 Felly, yn posibl i ddiffenwys i'r ddiffenwys i ystod yn FFWF, byddai Hulmes Y Ysaf ond myr i mwynteyntau y gynhyrchu. Felly, y Cymdeithasethau willo gan ddatblygu i'r ddarparu hynny, ac, efallai, fyddai hynny byddai ei chymdeithio cyfreith o hyd i ddim yn ddigon i'w ddigon i'r ddifolio ddigon i'r ddifolio, wrth wybodaeth na wneud hyn ac Ieithio ond y Com Jessie yn myr i dresses amdano uchydig ar y ddiffenwys, ac mae ein bod ganddysig iawn i ddigon i ddifolio i chi fod eich cyfrant. O'rèneu i gael dydag i'n gennym ei dweud i ddefnyddio beth oedd. Mae cyfrant yn cyfrant yn cynnig oedd yr hyn yn fasgfynol nid. Felly, rwy'n ei ddwyperu i credu i'r cyfrant ar gyferrwyaf oedd unrhyw o'r newydd o ddweud y cysylltu aeth yn gyfnogwlad seef yn Cyfrans. Fyng y model 4, maes atdag yw cael hwn o felch yn ei ddewch i'r myngau. Maes y model 6, I was very firmly remains the destination. Members will be aware. I started this process in December last year, when I was considering the report of the independent review into Murray maternity services. I then proceeded to meet and engage with senior teams and boards, with clinicians, with local community campaign groups and elected members from right across the political spectrum. This was important to do and it helped me to come to my final decision, which I announced in this chamber in March. This was to progress with model 6, a full consultant-led maternity unit at Dr Gray's with model 4 and networked maternity model, linked primarily with Regmore as part of the development towards that final destination. I also announced in line with the recommendations of the independent review that I would bring some level of independent assurance to this process. I was delighted to announce in July that Professor Linda Dacastica would lead this work. Since then, Professor Dacastica has identified further clinical support and expertise to work with her to provide this external assurance. The team working with Linda includes representatives from relevant specialities such as pediatrics, anesthetics or obstetrics and midwifery. The external panel will be a sounding board and a critical friend to both NHS Grampian and NHS Highland. Crucially, it will provide assurance and reassurance to the community and to me here in government. This has already begun through meetings and email exchanges, providing me with a further level of scrutiny and advice on progress and plans. Presiding Officer, members are aware of the NHS Grampian and NHS Highland draft joint plan submitted to me on 1 July. I welcome this plan, but at the time I was expecting further information before giving my response to it. The model 4 plan is an important step in the journey towards model 6, and I was pleased to see the ambitious timescales within it. What I can say here today is that, before giving approval to model 4 plans, I am very clear that further work is required. There are elements to be worked through locally and nationally to deliver for families in Murray. At a local level, clinical teams in Highland and Grampian need to develop the safe pathways of care to bring reassurance to both the women involved and in Murray and to clinicians too. At a national local level, there is work to be done to address the on-going challenges of recruitment. I have asked Highland and Grampian to share their recruitment plans to meet the 2023 deadline in the model 4 plan. There are some key elements in the model 4 plan. I wish to draw the chamber's attention too. Firstly, the intention for NHS Grampian to introduce increased obstetric anti-natal care to Dr Gray's is welcome. It could result in at least 1,000 anti-natal appointments a year delivered in Dr Gray's, therefore reducing the amount of travel for pregnant women. The other element that I want to highlight today is plan cesarean sections. That is not included, as we know in the model 4 plan, due to its dependency on other services and skilled staff being available. I expect plan cesarean births in Dr Gray's to be covered as part of that model 6 plan, which I am expecting at the end of this year, and ambitious progress to be made to deliver that ambition. I will ask Linda Dacasticaar and her external assurance panel to look at the issue in further detail. We should view the interactions between model 4 and model 6 as a continuum. We will not wake up one day and suddenly switch from model 4 to model 6. I expect model 6 to be phased in over time and clear that elective sections should be given priority within that phasing process. Concerns have been raised with me by local campaign groups and, indeed, by clinicians with regards to the projected numbers in the NHS Highland draft business case for women giving birth in Regmore. I have asked the external assurance panel, which I have just spoken about, to take this forward and investigate with boards and, indeed, with clinicians at pace. The ambition is to achieve choice for women living and money, the choice to birth in Regmore if they wish to go there and where clinically appropriate. Of course, I understand that there are concerns. There are concerns that progress is not being made quickly enough and concerns that clinicians do not feel the changes proposed are safe. I hear those concerns and I do take them very seriously indeed. I commend the steps that NHS Highland is taking to engage with the clinical teams to identify and address those concerns. That takes time and I have always been clear that change will not happen overnight. We must work with clinicians in Grampian and, of course, in Highland and, where there are legitimate concerns, those must absolutely be addressed. I understand that the priority for women in Murray is that they have access as soon as possible to the widest range of maternity services that they can safely and realistically be delivered as close to home as possible. The independent review of maternity services in Murray proposed, and I agree with this proposal, that the first step in achieving this is to implement a network maternity model, linked mainly to Regmore. I have already announced funding of £5 million to support improvements in Regmore to be clear when I visited Regmore earlier this year. I saw for myself investment was much needed. The investment in Regmore was not contingent on taking women from Murray. However, improved maternity services at Regmore will benefit all women who give birth there. The redevelopment in Regmore is key to improving the environment for both women giving birth and clinicians who work there. I know that there are doubts around model 4. I have heard clinicians from community members and campaign groups, too. However, the real prize for implementing model 4 will be opening up scope for more pre- and post-birth appointments at Dr Gray's and enabling more women to have their labour and birth in a hospital closer to where they live. That will be delivered by having the clarity of a safe model 4 as an interim solution, with robust pathways of care providing care closer to home and increased choice of place of birth. Women who need obstetric lead care will be able to have the choice of Regmore or Aberdeen for the birth of their baby until consultant-led services are returned to Dr Gray's. It is critical that we continue to have a parallel focus on implementation of model 4 as the final destination. NHS care should not be about bored boundaries. It should be about working cross boundaries to deliver the best care for all women who choose to birth there. That is key to a networked model. I was clear back in March that I expected plans for model 4 and model 6 to run concurrently. I know that NHS Grampian has begun the process of planning what it requires for model 4 and to lay the foundations for model 6. As I have already made clear, a view model 6 is a continuum of model 4, an improvement journey with a focus on safety and led by clinicians. Oversight of this work is provided through the chief officers group jointly chaired by both NHS Grampian and Highland. I expect that model 6, planned by the end of December, expects to see evidence of collaborative working and joint plans from boards, for example, around the pathways of care. As part of this next phase of work, monthly meetings will take place between the board, between Professor Linda Dicastiker and my officials. I would like to talk a little bit about engagement and reinforce the importance of it, particularly on-going engagement. I am pleased to note that connections are already being made with the external assurance lead, and that includes community groups such as Keep Mum and Murray and Bam from a maternity voice partnership. Their views have been instrumental to getting us to this point, and their challenge will help us to shape the way ahead. I have spoken to Keep Mum just this week, and I have given them a cast iron guarantee that I remain absolutely committed to model 6, a return to consultant-led midwifery unit at dot degrees. I would like to outline what I see happening over the next six months or so. In November, I expect to have initial advice from the external assurance panel on the NHS Highland business case and on the numbers of women giving birth, which I know is, and Reg Moore, which I know is causing some concern. In December, I expect to meet NHS Highland and Grampian to discuss my expectations for the model 6 plan and its interaction with model 4. I expect to receive the model 6 plan by the end of December. Of course, I will keep Parliament updated in that regard. I am certain that everybody in this chamber wants to see women in Murray being able to give birth as close to home as possible, and we will endeavour to make that a reality and always ensure that the priority is the safety of women and their unborn children. From January to February, I expect to have a response from the external assurance panel on the plans received. That will be fed back to both Highland and Grampian. I hope that this statement gives some level of assurance to members, to the clinicians, to community groups who have raised concerns. Work to return consultant-led maternity services to Dr Gray's is progressing. Covid-19 is undoubtedly impacted on delivery timescales. The context continues to be the most challenging time that our NHS has ever faced since its creation. The chief executives, the executive teams at NHS Grampian and Highland continue to assure me of their commitment to deliver both model 4 and, crucially, the final destination model 6. I reiterate my and this Government's absolute commitment, not just to model 6, but to ensuring that we return that consultant-led maternity services to Dr Gray's to ensure that as many women in Murray can give birth as close to home as possible. Thank you, Government Secretary. We will now take questions on the issues raised in his statement. We have slightly overrun, but I intend to protect the around 20 minutes for questions after which we will need to move on to the next item of business as time is tight across the afternoon. It would be helpful if members who wish to ask a question could press the request to speak buttons now as soon as possible. I call First Lady Douglas Ross. I know that it is customary in the Scottish Parliament to thank the Scottish Government for making a statement, but I just cannot. I cannot on behalf of Murray Mums and families thank him for that statement because I share their anger, disappointment and frustration that we are no further forward. Months after the cabinet secretary previously came to this chamber and said that he would make this a priority, we are no further forward to restoring consultant-led maternity services at Dr Gray's than we were over four years ago when we were told to put up with a temporary downgrade for just a year. In his previous statement to this chamber in December last year, the health secretary claimed that he understood the urgency and the importance of the issue, but that statement he just read out does not understand the importance of this issue because we are still in the situation where there is nothing of comfort for Murray Mums and Murray families in that statement because the agonising worry and concern about being transferred in labour, be that Inverness or Aberdeen, is still there and shows no signs of ending. Quite frankly, Model 4 is a red herring and I'm pleading with the health secretary to listen to local representatives, to listen to keep mum and other campaigners and scrap Model 4 and move directly to Model 6. He shouldn't just listen to local people and local politicians, he should listen to the clinicians that wrote to him today. I'm sorry, Presiding Officer, the health secretary overran, how long can we speak about this issue because we have been waiting for months for this statement and I know people are watching this today to hear really crucial points put forward. Mr Ross, I have given you some latitude, I'm giving you some latitude, but I'm asking you, you've got 90 seconds, you're in two minutes, I'll give you two and a half minutes. Thank you. So what does the health secretary say to the health clinicians who wrote to him, 22, from NHS Highland today, to say that Model 4 remains fundamentally flawed? They say that Model 4 must therefore be rejected and the consultant-led service at Dr Gray's hospital re-established as a matter of urgency. Will he do that? Will he say today that Model 6 has to go forward? On electives to Zarians, last December he said in this chamber there should be a rapid reintroduction of electives to Zarian sections at Dr Gray's. Now we're hearing that's going to be part of Model 6 and also on Model 4, he's saying we should somehow celebrate that there's going to be more pre and post birth appointments at Dr Gray's. I've never had one concern raised with me by local women or families about pre and post birth appointments at Dr Gray's. They want to give birth at Dr Gray's and there was nothing in this statement that would do that. Okay, cabinet secretary. On a point of order, Douglas Ross. I wonder, Deputy Presiding Officer, if you will accept an emergency motion to ensure that a longer debate and discussion can be had on this issue. You have made such a motion in the past. I accepted it in the past. I don't see the need to do so on this occasion. I gave you an additional time. You've used that additional time and more. I've already explained that we're tight for time across the afternoon and I've called the cabinet secretary. If it helps, I'm happy to commit to a meeting with Douglas Ross if he wants to discuss his issues in more detail given the limited time that we have this afternoon. I do take the concerns that clinicians have expressed and written to me today, as Douglas Ross rightly references. He probably knows I've met with those same clinicians when I travelled myself to Rhaigmore. That is why I haven't stood up in this chamber and said that I am in principle giving agreement to Model 4 plans. It's why I've come to his point. I understand he's speaking from a sedentary position. I will come to his point about potentially his suggestion of scrapping Model 4. What have I asked Professor Linda De Castigar to do, who has a panel of a paediatrician, obstetrician, midwife, a range of specialisms in this field? I've asked her to engage with those clinicians, particularly around that concern between what seems to be a gulf between the numbers that clinicians are suggesting will be giving birth in Rhaigmore versus the numbers in the draft business plan by NHS Highlands. In terms of his concern about scrapping Model 4, his suggestion of scrapping Model 4, if I did that and if I do that, then we will not have those additional prenatal and anti-natal care at Dr Gray's and the type of scales that are being suggested by a grampiant in Highland, but also what we wouldn't have is the ability for Murray mothers to be able to give birth closer or many Murray mothers to be able to give other Murray mothers, if Douglas Ross just listens. I promise him that I will meet him if he wishes after this as opposed to him shouting from a sedentary position. What it will allow more Murray mothers to do is give birth closer to home in Rhaigmore in the intervening period as we get Model 6 up and running because I'm certain that Douglas Ross appreciates, I hope he appreciates the reality that getting Model 6 up and running, which I'm committed to, to give a cast iron guarantee that we want to get there, is going to take time. He's shouting again from a sedentary position when, as he listened to my statement, he would have heard that I said that the joint plan for Model 6 is due to me at the end of December and I plan to give an update to Parliament then. I'm more than happy, again, given that Douglas Ross continues to shout from a sedentary position. If he wishes to raise these issues with me directly given the lack of time or the constraints of time in this chamber, I'm happy to meet him separately if he wishes. Thank you, Presiding Officer, and I thank the cabinet secretary for prior sight of the statement. My constituents in Murray are extremely concerned that Model 4 is unsafe and it is at best a distraction from delivering Model 6, and at worst it could become the permanent solution. Those concerns are backed up by the clinicians in Rhaigmore hospital who tell us that the service in Rhaigmore is currently unsafe and can't take an additional 190 patients far less than 650 to 900. The gulf in those numbers is because the Government's estimation is based on UK-wide figures, not on remote rural figures, which demand a more risk-averse approach given the distances that patients will have to travel in on an emergency. Cabinet secretary is saying that he hears those concerns but he really hasn't in the statement given any indication as to how they will be resolved. He will have a plan at the end of December, but can I ask for the detail of how and more importantly when Model 6 will be delivered, not just the plan? I can't tell you when Model 6 will be delivered because obviously I have to wait for the detail of the plan that comes to me in December, then I'm happy to update Parliament around how long Model 6 will take. I, like everybody, if I could have Model 6 in place yesterday, I would have done that, and we would have done that, because I have an absolute commitment to return a consultant-led maternity care to doctor grades, no ifs, no buts, no maybes, no possibilities, and that is the final destination. What we're doing is working back from that final destination. What I would say, and I should have said this in reference to Douglas Ross's question, is that Covid will impact delivery timescales. I can't get away from that. In fact, since the independent review was published in December last year, of course we had the Omicron wave, we've had the BA2 wave, the BA45 wave, so there will be impacts, but I promise that there's no shortage of, certainly for me, pace and urgency to get a Model 6 delivered. In terms of Rhoda Grant's question, I'm happy to reiterate what I said in my statement that I acknowledge the concerns that are there from clinicians. I don't dismiss them by any stretch of the imagination, and that's why I've asked Professor Linda Dicasteker, who's leading the external assurance piece of work, to report back to me next month. I think that I said that in my statement, report back to me next month with her initial advice, her initial I hope assurance, giving me assurance and reassurance around those concerns that have been raised by clinicians. I will respond back to clinicians in very short order, but I'm happy once I get that piece of external advice from Linda Dicasteker to update members who speak in the chamber today. To ask the Scottish Government how it will continue to keep the invaluable voices and lived experience of the women and families of Murray central to its decision making going forward. I can be brief in saying that that will absolutely be part of the engagement going forward, not just from me, so yesterday I met with other groups like Murray and Banff MVP, and I've met with a number of local elected members, and I'll continue to do that. I will say that it's not just about my engagement, although I will certainly pledge to continue that engagement. I've asked that the external assurance lead to those conversations, but my absolute expectation is that the health board also continues to engage with those local campaign groups. They will be absolutely central to the process, however long it may take. Edward Mountain, people of Biodynical. Thank you, Presiding Officer. I've met twice with the maternity team at Regmore, and I listened to them. I actually really listened to them Cabinet Secretary, and they're worried about the safety of mothers and babies. Cabinet Secretary, the £5 million promised to Regmore will rectify some of the 15 years of under-investment, but it won't even buy one extra bed space. The cost for providing extra beds and additional staff for Murray Mums might be double that or even more. Will the Scottish Government guarantee to provide whatever funds are required and get staff in place before, and I mean before, Cabinet Secretary, approving a move to option 4? I also listen and hear the concerns of clinicians. I'm noticing from the Conservatives that they're shouting often from a sedentary position if they want to have further meetings. I'm more than happy to do so, but I think that we should treat this issue with the seriousness and the respect that it deserves. If Edward Mountain had read the NHS Highland draft business plan, he would have seen an important and crucial line that says that it's understood that further investment will be required for an alongside maternity unit, or Inverness-based community midwifery unit, which will require additional capital investment. I can only make progress in the statement if the Conservatives don't barric from a sedentary position. If he lets me read what that report says, it says that it will require additional capital investment along with revenue that will be needed to be encompassed within our current capital allocation. Of course, we'll continue to work with NHS Highland around the revenue and capital that is required, but that has been acknowledged already if Mr Mountain goes back and looks at the draft business plan. To ask the Scottish Government how NHS Grampian aims to cultivate a positive and supportive workplace culture at Dr Gray's and its other sites. That is crucially important. We are not going to make progress to that final destination of model six unless we take staff with us, the clinicians as well as the local community alongside us. NHS Grampian prioritises engagement with staff and has undertaken detailed work to understand how colleagues are currently experiencing NHS Grampian. It has a very active culture collaborative group, including colleagues from Dr Gray's, to promote best practice in developing a positive workplace culture. In addition, I have been told and given assurances that there is extensive staff engagement at Dr Gray's hospital right now to co-produce the new strategic intent for Dr Gray's, including development of the maternity services that have been discussed today. Women in Murray are being let down by a lack of services close to home, but they are also being let down by the Government's sheer inability to properly value our NHS workforce and fill vacancies across the country, particularly in rural communities. It is clear that Scotland needs a women's health campaign to lead and push on issues such as those. The First Minister told the chamber in June that the appointment would be made in the summer. The women's health minister told me in early September that the appointment process was almost complete. Can the cabinet secretary finally tell the chamber when Scotland will have a women's health campaign and show women in Murray and across Scotland through action rather than words that the Government is actually listening and taking its concerns seriously? I disagree with Karen Walker, who I respect very much, slightly and actually quite vigorously on this point, that we do value the NHS workforce and we do not just talk the talk on that, we put our money where our mouth is. That is seen by the latest pay-off or the final pay-off that we have put in the table for NHS staff, which is almost half a billion pounds, ensuring that NHS Scotland staff remain the best paid compared to anywhere else in the UK. I hope that that offer is accepted by our respect that trade unions will go through their democratic processes in that respect. In terms of the women's health champion, yes, she is right that it was due to be announced in summer, but it is so important that we get the right person for the role. Therefore, due to a variety of factors, as Karen Walker is outlining, there has been a delay but people are looking to make that announcement about women's health champion eminently. The consultants and staff at the maternity units in Rhaig Mawr's concerns are essentially that the business case prepared by NHS Highland Management fails to address very obvious issues such as underestimating the number of patients that would come from Murray, such as making no provision for decant in the proposed refurbishment of the existing maternity unit. It is surprising, cabinet secretary, that the issues of fact seem not to have been resolved and unfortunate to say the least. Therefore, can I ask the cabinet secretary, will Linda Dacascar, in her work meet with the consultants and staff, give enough time to them to listen extremely carefully to their side of the case, because without that, I fear that it will not be possible to guarantee safety, which is something that you have said is a sine qua non of going ahead with model 4. In short, yes, yes, Linda Dacascar. Well, it is why I have asked Linda Dacascar to look at the concerns that have been raised with me in that open letter from clinicians, and it is why I have not come to this chamber to say that I give final approval to model 4 plans. I could not do that in good conscience, because concerns have been raised, and therefore it is really important when those clinical concerns are raised that we ask other clinicians, as part of the external assurance process, to investigate those claims and come back and provide me with initial advice. When I get that initial advice, once I am able to analyse that and read through it and give it some detailed consideration, of course, we will ensure that Parliament continues to be updated. I thank the cabinet secretary for his statement. It is clear that considerable effort has been put into finding a workable solution to improve maternity care for women in Murray, but I am aware that until model 6 is up and running, women in Murray still have real and valid concerns about their care at such a crucial time in their lives. What support will be in place to help women to make informed independent choices about their birth plan, even though options may be limited until model 6 is fully operational? I have tended to agree with almost every member of the Scottish Parliament here that the situation that Murray women face at the moment is far from ideal. There is nobody in here, not from the Government, not from, I suspect, any political party here suggesting that we have an ideal situation and that we have the safest situation that we would all want to see for our own families or for ourselves if we are able to give birth. I want to give an absolute assurance that any model that we implement going forward and absolutely committed to model 6 as the final destination will have to be done safely. The issue about C-sections was referenced already to me. The reasons why we have not included C-sections within model 4 is because we are told by clinicians that that would be unsafe to do so, because even a so-called low-risk elective section could turn into a high-risk one very quickly, and therefore you have to have the appropriate facilities if somebody hemorrhages and you need to give a blood transfusion, etc. I want to give an absolute assurance to Ariane Burgess, if I can, that certainly for any woman who accesses information, support and care at Dr Gray's, certainly the feedback that I get is very, very positive in terms of the information that they are given, the informed choices that they are then able to make, but be in no doubt whatsoever. Does nobody in the Government, myself of course included, who thinks that the situation for women in Murray currently is ideal far from it? We have just over two minutes and three colleagues who still want to ask questions, so I am going to have to ask them for the questions and also the answers to be more brief. Stephanie Callaghan to be followed by Jamie Halcro Johnston. To ask the Scottish Government how NHS Grampian will adopt robust clinical governance arrangements within the maternity service that fulfil the requirements of the clinical and care governance framework. Well NHS Grampian, they do have a clinical governance committee in place and its role is to oversee quality and clinical governance for the board and ensure that quality standards are being set, that they are being met and of course continually improved in appropriate areas of clinical activity and that effective arrangements for supporting, monitoring and reporting on quality and clinical governance are in place right across NHS Grampian. Jamie Halcro Johnston to be followed by Gillian Martin. Thank you. Families in Murray have at least received an independent review into maternity services and this is something that patients in Caithness have been calling for in their area since 2016 in response to similarly unacceptable circumstances that have prevailed there. So can the cabinet secretary outline whether an independent review into maternity services in Caithness will be commissioned by the Government and if not, why not? I am sure that Mr Halcro Johnston is well aware that I met the local and can-brain group chat in Caithness and in fairness. I think that we both found the meeting a very constructive one. In fact, we have already started some conversations around how we can make improvements to the services provided for women and their families in Caithness. In response to his direct question, he will know that the best start north review was paused due to the pandemic, that encompassed a number of health boards in the north, Highlands and indeed including NHS Orkney 2 in that conversation. That work is now resumed and that will include of course looking at the issue around maternity in Caithness. In the north-east we have been struggling with staff vacancies for considerable times. So my question is about targeted support for increased recruitment and retention from medical staff to money and a cross-grampion to ensure a robust service, particularly in midwifery and obstetrics, as we move to model 6. Is a concern that I have that we just do not have those people in place even at the moment? Is that enhanced provision that has been looked at, what are we doing to target support? Gillian Martin raised with me by my colleague Richard Lochhead, who is unable to be here because he is at an STUC meeting with the First Minister yesterday. The assurance that I gave to him and I gave to Gillian Martin today is that I recognise that national and local actions will be needed to address those local staffing challenges. I have asked both Highlands and Grampians to share their recruitment plans to meet the 2023 deadline in the model for plans. So there is extensive work under way. I am happy to write in more detail to Gillian Martin given the time constraints about what is happening in relation to recruitment, but it is going to be a crucial part of those model for plans and, of course, crucially part of those model 6 plans in the future too. That concludes the site of the business. There will be a brief pause to allow the front benches to change before we move to the next site of the business.