 Os yw'r cysylltu'r cwestiynau. Rydyn ni'n ffrindio beth o'r ffordd 5479 yn deuaith gynhyrchu i Finaslawa o'r Pagaggau Cysebeth iexhaedd. Rydyn ni'n defnyddio beth o'r debat o'r defnyddio beth o'r gerdag pwyllt nesaf. Rydyn ni'n defnyddio beth o'r ffordd o'r ffordd i exhaedd. Rydyn ni'n defnyddio beth o'r prifysg rests o'r ffordd o'r ffordd yn beth o'r ffordd o'r ffordd o'r pach. we should take that opportunity. Every single day our amazing NHS staff are performing miracles. There is the caring, the examinations, the diagnoses, the treatments, the operations, the saving of lives and the delivering of newborns. But there are also the parts that are easily forgotten or not recorded by a statistic. Giving advice, holding hands, sharing tears of grief and joy. Comforting those who have lost loved ones. Simply put, just being there and caring. We all have our own personal stories of how the NHS has touched us. We all have our own family or friends who have worked for the greatest public institution in the UK. Just by coincidence, parading officer, this debate falls on the first birthday of my younger son. This time last year was the culmination of probably the biggest emotional roller coaster that I have ever personally been on. Within the space of a week, I had welcomed the birth of my beautiful niece only for our heart to stop the next day and after days of battling for us to sadly lose her. The next day to being elected to this Parliament and then a few days later the birth of my own son, part joy but also part guilt for the tragedy that my own brother and sister-in-law were going through. I can honestly say hand on heart that if it wasn't for the love and care of the neonatal nurses and the midwives, my family and I couldn't have got through that week. So to all our NHS staff, the porters, the nurses, the midwives, the doctors, the consultants, the allied health professionals and all the rest, thank you. Thank you for caring. Because what we should never forget is that it's not the buildings, the medicines, the equipment, the treatments that make our NHS great, it's the brilliant people that work for our NHS. But our thank you's are not enough. They should be respected and rewarded for the job that they do too because goodwill and dedication to the NHS and their patients only goes so far. That's why the context of today's debate is so important. A record number of vacancies in all parts of Scotland's NHS, GP vacancies, consultant vacancies, midwife vacancies, nursing vacancies and more. And just take that last example on nursing vacancies. More than 2,500 nursing staff missing from our hospitals across Scotland. Since 2011, the number of vacancies has increased from 660 to 2,500, four times the number in only six years. And of those vacancies, the number going unfilled for more than three months has increased 300 per cent and now sits at almost 750. With nursing staffs themselves reporting that they don't have the right number of colleagues to be able to do the job properly. The Royal College of Nursing's centenary survey of its members in 2016 showed that staffing levels were their biggest concern as they just don't feel that there's enough of them to care for their patients. And without the right number of nursing staff, patients simply do not get the care they need whether that is in hospital, at home or in a care setting. Nursing staff want to do their very best for patients but their best efforts are often coming up against the reality of pressures on the workforce. In short, too few nurses are doing too much work for too little reward. Under resourced, under staffed and under pressure and clearly under paid. Under paid by this Scottish Government that has the ability to do something about it. Under paid by the Government who would need to recognise the impact that their austerity is having on the recruitment, retention and morale of Scotland's nurses. I met with some of Scotland's nurses this morning. I want to give just two examples. Graham, who has been in service for 32 years, told me that this was the lowest morale among staff ever. In his words, goodwill only goes so far, goodwill doesn't pay the bills. Or Ellie, one of the trainee nurses who told me about staff having to step in to do shifts or bank shifts to do roles that they shouldn't be doing as trainees. Others told me about nurses having to take second jobs or even shamefully having to attend food banks. NHS staff having to attend food banks. Let me set out what this Government's policy of austerity means for Scotland's nurses. This is independent analysis done by SPICE. Pay at the starting point of band five has increased by 6 per cent over the period April 2010 to 2017. Over the same period, prices as measured by the retail price index have increased by 22 per cent. That means that band five's starting point pay has fallen by 13 per cent in real terms over the period. That is the equivalent to a reduction of £3,400. I am happy to take an intervention. I thank the member for taking an intervention and reflecting on his figures. I went and asked SPICE about those figures. The answer that they gave me was a nurse starting on band five in April 2010, who progressed up one point per year and would now be on a salary of £29,000 and £33 as of April 2017. That is more than £3,000 than the member suggested, and the cash increase of 37 per cent and the real terms increase of 12 per cent. Does the member recognise those figures? I would say to Ivan McKee that we are talking about starting salaries, and that does not take into account the progressions. I am more than happy because we are publishing the SPICE analysis in order to say that. What I do not understand is that already the SNP benches are jumping to having an argument about numbers and bands when I have laid out in the words of staff about the experiences that they are having on staff. I do not think that they will appreciate it. I do not think that they will appreciate it. Can I ask the member what a recourse of action is in any member in the course of the debate who might be dismissalding the Parliament with a little bit otherwise to correct the factual situation at its earliest opportunity in reference to Mr Sarwar? I think that all members know the rules of this Parliament. Mr Sarwar, please continue. I think that Mr Sarwar should perhaps reflect on how his intervention and perhaps that of the SNP benches reflect on the NHS staff who will be watching this debate. Is it any wonder that we have record levels of vacancies, record levels of sickness absence and a vacancy crisis in Scotland's NHS? On the one hand, the Scottish Government is overseeing the vacancy crisis. On the other hand, it is paying hundreds of millions of pounds out every year to private and urgent agencies. In the past year, Audit Scotland confirmed that, right across the NHS, £175 million has been spent on private agencies. £175 million of cash is going on agencies when Audit Scotland reports and I quote, "...agency staff are likely to be more expensive than bank nurses and also pose a greater potential risk to patient safety and the quality of care." It makes no sense at all for the cabinet secretary to be throwing money at private agencies while starving the NHS of cash to resolve the vacancy crisis. The verdict of the Royal College of Nursing has been damning. Nursing leaders are clear and again I will quote directly from them, "...budget savings achieved through pay restraint are being used to meet efficiency saving targets for the NHS." They go on, the result is that NHS staff pay has fallen way behind the cost of living and many nursing staff are now struggling to survive on their pay packet, and worryingly they go on, it is negatively impacting on the quality of care being delivered to patients. This is what SNP members should be really reflecting on. This is happening in Scotland, this is happening in 2017. Nurses in Scotland's NHS on the watch of an SNP Government and an SNP cabinet secretary are struggling to survive on their pay packet. I want to repeat that, nurses in Scotland are struggling to survive on their pay packet. The RCN's most recent employment survey of members found that almost one in three struggled to pay gas and electricity bills. It found that one in seven had missed meals because of their financial difficulties. More than half reported that they were compelled to work extra hours to increase earnings, and one in three were working shifts at night and weekends to help pay bills and meet everyday living expenses. The RCN career service has seen a marked increase in calls from members with families seeking advice on career options outside of the nursing profession, often citing pay restraint and the increased and limited opportunities for skilled and experienced nurses for progress in their careers. The RCN membership survey is actually a membership survey of the RCN in the whole of the UK and not just Scotland. I wonder if you would care to comment on that. I thank the member for that intervention. I have already said that I met nurses in Scotland this morning who reflected on the same experience that has been come across from members right across the UK. Pay restraint has an impact in Scotland. I would say to Emma Harper that having been a nurse, I would expect you to understand acutely about the struggles and strains of the NHS staff right across the country. I would hope that, as a former member of a union, as a qualified nurse, she will be voting in favour of a pay increase for nurses today. That is not the Labour Party reporting those facts. Those are damning facts reported by nurses. Many are taking second jobs. Some of them are using food banks to feed their families. That is happening in Scotland. That is happening in 2017. I note that the Scottish Government amendment calls for an assessment of pay restraint. I say to the cabinet secretary that the RCN, Unicent and others are already telling us the consequences of pay restraint. The only people responsible are the Scottish Government. In control of every aspect of Scotland's NHS for a decade, the First Minister herself took decisions that we are now reaping the consequences of, like the decision to cut the number of student nursing places. Indeed, there was strong criticism by Nicola Sturgeon and the SNP Government to splash the number of training places for nurses and Ms Weiss by nearly 300 in 2012-2013. However, how do the First Minister react at the time? I quote again directly from the First Minister. A reduction in intake for the 2012 academic year is a sensible way forward. How she must regret those words today. Today, the Parliament can unite and send a message to Scotland's NHS staff. We can tell them loudly and clearly. You are our most valuable asset. You make the difference. We recognise how important the work that you do is. We respect you and you will be rewarded. That is why our motion is clear. To scrap the pay cap and give the NHS staff a pay increase that they deserve—not the alternative that is to carry on with more austerity and more cuts. That is why the choice is clear. Focus on a labour motion that will give the NHS a pay rise that it deserves or focus on the SNP's obsession only with running another independence referendum. I am very happy to take part in this debate and move the amendment in my name. As Health Secretary, I have the good fortune to regularly see the excellent work that our health service staff do day in and day out. The men and women provide care to every family in our country, working to ensure that Scotland is as healthy as possible and that our health service is first class. I know that I am not alone in this chamber, and I agree with Anna Sabur on this point that they have not only the thanks of my family but the thanks of us all. In my opening remarks, I want to focus mainly on the issue of pay. I will return to the issue of workforce levels, of which we have record workforce levels, although we have record demands on our health service. I will come back to that and the issue of agency spend in my closing remarks. The independent pay review process in the NHS can trace its origins back to the 1980s, and it is the independent NHS pay review body that considers and then makes recommendations that advise all four countries on the uplifts that should be applied. With staff representatives, we have valued the independent pay review process to date. In Scotland, we have been clear in our view that ours are annual settlements. However, there continues to be a challenge to this process, as the UK Treasury has in recent years insisted that pay restraint of 1 per cent uplifts will be maintained until at least 2020. In turn, the UK Government's Department of Health for England has adopted this approach, supported by Labour-run Wales. The Welsh Government has agreed that they also intend to apply the 1 per cent restriction until 2020. Perhaps an example of Labour saying one thing during an election campaign and doing an entirely different thing when they are in government and have the power to pay nurses. I thank the cabinet secretary for taking the intervention. Can she confirm that her own submission to the independent pay review body recommended continuing a 1 per cent pay cap for Scotland's NHS staff? Can she confirm that? Our pay policy is in the context of not just addressing the pay uplift but low pay and no compulsory redundancy policy. However, as the RCN has recognised, we are all bound by the Treasury, because what the Treasury gives in terms of the resources to the Department of Health is exactly what we get in consequentials. I will come back to the issue of the pay review body in a second. However, another aspect of where our approach has differed from elsewhere is that we have consistently applied the recommendations of that pay review body as well as taking additional action to help the lowest paid. The result of that is that we have seen a steady divergence in recent years where agenda for change staff in Scotland are better paid than their counterparts in England, Wales and Northern Ireland, because we are the only country to apply the full pay review body recommendations in 2014. We are the only country to even request recommendations in 2015. Our staff are now paid more than their colleagues undertaking the same duties in those other parts of the UK. As the Government amendment notes, nurses in the first pay point of agenda for change band 5 are now paid £312 more than their counterparts in Wales and England. In fact, to every pay point in band 5, staff in Scotland are paid between 1 per cent and 2 per cent more than their counterparts in Wales and England. A band 5 nurse who started on the first pay point in 2010 and progressed annually within it will have started on 21,176 but will have advanced to £29,34 now. Based on Labour's analysis, that would be a real-terms increase of over 12 per cent or 37 per cent in cash terms. As the unions recognise, it is not just about pay, it is also about pay progression. I will come back to that point in a second. Of course, there is the real job security that we have been able to bring. It has been this Government, with the support of Parliament, that has delivered our no compulsory redundancy policy since 2007. I know that this commitment is valued highly by NHS Scotland staff and compares favourably to the likes of the more than 20,000 compulsory redundancies that have taken place in the NHS in England since 2010. However, the difference with our approach in Scotland to elsewhere is even more pronounced when we look at the position of the lowest-paid workers in the NHS by delivering the real living wage for a number of years, by ensuring additional uplifts for the lowest-paid above those recommended by the review body and by working in partnership with unions such as Unison to provide upskilling for previously banned one staff. We now have entry-level support staff in Scotland being paid over £1,100 more than their opposite numbers in NHS England. For those dedicated, hard-working NHS support staff who are helping the delivery healthcare to the people of Scotland, I know that those additional amounts can make a real difference. However, there are clearly staff who have reached the top of their bans for whom inflation repressions will have outpaced their uplift, and while staff at the top of their bans are relatively better off than those in England and Wales, I know that they face real challenges given those inflationary pressures. To the cabinet secretary rightly, it highlights that those at the top of the pay band will, in real terms, be worse off year on year that we have this pay cap, but we should also confirm that a nurse starting today is £3,400 worse off in real terms than a nurse starting in April 2010. Nurses in Scotland are over £300 better off at the starting point of band 5 than anywhere else in these islands, including in Labour-run Wales. Of course, no one stays on point 1 of their band. Labour seems to misunderstand and not understand the way that pay progression works. It is about pay and pay progression. Those nurses starting at point 1 in 2010 will now be £7,500 better off, because they would have worked through that scale. However, the Scottish Government, alongside NHS employers and the staff side, works together at all levels to deliver the outstanding health service that we all use and rely on. We greatly value the insight advice and sometimes the necessary challenge that the NHS Scotland unions and staff bodies bring. As I look forward to meeting with the RCN, Unison and others to discuss pay over the next few weeks. In fact, I met Unison health staff earlier today. What was interesting about what one of the nurses was telling me was that yes, pay and the percentage of pay increase is one element and is important. Equally important is pay progression, is seniority pay, is recognition for continued professional development and training, and all those issues are equally as important. Those are the issues that I will address in my meeting with the unions. Not a promise of jam tomorrow from a party that has no prospect of winning the general election, but real action in the here and now, working with the unions in partnership to address those issues. Our constructive approach to partnership working was also evident during the recent negotiations to effectively do away with the lowest band 1 level in NHS Scotland and move the staff on to better pay and more rewarding roles. Again, not promises of something tomorrow but something today. Partnership with staff is always the best way to resolve issues. I can confirm today that I have written to the staff side representatives to arrange to meet and discuss jointly commission work to develop an evidence base that will help us assess the impact of pay restraint and that can be used in the next round of submissions to the independent NHS pay review bodies—no, I am in my last minute—and one thing I would say to the unions—no, I said I won't because I am in my last minute—in conclusion, we believe that there can continue to be value in the independent pay review process, but we are willing to explore alternative approaches if that is in the best interests of NHS staff. Bearing in mind, it was the unions many of whom wanted the independent pay review process. If they are now saying that they think that that has run its course and the unions want to engage with me on looking at a different set of pay negotiation structures—perhaps Scottish pay negotiation structures—then I have made clear to the unions on many occasions that my door is open to that, that that has to be with the staff side agreement. That is something that I will put on the table to discuss with the unions in the NHS, whether they want to maintain the independent pay review body process or whether they want to move forward in a different way. We will move forward working with the NHS staff in partnership to deliver Scottish solutions that work for the benefit of all of our hard-working NHS staff. Donald Cameron will speak to remove the amendment in his name. The debate today is about the priority and choices for our national health service. Do we want a strong NHS that is able to cope with rising demand, an ageing population and the pressures placed on its staff? Or must we have an NHS that is unable to handle the heat with plummeting staff morale, longer waiting times and longer waits for appointments? Nobody in this chamber would opt for the latter. However, the record of this SNP Government will inevitably lead to the very issues that we want to avoid. This Government has been in power for more than 10 years now and has had full control of the direction of the NHS during that time. What is their record? Significant staff vacancies in nursing and midwifery and consultants in allied health professions, people waiting well over the 18-week target for referral to treatment and a failure to meet waiting time targets in accidents and emergencies within only seven out of 52 weeks met last year. Most pertinently, in this debate, it gets subtle. Has Donald Cameron recently looked at the relative for A&E performance of our departments in Scotland compared to Tory-run NHS England? It is night and day. A quarter of NHS A&E departments in England were in crisis over the winter, something that is not seen here in Scotland. Will he pay due recognition to the hard-working efforts of A&E staff that have delivered the best performance in the UK? We have been here many times before. This is an SNP Government that runs the Scottish Health Service. It should concentrate on its record and not point the finger at other places. Most pertinently in this debate, plummeting staff morale is present, with almost half of NHS staff feeling that they were unable to do their jobs properly because they were overworked. This is a depressing record for an SNP Government who regularly likes to trump it that they are the only party that can deliver for the NHS. It is a record that I will come back to in a moment. Let me first address the issue of Brexit, which appears in the Government's amendment. I would like to deal with this head-on, given its prominence in the media today, and it was mentioned earlier in portfolio questions. It is difficult to estimate the number of NHS employees from non-UK EU countries. We know that, in terms of the NHS, it is approximately 5 to 10 per cent. So undoubtedly, Brexit presents a challenge, and the UK Government has been very clear. One of the Government's top priorities as part of the Brexit negotiations is to secure the rights of EU nationals to continue to live and work in the UK. I have said it before, and I will say it again. The serious issues in NHS staffing in Scotland did not suddenly begin on 23 June 2016, when the UK voted to leave the EU. GP shortages have been in existence long before then. The SNP cannot use Brexit as cover for the existing workforce crisis. We are going to be 820-odd GP short by 2021. Many staff are close to retirement. Those who are left are overworked and under immense pressure. The health workforce in Scotland is in crisis due to nearly a decade of SNP mismanagement. It is not here that the SNP blames Brexit for their own problems, or use it as a reason not to take responsibility. Turning to Labour's motion, I have huge sympathy with the feelings and motivations behind that motion. We all want our NHS staff to be properly paid, but, at this point in time, those benches cannot support and enter the cap, partly due to tight budgets and multiple rising budgetary pressures. We believe that, for the time being, staff should continue to receive a 1 per cent pay rise and should be supported in other non-financial ways. If we are to secure the long-term future of the NHS, we should instead be ensuring that the short staffing problems that pervade the health service are addressed as a matter of urgency. Anasawa Y Llywydd, the member for taking intervention, but surely that extra support shouldn't be food banks. Surely there has to be a recognition that there is a direct correlation between staff vacancies, staff morale, patient outcomes and staff pay. Surely even the Tories can see that. Donald Cameron I accept that hard-working NHS staff deserve to be paid well as they do skilled and vital jobs. Indeed, I welcome the Government's commitment to ensure that all staff are paid the living wage. We acknowledge that the Scottish Government has passed on recommended pay increases and that staff in Scotland, in the NHS, are paid more than in other UK countries. However, as I have said, the NHS is facing rising demands with an ageing population and complex health needs. Any decision to increase pay has to be taken in a wider context. Despite the pay cap, staff costs still increased by 6.4 per cent in the last five years, and staff costs make up nearly half of all NHS operating costs. If we manage to reform the NHS in order to continue to deliver high-quality healthcare and truly shift the balance of care away from the acute services into the community, we would be able to invest what we save. Labour has come to this chamber today with an important issue, a very important issue, but it has made no mention or given any detail of the cost of what it is proposing. I have not said how it is indeed. Neil Findlay. In the NHS, there are huge vacancy rates. We cannot get people to take up posts, and yet the member is arguing for a cap of 1 per cent. In this place, there are no vacancies. There are armies of people outside who would be desperate to take up their posts, no gaps, and yet he will agree to an increased pay level than he is for nurses that will be paid to him and die. Is that fair? The point that I make to Mr Findlay is that you have given no details of how much this is going to cost. How is it going to be funded? The UK Labour has estimated that every 1 per cent extra on pay will cost the NHS £350 million. However, other figures suggest that it could be higher. Labour may want to supply some figures, although perhaps not by consulting with Diane Abbott this time. While the Labour motion does not address one of the central issues that face our NHS, we must address staffing levels. We know that staff morale is low, and we have seen time and time again that low morale is down to the fact that there are severe shaft shortages across the NHS, which this SNP Government has failed. No, I have taken several interventions that I need to crack on. The SNP Government has completely failed to tackle. We know that the most recent figures show that. We have quoted the number of consultant posts vacant, the number of nursing and midwifery posts that are vacant. Time and time again, the Government has ignored our warnings and even ignored the warnings of the very consistent calls from the professional bodies that show us that this cannot go on. The Royal College of Nurses, the doctor who led the Scottish Government's own cancer strategy, Dr Anna Greger, said that the NHS in Scotland is hurtling over a precipice with everyone pretending that it is going to be all right, and it won't be, she said. We are warning the Scottish Government over recruitment and retention. Professional bodies are warning the Scottish Government. Medical staff are warning the Scottish Government. They are becoming for years. The question is, when will the SNP listen? Do we want another four years under this SNP Government where targets are missed? Do we want another four years of crippling pressures on existing staff because of vacancies? Can we deal with four more years of inaction from a Government that deludes itself into thinking that they are best placed to run the health service while ignoring the serious concerns of professional bodies and staff? The answer to all those questions is a resounding no, and I move the amendment in my name. Thank you very much, Mr Cameron. We now move to the open debate. I call Monica Lennon to be followed by James Dorn and Ms Lennon, please. Thank you, Presiding Officer. I'm proud to be standing up in the chamber today to support our hardworking NHS staff and to vote at decision time this evening in favour of a wayd rise for the workers who are the foundation of our health service. The continuation of the unfair 1 per cent pay cap on earnings over £22,000 per year means that Scottish nurses will have received, on average, a pay cut of £3,400 under this SNP Government. The Royal College of Nursing Scotland and Scotland tells us that, since 2011, nursing staff have experienced a real terms cut-in earnings of between 9 and 14 per cent. That situation is, frankly, unsustainable. Nurses are the foundation of our health service, but they are failing to get the support and resources that they need from this SNP Government. The facts are clear. Nursing staff are under pressure, like never before, finding it more and more difficult to get the adequate time to care for their patients and, all the while, facing their own increasing financial difficulties. The RCN's most recent employment survey, which we have heard about today already, of its members finds that 30 per cent have struggled to pay bills, whereas over half have been compelled to work extra and on social hours just to make ends meet. Meanwhile, spending on agency and private nurses under the SNP has soared, and there is a vacancy crisis with unfilled nursing and midwithery posts. Since 2011, when the SNP formed a majority Government, the number of long-term vacancies has rocketed. Audit Scotland tells us that, in the same period, agency spend has also rocketed now to a level of £175 million. Perhaps that is an area of savings that the Tories could consider when they are putting questions across to the side of the chamber. Nine out of 10 nurses are telling us that they feel that their workload has got worse. In every aspect, NHS nurses are being overstretched and overworked. I brought to the chamber recently, Deputy Presiding Officer, in respect of MS nurses, particularly in NHS Lanarkshire, but right across Scotland. NHS nurses deserve, like all our staff in the NHS, a much better deal than what they are currently getting from the SNP. In recent years, I have had reason to be in and around hospitals more than I would like. Two years ago, this month, my father died in Hermeyr hospital in East Kilbride after a period of illness. He was only 60 years old, and it broke my heart. A couple of days before he died, one of the nurses prepared me and my family for what was ahead. His name was Paul, and although I did not want to hear what he was telling me, I was so pleased to see him because Paul had cared for my dad and nursed him during a previous admission. He cared for him with such compassion and attentiveness that I had not forgotten him and I doubt I ever will. Then there is Katie, another nurse who looked after my dad and my family, as we said our goodbyes. When I returned to hear my hospital just two weeks ago, this time waiting for my mum to be taken into surgery, Katie appeared in the waiting room and approached me. It was a lovely surprise to see her, but she gave me one of those hugs that smothers you in kindness when you are struggling to hold it together and leaves you fighting back tears. In between those experiences, last year, I had to be referred to the breast clinic at Hermeyr hospital to have some cancer tests. I went alone and I was terrified and again emotional. The nursing staff were simply first class. They kept me calm as I waited in between different examinations in a very busy waiting room. I looked around me at dozens and dozens of people queuing at the desk, people there with children, it was noisy, it was stressful and I simply wondered how the staff managed. In the last year that I have been in the Scottish Parliament, when I come here and I hear Scottish Government ministers and SNP backbenchers accuse me and my Scottish Labour colleagues of rubishing NHS staff, of talking them down, of playing politics, I feel sick to my stomach. When our MSPs come here to shine a light on the pressures that are facing our NHS, it is because we have nothing but admiration and respect for NHS staff. The nurses in this Parliament will celebrate later on a member's debate tonight. There are our friends and our neighbours and our loved ones too. I would ask the Scottish Government when they come here and deflect criticism of their stewardship of our beloved NHS on to the very staff who have been stretched to breaking point, is that fair? I know that we have a couple of nurseries on the SNP benches and I would really ask them to think about where their loyalties lie tonight when they come to press their buttons at 5 o'clock. How can you have been a nurse and served alongside these people and betray them this evening? I've got a few seconds left but I'm happy to, Deputy Presiding Officer. It's my way slightly different. I wonder how, as a councillor, could Monica Lennon defend the approach that South Lanarkshire took to the equal pay claims of thousands of women across the authority? I'm no longer a councillor but that is ridiculous coming from a Government minister to bring into a debate something that has got no bearing on this and she knows fine well that I support equal pay for all workers. I think that that is pretty shameful but let's get back to the point because at 5 o'clock you can smile but we've heard that nurses, nurses are going to food banks. We had a debate in the Parliament last night about food poverty. You can't sit there and say it's someone else's problem and turn away. Tonight, we're going to see if we're going to have an SNP Government voting with a Tory party to block a pay rise for nurseries. I was in the final seconds. Deputy Presiding Officer, thank you for your generosity. The choice is clear tonight. MSPs either support a pay rise for our NHS staff and believe the pay cap should be scrapped or they don't. It's black and white, Labour is clear where we stand on the side of working people. Others in the chamber should consider doing the same. Before I start with what I was going to say, can I just make it clear to members on that side of the chamber and right across the chamber, they do not have a monopoly on people having to deal with the health service. They are not the only people who have had people die in hospital and who care about the nurses and the doctors that treated them. What's happened from both those contributions is suggesting that we don't care about the nurses. We don't care about the hard work that they do and we don't respect the hard work that they do. Of course they do, because, like the people on that side of the chamber, every single person in here will have lost somebody in the health service. I just don't think that it's becoming of anybody to try and pretend that they've got a monopoly on that. The NHS is often described as a jewel in the crown of British society and with some justification, yet, despite what they say, it seems to me that across the UK it's the Scottish Government who recognises its importance and prioritises the needs of the NHS, whilst trying to balance the ever-shrinking gift of our own money passed down via the Tory austerity. The Scottish Government has consistently protected the front-line health budget at all costs, enabling our health service to be free at the point of need and, importantly, to remain public low. I will do that. Monica Lennon I thank James Dornan for taking the intervention. Can I ask him what he would ask the Scottish Government to do to stop nurseries in Scotland and our NHS in Scotland having to go to food banks? Scottish nurses are better looked after than any other nurses across the UK. What you fail to recognise at any time in any debate is that we work under the same financial restrictions as the rest of the UK. We make a conscious decision to have no compulsory redundancies, to make sure that the lowest-paid nurses have a £400 bonus, to make sure that they have a 1 per cent increase that other nurses across the UK don't get. So don't come here and tell us that the Scottish nurses are badly paid in terms of the rest of the UK nurses, because in Scotland we are doing everything that we can and the restrictions that we have to make sure that Scottish nurses are looked after. Across the UK, the NHS is under great pressure, but nowhere more so than in Wales. Under the devolved Labour administration, accident and emergency waiting times are longer, ambulance response time is slower, and patients in Wales wait longer than anywhere in the UK for many routine treatments. Maybe Mr Sarwar, who apparently has all the answers when it comes to running a national health service, could use some of his expertise to assist his colleagues in Wales. I could list a load of figures on how much money the NHS is receiving from the Scottish Government, but I think that it is important that we look at the result of that investment across Scotland. Again, we very often get quotes from certain politicians criticising the new Queen Elizabeth hospital, and yet in January there was a peak in the number of women who received maternity care across Glasgow primarily in the QE, and while numbers were high and patients were looked after at the best available facility, Scottish Labour seemed to see this as another opportunity to use a hospital as a stick to beat the Scottish Government with. The reality is, of course, that the only people who are damaging with their constant carping, outside of their own dwindling political reputation, are the hard-working staff across the Queen Elizabeth and other hospitals. For you to talk about trying to deflect criticism, we do not try to do that. What happens is that the politicians who come in here and criticise the health service workers are not us, they are in those benches there. The recent BBC documentary drama Scotland's Superhospital has been fascinating and shows just a fraction of the first-class state of the art hospital and what it does for the people of Glasgow. I was a patient in this facility and can vouch for the care that was given there. The other thing is that when you are there, parking is free. Why is that important? Because there are families who use the hospitals. I know a one family, two kids, chronically ill, have to use the hospital sometimes four or five times a week. If they had to go there and pay parking charges along with the stress of having to go to hospital in the first place, they would be in an awful state and it would make things much, much worse. Why is that an issue? Because until the SNP Government committed in 2007, this party here made sure that they had to pay for parking in the hospitals. The Labour Party was quite clear that parking in the hospitals was a justifiable price to pay, of course I will. I absolutely agree that the removal of parking charges was the right thing to do. What I do not agree with is taking off parking charges and having no traffic management system in the hospitals, because it is in John's hospital in Livingstone. Parking is chaos with people tending for chemotherapy and other treatments that leave an hour or an hour and a half early to drive around a car park for that hour to try and find somewhere to park. If we remove the payment system, there has to be a traffic management system. If Aldi's can do it, surely the NHS can do it. Can I just remind members how interesting traffic is and traffic parking in charges? The debate is not on that topic. Neither is the amendment. Mr Dornan, do not talk over me. Do not sit down please. I am looking at the amendment, I am looking at the main debate. Let us keep to that please and not drift into another area. Mr Finlay, please sit down. It better be. I am letting you say that. I am waiting to see if it is a point of order. I am sorry, officer. The issue of parking is relevant because it relates to nurses pay. They have to pay for parking if they do not use it. That was not in that. It is not in that it was being extended. It is not relevant to the amendment that is before me nor the motion. I want us to get back to the motion in hand. Both of you, please continue. Can I just clarify for me how far away from the work of the motion in the amendment— I have made my ruling, Mr Dornan. I want you to get on with your speech. Do not challenge me, please. Right. Nurses in midwives are one of the most valuable resources we have, and the Scottish Government also clearly recognises that, in order to sustain a high level of care, we must invest in the future of our nursing services, and that is why we are committed to free tuition and bursaries for those studying to be nurses. Not only are we committed to the development of the workforce, but Scotland has worked hard to maintain its no compulsory redundancy policy, while in England there have been more than 20,000 redundancies since 2010. Of course, Scotland works under the same financial restrictions as the rest of the UK, but I have figures here from the Royal College of Nursing showing that nurses here in Scotland are paid at a higher rate than their counterparts across the UK, which is just another way of showing how we value this service. I know that there is an election coming up, and I know that people want to grab headlines with motions criticising the Government. However, what I would ask is, in a motion such as this, how do we fund this extra pay? Would we scrap the no compulsory redundancy cap? Would we scrap bursaries for the nurses? Or would Scottish Labour take away more money from the other vital front-line services that they claim to protect? Where is the £350 million a week for the NHS, which we were promised, after Brexit, which this side opposed? As did most of that side, well, back then they did, but before they were told that they were no longer opposed it. It is almost like a cult over there, isn't it? Presiding Officer, I had the good fortune to be at the count on Friday to see the SNP take control of Glasgow City Council. There is relevance to this from the Labour Party. So what did I hear there? I heard Anas Sarwar telling a media company that this was a terrible day for SNP and independence and a strong showing for Labour. While Mr Sarwar continues to make fanciful and irrelevant contributions such as he did last Friday and again today, the Scottish Government will keep to the promise of improvement of the NHS and support for our hard-working and much-valued nurses. Thank you very much. I will have no comments about the length of time from MD. I intervened, you intervened and I have given that time extra to the speaker because I made a ruling in it. Mr Whittle, followed by Stuart McMillan, please. Thank you, Deputy Presiding Officer. First, I declare an interest in my daughter's healthcare professional in the NHS. I welcome the opportunity to speak in this debate and thank Labour for raising this important issue in the chamber today. I am sure that across this chamber there will be complete agreement that our NHS staff, like all our front-line public servants such as the police and fire servers and so on, deserve to be paid appropriately for the work that they do and the care and attention that they give on a daily basis. The question remains, of course, how this is achieved in a sustainable and consistent manner beyond the political rhetoric and posturing. In the last week, I have had the opportunity to witness first-hand healthcare on the front-line. First, I spent some time in A&E and you will be pleased to hear that I was seen well within the four-hour guideline. While waiting to be seen by the duty nurse, I was able to watch the nurse's station and observe what was actually going on. Her ass staff phoned through to the front desk asking them to stop sending people through because there was no room, patients complaining that they had already been sitting for half an hour and a nurse saying that she was fed up leaving the hospital feeling guilty even though she was well over her hours at eight o'clock in the evening and she was drew back on a morning shift. I did take the opportunity to speak with her and what she wanted above all was to feel valued. For us to understand the role that she did, to have the staff numbers and experience to cope with that demand, to have the flexibility in duty roster to cope with the fluctuating demand. On Monday night, I met a GP who was part of a practice that had taken the difficult decision to close a surgery in Fennick and resigned the rest of the practice in Crosshouse and Kilmores. NHS Ayrshire and Arran are currently looking for GPs to take over the practice and have only had one tentative inquiry since January this year. Five GPs potentially taken out of a system in Kilmarnock compounded by the fact that within 18 months a further six GPs are due for retirement in the same area. A potential loss of 11 GPs—I will finish this by a point, thank you—in Kilmarnock. As of two weeks ago, there were already 15 GPs advertised positions unfilled in Ayrshire. A recent presentation on primary care at Glasgow University makes it obvious that this is far from being an isolated problem—it is endemic across Scotland. Mary Todd Thank you, Presiding Officer. Would the member agree with me that, although there are difficulties in recruitment to general practice, the report today by the Royal College of General Practitioners about the impact of Brexit on the workforce in Scotland is particularly worrisome—I would say to Donald Cameron, your colleague—for those of us who represent rural areas, such as the Highlands and Islands, where up to one in four of the doctors is an EU national. The problem is that it is not just about recruiting staff from across the world. What about supporting our own and retaining our own home-grown GPs? Here is the thing. That GP told me that she wrote to Shona Robison two weeks before resigning the practice on 31 January, asking for help, and that she is still awaiting a reply. No, I will not take an intervention, thank you. She is still awaiting a reply. It is all very well having the rhetoric, but it is action that actually applies here and is patently not the case with this Government. When that GP joined the practice as a partner 10 years ago, it was the eighth one that she applied to. Now a GP can pretty much choose whatever practice they want to go to, and I was shocked to be told that the most dramatic change had happened in only the last three years. As has been alluded to, the practices that suffer the most are the rural practices as GPs migrate towards population centres. The people that suffer the most are the patients who lose continuity of care because it is not just GPs that we are losing. It is the years of experience in those communities and the relationships of trust that has been built up with patients over the years of treatment. Locums are being increasingly sought to fill gaps, and here is a major financial issue that must be addressed. Three years ago, they were paying a locum around £180 a day. Now I am told that the practice that has just closed was having to pay £250 for a locum to cover just four hours. With the pressure that our GPs are under, coupled with the demand, is it no wonder that they are working as a locum in such an attractive proposition? The issue, according to the GP and her colleagues, is not the money that they earn, it is being valued, is recognising that GPs are the gatekeepers, the healthcare professionals with long-term patient relationships built on years of working in a community. The play from GPs is firstly to stabilise the current workforce as an immediate priority. The consequence of not addressing this right now according to the GP is more people ending up in hospital. The consequence is that the next conversation that we will have will be how we deal with the mess and the fallout. It is true for politicians that are for GPs. The longer you leave the problem before treating it, the harder it is to deal with. The reality is that, as GP numbers have fallen, hospital consultant numbers have risen. With falling front-line GP numbers, the number of patients ending up in hospital inevitably rises coming through A and E. Patients that could and should be dealt with in local GP practices. That brings me to the labour motion. It is not just about the levels of pay. NHS, which is sustainable for the long term, must be the aim that, quite frankly, will take a radical overhaul of the way in which we view health and healthcare. It requires a culture change in how health professionals are viewed and treated both by this place and by the public more widely. The preventable health agenda, where there are potentially billions to recoup and reinvest, has to be placed front and centre instead of the lip service that it is currently giving. The job that healthcare professionals do must be made to be more attractive and a valued career path. In the words of healthcare professionals, that is more about just money. Choosing a career as a healthcare professional is not driven by financial reward. It is driven by a desire to care. What came across loud and clear in my recent conversations with healthcare professionals, way above all else, is concern for patients. What will happen to them if the NHS is not steered on to a more sustainable course, where the baseline is to improve long-term health outcomes through sustained continuity of care? If we are serious about recruiting into the health service to address demand, if we are serious about rewarding our healthcare professionals appropriately, simply throwing more money at the problem is not the right course of action, we need to stop treating the symptoms of the systemic issues in the NHS and focus on dealing with them long term. Let's stop trying to just keep the show on the road and start thinking about how we build a sustainable future for our NHS. Thank you. I call Stuart McMillan to be followed by Alison Johnstone. Mr McMillan, please. Thank you very much, Presiding Officer. We've already heard today comments regarding the Royal College of Nursing for Scotland briefing, and it's from some of the folk from the Labour benches. I'd like to just comment or quote as well from their particular briefing. The Royal College of Nursing Scotland stated that pay awards for NHS staff have been constrained by the UK Government's policy and public sector pay since 2011. It should, however, be noted that the Scottish Government has implemented recommendations made by the PRB to date even when the UK Government has not. That means that whilst terms and conditions remain broadly equivalent across all countries, pay rates for each of the pay bands vary. That means that, certainly in Scotland, there has been an increase and there is a higher level of pay across the bands in Scotland. I also want to touch upon a couple of points as well. I'll try to let you in later. The Westminster Government has reduced Scotland's fiscal deal budget by 9.2 per cent in real terms between 2010-11 and up to 2019-20. In spite of that, the Scottish Government has committed to continue to provide above-inflation increases in Scotland's health budget. Also, while the SNP Government has protected the front-line health budget, increasing it by 40 per cent from 2006-07 to 2017-18. Health funding now stands at record levels in 2017-18. Health spending in Scotland will exceed £13 billion, with resource spending being over £3.6 billion more than when the Government took office in 2007. Her Majesty's Treasury figures state that health spending per head in Scotland is 7.2 per cent higher than in England, equivalent to £152 per person. In terms of the NHS in Scotland, it is clear that those figures highlight that, although there are challenges in the NHS—I do not think that anybody on those benches could indicate that there are not any challenges in the NHS—there will always be challenges in the NHS irrespective of as to which party or parties are in power. That is going to be the case here. It will also be the case in England and also in Wales. We have already heard some examples of that in this debate this afternoon, but none the less. It is clear that, in terms of the finance and the importance that the Scottish Government places on the NHS in Scotland, it is paramount in the funding that is going into the NHS and the level of focus that is going in to make our NHS better and more responsive. Members from across the chamber have really got to try to understand that particular level in terms of the funding that is also going in. Our NHS staff are resilient. We have heard that already in previous debates. Our NHS staff are resilient, and they have unique skills that they bring to their patients and to the multidisciplinary teams in which they operate. Our NHS staff are always there at times of crisis to treat, care and reassure their parents and their patients. I have been very fortunate that I have not had to call upon NHS staff very often. I am fortunate that, with my family, we have been very fortunate from that perspective, too. However, with constituents that I deal with, on a regular basis, there have been challenges. However, the one thing that comes back time and time again is how valued our NHS staff are. I am sure that every member of the chamber fully recognises and appreciates every single thing that our NHS staff do for the country. The Scottish Government's public sector pay policy sets out the 1 per cent maximum increase for those earning more than £22,000 per annum, and the continued real-term reductions in public sector budgets in Scotland in 2017-18 flow from the UK Government spending round. Members of the Tories have to recognise that. Their cuts are coming to this Parliament, and that means that the constraints and pay bills across all public sector organisations are still required. However, it is also recognised that maintaining employment and fair rates of pay in the public sector is crucial in ensuring that Scotland's economy remains strong. The aim of the policy is to allow public bodies to provide a pay increase for all staff, with particular support for those in the lowest incomes and for employers to take their decisions about pay progression. There is a context between NHS England and NHS Scotland, and the proposal to increase the pay of NHS staff beyond 1 per cent annum is born primarily out of the fact that there are severe staff shortages of NHS staff, particularly nurses in England. Speaking in the BBC Radio 4 today programme, Jonathan Ashworth, the Shadow Health Secretary, revealed that, as a result of the staff shortages in England, labour would scrap the 1 per cent pay cap in place for all NHS staff. It would reverse the end of the busseries in the introduction of tuition fees plan for August for student nurses in midwys. Indeed, the latest UCAS figures have revealed the deep damage that Tory Government cuts are having on the nursing sector in England, with applications to English nursing courses down 23 per cent this year, after the UK Government abolished busseries that encouraged people to take up training. It is no wonder that that highlights the fact that Donald Cameron, earlier on today, did not want to talk about the comparisons to England, with a 23 per cent reduction in applicants, tuition fees and busseries scrapped, and with the issue of creeping privatisation of the NHS in England. I am conscious of time, so I am going to conclude with this point. The SNP Government continues to value the work of the independent NHS pay review body, and the Scottish Government again applied the recommendations this year. The Scottish Government has been consistent in its efforts to offer the right support to nursing students, keeping free tuition, protecting the busseries and creating the discretionary hardship fund, supporting our NHS staff for the future as well as today. It is time for the pay cap to be scrapped. Years of pay restraint have eroded living standards for our NHS staff. We can't deny the negative impact that this has on staff morale or the effect that it has on staff retention. The NHS in Scotland already faces severe workforce shortages, with a retirement boom on the horizon, and many staff are looking back at years and years of real-terms pay cuts and wondering whether they can afford to keep on giving to the NHS. I will support this motion today because the Scottish Greens believe that we must restore the value of pay for our NHS staff and, indeed, in our wider public sector. The pay cap has a direct impact on our wider communities. The NHS employs more than 160,000 people in Scotland, the majority women, and a below-inflation pay cap contributes to the gender pay cap and inhibits multiplier effects in our local communities and economies. Hospitals and health centres are vital anchors in those communities, and holding down pay has implications for them, particularly in our remote and rural regions. The Scottish Government's position is that it adheres to the NHS independent pay review body's recommendations. Passing on those pay uplifts in full, I am glad that that often results in better pay for NHS workers in Scotland compared with their counterparts in England. Ensuring a minimum increase of £500 for staff earning £22,000 or less is a positive measure, but I do not believe that it goes far enough. The independent pay review body last report is quite clear that Government sector pay policies set the context for its recommendations. On NHS pay in England, it says, we were told by the health departments that a 1 per cent pay award is funded. It is clear that a pay award higher than 1 per cent would require trade-offs in terms of service levels, investment decisions and, potentially, staff numbers, with associated implications for workload and pressures on staff and service delivery. If the independent pay review body is only prepared to make recommendations that are already in line with the Government's spending plans and sets the expectations that NHS staff should bear the cost of trade-offs between pay and service delivery, I struggle to see where the independence lies. The report also outlines the Department of Health's view that public sector pay restraint played a key role in the Government's intention to reduce the budget deficit. It seems clear to me that the report makes its recommendations in that fiscal context. I say that it is not for nurses, midwifes and healthcare assistants to play a key role in reducing the budget deficit, and the NHS pay should not be based on misguided economic austerity. Even the NHS pay review body report acknowledges that, in 2017, inflation is outpacing forecasts, and we are approaching the point where current pay policies will require change. Public sector workers did not cause a financial crisis, and they should not be expected to shoulder that burden 10 years on or to preserve the financial pressures on our NHS due to demographic change. In view of the UK-wide pay review body's overall approach, I would be inclined to support a Scottish system for pay review in future. However, if professional bodies and trade unions take a strong view that pay recommendations should still be set on a UK-wide basis, it is vital that the Scottish Government plays a full part in that process. The pay review body's report was blunt about the impact that postponing the draft budget had on the process, delaying submission of evidence from the Scottish Government, reducing time available for scrutiny and inhibiting the ability of other parties to respond to the Government's position. The Royal College of Nursing has told us that the pay cap has resulted in a 9 to 14 per cent drop in earnings for nursing staff since 2011. I believe that that grossly undervalues the care nurses give the long hours that they work and the pressure that they face. The Royal College of Nursing's recent survey of members found, as we have heard, that 30 per cent had struggled to pay gas and electricity bills and, staggeringly, 14 per cent had missed meals because of financial difficulties. Yes, certainly. Thank you. Can anyone in the chamber provide me with information about how many of the respondents to that survey were based in Scotland? Alison Johnstone. I was speaking to nurses yesterday and I can tell you that I can confirm that this policy is having an impact on them. Yesterday I spoke to an experienced nurse who has taken on a part-time job because she simply cannot make ends meet. Although I have heard that pay progression is still in place and that is to be welcome, the fact of the matter is now that someone doing a job could be paid less than someone was being paid for that same job in 2011. We have a problem here. Nurses should not have to cope with financial pressure at home as well as pressure at work. The Royal College of Nursing is calling for a pay award of 2.6 per cent in line with the retail price index, and I believe that that is right and fair. Economic inequalities are at the centre of health inequalities in this country, and that cannot be denied. You do not have to be living in absolute poverty to suffer poor mental health because of debt, to suffer stress because you have no work-life balance, because you keep taking on extra shifts to keep your head above water. Those financial factors have an incremental effect, leading to sickness and time off work. Staff absence in turn pushes up spending on agency staff, and NHS employees really feel that unfairness when they see how much is being spent on agency nurses and locum doctors. They could look to Denmark where hospital nurses are paid around 16 per cent more than here in the UK or Australia, where their pay would be over 20 per cent better, and we know, sadly, that many of them are. Our nurses do not go into this profession for the money, nor do our midwives, paramedics or public health professionals, our physiotherapists or psychologists, but they should not expect their dedication, professionalism and expertise to go unrewarded as their pay falls below inflation. The Government's amendment says that it will jointly commission work to develop an evidence base to assess the impact of pay restraint. I think that we have a good idea of what the impact of pay restraint is. I think that our NHS staff know the impact, and they have already made clear in previous submissions to the pay review body what the impact is. The Royal College of Nursing has polled its members on the action that should be taken on pay restraint, including the option to ballot for industrial action. That is how urgent the situation is. I believe that restoring the value of NHS pay will have a positive impact on staff retention and professional development and, ultimately, on the standard of care that we all want to receive. I congratulate the Labour Party on bringing forward that important debate, and I ensure it with the support of those benches tonight. I have spent this first year in my term as MSP for Edinburgh Weston on one of the steepest learning curves of my life. It has been my great privilege to service my party's health spokesperson throughout that time, and I have met, through my introduction to the many tiers and avenues of our health service, some of the finest, most dedicated professionals in our society. People who, in many cases and from an early age, have answered an inner calling to meet the needs of the most vulnerable and infirm in our society and have done so without thought of reward just as well, because there are very few roles within the health service that attract opulent financial recompense. Pay in the NHS has never been world-beating, but the cap that we debate today has seen a year-on-year real terms decline in take-home pay for hard-working staff across our health service. In the teeth of a hard Brexit and with the devaluation of the pound that comes with that, we see the value of those pay packets diminish still further and, with it, the buying power of hundreds of thousands of employees. We ask so much of those who we look to for treatment and for care, yet we offer so little by way of reward that we offer is diminishing by degrees. I do not think that it is melodramatic to say that to continue on as we have done so, with no prospect of pay increase in real terms for our NHS or social care workers represents an existential threat to the delivery of both health and social care in our society. At its bedrock, the NHS and the social care system that underpins it is nothing without its staff. The rhythms of our health service are constantly interrupted by the stuttering of staff shortages, inadequate workforce planning and an attrition in our staff base. Underpinning all of that is a need for fair and equitable pay to make a career in health or social care and attractive and viable life path choice once again. We cannot expect that pressures on our hospitals or GP surgeries to abate while they are so hungry for a new staff cohort that, in many cases, is either just not coming up through the ranks or who instead is looking overseas for opportunities that attract greater financial incentive. Adequate investment in our workforce is simply vital. It is the call that we, all of us in this chamber, receive from stakeholders in every speciality in the sector and in the Labour Party motion tonight. At all too many junctures in the system, the system is buckling under the weight of demand. Evidence in the revelations from Audit Scotland last September that our health boards have missed all but one of the national targets that they are expected to meet. Delays in accident and emergency offer the starkest such insight to the chronic problem that we face in throughput within our health system. I was very grateful to meet representatives from the Royal College of Emergency Medicine who opened my eyes to the reality of underpinning those massive delays beyond the four-hour target. A and E waiting times act as a weather vein for the natural state of flow in the health service. They do not point, as people often expect, to a problem in capacity in A and E, but instead the reality of how easy it is to clear patients out of A and E into the wider hospital. Put simply, those delays are caused by bed blocking, which is in turn caused by a profound shortage in social care capacity. I have raised many times the case of George Ballantyne, my elderly constituent who had to endure 150 nights in Liberton hospital. I will, in a second, be on the point at which he was declared fit to go home. I will take an intervention for you, Todd. Sorry, I perhaps missed the congratulations from my colleague, Alex Cole-Hamilton, to the Scottish Government about their incredible performance on A and E four-hour waiting times over the last number of years, compared to all of the other UK countries, given that it is indeed a canary in the mind target for the health of the system. I am delighted to congratulate Marie Todd in neither using the word coalition or Conservatives in her intervention to me this time. On that point, I think that you are missing the trick entirely. The point about A and E targets is the fact that we have a colossal problem of bed blocking in our hospitals. The delay in this discharge was due entirely to the fact that the social care package for Mr Ballantyne, of which I was speaking earlier, was that that was not available. No night-time check could be established into a programme, because there was no staff available to do it. That delay cost NHS Scotland hundreds of thousands of pounds. When those members on the Government benches asked me from where we get the money to pay for such an uplift, I point them to Mr Ballantyne and his protracted stay in the most expensive hotel in Edinburgh. The cost of failure demand in Mr Ballantyne's case is replicated across every health board in our country. As such, if we were only to recalibrate the direction of expenditure, we could free up far more resource to offer financial recompense at every level. It is precisely because we failed to invest in our social care workforce that cases such as this are so commonly raised within the proceedings of this chamber. We expect carers to attend their charges for sometimes as little as 15 minutes of session because of travel times and to receive a salary that they could just as well find stacking shelves in a local supermarket. Local authorities state with regularity that they commission social care on grounds of quality over cost, yet the reality of that split is felt most keenly by service users on the ground. Deputy Presiding Officer, it is often easy for members of the opposition to ask the moon of government to write checks that where we are in government, we could never hope to cash ourselves. However, on that, the solution to so much of the staff crisis that the devil's hour health service and much of our social care service is blindingly simple, and I'll finish here. Entice people back to the fold, invest in our workforce, give them a future of comfort and security, and they will visit it back on the people in their care 10 fold. We have so much to be proud of in the men and women who deliver care in this country. The very least that we can do as public servants ourselves is to ensure that they can do the job that they love with a measure of dignity and the proper reward. Thank you. Thank you very much, Mr Cole-Hampton. Before I call you, Mr Leonard, could I ask Neil Findlay, Marie Thorne, Emma Harper to press the request to speak buttons? I was a technical glitch in here. If you intervene, your request to speak button goes off. Sorry, Mr Leonard. I refer members to my register of interests, specifically my membership of the GMB and Unite trade unions. With this motion today, Labour is showing people a way out of a failing economy, in which working people are being made to pay the price for a crisis that they did not create. Wages that were once rising gradually are not increasing any more. Housing costs, even the price of food, cannot be afforded any longer. For too many people, fuel poverty is not going down, it is going up. We have the poor, the working poor and the public service working poor as well. People whose wages have been held down year after year. Nurses experiencing a real terms pay cut of 13 per cent since 2010. Other people working in full-time jobs in our national health service still below the poverty line, still forced to claim benefits and all done in our name. It is not as though we are living beyond our means. It is rather that we are not equitably distributing our means. All the demands for sacrifice are aimed at working people delivering our public services, while the idle rich are studiously ignored with the result that, in Scotland, the richest 1 per cent owns more personal wealth than the whole of the poorest 50 per cent put together. It has other consequences too. As Cheryl Gedling of the PCS union told the economy jobs and fair work committee of this Parliament on 18 April, and I quote, as long as we continue to have pay freezes and pay restraint, we will not eradicate the gender pay gap. In days gone by, incomes policy was part of a wider programme of action by government through a social contract to deliver a social wage, including food price subsidies and rent subsidies, increases to the basic state pension, investment in our industrial base and public services. However, what we have today is not a two-way social contract, it is a blunt, one-way fiat of austerity. In their amendment, the SNP Government made comparisons with England. I am sure that it will be a comfort to the midwives working around the clock in Whishaw, to the nurses in the Forth Valley Royal hospital in Larbott at the top of their pay band, to the porters toiling—yes, I will give way— Would you make the same speech to Labour Party conference in Wales, where nurses are paid less than in Scotland? Richard Leonard. The last time I checked, I was in the Scottish Parliament addressing the SNP Government. What will you say to the porters toiling long hours, working long weekends at Hermeyers hospital, to the ambience crews on call, stationed right across the country, to the hard-working cleaners in the Monklands hospital on £8.50 an hour the lowest paid? I am sure that it will be a comfort to them that, if they were living in England, they would be even worse off, subject to even more restraint. I am sure, in light of their experience, that they will greet with some cynicism to the suggestion in the Cabinet Secretary's amendment that the best resolution will be found in partnership working and the benevolence of the Scottish Government. When the NHS pay review body produced its recommendation, it said that the scale of efficiency savings that the NHS is required to make appear to be bigger, bigger in Scotland than other parts of the UK, with the Scottish Government telling us that health boards will be expected to make 3 per cent efficiencies in 2017 to 2018. I am challenging the Government today to support this motion to scrap the cap and allow for free and responsible collective bargaining. I have given way already. Let me turn to the Conservative amendment too, because we have a trade union act on the statute book, which is barely a year old. It is a Tory act, which I presume the Tory members here support. It is an act that singles out public service workers and puts at the very top of that list of public service workers' workers in health services. The very workers that we are discussing this afternoon, that is what is on the face of the act that they support. The act demands minimum turnout thresholds of 50 per cent. Minimum majority thresholds of 40 per cent in order for industrial action to be taken legally by health service workers. I am bound to say that if the same rules were applied to the local government elections last week, which Tory MSPs and ministers now apply to NHS workers, not a single Tory councillor would have been elected anywhere in Scotland. Of course, the Tory want to stop trade unions having a political voice too. I want to remind the Parliament finally of the principles of the health service set out by anir and Bevan. Bevan said that society becomes more wholesome, more serene and spiritually healthier if it knows that its citizens have at the back of their consciousness the knowledge that not only themselves but all their fellows have access, when ill, to the best that medical skills can provide. If the job is to be done, the state must accept financial responsibility. Those prophetic words of Nae Bevan are chosen carefully. They remind us that the foundation stone of the NHS is not medical machinery or pharmaceutical formulas but the skills and dedication of the people who work in the national health service. To the SNP, let me finish by saying this, it is no good complaining, it is no good claiming to be on the side of the workers in the NHS when you are not prepared to back them up. It is no good claiming to be investing in the NHS if you are not investing in the people who deliver the NHS, so I would urge all members to look to their conscience to accept financial responsibility and accept moral responsibility as well and back the Labour motion this afternoon. Before I call the next member, I would like to say to anyone on the front benches, if you are going to intervene properly, do not heckle from the side. Today's debate gives us an opportunity to highlight the different approaches to nurses pay adopted across each part of the UK. I welcome the Labour Party bringing this debate to the Parliament this week in advance of international nurses day, which follows this weekend. The debate gives us a chance to compare and contrast to the different administrations, the Scottish Government, the UK Government and the Welsh Government, each treating the most valuable asset of our NHS staff. As well as a clear process in place to determine nurses pay with independent pay review body making recommendations each year that cover all parts of the UK, the approach of each Government has differed. That tells us much about what we need to know about the priorities, focus and commitment of each administration and of the parties that run them. Both the Tory-led UK Government and the Labour-run Welsh Government have failed to implement in full the recommendations of the pay review body, the Scottish Government, run by the SNP and contrast has stood by the body's recommendations and implemented them in full. While Labour talks a talk, while failing to meet the PRB's recommendations but has the power to do so and the Tories look the other way, it is the SNP that has met its obligations to abide by the agreements that are in place, funding nurses pay to the level that is required by the review body. The Royal College of Nursing understands that well, as it said in its briefing in advance of the debate today. It states that the Scottish Government has implemented recommendations made by the PRB to date, even when the UK Government has not. That means that pay rates for each of the pay bands vary. For example, the starting salary for a newly qualified nurse is £21,909 in England, the same in Wales, £21,693 in Northern Ireland and £22,218 in Scotland. A band five nurse in Scotland earns £300 more than the equivalents in England and in Wales. It is a clear demonstration of the priorities that the Tories never stop talking about the top 10 per cent, the higher rate taxpayers who can afford to pay a bit more will never mention NHS staff who benefit from a similar amount in higher pay in Scotland. Never mind the benefit of the council tax, I am £400 lower in Scotland than the rest of the UK implementing the majority of households, because when it comes right down to the Tories' priorities, their target constituency is laid bare for all to see. If the top 10 per cent will argue tooth and nail for your interests, if you happen to have an NHS worker in a fraction of that, then they are not interested in even honouring the independent recommendations on your pay. Not only are the SNP and the Government honouring the PRB's recommendations, additional measures have also been put in place to assist lower paid in the profession. A flat rate £400 uplift for those earning £22,000 or less has been implemented, recognising the particular pressures on low-paid staff. The Scottish Government also understands the importance of supporting those entering the profession, ensuring that nurses are trained for the future to support our growing health service. Nursing busseries are still in place in Scotland and nursing students pay no tuition fees. That is in stark contrast to policies elsewhere in the UK where both are being scrapped. As a consequence, the number of English applicants to nursing courses has plummeted by 23 per cent, 10 times worse than in Scotland. It is no surprise that England is suffering from a 9 per cent nurse vacancy rate more than double that in Scotland, a consequence of the different approaches to the treatment of staff. The Scottish Government also understands the need to provide stability and security for our NHS staff. In contrast to the situation south of the border, where there have been more than 20,000 compulsory redundancies over the past six years, NHS Scotland has continued with its policy of no compulsory redundancies. The Scottish Government's higher remuneration practices also apply to other NHS workers. Entry-level support staff in Scotland are paid £1,128 more per year than their English counterparts. Consultant salaries in Scotland can be up to £2,000 higher than elsewhere in the UK. Those measures are underpinned by the Scottish Government's commitment to support our health service. With £500 million of real-terms funding increases over the lifetime of this Parliament, £500 million more than that is committed by Scottish Labour in its 2016. Will he agree that for any nurse or any NHS staff member in Scotland, to have to turn to our food bank is a scandal and unacceptable? What actions does he suggest should be taken if not given them a pay rise? If the member has been listening for the last five minutes, you have understood what I have just said. In Scotland, nurses are getting paid more than they are in Labour-run Wales. What has he got to say about that? I was just making the Scottish Government has committed £500 million more to the health service than Scottish Labour had in its 2016 manifesto that it was elected on last year. That is against the backdrop of a 10-year real-term 9.2 per cent Dell funding reduction from the UK Government to Scotland since 2010, when the Tories came to office. Not only in funding and support for its staff that NHS Scotland is performing its counterparts in England and in Labour-run Wales, any performance significantly higher in Scotland than across the rest of the UK. The Scottish Government has also stood firm against the creeping privatisation of services in the rest of the UK, a trend that has seen 7 per cent of health service provision down south now in private hands. In conclusion, the contrast between how the SNP Scottish Government funds and runs the health service here and how the Tory UK Government and the Labour-run Welsh Government run their health services could not be clearer. When it comes to fulfilling our commitment to implement the recommendation on nurses pay, as in so many other aspects of running our NHS, it is this SNP Government that the people of Scotland can trust to have their interests at heart and to deliver for staff and patients alike. Can I say to members that we have no time at all in hand, so really strict guidelines, please? Maurice Corry to be followed by Neil Findlay. Thank you, Deputy Presiding Officer. First, I thank Anna Sawa for bringing forward this important debate. This has been an extremely interesting debate so far on a very significant matter, so I am delighted to contribute to it. I join others in paying tribute to those who work in the NHS and care for us on a daily basis. I would also like to focus on securing the long-term future of the NHS in Scotland and how staff should be supported by improving the short staffing crisis. In the 10 years that the SNP has been in power in Scotland, the NHS has taken a turn for the worst with a major staffing crisis. The Scottish Government has taken a short-term view on job vacancies within the NHS, much to the detriment of our NHS in Scotland. We no longer have the numbers of staff that we need to ensure that patients get the best treatment possible. The number of nursing vacancies, for example, has been on the rise. On 31 December 2016, there was a vacancy rate of 4.1 per cent within the nursing and midwifery posts, which has risen from 3.6 per cent in 2015. Those vacancies are putting increasing levels on pressure on overstretched staff to continue to deliver higher quality services. Similarly, at GPs, consultants and mental health specialists have all seen a rise in a number of vacancies. Every empty post puts further strain on an already exhausted staff. Unlike what nurses have put down and put an undue stress on those working in our health services as the Scottish Government looks to solve this problem by sourcing locum doctors and nurses. The Scottish Government continues to look for temporary solutions rather than seeing the bigger picture, which is at the expense of the Scottish people. In fact, due to the poor workforce planning, the use of agency nurses has increased by almost 50 per cent in one year. That has inevitably led to a rise in the cost of agency staff and increasing by six times in three years. In addition, the Scottish Government is spending nearly £0.25 billion in locum staff. That is completely unsustainable and will do nothing to solve the long-term issue of vacancies in the NHS. I recognise that there will always be a need for locum staff. We certainly should not be reliant on the form of staffing as we are at present. What we are seeing is, in fact, a sticking plaster approach by this Government. Now, former MSP Dr Jean Turner, chief executive of the Scottish Patients Association, called for fewer locums and bank staff to be used and more NHS staff to be appointed. She stated in 2015 that our health service is in a serious state, really serious. If we want to care when we are old, we have to look after it today. Furthermore, the Royal College of Nursing Associate Director, Ellen Hudson, highlighted that we need to find new ways for health boards to focus on long-term sustainability of services. From that, we can only tackle this serious issue by fitting vacant posts on a permanent basis. Furthermore, gaps in the NHS and Scotland are only predicted to grow with many staff close to retirement age. That is particularly prominent among nurses and midwives of which one-fifth is set to retire over the next decade. That means that 18.2 per cent of the workforce are planning to retire within the next 10 years, which will have a significant impact on NHS staffing across Scotland. I put even more strain on an open burden staff. The Scottish Government needs to focus more on recruitment to ensure that we have a sustainable NHS workforce in Scotland for the future, and the Scottish Government is currently returning to retired GPs to fill staffing gaps. There have been also many cases of trusts and health boards in Scotland having to recruit from abroad due to the shortage of qualified staff. That is not the way to secure the future of our NHS in Scotland. In fact, it looks like we are starting to see the impact of Nicola Sturgeon's cuts from when she was health secretary. Between 2009 and 2012, the number of training places for nurses and midwives were slashed by more on the fifth and over 2,000 nursing jobs were cut to help balance the books. The Royal College of Nursing believes that those cuts are now hitting the NHS of Scotland as students from these years are graduating and taking up full-time jobs. The Royal College of Nursing has summarised the situation as follows. We warned that this was a short-sighted and would lead to problems. We have increased demand for services and not enough nursing staff with staff bearing the brunt of those pressures and health boards having to employ expensive agency staff to fill the gaps. In conclusion, the SNP Government was warned about its actions at this time and now needs to take responsibility for ultimately bringing those staffing shortages today. We now ask that they start planning the NHS workforce for the future and ensuring that we take measures to improve the sustainability of our NHS here in Scotland. I will be supporting the Conservative amendment, thank you. I have Neil Findlay to be followed by Marie Todd. Thank you, Presiding Officer, and I thank Anas Sarwar for bringing this motion and for getting the Government to act, because clearly they are acting now and would never have acted unless this motion had come forward. I have to declare an interest in this debate as both my wife and daughter work in the NHS, both of them very much at the lower end of the NHS pay scale. I also have to declare an interest to a member of Unite the Union. My wife and daughter's colleagues across the NHS, the porters, the clerks, the domestics, kitchen staff, tradesmen and women, as well as clinical support workers, nurses, physios, OTs and the rest have been subjected to years of austerity pay, where their salaries have been frozen or capped at no more than 1 per cent. Years of pay settlements below the rate of inflation, while, at the same time, the cost of basic food items such as beef and fish and dairy products, the cost of transport, the cost of gas and electricity have all soared well over 20 per cent in the retail price index, as forecast for inflation to reach 3 per cent. That has resulted in an effective pay cut of around £3,500 for a band five nurses people have already said. The reality of working in Scotland's NHS is that we have a system under pressure like never before. Staff are run ragged, morale is low, vacancies are up and the system is creaking at the seams and all of this overwhelmingly and disproportionately impacts on women workers who make up three quarters of our NHS staff, so much for addressing gender pay issues. The Scottish Government will claim that staff spending has increased by over 7 per cent. That may be true between 2011 and 2016, but, of course, it has been driven by an increased spend on bank, agency and overtime payments to try and plug that staff in gap. Indeed, agency spend has doubled over that period. We see staff working more hours via the staff bank and agencies to try and make up for lost pay. Aileen Campbell I wonder whether the member has taken the same message to Wales where they spend considerably much more on banking agency staff than we do in Scotland. Neil Findlay There is more chance that he may tell my Welsh colleagues some home truths than there is if your member is telling you some home truths, because you have to sign a statement to say that you cannot do it. That may be true, but it is driven by an increase in bank spending, agency spending and overtime payments to plug the gap. We see staff working more hours via bank and agencies. Audit Scotland tells us that agency staff costs more and pose a greater risk to patient safety and quality of care. On which planet is it sensible to be paying £84,000 a year to nursing agencies for one nurse for one year? That is the reality of what is happening. Of course, all of this impacts on vacancy rates, rates for nursing and midwifery staff, 3.6 per cent, 9 per cent health visitors, 5 per cent public health nurses, almost 5 per cent for general practitioners, 6.5 per cent for consultants and similar vacancy rates across the NHS. For tradesmen in the States, workers, it is difficult to recruit. For example, electricians and other craftsmen because pay has not kept up with industry rates. NHS staff do not want to be patronised. They are heartily sick of the warm words about them being angels and heroes. What they want is respect. They want a supportive management regime within the establishment they work with. They want an employer who cares about their wellbeing and the tools that they get on with the job that they enjoy and, crucially, they want the pay that recognises all of that. Unison, in the UK-wide staff survey, identified two thirds of staff feeling worse off in the previous 12 months. 34 per cent relying on overtime payments to pay their bills, half relying on financial support from family and friends and 11 per cent using a payday lender. What a state of affairs for our greatest public services? What a state of affairs for the staff who deliver the care that we need when we are sick and injured? Let us be clear that this is a major contributory factor in people choosing other careers. I want people to join the NHS. I am proud that my daughter, who works as a weekend hospital cleaner in St John's, will soon graduate as an occupational therapist and, hopefully, secure a job in the NHS. However, increasing stress, high vacancies and unhealthy management culture, combined with a decline in pay, is not a recipe for addressing the shortages and demands on the system. The Cabinet Secretary can and must act otherwise the problems that we have witnessed will pile higher and higher and higher. I want to see all our public sector staff paid fairly. The pay cap has hit people in many areas, including local government, police, fire, service and so on. The Government can act when it wants to. Let me publicly commend the Prison Officers Association for securing what was called a one-off £2,000 increase for prison officers in 2015. It seems that one-off has a flexible meaning just as once in a generation does where this Government is concerned, as that deal has been repeated again this year. As I say, I congratulate the POA. However, what about the other staff in the prison service? No £2,000 for them. What about staff in local government and our councils? No £2,000 for them. You must come to those cases. What about NHS staff? No £2,000 for them. Those public sector workers deliver the services that civilise our society. I support the call for an end to the pay gap, and I support the motion that has been put forward by NASA. Marie Todd, to be followed by Alexander Stewart. Thank you, Presiding Officer. I remind the chamber that I am a qualified pharmacist registered with the General Pharmaceutical Council. I am pleased to have the opportunity to speak in this debate, because until my election last year, as many of you know, I worked as a hospital pharmacist. One of the many staff groups paid under agenda for change. Each year, the NHS pay review body made a recommendation on how much my salaries should rise, although several times in the past few years, with it being a below inflation settlement since I was at the top of my pay band, I would agree that it is incorrect to describe it as a rise. The Scottish Government has honoured the review body advice every year, something that my colleagues here in Scotland were very thankful for. My colleagues south of the border in England have not been so lucky. The Westminster Government has not passed on the increase in several years. That has led to a marked difference in salaries between the two countries, with Scottish band 5 staff being paid up to £312 more than their English and Welsh counterparts. The difference is even more stark at lower bands, where, over and above the pay recommendations due to Scottish Government action for the lowest paid entry-level NHS support staff in Scotland are paid more than £1,128 more than their counterparts in England. The reality in the UK today is that nurses, junior doctors and care workers all get paid more in Scotland than in England. As you might expect, given my background, I believe that NHS staff should be paid more, but I wonder if that is possible given the budget cuts coming from Westminster. Along with many of my colleagues in the NHS, I know that the NHS in Scotland is relatively well protected behind a Government that is committed to a publicly run service free at the point of care. Of course, the austerity agenda supported by the Tories and their coalition partners, the Liberal Democrats, have cut public spending and that has an impact on the Scottish Government's budget by reducing the block grant. I will take an intervention. Alex Cole-Hamilton I am very grateful for Marie Todd for finally taking an intervention. I wonder if, even through her ultra-loyalist prism for the SNP Government, that, to describe her colleagues as being grateful for the miserly increase that we have seen under this Government, she does actually belie the statistics and research of the Royal College of Nurses in this country. Marie Todd As I have said before, I suspect that if that research, that survey, had been conducted on an individual country case within the UK, I think that we would have got very different results. The Institute for Fiscal Studies has said that spending growth on the NHS under your coalition Government was the lowest five-year average since records began, although that was generous compared with the cuts in spending to other Government departments over the same period. Given that constrained budget, the Scottish Government has to be congratulated for not only managing to increase pay in Scotland, but they have ensured that there have been no compulsory redundancies, they have maintained free nurse student bursaries in Scotland, they have maintained free nurse student tuition, not only that, they have created the discretionary hardship fund. That has not happened in England so the number of English applicants to nursing courses has plummeted by 23 per cent as a result whilst being substantially maintained in Scotland. That may be why the current nurse vacancy rate in England is 9 per cent compared with 4 per cent in Scotland, where wage increases have been more generous. There has been increasing policy divergence between the NHS in Scotland and the NHS in England and it is making it much harder to sustain a UK-wide perspective of the NHS workforce. I have already mentioned some areas of divergence. The Conservative amendment raises another, the level of spend on agency and locum staff. My Conservative colleagues will no doubt welcome the fact that NHS Scotland has a nationally co-ordinated programme for the effective management of all-temporary staffing. The team is working to establish regional and national staff banks to allow boards access to high-quality, flexible workforce of appropriately qualified, experienced and competent staff when it is required. They all work on NHS contracts and provide better value for money than alternative methods of filling the gaps. My Conservative colleagues will also no doubt be pleased to hear that NHS Scotland spends proportionately a third of what is spent in NHS England on medical and nursing agency staff. Some areas of divergence that we might want to consider are Scotland outperforms all other UK countries on the four-hour A and E target. Scotland outperforms on delayed discharges, too. There has been an increase of 11 per cent in England because of a lack of investment in social care. In Scotland, that figure has decreased by 9 per cent because of the contrasting policy. Scotland has consistently spent more per person on health than England since at least 2009-10. Scotland has a higher clinical staffing rate per capita than England, so more doctors, more nurses and more widwives work here in NHS Scotland thanks to the SNP Government's sound management of the NHS. I want to finish with a we mention of this evening's members' debate, secured by my colleague Emma Harper MSP, who is also a nurse. Later this week, we celebrate international nurses day, and over many years of working in office— Ms Todd, you really must close. Finishing is my last sentence. I have worked with some awesome nurses. I am sure that they will be pleased to know that I am still working with some awesome nurses. I am sure that they will be pleased to know that I am still working with some awesome nurses. You are finished with your contribution, thank you. I have Alexander Stewart, who is followed by Emma Harper. Thank you, Deputy Presiding Officer. I welcome the opportunity to speak in this debate, and also thank Labour for bringing this topic to the chamber today. As we know, the challenge facing the NHS has been described as a perfect storm—funding, structure and culture. Recently, the Scottish Conservatives constructed a 15-point action plan, highlighting a myriad of areas in which there is a massive scope for improvement, even with a demanding and rising ageing population. The action plan highlighted a multi-faceted problem that faces the NHS. Staffing is the key to managing its funding, and that is where huge cracks have begun to appear. My mother has been a district nurse, midwife and health visitor who gave decades of support to the NHS. Her drive to support patients in dignity from birth to death was exceptional, and she gave her working life to caring in the community. I am very proud of that. Wastage, overspending and delays still continue to blight the NHS in its day-to-day operations, and that is one area in which we can look at efficiencies and improvements and yield savings. Funding in the NHS in Scotland was roughly flat for the real terms during 2008-09, and that has seen a huge impact across the pace. Despite moves towards integration, the NHS is still broadly based on a traditional model. We acknowledge that, and we see that. We have social care and reliant on primary and secondary care. I pay tribute to all the staff who play a vital role in the sector. Their dedication, enthusiasm and commitment knows no bounds, and our NHS staff are the envy of the world. That is because of their dedication, commitment and enthusiasm. Staff feel disengaged from reforms. They also look at the workload basis, and if they are not managing that effectively and efficiently, they feel stressed and overworked. There are still far too many managers in our NHS, and that system is causing unnecessary tears of management, and those problems are all linked. Pay, training and support are vital to ensure that the staff feel valued within our NHS. If clinicians feel alienated from management reforms that are taking place, then the pressures that they face continue to move forward and continue to grow. Staff feel engaged if they are effective and they see better ways of managing things, and in turn reducing pressures on the workforce will ensure that we have better outcomes for our patients. All that is exactly what we want to see within our NHS system. I believe that that is happening the length and breadth of this country because of the dedication of the staff that work within our NHS. We know that we are dealing with an ageing population and we understand the demographics that are facing us, the bed blocking that takes place and all the other aspects that fall into place to ensure that we have issues to manage. At the end of the day, we have to manage the finances to ensure that the budgets work effectively and that individuals can work within those constraints. The whole situation is quite complex, but alone it is not the fact that we have to see that the SNP is spending millions of pounds on private health firms. In 2015-16 alone, 14 of the health boards have spent £51.6 million on private operations because NHS hospitals could not cope with the demand. I want to make some more progress, time is tight. The Government is also paying millions of pounds on agency staff and agency doctors and nurses in the system, and that has a huge knock-on effect as we go forward. For 10 years, the SNP has been running the health service in Scotland, and staff morale is, we are told, at the lowest ebb. They are failing their staff, letting them be left behind and left out. The Government has a track record, where it is looking at what the staff is achieving and not going forward. I want to try to make some progress. We also have to think about what we are doing when it comes to my own region in Midscotland and Fife. Tayside, Fife and Forth Valley have all had issues with reference to staffing levels and morale and targets that have been set by the Government, and they have failed to achieve many of them as we have gone forward. Much of that is unsustainable to ensure that we have a workforce that is fit for purpose and going forward. Even with new systems that they are bringing in such as NHS 24, the IT system is 73 per cent over budget and more than four years overdue. We have a lack of staff within the system, and the SNP is not tackling the issue, but adding to the issue and the complexities that we have faced within the problem. Technological glitches have been reported by staff who are struggling to cope in many hospitals across Scotland. Some are saying that low morale, staff vacancies, staff sickness and staff stress are adding to and compounding what is taking place within our NHS. NHS requires certainty as it moves forward. The Scottish Conservative Party has recommended that the NHS needs to invest now in dramatic service change that will have a positive knock-on effect and ensure that we have a way of managing our finances. The national working planning must be addressed by the Government. It cannot continue to speak under the carpet. That will go some way to making the changes that we require to revitalise. I pay tribute to the NHS staff, but I do not pay tribute to the Scottish Government who have looked over this for 10 years in decline and decay. I support the motion at the amendment in my member's name. Thank you. The last of the speeches in the open debate is Emma Harper. Presiding Officer, thank you very much. I am looking forward to speaking in this debate this afternoon. I thank Anasarwar for his opening comments about his own family experience and I am sure that everyone in the chamber, as James Dornan noted, has a direct experience of the NHS and interaction with the NHS. I must remind members that I am a nurse and I am also a member of the Royal College of Nursing. There is one thing that we can agree on across this chamber today that nurses should be paid more. This evening, I will lead a member's debate on celebrating International Nurses Day, because I think that we should shout louder about the invaluable work that nurses do here in Scotland and internationally, often in very difficult circumstances. Of course, I think that that should be reflected in their pay and conditions. Do the Labour Party ever ask themselves why we cannot pay nurses as well as we would like in Scotland? I have some bad news for the Labour benches. When you do not fully control your own budget, neither do you fully control the pay and conditions of NHS staff. I believe that this point has been made to them before. The Scottish Government has managed to maintain record levels of investment in NHS Scotland, while with standing cuts to the block grant. Funding constraints on the NHS are the direct result of Westminster's austerity agenda. We appear to control our budget enough to pay prison officers more. Why can that not apply to nurses? Emma Harper? I thank Mr Findlay for that intervention. I think that the whole understanding of this process and just raising taxes and looking at the whole aspects of how we look at the salary and the banding and the whole NHS, in my experience as a nurse who has worked 33 years and the most recent 14 in the NHS, I think that I see staff struggle with the workload every day. As a nurse educator, part of my duties were to support efficiently working and recognise people when they are under stress like I am right now. I want to make sure that I get this on the record. I hear what you are saying. My colleagues would love a pay rise, but how can we do that with the constraints that we are being put under by the constant austerity measures of the Tory Government? I am sure that all of us in this chamber will welcome the fact that, although many people have expressed concern about staff satisfaction in the NHS, we have a very high level of patient satisfaction in the NHS and many of our nursing workforce are to be congratulated for that. We have a record high of 90 per cent, the highest ever since records began in terms of inpatient survey satisfaction, and we also have in the Scottish social attitudes survey, the highest rate of confidence in the NHS in the last 10 years. We have another couple of minutes, Ms Harper. The Royal College of Nursing states in its briefing that pay awards for the NHS staff have been constrained by the UK Government's policy on public sector since 2011. It should be noted that the Scottish Government has implemented recommendations made by the pay review body to date, so every year as the pay review is processed, the Scottish Government takes on board those recommendations. I would like to appreciate the scrutiny of the Government's policies, and I think that that is a role that all the Opposition parties need to do, including me as a backbencher, but it is the role of the Opposition parties to come to the chamber ready with an approach that might support the NHS in a balanced, fair and level-headed manner. The 1 per cent rise in Scotland is further supplemented by the Scottish Government's measures for the lowest paid, like a flat rate of £400 uplift for anyone earning £22,000 or less. In Scotland, entry-level nursing support or NHS support get paid an extra £1128 more per year than their English counterparts. For me, one of my colleagues was at a recruitment event and said that nurses are leaving NHS England and coming to Dumfries and Galloway to get better pay and better work conditions because they see what is happening in NHS England. I welcome those nurses from England. Come and work in Scotland and we will look after you. We now move to the closing speeches. I call Miles Briggs up to six minutes please, Mr Briggs. Thank you, Deputy Presiding Officer. I am pleased to close this debate on the NHS for the Scottish Conservatives. Since being elected, it has been a pleasure to meet and learn from many of those people who work in our health service day in and day out. Their commitment and work ethic is what drives them each day. I want to thank them and pay tribute to their dedication as a number of members have done in today's debate. One message that they have told me directly is that the decline in the performance of our NHS in Scotland has not just been a recent thing. It started whilst the Labour Party was in charge in health in this Parliament. Over the 10 years that the Labour Party was in power in the Scottish Parliament, waiting times increased dramatically. Drug-related deaths and methadone scripts skyrocketed and Scotland had the highest prevalence of hospital superbugs in Europe, not to mention Labour's own hospital closure plans. We all have our own personal stories to tell about how the NHS and those who work in it have helped us and given us love and support and the amazing nurses who work throughout our health service. What struck me from today's debate was the fact that no Labour speaker wanted to justify what they do when they are in power and is certainly their record in Wales. After all, Wales is the only part of the United Kingdom where the Labour Party has been in consistent, unbroken control of our health service since 1997, over two decades—no, I want you to listen to this, Mr Finlay—and looking at the NHS in Wales, it is little wonder that Labour MSPs want to have that record discussed today. In Wales, for example, the Welsh Labour Party has not introduced the pay rise that they are proposing today. Your colleagues who are in power are not doing what you are proposing. Waiting times in Wales are at their highest and patients are having to be sent to England. No, thank you. Patients are having to be sent to England, Mr Finlay, for emergency treatment. That is your record in power in Wales. In fact, analysis shows that an average patients in Wales have to wait five weeks longer for treatment than they do in England. Labour has imposed record-breaking budget cuts and presided over the poorest access to cancer treatments anywhere in the UK, downgrading hospitals across Wales. It is a scandal today that, in Wales, the Labour Government has not met its cancer waiting targets since 2008. Mr Briggs, may I intervene and ask you to address what has happened in the debate this afternoon? This is Labour's record on the NHS, and it is certainly not one to be proud of. Here in Scotland, we are still seeing the impact of this. Labour's use of private finance initiatives, for example, has seen new hospitals built at taxpayer expense of £7.8 billion. Hospitals such as Edinburgh Royal Infirmary cost £180 million to build, but will cost the taxpayer £1.6 billion by the end of 2030. I do not think that that is right. James Dornan tried to make the point about the cost of NHS staff parking. That is a key issue to the cost that they are facing. I believe that it is an ongoing scandal that car parking charges are as high as they are in Edinburgh. I have been pleased to support the campaign alongside NHS staff, patients, visitors and the Edinburgh evening news at the Edinburgh Royal Infirmary. NHS Lothian, the private company running in the car park at the ERI— Excuse me, Mr Briggs. I think that the Presiding Officer earlier made a ruling on car parking, and I would ask that you address the debate that has taken place, and, indeed, the motion and amendments that were put forward. I think that it was an important point that we were all making as members that, actually, those costs impact on people's lives and their living costs and travelling and working to hospital is something that many nurses have told me is a significant amount. Certainly when that increase was proposed— Mr Briggs, I did ask you to move on to address the motion and the amendments, and indeed the debate that had taken place, taking due cognisance of what my colleague in the chair earlier said. I will indeed. Thank you, Deputy Presiding Officer. Of course, we all agree that everyone in our NHS staff deserves to be respected and valued and be able to work in a positive and safe environment. Something in which I am sorry to say that the health committee has heard is not always the case in the NHS, and NHS staff being bullied and often do not feel they are being listened to. My colleague Donald Cameron has laid out the SNP's failure to improve our health service over the past 10 years. Scotland's NHS is declined on the watch of the SNP, and major reforms are clearly required. The SNP has taken decisions on hospital closures and service redesign, such as the closure of Edinburgh cleft lip and palate surgery unit, against clear evidence, and that has impacted on our staff. As Brian Whittle set out, a radical culture change is indeed needed and required. Working for our NHS must become an attractive and valued career path again, especially in rural areas and areas such as general practice, which is struggling to attract graduates. Staff shortages are widespread, with over 2,500 vacant nursing and midwifery posts. Spending on agency staff has increased dramatically, and nearly a quarter of a billion pounds is now being spent in Scotland on local staff. We not only have an ageing population, but we also have an ageing NHS workforce. I am returning to the culture change that is needed within the NHS. Unnecessary A&E visits are costing NHS Scotland at least £33 million a year. Only this week, the Health and Sport Committee learned about the triaging work that is being undertaken by NHS Greater Glasgow and Clyde to help to take pressure off A&E units. I welcome that. Those are the sorts of reforms that would and can make a real difference to the performance of our NHS and give NHS staff the professional responsibilities that they are desperate to have. Our NHS should rightly be an institution to be proud of, rather than one constantly on the brink of crisis. It should be an organisation that values every member of staff and all those who care for us. Enabling our workforce to do their jobs and deliver high-quality care is something that we must all work towards. Mr Briggs, please come to a close until Labour can answer those questions. Mr Briggs, will you please sit down? I remind members across the chamber that when I ask people to close a debate with their contribution, there is a reason for that. There are time constraints and I expect that to be complied with. I now move on to Shona Robison to close the debate up to seven minutes, Ms Robison. I want to start on a point of agreement that has come out of the debate this afternoon. That is that we all care about the NHS and the staff that work within it and no party has a monopoly on that. Perhaps we can start with that point of agreement. I thought that Anasarwa Monica Lennon gave a powerful and personal testimony of her own family's support from the NHS. Monica Lennon talked about the high level of care that her family had received, and we would expect nothing less. Similarly, my family has received the same level of care in recent months, and for every individual nurse, healthcare worker and porter and everybody else, I want to thank each and every one of them from the bottom of my heart. I assure that everybody has done in the chamber this afternoon. I want to try to address as many points as I can that have been raised this afternoon on workforce, which a number of members have raised. First of all, I have said in this chamber time and time again that I do not run away from the challenges that the health service has. Although we have record levels of staffing, 3,400 whole-time equivalent, more nursing and midwifery staff in our NHS compared to five years ago, the demands on our NHS continue to rise. Of course, in terms of vacancy levels, as members have raised, yes, they are too high, standing at 4.1 per cent in December of last year. That is something that we are working very hard with boards to address. Similarly, on agency spend, again, something that a number of members have mentioned, agency spend is too high, which is why, as members have mentioned, we have a national programme to reduce agency spend. However, there is a context in that. Combined medical and nursing agency costs represent 2 per cent of the overall staffing and agency spend. Agency nursing represents 0.4 per cent of the total nursing and midwifery staffing in the NHS. That is too high, but we have to see the context to that. Of course, it is still less than when we took power back in 2007. As many members have pointed out, we have maintained things such as the student nurse bursary, which has meant that we have seen still a high level of interest in people coming into our nursing and midwifery courses compared to where the bursary has been removed south of the border, seeing a 23 per cent decrease in student nurse applications. That is something that is going to store up a whole heap of trouble and difficulties for the NHS south of the border. That has been perhaps one of the defining issues in the debate this afternoon. To all members, I have no difficulty with anybody, from whatever side of the chamber, criticising the record of my Government's power. That is what you are here to do. However, what is also a little disappointing in the debates is that nowhere in, for example, Anasarwar, Monica Lennon's speech or anybody else from the Labour benches, was there any recognition that pay rates are indeed higher in Scotland, that the Scottish Government has taken action to address low pay, that we still have nurse bursaries, student bursaries, that we have a no compulsory redundancy policy. All of those things I would have thought would have merited a mention in one of the Labour speeches but not one mention of any of that. I think that that shows a complete lack of balance. I accept criticism but, occasionally, it would be good to get recognition of some of the good things that are happening that the Scottish Government has brought in, just occasionally, to bring balance to those debates. Yes, of course. Anasarwar. I thank the cabinet secretary for taking the intervention. I recognise those things on a point of balance, but I will do it now so that the cabinet secretary can say that we are pleased that those things have happened in Scotland. We will also recognise that, in our own submission to the independent peer review body, she submitted that we should have a 1 per cent pay cap for NHS staff this year. Shona Robison, the Scottish Government put in a balance submission about pay, about progression, about tackling low pay and many of the other things that nurses tell me are important. It is not just about pay, it is about all those other things. We are constrained, as many members have said, by the Treasury and all roads that will effectively lead back to the Treasury in terms of what the independent peer review body can do. I thought that Alison Johnson made an important point here. She leaves a choice for us to make, because if we are part of the independent peer review body, that is the recommendation that we will have to implement. Otherwise, why are we part of it? If we want to have Scottish negotiating machinery, that is something that I am more than happy to talk to the unions and staff side about. At the moment, they do not agree that that is the direction of travel that we should have. Some of them do, some of them do not. We need to get agreement across all of the unions and staff side about that way forward. If that is the way that we want to go, then that is something that I will support. I also want to touch on something that Richard Leonard said—Lennan, maybe Freudian Slip—that I see you looking very proud. He said something that I thought was quite interesting, and I think that Labour will have to clarify in the winding-up speech here today. He seemed to indicate that Labour's position on partnership working had changed and that it no longer supported partnership working. He talked about unions should be free to negotiate outwith the partnership arrangements. I am paraphrasing, but essentially that is the point that he made. You do not want employee directors no longer to sit on boards having an equal voice around that table, representing the staff side. You no longer want partnership forums to be in absolutely the heart of decision making within our NHS. You see that unions like partnership working because it delivers for them in a way that it is not delivered in the rest of the islands. I think that the unions will be very interested to hear your comments about partnership working, and perhaps Labour can clarify whether that is something that they no longer support. To the rest of the members, I am sorry that I have not been able to come back on their comments, but we have a plan, a delivery plan and a comprehensive blueprint for the NHS. We will get on through that. We will work with staff. I will address pay and all the other concerns that staff have raised, not just about pay, but about unions when I meet them in the next few weeks. I call on Colin Smyth to close this debate up to nine minutes, please, Mr Smyth. Thank you, Presiding Officer. Next year, we will celebrate the 70th anniversary of Labour's greatest achievement on national health service. The founding principle that, no matter your class, your race, your age or your wealth, you should be entitled to quality healthcare free at the point of use, as is precious today as it was when I've ever established the NHS in 1948. Nearly 70 years on, equally precious is the principle that, if we want high quality healthcare, we need to value the staff who we entrust to deliver that care. As Richard Leonard said, the foundation stone of the NHS is not medical equipment or pharmaceutical formulas, but the skill and dedication of the people who work in the service. Today, the Parliament has the opportunity to match that principle and those words with our actions, to show that we are on the side of the nurses and doctors, to allied healthcare staff who look after their loved ones as if they were their own. Many members have taken the opportunity during today's debate to pay tribute to the commitment and dedication of our amazing NHS staff. We heard personal stories from Monica Lennon, Anas Sarwar and Shona Robinson, rightly so. However, we know that the best way that we can support and repay those staff is, as Alex Cole-Hamilton said, providing them with adequate investment in our workforce. What those staff need is decent pay and conditions. What they want is adequate staffing levels, but as speaker after speaker have rightly highlighted, we do not have those adequate staffing levels. Instead, we have a recruitment and retention crisis across our NHS. One in four of our GP practices reports a vacancy, and we have a ticking time bomb of GPs queuing up to retire. The Royal College of General Practitioners predict that, by 2020, Scotland will have a GP shortfall of nearly 830, just to bring coverage per head of population back to the level that we had in 2009. However, the crisis is not just in GP numbers. There are more than 2,500 nursing and midwifery vacancies, four times higher than the 660 in 2011. Nearly 750 of those posts have been lying vacant for three months or more, a rise of 300 per cent since the SNP formed a majority Government in 2011. The consequence of those high vacancy rates and of training posts going unfilled is an increase in the burdens on existing staff, adding to their already unsustainable workloads. Yet the Scottish Government has continued to impose a pay policy that means that someone entering a nursing today is in real terms worse off than someone entering a nursing seven years ago. A real terms cut in the value of their startling salary will make it more difficult to attract the new nurses, the new doctors and the new allied health professionals who so badly need a health service. As anas Sarwar outlined, independent analysis by the Scottish Parliament Information Centre shows what that means for those staff. If nurses paid simply stayed in line with inflation over the past seven years, so not even a real terms increase, the band-fi startling point in April 2017 would be £25,839. Instead, it is £22,440. Excuse me, Mr Smith. There is far too much background noise going on. Can we please have some courage to say for Mr Smith? In other words, a nurse startling salary today is £3,400 less in real terms than a nurse startling salary in April 2010 under this Government. That is an undeniable fact. It is just disappointing that, listening to some SNP contributions today, they are in denial over the impact that this has on recruitment. Their argument seems to be that it is fine because it is a little bit better for agenda for changed staff at pay bans 49 in Scotland than it is in England. It is touching to hear SNP members today who want to break up the UK and have nothing to do with the NHS in England or Wales or Northern Ireland to suddenly shed crocodile tears for nurses in other parts of the UK. The irony is lost on SNP members after members who had more to say about England and Wales than they did to say about Scotland when they want to walk away from England and Wales. I have to say that, if the height of the SNP's aim is to be a little less uncaring than Tory Health Minister Philip Hammond, then, frankly, it is time that they raise their ambitions. It is an approach that was only surpassed by Miles Briggs, who we thought was trying to walk out of this Parliament by standing for Westminster when it seems that he is actually making a bid for the Welsh Assembly. I know the SNP-Senior amendment today that, quote, the best resolution will be found by the Scottish Government working in partnership with NHS staff representatives. It calls on, and I quote again, the Scottish Government to seek agreement with the staff side through the representatives on unions. I have not finished that point, but I will give way yet. I wonder if you could clarify Labour's position on partnership working. Does Labour support partnership working or does it not? Of course partnership working, if we can deliver the pay rise that we want to see for all staff right across the UK. That is what will be contained within the Labour Party's manifesto at this next election. The SNP amendment talks about working jointly with the unions and representatives to commission work to develop an evidence base to assess the impact of pay restraint. Using that evidence as part of their submission to the next pay round of the NHS independent pay review body. I have to say that it is a bit rich of the Scottish Government to talk about joint submissions with staff to next year's pay review body when their own submission to this year's pay review body went against those staff and actually argued for a real terms pay cut. As Alison Johnstone pointed out, the pay review body based the recommendations on the pay policy of the Government. The reality is that evidence is already here in this year's staff side submission to show the impact of pay restraint. The 44-page submission to the NHS pay review body for 2017-18 states that public sector pay restraint has clearly damaged both the finances and morale. It goes on to say, and I quote again, that unless action is taken now, minimum wage levels will overtake agenda for change pay points. It states that that can only be avoided by a significant pay increase. If that evidence is not enough for the Scottish Government, it should read rather than try to rubbish the Royal College of Nursing's most recent employment survey of its members, which found that 30 per cent struggle to pay gas and electricity bills. 14 per cent miss meals because of financial difficulties. 53 per cent have been compelled to work extra hours to increase earnings, and 32 per cent were working extra nights and weekend shifts just to make everyday living expenses. That corresponds with a year-on-year increase of 30 per cent over the past five years and the number of RCN members having to seek specialist money advice from their union's welfare service. Many more are borrowing money to meet essential costs, like childcare or taking second jobs, and some are having to use food banks to feed their families. Yes, food banks. Maybe that is what Donald Cameron meant about supporting nurses in other ways rather than giving them a pay rise. No wonder nurses in Scotland are being baladied on industrial action to try to end the pay cap. Yes, nurses in Scotland before any more SNP member tries to pretend that this is not an issue for nurses here. We do not need to wait until next year to see the evidence of the impact of the pay cap. It is there before our eyes. It is just that the Scottish Government is ignoring it. It has the power to make different decisions as it rightly did with prison officers. It has the power to be more progressive than the Tories. However, as usual, it has chosen not to use those powers and therefore not to support Scotland's healthcare workforce. The SNP amendment makes one valid point on the impact of Brexit. Scotland's health and social care sector employs around 12,000 EU nationals. We know that parts of the sector simply would not function without their contribution. However, Theresa May and the Tory Government shamefully will not make a commitment to protect the status of each and every one of those EU nationals. The truth is, despite their anti-immigration rhetoric, if they go into hospital, we are more likely to come across a migrant caring for us than a migrant lying in the next bed. We are not content with misleading us with their false claims on the back of a big red bus that the NHS would receive an extra £350 million a week. If we left the EU, the Tory hard-brexiteers are now shamefully using EU nationals working on our NHS, such as poker chips, in their negotiations. It is sick then, it is wrong and it needs to stop. However, let us be clear that the staffing crisis that the NHS faces is with us right here and right now, even before the hard-brexiteers have their way. The SNP amendment is full of worn words, but it is as cold as the Tory amendment by its failure to address the crisis. Like the Tory amendment, it will not put a single peri in the pocket of nurses struggling to pay the bills. It will not contribute to the recruitment of a single new doctor, so we have a clear choice when we come to vote shortly. This Parliament can choose to be on the side of our NHS workforce, to choose to say to the Scottish Government that it is time to scrap the cap, time to vote, to give our hard-pressed NHS staff a well-deserved pay rise and begin to tackle the recruitment and retention crisis, or it can choose to vote to continue austerity, to say that nurses go into food banks as acceptable. Labour knows which side we are on, the side of the NHS. That concludes our debate on scrap the NHS pay cap. We now move on to the next item of business. It is consideration of business motion 5517, in the name of Joe Fitzpatrick, on behalf of the parliamentary bureau, setting out a business programme. I would ask any member who wishes to speak against the motion to press their request to speak back now. I call on Joe Fitzpatrick to move motion 5517. No member has asked to speak against the motion. The question is that motion 5517 be agreed or are well agreed. The next item of business is consideration of parliamentary bureau motion 5521. I would ask Joe Fitzpatrick to move motion 5521 on committee meetings. There are four questions that we have put as a result of today's business. I remind members that, if the amendment in the name of Shona Robison is agreed, the amendment in the name of Donald Cameron falls. The first question is that amendment 5479.3, in the name of Shona Robison, which seeks to amend motion 5479, in the name of Anas Sarwar, on scrap the NHS pay cap, be agreed. Are we all agreed? We're not agreed. We'll have a division and members may cast their votes now. The result of the vote on amendment number 5479.3, in the name of Shona Robison, is yes 62, no 55. There were no abstentions. The amendment is therefore agreed. The amendment in the name of Donald Cameron is therefore preempted. The next question is that motion 5479, in the name of Anas Sarwar, as amended, be agreed. Are we all agreed? We're not agreed. We'll move to division and members may cast their votes now. The result of the vote on motion 5479, in the name of Anas Sarwar, as amended, is yes 62, no 55. There were no abstentions. The motion, as amended, is therefore agreed. The final question is that motion 5521, in the name of Joe Fitzpatrick, on committee meeting, be agreed. Are we all agreed? We are agreed. That concludes the decision time. We'll now move to members' business, in the name of Emma Harper, on Celebrating International Nurses Day. We'll just take a few moments to change seats.