 Y dyfodol o busnesau yn ymdau, o'r môl ym 7538 yn y ffordd Jacki Baley, o adreciaid y crisis yn y NHS a'r cyfnodol. Yn dweud y ddweud, rwy'n dweud i'r ddweud i'r dyfodol, i'n dweud i'r ddweud i werthu fynd i ymdau. Nid yw ydych chi'n ddweud i'r cyfnodol, rwy'n ddweud i'r cydymais iawn dw i. Straeth eich cydwyn oikepo bwrdd anghyddu ac nosgliadau yn mynd, ac Charlotte Bailey i ddim yn eu Hoff Y Cymru yn y mêw o mynd f fractions gweldiaethodau yn ffro Thorach. Inni'r cyf LET chei, yn y mae ddiolch o fyndiau'r séun am defnydd o hyd ynmyn ansluoedd. Mae hwn i amdright Illy, mae hwn a hyfod IS i neud mewn bryder o sydd ar gyferwith portfolio that we debate the NHS crisis. In government the SNP run away from accountability. Every day, lives are being put at rest due to the state of our health service. Every day, staff are being asked to perform miracles under increasingly difficult conditions, and every day the situation further deteriorates. Christmas, the number of Scots waiting more than 12 hours at A&E soared to its highest point on record, leaving almost 2,000 a week stranded in waiting rooms for more than half a day. One in seven Scots stuck on a waiting list. Crucial cancer treatment targets badly missed and performance keeps falling to new lows. Delayed discharge has spiralled out in control, resulting in more than 1,900 beds being occupied every single day by somebody ready to be discharged but waiting for a care package that simply does not exist. The list of failures goes on and on. Heroic NHS staff are exhausted and they are demoralised. It is right to thank them, but they do not simply want praise, they want action. The situation is so serious that Dr Ian Kennedy, the chair of BMA Scotland, has warned that there is no way that the NHS in Scotland can survive. In fact, many of my members are telling me that the NHS in Scotland has died already. That is a shocking observation from people who are on the front line. Our NHS has served the people of Scotland for decades. The very existence of the NHS is now in danger is beyond belief. For the last 15 years, the NHS in Scotland has been run by the SNP. It is entirely devolved. Cabinet Secretary, this is on your watch. In the 600 days that you have been in office, you have performed worse than your predecessors, and things have got worse, not better. You took some responsibility for those serious failings. I will take an intervention. I thank the member for giving way. I just wonder if she would accept that she is somewhat exaggerating. There are some parts of the NHS that are clearly struggling, but there are other parts of the NHS that are doing very well. Jackie Baill. I thank John Mason for his intervention, but he might like to note that I am quoting the words of Dr Ian Kennedy, the chair of BMA Scotland. He is not exaggerating. The SNP Government lacked the vision or the political will to save our NHS. Last week, anasawa and I hosted an emergency round table to listen to front-line NHS staff. We heard directly from them about the impact that this crisis is having. They told us in their words that this is causing them moral injury because they feel unsupported in their work. One front-line worker said that the conditions that they were working in meant no dignity, no respect, no safety for patients. They also told us that this crisis in our NHS is not because of Covid, it is not because of flu, it is not Strep A, it is not winter pressures, it is the result of 15 years of SNP failure. The staff on the front line knew best how to restore our NHS, how to save lives and modernise the system for the future, but this SNP Government is not interested in listening. The Government's amendment today says it all. Excuses after excuse is not our fault, no solutions, what a pitiful dereliction of duty. I wonder if she would listen to the head of the GP council here in Scotland in terms of the BMA's Scottish GP council. Dr Andrew Bewist said that I was not at all convinced by Keir Starmer his ideas behind reform. They seem very marginal and falling on from West Ruiting's naive comments on GP reform. I think that further work is required from Labour. Is not this a demonstration that on any subject, but particularly health, that Labour is completely out of ideas? Jackie Baillie or Scottish Labour? This is fascinating. The cabinet secretary is presiding over the collapse of the NHS in Scotland and what he wants to do is talk about the NHS in England—completely irresponsible, a complete dereliction of duty. Ms Baillie, can I ask you to resume your seat for a second? We are barely five minutes into this debate. We are already having accusations levelled through you and not through the chair, and we've got front benches and back benches yelling at each other while somebody's on their feet speaking. Could I please ask for a degree more decorum and respect in this debate as high as emotions will be running and conduct this debate in a respectful manner? Ms Baillie, I will give you that time back. The SNP turns its backs on Scotland's front line medics and nurses. We are listening to their concerns and their ideas for rebuilding the NHS. They tell us that the crisis in the NHS cannot be resolved until we tackle the crisis in Scotland's primary care and social care. Dr Andrew Buist has said that our primary care system is the foundation of the NHS in Scotland and desperately needs more, not less investment. I genuinely fear for practices already struggling to keep pace with spiralling demand. The consequences for the communities deprived of their GP services or having to cope with the brutally diminished service are severe. The SNP's response is cutting £5 million from GP budgets, cutting £65 million from primary care, presiding over a cut in the number of whole-time equivalent GPs. Numbers have gone down by 81 since 2017 at the same time as they promised more. That is a legacy of failure that is now driving up pressure and demand in the NHS, but that is not the only broken promise that is piling pressure on the NHS. Eight years ago, the SNP pledged to end the dangerous and costly practice of delayed discharge. They failed. Tackling delayed discharge is vital in supporting our NHS. As Dr Ian Kennedy said, the key to unlocking the front door of our hospitals lies at the back door. The exit block is the real reason for many of the issues at the front door of our hospitals. The SNP's failure to tackle delayed discharge is causing huge capacity issues for hospitals with potentially deadly results. It is not the fault of the people occupying the beds. It is a failure in social care due to a lack of investment over years. Until we see parity of esteem between health and social care, we will not end the problem. We need to support a system that values health and social care equally and is rooted in the community and is about funding prevention, not just crisis. That means support for voluntary sector activities that sustain people in their communities. The Government's approach to cutting their budgets is short-sighted and just plain wrong. Let me turn to social care staff. We have all in this chamber rehearsed the numbers about health vacancies, the exodus of staff from the NHS, 6,400 nurse vacancies, 14 per cent vacancy rate for consultants in some areas and too few GPs to cope with demand. Yet there is little said about the rising number of social care vacancies, the difficulty in recruiting and retaining staff. Of course, the Government does not bother to gather this data. If social care mattered, they would be counted. If social care mattered, they would pay the predominantly female staff a decent wage. Time and time again, Labour has called for decent pay for Scotland's care workers. In two successive budgets, we have called for £15 an hour. Start with £12 immediately, negotiate a path to the rest. Time and time again, the SNP Government has voted with the Tories against Labour's proposal and the Greens. The Greens who made promises about this in their manifesto have quietly dropped their promise, the price of their ministerial mondeos paid for by social care staff. The fact is that, while the SNP and the Greens pay lip service to our care workers, they are happy to see them paid less than supermarket staff. It is little wonder that we are now facing an exodus of staff. Earlier today, I welcomed the social care sector, care workers and family carers to the Parliament for a round-table discussion. They could not have been clearer about the change that is needed. We must not either forget the enormous debt that we owe to family carers. Family carers work day in and day out to care for their loved ones. By doing so, they are relieving pressure on the NHS and the social care system, but they are being failed too. Care packages, slashed, respite care, withdrawn, the SNP failure to implement key recommendations of the feely review, including the scrapping of non-residential care charges. That alone would make such a difference to the cost of living for those who rely on social care, but the SNP dither and delay. There is no doubt that our NHS and social care system is in disarray. Lives are being lost and the staff are exhausted. It does not get any more serious than this. No amount of shuffling the debt chairs will do to end this crisis, but the SNP could act now. Let's have a credible recovery plan. There is not just short-term sticking plasters, but a long-term approach that recognises the immense contribution of both primary and social care. To start, the Government needs to invest in primary care, reverse the plan cuts, put in place a credible workforce plan that will deliver more GPs and more staff. In terms of social care, scrap non-residential care charges, you could do that overnight, endally discharge and give social care workers a decent wage rise. The SNP's flagship national care service is in a great deal of trouble, lacking in vision, more about structures than changing culture and costing £1.3 billion, not a penny of which is going to go on providing direct care. Increasingly, being rejected by stakeholders, so let's pause the bill, use the money to fund care packages now and take the time to get this right. Both the NHS and social care are standing at the cliff edge of a catastrophe. The situation could not be more grave, but I do not believe that all hope is lost. Naib Evans, the founder of the NHS, said that the system would continue to exist as long as there are folk left with the faith to fight for it. Well, Presiding Officer, Scottish Labour are ready to fight for it. NHS staff are ready to fight for it. Millions of Scots who owe the NHS their lives are ready to fight for it. Scotland is ready to fight for it, but is this Government? If it is, it will back Labour's motion today and send a message to thousands of NHS staff that all is not lost. If it is, it will send a message as well that this Parliament is united across party lines in defence of our NHS, and it will also send a message to thousands of Scots on waiting lists who do not give up hope. I move the motion in my name. I now call on the cabinet secretary to speak to and move amendment 7538.2, cabinet secretary, around eight minutes please. Thank you very much, Presiding Officer. I welcome the chance to respond to the motion on the pressures that are facing the NHS and social care. Can I remind Jackie Baillie and Scottish Labour, of course, that the very first act of government business in 2023 was me standing in this very chamber to give an update on those NHS pressures? As I have outlined, I am happy to give way to Jackie Baillie. I believe not to be pedanting about it, it was a statement and it was something that the Opposition demanded that the cabinet secretary do. Can I say to Jackie Baillie that it was not that it was proactively offered by this Government? As I have already outlined in recent weeks and months including to this chamber last week in that statement by any objective measure, this is the most challenging period that the Scotland's NHS and I suspect NHS systems right across the UK have ever faced. We recognise these unprecedented pressures and, of course, we have put forward a series of actions announced in October last year in relation to helping our NHS and social care through this very challenging winter. As I say, Scotland is not alone. Those are challenges that are being faced not just across the UK but in health services right across the world. We have that perfect storm of pressures that we are encountering and that is impacting on our health and social care systems. However, one of those impacts that is noticeably lacking from this motion, is not a single mention in the labour motion of Covid-19, which is still exerting enormous pressure on our health service. It is not for the first time that Scottish Labour has brought a debate about pressures on the health service in this Parliament and failed to mention the word pandemic. To ignore the pandemic and the impacts of it is to ignore reality. I am all for debate on our NHS, but it is a debate—I will shortly—but it is a debate that must be grounded in reality. Our entire health and social care system is still facing the continued impact of the pandemic, the biggest challenge that our NHS has ever faced in its 74-year existence. Indeed, the most recent statistics on Covid showed that Covid cases are at their highest level since this summer. On the weekend, on 15 January, there were 1,100 patients in hospital with Covid-19, and we have doubled the number of patients since last November. The motion euphemistically refers to the global pandemic, which caused such loss, such suffering across the world, as—I quote the motion—a short-term problem. Covid is not and never will be a short-term problem. Try telling those who have lost a loved one to Covid this week or over the course of the last three years that Covid is a short-term problem. Try telling those who are suffering from long Covid that the pandemic is a short-term problem. To describe Covid as a short-term problem is an insult to every single person that has suffered and continues to suffer from Covid so badly as a result of this dreadful virus. If Labour had any decency, they would apologise for such an insensitive motion in front of Parliament today. Alex Cole-Hamilton Grateful to the cabinet secretary for giving away. He will be unsurprised by what I am about to say, because we have done this dance before. Of course, there has been a global pandemic. Nobody can deny the impact that that has had on our health service, but those problems were manifest in our health service and our social care service long before anybody had heard of Wuhan, China. In fact, the NHS chief executive retired Paul Gray said that it only hastened the date. The crisis was always coming down the tracks. As I say, you cannot airbrush the impacts of the pandemic that has had on our NHS. I want to pay tribute to the extraordinary efforts of our workforce across the entire NHS and social care systems. Our deep appreciation of our workforce is, of course, reflected in our commitment to have constructive industrial relations with the unions representing the workers in our services. I am pleased to say that, due to that approach, due to that meaningful dialogue and positive engagement that I have had and that we have had as a Government with the Third Union's, Scotland, of course, is the only part of the UK not experiencing strike action from health staff this winter in Conservative-controlled England and Labour-controlled Wales. The respective Governments have singularly failed to meaningfully engage with their workforces. As a result, we see nurses taking action. Regretfully, I do not doubt nurses taking action, strike action in England today and, indeed, tomorrow. I am happy to give way to Michael Marra. Cabinet secretary said to the senior clinician that said to me just last week, I am thinking of chucking it, to be honest. I actually do not know anyone who is not starting to think of chucking it. The NHS is finished. Does he agree with his backbenchers that these people are exaggerating? I speak to clinicians every day of the week. In fact, I spoke to Royal College of Emergency Medicine today and what I would say to that individual who spoke to me, Michael Marra, is that we will reward you appropriately. That is why we are offering the biggest pay-off or the single biggest pay-off or the record pay-off or one that hasn't been offered in Wales, hasn't been offered in England. We are going to make sure that they are rewarded and we will continue to invest in our workforce. What have we done about some of the incredible pressures that our NHS is facing? Of course, the Scottish Government's draft budget includes additional investment to increase the adult social care wage, and the creation of the national care service will provide a real opportunity for underpinning fair work in social care and delivering national sectoral bargaining for social care workers. However, be in no doubt whatsoever, we are not waiting for the national care service to come into fruition to make those improvements in social care. To address some of the demands in the system that we face currently—if you do not mind, I will make progress if I can because I have taken a few interventions. I also announced £8 million to procure an additional 300 interim care, but that is on top of the 600 that we are already using. Of course, I also announced further plans to recruit more staff, additional staff, to NHS 24, which is an incredible service, helping us to reduce some of that demand at the front door of acute science. Of course, as health secretary, I have retained the emergency powers and the ability to direct that are set out in the NHS Act 1978. I am well aware that a number of members have called for calling a national merger incident or putting the NHS back in emergency footing. However, I would say that the blanket pause of elective procedures would be the wrong thing to do and would have significant impacts on health service, but more crucially, on patients waiting. I believe that it is important that we allow NHS boards to make decisions that are necessary at a local level. Of course, I have provided guidance and will give support to NHS boards where possible. Our strategy is unapologetic. We will invest in social care to try to help with that exit block, which we know is causing such significant challenges in our busiest acute sites. We will also do our best to reduce demand at the front door. That is beginning to pay off. We can see that attendances at the front door of busy hospitals are lower than at pre-pandemic levels. People are, of course, coming in sicker with higher acuity. That is something that is coming across from clinicians on the front line day in, day out. However, if we deal with the front door and the exit block, I believe that we can make a difference and see that recovery. That is what our relentless focus is on. I will give way to Monica Lennon. To the cabinet secretary, it is good to hear about the work that is intended to improve the situation, but he knows as well as I do that in Lanarkshire we have had a code black situation for quite a long time now, hundreds of days, and we are not seeing that improvement. If we want to talk about wellbeing for patients, staff and safety, it is not fair work every day to come to your work and be working at the highest level of risk possible in the NHS. When will we see improvements in Lanarkshire on that information? Is there any chance that we are going to de-escalate from code black any time soon? We will see an improvement in Lanarkshire. I have spoken to the new chief executive, Jan Gardner. If Monica Lennon has not had the opportunity, I would urge her to do so. I have been very impressed by the idea that Jan Gardner has brought forward to try to make improvements in Lanarkshire, but I would certainly say to Monica Lennon that it is well worth her time speaking to the chief executive. I will end and conclude by saying that we still have some challenging times ahead in terms of our NHS. I have no doubt about that, but I remain confident that, with the combined efforts of an incredible workforce and the will of this Government, as outlined in the amendment that I am moving my name today, those challenges will be met and they will be overcome. I will end where I started, Presiding Officer, and that is to pay tribute to our brilliant NHS and social care staff. They provide exceptional care during the most challenging times. Can I offer them a promise that we will honour them, not just by our warm words, but indeed by our deeds? To speak to and move amendment 753.1 for in six minutes, Dr Wilhoney. Well, after that speech, it is clear that the cabinet secretary just doesn't get it. Under this health secretary, our NHS is on its knees, facing a perpetual winter, with waiting times for A&E and cancer treatment at their worst ever levels. This comes on the years of savage SNP Government funding cuts to council budgets. Let's not forget the plans for a national care service that would scrap local accountability and impose total ministerial control with the cabinet secretary driving the bus. Let's look at some of his key performance indicators for the past year. In November 2021, just 75% of patients were seen in A&E within four hours. Remember, the target is 95%. Let's fast forward 12 months, and the monthly figure drops to 67%, the worst month-on record. In November 2022, over 13,000 patients waited eight hours in an A&E department, twice as many as the previous November, while the number of patients waiting over half a day doubled to 5,000. The situation is so bad that, in January last year, a patient waited more than three and a half days to be seen in A&E, and through freedom of information requests, we have discovered long waits even to be triaged in our A&E departments. Now we have the major hospitals across Scotland that are so overwhelmed that they have paused non-urgent elective operations. NHS Scotland is fantastic because it is full of fantastic, hard-working, dedicated professionals. It is the cabinet secretary who is clearly underperforming, not providing an effective plan, but rather what can only be described as a flimsy recovery document. What do all those numbers actually mean? Let me put this into context for everyone here, for everyone at home, because these are real people. The cabinet secretary says that attendance is a down. I saw an elderly patient over the Christmas period who had significant central chest pain. Because of all the messaging going out around A&E and the concerns about long waits, she was too scared to go in and instead waited to see me the next morning and I had to blue light her in to hospital. This lady has been failed by the system and by this SNP Government. If the cabinet secretary would like further examples, I'm more than happy to provide them with children being unwell overnight with parents unable to get through to NHS 24, with patients having fallen, lying on the ground, waiting for help, with patients with injuries resorting to DIY measures, in the real world where I am seeing patients, people are suffering and in the winter time it could be something as simple as slipping on the ice, necessitating your need to be seen in hospital. That is a Scottish hospital, which is why deflecting is simply not good enough. But what about patients with time critical cancer referrals? Waiting time for cancer treatments are also the worst ever on record. In fact, it's been a decade since the SNP last met the target. Let's look closer at this health secretary's stats. In the third quarter of 2022, just 74% of patients started treatment within the official 62-day standard. We have shocking evidence of a patient who waited two years to start cancer treatment and also a six-month wait for breast cancer treatment, seven-month wait for bowel cancer and over a 16-month wait for prostatic cancer. It's just cancer. Now, what about children and mental health? The SNP have never met their target. Never. We know teenagers in Scotland referred to child and adolescent mental health services with eating disorders. Suspected ADHD or autism are being told to expect a two-year wait for a cancer appointment. Patients are being advised if they have savings to go private at a cost of around £1,500. In August 2021, the cabinet secretary committed to clearing waiting lists and both mental health and psychological therapies by March 23, with over 8,000 people waiting. This is unlikely. I'm afraid I have no time. Scots either have to sit back. I was very clear. I think you should maybe listen. Scots either have to sit back, shut up and wait or dig deep and go private to get basic health care, relive their pain or allow them to function again. I've been very clear three times. Indeed, the member has made it clear that he's not taking any interventions. Dr Gohani? I think we should just allow Dr Gohani to resume his remarks. Thank you. The SNP and its cabinet secretary will blame Covid, strepe or the flu for pressures on the NHS today, but the underlying problems facing Scotland's NHS are long in the making, long before Covid, but during the SNP's period in government, failed workforce planning, cutting the number of student nurse places, failure to solve delayed discharge from hospitals as promised in 2014. That all predates the pandemic, and we've been pressing the cabinet secretary month in, month out to plan and prepare for this winter. As he knows only too well, nursing vacancies are up 10 per cent this year. There are now 6,319 nursing vacancies in NHS Scotland. Also in the year to March 22, over 7,000 nurses left the NHS. One in nine nurses, the highest number of leavers on record, delayed discharge is at a record high. Don't get me started on primary care, where a BMA survey found 81 per cent of practices say patient demand exceeds capacity. We're seeing practices collapse, GPs cutting out or even leaving the profession due to workload pressures and burning out, with patients struggling to get the care they need. And we have a cabinet secretary who is leading the charge of a £1.6 billion national care service, where stakeholders fear hyper-bureaucracy, poorer service in remote areas and poor... Dr Kelly, you're over your time, could I ask you to conclude please? It would be great if I wasn't interrupted so much. We'd like to see the Scottish Government introduce the kinds of steps we have recommended. Scotland's NHS in the peril of state, I declare my interests as a practicing NHS doctor and I move the motion in my name. Thank you, Dr Glehani. I now call on Alex Cole-Hamilton up to six minutes, please. Thank you very much indeed, Deputy Presiding Officer. I'm very grateful to Jackie Baillie and the Labour Party for making their Opposition Day all about this crisis in our NHS. I rise to speak on that basis for the Liberal Democrats. It's hard to remember, Deputy Presiding Officer, a time when things were this hard and our NHS was engulfed in such a crisis. Indeed, every new set of health statistics reveals yet another unwelcome record. We have heard so much of that today. It is exhausting to put it plainly. Things have never been this bad. Not a day goes by when I don't receive an email, a phone call, a visit to my constituency office from someone who has been waiting months for a routine operation, weeks for an important diagnosis, days just to speak to somebody in their local GP surgery. Every day, we hear more alarming reports from the front line and of Scotland's A&E departments. The huge impact on patients cannot and will not be overstated. We've heard from the Royal College of Emergency Medicine how the dysfunction in our NHS is measured out in human lives. It results in more than 40 preventable deaths each week. Perhaps we should just stop for a moment and consider that number. Every one of those is a husband, a wife, a brother, a sister, a son or a daughter that could have, should have, would have come home but for the crisis in emergency care. Just yesterday, I heard the heartbreaking story of an elderly patient forced to spend her final days on a trolley in the middle of a busy A&E department. Those are accounts that are becoming sadly familiar, but we cannot afford to become accustomed to them or desensitised to what is daily unfolding in Scotland's NHS. The stakes are just too high, and people's lives are literally on the line. Neither can we afford to accept the toll on our staff. They are on their knees. I saw it just this week when I visited a medical practice in my constituency. They are a popular medical practice in a bustling part of our nation's capital, but they have had an open vacancy for a partner for a year. They cannot hope to fill a locum vacancy when somebody needs to go on leave. Doctors have spoken movingly about what they describe as the moral injury that they are suffering, of being unable to provide the care that they want to and that their patients desperately need. I know we in this chamber speaking one voice and saying that none of this is their fault. On the contrary, we owe them a huge thanks for the incredible efforts that they go to and the fact that so many are sticking with it. We are blessed to have them and they deserve so much better. I would like to turn to the crisis engulfing mental health care in Scotland. Children and young people in Scotland are still facing devastatingly long waits for treatment. LiveDem Research has revealed that since mid-2019, the Government's 18-week treatment time guarantee or target has been breached by a cumulative 2.7 million days. The Government says that it will clear the dreadful waiting lists by March, but they are getting worse by the day. The chances of them achieving that goal are, frankly, vanishingly small. I thank the member for giving way. I absolutely do not deny the pressures on mental health. In recent correspondence I had with NHS Greater Glasgow and Clyde, which is put on the record, that they are now on schedule to clear their CAMHS backlog by March this year. There is some really good work, some achievements being secured in the NHS, but I do not deny the existing pressures that are there that should welcome the successes where they are existent and evident. I salute the efforts of health boards who might be achieving that target, but they are not universally happening in that way. I hope very much that we will. It is a target that I certainly want the Government to succeed in, but manifestly, from the correspondence that I receive in Lothian, we are nowhere in near clearing down those waiting times by March. The Government says that it will clear those targets by March, but they are getting worse every day. It is vulnerable young people who are paying the price. In previous budget negotiations, my party secured £120 million extra for mental health, but the SNP and Greens have just cut it again by a staggering £38 million. Young people are suffering under the long shadow of lockdown. Any specialist in the country will tell you that. Any schoolteacher in the country will tell you that. They cannot have picked a worse time to cut that funding. Liberal Democrats led the way in getting this Parliament to declare a national mental health emergency. Now, this Government needs to step back and give that declaration the proper funding that it deserves. In the face of multiple crises, it is natural to wish that someone somewhere in a position of power might be working with every breath in their body to make things better. That is what the Scottish people expected of this place and what they hoped for. Sadly, they are faced with an SNP Government, led by a First Minister who spent her weekend scheming about how best to break up the United Kingdom. My First Minister is more interested in which election to make about her pet project rather than making sure that NHS staff are treated fairly and patient seen on time. Let's get real. One in six people who could not get a doctor's appointment last year conducted a medical procedure on themselves or got someone equally unqualified to do it. The waiting times for primary care are so bad that it made sense for a Ukrainian refugee to travel home to face the bombs and the bullets of her home country than the cues of our Scottish NHS. That is the grim reality in Scotland in 2023 under the health secretary, under this First Minister and this SNP green administration. No amount of plotting or scheming or wishing for a future nationalist utopia can hide that fact. The cabinet secretary accuses others of being out of ideas. If he is open to them, let me offer some. Activate an immediate staff burnout prevention plan that guarantees better play and time off when people need it, as well as safe staffing levels. Replace the meaningless treatment time guarantee with real-time information for waits and operations. Reform the funding structure so that dentists can return to taking on NHS patients. Put more councillors in schools and establish a single point of contact for those on-cams waiting lists. Stop the ministerial takeover of social care and invest the billion pounds that you will spend on it on services and staff. Call of Staff Assembly that puts the expertise of front-line staff at the heart of solving the emergency. It is an emergency. Get to work, cabinet secretary. We will now move to the open debate. Speeches of up to six minutes. I call Paul Sweeney to be followed by Julian Martin. I rise to support the Labour motion because the crisis facing our national health service impacts on every one of our constituents. As we have seen in recent weeks and months, its continued decline is not only a matter of grave concern but a matter of deep regret. The national health service is Labour's greatest ever achievement. I can assure everyone in Scotland that defending it against cuts, neglect and continued decline will always be a priority for this party. Let's look at that continued decline. As has already been outlined very eloquently by my friend the member for Dumbarton, since the cabinet secretary has been in post, we have seen Scotland's national health service experience the worst A&E waiting times on record, the highest ever number of patients languishing on NHS waiting lists, the worst performance against cancer waiting time targets, the largest increase in levels of delayed discharge and the most vacancies ever recorded in the NHS workforce. That can only be described as a litany of failures, a litany of failures that has devastating human consequences for the people we are here to represent in this place and a litany of failures that, frankly, should see this cabinet secretary resign. I reference the human consequences. I am happy to give way. I am going to ask the same question that I was going to ask Dr Colhaney, who would not take me. A lot of GPs and clinicians at senior levels said that the current situation with our pensions is a problem when it means to retire early. Would possibly be supportive of moves to get the same pensions situation that high court judges get given by the UK Government to stop the drain? I recognise the point made by the member and I think that that is very important. I actually raised that while there was a member in the House of Commons repeatedly with the Treasury and HMRC to try to address this. It is a cross-party effort, and I recognise that. However, it is not the single factor driving vacancies in the national health service. Many things that this cabinet secretary and his team can be doing to mitigate and to solve these problems within our NHS workforce. In particular, we are seeing young doctors in medics going to Australia in huge numbers, and that is not because of pensions. I can say that this, Deputy Presiding Officer, is a human consequence of those failures, because it is incredibly important to reference that. Statistics are released on a regular basis, and I fear that at times it is forgotten that behind every one of those statistics is a human being, often in tragic circumstances. I cannot be alone in this chamber in reflecting on the fact that my inbox is regularly inundated by constituents detailing their harrowing experiences when they call on our NHS services. I want to be clear that, by detailing those experiences, neither I nor those constituents are being critical of the staff who work on the front line day and night to keep our NHS afloat, despite the incompetence of Government policy. The content of those emails and correspondence range hugely, but one thing that binds every one of them together is that they paint a picture of a healthcare system that is crumbling and failing patients. In November, I was contacted by an ambulance driver who told me that when he started his shift that morning at 7am, his first patient had been waiting on an ambulance since midnight. He went on to detail horrendous cases, like that of a toddler, with complex medical needs who was having recurring seizures and had waited for over five hours on an ambulance. When the crew arrived, the patient's oxygen levels were so low that the condition was deemed to be life-threatening. In October, I was approached by a constituent when on a constituency visit. That constituent told me a harrowing story about his father who had suffered a stroke. Because of the delay in getting to A&E on time because of ambulance shortages, he has been left permanently disabled. When the family asked the cardiologist how severe his stroke had been, they were informed that if their relative had got them in a car and brought them up to A&E instead of waiting on the ambulance within the appropriate time frame, they would have been left without any permanent complications. Imagine the guilt, the tragedy of that and then the lifelong complexity and burden. Just last week, I was contacted by a constituent whose mother-in-law was immediately fit to be released from hospital into a care setting in October. She was released on Friday 13 January and was charged £430 for the privilege of an ambulance to transfer from the hospital from one health board to another. I could go on all day about the cases that have been brought to my office, showing the state our NHS is in. In every single winter, we go through a crisis worse than that which came before. Every winter, we hear details of harrowing and devastating tragedies that could have been avoided. In every winter, this Government comes to the chamber parroting excuse after excuse. It is not good enough, Deputy Presiding Officer, and as much as I respect the cabinet secretary, I think that on this occasion he is in over his head on this. We have a workforce that are the best in the world, but they are exhausted and demoralised beyond precedent. The Labour Party has continually called for and argued for an integrated health and social care system for an increase in pay for social care workers to £15 an hour and for a fully funded sustainable workforce plan to be the backbone of this Government's plans moving forward. To date, we have been ignored, accused of scaremongering and, worst of all, accused of talking down the very national health service that the party created. Each of those accusations is not only a grotesque mischaracterisation of our position, but a slap in the face to those of us who want nothing more than to see a national health service fit for the 21st century, a national health service that patients can rely on, and a national health service that values and cherishes its workforce. Based on the current trajectory under this Government, it is unlikely that we will see any of those anytime soon. I now call Gillian Martin to be followed by Sue Webber. Every country in the UK has a health service that is under a great deal of pressure at the moment, and it is almost my hope that we come to the chamber, open-minded to policy interventions that we can make based on the advice of the professionals who know what they are talking about, and in the budget that we have available to us. We have also got to take into account what patients need from our NHS and, with their expectations in mind, what level of tax they are prepared to pay so that Governments can meet those expectations. I think that that aspect of things can be often ignored. Warm words are bound from politicians about our precious NHS, but how often do we really admit that to maintain this magnificent thing that Scottish and wider UK citizens enjoy the benefits of, we must collectively dig deeper into our pockets in terms of tax? This is the UK conundrum. UK politicians in competition to be the next Government simultaneously do not want to upset the upper and upper middle classes. The powerful right-wing press, the king makers, as we know they are, by taxing the better off, but they want to maintain a facade of cherishing the NHS, even when their actions in Government contradict that. Yet, in Scotland, people voted for the SNP and the reforms that we outlined in our manifesto and the approach to public spend on health and tax, albeit with the limited powers that we have in that regard. In my view, the full suite of tax and borrowing powers would give the Scottish Government of whichever stripe the means to protect the NHS long-term that we want, especially in the face of the erosion of national health service from subsequent UK Conservative Governments, and, I am sorry to say, Labour health secretary in waiting, Wes Streeting, of whom Diana Abbott said, I will finish this point, of whom Diana Abbott said, inch by inch, Wes is trying to push for a privatised, insurance-based NHS. To the Labour motion in front of us, I remain astonished that Opposition parties are not compelled to produce detailed budget plans for scrutiny. As it stands, the public cannot take the Opposition proclamations and demand at their word. How might Scottish Labour's demand for the pay for carers be funded? We do not know. Which other public sector would they take? I would like to hear the answer. Jackie Baillie, thank you very much. I am grateful to the member. We have outlined over two successive budgets how we would pay for this, but can I point to her the £1.3 billion that you are about to spend on a national care service that nobody believes in? You could use that to fund social care pay. I have heard of back-of-enveloped stuff. I cannot see the envelope in Jackie Baillie's desk. There we go. Which other public sector would they take money from to put more into the NHS? Again, we do not know, and the Conservatives get up in this chamber every week and complain about services that are delivered by the Scottish NHS. We wanted the Scottish Government to replicate the tax cuts for the richest to the least trust put forward. How would we have maintained the current record spending that the SNP has put into the Scottish NHS if we had done that? The simple answer is that we could not have. In particular, we know that we love it when we compare the Scottish NHS with the service that is run by them south of the border. However, it is not just me pointing it out. In a good morning interview in Good Morning Scotland, Sandesh Calhanna was pressed that if he was calling for the head of my friend and colleague, Humza Yousaf, for long waits on A&E, he should surely condemn his Conservative counterpart in England, where those waits are longer, the situation for our precarious in terms of patients being left without care, and the investment in the NHS there has been stripped out by his colleagues. Let's not forget that the nurses are in strike today as well. I have massive sympathy for anyone with responsibility for the NHS, wherever they are in the UK. We still have Covid, causing staff absences and increased admissions. As we are warned by our health boards, recruitment is suffering because of Brexit. We need better workforce planning, including targeted immigration, action and pensions—I mentioned intervention to Paul Sweeney. I also have a smidge of sympathy for Scottish Labour, who have been done no favours by their leadership when it comes to health over the past couple of weeks. They must have been horrified when Labour leader Keir Starmer played amateur doctor on television on Sunday. Similarly, they must have been hiding behind the couch when West Streeting— Hello, could you sit for a second? Could we have less chat from across the front benches, please? Because it's interrupting our ability to hear Ms Martin. Ms Martin, please resume. Thank you very much, Presiding Officer. Similarly, they must have been hiding behind the couch when West Streeting went to war with GPs, prompting the UKBMA chair, Dr Philip Banfield, to say that Mr Streeting does not understand general practice and the Labour Party has a lot to do now, between now and the election. The Scottish NHS is under the same pressures, but, my goodness, our cabinet secretary is working with the sector, negotiating to avoid such action, providing extra care beds to ease the current pressures, and listening to the professionals. Finally, there is one thing that we across the chamber and across the health and care sector are united on. That is that a great deal of the issues in the A&E and the wards have been caused by poor patient flow through and out of hospital. The social care system in its current state needs reform. The Scottish Government is working now to secure more places and care settings for those ready to leave hospital, but there is radical structural reform needed in the form of a national care service, one that has the support of unison, I may add, and of a lot of service users that we have spoken to in our deliberations. It is a chance for us all to come together. The member is just about to compete and how we achieve that service and eradicate the major cause of the issue that is before us. Let us work together to shape this national care service and make it our whole Parliament's defining achievement of the sixth session. Thank you, Ms Martin. I now call Sue Weber to be followed by Christine Grahame. Thank you, Presiding Officer. Our NHS is on its knees, with waiting times for A&E and cancer treatment at their worst ever levels. Yet more parliamentary time was set aside to discuss independence last week than our failing health service. As Jackie Baillie has already stated, it is only in opposition to the debate time that we get to chat and discuss the issues in detail. Today, with 1 in 7 languishing on waiting lists, I want to focus on waiting times. The real-time impact of pausing and restarting elective surgery is that we never really know the accuracy of median waiting times. All patients are asking for is clear and accurate data on approximate weights. Public health data, as it is presented, presents average weights as 19 weeks. However, that data uses the average median and does not count urgent cases. As Dr Gohani has mentioned, some health boards are not doing any elective surgeries, so it is impossible to deliver a four-week weight. We have angry, distressed patients when they are dealing with moving medical goalposts. When patients have this unrealistic ideal of their waiting times, they have increased contacts with their GPs through the phone services, more calls to the hospital secretaries, wondering where they are in the waiting times. All of that adds to the daily pressures that our front-line staff are facing. Lauren Benney, head of Scotland at versus arthritis, said, people need clear and regular communication but when they can expect to receive surgery. What information and support is available while waiting? Many fear being forgotten or fear abandoned to manage their pain alone. I am very grateful to Sue Webber for taking my intervention and I think that she is outlining very eloquently the reality that many of us will face with our constituents. Those people who are given letters tell me that their treatment will be begun in 12 weeks when there is no hope in how they will be seen within 50. People make life plans on those letters. They agree to attend weddings overseas, so they put off holidays in the hope that they will be seen. We need to make sure that their patients are seen in real time. Does she agree? Yes, I do. Alex Cole-Hamilton, I am sure. The difference between a 33-week weight and a 19-week weight can be devastating for people, as you have just outlined, especially those with arthritis, whose physical and mental health are worsening by the day. Those are still quotes from Lauren Benny. Slowly eroding their independence, Edinburgh University researchers found that people's quality of life significantly deteriorates after each six-month period of waiting. People waiting with arthritis for hip and knee replacements are living with severe pain, struggling to move around and are often unable to work. In terms of healthcare economics, those operations are some of the most effective treatment offered by the NHS. It is unacceptable that people are facing long waits or financial instability to access them. We are increasingly hearing from people who feel that they have no choice, but to use savings or borrow to pay for surgery privately, and especially devastation in financial hits when we are living costs are soaring. Before I get any interventions on this, yes indeed, this does risk widening health and qualities further, and this has to change. Remember, pain is crippling and it is debilitating. People have little or no confidence in taking practical steps themselves to reduce the impact of their pain on their daily lives. Reliance on pain medication is very high, although a lot of self-management resources have been suspended due to the pandemic. The medication options themselves, from prescription to over-the-counter, all take a toll too, from fatigue to nausea and, dare I say, constipation. They too impact on your ability to work and your ability to have a normal life. We are calling on the SNP Government to introduce a pre-hab for those who are waiting treatments so that people can live well while they are waiting. Reliance on pain medication is so high, and it is impacting the quality of so many people's lives. The Cabinet Secretary told us that we would all be well when he brandished his NHS recovery plan in August 2021, and then again, everything was under control when presenting the winter resilience plan in October. Now he has been forced to concede that everything is far from well, yet rather than working collaboratively with other politicians who have plenty to offer in what is undoubtedly a national emergency. On Tuesday, last week, Mr Yousaf was utterly dismissive of the Conservative NHS plan, produced by someone who knows what they are talking about. The Scottish Conservatives 14-point plan includes streamlined specialists, supersaturies, the expansion of same-day operations and more off-peak scanning. My colleague Dr Gohani is a practising doctor and a former orthopedic registrar. He spent the holiday, as he said, touring practices to get a genuine feel of what was happening across the country, and I have spent over 25 years working with healthcare providers across Scotland, England and Northern Ireland. I remember that the SNP has spent years hollowing out our local councils with savage cuts on the horizon. Their plans for a national care service would scrap local accountability and impose total ministerial control. Last week, in the statement, Mr Yousaf— The member is concluding shortly, thank you. It is right for local health boards to retain decision making at a local level so that they can determine how best to fix their services. Perhaps the Government should heed its own advice when it looks to waste £1.7 billion ripping social care from local authorities. First, let me put on record my gratitude to all who work across our NHS and care sector in whatever capacity. I will address the Labour motion. It would have had more heft if it had at least mentioned, if only in passing, the devastating impact of Covid and, indeed, the years to follow when the NHS throughout the UK and healthcare throughout Europe and the wider world was dealing with a raging pandemic, adapting procedures in the face of this virus, which brought what I might term the usual provision of healthcare to a standstill. It does not recognise that it will take years for recovery. To this day, sanitation is high, mass protection continues, ambulances have to be sanitised after every patient. All of that adds to delays and Covid still stocks hospital corridors. Add to that the pressures of influenza are not mentioned by Labour, which itself can be very serious and possibly is proving more so despite vaccination to some groups, including myself, falling on us perhaps having reduced resistance after years of masks and hand sanitisation. Then there is the welcome but extra pressure of the demographic shift, again going unsaid in the Labour motion as we all live longer, a good thing, but with age it naturally brings additional demands on our health services and, indeed, our care sector. Wherever you look across the UK, the issues remain the same. Indeed, worse in Wales where Labour is in government and in England are the Conservatives. I do not say this with any slight degree of satisfaction, not the least, but simply to put this debate here into context. Another context. In my 24 years and years during the Labour-Liberal-Democrat Coalition into date, much of the attention has been on firefighting the increased demands on the NHS. Some good progress was made and I welcomed free personal care under the Labour-Liberal-Democrats and, of course, free prescriptions, free school meals to P1 to P5 and the child payment. Those are all interventions under the SNP Government, which are aimed at reducing NHS pressures. In England, it is over £9 per out and prescribed. Some are therefore south of the border, rationing themselves to medication to the endangerment of their lives, let alone their health. The problem is, as it always has been, how to move from the immediate demands exacerbated as I have narrated to a medium to a long-term solution. I therefore welcome the BMA's suggestion and I quote, "...BNA Scotland is calling for a national conversation with all stakeholders to take a long-term approach to what we want and expect from our NHS. Only when we fully understand what we need and want from the NHS can proper consideration be given on how we resource it. The national conversation, commissioned by but independent of the Scottish Government, would act as a facilitator for a dialogue between the public health and care sectors, Scottish Government and political parties. Its purpose is to inform the reform and it must have practical outcomes. Now is the time to seriously consider what the NHS provides within the resources that we provide it with and ask difficult questions around what we as a society want from a national health service free at the point of need, what we can afford to deliver and how we deliver it. There are no easy answers, I agree. Covid was a wake-up call for all of us from the growing needs of care at home or in care homes, the varying standard of that care, integrating health and social care, standardisation of care provision, recruitment and retention, the expanding use of pharmacies and allied health professional services, so that the right treatment is provided at the right time by the right health professional. That, as the BMSA states, is not easy. I will, yes. I thank the member for giving way on that point. Would the member agree with me that whilst care is absolutely critical, resourcing it is also essential and the disproportionate cuts imposed by this Government on local government has only exacerbated the delayed discharge problem. I am coming to resourcing. For example, in this thoughtful discussion, let's consider what the role is of health boards. What should the relationship be between GP practices and the health board area? Should more GPs be directly employed by the NHS rather than in private practice? How much more can technology be used? Becair sector, what should the state provide? What kind of workforce do we need? Where do we get it? With Brexit, some options are closed. What will be required as our ageing population increases and how do we, as a society, afford expensive treatments and drugs? What price do we put on all this and how do we fund it? I conclude with this, and this is the only party political thing that I will say. As a result of the disastrous and costly funding of public buildings, such as NHS buildings using PFI—private finance initiative under Labour—the cost each year to the Scottish Government in repayments to the private sector on NHS buildings alone runs at £250 million a year, which could have been better spent on services. Of course, it is the job of Opposition to all Government to account, but too often that is with press headlines in mind. Opposition must offer solutions and, most importantly, credible funding sources on what is virtually a fixed budget, now reduced in value by £1.4 billion due to inflation. So please, chamber, less heat, more light please, turn down the volume on theatrical rhetoric, turn up thoughtful and responsible debate. That is what the Scottish public wants. Our NHS is in crisis, and we urgently need the NHS recovery plan, as Jackie Baillie has said. I want to pick up this point about Covid. Yes, Covid has massively impacted right across public life, including the NHS, but we cannot pretend that the problems in our NHS are not long-term and deep-seated. I forgive you and Lothian that, up until the first lockdown, the Scottish Government's target of 95 per cent of patients to be admitted, discharged or transferred for any treatment within four hours from arrival, was last met in October 2017. That is an on-going challenge, and we need to make sure that we look at the issue of staff investment in doctors and nurses, and critically scare staff, who will not be attracted to a profession where the salary is lower, not just than many other jobs, but it is significantly more stressful. It can often require people paying their own travel costs to support clients, and it means that people do not have the career development opportunities that we should be giving carers. That is why we need the national terms, conditions and decent career opportunities that Jackie Baillie talked about, not a bureaucratic, centralising organisation that will strip yet more investment from our cash-drap local authorities, who are on the front line trying to provide care for our communities. When we look at NHS staff, we need to focus not just on this year's pain negotiations, but that is critical to make sure that they get a decent reward for their work. We also need to ask what more can be done to support staff retention, because the pressures on the NHS in terms of understaffing and the stress that many staff are facing need to be addressed and the eye-watering long-times that people have to wait for treatment are not just affecting members right across the public. They are also affecting NHS staff, too, who cannot continue working for the NHS because they are waiting for an NHS operation or a treatment. When I recently met NHS Lothian staff members, it was heartbreaking to hear about their own personal situations and pick up the anger about the use of agency staff when they would rather have full-time permanent NHS staff doing those works. We have key issues that need to be challenged. I want to say that the long-standing backlog of challenge in NHS Lothian, a lot of our problems are due to systemic underfunding. NRAC has not been delivering sufficient investment for years. In the Lothians, we have a growing population, and we will continue to see more people needing support in the future. Our projected net population growth is 84 per cent of Scotland's projected net growth. 84 per cent—we need a discussion about that now, because we will get more younger people, but we are already getting an ageing society, as Christine Grahame just mentioned. NHS Lothian needs that support now, because, as I understand it, from the helpful griefings that we get from the staff who are running those services, our services in Lothian are already at capacity. That is before that population increase. We urgently need investment in staff to keep the services going, but we also need new buildings, particularly the new eye pavilion, but there are other key investments that we need. That needs to be factored into an NHS recovery plan to create the investment, to tackle the projections that we have going forward, and to make sure that we provide services now and we have confidence for the future. A particular issue that Jackie Baillie rightly finished on is the need to focus on preventative care, because our GPs and access to community healthcare services are critical. Last year, we saw our GPs seeing significant cuts from the Scottish Government, and that does not help. In Lothian, we do not just need capacity increased in our hospitals, we need to challenge the fact that we do not have capacity in our communities as well. Day after day, I get people phoning my office. They struggle to get access to GP appointments with lengthy phone waits. They have to phone day after day, because there simply are not enough appointments available. That means that underlying health problems go untreated, and that is a disaster for people personally. Potentially, dangerous symptoms do not get picked up. For example, in relation to cancer, they do not get treated, and swift treatment, as we know, with the fantastic services that we have in NHS, can save people's lives and give them different outcomes. That is why people are going to A and E, because they are desperate to get the help when they need it. When they are experiencing pain day after day and they have waited weeks to get access to support, we need more information. Last week's briefing on survival cancers was very impactful to make sure that people get access to their GPs. They are critical, and then we can get access to operations and the treatment that people urgently need. However, I want to ask in the summing up—I would like to hear from the cabinet secretary—what action he has taken to prioritise additional investment in GP services across the country, and particularly in community access, but focusing on Lothians, not forgetting the crisis that we have currently got that is getting worse. Day after day, people are frustrated, they are upset, they are stuck in hospital, waiting for the operation that they urgently need. I had somebody this week who needs to go to another health board to get the operation, but they are stuck in a bed in Lothian and they do not want to be stuck there. They do not just want the operation, they do not want to be blocking somebody else getting access to that bed. People cannot go home because it is not the care that they need available and there is not step down care homes in care homes either, so we urgently need action. And investment in care, preventative care is absolutely critical. I would push back on all the SNP comments who say, we are not being party political. The SNP has been in power for 15 years. The crisis in our NHS is long standing. It is due not just to lack of investment, it is due to lack of right priorities. Prevention is better than cure, and we are getting the opposite of that now. We do not need social prescribing in three or four years' time when we do not have the cultural organization. Ms Boyack, you need to bring your marks to close, please. And that is investment now, thank you, Presiding Officer. I now call Emma Roddick to be followed by Edward Mountain. Ms Roddick. Thank you, Presiding Officer. It is an inescapable fact that the pandemic is the greatest challenge that our NHS has faced since it was created 74 years ago, as with healthcare systems across the world. I am not sure how Labour has quite managed to square the circle in their motion where they claim that the pressure on the NHS here in Scotland is not caused by short-term issues, but also that they must be addressed by a recovery plan, because there is, of course, an on-going recovery plan funded with £1 billion because our NHS needs to recover and recover from what they call short-term issues. Labour has its fingers and its ears on this, but the current issues that we are facing are enormous, and it is inevitable that there will be some effect on the NHS and its workers. Those issues include Brexit, which has seen us lose so many of our staff who no longer feel welcome in the UK thanks to decisions made down south. The Covid pandemic, which even putting aside the current high number of cases, has seen thousands of people who would otherwise be well admitted to hospital, struck with long Covid, or otherwise weaker as a result of catching it. Of course, there is the Tory-made cost-of-living crisis, which is pushing people into poverty-related health issues and putting pressure like I have never seen on to budgets thanks to overwhelming inflation. Those issues have widespread and long-lasting effects that cannot be ignored, and they certainly cannot be separated from the significant pressure that Labour highlights exist in the NHS. The member is seeking to outline a number of those challenges, but does she accept that clinicians are saying that this has been 15 years in the making and that the issues that the member is relating to to the chamber are exacerbating a situation that was already extremely difficult because of the decisions of this Government? I am not sure which clinicians the member is referring to, but there is certainly work going on. I am looking at the Scottish Government amendment to the motion. I am not seeing any denial that there are problems within the NHS, but I am going to come on to the difference between how it has been dealt with here and how it has been dealt with down south, because the context and the issues that I have just outlined exist in the rest of the UK too. What matters most is how the relevant Government chooses to react and how they deal with the issues. In Scotland, the SNP Government has eased delay discharge by purchasing additional care beds and providing additional support to NHS 24. It has got round the table with unions and provided an offer of a 7.5 per cent raise for agenda for change staff. You can compare that to what the UK Government has done, which is disrespect unions and bring forward legislation to prevent folk going on strike. Perhaps the different tack taken here in Scotland is why we have the best performing A&E service of any of the four UK nations, and perhaps the fact that we have the best-paid staff in the UK and make the time to sit and talk and negotiate with them is a big part of why we are avoiding strike action here today, unlike other parts of the UK. Perhaps Labour could look at the bigger picture, could look at the contrast between the two systems on offer and the positive change that has been made here. Rather than coming here making claims about the NHS being on the brink of total collapse, we should make actual, costed, reasonable suggestions and back us when we demand more freedom with the budget that would allow us to make even more progress even more quickly. I used to be a caterer. My wee sister is still a far better one, and I would love to see support for caters. I know the incredibly ambitious national care service is going to make massive needed changes to their experience. Labour seems to be both demanding that we spend money that we do not have and complaining about the money that is planned to be spent on the national care service. It wants us to spend more money but not like that, even though the service is enormously backed by the public. The increase in adult social care pay this year to £10.90 an hour is part of a 14.7% increase in the last two years and the same as what the Labour Government in Wales is offering. To offer more overnight, as Jackie Baillie asked for earlier, would require greater fiscal powers and or cutting budgets elsewhere. Even increasing pay for care staff to £12 an hour would cost the Scottish Government hundreds of millions. I will take an intervention. I am very grateful. We have been asking for this for some time now, but it is not an overnight request. Does she agree that £10.90 is only a 3.8% pay rise during what is an incredible cost of living crisis? When compared to a ban 3 NHS, they have got significantly more. Do you think that they should get the same? I was quoting Jackie Baillie earlier when I said overnight. I do not think that anything she has just said is in conflict with how I presented that. It is a real shame that we lack access to the levers of powers required to address this fairly and that Labour, even after the Tories tanked the economy last year with its irresponsible UK governance, is still failing to back calls for greater power. We should not be tied here to public spending decisions made by a Conservative Government in another country. We should be able to borrow where we see fit to react to events and fund our NHS properly, because here in Scotland the Government does want to protect the NHS. It does not want to let privatisation and it is not focused on cost cutting above good public service. We cannot keep relying on the promises of a flip flopping irresponsible Government elsewhere when last year showed us that we cannot rely on its block grant figures one month to the next. If we had employment powers here, we could defend workers against the attack that we are seeing on their rights—the introduction of the most restrictive anti-trade union laws anywhere in Europe. I wish we could be here debating a greater vision from Labour—one where we can protect and strengthen employment rights rather than just put more money in and do it more quickly without any indication of where else within the fixed budget that they would take that money from. The Scottish Government funds the NHS to a higher level proportionately than other Governments across the UK and will continue to do that, all the while keeping this public service in public hands with public accountability. I now call Edward Mountain to be followed by John Mason. I would like to start off my contribution by thanking the Labour Party for giving us the opportunity to discuss the national health service. I do not agree with all of your motion, but I am very grateful that you, like us, want to concentrate on this subject, which is a subject that, dare I say, is very close to my heart and has become very personal in the last year. Let us have a look at some of the problems that we are facing across Scotland, and let us turn the spotlight on the Highlands. In December, we know across Scotland that just over 50% of patients were seen within the four-hour waiting time. That is the lowest figure ever recorded. The crisis in A&E has extended outside A&E on to the Ambulance Park. We have seen for the first time in the Highlands ambulances waiting with patients to be treated in them. Some of those ambulances that were being deployed were deployed across the Highlands with only one member in the crew. It was the First Minister who admitted that there were about 1,400 instances of single-crewed ambulances being deployed. I am grateful to Edward Mountain for giving way. We obviously do not want to see any instances of single-crewed ambulances, but will he accept the figures from the Scottish Ambulance Service that well over 95 per cent of those ambulance call-outs are double-crewed? The single-crewing, which should not happen, is a minority where a double-crewing is a significant majority. The overwhelming instances of call-outs are double-crewed. I will accept that point. However, when you are stuck on the A9 in a car in a single-crewed ambulance, it turns up to collect you. I bet you wish that there would be two people in that ambulance, so not only can you be treated that you could be taken back to the hospital. Let us look at the other issues that we have in there. The PIC team that was going to be disbanded, a group of doctors established who were working seven days a week delivering care outside the hospitals on the ground. In fact, they were the only ones capable of dealing with patients who were stuck in ambulances on the forecourt because, according to convention, A&E doctors do not go out to ambulances, but the PIC team doctors could go out, and they were the ones that looked like that they were going to be cut. What about those other people that you want to see, the people you really want to see, your GPs? Well, there has been a big fall in the number of GPs, higher demands, and it was Miles Mack, who is one of the Highland GPs, warning about the challenges of recruiting GPs across the Highlands. It is really difficult. I know of at least three GP practices across the Highlands that only have one GP. What happens when that GP is sick? I met a constituent the other day who has waited 12 weeks, Cabinet Secretary, 12 weeks for a telephone appointment. They said to me that they were desperate for the telephone appointment because they wanted to get on another waiting list. They told me and their exact words were, and I quote them, they felt it would be easier to get an appointment, face-to-face appointment, with the Pope than it would be for their GP. We should not be in that situation. Let's look also across the Highlands. Let's look up at Caithness. In 2016, there were 250 births in Caithness general. We centralised it. You centralised it, Cabinet Secretary. Your government centralised it so that all births now take place in Rhaigmoor, except for a very few of them. What we know that now, last year, 180 births were carried out in Inverness. Only 10 in Caithness. Of the 180 births, over half of them were induced. Is that the way we want to be going forward? Is it down to the shortage of staff? Is it down to the fact that we aren't providing what we need? Look at the orthopedic figures. 2,569 patients waiting for orthopedic surgery. Research from Aberdeen suggested that it might be seven years that those patients have to wait for treatment. That's not actually going to be sold, Cabinet Secretary, in your motion by the National Treatment Centre, which you are delivering two years late, over budget, still not fully staff, 20% of staff still to be found. You say that when it's working at full capacity, it will be producing approximately 2,000 cases a year. We've got that many in the Highlands. This is a national treatment centre and we should never ever forget that the national treatment centre will only be dealing with the easy cases, the easy orthopedic cases, not the difficult ones, not the ones that have been waiting for four years who his hips and joints are so damaged because they waited so long. That is not all that it promises to be. It will leave, I think it is, just according to my figures and worked out that those people in the Highlands, 868 patients, will have to travel out with the Highlands either to Aberdeen or the Golden Jubilee to get the treatment they need. Of those, 184 patients have been waiting for an excess of three years. It's completely unacceptable, cabinet secretary. This is the state we're in and let's look very briefly. Well, I haven't got time. I don't think, Presiding Officer, you're going to be tight on me, but if I said to you that a neurological development assessment waiting list is over 700 children long, it meant to have a 36-week treatment time. Only in the cabinet secretary's mind, they estimate it's going to take two years. So what we've got is unacceptable pressures being placed on by mismanagement. I think it's unacceptable and what it will result in without doubt is bullying. Bullying because people are set targets that they can't achieve their unrealistic. I believe that this Government has got a lot to answer for the state of our national health service, something that I'm really proud of and passionate about protecting. Now, I've said to your two predecessors, cabinet secretary. Mr Mountain, you need to conclude. Freeman, it was time for them to go if we want to protect their health service. I say the same to you. Your time is up, cabinet secretary. You've failed us and you're a disgrace. Thank you, Mr Mountain. What I would remind members of is that they should address remarks through the chair. References to you are in fact references to me and I'm sure that's not entirely what the member was trying to say, hopefully. I now call John Mason to be followed by Gillian Mackay. Let me give you a summary of my most recent personal... Mr Mason, please sit down. Less sedentary commentary from across benches, please. We need to hear the speaker who has the floor, which is Mr Mason. Let me just give you a summary of my most recent personal experience of the NHS. On Saturday afternoon, I went to visit my very elderly aunt in hospital and that happened to be in the Ayrshire and Arn health board area. I was only there for a short time, but I have to say that the whole experience was welcoming, it was friendly and it was relaxed. Someone came and let me into the ward even before I had the chance to press the buzzer. I was directed to my aunt's ward, a seat was brought beside her bed for me to sit in. It was a lovely bright ward, lots of daylight and with just six patients in it. I could see the staff chatting to the other visitors as well as the six ladies who were staying there. When it came to time for tea for the patients, they sought to interact with my aunt, helped her to drink it, went and got more milk when she said that it was too hot, and frankly, they did all that I would have expected and would have hoped for and in a warm, friendly and relaxed way. What a good advert for the NHS and especially in this case for Ayrshire and Arn. No one is denying that A&E is facing challenges, no one is denying that elective surgery has been suspended in some cases and no one is denying that GPs are under extreme pressure. However, let us not make sweeping and false declarations that the whole of the NHS is on its knees and the whole NHS is broken. That is most certainly not the case. Many parts of the NHS are working extremely well and are fulfilling the roles that they were designed to do. I know that the member's comments are about sweeping generalisations and previous comments and the intervention about exaggeration. Would he like to just clarify for the chamber, does he agree with the clinicians who are saying these things, that the NHS is struggling, it is suffering, it is on its knees and that sort of language? I thought that I had been clear but I think that my point is that some parts of the NHS are clearly struggling and some parts of the NHS are doing incredibly well. It is a mixture, it is not one picture. I do not think that exaggeration and bringing up the most extreme individual cases serve opposition politicians well at all. We will do ourselves and the country a better service if we discuss these challenges in a serious and sensible way and especially if we focus on what practical steps can be taken. The Labour motion says that this crisis in parts of the NHS has not been caused by short-term problems. Well, in fact, it has been caused by a number of things, both longer-term and shorter-term. Short-term, we have had Covid, which has been like a major injury or accident to our health system. When you or I have a serious accident or operation, it can take a long time to recover and fully regain our strength and, in the same way, Covid was a major blow to all of our health systems and it is taking all countries time to recover. However, I fully accept that there are longer-term problems, including, for example, overall UK funding for the NHS. The UK is spending 39 per cent less per person on healthcare than Germany is and 21 per cent less per person than France is. Those are the statements highlighted in the new statesman last week, which I understand are based on OECD figures. This UK underspend on health is the result of both Conservative and some Labour administrations at Westminster peddling the idea that we can have high-quality public services while reducing the amount of tax that everyone pays. I am afraid that that is just not possible, and so now the chickens have come home to roost. Lower taxes means poorer health and other public services. Yes, health is devolved in Scotland and we can vary income and other taxes to some extent in order to gain more funds for the NHS. However, we are constantly warned that we must not stray too far from UK tax rates in case every better-off person moves south and so we can only really vary health investment to a limited extent. There is certainly no way that Scotland can make up that 21 per cent funding gap with France or the 39 per cent funding gap with Germany. I am sorry, I have taken an intervention already. I do not think I have got time. We are looking at a UK funding problem here, not a Scottish one, certainly not only or even primarily a Scottish problem. Let us remember that repeatedly in budgets in recent years Labour has told us that we should be funding local government better. Funding local government better broadly means giving the NHS less. Those are the two main areas of expenditure in Scotland, so Labour cannot have it both ways. I am sorry, I do not have time. I have got one minute left and I have got a huge number of important things to say. Either we have been giving the NHS too much funding and local government too little in recent years or we have been giving local government too much and the NHS too little. We see in Labour's motion the idea that we should focus more on preventative healthcare. Absolutely, I think that everyone here agrees that we should do that. However, the problem is that no one here has come up with a workable plan as to how we do that in practice. Again, it is a question of choices, it is a question of where do we disinvest in order to find the funds to invest more in preventative areas. We have seen the tragedy of the air crash in Nepal this week and members may know that I lived and worked in Nepal for three years. When I think of the health services in that country in comparison to what we have here in Scotland, it is like night and day. We can tend to forget how fortunate we are in comparison to most other countries in the world and if we want to maintain and improve that position going forward and if the UK wants to match countries like Germany and France, we need to have a serious adult debate about what we want and how we are going to pay for it. That should not be just amongst ourselves as politicians, but we must engage the wider population of Scotland. Do we want to be a low-tax country with a declining NHS or are we prepared to pay more for the quality NHS that I want to see? I now call Gillian Mackay to be followed by David Torrance. In the chamber before Christmas recess we all noted the strain that could be brought on the NHS over winter. Sadly, we are now seeing the reality of this played out in our hospitals across the country and I believe that we need to both tackle the current issues and ensure that we build in resilience for the future, that we plan services anticipating demographic change as well, and we do the work now on preventative care and public health to help people to not become sick in the first place and stay as well as possible if they do have a health condition. In the current period, work on going, on recruitment and retention needs to gather pace to ensure that services are fully staffed and that patients are seen in a timely manner. Some of this is undoubtedly about pay and I am pleased to see the progress that the cabinet secretary has made with unions. I hope that talks can be resolved in a way that is acceptable to all. I am very grateful to the member for taking the intervention. The member mentions pay, and we know that pay in the social care sector is extremely important and is outlined by my colleague Jackie Baillie. In the green manifesto, they were committed to £15 an hour for social care workers. Can I ask the member why that disappeared and have wanted butthouse agreement? That commitment has never disappeared from our work in government. The difference between ourselves and Labour is that we are in government, working as hard as we can to push forward on uplifts. There have been several uplifts in the last year, so while Labour will continue to shout from the sidelines, we will continue to do the work in government going forward. As well as pay, working conditions are also something that I hear about regularly in meetings with unions and NHS workers. Some of those issues and pressures are health board and sometimes hospital specific, but some indicate wider issues. Many in the chamber will be aware of a story that broke in Forth Valley health board in my region where one nurse was left to support 37 patients on their own. The scale of the case is, I hope, an extreme example. The implementation of safe staffing legislation is essential to ensure both patient and staff wellbeing. The cabinet secretary has previously set out to Parliament steps that were under way, and I would ask that, in summing up, either himself or the minister could give an update on that. To boost retention and ease pressure recruitment, as I said, is essential. We need to allow staff the time to take breaks, go home on time and not have to take on extra shifts when they are already tired. I hope that the UK Government will listen to the suggestion that I put to the cabinet secretary last week on fast-tracking visas for international workers coming to the Scottish NHS. That could allow faster access and provide a more attractive option to those workers who were put off by Brexit. Work in the health committee has highlighted that people do not understand all the pathways available to them. We have to be explicit with patients as to what treatment options are available and changing the way people view their healthcare is not always a quick process, but we need to well advertise all the different routes. The diversity of urgent care, in particular at the moment, is essential to be well understood. I hope that we can collectively support services such as GPs Out of Hours, which is staffed by passionate people who often have other commitments, too. With the stream that we are seeing across the health service, there is a real danger that we will rely on a dedicated few or risk seeing the service eroded. I hope that, in the future, we can also see more digital offerings from NHS 24. Not everyone is comfortable speaking on the phone and some can't. Some may find waiting in long queues on the phone difficult if they have, for example, multiple caring responsibilities. A chat function may be more suitable to some, and I hope that that could be explored. In the medium term, dealing with the backlog of treatment as the results of the pandemic will continue to need to be addressed, even after the peak of winter pressure. We are all aware across the chamber that three health boards have taken the decision to pause elective surgery, and I hope that that can be as short a term as possible. Many have also seen conditions progress quicker because of restrictions and not being able to access services that had to be shut for public health reasons. For those who have had operations or treatment postponed, we need to make sure that they are well informed. I hope that the capacity brought in by the national treatment centres can also help with waiting lists, and I am always grateful for information from the cabinet secretary on progress and detail on that. In the long term, we also have to be looking to what services look like in the future and plan for that now. There is a danger in the middle of increased pressure that we recruit to plug gaps without forward thought. Patients want to have more services delivered locally. We have seen a move towards this through the development of hospital at home and through statistics showing that more people are wanting to die at home. With an ageing population, that means more palliative and end-of-life care is delivered in people's homes rather than in hospital. That presents its own challenges for primary care workforce and social care workforce, where district nurses, social care workers and GPs are often on the front line. The need for recruitment across the health service now is clear, and we need to ensure that that mix is right to fit what we would like to see from healthcare. We should be making that move towards preventative health spending and keeping people well from the outset. That is not to say that all ill health can be prevented, and that would be too much of a simplistic viewpoint. However, preventative spending saves time in hospital and costs at the acute end. Mr Mason does pay for itself eventually. Preventative spending should also cover mental and physical health and be appropriate for whatever impairment or health condition the person already has. I recently met some amazing school nurses in Falkirk who are carrying out that preventative work and would encourage everyone to speak to school nurses in your area. I would like to end, as others have, by thanking all those across health and social care who have worked relentlessly, not just this winter but over the last number of years, to ensure that those who need care can get it. Thank you, Mr Mackay. I now call David Torrance to be followed by Rosam called. David, let Mr Torrance. Thank you, Presiding Officer. The public health challenge facing Scotland as a result of the Covid-19 pandemic is unprecedented. Over the last two and a half years, the pandemic has had a significant impact on the health and wellbeing of individuals, families in the entire communities across the country. This cannot be ignored. It has increased the demand for social care services, shine a light on the health inequalities that exist across the population and change the way in which every single person lives their life. Full recovery will take years and it is naive to think otherwise. The Covid-19 pandemic has impacted on our health both directly and indirectly, as has caused direct and tragic harm to people's health, affected our broader way of living and society, impacted on our economy and hugely damaged in the effect on poverty and inequality. Priorities have been focused to adapt to the changing needs of our healthcare system while national and local government NHS boards and other partners work tirelessly to address those problems. It would be delusional to suggest that the impact of a pandemic was not still a factor in the problems that were faced by our NHS. I have said it before in this chamber and I will say it again. While it suits Labour's narrative to stand here and criticise Scotland's NHS, it is not just here in Scotland that healthcare staff and services are under strain. The NHS in every part of the United Kingdom is facing significant pressures. Although our performances can be approved upon, our accidents and emergency departments continue to perform better than those in England, Wales and Northern Ireland. As Dr Gwaghani mentioned in November figures, Scotland's core A&Es were 9.2 per cent better than in England, where if Tories are in power and 6.3 per cent better than in Wales, we are Labour in power. Despite what Labour would like us to believe, reality is that the entire country is still ruling from the shockwaves of a pandemic. Through you, I will not be taking any interventions from the Labour Party. Maybe you should listen to the legacy of the neighbouring power that is now affecting the NHS. We have heard the cabinet secretary and the First Minister set out the action of the Scottish Government that is taking to improve A&E waiting times. A 50 million urgent and unscheduled care co-operative with the help of implementing a range of measures to drive down A&E waiting times. That will include offering alternatives to hospitals such as hospital at home, directing people to more appropriate urgent care settings and scheduling urgent appointments to avoid long waits in A&E. The £600 million health and care winter plan will also support recruitment of 1,000 additional staff, delivering £45 million for amblin services to support on-going recruitment and service development, and £124 million to assist health and social care partnerships that expand care at home capacities. Those measures do not sound like a lack of action to me. In December, it was announced that the health and social care services will receive the highest ever budget settlement over the next year, paving the way for sustainable public services in Scotland, with a £19 billion package helping to tackle the immediate pressures caused by the pandemic and the tough winter by supporting the delivery of health and care services that are fit for the future. Once again, the commitment does not sound to me like the Scottish Government is fully aware of the importance of supporting our health service and its staff. There is another pressure facing our health boards, one that is inflicting a great deal of damage across the country, but somehow I do not think that we will hear it from any of the Labour speakers today. Maybe it is just that it has very short memories when it comes to PFI and PPP contracts. The people of Scotland are still paying the price for Labour's shameful PFI and PPP contracts on the NHS buildings, with the Scottish Government paying over £250 million every single year for contracts being under previous administrations. That is a staggering amount. Just imagine what that money could do to help support our NHS services. I have seen the effect of his damaging agreements located at Victoria hospital in my constituency. The hospital was built with a capital cost of £170 million, but by the end of a 31-year contract, NHS Fife will have to pay £887 million for that hospital. I will say it again for my Labour colleagues. £887 million for that hospital, a disgrace. Labour's PFI legacy will be long-remembered by people of Fife and beyond. Their all-advised PFI deals have left the Scottish Government paying anum sums for the above the odds of our hospitals and schools. Money that could be much better spent on front-line healthcare rather than paying the cost of Labour's mismanagement. The consequences of Mr Brown and his only game in town public sector borrowing ffiasco could almost be forgiven if lessons had been learned, but Labour's party has learned absolutely nothing from its toxic legacy and they want to keep the door open to Tories to increase private sector input in our precious NHS. It is really no surprise that the people of Scotland do not trust Labour any more than they trust Tories. Rather than standing here and having an honest debate about Scotland's NHS, we acknowledge that these important issues are being faced by every health service across the UK. Labour would rather ignore the inconvenient facts that do not fit in the rhetoric and seek sound bites on which to attack the Scottish Government. In conclusion, Presiding Officer, there are problems that must be tackled, and there are challenges that require long-term solutions. No one is denying that, but I, for one, am thankful that the Scottish Government is determined to continue taking real action to address the problems that are being faced by our NHS and its staff by taking action to alleviate the pressures that are being felt by our services. A whole system approach is a right way forward as progress through this critical period and look towards the future. A future of our health and care services ensures that everyone gets the care that they need, when and where they need it. Thank you, Mr Torrance. I now call Rose McCall to be followed by Colin Smith. Thank you, Deputy Presiding Officer. I am going to come at it from a slightly different angle. I will never forget that it was thanks to our NHS that my husband is alive. The care and attention that he received was fantastic, and I will be eternally grateful to the surgeon and all the staff that work to ensure that my husband could come home. That is what everyone wants, is it not? People want to get on with their lives as best they can, safe in the knowledge that, when they need professional medical help, it is there for them, and that the stress, strain, pain and trauma that they are experiencing is minimised and that they and loved ones will be treated in a safe, speedy and sympathetic manner so that they can return to their lives as soon as humanly possible. I know that my husband received that care, but I also know that we were lucky. I know it because I was told it. I was told it on four separate occasions by four different medical professionals for four different reasons. The telephone operator at the emergency services because we had an ambulance with us within 20 minutes instead of over eight hours. The paramedics because they had just finished a local call and had not gone anywhere else when the request came in. The emergency doctor because Covid lockdown at the time had meant that there was reduced numbers of patients in A and E, and the psychologist who was assigned who would not usually be assigned because family could not visit the hospital who helped him over his depression. This is not the case for many. They do not have luck on their side. My husband was a grown man experiencing a mental health issue brought on by a stroke. Imagine being a child battling with a mental health issue. Living with anxiety, for example, worry so deep that it consumes your every moment. Sleep is no release. Being permanently vulnerable. Worrying so encompassing that it changes your physical state. Pain and nausea, taking over, debilitating. Imagine having this day in, day out. What are your chances of getting support? You are meant to be seen within 18 weeks. You are one of 28,000 people referred to and a third will not be seen. That is 8,988 children in Scotland right now not seen within 18 weeks. Imagine that you are now one of the 6,553 children refused calms treatment. You have waited over four months and in some cases over a year and then you find out that you have been rejected from the service. Your GP has referred you. That in itself has taken months, your years on and you are no further forward. As stated by Alex Cole-Hamilton earlier, this Government has its own NHS recovery plan set targets to clear calms and psychological therapies by March of this year. That is 10 weeks. With 8,331 children and young people on the list waiting to start treatment at the end of September, it is safe to say that that will not be met. The fact is targets set by this Government when it comes to health are rarely met. As I have said, 90 per cent of children and young people to start treatment at calms within 18 weeks has not been met. 95 per cent of A and E patients being seen within four hours has not been met. 95 per cent of patients to begin cancer treatment within 62 days have fell. That has not been met. It worries me, Presiding Officer, as no one is setting these targets for the Scottish Government, they are setting them themselves. It seems like they are setting up the NHS to fail. The British Medical Association has highlighted this very point by stating, for far too long the debate on health service has focused on quick fixes or short-term performances against waiting-time targets that are widely accepted as completely unrealistic. Let's look at staffing issues. The fact is that managers within the NHS have been predicting a massive short form in staff. It's been on the cards for years. They all knew this day would come. If we want an example, we don't need to look any further than the First Minister, when she was health secretary and herself confessed far easier time than we have now. She was slated for sowing the seeds of a hiring crisis in the Scottish nursing sector with the controversial decision to slash the number of student nurses between 2007 and 2012, which has led to a decade of long-suffering staffing shortages. At the time, the Royal College of Nursing strongly criticised the move by the Scottish Government to slash the number of training places for nurses and midwives by nearly 300 back in 2012-2013. Announcing the cut to student nursing places back in 2012, said that the reduction was a sensible way forward to minimise the risk of oversupply, so that aged well. Again, the BMA is highlighting this, asking us to take serious steps to make working as a doctor or nurse an appealing career choice, as currently we have less GP capacity available to care for the people in Scotland than we did since 2009. I am finding it difficult to hear my colleague because of the conversations that are going on in the chamber. I would ask all members to please note what Ms White has said, and we obviously have to listen to the speaker who has the floor. Ms McCall, please resume. Thank you. We have to cut through the political fog, because when all is said and done, the people of Scotland are not getting the healthcare that they should. They need an NHS when they need the NHS, and it is our job to focus on fixing the problems, not blaming others or highlighting how much better off people are in Scotland. Believe me, people just need to feel that they are being taken care of in a scary, stressful time when they are ill and they do not know what happens next. When our amazing NHS staff come forward time and time again to help and treat the sick and the dying, they want our politicians to step up, be realistic and just make it better. Can we agree to get Scotland's NHS off-life support and ready for the people who need it when they need it? Thank you, Ms McCall. I now call Colin Smith. We follow by Emma Harper. Emma Harper will be the last speaker in the open debate. Mr Smith. The crisis that we have heard today in our health and social care service has engulfed every part of our NHS in every part of the country, but in rural areas where services are especially precarious, the impact has been profound. A day rarely goes by when my inbox does not contain another heart-breaking case exposing how utterly broken services are. Today, a third of beds in Dumfries and Galloway royal infirmary are occupied by patients whose discharge is delayed by the lack of carers and the lack of care home places. Over 3,000 hours of assessed care are not being covered. I want to share just one such case. I was contacted by a constituent whose mum was receiving pallative care after a cancer diagnosis. Pat's wish was to spend what time she had left at home. Her care needs were, of course, increasing, but that wish was not too much to ask. An assessment was made, a care package agreed, but there was no carers to deliver it. Marie Curie did what they could, as did the family, but the growing burden on Pat's husband became too much and he was admitted to hospital utterly broken. And what was the solution? Well, there were still no carers, so Pat was also admitted to hospital even though she wasn't receiving any medical treatment. Pat sadly died several days later. The only saving grace was because she was in hospital and her husband had also been admitted. He was by Pat's side in her final moments. Presiding Officer, this is not an isolated case. The lack of care is the problem of delayed discharge. It hasn't just appeared because of Covid or because of the flu. It was there in 2015 when the SNP promised to eradicate delayed discharge, but eight years on we have never been so far away from achieving that. The cabinet secretary consistently says, we can't afford to pay our care workers that bit more that could help recruit the carers needed to avoid more cases like Pat's. The delayed discharge last year cost NHS Dumfries and Galloway over £6 million alone. Presiding Officer, we can't afford not to give our care workers a decent pay rise. Until we do, there's no route to end and delay discharge, no way to avoid more cases like Pat's. Two years ago, community hospitals in Carcubra, Newton, Stewart, Lange and Moffitt were all closed, removing nearly 60 beds. Post Covid, they remain closed because nurses from those hospitals are in the community in many cases having to carry out the role of care workers because we cannot recruit those workers. The health secretary's second plaster is to pay health boards to discharge patients not back home where they want to be but into care homes where they don't want to be and rural areas often miles away from their families, but it won't work. Many boards are already buying up beds in care homes, but they aren't enough because those homes also can't recruit care staff. In the last year alone, two care homes in Dumfries and Galloway have closed and just this week it was joined by another in East Ayrshire. When I have diktats from health and social care partnerships, it's the one this week in Dumfries and Galloway, sanctioning the discharge of patients from hospital even if they haven't had suitable re-enablement and the discharge of patients not when their care package starts but when a date has been given for that care to begin at some point in the future with all the risks that brings. It's not just in social care recruitment that government in action has led to this crisis. In 2018, the maternity unit at the Galloway hospital in Strunrar was shut. We're told temporarily because of a shortage of midwives. One of my constituents, Claire Ferman, lives in Glenlose, 50 miles from that unit in Strunrar. Her first pregnancy was with Abbey, who sadly was stillborn. Despite the heart-breaking end to that pregnancy, she had to drive herself to the hospital in Dumfries to deliver Abbey 60 miles away. Since then, she's had three children, Molly, Andrew and James, and along with her husband Richard, has clocked up over 7,500 miles between her home and hospital in Dumfries for maternity appointments, because even before the maternity unit in Strunrar was closed, services had been scaled back. Claire suffered from hyper-emesis during pregnancy. It meant that she had to stop on the journeys to Dumfries every 15 minutes to be sick. Claire told me that she was aware of women in Wigtonshire who decided not to get pregnant because they were so scared of having to make that journey in a rush if they went into labour for fear that they'd have to give birth in a lay-by at the side of the road. Claire herself said, out of as many children as I could, that she absolutely loved having children. I got sterilised the last time I was in hospital because I couldn't face doing that journey again with hyper-emesis. There's still no sign of that maternity unit. I'll give way to Emma Harper if I can give that time back. Not really, I'm afraid. You're going to have to accommodate it. I'm sure that Emma Harper will cover her point in her own speech, but that maternity unit is still not open. The eighth-largest of Scotland's 22 community midwifery units hasn't reopened for in-hospital bus. We've seen a 60 per cent increase in the already high level of nursing and midwifery vacancies in the region since that unit closed. I could talk about so many other services in the region that are on their knees. Dentistrain, the last few months alone, dental practising in Dumfries, Castle Douglas, Gretin have all closed, affecting 15,000 patients. You can't register with an NHS dentist in Dumfries and Galloway at the moment. Take GPs, residents in Lockerby, Moffittshire and Rar have all seen their surgeries brought under direct control by the NHS because there simply aren't enough GPs. The legacy of 15 years of SNP Government on the NHS in Dumfries and Galloway is where delayed discharge has risen by 56 per cent in a year. You can't get an NHS dentist. GPs surgeries are closing women's fear for their health when pregnant. Our NHS and social care services desperately need a proper long-term plan. I think that we've heard today that that's a plan. This cabinet secretary and this Government are clearly utterly incapable of delivering. Thank you, Mr Smith. I now call Emma Harper, the final speaker in the open debate, up to six minutes, Ms Harper. As a former NHS employee in education and in the perioperative environment, I hear from the fantastic colleagues regularly about what's happening on the ground. I'm acutely aware of the challenges that are facing our health and social care system and I know the lengths that staff are going to meet the unprecedented demands that they face. In addressing Colin Smith's issue about maternity services at Stranroir and Dentistry, I know that you would have taken an intervention if there had been time. I raised that issue directly with the cabinet secretary on Tuesday at the Health and Sport Committee. The cabinet secretary is aware that Marie Todd, the minister, is addressing maternity issues in supporting the work of the group with you included. I know that the cabinet secretary has given a commitment to get back to me on some of the issues that I raised on Tuesday at the Health and Sport Committee, so I'm sure that, when I get that response, we'll be able to work together to help to support what works best for our constituents in the south of Scotland. The other issues that I wanted to address this afternoon, national treatment centre comment that Edward Mountain made regarding just doing the easy cases. In my experience in orthopedic surgery, sometimes it is easier to do five total joints in one day with planned predictable manageable cases rather than one very long difficult loss of blood surgery that takes up the whole orthopedic session, so that's something that off the top of my head I'm thinking about and maybe it's something I will be pursuing down the line as well. You know, Presiding Officer, this is the most challenging winter in the Scottish NHS that has ever been faced and immediate pressure will continue to occur in the coming weeks. I also want to pick up on what Christine Grahame's comment was about Covid still stocking the corridors and I would like to just make a plea to people to get your Covid vaccine if it's due and if you're negating it and get your flu vaccine as well because that ultimately will help keep folk out of the acute care bed, so that's something that I think many members across this chamber would actually agree about and I know that the Labour Party might not like to hear this but our NHS in Scotland is performing consistently better than the NHS in any other part of the United Kingdom and this includes in Scotland the fact that our staff are paid a bit more in our NHS in Scotland. The Labour motion talks about properly funding our Scottish health and care service and the Scottish Government is ensuring that all actions are being taken to support services and additional measures outlined just this month are already having an impact in NHS Dumfries and Galloway. The measures will help the NHS and social care sector with on-going extreme winter pressures. Health and social care partnerships have received a share of £8 million to procure around 300 additional care home beds to help alleviate pressures. We're trying to help alleviate the pressures with the 300 additional care home beds that's caused by the delay in discharge so that's allowing them to pay more for the national care home rates for beds, which is £790.50. That is in addition to the 600 interim care beds already in operation in the country and I will give way to Jackie Baillie before I want to know what is working in NHS Dumfries and Galloway. Thank you very much to Emma Harper. Does she recognise that when Nicola Sturgeon was health secretary she failed to pass on funding for the NHS to the NHS that would have meant that we would be £1 billion better off today? I would say to Jackie Baillie that what is being passed on for the NHS in Scotland is more than the consequentials that is being given to us. It's urtax-paired money that's being divvied up by folk that we didn't even vote for so that's something that I would actually probably good that you did that intervention on me. In Dumfries and Galloway, thanks in no small part to the work of the health and social care partnership chief operating officer Julie White, the support has enabled the board to discharge 25 people from hospital who were medically fit for discharge but they were delayed. This was achieved in one week and I congratulate Julie White and the teams on the success and I understand that the approach taken by Dumfries and Galloway health and social care partnership is being shared with other boards and I look forward to the update from Julie and the team at the NHS Dumfries and Galloway in the health and social care partnership to hear how that was achieved because if some boards can make it work then yes let's share the good practice and get it done. In addition, NHS 24 are taking forward plans to recruit around 200 new starts before the end of March and in the run-up to Christmas over 40 whole-time equivalent call operators, call handlers and clinical supervisors were recruited, allowing for more people to be directed to the most appropriate care setting for them. More generally, on funding, the Scottish Government has committed over £18 billion in the budget for health and social care and that's around 52 per cent of the overall budget for the Scottish Government. Again, we didn't have control over what comes our way and again I want to pick up on Emmerodic's points about employment law. It's really hard to manage what we would like to do when we are constantly got a ball and chain rune the neck of this place. I would like Labour to be a bit more realistic. The £600 million health and care winter plan is supporting the recruitment of 1,000 additional multi-discipline staff and delivering £45 million for the ambulance service to support on-going recruitment service, and I realise, Presiding Officer, that I am out of time. In closing, I welcome the steps that the Scottish Government continues to take to help to support our fantastically valuable national health service in Scotland. Thank you very much. We now move to closing speeches. I call Tess White for up to six minutes. Presiding Officer, listening to this afternoon's debate, it's painfully clear that this SNP Green Government has run out of ideas and it's run out of road. The Cabinet Secretary for Health says that the NHS is facing challenges. The fact is that under Humza Yousaf, Scotland's NHS isn't just on life support. Presiding Officer, I've only just begun, I know you're keen, but I'd like to continue, thank you. As we've heard today, we're seeing patients stuck in ambulances on the hospital forecourt week after week of record waiting times in A&E, moving medical goal posts, a delayed discharge crisis, non-elective surgery paused, massive backlogs in potentially life-saving treatments, diagnostic tests and operations. So many people in pain. Dr Sandesh Gulhane said to us that the SNP Government will blame Covid and true to form, Emma Roddick and Humza Yousaf blamed Covid. The majority of speakers in this debate today have exposed the fact that the underlying problems are long in the making. I want to say to Emma Roddick about fingers and the ears, listen to what is being said today. Paul Sweeney shared harrowing stories. Sarah Boyack talked about preventative care being stopped. Today we've heard so many stories of people who are frustrated, upset, forgotten or abandoned. NHS front-line workers are telling us time and time again that patient safety is at risk every single day. Dedicated staff in our NHS are exhausted, disheartened and in disbelief. Not surprising, sadly, as Michael Marra flagged, clinicians are thinking of chucking it in. Alex Cole-Hamilton has exposed a shocking story of a refugee having to go back to Warton Cief for her medical treatment. John Mason had the temerity to accuse Jackie Baillie for exaggerating the crisis. Pause on that. Try telling the patient in Inverness who's waiting 12 weeks for a GP telephone appointment or for the patient who's waiting four years for a hip replacement or someone who's waiting for life-changing cancer treatment. I say to Gillian Martin who is hiding behind the couch. Imagine how they felt on Monday. When the First Minister used a press conference on the crisis in our NHS to grandstand on the constitutional wrangling over the Gender Recognition Reform Bill, that was on the same day it emerged that one patient in NHS Grampian in my region waited five years for a simple CT scan. As we've witnessed today, all the SNP do is sing from the same songbook, deflect, distract and as we've heard again time and time today blame the UK government or as David Torrance did, blame Labour for over 15 years ago, really? Or as Emma Roddick says, blame the UK government for the ball and chain on employment legislation? Poppy Cox obviously doesn't understand employment legislation but the question remains how can the NHS come back from the brink after 15 years of mismanagement under this SNP government? We have sensible policy proposals and the cabinet secretary said earlier where are your ideas. He has run out of ideas. He's asking us for ideas I'd like to say that we do have published ideas crisis management maximum waiting times and electronic repeat prescription system an app for live hospital well if the cabinet secretary from a sedentary position said do it tomorrow I'd say we'd be waiting 15 years cabinet secretary and prehab our published proposals could make a real and defining difference not just to how the NHS workforce and the pressures it faces but to patients experience of the system and if the cabinet secretary would like some ideas because he's run out of them we would gladly meet the cabinet secretary to share our ideas on the wider health system itself we know that delayed discharge is a massive issue which prevents the flow of patients through the NHS from A&E on to our wards more often than not bed blocking is caused by a lack of social care packages at home or in the community as we've heard today thanks in part to savage funding cuts for local authorities by this SNP government but instead of going full throttle to address this problem now the SNP in its wisdom has decided to introduce legislation to set a centralising national care service three years down the road and with soaring cost implications for the public purse the reality is presiding officer the 300 additional care home beds announced by the health secretary won't cut it when there are more than 1,700 people in hospital who are clinically safe to leave but can't on staffing we know the NHS workforce is massively understaffed with high vacancy rates in fact figures from the bma suggest that that consultant vacancies are more than double the Scottish government official figures there's still no proper workforce plan presiding officer the NHS will continue to hemorrhage staff if they're working conditions don't improve this isn't the exception it's the norm and we must urgently find ways to address it thank you thank you miss white and i call kevin stewart to wind up for around seven minutes minister presiding officer i think we are all aware of the pressures that our NHS and social care settings are facing during this very challenging winter and i do not now seek to lessen the extent of these challenges nor the very real impacts that they have on people across scotland whether that's hard working frontline clinicians working day and night to deal with unprecedented unprecedented demand or those who are waiting for treatment or facing delays when visiting hospital this is a moment of significant challenge and we are determined to support all of health and social care through it presiding officers the cabinet secretary has remarked earlier there is no mention in the original motion proposed by miss bailey of the impact of coven 19 of strepe of aniflu all of which are placing significant pressures on hospitals and wider services this is not the first time that this has been pointed out to scottish labour when responding to one of these motions in his response the cabinet secretary set out the detail on the numbers of people affected by coven 19 alone who are now receiving care in our hospitals and clinical settings across our country to ignore that critical clinical picture is to ignore one of the key underlying causes of the pressure that health and social care settings face it also misunderstands the solutions that are needed to help reduce pressures in hospitals and the steps we can take all take collectively to mitigate those pressures there's also no mention of the impact of brexit and the UK government's mishandling of the cost of living crisis in this motion and brexit continues to have an effect on our health and social care staffing the nuffial trust recently highlighted the impact of brexit on the health workforce outlining that there was a decrease of 28% in the numbers of EU and EU free trade area nurses and health visitors on the UK register between September 2016 and September 2021 that is a potential decrease of more than 10,000 people working in health settings across the UK whilst not all of those would be working in Scotland it is undeniable that brexit which Scotland did not vote for has had a significant impact on the recruitment of health and social care staff finally we know the impact of the UK government's mishandling of the economy has had making things worse this has put more pressure on households exacerbating mental and physical health challenges and as we have seen we have had folk turning up our hospitals who have been suffering from extreme cold because they are afraid to put their heating on these are the things that people are facing because of that cost of living crisis and these are the things that our health and social care services are having to deal with we have done what we can to mitigate these challenges we have introduced the scott's child payment in addition to wide-ranging support measures to assist families who urgently need support through the cost of living crisis Presiding Officer this government immensely values the contribution of people from across Europe and the world who work in the NHS and have chosen to make Scotland their home and that is why in our proposed amendment to this motion we have outlined our belief that freedom of movement within Europe would help us address our some of our recruitment challenges we have taken sensible and ethical approaches to staffing including investing in training places creating new roles and routes into NHS Scotland and publishing the national health and social care workforce strategy we have also announced measures to deal with hospital discharges and the surge in cases we are seeing as a result of winter pressures including Covid-19, flu, strepe and other infections. I thank the minister for giving way on that point. I mentioned in my speech the £430 ambulance charge for the 95-year-old constituent to be transferred from one health board area hospital to a care home and another health board area would he recognise that that particular instance is not something that we should be tolerating in the NHS? I was going to come to that point and I would be really interested to see further detail of that case because a transfer between one health board and another should not be charged for by the Scottish Ambulance Service. I would be really interested in seeing the detail of that case from Mr Sweeney and we will investigate it without doubt. As I was saying, we have announced those measures to ease those pressures which include Covid-19, strepe and flu and other infections. The cabinet secretary outlined the actions that we are taking, not only the increased capacity for interim care beds and scale-up in NHS 24 recruitment that was announced last week, but also the investment through the NHS recovery plan to support national treatment centres and additional investment to increase adult social care workers and putting in place the national care service, delivering the long-term reform that is needed to provide fair work and national sexual bargaining for social care workers. We have also highlighted that Scotland is the only part of the UK not to experience strike action from health staff this winter. That is because the cabinet secretary has continued to talk with and listen to staff and negotiate properly, unlike south of the border. He is right to highlight our profound respect for the workforce and this Government's commitment to positive and meaningful engagement with trade unions. We will continue to negotiate in good faith to achieve an outcome that avoids industrial action and rewards our workforce with the support that it deserves. I recognise the strength of feeling in all sides of this debate, but there have been some cases where there has been more heat than light today. Both myself and the cabinet secretary have been consistently clear that this will be one of the most challenging winters that the NHS in Scotland has ever faced. The picture of it presented by the original motion ignores critical context such as the impact of Covid-19, flu, strep A and other infectious diseases on the health service. It ignores the impact of Brexit and the impact of the cost of living crisis, which is exacerbating those pressures. The steps that this Government has taken to support patients as well as professionals and put in place the long-term reform that is required within health and social care. I urge members to back the amendment in the name of the cabinet secretary today. As we meet today to debate in this Parliament outside of this place, our NHS continues to face a huge crisis. Yet again, it is Scottish Labour in opposition business time that has had to bring those issues to the chamber as outlined by Jackie Baillie in her opening speech to ensure that the Government can be held to account on those issues. Of course, our thoughts as I begin are with all of our dedicated and hard-working staff on the front line in our NHS. Never before, Presiding Officer, have our accident and emergency departments had so many patients waiting over 12 hours to be assessed. Never before have we experienced such a level of delayed discharge with record numbers of patients stuck in hospital, but they cannot secure an appropriate care package. Tragically, as we have seen many times before, declining performance in cancer treatment. The Scottish Government has failed to meet its 62-day cancer treatment standard since 2012. All those statistics that we see week in and week out are not just about box ticking exercises. It is more fundamental than that. It is about people's lives. It is about improving health outcomes by ensuring that people have a higher likelihood of being treated before their condition worsens. In many cases, treatment can be the difference between surviving and recovering or dying. Indeed, we know that waits of over eight hours in accident and emergency departments have already led to unavoidable death. In our hospitals, patients who need to be in intensive care or high-dependency units are sitting in A&E departments for hours waiting. It is just not safe. Patient safety is at risk every day in our A&Es across Scotland. You just can't give the care that you want to give to patients. Those are not my words, Presiding Officer. They are the words of Dr Layla Peel, the Deputy Chair of the BMA in Scotland and other of those front-line voices that we have heard throughout the debate that very sadly have been characterised as exaggerated by members in the SNP benches. However, that is the reality. It is the reality that I have heard, the reality that we have heard from colleagues across the chamber today. The cabinet secretary in response has thought, as he always does, to advocate himself of responsibility by lining up excuses after excuses. I have to say to the cabinet secretary that I found his weaponising of Covid in his remarks most unedifying, because the reality, cabinet secretary, is that clinicians, those on the front-line, are saying that the cause of the current crisis is not about Covid, is not about strep A or the flu or winter pressures, is years of mismanagement and decline. Dr Peel, who I just mentioned, said, I am going to quote. The word unprecedented is being used a lot to describe the crisis. It makes it sound like the current situation wasn't entirely predictable or preventable, like this isn't a crisis years in the making. Front-line workers are sick and tired of not being listened to by the Government and are appalled by moves as they see to blame patients for the appalling situation in our NHS. Our national health service is battling for survival in the gravest of moments that is faced since its establishment by the Labour Party. The gravity of the situation demands a response from the Scottish Government of a proportionate magnitude. I will in a moment. It needs more than the reactive sticking plaster proposals from the First Minister and the health secretary. I will give way to Bob Doris. In December, the Northfield trust said that the health and care sector is still reeling from the effects of a global pandemic and is now grappling with rising cost pressures. Are they weaponising Covid? As the member had listened to what I said, I quoted a front-line clinician pointing out that Covid, strep A, flu, all of the issues that we have heard are exacerbating an issue that has been 15 years in the making. This crisis has been building year on year and this Government has not sought to address it appropriately. Because their recovery plan does not even come close to addressing the scale of the problem facing our health service. This is a twin crisis, a twin failure of Government in both healthcare and social care, and that is why we need a joined-up approach to deal with the problem, because we will not be able to deal with issues facing our health service if we do not address social care. This morning, along with Jackie Baillie and Anna Sarwar, I met a range of stakeholders, including people on the front line of delivering social care. Their testimony on the scale of the challenge being faced in social care was powerful, and they were clear in stating that the Scottish Government is not doing enough to address the key problems in social care. I will give way to the cabinet secretary. I am grateful to Paul Cain for giving way. Next year, if you look at next year's budget, where every single penny is allocated, can he tell me where you would find the money or where you would cut money from in order to fund social care wages to £15 or even £12 an hour? Do not say the national care service, because it would not even remotely cover any wage rise in 2023-24. I am not going to take a lecture from the cabinet secretary, but I should. He is obviously quite upset by my response. There needs to be a conversation about his national care service plans, because they are where we could take money and use it to get it into the front line on social care. Our budget proposals will come forward as they always do, and we will provide that information to the cabinet secretary. I go back now to my point. He does not want to listen. Mr Cain, can you resume your seat? I said it at the beginning of the debate. I do not know what has happened in the interim, but it appears to be reigniting at the end of the debate, where front benches and some back benches are hurling comments at each other while a member is on his feet to try to speak. I would encourage people to speak with respect and I would invite Paul O'Cain to continue and to start concluding his remarks. I am very grateful. Perhaps he does not want to listen to what I heard from social care workers today, which is that they have grave concerns about the situation in social care. They have grave concerns that the national care service bill is ill-thought-out, that it should be stopped, that we should come back round the table and get it right. I heard a quote from Gillian Martin about unison being in support of the bill, but that is certainly not the conversation that I had with unison this morning. I do not believe that I have time to take the minister. They are calling for this process to be paused and for us to think again about the detail. I will conclude, Deputy Presiding Officer. I plead with the Health Secretary to show some humility to listen to the experience of staff on the front line and patients who have witnessed the crumbling foundations of our NHS with their own eyes. As our doctors, nurses and our support and social care staff who deserve so much better than hollow words, patients across Scotland deserve better than the underwhelming action of the SNP Government. Presiding Officer, we on these benches will always fight to protect our NHS. Will the cabinet secretary? That concludes the debate on addressing the crisis in the NHS and social care. It is now time to move on to the next item of business, although there will be a brief pause to allow the front benches to change.