 I'm delighted to open this afternoon's debate on staffing in Scotland's health and social care services, and I would like to begin with a tribute to the incredible work that dedicated staff within our NHS and social care sector carry out on a daily basis. It can be difficult work with long hours, often in challenging circumstances. The efforts of staff frequently go unnoticed and yet professionals in the NHS and care sectors are still among some of the most dedicated public servants of all. They need our support so they can get on with doing what they do best, caring for patients, treating illness and saving lives. But that work is under threat. It has become clear that the NHS workforce is overstretched and struggling to meet ever-increasing demands on frontline services. In the last few months, I have met patients, medical staff, pressure groups, professional associations and individuals, and their message is clear. Across the board, staffing levels in the NHS are in crisis. It's a deep, systemic problem that cuts across the whole workforce. It's not just happening in one branch of the medical profession. It's in many. It's not just in the NHS, but in the social care workforce too. It's not just in rural Scotland. It's happening right here in Edinburgh and other urban centres. We know that this problem will get much worse. We have an ageing workforce, many of whom will shortly retire. We see bodies like the Royal College of Midwives saying that there is a, quote, retirement time bomb in nursing and midwifery with one in five due to retire over the next decade. It's worse in general practice. The Scottish Government's own figures say that one in three GPs will retire in the next 10 years. That brings further pressure on those who are left to battle the increasing demand. In many senses, it's a vicious circle. Don't listen to me on this. Listen to the professionals. Listen to the BMA who say, and I quote, that vacant posts place immense pressure on the service. When NHS boards cannot fill a post, other doctors within the team have to cover the workload or the service may be reduced. Staff are asked to work increasingly long hours and more intensely to fill the gaps. After the last session, I am aware that efforts were made in this Parliament on a cross-party basis to try and avert this crisis in a collaborative manner, but that the SNP Government sat on its hands. In many ways, this debate is a lament for that lost opportunity. We are now reaping the whirlwind because the crisis is upon us. I have no hesitation in condemning the sheer lethargy of the Scottish Government, which has brought us to this point. Often in politics, some of the most robust arguments we have are about stark vigorous policy choices taken by a Government for better or for worse, but not here. Despite the repeated warnings, there's no sign of vigour. Instead, we have inertia, we have listlessness, we have a Government sleepwalking through this crisis. What answers do they bring? There are two standard responses. We are told that patient satisfaction is at an all-time high and that NHS staffing is at record levels. We are presented with a wall of numbers, a barrage of statistics, as if that provides all the answers. Let me save them some time this afternoon. Let's look at these claims. On patient satisfaction, patients are of course the most important people in our health service. Their care is paramount, and it's our job to ensure that they have access to world-class healthcare, free at the point of use and based on need. It's obvious that one benchmark that we can measure the NHS with is patient satisfaction. However, what is fundamentally important is that we have sufficient numbers of highly trained staff to surround that patient and provide that care. Patient care and staff wellbeing are intrinsically linked. While the Scottish Government may be able to talk about patient satisfaction today, if the NHS remains chronically understaffed and staff numbers are morale plummet, that will vanish overnight. On staffing levels, the Scottish Government and in particular the First Minister like to tell us repeatedly that staff numbers sit at record levels, that the NHS has never employed more people. But record numbers of staff does not mean that there are enough staff. Again, don't listen to me, listen to the professionals, listen to the Royal College of Nurses who say as follows, the increase in staff is not keeping pace with demand and even more worrying almost 600 posts have been vacant for three months or more. Listen to the Royal College of Radiologists whose UK workforce report of last week says this, the mismatch between growth in workforce and demand is even more marked in Scotland where the consultant workforce grew by 3 per cent between 2010 and 2015 and a number of CT and MRI scans each increased by 55 per cent. Let's not forget the key role radiologists play in several aspects of NHS care, especially in cancer treatment. It's a very simple, very clear picture. Demand is outstripping staff numbers. So merely parroting the line of there are record numbers of NHS staff is no answer to this crisis. There are record numbers of people getting old in Scotland. There are record numbers of demands being placed on the NHS. It is quite simply selling a fantasy that our NHS is coping under SNP stewardship. Rather than the band on the Titanic, the Government is trying to reassure us that all is well when, patently, it is not. Nobody is buying it. Yes, of course. Willie Rennie. I agree with much as to what he's been saying this afternoon. He would also recognise with the GPs that it's not just an issue of increasing demand but a change in the nature of the workforce too. The Royal College of GPs say that there are going to be over 800 GPs short by 2020. It's got worse than last year. Do you think that the Government is doing enough in that regard? Donald Cameron. No, Mr Rennie. The Government is not doing enough and I'll come on to the GPs in a moment. Let's stick with the Royal College of Nurses, who have said several times that without changes to the way health services are delivered, there's a risk that Scotland could return to the boom and bust years where health boards targeted the nursing workforce for cuts simply to balance their books. My central charge against this Government is one of failing to take responsibility. The Government must recognise that this isn't the fault of the previous administration. This isn't the fault of Westminster, that it's no good trying to distract us by pointing to what's happening in England or Wales, that after almost a decade in government, with five more years to go, the buck stops with them. And while we're on it, I note the Government's amendment today contains that toxic mixture of belligerence and avoidance of responsibility we've grown used to. Brexit is blamed as if these staffing problems somehow only came into existence on the 24th of June this year. The UK's Government approach to the NHS in England is criticised, though notably without mention of the fact that health spending in England decreased at a significantly greater rate than in Scotland over the last five years. Whilst on this topic of comparing our position to that of the NHS in England, if I could be permitted to quote from the Bible, first remove the beam out of your own eye and then you can see clearly to remove the speck out of your brother's eye. I've only been around a short time, but even I know that health policy was devolved completely and without reservation to the Scottish Parliament in 1999, that the SNP have run the health service for almost a decade, and that when it comes to the state of the NHS workforce in 2016, only one party and one government is culpable. The longer the SNP tried to dodge these issues, the worse the problems will get. We are in the depths of the most serious crisis to affect the NHS in years and it's time for the SNP to take responsibility and belatedly to take action. Let me touch briefly on a few areas which I hope other members will explore across the chamber in more detail during the afternoon and which time does not permit me to cover. Locum and agency costs. As we revealed last week, the NHS spent almost a quarter of a billion pounds on locum doctors and nurses last year. That's a £41 million increase on the previous year with some health boards even doubling their spend. The cost of that is one thing, but it also reveals the massive staffing problem at the heart of the NHS, especially when this money could go towards employing permanent staff. Again, don't listen to me, listen to the professionals. The Royal College of Nurses say, and I quote, An increase in bank and agency staff is an expensive temporary fix that does not address staffing shortages and is not sustainable in the long term. Let me talk about the social care workforce because it's not just our NHS staff that is under pressure. Our social care workforce is stretched and getting older. A study conducted at the end of last year noted that 62 per cent of social care staff had to carry out additional work most weeks and, worse still, around 90 per cent said they felt they had seen a reduction in the amount of support available to the people they cared for. The health committee last week heard from social care workers, as well as leaders in the sector, with the latter saying that around 60,000 extra social care staff will be required in Scotland to meet growing demand as a result of our ageing population. Quite frankly, we are at breaking point. Lastly, on multidisciplinary GP hubs, there is a general consensus that the future of primary care will see the creation of multidisciplinary hubs with a number of health professionals working alongside GPs in the community. We welcome that direction of travel, but to achieve that, we must recognise that more staff will be needed with a broader skill mix and, at the moment, there is a shortage of those other professionals in any event. If there are already workforce issues in terms of advanced nurse practitioners, physiotherapists, dentists and mental health workers, then realising that multidisciplinary vision becomes all the more difficult. Where do we go from here? I am the first to accept that there are societal factors outwith everyone's control, which makes solving this crisis challenging. I accept that medical advancements are keeping people alive for longer. That is clearly to be welcomed. I accept that it is a challenge to find people to take up posts in some of the most rural communities in Scotland such as my own region, the Highlands and Islands. I accept that recruiting to some parts of the medical profession is harder in certain disciplines such as general practice. I accept that, to our shame, health inequality still exists in many parts of the country and this puts additional pressures on our health services. What I do not accept and what none of us can accept is that it is enough simply to carry on as we are. Not only must the Government take responsibility but they must begin to tackle this crisis head on. We need clear, focused—yes, indeed. I think that he is probably almost at the end of his speech. At what point are we going to get an apology from the Tory party on all of the things that they have done, all of their policies that have exacerbated health inequality? On that, they are as culpable as the SNP. We need clear, focused workforce planning based on the best data available to plan for the years ahead. I point to one example of what can be done in terms of investment. The Scottish Conservatives are committed to fight for an increase in the amount of money spent on general practice. We would increase the share of the budget that goes to general practice from 8 per cent of the total NHS health board spend in Scotland to 10 per cent by 2020. We are supported by the Royal College of GPs. So far, we are the only party to call actively for such a pledge. In an interview in April, the First Minister admitted that the share of funding going to general practice had to increase, saying, I am not disputing the key point here, which is that we have got to increase that percentage. With respect, what are you waiting for? The Scottish Government talked a good game about investing in primary care, yet the facts say something totally different. Only a few days ago, the Royal College of GPs stated that we will have 830 fewer family doctors by 2020 if we do not act now. We are losing almost one GP a week. The Government's response, we have created more training places. We heard from a GP in the health committee only yesterday who said, not only will they not fill the additional hundred places that have been created, but there are still a number of unfilled places from the previous recruitment round. Everyone in this Parliament cares about our NHS, but words are not enough now. The Scottish Government's programme for government was weak on short staffing, weak on supporting primary care, and weak on supporting our hardworking doctors, nurses, social care workers and other health professionals. Scotland deserves better. While the staffing crisis requires immediate actions, there is a long-term aspect to this, too. We have to create a sustainable NHS that is properly staffed over the next five years, but also over the next 25 years. We have to raise our line of sight beyond the present and look to the future, to the health service that will exist in, say, 2041. How will it be staffed then to cope with many of us who will be needing more care? If I could finish by saying, it was once said that a politician thinks of the next election, while the statesman thinks of the next generation. In terms of the NHS and its staff, every one of us across this chamber should aspire to the latter. I move the motion in my name. Cabinet Secretary Shona Robison. Thank you, Presiding Officer. I am very happy to take part in this debate, and I move the amendment in my name. I think that it provides another opportunity to acknowledge the extraordinary commitment and dedication of our health and social care staff across Scotland, and I pay tribute to them. It is also an opportunity to ensure that those staff have the right environment to continue providing a world-class service, and I will come on to that in a moment. I recollect, and I am pleased that Jackson Carlaw is sitting next to Donald Cameron. That is very appropriate, because I remember when Jackson Carlaw was a health spokesperson for the Conservatives. He often used to make the point in this chamber that no party was in a position to criticise the record of others on the NHS. Given almost quoting him here, I think that the Tories are in charge of the NHS in England and Labour are in charge of the NHS in Wales. Therefore, it is a surprise of the tone of the Tory motion today. It talks about having no confidence in this Government's workforce plan. Indeed, Donald Cameron has just cited the figure of 830 GPs that the RCGP say is required. However, just this weekend, the RCGP issued a news release estimating a deficit of 8,371 GPs in England. Surely, the same accusation that the Tories are making today in this place of this Government on Workforce Planning must be true of their own Government in charge of NHS England. How can it be otherwise? Another example of this double standard, which I am sure Jackson Carlaw would never have done when he was a health spokesperson, was demonstrated last Thursday's FMQs when Ruth Davidson quoted pockets of meltdown in NHS Scotland. That quote originated from a report that examined 94 hospitals, only three of which were in Scotland. 87 sites are in England under the control of the Conservative Government at Westminster. On those benches, we will point out the double standards of the Tories coming to this place, criticising our record on the NHS when the record of their own party in government in England is woeful to say the least. I could quote many, many organisations that are saying much more powerful words about the record of the Tory party in charge of the NHS in England. We only have to look at the junior doctor strikes that have been happening in England compared to the constructive partnership relationship that we have with our professions here north of the border. I'll take Jackson Carlaw's image. I'm grateful to the cabinet secretary who has sought to paraphrase quotes that I don't quite remember making, but what I did do in the last Parliament was work extremely hard over those five years to say that the only way we were going to make success of Scotland's health is if all the parties worked in a bipartisan way and that that required the Scottish Government to take the initiative to work with the other parties in this place to achieve that. We only have until the end of this Parliament, then it's too late, but that initiative hasn't come from the Government. They haven't approached this party or the Labour Party. They're determined to go their own way and they're not making a success of it. Cabinet Secretary. That can be patently refuted. I have met the Opposition parties in this place. I have done that in this session, as I did previously, as have the ministers on these benches, so that is just factually incorrect. Let me look at the claim about the cost of employing agency staff in Scotland's NHS, which was the basis of Ruth Davidson's attack. When the NHS in England spent a staggering £3.7 billion on locum nurses and doctors last year, up £400 million on the previous year, I'm clear that agency spend here is too high and we want to reduce it, but the fact remains that agency spend here in Scotland is very low at 2 per cent of the overall staffing budget and, of course, in any organisation the size of the NHS, you will occasionally have to use temporary staff to fill short-term gaps in the workforce. We are working very closely with boards to reduce that, but the fact remains that Scotland spends proportionally one-third of what is spent on agency staff in England. I think that Mr Cameron would do well to heed the very wise words that are on the record of Jackson Carlaw when he was health spokesperson. I want to be very clear about the record of this Government on staff numbers. In Scotland we are better equipped to deliver services than we have ever been, but yes there are challenges, absolutely. Under this Government, NHS Scotland staffing has risen to an historically high level by more than 11,000 staff. Consultant numbers are at a record high, with almost 5,200 in place, a 42.9 per cent increase under this Government. Nursing and midwifery staff have increased by 4.6 per cent, and 96 per cent of medical training places in Scotland are filled, with fill rates for GP training up 4 per cent on last year. On that point of staff numbers, the growing difficulty in getting appointments within NHS Ayrshire and Arran and elsewhere following GP referrals and the increasing number of times the 12-week waiting time is not just being breached but, indeed, utterly ignored by NHS Ayrshire and Arran. I acknowledge that there are some of those posts that are particularly difficult to fill, some specialties are difficult to fill and in some geographic areas they are particularly difficult to fill, which is why, of course, in the national clinical strategy we talk about the need to look at appointing specialist staff on contracts that cover more than one site, making it more attractive to recruit them to a district general hospital. We are looking at all ways of making those posts more attractive and we have had some success with that. I recognise also the particular challenges that we have within general practice, which is why there has been such a key focus for me personally and this Government on that. Of course, extensive efforts made through the primary care transformation fund, the £85 million investment over the next three years, the fact that we are working with the BMA on a new GP contract from 2017 onwards, the fact that we have got rid of the co-off and all the bureaucracy that goes with it. So it is absolutely unfair for Donald Cameron to claim that we have not been giving primary care in general practice the priority that it needs. Of course we have. Now, while we have the highest number of GPs per head of population in the UK and, of course, that number has risen to an all-time high, we recognise that we need to do more. We need more GPs. We accept that, but it is not all about securing numbers. We have increased the training places for GPs. We have increased the training places for GPs to grow our GP workforce, encouraging trainee doctors into general practice, helping to make general practice a more attractive option and encouraging established GPs to return to practice. We need to do more. We accept that, but we need to have the multidisciplinary team around GPs. That is what we are working to do, but it is not simply a numbers game. I will give way on that point. Alison Johnstone, thank you. The multidisciplinary team will, of course, consist of midwives and health visitors. In Glasgow, the healthier, wealthier children initiative has had a significant impact on the health of those at risk of poverty. They have received more than £11 million in benefits that they might otherwise not have known about if it had not been for those well-informed midwives and health visitors. Will the Government commit to green manifesto calls so that that scheme be rolled out across Scotland? I can say to Alison Johnstone that I very much welcome the contribution made by health visitors, midwives and others through the healthier, wealthier children's project, which we have funded. The role of the NHS staff and their partners in income maximisation is something that we need to make sure in tackling health inequalities that everybody sees as part of their role to do so. I can commit to supporting the role out of that and we can build that in through the workforce plans as we take that forward. The multidisciplinary model that we have for primary care with the link workers and others lends itself very well to seeing part of that as tackling health inequalities and income maximisation also. NHS boards are, of course, required to have the correct staff to meet the needs of the service and ensure high-quality patient care. We are working very closely with boards through the new world of integration to support their efforts on workforce planning and recruitment. Of course, we will work with the RCGP, the BMA and others to take that forward. We have a vision through the national clinical strategy and I intend to introduce proposals for a regional and national planning system in a draft national healthcare workforce plan by the end of the year with the plan published in the spring of next year. I can assure our stakeholders— Too late, Mr Rowley. Sorry. Sorry, cabinet secretary. Mr Rowley was looking to intervene. I told him that it was too late. Sorry. We will consult widely on that workforce plan and the draft of which I have just announced. Safe staffing and law, of course, will be taking that forward. Very, very important. Again, that was something in the programme for government. We have a commitment to maintain tuition and bursaries for nurses and midwives, again, something that the UK Government has ditched. So, in conclusion, Deputy Presiding Officer, we value the work of all of our NHS and care staff, whether they originate from Scotland or elsewhere. Of course, our EU citizens who work in Scotland, who account for approximately 5 per cent of the workforce, make a huge contribution. We want to do everything that we can to make sure that they continue to work here in the NHS and our care services. Presiding Officer, I hope that this afternoon is a productive and constructive debate. I will continue to work with other parties on the NHS and our care services, but that is a two-way street. What I would expect other parties to come forward with is constructive proposals. I hope that we have heard a bit more of that this afternoon than we have heard so far. Could you move the amendment, please, cabinet? Did you? Thank you very much. I now call in Anna Sarwar to speak to and move amendment 1554.2. You have around seven minutes, please, Mr Sarwar. Thank you, Deputy Presiding Officer. Having listened to the health secretary, it is now becoming clearer by the day that Scotland's NHS, the patients who rely on it and the staff who work in it are being let down by this Government and by this cabinet secretary. First, let's accept reality. The NHS is already independent in Scotland. This Scottish Government sets its budget. This Scottish Government decides its priorities and oversees its delivery. It is time to stop attempting to shift the blame and instead accept the responsibility that you have been in charge for almost 10 years. The crisis that we currently see in workforce planning have happened, not despite this Government, but because of this Government's record and its decisions. The cabinet secretary chooses to use Jeremy Hunt's record as her measure of success. Is that the limit of our ambition for Scotland and the limit of our ambition for Scotland's NHS? I give it to the health secretary. She is better than Jeremy Hunt, but I hardly think that being the second worst health secretary in the UK is much of a compliment. We have heard a lot today about the failures in England and Wales, but isn't it surprising that we have a Scottish health secretary responsible for Scotland's NHS as part of the Scottish Government, as a member of the Scottish National Party, who wants to endlessly talk about failures in England but not talk about what is happening here in Scotland? There is a reason why this health secretary laughs at the failures rather than takes it seriously. Patients' treatments are undermined, staff are undermined and the health secretary finds it funny. I will take the intervention. Can you just clarify whether you are going to be voting for the Tories tonight? I will tell you who I will be voting for tonight. I will be voting for our NHS workforce, who are dedicating their lives working for our NHS, who this health secretary is letting down every single day. After almost 10 years of a sticking plaster approach, we are seeing the consequences of this Government. The consequences on patient care and the consequences for our overworked, undervalued and under-resourced NHS workforce. So please don't stand here and use those dedicated everyday heroes as cover for your failures. The absolute mess in workforce planning has let them down and they deserve more than just the minister's warm word or her fake moral outrage today. We know all is not well in our NHS. Today in Scotland, there are massive numbers of vacancies across health boards. In primary care and in hospitals, the number of vacancies left unfilled by this Government is leading to the expected standards of patient care being missed and it is getting worse. Today, there are 2,500 nursing and midwifery vacancies in our NHS going up, not down. Within that, 300 mental health nurse vacancies and that is meant to be a priority for this Government and this is a direct result of decisions taken by this Government. When Nicola Sturgeon was health secretary, she actually cut training places for nurses and midwives and this is now coming back to haunt our hospitals. Let me quote, This widening gap in staffing is not sustainable and puts even more pressure on existing staff who are working flat out on a ward and across communities. Nursing staff are unable to provide the care they would like to and the last NHS staff survey showed that only one quarter of nursing and midwifery staff feel that there are enough of them to do their job properly. It is not my words, Deputy Presiding Officer, but the words of the Royal College of Nursing in Scotland. What is the consequences of this failure? More stress and more strain on our already overworked and overstressed staff. One in 20 of our workforce is off on sick at any one time. That is the equivalent of six MSPs being off sick indefinitely. We would not accept that as tolerable for our place of work. Why is that acceptable for our NHS workforce? What has it meant? It has meant a massive rise in private agency spend, 600 per cent increase in the health secretary's own area of private agency nursing, and I apologise, 600 per cent across the country, 1,000 per cent in the cabinet secretary's own area, £25 million of taxpayers' money going last year, because this Government cannot do their job properly. The situation with GPs is not any better. Our primary care sector, for most, the front line in our NHS is in crisis. Every day we hear of the challenges that our GPs are facing, and again a direct result of decisions taken by this Government. One point six billion pounds of cuts in primary care, and the consequences, one in four GP practices reporting a vacancy, one in four training places for GPs unfilled, record numbers of early retirement, 277 in greater Glasgow and Clyde alone, practices closing 17 in greater Glasgow and Clyde alone, and too many GP practices lists closed too. I notice the silence now when the hard facts are presented to this Government. GP practices increasing turning to locums to cover, but in some cases unable to secure the locums they need. According to the RCGPs, a desperate need for additional GPs to meet demand, 830 GPs by 2020. The Government have taken too long to recognise they have a problem and now not doing enough to solve it. The mess does not stop there. We have over 400 whole-time equivalent consultant vacancies in our hospitals directly affecting patient care. The mess in the NHS is of this Government's own making—a complete and utter failure to properly workforce plan. Nursing vacancies up, midwifery vacancies up, GP vacancies up, consulting vacancies up, waiting times up, private agency spend up, and this workforce crisis is no longer sustainable. It's time that the cabinet secretary listened, woke up and acted for the NHS and I formally move the amendment in my name. We now move to—could I have some quiet please? Could I have some quiet and some respect for backbenchers coming up please? I did say please, I may not next time. We now move to open speeches of around six minutes and it's fairly tight. Can I please call Ruth Maguire to be followed by Brian Whittle? I welcome the opportunity to speak about the crucial issue of health. I recognise the challenges in our national health service. Importantly though, I also recognise the responsibility we all have to work constructively to tackle these challenges, something that some of the language today isn't really contributing to. Staffing numbers are important, the link between safe and sustainable staffing levels and high quality care as well established. I welcome the Scottish Government's commitment to enshrining safe staff levels in law, work on which we'll begin this year, as well as the cross-party support for such a move. A point that I would gently ask members to reflect on in relation to staffing, recruitment and retention is the importance of highlighting where we can, areas of good work and practice. We should perhaps ask ourselves if all folk here is cries of doom, gloom and crisis, whether it's likely they're going to want to work in that area, and perhaps a constant narrative of what's only going wrong damages more than it fixes. We know that an ageing population is one major issue facing the NHS in this country, and while our population are living longer, their health and social care needs are greater for longer periods in their lives. However, with the health of all citizens being so inextricably linked to their socioeconomic situation, perhaps an even bigger issue facing our NHS is that of deep-seated health inequalities. Inequality stemming from wider issues of generational poverty and deprivation, whole communities experiencing poor health and prolonged issues. That inequality is brought into sharp focus when looking at life expectancy figures in my constituency, Cunningham South. The highest rates of male life expectancy are found in an area called Whitehurst Park in Coeining at almost 84 years old. The lowest rate occurs in Fullerton and Irvine, with an expectation of life as 66 years for newborn males. This is a difference of 17 and a half years. These communities are only a short distance apart, probably about five miles or so. I think that we need to be really clear. To provide the healthcare system that we all aspire to requires much more than increased staffing levels and a fixation on numbers. To quote the SCVO, challenges of historic and deep-rooted health inequalities can only be met by switching focus to preventative methods. Tackling economic inequality and empowering people to make choices about the care they receive. This is exactly what our new health and social care partnerships aim to deliver. Those represent a radical integration of health and social care, perhaps the most radical reform in healthcare in Scotland since the formation of the NHS. As well as better addressing the needs of older people, major users of health and social care services, a shift to community services paves the way to empower a truly community health service, working with integrated authorities, social care, community care, primary care and general practice to deliver the reforms needed for successful community health services. Supporting the shift in the balance of care away from acute settings towards primary and community is not just about access to GPs, but to multidisciplinary teams of professionals centred around those GPs. It is also about raising awareness of where is the right place to get help and managing pressures on GPs and hospitals. I welcome the commitment of the Government to recruit up to 250 community link workers to work in GP surgeries during the lifetime of this Parliament. Returning to my constituency, I would like to highlight some of the recent good work of our health and social care partnerships locally. The co-winning locality planning forum identified the following priorities to engage with local early years nurseries to hear directly from parents, to introduce GP visiting sessions in local nursing homes and to make occupational therapy advice available in the local pharmacy. Our and locality forum has prioritised addressing issues of social isolation, which we know impacts on people's health, to improve low-level mental health and wellbeing, particularly among young people, and to improve access to local physiotherapy for those with muscular skeletal concerns. Locally agreed priorities and actions, a new way of working in and with the community, and I look forward to watching them progress. Much of today's debate will focus on our health staff and highlight the important role that those workers play in society. In commending the dedication, professionalism and commitment of those workers, I would like to mention the contribution of EU citizens to that workforce. As the cabinet secretary said, a considerable number of our workers come from elsewhere in the EU. 14,000 people in our health and social care sector. I will conclude by saying that we greatly value the work of EU citizens in NHS social care across Scotland. Their contribution to our society is valued. I look forward to continuing to support the Scottish Government as it works to ensure that their rights and place in our nation and NHS workforce are protected as we continue to develop and improve Scotland's health service. I call on Brian Whittle to be followed by Sandra White. Thank you, Deputy Presiding Officer. Can I start by saying how interesting it was to hear the health secretary pretend to support cross-party collaboration and then accuse Labour of perhaps voting with us? I think that we can draw our own conclusions as to her sincerity. I spent the parliamentary recess researching health inequality, its causes and long-term solutions. I had the opportunity to speak with many organisations with knowledge of this topic, including medical organisations like the BMA, GMC, SAMH and the Royal College of Midwifery. Those conversations highlighted several issues directly related to health inequality and its implications for the NHS workforce. Shortages and GPs, nursing staff, mental health specialists and consultants were a consistent theme. Take midwives for example. We have a chronic shortage of midwives in many areas across Scotland, but vacancies for newly qualified midwives are not being properly advertised or filled. According to the Royal College of Midwifery, it seems that a lot of midwives have been offered bank jobs instead of substantive posts. They should have been offered permanent posts, so it's a bit of a fudge. With so many midwives set to retire in the next few years, yet at the same time many of Scotland's newly qualified midwives are looking elsewhere to build their careers, thanks to a lack of opportunity and, crucially, job security in Scotland. We need them to work in our NHS. When it comes to primary care, our GPs are the front line, not only for treatment but for health education and tackling health inequality. If we get the right support and resources to our GP practices, they can take some of the pressure off of our secondary healthcare. Turning GP surgeries into community healthcare hubs is wholeheartedly supported by the Scottish Conservatives. Not just having GPs but a range of expertise in areas such as mental health, physiotherapy and nutrition under one roof would allow patients to receive more targeted treatment faster, reducing the need for secondary treatment at hospitals. Healthcare professionals tell us that what they want most is to have the time they need to treat the patients without feeling like they are watching the clock. Time is the reality of what we are debating today. Time to be able to give a longer term, substantial and ultimately a more beneficial intervention for their patients. Consistent and sustainable staffing and retention speaks directly to increase time with patients. Also, as I have already discussed in this chamber, preventable disease costs our NHS in Scotland several billion pounds a year and a monumental amount of time. According to many within the health service, the epidemic of preventable disease is the greatest danger to the survival of our NHS in the next 20 or 30 years. This Government and this Parliament needs to start paying better attention to this. Type 2 diabetes linked to obesity and inactivity and also an increasing cause of amputation and blindness is costing our NHS over £1 billion a year, 12 per cent of the Scottish health budget. Osteoarthritis and other musculoskeletal conditions costing some £354 million a year in Scotland, a condition exacerbated by obesity and inactivity. The rise of poor mental health, which according to mental health organisations like SAMH, can often be prevented by encouraging lifestyles with greater physical and mental activity and fostering a culture of inclusivity. Heart chest and stroke conditions continue to be a major cause of death in Scotland, again often linked to inactivity and obesity. Despite consistent investment, despite a real desire and commitment to tackle those issues, health inequality and the attainment gap continue to grow. Albert Einstein said that we cannot solve problems by using the same kind of thinking that we used when we created them. Yet for years, Governments of all stripes have taken an attitude towards the NHS that has focused on doing more of the same with added money. The health of the nation does not exist in a vacuum. It will take collaboration across the chamber and across portfolios to effectively set a path to a healthier Scotland. Without the development of a structured and progressive active healthy lifestyle programme accessible to all, health inequality and therefore the attainment gap cannot be closed. Lack of understanding regarding choices available, lack of finance, disability, being a member of the LGBTI community and among the many issues cited as barriers to participation in an active lifestyle. That Parliament can start to remove those barriers. We can take the hard decisions thinking longer term or we can decide that those issues are too difficult to tackle because we don't quite understand them or we've got an election to think about or perhaps a constitutional issue to chew on and leave them for the next Parliament to deal with. I would like to ask my colleague across the chamber to perhaps reflect and consider the effect that the welfare reform measures brought in by the UK Parliament have had on the very groups that he's just mentioned and the fiery fact that health inequality, as you are alluding, is related to wealth inequality. Brian Whittle In the words of Larry Page, the Google founder, if you choose a harder problem to tackle, you will have less competition. This Government's insistence tinkering around the edges with our health ever nation reminds me of a quote from Montgomery Scott, chief engineer on the Starship Enterprise, when he said, The more they overthink the plumbing, the easier it is to stop up the drain. I say to this Government, stop what you're doing, it's not working, the plumbing's backed up, do something better. The Scottish Conservatives commit to giving our health service the resources and structures to recruit and retain a workforce, allowing them the time to take the lead in tackling preventable conditions so we can once and for all shed the unwanted tag of the sick man of Europe. Sandra White Thank you very much, Presiding Officer. Like other members have said previously, I recognise the demands that have been put on the national health service, including primary care and general practice. I, too, commend all the workforce in our health service. I mean all the workforce from the porters, domestic staff etc all the way up because without all of them the health service would not be able to operate. I thank them very much for their hard work and their dedication. When I read the Tory motion, I generally had to shake my head that there is a party across here supporting an austerity agenda leading to massive budget cuts which directly affects our most vulnerable people and whose party in Westminster is presiding over the biggest crisis in the health service in England. All I can say is, thank goodness, thank goodness, you are not in charge in this Scottish Parliament. That is one thing that we desperately don't need in that respect. I know that the Tories in Labour as well, obviously I heard Arnys Sarwar's contribution. I'll come back to perhaps Arnys Sarwar shortly. They don't like to be reminded of various things that's happening but I do think that it's worth reiterating and worth listening to the difference between the health service in Scotland and that in other areas. Scotland's core A&E department has outperformed the rest of the UK for the last 17 months. If Scotland's GP ratio was the same as England, we would have 931 fewer GPs, a reduction of 19 per cent. Indeed, we have the highest number of GPs per head of population. A gender for change staff are better paid in Scotland than anywhere else in the UK. That's another fact. Entry pay band is £881 more than in England, and in Northern Ireland it's £1,300 more. We have maintained no compulsory redundancies policy in the NHS, whereas in England there have been 19,650 compulsory redundancies since 2010. That is the reality of the NHS under the Tories. I just want to come into Mr Sarwar's contribution. I just want to say to Mr Sarwar and his contribution that I won't take any lessons from the Labour Party who represented the people of Glasgow in Westminster, in Holyrood and the council, the most deprived areas in Glasgow. I didn't improve one single thing, so I won't take any lessons from yourself. I want to look at perhaps a bigger picture in some people who have already touched that particular part across Scotland. That is a preventive measure. I believe that the SNP Government and its previous administrations, as they were called then, did their best to lead the way. I think that the SNP has picked up in this very, very well, because prevention is the best way forward. It might not get a result tomorrow, but in the long run it will be the best way forward altogether. Let's look at some of the prevention measures. We've been looking at the breast screening programme for 50 to 70-year-old women every three years. Even women over 70 years of age can self-refer to the breast screening programme. The bowel screening programme, which I was delighted to launch along with Alex Neil when he was the health secretary, has been a fantastic success. I see that Mr Sarwar is as usual in himself, turning his back to the Presiding Officer and the chair. Perhaps the Presiding Officer would like to say something, but I know he is absolutely not interested. That's for me to decide. I'll point that out for you, Presiding Officer. The cervical screening has been a fantastic success as well, routinely for 50 to 64-year-old women every five years. It's fantastic. The flu immunisation programme, the adornable erotic annualism, which is just a new one out, is absolutely fantastic as well. It's all about prevention. Let's not forget about one of the really great success stories of the Scottish Government. That is the free school meals programme, which is doing a fantastic job in ensuring that kids who come from areas that can't afford it are getting any attritional meals. That is something that we should all be very proud of, helping to reduce poverty and improve their diet as well. In conclusion, others have mentioned various organisations, so I'd just like to mention a couple of quotes from them as well. The SCVO, which Ruth Maguire has already mentioned, says that preventing problems from degenerating into crises or preventing problems arising in the first place should remain a priority. Given that that delivers better outcomes for the people who use the services, it also saves the public sector monies. If I could quote from the RCN, it mentions the fact that community, health-visiting and district nursing teams offer core healthcare services across communities, delivering care to people of all ages in their homes and local areas. The Scottish Government is already investing in health-visiting, which provides universal services for children up to the age of five. I think that that is a pretty good success story, Presiding Officer. Thank you. Neil Findlay, to be followed by Gil Paterson. Thanks, Presiding Officer, and I declare an interest in that both my wife and daughter work in the NHS. Every day we see and hear of our NHS and social care system under huge and increasing pressure. We have a GP crisis—it's not one that's coming but one that's here and it's here now. Is it really a surprise to learn that if you cut the GP budget and leave the service short of almost 1,000 doctors, you end up in the state we're in? In my region of Lothian, 39 practices with closed or restricted lists. Is it a surprise that we hear from nurses, mental health professionals, clinicians, physios, OTs, etc. the same plea for anyone to address the staff shortages that they're all experiencing? All of these people have a burning desire to do the best for the patients they care for, but all the while they're being worn down by the pressures, the shortages and the declining staff morale, whilst their services are propped up by agency staff, locums, bank staff and the private sector. My fear is that this is only going to get worse. I spoke with NHS Lothian today and they are trying to find 90 million of so-called savings and next year it will be 60 million. This is a six to seven per cent cut year-on-year and yet the Government claims it is not cutting NHS budgets. However, if health inflation is 6 per cent and boards are only getting 1.7 per cent then that surely is a cut. On top of that, the Government cuts things like the drugs and alcohol support budget. Then it tells boards that they have to make up the shortfall. I'll give way to the cabinet secretary if she can tell me where they're going to get that money to make up the shortfall. We've been very clear with boards that many of the boards have already maintained the same level of alcohol and drug funding, and we're working with those other boards to make sure that the level of service continues. Many boards have already done that, so I would hope that Lothian would follow suit. Neil Findlay told me today that they have no money to fill that gap in the budget, and I absolutely understand why. One of the most pressing issues that we face is in mental health provision. This year, NHS Lothian reported just 44 per cent of patients needing psychological therapies had been seen within the 18-week waiting time. 26 people had to wait for over a year. In dementia support, I have had constituents wait up to 380 days for post-diagnosis support. This week, we saw the link between deprivation and poor mental health. This gets to the crux of the issue—the health inequalities that scar our country. I see no real concerted cross-government effort to address that. Where is the redistribution to eliminate the root causes of health inequality? Poverty. Why do we see councils in the front line of that fight having their budgets slashed? I didn't hear Sandra White mention that Glasgow has one of the worst local government settlements of any council in the country. How is that going to address health inequality? Just to correct you, Glasgow City Council has the highest investment of any mainland council. Perhaps if your Labour colleagues on Glasgow City Council spent it on things that meant people in need, they might have got somewhere. What a pathetic response that is. You're supposed to be there representing the great city of Glasgow demanding more resources for your constituents and you're overseeing a crisis in local government in the city. That's what you are there doing. Where are the policies that are meant to be put in meaningful, long-term, sustainable resources into those communities? For example, in my region, the blackburn local employment scheme, an employment scheme for young people in one of the most needy communities in the region, threatened with closure because of cuts to the skills budget. What impact will that have on the health and wellbeing of young people in that area? Isn't it a scandal that the cabinet secretary, Keith Brown, responsible for that project won't even meet with me and the people who run it to discuss it? I got a letter last week refusing a meeting. Presiding Officer, this Parliament has powers to raise funds and end the cuts. The Government is making the political choice not to and our healthcare system is suffering. But the biggest failure of all, I believe, is in social care. Last week, the health committee heard from 25 social care workers. Their words should make us all sit up and take notice. They said that they don't feel valued by society or by their employers, but they do feel valued by their clients. No, I'm in my last minute. It's too far on, thank you. They said that there is never enough staff. They don't get paid for travel time or gaps between visits. Some of them have to buy their own uniforms, pay for their own mobile phone calls. Many said that induction training was at best patchy. They asked who supports the carers wellbeing. Many of my colleagues are suffering from the effects of drugs, alcohol or depression. They quite rightly asked how on earth are we going to attract the carers of tomorrow on the terms and conditions that we receive. I have to say that I had hoped that, in this debate, the Tory party would have showed some uncharacteristic humility. The party that has cut public spending with relish, its members cheering on Cameron and Osborne's every budget, now here in the chamber with the brass neck to pose is the great defenders of the NHS. Mr Cameron, who moved a motion, should have had the common decency, at least to look embarrassed. Gil Paterson, to be followed by Jamie Greene. Thank you very much, Presiding Officer. Only last week I spoke in a Labour health debate on local services, which in itself was a bit ironic, but today it's something else. We are here to debate on a so-called national health crisis. I should take the opportunity really to check if this debate is not meant for Westminster. I needed to check as a crisis and no confidence from the motion as the words being uttered by patients, families and professionals in regard to the current situation in the Tory run NHS England and its colleague Jeremy Hunt. However, hold the presses. The Tories had come across a report showing, according to Ruth Davidson, Scotland's NHS is facing pockets of meltdown. That report linked it to an article that hospital accident and emergency performances is now the worst it has ever been and that, in another story, we ended the last financial year reporting the largest deficit in the NHS history. It doesn't sound good at all for Scotland. However, as the cabinet secretary said, out of the 94 hospitals used in the report, only three were from Scotland. Namely Aberdeen, Royal Infirmary, Ninewells and Dundee and Rigmore in Inverness. However, what the cabinet secretary didn't say when it comes to the accident and emergency performance, the relative statistics for the referred Scottish hospitals areas are NHS Grampian at 96.7 per cent, NHS Highland at 97.5 per cent and NHS Tayside on a phenomenal 99.2 per cent. Nationally, the core of the A&E services for Scotland overall in June was 95 per cent, compared to the under 86 per cent in Tory run England and under 79 per cent in Labour run Wales. Overall, Scotland's core A&E departments have outperformed the rest of the UK for the last 17 months. Alex Cole-Hamilton Alex Cole-Hamilton has never happened before. I thank the member for giving way. Would the member please tell the chamber how this constant misdirection as to what is happening in other parts of the United Kingdom should make up for the fact that there are patients languishing on waiting lists and in hospitals in the jurisdiction in which you have been in power for the past 10 years? Gail Paterson I thank God that it is in power to be quite honest because under your record that is the stats that I am quoting. It doesn't matter what performance indicator you want to look at, this Government outperforms anybody, including your own, to be quite honest. When you visit the actual story, the headline reads NHS hospitals in England reveal a £2.5 billion record deficit. The original references to meltdown is targeted at Tory run NHS England, but here we are debating a report that has no relevance in Scotland. From the motion, I sincerely agree to commend the staff across NHS Scotland for their hard work and dedication. During the terms of this Government, we have seen our staff ensure that our hospitals are cleaner and safer. There have been major reductions in the number of hospital-acquired infections since 2007. Cases of C.Diff in patients aged 65 and over have reduced by a whacking 86 per cent and cases of MRSA have reduced by 87 per cent. NHS Scotland has one of the safest healthcare systems in the world, with record low infection rates and an internationally recognised patient safety programme. In regard to investment in primary care, I am proud to say that my constituency has benefited significantly as big investments in the Golden Jubilee hospital. A result of a tremendous effort on many, many people, the previous finance secretary who played no small part in the effort himself, was able to announce not only that a new much-needed health centre in Greenock, which is not in my constituency, will be built, but that, as part of a combined capital investment of £38 million, a new Clydebank health centre will be built, which is in my constituency, no thanks. That will allow the continuation of community health services in Clydebank. With mental health provision high on this Government's agenda, I understand from NHS Greater Glasgow and Clyde that primary mental health services will form part of the new health centre. As the focal point of primary healthcare in Clydebank, that, for me, only adds to the importance of already shown by this SNP Government. Despite the positive results and steps from NHS, Tories here and in Westminster, through narrow mindedness and self-worth, have taken Scotland into uncharted waters, with approximately one in twenty of NHS Scotland's doctors coming from elsewhere in the EU. The Tories are managing to threaten our NHS, not just through front-door cuts to Scotland's budget, but via the back-door using Brexit and threatening the ability to recruit health and care staff in the future. To conclude, Presiding Officer, I think that this debate from the Conservatives is a bit rich and I do think that there is a considerable dose of breast necketry calling this debate on health today. Presiding Officer, I commend the Cabinet Secretary's amendment to the Parliament. I remind members that, in all contributions, they should speak through the chair. I call Jamie Greene to be followed by Alison Johnstone. Thank you. It sounds listening to the speeches today that Sandra White and her colleagues on those benches really like facts. Here are some facts. Shortfalls and GPs, consultancy vacancies up, nursing vacancies up, agency uses up. The problem is, Presiding Officer, that these are facts that they don't like and are facts that they don't want to listen to. I'd like to talk today about what really matters in this debate, and that is people. The people involved in this complex, ever-growing and ever-demanding system are the ones really affected by the decisions that we make in this Parliament. Also decisions that are made in the health authorities that manage those services. Those people are patients. Those people are also nurses, doctors, GPs, consultants and locums, and they themselves paint a picture of the NHS in Scotland today. I'll focus much of my speech on the area that I represent, the west of Scotland, because those are people that write to me and tell me their frustrations and their woes and their battles. Before we look at the areas where there is much work to be done, it is entirely right and appropriate that we pay tribute to the staff who work across the NHS. For often, as we stand here and debate the bigger picture, it is they who are looking after our friends and parents, sons and daughters, neighbours and colleagues. My region is primarily looked after and covered by NHS Greater Glasgow and Clyde and NHS Ayrshire and Arran. I am deeply troubled by many of the statistics that I read. I am deeply troubled by the stories that I hear from the people who have contacted me in my short time as an MSP in this place. I have three areas of concern. The first is waiting times and targets. NHS Ayrshire and Arran has seen psychological therapy waiting times sitting at 73 per cent where the target is 90. 73 per cent where the target is 90. What does that actually mean? It's not just a number. Those are people who are waiting to see someone, a specialist for things like CBT or talking therapies. Those are people who may be suffering from depression or addiction. The overall 18-week referral to treatment target is 90 per cent. It's currently being met at just 74 per cent. In Inverclyde, one constituency contacted me a few weeks ago to say that she was told of a three-month wait for a mammogram after telling her doctor that she'd discovered an unusual disease. Three months of worry and distress. After persistent daily phone calls to Inverclyde Royal Hospital, she managed to bring that forward. But it shouldn't have to be he who shouts the loudest gets an appointment. My second area of concern is vacancies. The vacancy rate in North Ayrshire and Arran is double the Scottish average at 16 per cent. Yesterday, as I walked to this chamber, I chatted with the people from Parkinson's charity standing just metres away from here. They told me that in Ayrshire there was just one single Parkinson's consultant and there should be three. I was told about people who had been waiting 18 months for an appointment. The vacancy rate on that same health board is as follows for consultants. 25 per cent for cardiology, 50 per cent for orthodontics, 22 per cent for child and adolescent psychiatry specialists and a staggering 35 per cent for geriatric specialists. Those are very, very high numbers in terms of vacancies except that these are specialist areas and that recruitment can be difficult in certain parts of Scotland but more must not be done. It is clear that a culture of poor workforce planning is contributing to this bill and it is not just an occasional requirement, as the cabinet secretary said in her opening statement. The third really important area that I'd like to mention today is that of wellbeing in the west of Scotland. The 2015 Scottish Health Survey released yesterday showed that really pitiful progress has been made on this. Two thirds of Scots are classed as overweight, with 28 per cent classed as obese. Very little has changed in seven years. That same survey said that 21 per cent of Scottish adults smoke whilst it is 17 in England. A quarter of Scots are classed as drinking too harmful or hazardous levels. Alcohol-related morbidity has increased. It showed in the new Scottish index of multiple deprivation data that in my area, Greenock and Paisley are areas that have been consistently among the 5 per cent most deprived in Scotland since 2004. So what has the SNP Government done to tackle this after nine years? Well, as we pointed out yesterday, the Scottish Conservatives said that areas across Scotland have seen very little improvement in wellbeing. And not only that, but we have a First Minister who, as health secretary, made decisions that result in this crisis but still refuses to take personal responsibility for the very issues that we're standing here discussing today. There's a £60 million black hole in the funding for NHS Greater Glasgow and Clyde. There's a £30 million black hole in the funding for NHS Ayrshire and Arran. Both of these health authorities have major on-going problems with delayed discharge. Thousands of days of bed days are lost each month. So, whilst this debate, in conclusion, will focus on the politics and the policy of the NHS, I sincerely hope that there is the voices of the people of Scotland who are suffering at the hands of after nearly a decade of the SNP in power that we listen to those voices the most. Alison Johnstone, to be followed by Stuart Stevenson. Presiding Officer, we in this chamber are agreed that the NHS faces serious workforce challenges and it's vitally important that workforce planning is thoroughly scrutinised. And we're agreed that no part of our health service is more valuable than its dedicated staff. But the challenges that we face, they shouldn't be underestimated. Audit Scotland tells us that we'll see a 50 per cent increase in the number of people aged 75 and over by 2030, so it's essential that workforce planning properly anticipates those pressures and that our approach to an ageing society is a positive one, one that focuses on enabling people to maintain dignity and independence in old age. My party supports parity of esteem for mental health and physical health, and we support the balance of care shifting towards preventative spending, but we can't look away from the injurious effects of cuts to both local and national government budgets. Cuts can't deliver a properly resourced system of community-based care and social care, so we have to use all the powers that this Parliament has to challenge those cuts. Conversations about an ageing society shouldn't obscure the fact that too many people in Scotland aren't living longer. There is a huge disparity in average life expectancy in the most and least deprived parts of Scotland. Ruth Maguire pointed that out in her contribution. The parts of Scotland where staff and resources are under the greatest pressure are often badly affected. We mustn't let conversations about an ageing population divert our attention from the wealth of compelling evidence that shows the benefits of early intervention and spending on the early years. The Centre for Research on Families and Relationships is a consortium of seven Scottish universities, and in March this year they published a paper on financial vulnerability, a clarion call for the Government to do stuff that works. I mentioned earlier the healthier, wealthier children project in NHS Greater Glasgow and Clyde. That has been shown to put money into families pockets in six years over £11 million extra in benefits for thousands of pregnant women and their families. It will take focused workforce planning to ensure that we have sufficient numbers of midwives and health visitors with enough time to deliver projects like this, but I welcome the cabinet secretary's assurance that this initiative will be rolled out across Scotland. I would also draw her attention to the impact that workforce shortages have on unpaid carers. Young carers in particular deserve the financial support that our young carers allowance proposals could provide. Ambitions for the integration of health and social care are clear. We all want to see services working in a joined up way, but the workforce planning requires as complex, and we have to ensure by working with organisations like the BMA, the RCGP and the Royal College of Nursing that the models that we use are the right ones. The Royal College of GPs, as we have heard, estimates that by 2020 we could have a shortfall of 830 general practitioners. That is why I give my full support to the colleges calls to increase the proportion of NHS spending on general practice to 11 per cent. A third of GP practices across NHS Lothian have been forced to restrict their lists, and in some parts of Edinburgh up to half of surgeries are unable to register new patients. We are all aware of the challenges. I acknowledge that some good steps towards improving GP recruitment and retention have been taken. I welcome the new GP training bursary, I welcome the new graduate school of medicine, but those actions are long overdue. Yesterday, Dr Elaine McNaughton from the Royal College of GPs gave evidence to the Health and Sport Committee, and she argues that professionals have spent 10 years highlighting the retirement bulge. Recent studies show that widening access to careers in medicine can improve the care that we provide to communities that are typically underserved and undersourced. I call on the Government to ensure that a more diverse range of young people are able to enter health professions, and I acknowledge that that is recognised in the Government's motion. Flexibility on university entry requirements is another way to deliver a more diverse body of medical graduates, and we badly need to do more to retain the doctors who are trained in Scotland. I welcome the 27 per cent rising junior doctors applying to train here, but we cannot deny that many of the doctors that we train do relocate, and we need to have a realistic approach to workforce planning that acknowledges that complexity. That highlights the need for welcoming inclusive immigration policies in Scotland, and I am deeply concerned about the impact that withdrawing from the EU could have on our ability to recruit and retrain health and social care staff. That is why I have to say that it is surprising to see that motion tabled by a party that has done so much to depredise the careers of doctors, nurses and social care staff from the EU. He has given so much to the NHS, but now has no certainty over whether they can remain here. When a Conservative UK Government is overseeing deteriorating services in the English NHS, in the words of Chris Hobson, the chief executive of NHS providers, it is increasingly failing to do the job that it wants to do and the public needs it to do through no fault of its own. When junior doctors in England have felt compelled to strike, I find that a rather unhelpful motion. Donald Cameron's motion invites the Parliament to express no confidence in the Scottish Government's workforce planning and yet calls on all parties to work together. In my view, this is a mixed and unhelpful message and, as he would have it, is no answer to this crisis. In conclusion, the Royal College of Nursing has called on all stakeholders, including politicians and health professionals, to put vested interests to one side, to work together for a common cause, to ensure our NHS is sustainable for the future. I believe that this is the approach that we must take because we will not be able to deliver and develop a sustainable, responsive health and social care service if we do not. Stuart Stevenson, to be followed by Daniel Johnson. Let me start on a note of consensus that I hope we would all agree with. There isn't a party or a person in this chamber who is going to say, we should scrap the NHS and have something different. We're having a debate about how we all wish to improve the performance of the NHS to support the people in our country with a free at the point of need health service. Very much the Chinese model of providing health that goes back thousands of years, you only paid your medical practitioner when you were well and you had access to their skills when they were ill and that is in essence what our NHS is about. Of course, the history of how we got to here is a long one. If we look at death records from the Victorian era, we'll find about 50 per cent of the records show that people died without any medical attendance certifying us to cause of death. Access to health services 150 years ago was a privilege available only to the few. In 1911, Lloyd George introduced an old age pension for the first time and that started to lay the basis of providing support to people who couldn't necessarily afford to provide it for themselves. My aunt Stewart registered as a nurse in 1923, a year after the establishment of the nursing register and her sister the year later. In 1945, my father, at the rather elderly age of 41, graduated—I will, if you wish—Mr Finlay. Maybe every time he gives this speech, I'll let Jackson Carlaw and myself that we can leave because we've heard it umpteen times but I'm sure it'll entertain the new members. Mr Stevenson, a cruel intervention. Oh, I thought it was one of Mr Neil Finlay's kinder interventions. He is a man not known for his passivity in engaging with his opponents and I welcome his hostility as it is a clear indication that I'm on the right path. My father, who graduated MBCHB on the relatively advanced age of 41 in 1945, was a step in the road. Of course that was before the establishment of the health service. He very much welcomed the establishment of the health service. He was the traditional old-style GP that we used to have in the 50s and 60s. The front room of the house was the surgery. There were no ancillary staff. His working hours were 7.30 in the morning until 9 o'clock at night. The range of services that he could provide and the skills that he had were probably substantially less than a nurse practitioner in today's GP practices. We've come on a very, very long way indeed. Indeed, when I worked as a nurse myself in 1964, the staffing levels that we had were substantially worse than they are now. I remember one weekend when we used to work 13 hours a day, Saturday and Sunday, when there were only two of us on duty in the ward when there should have been six. That wasn't an uncommon occurrence. Things have got better, but they are yet to achieve perfection. We have an ageing population. I am not, thankfully, the oldest person speaking in this debate, but I am one of those who might reasonably expect in the near future to make greater calls on the health service. I'm like many of my age group. I'm benefiting particularly from screening programmes. Most recently, in my case, and I know you all wanted to know this, the bowel screening programme. Details will be available at the back of the chamber later. Of course, my wife and others of her age group have, for many years, been experiencing different kinds of gender-related screening that are appropriate to them. I think that Brian Whittle was absolutely right. Preventative care is a very important part of achieving health for us. I want to say a word or two about rural services, because a lot of my constituency is essentially a rural constituency. When I first got elected in 2001, dentistry in the north-east of Scotland, I found it impossible to get either a national health service dentist or even a private dentist, such as the shortage. However, now we have a good dental health service, in part because of actions by the previous administration, continued and supported by the present administration, but threatened by Brexit, because most of the new dentists have come from Poland. Their excellent dentists are highly respected and valued by people in their communities. That is, of course, a pattern that is repeated right across the way. Of course, in dentistry, my first dentist was unqualified, so in dentistry, too, we have made enormous progress. It is worth saying, Presiding Officer, that it is increasingly difficult to get GPs to work in rural practices with many more GPs, but it is difficult to get them to work in GP practices in rural areas, because the work is harder, it is more diverse and it takes more time. I very much welcome the support that has been given from Grampian health board and the Government to them in looking for more GPs to work in rural areas. Particularly GPs in training, we have training practices, they learn a lot and realise that living in a country location is both good for their personal health, mental health and physical health, but also an opportunity to support people in communities right across rural areas. I just say one final thing, Presiding Officer. Very brief final thing. Let's get the Tories really on message on preventative care. Let's get them supporting minimum pricing for alcohol. That would be a good start. I could give you another dozen if I had time. Thank you for following by James Dornan, Mr Johnson. Thank you, Presiding Officer. With a little bit of trepidation that I follow after Stuart Stevenson, I don't quite know how I'll follow that, but let me make an attempt. When you think of a doctor, I think you think of a GP. I think we can all picture ourselves in the GP office. Sitting there might be with a degree of trepidation waiting for an injection. It might be with a degree of hope, hoping that it will put your mind at rest that the symptoms you've been worrying about for the last few months aren't as bad as you might fear, or maybe it's frustration trying to hold down your child as the GP takes its temperature. The reality is that it's the family doctor, the GP that is the guardian of our health service, and we love the health service. It looks after us, it looks after our families, and it's our GPs that are the gatekeeper to accessing that health service and who provide the continuity of care. Indeed, it's GPs that are the future of the NHS. We've heard a lot so far in this debate about the integration of services, about preventative therapies, and indeed Alison Johnson was right to point out that the pressures and the requirements that an ageing population will place on primary care. However, those things do take resource. Without wishing to use the euphemism of resource, that means money and people. We've talked a lot about facts in this debate. The facts are these. The RCGP estimates that, in real terms, funding for primary care has fallen by more than £1 billion. I welcome that Shona Robison says that primary care is her top priority. However, in reality, that proportion of spend has fallen from 9.8 per cent to 7.6 per cent. We have a quarter of vacancies for GPs unfilled, and indeed, while the 4 per cent increase in GP training places being filled is welcome, that's only taking it up from a third of places being unfilled to 69 per cent. That's not really a record to be proud of. It's easy to trade telephone number statistics. It's easy to try and claim billions of pounds worth of investments or cuts, but the reality is that, in primary care, what those things mean is difficulty getting appointments and difficulty to even register for a GP if you're moving into a new area. That leads to pressure in our hospitals. In terms of trying to get to those realities, I held a local summit with local GPs and health board officials because I wanted to do something. I probably wanted to reassure that things weren't as bad as us politicians were making out. I hope to be told just as there are facts, but don't worry too much, but it was worse than that. They were using the word crisis more than I was. Indeed, we will be aware of the situation of the south side medical practice, which has hit the headlines recently. They faced a situation where retiring partners, ageing patients, expensive locums, backfilling vacancies and unaffordable premises meant that they had to hand back their practice to the health board. The sixth practice in Edinburgh to do that. Possibly the 5,000 patients that they look after could be absorbed by their practice, but all the other practices in our area are full as well. We have half of all GP practices in south Edinburgh are closed to new patients. We are stuck in a vicious cycle of it being hard to recruit, making the job harder for GPs, putting new doctors off coming in. The health board officials were painting a pretty difficult picture, too. They are being supportive of the practices that are under those pressures. They are wanting to step in, but they told me that they lack the simple measures and powers that they need. They would like to take on premises, but their lawyers tell them that that would be regarded as speculation. They frankly cannot afford the increased cost of employing GPs directly, which is more expensive than employing them through GP practices. The future of our health service is in primary care. It is about integrating facilities, about providing physiotherapy, dentistry, pharmacy on site. It is about having better facilities, about having other professionals on site, but we need resource to do that. The doctors probably would like that situation, too. Doctors do not want to take on the risks of running a business. They want professional support, and they want a good place to work. If we want to attract new GPs, that is what they want. Probably one of the most worrying lines from the meeting that I held was that the GP partnership model is dead. Not my words, but the words of the professionals there. That is what this Parliament needs to do. That is what we need to do, is recognise the issue. Not just talk about the telephone numbers, the stats, but recognise that we need to make a change. If we want GPs to do the job that we all value, that we recognise, that we need to make the changes and to give the health boards the ability to deal with the situation as it occurs, because this is a crisis. It is a real crisis. It has a real impact on people, our constituents. It is not good enough, frankly, to be making comparisons between what we have here and other parts of the UK. It is not good enough at all, because it does not change the reality that our constituents are facing day by day. We need to face up to this situation, we need to empower health boards and we need to deliver the resource, the training and the investment that our primary care needs if it is going to face the future. Some political decisions have you leave you with your mouth hanging open at the sheer lack of self-awareness. James Kelly's re-launch of his repeal of the offensive behaviour three days before the old firm ground was one of them, and then there is this lesson a week after the leader of the opposition raised a debating matter, which seemed to many, as they did, to say that they were going to do it. From what I can see in social media to be the deliberate attempt to mislead the Parliament on this very subject matter, we have the Tories coming back to this chamber on the same thing. I want to read to you some very, very uncomfortable headlines. NHS has begun drawing up a formal list of hospital departments that will be closed amid the worst financial crisis in the history of the health service officials have revealed. Hospitals will embark on a glut of closures with accident emergency units and key services for the elderly among those stripped out and centralised. NHS leaders have said that it is not here in Scotland and it is not under that Cabinet Secretary for Health. In the Westminster Government, NHS Jeremy Hunt is responsible for that, and that is why they have got such a gall. They talked about the NHS being in crisis here. We are seeing more and more pressure on staff trying to run harder and harder. We are reaching breaking point, they say, down south. That is the reality, and that is the difference between here and there. While things are getting, there is a lot of work to be done here, a lot of pressure has been put on, and there has been absolutely no acknowledgement from this side, which I would understand, nor from that side there, on the pressures that we have to put up with. With the continual cuts from Westminster, with the continual pressures from on-going austerity, from welfare inequality, from making sure—I cannot remember which one, one of the back benchers was up there saying, sorry, Jamie Greene said, that we have to do more about alcohol, the problems with alcohol. There is no Government in the history of this Parliament that has tried harder to take on the curse of alcohol in Scotland than this Government, and the party who has stood in the way more than any other party to try and make sure that we can defeat that is this mob over here, although thankfully the business has many of them at that point. I'd be careful with your language, please, Mr Dornan. I don't like the use of the word mob. Is it unparliamentary, Presiding Officer? I think it would be more polite when it's on your point. Thank you. I will do. No, I won't take an intervention, not from you. Down, Mr Carlaw. Brian Whittle talked about the sick man of Europe. If you remember, the reputation of the sick man of Europe we have for that, and we've had it deservedly for some time, was not built up in the last 10 years. That sick man of Europe was built up over 60, 70 years, and the reasons for it is a long time. Hold on, will you sit down and I'll take an intervention in a minute. Please, through the chair, gentlemen. It's built up over 60, 70 years, and it can't possibly be cured in 10 years if we've not had the solutions to deal with it. We're only starting to get some of the powers that will deal with it, and I'm more than happy to take your intervention now. Mr Whittle. I was going to suggest to you that it has been built over a period of time, but over the last 10 years what has happened with health inequality in this country absolutely zipped. Nothing. You have had no impact at all on the health inequality of Scotland. Hold your head in shame. Mr Dornan. That, I think, is the reason why my language has not been as pristine as it usually is, and I apologise, Presiding Officer. I have to hold my head in shame when he's a member of the party who's been in control of our purse strings for hundreds of years, then and then are being in control of us for hundreds of years. We've never had the powers to be able to take these things on, we've never been able to grab these problems and deal with them, and he tells us we should hang our head in shame. They're the ones who are bringing in the austerity measures, they're the ones who are bringing in welfare cuts, they're the ones who are making sure that the poorest in our country are having to live in worse conditions than they've ever had before. And I'm surprised that people like Neil Findlay and others aren't backing us as opposed to supporting them half the time on this. Yes, I'm more than happy to take an intervention from you. Of the powers that the Scottish Government does have, which of them have been redistributive? It's very difficult if we're completely redistributive when we don't have all the powers, and we're only getting them just now. That is not the answer. Yes, we are all ready. How many mitigations have we had to put in a welfare bill? You know that's rubbish, Neil, but feel free to make silly gestures. Donald Cameron's opening was very interesting. He talked about missed opportunities, and that's been a missed opportunity for us to make a difference. There were two missed opportunities. One of them was on 18 September 2014, and the other one was just a few months ago when we voted to leave Europe instead of staying in Europe, because I'll tell you if you think things are bad just now, just wait till the Brexit kicks in. That takes us on to what this is all about. This is all meant to be about staffing in the health service, and if we are going to be trying to staff in the health service, we're not going to be able to do it if what we're doing is banning people. Stuart Stevenson just mentioned earlier on from coming here to work. We need the people from Poland, the dentists from Poland. We need the doctors from elsewhere across the world, including Europe. It's something like 20 per cent of the UK hospital doctors that are from outside the UK. We need them. What you're doing with your immigration laws, with your Brexit, is banning these people from coming here. You mentioned the Bible. What was it, the beam in your eye? I would suggest that the Bible quote that you should have been looking for is let those without sin cast the first stone. Can you wind up, please, Mr Donner, over time? I will suggest that if we're going to have a debate like this, let's have it, honestly, but let's have it based on the fact that both sides accept that we are working under extremely difficult circumstances, that there are issues to be dealt with, but let's not pretend that everything else is rosy in what we are doing as we're sitting in our hands, because this Cabinet Secretary has been working very hard to make things better. Thank you very much. I now call Jeremy Balford to be followed by Alex Cole-Hamilton. Mr Balford, please. Thank you, Deputy Presiding Officer. Can I agree with Mr Stevenson that no-one in this chamber wants to see the NHS in Scotland fail? We all understand the importance and the place that it has within our society. Our family, our friends, our neighbours and even ourselves have benefited from the treatment that we have received from doctors, nurses and other professionals. As I mentioned before in this chamber, on at least three or four occasions, the intervention of the NHS has saved my life and allowed me to be here today. However, we need to be honest about where the NHS in Scotland is and what its future is. If anyone goes to the doctor, they will often be given the bad news before the good news. They will often be given the diagnosis before the treatment. The bad news is that primary care in Scotland is failing and is in a critical condition. Unless something is done by this Government now and in the next few years, we will see more and more GP practices close, GPs walk away and patient care decline. Why is the NHS primary care in Scotland feeling so bad? We have heard many reasons, but let me just highlight briefly a few. Firstly, and most obvious, there is a funding issue. Primary care services only get 8 per cent of the national health service budget. This is simply not enough with an ageing population and with many new techniques required. We have heard that, in real terms, the amount of money primary care receives has not gone up in the last 10 years under this Government. The money is given to hospitals to meet targets set by politicians, and yet even those targets are being missed. Two constituents have contacted me just this week about waiting lists in NHS Lovian. NHS Lovian seems to be disregarding the waiting times given to them by the Scottish Government. One has waited 48 weeks for an appointment with a consultant, the other has been referred by the GP in June and still has no date to go to hospital. If the minister is aware of this, if he is, is he going to intervene in this issue with the management of NHS Lovian? There is a lack of investment in our buildings. GP practices are no longer often fit for the 21st century. It is no longer acceptable to go to an old Victorian house as perhaps Mr Stevenson's father worked in. People need to go to buildings that are disabledly friendly and open to all and good for doctors and good for patients. The second reason is that younger doctors are simply deciding not to go into GP practice but rather enter specialities in hospitals. Younger people want a better life balance than perhaps again Mr Stevenson's father. They do not want simply to work all the hours that he did and often the hospital is a better option for them. Is it too much? It is often that GP practices are now having to recruit salaried employees rather than partners within the practice. Again, if you look at the numbers across Scotland, you will see that the number of salaried GPs is increasing where the number of partners is going down. Again, the system cannot survive in that. Thirdly, the population in certain parts of Scotland, particularly here in the central belt, is increasing and putting pressure on GP practices. For example, here in Edinburgh, in the last 10 years since this Government came to power, 50,000 more people have wanted to register with the GP within Lorien. There are simply not enough spaces left. Let me again give an example that came in by email to me this Tuesday. I, my constituent said, have spent an hour on the pavement outside my local GP surgery, queuing for a registration form. There are about 30 disappointed people who could not register because they only can take on 25 new patients a week. That is not to go and see your GP but simply to register before you want to go and see your GP. That cannot be acceptable in 21st century Scotland. Let me say that this is not the thought of the GPs but is the thought of the Government for its lack of strategic thinking and planning. Let me move briefly, Deputy Presiding Officer, to what I believe are some of the practical solutions that this can turn us around. First, there needs to be a plan, not a plan for tomorrow, not a plan that will throw some headline money in a certain way, but a plan that will give us a long-term solution that will encourage young doctors into becoming GPs. A solution that will make GP practice something that young doctors want to go into. Secondly, we need to stop asking doctors to keep filling out form after form. I came on my bus this morning with a GP. He said to me, my job would be so much easier if I didn't have to tick boxes and fill out papers. Doctors became doctors not to be administrators but to help people with the medical care. Deputy Presiding Officer, if you get a tear in a sail when you're sailing, it doesn't matter. It won't affect the boat much. If that tear gets larger and bigger, the boat will become more and more difficult to sail. There was a tear in our NHS in Scotland. The question for this Government is, will it let it get bigger and bigger or will it deal with it in a proper, mature fashion? I'm calling the last two speakers, Alex Cole-Hamilton. Marie Todd will be the last speaker, and it will be Mr Cole-Hamilton a very tight six minutes, please. Thank you, Deputy Presiding Officer. About 48 hours after I was elected to this place, a very strange thing happened. People initially in single numbers but then a steady stream of people emerged at my local office. With prescriptions and attached to those prescriptions were stapled letters from the East Craig's partgrove medical practice saying, help us, contact your MSP, we cannot go on like this. I have never heard anything of the like in our nation's capital that GPs in a popular and well-regarded medical practice should be actively seeking their constituents to contact their elected member of parliament to talk of the abject distress in which their surgery is going. It's not just GPs either. It's other professions as well, whether it's a cross-pediatrics, nursing, allied health professional, or with free. There is a fundamental and existential crisis in our health service, yet all we have here is the Government benches saying repeatedly and the sentiment of this debate, crisis, what crisis. In fact, the Government amendment, I find it astonishing that the SNP should seek to amend the motion today by deleting the word serious from advance of the word serious crisis in our healthcare profession and I think that a measure of how this SNP Government regards the problem before it. We have at every turn a problem that manifests itself in our waiting rooms, in our hospitals, in our casualty departments and the eyes of the entire profession. In fact, the entire eyes of several entire professions are fixed firmly on an SNP Government with its fingers rammed in its ears. Just two weeks ago, I raised this directly with the First Minister of Scotland at FMQs. She sought to give me something of a beatdown on this and said, if you half-close your eyes and look at it in a certain light, the number of GP trainees was actually at 92 per cent of vacancies. Well, what utter nonsense that turned out to be. The Royal College of GPs with whom I met yesterday and who presented to the health committee of the Scottish Parliament, who monitored this situation exceedingly closely, said that they had entirely no idea where this figure came from. In fact, not only that, but the trainees who are in posts at the moment training to be GPs, 50 per cent of them, this is astonishing, 50 per cent of those trainee GPs are not domiciled in Scotland yet they are training in Scotland and are not expected to practice in Scotland. That shows that the Government's sole response to this crisis is not working and it needs to be augmented. All told, since Liberal Democrats first raised this problem back in FMQs a year ago, we have lost 90 for the GPs to the profession. I'd say that serious. When half of those trainees are not domiciled in Scotland and are not planning to practice in Scotland, I say that serious. At this rate, when we will have 1,000 fewer GPs than we need by 2020, then I'd say, that's pretty damn serious. When you consider the perfect storm of the ageing demographic and our surging populations in certain parts of this country, we need to meet the investment our GPs put in our communities with proper investment in GPs. Ten years ago, that investment accounted for 9.8 per cent of the health budget. That has diminished to a shocking 7.4 per cent and that's why the Liberal Democrats absolutely support the RCGPs call for an 11 per cent percentage of the overall spend in NHS. However, we have to do so much more than that. I offer three particular solutions to the Scottish Government for consideration. First, we need to box clever. Ten per cent right now, ten per cent of all the appointments that GPs could have easily dealt with under the minor ailments in terms of the community pharmacist. Secondly, a lot of people still aren't aware of that facility available. That's a challenge that the SNP is still to meet. 30 per cent of all appointments have something to do with MSK or musculoskeletal conditions. As we've seen in Grangemouth, where GPs, by necessity, have had to divert all their MSK cases into physiotherapists, we can see a massive reduction in workload as a result of that. Finally, and most importantly on this, is a reality that one in four patients who present to Scottish surgeries do so with underlying mental health conditions. As I said to the First Minister two weeks ago, this is not going to be solved by link workers in surgeries. You need actual, fully trained, full-time, qualified mental health practitioners in our surgeries and not just link workers. They're absolutely fantastic, but they aren't going to solve people, give them that primary care when they need it, as they need it. Secondly, innovation. I do support what the Scottish Government is doing with the Nuka model in Forfer. I think that there are many examples globally which would see replication well used within the Scottish NHS. Finally, we need to do so much more with planning, because right now we have a proliferation of housing developments in my constituency of Edinburgh West, and yet, whilst the SNP are answering the undeniable housing need by building tens of thousands of new homes, they are not building a single new community. That is because there are no new health centres growing with those. I have written to your colleague in the Cabinet to ask her to look at planning legislation, to review section 75 orders, so that we can compel developers to build new health centres so that those can support communities that are otherwise just going to present yet another drain on our already struggling surgeries. I'll finish here, Presiding Officer. I'd ask you to finish now, please. This is a deadly serious problem. I appreciate that, but you're cutting out time for other members. Well, you finished it for me, but it is a deadly serious problem. Thank you very much. We have to take it more seriously. Thank you very much. That's why we'll be supporting them. I call Marie Todd and you've got a very tight six minutes, even tighter than before. As you're the last speaker, everybody else who took part in the debate should be in the chamber for winding up just a warning to someone who's not here. First, I have to declare an interest. I'm a pharmacist registered with the General Pharmaceutical Council and until my election in May I was employed by NHS Highland. During yesterday's debate on the economy, the Conservative member Murdo Fraser urged those of us on this side of the chamber to be less dismal, less miserable, less downbeat and less pessimistic, to be more positive, more cheerful, more hopeful and to show some real leadership in seizing the opportunities for the future. Today, I want to urge my Conservative colleagues to take a dose of their own medicine and look at some of the success stories in NHS Scotland as well as the opportunities to innovate. First, let me say that our ageing population is a real success story. People in Scotland are living longer, healthier lives. Nowadays, people with complex medical conditions are living longer and more fulfilling lives at home than ever before. There are more effective treatments available than at any time. Scotland's NHS is receiving record funding. We have record numbers of staff with the highest number of GPs per head in the UK. Scotland got rid of the much-malined and bureaucratic quaff payment system and in Scotland nursing students continue to have free tuition and bursaries. To me, that represents a commitment to ensure that the NHS is equipped to provide a first-class service in all the future, despite Scotland's changing needs. Let me tell you more of what I really welcome from the Scottish Government. As someone who worked in a psychiatric hospital for the last 20 years, I welcome the focus on mental health and parity of status with physical health. This is the first Government of Scotland to have a mental health minister, the first country in the UK to have mental health waiting-time targets and I welcome the extra money coming to mental health to invest in primary care settings. Let me tell you about some of the innovations happening in our constituency of the Highlands and Islands. A couple of weeks ago, I visited the Centre for Health Sciences in Inverness. I met trainee surgeons from all over Scotland who were attending surgical boot camp there, an award-winning training package rich in simulation, which is happening in the Highlands. Of course, the opportunity to conduct research into medical education is making the Highlands a more attractive place to work and I met a talented young surgeon who has chosen to come and work in Rakemore to take up that opportunity. Those innovations paid dividends. Just last week, I visited the University of the Highlands and Islands where they have a new school of health, social care and life sciences on offer, our nursing courses, allied health professions and very soon a graduate entry medical programme. There are challenges in rural recruitment and they are keen to align and develop their curriculum and research to meet the needs of our region and help to drive forward different models of health service delivery. Those innovations pay dividends. Let me tell you about some of the changes that are occurring in my profession of how care is delivered in pharmacy. The move away from the supply of medicines towards sharing our expertise and choosing the right medicine is part of a much bigger picture of developing the multidisciplinary team. Everyone works to their full potential and doctors only do what only doctors can do. The chronic medication service, which encourages joint working between doctors and pharmacists to improve the care of patients with long-term conditions, means that for a serial-long, a year-long prescription can be issued and vastly reduce the number of GP visits and enables the pharmacist to prevent and address medication-related issues. The minor ailments scheme, already very successful for some of our population, could be extended to cover more people and more conditions. With the extra training currently available in clinical skills and prescribing, pharmacists will be able to do even more to help reduce avoidable harm, to help patients make the best use of their medicines and to free up GP time to focus on the more complex cases. When Ruth Davidson spoke last week about the NHS-facing pockets of meltdown, she was talking about the havoc that is being wreaked on NHS England by her own Conservative Government at Westminster. The Scottish Service has in fact been bucking the trend south of the border, resisting privatisation, posting a long series of improvements in all the stats that are plummeting fast in England. There will always be pressures on the NHS, but the devolved service under the control of this Scottish Government is coping remarkably well compared to its counterparts in the rest of the UK. Despite the cuts, staffing levels and patient satisfactions are both at record highs. That is why, when I was working as a pharmacist and I used to attend conferences down south, my medical and pharmacy colleagues would say to me, You are really lucky to work in Scotland. I have to say that there is no doubt that there are challenges ahead, but we in Scotland are rising to meet them. Can I begin by declaring an interest as a councillor in Dumfries and Galloway? Also, when I was elected in May, I was employed by Parkinson's UK, although that employment has now ceased. This year, we celebrate 68 years of Labour's greatest achievement on national health service. The principle that, no matter your class, your race, your age, your financial circle, you have to be able to do what you want to do. The principle that, no matter your class, your race, your age, your financial circumstances, you should be entitled to quality healthcare free at the point of use is as important today as it was when Ngai Bevan spearheaded the establishment of the NHS. However, there is another principle that Labour subscribes to. If, seven decades on, we still want quality healthcare, we need to properly value our health and social care workforce. As we have heard in today's debate, the reality for health and social care workers in Scotland does not match that principle. There have been plenty of worn words about the workforce in the debate, but what they really want is fair paying conditions and proper staffing levels. Cabinet Secretary. The member will do what Neil Findlay failed to do, and that is to recognise that this Government is going to pay the living wage to those care workers working with adults from 1 October. Would he welcome that? Mr Smith. I absolutely will, and I will come to detail what I think the Government needs to do to review the way that policy has been implemented in the course of my speech today, because it is an important policy to support, but the implementation, frankly, has been chaotic. Now, as I said, there have been plenty of worn words about the workforce. What we need is fair pay and conditions and proper staffing levels. Speaker after speaker have rightly highlighted the recruitment and retention crisis facing Scotland. One in four of our GP practices report a vacancy, and we have a ticking time bomb of GPs queuing up to retire. On my health board in Dumfries and Galloway, the number of GPs has fallen from 134 in 2012 to 118 this year. A quarter of GPs are looking to retire in the next decade, and there are more than a dozen vacancies, including GP practices facing cuts in hours and possible closures. Across Scotland, the Royal College of General practitioners predict that by 2020 Scotland will have a GP shortfall fall of 830, just to bring coverage per head of population back to 2009 levels. That does not take account of the added pressures on GP services. We have an ageing population who needs more clinical care than ever before. However, it is not just in GP numbers that we have a crisis. The picture is no better when it comes to consultants. There are more than 350 vacancies, with nearly half vacant for more than six months. What about nursing and midwifery posts, where there are two and a half thousand vacancies, including more than 300 mental health nurse vacancies? The cabinet secretary said that there has been an increase in nursing and midwifery staff in posts, but that fails to acknowledge that this has not kept pace with demand. It does not acknowledge that the vacancy rate of 4.2 per cent in June 2016 has an increase from 3.7 per cent over the year, with almost 600 nursing and midwifery posts lying vacant for three months or more. The consequence of high vacancy rates and training posts going unfilled across the health and social care sector has an increase in the burdens on existing medical staff, adding to already unsustainable workloads. The utter failure of proper health and social care workforce management and planning by the Government is shown even when it comes to the way that the Government implements positive policy initiatives that we support. The cabinet secretary raised the issue of the living wage. She rightly said that from 1 October this year, integrated joint boards are required to ensure that the living wage is paid to care workers. That is an aspiration that Labour very much supports. I do not need any lectures about the importance of the living wage. I said earlier that I was a councillor and I am proud to have played my part in ensuring that Dumfries and Galloway was the first councillor in Scotland to achieve living wage accreditation. I am also pleased to tell the cabinet secretary that all commission social care workers will receive the living wage in Dumfries and Galloway from 1 October. I can also tell her that the funding provided by the Government to meet this commitment was nowhere near adequate enough. With just 10 days to go across Scotland, it is true. I am happy to share the figures with the cabinet secretary that showed quite clearly, because Dumfries and Galloway is a low-wage economy and that was not taken into account in the form of when it came to allocating funding. The cost is actually more than the funding that was provided for that area. With just 10 days to go across Scotland, councils and providers are scrambling around trying to put in place quick fixes in their procurement policies to meet the deadline. Fixes that may get them through the next year but are unsustainable and will not guarantee care workers living wage in the long term without a serious rethink by the Government. The buck for this rest squarely with the Government. This was a policy initiative that was landed on local government at the 11th hour in funding negotiations between the Government and COSLA if you can call the imposition of cuts and negotiations. The first social care providers knew about the policy was when they read about it in the newspapers. No proper calculation was made of how much it would cost with the Government's so-called national estimate of £40 million now widely ridiculed, including the unrealistic assumptions made about funding. It has been a classic case of the Government almost grabbing defeat from the jaws of victory. I hope that the Government will review the implementation of the policy by firstly asking local councils exactly how much it will cost to implement the living wage instead of relying on the fantasy figures. Secondly, ensuring that they provide a sustainable long-term funding formula that takes account of factors such as rurality. Thirdly, I hope that the Government not only recognised the importance of the living wage to social care workers but also trained in and career progression. Finally, I hope that it will show some respect to providers by involving them in those particular talks. Despite the crisis and despite the challenges— I'm afraid that you had to stop it finally, and it was a good point. Thank you very much. I move on to Irene Campbell's wind-up. The Government Minister, a very tight eight minutes. Eight minutes. Thank you, Presiding Officer. The Conservative motion calls on all parties to work together, and we're always ready and willing to do just that. But when they are ready to come forward with any ideas or any policy initiatives, we'll listen, but sadly that has been lacking from many of their contributions today. In extending that hand across the chamber, I also want to be robust in articulating the strong record that we have, because that record is both reflective of the challenges that we face and demonstrates the progress that we have made in actions that we are taking in seeking to address those challenges. Much of the discussion today has been on GPs, and in that context we should bear in mind that under this administration, no matter how uncomfortable the truth is for the Tories or the Labour Front Bench, we have the highest number of GPs per head of population in the UK. Indeed, if we had England's GP ratio, we'd have 931 fewer GPs. We have substantially increased the number of new training places for GPs by 100 across Scotland this year, one of a number of initiatives to grow our GP workforce, encourage trainee doctors into general practice and to make a GP more attractive option. We are funding initiatives to encourage established GPs to return to practice, and we are continuously looking at how we can support and improve primary care and GP services. A point raised by Gil Paterson, investing £85 million over three years to put in place a long-term sustainable change within primary care that can better meet changing needs and demands, including support for recruitment and retention. I was going to give way to Liz Smith. Liz Smith, please. Thank you Minister for giving me the opportunity. What is the comment from the Scottish Government about the comments from Aberdeen University, who feel that because of the Scottish Government's capped fee policy that the number of medical students that it can take on is fewer than it might be if that capping policy was not in place? Well, intake to Scottish medicine schools, the Scottish domicile proportion is 48 per cent, and we want to make sure that we offer all opportunities to anyone who wants to study in our NHS, in our institutions. It should be noted that none of our actions or activities have been driven by Government in isolation. This Government has always valued the strength of our relationship with those providing the health services that we value so highly. By working alongside the BMA, we have been the first in the UK to abolish the bureaucratic quality and outcomes framework, which will support the negotiation of a new GP contract in 2017. A point that was made well in Marie Todd's excellent contribution. By working with doctors, we have avoided the confrontation with junior doctors that has dogged the UK Government, and we are working with the GPs on the new contract and with our consultant workforce. Moreover, we have seen NHS staff numbers rise to a record high, with more consultants, nurses and midwives delivering care for the people of Scotland, and we are indebted to our dedicated staff who in the last survey remain committed to their roles and willing to go with the extra mile at work. However, we are determined to continue to attract and retain the best talent in the healthcare profession and improve the experience of our staff. That is why, earlier this year, the First Minister announced the £27 million package of support to increase staffing levels throughout the NHS, including training, 500 more advanced nurse practitioners and support for nursing and midwifery students' experience for national hardship. Mr Briggs? The First Minister, please outline how many GP positions remain unfilled from the previous recruitment round, which took place. It is an on-going process. However, I just want to make the point to Miles Briggs. Has he made any representations to the UK Government, because if we were suffering the same level of GP ratio problems that they are in England, we would have 931 pure GPs in England. Of course, we lead the UK in the development of mandatory nursing and midwifery workloads and workforce planning tools that help health boards to plan for the number of staff that they require. I said at the start that this Government does not shy away from the challenges that we face. The workforce is ageing, recruitment and retention remains an issue, and we need to shift the shape of our NHS so that it is responsive to the local needs and delivers more community-based services with a focus on early intervention and prevention, a point that was made by Ruth Maguire and Brian Whittle. That requires sophisticated planning and co-operative working, and that is why, along with our partners, we are developing a national healthcare workforce plan. We already have confidence in workforce planning in our NHS, but in line with our manifesto commitments and need to see the pace of change increased, we need boards to give more workforce planning a much higher profile. That work must also be cognisant of the new context of integrated joint boards and health and social care integration. Many members have made some very useful and constructive comments. For instance, Ruth Maguire and Sandra White described eloquently the societal inequalities that are faced in Scotland. To be fair, Brian Whittle—I know that they are laughing, but I am going to point out that he too talked about the way in which we cope with that need to be rooted in prevention and early intervention. The review of targets in the appointment of the former CMO, who has been an evangelist of empowering people and communities, shifting people from being passive recipients of care to active agents of change in their own lives, is a collective opportunity to shape the future tone of the NHS. Linked to that, Alison Johnstone made excellent points on the need to be continually active on the early years. Again, I commend the early years' collaborative and the many income maximisation workstreams that are happening across that. Again, Alison Johnstone made excellent points about doing what we can to support our carers, and that is an area that I am actively pursuing as we implement the carers act. Mary Todd spoke with passion and authority about work happening on mental health and the real-life impact that national initiatives are having locally, also ensuring that our professionals work at their full potential. Stuart Stevenson also made excellent points on drawing on the post-Brexit borough left by Messers Cameron, Johnson Farage and the rest of them and the impact that that will have on our valued EU dental staff contributing to our communities and our NHS. There were also, however, some comments that were less constructive. Neil Findlay, although I acknowledge he cares about tackling inequalities, fails to recognise progress on areas that I think deep down he agrees with. We know that there is work to do to see the culture change that properly values our social services workforce and that the work that they do daily on our behalf to allow others to live in dignity. To fail to recognise the investment that we have put in to enable the payment of living wage for social care workers from 1 October is completely disingenuous. That is investment in staff and a positive huge step forward made by this SNP Government and one that I am proud of. Alex Cole-Hamilton, I want to reassure him that much about what he spoke out about in terms of MSK is being acted on. However, like James Dornan, I found the lack of awareness from some of the Tory benches to be absolutely astounding. To talk about inequalities and that we should do more in a society when it has been their party that has pursued a harsh and unflired programme of welfare reforms, when it has been them that has brought in the bedroom tax, cut budgets and peddled an unhelpful narrative of skivers and scroungers, they need to have a long hard look at themselves and really think about the dreadful impact their party has had on families, communities and those and leave in the past. My remarks contain details of action activities and investments to tackle the challenges that we face in responding to the needs of our fantastic and dedicated NHS staff and also responding to the changing societal demands that are placed on our NHS. We have an NHS that is valued by this Government, supported to respond to our country's needs and we are a Government not blind to the challenges but determined in our effort to tackle them and we will work with those who have that same effort to want to do as best as they can for our NHS. Thank you very much, Colin Miles-Wiggs, to wind up the preservatives till 5pm. Please, are there about? Thank you, Deputy Presiding Officer. I'm pleased to close this afternoon's debate, which has allowed members from across the chamber to highlight the very real challenges our NHS is facing, as well as giving Stuart Stevenson the opportunity to tell new MSPs about his personal and family medical history. My colleague Donald Cameron set out specific concerns about recruitment of GPs, nurses and consultants, and I wish to back up those comments. Alison Johnson, Neil Findlay and Jeremy Balfour have outlined the pressures on GP services, in particular the severe challenges faced by NHS Lothian in my own region and the region that we represent. One third of GP practices across NHS Lothian have stopped accepting new patients and that figure is around 40 per cent in Edinburgh, with NHS Lothian predicting that this is set to become half of all GP surgeries. That is the crisis that we are here to debate today. We have a growing population, but quite simply our GP services cannot cope with growing demand. Local residents are increasingly concerned about the situation and the impact that it is having on the provision of local services and the time that it takes to see a GP here in the capital. Only this morning, my colleague Ruth Davidson and I were presented with a patient's petition of 1,208 signatures, which have been collected locally by our constituent, Mrs Denise Palmer, to support saving the south side surgery in Newington. I commend Mrs Palmer for her initiative in gathering these signatures from fellow patients and will be sending that petition to NHS Lothian. As Daniel Johnson has outlined, the south side surgery is now the sixth practice to be taken over by NHS Lothian in recent months after repeated efforts to recruit two new GP partners have failed. I have to say that today the Scottish Government's focus on the GP crisis here in Lothian and across Scotland has not been acceptable. The press release announcement that we saw in June that the Scottish Government was developing a locum service of pulled retired GPs in Lothian has not exactly given confidence to the health professionals and patients across Lothian that the SNP Government is actually working to deliver a long-term sustainable Scottish GP workforce that is fit for the 21st century. We need to support our GP sector and that's why Scottish Conservatives have proposed a very clear commitment that we should increase NHS funding for GPs to at least 10 per cent of health spending by 2020. This additional resource is critically important and if we're to attract the GPs we want, given that nearly one in five will be considering retirement in the next decade, we need to put this funding in place now. As we've heard, the Royal College of GPs has already warned that Scotland could face a deficit of 830 GPs by 2020 and our hospitals are also experiencing real recruitment difficulties. Just five of the 16 vacancies in emergency medicine were filled. The Scottish Government and the First Minister, as a former health secretary, cannot say that we haven't been warning about recruitment, about consultant recruitment, GP and nurse recruitment, as those have been building up on this Government's watch. Scottish Conservatives, alongside the medical representative organisations, have consistently warned about this and demanded more action. In August, the Scottish Government announced the opening of applications for 100 new GP training places in Scotland. However, the fact that the Scottish Government has failed to fill those in the past, alongside the fact that a quarter of training places in GP surgeries remain unfilled, do not fill the profession with confidence that the workforce planning and workforce needs are being met by this Government. As Alex Cole-Hamilton outlined, with only half of medical students studying in Scotland being Scottish domicile, the training of our future GPs is clearly an issue that this Government has not focused on addressing either. On that point, I take it that the member does not then recognise the fact that the introduction of a new graduate medical school with a focus on primary care and rural areas. Is that not a good thing and would that not be something you might welcome? The cabinet secretary is not taking the point that half of students studying here in Scotland are not domicile. They might leave our country. It is something that you have not put in place. There is a bigger point here, which SNP members on the back benches have not understood, that our Scottish NHS does not depend on the SNP. It depends on the workforce that delivers our health services day in, day out. We welcome the fact that the Scottish Government is moving towards GP hubs and a multidisciplinary team. That has the real potential to move patient care in the right way, to deliver the health service when we need it and where we need it. However, that cannot and must not become a cover for staff shortages in our health services if it is truly going to reform patient experience and patient access to services and provide the cultural change that will bring all health professionals together. It is also, I believe, important for the Scottish Government to outline what investment plans it has to develop better IT and communication systems as this will be how we make the future patients see the right health professional and also that the GP hub network is truly going to work when the issue of patient data responsibility needs to be urgently addressed. Since being elected, I have had the pleasure of meeting with many of the professionals who work day in, day out in our health services. I am sorry to say that the overwhelming message that they have given me is that they feel demoralised and in many cases undervalued by this Government. One GP that I met in Parliament last week told me that the service was literally crumbling around him and that the professionals involved feel that the Scottish Government ministers simply do not understand the severity of the situation. It is clear for anyone working in our health service that the service faces a major workforce planning challenge. When health boards are spending £248 million on temporary agency staff, alarm bells should be ringing in Bute House, a situation that is clearly contributing to the budget pressures of all NHS boards and one that is totally unsustainable. In fact, in the very good briefing that was provided by the Royal College of Nursing in Scotland ahead of today's debate, it states that against the backdrop of funding decisions by health boards based on making savings, increased demand for service and a health reform agenda, there is no single workforce plan supported by clear data to build for the future. There is no plan, cabinet secretary. That is what professionals are saying to you. That is a shocking indictment on this Government's planning and management of our NHS workforce in Scotland. Presiding Officer, to conclude, we want our health service to be the best that it can be, the best health service in the world, delivering the best healthcare for people across Scotland. After nine and a half years in office, its time SNP ministers took responsibility for the NHS workforce crisis that they are presiding over. Thank you. That concludes the debate on NHS Scotland's staffing crisis. It is now time to move on to the next item of business, which is consideration of business motion 1571 in the name of Joe Fitzpatrick on behalf of the Parliamentary Bureau, setting out a business programme and asking any member who wishes to speak against the motion to press the request-to-speak button now. No one seems to object to calling Joe Fitzpatrick to move motion number 1571. I am moving the motion on behalf of the Bureau, which was agreed at the Bureau this week. I hope that the chamber will support it. Joe Fitzpatrick is behind me so that I can move. Did they finish early? A little bit. A little bit. Joe can move. I will call the question that motion number 1571 in the name of Joe Fitzpatrick be agreed. Are we all agreed? All agreed. The next item of business is consideration of three parliamentary bureau motions. I asked Joe Fitzpatrick to move on block motion 1570 on office of the clerk, motion 1572 on designation of lead committees and motion 1573 on the variation of standing orders. Moved on block. Thank you very much. The question on the motions will be put at decision time, to which we will come very soon. There are four questions to be put as a result of today's business. I wish to remind members that, if the amendment in the name of Shona Robison is agreed, the amendment in the name of Anasawa falls. The question is that amendment 1554.4 in the name of Shona Robison, which seeks to amend the motion in the name of Donald Cameron, be agreed. Are we all agreed? All agreed. We are not agreed. Parliament shall move to a vote and members may cast their votes now. The result of the vote on amendment 1554.4 in the name of Shona Robison is as follows. Yes, 62. No, 55. There were six abstentions. The amendment is therefore agreed. The next question is that motion 1554 in the name of Donald Cameron, as amended, be agreed. Are we all agreed? All agreed. We are not agreed. Parliament will move to a vote and members should cast their votes now. The result of the vote on motion 1554 in the name of Donald Cameron, as amended, is yes, 62. No, 54. There were six abstentions. The motion as amended is therefore agreed. I propose to ask a single question on parliamentary bureau motions 1570, 1572 and 1573. If any member objects a single question being put, please say so now. No one objects. I put the question therefore that we agree motions 1570, 1572 and 1573. Are we all agreed? We are all agreed. That concludes decision time. We will now move on to members' business. Members could change their seats.