 The next item of business is a debate on motion 6.899 in the name of Jackie Baillie on protecting primary care. I invite members who wish to participate in the debate to press the request to speak buttons now as soon as possible. Place an RTS in the chat function if joining us online. I call on Jackie Baillie to speak to and move the motion for around six minutes. For most people across Scotland, the first point of call when it comes to their health is their GP. General practitioners are very much at the front line of our NHS. Without functioning GP services, our health system would collapse. In some areas of Scotland, GPs are closing their doors, they're handing back their contracts. Thousands of patients are being left without a GP. In other areas, lists are closed to new patients and practices are simply unable to cope with the volume of patients they have and unable to fill vacancies as GPs retire. I have letters from GPs, from Lothian, Aberdeenshire, from a medical practice in Falkirk, which is struggling to survive. The Scottish Government must act to address the looming crisis in primary care or more patients will struggle to get the help they need. Let me illustrate that with some of the facts. GPs are seeing 500,000 people a week. That is a lot higher than before the pandemic. Most of them are working additional hours to try to meet demand. Many of them can only provide emergency appointments due to short staffing as a result of vacancies or illness. A recent BMA survey shows that 81 per cent of GP practices said that demand exceeded capacity. 34 per cent reported GP vacancies and they estimate that there are about 1,000 GPs short just now. The Royal College of General Practitioners say that there is a need for even more GPs by 2027. There is, although that is a lack of clarity about GP numbers, the Government-based numbers on headcount, but the truth is that many GPs work part-time. The flagship target of 800 GPs is well short of what is actually required. Can I ask the cabinet secretary to outline the urgent action that he intends to take to improve practice staffing and if he will be transparent about GP numbers? The SNP also made claims about the increase in multidisciplinary teams. It is contradicted by GPs because, despite the recruitment activity, the RCN reports that 12 per cent of posts for district nurses are unfilled. When you consider allied health professionals, 346 physiotherapy places vacant. Faced with these challenges, it is extraordinary that the SNP has cut the health and social care budget by £400 million. 65 million alone from the primary care development fund and 5 million from the GP sustainability fund. Our tone deaf health minister, Humza Yousaf, announces this at the same time as he is telling people to stay away from A&E and go to their GP instead. This is just about the most wrong-headed decision I have seen, cutting resources from GPs when they most need it during a winter crisis. It is breathtaking incompetence on the part of this SNP health minister because GPs are on their knees. If they fail to address their serious concerns, more people will end up in already overwhelmed acute services when they could have been dealt with locally in primary care. I urge the cabinet secretary to reverse the cuts. Listen to the BMA, listen to the Royal College of GPs. They are telling you that there is a crisis. For goodness sake, please act. Perhaps he could use the £20 million earmarked for a referendum for this purpose. It never fails to astonish me that when the nation is focused on the crisis facing our NHS this winter, the SNP are focused on the constitution. At the start of the week, we had extraordinary revelations that senior NHS executives were discussing the privatisation of our NHS. The discussion was green-lighted by Caroline Lam, the most senior civil servant in charge of health in the SNP Government. Either the cabinet secretary knew about this and is complicit, or he didn't, in which case he really isn't trusted to be in charge. Either way, you can usually judge how close to the mark you are by the volume of abuse and aggression by SNP members and supporters, not just on social media but in this chamber. That is a damaging story for the SNP. What it tells us is that the NHS is not safe in SNP hands. Inside or outside the UK, the SNP would contemplate a two-tier NHS where those who can afford to pay will get faster and better treatment and those who are not wealthy would receive a poorer service from a residualised NHS. The SNP is already presiding over a two-tier system. More and more people are paying for private consultations, diagnostics and operations. There are some 700,000 people on waiting lists, though one in seven Scots are being failed by the SNP and by Humza Yousaf. The minutes were also interesting in confirming what we already know. The cabinet secretary doesn't listen. He doesn't listen to clinicians. He doesn't listen to civil servants. He is paralysed and doesn't make decisions. People across the NHS have lost confidence in him. As for the £1 billion black hole in the NHS budget, look no further than Nicola Sturgeon. When she was health minister, she failed to pass on funding from the Labour UK Government to the health budget. Let me finish by giving the chamber two quotes. The first from the Scotsman leader yesterday. Whether or not this was part of a brainstorming exercise, it is deeply concerning. It has come to this and they are right. Finally, from Neil Mackay writing in The Herald, if the NHS is a benchmark, then the SNP is unfit for government. Damning words indeed. This cabinet secretary is unfit for office. The SNP is unfit for government and Humza Yousaf should do the right thing and resign. I move the motion in my name. I now call on Humza Yousaf to speak to move amendment 6889. Two cabinet secretary for up to five minutes, please. I move the amendment in my name. Doesn't it just so show an insecurity in her own argument that Jackie Baillie was not able to take a single intervention in a debate? This is meant to be a debate. Jackie Baillie, happy with 14 seconds in to give Daniel Johnson away. Daniel Johnson is so keen on interventions. Can he answer this? Did he know about this meeting and agree to it, or did it happen without his consent? No, a meeting of five people with one chief executive present, believe it or not, with 160 over 160,000 healthcare workers, I don't know about every single meeting that takes place. So, actually, what I would say to Daniel Johnson is when I meet with chief executives, when I meet with the chairs of health boards, not a single one of them has ever, ever floated the idea of charging patients. And if they did, frankly, I would tell them that that issue is not up for discussion under this government. And what I would say to Jackie Baillie and to Scottish Labour who brought this one as a very serious debate, and a very serious issue, not given any, I think, serious consideration by Jackie Baillie and a really, frankly, ludicrous contribution, is that we should start from the position of thanking all of our primary care teams, our general practitioners, those who work in reception, our multi-disciplinary staffing staff, but also, of course, primary care right across the piece. And I want to thank every single one of them. On her concerns about the founding principles of the NHS and thanking our healthcare workforce, let me give them also a categorical assurance that our Scottish NHS will never be sold off into private hands under this administration. The government holds true to the founding principles of the NHS, of Nye Bevin and his vision of patient care, which is free at the point of need. And we should be judged on that track record. That track record, of course, is of abolishing prescription charges. Removing dental charges for young people, continuing to fund free eye tests. Let us have it recorded today that this government will keep the NHS in Scotland publicly owned, publicly operated and free at the point of use. And when Jackie Baillie decries the Government for having to re-profile health spending in order to have to combat sky-high inflation due to Conservative mismanagement of the economy, or indeed to afford record-high pay deals, there is one place that I would love to be able to save money, and that would be in the £250 million that Scottish people are still paying the price for Labour's disastrous PFI and PPP projects building hospitals in Scotland. And, of course, Jackie Baillie was only in government for the briefest of periods. She was only ever trusted in government for the briefest of periods, but she should take the opportunity to apologise to every single person in Scotland still paying the price for Labour's privatisation of our NHS. In terms of our GP practices and primary care, they have been impacted by Brexit, by the pandemic, of course, by the cost of living crisis. We will continue to invest in our multidisciplinary teams. Jackie Baillie seemed to be talking them down, but 3,220 multidisciplinary staff and professionals recruited since 2018. So, when you walk into your general practice, you're likely not just to be able to see the general practitioner who does a phenomenal job. You may well be able to see the physiotherapist, you may be able to see the advanced nurse practitioner, and a multitude of multidisciplinary staff right across the piece. Those individuals are there in order to, I will shortly, in order to be able to not just give the best service possible to the public that they're seeing, but also to ensure that the workload, which is incredible on GP practices, is being spread more evenly. I'm happy to give way to Mercedes. Mercedes Villalba, very briefly. Thank you. I'm very grateful to the Minister for Giving Way. I've previously raised my constituents' concerns about declining quality of patient care at GP practices, some GP practices in Aberdeen. I've raised it with the Cabinet Secretary. He's previously given a commitment that his officials will determine improvement plans that practices will be putting in place. I'm yet to receive an update from the Minister, so I'm just seeking today a confirmation that this will be forthcoming. Yes, I will give that update. Mercedes Villalba is absolutely right. She has raised this issue on several occasions. With me is, of course, an issue for the local health and social care partnership. I will endeavour to get her an update. I will end, Presiding Officer, by saying that there are several initiatives under way that are addressing GP recruitment challenges. We have, of course, recruited 277 GPs as part of that 800 target. There will be figures published soon that will give an update to those figures. Let me just say that there's not a single silver bullet when it comes to GP recruitment and retentions. We have a number of interventions that are under way, but, importantly, I also make no apologies whatsoever for doing what I can to ensure that timely access to our GP services for patients up and down the country is a top priority for this Government. Thank you very much, Cabinet Secretary. Can I just say that there is a little bit of time in hand and, therefore, I can give a bit of time back for interventions, and I would far prefer that than people shouting from a sedentary position. So can I now invite Sandesh Gulhane to speak to and move amendment 689.1 for up to four minutes, Dr Gulhane. Jackie Baillie's debate today is timely. Timely because this week we learned about damning minutes of meetings by senior management of Scotland's health boards, which are ultimately under the control of the Scottish Government's health secretary. These minutes tell us that the health secretary's NHS bosses have been weighing up charging wealthier patients to access NHS services. After 500 days of failure in charge of Scotland's NHS, this is a new low. The Cabinet Secretary is on record saying that he would never consider charging anyone to use the NHS and that he finds the ideas abhorrent. I wonder if he also finds his record in office to be abhorrent. He's a snapshot. The worst cancer waiting times on record. The worst delayed discharge record with an average of 1,832 beds occupied each day due to delayed discharge. You're hearing the Cabinet Secretary for a sedentary position say better than England. We live in Scotland. The worst NHS backlogs, almost 700,000 patients were waiting for NHS treatment, according to latest figures, are the highest number since that was recorded in its current form. I will, yes. Jillian Martin. We live in Scotland. The Tories are presiding over the English NHS. Isn't it right for us to criticise your policies in England where you're privatising by stealth day on day and day? What people won't want you in government in Scotland? To the chair, Ms Martin. Dr Gullhane. Well, the first thing to say is you should be representing your constituent. To the chair, Dr Gullhane. The member should be representing her constituent here. The second thing is we can't trust SNP statistics as we have found out when it came to energy because they are not comparing England properly. If we look at the stats, it is clear the SNP stats are false. To be clear, this is not the fault in any way of hard-working NHS front-line staff and perhaps instead of platitudes from the cabinet secretary, he should fund us properly. Now such is the seriousness of this week's revelations that the First Minister also weighed in saying emphatically that the founding principles of the NHS are not up for discussion. Well, they are being discussed under the SNP's watch and what else could be being discussed? Yes, if I can get the time back. I wonder if Sandesh Gullhane will recognise and apologise for his party's economic mismanagement, which has meant that my health budget is worth £650 million less. If he thinks that there are other places where we should be reprofiling the health and social care budget, he should name them. At the very least, he should stand up and apologise for his party's economic mismanagement. Dr Bill Haney, I can give you up to five minutes. Well, the first thing to say is that when errors were made by Liz Truss and Quasie Quarteng, they resigned unlike the SNP who never take responsibility for anything. The other thing to say is I'm not sure if the Health Secretary looks around the world and sees inflation being a global issue. The last question that the Health Secretary asked, maybe you should listen to your own questions. £1.5 billion— Cabinet Secretary. His last question. £1.5 billion setting up a bureaucratic national care service. There we go. Found your money. We hear that senior management are concerned about the disconnect between political decision makers and clinicians. They speak of a siloed conversation behind the Government's closed doors at the chief medical officer and chief nursing officer. Language that is so stark that senior management appears to have little confidence, little trust in this Health Secretary. His input, his suggestions are divorced from the reality of life and purpose of the service. Let that sink in. Divorced from the reality of life and the purpose of service. Prime Minister, primary care is the backbone of our health service and the NHS is at a breaking point, increasing unsustainable demands of capacity, GP experiencing burnout, demoralisation, ultimately more and more doctors at the end of their tether choosing to leave the profession. Last year, the Scottish Government pledged £30 million in a sustainable support package. But what we saw was a cut in this year's budget of £5 million. So instead of grandstanding, instead of talking about money they don't have and using it on their pet projects, they should be funding the NHS properly. Let me reiterate. Every additional day this Health Secretary remains in office, makes him and the SNP Green Government he serves even further divorce from reality. You cannot trust the SNP on health. NHS staff and patients don't trust his cabinet secretary. Neither do it seems senior NHS managers. He should do the right thing and step down. I move the Scottish Conservatives' motion in my name on the declaration of interest as a practicing NHS doctor. I now call Alex Cole-Hamilton for up to four minutes, Mr Cole-Hamilton. Thank you very much indeed, Deputy Presiding Officer. I'm pleased to rise from my party to speak in this important debate. I thank Jackie Baillie very much for securing time for it in the chamber today. Deputy Presiding Officer, if you'll permit me, I'd like as many of the contributions we've heard so far have done to focus my remarks on the crisis currently facing our general practitioners. I was recently contacted by a group of GPs who work at a practice in my constituency. I know that others have had similar approaches. One of them told me, and I quote, things in primary care are bleak. Everyone is simply exhausted and working harder is not possible. Last month, that same practice received a letter from the SNP Green Administration confirming a cut of £5 million in promised funding to Scottish GPs in this financial year. The Government has blamed this broken commitment on budget pressures caused by inflation. That's also a slap in the face to our GP practices as it completely ignores the fact that those practices are under the same, the very same inflationary pressures themselves. They are getting it from both sides. It is also yet another grim case of this Government playing games when it comes to announcing funding. The new figure was announced as part of the winter resilience package, giving the appearance that this was somehow new funding when it is plainly a funding cut. This week we saw the first frost of winter. Cuts at this juncture will have a direct negative impact on the practice ability to meet the inevitable increase in demand that the cold weather will present. These cuts make it even harder for those heroic healthcare staff to provide the timely, high quality care they so desperately want to provide. Presiding Officer, there has long been a workforce crisis in general practice with a lack of GPs, practice nurses and other clinical staff. As we have already heard, 81 per cent of practices have reported that demand is exceeding capacity with 1,000 GPs needed to plug the gap. In 2017, the SNP promised to increase the number of GPs in Scotland by at least 800 over the next decade. Five years on and the numbers have improvement has been glacial. There are GPs who have forced to pay the price for yet more ministerial disinterest in that regard, with levels of burnout amongst the highest in the health service. Lib Dem research has found that almost every single GP who is leaving the profession is retiring ahead of time before the planned retirement date. Many others are leaving for other reasons just at a time when we need them most. Who can blame them? Our health service is being overwhelmed. Despite how many times the cabinet secretary denies it, SNP minister's management set us on this course long before anyone had heard the word Covid. I mentioned again that Paul Gray, the former head of NHS Scotland, said that this crisis was inevitable, that Covid only hastened its arrival. The SNP and the cabinet secretary need to cut out the excuses to stop abdicating responsibility and to get on with the day job. It is a damning verdict of the SNP's handling of the NHS that senior health bosses have even been discussing extreme proposals like charging for treatment. They are clearly alarmed at just how bad things have become. I feel duty bound to highlight the intensive hypocrisy in Conservative MSPs raising the alarm on threats to the NHS when Rishi Sunak registered with a private GP practice that guarantees same-day appointments. Let's not forget that it was a Tory Government that failed to take the NHS off the table in negotiations. It would seem that Scots currently have the worst of both worlds when it comes to protecting our most precious national treasure. It goes without saying that my party, the Liberal Democrats, are utterly committed to the core principles of our healthcare system, that it is available to everyone and free at the point of need. It was, after all, Liberal Democrats who brought free eye and dental checks, free personal care into Scotland. We're also committed to supporting all those on the frontlines of our NHS. They have been asked to go beyond the call of duty for far too long. Their service warrants far better treatment than this. Thank you, Mr Cole-Hamilton. We now move to the open debate. I call first Paul O'Kane to be followed by Bob Doris for up to four minutes, Mr O'Kane. Thank you, Deputy Presiding Officer. Primary care is the front door of the NHS. It's the cornerstone that allows interventions early as possible to ensure people can be successfully treated in the community. It refers people to the support they need in the right place, and it should be able to do that at the right time. It is this early intervention that keeps people out of hospital by diagnosing, referring or treating them before their condition deteriorates. It is a vital service that people have trusted over many years. Our relationship with our GP is a crucial one in all of our lives, and supporting general practice is crucial to reducing pressure on acute and emergency services. A survey from the British Medical Association has revealed that four in every five over 80 per cent of GP practices in Scotland have reported that demand for their service is exceeding their capacity. Almost half have reported that the level of demand for their service is substantially exceeding capacity. My colleagues have already said that I am not alone in looking at my mailbox and seeing that it is full of people who are struggling to see their GP and full of GPs who feel at their wits end trying to do the job that they love fully. Indeed, Dr Andrew Boost, chair of the BMA Scottish GP committee, has issued a stark warning saying that the situation in primary care is at a tipping point because of this Government's decision to slash funding for GP practices by £65 million. To recruit 800 GPs by 2027 is short of what is required and it clearly kicked the issue down the road. The SNP has had 15 years to get NHS workforce planning right but they have failed measurably year after year. Presiding Officer, I will take an intervention from Emma Harper. Emma Harper. Thank you very much Paul O'Kane for taking an intervention. I would just like to know if the member would not accept that the SCOTGEM programme unique to Scotland, introduced by the SNP, is welcome and it is specifically looking at addressing GP vacancies in rural areas. Paul O'Kane, I can give you the time back. I thank Emma Harper for the intervention. Of course it is important that we look at every community in Scotland in terms of what their needs are but it is clear that the issues go far beyond that and we need a sustained investment. There has been 15 years of a lack of a strategic plan in terms of getting GP vacancies across acute and all healthcare settings. I would like to make some progress if the cabinet secretary does not mind, I am conscious of time. Presiding Officer, the national health service is the Labour Party's proudest achievement. It has transformed the health of our nation and has envied across the world for its defining principle of providing healthcare which is free at the point of use. Yet this week it has been revealed that the possibility of creating has been explored under the watch of this cabinet secretary. The First Minister and the cabinet secretary were scrambling this week to state that they do not support any shifts towards privatising the NHS. SNP backbenchers and SNP members were scrambling to add BBC journalists to the list of things that are to blame for the current state of the NHS in Scotland. Perhaps we should not be surprised by what we heard this week because the SNP has formed on this. We are still appointed to Cabinet by Alex Salmond and Nicola Sturgeon. In his book, Grasping the Thistle, he said, we could encourage the private sector to compete with established NHS hospitals, clinics and other services. We would encourage NHS management and staff to buy out existing NHS facilities and services. He does not want to hear this and his colleague under favourable financial terms and join the private sector. Presiding Officer, our NHS is on its knees and its front-line staff are suffering. They have had enough of this failing health secretary not listening to what they need. That is why the RCN are striking for the first time in the history. Ambulance service staff, including paramedics, are striking for the first time in over 30 years. He should deliver a decent and acceptable pay rise for NHS and social care staff, which is essential to avoid strikes, but to retain and recruit staff we need to make essential improvements to our health service. Not my words, Presiding Officer. The words of another former SNP cabinet secretary, Alex Neil. The health secretary perhaps should heed the advice of his former colleague and get back around the table and listen to what staff are telling him. It is clear that the health secretary has lost confidence of front-line staff, patients and their families. His record speaks for itself in comparison to his predecessors. He has no idea. He has no plan and he has no support to offer. Patients and staff deserve so much better than this Government and this cabinet secretary. Bob Doris, to be followed by Graham Simpson for around four minutes. Thank you, Presiding Officer. I am not sure about grasping this. I think that the Labour Party are clutching its throes this afternoon with this debate. The challenges facing Scotland's NHS are played for all of us to see, but so is the clear, focused and considered action of this Scottish Government seeking to address them. Some of which I will return to later in this short debate. It is of course right that our Scottish Government's NHS recovery plan is properly scrutinised and in that context this debate could serve Parliament well. However, what does not serve our Parliament well is for the Labour Party to effectively present false accusations as if they are factual and a motion on the Scottish NHS that is patently and demonstrably untrue. It is an exercise of significant deceit and indeed hypocrisy to suggest that the Scottish Government is considering privatising the NHS. With regard to the Scotland's NHS being free at the point of use, it was our SNP Government that abolished prescription charges that were in place when Labour was lasting control of this Parliament. It is our Scottish Government that maintained free eye tests in this country. It would cost over £20 in Labour-controlled Wales for that eye test. It was, of course, the Labour Party who brought PFI to our NHS in Scotland with PFI-PPP contracts still costing the Scottish Government every single year £250 million liabilities run up under the Labour Party. It was the Scottish Government, however, that sought to unpick Labour's PFI. Indeed, in my city of Glasgow at a cost of £26.3 million to abolish charges put in place by the Labour Party to park at the Glasgow royal infirmary. No NHS privatisation under our watch, the Labour Party are not in charge of the NHS here in Scotland. Now, where I do agree with Jackie Baillie of the pressures on GP services, that is why I am pleased to see efforts to recruit 800 additional GPs by 2027 around track with 277 already in post by 2021. Of course, we need to strive to go further. We must do more, Cabinet Secretary. But I'll tell you what doesn't help. It doesn't help that when we look to attract additional GPs or indeed fill vacancies elsewhere within health and social care in Scotland that we have a Labour Party and a Labour Party leader in care stammer doubling down against freedom of movement of people and to talk about too many immigrants in our NHS and then to deploy some cheap gutter level right wing rhetoric about immigration dependency. Just shameful, Presiding Officer. Shameful. In relation to the contributions overseas that we make in our healthcare system, we need to ensure that overseas trained GPs in Scotland do not leave because of UK visa problems. I mentioned that because in my preparation for today's debate I noted the chair of the BMI Scottish GP committee, Dr Andrew Bews, said that we are desperately short of GPs as it is. The last thing we need is to be in a position where fully qualified clinicians have been left with no choice but to leave Scotland because of an issue with the terms and conditions of their visa. We are in negotiations with the UK going to resolve some of these issues. Labour do also make another important point in relation to malted disciplinary teams. Yes, we want more workers than that, but to deny the fact that this is 2018, there is 3,120 more of them in our NHS just doesn't cut it. Yes, we need more, but we will look at the progress that we have made. The year 2018 is very important, Presiding Officer, because that predates on the pandemic. It shows that the Scottish Government was well aware of the demographic challenges in Scotland's healthcare and social care system and we are taking steps pre Covid-19 to address those and its work in progress. Finally, Presiding Officer, I do note that in this year the budget of primary care in Scotland is actually on the increase and in terms of the most integrated joint boards are also going to use their reserves to invest in primary care. It is helpful to get more information to the Cabinet Secretary in relation to that. Let's try to work legitimately to improve Scotland's NHS, but let's base the demands, the doubted challenges that NHS has here in Scotland on the facts, not on labour fantasy. Thank you, Mr Doris. Graham Simpson to be followed by John Mason for up to four minutes, Mr Simpson. Thank you Presiding Officer and I also thank Labour for bringing this debate to the chamber. The only time we get to hold the Government to account on health is during opposition time and even then we know Labour and ourselves will lose the vote because the SNP and the Greens were banned together to defiantly say we've somehow got this all wrong. Now, Humza Yousaf often talks about challenges. He talks about a recovery from the pandemic forgetting that the NHS under the SNP was creaking before the pandemic. Of course, the background to this debate today as you've already heard is the leaked discussion of health chiefs where various ideas were floated, including charging people who can afford to pay. But we already have a two-tier health service under the SNP. I've had constituents come to me who can't even get to speak to a GP and have contacted me to say they've gone private. One in particular stands out and that's someone who ended up paying thousands to see a GP privately then pay for a minor procedure. That's just not acceptable. Quite apart from the unthinkable leak discussion we've already have a health service where those who can pay get health treatment and those who can't or won't don't. We're all proud of our NHS but under the SNP it is becoming the national have not service. That is the reality on the ground. Presiding Officer what happens in general practice affects what happens elsewhere in the health service. If people can't see a doctor they may well end up at A and E instead or end up getting sicker or being avoided. We need to know what's happening on the ground but currently we have no idea which GP practices are offering phone calls, no calls or face-to-face appointments. That's not acceptable at the best of times because you need data to be able to plan and it's certainly not acceptable now. In my own area Lanarkshire things are particularly bad. From October of last year we've spent 315 days at code black level. We're facing a second Christmas at code black. Graham Simpson knows for patients and staff in our area in Lanarkshire that this is frightening stuff. Does the member agree with me that the health service is the most important and the most important so does the member agree with me that we need an urgent plan from the ministers to get us out of code black because cabinet secretary is right to say we need to thank the staff but we can't thank the staff if there were to be unsafe conditions. I thank Monica Lennon for the intervention. She's absolutely right. Lanarkshire is in a state of crisis and has been for too long and we need to see an action plan to get our area out of that situation. It's completely unacceptable. Now we've all been inundated with constituents desperate for help. Here are a couple of personal testimonies one from a resident in East Kilbride who said they found themselves requiring support from a GP today they say. They went to the medical practice and requested an appointment for a foot issue, a very sore foot. They were told there were no appointments and there was no pre-book appointments available. That kind of thing is commonplace. I have other examples but I'm aware of the time I won't go through them, it's not good enough. The situation we face is not good enough not just in Lanarkshire but across Scotland and frankly the buck stops with the cabinet secretary and no one else and he should do something about it Thank you Mr Simpson. John Mason to be followed by Gillian Mackay there is now no time in hand Mr Mason so up to four minutes please. Thank you, I told Mr Kidd that would happen before I got to speak. Thank you very much for the opportunity to speak and members might not be surprised if I start from a financial angle. Whether we are independent or not whether we have borrowing powers or not we still need to set budgets we need to live within our means and we will never have as much money Labour and others have complained in recent years that local government has not had the funding it deserves and one of the reasons for that is that we have prioritised health and the NHS if Labour were in power they could do things differently but what they could not do is give more to local government and give more to the health and the NHS so if we can agree in the first place that the NHS will always have a budget and that budget will never be able to meet all the demands that every single person in Scotland wants it to meet secondly once we have decided on a figure for the NHS and health we need to decide how to split it up how much should go to GPs and other primary care and how much to hospitals, A&E etc etc now I think most of us here would agree that we should focus more on preventative care and less on reactive care but what we have not agreed on so far is how to make that switch if we cut funding to hospitals including A&E in order to invest more in primary care including GPs waiting time for hospitals would probably increase more and I wonder if the opposition parties would be willing to support that or would they still turn up at FMQs every Thursday to complain about hospital waiting times because let's be honest every time there are demands to reduce hospital waiting times that discourages more investment in preventive services such as GPs and even within GP funding there are choices to be made the 100 or so deep end GP practices which work in our 15% most deprived areas would argue that funding should be more skewed to the poorer areas and I wonder if Jackie Baillie would support a reduction in GP services in a better off area like Helmsborough in order to increase funding for GPs and to the better and the better to be made if it's very brief I'm a member of taking the intervention I just simply ask the member why is the his expectation and ambition for our health services so low so amazing we can all talk about ambition and I'm happy to do that but I'm taking an angle today that we have a relatively fixed budget for each other can I next say that while parts of the NHS are under severe pressure much of it is providing an excellent service and I certainly get good reports both directly from constituents and through care opinion emails for example if I may quote at my 34 week midweek midwife appointment my midwife noticed a stop in the baby's growth so sent me to the princess royal for a scan the growth scan showed the baby was smaller from this minute the care I received from the PRM was amazing I was sent to either maternity assessment or daycare every day for monitoring and every single member of staff was amazing I was admitted one night into ward 72 and again the staff were amazing it was decided I would be induced at 37 weeks throughout this long and scary process again the staff on ward 72 plus the doctors were so reassuring and kind I was took to the Labour ward after two days in ward 72 and had Hannah as my midwife a real asset I had a problem at the end of my labour and had to have doctor intervention again the doctor was amazing after birth I was took to ward 63 where again the staff were all so nice and caring after getting home my community midwife noticed my little one had some jaundice so back up we went we were readmitted for two days back into ward 63 this was very upsetting for me at the time and the compassion I received from all the staff was just amazing throughout our whole journey every single person we met healthcare workers, cleaning staff, midwives, doctors were all second to none I know the NHS is having a hard time and we can all tell these people are overworked and under staffed but that doesn't take anything away from the care they give we have an NHS I see my earlier plea has fallen on deaf ears we now do have no time so I am going to hold everybody strictly to their time limits Dylan Mackay to be followed by Sarah Boyack for up to four minutes there is no doubt that primary care is under immense strain survey results from the BMA warned that 81% of practices said that demand for their services were exceeding capacity we know that as a result of the pandemic people are presenting later often with more complex conditions and sometimes with more than one complex condition receptionists bear the brunt of telling patients about alternative pathways and often are trying to get patients the treatment they need in the quickest way possible the health and social care committee report on alternative pathways highlighted that these need to be better communicated and that we need to move away from the expectation that every primary care appointment needs to be with a GP diversify appointment types and ways of booking so that we can make it easier to access an appointment at a convenient time many practices do late nights to facilitate appointments for those who are working but by facilitating phone or video appointments we may be able to better make use of appointments and reduce the constant pressure to work longer hours the Royal College of GPs has said that we urgently need a national conversation focused on the management of public expectations of what general practice can realistically be expected to deliver better public understanding of how to use our public services is needed including the new ways of working in general practice we need to make sure that GPs have the technology to be able to facilitate these appointments we also need electronic prescribing GPs valuable time being taken up having to sign individual prescriptions should be a thing of the past IT systems can take time to roll out however but if the cabinet secretary could look at what solution could be found to reduce the number of particularly repeat prescriptions needing to be physically signed I believe that would go some way to reducing the workload many people will be on medication for the rest of their lives and aside from medication reviews many of these will just be signed monthly with no contact with the patient we seriously need to consider if this is a good use of GP time and how we make this less cumbersome the Royal College of Nursing in their briefing highlighted the vital work that district nurses and other nursing staff as part of multidisciplinary teams do to ensure that they keep patients as well as possible often visiting them in their homes and in community settings the contribution they make to the primary care team should never be underestimated RCGP highlighted that as well as talking about resilience we need to have a conversation about why GPs and other primary care staff become overwhelmed in the first place and fix or mitigate those issues short-term fixes to the health system must be paired with longer-term strategic planning to address workforce and workload we must aim towards a point where GPs do not feel overwhelmed through working for their patients I have previously mentioned in the chamber the need to support out-of-hours and they are a key part of primary care which also helps to relieve pressure on A&E's and provide an alternative route where we are relying on dedicated staff doing this in addition to other roles and we need to make this more sustainable Presiding Officer, we need to tackle the acute problems this winter and make sure that the situation does not worsen for staff and patients at the same time we need to work to make general practice more sustainable and put it on a good footing to be able to promote and support good health rather than the current cycle of constantly being a national sick service I want to thank all the organisations who sent briefings and every single person working in health and social care who are doing the utmost to support those who need it through the winter and through the rest of the year I now call Sarah Boyack to be followed by Jeremy Balfour for up to four minutes Presiding Officer, we rightly take pride in our NHS in its founding principles of universality of care, respect and dignity and the last thing we need to do to your service but that's actually what's already happening in Scotland and today's amendment from the SNP Government is appalling it does not acknowledge the massive pressures our NHS is facing and that that's increasingly impacting on people's health with our hardworking NHS staff being under huge pressures not just because of Covid but because of long term systemic under staffing and a lack of action to recruit staff and support and retain staff and I want to bring to the chamber's attention the experience of my constituents in the Lothians A&E GP's, dentistry and care services we see pressures right across our NHS waiting times on accident emergency in Lothian are damming since May this year and up till November there was only one week during which the percentage of people seen within the Government's four hour target was 70 per cent last week more than 1700 people were stuck in A&E for more than four hours only 63 per cent of those attending NHS Lothian's emergencies were seen in four hours and in the same week 200 people more than 200 people were stuck in A&E for more than 12 hours 12 hours when you've gone to accident emergency just think about that for a moment so Jackie Baillie's focus on GP's was absolutely right because people are going to A&E because they can't access their GP's and GP surgeries have started contact to my office something I've never seen before talking about the real pressures they're experiencing exacerbated by the reduction in funding and I'm told that in Lothians we lost £9 million because GP services in Lothians were unable to recruit the GP's and that money is not coming back I've had constituents reaching out because one had to wait a month to see his GP another one said it finds it extremely difficult to register with a GP because it's a cue outside the practice every week and in Musselborough people haven't been experiencing issues with accessing a GP for years to such an extent that an independent review had to be set up so our front line services are under massive pressures with our GP's being depleted and demoralised not my words but the Royal College of General Practitioners and it's not just GP's if we look at the pressures on our NHS dentists in Lothian it is shocking one of our Labour FY request revealed that between 2021 and 2022 92 dentists withdrew from NHS and at the beginning of this year out of 163 general dental practices in Lothian only 51 confirmed their accepting new patients with some only accepting children and that creates the two-tier system I started my speech talking about with those who can afford go private and the rest are forced to wait months or borrow money from friends or family to get private treatment or literally be in pain or lose teeth that is not acceptable now it's being said from the First Minister that the founding principles of our NHS are not up for discussion but actually we're already losing our NHS dentistry that's not acceptable it was the Scottish Labour Party that launched a call for national care service so welcome the proposals from the SNP to say the deliver it but the reality check on the experiences that our carers have giving us decent terms of conditions across the country career development opportunities we're seeing SNP centralisation and that is adding to delayed discharges in September this year there were more than 6,500 beds occupied by patients in Lothian who could have been sent home that is not good enough we need an NHS invested in and the patients that deserve and the staff that do everything they can they need our support now for up to 4 minutes thank you deputy the national health service is an institution that the United Kingdom can be immensely proud of the provision of medical care that is free at the point of need fundamentally demonstrates our commitment to the idea that means should not determine access to healthcare and I have spoken on numerous occasions about my own personal experience of that life-saving service and throughout all our debates on this issue we should remember that this is our goal and it's our hard-working healthcare professionals on the front lines that should be supported in any way possible Presiding Officer it is evident that the NHS Scotland is going through a difficult time my older brother has just retired as a GP and his generation are walking away because of practices that are going on now numbers of GPs in Lothian is falling I know of numerous practices here in Edinburgh that if you don't phone between and five past eight you will not get an appointment not only for that day but you won't get an appointment for the week ahead and as Sarah Boyack has just pointed out dental treatment in the Lothians for NHS patients is collapsing and my own GP has decided to go private and me and my family still are waiting to find a dental practice because there's simply no dentist taking on that work we have a two-tier system already here in Lothian Health Secretary please come and visit the places within my constituency within my region rather than sitting in your office thinking everything is fine it is bleak Presiding Officer that is the only word for it we are proceeding through this most difficult of winters without a properly functioning primary care service now it's true that we are recovering from a pandemic but to claim that all the problems on our health service began in March 2020 is far too far too long the SNP Government has hidden behind the pandemic as an excuse for their failings when in reality the situation that we find ourselves is of the making we need action now the cabinet secretary will say well I haven't got the money to do it well let me suggest away not only let me suggest away but let me suggest away that at least three or four committees in this parliament that two candidates last week can suggest that's 1.3 billion in getting rid of your fancical plan for a national care health service it simply will not work the trade unions tell us it won't work the professionals at the front line tell us it won't work and actually the third sector are telling us it won't work put it aside put that money into primary care into hospital care and that will do so much more for the patients of Scotland front line services such as A&E and GP practices rely on other services in order to run smoothly and the deep running problems in our health and care date back long before the pandemic and are deeply rooted in the mismanagement of this SNP Government but this is not an abstract problem I haven't got time it's just numbers it's not just numbers on a page or even debate points within this chamber these are people's likes and their wellbeing the Government must act now to stop the stress on the system and perhaps a good place to start with for you to take some responsibility and for the First Minister to replay for man at the top thank you thank you Mr Balfour the final speaker in the open debate which is Stuart McMillan for up to four minutes Mr McMillan thank you very much first of all it says something that Labour has brought forward a motion that is both factually inaccurate and fairly male headline it does appear to me therefore that the journey to becoming red Tories is well under way I know it's been a while since Labour were last in power here and also in London but looking at the record of privatisation in the NHS the thing is certainly worth reminding them of it 1999 saw the transition from a public sector provider to include the private sector under the disguise of choice and competition then there is the cost of the PFI contracts which my colleague Bob Doris touched upon earlier hundreds of millions of pounds out the health budget and profit payments every single year that money could be and should be going to patients so when Labour come to this chamber to make a claim that they know is false they need to be reminded of their distant past but not yet a forgotten past as for the blue Tories being divorced from the reality of life and purpose of the service it takes a huge amount of brass neck to come to this chamber to make such a claim Gillian Martin in her intervention on the issue of regard and privatisation and the public know that's what the Tories want to do as well I only have four minutes Mr Balfour thankfully this SNP-led Government do not agree with either of their four mentioned parties I'm pleased that the health secretary announced but he didn't need to about the founding principles of the NHS that they are not up for discussion they are free at the point of need with that I do welcome the Scottish Government's investment in 20 healthcare professionals being recruited since 2018 and the Scottish Government is committed to investing at least 170 million pounds a year on growing primary care multidisciplinary teams but we've heard from the opposition today about costs and finances and cuts I'm not sure if they understand a few simple economic facts Brexit has been a disaster and as I stated in Christine Grahame's review for the interests of Sandesh Gwaghani a former member of the Bank of England and the Monetary Policy Committee Adam Pozen suggested earlier this year that Brexit was responsible for up to 80 per cent of the increased prices in the UK inflation is currently running at 11.1 per cent largely caused by Brexit added to this are EU nationals who have left their employment in Scotland some of whom some of whom would have been working in Scotland's NHS those are undeniable facts that the opposition need to listen to and also accept added to this is the current race to the bottom on immigration that both the Tories and Labour are competing on did the parties in this chamber not realise that this might actually make it harder to encourage people to come and live and work in Scotland whether it's in the NHS or in any other aspect of employment if both of these parties want more money into the NHS and we would all want more money into the NHS they need to indicate from which budgets that money is going to come from because of their limited finances because of the limited financial situation this Parliament sadly currently faces and we've heard from some today about comparisons with the NHS elsewhere so once again for the benefit of Sandesh Gwaghani prescriptions are free in Scotland but are £9.15 in England mental care is free in Scotland for under 26 it's without an opt-in and NHS ITES remain free in Scotland in comparison to England and Wales where they cost £21.31 a time also Scotland has 95 GPs for every 100,000 people compared to 78 in England, 18 Wales and 75 in Northern Ireland so in contrast to this positive progress in June 2022 the health foundation indicated about UK so when the foundation UK criticised the UK Government a lack of action and said it's unlikely to meet the target of 6,000 added GPs by 2023-24 training officer I know that the NHS does have its challenges it always has done, it always will do but I know that this SNP-led Government are focused and determined to make our NHS stronger for generations to come thank you we move to closing speeches I'd be grateful if we could have less talking across the chamber while people are speaking, I call Tess White up to four minutes Ms White thank you, Presiding Officer how many warnings from the front line of our NHS will it take for this health secretary not just to listen but to act primary care is at breaking point members today have laid bare the facts that there simply isn't the capacity to meet demand sadly Graham Simpson highlighted the fact that under the SNP that we now have a national have not service Jeremy Balfour outlined the alarming stats and bleep picture Dr Sandesh Gulhane highlighted the lack of trust in Hamza Yousaf and shed light on conversations taking place behind government closed doors Jackie Baillie stated that GPs are on their knees and as Hamza Yousaf says go to the GP rather than A&E and what does Hamza Yousaf do he deflects and he blames Labour and he makes personal attacks on Jackie Baillie and he sneers at Dr Sandesh Gulhane Alex Cole-Hamilton says that it's a slap in the face to GP practices and the heroic healthcare staff and Paul O'Kane talks about GPs being at their wits end and research by the British Medical Association clearly shows that it's not just some practices that are struggling it's the vast majority and if primary care buckles it will be catastrophic not just for general practice and patients but for the whole healthcare system there are two overriding issues affecting primary care a lack of GPs and a lack of resources Bob Dorris raised Hamza Yousaf's plan to recruit 800 additional GPs by 2027 but the BMA says we don't need 800 additional GPs we need a thousand and we don't need them by 2027 we need them now we also need to stop the hemorrhaging we also need to stop the hemorrhaging of existing GPs Bob Dorris would you resume your seat in search of better conditions abroad early retirement or those who are considering cutting the sessions they currently work and Mr Dorris talks about blame he's blaming Brexit for these dire situation you cannot plug the gaps when the system is a sieve more than a third of practices report having at least one vacancy which is higher than this time last year it takes years to train a doctor the SNP government must focus on retaining the talent we have Hamza Yousaf says judge me by my record on resources the 65 million pound cut from the primary care budget and 5 million pounds in support payments means GP practices will have to try to meet patient demand with even fewer resources than before and the kicker the 65 million pound slashed from primary care was announced on the same day the crown office confirmed that almost 51 million pounds of tax payers money has been spent on the Rangers militias prosecution if the health secretary left his bunker and he's spin doctors and listened to our doctors and nurses on the NHS front line he would understand that establishing multidisciplinary teams in primary care is vital for us to scale up our patient care and we know there are problems putting multidisciplinary teams in place which can help to spread the GP workload Presiding officer we have an NHS recovery plan which has seen things get worse not better we have a winter resilience plan which is telling the public to only access urgent care if the situation is life threatening piling even more pressure on primary care and things are so dire that NHS leaders have considered introducing a two-tier system for treatment which would charge the wealthy Humzae Yousaf, thank you Presiding officer must step aside and let someone else step up who has the confidence of the medical profession I now call the minister for up to four minutes Thank you Presiding officer I'm very grateful to members for the many considered contributions on this absolutely vital subject I believe there is support across the chamber for this Government's steadfast position on maintaining Scotland's NHS as a publicly owned publicly operated and free at the point of need service Far from denying the challenges that primary care faces the first thing our amendment does is recognise those pressures I was very open earlier this month in the debate on alternative pathways to primary care about the challenges that the NHS is facing it will take time to recover from the Covid pandemic and we have yet to see the worst of the cost of living crisis however I also believe that primary care is in a better place to respond to those challenges as a result of our investment and our reforms Evaluation from local areas shows that our reforms are working the expanded multidisciplinary team that's 3,220 whole time equivalent healthcare professionals who test what appears not to know about support the effective use of time and expertise reducing multiple appointments for the same issue freeing up time for longer appointments where required and is associated with high staff and patient satisfaction these reforms are also helping to cut GP workload one moment and to make general practice a more attractive career by allowing GPs to focus on complex rather than routine care and leadership in turn improving patient outcomes improving community health and improving practice sustainability I'll give way to Monica Lennon briefly Monica Lennon I'm grateful to the minister she heard me say to Graham Simpson that NHS Lanarkshire has been in code black for 315 days since October of last year your plan isn't working minister so when will we see a plan that will work and when will we get out of code black in Lanarkshire Minister I absolutely understand the pressures that are being faced in NHS Lanarkshire I acknowledge them we are in regular contact with NHS Lanarkshire and we have increased the level of staffing right across the board in NHS Lanarkshire now GPs are rightly passionate about their vocations they want to encourage new medical graduates into the profession so do we all and what we say to the world matters our support in the public discourse for the sterling work on general practice teams must be crystal clear and unequivocal if we are going to attract new undergraduates to choose general practice as the worthwhile and rewarding career we know it to be now let me tell you a little more about some of the initiatives we have under way we are listening to what GPs tell us and this government is responding in June we launched a new recruitment drive to attract qualified GPs to move to Scotland and we discovered the joy assist some of our most remote areas to bolster GP coverage we are increasing medical school places by 100 each year over this Parliament recruitment into GP specialty training in 2022 has so far been better than any other year on record with a 98% full rate in October we announced 35 additional places for GP specialty training and there were 1184 established GP training places in Scotland as at November 2021 and as mentioned by Emma Harper Scott Jem our four year graduate entry medical degree with a focus on general practice is proving successful the first cohort of 52 student graduated earlier this year now to finish I think it's perfectly valid to compare the SNP run NHS in Scotland to the Tory run NHS in England and the Labour run NHS in Wales I think it's perfectly valid to look beyond the opposition rhetoric at what these parties actually do when they are in power in closing I want to reiterate my immense gratitude to our dedicated workforce who worked day in day out to deliver the care that our citizens need in general practice and elsewhere in our NHS Thank you Minister, I now call Calyn Mocken to wind up the debate for up to five minutes Ms Mocken Thank you, Deputy Presiding Officer Well in closing for Scottish Labour I want to be clear that this motion is brought to the chamber to ensure the voices of patients carers, GPs and all primary care staff are heard loud and clear and oh boy has that been necessary it is obvious that this SNP Government and these back benchers are ignoring the pleas for help from all corners of our healthcare system it is unfortunate that in his amendments to our motion today the cabinet secretary suggests that pressures on primary care are only due to the effects of Brexit the global pandemic and the cost of living crisis Granted Deputy Presiding Officer these do contribute to the pressures that are there Of course they do but there is a glaring omission that it is his the First Minister's and the entire Government's shocking mismanagement of the health service here in Scotland and honestly, one second their lack of openness to scrutiny constant harking back to what happened many many years ago my colleague Paul O'Kane pointed out they have been in government for 15 years given the cabinet secretary's closed approach it is disappointing that although not surprising that his allies of the SNP are considering options such as privatisation of the NHS in Scotland I give way to the cabinet secretary something more recent than perhaps not 15 years ago I wonder if Carol Mocken will want to apologise for Keir Starmer talking down overseas workers in their national health service because anti-immigration rhetoric will certainly not help our NHS in this time of need Carol Mocken and tired rhetoric that this Government brings to us it is constantly constantly ignoring their own position here in Scotland I actually wanted to say that I was heartened by the opposition that we have in the chamber to the notion of privatisation of our much loved NHS and I do believe the Government there but I want to ask Stuart McMillan does he actually believe that the BBC were lying to us about what happened it cannot be understated just how concerning the broadcast reports of keeping privatisation where it truly sent a shock wave through the NHS and the public when the story broke and I see that the cabinet secretary is actually laughing at that a fact made obvious by hold on a second Ms Mocken can you resume your seat a second I've made a number of pleas during the course of this debate for a degree of decorum respect for those who are speaking across the chamber it's not helped if we get barricing both from Government benches but also from the opposition benches to the point where the person speaking is having to almost yell into the microphone can we have a bit more respect for the remainder of this debate and give you back to five and a half minutes okay thank you I want to just come back that I think that it made it more real to us that there were so many people sent out to trash this story because obviously the government were concerned and I want to just give me one second I want to just in particular mention the member Bob Doris who I have had a lot of respect for in this Parliament but I did think that the speech that he gave today was really not a fair representation of what is going on of course I'm taking intervention can Carl Mocken name one SNP MSP who has said that they will want to privatise the Scottish NHS just one sitting Carl Mocken thank you a change of heart there of course Mike Russell but actually what I would like to say to the member is I wonder if the convener of the health social care and sports committee I wonder Carl Mocken continue I wonder if the convener of the health social care and sports committee would like to add to the work programme that perhaps we should scrutinise some of this information that we have today Deputy Presiding Officer I realise that I will have to close I think that what I have to say is that for the people of Scotland for the workforce for the health service we need the Scottish Government the Cabinet Secretary and if I'm honest the backbenchers to be much more open about what is actually happening in our health service we need to look at what cuts have been made to make a difference and we need to ensure that this Government will put up with scrutiny from the opposition benches because good opposition makes good government and I want the people of Scotland to have a good and fair public health service thank you Deputy Presiding Officer thank you Ms Mocken that concludes the debate protecting primary care there will be a brief pause for the front benches change