 The next item of business is a member's business debate on motion 7538 in the name of Edward Mountain on shortage of radiologists. This debate will be concluded without any question being put, and I would ask those who wish to speak in the debate to press the request to speak buttons now. I call on Edward Mountain to open the debate. Around seven minutes, please, Mr Mountain. Thank you, Presiding Officer. I would like to thank all members who signed this motion, giving the Parliament the chance to debate what I believe is one of the most urgent issues impacting on the standard of patient care across Scotland. I would also like to thank the radiographers and radiologists across Scotland who are shielding the additional burden that the shortfall in their numbers is causing. Especially to those radiologists and radiographers who I have met not only at Rhaig Mawr but in other places and for those who have contacted me from across Scotland asking for help. I want to recall that I believe that by bringing this matter to our attention, you have shown a dedication to your profession and it is now time for us politicians to stand with you to support and to help you. Let us be under no illusion that radiology is the heart of modern medicine. It is an essential part of speedy and accurate diagnosis of many conditions. In so many cases, patients rely on the expert opinion of a radiologist and in some cases, as a radiographer, to help to diagnose their ailments, which then allows for surgical operations to take place. The shortfall in radiologists across Scotland means that diagnosis and operations are delayed and patients are left waiting too long for vital treatment. It also means that radiologists and radiographers are working under intense amounts of pressure. The evidence speaks for itself, I believe. Between 2010 and 2016, the number of scans undertaken has increased by 65 per cent per year, whilst the number of radiologists to read them has increased by 1 per cent a year. What does that mean? Imagine that you are waiting for a scan to be read having been told that you might have lung cancer. Every day, you wait seems like an eternity. You want and you deserve a quick result. It is very frightening and I can tell you personally that it is very hard to bear. This is a problem that is not going away anytime soon, with at least 20 per cent of consultant clinical radiologists expected to retire in the next five years. According to the Royal College of Radiologists, only one out of 20 Scottish health boards are able to meet reporting requirements within staff contracted as. That means an annual bill of nearly £4.5 million on overtime and outsourcing alone in 2015 and 2016. The radiology recruitment crisis is being felt by all across Scotland and perhaps no more so than the people in the Highlands, where imaging examinations have increased by 250 per cent. NHS Highlands is unable to meet reporting targets, with around 8,000 scans that are still waiting to be reviewed. Just how many patients is that waiting to be told what is wrong with them? I can tell you that it is too many. Safety fears have been raised internally by radiologists at Regmore since 2014, when there were 13 of them. Now there are just 7.8 staff members. Two have left in the last six months. Let us hope and pray that two more do not leave in the next six months. Over £300,000 is being spent annually by NHS Highlands to have scans read. How many radiologists and radiographers with this employ? Probably enough to prevent the need to have those scans being read outside the Highlands. Here is another fact. At present, there are only two interventional radiologists at Regmore. Frankly, that is not enough to deal with the problems in the Highlands. It is clear that the radiology team at Regmore is overstretched and understaffed. They are almost below critical mass. Statistically, they are having to do one night on call every week. The publication of the Scottish Government's NHS Highland radiology review cannot come soon enough. The review must identify not only how many radiologists are needed based on current demand but the reasons why they cannot be recruited and why they are not being retained. It must also find solutions that will improve patient care in the short term. This is not a time to hide behind the problem or to use political spin. Delivering an improved service for patients is the number one priority here. The issue is just too important for anything else. I believe that this is about people and not about politics. The Chairman of the Royal College of Radiology's Scottish Committee stated earlier this year that a perfect storm of increased demand, no significant increases in consultant numbers or trainees, chronically unfilled posts and a tsunami of expected retirements in the next three years means that we need a suitable solution now for the sake of our patients. I welcome the Scottish Government's somewhat tardy announcement of an additional £3 million to increase the number of radiology trainees in Scotland by at least 50 in the next five years. It is a pity that this was not done three years ago, so the current situation could have been avoided. However, I have to ask the cabinet secretary how many of those will be coming to the Highland because they are sorely needed. It is a step in the right direction, but it will take time to filter through to the front line. Radiologists across Scotland must be recognised and praised for their dedication to their patients at a time when they are struggling under an increased workload. Finally, let me be clear that Highlanders are sceptical about losing local hospital and medical services, whether they are in Portrey, Thurso, Wick, Rase, Golsby or Straspe and seeing them centralised in Rhegmore. Now they will be even more concerned, and rightly so when they hear that there are insufficient staff at Rhegmore to provide the services that they are losing because of staff shortages in their hospital. It is time for the Scottish Government to match the dedication of radiologists and radiographers across Scotland. I hope that we can do more to resolve the crisis. I look forward to hearing the other speeches this evening. I move to the open debate. Speeches of four minutes, please. I have Kate Forbes, followed by Jamie Halcro Johnston. I apologise to you and to other members in advance that due to a long-standing commitment I cannot settle the very end of this debate. It is standard practice to thank members for proposing a debate. I want to thank Edward Mountain for this evening's debate. Last week, I was speaking at a school when a child asked me how I got on with regional members for the Highlands. My response was that there is a pile of work to do in the Highlands and Islands, and we will make more meaningful progress if our United Aims is to serve the Highlands and Islands. I am pleased that Edward Mountain references the commitment of NHS employees in his motion. I know first-hand and many of us will know first-hand that nurses, doctors and other healthcare staff do a power of work for our patients. Having seen what our nurses do in particular from the vantage point of having been a patient and being related or friendly with staff, they deserve our continual and authentic praise. The challenge for managers and decision makers like us is to make sure that they are as well supported as possible. That brings me to the subject matter before us this evening. It is, of course, a very timely debate. I do not know if it was an intentional timing to come immediately after the Royal College of Radiologists welcomed a statement from the Scottish Government and commended the Scottish Government's efforts to resolve the challenges that we all accept are facing in terms of radiology services. Last week, the Health Secretary, Shona Robison, announced an additional £3 million to increase the number of radiology trainees in Scotland by at least 50 over the next five years. That is absolutely the right thing to do, because the number of radiology trainees in Scotland as a proportion to the number of consultants compared to other hospital medical specialities is one of the lowest proportions. There is particular work to do in terms of getting trainees interested in choosing radiology and then going on to train as consultants. Of course, it takes years. That is why long-term funding is critical. It is a case of looking to the next five years, 10 years, 20 years and 30 years to make sure that we are not revisiting those debates and that, in five years' time, we can look at the power of work that has gone on and be commending the staff for what they are doing. Edward Mountain mentioned the unique situation in the Highlands. Of course, there has been an increase of consultant radiologists everywhere in Scotland except the Highlands. That demonstrates to me that it is not just a simple matter of throwing money at something. We know fine well that, when it comes to recruitment, there are unique and special challenges in the Highlands that will take more than hard cash to solve. It is about ensuring that there is key housing available in the right places. It is about ensuring that consultants are able to access continuing professional development and linking them up with hospitals elsewhere. Critically—this is something that is not often talked about—it is about offering opportunities to work in rural areas for trainees early on in their careers. The number of various different colleges that have told me that, if they are able to include rural modules for one-of-a-better-word or traineeships early on in somebody's career, they are actually more likely to come back. As an add-on to that, if we could get more youngsters, more pupils from Highlands high schools choosing to go and train as consultants in all different disciplines, they too are more likely to come back to the Highlands. It is a bigger issue than just throwing money at something, but clearly we need to solve the long-term funding. Just very briefly, 20 per cent—one in five consultant radiologists—are from outside the UK who work in Scotland. Putting in place more stringent visa requirements and deporting people is not going to help. We need to make sure that Scotland is an attractive proposition, making it easier to recruit. On that note, I will stop. I have Jamie Halcro Johnston to be followed by Fulton MacGregor. I congratulate my colleague Edward Mountain on securing this important debate. In June 2017, 86.9 per cent of patients across Scotland urgently referred with suspected cancer began treatment within the 62-day target time, significantly below the target of 95 per cent. In NHS Grampian, which covers part of my Highlands and Highlands region, that figure is even lower, at only 82.3 per cent. That figure is in part due to delays in diagnostic services such as radiology. That is hardly surprising, given that NHS Grampian saw a decrease in the number of whole-time equivalent consultant radiologists per 100,000 people between 2014 and 2015, compounding the problem that the region already has one of the fewest radiologists serving its population in Scotland. It is not just radiology services, and it is not just in the Highlands. Health services across Scotland are increasingly under pressure. Patients are facing increasing delays to services. The Audit Scotland report on workforce planning from July pointed to a whole range of specialities where consultant vacancies—vacancy rates—are similar to radiology. That is not talking the NHS down. None of this is criticism of the hard-working staff in our NHS. They are being let down by those higher up, and a Scottish Government that is getting workforce planning wrong across Scotland. In August, I was contacted by a constituent in Murray, who, having been diagnosed as needing cardiac surgery, had waited since the beginning of the year for treatment. On their behalf, I wrote to both the Cabinet Secretary for Health and to NHS Grampian, their local board. In her reply, the Cabinet Secretary admitted the three-month delay from my constituent surgery was totally unacceptable. In this case, care had, and I quote, fallen well below the level that I would normally expect a board to deliver for their patients. Yet, a month after they had acknowledged that they had received my letter, I am still waiting to hear back from NHS Grampian. My constituent still waits for the surgery that they so desperately need to allow them to get back to their work and to their life. However, the delays are not just affecting constituents in Murray. In Orkney, which has an agreement with NHS Grampian, one constituent has been forced to wait over 10 months for an outpatient clinic. They are still waiting, and they are not alone. The Orkney heart support group has said that they are, and I quote again, aware that patients waiting to see cardiologists are experiencing extended waiting times, often well in excess of the 12-week national limit. They go on to say that we have experienced our concerns to NHS Orkney, and they have acknowledged that there is a problem, but to date have no solution. The situation gets worse. I have now been advised by two different sources that some heart attack victims in Orkney are having to wait in beds in Kirkwall's Balfour hospital for over a week while they wait for a bed to become available in Aberdeen for specialist treatment. If that is the case, delays at NHS Grampian now mean beds being blocked in Orkney and patients. Patients who have suffered heart attacks are forced to wait for treatment. I have written again to NHS Grampian and to the health boards in Orkney and in Shetland to get a fuller picture of the delays, the services, how those are impacting local patients and what is being done to reduce those delays and get patients seen and treated. I again thank Edward Mountain for bringing him this debate to Parliament. I thank the thousands of NHS workers across Scotland who are doing their very best to see and treat patients as soon as they can, but as a Cabinet Secretary and to the Scottish Government, I say this, they must get on top of those delays. NHS services must be properly staffed and properly resourced, and workforce planning is a key part of that. Waiting list targets should not just be aspirations, they are there to be met. I have heard that the issues that are described as a looming crisis, there is nothing looming about it. I thank Edward Mountain for bringing this important issue to the chamber, although I do not necessarily agree with the overall approach that he took, but it is an issue that needs to be raised. In terms of what the Government has done to release some statistics, the number of consultants with speciality in radiology in NHS Scotland has increased by more than 41 per cent to 317 whole-time equivalents in recent years. As Kate Forbes said, it is ironic that this debate has been brought to the chamber today when the health secretary has made announcements last week in relation to £3 million of additional funding to increase the number of radiology trainees. As far as I can tell, that has been very well accepted by the radiologists and those working in the profession. I know that the Scottish Government has also enhanced the supply of doctors to fill radiology training posts with 26 new training places over the past four years, an increase of 20 per cent and with further training places for 2018. In addition, the national radiology implementation programme aims to develop a longer-term vision. I am sure that the cabinet secretary will talk a wee bit more about that, but Edward Mountain raised the point that it is an issue that needs to be addressed. That is why I am glad that the cabinet secretary and the Government have done that. I think that Kate Forbes finished a very important point about the Brexit scenario, which is hanging over everything in UK politics at the moment. I wondered when Edward Mountain said, you know, let's not hide behind politics, I did wonder if he was actually meaning no dimension Brexit, because that is an important barrier and it's going to be difficult to… I've only got four minutes, will I get extra time? I might think about that. I will take the intervention then. I understand the problems around Brexit and it's something that the health committee we've raised, but the problems in our health service didn't start on the 23rd of June. We are here debating this because, after 11 years, we have a crisis in our health service under his Government. I accept the member's point, but what I am saying is that that is why I gave some of the stats of what the Scottish Government has done to address the problem. That's why I started off with that. What I am saying is that, in terms of the Brexit situation, it isn't going to make things easier, it isn't making it easier to attract highly skilled European staff to the country. I think that the Conservatives need to recognise that that is an issue. I am not a Highland MSP and I know that the issues are a wee bit different, but I want to talk about the issues in NHS Lanarkshire. I spoke to Calvin Brown at NHS Lanarkshire today just to get some stats. All three of our major hospitals, Monklands, Hermiles and Wisher, are served by a fully staffed and equipped radiology department. There are approximately 360,000 radiological examinations carried out per annum in NHS Lanarkshire, and each hospital is staffed and equipped for plain radiographs, ultrasound, CTE and MRI scanning. There is a lot of work going on locally in the Beatson, which is based at the Monklands. I had the privilege of visiting that a few months ago and seeing some of the radiograph work that was going on there. Certainly, what I have seen was a staff team that was very enthused. As rightly, Edward Mountain pointed out, enthused about their work and throughout the wider hospital community. In NHS Lanarkshire, there is, over those three hospitals, a 3.3 full-time vacancy shortage. I am assured today that the health board is working extremely hard to fill that gap, and that it is looking at all the different recruitment options. I would like to say thanks to all the radiographers in everybody in our NHS that are working really hard day in, day out, and to keep up the good work. I am happy to accept a motion under rule 8.14.3 that the debate be extended by up to 30 minutes, and I would invite Edward Mountain to move the motion. I move that motion. Thank you. Are we all agreed? The debate is therefore extended. Colin Smyth will be followed by Marie Todd. Thank you, Presiding Officer. Like other members, I thank Edward Mountain for tabling his motion on this important subject and echo the comments of other members in thanking an incredible, hard-pressed NHS staff for all the work that they do. The shortage of radiologists in Scotland is pushing the field to the brink of collapse. Those are not my words, but the words of the Royal College of Radiologists. According to the Royal College, whilst radiology has seen a significant increase in demand, with imaging workloads increasing by 55 per cent between 2010 and 2015, the number of consultant radiologists has increased by just 3 per cent. The most recent figures from the Royal College showed that Scotland had just eight radiologists per 100,000 population compared to an EU average of 12, and the figure for consultants is even more dire at 5.4. Across Scotland, an average of 8 per cent of radiologist posts and 13 per cent of consultancy positions are unfilled at any given time. Interview panels are regularly cancelled due to a lack of suitable candidates, and the Royal College's 2015 survey found that 68 per cent of consultant vacancies advertised initially failed to find anyone suitable. The problem is set to get worse. 19 per cent of current radiology consultants are due to retire within the next five years and as many as 53 per cent by 2030. However, that is only half the story. According to the Royal College, there are significant regional differences, with rural areas typically struggling most. In my own home region of Dumfries and Galloway, half—that is right—half of the consultant radiologist positions are not filled with a permanent member of staff. This recruitment crisis has put in a significant financial burden on our NHS. In 2015, 5.25 million was spent on outsourcing radiology services to the private sector, an increase of 1.75 million from the previous year. Spending on the locoms and private agency staff has spiralled out of control under this Government, increasing by 113 per cent between 2011 and 2015. It is clear that this crisis is also impacting on patient diagnosis and treatment, not least in oncology. Cancer waiting times are the worst they have been for a decade, with 13 per cent of urgently referred patients not receiving specialist cancer treatment within the targeted time. I am sure that the cabinet secretary will tell us today that the Scottish Government has committed to increasing the number of radiology trainees by 50 over the next five years. That is welcome, but not only is this way below the estimated need of 20 to 25 per year suggested by the Royal College of Radiologists, we know that it takes at least five years to train a consultant radiologist. More needs to be done now to mitigate this crisis. I hope that the Government will listen to the proposals from the Royal College of Radiologists, including their call for a sustained programme to recruit more international medical graduates to fill vacant posts, an issue where it seems there has been a lack of engagement by the Government and little progress towards resolving challenges relating to general medical council requirements, visas and NHS human resources. Cancer research has also put forward proposals to increase the number of radiologists in the short term, including making consulting contracts more flexible to minimise early retirement, incentivising radiologists to train and work in health boards such as NHS Highland in Dumfries and Galloway, where shortages are most acute. Embracing a skills mix approach, there is widespread safe use of radiographer reporting, exploring international models for interpreting scans and considering ways to support health boards through artificial intelligence, network solutions and tele-reporting. Ultimately, the solution lies in tackling the acute shortage of staff. Sadly, the recruitment crisis is not confined to radiologists. Ella, today at health and sport questions, I highlighted the recruitment challenges facing NHS Dumfries and Galloway, where they have almost 150 nursing and midwifery vacancies, 26 allied health professional vacancies, 28 consulting vacancies—almost 22 per cent of posts—and 42 per cent of GP practices have a vacant GP post. Presiding Officer, those figures and today's debate has been a dammon indictment of 10 years of abject failure when it comes to NHS workforce planning by this Government. Thank you Presiding Officer. Can I remind the chamber of my work as a clinical pharmacist for NHS Highland prior to my election last year? Sir Edward Mountain identifies a serious issue. Throughout the UK, there is a shortage of consultant radiologists, so imaging departments are having to work incredibly hard to keep up with demand for these services, and I thank them for their hard work in ensuring that quality is maintained in these challenging times. Let's have a look at the context. Demand for radiology has risen steeply in recent years. Why? Rapid advances in technology have meant that imaging can be used at a much earlier stage of the diagnostic process. It is also frequently used to monitor the progress of disease nowadays and to perform image-guided treatment. The ageing population, which, of course, is very welcome, has been another driver of demand. Radiology today is a cornerstone of diagnosis and treatment, and radiologists are at the heart of patient care for almost all clinical specialties. Current and pending retirements within the radiology profession are likely to sharpen the situation in coming years. That is the current UK-wide picture, but those issues are much more pronounced in rural areas such as the Highlands. I can assure you that the situation in Cornwall is every bit as acute as it is in the Highlands. The minimum 15 new training posts that are announced by the Scottish Government, which has been welcomed by the Royal College of Radiologists, will certainly improve the situation in the longer term. I was extremely heartened to see the advice from Nicholas Strickland, president of the Royal College of Medicine, to her colleagues. I quote, "...obviously it is crucial that you all start planning immediately where these trainees will be sent and it might be wise to consider some new rotations specially designed to encourage struggling hospitals to take and nurture trainees in the hope that they will ultimately choose to apply for consultant posts there. It is very clear from the evidence that taking sessions that we have had at the health and sport committee that when folk experience Highland life in their training, they are drawn to come back. It is not just me who thinks that the Highlands is a great place to work and live." That is the long-term solution, but more creative short-term solutions will also be required. One of the reasons that radiologists are such a precious resource is that they take over a decade to train. I can assure you that it is a lot longer than three years and I can assure my colleague on this side of the chamber that it is a lot longer than five years. Those guys are medics first. They do a five-year undergraduate year degree. They do two years postgraduate foundation training and then they do five years specialist training to be radiologists. Local interim is important to recognise the crucial and key role of advanced practitioner and consultant radiographers in imaging departments, but at the same time we really must recognise that there are certain tasks that only radiologists can do. Local interim solutions such as short-term imaging outsourcing and identifying any future in-sourcing capacity using imaging IT networks between hospitals and possibly other health boards could be explored, but those would be options for local management and for health boards. Will I get one moment? Edward Mountain. You raised a very interesting point there. Speak through the chair, please, Mr Mountain. The member raised a very interesting point there about outsourcing. Currently we are spending £4.5 million a year for outsourcing. Much of that is going to extra payments and using private firms to make up the shortfall. Therefore, the £3 million that the cabinet secretary has put forward seems quite light. Would the member agree that it might be better to increase that number so that we can reduce the amount of outsourcing that we need and not continue to spend £4.5 million a year? I think that I have already established that it takes 12 years to train a radiologist. It does not matter. There is not going to be a quick fix without using outsourcing. One possible UK-wide solution that has been suggested by the Royal College of Radiologists is to try to recruit more graduates from abroad to meet our short-term requirements in radiology. As others have mentioned, how easy that option will be with the current UK Government, which has clearly anti-immigration and aims to reduce immigration, I do not know. To begin to take on those challenges, we have to acknowledge that they are complex and that the solutions that will be required will be equally complex. They will require Governments to work with groups such as the Royal College of Radiologists, the Society and College of Radiographers, postgraduate deineries, local health boards and management to achieve a balanced, coherent and sustainable approach to the problem, and to ensure that appropriate workforce planning is in place for services across Scotland and in particular rural areas in future. Miles Briggs, followed by John Finnie. I would like to start by congratulating and commending my colleague Edward Mountain for bringing this debate this evening to Parliament and for the excellent work that he has been doing and undertaking on behalf of his constituents across the Highlands and Islands to highlight this major issue of concern. I thank Cancer Research UK for their useful briefing for today's debate and also pay tribute to the outstanding efforts of all who work within radiology in Scotland's NHS. We should be in no doubt how serious the situation we are in as a result of the shortfall in qualified radiologists across Scotland. Earlier this year, the Royal College of Radiologists spoke out in the starkest of terms with Dr Grant Baxter, chairman of the college's standing Scottish Committee, stating, having been a doctor for 34 years, I have never seen it as bad as this. Scottish radiology is on the brink of collapse. If that happens, there will be no medical diagnosis or surgical operations at all, since none can occur without radiologists interpreting the scans and x-rays. A perfect storm of increased demand, no significant increase in consultant numbers or trainees, chronically unfilled posts and a tsunami of expected retirements in the next three years means that we need a sustainable solution now for the sake of patients. The Government is known about this for 11 years. To get the facts clear about the expansion that we have seen in the consultant radiology workforce, it is not true to say that there has been no expansion. We have seen a 41.9 per cent increase in the consultant radiology workforce since 2007, so it is not true to say that there has not been an expansion. Demand has grown and we need more, but it is not true to say that there has not been an expansion. Miles Briggs For constituents of my colleagues across the Highlands and Islands, that will just tell them exactly what they are concerned about, that this Government is not addressing the issues facing the Highlands and Islands. Scotland already has a much lower-than-average number of radiologists compared to the EU. The EU average and the latest workforce statistics show a vacancy rate of over 14 per cent for clinical radiology consultants, much higher than the general consultant vacancy rate and almost 10 per cent higher than the rate five years ago. Almost a fifth of clinical radiology consultants will and plan to retire within the next three years, while 36 per cent will do so by 2025. Cancer Research UK is warning that NHS Scotland simply does not have the workforce capacity to meet the current demand. There can hardly be a clearer example of this Government's failure in national NHS workforce planning than radiology. Radiology is a key part of our cancer diagnostic services, but the pressures on radiology mean that too many patients urgently referred for suspected cancer are waiting too long for the early diagnosis and subsequent treatment that we all see and understand and agree is so vital. The lack of capacity means significantly more money is having to be spent in outsourcing, as we have heard, with more x-rays being sent to countries such as Australia for analysis. The cabinet secretary will no doubt say that the Scottish Government is committed to increasing numbers. We have welcomed, as my colleague Edward Mountain has already said, the 50 new training places. I hope that she will outline this evening how many of those will be Scottish domiciled, but we do not believe that it is enough that the Scottish Government action is going to deal at the heart of the current crisis or meet what is going to be an ever-increasing demand for imaging services in the future in Scotland, with imaging workload increasing by 55 per cent between 2010 and 2015 alone. Kate Forbes mentioned that we need a 10-20-30-year solution for that. Therefore, today I am calling on ministers to initiate a comprehensive national review of current radiology services across Scotland, which can also address the plans for the needed increase in capacity that our health service faces in the future. As part of a review, the Scottish Government should work closely with the Royal College of Radiologists and other key stakeholders to take forward their proposals to improve the situation. I hope that ministers will now commit to this national review when you close the debate this evening. This is an issue too important for sticking plaster solutions and patients across Scotland need to have the confidence that this Government is going to put in place a radiology service that is truly world-class and meets the needs of our population. As ever, I am always very enthusiastic to congratulate public sector workers, and that applies to NHS Highland 2. There is much to commend this report. However, although Mr Mountain told us that this was about people not politics, I found the last section of his motion when he asked the Scottish Government to match the commitment of NHS employees. It is quite, frankly, gratuitous—not gratuitous in its own right, but on the back of what I thought was an ill-judged intervention earlier on this very issue when he called for the cabinet secretary's resignation—that lacked proportionality. It is the nuclear option, an indicative of a political mindset that I will return back to. As a Highlands and Islands MSP, my obligations are very clear. It is to understand the issues. I am cited on the Highland health board paper of 26 September, where, quite evidently, there is no denial about the scale of the problem. Indeed, the chief executive's report says that radiology services are under unprecedented pressure due to the shortage, and that is compounded by increased demands in the service. We also know that several groups of clinicians expressed concern, and, likewise, I am cited on the letter that was put back from NHS Highland to them. One of the calls was for improved terms and conditions, and I know that it has been suggested that there is further dialogue with the Scottish Government. Clearly, that is a way of perhaps helping, so I encourage the cabinet secretary to enthusiastically participate in that. I appreciate that there are shortages all over the place, but there are particular challenges with the Highlands. I am also cited on their action plan. I think that we need to look at every individual's roles and responsibilities. The Scottish Government has a very clear role to ensure adequate funding, and I welcome £3 million. I look forward to Mr Mountain and his colleagues contributing to this debate on taxation, because, without adequate funding in all your wish list—this will be the first one of many that will be coming from me, I have no doubt—we need to understand the funding requirements. NHS Highland has a requirement to ensure the delivery of safe service. That will require a workload assessment, workforce planning and safe staffing levels. MSPs have an obligation, and that is to articulate constituents' concerns and hold to account those bodies, whether they are Government and Opposition. I have done that in relation to, for instance, consultations on hospital bills, GP services, nurse practitioners and drug services, waiting times, care at home. Cabinet Secretary has had quite a number from me, but it is also about how we conduct ourselves. To do those things, we must understand the issues, and we must read the briefings from NHS Highland, and we must attend the briefings from NHS Highland. There are a number of complex issues there, and that will lead to the potential for some informed comment and not the rabble-rousing in cheap headlines. At this point, I want to talk about the shocking abuse that my colleague Gail Ross has had in relation to health issues in the Highlands. She is not a member of my party, but I know that she works tirelessly on behalf of her constituents and does not deserve the abuse that she has had. I have to say that, in relation to that abuse from the community, I expect a Minister of Religion to be mediating the mob, not aggravating the mob or motivating them. People need to pay attention to how they respond to their elected representatives and how they are working. In the short time that I have left, Brexit will fuel the problems, not simply of recruitment, but I suggest the problems of retention of staff, because already we see people who have had enough and are heading off, and that is not a good state of affairs. I commend the work that is going to address the problem. I do not think that we need to recount the past. The reality is that we have to deal with the situation at the moment. I urge the Scottish Government to do their very best to put in place a plan that not only addresses the issue of radiologists but elsewhere. I urge my colleagues to promote the Highlands, not top down the Highlands, but to promote the Highlands as a place to come, live and work. That would be a proper manifestation of people not politics, Mr Mountain. I would like to thank my colleague Edward Mountain for bringing this very important issue today. I do not think that he is talking down the Highlands in any way. In fact, it sounds to me that he is sticking up for his constituents in the Highlands, which is absolutely the right thing that he should be doing in this chamber. We all know that the NHS is about people, and without the committed staff or hospitals and surgeries that rely on across Scotland, the NHS would be nothing more than an acronym, which is why I feel very strongly about this issue today. I want to participate to bring some examples from my own region into this debate. In the west of Scotland, we have had our first share of difficulties with radiology vacancies. In NHS Ayrshire and Arran, the clinical radiology consultant vacancy rate has reached 34 per cent, and to give that some scale, the national rate is 14.1 per cent, less than half. To put those statistics another way, that means that there are just 4.5 consultants per 100,000 people compared to 5.4 across Scotland. They are just numbers, but, as I said at the beginning, NHS is about people, and those people are constituents of mine who have contacted me who are struggling to get appointments for scans, are waiting far too long for routine scans, and many of those scans are there to pick up important areas of concern that may require further investigation or, indeed, treatment. Those are serious medical issues. As mentioned by others in the chamber this evening, the spokesman for the Royal College of Radiologists warned that Scottish radiology could be on the brink of collapse. That was earlier in February this year, and it said that it faced the perfect storm. The Royal College of Radiologists went on to suggest that the Scottish Government should undertake a vigorous recruitment programme in the short term and, at the same time, begin a long-term planning strategy to increase the number of radiologists that train here in Scotland. It said that both measures needed to start together and without delay. However, one could argue that a long-term strategy on planning should not happen today or tomorrow. It should have happened years ago. Now, to give credit to the Government, there is a recruitment drive at the moment to attract students to radiology happening. It is welcome. In the west of Scotland, the west of Scotland radiology training scheme, I believe, is the largest in Scotland, and it is currently training a number of students in hospitals in my region. However, I would be interested in hearing from the cabinet secretary about the relative success of this recruitment drive relative to the demand that we know we face. We have already heard the length of time that it takes to train someone. What are we going to do in that lengthy interim period, while those new students are coming through the system? The health secretary also earlier this month said to my colleague Mr Mountain that she would be meeting the Royal College of Radiologists to listen to their concerns. I would find it very helpful in response if the minister could update the chamber as to what actions were agreed at that meeting. It is clear that the failure to adequately plan our NHS workforce across a wide range of specialisms, not just radiology, is now physically impacting the quality and quantity of care available. As always, we bring those issues to the chamber and we get the same responses. We have heard them all today. Brexit is somehow a barrier to fixing a problem that the Government was warned about a decade ago—way before—no, I will not. I am short on time. The second one that we always hear is that things are just as bad in England. We have heard that again today and last week. In fact, it was a week ago that I stood in the front bench in this chamber to bring up another issue of workforce planning around the lack of GPs in Scotland and we had exactly the same response from the centre benches. The third one that I have heard today, which is a new one, is the fact that demand has risen. Surprise, surprise, of course demand has risen. Did we not think 10 years ago that demand would be rising for such services? All three of those defences in my view are absolute nonsense and I am sick and tired of listening to them. There is no shame in bringing up this issue in this chamber because the people of Scotland are listening to this and we expect the minister to say exactly what she is doing to address the problem, not just in the short term, but to make sure that in another 10 years whoever is sitting on these benches does not have to have this debate because, Presiding Officer, I want to go back to my region and tell people in Scotland that we raised this important issue. We are not scaremongering and it is absolutely right and proper that we raise these issues in this Parliament. I thank my colleague Edward Mountain for bringing this matter to a member's debate. I have enjoyed the most positive contributions of others in attempting to find solutions and highlight the challenges that we are facing throughout the country on this matter. I am particularly pleased to see the cabinet secretary here as together we must find solutions. I also welcome last week's announcement of funding and training by the Scottish Government. Recently, in my constituency, as we have heard, concerns were raised by the medical profession that the problem of a shortage of radiographers was also a considerable issue for the Highlands, which impacts on a wide range of services and also on patient care and diagnosis. As we have heard from many speakers, radiology is a crucial part of any health service. It provides diagnosis and monitoring to assist on-going treatment. I understand from the Royal College of Radiologists that, often in the gene studies, are going unreported because there are not enough radiologists to interpret them, meaning that patients are subjected to increased stress and worry awaiting results and potentially treatment delays. As elected representatives, I firmly believe that we must work together to see improvements in healthcare both locally and throughout Scotland. That is why I was quite disappointed to hear that this is just a Scottish Government problem and that no real solutions are coming forward from either side of the chamber. Many of the constituencies that are represented here this evening face the same challenges of remote and rural healthcare and access to diagnostic services as my colleagues and I do in Highland. We must insist that our health boards provide a sustainable service, particularly to those in remote and rural areas. We all agree that travelling for hours on end for an outpatient appointment is unacceptable. Travelling for hours on end to attend diagnostic clinics and then waiting weeks for a radiologist to have time to produce the report is worrying for patients and it is creating a real resentment towards the way NHS Highland is currently managed. As John Finnie has alluded to, the situation is particularly difficult in Caithness at the moment and I would like to thank him for his kind words. At this point, I would also like to pay tribute, as others across the chamber have done, to all the staff that currently work in the NHS, some under very difficult circumstances. I think that we all agree to thank them for all their hard work. Scotland's chief medical officer, Catherine Calderwood, visited Rhaigmoor hospital in relation to the issue and said that new ways of working should be explored to maintain a high-quality service. She said that we have to change some of the ways that we are working, if we are not going to have as many doctors as we did have because of recruitment issues. However, there are some very good solutions, technological solutions, but that also involves the use of other staff, radiographers who can also report on x-rays. There is simply no point in complaining about this issue without looking at the alternatives and the solutions to the problems that we are facing. Kate Forbes said that it is not just about funding but also about recruitment and retention in the Highlands. Clearly, that is not something that happens overnight. As Marie Todd said, it takes more than a decade to train a consultant radiologist. However, I suggest that by having a clear strategy, policy and implementation, we can find solutions to recruitment and retention of permanent, skilled staff to cope with the increase in demand in Highland and across Scotland. I certainly welcome the opportunity today to respond on this important topic, and I thank Edward Mountain for raising it. I fully agree with the respect and admiration that I have shown today across the chamber for the great work that is carried out by radiologists and the first-class service that the staff deliver, often under difficult circumstances to the people of Scotland. I begin by assuring members that we are absolutely committed to a sustainable radiology workforce that continues to provide a high-quality service to the people of Scotland before coming to the chamber. I came from chairing the first meeting of the ministerial cancer performance delivery group. The key item on that agenda was the national radiology transformation programme. We have reviewed the radiology service and we are now into the implementation of that transformational programme. With all due respect to Miles Briggs' call for a review, we are beyond the review and we are now implementing the changes that need to be made. I will say a little more about that programme further on in my remarks. The other important item that was on that agenda today was hearing from NHS Lanarkshire, which I am sure Fulton MacGregor will be interested to hear, because it is now the best-performing board in meeting the cancer targets because of the changes that it has made within NHS Lanarkshire. Again, we want to roll out across the rest of Scotland. Miles Briggs has taken the intervention. All members across the chamber, whichever community they come to represent in this Parliament, are aware of problems with shortages. The review specifically has led to 15 new places, but is that going to be enough in the long term? That is an issue that has not been answered within the review that we know tonight's debate has demonstrated the fact that demand is growing. Are you confident that that will make the difference? It will make a huge difference, but of course we keep every specialty under review in terms of the numbers that are required going forward. Of course we do, but I think that it will make a huge difference. I will come on to say a little bit more about the detail of that in a minute. I want to emphasise the considerable commitment that is shown day in, day out, not only by radiologists and their staff, but by many other medical specialties and professions in our NHS. I certainly agree with the terms of the motion that is essential that we match that commitment with the steps that we are putting in place to improve how services are delivered and how workforce planning reflects that. It is also important that we put the progress that we are making in radiology in the context of the work to implement part 1 of the national health and social care workforce plan published in June this year. That is a key part of our delivery plan and demonstrates our commitment to a sustainable workforce that will continue to provide a consistently high-quality healthcare service. The steps that are taken in the plan will help us to improve the data that we have, develop our knowledge of the effects of different supply and demand factors and enhance our ability to recruit and retain the staff that we need at a national, regional and local level, constantly keeping that under review. We have seen significant expansion in the number of radiology consultants in recent years and have implemented considerable increases in the radiology training establishment. As Kate Forbes pointed out, there are particular challenges of recruiting to posts in rural areas, and we are far from complacent. We recognise that there has been a marked increase in the demand for diagnostic services provided by radiology and how vital services are underpinning the wider healthcare system. We are already working closely with NHS Highland to support improved performance of its radiology service and are taking forward a comprehensive range of actions to address the issues that we have discussed today. In August, the Scottish Government access support team carried out a review of NHS Highland's radiology service to support improved performance and sustainability. As a result of that, work is already in hand to address immediate radiology staffing priorities. Steps are being taken to ensure its capacity to accommodate demand, including the development of an evidence-based staffing model in order to support the radiology service in NHS Highland in future. In a second, I have also asked NHS Education for Scotland to look at the distribution of radiology trainees in the north region to ensure maximum value and optimal utilisation of the training potential within the board. That, of course, will apply to the new training posts that I announced. Edward Mountain Presiding Officer, thank you. My question to the cabinet secretary is that, at the moment, there are 7.8 radiologists in the Highland region, and that was based on a requirement six years ago of 13. The radiologists estimate to achieve all the scans being read on time. They need 20. Is that the figure that she is working on for NHS Highland in the future? Shona Robison That is why the work of NHS Education for Scotland is so important to make sure that the distribution of trainees is the right distribution of trainees and the establishment of the posts is the right number. That work is absolutely essential. Of course, on 21 September, I held a very helpful and productive meeting with the Royal College of Radiologists to discuss those very issues. I do not know why Edward Mountain might want to hear this, because it is important. We agreed in a number of areas where we could work constructively together to address a range of points raised in relation to both NHS Highland and the wider radiology staffing. I also welcomed the college's offer to support clinical leadership with consultants in NHS Highland and, more widely, in the north of Scotland, with the aim of maximising recruitment potential and to develop effective cross-board regional working for radiology. I will be meeting with the college again in the coming months to discuss progress regarding those matters. There is also potential to strengthen the multidisciplinary team approach and make full use of reporting radiographers to enhance capacity and productivity across the service. I can confirm that NHS Highland is currently training additional reporting radiographers, and that work is already under way to increase the reporting radiographer capacity across Scotland. Nationally, we have enhanced the supply of doctors to fill radiology training posts with 26 new training places over the past four years, an increase of 20 per cent. That is, in addition to the significant expansion that we have seen in the existing consultant radiology workforce, which has increased by more than 40 per cent since 2007. We have established a national radiology implementation programme supported by NHS boards, which aims to develop the longer-term vision for radiology and to reduce demand on services. I can confirm that the Royal College of Radiology has kindly accepted my invitation of a place on the programme board to contribute its valuable perspective and experience to the work. On 26 September, I announced an additional £3 million to increase the number of radiology trainees in Scotland by at least 50 over the next five years. I am pleased that people have crossed the chamber have welcomed that. That announcement was made in the context of our wider package of measures to improve waiting times for diagnosis and the treatment of cancer patients in Scotland. I am also pleased to note that the Royal College of Radiologists has welcomed that announcement and I have acknowledged that the additional training posts reflect our long-term commitment to enhance the radiology workforce. I think that the college president referred to it as a much-needed step in the right direction to address this problem and help to safeguard the health of the Scottish nation. I certainly look forward to working closely with the college and NHS boards as we take forward this really important range of initiatives to further strengthen the radiology workforce. I am confident that it will make a real difference and will help to address the many important issues that have been raised in this Parliament this evening.