 Rwy'n amlwg, mae'n bwysig iawn o'r Daugiau busnes yn 9990, i bwysig iawn o'r Prifysig Greum Ni na chi'n ddoch i'r cérd y bwrdd, yn Gwyl Gît Work, yn lwybwynt yn 20 yng Nghyrgrifennu ac yn duion o bwysig iawn, ddefnyddu ichi'r dddorol yn gwneud o ddangosiedig ddim yn bwysig iawn. Mae ddych yn gael yn gwybod a fyddfa feddwl, a'i ddim yn gwybod i bwysig iawn, bobl yn ddoch i'r ddweud i feddwl i merbyngu sydd yn fwybwynt sy'n gwybod. I'm not going to mention point of order. It's a privilege to lead this debate and I thank all members who signed the motion to allow it to proceed. Hospital is a scary enough place for adults and for children more so and for the parents and carers, very stressful and indeed upsetting. So the philosophy behind ambulatory pediatrics, which is a bit of a mouthful, is that children should not be admitted to hospital unless absolutely necessary and as much as possible care should be arranged in their own homes. I might add that this is perhaps especially important in rural areas with long distances to a hospital local or indeed a hospital outwith the area with remoteness and limited public transport. I have no doubt that this process helps with the entire experience, indeed the treatment and healing and recovery process for the children. Adult services indeed have since built similar models on seeing the success of the paediatric ambulatory units. So tonight I am pleased to congratulate NHS Borders paediatric ambulatory care unit, which has recently celebrated its 20th anniversary. The unit is based at Borders General Hospital, no locally as the BGH, in Melrose. I understand that the ambulatory care unit is a fundamental part of a wider innovation of children's healthcare at NHS Borders, which also includes social care, with a focus on keeping children at home and, as I say, avoiding time in hospital where possible. As I stated, it was set up on 20 May 2003 to allow the children to receive treatment and return home, rather than having to be admitted to a ward, and that, over the past 20 years, thousands of children have attended the unit to have a range of assessments, procedures, investigations and treatments. Located in ward 15 of the BGH, the unit, named quotes only for the day, closed quotes, was set up to provide daycare for children who require such things as blood tests, medical assessments and allergy testing. Before the unit opened, the children would have gone to Noah's Ark and been treated alongside children who have been admitted to a ward as inpatients. They also do BCG immunisation clinics at the unit. The service, importantly, separates inpatient and outpatient services. Only for the day, it also provides a friendly, relaxed environment for the children. The nurses can dedicate their time to caring for them, and they build up relationships with the children and their families, again, all helping the healing process. Of course, that means less time waiting for treatment and less anxiety, as I have said already, for everyone. The success of the unit pays credit to the paediatric nursing team for the commitment, quality of care and, indeed, innovation in developing the service, and contributing to a better experience for children and families, who, as I say, have been able to avoid being admitted to hospital thanks to the unit. Indeed, former patients and parents have shared their thanks to the unit. I will refer to one mum whose daughter was the first child diagnosed with a nut allergy at the unit, and that girl has just celebrated her 24th birthday. As I have said, adult services have built similar models because of the success of the unit. However, I want to end on a quote from Dr Andrew Duncan, consultant paediatrician and associate director of medical education at NHS Borders, who said, Over the last 20 years, the backbone of the service has been our amazing paediatric nursing team. They have shown huge amounts of flexibility in the imagination and development of the service. New skills have been developed in intervention blood tests, psychological support and undertaking specific procedures such as specialist immunisations and accessing medical devices. This has meant that many children have been able to be treated locally rather than travelling out with the borders. We all know that staying at home makes a huge difference to the lives of children and families, and we are proud to have provided the service for the past 20 years. My congratulations again to all on the team to NHS Borders and the BGH on the service, and I look forward to hearing contributions from other members to see if that is reflected in other parts of Scotland. I thank Christine Grahame for bringing forward this important debate, which recognises the work of NHS Borders paediatric ambulatory care unit following its 20th anniversary in May, and I join in celebrating those achievements. Over the past 20 years, the care unit, the specialist team of nurses, has provided blood tests, medical assessments and allergy tests, as Christine Grahame has said. They have supported thousands of children in the comfort of an outpatient setting. That means fewer children being admitted into hospital for treatment or travelling to be treated in other parts of the country. For children and their families, the reassurance that that provides is a familiar setting and results in less stress. The unit has also helped to free up bed space at the BGH hospital across local services, offering peace of mind for children and their parents. The team of paediatric nurses has developed skills, including specialist immunisations and the use of medical devices. They have also, as Christine Grahame alluded to, offered psychological support to children and parents across the Scottish borders. The staff deserve our praise, our recognition and our thanks for their work, and I thank them hugely for that. I also want to take this opportunity to address some of the pressures that health services in the borders are currently facing. Having visited the BGH last week, it is clear that the present SNP Green Government has not yet delivered a meaningful NHS recovery plan. During the visit, I learned about the severe pressures being felt across the service, and there is simply no capacity to flex as this winter approaches. Problems seen in A&E, through the wards and into the step-down borders view interim care facility, I will take the intervention from Christine Grahame. Can I just say to the member that it is very unfortunate that you are taking this opportunity to attack the health service, rather than just for once to congratulate the unit at the BGH in something that it is delivering? You were doing so well until then, but you have disappointed me entirely. As were you, Ms Grahame, but talking through the chair, please. I thank Christine Grahame for her suitable justizement. I am sure that, on representing borders, we can continue to clash in future. However, I want to take this opportunity to address some concerns that were raised with me directly by senior NHS managers, including the chair of the health board, whilst I visited the hospital last week. Problems seen in A&E, through the wards and into the step-down borders view interim care facility reflect the very real pressures that our local health service is facing, particularly in social care and care at home. Many hospital patients who are ready to be discharged are being forced to wait several weeks, and sometimes, sadly, months, for care packages to be discharged from hospital. At the time of my visit, sadly, 80 out of 310 beds were occupied by patients ready to be discharged, and that was creating bottlenecks throughout the hospital. Despite the huge efforts of staff—and, Ms Grahame, I celebrate the huge efforts of staff—this is still, sadly, resulting in elective surgery appointments being cancelled. Alongside the board chair, Karen Hamilton, I visited the medical assessment unit, and this is supposed to signpost patients to award or another setting within 72 hours. Last week, there were five patients receiving end-of-life care in this unit. As one member of staff said, this is a busy place, this is not a good place for people to die. Deputy Presiding Officer, those patients do deserve better. I have recently also met with GPs from Elston medical practice, and they are increasingly being asked to deliver secondary care in a primary care setting through no fault of NHS staff whatsoever. It is simply because of the capacity in the system. Innovations such as the paediatric ambulatory ward and the health board's hospital at home pilot, which I had the privilege and honour to see in action, are very much to be welcomed. So is the commitment shown by staff. However, as we prepare for this winter, NHS border wards and facilities are already above capacity and there is no room to flex. The hard-working workforce is operating at full capacity, so I hope that the minister is here today will listen to patients, clinicians and the proper resource of the NHS and social care sector in rural areas. I commend staff at NHS borders on their efforts in pediatrics, in the wards, in the operating theatres and throughout the specialist mental health and other services. As winter approaches, I urge ministers to give them the tools and the resources to do the job. Is it not important that a member, taking part in the debate, speaks to the motion before the chamber and does not deviate so far that they are not speaking to the motion? I thank Christine Grahame for her point of order. That is indeed a requirement of understanding orders. However, I did not see any reason to intervene on the member who was referring to the motion at various stages throughout his speech and I call Colin Smyth to be followed by Emma Harper around four minutes, Mr Smyth. Thank you to Christine Grahame for lodging her motion for the debate. I think providing a welcome opportunity to commemorate the 20th anniversary of the Pediatric Ambulatory Care Unit at Borders General Hospital, but also a chance in particular to thank all those NHS staff past and present for the outstanding care that they have provided for children across the borders over many years. I am personally immensely proud and grateful for the remarkable contribution that this unit and the wider NHS borders team make every single day to support so many of my constituents and those of other members. More so, no more so, than in these incredibly challenging times. Two decades ago, NHS borders embarked on a journey to enhance healthcare accessibility for the region's children and families. The inception of the unit, known as Christine Grahame has said, only for a day on 20 May 2003, was a testament to the staff's commitment to the wellbeing of our youngest citizens. As we have heard since then, the team working from the unit have treated thousands of children crucially without the need for them to be admitted to a ward, or, also importantly, sometimes to travel with the region for treatment, making a significant contribution to the innovation of children's healthcare within the NHS. As Dr Andrew Duncan, consultant pediatrician and associate director of medical education at NHS borders, said at the time of the 20th anniversary when paying tribute to the pediatric nursing team, new skills have been developed in interventions, blood tests, psychological support and undertaken specific procedures such as specialist immunisations and accessing medical devices. Prior to the unit being set up to provide daycare for such things as medical assessments and allergy testing, children would have to come into hospital to know as ARC and be treated alongside children who had been admitted to the ward as inpatients. With all the anxiety, that can mean for children, but also for their parents. In 2003, the new unit was forward thinking and 20 years on it continues to play a hugely important role in the care of borderers, but also in influence of other such initiatives across the rest of Scotland. However, it does so at a time that our NHS is facing its biggest challenge in its 75-year history, and no more so than the care of children in the borders. For all the positive achievements of the unit, we still have the challenge of the average wait time for pediatric surgery outpatients in the borders running currently at an average of 74 weeks. Child and adolescent mental health service waiting times in the borders mean that currently only 31 per cent of young people are being seen within 18 weeks. Fallen shot of the Government's legal... I'll take an intervention on that. Emma Harper I thank Colin Smyth for taking an intervention. Would you welcome the fact that the pediatric ambulatory care nurses are mental health first aid trained because it can be quite anxiety-provoking and it can also help to deal with some young people that are having mental health challenges? I know that we're the start of a new term, but can I remind the chamber that all comments should be through the chair? Colin Smyth Thank you very much indeed, Presiding Officer. I do very much welcome that fact, but we do have a challenge that, at the moment, the Government's legal target is 90 per cent of those young people being seen within 18 weeks, and at the moment, Scottish Borders is currently running that 31 per cent. I know that there's a lot of work taking place to tackle that, particularly the longest waiting times, but we do have a lot of progress to make because these are not just statistics of their children, their families, dealing with anxiety and uncertainty that comes with those prolonged waiting times. Presiding Officer, are NHS staff in the borders and across the country are working tirelessly to deliver the best possible standard of care, but we really do need to redouble our efforts to make sure that they have the resources to do so. Too many, including children, are still waiting too long, and two years from the publication of the Scottish Government's recovery plan, those waiting times are not going down the way they need to. The hard work, the professionalism of our NHS staff is inspiring, but let's give them the resources and the support that they need to provide the high-quality care that our children, families and communities, right across the borders and across Scotland, deserve. The Pediatric Ambulatory Care Unit is a shining example of that high-quality care and of the NHS values that all of us are proud of—compassion, accessibility, equality and innovation. It's leading the way, not just in children's healthcare but also inspiring changes in the way we deliver adult healthcare as well. Presiding Officer, I'm very happy 20th Anniversary to the Pediatric Ambulatory Care Unit at Borders General Hospital. I wish all those involved many more decades of the excellence and the compassionate care that they provide every single day, and for which we are all immensely grateful. Presiding Officer, I welcome the opportunity to speak in this debate and congratulate my friend and colleague Christine Grahame MSP on securing it. What an excellent contribution the member made also speaking to her motion. I too want to start by thanking all of the staff at NHS Borders for the work that they do every day, but in relation to today's debate, I want to pay particular thanks to those staff working in the Pediatric Ambulatory Care Unit at Borders General Hospital. As a registered nurse myself, I have experience in adult ambulatory care and a wee bit of pediatrics as well, and I know the vital importance of ambulatory care. It bridges the gap between the hospital and community children's services. It concentrates on areas such as accident and emergency and outpatients. It works at improving communication with families and the primary healthcare team, and it importantly works with the home care nursing services to develop new services such as day units. Presiding Officer, the unit at Borders General is a fundamental part of the wider innovation of children's healthcare at NHS Borders with a focus on keeping children at home and avoiding time in hospital where possible. The Pediatric Ambulatory Care Unit was set up 20 years ago on May 2003, as has been described, and it is to allow children to receive their treatment and go home rather than needing to be admitted as a ward inpatient. In the last 20 years, over 8,000 children have attended the ambulatory care unit to have a range of assessments and procedures and investigations and treatments, and that has been described by colleagues as well. Over the past 20 years, as Dr Andrew Duncan describes, he says that the backbone of the service has been our amazing pediatric nursing team. It is worth mentioning that again. They have shown huge amounts of flexibility and imagination and development in the service. We know that new skills have been developed, such as intravenous interventions and blood tests, and psychological support, which I have mentioned in my intervention, because it is really important that we help to support mental health addressing of any young people, whether they come through any service but including the ambulatory care service. The work that is being carried out by the exceptionally dedicated and specialist healthcare professionals has meant that children have been able to have the treatment locally rather than travelling outside of the Borders. We know that staying at home makes a huge difference to the lives of children, but the families and the team, both past and present at NHS Borders, should be absolutely proud of the service that they have created. Ambulatory Periodics is an exciting and challenging area to be involved in, with much scope for development. I was interested to read that, over the past 10 years, there has been a 30 per cent increase in the number of under-five-year-olds attending emergency departments. That compares to an increase of 15 per cent for all children and young people seeking urgent care over the same time period. Those figures are due to a change in demographics and a change in carer behaviour, and for several reasons. I was swithering about whether to include more detail about the issues of attendance at emergency departments, but I will mention that the lack of periodic experience in primary care and the assessment of risk play a role in increasing referral rates to secondary care services. That demonstrates why periodic units, like the one in the Borders General, are so important. In periodics, investment in a virtual hospital care model is increasing as acute settings struggle to manage the pressures of the increase in demand. I would like to ask the minister whether learning can be taken from the Borders unit and replicated across other health boards to alleviate pressure on boards and help to improve outcomes for children and young people. In conclusion, I put my thanks on record to all the staff at NHS Borders for leading the way in the pediatric ambulatory care unit and congratulate Christine Grahame on securing the debate. I thank Christine Grahame for bringing this motion to the chamber today. As I begin my remarks on behalf of Scottish Labour, the health team and an MSP for the region, I congratulate NHS Borders on the 20th anniversary of its pediatric ambulatory care unit, based at Borders General Hospital in Melrose that we have all been talking about this evening. There are a few things more important than the health and wellbeing of our children and that there remains such specialist and focused provision in the Borders today is a real positive and shows the importance we can place on dedicated pediatric care. Looking at the NHS Borders description of the word, it is heartening to learn that amongst the key aims of the unit includes a desire to reduce waiting times for children and have nurses in place with a specific responsibility to care for them whilst visiting the Borders. As many others have said, that will be greatly received by the young people but also by their families. Importantly, this service remains in the Borders, in a time when so many people have to leave the Borders for work and other services, this NHS provision remains firmly within the Borders and services the people of that area. As an MSP for south of Scotland, I cannot count the number of occasions I have heard residents having to travel to Glasgow or Lanarkshire or Edinburgh to receive services. It is undoubtedly the case that the provision of services, including health services, is severely limited at times in more rural areas, so this service should be welcomed and long may it continue in the Borders. As the motion states, it is apt that we take time in this debate to pay credit to pediatric nursing teams in the Borders and across the country. The service of care that they provide, the compassion, the show and the contribution that they make to the operations of our NHS is rightly recognised in the motion and has been recognised by all members in the debate. However, it would be remiss of me and it would be remiss of Opposition not to mention that there are problems within the NHS and that we should consider them. We did learn this morning about staggering waiting lists for people, well over one in seven Scots, with thousands of children and young people, particularly in CAMHS on long waiting lists. The Government has not yet met the target for CAMHS waiting times for CAMHS. It is important that we discuss those points when we have the opportunity. However, I accept that we are here to commend the work of the Pediatric Ambulatory Care Service and I once again do that. I, like my colleague Emma Harper, thought the words from the medical director were wonderful when he put forward the point that he thought the nursing services had done so well over the 20 years in this service. In concluding, it is right that we have come together to debate this important unit, but I do think that we have a responsibility in the chamber to ask a minister when they are here to talk to us about the ways in which we can improve services. I hope that the minister tonight will congratulate the service but will outline some of the issues that have to be addressed and how the Government, particularly on this day with the programme for government, will do that. Thank you very much, Presiding Officer. Let me start by passing on my congratulations to NHS Borders on the 20th anniversary of its paediatric ambulatory care unit and by thanking Christine Graham for bringing this important anniversary to the attention of the Parliament. The innovation that has been shown by NHS Borders and children's healthcare locally is something that they should be very proud of. The health and wellbeing of our children is of the utmost importance and it is our aspiration that Scotland should be the best place in the world to grow up. Supporting and maintaining the health and wellbeing of Scotland's children will in turn make for a happier, healthier, more prosperous future adult population. At a more fundamental level, we have an obligation to protect, to nurture and to care for our next generation. Put simply, we have to get it right for every child. It is in this context that our child health surveillance programme and network of children's nurses have become vitally important. I am proud to say that each young family in Scotland is entitled to the support of a health visiting service between from pre-birth to a child's starting school. Our universal health visiting pathway provides families with a series of 11 home visits as a minimum standard. That sequence of visits best ensures that the health and development of Scotland's children can be well monitored and promoted. While our health visiting service is universal, we also offer young mums the option of accessing more intensive support through the family nurse partnership. That helps to guarantee flexibility of approach and the provision of targeted care to children and families who need it most. All of our children are able to access the support of a school nurse as they move through education between 5 and 18. Our school nursing service is designed to focus support around priority areas that are most likely to influence health and wellbeing in later life. That approach ensures that school nurses can focus on prevention and early intervention, helping children to navigate health and wellbeing concerns and go on to drive into adulthood. Whilst all of those services provide significant benefits, it is really important that they do not operate in isolation. Our getting it right for every child framework provides the foundation upon which complementary children services can integrate effectively. GERFEC ultimately offers fertile ground for the development of initiatives just like the paediatric ambulatory care unit in NHS borders. As we have heard today, the ambulatory care unit is an innovation that puts the needs of children absolutely at the heart of care and ensures that, as far as possible, services are tailored to the individual. That is exactly what we would like to see all over Scotland. We are more than happy to work within NHS borders to examine what it is that it is doing and how much can be rolled out all over Scotland. Of course, it has already inspired a service of hospital at home, which we have debated in this Parliament, so that our further investment of £3.6 million into hospital at home provides acute-level care at home and avoids hospital admissions for adults, supporting more than 11,000 people in the last year. I simply ask her to look again at hospital at home and the home first programme, which is especially important in rural areas. Will she consider providing additional funding for our councils and health board areas? There are rural areas, because the cost of delivering those services in those areas is significantly higher. I would not dream on the hoof in the chamber of interfering with the NRAC formula, which I already understand accounts for the extra burden that rural authorities have, but I agree with you absolutely that it is more important than ever in rural areas that those services are delivered closer to home. We remain absolutely focused on ensuring that the health service recovers from the greatest challenge in its history, the pandemic. I recognise that challenges remain and that there are still unacceptable weights in some specialties, but we are committed to delivering sustained improvements and year-on-year reductions through service redesign and enhancing regional and national working. We have provided record funding, with more than £19 billion in the 2023-2014 budget, supporting recovery and reform to secure sustainable public services. The range of reforms across primary and acute services will not only help to speed the recovery from the pandemic, but they will also reduce unnecessary demand for services and develop new pathways of care that are better for patients as we face the health challenges of coming years. That includes building and investing in the recruitment and retention of staff. NHS staffing levels are historically high under this Government, with nearly 23 per cent more people in post. We have taken forward measures to help to retain staff and to look after their wellbeing, including the development of a wellbeing hub. We continue long-term investment in healthcare education and funding of record numbers of nursing and midwifery student places. We have also seen a 143.1 per cent increase in the staffing of psychology services since 2007. That demonstrates our commitment to mental health services, which also includes improving access to community mental health and wellbeing support. Through our investment in community mental health services, we are providing local authorities with £15 million per year to fund community-based mental health support for children, young people and their families. 5,093 children and young people started treatment in camps in Scotland in the most recent quarter. That means that the last six quarters have seen each of the six highest figures on record for the number of children starting treatment in camps. I would not for a second deny the challenges that we face and the improvement that we still need to make, but we cannot dismiss or ignore the seismic and continuing impact of the pandemic and what that has meant for the NHS and its workforce. It is therefore disappointing that my colleague Craig Hoy was unable to resist the opportunity to score some political points in this debate. We did not hear him talk up Scotland for being the only part of the UK to have avoided strikes in our NHS. We did not hear him say that our health and social care staff in Scotland are paid more than any of their counterparts in any other parts of the UK, even before today's announcement of £12 per hour from next April for social care staff. We did not hear him mention that we have more staff of all professions per head of population in our NHS and we certainly did not hear that in Scotland we have the best-performing A&E in the UK, not just this week, not just this month, not just this year but for the past eight years. Our NHS is still in recovery. Our NHS all over the UK is in recovery. Every country is facing challenges in terms of improving health as we move through and out of the pandemic, but we must move forward. We must make sure that recovery and reform are not just words and that they are concrete actions that ensure that, like in NHS Borders, we are getting it right for every child and getting it right for everyone. Thank you. Thank you, minister. That concludes the debate and I close this meeting of Parliament.