 I would be grateful if members who wish to speak in the debate could press their request to speak buttons now. I call on Sandish Gulhane to speak to and move the motion. Imagine a scenario where a country's health service is in crisis, struggling to deliver timely care after years of failed workforce planning. Imagine that this country's government is fully responsible for running healthcare that controls by dictate the number of local school leavers who can enrol as student doctors, student nurses and paramedics in our country's universities. It's where we are in Scotland today. The government consciously limits the number of local domiciled students to just over half of all medical school places across Scotland's universities. There are very much students who are more likely to stay and work in Scotland once graduated. Little wonder that there are staff shortages and it's all down to the SNP. Before proposing a solution to tackle, let's talk about some of the damage from a decade of failed workforce planning. Let's consider the current calamity in more detail. According to the Royal College of Nurses, our NHS needs another 3,400 nurses. This has not happened overnight. It's happened under the watch of five SNP health secretaries. It's important to remind the country that when the First Minister was in charge of health, she was the one who failed to future proof the workforce. By cutting the number of student nurse places in 2012, this was a spectacular era of judgement. By 2015, our NHS had a shortfall of 1,613 nurses. This rose year and year by June 2019. Nine months before the pandemic, the shortfall was 2,879. Let's get this straight. This had nothing to do with Covid. The Government may argue that Scotland has more nurses now than ever, but there are also more vacancies now than ever. 4,800 nursing and midwifery posts are unfilled. Where is the plan? If we now turn to students of medicine, our future doctors, according to the Scottish Government, of nearly 5,000 students, just 54.5% are Scottish domiciled. This is down from 63% a decade ago. To be fair, there has been a rise in the total number of medical students over the past four years, with the annual student intake rising by 190, but this came on the back of year-on-year declines since 2007. Trained doctors account for 44% of doctors employed by NHS boards. I am sure that you now realise why chaotic knee-jerk reactions to a staffing crisis do not work. It has been unfolding for over a decade. Let's take primary care. It takes at least 10 years to qualify as a GP. During that time, every year, students enter medical school and highly experienced doctors retire. Today, the chronic shortage of GPs is a shortage that impacts the health of our country as a direct consequence of decisions made in 2009 when the First Minister was running health. Let's not pin everything on the leader. Her successes are not crowned in glory either. According to the BMA, 83% of GP practices report that demand now exceeds capacity, 42% report that demand substantially exceeds capacity and 28% report at least one vacancy. That means that as many as 225 full-time equivalent GPs are missing in Scotland. Allow me to quote the Government's own data. The number of full-time equivalent GPs in Scotland in 2019 was 3,613, 62 fewer than in 2013. Between 2015 and 2018, only 39 additional GPs were recruited. Allow me to stress this again. This is before the pandemic. According to Audit Scotland, even if the SNP managed to recruit 800 more GPs, the gains will be wiped out by the number of doctors expected to retire. When retirements are taken into account, the number of GPs would only increase by 18 in the 10-year period to 2027. The SNP Green Government risks a bitter legacy. Where is the plan? In our hospital workforce planning is also in absolute chaos. BMA Scotland reports that vacancies for consultants have risen by 15%. We now know that one in five consultants who were aged 45 to 49 back in 2010 have left the profession by 2020. The BMA also finds that 45% of consultants surveyed are considering retiring over the next five years. The SNP Green Government is clearly distracted by other matters to focus on retaining those highly experienced doctors who are vital for patient care and vital for training the next generation of doctors. Of course, there may have been characteristic knee-jerk responses, such as another £32 million to create another £139 training doctor posts. Is this welcomed? Yes. Is it part of a well-thought-out strategic plan? No, not at all. On this side of the chamber, we want to provide solutions. Today I want to focus strategically on workforce planning. I want to make sure that we have more Scottish nurses, doctors, paramedics entering universities here in Scotland. This is really important because students who have gone to school here or have a close connection are more likely to stay in Scotland when they graduate from a Scottish university. They will stay here to care for the patients in Scotland's NHS and will go on to train the next generation of healthcare professionals. I find it shocking to read that Scotland has a lower percentage of home domicile doctors in comparison to England and Northern Ireland. Around 78 per cent of England's foundation doctors are home domiciled. Northern Ireland is 89 per cent, but Scotland is just over 54 per cent. The problem is the arbitrary cap of a number of young Scots that the Scottish Government will fund through medical school. The cap is arbitrary. As the workforce stats make clear, decisions on the cap each year are not based on realistic workforce planning. It is also not down to our young Scots who are not being qualified. More and more Scots are meeting the academic entry requirements for medical schools. That led Professor Angela Thomas of the Royal College of Physicians Edinburgh to warn of a brain drain where high-achieving Scotland-based school leavers, with no place to go in Scotland, moved to England. The cap also creates a barrier to medicine for students from less affluent families. Despite having the grades, if they cannot enroll in Scotland, they will be faced with university fees elsewhere that they cannot afford. It is really important that we listen to the professional organisations that exist to protect patients and improve education and practices across our NHS. The Royal College of Physicians and Surgeons of Glasgow concludes that removing the cap is the right thing to do, and it would be a shot in the arm for the NHS. Of course, in medical schools, we need to optimise student numbers as standard must remain high and the funding model must be right, too. However, Scotland needs to start training larger numbers of nurses, doctors, surgeons and other healthcare professionals in order to cope with demand. Removing the cap on medical school places will not solve the crisis that we face this winter, but it is a step in the right direction. We can build an NHS here in Scotland that will be the envy of our neighbours and the envy of the world. Let us do this. Remove the cap permanently. Let us provide opportunities here in Scotland for our own bright young people and let us ensure that we have a well-staffed and resourced NHS that is able to deliver world-class care. I now call on Humza Yousaf to speak to move amendment 2 on 39.2. Today's motion by Sandish Gohani asks to remove the controlled intake cap on funding training places for students from Scotland studying for frontline NHS roles. I can understand why that might seem a laudable aim, but I fear that the unintended adverse consequences have not been clearly thought out. I will talk to some of those shortly in a second. We have a controlled intake for medicine for a very good reason, which I will set out very shortly. I have also received advanced sight of a soon-to-be-published report by the Royal College of Physicians and Surgeons. I received that copy last week in the report, although they have made mention of the need to grow Scottish domiciled and widening access student places. As part of a planned approach to expansion, which is something that we agree on, they made no mention of removing the cap. Our planned expansion will maintain our commitment to widening access and Scottish domiciled student places. I will come back to that point. I want to intervene on Dr Gohani about who is unable to take the intervention. The Conservatives also seem to be attempting to quote-unquote fix a problem that does not exist. Last year and this year, every single Scottish domiciled student, even those who had requested a deferral for appeal in 2020, all of those who met the conditions of their offer at a Scottish university were offered a place. We have around 6,000 students studying medicine in Scotland. Also listening to Dr Gohani and the Conservatives, you would not have known that we have had, of course, a 20 per cent increase in NHS staff since we took power. In fact, more than 11 per cent increase in qualified nurses and midwives. At nine years of consecutive growth in NHS staff, almost 60 per cent increase in medical and dental consultants, you would not have known that listening. Of course I would. I am grateful to him for giving way. Does he acknowledge that almost every medic that you speak to says that there is a shortage of doctors and that one of the reasons for the shortage of doctors, particularly those that are domiciled in Scotland, is because of the cap on places that prevents some universities with medical schools who would like to take more from doing so? Cabinet Secretary? Let me say that I absolutely agree with the point that we need to increase the number of medical graduates and, of course, doctors. That is why we have committed in our manifesto and we are increasing and expanding the number of medical graduates. We have promised to increase that by 100 per annum. Let me turn to some of the arguments of why there are unintended consequences. First, we have seen an increasing undergraduate number since 2016. That was in response to a UK under-supply of graduates between 2015-16 and 2020-21. The controlled intake for medicine grew by 22 per cent. It has further increased to 1,117 in 2021-22. Our modelling shows that we need to further increase that number. That is a point that is made by Liz Smith. That is why our 2020 programme for government commits to increasing those undergraduate numbers by 100 each year over the course of those parliamentary terms. That will allow us to increase numbers to ensure that we have sufficient supply with a degree of headroom, but in a planned fashion. If we were to go down the route that Dr Gohani suggests and the Conservatives suggest, my concern would be that we would have no idea of how many students to expect until they matriculated each year. We may find that we do not have the clinical capacity to train them. Even if we were able to train them, we may find that there is no job for them as a qualified doctor at the end of the day. That would lead to a real danger of creating medical unemployment. Secondly, our planned increases have allowed us to focus undergraduate education on areas of known NHS patient need. For example, we know that we will need more doctors working in community settings in future to care for our ageing population. That is why we commissioned Scotland's first graduate medical entry programme with its focus on producing GPs and a focus on remote and rural placements and two GP track courses at Glasgow and Aberdeen universities. If we had no control over places, it would then limit our ability to commission our medical schools for new and innovative approaches to respond to those long-term policy drivers. The point that I want to intervene on Dr Gohani was that our planned expansion has allowed us to focus on opportunities for Scottish students from all sectors of society. The 50 ring-fenced widening access places that were introduced and maintained annually in 2016 were increased to 60 places in 2021. All those places have been filled this year by students from some of the most deprived backgrounds of Scotland, which I think is something that we are all welcome to. We have also set up two pre-medical entry courses at Glasgow and Aberdeen universities, which are aimed at those from less socially advantaged backgrounds who may have narrowly missed out the grades that are required to study medicine. We have also widened access to medicine in the widest possible sense. The course at Edinburgh University for Graduate Health Professionals is a unique route for experienced healthcare professionals to study and become doctors. The HCP-med programme is specifically designed for healthcare professionals living and working in Scotland. Essentially, if we were to have no control over numbers at all, widening access students would be the very first to lose it. If we have a free-for-all, those who are furthest away and have traditionally been furthest away from gaining access into medical schools would be the ones to lose out. I understand and am probably fairly short of time, Presiding Officer. There are many other reasons why it is important to have a mixed economy of medical graduates. We are delighted to have those who want to study from across the UK and internationally, too. I will end by saying that it is for all the reasons that I have highlighted, but particularly and crucially, the point around widening access. If we remove the camp, we then remove those ring-fence widening access places, too, and it is for those reasons. All UK nations that are set, controlled and taken from medical undergraduate places, I would ask Parliament to reject the motion and support our current process for planned expansion to meet the future medical workforce of the NHS in Scotland. I move the motion in my name. Thank you. I now call on Jackie Baillie to speak to and move amendment 2139.1. Thank you very much, Presiding Officer. I have much sympathy with the intention underlying the Conservative motion, so we will support it at decision time, but I am genuinely concerned about the practical implementation of lifting the cap on medical training places. I also think that restricting this to front-line staff may result in an unfortunate focus on some parts of the NHS and not others, where there are critical shortages, too. I thought that the SNP amendment was just a tad self-congratulatory, considering that it has been in charge for the past 14 years. I cannot help but recollect that it was 10 years ago that I was last Scottish Labour's health secretary, and we were discussing workforce planning even back then. It is beyond depressing that nothing much has changed in that period. There is no getting away from the fact that it is the SNP that has presided over historic workforce planning failures across our NHS. The problems are not new. They do predate the pandemic, but they have absolutely been exacerbated by the pandemic. I well remember Nicola Sturgeon when she was health minister cutting the number of nursing places, despite warnings from myself and the Royal College of Nursing about the consequences of so-doing. In fact, during her tenure, she presided over some of the smallest intakes of medical students in the last 14 years. To deliver on removing the cap in funded places requires additional investment in our medical schools across the country and the capacity to deliver foundation places to all graduates on completing their degree. I am not sure that the Conservatives have done their sums on this and have any idea what it would actually cost. Where would they set the bar? Should everyone that applies be given a place? Last year, 9,530 people applied to study medicine in a Scottish university. 1,290 were given a place. I am sure that the Conservative proposition is not that all 9,530 should be offered a place, so you would probably need to set a limit. Understanding that is critical. Indeed, what is regarded as front-line staff? We know that there is a shortage of A and E consultants, a shortage of nurses, a shortage of GPs, but what about consultants in urology, vascular surgery, psychiatry or allied health professionals in physiotherapy, diagnostic radiotherapy or occupational therapy? There needs to be an expansion in their training places, too. There is no doubt that there are acute shortages across the NHS. Just listening to the evidence presented to the Health and Sport Committee should leave no-one in any doubt about that. John Thomson of the Royal College of Emergency Medicine told us that there was a shortfall of 130 A and E consultants. The BMA told us that the vacancy rate for consultants stood at 15.2 per cent more than double the official Scottish Government figures. Dr Lewis Morrison told us that doctors were washed out physically and mentally. Margot Cranmer of Unison said that nurses were stressed and exhausted. A paramedic whistleblower said that they were exhausted, undervalued and overwhelmed. All of that is before we reach peak winter pressure. We need to urgently address workforce planning, but it will not alleviate the pressure on the NHS that is happening right now. It takes a long time to train those people for those roles. Scottish Labour has put forward a series of suggestions about what we think needs to be done now. Let's start with the working time review for every member of staff planning to retire early, offering them flexible working so that we do not lose their skills from our NHS. Let's ask the hundreds of staff who have left the NHS recently to come back to help their community, especially over this winter. Let's give staff better facilities in the workplace, such as hot meals, rest spaces and access to mental health support. I know that the Government has made money available, but in some areas improvement is far too slow and too patchy. I am afraid that I do not have time. Let's also make sure that there is a long-term pay deal in place that addresses low pay in the health and social care sector to stop the hemorrhage of staff. It should not escape our notice. For the first time in its more than 100-year history, RCN members in Scotland have voted to take selective industrial action. There is a real urgency to improving pay in social care by paying staff £15 per hour. Scottish Labour supports increasing the number of places for Scottish domicile students on medicine and nursing courses, doubling the number of widening access to medicine places and increasing student intakes for key health professional roles. The problems with workforce planning are manifest. The time for talking has long gone. We need urgent action now, and the Government must listen to the royal colleges, trade unions and the workforce if we are not to have a crisis each and every winter from now on. I move the amendment in my name. Thank you very much, Presiding Officer, and I thank Dr Sandesh Gill-Honey for securing time for this important debate. It is dispiriting that, once again, it is opposition time that is given over into the workforce crisis in our health service, particularly after the warnings that the Health and Sport Committee of the Scottish Parliament were given this week. I congratulate them the less than I assure them of the support of the Liberal Democrats at decision time, notwithstanding the caveats that were rightly raised by Jackie Baillie about a complete removal of the cap. Nevertheless, I support his intent. Likewise, we will support Labour's amendment. A decision to dedicate your life to join the medical frontline is a noble one, but it can also feel like a thankless one. As the past 19 months have highlighted, if you make that decision, you choose a career that is defined by self-sacrifice and perseverance under incredibly demanding circumstances. People who enter the profession do so because they care passionately to the service of our sick and are vulnerable. There is no higher calling in our society. We are very fortunate to have so many people write that in Scotland. However, evidence shows that we are losing them. In our current context, we cannot afford to do so. The BMA released a report that 15 per cent of consulted roles in Scotland could lay vacant. To put that in perspective, that is an entire large hospital's complement of consultancies should we not fill them. At a health committee last week, the Royal College of GPs told us that there was an enormous strain on their work port. As a result, individuals have to choose between sacrificing their profession or their wellbeing. At the same committee meeting, the Royal College of Nurses told us that nurses in Scotland face a similar struggle, leading to a significant issue of retention within the nursing workforce. That is just not acceptable. No-one should have to choose between their profession and their mental health. As a result of that choice and other factors, front-line medical professionals in Scotland are choosing not to work here, instead deciding to work aside from the board or giving up the profession entirely. We must do more to prevent this, given how much we have invested in individuals. A key part of the solution lies in planning for our workforce. As we have been told, the Scottish Government's workforce strategy is not equipped to deal with the crisis our NHS is experiencing. This is the same Government that delivered its integrated workforce plan a whole year late. That is why the Scottish Liberal Democrats have called for the presentation of an annual workforce report, a debate in this Parliament, which would include a study of reasons why newly qualified staff leave NHS Scotland to work elsewhere. Moreover, we need to look at the way we deal with people working within our NHS, the way that they suffer burnout, the way that we aren't supporting their mental ill health. We need to do that from the very start of their career in the NHS. Currently, just over half of medical students at our universities here are Scottish. We must ensure that the Scots who wish to train and work on the NHS front-line are equipped and incentivised to do. It should be of no surprise that there are severe burnout and mental stress issues currently on offer, which may be off-putting. Within ambulant staff alone, mental health absences are up 300 per cent since 2017, according to a freedom of information response received by the Scottish Liberal Democrats. That is why we have called for a substantive mental health package for front-line staff to help to deal with this crisis. This crisis is one that has grown under complacent SNP Government. Perhaps we should not be surprised. After all, this is the same Government, led by a First Minister, whom, in her tenure as health secretary, cut 300 student nursing places, claiming that it was the sensible way forward. That is not the sensible way forward, and we are reaping that whirlwind now. Restricting training places, neglecting strategy and not providing staff with adequate support is not a sensible way forward in anybody's book. The NHS is one, if not the most vital service in our country. The people within it provide a service that we could not do without. Front-line staff deserve their unwavering care, effort and support from this Parliament that they have continually shown to our country. We have all witnessed the impact that a front-line medical staff shortage has had on our NHS. Shortages put pressure on our heroic NHS staff, who work tirelessly to ensure that we can receive treatment whenever it is required. The problem is that a shortage of NHS staff creates waiting lists, waiting times and backlogs for many people who are in urgent need of care or treatment. As we have heard in this chamber, people are waiting too long for an ambulance, too long to be triaged at ANE and too long to see their GP. Our NHS was under pressure long before the pandemic, but it is now at breaking point. We need a solution to the staffing crisis, and we need it now. If we look more in-depth at the shortage of NHS staff, we know that the Scottish Government has presided over increasing shortfall and workforce planning issues, and you do not need to take my word on it. When NHS Lanarkshire front-line staff were interviewed by STV, one emergency medicine consultant said, from a nourishing point of view, the military support is helping as it gets basic stuff done, like observations and bloods and initial assessments, but they can only do certain things. We do not have more doctors. My colleagues and I do not want to think about winter, as we know that it will be worse than what it is at the moment. We need a break and we will not get one. We will cope because there is no other way. Health professionals are on the front line, and for them to do their job, there needs to be enough staff to cope with the demand of patients. Staff shortages are not the fault of our NHS. It is the fault of those who manage and oversee the internal structure of our healthcare service. It is the fault of the Scottish Government as they have not addressed those long-standing issues. The SNP has been repeatedly warned about the increasing shortfall in the number of NHS staff nurses, doctors and ambulance crew. However, despite recent commitments of funding by the Scottish Government, more action is needed. As my colleague Sandesh Galhany rightly said, where is the plan? Since 2016, the Scottish Conservatives have repeatedly called on the Scottish Government to remove the cap on funded places for front-line medical students. I am therefore pleased to support the motion today, which calls on the Scottish Government to do just that, as a response to the concerns raised by the pandemic, but also to tackle issues that have existed for years. It is not just the Scottish Conservatives who have called for the cap to be removed. The Royal College of Physicians and Surgeons of Glasgow has also called on the Scottish Government to remove the cap on medical school places in Scotland. The reason is clear. The last two years have presented an unlikely opportunity to create more spaces for students to take their rightful place on medical university courses after their exam results were revised due to the exam fiasco created by the SNP. The upgrading of thousands of exam results has led to calls to increase places at Scottish medical schools to accommodate the number of students who meet the entry requirements. I acknowledge that the Scottish Government has increased the number of medical places, but it is not enough. By further increasing the number of medical students that our universities can accommodate, by looking at the shortfall in positions across Scotland, we can start to address the issues that are experienced by all health boards. In closing, I thank our NHS staff for their dedication and hard work, especially during the peak of the pandemic. However, they need more support, and by more support, I mean more colleagues. There is a staffing crisis across our NHS that is directly impacting our NHS. The best and quickest way to create an opportunity for more NHS staff is to remove the cap to allow more students to study and gain the qualifications that are needed to advance their medical career. I join my colleagues by calling for the cap to be removed, to support students and to help to alleviate the staffing pressures that our NHS has experienced for years. It is important that we set a context around that. Staffing levels in NHS Scotland are at an all-time high, following nine consecutive years of growth. As the cabinet secretary also mentioned, the Scottish Government fully funded all places for Scottish national students holding an offer from a Scottish medical school where they met the terms of their conditional offer. As the cabinet secretary also mentioned, there has been an increase of 25,000 increasing staff in NHS from 2006 to 2021. Last year alone, there was a 3.6 per cent growth resulting in an increase of more than 5,000 staff members. There has been undoubtedly a rise in demand for services in response to the Covid-19 pandemic. The Scottish Government is investing in several ways to address the issue. There is the establishment of the national centre for workforce supply with its £11 million investment. One of the focus areas for the centre will be offering boards expert advice on labour market intelligence and to help to coordinate recruitment programmes. That obviously needs to work hand-in-hand with social work recruitment. There is no doubt that Brexit has made a massive impact on that. I have seen staff in one constituency move between the care sector and NHS sectors during the pandemic. It is important that investment in medical and nursing education has also been sustained during the pandemic, with record numbers commencing training in 2021, £4,000 during six of nursing and £1138 for medicine. That number is set to rise further this autumn. Work has also been undertaken through the pandemic with national bodies to ensure that many former nurses, doctors and allied health professionals who wish to return to work in the NHS are able to do so. The Scottish Government also has record staffing levels, and the best-paid staff in the UK recently giving staff a 3 per cent pay rise. On the specific issue of doctors, the proposed significant expansion of trainee doctors underlines the Scottish Government's commitment to support the NHS, not only in response to the pandemic but also as we look beyond and plan to build longer-term resilience. We also know that £32 million has been committed to increase a further 139 trainee doctor posts to support NHS services. In psychiatry, five posts will be recruited for 2022 start, and that will give much-needed support to the delivery of mental health services in NHS Scotland. There will be a further 22 medical specialties that will benefit from the creation of additional training places, including clinical radiology, anaesthetics, clinical oncology, medical oncology, geriatric medicine and infectious diseases, along with neurology and respiratory medicine. The majority of those training doctor places will commence in August 2022. Since 2014, 574 trainee posts and expansion posts have been created in a wide range of specialties, with 100 of them in general practice. The Scottish shape of training transition group, which is responsible for deciding the number of trainee posts and medical specialties in which they will be created, will not be taking a similar process for 2023. I want to also touch on the Labour amendment that mentions staff burning. That is really important. The Scottish Government is committed to safeguarding the mental wellbeing of the workforce and has committed an additional support package of £4 million for staff wellbeing. Having led a member's debate on mental health just recently, I am aware that work in health, social care and social work experience higher levels of mental health problems, and those have been exacerbated in the Covid-19 pandemic. The additional funding will focus on staff's physical and mental needs and, of course, will include provision for what drinks, food and other measures to aid, rest and recuperation. Importantly, another £5 million has been committed to establish health and social care and mental health work, to establish enhanced existing wellbeing and mental health provision, including the national wellbeing hub and the 24-7 national wellbeing helpline. In conclusion, the level of new domestic care in places in Scotland is proportionately higher in Scotland than anywhere else in the UK. With the measures highlighted, we will continue to do so and support the Scottish Government amendment. For me and most of my constituents, this is a simple issue. It is about doing what is right to help an NHS that is struggling to keep its head above water. It is about making sure that we have well trained and well looked after staff who are supported to give the best care in the world. I do not want it to become a party political issue and I do not think that the issue would benefit from it, but this Government must step up. I worry that, going into winter, we see a repeat of the capacity crisis that we have seen year after year in Scotland and elsewhere. That is undoubtedly exacerbated by this Government's failure to properly engage in serious workforce planning. That is not a new problem, nor is it, as some spin would have you believe, a problem closed solely by Covid. Warnings were in place long ago, and many of my colleagues who are sitting in the last Parliament will make the same points that I will make today. As Jackie Baillie indicated, we will on these benches support the motion on removing the cap. We must remove the cap on funded places for front-line medical students, but we cannot do so without additional investment for our first-rate medical schools and the capacity to deliver foundation places to all graduates on completing their degrees. That is basic common sense and, equally, I believe that it is achievable with the correct political will. Indeed, the problem is generally applicable across the medical fields, as Jackie Baillie indicated. I have repeatedly raised issues in the Parliament around the increased number of trained pharmacists that we need across Scotland, and without moving away from the purpose of this debate, I just wanted to make that point again. There is a staff shortage emergency in the NHS in Scotland, and we have to be honest about that. Beyond that vital need to get more quality front-line staff into our NHS, we need to take care to look after those who are already putting in incredible shifts day after day. Margo Cranmer, the chair of the unison's nursing sector committee, has described Scotland's nursing team as stressed and exhausted, and I thought that it was worth stating that again. It has already been mentioned in the debate. She goes on to say further that substantial investment in extra staff and changes to their working lives are essential. Staff retention is nowhere near where we need it to be, and I view maintaining a satisfied workforce as a top priority for any service that wants to tackle the challenges ahead. I do not think that, in all honesty, we can say that that is where we are in Scotland at the moment. We have all spoken to constituents and representatives of medical and NHS staff who have no end of stories about the strain and pressure that they are under. I want to give them something to hold on to, not just a few headlines or motions of thanks. As well as lifting the cap, let us get a long-term pay deal that seriously reflects what health groups and trade unions are asking for, and offer a working-time review to every staff member considering retirement. That will give us the opportunity to offer more flexible working arrangements and retain staff for longer. Staff who are fed up with being a secondary consideration. At the heart of all that is low pay, and as a mistake, the Government is making again and again. We are supposed to be designing a transformational national care service, but, as of yet, the Government has still not committed to £15 an hour for social care workers. The NHS recovery plan that was presented to the chamber only a few weeks ago was equally full—yes, I'll take an intervention—very briefly, and the member is closing. I wonder if she could tell me very briefly how much £15 an hour would cost and from where in the health budget should we take that money from. I apologise. I think that this is what the Government does time and time again. It tries to move the debate away from what we know will solve many of those problems. The trade unions are telling us that we can offer this to the staff and it will have a result. If you can just let me conclude, in November as the colder nights approaching, we may still be in serious difficulties no matter what. We can start the work now, and in the months and years to come, we can return to this place with a sense of achievement if the Government delivers for the NHS staff. It starts with pay, wellbeing measures and workforce planning, not spin. Thank you. I call Cocap Stewart to be followed by Sue Weber. Standing in the Scottish Parliament, we are fortunate in that we get to experience visceral reminders of the rich history of our country. Since the 18th century, Scotland has been credited with producing some of the greatest thinkers, writers, scientists and physicians that the world has ever seen—a formidable reputation that defines us to this day. Such a reputation does not merely emerge through chance, rather there is an undeniable relationship between the level of talent that we see here and the established focus on education that has shaped this country for hundreds of years. Here in Edinburgh, we have the oldest medical school in the United Kingdom and with my own constituency of Glasgow Kelvin, the University of Glasgow School of Medicine, boasts incredible contributions from an impressive history of alumni dating back to the 17th century. Today, medical students face incredible challenges navigating a notoriously competitive field of study while enduring the additional pressures of the pandemic. I would like to take this opportunity to thank the students who have volunteered to help the NHS during a time of crisis. There are now over 21,500 more NHS staff since this SNP Government came into office, including more doctors as well as qualified nurses and midwives. The number of GPs working in Scotland has increased by nearly 12 per cent since 2006. It is our duty to ensure that those numbers continue to rise and that our NHS workforce is as strong as possible. In remaining mindful of that goal, I am delighted to see that the number of medical places in Scottish universities has increased in recent years. The University of Glasgow has spoken positively about the upward trend in Scottish medical students, which is achieved by converting 100 former home nation places into Scots places over several-year glide paths in line with Scottish Government policy. Our Government has also shown that it is committed to improving the lives and working experience of junior doctors up and down the country. The commitment is evidenced by a willingness to engage with external stakeholders about goals to implement a 48-hour working week, by the £32 million pledge that will create additional trainee posts and by the further £4 million dedicated to NHS staff support and wellbeing. After all, it is only by investing in the medical and physical health of our workers that we can expect to retain our new recruits, building long-term resilience and maintaining high standards of care across the NHS service. Ultimately, there is no question that recent disruptions have created in-electable vacancies and gaps within the current system. Although certain things have been out with our control, I will take an intervention. Do you acknowledge that there were staffing problems before Covid and that it has not just been the Covid that has probably caused these problems? I acknowledge that free tuition fees in this country is the best way of widening that access and addressing any shortfalls in staffing, which we are making great progress on. As I was saying, while certain things have been out with our control, what we can influence is the way that we value our healthcare workers. It is an immense burden that has been placed on their shoulders. As we brace for winter, we want to provide our assurances that there will always be a place for Scottish medical students here, that they will always be fully supported in achieving their goals and reaching their full potential, not least because of free education tuition fee in Scotland. Our NHS is under pressure like never before, and it is increasingly clear that the SNP does not have any positive ideas to turn things around. All the offer that the people of Scotland and our hard-working NHS staff have is more excuses. The SNP does not want to admit that removing the cap on funded places for those key NHS roles is the right thing to do. The current crisis in the Scottish NHS in the large part is to the lack of GPs, doctors, nurses and paramedics. The list goes on. A problem that stems from Nicola Sturgeon's decision to cut the number of funded training places at Scottish universities when she was health secretary a decade ago. When the Scottish Parliament first sat in 1999, more than 60 per cent of medical places were filled by Scottish domiciled students. That has dropped by around 10 per cent due to the decisions taken here in this chamber. We cannot continue with a policy that is holding back our NHS and, after 14 years to sort things out, the SNP has failed. We know that the applicants are still there and are still applying. We know that Scottish universities are filling the funded places and that it could fill more with suitably qualified young Scottish people. The widening access places could and would be maintained. Surely it would be worth giving that suggestion more than a cursory glance. Finding that we have a wide range of diverse new training places outlined by Paul McClellan earlier means that the threat of the lack of training places for our graduates from the medical schools and nursing schools, as stated by the cabinet secretary, is a conflicting statement. Would it not be a more desirable problem to have to have too many than the workforce crisis that we face today? Surely our universities are better placed to meet and plan for the longer-term workforce needs. The vice-president of the Royal College of Emergency Medicine stated in the health committee earlier this month that the training scheme had nationally determined numbers and was six years out of date. One in five consultants were considering early retirement, one in two seeking to reduce their hours. We right now have one A&E consultant for every 6,500 patients. It should be one in 4,000. There are 130 whole-time equivalent emergency medicine consultants short, and GPs are already facing unprecedented demand. Andrew Buiss from the BMA translated the issues that we had to meaning that right now we have 250 whole-time equivalent GP vacancies in Scotland. We cannot keep lighting the problems get worse. The SNP's incremental increases in funded places simply does not meet the scale of the challenge that we face. I would urge members across the chamber to ask themselves if we are doing enough to protect and the future proof our NHS. We cannot keep doing the same thing and hoping that the staffing shortages will sort themselves out. We need a bold new approach. Is the SNP Government ready to admit that they have got it wrong? For a national Government that claims to care about Scotland to be overseeing a system in which we are turning away bright young Scots, who want to be nurses, doctors, paramedics of the future, is nothing short of shameful. By keeping the funding cap in place, we are selling Scotland short. We have the talent. Let's do something about it and accept and support the motion presented by Dr Gohani today. I call Gillian Mackay to be followed by Bob Dorris. The pandemic has been an extremely difficult time for all of those learning and working in the NHS and I too would like to express my sincere thanks for their efforts. We know that the NHS workforce was under pressure before Covid and that the pandemic has intensified this pressure. It is vital that every avenue is explored in efforts to ensure that our NHS has the staffing levels that it needs. However, it is also important that any decisions are made with a view to the long-term impact. In their statement about today's debate, the BMA said about the Conservative motion, simply taking steps such as these without a proper strategic long-term plan for our whole workforce could potentially be counterproductive. Right now, we have staff shortages in the NHS and the staff that are in post have experienced huge increases in their workload. That means that the number of clinicians available to engage in teaching and training is reduced. Any move to increase medical student places must take account of that or we risk piling even more pressure on existing staff and creating bigger class sizes with fewer teachers, which, as the BMA has warned, could affect the learning experience. In the wake of the pandemic, proper workforce planning will be essential to secure the sustainability of the NHS. However, that must be long-term strategic planning, which anticipates how the decisions that we make now will affect the workforce in future generations. The BMA has also warned that if the Conservatives are proposing that we lift the cap on Scottish students without increasing student numbers overall, there are issues around how that is done fairly and appropriately. Increasing student numbers is, of course, an important part of long-term workforce planning, but we must also look to the short term. We need to retain the staff that are in place now, but that will become increasingly difficult while pressures on the NHS continue to increase. Staff are exhausted, they are worn down and burned out. Mental health support will play a key role in supporting the workforce, and I have heard positive feedback about the national wellbeing hub, but it is only part of the picture. We fundamentally need to improve working conditions for staff and ensure that they feel valued and that their contribution is recognised. I have been dismayed by some of the questions that have been asked in Parliament about why GPs are not seeing patients or when can we see GP practices reopen? GP practices are open, and GPs are seeing patients. General practices in Scotland see more than half a million appointments every week. There are, of course, on-going issues with waits for appointments, and I do not want to minimise the distress that this is causing to patients. People are waiting far too long, and that is unacceptable. However, that is due to the immense pressure that is being placed on GP services, not because their doors are shut to the public. We do GP service by pretending otherwise, and that will certainly not help retention. I would like to conclude by turning to widening access. I welcome the Scottish Government's commitment to doubling the number of widening access places to help to create a more diverse medical workforce. The NHS needs to reflect the diversity of Scotland and there is evidence that a diverse workforce can improve the quality of care. Widening access is essential from a social justice perspective, but there are also numerous benefits to the NHS and patient care. We know that students from the poorest 40 per cent of neighbourhoods are less likely to be studying medicine and the other professional courses such as law, veterinary medicine and architecture than any other courses at university. People who are care experienced, young carers and asylum seekers may also be less likely to study medicine. That means that we are missing out on a significant pool of people who could go on to become excellent clinicians. It is to our and to the health services detriment and it needs to change. We need an recruitment and retention strategy with real teeth because it is evident that the one in place by Labour ministers is totally ineffective and is putting our NHS at breaking point. That was a Conservative member of the Senads in Wales. I do not believe that statement, Presiding Officer. I do not believe it and neither is it true of the NHS in Scotland. I could also make a point that the vacancy rate for nurses midwifery in Scotland is 7.1 per cent. Not good enough and a real significant issue is 10.3 per cent in England. That is not to remotely pass the buck in relation to significant and major issues in Scotland, but it should be placed in context. I would like to agree with many of the aspects of the matters that Jackie Baillie raised. Pressures in staffing were absolutely existent before the pandemic. I agree not just in Scotland but across the UK. That can be true at the same time as acknowledging the record levels of investment in the NHS by the Scottish Government and record staffing numbers up 21 per cent during this Government's time. Action was also taken prior to the pandemic to tackle pressures with the expansion of medical, nursing and midwifery training places, as well as an increase in levels of postgraduate specialist medical training. As part of the NHS recovery plan, there is also a commitment to grow the number of undergraduate medical training places by 100 per annum over the lifetime of this Parliament, as well as an ambitious plan to double those from the poorest background. That puts into perspective the calls from the Conservatives to remove the cap on funded training places. Action has already been taken. Action of a costly plan to significantly increase those places. I would, however, welcome additional information from the Scottish Government in relation to the creation of a national centre for workforce supply. What that centre will be with the workforce planning more generally, there has to be a connection surely, including having sufficiency of places at medical schools and, of course, across other disciplines. Those things have to talk to each other. That is important. By the end of this year, the Scottish Government will publish a national workforce strategy that supports the delivery of its Covid recovery plan, with more details than key workforce targets. Will the national centre for workforce supply feed it into any revisions of those targets on an on-going basis? Will that strategy have specific targets on recruitment and retention that we can monitor? Will it feed into those assumptions in training places over the years? It is right that this is all scrutinised, Presiding Officer. I want to return once more to Jackie Baillie's amendment, as it references various important matters outwith training places such as recruitment and retention of staff across the NHS, as well as targeting potential NHS returners. Absolutely. However, we contend that much of that work is already happening, but it is absolutely right that we should do more where we can and we should monitor the success of that. There was more I wanted to say, but in the time that I have left, I want to talk about those who are already qualified to work on more NHS, be those nurses that I met at a parliamentary event just a few weeks ago in this place, who are not allowed to work in the NHS, trained in Scotland but who are not allowed to work in the NHS because of their asylum status. That is scandalous against their human rights. That is an absolute act of self-harm on Scotland and Scotland's NHS, or that it is not a medic. I do not want to mention this person's discipline, but someone about to graduate on another medical discipline who contacted me just the other day to say that, because of their asylum status, they will not be able to pick up paid employment in the NHS. Surely, to goodness, there are things that we can do in this place to improve things, but there are also things that we can do within the UK to fill out everyone who is qualified to work on NHS to take up employment and do so. Thank you. We now move to winding up speeches, and I call on Michael Marra up to four minutes. Thank you, Presiding Officer. As has been referred to throughout this debate, the chronic shortages of staff that we see in our NHS were exacerbated by the pandemic or not caused by the pandemic. This is a crisis of 14 years in the making. As my colleague Jackie Baillie forensically set out, we have seen this Government preside over historic failures in workforce planning. They were warned time and time again. Further to this, and for far too long, we have seen under-investment in higher education, who are training our NHS staff of the future. The funding awarded for Scottish students comes nowhere near to meeting the cost of training those students. We welcome today's call to increase significantly funded places for front-line medical staff, but there is worryingly a lack of understanding from the Tories on the practical constraints that that would face. Jackie Baillie set out the 9,530 applicants and the 1,290 students that were admitted and asked a very reasonable question about where that bar would be set. The health secretary and we are repeated by Paul McClellan fell into some of that too, hailing the number of those admitted who met the entry requirements. It is seemingly unaware that those entry requirements are, of course, in very significant parts set to limit entrants on the basis of the number of funded places supplied by this Government. I welcome the broad agreement across all the parties that have spoken about the fact that much more can be done to recruit young and older Scots, and it would be good to hear more about how that can develop so that we can increase the domiciled Scots involved in our NHS. Currently, we have acute shortages in a range of areas—vascular surgery, urology, internal medicine, mental health, as highlighted by Alex Cole-Hamilton, to name but a few, but nurses and crucially, GPs too. When the health secretary makes a trip to my lachy ward to glumly announce a national scheme for new GP surgery buildings, the photo that I saw was pretty glum, I have to say. It was not only the risible figure of £7 million that attracted ridicule but crucially the fact that there are no GPs to go into those fantasy buildings. Long-term cuts made to training places—no, thank you, in a while, if you bear with me—have real-world consequences, and not just for those young people who would hope for a lifelong productive career in medicine and care. Take the breast cancer care crisis in my home city of Dundee. What we get from this SNP Government are denials and a deputy First Minister burying his head in the sand. Crisis? What crisis? Instead, Labour is listening to those who know what they are talking about, the workers in the service, the patients requiring care and the tragically bereaved families. They know that one clinician cannot do the work previously done by three specialists. So when the health minister on the same visit, and I think that this is why he looked glum, told the people in Dundee and across Tayside that there is, and I quote, a full service, utter fantasy. The perverse situation is that the SNP tells that the cause of this crisis, which we are to at the same time believe does not exist, is national staff shortages in these specialist positions. Who is in charge of training those people, of providing those skills? It takes years, they say. The SNP has had 14 years. I think that Carl Mawkin touched on a very relevant point in this. What we should be doing as well as recruiting more is retaining and valuing the workforce that we already have. If only the SNP Government and NHS Tayside management would listen to that point in terms of retaining the staff, the specialist breast cancer staff in Tayside, then we wouldn't be in the situation with a crisis in that service in my constituency. The staff within the NHS is to so many members have said that they are doing tireless work, performing miracles every day under the harshest of pressure and without the support that they need from the SNP Government. All of this is so important, Presiding Officer, when we see a lack of planning, a lack of specialist staff, services come under increased pressure and for far too many those services cease to exist. The consequences are life-threatening. The population is reaping what the SNP shows. I will try to address some of the points that are being raised by members of the Opposition, and my own colleagues. In the backbench, there has been a very good and interesting debate. We have managed to get into a little bit of the detail of the Tory motion and some of the consequences that it would have, but that issue could do with further debate. I am happy to engage in that debate, be it with Dr Gohanion, whether he did any of the health spokespeople across the chamber. Jackie Baillie made a very good speech. As you can put that on a leaflet, if she wishes. I thought that she made a very good speech. She has declined my offer, I am not sure why. I thought that she made a very good speech. I thought that she and Michael Marra did well, and a couple of other members also focused in on it. The pragmatic and practical challenges with the Tory's proposal are very clear that the Tories have not thought through that proposal in any great detail whatsoever. They are not able to answer questions about, for example, how many places universities would then have to take on, how much that would cost, have they spoken to medical schools in terms of whether they have the teaching staff in place, have they spoken to NHS health boards about the number of trainees that they have in place, do they have the capacity to train all what would be an uncontrolled expansion of medical students? Those are conversations that they clearly have not had, or else they would have gone into the detail of that. Jackie Baillie and others went into those practical and pragmatic issues with that cap. Jackie Baillie said that she will still support the Tory motion despite poking holes right the way through it. Of course, I am always happy to give way to Jackie Baillie. Would the cabinet secretary not agree that the intention behind the Tory motion is a valuable one, even though, practically, she has not thought the consequences through clearly? That is why I am delighted that we have committed to increase medical graduate places by 100 per year. That is why those places were filled. Every single Scottish domicile student met the conditions of their offer and were offered a place in the Scottish University, so I am delighted about that. Although many of the stations in the Labour motion are very good, I cannot support it, as I do not agree with the inaccurate preamble at the beginning of it. If I also looked at our workforce statistics, I will come to why it is inaccurate. If I looked at our workforce statistics, I mentioned that in my opening remarks, we have an excellent record on NHS staffing. That is why we have record numbers working on NHS under this SNP government. I will not give way at this stage. I have a 20 per cent increase in our staffing since we came to power, more than a 11 per cent increase in qualified nurses and midwives. We have seen a 58 per cent, almost a 60 per cent increase in consultants, medical and dental consultants. When I look at comparisons across the UK, we have 94 GPs per 100,000 in Scotland. That compares to 76 per 100,000 in England and 75 per 100,000 in Labour-controlled Wales. I cannot speak much to Alex Cole-Hamilton's speech. I am ashamed that he was not here. It would have allowed me to intervene in what I thought was a contribution riddled with inaccuracies. Meghan Gallakor asked for when our workforce plan will be published later on this year. I thought that she and Dr Gohani perhaps made an inaccuracy or something that was maybe not quite as it was being portrayed. I may have got this wrong, but they both seem to suggest that the Royal College has said that a cap should be removed in perpetuity. That was not my understanding of the Royal College's statement. It was that they had asked for the cap to be removed in 2020 due to the increase in applications because of the situation in relation to exams. Of course, we did that. We removed the cap, essentially in 2020, to deal with those additional applications. However, if I have that wrong, I am happy to correct the record. From my perspective, I would again say to Carol Mawkin, who has always stood up here quite rightly so and said to the—reminded every single one of us, be it in Government or this whole chamber, that the wellbeing of our staff is crucially important. That is why I am delighted that we have invested £12 million in the wellbeing of staff in terms of her call for £15 an hour for social care workers. I did ask her the very reasonable question on how much that would cost. She seemed to say that that was an immaterial consideration. I do not think that that is correct, and I am afraid in Government that we have to give those matters consideration. However, if, as part of the budget negotiations, which we are undoubtedly about to enter into, her party wishes to bring that case forward, then, of course, we would have to demonstrate where that money is going to come from. I will end, as an old Presiding Officer, to say that I understand that there are challenges. Those challenges have undoubtedly been exacerbated by the pandemic. However, I am also proud of this SNP-led Scottish Government's record on NHS staffing, which is at record levels. It has been growing for nine consecutive years, and I do not doubt that it will grow for that 10 consecutive year in a row. I am happy to move the motion in my name. I am very grateful for the opportunity to be closing this debate for the Scottish Conservatives, especially given the urgency for action. I would first like to express my sympathy with those who have been directly affected by the NHS crisis, and I would like to express my gratitude to the NHS staff who are working under extreme pressures to keep us all safe. Today, from this side of the chamber, you have heard my colleague's call for action from the Scottish Government on removing the cap on funded places for front-line medical students. As you have heard my colleague Dr Sandesh Guliani, a practising doctor who day in and day out faces those challenges alongside his colleagues, he could not have been more accurate A distracted Government that focuses more on ideological and constitutional obsessions is no friend of the NHS. I would echo what Dr Sandesh has said. We urgently require a strategic workforce planning to ensure that the NHS is prepared for the future. That is why it is important that the SNP listens to the medical staff like Dr Sandesh on the ground. My colleague Megan Gallacher referred to the NHS Lanarkshire, whose staff, I quote, do not want to think about winter as we know it will worsen than it is at the moment. That is not all. My colleague Sue Weber highlighted the lacklust of increased to funded training places that will not scratch the surface of problems that we are facing. I want to pick up on a few other contributions around the chamber today. I do not have enough time at the moment, sorry. It was great to hear all the statistics and words from the cabinet secretary, but what is needed is for a plan to translate into change and delivery for those on the ground, not just for short-term, but we must have a long-term strategic plan that works. I welcome the cap removed for a year. However, why just a year? Why not just remove it? I thank Jackie Baillie for drawing attention to the SNP planning failures and highlighting the need to improve infrastructure to support current staff. I agree with Alex Cole-Hamilton that we are losing people in the medical profession that much more must be done. I agree with Alex Cole-Hamilton on the Scottish Government not being equipped to deal with the NHS crisis. Today, we have heard from other members around the chamber. I am going to quote some SNP members, Paul McClellan, Cwcab Stewart and Bob Doris. They talk about basically actions being done and there is nothing wrong. We have a great talent here in Scotland. Yes, you are right that what Cwcab Stewart said, we do have great talent here in Scotland, so let us keep it here in Scotland. Carol Mohan talked about NHS keeping their head above the water, nursing staff stressed and exhausted, and Gillian Mackay spoke about that we need a proper workforce planning must be in place. Our priority must be to ensure that good as we look forward, we are able to provide the best standard of care for patients. We can only do that by improving the conditions on the ground, ensuring that the NHS and its workforce are prepared for the future, not sticky plasters from the SNP. Every day, we read more reports that there are not enough doctors to keep up with the demand and that the chronic shortage of front-line staff is threatening the health sector's recovery. It remains a myth to me why the Scottish Government haven't strapped the cat-crap all together, not just for a year, not yet. Let's highlight some figures just in case the SNP have forgotten. Firstly, 55 per cent of surveyed Scottish ambulance staff have witnessed adverse clinical events patients dying or becoming seriously ill because of long waiting times. Secondly, 42 per cent of GP practices reporting that demand is substantially exceeding capacity. And last but not least, Presiding Officer, waiting times. The SNP Government is still failing to get to grips with an acceptable strain on Scotland's Aewards. Let me highlight and make it clear to the chamber today we are not blaming the NHS staff in any way. This failure lies solely upon the leadership from the SNP Scottish Government. Presiding Officer, I know what I want to talk about right now as a personal experience. My son is currently studying medicine at Dundee. However, this may not have been the case as he was denied a place at first and then he was fortunate enough to have accepted in the second round, however many of his friends. Also, successful students were not so lucky and we lost that talent to universities outside Scotland. This is exactly the type of brain drain that my colleagues speak of. In conclusion, Presiding Officer, staff are working tirelessly. People's lives are at risk. All while there is a cap on the number of people who can train in the various services that this country so desperately needs. That is why our motion today calls on the Scottish Government to remove the cap completely on funded places for the front-line medical students. The reality is that, without urgent action, the situation is only going to get worse. I urge all parties to vote for our motion today and I support the Conservative motion in Dr Sandish Gulliani's name. Thank you. That concludes the debate on removing the cap on funded places for front-line medical students. It is now time to move on to the next item of business, which is consideration of business motion 2155, in the name of George Adam, on behalf of the parliamentary bureau setting out a business motion. I call on George Adam to move the motion. I call on George Adam to move the motion. Thank you. No member has asked to speak on the motion and the question is that motion 2155 be agreed. Are we all agreed? The motion is therefore agreed. The next item of business is consideration of business motions 2156 and 2157 on stage 1 timetables for bills. I ask any member who wishes to speak against the motions to press their request-to-speak buttons. I call on George Adam, on behalf of the parliamentary bureau, to move the motions. Thank you. No member has asked to speak against the motions. Therefore, the question is that motions 2156 and 2157 be agreed. Are we all agreed? The motions are therefore agreed. And there are six questions to be put as a result of today's business. The first is that amendment 2138.2, in the name of Graham Day, which seeks to amend motion 2138, in the name of Graham Simpson, on delivering promised road infrastructure across Scotland, be agreed. Are we all agreed? The Parliament is not agreed. Therefore, we will move to vote and there will be a short suspension to allow members to access the digital voting system.