 The next item of business is a debate on motion 16702, in the name of Miles Briggs, on looking after those who look after us. May I ask those who wish to speak in the debate to press the request to speak buttons, and I call on Miles Briggs to speak to you and move the motion for up to eight minutes, please. Thank you, Presiding Officer. I want to open today's debate by paying tribute to all those who work in our Scottish NHS and social care services. I know every MSP across the chamber, from whatever part of Scotland they represent, will have seen at first hand the dedication and commitment of our NHS staff in providing each and every one of us and our families with the care that we need in good times and in bad. Any organisation at its heart is its people and the NHS is no different. Deputy Presiding Officer, sometimes in politics there are cases that make you stop and think about how we need to collectively do something to bring about a change. Perhaps one of the most shocking and tragic cases that has stayed with me during my time as Conservative health spokesman is that of 23-year-old junior doctor Lauren Connolly. Lauren was killed after her car veered off the M8 motorway as she drove home from a 12-hour night shift at Inverclyde Royal Hospital in Greenock. Dr Connolly, from East Kilbride, had just been working seven weeks in her medical training at that time. It tragically highlighted the fears over long working hours and fatigue faced by so many who work in our NHS, with staff often frequently working exhausting 100-hour weeks in shift patterns of 12 consecutive days. I want to pay tribute to Lauren's father, Brian Connolly, who has since the tragic death of his daughter campaign tirelessly alongside the BMA for stricter limits on working hours. I spoke to Mr Connolly last night. He told me his wish that there would be greater public awareness of the hours that junior doctors work, the tiredness that it causes them and the consequent risks to themselves and patient care. He would welcome the support of all MSPs across this chamber for his campaign in trying to rectify those long-standing problems and improve the health and safety of junior doctors across our country. Dr Connolly is determined that we see the First Minister's 2017 pledge to implement a 48-hour working week delivered, and I hope that all parties will agree to attend a cross-party meeting that I am organising to help to take that forward. People who work in our NHS are superheroes in many people's eyes, but they are not superhuman. We need to understand the impact that the on-going NHS workforce crisis, which sees high vacancy rates in nursing, consulting and mental health posts, as well as high absence rates across the health service and the impact that this is having on staff and staff morale. As the British Medical Association states, there are simply not enough health professionals working in Scotland's NHS today across all professions. 61 per cent of doctors are working over their allocated hours. The British Dental Association recently warned of 57 per cent of associated dentists looking to retire from general dental practice. One in four GPs practices in Scotland has a vacancy, and Scottish NHS is short of 2,400 nurses and midwives. After 12 years in charge of our Scottish NHS, SNP ministers need to accept that they have presided over a workforce crisis that is impacting on the wellbeing of NHS staff today. It is little wonder then that the Royal College of Nursing accused Nicola Sturgeon of a spectacular error of judgment when she cut the number of student nurses, while Health Secretary quadrupled the number of unfilled nursing posts and put all NHS under unprecedented pressure. Perhaps more concerning is that the BMA also continues to believe that official figures are continuing to under-report the actual extent of vacancies amongst the consultant workforce. The BMA research published last year showed that the actual vacancy rate is likely to be running substantially higher than the official figures. FOI data showed vacancies actually at around double the level recorded by official statistics, a difference of around 375 whole-time equivalent vacancies. That would be enough doctors to potentially staff a large hospital that are missing from our Scottish NHS today. We need to understand the severe pressure that NHS staff are under and how that negatively impacts on their own health and wellbeing. Retention of staff has to become the number one priority for this Government and for the health services that we all want to see perform well. That is why Scottish Conservatives have brought this debate forward today. We need to see our NHS working environment take into account the wellbeing and needs of those who work in them. That is why Conservatives are calling on ministers to review NHS and social care staff workplace support services in order to look to improve and promote wellbeing. We have a few ideas and I know that other members across those benches will also have them and perhaps more importantly groups outside of this Parliament as well to how we can move towards a more holistic approach to the wellbeing of our NHS staff. One of those is sleep pods and phone charging points for hospitals where NHS night shift staff can rest before they attempt long journeys home. Free parking for NHS staff, still today NHS staff in Dundee Glasgow and here in Edinburgh continue to face unacceptable parking charges. Mental health and financial advice support for NHS staff. Salis based in NHS Lanarkshire is already offering this to all NHS staff and it is something that I would like to see rolled out across the country. Free health checks at community pharmacies to help provide NHS staff with lots of additional holistic support services from white management. A focus, I think, importantly on NHS staff wellbeing. NHS Board has recently told the Health and Sport Committee how they have a wellbeing Wednesday. I think that we need to look at how we are actually taking forward this good practice across all our health boards. Parties, as I have said, across this chamber and maybe more importantly representative bodies will have ideas how we can achieve this. I agree and hope that we can take that forward. I have to say that I am somewhat disappointed in the cabinet secretary's amendment for today's debate. This debate should and can be about how Parliament can collectively do something to support and improve the working lives of those who work in our health and social care services. When the cabinet secretary first took over as health secretary, she said that she would take an approach to this job with mature reflection. I do not think that the approach that is taken today in trying to delete the mention of a workforce crisis that we have across our health service is productive. Sandra White. I thank the member for taking intervention. I just wanted to ask the member that you have quoted the BMA at quite length. The BMA Scotland GP spoke of the potentially devastating effect that Brexit will have not just in our health service but in medicines also. Do you agree with that? I have been absolutely clear in terms of the impact and the potential challenges of Brexit, but the workforce challenges that we face across our NHS did not start with Brexit. They have had 10 years of SNP Government, which has built them up. SNP ministers and SNP members need to understand that, after 12 years of being in charge of our NHS, the SNP has no one else to blame but themselves. I welcome the constructive amendment that the Labour Party has brought forward, and we will be supporting that at decision time this evening. To conclude, Deputy Presiding Officer, I hope that this is an opportunity for us to focus on our NHS staff and what we can do to make their lives easier. It is time that we change the approach that is taken to look after those who look after us. I move the motion in my name. I now call Jane Freeman to speak to and move amendment 16702.3 for six minutes, please. Thank you, Presiding Officer, and I start by thanking Miles Briggs for bringing this motion before the Parliament today. I am immensely proud of our health and social care staff. The quality of care and treatment and the compassion and dedication that is shown by our staff is unparalleled, and we thank each and every one of them. Whatever their role, they contribute directly to our nation's health and wellbeing and to our society. Of course, I recognise the pressure that there is from increasing demand on health and care services. The reasons for that are well rehearsed, demographic challenges, increasingly complex care needs, advances in the care and treatment services that we are able to offer, and I recognise that those pressures are felt by our staff. That is why we have acted and will continue to act to support our workforce, increasing training numbers in our nursing and midwifery places, our medical undergraduates, our medical postgraduate programme and in the AHI pathways, promoting training pathways, supporting board recruitment and retention, promoting staff health and wellbeing, and increasing the employee voice. Delivering sustainable services is not simply about supporting recruitment and retention. The health and wellbeing of our workforce is of fundamental importance. That is why I am happy to support the amendment that Monica Lennon has brought forward today. We must keep listening to our staff and learning from their experience, so I am also welcome and happy to take forward the review of support that has been proposed by Mr Briggs in his motion. There is a threat to our work to support our health and care services that cannot be ignored, and that threat is Brexit. While I accept that some of the challenges that we face did not start by Brexit, we have had three years of waiting to see what will happen with Brexit, and we still do not know the answer to that. Since the inception of our health service, our health and care services have benefited from inward migration. They have benefited too from our healthcare professionals working elsewhere and bringing that experience and knowledge back home to apply here. Free movement is vital for us to continue to attract dedicated professionals to help deliver these services. It is simply wrong that our EU health and social care staff should no longer feel welcome, and it is absolutely devastating that skilled colleagues who have built their lives here in Scotland should be planning to leave as a result. We will continue to advocate on their behalf, and we will continue to argue for a tailored immigration policy that meets Scotland's needs and reflects our values. We are taking comprehensive action to support increasing medical, nursing and midwifery trainees through the system, including bespoke support for speciality medical training and midwifery to promote rural training and recruitment. We are maintaining free tuition fees and increasing the nursing and midwifery student bursary to £8,100 this year, £10,000 to 2020. A non-means-tested bursary but scrapped in England by the UK Government. For the seventh successive year, we have increased the number of student midwifery and nursing places. We have provided funding for adult social care workers to be paid the living wage, benefiting up to 40,000 care workers—yes, I will. Jackie Baillie. Cabinet Secretary, who helpfully met me recently to discuss payment of the living wage to overnight care workers. Despite local authorities having the resources to do so, some of them have not passed this on in full, particularly for those employed in the third sector. Can I ask her what progress is being made to ensure that payment starts at the very beginning of this new financial year? I am grateful to Ms Baillie for raising this. She is a long champion as I do. The intention to support 20 for our care wherever it is needed is a really important one, and I know that we both share that. I met with COSLA yesterday to look specifically at the information that we have so far on where this is not being applied and to determine what further action we can take. I am not yet clear of exactly all the local authorities that are not yet applying this. Some of the data is not yet complete. However, as soon as we know that, between COSLA and ourselves, we will not act with those individual authorities and I will ensure that Ms Baillie and others are kept up to date. Our NHS staffing levels are at a new record high, up by over 13,000 whole-time equivalent staff under this Government. To support local recruitment efforts, we have provided record levels of investment with resource and capital expenditure exceeding £14 billion for the first time this year. Members will be well aware that, to facilitate workforce and workload planning, we have introduced the health and care staffing bill, the first multidisciplinary workload and workforce planning legislation in the UK. The bill recognises the fundamentally multidisciplinary nature of health and social care services. It is an important piece of legislation, important for our workforce planning and important for our staff. I look forward to continuing to work with members across the chamber to make sure that we get it right for the whole system of health and social care. Presiding Officer, it is absolutely the case that the care, compassion and support that we ask our health and social care staff to give to those who need them is care, compassion and support that they should receive themselves. I do not believe that we can have one without the other. We have across our health boards a number of initiatives looking at the wellbeing and the mental health support for our staff but the challenges remain and I am always open to good constructive ideas that we can try to introduce to improve that approach. We will meet, in fact, the BMA later today to discuss further with them the work that we are undertaking with respect to junior doctors. I remain absolutely committed to high quality, sustainable health and social care. At the heart of that is a healthy and cared for workforce. We are working hard to deliver on it but there is more for us to do. I look forward to the debate and move the amendment in my name. I call Monica Lennon to speak to you and move amendment 16702.1. No more than five minutes please. Thank you, Presiding Officer. Looking after those who look after us is the title of this debate and I hope that today's debate reminds all of us that we should never take our health and social care staff for granted. I am grateful to Miles Briggs for securing this debate because the BMA is in and unable for their helpful briefings. I associate the Scottish Labour Adventures with Miles Briggs's remarks about Dr Lauren Conley, who will be sadly missed by her family and her colleagues. Lauren was from East Kilbride in the region that I represent and a peer tribute to Lauren's father and the family who continue to campaign. Eight years on, since Lauren died, the latest GMC survey found it nearly one in every four UK doctors in training say that they are burnt out because of their work. A recent BMA survey found that 91 per cent of doctors are working more than they are allotted hours. We know that this problem is not isolated to doctors but extends to all staff affected by the NHS's workforce crisis and social care staff are also at risk. The social care sector, as we know, is fragile and staff often experience poor working conditions, sometimes on zero-hour contracts, low pay and facing demanding shift patterns. Health and social care staff are being stretched to their limits, working more than they are contracted hours at times and staff that I speak to feel like they are always on call. Ahead of the debate, I was also keen to look at what support is available to staff and I was interested to hear from Unison that some NHS workplaces have implemented staff wellbeing initiatives such as lunchtime yoga, something that we perhaps all could benefit from. I note that Scottish Conservatives have called for provision for sleep facilities so that staff can catch up on much needed sleep before driving home, for example. I think that those are all ideas that are worth exploring in any measure that will protect staff and promote health and safety in the workplace needs to be encouraged. On those benches, we are concerned at the working conditions that allow staff to become so exhausted and stressed in the first place. Until the Scottish Government accepts that there is a workforce crisis, they will never truly address the real systemic problems our health and social care services face. Research by Scottish Labour found that between 2015-16 and 2017-18 there were 1 million days of NHS staff absence caused by stress. Today, I attended an annual review of NHS Lanarkshire, where I raised my concerns about staff wellbeing there because in Lanarkshire staff absences and vacancy rates are above the national average. So, whilst any measures to support staff are absolutely welcome, we need to ensure that the focus remains on the root causes of poor staff wellbeing, such as too much work and not enough staff. Research from the BMA, from the GMC, UNICEF and others tell us that factors that contribute to stress can also include workplace culture and bullying and harassment. If our health and social care staff are truly valued, that must be deflected in the workplaces. However, we have reason to be concerned that some workplaces are not the supportive environments that we expect them to be. This year alone, we have heard worrying cases about staff bullying, concerns about whistleblowing and how it is dealt with, and it is too important to shy away from those issues. I acknowledge that the health secretary has said she will appoint whistleblowing champions to every health board. That must happen as a matter of urgency because every day that goes by, where staff do not feel able to report their serious concerns, we have more staff feeling demoralised and, of course, patient safety can be at risk. I think that the on-going issues at the Queen Elizabeth University hospital show how patient safety can be compromised when staff's concerns about infection control, about estates and cleanliness are not acted upon. We can support the Conservative motion today because it gives all of us an opportunity to show our appreciation and concern for health and safety of staff. We would suggest that more extensive action is required to tackle the root causes. That is why I am pleased to hear from the cabinet secretary and Miles Briggs that they can support the amendment in my name. We have sympathy for much of what the Government is saying about the potentially devastating impact of Brexit on health and social care and the EU citizens who are valuable members of our workforce. I am a bit concerned about the amendment because it took out the line about the workforce crisis and we have to face up to those facts today. In conclusion, Scottish Labour will always support our health and social care staff to get the working conditions that they deserve and the work-life balance that they need. I move the amendment in my name. Thank you very much. I now call Alison Johnstone. Four minutes please, Ms Johnstone. Thank you, Presiding Officer. I, too, would like to thank all of those who look after all of us. It is clear that workforce pressures are severely impacting the wellbeing of health and social care workers. That is the message that is coming from those on the front line. In May 2017, the Royal College of Nursing launched a survey of nursing and midwifery staff in the UK with over 3,300 responses from Scotland. The findings clearly show the impact that insufficient staffing has on staff wellbeing. More than half of respondents reported a shortfall on planned numbers of registered nursing staff on their last shift or last day worked with around two thirds having worked unplanned extra time. In addition to that, over half of survey respondents said that care was compromised on their last shift. There is a clear correlation between those conditions and poor staff wellbeing. One respondent stated that, when nursing staff are overstretched due to insufficient staffing, they often suffer the consequences personally, not being able to stay hydrated, to eat or use the toilet, impacts on their physical and emotional wellbeing. Those conditions are so poor that they are often unable to have their basic human needs met. I recognise that the Scottish Government has taken positive steps to address workforce pressures, such as the new GP contract, the introduction of the health and care staffing bill and the increasing of nursery and midwifery student bursaries next year. However, the workforce will not increase overnight and there is significant cause for concern around staff wellbeing during this interim period. There are also significant pressures around the implementation of the new GP contract. Last year, the Royal College of General Practitioners commissioned a survey of its members, which found that 35 per cent of those surveyed had spent consultation time explaining to patients why they had been offered appointments with other healthcare professionals instead of a GP. The place is strained on GPs who have insufficient 10-minute consultations with increasingly complex health conditions, but it also causes distress to patients. The same survey reported that 60 per cent of respondents were aware of patients who had become distressed, angry or confused when signposted by medical practice receptionists. Changes to service as a result of the GP contract as welcome as they may be must be urgently communicated to Scotland's population to ease the concern of patients and to lessen the strain on practice staff. There are also substantial pressures in the social care sector where 15 per cent of social care workers work unpaid overtime and 11 per cent are on zero-hours contracts. There is a significant disparity between the value of care and the support carers receive and it is important that professional caring is valued and considered an attractive career. Social care workers do difficult and essential work in people's homes and care homes in the communities, but it remains one of the lowest-paid sectors fuelling the gender pay gap. Enabled Scotland is called for the extension of the Scottish living wage to cover every hour worked by social care staff, including, as Jackie Baillie has highlighted, overnight sleepover support. However, that needs to be properly funded by commissioners and, as we have heard, all aren't doing so. In February, I urged the Scottish Government to put fair work at the heart of Scotland's care sector by adopting in full the recommendations of the fair work conventions review, fair work and Scotland's social care sector. That reported that front-line care workers don't feel respected for the work that they do. They do by their colleagues, they do by their employers, but they don't feel particularly valued by the Scottish Government or the wider public. We have to change that. Equitable pay is important, but we need to make sure that social care workers feel respected and supported. Presiding Officer, there are positive measures that we can take to address staff wellbeing by ensuring that workers in all sectors feel valued and are fairly paid, but it's key that when changes are implemented to ease workforce pressures, we have to communicate them properly. We can't have a healthy workforce. No, no, no, please, you must conclude. I was making the signals. I call Alex Cole-Hamilton, followed by Brian Whittle. It has to be four minutes, Mr Cole-Hamilton. Thank you, Deputy Presiding Officer. Can I start by echoing the thanks that other members have made to the Conservatives for the Securing Time for this debate and echoing the thanks to our workforce who look after us? On two occasions, I'm sure that many members can tell similar stories to this, but on two occasions primary healthcare workers have represented the bridge between normal life and oblivion for my family. That's in the first case when my eldest son was born and wasn't breathing. They revived him after huge complications in theatre. Secondly, much more recently, with my four-year-old daughter Darcy, when a whole team of clinicians stayed behind when their shift had ended to operate on her to extract a coin that she had swallowed. I owe them the lives of my children. I'm sure that I'm not alone in this chamber of people who have similar personal stories to tell. NHS is unique in this place, isn't it? It's something that attracts great love but at times great derision as well. I think that it's important to separate, and to put on record that as an opposition politician, and I speak for all opposition politicians, I'm sure that while we sometimes attack Government policy and sometimes the governance of our health boards, we never ever attack the work of our front-line staff. They are heroes of our country. The first thing that I'd like to say and attribute to them is that, as many have already, there just aren't enough of them. There is a workforce crisis. It's wrong of the Government to try and amend the Conservative motion to delete those words today. We have seen, since I was elected, many of my colleagues on these benches were elected in 2016, warning lights across the dashboard of workforce planning in a range of disciplines. For me and my party, no more is that more profound than in the area of mental health. We already know about the waiting list that children and young people face in terms of waiting for adequate mental health. Right across mental health at all ages, that is a source of great importance, and I'll tell you why. For example, we were going to recruit 800 mental health workers. In the two years since that policy was announced, we've only recruited 106. Put that in context. When one in four appointments are made with a general practitioner, because of an underlying mental health complaint, there's no wonder that our GP morale is rock bottom, that they're having to deal with things that actually would be better solved by mental health practitioners. I asked the Government to respond to the concerns that we have about the short uptake or the slow uptake of those positions. Morale is so important, and that feeds into morale as well, but there are many factors that are lowering staff morale in our front-line NHS, whether that's having to send people a 12-week waiting time guarantee letter that they know they have no hope of meeting in closing wards to elective surgery because there are no receiving beds in the wider hospital to receive inpatients because of delayed discharge. I actually had a senior neurosurgeon come to my constituency surgery to talk about how low the morale was in his department because of repeated closures of his ward due to the lack of inpatient beds. We've also heard a thing or two about safety, and Alison Johnstone is absolutely right to cite the concerns of front-line nurses who say that patient care was compromised on the last shift that they did, but it's not just patient care. We need to recognise that staff need to be kept safe as well, and that's why we've sought amendments in the safe staffing bill to recognise the preeminence and importance of safety in our staff. I think also our approach to whistleblowing matters hugely because we need our staff to understand that, firstly, they are being listened to, they are being believed, that they will see corrective action and culture change, and that is not universally accepted or well-regarded service across our NHS. You can see that in the fact that sometimes clinicians will phone national newspapers about a problem before they phone the national whistleblowing helpline such as the consent. I just want to close by saying that we also have to thank our social care workforce and those unpaid carers looking after their loved ones, but we all owe them a huge debt of gratitude. Thank you very much. I'm sorry. Time is very tight in these short debates. I call Brian Whithill to be followed by Emma Harper. Mr Whithill, please. Thank you, Deputy Presiding Officer, and I am delighted to get the opportunity to speak in this debate, but I refer members to my register of interests in that I have a close family member who is an NHS healthcare professional. As the chamber knows, my big passion lies in the preventable health agenda and that escalating cost of treatment of preventable conditions to the NHS is unsustainable. My view is that we are not managing the sustainability of the NHS rather we are managing its demise. We know the conditions that we are talking about the COPD, obesity and preventable cancers, some MSK conditions, mental health, stroke and so on. If we are to maintain the long-term future of our most precious public service free at the point of delivery, it is crucial that policy tackles this issue. In developing our strategy, we must ensure that we have a delivery mechanism and key to this delivery will be our NHS staff. I wrote a paper last year about changing Scotland's relationship with food, drink and physical activity. The very first action point noted that in asking our healthcare professionals to look after us and deliver a healthier wellbeing message, we have to look after the health of our healthcare professionals first. It has to be the first step. In so many cases, our healthcare professionals work in an environment that leads them to be more unhealthy than the people they are delivering the healthcare message to. We need an environment where they are able to look after their own health and wellbeing, where they can adopt an active healthy lifestyle of their own before they are asking and recommending that to others. That should be the foundation of any strategy. Some potential interventions are on the face of it reasonably straightforward, ensuring that every staff member has access to a hot meal during their shift and an adequate break time to eat it. Some hospitals do not have staff rooms that allow a fridge or a microwave, leaving the right shift with the only option being a vending machine. Utilising any on-site facilities, such as gym equipment and the physio department with instructions to do so to Monica Lennon's point about taking a bit of yoga classes and giving them time allocated to do so is another example. If we are going to ask our healthcare professionals to deliver a service that has a focus on getting the population to be more physically active and to be more nutritionally aware, it is obvious that we need to afford them the very same opportunities. Without that step, the subsequent steps become problematic. The quality of care in this environment, not to mention the health of our healthcare professionals, including a reduction in absenteeism for both physical and mental health issues, could be greatly enhanced. We believe that that would allow the opportunity for healthcare professionals to deliver the kind of preventive care and acute care that they desire to do so. As an example, the cardiac physiotheraid department at Crosshouse Hospital at NHS Ayrshire and Arn has been running an extended community rehabilitation programme that will not only help chest, heart and stroke sufferers, but also welcomes people with other conditions such as obesity, mental skeletal sufferers and so on. The cobalm, medite, exercise and education classes have been very successful in not only reducing further re-emissions to hospital or doctors' appointments, but they have been very instrumental in increasing the quality of life for those who are suffering with those conditions. Those are innovative and creative solutions that our healthcare professionals can come up with if they are given the support, room and encouragement to apply their knowledge. Therefore, the appointment to read the amendments by the cabinet secretary who seems to tow the SNP line or trying to blame Brexit for everything. There are staff shortages and there will be a lot, and they will be there long before Brexit. I wonder if she can consider the impact of Nicola Sturgeon cutting nurse-and-win witheray places in 2012 when the current staffing rates poor workforce planning. There are multiple Scottish applications for every midwife training place or nurse place or doctors at medical schools or physiotherapists and so on. The reason there is a shortage, especially among Scottish applications, is because the Scottish Government has capped the places. Deputy Presiding Officer, I am at the end of my speech. The member has got six seconds. Deputy Presiding Officer, in conclusion, this is a serious debate. It is a health debate that is long over during this chamber, but has been systematically avoided during Government debating time. Our NHS staff are the main driver to deliver a healthier Scotland at its time looked after their health. Thank you very much. I call Emma Harper to be followed by Lewis MacDonald. Ms Harper. I am pleased to speak in this afternoon's debate on the work that both the Scottish Government and health boards across Scotland are carrying out to ensure appropriate levels of staffing in our NHS. I would like to start by saying that I do recognise that across NHS boards in Scotland there are challenges with the recruitment of health professionals, particularly GPs. I have just read a report or heard an announcement that there are 100,000 employees short in England and 40,000 nurses short in England. If we are going to try and recruit to Scotland, we will not be getting them from England, we will have to get them from somewhere like Europe, and that is going to be a challenge as well. I will not take an intervention because we did not have a lot of time. We cannot fix the health staffing issues immediately, but there are things that are being implemented by the Scottish Government to support this. One project that the Scottish Government has implemented that aims to support recruitment of GPs to rural areas across Scotland is the Scottish Graduate Entry to Medicine programme. SCOTGEM is a partnership between St Andrews and Dundee University in NHS Scotland, and it is a course orientated towards the current NHS Scotland workforce requirements, particularly in remote and rural areas and general practice and other medical specialties. While SCOTGEM graduates will be entitled to enter any branch, the course and selection of students are designed to attract those interested in a career in a rural area. In an area of the south of Scotland, there are five GP practices across the Freeson Galloway that are set to take part in the pilot, and I look forward to seeing its outcomes. I know that the Scottish Government is committed to supporting our highly skilled health and social care workforce to deliver a resilient, efficient and highly quality healthcare service that is already world-renowned. As a member of the Health and Sport Committee, I have been involved in the safe staffing legislation as we take this bill forward. The first multidisciplinary workforce and workload planning legislation in the UK is now approaching stage 3. The effective application of the legislation will support the wider workforce planning process by enabling a rigorous, evidence-based approach to decision-making on staffing, which takes account of patients and users' and healthcare needs. I would like to just pick up on a couple of points that were made as an employee of the NHS prior to coming here. While the SNP Government was leading for nine years, so I was an NHS employee for nine years prior to coming here, I felt that I was always positively supported in many ways. It is not the SNP's fault that there are issues around staffing and challenges. There are many issues that contribute to that. The required evolution of processes to support all staff takes time. I absolutely agree that Miles Briggs has highlighted various ideas and options for supporting staff, and Monica Lennon has brought that up, too. I would like to have expanded on that further, but time won't really allow. At the end of Miles Briggs' motion, it talks about a review of promoting wellbeing and looking after those people in Scotland, so the people who are caring for us, especially me, when I have been in hospital myself relating to my type 1 diabetes. The goal for us is to help to support people while in work and prevent sickness and absence. NHS Dumfries and Galloway has introduced that, too. I would encourage the Government to review current practices across health boards, because I think that we need to make sure that the people across NHS Scotland are supported, because they are working really hard. Thank you very much. I call Lewis MacDonald. We have followed by Sandra White, Mr MacDonald. Last year, we rightly celebrated 70 years of the NHS. This year, we need to look forward as well and consider what kind of health services we want and expect for the next generation. Some things are bound to change. People living longer means new challenges for health and care, as well as a different demographic balance. New technologies are part of the way forward. This morning's press and journal highlighted the potential for GP consultations going online at Count as Wells in Aberdeen, where internet speeds of 1 gigabyte per second will provide fast and secure connections. The same newspaper also highlighted the decline in the number of GP practices in Grampian, down by more than 10 per cent in the last 10 years. GP practice numbers have also fallen in many other areas, from Lanarkshire to Orkney and the Western Isles. The future delivery of care in communities will require not just enough GPs, but also a whole range of other healthcare professionals from pharmacists and physician associates to occupational therapists and advanced nurse practitioners. It is a good time to consider what primary care will look like in the next 30 years and what staff and skills it will need and what support those staff will require. The Health and Sport Committee is doing just that, and I hope that many of all our constituents listening to this debate will take the opportunity to go to the Scottish Parliament website and tell the committee their views. Hospital care also faces real challenges right now, and many of those are also fundamentally about staff. One thing that has changed very little in relation to the national health service is how far we depend on the dedication and commitment of healthcare staff. Monica Lennon and others mentioned issues raised by staff organisations like the BMA and the RCN, and they tell very similar tales. Nurses in Scotland and across the NHS have described how often they have to cope with inadequate staffing levels, how often they have to do more than their planned shift in order to ensure that patients receive the care they need. Others talk about going the extra mile to cover for ill or absent colleagues or long-term vacancies keeping the NHS afloat, but often feeling that they get little thanks for doing so. All of that is bound to affect the quality of care. It also risks the kind of reputational damage that makes recruiting the next generation of healthcare professionals to the NHS all the harder. Those are challenges which must be faced whenever we call them and addressed sooner rather than later, because otherwise we risk the very goodwill and commitment that is so important to the NHS from the people who work for it. We also need to acknowledge today the issues facing the social care workforce. The health and care staffing bill, which Emma Harper mentioned, does acknowledge the need for parity between health and social care as part of the process of health and care integration. When it comes to pay and support for staff, as we have heard, social care is still the prudellation of the NHS. The Joseph Rhinetree Foundation says that 15 per cent of the social care workforce live in poverty, enabling to describe that as Scotland's most vulnerable people being cared for by Scotland's most vulnerable workforce. That clearly has to change. When we look to the future, we have to think about how to close the gap between the NHS and social care at the same time as addressing the staffing challenges in the NHS itself. We can only create the high quality, integrated health and care sector that we all want and need if we start by supporting those who work there now and in the future and make the sector an attractive place to work for the next generation too. Thank you very much. I call Sandra White to be followed by Annie Wells. Thank you very much, Presiding Officer. Can I start by thanking Miles Briggs for bringing this debate forward? I think that credit is always due, and I'm happy to say that as I think that everyone in this chamber is also. I can also mention the fact that that's why the SNP Government is committed to supporting a highly skilled health and social care workforce. We want to deliver a resilient, efficient, high quality healthcare service. As far as I can see, about the various areas of my constituency, that is recognised amongst being the best in the world, the Scottish healthcare. I recognise being one of the best in the world. We talk about staff morale. I often ask myself, and I'm going to ask the opposition parties too, particularly Miles Briggs, when you're constantly talking about crisis, crisis in the health service, crisis in the NHS. Do you not think that that is something to do with the morale as well of people who work in the health service? I certainly speak to them and have been for a while now. That word, crisis, they feel as though you're using this as a political football. I just leave it there. I'm sorry, I don't have time. You speak to the healthcare professionals out there. You listen to the BMA and others also. That is what they say. I don't have time. Sorry, Miles, I might come back in again. You mentioned the fact about staffing. We agree but we're looking at staffing. We're looking at staffing in the NHS and it was said by the Cabinet Secretary earlier on. The staffing level now is 13,600 more. It's actually a record level. It's went up by 10.7 per cent and increased. That's a good thing. It's not a bad thing. So I think it's time we did look at some of the positive issues. I'm not saying we're perfect, but I think it's about time we looked at some of the positive issues there. I do want to turn to Brexit. I think that I have to turn to Brexit. Before I do turn to Brexit, we mentioned in Monica Lennon's motion that we should be acknowledging that the health and social care staff experienced reports found that 79 per cent of NHS staff feel they're being treated with dignity and respect. I think that we have to look at that also and I think that that's only fair. If I turn to the Brexit situation, I've only got two minutes, not even that. I want to turn to the Brexit situation. I've already mentioned the BMA and the comments that the BMA said and absolutely quite rightly too. But we've also got the view of 24 health professionals in Scotland who wrote an open letter to the UK Government. They said that doctors, nurses and healthcare professionals from Scotland, we see the damage. Brexit is already inflicting on our treasured national health service. Make no mistake about it, Brexit is costing us lives. That's not my quote, that is their quote. So let's look at what other people are saying in regards to Brexit and let's look at what the EU citizens make a fantastically vital contribution to our economy. They drive the population growth, they work in all the sectors and the vast majority of EU citizens in Scotland are of working age 84 per cent and 76.8 per cent of them are in employment. And because of what's happening with your Government, the Tories and Westminster we will lose these people. No, I can't, John, sorry. We will lose these people. And these people are already leaving because they're absolutely terrified they will not be able to stay in this country. A loose McDonald's contribution I found was very interesting but if you're quiet you might hear some interesting facts and figures. I found a loose McDonald's contribution very interesting. Care homes, care staff. That is absolutely true. We took evidence that Miles Briggs knows full well on the health committee and that was what was said. These people are leaving and they're frightened and that's all down to you. So please don't talk about just a crisis. You take responsibility what your Government is doing with Westminster to the health service here in Scotland. Thank you very much. I remind members to use full names even when in full flow. I call Annie Wells to be followed by Fulton MacGregor. Mr MacGregor is the last speaker in the open debate. Annie Wells. I first of all want to put on record my personal thanks to NHS and social care staff who work so hard to care for us and I can think of at least a handful of individuals who have helped my family so much during difficult times. It's not just the act itself of providing healthcare and all the years of studying that go into that but the little acts of kindness that we can all probably think of that have touched us some way or at some point in our lives. That's why I hope we can all get behind this motion. People who go into health and social care do so because they care about people and for that reason alone we should do all we can to care for them. The context of this is important with our NHS facing numerous problems. The NHS workforce in Scotland is getting older with the proportion of staff aged 50 and over increasing from 29 to 39 per cent in the last 10 years alone. Absence rates due to sickness are at the highest level for a decade in part due to rising workloads and we are experiencing a recruitment crisis. Just as examples, one in four GP practices currently have a vacancy in Scotland. Hospitals are short of nearly 2,500 nurses in mid-wise and 5.5 per cent of CAMHS posts are vacant. It's no wonder then that staff are struggling. Even without considering the factors that the Government has control over the jobs themselves are extremely demanding both physically and mentally. We've heard some extremely sad stories already today and unfortunately they're not that difficult to find. As we've heard not only are people's lives in danger because of extreme fatigue as we saw with the young medic Lauren Connelly who died while driving home last year after a night shift but those roles take an extreme toll on people's mental health. Statistics last year revealed that the number of staff absent due to stress, depression and anxiety rose by nearly 18 per cent between 2015-16 and 2017-18. We are advocating today is a creation of a working environment that provides holistic care and support to all NHS and social care staff. Those are simple measures that would make a real difference. As we've already had parking for example as a real issue for many NHS staff especially in Glasgow. In recent days we've heard more about the on-going saga of parking at the Queen Elizabeth University hospital where it's been reported in the past that nurses have slept in their cars just to get a space. The Royal Infirmary launched a petition against the £20 charges being levelled at the aim for the privilege just to park at their work. Any future Scottish Conservative Government would launch a more widespread review of parking across all hospitals for staff, patients and visitors. We wish to see sleep pods in hospitals for shift staff to rest after the shifts as well as health checks at the local community pharmacies which will include blood pressure checks and weight management programmes as well as the option of free-flow jobs. Mental health support too is vital which is why we want to see every health board have an inbuilt facility where staff can get any necessary mental health support as well as financial advice. Those are again simple measures that could lay the foundations of a more supportive working environment. The most valuable resource in our NHS is its people. Therefore it's only right that the workplace services are improved to promote the wellbeing of its staff. The Scottish Conservatives today are calling for basic measures that will make a real difference to people's working lives. Only then can we say that we are truly looking after those that look after us. Thank you very much. I call Fulton MacGregor. We move to closing speeches. Can you say opening speeches? That has shocked everybody. Fulton MacGregor. I would also like to thank the Conservatives and Miles Briggs for bringing this motion to the chamber. I agree with the principle that our NHS and social care workers are one of our most indispensable resources in this country. They can face considerable pressure in their careers and on a day-to-day basis. The Scottish National Party Government can certainly be seen to be backing and strengthening our workforce so that they can deliver the efficient and high-quality service that they do constantly day in and day out. I think that it's only proper that as the constituency MSP across my constituency and the health service and social care services, whether it's at the Monkmans hospital, the health centre, the day services and many, many more. I want to pay a particular tribute to EU workers and I'm not sure why the Conservative benches are so keen to bring forward this motion about the impact of health and workers but are resistant to the impact on EU workers who are going through a torrid time just now and it is really impacting on their health and they're also having to work under such circumstances. As the cabinet secretary has already mentioned, the health and care staffing Scotland bill is the first multidisciplinary workload and workforce planning legislation in the UK, showing that the SNP really are taking the lead in supporting our healthcare professionals. Using the ground-breaking evidence-based approach to nursery and midwifery workload and workload planning, the health and care staffing bill will provide assurance for staff and service users that appropriate staffing is in place irrespective of their healthcare setting and that will allow apologies for that. Apologies. I've lost my place. We didn't notice. Presiding Officer, I do want to focus the rest of my remarks. Apologies for that. I do want to focus the rest of my remarks on a local issue in my constituency. I was shocked and astounded to recently learn that Lamontshire's joint integrated board meeting was a recommendation to close the dementia day services at East York Gardens in Cote d'Ike. This is a fantastic local unit providing an invaluable and critical service to many vulnerable patients across my constituency. For the context, the day service doesn't just care to those individuals and families living with dementia, but I know that even a local nursery attend their weekly to build relationships in bond between the generations and they find us a very valuable experience, but probably most concerning and relevant to today's debate is the fact that the decision was made to close the service days before it was made. This has caused considerable distress for all concerned. As soon as I found out about it, I wrote to the board urging them to reject the decision to close the centre and to undertake a full equalities impact assessment before making any further recommendations. Those decisions cannot be taken lightly and it's not just for the service users but also for staff to be notified only days before it's just not acceptable. I must have had an absolutely massive impact on their health. Presiding Officer, I can see that I went into my last minute and obviously I jungled my speech earlier. The board went ahead and made that decision despite representation against it. I have to give credit where credit is due. The Conservative party resisted it as the SNP, the local Labour party, and I don't think that that's acceptable not for the notice that was given and that's placed on staff members who work there. No engagement with unions or with MSPs or with councillors at all is just totally not acceptable and fits in exactly with this motion. To conclude, Presiding Officer, I do welcome the motion being brought forward but, as Sandra White said, we all must work together to deliver the best healthcare services. There is further work for the Scottish Government that will summarise that and I've outlined some of the work that has been done but funding must be prioritised from the UK Government too and at a local authority level, councillors of all parties must put local politics to one side and that way we can get the best services that our nations deserve. Thank you. Closing speeches. I call Monica Lennon and close for Labour four minutes please. Thank you, Presiding Officer. Fyllton McGregor is always a hard act to follow but I'll try my best. I think today it's been a short debate but I think it has been a useful debate. We've had members reflect on how important the NHS has been to them and their family and I'm glad to hear that Darcy, Alex Cole-Hamilton's young daughter is doing well and she got us all very worried we all followed that very closely on social media so we all have in common and are out of need. We all need to pick up that phone and phone for an ambulance or get to the doctors and it reminds us all that we're all actually human beings. However, what almost unites the Parliament is the reality that we do have a workforce crisis. There has been a failure to plan effectively for the needs of the workforce and Lewis Macdonald as a Labour colleague but I think actually channeling has convener had was rightly looking to the future thinking about the challenges the next generation in terms of workforce, looking at the role of technology and also very nicely plugging the health and sport committee survey which is on going I believe the closing date is the 30th of April and I hope that all of us will encourage our constituents to take part and have their voice heard because we know when people feel that they're not being listened to whether that's patients whether that's people requiring social care or indeed workforce if people don't feel they're being listened to whether that's the language for the annual review and there was a mixture of that people who genuinely are appreciative and recognise the great work and some of the innovation that's under way but also a frustration that health and social care integration isn't happening quickly enough people are not knitting together and the cabinet secretary will hear me often talk about resourcing and my concerns about under investment across the spectrum of health and social care but it's not always about the money it's not always about that and that's why we need to make sure that we have the right culture we need strong leadership at the top and all of our health boards and all of our health and social care partnerships because sometimes we find that people are raising issues people do have good ideas we have the best staff in the world but people feel sometimes that they're not being listened to and also when I speak to colleagues in unison for example their concern is that they're doing quite well but the training and development is not always keeping up with that and people feel that sometimes there is poor management and I know these are all issues that the cabinet secretary will recognise not just from our time leading a health board or sharing a health board but now as the cabinet secretary I think that there are points where we can all work together and we have to continue to do that because all of this is far too important so for the point that I've made about the fact that there is a workforce crisis and we're doing the people of Scotland and our health and care staff I guess there is if we deny that fact so for that reason we won't support the amendment in the cabinet secretary's name but I think there are shared sentiments across the chamber to be today I think listening to colleagues like Emma Harper who again is a valued member of the health and sport committee we need people in here the fact that we have a mental health minister who was a mental health nurse and attributes to this Parliament but we will need to at times step out of our own comfort zone and or maybe party positions to find ways of working together to go back to the beginning Miles Briggs highlighted that the tragedy of Dr Lauren Conley we can't have any more tragedies like that I don't yet have an answer from the Government about what we're going to do to reduce the fact that in those years that I mentioned there were 1 million working days lost in the NHS some of that will be outwith of the workplace we get that people don't come into their work and switch off from their outside life but these are the big challenges that we face and I hope after today looking at what we've agreed in the debate there's a lot there that we can build on and develop for the future Thank you Cabinet Secretary, five minutes please Thank you very much and can I thank all the members who have contributed in the debate I think that it's been a very helpful one and helpful to me to hear some of the propositions that people have put forward I want to cover some of the points that have been raised Mr Briggs was right to recognise the work of Brian Conley in response to the tragic death of his daughter and in recognising that I want to in passing also pay tribute to Fabiani who has of course long championed this issue I want to just advise members of where we've got to in this work I will be talking with the BMA shortly about all of this but so far we've got to a point where no junior doctor is required to work more than seven days in a row working seven nights in a row has been abolished and by August this year a minimum 46 hour rest period will be implemented and we are continuing to work with the expert group 28 hours working week with no averaging so we're taking steps in this direction because it is of course vitally important in terms of some of the issues that were also raised I need to make the point that I know the BMA and others have raised with the UK Government and that is about their recent changes to pensions and the impact that is having in terms of many of our medical workforce both consultants and GPs at the new Gorbo's health hub who was raising that precisely with me. This is a serious matter and we will continue to press the UK Government alongside colleagues in the BMA and others to look at this again because I am certain that there are unintended consequences here and I hope our colleagues in the Conservative benches will support us in doing that Can I make the point and thank Ms Lennon for raising yet again the point that she makes very often is quite right to do so and that is a point about culture and the importance of culture in our workforce why do people enjoy their work partly because it is recognised and valued partly because of how it is played but also because of the culture in which they work where they feel that ideas and concerns and issues that they have to raise are recognised and that there is no negative come back to them I will come back to this chamber after the Easter recess and report on the outcome of the independent start review with respect to NHS Highland and in that context I also want to bring members up to date on where we are on the national whistleblowing champion and on those board issues that Ms Lennon quite rightly laid and raised and I also make the point with respect to project lift which is a values based leadership programme across our health service important part of that which is trying to address some of the issues that you raised in terms of training and support as people take on additional responsibilities Ms Johnson of course made an absolutely important point and one that I will follow up on which is about the urgent need for communication on the changes that the GP contract will bring to the patients experience and now one year on we can use some positive examples we now have GPs able to offer at least 15 minute appointments and also patients feeling that they saw the right person for the concern or the medical issue that they had so I will pursue that she's also right to talk about the value of social care staff and the importance of that being a career that's one of the areas of work that we're busy on in terms of looking at how people continue to work in social care whilst building up some of the skill and education-based practical modules in order to pursue their career in social care of course that has to be done in partnership with our local authorities and also with the private and independent sector providers but all of them I believe are well supportive of the approach we need to work out how much more we can do not least making absolutely sure through local authorities for the real living wage for 24 hours care is actually used for that purpose and I am determined that we will do that let me turn to the point about is it a crisis, is it a challenge there are challenges that we face but my point is simply this calling it a crisis doesn't take us one step further forward in addressing some of the measures that we have to take it does not help our staff in social care workforce I am not dodging, no I can't I am not dodging the issues that we have to address I am not dodging the challenge and Mr Whittle I did not claim that Brexit was the sole reason for all of this but what I will not accept is Scottish Conservatives pretending that Brexit has got nothing to do with you and that it's not affecting our health and social care workforce I did not say that but what is not helpful is for members to choose to use this to score political points not do their research find out the facts about what we are doing and address this maturely I call Michelle Ballantyne to wind up Ms Ballantyne six minutes and I warn members I tend to move swiftly on to the next debate so we don't lose time Ms Ballantyne we call it our NHS those are the words we use because every one of us is touched by it at some points in our life last year the NHS celebrated its 70th birthday in the words of the Scotland's chief medical officer we are moving into an era of realistic medicine in NHS Scotland moving away from the current doctors knows best and culture to shared decision making with their patient and healthcare professional a change I welcome I think it's the right move but it is a change that will bring challenges to staff I spent 27 years working in the NHS first as a nurse and then in management and I can tell you that in 27 years we never stopped changing I doubt very much we'll ever stop changing the NHS but this does bring challenges now the cabinet secretary argues the word is it a challenge or is it a crisis well it's always a challenge but it becomes a crisis when the numbers start to escalate absences due to stress increased by nearly 20% over the course of the three years from 2015-16 to 2017-18 is that not a bit of a crisis one in four GP practices in Scotland has a vacancy is that not a bit of a crisis there are over 400 vacant consultant posts is that not a bit of a crisis and hospitals are short of 2,400 nurses and midwives at the last data I had is that not a bit of a crisis now they're all challenges they are all challenges and I will agree with that but I think we have to use our words carefully I totally agree with that but it is a crisis for the staff there it is a crisis every day when they come to work and there are shortages of staff on the wards it is a crisis for them when they feel they can't deliver the standards of patient care that they want to deliver it is a crisis for social care staff when they find themselves with four people on a rotor that requires 10 it is a crisis when the only applicants you can get for a social care job is somebody with no experience for a profoundly disabled person that is a crisis now I don't I'm not looking to undermine it like all the people here who talk about the NHS and the people who work there of course we all value everybody of course we acknowledge it this debate is not about undermining people it's about saying we need to acknowledge the issues that we face and we need to acknowledge them together now we can argue about the words but the reality will stay the same and actually the cabinet secretary described the problems that the NHS faces as well rehearsed but we do need to stop rehearsing them and we do need to come together to address them you listed the improvements you're taking forward and we welcome those I do, I acknowledge that a lot of them are good things that need to go forward but you also indicated that during it several times that you will listen and reflect I hope you will because recently when I've been talking to NHS staff what I'm finding is that senior professionals in the NHS are increasingly reluctant to speak out about their thoughts and experiences because when they do they are taken aside that is not the kind of atmosphere we need to work in people need to be free to write and talk constructively about what's going on around them and a number of members Monica Lennon, Alex Cole-Hamilton also raised this issue and asked you to bring forward your appointment of whistleblowing champions because this isn't just about people who are down in the NHS who are finding it difficult with the management structure this is also senior people who have things to say and don't feel able to say it so we must, must start to listen and work together on it Miles obviously Briggs talked in his opening about the impact that it has when health staff are stressed when they're tired when they're overworked and the tragic death example of the real horrific thing that can happen so I do welcome the changes you're bringing forward in terms of staffing change but it doesn't go far enough and we do need to keep looking at this Brian Whittle stressed the importance of making sure that those who look after our health have someone to look after theirs we need to ensure that all staff in the health profession and social care profession get regular clinical supervision and notice that that has started to slide they need to be able to talk about where their mental health is and how they are coping with the pressures they actually incur we need to ensure that our staff are fighting fit and able to pursue the work that they need to do and I understand why Emma Harper is denying that the SNP have anything to do with what is going on in the NHS staffing levels I remind her of what Miles Briggs pointed out that the Cabinet Secretary at the time, Nicola Sturgeon was warned when she made decisions about nursing places that it would have a longer term effect so I think it is slightly hypocritical to step away from it and say that the decisions made in the past have no impact on the present I don't think we should use it as a political football we should be perfectly honest as somebody who has spent a long time and you can cough all you like because that's exactly what you're doing when you do that as somebody who spent a lot of time in the NHS I would be quite happy if Government had nothing to do with the running of the NHS quite frankly that will never ever happen because of the money around it but it should be run by the people who know best don't I'm in my last seconds in fact I've got to sit down so I think we do need to focus on this that is a crisis denying it doesn't solve the problem we have to work together to solve it thank you very much that concludes that to be