 The next item of business is a statement by Humza Yousaf on the independent review of Murray maternity services. The cabinet secretary will take questions at the end of his statement, so there should be no interventions or interruptions. I call on Humza Yousaf for around 10 minutes, cabinet secretary. I am delighted to be able to update Parliament and members on the action that will be taken following the publication of the independent review of maternity services in Murray and, namely, our next steps for the reintroduction of consultant-led maternity services at Dr Gray's hospital in Elgar. I am currently considering the 37 recommendations in greater detail and I want to take the time to do this, primarily in discussions with NHS Grampian and NHS Highland, but, importantly, local people, the local community, including, of course, elected representatives. At this stage, it is important to say that the Government has not ruled out any of the options presented. Members will be aware that I have been committed to the reinstatement of consultant-led maternity services in a safe and sustainable way. That is a commitment that was reiterated as part of our manifesto. Members will recall the members' debate from Douglas Ross on this very topic back in June. I very much welcome this much-anticipated report. In particular, I welcome the thorough and consultative approach that the review team took. I met Ralph Roberts, the chief executive of NHS Borders, who led the review on Friday. He told me that around 300 individuals contributed their views and the team held nearly 50 evidence sessions. The outputs of those discussions are very evident throughout the report. I would like to give my thanks to Mr Roberts to the review team for the thorough and substantial report that they have produced. I would also like to thank the members of staff and professionals from across NHS Grampian, NHS Highland and the wider Scottish Health Service for their contributions. In particular, and most importantly, as I say, I would like to thank the local representatives as well. Most importantly, the women, the families who have shared their views and their own experiences without them in this report would not have been as impactful and powerful. This afternoon, I will speak to the report, but I am keen not to pre-empt any final decisions that I will make in this regard. I will then say a bit more about the immediate actions that have already begun and, of course, I will touch upon the medium and long-term issues, which I know are of great importance. I am heartened by the response to the report thus far, with both NHS Grampian and Highland welcoming the report and signalling their intention to work together and with the Scottish Government to work through the challenges for any implementation of the recommendations. Keep Mum, who led the campaign and continued to lead the campaign from its energy services, has also responded fairly and positively. She welcomed that the voices of women and their families have been heard in the report. I know that people need to have time to digest and consider the findings, and they are waiting for a strong signal from the Government about the next steps and implementation. When we appointed Ray Roberts to chair the review in March of this year, we asked the review team to work with NHS Grampian and NHS Highland and stakeholders with an interest in local maternity services to explore the best obstetric model that will provide safe, deliverable, sustainable and, indeed, a high-quality maternity service for the women and families of Murray, in line with the Scottish Government's ambition that is described in the best start at a five-year plan for maternity and neonatal care. For those who have had the opportunity to read this extensive report, I am sure that you will agree that it is comprehensive, but it is also very grounded in pragmatic and realistic. That is not the first report that I know into maternity services at Dr Gray's in recent years, and it is very important that we acknowledge the work that is already under way in NHS Grampian again through the best start North programme to look at maternity services across the whole of the north of Scotland. As I say, what I would like to do this afternoon is set out how we intend to move forward with the immediate and short term, but I will touch upon the medium and long term as well. The report itself sets out a preferred approach. It has a detailed plan on how that could be taken forward, but the report also has a number of supporting recommendations, namely on existing service provision. The report highlights actions that will support the safe reintroduction of elective C-sections at Dr Gray's. On culture, it talks of a cross-site working for staff in the commissioning of a cultural safety programme. It demands leadership from not just the board but also from the Scottish Government. On workforce and recruitment, which we know is absolutely key and has been a challenge to sustainability in the long term, it makes important recommendations. We are already making inroads through our implementation of the best start, our forward plan for maternity and neonatal services. Clearly, I recognise that further work here absolutely remains. Finally, on infrastructure, I would like to commit here. Today, we will work closely with both NHS Grampian and Highland to secure the future of Dr Gray's hospital and will invest in its future development in whatever form that takes. I want to pause just for a moment to reflect on the fact that NHS staff in maternity and neonatal services—like all NHS staff, of course—have continued to provide high-quality maternity and neonatal services each and every day for the past 20 months. I want to pay tribute to their on-going hard work and thank them for their dedication, their resilience and determinations in the face of a global pandemic. Moving on to the immediate actions that we intend to take in relation to maternity services, Dr Gray's. I was able to meet both NHS Grampian and Highland briefly this morning, and they have expressed to me certainly their determination and commitment to take forward the recommendations in the review. I have made arrangements to travel to Moray in less than a fortnight in the 20th of December to meet with local people, including local campaign groups such as Keat Mum, clinicians and elected representatives, and the health boards again to discuss the report recommendations with them. My office, if it has not already sent out invitations, will be sending out invitations to interested parties by the closer play today. Douglas Ross tells me that that date is also his wife, Crystal's birthday. I am sure that she will be delighted that he has chosen to spend it with me, as opposed to her. We will work at pace with NHS Grampian to look at what is possible in the short term, including the rapid reintroduction of elective Caesarean sections. That will quickly double the number of women who can deliver at Dr Gray's up to 40 per cent, around 400 births per year. However, I have heard the comments from my colleagues, including Richard Lochhead, who will not be surprised continually and often asks me and brings forward issues around Dr Gray's that that still means that the majority of women will not be giving birth in Moray. Therefore, we have to look at the medium in the long term, which is an issue that was raised in the parliamentary debate here in June. Those discussions will obviously have to include NHS Highland. Also recognising the report highlights the critical role of Rhaig Mawr, a choice for women to deliver their babies when the maternity unit has been improved and expanded. However, I want to be clear for this to be sustainable. There are a number of relevant actions that first need to take place. I know that we have previously tried to implement this model, but it quickly became unsustainable, quickly became undone. I am determined to ensure that we have the relevant infrastructure to support change prior to any implementation, which brings me on to the medium in longer-term recommendations in the report, particularly model 5, the development of a midwife-led consultant-supported unit that would be located in Dr Gray's hospital in Elgin. That is an option that I was pleased to see supported by the Keep Mum campaign group in the recent response to the report. Under the model, consultant-supported births, including emergency sea sections and instrumental deliveries, would allow up to 70 per cent of Murray women to deliver their babies in the local community. The report highlights some of the challenges and preconditions for the model, and they cannot be ignored. The model is set within the wider context of a vision for future development of Dr Gray's, which will require a clear strategic plan for the hospital, and serious practical and financial consideration will need to be worked through to support such a change. That brings me back to the commitment to reinstate consultant-led maternity in a safe and sustainable way. We want to deliver that commitment quickly, safely and sustainably, and I fully expect that models 4 and 5 will allow us to return to consultant maternity services to Dr Gray's in such a way. We will have to do that, without a shadow of a doubt, in concert and consultation with the local community, local clinicians and local representatives and health boards. It will have to be done in a way that is open and transparent from the Government about the challenges, but I hope that the community will see that we will also work on that with PACE. I could talk at length on the report, given how extensive it is, but my focus now, as I have said, is to meet local people to discuss the findings and get on with the action. I give them absolute commitment that we will not waste any time or that there will certainly not be a lack of PACE or urgency in relation to taking forward and driving forward our work to restore consultant-led maternity services to Dr Gray's. The cabinet secretary will now take questions on the issues raised in his statement. I intend to allow 20 minutes after which we will have to move on to the next item of business. As any member wishes to ask a question, he should press the request-to-speak buttons now as soon as possible or place an R in the chat function. I start by calling Douglas Ross. I also want to acknowledge the work of Ralph Roberts and his review team, but in particular I want to thank the women, the families and the staff in Murray who shared their experiences. The staff at both Dr Gray's and Aberdeen, I know through personal experience, are the very best we could hope for in our area, and throughout their report they are rightly commended by everyone for everything they do. First and foremost though, the review said that the status quo was promptly considered to be inappropriate. It goes on to say about the current model that both Professor Cameron in his report and the review group believe that there are potential risks to patient safety. So I have to ask the cabinet secretary why we have been living with this model in Murray now for over three years. Does he believe that the staffing and capacity can be found at Redmore to take hundreds of additional women from Murray each year, given that the numbers transferred to Inverness has actually fallen every year since our maternity unit was downgraded and was just 16 last year? I welcome that elective Caesareans will return, but does the cabinet secretary believe that the induction of labour at Dr Gray's should also be made available if possible? Finally, will an action plan with key milestones be provided once he has looked through the recommendation so that everyone locally can keep up to date with the progress or otherwise being made? I just wanted to finish by saying that my hope is for as many women in Murray to give birth locally. As a family, we are blessed with two great boys, but they were both born in very different circumstances. Alice came into this world at Dr Gray's, and after a few days of great care and support, we travelled just a few miles home with her newborn. With James, it was a different scenario. As Crystal's labour progressed, his heart rate started to dip every time she had contractions, and for someone to be on a green pathway right up to that point, it brought me to hear that. I tried to be strong for her because I knew that it was stressful for Crystal as well. To then see your wife taking in a trolley through hospital, strapped into the back of an ambulance and then taken through to Aberdeen, it was one of the worst experiences that I have ever faced. At that moment, you feel utterly helpless at the time your wife and unborn child need you most. I just say this because, whether it is 40 miles to Inverness or 65 miles to Aberdeen, that journey adds stress, anxiety and worry at an already emotional time. I just hope across Parliament that we can agree to do everything possible to maximise the number of women able to give birth in Murray and do everything possible to minimise those who have to leave our area to have their children. I thank Douglas Ross for his questions and I speak to him first as a father, as opposed to as the health secretary, that I would have hated to be in the position that he was in. When my wife gave birth to our daughter a mile, she was already in a high-risk pathway. We had unfortunately misguided a number of times before that, and my daughter was transverse and therefore not in the right position. She decided just for fun to arrive three weeks early. We were only 20 minutes away from the hospital that we had to be at, but I recognise his feelings and emotions around being helpless, let alone having to drive for the period of time on the back of an ambulance that his wife had to be transported in the back of an ambulance. As a father, as opposed to the health secretary, let me say just how unacceptable I find that entire situation. That is the question that Douglas Ross asked me. He said, do I find it acceptable that we have had this model for the last three years? I do not find it acceptable. He is right on behalf of his constituents to be upset, angry and frustrated. That is why I say that I have no issues with him characterising that and the current situation in that way. That is why I have also been impressed, I have to say, by the cross-party campaign that has been there, as I say. My colleague Richard Lockhead, who was one of the first to phone me on Friday when the report was published to understand and to put his concerns as a local MSP, not as a Government minister but as a local MSP, put the concerns of his constituents forward to me. Douglas Ross has done exceptionally well to raise his issue in our Parliament, and I want to pay my tribute to that cross-party campaign. On a specific question about Regmore, I ask that very question to Pam Dudeck, to Boyd Roberts and the team at NHS Highland. He will know that Regmore is going under significant development and we have promised to invest in that development. I absolutely believe that the additional women who may have to go to Regmore have the capacity to be able to deal with that, but I will give him further assurances in and around that. On a question about induction-led labour, I would say that it is really important for me to be able to go up to Murray, to go on to Dr Gray's and to be able to speak to the clinicians. I am not a clinician, and therefore it is not for me to be able to say what can be done safely. What I want to be able to say to Douglas Ross and to the community that is watching, we want that consultant-led maternity service there in Dr Gray's. We want as many women as is safe as possible to give birth at Dr Gray's. We will do that with urgency and pace, but we also have to recognise the significant workforce challenges that exist. That is why I think that Douglas Ross's last point, which I will end on, is really important, that there has to be an implementation plan, clear milestones. However, I will be upfront and realistic about that. Members might not always like the timescales and the might challenges that tell us to go even faster. That is their prerogative, and so may the local community. However, I will be upfront about the milestones and the implementation. At the next stage is our visit to Murray, to speak to local community, local clinicians and elective representatives. I would hope that, early in the new year, we will come forward with further detail of the recommendations that we are taking forward and an implementation plan to follow. I welcome the statement from the minister in its positive to see progress on this issue. Progress led indeed by Ralph Roberts, the chief executive of NHS Borders, from my own region. I thank him and the review team for their work alongside the hard work of local campaign groups who have pushed the issue forward. Despite the progress that is detailed in the statement, can you offer some clarity about what will be done to solve the underlying issues, which is, as is in many other parts of the country, a lack of staff? There are 365 whole-time equivalent nurse and midwifery vacancies in NHS Highland and 465 such vacancies in NHS Grampiam. There is on top of that a known lack of paediatricians. The statement today barely addresses this. What can be done about this? I think that the fair challenge goes to the crux of the issue that NHS Grampiam Highland spoke to me about today. However, plans are under way by the health board already to increase recruitment in both health boards. However, that is the crux of the issue. That is why I have to be realistic. It would have been unrealistic of Ralph Roberts' report to suggest that Model 5 could be implemented within a few months or even within a year, because there is no way to get the workforce to be able to do that. Of course, there are infrastructure issues with the model that we have to develop. I can give Carol Mawkin an absolute assurance and to the campaigners, who I know will certainly be watching today's statement, that we understand that workforce and the infrastructure at the hospital are two key issues that we have to demonstrate—not just progress on but investment—and I have already given a commitment that we will invest in both those aspects. I want to thank the cabinet secretary for that comprehensive report. First, I want to thank the people who have come forward with lived experience and shared those experiences, which must have been quite distressing for them, but I have pushed for action on that. I am also glad to hear that there will be on-going conversations with them. My question is a reflection of Carol Mawkins. It was really asking the cabinet secretary to outline the action that the Scottish Government has taken to increase the number of appropriately trained clinical staff. As he has answered in part, I was just wondering whether that would also be in terms of including Dr Gray's but as well as other rural healthcare centres. In short, I know that there are a number of issues that have been raised by members right across the country, particularly in remote rural and island areas about workforce retention, recruitment and retention. Therefore, we are working with those health boards. We understand the unique challenges that are there and, already, we have seen an increase in the workforce in some aspects, but on that particular issue around Dr Gray's, we have to tackle that workforce challenge that is the crux of the issue, as well as the infrastructure, which is the slightly easier part that we can invest in infrastructure and build and so on. However, the workforce challenge is far more difficult, and that is why we have to make sure that there is a sustained effort for consultant-led maternity services in Murray. Thank you, Presiding Officer. One of the preferred options for Murray is for a midwife-led service such as Cathness. The result in Cathness is less babies than ever before being born there, with only about 20 to 30 per cent of all far-north births happening in Cathness. What work will the Scottish Government commission to assess if NHS Highland can truly take on the additional work without disadvantaging their catchment patients and what the additional costs will be and who will fund these? That is all part of the discussions that are taking place. When my discussions with Rayford Roberts on Friday, he said to me that there is no doubt that people will make comparisons to the situation in Cathness and what is happening to Dr Gray's. I can understand why that is done or why the interdependency and interactions are mentioned. We are talking about two different scenarios, but the impact that the models and recommendations in Rayford Roberts' review on what impact they would have in other rural health settings is a very fair question for Edward Mountain to ask. I promise him that our conversations will be focused not just on Dr Gray's but also on some of the other rural health sites that may well potentially be impacted by any decisions that are made in relation to the review. I am more than happy if he wishes to be part of the conversations in this regard to take forward those discussions with Edward Mountain. It is very welcome that the independent review focused on listening to the women, families and service users in Murray, as well as the staff involved in delivering the services. The cabinet secretary has outlined some of the steps that the Scottish Government has taken to ensure continued stakeholder engagement. Does the cabinet secretary accept that mothers in rural areas must have the choice of having their maternity care close to where they live for so many reasons, not least their mental health? Can he give me assurances that their views will continue to be taken into account as decisions are made going forward? I fundamentally agree with that point, and I spoke to Douglas Ross in my own experience of that. I was very lucky and very blessed that I had the hospital where my wife gave birth—as I said, literally 15 or 20 minutes away—from our own home. It is a fundamental recommendation of the best start policy that women have care delivered as close to home as possible, but that has to be balanced. I know that every member understands that, but it has to be balanced in relation to the safety of both the mother and the baby, as well. The introduction of near me across the NHS has allowed many women to access care in the local area, when they may have previously had to travel to big urban centres. In addition, the development of community hubs and community teams under best start will provide as much anti-natal and post-natal care in the community as possible. Ultimately, Gillian Martin is right that having that care and being able to deliver your baby to give birth as close to home as possible is certainly an ambition of this Government. I welcome the review, but I feel for families who are rightly frustrated by delays. Therefore, it would be good to have a clear indication of the time frame for the restoration of home maternity services Dr Gray's. In the meantime, what support is available to families who have to travel to Aberdeenor, Inverness or maternity services by way of accommodation and by way of child minding for their families? Those are all very fair points. For me, I completely accept the desire of the local community and other stakeholders to have an interest in this matter to see a detailed implementation plan from the Government, so we will do that. As I have said a number of times in this chamber already, the first instance that I would like to meet with the local community, and I include local representatives. If I have not invited you and you are a local elected member, and you would like to be part of the discussions, please get in touch with my office. I have no issues with inviting whoever to that conversation. Then, of course, we will give detail of the recommendations that we are seeking to take forward. Alongside that, we will look to plan, bring forward an implementation plan with key milestones. Ray Robertson's review goes into the detail of those timescales that he thinks will be involved. You can imagine, as Cabinet Secretary for Health and Sport, that I want to try to push those as much as I can with pace. On Rhoda Grant's second point about what support is available for women and families who may have to travel to Aberdeenor or to Rhaigmore, I will look into that. If we can do anything further on that, I would be very open to that. Again, it is a fair request, particularly if there are accommodation costs and travel costs that are involved. I can look into that matter offline. We have five minutes and five speakers, so I think that there are questions and responses as far as possible. First, Emma Roddick, to be followed by Ariane Burgess. Thank you, Presiding Officer. The delivery of those recommendations within the timescale set-out will, of course, take time and critically dedication by all those involved. Can the cabinet secretary give an update on discussions with NHS Grampian to ensure that the board has a full leadership team in place in a timely manner? To be brief, I had a discussion with the health board this morning. I will meet with him again, as you would imagine, on 20 December. I can assure Emma Roddick that the points that she raises are very much part of the discussion that we are having. Of course, the health board's input into that will be of vital importance as we progress those actions. The independent review found that maternity services are key to the wider economic and community wellbeing of the population, so it is vital that Dr Gray's hospital is supported to improve its ability to provide high-quality maternity care for local families in Murray. That review is not the first. The 2019 Allen Cameron report found that working relationships in the Dr Gray's maternity service were dysfunctional and damaged to the extent that they may impact upon patient safety. I would like to ask the cabinet secretary whether the Scottish Government is supporting Dr Gray's to implement the recommendations from that review, particularly the recommendation to develop a full package of support for all staff who have been adversely affected by the issues within the Dr Gray's maternity service, so that those recommendations do not get lost as work to implement the new recommendations begins? Yes, in short, we will not ignore previous recommendations, but I am sure that Ms Burgess has done that, but there is a fair bit of detail on culture within Ray Roberts' report. Of course, we will take forward those recommendations to it. Over the course of the pandemic, we have seen the benefits that services such as near me that the cabinet secretary mentioned a short time ago can deliver to reduce the need for in-person appointments. Can the cabinet secretary outline what role he envisages such technology may have in the delivery of services in Murray going forward? Just to be brief, as part of my previous answer to the previous question that I mentioned, near me, I think that technology absolutely has a role to play in possible anti-natal care, post-natal care as well, but that does not detract. We should be very clear about that. It does not detract from the desire of women, families and the local community to give birth as close to home as possible. Technology is absolutely a great enabler, but that does not take away from the desire of women and families to give birth as close to home as possible, which is what we want to progress through this report. In the interests of brevity, I ask the cabinet secretary, given the number of patient transfers that have had to be conducted, sometimes on short notice to either Regmore or Aberdeen, what impact does he think that the on-going problems have had on an already overstretched ambulance service in the Highlands and Islands? I suspect that it does not help, which is the obvious answer that I would give to Jamie Halcro Johnston. Certainly, that is part of our consideration about how quickly we can ensure that more births take place at Dr Gray's and, indeed, as close to home as possible for people whether they are in island communities or in remote and rural communities. The recommendation references the importance of culture to quality and safety in any service, and that is not only beneficial to service users but also of equal importance to staff. Can the cabinet secretary give an indication of the work that will be required to progress the delivery of a cultural safety programme? Interesting for brevity and probably better writing to Stephanie Callaghan with the detail of that, but what I would say is that she is right to highlight this, as I said in my response to Ms Burgess, that the extensive report from Ralph Roberts goes into the importance of culture in the workplace, which I think is a vitally important part. We can focus often on the clinical expertise and the infrastructure that is needed to deliver the recommendations within the review, but what I would say is that culture of the workforce and cultural safety, and that is one of the recommendations for Ralph Roberts, is to invest in cultural safety as a programme and certainly a vital part of his report, which I intend to take forward. Thank you very much, cabinet secretary. That concludes this item of business. I will give you a short pause before we start the next item.