 The next item of business is a statement by Shona Robison on delivering an enhanced trauma network for Scotland. The cabinet secretary will take questions at the end of her statement and so there should be no interventions or interruptions. I call on Shona Robison, 10 minutes please cabinet secretary. Thank you, Deputy Presiding Officer. I am pleased to be able to set out the next steps and the creation of an enhanced trauma network for Scotland. This builds on the excellent services that are already provided by NHS staff across the country and will lead to full implementation of four major trauma centres in Aberdeen, Dundee, Edinburgh and Glasgow. The dedication of our NHS staff in delivering trauma care is beyond question. Those plans will help to support them to achieve even more. That is why, through the new enhanced network, our trauma teams up and down the country will work together and with the Scottish Ambulance Service to make sure that patients facing life-threatening injuries receive the best care possible as quickly as possible. A trauma network provides clinical leadership throughout the entire patient journey, not just in a trauma centre. From trauma prevention right through to rehabilitation in the community, trauma centres sit at the heart of a trauma network providing multi-specialty care for severely injured patients. They provide consultant-level care and are fully equipped to provide definitive care for the most severely injured people with multiple serious and complex injuries to the head, chest and body. Uniquely, trauma centres provide a dedicated trauma service. A trauma service is a highly specialist team expert in major trauma care. It has a dedicated trauma ward, which is led by specialist trauma consultants supported by doctors, nurses, physiotherapists, occupational therapists and other health professionals on a 24-7 basis. The last vital component of any trauma network are existing hospitals called trauma units. They deal with the vast majority of trauma, those who are not as seriously injured as major trauma patients. A trauma network cannot succeed without all of those vital components in place. It should therefore come as no surprise that trauma networks require significant planning and investment in order to resource them appropriately and give seriously injured patients the best care possible. There has been a rigorous debate in the clinical community as to what the optimum model for Scotland would be. I am grateful to them and the chief medical officer for shaping the plans that we are now taking forward. In September 2013, the national planning forum's major trauma subgroup produced a report with a number of recommendations for the development of a major trauma network. They recommended that a trauma network should be developed and that, as a first step, it should be a four-centre model. However, they also recognised that there was no clear consensus among clinicians as to what the optimum number of centres was. In April 2014, my predecessor, Alex Neil, asked for the suggested four-centre model to be taken forward as a practical first step. However, in line with the 2013 national planning forum report, we knew that the findings of the geospatial evaluation of systems of trauma care or geos studies should be taken into account when considering future configurations of a trauma network in Scotland, including whether the number of major trauma centres can and should be reduced further from four major trauma centres and where the optimal locations might be. The fieldwork of the geos study was conducted in 2014 and the report was compiled thereafter. The geos study was noted on a number of occasions by the national planning forum major trauma oversight group as they took forward their work. In 2015, the geos study cast out on the four-centre model and, instead, suggested two trauma centres as the optimal configuration for Scotland. I had a choice whether to ignore the geos report, accept it or ask that further work was done to assess the relative benefits and risks of this alternative model. I judged that the report had to be fully considered to ensure that the right model for Scotland was being developed and to try to address clinical concerns. Clinicians and other NHS staff then worked tirelessly with the geos study group to assess the risks of having just two centres and, in the spring of last year, it became clear from that further work that those risks outwead the notional benefits. The views and concerns of clinicians and the Scottish Ambulance Service on a two-centre model were critical at this stage. As a result, I asked the chief medical officer to lead an implementation group that would look at how a new trauma network based around the original model of four major trauma centres in Aberdeen, Dundee, Edinburgh and Glasgow could be made to work in practice, taking cognisance of the lessons learned from the geos report, the concerns of the Scottish Ambulance Service and Scotland's unique geography. In June last year, the Scottish Government announced that we would have the necessary preparatory work for an enhanced four-centre trauma network completed by December 2016. A commitment that was repeated in our programme for government when we have now delivered that. As part of building a consensus around the model, the chief medical officer has visited clinicians across the country to get views on what the model should look like and how it could be made to work in practice. All of that has been done with expert advice, collaboration and support from our NHS throughout meeting the commitment that is set out in our programme for government. I would like to take the opportunity to thank the chief medical officer for her hard work and perseverance in taking forward the complex project. The chief medical officer's report, Saving Lives, Giving Life Back, sets out how we will deliver an agreed and unique network model of trauma care in Scotland, one that will enhance trauma services across Scotland and deliver improved outcomes for our most severely injured patients. There has been a great deal of good work done in parallel to developing the network model, complementary initiatives that can and will help to make the trauma network sustainable and simultaneously start us on the road to delivering enhanced trauma care. Early progress will include the Scottish Ambulance Service trauma desk will be expanded to operate 24-7 so that patients can be triaged appropriately and access definitive trauma care as quickly as possible. The trauma desk will be up and running by October. A triage tool that helps paramedics to quickly identify major trauma patients and tells them where they should be taken will be tested in the summer. The Scottish Ambulance Service will recruit additional staff with the aim of having staff in place by July. Vital trauma equipment for all Scottish Ambulance Service vehicles has already been procured and will be in universal use by the end of February of this year. We anticipate that Aberdeen and Dundee will take a shorter period of time to establish trauma centres over the next 12 to 18 months. That will be guided by the Scottish trauma network steering group and set out in a national phased implementation plan later this year. It is extremely important to note that the steering group's plans will not be developed in isolation. Clinicians from all regions, including Aberdeen and Dundee, have been fully involved in the development of the network model and will continue to be fully involved as the network develops. The new trauma network model and the way forward is now fully supported by healthcare professionals across Scotland and the Scottish Ambulance Service. They will continue to work with the new network's steering group and the trauma centres and hospitals in their area to deliver the changes needed. We are investing an extra £5 million in 2017-18 to accelerate those improvements. Over the lifetime of implementation, the anticipated cost of the new enhanced network and force centre model is approximately £30 million. The final cost will be informed by the development of the network's steering group's plans. That new network will not only benefit people with major trauma. 6,000 of Scotland's seriously injured patients each year, of whom around 1,100 will have major trauma injuries, will benefit. Once fully operational, we expect an additional 40 lives to be saved, but many more will go on to have an improved quality of life due to improved rehabilitation pathways. If members still have any doubt about the scale and complexity of what we are trying to achieve, I would urge them to speak to the doctors and NHS staff who have been involved in developing the network model. The 11 January marked an important day in changing trauma care in Scotland for the better. Through the network, we will provide world-class trauma care that will save more lives and help thousands more people to make a better recovery and get on with their everyday lives. I am confident that the right model has come out of all that work and that it will enhance our trauma services and save more lives every year. I am proud of the efforts of our NHS staff who have helped us to steer through this very complex and difficult process. I am very happy to take questions on that statement. The cabinet secretary will now take questions on the issues raised in her statement, and I will allow around 20 minutes for questions. A lot of people want to ask them, so please would all participants bear that in mind. It would be helpful if members who wish to ask a question were to press the request-to-speak buttons now, and I call on Donald Cameron. I thank the cabinet secretary for prior sight of her statement, but I find it strange that it had to take calls from Ruth Davidson at last week's FMQs to get her to come to this chamber to address this issue to Parliament. The fact that the First Minister went to the media instead of telling this Parliament is unacceptable. Will it always be the case that we have to apply pressure on the Government in these circumstances? Turning to the issue in hand, there has been, I am afraid, a complete failure of forward planning here, given that these vital trauma centres were supposed to be in place last year and are now subject to a three-year delay. That delay is intolerable because these are quite literally life-saving centres, whose very existence for those with severe injuries will often make all the difference between life and death, as the statement recognises. Given that the week ending 8 January 2017 revealed the worst NA figures since March 2015 and the Scottish Ambulance Service tells us that ambulances are struggling to attend life-threatening call-outs quickly enough, there is clearly serious pressure on the whole A&E and trauma system, so further delay to these trauma centres is just about the last thing the system needs. There is a distinct lack of clarity on another issue. The Scottish Government didn't know how much the new network was going to cost—not our words, but those of the Scottish Government who told SPICE last week—that the costs of the Scottish Trauma Network have yet to be determined. We have now learnt that the network could cost up to £30 million to establish, but we do not know what the running costs will be. With that in mind, and on the basis that the cabinet secretary states the necessary preparatory work is complete, presumably she is in the position to confirm what the expected yearly operating costs are for the service. Shona Robison I was very happy to come here and make a statement to the Parliament, and I am very happy to set out the detail of the complexity of that and to be able to share with Parliament some of the detail of why it was important to reach a consensus among clinicians that previously was not there. I would hope that members across the Parliament would agree with me that it was right to take the time to build that consensus rather than to push ahead with a model that did not have that clinical buy-in. I hope that members in the light of the detail information provided today will accept that. I do not accept Donald Cameron's criticism of a failure of forward planning. That was not an issue of a lack of forward planning. It was an issue of a lack of clinical consensus that had to be built, and the chief medical officer has done sterling work at doing that, the length and breadth of Scotland. The member refers to pressures within our A and E departments in the Scottish Ambulance Service. Winter always brings pressures, and what is important with the major trauma network is the additional layer of support that will be provided for those most injured patients—those with major trauma injuries, which we are talking about, around 0.2 per cent of all of the 6,000 who are injured. It is a very small number of people with major trauma that would ever go anywhere near our A and E departments. Most A and E departments see very few major trauma patients, so that new layer will help to support those patients who are the most injured with major trauma injuries. On the cost, £30 million has been on the public record for quite some time. I have said in relation to the network that £30 million should be taken as a guide for the network to work on, but the steering group will be doing further detailed work around the phasing of that £30 million. We have already announced £5 million for 2017-18, and I have outlined in my statement what those early priorities for that spend will be. I hope that that gives Donald Cameron some clarity. I thank the cabinet secretary for prior sight of the statement. This is the second time that the cabinet secretary has attempted to hide behind the First Minister, and he has been forced to this Parliament to explain her failures. She promised that the trauma network would be delivered by 2016. It is now delayed until 2020, at least, on its own figures—6,000 patients expected to benefit each year, meaning that up to 18,000 patients will be failed by the cabinet secretary. I listened with interest to the cabinet secretary saying with a straight face that I quote, We are interested in investing an extra £5 million in 2017-18 to accelerate those improvements. Only in Shona Robinsons world is a delay of three years an acceleration. One of the excuses that the cabinet secretary gave for the delay is that it was a debate between two or four trauma centres. We always knew that two of the trauma centres would be in Glasgow and Edinburgh, so can she tell us why those are not up and running already? In conclusion, the cabinet secretary likes to talk about England. The fact is that, under the cabinet secretary, those new major trauma centres will be delivered 10 years after the NHS in England. Will she take this opportunity to apologise? We give the opposition copies of the statement an hour in advance so that they can read the statement and then frame their questions based on the statement content. It is quite clear that Anna Sarwar has done neither of those things. If he had listened, or if he had read the statement and then listened to the statement, he would have seen quite clearly why it has taken time to reach a consensus among the clinical community of the right model for Scotland. I reiterate what I have said. It was very important that that consensus was built around the clinical community in order to have a sustainable major trauma network to benefit the people of Scotland. Anna Sarwar shows how ill-informed he is by saying just to paraphrase that 18,000 people will somehow not be missing out on good trauma care. How ill-informed that is, because if he had listened to the detail of that, he would have heard that 6,000 people a year who experience trauma in Scotland already get first-rate treatment and care for their injuries through our existing network of accident and emergency departments. What we are talking about here is the 1,100 people within that 6,000 who have major trauma injuries. If he had listened to the detail and read the statement, he would have seen that detail. What we are talking about is 1,100 people with major trauma injuries who will be treated within those new major trauma networks. They already get excellent care. What this is about is providing optimal care and importantly about rehabilitation. Perhaps if Anna Sarwar listened to anyone other than himself, he might learn something from us. We move to the open questions. I have Fulton MacGregor followed by Miles Briggs. I would like to take this opportunity to remind the chamber that I am the parliamentary liaison officer for the cabinet secretary. To ask the Scottish Government when the four trauma regions will have detailed implementation plans in place. I do not know what the Labour benches find so amusing about the development of a major trauma network that could save 40 lives a year. Perhaps they need to take the subject a little more seriously than they are. To Fulton MacGregor on his question about when the four trauma regions will have detailed implementation plans in place, we expect the four regional trauma networks and the Scottish Ambulance Service to have their regional implementation plans completed by October of this year. Those plans will inform the completion of a phased national implementation plan for the entire trauma network, which will be ready by the end of the year. As I said in my statement, Aberdeen and Dundear will be the trailblazers for the network. They are ahead of Glasgow and Edinburgh at this stage. It is quite right that we support them to get on with the establishment of the major trauma centres for Aberdeen and Glasgow, which will then be followed by Edinburgh and Glasgow in due course. Deputy Presiding Officer, will the cabinet secretary commit to publishing all the materials and documents, including details of ministerial discussions, around the decisions to support four trauma sites? How will the trauma site network form part of the workforce planning strategy? When will the Parliament receive information regarding that? Shona Robison I said to Miles Briggs that quite a lot of that information is already in the public domain. The Geo study, for example, is already in the public domain, so a lot of that material is already in the public domain. However, if there is other material that would be helpful to Miles Briggs and others, I will certainly look at his request. In terms of the workforce plan, of course, that will form part of the workforce plan, although it should be remembered, as I said in my statement, that this is about enhancing the existing trauma capability by adding the major trauma network layer on top of our trauma services that already exist. Part of that will be staffing resources to make sure that they have the adequate staffing, because it requires not just those working on the front line, but the staff behind them. I can confirm that that will be part of the workforce plan, which will bring it forward in the spring. Lewis MacDonald and Alex Cole-Hamilton I hope that the cabinet secretary, having no doubt spoken as I have to those involved in developing plans for a major trauma centre in Aberdeen, will understand their frustration that, even at this stage, the Government is not yet ready to go. However, I have read closely Catherine Calderwood's report that was published last week, and I listened closely to what she said. If, indeed, Aberdeen royal infirmary will be ready to provide a dedicated new trauma ward this year, if, indeed, a full-blown major trauma centre could be established at Forrester Hill within the next 12 to 18 months, what is holding up the deployments going forward? Is the issue, as Catherine Calderwood seems to say, that staffing is a constraint? Why will she not now put in place the regional trauma network for the north of Scotland that she has talked about? What is to prevent that happening now? I think that there would have been a great deal more frustration in Aberdeen in the north-east had we gone ahead with the two-centre model that came to my desk, which we had to give consideration to. The member says why. When a group of clinicians come and cast doubt on the sustainability of a clinical model that they are pursuing, it would be quite reckless not to listen to that clinical advice. What we then had to do was to try to build and rebuild a consensus around the four-centre model, which is what the chief medical officer has taken forward with the clinical community. We now have that, and that is very important if we are going to have a model that is sustainable. Of course, it is unique and bespoken to Scotland. It is not based on centres and networks elsewhere, but on major populations that take into account very much Scotland's unique geography. I have taken forward Aberdeen and Dundee. As I have said, the 12 to 18 months time frame is realistic for the two centres that are out of the stops most quickly. They are very keen to get up and running. The steering group will be setting out the work that needs to be taken over the next few months. As I laid out in my statement, an important component of that, before anything else happens, is the Scottish Ambulance Service having their 24-7 trauma desk and making sure that, as a triage service, it has its enhanced services in place. I would then want to see very quickly the detail of how Aberdeen and Dundee will be getting up and running, getting their trauma wards up and running, and getting the staffing in place. I am very happy to keep Lewis MacDonald informed of some of the detail of that as we take it forward. I am sure that the CMO will do likewise. Alex Cole-Hamilton, followed by Clare Haughey. I thank the cabinet secretary for an advanced copy of her statement. With increasing pressure on every aspect of primary and acute care, getting triage right will be absolutely essential. I welcome the improvements that are outlined in the statement to that end. When the last trauma survey was conducted in the 1990s, the injury severity scale was calibrated so that scores of 16 or more on that scale were classified as serious trauma. Despite advances in triage around head trauma, head injury of any magnitude is still always given an automatic score of 16. To prevent inundation of our new trauma centres from the automatic referral of head injury when a patient could receive exemplary and appropriate care in local hospitals, will the cabinet secretary commit to reviewing the injury severity scale in respect of head injury to take account advances in triage in that area, whilst not of course compromising on patient safety? I am happy to write to Alex Cole-Hamilton on the detail of his question, but we have to be very clear that the definition of major trauma is very specific. Those are the 1,100 cases in the 6,000 serious injuries that involve major trauma, including major head injuries and major trauma to the head. It is a very specific group of patients who require the services of major trauma teams. As I say, I am very happy to write to Alex Cole-Hamilton, but I hope that he will appreciate that we are talking about a very small number of people out of those who have serious injuries. To ask the Scottish Government how effective communications and the development of the new network will be delivered to both clinicians and the public. I say to Clare Haughey that the new Scottish Trauma Network steering group will work closely with clinicians and NHS staff from the four trauma regions to maintain effective communications to ensure that the national trauma network is implemented. The new Scottish Trauma Network website will also serve as an effective communications tool, which will help to keep clinicians and the public informed, and members of the Parliament informed as the network develops. The new Trauma website is available at traumacare.scot, and I hope that members might avail themselves of the information on that. Ross Thomson and then Ivan McKee. In her statement, the cabinet secretary stated that we are investing an extra 5 million in 2017-18 to accelerate those improvements. Of the 5 million fund to mitigate against the delay, can the cabinet secretary clarify how much of the fund will be allocated to the Aberdeen trauma centre and how much does she expect to be required to deliver the Aberdeen trauma centre on time? I laid out in my statement what the initial priorities are for that 5 million spend, including the development and enhancement of services in the Scottish Ambulance Service. I am sure that the member will appreciate that, without the Scottish Ambulance Service being able to triage through its 24-7 trauma desk, that is the glue in the rest of the network. We have asked the steering group to develop some of the more detailed costings that will include the development of Aberdeen and Dundee over the 12-18-month period, which goes beyond the 5 million, and that work will be on-going. The 12-18-month period of the straddle is two financial years, and I will want to make sure that, in planning for 2018-19, any additional costs of developing Aberdeen and Dundee are included within that. I am very happy to keep Ross Thomson informed as the detail of that work goes forward. Ivan McKee, followed by Jenny Marra. I thank the Cabinet Secretary for Advanced Sight of the Statement. Based on some of the questions that were asked already this afternoon, it is clear that some members have not read the CMO report and do not understand the concept of a trauma network. Can the Cabinet Secretary provide details of the additional services that will be provided by the major trauma centres over and above those that are already provided for in local emergency hospitals and how all those services combined with the Ambulance Service and the Scottish Trauma Network to improve patient outcomes through the trauma pathway? As I said in my statement, severely injured patients already receive excellent trauma care in Scotland. We should remember that that is not about people not getting trauma care at the moment that they already get trauma care. It is about optimising the trauma care for the most severely injured, those who are suffering major trauma. Uniquely, major trauma centres provide a specialist dedicated to trauma services, as I outlined in my statement involving a highly specialist team expert in major trauma care, with a dedicated trauma ward led by specialist trauma consultants, supported by doctors, nurses, physiotherapists, occupational therapists and other health professionals on a 24-7 basis. The trauma units in other hospitals will support the major trauma centres. They deal with the vast majority of trauma and will continue to do so to those who are not as seriously injured as major trauma patients. The trauma network will provide clinical leadership through the entire patient journey, not just in the trauma centre but from trauma prevention right through to rehabilitation in the community. Importantly, clinicians in the trauma centres will be able to support those colleagues in the trauma units and beyond when dealing with trauma cases and will help to develop and enhance the skill level of all those staff working together to ensure that the patient gets to the right place quickly and has the best outcomes possible. The chief medical officer has said that she anticipates Dundee to have its trauma ward operational this calendar year. The cabinet secretary this afternoon keeps saying 12 to 18 months in respect to Dundee and Aberdeen. Can she agree with Catherine Calderwood's expected timescale on the opening? Can she tell Parliament if there are any other factors other than funding and workforce that Catherine Calderwood outlines that will affect the timeline of the opening of these centres? As I set out in my statement, the first thing that has to happen is the enhancement of the Scottish Ambulance Service, because it is the triage organisation that will get the major trauma patient to the right place. We have to have that up and running first on a 24-7 basis through the trauma desk. That has to be the first thing that happens. I set out in the statement the timeline for doing that over the next few months. I, having met those who are leading the major trauma centre in Dundee, are trailblazers. They want to get on with delivering the centre in Dundee. They are very keen. They are getting on with the job. Some things have already changed and are already in place that were not there previously to enhance the patient experience within nine wells of patients who have suffered major trauma. Improvements have already been made, so, yes, I can confirm that. The issues of funding and workforce are in the main. That is about making sure that they have the equipment and that they have the skills available to them. Most of those skillsets are already there, but it will have to be enhanced in Dundee or looking at that at the moment in terms of what new staffing will be required to deliver the centre. However, I am very optimistic that it can be delivered within the CMO's timescale. The last of the questions, I am afraid. Stuart McMillan, very quickly, please. The statement indicates that the lifetime implementation cost will be approached with £30 million. However, can the cabinet secretary tell me how investment in the trauma network in future years will be determined? As I have said already today, the detail of the costings will be developed by the steering group. The £30 million figure is one that has been on the public record for quite some time, and I am happy to confirm that as a guideline budget. However, within that, the phasing of the spend over the next three years is going to be important in the detail of that, given that what we are talking about here is a network that is quite different from the original model envisaged, will have to be done. That detail work will be taken forward by the steering group. Again, I am very happy to keep Parliament updated on that.