting lists in Scotland. Those who can afford to do so are going private. The 62-day waiting standard for cancer treatment is going the wrong way. In fact, it has not been met since 2012. That is shameful. Some of the biggest health boards have cancelled elective surgery. Covid infection rates are rising. Over 1,000 hospitalisations and test and protect are failing to contact people with performance now well below world health organisation standards. Of course, delayed discharge is up by almost 50 per cent. The workforce is struggling. A paramedic described how ambulance workers are feeling exhausted, undervalued and overwhelmed. Doctors and nurses go home from a shift to A and E crying because of the stress that they are under. All of that is before the winter flu season starts. The NHS recovery plan does not address any of those immediate challenges. It talks about a rise in activity starting in 2022. Outpatient rises promised during the election for next year will not happen until 2025. As for workforce planning, there have been three plans published in the last Parliament, and they have simply failed to address the shortage of staff. Scottish Labour set out very clear plans for what we would do differently to remobilise our NHS and support the staff who work so hard on our behalf. I commend them to the cabinet secretary to read. Let me turn to social care, which will be covered substantially by my colleague Paul O'Kane. The Government's approach to this is frankly hugely disappointing. Instead of changing culture, as the Feely review recommended, the focus has all been about structural change. It looks like a case of rebadging and shifting the deck chairs where what is required is to move away from funding crisis to funding prevention, away from limiting care based on budgets to actually doing an honest needs assessment and building care on that basis so that people can live independently. As for the £800 million that has been promised over the next five years, Feely identified the gap as being about £660 million, so little growth available, little headroom is happening, and the Government frankly does not need to wait for the establishment of the national care service. It can do things now. Where is the remobilisation plan for social care? Restoring people's care packages, restarting respite care, ending non-residential care charges and pausing commissioning, all of those things that the Government could do now. When we talk about valuing staff, that applies equally to social care. Social care staff were at the front line of the pandemic. The epicentre of Covid cases was in our care homes. A third of Covid deaths have occurred in our care homes. They had to fight for testing. They had to fight for access to PPE. The cabinet secretary knows that this is a predominantly feminised workforce, which is characterised by low pay. I know that the SNP is opposed to giving them a wage rise to £15 per hour, indeed aligning themselves with the Tories. The Greens promised that in their manifesto, but that has been sacrificed at the altar of expediency in exchange for ministerial positions. We have a real opportunity to change care, to value the workforce, to treat people with dignity and to create a system that enables people to live independently. The Government's plans are wanting in that regard. Frankly, the voices of those of carers and those cared for are not being heard, and that is a disgrace. I move the amendment in my name. Thank you very much, Deputy Presiding Officer. May I start by echoing the thanks that has been offered to our valiant health and social care workers? We will never fully be able to repay the debt that we all owe them. American clinician Attle Gawande once wrote that the battle of being mortal is the battle to maintain the integrity of one's life, to avoid becoming so diminished or dissipated or subjugated that who you are becomes disconnected from who you were or who you want to be. The provision and effective delivery of social care is a vital part of how we answer that challenge, of how we offer dignity, agency and independence to our most vulnerable residents. It is a critical piece of the jigsaw for all other aspects of care and treatment in our society. If social care is broken, it causes an interruption in flow throughout the whole of our health service. We know that the record-breaking A&E waiting times are not caused by a deficiency in emergency care, but they are instead the result of insufficient social care provision in our communities. People are waiting in A&E departments before admission to the main hospital because inpatient beds are taken up by those well enough to leave hospital but lacking the necessary care provision to receive them home. We need to reform social care. Of that, there is no doubt, but we need to reform it through paying care workers handsomly, dealing with market inconsistency, reforming self-directed support and making care a profession of choice once again. We do not reform it by stripping decision-making power and money away from the local care partnerships that are currently delivering it. The last thing that we need is a big, clunking, centralised bureaucracy, ultimately run by Scottish ministers—those same ministers who are in part responsible for the catastrophe in our care homes in the foothills of the pandemic. It is cynical for this Government to brand their proposals a national care service because it is, in fact, a ministerial takeover of social care. That branding exercise is deliberately designed to make it sound like our most treasured national health service, but that is where the similarity ends. The NHS was forged in the rubble and poverty of war. For the first time, it offered medical care and treatment to every citizen in the United Kingdom free at the point of delivery. It is the most successful model of socialised medicine in the world, but the proposal behind a national care service, however, will not see it offered free at the point of delivery. It will not be a socialised model for the delivery of care, nor will it see care nationalised because it will still be provided by the private and charitable organisations that account for the lion's share of the market. The naming of the project is a cynical attempt to win public support when, in all actuality, the delivery of that care will suffer. The new model simply transfers power from local authorities and local communities and gives it to ministers to determine what the shape of the care service looks like. Liberals stood against the centralisation of Police Scotland, and we shall stand— Mr Cole-Hamilton has said that the Government will set the frameworks. That is right. What we want to see is standardised high levels of care throughout the country, rather than the postcode lottery that folks moan about just now. How would Mr Cole-Hamilton suggest that we tackle the postcode lotteries? Your meddling in the centralisation projects that have gone before has not helped people at the business end of the delivery of service, nor will it help in the delivery of care. Liberals stood against the centralisation of Police Scotland, and we shall stand against the centralisation of our care system, because for our party, as a matter of principle, decisions are better made when they are made closer to the people that they most affect. For all that they wish to be remembered with the same reverence as Naib Bevan, the father of the NHS, this Government's national care service is a cynical power grab and nothing more. I move the amendment in my name. Thank you very much, Mr Cole-Hamilton. We now move to the open debate. As a result of a number of fairly lengthy interventions, whatever headroom we had in terms of additional time has now been exhausted, so any interventions will have to be accommodated in your allotted time. I call first Alasdair Allan, who will be followed by Sue Webber. Dr Allan, four minutes please. Presiding Officer, to say that our health and care services have been through an unprecedented shock in the last year and a half would of course be a triumph of understatement. All of us are aware of the impact that the pandemic has had on those services in our own communities. As the cabinet secretary has mentioned, the health and care workforce has been instrumental in delivering an amazing vaccination programme since December of last year, despite the numerous challenges that have had to overcome in the process. Dr Allan, could you just move your microphone slightly towards you? Is that better? Very good. Families have often faced distressingly minimal contact with loved ones in hospital and care settings, and staff have had to deal with the physical and emotional exhaustion of a year and a half from hell. All that is before we consider the huge stresses on them of trying to help treat individual people with Covid. I mention all that, not as a platitude to everyone concerned, nor as a means of deflecting from the challenges ahead. This winter will bring with it some daunting challenges, not least of which we will be dealing with the backlog, as others have pointed out, of non-Covid procedures that clearly now exist. The plans that the Scottish Government is setting out today are genuinely ambitious, not least the £1 billion NHS recovery plan, the development of a national care service and the recognition of the needs of our care workers. The policy of ensuring that at least 10 per cent of front-line health spending will be dedicated to mental health is a major step forward in its own right. The plans focus on providing alternative pathways of care to allow people to be treated more quickly closer to home will, I am sure, be welcomed. When fully operational, the national treatment centres will provide capacity for over 40,000 additional surgeries and procedures across 12 specialities, including cataracts, hip and knee surgery. That will mean recruiting an additional 1,500 staff from those centres. Standing still is not an option for our health and care services. The way ahead demands that we make changes and that there are many to be made. Given my island constituency, I make no apology for asking today that those changes are island-proofed. People in the islands who have a family member—I look forward to doing so. Stephen Kerr is very grateful to the member for giving way. He is making a very good point about island proofing. Does the member agree that Causola's comments, that this consultation cuts through the heart of governance in Scotland and will have serious implications for local government? Does he agree with Causola's comments? Before I come to the island issue, I will merely say that people across the chamber understandably regularly raise what is referred to as a postcode lottery in terms of services. If we are going to address that, we are going to have to think about what that implies for how we provide the same high standard of care across the country. That is going to mean change. The point that I am making about the islands is that people who have a family member in hospital on the mainland—people from the islands—face very significant extra stresses and costs just to visit people or even just to find out what is happening to them. Stresses and costs which are multiplied if there is not good communication between different parts of the NHS as well as with patients, airlines and families. Sometimes I am afraid to say that hospitals have not always appreciated, for instance, what discharging a frail person in Glasgow and then asking them to find their way home to the outer hebrides actually implies. We need a stronger protocol in place about those issues. Healthcare cannot be seen in isolation from wider economic issues in the islands. If we are going to have more care workers in rural areas, for instance, we will need to do some serious planning about where it is that they are going to live. I believe that today is an opportunity for the chamber to unite if such a prospect is not altogether farfetched and recognise both the needs of our health and care services and the way that we can make them fit for the future. Scotland's A&E is in crisis. Waiting times have spiralled out of control and referral times are equally as bad. Our workforce in the NHS is at breaking point. A fifth of patients are waiting too long for mental health treatment and over a quarter of all vulnerable children are waiting too long for their mental health treatment. The creation of a national care service would be a massive undertaking, there is no doubt. So have the SNP reached a new low in terms of self-awareness? I am sure that I am not alone in wondering why the Scottish Government think that they can run a national care service with all the issues that they face running the long-established NHS. The drug death rate has almost tripled on the SNP's watch. Deaths caused by alcohol are at their highest level since 2008. Waiting times for residential rehab can be up to a year. Frank's law has not yet been fully implemented. Yet the SNP wants more powers and responsibilities when they are incapable of using those that they already have. We know under the SNP Government that Scotland is facing an A&E crisis and that NHS waiting lists are faring no better. We have heard that before the pandemic 450,000 were on the waiting lists and now that list is topping 600,000. This crisis is an indicator that the entire system is fractured. Behind every statistic is a person or a family desperate for help, often in chronic debilitating pain. They have all been failed by the SNP who have shown no leadership or detailed plan of action. They have neglected the NHS and they have neglected the people of Scotland for years. The SNP should stop trying to rewrite history when the facts clearly tell a different story. The pandemic did not cause this crisis. The SNP did. Bed capacity has routinely been operating at 95 per cent before the pandemic and you spoke of admissions but not of discharges. The public have demonstrated immense gratitude to all those who are working in the NHS throughout the pandemic and before. Covid has made NHS staff work harder and faster than ever before. I know that first hand because I have stood and worked alongside them for years—I swear that I am not telling how many years, frankly, because my age away—but other amendments today focus on the workforce challenges that are faced. One in 17 people work in the NHS already in Scotland and there is also now a long-standing recruitment crisis. Across Scotland, a record 4,854 nursing and midwifery posts are vacant. A significant number of nursing staff are on work-related sick leave through stress and other mental health issues. Where are you going to find 1,500 new staff for those treatment centres? How long does it take us to train them? In 2017, SNP ministers pledged to recruit 800 GPs by 2027. However, with just over 200 added to the overall national headcount right now, that looks like it is also likely to be missed. Mr Hoy spoke of the 197 warnings that were issued to the Care Inspectorate over staff shortages in care homes. Staffing levels are now reaching crisis point across Scotland in all healthcare sectors. There is no overnight solution to this workforce crisis. The SNP's NHS recovery plan is a flimsy plan pamphlet that recycles old promises and fails to tackle the long-standing issues. I have literally 12 seconds. It is full of gaps. The Scottish Conservatives believe that healthcare professionals should be given the support that they need to end the backlog in treatments and hospitals, restore A and E waiting times, speed up our ambulance service and return to full-face GP surgeries. Scotland's NHS needs a real plan to get our health service back on track. I now call Clare Adamson to be followed by Karen Mocken. As my colleague Kevin Stewart pointed out earlier, Covid has changed all our lives. It has shone a light on the challenges of those who depend on social care and health services as never before. It impacts on carers, those in isolation, on shielding lists, those with disabilities and those who are lonely in our communities. However, it has also shone the civic spirit in which our communities rose to the challenges of Covid and we must learn the lessons of that. It is not about getting back to normal, it is about getting back to better. Building a better solutions in our communities, a patient-centred service that has wellbeing of those working and fair work at its heart. In 2009, I was a councillor and one of the things that deeply disturbed me at that time was that a Scottish Council commissioned services by a reverse auction, a race to the bottom on cost, not about the quality of service, not about an existing quality workforce and not about the wellbeing of those who would have to deliver those services. Fair work at the heart of that will mean that the wellbeing of those workers will be better, they will be paid at least the living wage and it is crucial that in delivering the services it is going to build a care service that delivers dignity and respect to our neighbours, their families and friends and those in our communities who depend on those vital services. It will be no surprise to those who have been here for a while that, for a number of years, I have championed the cause of pancreatic cancer. Part of the work that I have done over the years has been asked, the community has asked for a sea change in the way that we tackle the way that we look at pancreatic cancer. It is an unforgiving illness like no other. It is one of the poorest survival rates of any cancer. Late diagnosis frequently is something that happens and with what are days and weeks for pancreatic cancer can be months and years for survivors in other cancers. One of the things that they asked for was that they have a pathway to diagnosis that met the needs of those who were coming into contact with this terrible disease. The cancer recovery plan announced in December is investing £114.5 million to tackle and help those like those with pancreatic cancer. The early patients port that will be given and the one-stop shop of diagnosis and treatment will change the lives of people who are coming into contact with it. Not only that, the SHPBN networks in Scotland now have a patient support network. That was all championed by Jeane Freeman and has all been happening while Covid has been going on. It is a testament to the immense pressure that our health service people have been under that they have been able to make such progress in this area alone. That is what we have to be moving forward with. An independent review of social care gives us a clear road map for recommendations for a future care provision in Scotland that we can all rightly be proud of, we can all rightly take part in, we can all rightly ensure meets the needs of our friends, our neighbours and our communities going forward and that we have learned dignity for those in receipt of the services but also for those who are working in our services. I share the thoughts of the cabinet secretary and previous speakers in wishing to mark the heroic efforts of our incredible NHS and social care workers during the Covid-19 pandemic. I recognise the work that they will no doubt have to continue doing for quite some time to come. But let me be plain. Surely the best way to recognise that heroism is to give staff the pay increase that they deserve. A round of applause is nice but a pay rise will keep a roof above your head and food on the table. It is of course welcome use that further staff capacity will be added to the health service which is struggling from years of poor management and underfunding. If we are to retain staff and make them feel valued, then the best way to do that is through good, well-paid jobs. The BMA Scotland has correctly described that the proposed 3 per cent pay increase for medical and dental staff is doing virtually nothing to help low morale or end serious difficulties with staff retention. The slightly larger increase for staff on agenda for change grades has been contentious to say the least. It is clear that the annual difficulties in getting a fair settlement for NHS staff is rooted in the fact that the work of those in the community, in hospitals and emergency response is not valued as highly as it should be. In one area in particular, the problem is becoming particularly acute. I could go on for a long time about the problems regarding mental health services in Scotland but I have only four minutes. We in this chamber are all more than aware of the need to improve mental health services but a key starting point for any forward plan has to be recognition of what has gone wrong and I am not seeing that here from this Government. In fairness, they say things but you never do anything which says to me that you do not recognise the scale of the problem. So, as a reminder, the number of children and young people waiting a year or more for mental health appointments is at record levels and an increase of 115 per cent over the last year. The Government's target to see 90 per cent of referrals within 18 weeks has never been met, never been met, not once. Almost one in four referrals to CAMHS are rejected with little data regarding what then happens to those who are not accepted. Undoubtedly, success of lockdowns, though necessary, have taken a considerable toll on services and the mental health of many but we should not pretend that Covid is the cause of those startling failures. It all stems from policy decisions and where priorities lie. The fact is that mental health has never been given the prevalence at once by this Government and until that changes, the spiralling decline in the mental health of thousands across Scotland will continue. To start making progress, we need to dedicate to... Carl Maw can not agree that this Parliament is the first Government that had a mental health minister in the whole of the four nations of the UK. I think that we would hope that we would be making more progress and making less reports and that we would actually be changing services for the better of people. To start making progress, we need dedicated mental health workers in every GP practice, not just access to one, and significant increase in mental health spending across the NHS without detriment to other services that are equally under strain. We need the resources. There are not simply possibilities at this point that absolute necessities. If we are to get the country back on its feet, yes, we will be asking people to work hard and rebuild Scotland, but we have to do our bit. We have to work hard for them. That means giving people the sort of world-class treatment that Scotland was once famed for. The Cabinet Secretary for Health and Sport can play a leading role in that, but the Government needs to take action. The first line in the Scottish Government's health recovery plan reads, Scotland's national health service is a most precious institution and that we can all agree on. In our hour of greatest need during the pandemic, the women and men of who staff at NHS provide exemplary care in the most trying of circumstances. The aim of the plan, of course, is to drive the recovery of NHS, not just to its pre-pandemic level but beyond. That recovery plan is backed with over £1 billion of targeted investment over the next five years to increase NHS capacity, deliver reforms and the delivery of care and get everyone the treatment that they need as quickly as possible. We have only got four minutes, and I want to focus on a couple of key points, both in health and in social care. The plan sets out key actions for the next five years to help address backlogs in healthcare and increase capacity by at least 10 per cent. Other key actions for me include investment in national treatment centres of more than £400 million, contributing to the delivery of over 40,000 additional elective surgeries and procedures per year. I know that that will be welcome at East Lothian community hospital by my constituents. Raising primary care investment by 25 per cent, supporting GPs, community pharmacists, dentists and optometrists. What is really vital, as well, is work to support workforce capacity and planning, a national workforce planning strategy that supports remobilisation, recovery and renewal of health and social care services. That strategy will be published by the end of the year, articulating a long-term health and social care workforce vision alongside our priorities for workforce growth, recruitment, retention, training and development. I know that the health cabinet secretary is dedicated to that, and I think that it is a really important piece of work as we go ahead. The strategy builds on on-going work to support the board's workforce capacity. Moving on to care, a national care service will be one of the biggest ever achievements of this Parliament. The member has said that he is not taking intervention. A national care service will be one of the biggest ever achievements of this Parliament. The social care sector directly employs 205,000 people in Scotland, approximately 8 per cent of the country's workforce. The sector is estimated to contribute between £3.4 billion and £3.1 billion to the Scotland economy, so it is a really, really important part of our economy. I, like everyone else, received Oxfam Scotland's briefing for this debate, and it is an entitled place in care at the heart of the Covid-19 recovery, and I think that is something that we have to remember. Care issues and poverty are also the issue that Oxfam mentioned, and they are deeply linked. Those caring for adults on an unpaid basis support escalating care needs and financial pressures, with Poland conducted during the pandemic, showing nearly 30 per cent reported struggling to be in chains and meet. They also say that Scotland must commit to a new national outcome on valuing and investing in all forms of care. When we had the local government committee, we both had the cabinet secretary, Sean Robertson, and also the local authorities, COSLA. They also mentioned that it was really important that it was an outcome, so a proposed new national outcome on valuing and investing in care is vital as we move ahead. Outcoming value on investing in care to embedded within the national performance framework to drive policy and spending decisions. Just coming back to unpaid carers for disabled and elderly care, unpaid carers provide support and care for family members with additional support needs without pay. Prior to the pandemic, there were estimated 788,000 carers, including 44,000 young carers in Scotland. I know that a national care service will take into consideration that most of the care done in Scotland is unpaid, while ensuring that those paid to care are protected from poverty, it must deliver for the people doing unpaid care and those supported by the carers. In conclusion, the actions of the Government is taking will place us in a better place as we recover from Covid. 2021 has exacerbated an already crumbling Scottish health service. Sean, a light on to how bad we have it. Any waiting times at record level, one patient forced to wait on the floor in a corridor for almost 18 hours. Ambulances queuing around the block to get into hospitals, forcing patients at home to wait extraordinarily amounts of time. Waiting lists for outpatient appointments at all-time highs, non-emergency surgery cancelled across Glasgow, GP demand at record levels and wait where the Europe capital of Covid. All we hear is deflection and blame and what aboutry. This is down to the SNP Scottish Government who have had devolved control of our Scottish NHS since 2007. The Scottish NHS, the Scottish patients, the Scottish people need action now. We need help now. The 1 billion recovery plan is full of rhetoric and catchy soundbites—x millions here and y millions—I'm afraid I won't get the time back. It's full of catchy soundbites—x millions here and y millions there, but there is no detail and there is no plan. Let's take recruiting. The Association of Anesthetics tells me that there are 2,000 job vacancies. The Royal College of Nurses says that there are 3,000 job vacancies. The Scottish Government will be recruiting 1,500 staff. We're still in deficits, not even going to make a dent. Let's talk about a lack of a plan. Anesthetics do not form part of this recruitment strategy. The same branch I told you had 2,000 vacancies. They are the key to allowing both emergency and elective surgery to be performed. They are the first to get pulled into ITU with Covid numbers surging and most likely to suffer burnout. However, they are not deemed worthy of being part of a coherent recruitment strategy. There is no plan here. I asked the Cabinet Secretary for Health to tell me about his redesign of the referral pathways. The Cabinet Secretary proceeded to tell me about the diagnostic centres opening up in 2025-26, with one perhaps in 2022. This is not detail but simply rhetoric. Where is the detail on the design? The NHS recovery bill set up a vision for the future, but it neglects us today. Let's look at the social care element. I have a patient who has home help, but her care is a frustrated because they don't have enough time to do the things they want to do for the lady. The scope of the redesign is too big. It will take too long to get everything organised and set up. I implore the Government to get help to where it is most needed, and then we can get about doing more. Do I have hope that this will be implemented and delivered on time? Ferries, superfast broadband, taking responsibility for 11 devolved benefits, all delayed and full of broken promises. I have little hope. We can all agree that Covid has hit us hard, but morale was at an all-time low before Covid. Now, the Medical and Dental Defence Union of Scotland is telling us that most GPs and dentists are thinking of leaving the profession. Moral really is at rock bottom. The First Minister and Cabinet Secretary for Health say that we are not at a crisis. Record A&E wait times, ambulances queuing around the blocks, record waiting lists, cancelled surgeries and GPs' demands at record levels. Yesterday, I had 80 patient contacts in my surgery. 80? That is not sustainable. If that is not a crisis, I do not know what a crisis is. Ladies and gentlemen watching at home, we are in a crisis, but perhaps to paraphrase JFK, the Chinese have two brush tricks for the word crisis. One means danger, and the other means points of change. I hope that this Government can finally admit that we are in crisis. The NHS is in danger, except this. We are here to work across the floor to create a plan and provide expertise to really deliver a workable solution for Scotland. However, please focus on today and help the people now. If a member takes an intervention, they are not getting any time back. That is a matter for the chair. I would also just add, by way of clarification, that there is not any time—I think that the previous PEO in the chair made that clear—and we are trying to allow everybody to have their four minutes, because there could come a point where that may not be the case if we have lots of extensive overruns on each member's speech. I too would like to extend my sincere thanks to our health and care workers who are working so hard to keep us safe and well. They have been going at a superhuman pace throughout the pandemic, and I can only imagine how exhausted they must feel. It is only right that we take every opportunity to express our gratitude and appreciation for everything that they do. If my amendment had been selected, it would have focused on mental health. We know that the pandemic has had a devastating impact on our collective mental health, but we have not all been equally affected. The most recent report from the Scottish Government's Covid-19 mental health tracker study found that young adults, women, people with physical and or mental conditions, and people in a lower socioeconomic group are more likely to report experiencing poor mental health. The Scottish Government's mental health strategy was published in the time before Covid-19, and we have to recognise that circumstances have materially changed since then. That is why I welcome the Government's commitment to publish a refreshed mental health strategy and a mental health workforce plan as part of its agreement with my party. It is vital that the refreshed strategy takes account of how some people have been disproportionately affected by Covid-19. It must consider the social determinants of mental health if it is to effectively address the huge rise in mental distress caused by the pandemic. Non-communicable diseases post-pandemic also need to have more of a focus as we begin to emerge from the worst of the pandemic. Smoking and drinking rates among the biggest smokers and drinkers have increased over the pandemic. We need to prioritise good health for our nation in improving outcomes through reducing poverty, improving access to food and reducing availability of health harming products. No company should be allowed to profit from damaging other people's health. This session has the ability to be the public health Parliament, and I hold on to the hope that we can work cross-party to achieve that. I would now like to focus on social care. The Scottish Greens and the Scottish Government are committed to ensuring that the national care service upholds the principles of fair work, which is why we have committed to a system of national collective bargaining on pay and terms and conditions within the social care sector, so that we can build on all care staff receiving the minimum wage, as the living wage is a minimum, while working to a higher rate of pay, and to improve access to treatment very briefly. The Scottish Greens committed to £15 an hour in their manifesto in terms of care workers. Are they still committed to that position, given that they are now in Government, and will they support them with amendments today? I personally am still very much committed to working to £15 an hour. I am still committed to it. Mr Mackay, you do not have the much time left, so please… We also want to better recognise the contribution of unpaid carers, without whom our social care system simply could not function. Almost two thirds of unpaid carers have been unable to take a break from their caring roles since the start of the pandemic. Too often, unpaid carers become worn down and exhausted due to inadequate support and may even be forced to neglect their own health. That is why the Scottish Greens and the Government are committed to introducing a guarantee of short breaks and flexible healthcare appointments for unpaid carers. We will also ensure that care workers and unpaid carers can access bereavement services whenever they need to, so that they are not left unsupported at one of their greatest time of need. I would like to end my speech by focusing on the NHS recovery plan. I welcome its publication, along with the acknowledgement that the pandemic has placed our NHS under severe pressure, and there is much more work to be done to help it recover. However, I do have concerns about workforce shortages undermining the plan's ambitions, and I would like the cabinet secretary to reflect on that in his summing up. I now call Christine Grahame to be followed by Katie Clark. Up to four minutes, please, Ms Grahame. I put on record my thanks to all working at the Border General Hospital, primary care services across McRothan, South Tweeddale and Lauderdale, my constituency, GPs, pharmacists and others, the ambulance services and the first responders. I want now to focus my short contribution on the care sector, those delivering it at home and in residential settings. This horrid pandemic exposed us never before that this is a Cinderella service with low pay, low regard, from people serving and caring with kindness and skill, the most vulnerable in our society. None of us in this chamber or generally society at large is innocent of taking those care professionals for granted. I therefore welcome the Feeley report with the creation of a national care service, the scrapping of non-residential care service charges. In fact, I was here in 2002 when we introduced free personal care for the over 65s, limited though it was and introduced in Scotland though not in England, and also here when the Frank's law was introduced just fairly recently, which extended that to the under 65s. I was also here when the integrated joint boards were launched to ease the movement and transition from hospital to home. This is an extremely difficult nut to crack, but a start has been made, money was wasted, I haven't got time very sorry, only four minutes. I recognise to the fair work conventions report into social care with work taking place to embed fair work principles for the social care workforce, leading to better terms and conditions. I would also like to see more publicity to the existing courses where someone can transition from the care sector through to nursing through college courses, so there is a professional progression formula. But what must be heard in all of this is the voice of the carers and those who care for, not just heard but he did. Like many, I was extremely moved by the clap for carers on Thursday evenings when the tenements around me echoed with the cheers, the rattling of pots and pans and whistles and even the occasional bagpipe. But being moved is not enough. I, like others, want to see more than recognition but pay, which better matches their skills and commitment and recognises their duty to the job that this caring for the most vulnerable is of occasion. That would be a good place to start. We all, for enurations, left much of care of the elderly in residential settings to the commercial sector and companies, some good, some bad, just as when it's been in the local authorities it's been some good, some bad. It's time we made sure that our very elderly, and we have to declare an interest, are cared for properly when they come to the end of their years. I now call Katie Clark to be followed by Emma Harper, who will be our last speaker in the open debate. Ms Clark, up to four minutes please. I would like to add my voice to the tributes to all NHS and social care workers. In the short time available, I'm going to focus on the national care service. It is right that we recognise that social care is an essential component of the welfare state like the health service. There is much that is positive about the proposals from the Scottish Government, but my concern is that it is therefore a national care commissioning service, not a national care service, and that it will lead to a huge rise in the amount of tendering and a further centralisation and erosion of the power of councils. The idea of the national care service was, of course, modelled on the NHS. The NHS employs doctors, nurses, lab technicians, porters, cleaners and many others. It provides a service. A considerable amount of effort has gone into stopping it being privatised. That national care service proposal will not employ care staff but will commission services from the private sector, the third sector and presumably the public sector too. It is not clear that the public sector, such as councils, will even have preferred bidder status. Last year, the First Minister said to support calls to remove the profit motive from the care home sector. The consultation, however, does not mention the word profit once. There is no acknowledgement within the consultation that the private sector's explicit obligation is primarily to shareholders, not to the needs of residents. Within the proposals, outsourcing is encouraged. Nothing is done to challenge the current private sector-dominated model, so I have a number of questions that I would like to put to the minister. Are there any companies that are currently delivering care that will not be allowed to bid under the new care system? An investigation by the ferret in 2019 found at least 44 Scottish care homes that were owned by companies based in tax havens such as Jersey, the Isle of Man and Gibraltar. Will the Scottish Government follow the example of countries like Denmark and ban offshore ownership? The Scottish Government proposes extending the scope of the national care service to children's services, community justice, alcohol and drug services, social works and elements of mental health services. Will the Scottish Government legislate to ensure that no contracts will be awarded to companies that fail to recognise trade unions or do not apply union-negotiated rates of pay, in line with the demands from the Scottish Trade Union Congress? The principle of setting up a national care service that operates like the NHS is right, and as I say, there is much that I hope will be very positive in the proposals that the Government is coming forward with. However, as they stand, the Scottish Government proposals do not deliver a national care service that will be delivered in the public sector that will be free at the point of use. I believe that that is the kind of social care service that we should be continuing to campaign for. I now call Emma Harper, who, as I said, will be the last speaker in the open debate up to four minutes. I welcome the opportunity to speak in this debate on recovering, remobilising and renewing health and social care in Scotland. I want to include my immense and sincere thanks to all our health and social care staff in Scotland who are working flat out every day under intense pressure due to the pandemic. I remind members that I am a nurse and am about to join the flu and Covid-vax programme locally just in the next week. Over the past 18 months, NHS colleagues and health and social care staff have really stepped up in the face of Covid-19. Many of my colleagues and NHS contacts are feeling undervalued. There are many reasons for this. It could be part of the fatigue that everybody is feeling. However, I know that one reason is that all of the work that is being done in healthcare prior to Covid and now dealing with Covid is driven by evidence and informed scientific informed research. Science must be valued, research must be valued, the healthcare and medical experts are GPs and consultants in acute care must all be valued by all of us politicians, media and members of the public. I would ask the minister in his closing to provide assurances that the professionals are valued, that their knowledge, their expertise, the scientific evidence and the input will continue to be considered when tackling Covid and when future healthcare decisions are made. The Scottish Government's NHS recovery plan is backed up by more than a billion of investment over the next five years. It is imperative to ensure that people receive care, including some cancer screening and non-elective procedures that were paused during the pandemic. Alasdair Allen mentioned the investment in national treatment centres of £400 million contributing to the delivery of more than 40,000 additional elective surgeries and procedures each year. That includes the new fast-track diagnostic centres, including one of them in NHS Dumfries and Galloway, which was opened in June. The plan also provides £8 million to support the mental health and wellbeing of our health and care workforce, and mental health support has already begun. That includes access to counselling, support for managing stress and support for optimal work practices. On mental health, it is extremely welcome and right that there is a focus on ensuring the wellbeing of young people as supported. Through my own case work, I know how press calm services are and how this can have a negative effect on young people. They have had a particularly challenging 20 months so far. They have had to adapt to homeschooling, haven't been able to partake in usual activities and this has had an impact on their wellbeing. Ensuring that at least 10 per cent of front-line health spending is dedicated to mental health and recruiting 320 additional child and adolescent mental health service workers is therefore needed and is welcomed by Sam H Charity. The NHS recovery plan commits £130 million to delivering Scotland's national cancer plan. While that, along with the commitment to re-establish a national centre of excellence for remote and rural medicine, is great to hear, I would like to touch on the modernising patient pathways work, which has been taken forward as part of the recovery plan. The programme will look at cancer pathways and I would ask the health secretary to commit that this work will ensure that no patients in D&G, including in Wigtonshire, will make unnecessary travel to Edinburgh for treatment when Glasgow is closer. There is so much to welcome in the Government's recovery plan, including an increase in funding for primary care, for GPs, allied health professionals—that is worth more than £12 million—and improved training and systems to enable more efficient triage of patients. Most importantly, the plan sets out the foundation for establishing a national care service that others have touched on today, but due to time I will not. In closing, I want to welcome the plan and look forward to it progressing. Ms Harper, we now move to the winding up speeches. I call on Willie Rennie to wind up for the Lib Dems up to four minutes, please, Mr Rennie. Thank you, Deputy Presiding Officer. It was an extraordinary start to this debate. We were told that this was supposed to be the introduction of the central reform of this Parliament, the creation of a national care service. However, the health secretary hardly mentioned it at all in his opening contribution. If this is going to be such a major change in this Parliament and to the way that the social care service is run, it deserves to be better led than has just been done in this debate. It is no way to lead a major reform. There have been some excellent contributions in this debate. Sandesh Gulhanihoo set out from great experience the long-standing difficulties that we see in the NHS now that were there before the pandemic, which meant that we were not ready for the pandemic when it came, and now we are suffering the consequences of it. As Jackie Baillie set out the long waits to get treatment, Craig Hoy again very good contribution set out in detail some of the problems around diagnostics, the legally binding treatment time guarantee that has not been met for years way before the pandemic, and obviously accident and emergency waits as well. Carol Mocken and Gillian Mackay set out the problems with mental health services that my party has been dedicated to reforming for some years, but yet we have not seen the improvement that I think we deserve. Yet this Government, with this backdrop, with this years of failure on the NHS thinks that it is best placed to take control of the care service of this country as well. I think that it should sort out its own problems before taking on other people's problems. The Government is exhibiting typical avoidance behaviours. It is avoiding the big central problems of the care service. Jackie Baillie rightly says that it is more about culture than it is about organisation. She is right about that, but this is the third major bureaucratic reorganisation in just 20 years of this pandemic. We started off with joint futures, then we had the IGBs and the health and social care partnerships. Now we have central control. None of the other reforms in terms of big bang reorganisation made any great difference, so I am not sure what the Government thinks is going to make a difference this time round. The minister said—and I will take him in a second—he said that the current structure was preventing him from paying health and social care staff properly. That is utter nonsense. If the Government wanted to pay health and social care staff more, it could do it right now. There is absolutely nothing preventing it from doing so. I will take an intervention from the minister. I want to intervene on the point where he said that the Scottish Government or we think that the Scottish Government is the best place for the creation of a national care service. We do, but does he not recognise that we were also given a mandate by the people of Scotland who voted for us for the fourth time? I know that sticking to manifesto promises is not his strong point, but does he recognise that it was in our manifesto, and therefore we have a mandate to take that forward? When the minister gets cheap, it knows that he has not got an argument to justify his case. That is the case this time round, because we have seen with the centralisation of the police if that was not the biggest warning that the Government should heed. I do not know what more would be. The big bang reorganisation is done in a rush to solve a problem that it does not have the actual solutions for. The consequences are quite severe. Political decisions have consequences, and we need to be incredibly careful about that. Alex Cole-Hamilton rightly set out that this is a cynical attempt by the Government to try and compare its reforms with the creation of the national health service, but the national health service was free at the point of delivery. This is just a central power grab and nothing more, and the Government should do better at setting out its case than the pathetic attempt that it has made today. I now call Paul O'Kane up to six minutes, please. Thank you, Deputy Presiding Officer. I want to begin with a common thread that has run through our debate today and do what colleagues have already done and thank all of our hardworking NHS and social care staff for all that they have done and all that they will continue to do. They have worked hard on the front line caring for us all, caring for the sickest people in Scotland, keeping services going in an unimaginable set of circumstances. Of course, we owe them our deep gratitude. However, as we have heard this afternoon, warm words of thanks are not enough. Words will not solve the crisis in A and E where people are waiting on average six hours for an ambulance. Praise from ministers will not address the over 600,000 people waiting for treatment or diagnosis, and applause does not make a £15 an hour wage for care workers a reality. A Government motion and thin recovery plan that fails to recognise the scale of the crisis is cold comfort to those who know what is happening on the ground, the doctors, nurses, healthcare assistants and support staff, who, as we have heard already today, have used words like exhausted, undervalued and burnt out to describe their day-to-day experience. I know that ministers and members on the SNP benches are quick to retort, saying that those are unprecedented times. Of course they are. Indeed, the cabinet secretary continually cites the pandemic as he seeks to justify the variety of very serious and imminent challenges that have been referenced in today's debate. He refuses to acknowledge what not just we in this Parliament are saying, but what professionals, patients and carers tell him, that this is a crisis that has been growing since before the pandemic and has been exacerbated by it. My colleague Jackie Baillie spoke about the stress of people waiting on waiting lists—400,000 people languishing on waiting lists pre-Covid-19. The BMA in Scotland has been worrying about workforce pressures in the healthcare sector since before the pandemic, as was mentioned by Craig Hoy. Before the pandemic, ambulance turnarounds were taking longer, with 17,926 turnarounds taking over an hour—a shocking increase of 634.4 per cent since 2014. How can the Government be taken seriously when it talks about a planned recovery but refuses to admit that the crisis has been unfolding under its watch for 14 years? On the recovery plan, the cabinet secretary has been fond recently of saying that he does not have a magic wand when answering members' questions in relation to the issues. I must say that he is increasingly clinging on to his plan as though it might be. It has been described as only a best start by Dr Lewis Morris in the chair of the BMA, and it is further described as unrealistic and that it has a number of worrying gaps. The RCN said that there is little detail in the plan on how issues such as staff burnout can be addressed, and it has warned that nothing is feeling undervalued and underresourced for far too long. As Sue Webber and others pointed out, it is time that the Government showed how it will support and retain exhausted staff in the system at the moment. I wish to turn to social care. In 2011, Scottish Labour first advocated a national care service. As my colleague Jackie Baillie likes to remind the Government, we welcome all converts, however late. However, we have always been clear, and I think that we have heard today from Willie Rennie and others, that it has to be about culture and not solely focused on structure. This national care service has to be about those who live in our communities and need access to the right care and the right place and the right time. I think that Clare Adamson was right when she spoke about rebuilding our communities better in a sense. It must be about ensuring that older people are holistically supported as they live longer in our communities and ensuring that care homes adhere to rigorous standards and are held to account for those to drive up quality and the training and retention of staff. It must be about ensuring that people who have learning disabilities can live their lives with choice and control and are not simply facing false choices with ever-diminishing budgets. People want a seat at the table where the decisions are made, carers want a voice at those tables, and those who use social care want a meaningful say in the decisions that impact them. If the Government insists on driving the agenda, it is about drawing power towards the centre and does not recognise the importance of local decision making with people who use services having a say, then that will simply be upheaval and structural change with little real change on the ground. The people of Scotland cannot wait five years for the Scottish Government to work out what the big vision is on a national care service. There is action that can be taken now and action is needed now. Indeed, there are practical steps that Jackie Baillie alluded to that will make an immediate difference to the lives of people in receipt of social care and those who support them. That includes restarting respite services and creating a plan around that, ending non-residential care charges, pausing commissioning and addressing the poverty pay that we have heard about in the sector by supporting a pay rise for social care staff to at least £15. I welcome Gillian Mackay's support of that and that she has held through to the Green Manifesto, and I do hope that she will influence her colleagues in ministerial office. Our social care workers deserve more than warm words, and as my colleague Carol Mawkin pointed out, they must be valued. The Government speaks in their motion of fair work, but they have failed to deliver. One in five workers are on insecure or temporary contracts, and 15 per cent of staff work is unpaid over time. Once again, we, from those benches, call on the Government to give care workers the pay rise that they deserve and to show that they are valued. It is clear that, after 14 years in power, the SNP Government has mismanaged the NHS, and we are facing a serious crisis before we even get to the crisis that winter will bring. The Government has lightened down health and social care staff, and if it is serious about the challenges that face Scotland, it must show that it values every single member of staff in the NHS and creates a plan to match. I now call on Miles Briggs to wind up for the Conservatives up to seven minutes. I, like others, start by saying thank you to all those who have provided care to our fellow Scots throughout the pandemic. From the outset of this public health emergency, we have faced a significant challenge and a negative impact on all our care systems across Scotland, but perhaps most important for those who provide unpaid care. I believe that they have been and should be at the forefront of all our concerns. I am disappointed that we have not really seen that outline today by ministers. Prior to the pandemic, there were an estimated 788,000 carers, including 44,000 young carers in Scotland. The Covid-19 pandemic has significantly increased the numbers of unpaid carers in our country, with social care support packages being cut or reduced, with reductions in respite care and the closure of childcare and school facilities. However, the pandemic has also resulted in the significant expansion of unpaid carers in Scotland. Research in June 2020 showed around 392,000 more people, more of our fellow Scots, 60 per cent of which were women, had become unpaid carers, taking that to a total of over 1.1 million of our fellow Scots, taking on a caring role in our society for a family member of loved ones. That is the group of people that I believe this Parliament must be focused on at not top-down reforms. Unpaid carers have reported significant challenges with nearly two thirds highlighting the financial impact of additional costs and the impact on family budgets. It is now estimated that the economic value of unpaid care in Scotland alone is estimated at an outstanding 37 billion pounds of unpaid care provided. I want to look at some of the consensus that I think we can find across the chamber, especially in the development of a national care service or standard, as I think we probably are all on the same page with. We have the opportunity, coming out of the pandemic, to take forward a number of welcome reforms. We in those benches have argued for them in committee and in the chamber previously. The development of a national clinical standard for social care is long overdue and something that I hope we will see work progress urgently on. Workforce planning is something that this Parliament has got wrong for too long and the Scottish Government needs to look towards how we make sure that the workforce for social care is put in place. The career pathway is also developed to make sure that people can progress in their career choice and to make caring that career pathway that we all want to see it be. What would be unacceptable, and we have heard that from members across the chamber, is that we are just about to see an SNP green ministers look to undertake, take away all local accountability and undertake a paragraph and removal of local decision making and choice within care. The proposed scope of a national care service represents a significant expansion of the recommendations contained in the independent review of adult social care that has previously been outlined by the Scottish Government and we have had no explanation today of why that has been and why this is going to be the case. Local government is only just starting to recover from this pandemic. Ministers have said previously that local government is crucial to Covid recovery and indeed we hear ministers speak about community wealth building, where local authorities will be the ones who should be focused on partnerships and local spend of budgets. As Craig Hoy and Katie Clark both mentioned in their contributions, a total restructuring of social care in Scotland will be destabilising and presenting many significant challenges. There are a number of questions that this debate has also brought forward, which I hope that we will soon hear from ministers answers to. A national care service would see staff face a change of employer and terms and conditions around their employment and pension rights. Likewise, we have seen and heard no detail of what a national care service means for infrastructure in place. Council-owned properties, for example, and procurement contracts in place today are currently legal binding documents. How will that be unpicked? A bureaucratic argument for councils to have to face is something that ministers need to start answering questions on. Above all, something that has not really been looked at is that we have seen the integration of health and social care take place. What does that mean? Is that a flagship project of this Government that it is now turning its backs on? Scotland's local authorities and our vital third sector have been quite simply outstanding during this pandemic, and the can-do attitude that it has shown to immobilise services for our fellow Scots has been invaluable during this national response. Are we truly now seeing SNP ministers saying to them that the centralisation of power and top-down reform is the thanks that they can expect? During the pandemic, we have seen genuine partnership working. That partnership working now seems to be under real threat. The SNP Green coalition's centralising approach is clearly starting to generate serious concern across local government. It is little wonder that COSDA has described the Scottish Government's proposals as an attack on localism that could spell an end for anything other than central control in Scotland. Those are real and valid concerns, and we have heard no answers today on any of them. The concerns of local government are not just simply dismissed by ministers. We are not hearing any opportunity for them to make sure that they are seeing their powers protected. To conclude, Scottish Conservatives believe that the local delivery and local accountability of our health and social care services is vital. We will make sure, as those reforms are progressed and brought forward to the Parliament, that Scotland's carers and our local councils, quite rightly, are at the heart of any national care service. I support the amendment in my colleague Craig Hoy's name. I call on Kevin Stewart to wind up the minister up to nine minutes. Thank you very much, Presiding Officer, and I would like to echo the thanks that many in this chamber have given today to the staff who work in our health and social care services. In particular, I would like to thank Lisa and Jenny, nurses whom I met at the CAMHS service here in Edinburgh today. Emma Harper asked that we all ensure that professionals are valued. I tell you, Emma, that those professionals are so valued that I am going to be speaking again very soon to Lisa to get even further insight into what they are doing there. I think that we can all agree that our health and social care services are a lifeline to many. Our current system is under pressure, especially as a result of the pandemic. It is quite sad that many folk today have not mentioned the fact that the pandemic is still on-going or the challenges that we have had to face because of that global issue. The recruitment and retention has been challenging for some time, and even more so in the past 18 months. We are also seeing a greater demand in the system and people with higher levels of need from acute and community offers than before the pandemic began. In the community, that has turned to increased pressure on unpaid carers, and I agree with Miles Briggs on that. Many of whom are now desperate for a break, and the Government will work hard to address those issues, matching reform and recovery with investment. I will give it to Alex Cole-Hamilton. I am grateful to the minister for giving away. Does he recognise that one of the main reasons that unpaid carers are on their knees and in desperate need of respite is that his Government refused to allow adult respite services to reopen until now? I have to say, Presiding Officer, that some folk try to avoid listening to clinical advice when it suits them. Many of the day services are now open. They are not up to full capacity yet because we are still following guidance that we have from the scientists and the clinicians. I am more than happy to speak to Mr Cole-Hamilton or any other member about that, but we cannot have it always. We cannot have a situation where we could be accused of putting folk at risk if we were not to follow that advice. We cannot wait for a new national care service to be established to address the issues. We will act now to improve services for the people who rely on them, for unpaid carers and for the people who work in our care services. We are taking action with local partners to address the immediate pressures on care-at-home services, which in turn are placing pressures on our NHS. That includes establishing a dedicated webpage for social care vacancies, making it easier for people to find and apply for roles in care. We are also issuing targeted communications to nursing and social work students to encourage them to join the workforce. Again, the elephant in the room here—if anyone wants to talk to any of the care providers, please do—is the amount of staff that have left because of Brexit, folk returning to their home nations. That has caused us great grief, which those folks and those benches will never admit. We have allocated an additional £380 million to health boards to help with costs arising from the pandemic this financial year. That comes on top of the £1.7 billion that was already provided to health boards and health and social care partnerships last year. We will match our ambitions with further funding. We will deliver a 25 per cent increased investment in social care over the lifetime of this Parliament, equating to around £840 million. That funding will provide better support for people who access services and better terms and conditions for the workforce. I will take Pam Duncan-Glancy. One of the things that has been highlighted by Inclusion Scotland is the importance of open eligibility for social care. It has said that the 25 per cent increase may not be enough to do that. Will the Government commit to increasing that, and will the Government commit to living by its intention to support disabled people's independent living and the definition of independent living by ensuring that it is enshrined in the legislation to develop a national care service? That is a huge amount for me to answer in a very short period of time, so I will meet Pam Duncan-Glancy about some of those issues. Let me tackle the eligibility issue. The eligibility issue is one of the major difficulties that we have that causes the postcode lottery in various parts of the country. That is why we want to get rid of that and have national standards so that folk know what they can expect and what they deserve, rather than that postcode lottery. I do not really have much time, I do not think. I will maybe take Mr Briggs very briefly. Miles Briggs. I thank the minister for taking this intervention. As a former Aberdeen City councillor, what does he say to the president of COSLA when she refers to and he has not touched on the national care service as an attack on localism? Does he agree with that point? I will agree with that point and I will come to that later on in my speech. I want to turn to the workforce, because I think that that is immensely important. Improving terms and conditions will improve the experience of the current workforce and also help to attract and retain new staff into the sector. We will work with COSLA and sector stakeholders through the fair work and social care group. Through that, we have developed already a set of standards for terms and conditions that promote flexible and family-friendly working. We have maintained our commitment to adopt social care workers, ensuring that they are paid at least the real living wage. The Government is providing £64.5 million of funding this year to do so. The ministers in this last minute. We recognise that we need to go further. There is absolutely no doubt about that, and we will go further. Our ambition is also to bring the pay terms and conditions of nursing staff working within the care sector in line with those in the NHS. We will review options to achieve that. We recognise the challenges and complexity of delivering this across a varied landscape of over 1,000 unique providers. However, the Scottish Government will push for a national wage for care staff and enter into a national pay bargaining for the sector for the first time. It is vital that unpaid carers are recognised as equal partners in care and are able to take breaks to protect their own wellbeing. That is why we are consulting on enhanced rights to breaks from caring alongside the creation of the national care service. We are proposing the biggest public sector reform for decades since the creation of the national health service. With the consultation for a national care service under way, we are having open and honest conversations about what people want the future of social care to look like. I encourage everyone to get as many people as possible to respond to that consultation. We have also created a group of people with experience of social care to hold us to account if they do not think that we are being... If the minister could wind up, please. Putting people at the heart. The social covenants steering group is going to be immensely important and will put human rights right at the very heart and drive up standards right across the country. Local accountability will be key to ensuring that this works for people. Under our proposal for community health and social care boards, we will see for the first time people with lived experience sitting on boards alongside locally elected members and health and social care professionals. That is bringing those with lived experience into the decision making process, which is absolutely vital. From the rubble of World War 2, our respected national health service was born. As we emerge from the shadow of Covid, we can build a national care service that we can be proud of that delivers for our people. Thank you. It is now time to move on to the next point of order, Sandesh Gulhane. Just for the record, I forgot to declare my register of interest, which is I'm a practicing doctor. Thank you, Mr Gulhane. I appreciate your point of order, which is noted.