 i unig wedi fy ng Holder neu eit coresent ing rozpill nawr, am jagud a'u cael pianos aeis fldiw임を brio? Rydw i fairwch leolwch chi'r gall Walton 4, 4, 6ach?混h Rydw i bwumenu hwer i gael� wrth Majesty dda, i unig wedi gael gwnaeth pwy attack gave. Rhoad y Gwent i amdanoch gael i Statiwyd yn rhoi'r unrhyw o bautennig nhw. Mae'r gwaith o gwaith yn cael ei wneud o bwysig, rhaid i'w bryd ei fod y cymryd i gimbrannu'r gwaith, cyllid i gael i ddechrau'r hyn, cyntaf iawn nesaf, o'r gwahanol i'r gwaith, oedden nhw yn y gychwyn i chi chwech chi'n gwaith i'w gwaith i gael i gael i'w gwyn amdanoch. I call on Rhoda Grant to open the debate for around seven minutes, Ms Grant. Thank you, Presiding Officer. I wish to thank the members who signed my motion allowing this debate to take place. I would also like to thank all those individuals and organisations that have provided briefings, far too many to name and that shows the level of interest. Staffing issues are common throughout the NHS. Indeed, last weekend we saw the RCN survey of nurses point out that 90 per cent of nurses said that their last shift had been understaffed. Currently across Scotland there are 6,209 nursing and midwifery posts vacant. In NHS Highland this is 296, 8 per cent of all nursing and midwifery posts in the board area. When staff shortages are issues elsewhere in Scotland and the highlands we bear the brunt because it's easier for people to change their careers without impacting on their families when they live in the central belt. In the north we need to attract people not only to move themselves but also to uproot their whole family and therefore it's a lot harder for us to recruit. Add to that the shortage of affordable housing, local services and public transport. Therefore it's no surprise that in NHS Highland waiting times are amongst the longest in Scotland. They're attempting to recruit from all over the world and it's not for the want of trying that they find themselves desperately short staffed. For tree hospital urgent care unit is closed more often than it's. Open home care and care homes are desperately short staffed as well. The new Broadford hospital, which was opened by the cabinet secretary only weeks ago, cannot be fully utilised because of a lack of staff. Dentistry and Murray is also so dire that NHS Grampian are requiring dentists in Aberdeen to step in and help. Dunbar hospital minor injuries unit only recently reopened as there were staffing challenges due to staff being moved to support the Covid response. Staff are also totally burnt out by the pandemic. Some are off sick with stress, other with mental health issues and some are leaving the profession altogether or taking early retirement. Turning to the specifics around maternity care, since the Caithness general's maternity service was downgraded, any births with likely complications have been sent, usually by road to Inverness, over 100 miles away. A petitioner this week made the point that that is like a mother in Edinburgh travelling to Newcastle for maternity care. At the time of the downgrade of Caithness maternity unit, clinicians in Inverness expressed concern with regard to staffing in Inverness and whether they would cope with the additional numbers. The local community in Caithness was obviously concerned due to the long distance women needed to travel to access the services. Risk assessments were carried out on the service in Caithness due to lack of paediatric support, but nobody has risk assessed the journey from Caithness to Rigmore hospital in Inverness. The same situation is now... Alex Cole-Hamilton I'm very grateful to the member for giving away. I absolutely share her sentiments about the distance, the unacceptable distance that expected mothers expected to travel from Caithness to Rigmore. She will recognise that a lot of work has gone into a similar situation in Murray and a solution largely found, but no such solution or government time has been devoted to the Caithness situation. Doesn't she agree that that is a crying shame? Rhoda Grant Indeed, I do agree and I have written repeatedly to the cabinet secretary to ask him to visit people in Caithness and speak to the community there and I understand he is going to do that, which is extremely welcome. The situation, as the member said, in Dr Grayson Elgin, which is part of NHS Grampian, is the same. Again, the plan is to remove complex cases to Rigmore hospital in Inverness, but this time the clinicians management and indeed the community know that this can't happen without additional staffing and investment at Rigmore. Despite that, it appears a ffated company. We read in the news at the weekend about two cases, one in Murray and one in the south of Scotland, where babies were born by the roadside. Those were births that were deemed too complex to be supported in the local community mid-wiflet unit, yet it is somehow safer for these babies to be born by the roadside without any support. I really don't believe that. The risk created by this system to mothers and babies is enormous, especially in the winter months, and it puts added pressure on paramedics, which is also unacceptable. I beg the cabinet secretary to take the risk on board, because it should not take a death to prove it. We need to act, we need to train more staff in all disciplines, but crucially in maternity obstetrics and pediatrics. In the Highlands and Islands, we have our own wonderful world-renowned university, a new university, at the cutting edge of delivering education and research differently. The university used to run a fast-track midwifery course, and the course was open to nurses, was held close to home and allowed them to enhance their training into midwifery. The course was building steadily and would have been in place to provide the maternity workforce of the future, albeit drawing from already stretched nursing workforce. However, as so often happens, it was centralised to Napier University in Edinburgh. The difficulty that this creates is what I alluded to in the opening. People are reluctant to uproot their families to further their careers. Therefore, to grow our own workforce, we need to provide that training close to home. Evidence given by NHS Education for Scotland highlighted that midwives are more likely to remain in the area that they were trained. I am sure that that goes for other disciplines. The situation also adds costs to our health boards. Employing a locum or bank staff is much more expensive than employing a full-time member of staff. The use of locums also creates issues for the patients as well, because there is very little continuity for them. There are also issues in the way that we train our professionals. We focus on team-working within specialities. What we need in rural areas are generalists who are able to turn their hands to a number of conditions and need to be able to work with very little support. We currently recognise a depth of knowledge through career progression and salary, yet those with a breadth of knowledge find their skills unrecognised both professionally and financially. I have used maternity services to base those points on the same as true in other disciplines. Mental health services and caithness are at breaking point with tragic consequences. GPs are handing back their practices to health boards. We have some of the longest waiting lists in Scotland. The situation is untenable. I urge the Cabinet Secretary to act. Any other further delays will lead to a loss of life. Thank you very much. I now move to the open debate. I call for Jackie Dunbar to be followed by Sandra Scolhane for around four minutes. I am pleased to be able to take part in this important debate today and congratulate Rhoda Grant on securing it. I want to start off by agreeing with Rhoda Grant that there are many complex challenges in our NHS, and in particular with NHS recruitment and retention, here in Scotland as well as across the rest of the UK. The Covid-19 pandemic systematically changed the way that we do healthcare in Scotland, and there is no doubt that the pandemic exacerbated pre-existing challenges in health and social care. It caused staff to change working patterns and practices, adapt into enormous challenges and to hugely demanding environments. Of course, that is going to have an impact on recruitment and retention, that is self-evident. However, what is important is what we do to address those issues, bearing in mind the combined impact of the pandemic and of Brexit, which it must be accepted, has caused massive barriers to the recruitment of staff to our health service. The challenges cited in Rhoda Grant's motion are not confined to just the highlands and islands. We have our own challenges in Aberdeen-Donside and across the whole NHS Grampian. Continued workforce supply challenges alongside high levels of vacancies, particularly in medical specialities, nursing in midwifery and recent increased vacancies with allied health professions, bring in over reliance on supplementary staffing across our NHS, including across Aberdeen. The current available supply of staff is insufficient to meet the ever-increasing demands of our health boards. However, there are opportunities to look to alternative supply pathways. Participation in further international recruitment initiatives, using the networks of current NHS staff, continued development roles, links with further education, apprenticeship programmes and a review of all agency placements, will be key to making the changes necessary to address supply challenges. How is this achieved, particularly for NHS Grampian? The Scottish Government must continue to support the board to extend the workforce market to a wider range of potential applicants. We must utilise current supply pathways while seeking to widen those routes through the innovative approaches. Implement an easy and intuitive process that encourages individuals to apply for posts and improve candidates' experiences of recruitment. That must be an approach that invests in marketing the brand of NHS Grampian, offering a range of jobs and career opportunities. Create a service model that is service-based and influenced by the diverse resource, capacity and skills of the existing and future workforce. That model must be applied in a way that uses skills, generates effective teams and is efficient in creating a workforce fit for purpose. Finally, in order to ensure retention, the board must be supported to implement the staff governance standards within a culture that values and listens to staff and their contributions, one that ensures that the current workforce is offered appropriate development opportunities. I ask the cabinet secretary today for a commitment that the board will be supported with his aims and that all action will be taken to ensure the sufficient staffing of our valued NHS, which is so important to many constituents across Donside. I have heard lots of complaints about an ageing workforce being an issue facing our NHS, however, when I touched base with NHS Grampian ahead of this debate, I learned that an ageing workforce is recognised as an opportunity in having highly experienced staff. I pay tribute to the board for exploring new and innovative ways of working and opportunities for staff who wish to remain working beyond their retirement age. The board is fully supporting the ageing workforce and in many cases are providing opportunities for older staff to move into mentoring and senior roles, as well as into career advancement. In closing, I again welcome this debate, the steps that the Scottish Government is taking to support NHS recruitment and retention, and I reiterate my asks of the cabinet secretary. Thank you, Mr Dumbart. I now call on Senator Gohani to be followed by Jackie Bailey again for around four minutes, Dr Gohani. Thank you. NHS staff have played a vital role and an enduring role during the Covid pandemic. Like all my colleagues in this Parliament, I would like to reiterate my thanks for their efforts and continued resilience as we begin rebuilding from the pandemic. Jackie Dumbart just spoke there of an ageing workforce, and the worry is that the ageing workforce retires with no one to come in behind them. That is the worry. It is not their age. I share Rhoda Grant's concerns that the SNP Government has yet to adequately support NHS staff in Scotland. We are faced with serious recruitment and retention problems, and not only in the Highlands and Islands. Many of the issues we see today are as the result of failed workforce planning. The SNP Government are not treating long Covid with the urgency it requires. The numbers of those suffering for more than a year has doubled in just six months. Across Scotland, it is estimated that we have over 150,000 people suffering from long Covid. Of those, 64,000 have been experiencing symptoms for more than a year. That is increasing the strain on services and on NHS staff. The recent workforce plan was insufficient and lacked ambition. The number of unfulfilled registered nursing posts in NHS Scotland continues to grow, increasing pressure on already overworked and exhausted nursing staff. The latest stats on the nursing workforce published two days ago showed that 9.5% of registered nurse posts in Scotland were vacant at 31 March 2022. That is a record high. The rate equates to 4,605 registered nursing posts unfilled compared to 4,500 by the end of 2021. The overall number of vacant nursing and nurse posts is 6,209 as of 31 March up from 4,495 at the same date in 2021, an increase of over 38% in 12 months. Non-Covid sickness absence in the whole NHS workforce has also increased to 5.7% up from 4.7% on 31 March 2021, increasing the pressure on the whole service. Colin Pullman, the Royal College of Nursing Scotland interim director, says that nurses deserve more than to turn up to work shift after shift and to be expected to deal with significantly increased demand with fewer and fewer nursing staff. I couldn't agree with him anymore. Immediate action is required to support staff retention. To address long-term recruitment issues, we would take a need to take a comprehensive approach towards workforce planning for the whole of NHS Scotland in every profession and at every level. Furthermore, we would remove the cap on funded places for front-line medical students to increase the number of home domiciled students because we know that they are more likely to continue working in NHS Scotland. Succesive SNP health secretaries have simply failed to adequately treat workforce planning in our NHS, and the devastating results are clear for all of us to see. Thank you, Dr Gilhane. I now call Jackie Baillie to be followed by Alex Cole-Hamilton again around four minutes. Let me join with others across the chamber in thanking NHS and social care staff for their hard work and congratulate Rhoda Grant for securing that debate. She makes a powerful case for training NHS staff as close to home as possible and specifically for training to be provided at the University of the Highlands and Islands, and I support her in that call. I want to talk in more general terms about staff recruitment and retention. The comment from the Royal College of Physicians and Surgeons of Glasgow summed it up for me when they said, there are not enough staff to meet the needs of our patients and went on to say, the challenges of workforce shortages are not new, they existed long before the pandemic and have deteriorated since. On Tuesday, NHS workforce statistics were published. 9.5 per cent of registered nurse posts are vacant. That is a record high. The overall number of nursing and midwifery posts is 6,209 vacancies up by 38 per cent in the last 12 months alone. The day before that, the Royal College of Nursing published a frankly shocking survey that told us that eight out of 10 nurses had patient safety concerns while working on their last shift because they were so understaffed. Earlier this year, six out of 10 were actively considering leaving their job. At the start of the pandemic, it was three out of 10. The key reasons for leaving including feeling undervalued, under pressure at work, unsafe staffing levels and low pay. 40 per cent are working beyond their contracted hours and 67 per cent are too busy to provide the level of care they would like. The Royal College of Midwives also surveyed their members. 70 per cent of them are considering leaving the service. Like the RCN, their members cited safety of their patients due to the lack of staffing being a very real problem. Faced with all this pressure, it is little wonder that staff are leaving the NHS. It is not just nurses. One in five consultants are leaving the NHS well before retirement. They are citing burnout as one of the key reasons. There is a shortage of allied health professionals. There is a shortage of GPs, too. In fact, with a GP, their workload is enormous and there is simply not enough of them to cope with rising demand. Although we would all welcome the Government's plan for 800 more GPs, I reflect on the words of Dr Andrew Buist from the BMA that training an extra 800 is not the same as getting them into practices where they are needed to improve access to patients. Getting workforce planning right is critical, but that will take time, so the retention of existing staff must be an urgent priority for the Government. We need to care for them so that they can continue to care for us, but that extends beyond just their welfare, important though that is. We need to pay them better to recognise and reward their hard work, and that is in both health and social care. We also know that the NHS lacks flexibility. Rather than letting 40 years of experience walk out the door, why not see if you can retain their knowledge and skills on a part-time basis? Above all, let us implement the Health and Care Staffing Act 2019 so that everybody in this Parliament voted for unanimously to ensure that there are safe staffing levels. It has been on the statute book for three years and nothing has happened. The cabinet secretary says that he will publish a timetable by the end of June, and that is very welcome. However, a timetable that is vague, which pushes implementation years down the line, will simply be unacceptable. There is a huge crisis that has been unfolding for years, and the cabinet secretary is giving the appearance of being asleep at the wheel. I hope that he wakes up before it is too late. Thank you, Mr Billy. I now call, let's call Hamilton to be followed by Cal Mocken again for her in four minutes. Thank you very much indeed, Deputy Presiding Officer. Can I start by thanking Rhoda Grant for securing parliamentary time for this important debate? Can I also, Presiding Officer, associate myself with her remarks around the difficulties faced by expectant mothers travelling from Caithness or Aigmore to deliver? Under nobody's estimation, is it safer for a baby with complex needs to be born by the side of a road than it is in the care of a hospital near to their home, which is what we should all aspire to see for their families? I will to the cabinet secretary. I thank Alex Cole-Hamilton to give way, and I don't disagree with his comment a moment ago. Will he recognise, though, that the decisions taken around Caithness, of course, were themselves because of a very, very tragic case, and actually patient safety was put at the heart of that decision when it was taken a number of years ago? Alex Cole-Hamilton, give me the time back. I do recognise that. It was taken a number of years ago. Things have moved on. We need to listen to the community, we need to listen to clinicians and actually make things safer for mothers to be able to deliver their babies close to their home in Caithness. I also give thanks to the Royal College of Nursing, who alongside others have worked tirelessly to provide the country with the information that we are largely debating today that illuminates the current crisis in nursing, and it is a crisis. It is unfortunate that this information is such bleak reading after we have been talking about it for what feels like years. Released this week, as we have heard, the last shift survey report has revealed that awful statistic. 90 per cent of nurses or respondents believed that the number of nursing staff on the last shift they did was not sufficient to properly meet patients' needs. Not only is this dangerous for patients, it puts an inordinate amount of stress on staff themselves as the report highlights, and they sacrifice their own wellbeing to deliver care that their patients need. As a result, 63 per cent of staff in Scotland subfaid feel exhausted to the point of negativity by the end of that shift. I would like to highlight that this is almost 10 per cent higher than the average UK number, and the daily reality, Deputy Presiding Officer, is dire. It is quickly becoming in fact untenable. Describing their experience in the recent RCN report, one nurse said, and I quote, One day I walked onto my shift and I was on my own in the entire floor. I can't describe how I felt at the end of that shift emotionally and physically. Something should be done about the staff shortages and fast. Otherwise, nurses will be forced to leave one by one, and the few remaining will die of stress and burnout. That reality is particularly stark in remote and island communities. I think that those words speak for themselves. The reality is that we have passed as a Parliament legislation that should not allow them to happen. In the safe staffing legislation that we have passed, we have recognised as a Parliament that we cannot allow shifts to proceed in those unsafe ways, and yet still they do. Cabinet Secretary, I welcome the final announcement of a longer overdue timetable for its implementation, but we have been waiting three years, and I would reiterate the point that I often make that it is not just about headcount. We need to be sure that every shift has the right mix of skills and experience to deliver patient care safely. As that nurse described, those unbearable working conditions mean that more and more staff are lost to the profession. They will be forced to give up the job that they love, and that potentially puts those off who are considering entering the profession in the first place. That will lead inexorably to fewer staff, putting more pressure on current staff, worsening working conditions like never before. It is a vicious cycle and one that we need to break. That is why the Liberal Democrats have called for the establishment of an NHS staff assembly to learn from the lived experience of staff. I was heartened that, yesterday, Humza Yousaf agreed to look seriously at that. It is also why we have repeatedly called as a party for a burnout prevention strategy, which would implement mental health help for front-line staff supporting them in their job. This plan has been voted down successively and routinely dismissed by this Government, including in the same exchange when Humza Yousaf referred to this idea as just being a piece of paper. Despite the health sector telling us repeatedly about the money being invested into staff welfare, it is yet to produce a piece of paper on how that money will be spent towards supporting NHS staff. A burnout prevention strategy is exactly what those people need. The motion today references training NHS in all areas of Scotland, not just in the central belt. It is something that the Liberal Democrats are fully supportive of. It cannot be a postcode lottery. Widespread training programmes are an important step in producing widespread care. That is vital to ensuring our nation's health. I would like to end, Presiding Officer. You would be very good to me on the words of Pat Cullen, the RHCN's chief executive. To those from Government who are listening to my words, we have had enough. The patients and those who are careful have had enough. It is long overdue that this Government not only listens but acts. Thank you very much. I am always good to everybody. Carol Mochan, to be followed by Brian Whittle for around four minutes. I thank Rhoda Grant for bringing this important motion to the chamber. I would like to start by echoing the points made by Rhoda Grant regarding the difficulties of recruitment in rural areas in our own area of NHS Highland. The recruitment is a major concern across the NHS but it is definitely heightened in rural areas. As Rhoda Grant mentioned, the RHCN advised before today's debate that in NHS Highland 224 registered nurse posts are vacant, which is nearly one in 10 posts. That is reflected in other rural areas. That is a significant cause for concern and one that this Government ought to take very, very serious and act upon. This is an on-going issue that has been debated many times in this chamber and has been raised repeatedly by nursing trade unions. I say it regularly in the chamber but the Scottish Government cannot take time to pat itself on the back while vacancies remain high across the country and, as vacancies remain high, staff remain under pressure and services continue to be strained. That Government must consider carefully the ways in which recruitment can be improved and that must include the training of NHS staff close to home. Covering a rural constituency myself, I hear this time and time again many of the points made by Rhoda Grant earlier in this debate. We have first-class university and college facilities across Scotland and it is important that training programmes are rolled out in our rural areas, one such as in Highlands. In my own area and the borders, for example, to ensure that those who wish to enter the healthcare profession can train and then hopefully take up posts close to home. Moreover, in our efforts to ensure that care is community-based and available locally, we must also recruit more in key areas and that includes mental health and learning disabilities, as was referenced in the RCN briefing, to ensure that such services have the staff to meet the demand and that the services can be delivered close to those who rely on them. That helps both patients and staff. Both can benefit from facilities close to home and that is so important in rural areas. Indeed, Deputy Presiding Officer, we know that recruitment and retention are both very closely linked and have been mentioned across the chamber in this debate. Just last month, I highlighted at First Minister's question discussions with Unison trade union that workplace pressures in NHS borders had less staff to report to the union issues, including staffing levels that are dangerous for both patients and staff, and that staff are not receiving proper rest breaks. That is unacceptable, and I know that the Government has acknowledged that and said that it will address that. On those benches, we have to keep pushing to ensure that the staff's safe staffing legislation is enacted and that the Government is taking that seriously. Those points have been made in the chamber before, and we must start to enact some of that work. It is a workforce that gives us so much to the community and to our country, but it often feels that it gets so little back. Is it any wonder therefore that vacancies remain so high and that staff feel under so much pressure? If we want to recruit and then retain a skilled workforce serving every part of our country, including rural areas, we must start by leviating some of the barriers to recruitment of students, and we must address workplace pressures that are currently facing staff, making the healthcare setting an appealing one to work in. It is clear in Rhoda Grant's motion today that, in the Highlands, we have seen the removal of a key training programme from local university being moved to a large city in Edinburgh. It is also clear from the contributions and from trade unions and NHS workforce briefings that the current workforce pressures are significant and putting strain on the ability to deliver the service that patients deserve. That highlights two very clear issues, both in recruitment and in retention, yet there are two issues that can be fixed by bringing training programmes closer to home. For rural areas, that means that we would have some valued NHS staff close to home that could provide those services. It is a significant point that should be followed up by the cabinet secretary. Thank you, Ms Mocken. I now call on Brian Whittle to be followed by Michael Marra again for four minutes. Thank you, Deputy Presiding Officer. I add my congratulations to Rhoda Grant for bringing this debate to the chamber. I think that she would recognise us well. We are not the first time we have discussed such issues in this chamber over the last couple of sessions. I want to start with the conversation that I had with my daughter when she was at university studying law. She came in and decided and said to me that she actually wanted to change to midwifery. There is a switch for her. She has gone from studying law to studying midwifery. We looked at that possibility and at the time there were 10 more applications for each individual place that was available to study midwifery at college. I raised that with her. She still wanted to do it. I know that she went and she actually got one of those places. Having looked at that, I looked at other medical professions, nurses and physios. There are four times as many applications for the number of places that are available. My colleague, Sandesh Gohani, talked about the cap on medical students from Dumerseld in Scotland. There is no lack of applications for them. I was mentioned earlier that, in the last term, it was highlighted that we had a shortfall of 864 GPs in Scotland. The Government responded by suggesting that it would train a further 800 GPs over the next decade. That failed to take into account, of course, turnover of GPs. In fact, the Audit Scotland report suggested that, in that 10-year time, we will still leave a shortfall of 600 GPs. I case very early on in my political career with a constituent who, unfortunately, lost a child and childbirth at Crosshouse, and they had an inordinately high number of baby deaths at that hospital. We managed to get a NHS report into that, and it discovered that we were 24 staff short in the neonatal unit. I have to say that my daughter is now working in that neonatal unit, but when she first qualified as a midwife, she could not get a job in Scotland and actually had to travel to Preston and do three 12-hour shifts and then get the train back up again. She now, fortunately, works within the Scottish National Health Service. Where is the workforce plan? I think that one of the things that I would suggest, especially around the lack of GPs, is that the importance of having Scottish domicile students is where they tend to work relates to the postcode that they put on their UCAS form. I think that that is highlighted in Rhoda Grant's motion. One of the things that we are discussing today is recruitment and retention, and I think that, quite frankly, is our own way round. The first thing that we should be doing is making sure that we retain the staff that we have. It is trying to fill up a bucket with a hole in it. We need to create an environment where our medical staff want to work. We need to start to take more cognisance of reports of bullying, we need to make sure that there is advancement, we need to make sure that the hours that they work and the shifts that they work are much more in keeping with a balanced life. I remember talking five years ago about making sure that there are hot meals of an evening shift where it was not happening before. More important these days is ensuring that things such as mental health support are available for all our staff. If we want to invest, which is my passion in health service, further upstream in that preventative agenda, then we need a workforce that will be able to deliver that. One of the first things that I ever said in here is that to improve the health of our nation, it must start with looking after those who look after us. We will discuss recruitment and retention. Let us make sure that what we mean by looking after the health of those who look after us. That would go an awful long way to starting to deal with the issues in Rhoda Grant's motion. Thank you very much, Mr Whittle. I now call on Michael Marra for around four minutes, Mr Marra. Thank you, Deputy Presiding Officer. I offer my thanks to my colleague Rhoda Grant for bringing this debate to the chamber and for highlighting the needs of her constituents in terms of not just workforce planning, but the particular challenges that pertain to the population of the Highlands, in terms of the dispersed population and the special accommodation of that that must be made if we are to ensure that our national health service can provide for them appropriately. I want to talk unsurprisingly in this debate about my own constituents and the challenges that they face in some of the same regards, workforce planning in particular, but the major shortfalls in oncology consultants at NHS Tayside and particularly for breast cancer patients. Many of the issues that have been highlighted so far pertaining to workforce planning are impact on that situation. I know that the cabinet secretary recognises that these are challenges across the whole of Scotland. A 2020 Scotland workforce census demonstrated that an estimate of around 18 per cent of consultant clinical oncologists are forecast to retire by 2025. My home city has borne much of the brunt of that, but how many patients I ask will have to have their cancer treatment compromised before we see change in response to that on a truly systemic level. I confirmed to the cabinet secretary this morning in general questions that the final breast cancer oncologist has left employment at Ninewell hospital in the last couple of weeks. Of course, there is a considerable history to that issue. We need a comprehensive workforce plan. The recruitment is clearly part of the response, but I am increasingly coming to the conclusion that it is now clear that a recruitment process alone will not deal with that issue. When a prospective consultant sees an advert, they will research the centre, google the record, speak to colleagues in the international community that are involved in those services. What will they find in Dundee as a record of conflict between clinical staff and management? A seriously flawed Health Improvement Scotland report and reports of a culture of bullying as referred to by members in exchanges in Parliament this very day. Sandesh Gohani raised that issue. I will take his point. Does Michael Marra agree with me that this secret report needs to be made public and urged the cabinet secretary to intervene? I would certainly agree that all documents pertaining to the situation should be put in the public domain. The report that the member refers to in terms of the report by the Royal College of Physicians of London, I believe, is a report commissioned in 2019 and is shrouded in some issues regarding conflicts of interest arising from some of the members involved in the production of the report. It seems that have been shelved and the reasoning for that has never been entirely clear and open. I think that what we really need on this issue is full transparency and openness around all of the publications. I would say that there is also a further document that I would like to see the cabinet secretary produce, which is the right of reply response to the Health Improvement Scotland report submitted by the clinicians in Dundee in response to that report. That should be provided as well. Only when we actually deal with this underlying issue are we going to deal with the fact that we cannot meet the recruitment requirements around this area of specialism in Dundee. The board of NHS Tayside must now step up at long last and perform their legal functions in this matter to challenge rigorously in their own code of conduct the executive officers who are presiding over a chronic situation that will only be helped by full openness and real honesty on all parties. Those questions were asked to the First Minister by Labour colleagues in February 2021, 16 months ago now. We saw more of a year of obduscation and denial from the Scottish Government. As late as November 2021, the Deputy First Minister appeared in the chamber in complete denial, saying that to raise the issues was a disservice to the women of Tayside. On 27 January this year, I advised the chamber and seemingly the cabinet secretary for health that there had been further resignations tendered from the service. As I said today, I informed the chamber that there are now no breast cancer oncology specialists in Dundee. The cabinet secretary for health gave assurances that day that he and other ministerial colleagues have been deeply involved in the issue. I am afraid that that is now becoming as much of a concern as a reassurance. There is a fundamental breakdown of trust and only full transparency will restore it and the services that the women of Tayside and Dundee need. Thank you very much, Mr Marra. I now invite Hamza Yousaf to respond to the debate, cabinet secretary, for around seven minutes. Thank you very much, Deputy Presiding Officer. I thank Rhoda Grant for being in this important member's debate to the Parliament. I thank members who have contributed from across the country and across the political spectrum. Although I may not agree with the characterisation of all their points, I certainly think that the substantial points that have been made in relation to recruitment but also retention and staff and workforce planning are important points. I will try to touch upon some of the general points, but I think that I would do a disservice to the debate if I did not touch upon some of the key themes and key points related to NHS Highland, which Rhoda Grant has raised in this chamber, too. Of course, other members are correct. The issues that are pertaining to NHS Highland are not unique to NHS Highland. They are replicated often in rural, remote and island communities. I will address some of those more general points, too. On the issues that Rhoda Grant has raised, she is right. I have been, as she knows, recently to NHS Highland on a couple of occasions over the past few weeks to open two new hospitals in NHS Highland. I am pleased with that Scottish Government investment, but she is absolutely correct that, on both occasions, when I visited Bedknock in Strathbae and when I visited Broadford hospital in the sky, the issues of workforce recruitment and retention were raised with me repeatedly by staff. Rhoda Grant is also correct, and other colleagues, such as Jackie Dunbar, touched on that point, too, that it is not just about a job offer. It is about housing. We know that. It is about transport links. It is about education and so on and so forth. Again, I will try to touch upon some of those points when I can. Workforce and recruitment of workforce are key, and I will touch upon retention issues soon. I recognise that there are vacancies in particular staff cohorts that are far too high, so a number of colleagues have raised the workforce stats that have recently been published around nursing vacancies. He has agreed that they are not going to get a difference of opinion for me, suggesting that those vacancies are acceptable. However, I also want to put on record and robustly defend the action that we are taking. We are doing our best to recruit an extremely challenging and competitive market at the moment and recruit as many nurses and qualified nurses mid-wise as we possibly can. However, overall, our workforce record in this Government is one that I am very proud of. Since 2006, we know that there has been almost 30,000 increases in whole-time equivalent staff right across the NHS. I will take the intervention. I am very grateful to the cabinet secretary for taking the intervention, but it is not just about recruiting current staff, but about training staff and the training numbers. Wouldn't a long-term strategy be, in fact, if we had done it five or six or seven years ago, we would not be in this situation just now? Underway and training programmes, and incentive and incentivisation programmes for rural health boards that help to attract people and keep them there. However, I will come to the retention point in more detail. I was about to say that we have a proud record of recruitment in the NHS, as I say, from 2006 over almost 30,000 whole-time equivalents recruited to our NHS. I look at NHS Highland in particular, because I know that that is an area of key interest in this debate. We have seen that the workforce is up by 33.6 per cent. That is higher than the growth across average NHS Scotland. In relation to medical and dental consultants, that increase has been more recent than since December 2019, which is pre-pandemic. The increase in the workforce in NHS Highland has been 7.8 per cent. I was making a moment ago in response to Brian Whittle that we are doing what we can to ensure that we can recruit and retain, particularly to rural health boards. Our golden hello payment for GPs new to rural areas and via a primary care rural fund to support established GPs with our rediscover the joy programme, which we are hoping to extend to other health board areas, too. On some of the challenges raised by Rhodogant more specifically, I take the point that she has made about KFNS. I think that Alex Cole-Hamilton made those points too. I have, as she graciously noted, agreed to meet the campaigners in KFNS. Of course, I am sure that MSPs are invited to any of those discussions too. I hope that members will take that at face value, that it is the safety of mothers and their unborn children, which is of paramount importance to all of us. I agree with her point that giving birth in a labai is not what any of us would want for our own children, and we would not want our own family members to be in that position. Of course, I give way to Rhodogant. I think that we all agree that giving birth in a labai is unsafe, but I would be really grateful if the cabinet secretary would commit to doing a risk assessment on those journey times in emergency situations or indeed in routine situations. Yes, I will certainly explore how we can do that in a way that is absolutely meaningful. I was just about to make the point that I made in intervention to Alex Cole-Hamilton, which we have to bear in mind that there was a really tragic case. Of course, the review done into that tragic case said that death could have been avoidable, and therefore the difficult decisions around KFNS were taken. However, I take Alex Cole-Hamilton's point in response to that, which was a number of years ago, and things should have moved on from there. On education and training, which I think is a really important point raised by almost every member who has spoken and mentioned a very personal perspective from Brian Whittle, we are really keen to try to ensure that we can train the workforce in remote and rural and island health boards where possible. I think that is a really important endeavour for us here in Government and members across the chamber. We will be aware of the Scotland's first four-year graduate entry medicine programme that is hosted by the universities of St Andrew and Dundee from 55 students in 2018 to 70 students this year. Of course, particular relevance to NHS Highland is that the Scotland's programme includes periods of time at living and studying in NHS Highland. We know—and I have heard from remote and rural health boards—time and time again that if we get them to live here, get them to train here or study here, we have a much better chance of retaining them as well. On the points that were made by Jackie Dunbar about a more co-ordinated approach across rural health boards, I think that that is a point that is really well made. That is a point that I can absolutely commit to. She asked me to commit to supporting Grampian in terms of her staffing and recruitment, but I have to say that our recruitment activity at times can quite frankly be a bit ad hoc. Having a more co-ordinated approach, particularly across remote and rural health boards is something that I am very keen to do as well. On the midwifery training, which is again a key part of the motion that Rhoda Grant has raised today, she is concerned about the discontinuation of the pilot at UHI. She will be aware of the review that took place into that pilot and into midwifery workforce education that took place by Nes. The report was published in March of last year. She can come back to me if she has got any specific points on that, but it should be said that it did say that the current suppliers that we have, the current institutions that are providing that training, that educational opportunity, they should continue. That is why, in January this year, Edinburgh Napier University welcomed students from across Scotland to undertake the new shortened midwifery programme. In just 20 months, students will qualify and will continue to work in their home regions, including, of course, Northern Scotland's health boards. I have outlined that we are exploring every possible avenue to improve health and social care by investing in those people that mean so much to us. The staff that care for us are the people that we have clapped for and applauded. That is why we will invest in them, in their pay, in their terms and in their conditions. We will do everything that we possibly can to work with our remote and rural health boards, including NHS Highland, to see how we can support them in recruiting and retaining staff for the future.