 I will get back later in the day to you in that regard. The next item of business is the debate in motion number 15098 in the name of Jenny Marra on health. I would invite members who wish to speak in the debate to press their request to speak buttons and I call on Jenny Marra to speak to and move the motion. Ms Marra, you have 14 minutes or thereby please. Thank you Presiding Officer. We come to the chamber this afternoon to discuss health and social care integration. While we make our speeches and debate today, thousands of people across Scotland will be in their homes, having just perhaps had a visit from a carer at lunchtime to give them their lunch. Many will have been helped by a carer this morning to get out of bed, to wash, to shower, to dress and to have been given their breakfast. Many of the carers will have then done the washing up, put the bin out, perhaps dealt with any family issues, made sure their charge has what he or she needs and wants for the day, made sure they are warm enough that the radio or TV is on the right channel, that those lucky enough to receive visitors know what's happening throughout the day, that the key is in the right place, that there is enough tea in the caddy, all the while they are watching the clock. The myriad, Presiding Officer, of seemingly small but important challenges is one of the reasons that health and social care integration is challenging on a daily basis. Medicines are to be taken. The GP has prescribed three times a day. Carers can't administer medicines. This has to be done by someone else. Who is that person? This is an example of the day-to-day challenges that makes bringing health and social care together so complex and challenging. That is the reality on the ground, a window into many homes across Scotland this afternoon. It is the right thing to do, because we know that many, many old people and they are the majority of recipients of home care. They desperately want to stay in their own homes. Last week, Audit Scotland published its report on health and social care integration. There were some very challenging messages for this Government in its pages. At the start of the summary it noted that there is evidence to suggest that integration authorities will not be in a position to make a major impact in 2016-17. The Labour motion sets out clearly today that Labour would spend the Barnett consequentials from the Chancellor's spending review on health and social care integration, channeling this money through our health boards into the integrated joint boards. It is plain for everyone to see that social care needs more investment if it is to be successful. It is clear in Scotland and it is clear across the United Kingdom and across most of Western Europe. It is plain for everyone to see that that need becomes more and more urgent every day as our population ages and more and more people require care. The Scottish Government itself has estimated that the increase in the need for health and social care services will rise by between 18 and 29 per cent by 2030. It is plain for everyone to see also that investment in this area is about prevention. Ten years ago, Campbell Christie made some strong recommendations about preventative spending, which this Government signed up to in opposition, but we have still not seen that shift that is necessary. The Scottish Government itself estimates that £138 million to £157 million could be saved from doing integration properly. I personally think that this is a conservative estimate. It is now nearly a year since Cabinet Secretary Shona Robison announced that delayed discharge would be abolished by the end of the year. I cannot criticise the Cabinet Secretary for her ambition on that, but she will have made this statement in full knowledge that keeping people in hospital is exponentially more expensive than caring for them at home. Some estimates she will know put a week's stay in hospital at nearly £4,000. Last week's Audit Scotland report states that, in 2014-15, NHS Scotland used 625,000 bed days for patients who were already ready to be discharged. That is roughly 89,000 weeks at £4,000 a week. Those are eye-watering sums of money. The Cabinet Secretary for Health and Sport has the right ambition to get rid of delayed discharge and to have the care infrastructure in place in the community to enable that. However, I think that she would need to admit to herself that it cannot be done without that further investment. It cannot be done without that preventative spending. That is why—yes. I thank the member for giving way. She does present the challenge between preventative spending and reactive spending. One answer would be that we cut the hospital budget and put more into the community. Does she support that approach? The health consequentials that are coming to Scotland from the comprehensive spending review would be spent exactly on health and social care integration. It is absolutely preventative spend. That is why the allocation of Barnett consequentials is the only and the right thing to do with the health funds that are coming to Scotland from the chancellor's statement. There is no reference at all in the SNP amendment to the Barnett consequentials. I ask the cabinet secretary today to outline what her plans are for this substantial sum of money or at least her priority areas where it will be spent. I would like to address a topic that I hear regularly about from health boards, local authorities and social care providers. The thorny and complex issue of governance that the Audit Scotland report raises. It says that the Scottish Government should resolve tensions between the need for national and local reporting. Caroline Gardner, the Auditor General, states that, if the new bodies are to achieve the scale and pace of change that is needed, there should be a clear understanding of who is accountable for delivering integrated services. The tension between national outcomes that integration authorities are required to meet and local autonomy is leading to some confusion and problems with Governments. I am sure that this is something that the cabinet secretary has been working on, and I wonder whether she will use this opportunity today to update the chamber on progress. The report has identified risks, including difficulties with agreeing budgets, complex governance and workforce planning. We have been challenging the Government on workforce planning in the health service for many, many months now, but with the persistent problems of GP recruitment, it seems likely that this problem will continue to persist, and I wonder if the cabinet secretary will also update us on that today. Let me turn to the SNP amendment. First, the tone of the amendment does not quite chime with that of the Audit Scotland report released last week and the many challenges that it identifies. I do not think that there is any room for complacency here, but that is really what the amendment suggests that the Government's approach is, and that is concerning in itself. However, more specifically, Labour will not be supporting the SNP amendment tonight for not just that reason of complacency, but for two very important specific reasons. The amendment says that NHS funding is at a record high level. The Scottish Government can take credit for inflation over the years if it wants, but anyone who has read the Audit Scotland report will have learned, if we did not already know, that under the SNP the health budget decreased by 0.7 per cent in real terms between 2008-9 and 2014-15. That is on page 9 for the chamber's reference. While the SNP congratulates themselves on inflation, we on those benches are more concerned with spending on our NHS in real terms. Secondly, I do not think that being satisfied with progressing the living wage for care workers is nearly good enough. That is specifically what Shona Robison's amendment says that the afternoon that they are making progress. We know and we hear stories every day of care workers' jobs being viewed as the lowest rung in the employment market, with carers leaving caring jobs to take up jobs in supermarkets when they open and, as those jobs become available, to get better wages and better terms and conditions. Is this the kind of society that we are satisfied with that caring roles with all the emotional and physical demands of that job and the value that should be placed on the dignity of caring for our elderly in their own homes, that that job is remunerated so badly? I know people in my own community, women especially, who would make marvellous carers but are being paid more in other jobs such as cleaning and supermarkets than to look after our elderly citizens. Many would like to take on a caring role, and they have told me that as they would like to give back to use their skills, they would like to bring up their families, to care for people and to do that valuable job. However, our Government simply does not value it highly enough to pay it well enough to allow them to take up those opportunities. I do not think, quite frankly, that it is good enough that the Scottish Government simply congratulates themselves today on making progress on this. The First Minister is one of the most powerful politicians of our era. With all her power, support in the party, in the country, her votes in this chamber and her rhetoric of equality and women's rights, you would think that it would be her ambition to nail her leadership firmly to delivering a living wage for all care workers. We raise the value of caring roles, and we raise the living conditions of many women in Scotland on low pay. However, I have still to hear the First Minister a year on from taking power tell us specifically what she is going to do, what she will boldly commit to to change the face of our community. Labour contends today that our care workers should have the SNP's unstinting support for all the reasons that I have outlined. It should commit to the living wage for care workers to raise the value of this crucial job in homes across this country, and it should commit to spending the health consequentials on social care to make this happen. I move the motion in my name. I now call on Shona Robison to speak to and move on at 1.5.098.3. Cabinet Secretary, 10 minutes are thereby placed. Thank you, Deputy Presiding Officer. I am very pleased to take part in this debate. Today, it provides a timely opportunity to reflect on our progress towards integrating health and social care in Scotland. I welcome, by and large, the constructive tone of Jenny Marra's opening statement. Last week, Audit Scotland published its first report on integration, as has been said. Douglas Sinclair, chair of the Accounts Commission, said that integration has the potential to be a powerful instrument for change, and the Scottish Government, NHS boards and councils have done well to get management arrangements in place. However, there is a real and pressing need for integration authorities to take the lead now and begin strategically shifting resources towards a different, more community-based approach to healthcare. I agree with that. The Government committed to legislating for integration back in 2011, because we recognise that we need to ensure that our system of health and social care focuses on the people who need it most, people with complex needs and multimorbidities, many of whom are older, for whom well-integrated care offers the best opportunities for better outcomes and better lives. We have come a long way since 2011, working exceptionally closely with a whole spectrum of stakeholders and partners, including the NHS, local government, the third and independent sectors, professional and staff bodies, the patient, carer and service user representatives that we have consulted, legislated and are now implementing the most significant changes to the way that the NHS operates since it was established in 1948. Changes that are just as significant for social care services and colleagues working in local government. As the Audit Scotland report sets out, success now will depend on us continuing to work together, along with strong local leadership and commitment to improvement. The framework is in place. Health and social care partnerships are establishing their arrangements for integrated governance, looking at improving pathways of care, bringing together different organisational cultures. Some have already gone live and all will be up and running from April next year. We and partnerships are on time, no small achievement in itself, and we are ahead of where we need to be. The Kings Fund noted at our NHS Scotland event in June this year that, quote, Scotland has made the most progress on integrating health and social care in the UK, but we are not complacent, and the amendment, I do not think, does strike a complacent tone, but it does recognise the positive elements that have been said, not by us but by others as well. We do recognise it much more as yet to be done. I agree that we need to see greater urgency from some partnerships as they delegate budgets for integration and develop their strategic commissioning plans. I have written to partnerships to reinforce the importance of showing strong leadership and making progress in the light of the Audit Scotland report. We have produced extensive statutory guidance on budgeting and commissioning, and we are investing £1.7 million this year on improved health and social care data to help partnerships plan services more effectively. Partnerships need to use the power of the £8 billion of health and social care resources combined under integration but previously held separately to drive real improvements in community-based, anticipatory and preventative care. Audit Scotland rightly draws attention to the need for robust indicators and measures of progress, and we have legislated for outcomes and have published a first set of measures in statutory guidance. Of course, we will keep those under on-going review to ensure that they keep pace with changes across health and social care. Every partnership will publish an annual report using those measures and outcomes, which will allow us to monitor progress and offer support where it is needed. I want every partnership to be bold and ambitious. Achieving our goals will be a challenge in what happens in communities within partnerships in primary and social care settings, involving pharmacists, social care teams, GPs and the third sector support. It must be as important as what happens in hospitals. Our ambitions for health and social care integration are clearly set out. Audit Scotland has recognised the financial and practical support that this Government is providing to health and social care partnerships to implement these ambitious reforms. When I talk about partnerships, I am talking about our health and social care workforce. Around 350,000 people work in health and social care in Scotland across the statutory organisations and the third and independent sectors. If they are all to play their part, effective workforce planning will be key, and that is why we have legislated to require partnerships to develop an integrated approach to workforce planning and will support them in achieving that. We know that we have a hard-working and dedicated workforce. For example, the recent survey of people working in social services in Scotland, in a minute, the view from here, found that 75 per cent of respondents are driven by a desire to make a difference. How many of those hard-working staff earn less than the living wage? I am just coming on to the living wage, but of course he will be aware that all of those working in the statutory sector already receive the living wage. I was just coming on to the living wage. The Government fully supports the living wage, and he will recognise that, as other members have— Dr Simpson, continue, Cabinet Secretary. He will recognise, as other members will, the difference that that can make to the lives of those working in social care. That is why we have taken direct action to raise rates of pay for those parts of the public sector under our direct responsibility. In doing this, we have set an example that we would encourage all employers to follow by committing to paying the living wage. We have done further than that. In a minute, we have provided, this year alone, £12.5 million as part of a tripartite arrangement with local authorities and care providers, worth £25 million to improve the quality of care in the care sector, by jointly investing in improving fair work practices for care workers, including making progress towards the living wage. I will take your point. Dr Simpson, thank you, cabinet secretary. That investment, of course, is very welcome. With the integration, those care workers will now move substantially under the new IJBs, so will they be counting as part of the statutory workforce and therefore be subject to the same very welcome measures that the Government has put in place already for the rest of the health service? IJBs will be required to commission services from the third and independent sectors, whose voices will be around that table. Of course, we have put in place statutory guidance that requires all public bodies to consider, including a question on fair work practices as part of the procurement process. I think that that is a very strong lever for the IJBs to use the guidance that makes it clear that the Scottish Government sees the payment of the living wage as a significant indicator of an employer's commitment to fair work practices. It is one of the clearest ways that an employer can demonstrate that it takes a positive approach to its workforce. Some local authorities are already doing that. I encourage all partnerships through the new integrated arrangements to do the same, but it does not stop here. I am committed to making further progress even than that by working with COSLA, as we are doing with Scottish Care, with the community care providers Scotland and others, to further progress fair work practices. In order to reach a common understanding about the scale of the challenge, I am happy to put the information that we have on the costings of delivering that living wage into SPICE, if that would be helpful, because I think that we need that common understanding. I will put that in to SPICE so that we can look at the challenge that we need to make. I want to just use the rest of my time to talk about my visit to Oak Ridge care home in Glasgow this week, where I saw first-hand very progressive work on integration and on intermediate care in particular. What struck me most about this visit was the absolute commitment of all of the staff and the strong leadership that is shown by the new health and social care partnership in Glasgow to improving people's quality of life. I was told that staff felt motivated and empowered by the work that they were doing with a strong belief that they were involved in something worthwhile and improving outcomes for older people. Through the work that they have done, last November, in Glasgow, they recorded 106 delayed discharges that were over three days in duration. At October this year, the number was 25, a reduction of 76 per cent. In fact, the staff were able to name those people who were delayed in the system in Glasgow at the moment because they are in such small numbers. That is a great achievement, and we want other partnerships to deliver that. Of course, more than half of all partnerships now have delayed discharge over three days into single figures. There are five that account for 60 per cent of the rest of the delays. I can assure Parliament that we are working very hard with those five partnerships to ensure that we get delayed. I am conscious of time, so I have to move on because I want to address this final point about the budget. On the forthcoming budget, it is worth remembering that this Government has passed on every penny of health resource consequential since 2010-11, and page 9 of the Audit Scotland report that Jenny Marra referred to makes it very clear that there has been a real-terms increase in resource spending to health. The figure that Jenny Marra quoted includes capital. I do not know why she is shaking her head if she looks at page 9 of the Audit Scotland report. It makes it very clear that health resource spending has increased in real terms. Capital spending is a different matter, and we know that, because of the 25 per cent decrease from the Westminster Government to the Scottish Government, capital spending has been a challenge, but resource spending, as per our commitment, has increased in real terms. Audit Scotland confirms that. On the forthcoming budget, I cannot say much about that other than that I am sure that Parliament can be reassured that the direction of travel that I have laid out in my speech this afternoon will be continued in the decisions that we make in the forthcoming budget. I am very happy to move the amendment in my name. I now call on Dr Nanette Milne to move amendment 15098.2 in the name of Jackson Carlaw. Dr Milne, you have six minutes, so thereby please. Right across the country right now, front-line staff in both health and social care are working flat out to satisfy the needs of people in their care. I am not quite so familiar with the social care sector, but I am sure that they are no different from those in the NHS. In all the years that I have known the NHS, the vast majority of staff at all levels and in all settings have worked with commitment to ensure the best possible outcomes for their patients. We know, however, that many of those people are working under increasing pressure as the demands of an ageing population stretch resources to their limit. Many are needing retirement age, others retire early because of the pressures and recruitment is not always easy. We see that in large numbers of consultant vacancies, particularly in some specialties, in the difficulty in attracting new trainees into general practice and then keeping them in primary care once they are qualified, in the very real difficulty in recruiting home carers and in the continuing use of agency and bank staff to cover an increasing level of nursing staff vacancies. Health boards are doing their best to plug the gaps. My own NHS board and Grampian have put wide-reaching and strenuous efforts into solving the problem. That has resulted in a number of consultant vacancies being filled and an innovative scheme is in place to recruit and retrain nurses who had left the profession, but are showing interest now in returning to work in the NHS. Overall, as we know, demand for NHS services is outstiffing available resources, and the system as it is is not sustainable. That is generally accepted and has been made clear by the auditor general that the NHS will not be able to continue to provide services in the way that it does just now and needs to develop a more strategic approach to support the long-term change and the move to community care, which we all agree is required. The key to that is to achieve the Scottish Government's 2020 vision, which we are all signed up to, top of which is integrated health and social care and including an ambition to keep people at home or in a community setting for as long as possible and getting them back home as soon as appropriate should hospital care be required, but all this requires long-term planning and Audit Scotland has found that this is lacking, putting the plans for an integrated health and social care system at risk, they say. That is concerning given that all 31 integration authorities are expected to be operational by the statutory deadline of 1 April next year. As we approach that deadline, Audit Scotland's recent report flags up a number of concerns, such as uncertainties regarding workforce, a lack of evidence of progression towards an integrated system, the need to involve the voluntary and private sectors in consultation and a need for integration authorities to develop strategic priorities for use in developing a workforce strategy, showing how they will redesign health and care services and a risk management strategy to show that they are properly prioritising their work and their resources. Those concerns and others are about some pretty fundamental issues in developing a system that has to be up and running by April, but two issues at locality level were aiming greatly. The first is the suggestion that integration joint boards might be too large, and this sets alarm bells ringing with me that we could potentially see a repeat of the failed CHPs, which very soon lost the support and interest of local GPs, largely because their size made it difficult to reach agreement, make decisions and ensure service improvement. Those are exactly the words used by Audit Scotland in their report about their fears that IGBs might be too big. While we are discussing the legislation, I put heavy emphasis on the importance of GP involvement at locality level. Indeed, I feel that they should be lead players at that level because they are at the centre of community provision for patients, and I do not see how the new system will work if they walk away. Given that localities are key to the success of integration, I hope that the joint boards will monitor the situation very carefully and focus on how localities will lead the integration process and deal with any emerging problems promptly, because I have heard anecdotally that some GPs may already be feeling disenfranchised, and I would not like that to happen. The other concern that I have is regarding the cultural change that is required if integration is to be effective. Audit Scotland thinks that the joint boards might struggle to change how local services are provided, saying that once difficult decisions are made, there are still complex relationships to be negotiated by health boards and councils, and they are unsure if the IGBs will be able to exert the necessary independence and authority to change fundamentally the way local services are provided. Again, those relationships will be key to the success or failure of the new system. Of course, there is no surprise that the boards and councils have been finding it very difficult to agree budgets for the new integration authorities. I do not have the latest figures, but as of October, I think that there are only six integration authorities who would inform the Government of their agreed budgets. There will undoubtedly be funding issues as the new system beds in, and there will be uncertainties until the Scottish Government's financial plans are approved. That is why we have proposed our amendment, giving our suggested use of the consequential following the Chancellor's autumn statement of the proposed increases in health spending over the next five years by the UK Government. Jackson Carlaw will deal with that in his closing speech. Before I conclude, I want to quote from a couple of briefings that we have received before this debate. The First from RCN says that the success of integration is dependent on having and supporting a multidisciplinary workforce that can deliver the right care in the right place at the right time, whilst recognising the unique contribution of different professions and stressing that that needs to be fully resourced. It also emphasises that health and social workforce planning can no longer be done in isolation. My second quote is from Mary Curie, who pointed out that palliative care is integrated health and social care and should be a priority for joint boards, indicating that investment in palliative care has the potential to reduce acute care costs, as well as giving the care that people want during their terminal condition and at the end of life. I still have high hopes of the integration of health and social care. Clearly, there is a lot to be done before it becomes effective across the whole of Scotland. I have finished by commending all those who are working extremely hard at the present time to meet the April deadline for integration, and I hope that the efforts will be successful. I move to the end of Jackson Carlaw's name. Right, thanks very much. I now call on Jim Hume to speak to your move on moment 15098.1. Mr Hume, six minutes please. Thank you Deputy Presiding Officer. I'm glad we have the opportunity and thank Labour for this debate on the integration of health and social care. Obviously, we want to make sure that support is given at the right time and of course the right place. The Audit Scotland report couldn't really be much clearer. It stated that there are significant risks that need to be addressed if integration is to fundamentally change the delivery of health and care services. So integration places assets worth about £8 billion or nearly two thirds of the entire health and social care spend in the management of integration authorities. It is one of the biggest projects that the Scottish Government has had to co-ordinate. I appreciate that it's not easy to do so. It's not a task that anyone involved can afford to cut corners in, I believe. I note and welcome the Scottish Government's investment of £0.5 billion, as well as support and guidance into early integration plans. However, the Audit Scotland gave a sobering account of the real state of integration plans as I currently stand. As Annette Mell has already noted, integration authorities haven't yet agreed on budgets and, as of October, just six of the 31 integration authorities had done so. As a result, strategic plans are affected. There's uncertainty over long-term funding and significant challenges, of course, in recruiting and retaining crucial staff such as GPs and care staff. Deputy Presiding Officer, there's findings aren't really new to us. Problems have existed before the Public Bodies Joint Working Act, yet, rather than addressing them at the core, ensuring that they're not transferred into the flagship policy, the Government let those problems grow and reach a point where we're facing a real danger to the NHS. We don't want to shift problems from the NHS as it stands into the integration process. One of the main benefits behind integration, of course, was to save money. The widely welcomed integration principles called for a community-based, preventative approach to health. That means having patients treated in their community closer to home, more resources locally, allowing hospital stays and delayed discharges to be decreased. All very welcome. However, Labour wants to spend £200 million of the £400 million in health consequentials on social care. The Audit Scotland report makes no mention for the need for more money to be spent on that area. NHS spending is £12 billion, so, for example, with a 1 per cent inflation, that's £120 million, which would account for pay rises at least. That leaves only £80 million for mental health, GPs, A&E and everything else. You're saying that we shouldn't be paying social care staff more, is that what you just said there, when you said that we shouldn't be putting any more money into this? No, I did not state that whatsoever. Mr Finlay is very clear about that, and I'll be very clear. Labour here are walking away from mental health, walking away from the GP crisis, walking away from health inequalities and walking away from health problems in A&E. In this case, the Scottish Government has a duty, as recommended by Audit Scotland, to work with integration authorities. That means helping them to develop the performance monitoring to clearly demonstrate their impact. If I have time, I shall give way to Jenny Marra. We were very clear in our press statement this week that the mental health consequentials, which we estimate at £59 million, would spend them on mental health, and the rest would be allocated to health and social care integration. I don't read the press releases from Labour, but I do read their motion today. It makes no mention of mental health. Public monitoring and reporting of the integration authorities' progress must be supported. There's no clarity over what exactly integration authorities need to measure their change and success against. What integration authorities need is the information and assurances that will be able to report into a network of clearly set outcomes. Any investment in social care must meet the needs that we have now and what we anticipate in the future. Our population is changing, demographics are shifting, more people are living longer, but I also repeat my calls to ensure that they are also living healthier. Creating a consistent, sustainable and person-centred model of care is essential if we are to treat people in a holistic way. We can't separate their physical needs from their mental needs. Marie Curie is urging for the provision of care to people with terminal illnesses. Any person nearing the end of their life must have as much physical help as psychological support. A combination of healthcare and social care is, of course, necessary. We not only have the ability but also the duty to put resources in place for every person who requires care and support. As we know, care doesn't start or end with just physical support. It's time that the facts were faced by investing in our mental health services, investing in the psychological support for people and delivering a personalised and all-rounded care. By committing at least £200 million of the £400 million of health cash consequentials from the spending review solely to social care, we risk leaving mental health in the same situation as it is now. A situation in which young people travel hundreds of miles for treatment while others have to wait for up to a year to see a specialist. Staff and their pressure to deal with increasing demand and, of course, non-increasing supply—I'm sorry, I'm just finishing, I've only got a few seconds. The situation in which people in the most deprived areas have five times more risk of having poorer mental health than those in the least deprived areas. So integration of services must mean that those who have higher chances of reaching a mental health crisis will have those chances reduced and a crisis point averted. A big component of that solution, I believe, is prevention. I'm sceptical of Labour's calls for more spending at a time when integration authorities need more information. I'm wary that, by leaving mental health behind, we would be letting down thousands of people who could benefit from more mental health support in their community. I move the amendment in my name. Six-minute speeches, please. Colin Mark McDonald, to be followed by Rhoda Grant. I've been very supportive from the outset in relation to the integration agenda, having, before becoming a member of this Parliament, served on the social care and wellbeing committee at Aberdeen City Council and seeing for myself some of the challenges that were faced in terms of delivery of social care. It's worth noting that while I was a member of Aberdeen City Council, we managed to get the delayed discharge figures down to zero in the city of Aberdeen. Unfortunately, since we left the administration, that figure has slowly crept back up to a higher level. One of the difficulties that has been faced, and one of the reasons why that has occurred, has been a difficulty in ensuring that appropriate care packages are being put in place for individuals coming out of an acute setting. It's one of the issues that I have seen in a number of constituency cases in terms of individuals who have often been taken from an acute setting and placed into a care home setting rather than being allowed to return home, because the care package to allow them to return home cannot be put in place. That has persisted, even with the decision by Aberdeen City Council, a decision that I did not agree with, to outsource their social care to an arms-length organisation, Bonacord Care, rather than having it being delivered on an in-house basis. I believe that the reason why I was supportive around the health and social care integration was around the tackling and removal of the silo mentality that often existed between health and social care and the gaps that could arise into which individuals could find themselves falling. I felt that an opportunity to create a more joined approach was something that should be pursued. It is something that I still think that is going to turn out when the integration joint boards take effect is going to prove to be of benefit to all our constituents. I think that there are other areas that we need to look at tackling as well beyond the silos that existed between health and social care. Those are silos that exist within specific areas themselves. There are silos that exist within the health service between primary and acute services that I think still need to be addressed and need to be brought much closer together in terms of the way that they work. That would help in terms of some of the issues that were raised before about individuals finding themselves in an acute setting, which is obviously more expensive than perhaps being dealt with through the primary care sector. Even within the primary care sector itself, making sure that all the different professions within the primary care sector are working in a much more rounded and holistic manner to ensure that, for example—I know that we will be talking next week in the scheduled debate on primary care redesign—to ensure that, when an individual presents in a primary care setting, they present to the most appropriate professional at that time, that would again relieve workload pressures and create the system that allows people to be seen in the most appropriate setting and to be dealt with in the most appropriate setting. I have a huge amount of respect and value for the work that is done by carers, not least because my mother, when she was working, was a carer, and both in terms of being employed as a carer, but laterally was an unpaid carer after that. I recognise and understand the strain that is often placed upon individuals in that environment. I think that there are a couple of things. The first is that, in terms of the call for care workers to be paid a living wage, as the cabinet secretary pointed out, those who are paid through the public sector already receive the living wage, but, beyond that, the ability to effect a living wage for those who are employed outwith the public sector environment would have been immeasurably increased had the opportunity been given through the Scotland bill, as the STUC called for, for powers over employment legislation and employment rights to come to this Parliament. However, the other thing that would help, and perhaps we should encourage the integration joint boards to look more closely at, is a move away from unit cost purchasing when it comes to social care services and more looking more widely at the outcomes-based approach rather than the simple unit cost approach. That would perhaps allow for a greater flexibility in terms of the pay and conditions that are afforded to care workers. I realise, as I said to Jenny Marra, that I would take an intervention from her if she is still wishing to do it. No, she does not on that. What is very clear is that there are difficulties being faced in the care sector in certain areas. In my area of Aberdeen, there is a real difficulty around recruitment and retention. It was highlighted to me when I held a care sector jobs fair in my constituency, aimed at promoting opportunities in the care sector. Now I know from feedback that I have had from organisations that individuals were able to secure positions as a result of that jobs fair, but it was noticeable that, compared to a previous jobs fair that I had hosted, which was much more wide-ranging, a drop in terms of the footfall, because individuals do not necessarily see the care sector as an area that they wish to go. Part of that will undoubtedly be around the pay element, but part of it is also down to a perception of what the role entails. What we need to ensure that we are doing to help tackle some of that is to present a much more positive image of the work that is done in the care sector and have more people speaking up for the valuable role that is performed by those who work in the care sector, I think that that would be helpful in attracting more people into that role. One of the things that seems quite clear this afternoon is that we have a very conflicting message coming from opposition parties around where the health consequentials should be allocated. I have no understanding or knowledge of where the health consequentials are going to go. It sits above my pay grade, but what I know is that the cabinet secretary and the Deputy First Minister will entirely be focused on making sure that the health consequentials are spent in a way that benefits the people of Scotland. That, for me, is the most important element in all of that. Our motion rightly starts by paying tribute to health and social care staff. They often work way above their contracted hours to make sure that those that they care for are well looked after. Within the social care sector, they are often paid the minimum wage, are on zero hour contracts and expected to deliver high quality care in 15 minutes or less. On top of that, many carers are not paid for the hours that have been travelling between clients. I spoke to someone recently whose wife worked as a home carer, and that was the situation that she was in. She was out at work for nine hours a day, but only paid for five of them. The rest of the hours were unpaid travelling between clients. Although the travel was seen as a commute for pay purposes, she was still required by her employer to ensure her car for business usage, despite not being paid while driving it. That meant that she had to pay much more expensive insurance premiums. We need to value all health and social care staff. That means paying them a living wage, making sure that their contracted hours allow them to go ahead and plan to meet their own financial commitments. Payment for time spent travelling is essential. In the Highlands and Islands, we can have care workers travelling 20 or 30 miles between clients as part of their normal day. It is unacceptable that that might not be paid. We need to give them a career structure. Care is often described as a new retail, but frankly retail provides a better career structure and indeed better pay. We see social care workers building up on expertise often on the job-looking after-complex cases, and they need to be properly trained. I was speaking to a couple of carers who have been in the caring career for a number of years. They told me that it was only on joining their current employer that they were given any training at all. They told me that if they had received that training at the start of their careers, it would have made a huge difference to themselves but also to the clients that they were looking after. Others have developed expertise in specific areas and one growing area is home care for people with dementia. With the right knowledge of the condition, you can organise the home to be safe while allowing the client to live independently for many more years. Perhaps Jim Hume would acknowledge that mental health care can happen in the community with the right workforce and skills there. When I meet those dedicated people, I cannot but be impressed by their compassion and their love for their career. They get great job satisfaction for working with people, seeing their work lead to health improvement and maintaining independence. However, too often they move between clients, meaning that they cannot build relationships with people or even grow a knowledge of their condition. That is difficult for both the client and the carer. Integration of health and community care has been devised to remove some of the pressure from acute healthcare services and enhance community care. I believe that we are all signed up to the concept. However, there are real concerns. As others have stated, Audit Scotland has highlighted some of those concerns in its recent report. The point to funding is an issue. That was raised time and time again during the passing of the act through the committee process. The policy is right, but the transition needs to be funded. We also heard from Audit Scotland that the staffing profile is wrong and that it had been structured to fit past priorities rather than the situation that we now find ourselves in. Putting that right needs investment as well as workforce planning. Audit Scotland warns about funding as timely as we consider the carer's bill, and the bill is widely welcomed. However, the funding is woeful. It won't meet existing demand, far less meet demand created by the bill. Many unpaid carers are close to collapse and need more support, but that costs money. Bob Doris, briefly please. The member identifies something that Barnett consequentials on health and social care integration could be spent on. It would be a very worthy cause, but the Labour motion before us today says that we should all be spent on one thing and not the cause that Rhoda Grant brings to the chamber today. You have to, at some point, make a decision and not ask for money for everything and spend money on nothing. I am slightly confused by that intervention. I believe that unpaid carers provide social care in the home. If he does not recognise that, I fear for this Government. Unpaid carers save this country £10.8 billion a year, so I do not quite realise the point that he was trying to drive at. The very least that we can do is to support them and enable them to continue their care and grow while having the freedom to live their lives. They also need the training and information and to be treated as partners within the care team, and neither should we expect them to do things that we would not allow paid staff to do because we thought that it was dangerous. One initiative to put control in the hands of social care clients and their unpaid carers was self-directed support. I think that that was meant to empower people, and sometimes I truly believe that it does the opposite, because constituents of mine are telling me that they are only being offered fund-holding for the provision of their care. They need to find people with the skills to manage their condition. They have no cover for sickness or, indeed, emergencies, and they maybe themselves do not have the skills to employ people. Often, the people being employed as personal assistants do not have the skills for the job that they are employed to. I think that we really need to look at this to make sure that self-directed support is used for the purpose that it is designed for. In conclusion, we need to recognise the importance of social care and the workforce that delivers it. Investment and training in the area will remove pressure from our hospitals, which are much more expensive to run. That will allow them to concentrate on those who need acute care, both physical and mental acute care. People supported in their communities will enjoy more independence and will not be at risk of the disabling effect of hospital care. I am also very glad to take part in this debate today on health and social care integration. I think that we are all very committed to the aims of integration, for example, less duplication, a more joined-up approach, better use of human and financial resources, a more preventative approach and the third sector being full partners to name but a few. An attempt was made at integration in Glasgow some years ago. I was a councillor at the time and we had what Glasgow called CHCPs, community health and care partnerships, and I was a member of the east CHCP. At that time, I felt that there were opportunities that we had not had before. Elected councillors were involved in health discussions, which was a new thing for me. It meant that priorities could be set for the east end of Glasgow, which might be different from other parts of the city. For memory, children's dental care and breastfeeding were two priorities that we felt were important for our part of Glasgow. However, it did not work out in Glasgow. To Ann Lamont, the member shares my concern about the recent report to expose the fact that communities in deprived areas get poorer services and their GPs are under greater pressure. Will the member join me in asking the health sector to look at the formula, which disproportionately affects communities such as the ones that we represent in Glasgow? I have also been doing quite a lot of work in speaking to the deep end practices. I would certainly like to see more resources going into GPs practices and other community care at a local level in the neediest areas. We have challenges, as I questioned Jenny Marra earlier, about whether we can move resources out of the hospitals and into the communities, and that would be one thing that we need to at least consider. As I said, it did not work out in Glasgow, and apparently that was because of a clash of personality or style among some of those in a senior position. It does seem better now that all of this is on a statutory basis, but I have to say that I still have some concerns about Glasgow. The very fact that Greater Glasgow and Clyde NHS and the City Council are very large organisations makes the danger of huge bureaucracies all the greater. So will the joint board on health and social work just mean a third bureaucracy? Well, we shall see. Glasgow City Council's Executive Committee is due to consider a report on integration tomorrow. I think that I would better make some progress, if you do not mind. I was a bit uneasy to read under a section called procurement. The tone of that language suggests to me that the two silos are likely to carry on under the integrated board, having the veneer of integration but not the reality. On the other hand, I know that very often the staff on the ground do work very well together, and if there are problems, it is probably more likely to be at a management level. Another issue in Glasgow has been that the council has tended to be very much against devolving power down from the city chambers to communities or at least to sectors of the city. They want more power in George Square but not to pass it downwards. So I do wonder if Jenny Marra can assure us that while Glasgow is labour-led, we will see more decentralisation and not this continuing centralist approach. The Audit Scotland report touches on a number of those issues, and the recommendations include integration authorities should, quote, develop financial plans that clearly show how IAs will use resources such as money and staff to provide more community-based and preventative services. That includes developing financial plans for each locality, showing how resources will be matched to local priorities, and then it goes on to talk about shift resources, including the workforce towards a more preventative and community-based approach. That term, each locality, suggests to me something much further down than a Glasgow-wide level, and shift resources suggest to me that money will need to be spent in a different way from what it has been done in the past while we shall see. I wonder if Mr Mason thinks that the Government that he supports is a model of how he devolved power down from the centre down below. Is that a good example? Well, when I was a councillor, one of the big problems that we faced in Glasgow was ring fencing, and I seem to remember that that was under the Labour Administration, and I'm very glad to say that that no longer occurs. So, yes, I would like to see more devolution to local government, but I would certainly say that Glasgow City Chambers is far too centralist, and we need a much more devolved approach within Glasgow. Yes, Mr Mason, I can give you just over six minutes. I'm glad to say that the living wage is mentioned in the motion. However, I think that we have to stress again that the voluntary living wage is always second best, compared to a statutory minimum wage that sets out the compulsory living wage level. Clearly, the budget is the time to allocate expenditure rather than making decisions in today's debate. The reality is that we do need to choose priorities, and I'm sure that we'll come back to that in the budget debates. However, on that point, I do want to commend the Lib Dem amendment for realising that there have to be priorities, and we need to choose between competing needs. Obviously, Jim Hume's amendment particularly focuses on mental health, and I do support that, but I say that that obviously needs to be taken into the round. However, what I did find refreshing was the wording in the amendment that says, quote, puts at risk the ability of the Parliament to agree a step change, unquote, because that acknowledges that we have to make choices, and we cannot do absolutely everything as another party here sometimes seems to suggest. I personally wonder whether we need to disinvest first in order to put more resources elsewhere. For example, should we be cutting hospital budgets to put more into GP practices and community solutions? That would not be easy, and it would require acceptance across parties that we are willing to go down that approach and re-emphasise preventive spend. There's no point in being in committee and agreeing on preventive spend, and then coming into the chamber and attacking if that does actually happen. Thank you, Presiding Officer. I always welcome the opportunity to debate the NHS in this chamber, and no more so than at this time of year when the challenges facing the service are at their most acute due to winter pressures. Indeed, many staff tell me that winter pressures are now all year round. It is to the staff that I want to turn first, doctors, nurses, paramedics and allied health professionals—indeed, the whole NHS family—whether you are in primary or secondary care, I think that this Parliament thanks you, owes you our gratitude for all that you do to take care of us all year round. Let me also add my thanks to staff working in social care, because I know from constituents who care for loved ones just what a vital lifeline service that our social care staff provide, helping in enabling someone to stay in their own home. With the demographic changes that we face and an ever-increasing elderly population, this service is now under extreme pressure, too. It is the case that public sector staff are constantly being asked to do ever more with fewer and fewer resources. It is on that basis that I am genuinely disappointed with the SNP amendment. It is self-congratulatory. It fails to recognise the very real challenges that our health and social care systems are facing. It is all very well to engage in assertion and rhetoric and give us warm words about the staff. That is easy to do. Much harder is giving them the resources to do that job, but that is absolutely the territory that the Labour Party will occupy, because we need to get beyond the warm words. We need to get beyond the rhetoric. We need to take practical action that will make a difference in communities such as mine and communities across Scotland. The SNP's track record is not very good here. Let us look at some of the facts. Local Government, with its partners in the voluntary and private sector, is responsible for providing the overwhelming bulk of social care, alongside primary care in health. Local Government's share of the Scottish budget has been cut from 29 per cent in 2011-12 to 25 per cent in 2014-15. I suspect—I hope that it does not—it will fall further in the forthcoming budget. What level of cut will be inflicted on local government this coming year? In the NHS, the SNP Government has cut NHS spending in real terms. Audit Scotland, the Government's very own auditors, have said that the health budget decreased by 0.7 per cent between absolutely, because that amounts to hundreds of millions of pounds. I am happy to give way to the cabinet secretary. As Jackie Baillie will well know, on page 10 of the same Audit Scotland report, the real-term resource increase was 2.2 per cent. She has asked for more money for local government, more money for the NHS. Is not that a sense of undermining her own argument today that everything is a priority? Can she clarify what it is that she thinks more money should be set on? I do not regard everything as a priority. I am very clear that I think that the money should go into social care, because that is where the greatest challenge is that we face. I am going to describe this to you in a minute. However, let me just say to the cabinet secretary who is fond of occasionally engaging in smoke and mirrors. There are lines in her budget. Let me give you one example of them. £50 million for nursing and midwifery education is counted in the health budget line but is immediately transferred to be spent in education. There are other similar lines. They are in health, spent by others, but the budget remains in health to give an inflated level of expenditure. That is not transparency, that is not honesty in how you account for spending. Let me remind the cabinet secretary that, in the period from 2007 to 2010, a Labour UK Government raised spending in the NHS by much more than inflation. The SNP Government failed to pass that on to the NHS in Scotland in full. In the NHS today—I will give way if she can explain this point—why do we see month on month overspends, growing steadily in health boards across the country, structural deficits, where savings are rising from non-recurring spending, are building up, creating a black hole in NHS finances? Explain that, cabinet secretary. As I said earlier, a real-terms resource increase for every single year since 2008-9 to 2014-15, as confirmed by Audit Scotland, Jackie Baillie has just called for more money to be spent on nursing in a debate where her motion calls for more money to be spent on social care. You need to be clear and consistent in your arguments. What is it that you want money to be spent on? Cabinet secretary should listen carefully. What I am accusing her is of not being transparent and honest in the budget lines that are accounted for under health but actually spent under education. That is smoke and mirrors. That is an attempt to hide, if you like, the spending that is not happening in health. Let me go back to that, because both local government and the NHS are under enormous financial strain. The SNP's sticking plaster approach, frankly, is not sustainable. The pressure means that we do not focus on prevention. We focus instead on crisis. We fund acute presentations at the front door of A&E, instead of treating people at home where they know they can be treated effectively. There has been no shift in the pattern of spending. We all say that we want spending in primary care and in communities to prevent hospital admissions, but we do not do it. We would spend the consequentials coming from the UK Government, and their decisions on health amount to about £400 million. We would set aside the mental health funding allocation that we believe is in order of £59 million to spend on mental health, but we would urge the SNP Government to allocate the rest to social care. Let me tell you why. Needs in our communities could rise by almost 30 per cent. Elderly age groups will increase hugely. 75 years old and over will increase by a staggering 82 per cent in the next 25 years. We have 820 centenarians. That is fantastic. In 20 years' time, we will have 7,600. That is where the public policy pressure is, and we need to do something about it. I believe that we need to fund prevention work, we need to fund social care staff, we should give them a living wage because that raises quality and standards, it values them appropriately. This is the SNP's Government's opportunity to make a difference. If they do not seize it, shame on them. I would like to start my comment by commanding the work of the health and social care staff in my constituency across Scotland. Indeed, only last week I met the chief executive of the Golden Jubilee national hospital to discuss the expansion of services at the hospital, a true testament and recognition of the work by the medical and support staff at the Golden Jubilee. I welcome the Audit Scotland report, which is highlighted by the motion. It recognises that the aim of integrating health and social care is to ensure that people receive the care they need at the right time, in the right setting, with a focus on community-based and preventative care. Audit Scotland found widespread support for the principles of integration from those who are implementing the changes on the ground. While the report highlights a range of positives around integration of health and social care, it also highlights a number of issues that it considers should be addressed for integration to fundamentally change the delivery of health and care services. I am pleased, however, that Audit Scotland recognises that the framework set out by the Scottish Government allows for significant local flexibility and the report further recognises that the Scottish Government is providing resources to help support integration. That includes £300 million through the Integrated Care Fund, which will be distributed among the 32 local NHS and social care partnerships that have been set up as part of the move towards integrated services. The fund will support the implementation of partnerships, plans detailing how they will bring together health and local authority care services to fully implement the report. The report also acknowledges that, due to the needs of an ageing population and increased demands and services, there is widespread recognition that health and social care services need to be provided in a fundamentally different way. Therefore, Audit Scotland's report recognises both the need for integration of health and social care and that the Scottish Government is taking action to support that. The motion highlights health consequentials from the spending review. It is worth pointing out that the SNP has met its pledge to pass on every single penny of health resources consequentials from the UK Government since 2010-11. In 2015-16, the Scottish Government further and invested an additional £54 million, which brings the increase in the resource budget to 5.8 per cent in real terms since 2010-11. However, specifically towards the integration in June, following discussions with the BMA and the Royal College of GPs, £60 million of additional funding for the primary care development fund was announced to help to ensure continuing quality of care in general practice. That funding will further help to support the integration of health and social care. It is becoming a habit of the Labour Party to think that the Scottish Government indeed does Parliament has powers beyond the act, including in regards to the living wage. I welcome that the Scottish Government encourages care providers to pay the full living wage and fully recognises the real difference that it can make to the lives of people in Scotland. However, the Scottish Government cannot force employers to pay the living wage. Employment law is reserved, and the European Commission has also confirmed that any requirement on contractors as part of a public procurement process of public contract to pay their employees a living wage set at a higher rate than the UK's national minimum wage is unlikely to be compatible with EU law. Will you explain why Boris Johnson has made it a condition of all procurement in London that the contracts let the workers have to have to pay a living wage, not for the employers to pay all their workers outside that contract, but for that contract they must pay it? We should surely go at least that far. That's news to me. I'm entirely unaware that that won't be quite awesome. I'll need to check up because it didn't sound right to me at all. Through legal and financial means, the Scottish Government is doing sterling work to use the resources at its disposal to improve the healthcare sectors. The introduction of the carers bill, which will enshrine carers' rights and law for the first time in Scotland, has invested around £114 million in programmes to support carers. More than ever before, £28.9 million has been invested for health boards to provide direct support to carers. The Scottish Government has also significantly increased funding for short breaks, with £13.7 million being invested through the voluntary sector short breaks fund, allowing for over 15,000 carers and care for people to take a break, giving them an opportunity to relax without feeling stress or guilt. The short breaks fund is attracting international attention and is one reason why the International Short Break Association will hold its buy at annual conference in Edinburgh in 2016. That will provide an opportunity to exchange the knowledge and experience with organisations across the world. The Scottish Government also funds the Equal Partners in Care initiative. Through that, the Scottish Government has worked with NHS and social care professionals to improve how they work with carers and young carers. Let us not forget the distinctive Scottish policy of free personal and nursing care, which benefits around 78,000 people. I commend the cabinet secretary's amendment to the Parliament. I thank Dennis Robertson to be followed by Dr Richard Simpson. I was looking more or less to say, is there anything that we can agree on within the chamber this afternoon? That is that we can all congratulate those in the workforce, both in the health and social care sector. We can also agree that there are challenges in all sectors. Nanette Milne said that her knowledge and experience lay in the NHS. To some extent, my knowledge and experience is more in the care sector, having been there for more than 30 years. Some of the challenges that we have today are no different from the challenges that we had in the early 1980s, when I first started out in social work. It was about how we identify through assessment a person's need and how we resource that particular need. I think that it is absolutely right that we have this agenda about integration. Again, back in the early 1980s, I was looking at an integrated approach to some of the work that we were doing. Jackie Baillie was talking earlier about the preventative spend. I believe that we are making real progress in some of the preventative spend areas. The areas that I probably like to focus on are the work of community optometry. Community optometry is preventing people from going to acute sectors to ophthalmology for tests. It is work that we should be commending. I think that we should be looking at what we can do to encourage allied professionals to have a greater role and a more proactive role in the community. That might be a shift that perhaps the cabinet secretary in line with the integration could be looking at in more depth, and that is moving some of our allied professionals from the acute sector into the community sector to ensure that those people who require the appropriate occupational therapy or physiotherapy are getting what they require, perhaps in their home setting, rather than having to go to an acute hospital or community hospital in some cases. I was interested when Jenny Marra started her speech this afternoon, and it did remind me of again my early days in social work when I was visiting people who were adjusting to maybe old age or perhaps a sensory impairment. At that time, they were thinking, I can no longer do XYZ. With the right approach and enabling approach, it is amazing how much people can do in terms of just that adjustment if they are given the right encouragement and support from people who have the skills and the knowledge. I think that this is the important thing, the skills and the knowledge to provide that enablement so that people can perhaps stay in their home longer and safely in their home, because we have to ensure that if we are encouraging people to stay in the community that the right approach is taken to ensure that they are safe in that environment. We have to look at new technology, which was not around in my early days in social work. What is around now? That new technology can enable people to stay at home. There are so many things that we can do now. Again, I think that within the health service, we are actually using this digital technology to prevent patients from having to go long journeys. I think that it is commendable for people certainly in the islands. If we look at some of the progress that has been happening in Orkney and Shetland and using telecommunication to talk with consultants in Aberdeen, for instance. When I am talking about the Aberdeen or Royal Infirmary, I commend the work that Malcolm Wright has done with NHS Grampian. As Nanette Mellon said, they have increased their staffing levels through consultants and in nursing to a record high within the NHS Grampian area. However, that has been a co-ordinated approach. My colleague Mark McDonald was saying about people in their silos. There was a silo mentality within NHS Grampian. A lot of that is being dismantled. There is an integrated approach to the work within both the acute and primary sector within NHS Grampian. That is to be commended. The new chief executive in Aberdeenshire Council and NHS Grampian has three councils. Aberdeen City, Aberdeenshire and Murray. That sometimes is the problem. Is it a problem or is it just a challenge? The challenge provides the opportunity. The opportunity is for the councils and the health boards to work together to look at the best possible outcomes. It is outcomes that we are looking at in terms of patient and people living in the community. Recently, in the Health and Sport Committee, when we are looking at the areas around palliative care, it was encouraging to learn to some extent that we have got so many people with the skills and the knowledge in the community, but sometimes they are not being directed to the most appropriate patients. Palliative care is not just about end-of-life care. It is about ensuring that people who have long-term conditions have the ability to have the best possible quality of life in the community. I commend Jim Hume for raising the aspect of mental health. As Jim Hume knows, we all have mental health. Sometimes it is good, sometimes it is bad. When we acknowledge that many of our older people, and we have seen an increase of people with dementia and Alzheimer's, we need to recognise their specific needs and the needs of their carers. The carers quite often are family members. Quite often, family members have to adjust what they are doing in their own lifestyle, whether that be at work or maybe just even other caring roles because of children. That becomes difficult, but we have to realise that there are limited resources, but how do we best use them? It is not just a question of money, Presiding Officer. It is about taking the best possible approach to trying to ensure, as I will repeat, the best possible outcome for our patients and certainly in the community. That is about recognising that we now must need to have that challenge, take that challenge and take the opportunity of saying, acute, go to primary and get people to stay at home safely in their own community. The background to the debate has already been referred to by Labour colleagues and others, but the report by the independent care commission set up by Neil Findlay, who I had the pleasure of serving under the shadow of the minister, is not the only report on this subject, of course, because Labour actually proposed a far more extensive and inclusive approach with a cross-party independent commission to review health and social care in its widest sense, and this was our intended equivalent to what has now been announced as a national conversation. That proposal in our manifesto in 2011 was rejected by the SNP Government on the grounds that it would take too long, but four years later we are having a national conversation, interesting. But now the NHS is having great difficulty in meeting its targets. The recent audit Scotland report said that there has been a consistent failure and a trend downwards in many of the nine targets. Seven have not been met now since 2012. We have also got admissions of real difficulties with high levels of consultant and nursing vacancies, massive pressure and shortages in other areas. My point is that the acute services are under such pressure and partly driven by targets, but they are going to have great difficulty in shifting the balance of care. That is something that we can surely, Mr Robertson, all agree on as well, that it is something that we want to achieve. In fact, there are many things that we can agree on, and one of them is integrated health and social care. The main thing is, of course, to achieve prevention. Prevention comes in a number of categories. Primary prevention is achieved by addressing issues that are out with the field of health. In fact, that is a majority of health inequalities, for example, are related to things out with the health. Again, our commission on health inequalities said that, as a first step in achieving that, it supported the Scottish Public Health Observatory's report, which said that the living wage for everyone would achieve the greatest health outcome. That is a salutary comment for a health observatory to make that comment. When Labour makes the very modest demand that we should start by at least paying a living wage to our social care workers who are about to become part of the statutory sector, to which the Government is committed to giving a living wage. We are now going to have two categories of statutory workers—those inside and those outside. That cannot be right. It is evidenced from places such as East Greenfordshire, which have already brought in a living wage for care workers, that the consequences are an improved recruitment, an improved retention, a reduction in sickness rates and an achievement in progression of care workers into higher and higher standards and sectors, because they see it as a career path that is worthwhile and not a temporary occupation waiting while they get a better job. I think that commitment, which the Scottish Government has given through the Cabinet Secretary today, is a good first step. It is not a complete commitment and I understand the difficulties of that, but the agreement to put in spice the full costs will be helpful. I think that we estimated at around £60 million, so £25 million is not going to do the job, but nevertheless it is a practical step on which we are all agreed in terms of the direction, but we need to move quickly if we are going to achieve that shift in the balance of care. Of course, I am talking about the real living wage, Mr Carlaw, and not the Tory, Mr Osborne living wage, which is not a living wage but a new minimum wage. If we fail to shift to prevention, Audit Scotland predicted in 2012 or 2011 in its report that the resulting requirement of the acute sector would be an additional 6,000 acute beds. That is clearly something that we cannot afford to do. The integration of health and social care is vital, and that means that we need to have new models of delivering secondary prevention. Secondary prevention is about the care that many people have been talking about. The raw colleges currently indicate that as many as 35 per cent of hospital beds are occupied by patients who do not need to be there. I am not just talking about delayed discharges. I am talking about the very many patients who should not be in hospital in the first place, and that is the challenge for us that we achieve that with the new integrated joint boards. I understand that, since 2008, we have had the integrated resources framework as a method for determining the current budgets on which the IJBs can base their plans. I further understand from the Audit Scotland report and the answers that I have received that, through the ISD, we now have the health and social care data integration and intelligence project, HSCDIIP, which is an extension of the IRF data set. Can I ask the minister or the cabinet secretary if they will agree to publish the data in the HSCDIIP project, because we need to see what the budgets are of the £8 billion that the cabinet secretary referred to? It is clear, as our commission said, that integration in itself will not bring about a desired shift in the balance of care. The pressures on the acute sector will not be resolved without greater investment in social care, and that is the basis of our motion today. However, I want to say that we need to have some quick hits on this. We need to have some quick hits on this. Can I suggest two areas in which we should hold the IJBs to commissioning fairly rapidly? One is building on the very welcome programme started by Labour and developed much more fully by the SNP Government, and that is falls prevention. If we could get every frail person to have an assessment of their prevention of falls and tools to deal with it, we could prevent a lot of problems developing. We will be debating primary care next week, so I do not propose to go into that. I do have to ask you to come to a closed. There are other hits that we could have, but we need to have early front-line hits, because unless the front-line staff buy into this integration, then any amount of integrated frameworks are not going to deliver. We know that from the English experience that we need to deliver good hits, fast hits and quick hits on the front line, and part of that is to get the living wage for our social care staff as a matter of priority. I am afraid that I have to ask our next three speakers to keep to this six minutes, please. Richard Lyle to be followed by Malcolm Chisholm. I would like to begin my remarks again by saying that I believe that the SNP Government has a strong record on supporting health in Scotland, and I am sure that I continue to do everything that is power to make sure that the people of Scotland have access to the best healthcare available and that no group of people are overlooked when it comes to health. The First Minister has already confirmed that health is a priority of her Government, and I welcome that. The integration of health and social care services is one of the most ambitious programmes of work that the Government has undertaken. Government will provide, as has been said earlier, more than £500 million over the next three years to help partnerships. Integration will deliver sustainable health and social care services for the future that are centred around the needs of the patients. Scottish Government is taking action to develop social care and to provide support for all who require it, while the United Kingdom Government spending review falls far short of the ambitions of this Government and the SNP. I know that spending on health and social care has increased over the years since the SNP Government has been in government, and now it is around £12 billion. Just over a third of our total budget that has been spent on health shows this Government's commitment to health. However, I agree that we must have a desire to invest more in health. The population of Scotland is expected to rise to record levels of around £5.7 million by 2039. The average age of the population is expected to rise, and the people at older ages are expected to live longer than ever before. In fact, the number of people in Scotland aged 75 or more is due to increase by 85 per cent by 2039. As people are living longer, they are more likely to have more complex needs and develop long-term and multiple conditions. That means that demands and pressures on health and social care services will increase. Analysis in the NHS 4 valley of the impact of the ageing population on demand for hospital beds shows a projected increase in demand for bed days for those aged 65 or over, from around 2,500 in 2014 to over 4,600, as per the Marie Curie briefing, and I thank them for it. That is an increase of 84 per cent by 2035. We have to do more reintegrated social care to meet demand wherever possible. That is why I believe that we should increase investment whenever possible and whenever possible in social care to help to ensure the best possible quality of life for people living with eternal illness. 90 per cent of palliative care in the final year of life is delivered in the community. That can be provided in different places, including a home, a care home or a hospice. That can include many social care staff, including care home workers, social workers, nursing and care home staff, as well as family members and informal carers. I will play a vital part in ensuring that people can be cared at home for as long as possible and die there if that is their preferred place of death. I review by the London School of Economics estimates that providing palliative care to those who need it would potentially generate net savings of more than £4 million in Scotland. With that money, we could use it to ensure that more people in Scotland are healthy and receive the best care possible. As we adapt to an ageing population, the role of carers will become even more important. And care workers, by the way. There is a more overwhelming economic, social and moral case for continuing to improve the services offered to all carers. The carers bill, for example, will, for the first time in Scotland, enshrine the rights of carers in the law, propose the range of measures to improve and expand support for carers. The Government has shown its commitment to ensuring that we look after our carers and care workers and appreciate their tireless efforts. All carers in all aspects are two years, and I commend all of them for the work that they do each and every day. I would like to conclude by saying that health is a vital issue that cannot be caught up in a political process. It annoys many people that parties pray political football with health. It certainly annoys me. Let's get back to the fact that people are always going to get sick, so it's our job together as a Parliament to ensure that patients and providers of care receive all the help that they can get. We all want to invest more in all aspects of health by ensuring the possible best quality of life for the people who are living with terminal illness. We must not sit idly by and wait for a problem to arise. We must take the lead, and we must make sure that the people of Scotland and the workers who care for them receive nothing less than the best healthcare and, most of all, our support. I never like health to be a political football either, but I think that it is useful in that regard to look at Audit Scotland, because it is very much above party politics. Two recent reports from them, the NHS in Scotland 2015, said that there is a limited evidence of progress towards achieving the 2020 vision. End of quote, but they then went on to say that the failure to shift significantly to preventative and community-based services is what they particularly had in mind. Of course, the other Audit Scotland report that came out earlier this month, which has been referred to quite a lot today, is health and social care integration. The cabinet secretary is right in her motion. There has been some progress and we all welcomed that, but the thing that really alarmed me in that report was what it said about budgets, because budgets are absolutely key to successful integration. It said that health and social councils and health boards were having great difficulty agreeing budgets and that there was a risk that health boards and councils were seeking to protect the services that remain fully under their control. That really set alarm bells ringing for me. I give way to Dennis Robertson. Dennis Robertson. Very much for taking the intervention. You said that, obviously, budgets are an integral part, probably very important, but is the cultural approach, cultural change, to work alongside that budget change not just as important? I think that the two are inextricably interlinked, because I take it the reason for the budget difficulties is because health and councils are still trying to hang on to their own budget. They then went on to make specific comments about set-aside budgets, which I haven't got time to go into, but I hope that the cabinet secretary will look at all those issues, because I think that that is the main problem for me that is highlighted in this report. However, they have two other issues that are also relevant to the commission for the provision of quality care, which was a report for the Scottish Labour Party, which is hot off the presses, because Audit Scotland referred to the difficulty of recruiting social care staff, and particularly referred to high living costs in Edinburgh. Of course, the answer to that, at least a significant part of the answer to that, is the living wage and the development of a well-paid, well-trained professional workforce, which is highlighted in the report from the commission for the provision of quality care. The other interesting thing that Audit Scotland said is that the arrangements for localities are relatively underdeveloped. Again, today's report for the Labour Party, the bit on decentralisation, is possibly the most radical of all the proposals in that report today, because it is not just talking about locality budgeting, but building incentives into that budgeting. I think that there are really interesting and original ideas in that report today. Notwithstanding the fact that it was for the Scottish Labour Party, it was a commission that was not the Scottish Labour Party, I think that it pays study by all parties. How the budget is devolved is very important, but clearly the key issue for the debate today is the overall budget. The Labour's proposal today is for the health consequentials—at least the majority of them—to go to social care. That is not at the expense of hospitals, that is in order to help hospitals, among other things, but, crucially, to help hospitals. My own city of Edinburgh illustrates that better than anywhere else in Scotland, because I do not want to look at the overall figures for delayed discharge or bed days occupied by delayed discharges. I am noticing that Edinburgh has far more than any other local authority in Scotland. For example, for July to September this year, Edinburgh has 24,466 bed days occupied by delayed discharge patients. The next in Scotland was five on this occasion just over a half. July to September last year, Edinburgh was 23,965, and again it was way ahead of the second authority, which on that occasion, interestingly, was Glasgow. The cabinet secretary was therefore probably absolutely right to commend them on their progress over the year. I would argue, though, that Edinburgh is a special case, and those figures highlight it. I hope that special support will be given to Edinburgh. There are special factors in terms of the difficulty of recruiting social care staff, the absence of care home beds, the cost of living etc. I give way to the cabinet secretary. I assure Malcolm Chisholm that, as I understand it, the latest discussions have seen considerable progress being made between Edinburgh City Council and NHS Lothian on a plan to significantly reduce those delayed discharges. I hope that the member will well look into that. I am glad to hear that. I was told that the figures had gone down during November, and I am looking forward to hearing more about that at the meeting with the health board on Friday. I had a good example from Glasgow, but I do not think that I will have time to read it, but it is a cross-party group on health and equalities. We had a very interesting presentation about the community connections project in Glasgow, and it seems to me to be a very good example of preventative spend in the community, involving the voluntary sector. Clearly, we need more of that, but, as I say, it will be difficult for Edinburgh without additional financial support. However, I wanted to turn to Jim Hughes' amendment, because I have already pointed out that our amendment talks about the majority of the consequentials going to social care. Jenny Marra specifically said that there would be a considerable amount of money going to mental health. Of course, all that will go through the integration joint boards, because mental health, particularly community mental health, is the responsibility of those joint boards. I think that Jim Hughes and others might be interested to look at the very radical motion on mental health from Labour in the UK Parliament today, because that is very interesting, including reference to a right to psychological therapies. I have no time to give way because I am in my last minute. Psychological therapies is certainly one area that I have had a lot of concern about recently in terms of the availability, and in fact, the constituent had waited almost a year for cognitive behavioural therapy for one of my constituents. She told me last week that, after all that, all that she was offered was an occupational therapist, and she is so disgusted that she is not going to access mental health services again from the NHS. My time is up. I think that there are very reasonable and sensible proposals in the Labour motion today, and I hope that they will be adopted by the Scottish Government. If not this week, then next week. Many thanks. The last open debate speaker is Bob Doris. Thank you very much, Presiding Officer. I want to spend much of my contribution this afternoon by addressing the matter of care workers. In recent months, I have had direct experience of the wonderful job that care workers do for the frail and the vulnerable both in their own homes and in the residential care sector. Care staff have provided both a vital and a compassionate service for me and my family, and I place the highest possible value on that care. Now, I know my Glasgow MSP, but my apologies that I want to address my comments in relation to West Dunbartonshire Council and in relation to the living wage, because it was West Dunbartonshire Council that provided care for my family. They do pay their own care staff the living wage, however it does also acknowledge that other services that it contracts out to other providers do not necessarily do so. I will give a quote, which comes from the West Dunbartonshire Council's Labour Group's website. It said what I wanted to repeat in Parliament, so I will put it on the record. It said that COSLA has been working with the Scottish Government and the private sector employers to come up with a funding package that would allow for an expansion of the living wage. A variety of things pick out another one. It says that, in January 2015, COSLA agreed to include West Dunbartonshire Council within that, and COSLA agreed in principle to a £40 million investment package to address low pay in the social care sector. It mentioned £20 million potentially from Scottish Government funds, £10 million from employers and £10 million from local authorities. I mention that because we all do, from time to time, use the living wage as a political football, but we all agree that we want to deliver the same thing. It is also worth putting on the record that the Scottish Government firmly believes that it cannot force employers to pay the living wage. Employment law is reserved and the European Commission has confirmed that any requirement on contractors is part of a public procurement process or public contract to pay their employees a living wage set at a higher rate than UK's national minimum wage is unlikely to be compliant with UK law. I put that on the record because there is not a contest here. The Scottish Government is seeking to work in partnership with local authorities and the third sector to deliver the living wage, so there is a little bit of a phony war sometimes when we have that debate. I again put on the record that I firmly believe that there should be a living wage for the care sector. Of course, Ms Bailey. Jackie Baillie, I thank the member for taking me in intervention. He talked about Western Bansha, which is my constituency area, and there is a local authority who wants to implement the living wage that actually sees the benefit of it. Surely we should be using this social care money to do that, but also to do much more in terms of prevention. I do not see us as being a part on that. I just hope that the cabinet secretary is listening to the unanimous view across this chamber between Bob Doris and I as to what the money should be spent on. I thank the member for that contribution. I hope that we can keep that unanimous view when I want to talk about Barnett consequentials and health and social care expenditure and some consistency on that, Ms Bailey, but you have put what you have put on the record. I do want to talk about health and social care integration. The £8 billion fund is being managed jointly between the NHS and councils. We hope that there are better planned services and opportunities for service redesign. We hope that there is a focus on community healthcare prevention and early intervention. £500 million in three years to support that process, including £300 million for an integrated care fund. It is often said that money will lose its identity with health and social care integration, but it should also lose its political identity, quite frankly. It is not Labour's money or the SNP's money, but it is the money that we spend on behalf of the people of Scotland. However, we spend it, it can only be spent once. It is an absolutely valid plea to ensure that we pay all care staff a living wage. I have outlined that there are barriers to be able to have compulsion in relation to that, and I have put that on the record. I have also put on my record that there are giant cross-government discussions to support and deliver the living wage nonetheless. However, I also hope and expect that integration boards will continue in those discussions when they take forward any pay policies that they have. When we deliver it, it will not be a Labour and SNP victory, it will not be a victory by the public sector in Scotland and the contractors that they commission. However, the motion before us today calls on Barnett consequentials for health and social care to prioritise that. It is a valid plea, but only if it can be delivered in an honest, in a frank, in a consistent and in a budgeted way. Let me talk about two things that there is also cross-party support for in the health and sport committee that money can be taken away from, the palliative care inquiry that we have had. The best in the world, palliative care in Scotland, but it is still hugely falling short of anything that we would want to see for a humane society. That will take money to be spent on it and other politicians will make pleas for spending on that. The health and social care committee is also returning to access to new medicines, dramatically improved, but there are still medicines that are not being approved and there will be cat calls from other people in this chamber when that does not happen in calling for more funding. We have already heard earlier on this afternoon calls for additional support for carers via the carers bill, more financial support in relation to that. We heard the same with self-directed support. We heard the same in relation to GPs and our deprived areas in recruitment and retention. I could list on to that allied health professionals, nurse specialists again and again more and more and more and more. One final thing, an investment of £200 million for five new specialist surgical centres for frail older people, having their hip replacements and their cataracts across Scotland to enable them to stay in their home. That is money that is going to be spent. I merely say to others that we all want the living wage for those in the social care sector, but when we come to this chamber, let's not spend the same money five, 10, 15, 20 times because the care staff in Scotland will see right through that. Let's work in partnership to deliver it and have consensus in relation to that. Thank you. We now turn to the winding up speeches. I call on Jim Hume's six minutes please. Thank you, Deputy Presiding Officer. I've heard what other members have said, but the challenge is facing integration less than five months to go until health and social care integration goes live and the state of the planning is concerning not just myself but other members across this chamber. £8 billion will be jointly managed by integration authorities yet, as of October anyway, we only have six being able to, of the 31, to be able to provide their budgets unless there's any update to that figure today. So much information and co-operation and co-ordination I think is still missing and existing problems such as staff shortages do persist. This afternoon there was no mention of mental health in any of the other parties' amendments or their Labour motion. I welcome John Mason's support for my amendment and hope that he votes that way at decision time. Dennis Robertson has also welcomed Dennis's mention of mental health being a complex issue and it is a complex issue and one that we often just mentioned as a one body, but it is far more complex. I welcome that too. Jackie Baillie did mention £59 million, of course Jenny Marra herself did mention that I should have perhaps read their press release, but quite busy at the moment as you can imagine, so don't get to read all of your press releases. But the figures don't quite add up. If the £400 million goes to social care, then we have inflation take up £120 million, £59 million to mental health. I think that it's £11.2 million, the Scottish Government's own figures on the draft budget in real times reduced that leaves about £9 million to tackle GPs, accident emergencies or problems at Glasgow University, so perhaps there'll be calculators for Christmas in the Labour benches. I really think that it's not an issue affecting only those with the most severe conditions. Veterans, people in rural areas, NHS staff, school teachers, teenagers with eating disorders, middle-aged men and women suffering depression to some of the mental health problems that people live with. We're only beginning to tackle the stigma for some groups and others still remain largely unable to seek help. Last night at the CPG on rural policy it was highlighted that those in rural communities are less likely to refer themselves when they have mental health problems. NHS staff sickness absent rates have been highest this year since 2008. More than 5 per cent of staff were absent from their posts due to health reasons. Mental health is part of the rising problem as overworked staff take the tool of the pressures and stress. It's only right that we bring mental health conditions up to par with other conditions. In turn, that will decrease staff absent rates, increase preventative support for patients, which is mentioned in the report by Audit Scotland and in our amendment, and be a significant component of decreasing inequalities across Scotland. Royal College of Nurses notes that demand for NHS services is outstripping available resources, putting staff and patients under huge pressure. Just last week we saw the vacancy rate for nurses rise and I quote the RCN saying at unsustainable levels. The 2,400 nursing and midwifery vacancies won't help with integration. Audit Scotland pointed out that one of the biggest challenges for integration boards remains recruiting and retaining GP and care staff. Real-term spend on NHS services is falling, and just a look at GP spending shows a reduction of £11.2 million from last year. Last year, GP warns that 20 per cent of GPs could retire in the life of the next Parliament. BMA found that, in fact, one in three GPs in Scotland are hoping to retire in the next five years. One in three. The recommendation for the Government is to support integration authorities. Sharing lessons learned from GP clusters cannot be put into practice if there are not enough GPs to take guidance forward. GPs who must be at the heart of integration plans are currently in short supply. Benefits that localities and clusters have to offer can be many, but I fear that the Government is putting the cart before the horse with limited GPs to staff those changes. The NHS is at risk of becoming unsustainable, allowing more resources to be used proactively and preventively, and the community will ease the tensions from A and E, from acute psychological services and from the financial stretch that some NHS boards have been experiencing. The care provided right now is fragmented. A doctor cannot allow themselves the time luxury of seeing the holistic wellbeing of a patient but can only really address part of their health. Mental health foundation notes that up to 30 per cent of GP consultations contain an element of mental health. The integrated care network points out that the co-ordination is especially important for people with mental health issues who often require support from a variety of organisations. Yesterday, we saw that health life expectancy continues to have and, I quote, considerable variations at birth among different geographical and socio-economic groupings. I do not see how we can reduce inequalities by leaving mental health on the back burner and not structuring our services in a way that the unconcerned unwell are taken care of. The fact is that we have an opportunity to take health and social care to a level of fully inclusive and preventative support, despite that Audit Scotland notes the limited evidence of shift to more community-based preventative services. There are now 61,500 people requiring more than 700,000 hours of care in Scotland, and that is excluding 24-7 care, meaning that more than 500 people have waited for more than two weeks to be discharged as care was not available to them. I am calling today for more attention to be paid to mental health. Labour's call is not wise when it risks going against mental health, GPs, A&E and everything else. We cannot still see mental health services as Cinderella services, and the Scottish Government cannot start by recognising the need to increase investment in mental health. Thank you very much. Thank you, Presiding Officer. About 15 to 20 years ago, I took my young sons at that stage to a duck farm in Berkshire, and there was a really quite magnificent species of down there called a fifi duck. It had a terrific magnificent crown in its head, and I watched it in the water. It was very proud. It had a clear sense of where it wanted to go, but as I watched it over time, it just went round in circles and actually got nowhere at all. I am increasingly of the view that we have a fifi duck administration here in Scotland. That is not to disagree about the strategic objectives, about where the Government wants to go on health in a second. It is to say that, unfortunately, it is not a disagreement about strategic objectives. It is a concern about this Government's ability to follow through and deliver on the objectives that it sets. That is where I think there is increasing concern and criticism within Parliament. Neil Findlay. Mr Findlay. I know, as Mr Carlaw said, that it had to go somewhere else to see the ducks. Is he one of the few Tories who doesn't have his own duck house? Jackson Carlaw. I have a river that runs through the bottom of the property, but it is not mine. So I am increasingly concerned about the delivery, because if we are going to achieve these strategic objectives, then it is the follow-through, it is the management, it is the leadership in directing them to a conclusion that is important. Now, the Cabinet Secretary, it is not all bad news, and I thought that the Cabinet Secretary set out quite fairly a number of ways in which there is progress being made, but she denied that there was any complacency in the part of the Government, and yet I am going to read her amendment. She recognises that NHS staffing and funding at her record high level supports efforts locally and nationally to successfully implement health and care integration, shares audit Scotland's analysis that good progress has been made toward integration and that it has widespread support, welcomes the Scottish Government's commitment to enhance health and care, notes audit Scotland's recognition that the Scottish Government has provided significant investment to improve integrated care and endorses working with the care sector and progressing the living wage, noting that additional funding has been provided towards its achievement and associated fair work measures. Where in that is there any reflection at all of audit Scotland saying that there are significant risks? Where in that amendment is there any recognition that there are issues of any sort whatsoever? The motion irrespective of how the Cabinet Secretary would like to present it does evince the complacency that we always have when it comes to actually being able to demonstrate the real progress that is being made towards the issues. When we first heard evidence at the first session of the health committee on the move towards social care integration, it was apparent that there were about a dozen people around the table representing all the different parts that were going to have to be brought together and made to work effectively if this was going to operate. We talked, as Annette Milne said, about the problems that there were with the CHCPs and how, if that was not properly managed and led, various parties might effectively end up walking away. We recognised that there is a window of opportunity while we create this new arrangement to get it right, but if we do not, if it freezes at some point mid-stream, then what we have will not be what it is we intend to see. I thought that the RCN briefing we had, which I do not have time to quote from extensively, but it concluded, that our health and care services are creaking at the seams, that the need to shift care from our hospitals to the community is widely acknowledged, but on the ground there has been little or no action to make this a reality. We must look at different ways of delivering services to ensure that people get the care and support that they need. Investment in nursing and other staff will enable this to happen as key. That will ensure that the NHS is put in a sustainable footing for the future, while also meeting the Government's 2020 vision for care at home. A 2020 vision we agreed in 2011, we are nearly into 2016, and we are also looking in the next Parliament, obviously, about major service change in primary care. If we are going to have confidence that we can make meaningful progress on that, we have to be convinced that we are making the meaningful progress for the delivery of this very important change. I want to touch on some of the other things that are said. It would be ungracious not to applaud the Liberal Democrats' focus on mental health, but I say to Mr Hume that he cannot abrogate to himself concern for mental health in this Parliament. Throughout all the years that this Parliament has sat, members on all sides of this chamber have been passionate about bringing an additional focus to mental health. Frankly, I thought that it is a false accusation to suggest that there is a lack of interest from others. It is not enough to say that the Labour Party has abandoned mental health. I do not think that that helps the argument at all. I am not going to give way, Mr Hume, because you have spoken twice already. However, I am going to say that, for you to say that you are too busy to read the Labour motions, it is extraordinary, since this is the first Christmas in 16 years that there are no Liberal governments in power anywhere at all across the United Kingdom. You have got all the time in the world, Mr Hume, to lead the Labour Party. Mr Hume is making a point of order, so I am afraid that I have to ask you to take your seat. Mr Carlaw has two times in the last 10 seconds misrepresented my words in this Parliament. No point have I said that other parties took no interest in mental health. I only have stated that none of the amendments or motions today stated anything about mental health, apart from my own one. I also stated that— Mr Hume, could you hurry up, please? Yes, of course, thank you very much. If you have a point, could you please make it? Yes. The other point was that he said that I did not have time to read the motion. I said that I have not had time to read the Labour's press release. As you know, Mr Hume, it is not a point of order. I also do not appreciate points of order in the middle of speeches, as members will know. I did not have any choice about taking it, because his members also know that, if a member makes a point of order, it has to be heard. Jackson Carlaw. I will, nonetheless, help you by coming to a conclusion and leaving one or two of the other points that I was going to make for another day. Finally, a constituent wrote to me in a rather Freudian slip that he said that Nicola Surgeon is the highest-paid politician in the United Kingdom, and for that paycheck we need her to deliver. Nicola Surgeon, what we need if we are going to achieve delivery is a surgeon to cut through the complacency that exists and ensure that we move to the delivery of the health and social care integration and all the other areas of health that we know we need to make progress on. I am concerned that the strategic objective is there, there is agreement across the chamber on it, but the delivery is weak. I have never been compared to a fee-fee duck. I would even know what one looks like, but I think that that is a bit rich from a lame duck opposition. I promise not to make any more duck references. I will say to Jackson Carlaw, though, that on delivery he is right. We have to deliver, and I can assure him that the way that I operate as Cabinet Secretary for Health is very much focused on delivery, whether that is in making sure that our A&E departments improve their performance. I have been very focused on that over the last few months, and we get the winter plans that we need through to tackling delayed discharge and making sure that integrated joint boards work effectively. As other members have said, it is crucially important that we get integration right. A lot of time, energy and resources have been invested in what is one of the biggest reforms that we have seen in our health service, so it is important that we deliver progress and we get it right. I want to try and come back on as many comments as I can do within the time. I want to mention Jim Hume's comments on mental health. I am sure that Jim Hume will recognise that we have invested already an additional £100 million over the next five years to help to achieve some of the things that Jim Hume outlined in the improvements, whether that be on CAMHS or whether it be on access to psychological therapies or, indeed, the investment that we are making within mental health services in the primary care setting. It would be wrong to suggest that there has not already been a significant investment, but there is always more to do. I accept that, and that will work its way through as we discuss the budget going forward. Mark McDonald mentioned the removal of silos. I thought that he made a valid point that the silos are not just about the silos between health and social care, but that within health itself we have to make sure that primary and secondary care are working in a way that produces the outcomes that are required. He rightly referred to some of the particular challenges within Aberdeen city on tackling delayed discharge. Despite some of the recruitment and retention issues and capacity that they have due to the market conditions, they are continuing to make progress to reduce delays, but we need, obviously, to see more of that. Rhoda Grant mentioned the role of unpaid carers and the need to support unpaid carers. Of course, we all agree with that, and that is why the carers bill, which Jamie Hepburn is taking through Parliament, is so important. It does come with significant resource attach. By 2021, up to £88 million of additional investment will be made in supporting the carers bill, and that is important that we recognise that. John Mason talked about the need to ensure that we, through primary care and GP services, in particular, I am sure that we will talk more about this issue next week, that there was priority given to those GP practices operating in deprived areas. I have said in this chamber on a number of occasions that I agree with that, and we need to make sure, as we take forward those negotiations, that we indeed see the funding reflect more fully the challenges that we have within those areas. Jackie Baillie talked about the need for investment in social care and prevention. Of course, what is important is that there is a consistency around here, and here comes the rub. Jackie Baillie does not write to me asking me to invest more in social care and prevention. She writes to me demanding that I spend more in acute services. She wants a new A&E department within her area, and that is the rub because we cannot have a situation where we come to this place and demand that we spend the budget in one way while demanding in your own area that you spend the budget in a different way. The two things are not compatible. If a decision is made to invest in social care, then you cannot spend the same money on building new A&E departments. I am happy to give you that. The cabinet secretary might need reminded that her budget is what, £12 billion? We are talking about allocating up to £400 million less mental health consequentials on doing something that actually will prevent people getting into hospital. This is a long-standing demand from my community. You are wrong to dismiss it. It is about how services are provided near where people are. I think frankly that the cabinet secretary makes a mistake if she positions one against the other because that is simply wrong. The cabinet secretary is definitely wrong in that I am not dismissing the claim. I am merely stating that you cannot spend the money twice. If the money is to be prioritised for social care, then you cannot come to this place demanding that money is also spent on acute services. There are choices to be made. Those choices have to be made, so you have to be consistent in what you are calling for. There is not a money sheet at the bottom of the garden for any of those things. Priorities have to be set. If there is agreement that this is a priority, it means that the money cannot be spent on other things. That is just a fact. Dennis Robertson spoke about utilising digital technology, making improvements in health and social care. I agree with that. We have to ensure that we use the digital technology in order to make the systems work more effectively. Richard Simpson asked specifically around whether the information would be provided. I cannot find the reference, but he asked if the information would be provided in the HSCDIIP. Will the data be published? Yes. The data is already published and in the public domain, but I am happy to write to him, giving him that information in more detail. Bob Doris talked again about competing priorities and the need to ensure that areas such as palliative care, for example, are resourced. Of course, we have already made an announcement that we will support the palliative care framework, and we have allocated additional resources to that. I will end with a consensual debate. It has been very helpful, but people need to follow through on their rhetoric. They need to make sure that, if decisions are made to allocate resources in a particular way, they cannot come back and demand that that same money is spent in 100 other ways. That is the fact, and that is how budgets work. I hope that Labour will continue in the spirit of consensus as we take those matters forward. I wonder if I have been in the same chamber as the cabinet secretary for the last couple of hours. She came to that conclusion with no sense of irony whatsoever when she said that we want substance over rhetoric. My word, cabinet secretary, I think that you need to reflect on that. I begin by saying that it was a pleasure today to listen to Dr Simpson's commentary on that. He has got a complete grasp of this issue, and I know that he is stepping down at the election, but I think that the Parliament and Scotland will be poorer for the fact that he is not the ear to comment on such vital issues. We will not write his political obituary quite yet, but his contribution today was very powerful. Jackie Baillie set out the challenges in the whole health and social care system, and I will come to those in a minute. We have to start by saying that high-quality social care to our elderly and vulnerable citizens is one of the most important and precious pressing issues affecting our society. Jenny Marra, Annette Millan and the cabinet secretary all mentioned the Audit Scotland report. Of course, reports can and are spun by politicians in so many ways. We can all do that, and we can all talk about structures and management issues, but the reality is that, as a society, we are failing to provide decent care for our older and most vulnerable people, and the Government is failing to deal with a crisis that is actually here and now. Last year, the discredited white paper and independence in that white paper, the Scottish Government claimed that it would continue to provide world-leading social care. Will the cabinet secretary reflect on that statement? That is not the lived reality for so many people or their families. It is not the lived reality for social care staff, trying valiantly to do the work that they love, and it is not the lived reality for councils. Bled dry of funds with yet more and more pressures heaped upon them. Today, more than 61,000 people receive over 700,000 hours of part-time care a week, according to an average of 11.5 hours per person. On top of that, we have others in long-term residential care. Providing that care are 141,000 care workers. Care is a big employer in a sector that is only going to grow and grow. Those numbers prove what we already knew, that social care is an area that impacts on all of us. We all know or are related to someone either who is receiving care or who works in the sector. Indeed, many of us will depend on the care sector to look after us and care for us at some point in the future, some of us possibly sooner than others. I will not go into that too much. We have a growing elderly population. Many people live in longer, with multiple conditions, and all happen at a time of social care integration, running alongside huge cuts to public services. That is a perfect storm indeed. All the time, our hospitals are backed up with people who could and should be looked after at home and unfamiliar surroundings. However, as budgets have been cut, care has been privatised and standards have fallen. In 15 minutes, care visits, originally designed to be a management tool, have become the default allocation of care time. Contracting has driven down costs to the extent that the sector is now typified by low-pay job insecurity and poor conditions. Many staff who, as I say, love their job and go way beyond the call of duty to provide care are at breaking point or have left the sector altogether. They feel undervalued of little job security. They do not get paid for travel, some do not get paid for uniform, some have to pay their own mobile phone calls, and that type of system is what we have created. Time and time again, we hear care staff leaving to work in supermarkets or shops or in other types of employment anywhere else because they cannot live and bring up their family under such conditions. Mark McDonald wanted care staff to speak out positively about their jobs. Mr Lyle said that they were heroes. Let us listen to what some of those heroes are saying. This is a staff survey from unison of 18 months ago. The situation will have got worse since that staff survey was published. It reported how the majority of workers believe that the service provided is not sufficient to meet the needs of the people that they care for, both in relation to the time that they can spend with clients and the quality of care that they provide. 44 per cent said that they were working within very limited times, and there was a limit on how much time they could spend with those clients. One said that I have to rush from one house to the next. It is very, very stressful. I have told my manager that nothing is done. Another said that we are not able to deliver the care that we are trying to do and the care that we want to give or the care that we should be delivering to our service users. Another said that it is rush, rush, rush. I think that they forget that we are dealing with human beings, old ones at that. Another said that I have been a carer for 16.5 years. I am old school. I spend time with my clients, and therefore, if I am over time, so be it. Those are the people who rely on you. You cannot just go in and out. You have to have a couple of minutes for a wee chat, because it makes their day and that they do not want rushed in the morning or in the evening. If you speak to care staff, those stories are repeated time and time and time again. We know that 39,000 care workers out of the 140,000, 141,000 work in Scotland receive less than the living wage. That is no way to treat staff in this vital sector. All of that impacts on the care provided. We hear all the time about people not knowing which or how many carers they will see in a week or sometimes even a day, whether the carer that starts this week will be there next week. That is not good for the continuity or the quality of care provided. How can we build relationships between the carer and the client under such circumstances? It simply cannot be done. One carer recently told me that staff are not receiving the training and the need to carry out their roles. They only get the most basic low-cost training. I would appeal to everyone that that cannot go on. We cannot treat social care staff like second class or third class citizens and be surprised when the service that they provide is substandard. That is what we are doing to our elderly and vulnerable friends, relatives and neighbours. That is why today we published our commission for the provision of quality care in Scotland. That was an independent commission chaired by David Kelly, the former director of West Lothian community health and care partnership. That is a challenge to us all, and I am happy to provide any member with a copy of it. I want to thank Mr Kelly and the commissioners who sat and produced such a good report. They identify the need to set out a new social contract of rights and responsibilities that are understood by citizens, greater devolution of budgets to local teams and to develop local solutions with GPs, care staff, social work and allied professionals working together. I need to elevate the status of social care to make it a career that people want to go into and remain in, not one that they want to get out of in a career that is valued with training and a proper structure and sees the workforce as being central to the future of the sector. Of course, the biggest issue is cash. Some of this is as simple as money, and we must put more cash into the system. That is why Scottish Labour is committed to putting more money into the care system. We recognise the vitally important work that carers do, and today commit to a national care workers guarantee. Under that guarantee, we will ensure that 39,000 workers gain from a living wage for all care staff, ensure that all staff are paid for travel costs, end zero hours contracts for care staff and ensure that staff are well trained to do their job. All of that will improve morale and productivity, but, most importantly, it will improve the care that our mums and dads or neighbours and grandparents deserve. We need a service fit to address the problems and the issues of the 20s, 30s and 40s, not the 1930s and 40s, and we commit today to extra money to the health and social care sector. I will be telling today if the Government, with its majority, uses it to vote down additional funding for the army of care staff, who do so much good work. Thank you. That ends the debate on health. Before I move to next item of business, I understand that Dirk Mackay would like to say something in relation to the points of order raised earlier today by James Kelly on statements he made regarding the fourth-word bridge. Presiding Officer, I would like to respond to the earlier point of order from Labour. Let me be clear. The fault on the specific piece of bridge trust that we are repairing now was not broken in 2010. The fault that we are currently repairing occurred in the last few weeks. This specific part that we are currently working on was not identified as a need of repair in 2010. In 2010, the works proposed were for a far greater area. A decision was taken by Feta that it was not necessary to replace the entire area, which would have involved a lengthy and unnecessary closure of the bridge. Instead, a less disruptive set of works was put together, which was under way. MSPs have all been invited to a technical briefing, and my priority is to get this bridge fixed and to get people moving across the fourth bridge again. That is what I and this Government will remain focused on. A point of order from James Kelly. Thank you, Presiding Officer. Having listened to the minister's response and studied carefully the statements that he made yesterday and in Good Morning Scotland this morning, the points remain that his statements were contradictory. Therefore, I seek your guidance, Presiding Officer, as to what powers are open to MSPs when our minister has misled Parliament. Mr Kelly, I think that you should be very careful before you suggest that a minister has misled Parliament. On your specific point, if a member thinks that a minister may have given misleading information to the Parliament, he or she may raise this with the Scottish Government under the Scottish Ministerial Code. In addition, if a member realises that he or she has given incorrect information in a contribution in the chamber, there is a procedure for adding information to the official report on for publicising that correction. We now move to the next item of business, which is consideration of business motion number 15101. In the name of Joe Fitzpatrick on behalf of the parliamentary bureau setting out a business programme, I would ask any member who wishes to speak against the motion to press the request-to-speak button now. I call on Joe Fitzpatrick to move motion number 15101. I now put the question to the chamber. The question is that motion number 15101, in the name of Joe Fitzpatrick, be agreed to. Are we all agreed? The motion is there for agreed to. The next item of business is consideration of business motion number 15102, in the name of Joe Fitzpatrick on behalf of the parliamentary bureau setting out a stage 2 timetable for the Community Justice Scotland Bill. Any member who wishes to speak against the motion should press the request-to-speak button now. I call on Joe Fitzpatrick to move motion number 15102. I now put the question to the chamber. The question is that motion number 15102, in the name of Joe Fitzpatrick, be agreed to. Are we all agreed? The motion is there for agreed to. The next item of business is consideration of business motion number 15103, in the name of Joe Fitzpatrick on behalf of the parliamentary bureau setting out a stage 2 timetable for the health back on nicotine, et cetera, and Cure Scotland Bill. Any member who wishes to speak against the motion should press the request-to-speak button now. I call on Joe Fitzpatrick to move motion number 15103. No member has asked to speak against the motion. If I now put the question to the chamber, the question is that motion number 15103, in the name of Joe Fitzpatrick, be agreed to. Are we all agreed? The motion is there for agreed to. The next item of business is consideration of two parliamentary bureau motions. I would ask Joe Fitzpatrick to move motions number 15045 and 15104 on approval of SSIs. The questions on these motions will come at decision time to which we will now come. There are six questions to be put as a result of today's business. Can I remind members that in relation to today's debate on health, if the amendment in the name of Shona Robison is agreed to, the amendments in the name of Jackson Carlaw and Jim Hulme fall. The first question, then, is amendment number 15098.3, in the name of Shona Robison, which seeks to amend motion number 15098, in the name of Jenny Marra, be agreed to. Are we all agreed? Parents not agreed. We move to vote. Members should cast their votes now. The result of vote to the amendment number 15098.3, in the name of Shona Robison, is as follows. Yes, 63, no, 54. There were no abstentions. The amendment is there for agreed to, and the amendments in the name of Jackson Carlaw and Jim Hulme fall. The next question is at motion number 15098, in the name of Jenny Marra, as amended on health, be agreed to. Are we all agreed? Parents just not agreed. We move to vote. Members should cast their votes now. The result of the vote on motion number 15098.1, in the name of Jenny Marra, as amended, is as follows. Yes, 63, no, 54. There were no abstentions. The motion as amended is there for agreed to. The next question is at motion number 15045, in the name of Tofford's Patrick on approval of an SSI, be agreed to. Are we all agreed? The motion is there for agreed to. The next question is at motion number 150104, in the name of Tofford's Patrick on approval of an SSI, be agreed to. Are we all agreed? The motion is there for agreed to. That concludes decision time. We now move to members' business. Members should leave in the chambers, should do so quickly and quietly.