 The final item of business today is a member's business debate on motion number 1639, in the name of Liam McArthur, on island health boards. The debate will be concluded without any questions being put, so would those members who wish to participate please press the request-to-speak buttons now? I call on Liam McArthur to open the debate around seven minutes please, Mr McArthur. Thank you very much, Deputy Presiding Officer. Let me start by thanking colleagues for the cross-party support that has allowed this debate on island health boards to take place. I look forward to hearing the contributions of those who are able to participate this afternoon, including of course the minister, although passing was slightly surprised that no SNP MSP felt able to support my motion, which I do not believe really says anything unduly controversial. Indeed, in her recent response to me and my colleague Tavish Scott, the health secretary very reasonably I thought accepted many of the same points. He acknowledged the quote, unique nature of the islands that NHS Orkney and NHS Shetland are very distinct communities and that the respective NHS services are experienced in the demands of serving those populations. So as I attempt to set out why I believe our island health boards deserve protection, I am encouraged by what appears to be a decent amount of common ground between myself and the health secretary. Nevertheless, the First Minister's intention set out in her programme for government to examine the number and structure of health boards has set alarm bells ringing in Orkney and Shetland. From my conversations with those directly employed in delivering health and care services in Orkney, as well as the many members of the public who have been in touch with me over recent days, there can be no doubting the strength of feeling or the determination to resist any dilution of local control. Some of those concerns I know will not be confined to the island communities that Tavish Scott and I represent. That is because all the evidence shows large-scale structural changes inevitably distract attention away from the day-to-day business of delivering services. They can affect morale and the ability of organisations to recruit and retain staff and the savings often used to justify them invariably prove elusive if not elusory. Anyone doubting this need only look at what has happened since the Government decided to create a single centralised police force. Five years on, and surely only, Kenny MacAskill believes that this has been a success or delivered what was promised. A review of how health boards are performing, of course, is prudent. Given the crises that we are seeing in many areas of health and care provision, our review is perhaps even overdue, but I would caution against believing that structural reform is an answer to the maiden's prayer. Certainly for rural and island areas, such reviews tend to signal a retrenchment of services and decision making into the centre. That matter is not least to those who rely on those key services. At NHS Orkney's AGM earlier this week, the local patient group voiced its opposition to NHS Orkney being subsumed with a larger board serving a wider geographic area. Preserving NHS Orkney's identity is important. That identity shapes the ethos, priorities and approach. Little wonder then that there is such anxiety in the islands at what might be lost in any move to centralise services and decision making. Bringing together different boards with different identities, even priorities, offers no guarantee or, indeed, much likelihood that island needs would be effectively heard, understood, far less met. Moreover, it would remove the ability to be nimble in responding to local needs, to develop in conjunction with communities themselves, services that best suit the island's circumstances, and to enhance the skills of staff in ways that ensure both quality and breadth of provision. That is not an isolationist approach. Island health boards already work collaboratively with counterparts on the mainland. NHS Grampian is the obvious example with respect to the northern isles, but there may be opportunities in future to work with others in providing specialist treatment that it would be impractical to deliver in an island setting. Here, again, there is a note of caution. If the Government plans to merge mainland health boards, it must take account of the impact on all patients. For example, recent problems affecting the oncology department in Aberdeen, so some Orkney and Shetland cancer patients offer treatment in Dundee in Glasgow. Although the treatment itself may have been exceptionally good, outwith Aberdeen, isles patients face more complex travel arrangements and limited access to the support structure provided by Clann and the Red Cross in the north-east. Far from reducing the services that are available in the islands, I want to see those increased. The ambition is shared by NHS Orkney, staff, patients and local communities themselves who see that as crucial in their efforts to attract, retain and effectively serve their populations. The recent decision to locate the CT scanner in Orkney is a case in point. Speaking to the staff involved, I know that the scanner has already made a big difference in terms of early diagnosis, allowing more effective treatment, improving and, in some cases, saving lives, justifying the long, hard-fought campaign. More is possible that telehealth opens up opportunities to increase the availability of treatment in Orkney, reducing the need for patients to travel south or even to travel within Orkney. For those living in the smaller isles, for example, the option of a consultation in their local surgeries supported by their GP or nurse may appeal a great deal more than getting on a boat or a plane and travelling into Kirkwall, particularly during the winter months. Such an approach can therefore help to improve patient care, reduce travel and accommodation costs, unlock economies of scale and open up more interesting career paths for those working in health and care in our islands. That last point is important given the challenges faced in recruiting and retaining staff in remote and rural settings. The Royal College of Surgeons again shone a light on this issue last week in their report. Although there are no easy solutions, we need to do more to give those in training a taste of what island working has to offer. We need to develop a workforce that is comfortable across a range of general skills rather than training ever more specialists. We must ensure that more isles students can access Scottish medical schools. Widening access needs to be about rurality, not just about poverty. At the same time, there is no escaping the fact that financial incentives will play a part in the equation. Delivering good-quality health and care in our islands to a population living longer but with more complex conditions presents enormous challenges. Meeting those challenges is beyond the gift of simply any health minister. Decent transport links, for example, including reliable air services, are helpful. The availability of good mobile and broadband coverage is routinely and compellingly raised by GPs and nurses throughout my constituency. Those factors fundamentally affect the way in which health and care is delivered in Orkney. In turn, the way in which health and care is delivered in Orkney has a fundamental bearing on the economic wellbeing and sustainability of the islands that I represent. My plea to the health minister today is to ensure that this review, and it would be helpful to hear a little more about the timeframe and the process involved, protects island health boards recognising their unique status and the risks inherent in submerging them within larger, less responsive or less accountable setups. Failure to do this would drive a coach in horses through the Government's commitment to island proofing. More importantly, it would undermine the ability of health and care provision to be tailored to the specific needs of our island communities. That cannot—that must not—be allowed to happen. Thank you very much indeed. Deputy Presiding Officer, I would like to thank Liam McArthur for bringing this motion to the chamber today and commending for his efforts in highlighting concerns about health services not just within his own Orkney constituency but also acting as a champion for the islands. I have signed this motion and I support the principles that it sets out. As an MSP for the Highlands and Islands, I too share the concerns raised by Liam McArthur about the SNP's manifesto commitment to review, and I quote, the number, structure and regulation of health boards. In particular, I am concerned about how it might affect the health boards that affect my region. The needs of people in rural and remote areas of Scotland are, of course, vastly different to those of people living in more densely populated areas and, as such, require a very different approach to the provision of healthcare services. That is the case even more so in island constituencies such as Orkney and Shetland but also in the western isles and in the many smaller islands within Argyll and Bute, for instance. I spoke on this very matter at a recent meeting here in Parliament hosted by Kate Forbes MSP with the Royal College of Surgeons of Edinburgh, who have launched their report, referred to by Liam McArthur, on the delivery of care in rural surgery. They note the clear difference between the provision of healthcare services between urban and rural Scotland. The president of the Royal College in his introduction makes a particular point when he says that, and I quote, one size does not fit all when it comes to services delivery in these challenging environments and that the needs and provision will vary depending upon the speciality and the region. This statement is particularly poignant in the context of this discussion because time and again when it comes to the organisation of our public services, we have seen an increasing drive to centralise services by this Government. We have seen it with our far services following amalgamation. We have seen it with our police with the creation of a single force and we all know of the many problems that have been reported in that. We are even now seeing it in education with proposals announced a few weeks ago by John Swinney to create regional education boards, taking powers away from local councils and centralising them to a larger body. Recent history serves as a powerful reminder of the dangers of overhasty top-down centralisation and at a time when health boards are still adjusting to the huge reorganisation caused by the recent integration of health and social care. There are many valid concerns about committing to further reorganisation unless it can be clearly shown to be in the best interests of patients. On this side of the chamber, we are very sceptical indeed about the creation if it comes of super health boards run on a regional basis, if that turns out to be the case. I say if, because all of us here are somewhat shooting in the dark since we don't know what the proposals are. It may be that there are some elements which we can support and we will of course hold off from expressing a concluded view until something concrete has been put on the table, and like Liam McArthur I acknowledge that there is of course already joint working and collaboration across different health boards. It is vital that we know what those proposals are as soon as possible, not simply for us as elected representatives to be made aware, but more importantly so that the public, the patients, can have their say on the matter and be consulted in a meaningful way. Let me finish with a question to the minister and repeat a call that I made in early July for clarity on those proposals. Will she give clear details today of the Scottish Government's plans for the organisational structure of NHS boards in Scotland? If she is unable to do that today, will she tell us when that announcement will come? First, I have to declare an interest. I am a pharmacist registered with the General Pharmaceutical Council and until my election in May I was employed by NHS Highland. I am really grateful to Liam McArthur for the opportunity to speak in this debate. I represent the Highlands and Islands region, an area that covers nearly half the landmass of Scotland and is served by six different health boards. I want to take the opportunity first of all to acknowledge the aspects of today's motion which I believe we can all agree on. Like Mr McArthur I believe that often island communities do require different solutions to the central belt. I would go further and suggest that many communities require their own solutions. It is clear that providing health and care services in remote communities requires a higher per capita investment, and I recognise that decisions about how those services are most effectively delivered are best made locally. Unfortunately, I cannot in all conscience agree that the potential amalgamation of NHS boards would be to the detriment of the best possible healthcare in the islands. As a health professional, I was encouraged to ask regularly if the way that we had always done things was necessarily the best way. Innovation and change is vital to improving healthcare. We should always be looking for ways to improve the way that public services are provided, and whatever the financial constraints, our focus must be on patient outcomes and on quality of care. Governance and quality must not get lost during the reorganisation. Bigger health boards could be just as capable of reflecting the needs of a community as smaller ones. The key to success is for the individuals on the ground in the small local operating units to be empowered to deliver local solutions. I can absolutely understand that the people in the Northern Isles might be frightened that they will lose their voice, and I can assure them that people all over the highlands and islands share the same concern. We know very well that a one-size approach does not fit all. In fact, NHS Highland is an example of a large health board area that covers remote and urban areas, island and mainland. If you look at the example of health and social care integration, it operates different models to suit local needs. There is a lead model agency in one part of Highland, a lead agency model in one part of Highland and an integrated joint board in our Galambute model. If there is to be a change, it is vital that the engagement and consultation process enables us to make an informed decision. People must have the opportunity for discussion and a chance to identify any benefits as well as risks. Some things are already done well Scotland-wide, so NHS national procurement uses combined buying power to get the best deal on buying drugs and the savings go right back into patient care. I have heard from people working in island health boards that it can be difficult for smaller health boards to compete with larger, better-resourced ones to attract certain skilled staff. It is probably easier to conduct research and develop specialist knowledge and expertise in the large centres. Having fewer health board areas might just encourage the sharing of this precious resource or at least remove some of the barriers for staff in remote areas to tap into that. There may also be a possibility of reducing duplication of effort all over the country and I would pose the question, could having fewer health board areas reduce unnecessary variation in practice and outcomes, might it actually improve the quality of care? False boundaries are an issue and this proposed change could see them disappear. The most important question in this debate is, how can we best deliver high-quality care to communities? We have to answer that question by looking at the evidence, consulting widely and I hope that that is exactly what the review will do. Rhoda Grant, to be followed by John Finnie. Can I congratulate Liam McArthur for securing this debate? While examining structures of health boards, we need to make sure that the structures are fit for purpose. Service delivery must be at the forefront of decision making and the structures must be what delivers that best for the service. Our islands are unique. People who live and work on the mainland think that weather can be disruptive and they do not recognise the challenges that places on island life. While island life is wonderful in many ways, you cannot plan in the same way that you would in the mainland and that people take for granted here. It is normal to have plans disrupted because of weather, therefore providing services on an island must have at the heart of them the determination that systems will work in spite of weather. We do not expect lesser services, it is simply that we expect services to be delivered differently depending on local circumstances. Our island health boards are crucial with their knowledge and understanding of local conditions and are able to plan services to fit with their own unique local circumstances. That is not to say that they do not need support. Take for instance the patient transport budget, which was rolled up into the Highlands and Islands health board settlement for this year. I find that worrying because due to the size of island health board budgets, which are small, they do not have the same economies of scale to absorb those changes. I believe that the funds transferred to meet those costs were not sufficient and cuts will have to be made. Those cuts must not have a detrimental effect on patients. However, as I speak to people about that, I am staggered by the number of people who have been taken off island for routine check-ups that they feel are unnecessary and disruptive to their lives, because those check-ups could have been carried out for them locally using video links. Therefore, island health boards and their patients need to be able to request and to receive consultations via telehealth. I know that island health boards have the technology and expertise because they use it themselves into the island. What is missing is that clinicians on the mainland appear to be reticent in embracing that technology. That would not therefore augur well if those health boards that would not embrace the technology were then put in charge of delivering services to islands. If they had the technology, it would provide better services, it would be patient-centred, and that is why island health boards use it themselves, responding to local needs from people who are not on the main island but on other small islands that surround them. If those health boards who understand those challenges were to disappear, we would lose that knowledge and patients would be worse off. However, what we need from the larger health boards is a better understanding of the needs of remote and rural communities. They need to fit telehealth facilities into their consulting rooms. What we need from the Government is better broadband in our rural and remote island communities so that they can access those services. However, it is not just mainland health boards that have to change, but also services such as the Scottish Ambulance Service that operate a model for urban areas that simply does not work in rural areas, either as an emergency service or as a patient transport system. We need change, but the change must be of the mindset rather than of the structure. We need to protect the local knowledge and support those health boards to deliver for their patients. John Finnie, followed by Douglas Ross. I too would like to lend my congratulations to Liam McArthur for being in this very important debate to us. The motion talks about distinct communities, and my colleague Rhoda Grant talked about a mindset. If you were to go and read the Scottish Government's urban rural classification, if you have nothing better to do, you will see that there are various classifications. They are all fixated around centres of population. Time-driven drive over 30 minutes to a settlement of 10,000 or more is one of them. That is very challenging, because what we are talking about here is communities that might class as beyond very remote rural. They are significantly impeded by geography. However, the motion also goes on to talk about one-size-not-fitting all. I agree with that, with some exceptions. If previous speakers have alluded to them, they are things such as standard of care, terms and conditions of staff, and they should be protected. However, administrative arrangements are configured. However, there are challenges associated with that, too. In the previous session, I wrote to the Cabinet Secretary for Health and Sport about the challenges that are faced by the delivery of training to those who are involved in social care from ornish small islands. Of course, there is an assessment of needs, but there has to be a practical approach to how that is delivered, which bears in mind quite literally time and tide. Those are best done locally. I have no doubt about that. Island communities require different solutions. We have impact assessments that inform a lot of our decision making in this building here, but it is hard to change mindsets. That is a two-way thing—urban, rural, rural, urban—and I do not think that there is necessarily a very clear understanding of what some of the practical implications are. Those solutions come from communities, so I commend that there is a new innovative model of care for the small islands in the Highland Health Board area. The new model of health and care services is created, managed and owned by the last and native people, and that has seen a situation in which the islands of Eg and Muck come up with their own solutions to problems and deliver jobs there. Inevitably, it requires additional resources and other phrases in the motion. That is very important because, clearly, as has been said, there are additional travel and other costs associated with travel. The cost of everything has the travel added on it. An example is the one-size-fits-all delivery of training that moves from a situation in which the islands of the islands and the enterprise had the budget that took consigns of actual costs. When skills development Scotland takes the role over, it moves to a per capita head. That will desperately impact some of the small providers. Argyll training went out of business just last Friday. All decisions are best made locally, and they are best made from an informed basis. A colleague mentioned NHS Highland. I can stand at the north end of that and look over to Mr MacArthur's constituency in Orkney. I can stand at the southern end and look over to Glasgow. That is a ridiculous size, and that is certainly not the model that we should be looking at. It is certainly not the model that I am promoting that has an area that is the size of Belgium and Wales with Argyll and Bute either on. So, integration of health and social care has been a factor, and I do not know if that is a factor that has prompted some of the proposals coming forward from the Scottish Government. However, I would be suggesting, and my party would be suggesting, more rather than less local management decisions. The collaboration will continue, and there is no doubt about that. Not every health board can and could probably have every specialist. However, as we have heard from Mr MacArthur, the scanner in Orkney has made a difference. It is telehealth, and the IT infrastructure of the independent is very important. NHS is a shared resource, and it is a very valued public service. It is a resource that should be managed locally. For the good folk of Orkney, that should be from within the islands by NHS Orkney. I welcome the opportunity to contribute to today's debate and congratulate Liam MacArthur on securing parliamentary time for an important subject for Orkney and indeed all our island health boards. As a member of the Highlands and Islands covering an area of the same land mass as Belgium, I know that a one-size-fits-all model will never work for such diverse and distinctive communities. For me, it can never be the same healthcare provider in Kirkwall as it is in Keith. I think that Liam MacArthur alluded to that. I was encouraged when he said a letter from the Cabinet Secretary for Health also accepted these distinctive challenges in very different communities within the same Scottish parliamentary region. However, the signs are that the SNP, despite having the fingers burnt with many other mergers, is moving on further with the centralisation of services. As my colleague Donald Cameron has already mentioned, anyone who followed the merger of the eight legacy police forces in Scotland to the national police Scotland could not have failed to witness a havoc that merger caused. Jobs lost, staff morale at an all-time low, and despite crime figures falling, public confidence that communities are safer is also falling. The chief constable stated recently that it will take a two to three-year adjustment period to balance the forces finances. I put a point to the First Minister last week, and she was, as usual, quite dismissive about it. Communities in Orkney and in Shetland and the Western Isles will have looked at that centralisation of services and be worried when a similar approach is being proposed for their local health services. I do worry when I listened to Mary Todd as a backbench SNP MSP not recognising the failures of these mergers—I will give way in a second if I should like to come in—but the failure of these mergers and just assuming that those similar problems will not happen if you merge and make bigger the health boards for the islands. I will give way. I can allow you the time back, Mr Ross. Mary Todd. Thank you for allowing me to come back. Will the member acknowledge that people in his own area where he lives, in the constituency of Murray, have raised with him and me the concern about boundaries—false boundaries—caws by the health board area? People living in the area of Murray who may live closer to Rhaigmore hospital than to ARI are forced, because of the health board area of NHS Grampian, to travel to ARI. Will the member at least acknowledge that it is worth looking at that as a potential solution to some of those boundary issues? I thank Mary Todd for that intervention. I am not really sure that she has made the point very well for her own argument. What the people in Murray are saying to me is that living in between Aberdeen and Inverness, they feel that they do not get as good a service from the NHS as people are closer to those communities. It does not mean that, just because you live there, that you should have to put up with services being lost. What we should be looking at is delivering services locally, which is exactly what we are discussing in the debate today, not merging it into far bigger functions and then places like Murray get lost and forgotten about. That is a serious concern in our area. NHS Orkney serves a population of approximately 21,500 people, and the challenges for that health board are well known. The 620 staff employed by NHS Orkney do a fantastic job, and Scottish Conservatives commend them for the role that they play across the Orkney Islands. I know that, when presenting the NHS Orkney annual review, which Liam McArthur mentioned earlier this week, Cathy Cowan took the opportunity to acknowledge the efforts that were made in Orkney, in particular on the aisles, to help recruit and retain staff. They are a key asset, and they will be troubled, I think, by some of the proposals coming forward from the Scottish Government. I am hoping to meet the chief executive, Cathy Cowan, soon, and I previously met the chairman of the board, Ian Kinabra. I know how passionate they are about delivering the best possible care to local people as locally as possible. That is why it is difficult to hear some of the examples given about people having to go as far as Dundee to get vital treatment. I have always found that the best decisions are made locally and with the full involvement of those affected. Although there are no firm proposals on the table, it is clear that the statement that was made by the minority—I focus on that—is that the minority Scottish Government will examine the number, the structure and the regulation of health boards. As a Scottish Conservative MSP for the Highlands and Islands, I would urge the Scottish Government to consult fully on their plans. It is worrying that the RCN noted in its brief for this debate that there has been little or no engagement on the Government's stated intention. The briefing continues by suggesting that this could lead to a perception that change is being introduced by stealth by a Government talking behind closed doors. That cannot be allowed. I welcome today's debate, which allows us the opportunity to debate openly in Parliament and I will be listening carefully and with great interest to the Scottish Government's response to the points made. The last of the open speeches is Tavish Scott. Can I begin by with other colleagues thanking Liam McArthur for bringing this debate to Parliament this afternoon? I want to just briefly concentrate on the care that medical staff bring to the islands and in particular to say thank you to the Gilbert Bain staff and indeed across the NHS for the care that they brought to my father recently. We sometimes take these things for granted, but the professionalism of our staff is worthy of mentioning a debate that in some ways is around process and structure. I think that it would be helpful for the Minister today to be very clear with Parliament about what is going on. In today's press and journal, the cabinet secretary has quoted as saying that the objective of the Government is to reduce bureaucracy and remove barriers to effective patient care. That is in today's press and journal. I do hope that the minister in winding up today's debate can say exactly what those bureaucratic bits are and what are those barriers. Certainly, in asking my health service in Shetland to detail that, it would be interesting to compare the notes that the minister has clearly that illustrate why that need is so great. Of course, to reduce patient barriers and to reduce bureaucracy is the right thing to do, but let us have instead of just the language of this some concrete examples from the minister today which illustrate why this Government is taking this matter forward. I also hope in the wind-up, as other members have said today, that she will commit to bringing forward the proposals that the Government has to Parliament. It is known that this can be done by simply ministerial direction, by which I mean any changes to the structure of health boards and to the geographic coverage of our geographical health boards. Instead, I hope that the minister today will confirm that if the Government do conclude the plan to bring forward proposals to Parliament, that will be done through primary legislation. There is full and proper scrutiny and consultation, as other members have mentioned, of any proposals in this area. I want to just make a couple of points on the general issues that have been raised very well by members from across the Parliament this afternoon. The first one is on health and care joint integration. As Audit Scotland has made very clear, it is to put it mildly challenging—it is a challenge right across Scotland—but it is certainly challenging, as Mr Ross mentioned, in the context of areas where there are not coterminous boundaries. It therefore seems just beyond belief to me that anyone would propose merging the islands, whether they be the western isles or the northern isles, with mainland health boards, making that integrated joint board situation even more challenging. I hope that, on that argument alone, the minister would recognise the importance of maintaining the geographic consistency of what has been worked on. That is not to say that what is happening in terms of merging social care and health is not difficult—it certainly is. That is best illustrated by last week's Shetland Times, where the joint integration board in Shetland decided not to close a ward in a Gilbertbane hospital in Lerwick—not least of which, because of the argument put forward by one of the members—I may say one of the councillor members—who pointed out that the intermediate care teams needed to deliver the care that would happen were that ward to close wasn't yet there in terms of one care team as opposed to the four that would be needed. That is an example, I think, of the important point here of the accountability of our local health services to sensible arguments about the geography that we all face. That seems to me the principal argument around not making a change in this area. The second one is that, where the structural reform, as we have seen time and time again in Scotland, the management tier, through no fault of their own, then concentrates not on, in this case, patient care but on their own jobs and the future of their organisation. That will assuredly happen. You look no further than Police Scotland for the way in which chief constables across Scotland had to deal with their own staff and the consequences of that change. I hope that the Government will at least recognise that point and will be prepared to respond to it. Finally, the essential point here in terms of designing care and designing health in local areas is around the expertise of those who are involved in that service. I suggest that our recruitment challenges, not just in Orkney or Shetland but also right across the Highlands and Islands, as many have reflected in recent days, David Olson and no least David Olson in terms of the Highland Health Board, said that the one thing that doesn't help us to recruit is if there's another whole tier of structural reform. There seem to be some very good arguments for not taking this forward. I hope that the minister is listening. I now call on Maureen Watt to close this debate around seven minutes, please minister. Thank you very much, Presiding Officer. I welcome Liam McArthur's motion and the opportunity to discuss the points raised in it. This Government has placed the needs and aspirations of our island communities at the very centre of our agenda and will continue to do so. I welcome the opportunity to talk about how we are delivering on that commitment. The review of health mode structures, functions and relationships with local authorities hasn't yet begun. However, I can reassure members that the final proposals will ensure that the unique needs of our islands are reflected. The Parliament has not yet got a timetable for this legislation. Cabinet is still in discussion on the initial papers, and the legislation will be brought forward in the normal way and, of course, will go out to consultation with all those who wish to be involved in it. However, we have a commitment to locally delivered services where possible. We know that healthcare services of our islands are experienced in serving the unique needs of their populations. Delivery of those excellent services is something that the staff of these islands should be rightly proud of. As Rhoda Grant and others said, healthcare professionals know their populations and their needs, and that is precisely the direction of travel. NHS Orkney and Shetland are both developing new models of care so services can be delivered locally where previously patients had to travel to the mainland. For example, NHS Shetland has successfully worked with the Golden Jubilee to provide a shared pathway for patients undergoing joint replacement in Glasgow. That means that much of the pre-assessment and post-operative follow-up for those patients is provided in Shetland by local physiotherapists and nursing staff using telehealth techniques. I take on board the point that Rhoda Grant made that telehealth is sometimes restricted by the broadband services that are available. That is why we need to continue with the work that we are doing through Digital Scotland with upgrading the broadband. In terms of NHS Shetland, the board is also now working with NHS Grampian to use that approach that is through the Golden Jubilee in other parts of the orthopedic pathway. NHS Orkney is also increasing locally delivered services, including enhanced chemotherapy and gynaecology. Liam McArthur mentioned the funding for the CT scanner 200,000 that has enabled the board to acquire the scanner and enabling the provision of 800 scans in Orkney where previously patients had to travel to the mainland. That is local delivery where it was not before. John Finnie I am grateful for the minister accepting intervention. Does the minister accept that there always has been that cross-border collaboration about specialist treatment? That does not require any alteration to the administrative structures that should be local. Maureen Watt I accept that. As somebody from NHS Grampian, I know about the clans services that we have worked with people locally in delivering that and recognise the huge contribution that is made by the islands to the services at Aberdeen Royal Infirmary. Local delivery of such services is only possible with the workforce to support it. We recognise the challenges of recruiting staff in those unique areas. We also know that island boards are leading the way in designing models of care that maximise the contribution of the whole healthcare team. What I was saying before John Finnie intervened was that there is more that we can deliver locally, not less, and that is the direction of travel. In Shetland, the largest GP practice has improved access to the healthcare centre by successfully introducing advanced practice skill mix to their primary care team, which now includes GPs, advanced nurse practitioners, practice nurses, nurses and pharmacists. It is not simply within the health service that we seek to work more effectively for patients. Through health and social care integration, we have continued to build on the island's long history of joint working across the public sector. It is empowered local communities in the islands to develop and shape their health and social care services. It also allows them to take control of how best to use resources based on their detailed understanding of the needs of their populations. Local people are developing local solutions. That is community empowerment. That is devolution to local communities, not the centralisation that Liam McArthur and Donald Cameron try to assert. I am grateful to Maureen Watt for taking the intervention. I really couldn't disagree with any of what she said, but as John Finnie just illustrated, that has been going on for some time. I think that the islands have demonstrated their willingness to work collaboratively within the islands and between the islands and larger health boards. The concern is that a merger of island health boards into a larger health board area dilutes the voice of that health board, which at the moment can stand alone and make its representations as it sees fit. Because there are no firm proposals yet on the table, Liam McArthur is just surmising that that is what is going to happen. As the cabinet secretary said in reply to Liam McArthur and Tavish, what we want to do is reduce unnecessary backroom duplication and remove structural impediments to better care, given that we now have integrated joint boards. Do we still need to have the health boards, or do we need a structure that reflects the change that has taken place? We are supporting improvements through substantial financial investment across Orkney and Shetland. Resource budgets have increased by 15.5 per cent in real terms between 2010-11 and 2016-17. Both boards' uplifts for this financial year include £1 million for social care as part of the health and social care integration agenda. We are making significant infrastructure investments, including more than £60 million in the new state-of-the-art bar for hospital. That will again support a range of first-class primary care, emergency and elective diagnostic outpatients, day-case and in-patient services, all trying to reduce the amount of time that folk need to travel to the mainland. In terms of what Douglas Roth said, as a Keith Cwine, I expect the patients in Keith and Kirkwall to get the same high standard of care, however it might be delivered differently. Someone made the point about artificial boundaries, and that is exactly the situation that people in Murray find themselves. They might want to go to Inverness rather than Redmore if it can be delivered at Dr Gray's, then all the better. We have got to remove the artificial boundaries that currently exist. The commitments that I think have been seen by this Government with the appointment of the islands minister who is here with me today and everything that we will do in the future have said that we will be island proof. In conclusion, it is right and proper for this Government to review the existing structures to support improvements in patient care. We will continue to identify specific solutions for our island communities to help them to continue to flourish and prosper in the years ahead, not just for the benefit of Orton Shetland and the western isles but for all of Scotland's 93 island communities. That includes this debate and I now suspend this meeting until 2.30 p.m.