 I ask members who are leaving the chamber to do so as quickly and as quietly as possible. The next item of business is a debate on motion 4567, in the name of Kevin Stewart, on keeping care close to home and improving outcomes. I invite members who wish to participate to press the request and speak buttons now or as soon as possible. Place an hour in the chat function if they are joining us remotely. I call on Kevin Stewart to speak to you and move the motion. The Parliament will be well aware of the scale of challenge across our public services and the level of uncertainty that we have faced over the past two years. In that context, it gives me particular pride to reflect on the ways in which our front-line NHS and social care workforce and all those working to support them have stepped up and adapted to new ways of working during the most challenging of times. I would like to take a few moments to sit out some reflections on the health and social care response to Covid-19 and some of the lessons learned that are supporting us to future-proof our NHS and social care services to provide sustainable reform and better care for the people of Scotland. We know that demand for health and care services is increasing, and the Covid-19 pandemic has accelerated the need to make optimal use of the resources that we have. Innovation and transformation are critical to enabling our NHS to achieve reforms in the delivery of care. The impact of addressing the Covid-19 pandemic meant that many health and care services had to be suspended or reduced in scope and scale. That affected almost all aspects of NHS care. As a result, demand for our health and care services has increased, which is impacting on the efficiency of our services. For example, our services have increased and are now above 95 per cent of pre-Covid average levels. Average lengths of stay in hospital is up around one day compared to recent seasonal averages. Planned care waiting times have significantly increased and acute capacity is regularly above 95 per cent. Those issues are compounded by other challenges, such as infection prevention and control measures, workforce pressures and delayed discharge. The challenge of Covid-19 compelled our public sector to empower services to be flexible, adaptable and provide alternative pathways for people accessing healthcare. Teams blurred organisational boundaries with unprecedented levels of collaborative working between sectors. We must all now build on this momentum to transform the way we deliver care and how our systems work together. With NHS 24 as the key point of contact through our redesign of urgent care programme, we have provided wide-scale triage of people away from hospital services towards virtual hubs, staffed by an A&E team, established to prevent unnecessary exposure to a hospital setting and ensuring the right care at the right time. Where hospital attendance is required, that can now be scheduled. We are now seeing between a 15 per cent to 20 per cent reduction in people self-presenting. NHS 24 has focused on ensuring that patients receive the correct advice immediately without a requirement to be placed in a queue. Although that means patients may sometimes have to wait longer for their call to be answered, over 95 per cent of calls are closed first time, with patients getting appropriate support and advice without any requirement to be placed in a queue for a call back. The Scottish Ambulance Service continues to increase sea and treat outcomes to ensure that patients receive the most appropriate care first time, reducing demand on operational ambulances. As a result of that, 41 per cent of patients were managed in their local homes or community settings last year. Through the advanced practitioner role, the Scottish Ambulance Service has also provided vital virtual pre-assessment care, which positively impacts on reducing avoidable A&E attendances and safeguarding patients within the community. We have significantly increased the options for people to access health and care services. That includes increases in availability of digital mental health support and therapies, being able to monitor a condition from home or the ability to have a video consultation with a health or care professional. One of the key areas for keeping people at home is through telecare, which currently supports 180,000 people in Scotland. Local Government digital offices are currently leading on its transition to digital, which will support a more joined-up resilient service across our country. During the pandemic, the use of near-me video consultations in Scotland rose from around 1,000 consultations per month to a peak of 90,000 per month. Our aim going forward is to continue to provide safe, person-centred and sustainable care through video consulting with public choice as a key priority. Just after Christmas, the health secretary announced a series of actions to increase virtual capacity. That is key to reducing demand in our hospitals and ensuring that there is enough capacity within the community to provide care closer to home, to manage on-going pressures on acute care as a result of the pandemic and to support recovery towards a sustainable future. We have been focused on building virtual capacity since early in the new year. That work focuses on four priority pathways, which I will come on to to discuss in a moment. Combined, those services have avoided or saved around 655 bed days per day. That is the equivalent to adding a large district general hospital the size of acute care capacity to our existing bricks and mortar hospitals. Without those services, patients would have been admitted to hospital and or experienced a longer length of stay, adding to the already significant pressures and providing a poorer outcome for the patient. Through that work, we have enhanced hospital at home services across Scotland over the past few months. That work is critical as we move into the recovery phase and we are already seeing a significant impact. The level of care that we are able to provide at home continues to evolve and grow. We are now seeing the spread of services such as hospital at home. I have visited hospital at home services in Edinburgh and the cabinet secretary recently visited the Forest Valley service on its first birthday and was extremely impressed with the care that it provides. At that visit, the cabinet secretary announced a further £3.6 million that was made available this year to support further development. That takes our total investment in hospital at home to over £8 million. Those services enable people to receive treatments that would otherwise require admission to hospital such as an intravenous drip or oxygen supply. It also provides access to hospital tests under the care of a consultant in people's own homes. Evidence shows that those who benefit from the service are more likely to avoid hospital or care home stays for up to six months after a period of acute illness. For older patients, it means being able to stay at home longer without losing their independence, and that has contributed to overall improvements in patient satisfaction. Local management information, collected by Healthcare Improvement Scotland, shows that between September of 2021 and February of this year, four and a half thousand people were treated by hospital at home services who would otherwise have been admitted to hospital. That equates to approximately 26,700 bed days. Acute exacerbations of chronic obstructive pulmonary disease, COPD, are the most common cause of admission to hospital in Scotland. That condition affects 120,000 people in Scotland and is predicted to increase by 33 per cent in the next 20 years. Ambulatory respiratory services support patients with COPD in the community, once in place services can be expanded to manage other chronic lung conditions. We have increased capacity for respiratory rapid response services, and they are reducing the number of occupied bed days, length of stay and readmission rates. Since mid-January 2022, 21,000 bed days have been avoided, and that averages at approximately 176 beds per day. We continue to work with boards to upscale their service and reduce variability in relation to what respiratory services are in place. The impact will grow as boards further develop their pathways, particularly in the community. We have also enhanced outpatient, pirentero, anti-microbial therapy capacity, which is a multidisciplinary service that provides an alternative for hospital admission or supports early discharge for a variety of patients with infection, usually requiring IV therapy. To date, 22,000 bed days have been avoided or the equivalent of up to 197 beds daily. To ensure that we can respond to the future waves of the pandemic and the potential resurgence of the virus, we have been working with partners to roll out nationally a Covid remote health monitoring pathway. Over 6,400 Covid remote monitoring patient packs have been provided to 10 territorial boards and the Scottish Ambulance Service, and another 6,000 packs will be distributed this month. We are also embedding the remote monitoring approach across other specialities such as respiratory and maternity. Planning continues with a view to expanding virtual capacity and aiming to double the overall provision of acute care that is currently provided in the patient's own home, creating greater on-site hospital capacity and resulting in better patient outcomes at lower costs. We have a range of other actions that we are progressing to support flows through the hospital and minimise delays for patients, either being admitted or discharged, including the discharge without delayed programme. To support our ambition of providing more care in the community, we are committed to expanding our district nursing services set out in the national workforce plan published in 2019 and providing the necessary funding to support that. We are investing £47 million from 2020 to 2025 to increase the workforce by 12 per cent. That will introduce a minimum of an additional 375 nurses within the district nurse service. The service supports people to stay in their homes, avoids the needs to be admitted to hospital or a care home and can support early discharge from hospital. Our health and social care services continue to face unprecedented pressures. We have a lot of work to do to help the system to recover, deliver our ambitions, ensure that the people of Scotland receive the highest standard of care that they deserve, reduce waiting times and increase our workforce across the system. There is absolutely no doubt that we have a long way to go to address the full scale of challenge in our health and social care services. However, by working collaboratively and with the continued commitment and dedication of NHS staff and those in the social care sector, I am optimistic that we will not only recover but also innovate and redesign to deliver lasting improvements for the future. The Government and I will of course continue to update the chamber on that progress. Indeed Minister, I advise the chamber that we are very tight for time, so I will have to require colleagues to stick to their speaking allocations, even if they take interventions. With that, I call Sanders Gohani to speak to and move amendment 4567.2 to 9 minutes. If we are going to make a difference, if we are going to deliver improvements, we need to reject complacency. However, this motion is what we have before us. Once again, the SNP Green Government submits a motion that is heavy on self-congratulation but hollow on real targets, real commitment and delivery. We know why. Across the board, the SNP records on delivering its policy. Delivering on its promises is abysmal. You want examples? It varies wildly over due and over budget. Highland aluminium smelter, BiFab, Presswick airport, the privatisation of ScotRail, free laptops or tablets for every child, bikes for the poorest youngsters, renewing play parks, the SNP cannot even run a census. On health and social care, the SNP promised to end delayed discharge from hospitals. There is a nursing and midwifery staffing crisis, record A&E waiting times and our social care sector is at breaking point, all under the SNP watch. We need to see decisive action and a commitment to quality and to think about measurable outcomes. For taking intervention, I wonder if the member could tell us what the record on those matters is. South of the border, where his party is in charge. Dr Gilhoney. I think your constituents, I think the people of Scotland want to know what's happening in Scotland. Do you know why? Because we represent the people of Scotland and we should do better. That's why the SNP Green government should surely recognise that Scotland is strong in data-driven technology and that we should be adopting and integrating technological solutions to deliver our hospital to home care services. I'm pleased to hear the minister underscoring the importance of technology in our health and social care setting. The data-driven innovation and AI technology in Scotland is thriving through UK and Scottish government programmes, funding from major donors as well, equates to over a billion pounds and is being pumped into innovation and skills development in Scotland. In healthcare, Scotland has greatness at its fingertips, literally. Scotland has the potential to be a world leader, developing, testing and providing medical technology. We just need to want it. Yes. Sandra Scott-Honey for taking this intervention. Would he not agree with me that the Scottish government implemented respiratory care action plan, which includes technology and delivery, is actually a good step forward because that isn't happening south of the border right now? The obsession with south of the border, but actually I do agree that using technology and helping people in the way that Emma Harper describes is good for the people of Scotland. Scotland has the potential to be a world leader in developing, testing and providing medical technology. We just need to want it more and embrace our homegrown, home-funded start-ups and university spin-outs. I would argue that we don't really have a choice and need the Scottish government to speed up funding. We all know our NHS and social care services face huge workforce challenges. On hospital waiting times, we have a toxic cocktail of delays, growing backlog and delayed discharge, all of which impact our social care system, despite the incredible work of our health and social care staff. A huge concern, however, is the SNP-Green government's drive to create a national care service, which in turn threatens to further delay reforms. Perhaps the Minister might wish to reflect on how a centralised social care provision would simultaneously support vulnerable people in both Glasgow and Shetland. I'm afraid I'll now push for time. The SNP government forever complains about being hamstrung by a lack of cash, but earlier this month we learned that the SNP has spent nearly a million on private consultations and private consultants as part of their plans to centralise social care. With one such consultant raking in £90,000 a month, all that Scotland has said that reform cannot wait for a top-down structural organisation. I urge the minister to accept that localism must be at the heart of social care reform. Localism will be at the very heart of the delivery of the national care service, and we have spelt that out. Can Dr Gohanne tell us how he would eradicate the postcode lottery of care that often goes on without bringing in and to play the standards that are going to come in to play with the national care service? When it comes to long Covid clinics, you're not able to do the same. Maybe you need to have a consistent policy. This is not the time to centralise social care services, and I'm glad that the minister said that this is not. Instead of pressing ahead with a bureaucratic overhaul of services, which could lead to an increase in out-of-care service, the SNP must engage with carers and those who need support to ensure that the highest level of care is delivered. Let's consider what respected bodies outwith the Parliament are saying about, the SNP's latest flagship adventure. COSLA says that the plans for national care service are an attack on localism. Go on to say that it's deeply concerned that the consultation represents a considerable departure from the recommendations of the Fili review. They add councils know their communities and all the evidence suggests that local democratic decision making works. Then there's Audit Scotland concerned about the extent of the SNP government's plans for reform and the time it will take to implement them. Audit Scotland report outlined that many of the issues cannot wait for the Scottish Government to implement a national care service. Stakeholders told Audit Scotland of services in near crisis and explained that our lack of action now presents serious risks to the delivery of care services for individuals. Lessons need to be learned from past restructuring and public reform. Audit Scotland notes that previous reports on these matters have found that reform is challenging and public bodies have experienced difficulties in implementing elements of reform. Expected benefits are not always clearly defined and they really should be. Reform does not always deliver the expected benefits, especially in the short term. I'm afraid I'm pressed for time now. Audit Scotland says that any difficulties in implementing social care reform could have a significant impact on vulnerable people who rely on care and support. There's another highly qualified view that we should listen to. The Fraser of Allander Institute states that until we know the shape and the final shape of the national care service, we cannot say much about the funding settlement that will be required. The Scottish Government programme for government does state it will increase spending over 25% over the parliament, providing more than £800 million by 2627, some way short though of the expected money from the national insurance contributions of over a billion. Analysis by the Fraser of Allander Institute have a state the definition of social care that the £800 million relates to is hard to follow and it is not clear if this is cash or real terms increase. Presiding Officer, no one here is suggesting that reforming our country's social care system is anything other than complex, but we need to focus on working with and supporting those who know the problems best. That is why the Scottish Conservatives have proposed a local care service, which would ensure that supporters deliver as close as possible to those who need it, especially in our rural and island communities. We really must avoid imposing a centralised system that could well be disjointed and fragmented and which loses local responsiveness and creativity. As we have seen with the control freakery of the SNP asking its MSPs to submit the supplementary questions in advance, there is a tendency from this Government to favour a command and control model and an insufficient focus on enabling flexibility. It is not as if we are dealing with an administration with an amazing track record of delivering on its promises, its goals and its value, which we most certainly are not. Our health and social care staff continue to work incredibly hard and deserve a system that works for them. That is why I am pleased to submit today the Scottish Conservatives motion, which I move in my name and I wish to draw members to their attention to my register of interests as a practicing NHS doctor. Thank you very much indeed, Dr Gilhane. I now call on Paul O'Kane to speak to a move amendment 4.567.1 for up to seven minutes, Mr O'Kane. Thank you, Deputy Presiding Officer, and can I begin today's debate by thanking our NHS and social care workforce? Their efforts over the last two years have been beyond exemplary and they have worked tirelessly to keep our families safe and well and to ensure that people continue to get the care that they need in their local community. I know the aspiration that the Government expressed today in its motion in this debate. There is a lot to do and a long way to go, we heard the minister say, but forgive me if I take a few moments to perhaps question the unfettered optimism of the minister because it is clear that there are significant challenges and barriers to building and enhancing virtual capacity to support that sustainable future and provide the alternatives to hospital whilst improving patient experience. The Government's motion fails to acknowledge many of the realities that are facing patients and health and social care workers on the ground. Constituents, I am sure, have told us all that they are waiting too long to see their GP and that they are not always aware of the how or the why of why they are accessing alternative clinical pathways. I think that that is in stark contrast to the Government's proposition today, because we cannot ignore the failure to meet any waiting times, the continued delayed discharge figures and the lack of a robust plan to recover services and support staff as we emerge from Covid-19. The Government's motion puts significant emphasis on alternative pathways, yet evidence before the health, social care and support committee has shown that not anywhere near enough work has been done to make people aware of those services. Evidence that is submitted by those who work in and support patients to access these services show that waiting times to access them are too long and the route is often convoluted, and as such that puts additional pressure on general practice and accident and emergency departments. That is not just a recent trend that can be explained away by the pandemic. Indeed, one respondent to the committee's consultation said that, even before the pandemic, waiting times were overlong and, normally, by the time that you see anybody, your condition is worse. GP practices are at breaking point and patients are paying the price, with the pandemic exacerbating years of decline under this Government. Indeed, a poll that was carried out last month found that 86 per cent of Scotland's GPs who responded said that they have felt anxiety, stress or depression in the last year. That is what happens when the Scottish Government does not properly fund and support our NHS. That is the result of patients and the people who care for them suffering. Those examples are not just one-offs. The recently published 21 and 22 health and care experience survey has exposed plumeting satisfaction with health and care services in Scotland. The proportion of people who are satisfied with the overall care provided by GP practices dropped by 12 per cent's points in two years, with almost a third of people rating their overall care negatively. I do not believe for a second that that is a reflection on our hardworking GPs, support and reception staff, but rather not enough clarity and support for people in terms of alternative pathways. When it comes to building back the foundations of the NHS stronger than before, the NHS recovery plan has failed to deliver. Audit Scotland highlighted that the recovery from Covid-19 remains hindered by a lack of robust and reliable data across the NHS. For all the Government's talk of increasing the number of allied health professionals, there were over 1,000 whole-time equivalent vacancies at December 21, simply not good enough in showing that Government's rhetoric is not always met with reality. Social care, Deputy Presiding Officer, is in dire straits. The SNP has presided over the slashing of care packages, the withdrawal of respite care and a fail to immediately implement key, feily recommendations, including the removal of residential care charges. The crisis in social care impacts clearly on our NHS. Delayed discharges are hitting record levels, unacceptable waiting times in A and E, and despite that, the pace of change in social care has been slow and is faltering in the face of growing pressures from increasing demand and demographic changes. For months, the Royal College of Emergency Medicine has been warning that longer waits lead to more preventable deaths. This week, they repeated their calls for 1,000 beds across the system, ensuring that a failure to tackle social care pressures is bad for patients and bad for key services across our NHS. The social care workforce is demoralised and, understandably, they feel undervalued. There are significant shortages across the workforce, resulting in record high-delayed discharges putting strain on key services across our NHS. Unfortunately, the Government is doing little to make social care a more appealing career choice. Only six months ago, the Government rejected our calls to deliver an immediate pay rise to £12 an hour. Instead, it opted for that measly £40 pay increase. Today, Scottish Labour is calling for sex to be taken to ensure that patients who need to be seen in person can receive speedy treatment. Urgent action is needed to fix our social care system. The wait-and-see approach of this Government regarding the national care service is not good enough. Non-residential care charges must be removed immediately, as well as reversing the recent narrowing of eligibility to care packages and reopening the independent living fund. As well as reform, there is an urgent need to tackle poverty pay in the sector, which has a predominantly female social care workforce and experiences long-standing issues in terms of gender inequality. The proposed increase from this Government does not reflect the skilled nature of social care work, and the growing staffing crisis that is directly impacting our NHS will never be addressed while people can earn more working in a supermarket or a pub. The future of our social care sector is dependent on a strong, stable and valued workforce, and that is why Scottish Labour supports the fight for £15 to increase social care workers' pay. We believe that they need an immediate pay rise of £12 an hour, followed by a further rise to £15 an hour. I think that I am in my last minute. You are, and you do not have any additional time, I am afraid. I apologise that I do not have any time, had it come earlier than possibly. Deputy Presiding Officer, I will conclude that our amendment seeks to put forward tangible actions that will truly focus on building the capacity that we need in our health and care system. I will focus on our social care workforce, improving alternative pathways and ensuring that people who can get home and that there is no wrong door for them in terms of their care will ensure that people get out of hospital and improve their experience in our local communities. In concluding, Deputy Presiding Officer, I move the amendment in my name and call on the chamber to support it. Thank you. Thank you very much indeed, Mr Acain. Again, I remind you that we are very tight for time, and I call Alex Cole-Hamilton for up to six minutes. Mr Cole-Hamilton. Thank you very much indeed, Deputy Presiding Officer. I am pleased to rise for my party in this important debate. It will come as no surprise to members of the chamber that, as a Liberal Democrat, I will always champion services being kept as local to the people that they support as is possible. It is one of the principal reasons therefore that my party are against the creation of the national care service. Centralising services to ministers is not the answer to the on-going crisis in social care. It would take good local services and bring them under Scottish Government control, taking the power away from the providers who, let's be honest, know far more about what patients and staff require than this Government does. You only have to look at the scandal of sending untested and even Covid-positive patients into Scotland's care homes at the start of the Covid-19 pandemic to know that the Scottish Government should be nowhere near this. It is not just the plans to create a national care service that highlights that Government does not want to keep care close to home no matter what this motion may state. In Caithness, many expectant mothers now need to travel over 100 miles down the A9 to Inverness to give birth. That journey takes over two hours and there are on-going fears about unexpected complications for both mothers and their babies. Women face being stranded too far from home or a hospital to give birth safely. Compare that to writing here in Edinburgh. An expectant mother in my constituency, Cramond, would need only travel half an hour to get to maternity unit at ERI. Given the work that this Government has rightly undertaken to resolve issues with the Murray maternity service, you would think that it would strive to do something similar for Caithness, presiding officer you would be wrong. My colleague in Westminster, Jamie Stone, has been raising this since he was elected in 2017. He has repeatedly asked this Government to undertake a safety order. Even to the point of inviting the Cabinet Secretary himself to take a journey, many women are forced to endure every day from wick to raid moor. The Cabinet Secretary has seemingly so far refused to do so. He has not explained what meaningful action he is taking instead, and that is simply not good enough. Every single expectant mother in this country should be able to easily access maternity services close to them. They deserve access to the support that they need as they go through a major chapter in their lives. That should go without saying. Earlier this month, my colleague Beatrice Wishard raised the fact that there are no dedicated inpatient mental healthcare beds for new mothers to receive care alongside their babies at a mother and baby unit north of Livingston. That means that mothers in places such as Lerwick, Stonaway, Ullipool, Dundee, Hoik and Sennar could travel for miles to get the care that they need. I will briefly... Mother and Baby units are very highly specialised units for perinatal and infant mental health, and they could never be everywhere in the country. That is why we are strengthening community-based facilities. What I would say to Mr Cole-Hamilton in the chamber as a whole is that we have currently a consultation on MBU's, and I would really like as many folk in Scotland to respond to it, it closes at the end of the summer. Mr Cole-Hamilton, I am grateful for the intervention, but they are not in the places that they are required, nor is the peripathetic services on the ground that they can offer that service. It means that mothers and their babies are forced far from home and networks of support just when they are in their most need. The Government may point out that those units only need to support 150 women per year, but it is vital to note that there are 125 women every year who within 12 months of childbirth will receive treatment at an inpatient mental health unit, where they will be separated from their babies. The Government may also say, as the minister did earlier this month, that they are aware of barriers associated with receiving treatment far away from home, hence the mother and baby unit family fund. However, families need more than this. Women need to have access to treatment much closer to home, not as the Royal College of Psychiatrists say a postcode lottery when it comes to perinatal health services. Sadly, it is not just new and expectant mothers who have to face travel far from home. Many of our children and young people have or are waiting for a CAMHS referral. I am sure that I am not the only MSP who will have had families getting in touch to share their experiences of the system and in increasing volumes. Many who need support will, for the most part—I am afraid that I do not have time—have access to community services that provide help close to home. However, sometimes, more specialist treatment is required. In that case, options are becoming severely limited. There are only three in patient units dedicated to mental health of children and young people, and none of them are north of Dundee. In 2018-19, 118 admissions involved 101 young people under the age of 18 who desperately needed mental health support due to lack of space. Many of these additional—I really do not have time—were to adult units. Presiding Officer, we live in a time of increasing awareness around the mental health of our young people, yet we still fail to provide the right support for them. Some of them may be forced to travel potentially hundreds of miles away from their communities and their families just when they were most in need of stability and support. I find it appalling that this Government has allowed things to get to this stage. It simply must do better for our children and young people, Presiding Officer. No one in the chamber, nor indeed across this country, would doubt for a moment the vital work that our NHS does. That said, many people will not have access to that vital support in their communities. That must be rectified once and for all. This Government talks a good game when it comes to health and social care of this country, but one word in platitudes means nothing to the patients and staff who are having to suffer at the business end. It is time that this Government acts in their interests. I remind the chamber that members need to be in not just for the closing speeches, but for the opening speeches if they intend to speak in the debate. I call Gillian Martin, who will be followed by Alexander Stewart, for up to six minutes. Thank you, Presiding Officer. There are lots in the Government's motion to mention, there are lots in the Minister's speech to mention, but I want to talk about two aspects of reform—the roll-out of national treatment centres and the types of working that keep elderly people living independently for longer and highlight some of the evidence in relation to both of those issues from people who have engaged in the Health and Social Care and Support Committee over the past year. I am very pleased that NHS Grampian is one of the five boards in Scotland to receive Scottish Government funding to build a national treatment centre. The likely location is Aberdeen royal infirmary. The centres plan to be up and running this year and to improve the patient care service. The services to be included in the centre are outpatient urology, dermatology, respiratory medicine, day surgery and dosk facilities, MRI and CT scanning. As I have said, one of the aims of the development of the 10 centres is to reduce waiting times and give patients quicker access to procedures and diagnosis. However, I want to point to something that we have heard a few times in the Health and Social Care Committee, which I want to draw to the Minister's attention. I think that we need some serious investment. That is patient information. We have heard quite a lot that patients feel left and limbo when they are put in a waiting list hearing nothing more till they get their appointment letter, a system where patients can monitor where they are in the waiting list and when they can expect their treatment to reduce anxiety, manage patient expectation and allow people to plan and get ready for their procedure. Clinicians have said to us and to me personally that a patient knowing when they are going to undergo an elective procedure can allow those around them in the healthcare their GP and other health professionals to work with patients on their pre-operative care. That could mean dietary programmes, exercise, physiotherapy programmes and regimes ahead of surgery, if that is what they are having, which would ensure that the body recovers more quickly. However, it will also allow the patient to feel that they are working towards treatment, that they have a locus in their treatment, that they are actively involved in their treatment rather than simply waiting for a letter to arrive. That is a psychological thing, but that is important. There could be quite a gap between the diagnosis saying that they are going to have a procedure and getting a letter for it. I said at the start that I also wanted to mention independent living and care packages for the elderly. It is an issue that chimes with any of us with elderly loved ones, which is probably all of us, Presiding Officer. We have long had an issue in this country that many of our elderly population end up having hospital stays, sometimes quite long hospital stays, when that could be avoided. We also have variable rates of delayed discharge across health board areas, although I was very encouraged to hear the low figures of only 19 delayed discharges in Aberdeen, Royal Infirmary and Minister mentioned that in the evidence last week. When he talked about the success of the Granite Care Consortium's strategies in guilting elderly patients out of hospital swiftly with appropriate care packages and systems and interventions that keep a person living independently for as long as possible are our goal here. We know from clinical evidence that elderly patients can become disorientated when out of their familiar home environment and that physical strength and mobility can also deteriorate when they are in hospital. That can mean, in some cases, that they might not be able to go home at all. It might need more intensive nursing home care when they do go and that waiting for an enhanced care package could mean that they are in hospital for far longer than the other need to be or longer than is actually good for their mental health and physical health given the potential for the deterioration that I have just outlined. A hospital-at-home-type system that has been mentioned by the minister already can prevent hospitalisation in the first place, with targeted acute care interventions delivered at home. I really look forward to evaluating how that has been rolled out. I realise that it is not maybe out of the whole country yet, but I am really looking forward to seeing where that has been rolled out and what the outcomes of that have been. The good practice in Aberdeen, which I am obviously going to mention as much as possible, is what I was going to mention in an intervention to Alex Cole-Hamilton when he talked about CAMHS, because there is a success story in CAMHS in Aberdeen-Grampian area. The good practice in Aberdeen was mentioned again and highlighted by Dr Donald MacAskill in February when he came to speak to our committee. He pointed to agencies working in collaboration with one another when it comes to getting care packages that are prepared with the person that they are supporting at the assessment stage. That person is made aware of the options available to them and they can exercise control and choice with their front-line workers, the person that they see all the time, who that front-line worker is also able to exercise autonomy because they know the needs of their clients best. They do not have to get a second guess from someone else, they do not have to go through any procedure, they can put it, there is trust there. Dr MacAskill highlighted one very interesting aspect with work in regard to the role of the care technology in allowing a person to live independently in their homes for longer and pointed to Aberdeen again as getting it right in that area. It strikes me that that good practice is something that maybe needs to be rolled out and communicated across health board areas and health and social care partnerships. That good practice strikes me that it is not only that this approach is best for the people that are so-called clients, I heard that word, but people who need care, but that culture of trust is one in which front-line workers will be best able to do their jobs and hence more likely to give the type of job satisfaction that will keep them in the sector. We keep on hearing about people leaving the sector, we keep on hearing about this churn. I am going to just finish up with Dr MacAskill's words on the successful model. He says that there are lots of models that have consistent thread, which is partnership, collaboration, equality of treatment and critically trust. What best practice has it at its heart is collaboration rather than competition and trust rather than suspicion. I am grateful for this opportunity in contributing to the debate, which is key to this Parliament setting out its vision for care services in the coming years. I will be speaking in the support of the amendment in the name of my colleague, Sandesh Galhani. As others have done, I would like to put on record my thanks for all the hardworking staff within the care sector, both within my region and across Scotland. Those individuals have faced immense pressures over the past two years, yet have gone above and beyond to provide services for their opposed to required. The debate concerning how our social care system should be delivered is one that is rightfully being viewed with fresh eyes as this country continues to learn lessons over the past two years. However, while it is a good time to be debating those issues, it is also clear that many of the questions predated the pandemic entirely. The case for a meaningful investment and reform in our care system has long been clear, but it is far less clear how far such reforms should go and how quickly they should be delivered. However, unfortunately, the prospect of facing the sector as it stands is one of significant centralisation. Change may be needed, but now is not the time to overhaul care services in a way that is being proposed. Our amendment speaks about the importance of service to be tailored towards local need. Should enough, one of the things that was clear to me throughout my 18 years in local government was why care services are delivered most effectively at a local level. It is no accident that good quality care has always been associated with high localised delivery of care in many areas, and it must be scrutinised very carefully, if we are to see changes. For 15 years, I worked as a senior support for archhousing, and that gave me a first-hand insight into the processes, the procedures, the difficulties that face the sector and the service users. However, while we are clear that the services that are best delivered are at local equal, it is clear that the services that are delivered will need to depend on being properly funded. Today's debate is not time to rerun debates concerning local government funding, but the erosion of real-terms funding that local government has endured over the past decade is part of the reason for some of the problems that the care service has to advance and deal with on a day-to-day basis. Many of my challenges and my colleagues providing support across services are long financial security, and they ensure that they do that, but the reforms that we have to have to be lived up to. Mr Stewart talked about funding here, as did Sandesh Galhany earlier around the national insurance increase and the possible consequentials that will come to Scotland. Will Mr Stewart and his colleagues join me in asking the chancellor for some clarity about when we are likely to see that money and how much we are going to get here north of the border? I thank the minister for the intervention. Billions of pounds have been supported by the UK Government into Scotland over the past few years and will continue to be, so I have no doubt that money will come in close contact. Although the phasor of Allander institute has stated that the local costs of the national care service may not be known at this time, or that Scotland has estimated that those reforms will cost in the region of £600 million, a figure that may rise even further depending on the full reach of those reforms. Clarity of the cost, as well as the commitment from the Government to meet them, is something that we have yet to receive, despite COSLA and ourselves calling for that from back in last September. I would also like to raise the issue of workforce planning, which is something that the Government is still getting wrong and has had issues with for some time. Warnings from the BMA Scotland about the health and social care workforce pressurise pre-empt the pandemic, and we have to involve the caring support and the professionalism that is there. The publishing of the national workforce strategy in March is a step in the right direction, but the plan left many important questions unanswered. The strategy, the emphasis, the importance on attracting people into the caring profession is very much the case, and we need to also look at the long-term retention of workers. While I welcome the 1800 training places for caring roles, which will be funded through the national training transition fund, it is important to uptake those places as monitored closely to ensure that supply meets the demand. The recruitment strategy of the social care is due to be published by the end of 2022 and must be appropriately ambitious, given the scale of the challenges that face the sector. Fundamentally, we believe that local approach should be the centre of any care reforms and that local government should receive the support that it needs to deliver high-quality integrated services to ensure that they meet the demands of the individuals and the community. The title of the debate today is Keeping Care Close to Home. It is a very good soundbite, but I hope that in the coming years we see this becoming not just the narrative but the reality for communities in Scotland and all across Scotland, because that is what they deserve. Thank you very much. We should do it now, Paul MacLennan, to be followed by Sarah Boyack for up to six minutes, Mr MacLennan. Thank you, Deputy Presiding Officer. The last two years have been the most difficult of this country and indeed any health service has ever seen. No one could have forecast impact the pandemic would have and is still having and will have for quite a while yet. Most people want to be cared for at home, if possible, and to cover at home as soon as they can. There are a number of Scottish Government policy developments that seek to keep care close to home and improve outcomes, and I will touch on these later. The NHS in Scotland still remains under severe pressure. Covid-19 created a growing backlog of patients waiting much longer for treatment. That backlog creates a significant risk to recovery plans, and I think that the minister acknowledged that. Reform is key to the sustainability of the NHS and it must remain a focus, building on innovation seen throughout the pandemic. During the pandemic, many new and different ways of working were developed to support the continued delivery of critical services. We need to support innovation in and redesign of services to ensure that more patients receive personal-centred care in the right place, at the right time and in a way that helps staff to deliver high-quality care and treatment. There are a range of partner organisations that are central to research, innovation and service reasons. Those include the new national centre for sustainable delivery, NHS national services, the digital health and care innovation centre, health care improvements to Scotland and the Scottish health industry partnership. The increase in digital plan for before the pandemic and significantly accelerated as part of the response to the pandemic means that the time is now right to ensure that digital is always available as a choice for people accessing services and staff delivering them. That will allow more people to manage their condition at home, to be able to carry out key and post-operative assessments remotely and to continue to manage their recovery from home. The new national centre for sustainable delivery for health and social care, and I will refer to that at CFSD going forward, will be particularly important in driving innovation. It has been established to pioneer and deliver new, better and more sustainable ways of delivering services. It will be key to supporting NHS recovery and will aim both to reduce a necessary demand for services and help to develop new pathways of care. The CFSD will work collaboratively with partner organisations, academia, third sector industry to identify and implement improvements to care pathways across Scotland. It will also ensure that patients have access to appropriate clinically relevant information to inform their decision making. It will make sure that patients are aware of the terms that are available to them, including non-operative interventions. As part of our recovery, NHS and social care workforce planning has never been more important. Our workforce is at the heart of delivering health and social care services to the people of Scotland. Over 400,000 skilled and compassionate people work in many different northern settings in an integrated way. The Scottish Government has introduced measures to support staff and is monitoring their effectiveness. Scottish Government plans to recruit and retain staff that are ambitious and will be challenging to achieve, given that NHS is historical struggles to recruit enough people with the right skills. Our NHS social care and social work staff have been remarkable throughout the challenges faced throughout the Covid-19 pandemic. We all have to acknowledge the significant pressures that our workforce has faced and that sustained actions are required from, for planning and attracting into the workforce to support and develop our workforce. Supporting, delivering recovery and growth and transformation of that workforce. The workforce strategy sets out a framework to achieve a vision of a sustainable, skilled workforce. The Scottish Government has a track record of investing in our people, with record staffing levels in the NHS in 10 consecutive years of growth. The Scottish Government published a NHS recovery plan in August 2021, which set out key ambitions and actions to be developed and delivered over the next five years to address the backlog in care and meet healthcare needs for people across Scotland. That is part of a wider whole-system response, including social care and support from within communities. I want to touch at a hospital on home that I refer to earlier on. Hospital at home is one of the main ways in providing more care in the community and reducing pressures on hospitals. The ministers referred to £3.6 million that was available to support the expansion of hospital at home services with the aim of doubling current capacity by the end of 2022. The purpose, of course, of the service is to reduce hospital admissions for elderly patients by providing treatments in the comfort of their own home. All health boards can apply for money to help either develop or expand their services with the aim of doubling capacity for hospital at home, as I said by the end of 2022. The Scottish Government's total investment in these services is now £8.1 million since 2020. Evidence shows that those benefiting from the service are more likely to avoid hospital or care home stays for up to six months after a period of acute illness. We know that frail patients tend to occupy hospital beds for a longer period, and that is why the scheme has been expanded. Reducing the number of prolonged hospital stays, we will free up more hospital beds. In 2021, a new £20 million community living change fund to help to redesign services with complex needs was launched. That helped to address services issues raised in the 2018 coming home report about the need to avoid out-of-area placements and delayed discharge for people. The community living change fund is available to health and social care integration authorities to redesign and design community-based support for people with complex needs who, in the past, have endured long-stays in hospital settings or seek care outside of Scotland. In conclusion, continuing investment in a NHS workforce and digital transformation, combined with specific care at home initiatives, will see more people care for at home where they want to be. I also want to add my thanks to all those who work in our NHS and care workers for their incredible work through the pandemic. I suppose that the challenge is that their work is still pressured, they are still having to work long hours and we are still dealing with the after-effect of the pandemic as the health system in our care sector has to recover. What promoted me to speak in today's debate was the emails that I have been getting from constituents coming in on a regular basis. They are in touch because they are needing help in accessing care, either for themselves or for their relatives, and they cite deeply troubling and frustrating experiences. For example, people with dementia whose relatives are very worried about the length of time it is taking them to get access to care, which means that they can either be stuck in hospital or they are actually at home without the support that they need. That is something that worries their relatives. There are also people whose relatives have been stuck in hospital for a variety of reasons, but the key one being that there is no care available for them at home or their home needs to be made physically accessible for them and there are delays that prevent that from happening. Again, that creates stress not just for the person themselves but also for their families. It is not good for people's health and it has a definite negative impact on our NHS. If you look at the numbers in NHS Lothian, for example, in terms of delayed discharge, we are still seeing more than 200 beds a day taken up by people who are ready to actually leave hospital. It does not mean that they are entirely healthy and well, but they have finished the point at which they need hospital care and they now need care at home or step down care. It is really important that we get an approach that looks at all those things. The problem that I have with today's SNP motion is that it does not begin to acknowledge the scale of the crisis that people are currently facing who are getting in touch with us. I agree with the suggestion in the motion that more patients if it is very brief. I am happy to meet Ms Boyack to discuss the kind of cases that she has. I agree that it is unacceptable the weights here in Edinburgh. In comparison and contrast, as Gillian Martin pointed out, there are only 19 delayed discharges in Aberdeen. What we need is replication of what is going on in Aberdeen here in Edinburgh, giving the front-line staff the autonomy that has been given in Aberdeen to make sure that we get it right for people in this city as well as in Aberdeen. The challenge is that we have a city with an ageing population where we are growing, we are living much longer, so there is an infrastructure issue in terms of the accessibility of people's homes in the city, in terms of the care that is being provided, and it is not just from the pandemic that those statistics of delayed discharges go way back. That is why I am worried that the minister does not acknowledge the scale of the crisis that we have in our city, because nobody should fear growing old, getting ill or becoming vulnerable and not living a full life of dignity and respect, nor should their families have to worry. I will very much take up the minister's offer of a meeting, because as I make progress in my speech, there are particular issues that people have raised that I think the Government could be acting on now. A key issue that we get regularly from nurses and carers that we meet is that although they enjoyed us clapping for support through the pandemic, there are real issues about finance and the real issues about salaries, and delivering national terms of conditions and creating career opportunities is absolutely vital if we are to retain people in the care sector and recruit them to make it an attractive choice for people. We are in a cost of living crisis, so paying going forward has to be critical to that success, and that is why our amendment says not just an immediate rise to £12 an hour, but we need to go up to £15 an hour. As Paul O'Kane said, an extra £48 an hour does not cut it. If you look at the cost of private rent in Edinburgh, it is £1,000 a month, so that is a lot of money for people on low incomes. The fact that so many contracts are insecure or temporary and that 15 per cent of staff have to work unpaid overtime means that people will not see the care sector as a reliable long-term career opportunity, and that is one reason why we are experiencing shortages in terms of recruitment. I have also had feedback from families who are deeply unhappy about the issue of not being able to earn an income who are caring for a relative. It is simply not sustainable for many families to look after a relative full-time, without limit, without an income. Tomorrow, we have a debate on community wealth building. In summing up, I would ask the minister to reflect that there is a direct read across to this debate, because we could be supporting community and co-operatively owned not-for-profit care companies, which would give people decent employment, let them shape care in their communities and enable them to work as carers for relatives and reinvest in our communities. That is something that I have had directly from really distraught constituents getting in touch. For too long, we have relied on unpaid carers without giving them proper support and acknowledging the sacrifice that many people make. However, in a cost of living crisis, that pressure is going to be ramped up massively if people have to give up work to care for a relative, so we have to rethink how we support families. The points that Paul O'Kane made in his opening comments about addressing the funding gap that is identified in the Feeley report, giving people access to social care when they need it, reopening the independent living fund and looking for funding for respite care to support unpaid carers, because they need to be able to keep caring as well. We also need to look at reversing the narrowing of the eligibility for care packages. There is a lot that could be done now. It is worrying that, when you look at the statistics, 43 per cent of carers in a recent survey said that they did not feel supported to continue caring. We need to make sure that we fund people. I will finish on the point that we also need care homes. We are losing potentially five in Edinburgh that are council care homes, and I hope that our new councillors will look at that alongside care at home. I now call Christine Grahame to be followed by Julian Mackay. I would advise that we have no time in hand. The speeches are up to six minutes maximum and interventions must be absorbed within the allocated time. Ms Grahame. First of all, I start with what we all agree about. That is the consideration and dedication of our care workforce. We also agree that we want people who need care to receive this at home, or as close to home as is practicable. The practicality will depend on the level of care and, of course, on the level of funding that is available. I want to confine my contribution to care of the elderly. Let me start first with the positive. That is free personal care, introduced in 2002 by No Means Perfect, but introduced then under the Labour Liberal Executive and supported by the SNP. A recognition that helping someone, for instance, to dress her, open a can of beans and heat it should not incur a charge because they would not be charged for that in a hospital setting. According to the most recent information that I could find in 2017-18, it was nearly £500 million in costs and, of course, rising. Later, the Scottish Government introduced legislation to provide us to the under-65s in 2019, and that is a cost of £2.2 million. Secondly, I would add the integration of the funding of health and social care. In 2016, the Scottish Government legislated to bring together health and social care into a single integrated system, not an easy request, but what it was trying to do was to stop the competition between NHS budgets and social health budgets by giving the money to the health boards in the first instance. I think that that was an important step forward. It has had its successes, it has also had its difficulties. Both of those examples recognise the reform that was needed as the ageing population grows. Regrettably, I am part of that ageing population, being a septogenarian, so I appreciate the physical difficulties that arise, notwithstanding what you try to do as age interferes with your lifestyle. However, Covid has exacerbated the need for radical reform and the extent of the demand. I therefore welcome the intention to create a national care service that sets out, this is for Dr Gilhane especially, inter alia, to provide for consistency and improvement to be led at the national level, but ensuring provision of services are locally accountable and responsive to the needs of their communities, and they are designed at a local level with the input of those with lived experience. I do not read into that. Let us see how it develops. I do not read into that a power grab. I read into consistency in the level of the services, but the delivery and the design at a local level are the best of both worlds. Why has this fell so miserably with the GP contract? On the case, I am tackling the national care service, your point was that this would interfere with local design and delivery. That is not what is put in the proposals, which we can challenge a later date. However, all of these proposals take money. Where does this money come from? Here I come back to everything that we debate in this Parliament. Currently, the biggest chunk of the Scottish Government budget goes to the NHS. Over 80 per cent of that is for fixed costs, for hospitals, all the staff, all the laundry, all the transport, all the ambulance services, all medicines, GP services and so on. If you want to do more, then money must be raised, but we have very limited powers in year. Income tax, none on that, none on national insurance, none on companies tax, none on tax, fuel duties and so on. Given that, the list of the demands that the Opposition amendments make, while I think are perfectly reasonable, we need to fall at the first fence. Funding. Already £770 million has been taken from our budgets to mitigate Tory cuts to the very vulnerable in Scotland. 5.2 per cent has been cut in our resource budget and 9.7 per cent in our capital budget in real terms, not the Scottish Government figures, the independent Scottish fiscal commission. As you look at the nations that have the highest ranking for care of the elderly at home, then cast your eyes over the North Sea to Finland, Norway, Sweden and Denmark, internationally recognised as topping the charts, small independent nations with taxation powers to ensure their care services meet demand with compassion and can be funded. How can these nations—I mean in my last minute—how can these nations do this, and Scotland can't? We have similar populations, and in some we have similar communities. The difference is that they have control, not only of the policies and the social policies with which I agree with the Labour benches, but of their economies. They are independent. They tax justly. They tax the right people to deliver the services that we all want seen. You can come back here collectively over and over again and ask for more and more. In the summing up in the amendments, I would like to hear how they are being paid for and which budgets they are coming from. Do not mislead people that these things can be done when our hands are tied financially. I, too, would like to echo the comments of those who have spoken before me with regard to the dedication of our health and social care staff. The NHS, as it is, is currently set up as a national sick service. Too much care is still provided in hospitals and treatment services are prioritised over prevention. Meanwhile, demographic changes that we have heard from Sarah Boyack and Christine Graham have placed increasing pressure on services that have struggled to keep pace with demand and have had significant challenges due to the pandemic. The Christy commission made the case for shifting care into the community 11 years ago, but we have not seen the progress that we might have wanted to since then. I therefore welcome the clear acknowledgement from the Government that we need to increase our focus on prevention and early intervention to support people to live health their lives, and that begins in the community. Supporting and building community services and the community workforce will not only improve health outcomes, but will also enable hospitals to focus on acute and specialised healthcare. To effectively shift care into the community, we need to take a holistic whole-system approach that acknowledges the need to build community provision while reducing pressure on hospitals. Building capacity and social care will help to reduce delayed discharges that will alleviate pressure on hospitals and ensure that no one is stuck in a hospital bed when they do not need to be. Not everyone needs to be in hospital and not everyone needs acute care. There is ample evidence that health outcomes can worsen if people are in hospital and they do not need to be there. I have heard from stakeholders the impact of staying in hospital can have on those with certain health conditions. Disruption in routine and removal from familiar surroundings can contribute to deterioration in conditions. Gillian Martin raised many important points of good practice in our constituency, but I think that it again centres on an important point, which has been a running theme at health committee. That is how we ensure sharing of best practice without adding a burden to clinical staff. I do not think that we have the correct answer to that as yet, but I do feel that it would help in many services, not just in terms of how we deliver good care locally. We need to expand services such as hospital at home, which provides treatment and support while allowing people to be cared for in their own home. This is particularly important for older people with frailty who are at particular risk of being affected by institutionalisation and delirium. According to healthcare improvement Scotland, some 30 to 56 per cent have been shown to experience a reduction in their functional ability between admission to hospital and discharge. Reducing hospital admissions where appropriate can lower the risk of deterioration and support people to live more independently at home. For many people, being discharged from hospital is just the beginning of a difficult journey, and people living with long-term conditions are at higher risk of re-admission if they are not supported to self-manage their conditions. The third sector plays a vital role in supporting people in the community, and there is great work being done to assist people after discharge. Chest, heart and stroke Scotland's hospital to home service supports people who are returning home after a stroke or have been discharged from hospital with a chest or heart condition. It works with the NHS to build a personalised, flexible package of support, which can include setting recovery goals, emotional support and help maintaining physical activity and exercise. It is a great example of how third sector services can work alongside the NHS to make sure people can get the care that they need in the community without having to go into hospital. Primary care will also continue to play an essential role in supporting people to live healthy lives in the community. 90 per cent of patient contacts are through primary care and GP practices are often the first point of contact for patients. We need to expand the multidisciplinary team and increase the range of services that people can access at their local practice. During the Health, Social Care and Sport Committee's inquiry into alternative pathways to primary care, we heard much of the important role that community link workers play in general practice in connecting patients with resources in their community. GP's often only have 10-minute appointments with patients, which can limit the issues that they can cover, but link workers can spend more time speaking about complex social issues such as housing, benefits and employment, and engage patients with social prescribing, which was described by one witness as the bridge between the community and the NHS. RC GP Scotland has been calling for the roll-out of community link workers to all practices in Scotland. I am pleased therefore that it is part of the Bute House agreement that the Greens and the Scottish Government have committed to expanding community provision of mental health services linked to GP practices. Enabling people to access mental health support in the community without having to go on a waiting list will mean that more people can get the help that they need when they need it, while also reducing pressure on acute and specialist services. The Scottish Greens also support the embedding of welfare rights advisers in GP practices so that people can be connected to services that can support them with money advice and benefits. I welcome the Government's commitment to place money advisers in up to 150 GP practices in deprived areas. We know that the impact, stress and pressure on income can have on those with long-term health conditions and ensuring people can afford to keep themselves well is essential. Alongside providing services in GP practices, it is important that we empower people to access community support themselves. During committee sessions, we heard about the role of ALICE, the local information system for Scotland, which aims to allow people, living with long-term conditions, disabled people and unpaid carers, to access the information that they need to help them to live well. Having one point of contact for people who are looking for resources and support within their community is valuable, as it allows people to find out for themselves what is available without having to search through multiple sources. However, while ALICE was felt by some committee witnesses as a useful resource, other described it as difficult to use as it was not updated regularly. I would be grateful to hear from the minister what plans are under way to improve ALICE as it seems to be an invaluable resource that we should be making the most of. In this session of Parliament, there is a renewed focus on prevention and early intervention in community care, but that must be followed up by real action. We must now act to keep care close to home and I look forward to working with members across the chamber to realise that ambition. I am pleased to be able to participate in today's debate, adding my support to the Scottish Government's motion. I would like to start by adding my own personal thanks to Scotland's NHS and care staff after the incredibly difficult period that we have all gone through. We really do have to appreciate their efforts on the front line of the pandemic. It really was one of the most challenging periods for our NHS, and that must be recognised. Our NHS and social care staff played an immensely important role on the front line of the pandemic, providing healthcare and and or social care for those who required it. I do not think that we should ever forget about the selfless work that they put in throughout the whole pandemic, and we must make clear our thanks at every single opportunity. As we look to recover from the Covid-19 pandemic, we must use this opportunity to learn from the past two years and build back better, investing in our healthcare system after the pressure that it has been under, and using the lessons learned to build a more resilient healthcare system that is fit for the needs of the population and is fit for the future. It is key to invest in our NHS and our social care staff who have given so much during the pandemic and ensure that they feel valued and are able to react to the change in needs to our healthcare system. I am well aware of the public sector commitment. My sister-in-law is a nurse in the ICU, it is Reg Moore, and she was there at the very heart of the pandemic, but it was not just her that was affected, it was also her family. My nephew, barely 12 years old at the time, I remember of Facebooking him and he said to me, Auntie Jake, he says, I am so proud of my mum, he says, I worry about her every day going to work, but I know that she is doing the best to try and help as much people as possible. Presiding Officer, this recovery will not be easy. The pandemic has seen our NHS commander immense levels of pressure and the recovery will not be easy with waiting times for non-urgent procedures much higher than we all would like, but our Scottish Government has my full confidence to get us through this. With a record £18 billion committed in the Scottish budget to help both healthcare and social care, deal with the challenges moving out of the pandemic and into the post-pandemic era, and within that spend a commitment of £1.6 billion for social care integration, which will lay the groundwork for our new national care service. Although the Opposition members may like to view this as centralisation, I welcome the Scottish Government's commitment to ensuring services are designed at a local level while engaging with folk who have lived experience to achieve a person-centred approach with strong local accountability. People need to be at the heart of the decision-making around all of this to ensure that we get it absolutely right. Not just patients, but our healthcare and our social care staff as well. That is why I am pleased that the Scottish Government is investing in the wellbeing of our health and social care staff as well as the mental health of patients. I am sure that everyone would agree that those are incredibly difficult jobs, both mentally and physically, and it is crucial that our staff are able to seek assistance when required to allow them to perform at their best moving forward. We will only continue to see a healthcare system that works for patients if we continue to invest and innovate. The investment that is committed by the Scottish Government is absolutely key to the future of our healthcare system. Additionally, the investment in our staff to ensure that we have facilities that are fit for the needs of the population and fit for the needs of the future. Staff who are paid well can also cope with the pressures both mentally and physically that the jobs may demand. We have heard from the Labour amendment today that it would like a pay rise for the workers of up to £15. Most of us across this chamber would love to be able to do that if it was possible. My understanding is that we get no consequentials for pay rises, so we have to absorb that into the budget, but we have not seen a budget alternative from the Opposition sides. The member is, hopefully, coming to her last minute. When they are summing up, I would like to ask them where they would like to take the amount from. I say some across the chamber would like to give a pay rise. I know that the other side was suggesting that a public sector worker should take a pay cut of 20 per cent in the height of the furlough scheme. The commitment that the Scottish Government has shown in investing in our health service, committing to increasing investments in front-line health services by 20 per cent over this parliamentary term and committing to investing £10 billion over the next decade to upgrade our health infrastructure, ensuring that we have an NHS fit for the future, and that an environment in which patients continue to access high-quality care in world-class facilities. That is why I am supporting the motion today through establishing a new national care service. Before I begin, I would like to declare an interest. It will not have escaped the notice in the Parliament, but I have a disability. As such, I rely on carers to help me in my life. Those are people without whom my life would be more difficult, people who work hard, not only to ensure that my life is easier but a number of different people every day. Excuse me, Mr Balfour, could you please resume your seat for a second? Could I please ask the members to show some courtesy to Mr Balfour and not turn your back in the chair? For this reason, I want to say from the outset that I understand that the debates that we are having on this topic in this chamber regard real people who do real good in the lives of some of the most vulnerable in our society, and we should never forget that fact. The United Kingdom is unique among nations in the way that we provide care for those in need through our NHS. We have seen clear evidence for this throughout the pandemic where doctors, nurses, porters and others stepped up to care for all of us under unbelievable tough and stressful conditions. It stands an example of a way that the people of this country look after those in need. It does not discriminate based on the nature of the timing of the need. We in this country care for those in need. It is of the utmost importance that we preserve this national instinct for care and make sure that those who need it get it. The only way to achieve this is by properly supporting our carers in their jobs. There are over 700,000 unpaid carers in Scotland. None of them are properly supported in the essential work that they do. We have to ensure that all those people who provide care in Scotland, regardless of circumstance, are appropriately compensated so that they are not forced to look for two jobs but rather can see care as a viable career option. There are many elements or issues that are encompassed by today's debate, but I want to come to the proposed national care service. I feel that this proposal represents another instance of the SNP conflating doing something with doing something helpful. There are lots of arguments that can be made for a local approach to care as opposed to a centralised national service that the Government is proposing. However, the most compelling reason to a skeptic like me is that, in every instance, this Government has attempted to absorb power from locally to centralise it in Holyrood that has gone poorly, poorly wrong to save the lease. You would think that a Government that has been in power for 15 years would learn some lessons from its experience. In every instance where the Scottish Government has attempted to centralise the power of an institution, it has found itself presiding over declining efficiency and decline in good service for the people that it is trying to serve. I am not the first nor I will be the last to bring up the issue of Police Scotland. Look what happened with centralisation. Since the formation of Police Scotland in 2013, more than 900 police officers have been cut from local divisions. 140 police stations have closed since the formation of Police Scotland, which has affected rural communities particularly. Far from benefiting communities and merging, it has had the opposite effect. This Government has the opposite of the Midas touch. Every time they take up on themselves to hoard power in a central bureaucracy, communities suffer, individuals suffer. I feel that this road is heading down with the national care service. The Government will expect a central power to deal with the unique community needs of the people of Scotland, and has happened so many times before that the people who rely on this care will be the most to suffer. In closing, I want to briefly make reference to the issue of food, as it relates to care recently here, a presentation made at the CPG on older people's age and ageing about the importance of food within social care. Although that presentation was specifically about older people's needs in relation to social care, I think that the importance of food is applicable to anyone, particularly if we are trying to take action that will help social care. Food is the start of healthy and wellbeing, and I hope that the Government will consider that in everything that we are talking about. We need to protect what is most vulnerable. To centralise, we simply will not do that. Many of the speakers today have rightly thanked NHS and care staff for the work that they have done and are doing under immense pressure. Indeed, the motion from the Government says that the Parliament thanks Scotland's NHS and social care staff for going above and beyond during the pandemic. I think that many of those staff would say that it is great to say thank you, but how about listening to us? How about listening to our concerns and listening to what needs to happen? Interestingly, before I came into the chamber, I received a letter from the UNICEF-5 health branch, which says that the health and care system is under pressure to ensure services are delivered in a safe and timely manner. The Covid-19 pandemic has intensified existence pressures on staff and resources in all health and care settings, and the minister has acknowledged that. The NHS has been tested to the limits, and so have many of our members. NHS-5 staff are reporting serious concerns to their union, all underpinned by safe staffing concerns. Issues include dangerous staffing levels for both patients and staff, staff not receiving proper rest breaks, staff not being given opportunities to report serious incidents on date fix, NHS electronic incident reporting system and serious breaches of health and safety regulations. In June 2019, the health and care staff in Scotland Act became law. The first legislation in the UK to set out requirements for safe staffing across health and social care services. The political announcement and assent of the act have been rightly celebrated as significant steps forward for a safer environment for patients and staff. Whilst UNICEF accepts that Covid-19 has delayed much of the development agenda, it is concerning that the implementation of that, which is fundamentally concerned with the safe staffing and patient safety, seems to have been forgotten. Perhaps the minister and perhaps the Government can pick up on that point. I note that the health secretary, I assume, is busy and was unable to stay for this debate, but I will certainly be writing to him as soon as this is finished, with the very serious concerns that are being raised by trade unions in Fife about health and safety issues for staff and for patients. As Gillian Mackay made the point earlier, the NHS is a holistic service, and all those different bits that are not working will affect every part of the NHS, and we need to address that. I visited Curas on Friday off last week and was quite, quite shocked to hear the concerns of the West 5 villages community councils. They say that patients are struggling to access health services at the Valefield Health Centre. They say that Valefield Health Centre is the busiest GP centre surgery in West 5, yet it has only one doctor to 4,094 registered patients. They talk about the difficulty in trying to access those services, the difficulty in trying to get appointments and the failure of NHS Fife to engage with that community. Again, this is not acceptable. This is people raising concerns and being ignored by the NHS. You can imagine the knock-on effect that that has on other vital services. I will finish by returning to social care, an issue that I have raised with the minister on many occasions. I looked this morning at the fair work convention 2019 report. That report was very clear. It says that our overlaps in finance is that fair work is not being consistently delivered in the social care sector. Despite some good practice and efforts by individual employers, the wider funding and commissioning system makes it almost impossible for providers to offer fair work. We found that this mainly female workforce has limited collective voices. Effective work is highlighted in the fair work framework as vital for delivering fair work, providing the mechanisms for workers to pursue other dimensions of fair work such as security, fulfilment and respect. That would be one of the points that I would make to the minister, because someone else talked about the number of debates that we have had in this chamber. We keep coming to this chamber and having these kind of debates. The fair work convention has set out very clearly what is fundamentally wrong in social care at present, yet we are doing nothing to address that. Take that back. The minister will remind me that we have increased pay. I acknowledge that, although I think that the most amendment for Labour says that it does not go far enough. However, it is the terms and conditions that you completely fail into recognising the significant impact that they are having, because people can go and get jobs elsewhere that are less pressured, less stressful, less demanding, and get paid theirs that they are actually working in. In this job, people are being treated absolutely appallingly. Unless you address that, then all the talk in this place amounts to mere rhetoric. We must treat social care workers with fairness with decency. I now call Karen Adam, who will be the last speaker in the open debate up to six minutes. I am pleased to have the opportunity to speak on this motion today. I want to caveat that everything that I will be outlining has hard work in staff behind it, and I really want to acknowledge them and everything that they did through the Covid pandemic. Since forming government, the SNP has built a strong record to deliver high standards of care across the country. That is driven by our ethos of compassion, dignity and respect, and that is at the centre of everything when it comes to health and social care. That was firmly outlined when Shona Robison brought forward the new health and social care standards in Scotland in 2017. Traditionally, health and social care has seen those requiring support often taken out of their homes and placed in unfamiliar settings. However, as we have moved forward with the integration of health and social care, we have ensured that person-centred care and support is at the heart of everything that we do, which has seen an increase of more people being able to receive support in the comfort of their own home. By doing that, we are continuing to improve outcomes for people who require care while utilising the best technology that we also have access to. By scaling up our services with the £1 billion NHS recovery plan, we can tackle the pressures on our NHS by providing general practices and their patients with support from a range of healthcare professionals in the community and recruiting 1,500 more staff over the next five years for our national treatment centres, alongside 1,000 community mental health staff. Increasing primary care investment by more than 25 per cent to support GPs, dentists and pharmacists, investing more than £400 million to create a network of 10 national treatment centres across Scotland. I was pleased to see record investment from the Scottish Government across our health and social care sector, with £18 billion of funding that will fund health and social care. That will go a long way in supporting people who get access to the care that they need, while ensuring that carers working in the sector are paid more. That is a key aspect that underpins the service. Investment in our services and our population is key to Scotland's recovery from the pandemic. More than ever, we realise the fragility of our mental health as well as our physical. In part of my constituency, the health and social care partnership in Aberdeenshire has moved progressively to develop a hospital-at-home policy. There was recognition within the health and social care partnership that it had an ageing population and in order to have a system that supported the delivery of a long-term sustainable service, so a fundamental shift in thinking was required, progressive thinking. The opportunity to develop a hospital-at-home service presented itself when NHS Grampian undertook a whole system redesign, including transfer of resource from acute to community. That change meant that the acute geriatricians could be aligned to managing patients within the community. Alongside that redesign was acknowledgement that, wherever possible, our population is better served when we receive care in our communities, which has been at the forefront of the Government's record in health and social care. Before hospital-at-home, there were already various community models in place in Aberdeenshire, including community hospitals, virtual community wards and a multidisciplinary approach, meaning that the concept of managing patients within the community was already well established in the health and social care partnership. Hospital-at-home was the next logical step. Within the context of our response to Covid-19, we have benefited from the strong relationships with local authorities and the NHS. That enabled a swift, cohesive response, ensuring that our residents and staff have the protections and supports that they need to stay safe. Operation Home First, as it is known, became the next phase in the health and social care response to Covid-19 across Grampian, involving all three health and social care partnerships and the acute sector, and harnessing the strong collaborative of working and whole systems approach, which was adopted across all sectors during the response phase. That innovative and person-first principle, where place-based care was of paramount importance, embodies a framework within which we can create the right environment for keeping people at home safely, reducing hospital admissions where an alternative intervention is possible and making sure that people who need care in hospital do not need to stay in hospital longer. A key focus in directing support towards prevention and an increased community focus to improve outcomes for all, and not least, elderly people. That prioritises a goal of home first for all care, ensuring that the system remains flexible and agile to respond to any surges in demand and considering the whole person, their circumstances and supports. The model of best practice can be reflected across Scotland within a national service. In conclusion, I am sure that I am the only carer in this chamber, or person to experience a loved one received care. In that respect, I say that choice is an absolute necessity. The option to stay at home must be a right, and to many people there is no place like home. That sentiment I am glad to see embedded in policy for a progressive approach to healthcare for all. I am pleased to close for Scottish Labour in place my party's thanks to all the staff and the unpaid carers. We agree that the importance of having care at the centre of our communities close to people and easily accessible cannot be overstated. However, its usefulness is diluted quite considerably when waiting times are too long, services are overstretched and workers feel undervalued because they are overworked and underpaid. Our constituents are telling us that they are waiting too long to see their GP and have trouble accessing alternative clinical pathways. The Scottish Government knows this. The SNP and the Greenback Benchars know this, and it is time that they listened and spoke up for their communities and our hardworking, dedicated staff. We need some honesty to fix that problem. The Government brings forward this debate in a rather self-congratulatory motion today, but in reality, as we have heard for many on the front line and many who use services, the picture painted by the Scottish Government of investment and progress is not representative of their experience. Indeed, for some in our communities, it could not be further from reality. That is evidenced, unfortunately, by the 2021-22 health and care experience survey that was published recently, which, as my colleague Paul O'Kane exposed, people saw plummeting satisfaction with health and care services in Scotland. Deputy Presiding Officer, it is important to note in the debate today that this Government's handling of health services over recent years has witnessed health inequalities in Scotland becoming increasingly divisive. We live in a country where women from areas with higher levels of deprivation are less likely to attend cancer screening appointments. I wonder if she would agree with some of her witnesses in the health committee today. It is very difficult in terms of mitigation that the Scottish Government does when we are also subject to a lot of the money that has been taken out of people's pockets by things such as universal credit issues and social security at UK level, which is very strong evidence this morning. Thank you for the intervention. I think that the member knows that I strongly object to some of the policies that come to us through the current Government in Westminster and recognise how difficult it is for people, but here in Scotland we must do all that we can. If you are on the Labour benches, what you want to do is the things that we can do and that we can do now, and I think that that is where we differ in our approach, because we want to talk about what we can do and actually get it done. I will take a short intervention. It is short. I hope that the member, in her summing up, will give me the costings of the demands and quite good demands that they make in the end of their amendment about reversing non-residential charges, narrowing the eligibility of good care packages, opening the independent living fund and £15 an hour for care workers, all laudable, but I would like to know the cost, please. I think that the member will recognise that we need to spend longer to discuss all the ins and outs, but what I would reference to the member is that if you believe that you are doing everything, you are not doing everything that you can, there are alternatives and it is about political priorities. That is what being a politician is about. Scottish Labour, as has been highlighted by colleagues, does support the focus on building and enhancing virtual capacity to support a sustainable future, but the pressures on primary care services and the aforementioned impacts of such pressures cannot be and must not be ignored, as was recognised. It is not too late to bring care closer to our communities, nor is it too late to invest adequately in the services that we know will reduce the lines and hospitals, such as local government, family-based services, linked workers. Those will improve health outcomes across Scotland, but we are running out of time and we call on the Scottish Government to act radically and with purpose. Moving to social care, we have heard today a number of occasions that the pressures are facing our social care workforce. Like our primary care workforce, they are the very best of the country that have exceeded all expectations during the pandemic and have protected the most vulnerable in our communities at a most serious time. It is a disgrace that so many of them have been made to feel so overworked, underpaid and undervalued. It is a reality that we need some more honesty about that. Sarah Boyack described it so well, as was presented in Edinburgh. The reforms of national care service could bring, I believe, should be welcome and could address significant failings that we currently see oing to much involvement and reliance on the private sector. I say that reforms cannot wait for the national care service. We need things to happen now. Therefore, I echo the calls of my colleague and those highlighted in the Labour amendment in saying that non-residential care funds must be removed immediately as well as reversing the recent gnarring of eligibility to care packages and reopening the independent living fund. Moreover, to ensure that social care is both available and accessible within our communities, we must look to improving the pay of this sector. The self-congratulatory nature of the Scottish Government's motion today is what does not sit well with us. We cannot accept that GPs cannot be accepted, that care packages are not there for people, that carers feel unsupported. We can and we must do more. That is the point. Scottish Labour made to set out what we can do, and I urge the Parliament to support our motions. I now call on Sue Webber to wind up on behalf of the Scottish Conservatives up to seven minutes. Please, Ms Webber. Thank you, Deputy Presiding Officer. I welcome the chance to close the debate today on behalf of the Scottish Conservatives. I also want to pass on my thanks to all those who are delivering our health and social care in our country right now and will continue to do so for the foreseeable future. As we have heard from my colleagues today, the SNP urgently needs to address the social care crisis that has occurred on their watch. Now is not the time to centralise care services as the SNP is planning to. Instead of pressing ahead with the bureaucratic overhaul of services, it must engage with carers and those who need support to ensure that the highest level of care is delivered. Ms Webber has been in all the health and social care sessions and she will have heard repeatedly that in some areas health and social care is doing really well. There is good practice. Will the national care service not see those standards rolled out across the country when they are not doing so well? I thank Ms Martin for that intervention. We have heard a lot about the inequity of services across the country and I think that it does not need a national care service to deliver a much more equal service around the country. We have got good policies in Scotland. You cannot argue that the will is there. However, we are consistently referring people ineffectively into services. We have people ricocheting around our services and nothing quite fits and meets their needs. It is no use having good intentions, policy document after policy document and papers if they are not being put into action. It is fragmented and therefore causes distress to those in the most dire need. Yes, having access to services is key, but with all of this, we often lose sight, as Jeremy Balfour stated, of the person who is so desperately needing our assistance and support. We need equitable services across all the sectors. Right now, as I have just stated, we have inequity in service provision and it only further widens the inequalities that we face. Social care is patchy and broken. Right now, and in recent history, integration authorities have had only one priority. They have been focused on budgets, not people. All the resource and focus has been on reducing the burden of care, reducing the amount of care that is provided and delivered, delivering efficiencies and cost saving plans. People have come second. Reform is needed, but a national care service is not the answer. That is why the Scottish Conservatives have proposed a local care service, which should ensure that support is delivered as close as possible to those who need it, especially in rural and island communities. COSLA has said that the plans for the national care service are an attack on localism. They have added that councils know their communities, and all the evidence suggests that local democratic decision making works. Audit Scotland has shared concerns about the extent of the SNP Government's plans for reform and the time that it will take to implement them. It is also not clear what the costs of the national care service might be and the Fraser of Allander Institute has stated that until we know the final shape of the national care service, we cannot say much about the funding settlement that will be required. If we are truly determined to tackle health inequalities, we must surely recognise and celebrate that every community has different needs. We need community services, and time and time again we hear about person-centred care, but all the evidence that I hear time and time again is that people have to adapt to and accept what is available from the service, not the other way round. One of my constituents was a carer for her husband, but she suffered a stroke. Both were assessed as requiring a home care package, but limited availability meant that a package was put in place for the wife, which allowed assistance dressing and meals, but not enough for a daily shower, and was not allowed to assist with her husband. After an intervention, her care package was extended to allow for a daily shower, and an additional package was added to allow time to assist her husband as well, but that took a heroic effort from my staff to do that. Staff are overwhelmed having gone above and beyond the pandemic, but they have not been given the leadership that they need from the SNP Government. Another constituent of mine has suffered the consequences of not keeping care close to home. Margaret had to travel to Newcastle for her over-70s breast screening, where, following the test and follow-up appointments, in the Royal Victoria Infirmary in Newcastle, she was diagnosed with breast cancer. How many women over-70 have undiagnosed breast cancer? Margaret would have been one of them. That approach does little to suggest that the SNP Scottish Government is really doing all that it can right now to improve outcomes. We are not short of examples of the SNP failing to keep care close to home. The SNP has had to be brought kicking and scooming to the realisation that eye care in Lothian, in the Lothian region, should be local. It wanted patients to travel to Glasgow. While the commitment to the new eye pavilion was a welcome U-turn, no real progress has been made since the SNP's pre-election pledge in 2021, and NHS Lothian is facing a huge crippling bill to maintain the existing building. The SNP urgently needs to address the social care crisis that has occurred on their watch. Heroic staff are overwhelmed and continue to be overwhelmed, having gone above and beyond during and after the pandemic, but they have not been given leadership the need from the SNP. Just making some reference to some of the content that we have heard from across the chamber, Dr Gohani has referred to the toxic cocktails of delays that are contributing to our delays, discharge and hampering the recovery of services, where Ms Boyack mentioned that the motion from the SNP does not acknowledge the scale of delayed discharges that Edinburgh and Lothian are facing. Those were all there pre-pandemic, and I know that, because I was a member of the IJB. With that, I support the motion presented by my colleague Dr Gohani. I thank many folks for their valuable contributions today, which has been an extremely important debate. I was hoping to say that it is encouraging to know that we are united across the chamber in the importance of transforming and improving health and social care, but I am not sure if we are united because we have heard from many of the Tory speakers today—Mr Stewart and Ms Webber—that now is not the time for any change or reform. Folks out there who are working in health and social care would disagree vehemently, and they would say that now is the time to ensure that we get transformation and improvement in our health and social care system. We are all clear that health and social care services are a lifeline to many, and our current system is under extreme pressure, especially as a result of the pandemic. Ms Mawchen and her speech talked about honesty, and I think that we have to be honest about all that, because we are seeing greater demand in the system than ever before. We are seeing people with higher levels of needs from acute and community offers than ever before. Recruitment and retention has been challenging over the past number of months, the past couple of years, so let us be honest about all that. However, the Government itself will work hard to address those issues, matching reform and recovery with investment, and let us look at some of the suggestions that have been made today around about investment and recovery. Some have rightly pointed out that the pay rise that the Government has put in place for social care workers is a 12.9 per cent pay rise in a year. The Labour Party feels that that is not far enough, and I would like to go further. To increase to £12 per hour, I would have to find £620 million. To increase to £15 an hour, I would have to find £1.75 billion. Even then, I do not have the ability to ensure that that money would get into people's pockets and purses because of the desperate employment situation that we have. I think that Christine Grahame brought honesty to her speech about the fact that we in this place, if we make proposals, have to cost them and say how we are paying for them. Mr Rowley and I have had a number of conversations about that, and I always appreciate Mr Rowley's contributions, even though sometimes they are hard-hitting and ask the Government for more. What I would say to Mr Rowley and others who have talked about conditions is that I, the Government in cooperation with COSLA, want to go further in terms of conditions. I will take any help that I can get from across the benches to try to persuade my colleagues on COSLA to walk that mile with us to improve the conditions of the social care workforce. I know that Mr Rowley will be part of that journey with me, but my door is open to all in terms of that persuasion. The same goes with the persuasion that needs to be done in terms of the removal of non-residential care charges, because the Government wants to do that, too, but we have to do that in partnership with COSLA. Any help that members can provide in that front, I will gladly take that. On that point, when does the minister intend to remove non-residential care charges, given his commitment to it? Does he accept that Labour's plans have been costed and presented £2.6 billion in Barnett between now and 24-25, and we have outlined that several times in the chamber? Mr O'Kane is spending money that has already been spent, which is what the Labour normally does in those circumstances. I think that there has to be a degree of honesty from the Labour benches around about that. If Mr O'Kane wants to have a conversation with me around about funding, I will happily do so, but the first thing I would have to do is show him that his figures do not add up. On non-residential care charges, as I said, it is not within my gift to remove them. I have to have the co-operation of other partners, and we will continue to do that. No, I have to make some progress, because there are a lot of other members who have made valuable contributions in today's debate. There has been quite a lot of talk today about digital. Dr Gohani says that we are doing well here in Scotland, and I agree that we are, but we still have a journey to go in improving and increasing digital services. Gillian Martin mentioned what we can do in providing greater patient information to let people know and monitor their progress in waiting lists. I say to Ms Martin and members that NHS 24 is currently developing a website that will be available mid-summer, which will give people a greater idea about waiting times and their journeys. I think that we have a way to go here, but we are on the start of that journey. I think that that is one that will be beneficial to patients right across the country. Ms Mackay mentioned Alice, and Alice is a website run by Alliance Scotland. We will get in touch with her on plans to update. I understand that there has also been discussions with her about social prescribing, and I can maybe update Ms Mackay as we move on on that front. In terms of digital, I think that we have done well. We are, in some cases, at the very beginning of the journey, but the Government takes all of that very seriously. Let me turn to care homes, because we have set out as a Government one of the biggest changes to public service reform in a generation with the creation of the national care service. However, as we recover and rebuild from Covid, we need to act now and improve outcomes for people using services and the wellbeing of staff that work across the sector. During the course of this debate, we have heard a lot about the innovative work that is happening and the work that we need to build on and scale up and to increase the pace of change. We have been successful as a country in embedding care and support closer to home, ensuring that that is through self-directed support so that individuals have choice in their care. However, we cannot forget care homes. They are people's homes, too, and we know that healthcare for residents can sometimes be fragmented and can often be reactive care and poorly co-ordinated. That is why, today, I am delighted to say that we will soon be publishing a healthcare framework for adult care homes, which is a bold and ambitious document that will provide a series of recommendations that will aim to transform the healthcare for people living in care homes. We must continue to collaborate across services to ensure that we get unscheduled care priorities right. We need to strengthen those partnerships as we move forward. The existing strands of work under the unscheduled care programme, which I have mentioned today—discharge without delay, virtual capacity and the redesign of urgent care—are delivering improvements already, and they are pivotal in our approach as we move forward, and we are dedicated to getting that right. In conclusion, we are determined to explore every possible avenue that we can to improve health and social care by investing in our community healthcare pathways. By doing so, I know that we will improve the support and services offered to the people of Scotland. I would like to thank folk for their contributions in the debate today, and I look forward to working with folk across the chamber as we realise our vision for improved health and social care here in Scotland. That concludes the debate on keeping care close to home and improving outcomes. It is time to move on to the next item of business, which is consideration of business motion 4607, in the name of George Adam, on behalf of the parliamentary bureau, setting out changes to the business programme. I call on George Adam to move the motion. I call on Stephen Kerr to speak to and move amendment 4607.1. I moved amendment 4607 in my name. Last week, I outlined the reasons why we need the Deputy First Minister to face the consequences of his actions by appearing in this chamber to make a statement and to answer questions. Those reasons that I gave last week have not changed. Indeed, the Minister for Parliamentary Business himself has still not actually been able to explain why he is against the Scottish Government being scrutinised in this way in this instance. My amendment once again inserts a statement from the Deputy First Minister, which would allow him to clear the air, to outline his role in the ferry contract approval process, instead of hiding from parliamentarians and giving selected quotes to the media. This Parliament is the first line of scrutiny of the Government, not the last. We saw yesterday that the level of control the SNP whips exercise over their loyal subjects is quite formidable. I understand that the SNP, including Mr Swinney, will be whipped to oppose this amendment. I am sure that the Deputy First Minister is right that, of his own free will and choice, he chooses not to respect this Parliament by coming here, making a statement and subjecting himself to the scrutiny of parliamentarians who are elected to come to this place to do that job. I would invite any Scottish Green MSP to intervene right now and explain to this chamber why they do not support the Deputy First Minister outlining his role in the ferry's disaster to Parliament and not the media. We are a surprise. No one is willing to defend their voting position. This is shameful. We, to be clear, will support the final motion regardless, because we support the inclusion of a statement on reducing drugs deaths, but I would implore again all Members of the Scottish Parliament who consider themselves to be Parliamentarians to support my amendment so that we can finally get some answers from the Deputy First Minister for the growing scandal of the ferry fiasco. I call on George Adam to respond on behalf of the Parliamentary Bureau. We have discussed this matter on a number of occasions recently quite often. On this occasion, it is my intention to refer Mr Kerr and those in the chamber to my intervention in the discussion that we had last week on 18 May and to ask him to look at the official report and see my answers there. The question is the amendment 4607.1 in the name of Stephen Kerr, which seeks to amend motion 4607 in the name of George Adam on changes to the business programme be agreed. Are we all agreed? The Parliament is not agreed, therefore we will move to vote. There will be a short suspension to allow Members to access the digital voting system.