 I'm a business, which is a debate on motion 8536, the name of Anasarwar on health. I would invite all members who wish to speak in this debate to press their request to speak buttons, and I call on Anasarwar to speak to and move the motion in his name. Thank you, Presiding Officer. I'm delighted to open this debate and move the motion in my name. Every day, we are made aware through our work in this Parliament or through our own personal experiences of the heroics of our NHS staff as they support, care for or treat patients in Scotland's NHS. Working in the NHS is not easy. There are demands on time and resources in a rapidly changing environment on top of the priority to care for ill patients and communicate with worried relatives and friends. All the staff who work in the NHS deserve our thanks, and that is something that I know that every single member will agree with today. However, our thanks alone is not enough. Staff in our NHS also need the support of Government. On the evidence placed before us by the independent experts at Audit Scotland, the NHS in Scotland, NHS staff and patients are being failed by this Government and by this Cabinet Secretary. Last year, the Cabinet Secretary for Health was forced to come before the chamber to give her response to the worst Audit Scotland report since devolution on the state of Scotland's NHS. This year's report has shown no progress and, in fact, some cases declining performance. A decade of SNP mismanagement of the NHS is being felt by staff and patients, so let me, for the benefit of SNP members who may not have read the report, set out just some of its findings. On the funding of the NHS, the report has this to say, NHS boards had to make unprecedented levels of savings in 2016-17. We know that, over the next four years, Shona Robison has asked health boards to find an additional £1 billion in cuts, a complete financial mismanagement of the NHS and mismanagement that is affecting patient care. That is what Audit Scotland says in statements that are lifted directly from the report. I quote, People are waiting longer to be seen. The number of people that waited over the standard 12 weeks for their first appointment increased by over 300 per cent. From 21,500 people waiting in the quarter to March 2013 to 87,500 people in the quarter to March 2017. Of those, the number of people that waited over 16 weeks for their first appointment increased 10fold, from 5,000 to almost 58,000 people. For inpatient and day cases, they say, the number who waited over the guaranteed 12 weeks for their treatment increased by over 800 per cent. From 1,450 people in the quarter ending March 2013 to 13,300 in the quarter ending March 2017. The past year has seen a marked increase in people waiting longer than 12 weeks, and additional 7,500 people waited over 12 weeks in the quarter to March 2017, compared with the same period in 2016. People living in the most deprived areas of Scotland compared to those living in the least deprived areas are most likely to be diagnosed with breast, colorectal and lung cancer at stage 4, the most advanced stage of the disease, whereas those living in the least deprived areas are most likely to be diagnosed at stages 1 or 2. Every statistic a person failed by this cabinet secretary and this Scottish Government. It is a scandal that the overall health of the Scottish population continues to be poor and significant health inequalities continue. That is not just a health issue, it is an inequality issue. On cancer Scotland's biggest killer, the report lays bare the fact that, after referral for treatment, one in eight patients are not being treated on time. While in some parts of Scotland, that figure increases to as many as one cancer patient in every five not starting their treatment on time. Given that we know the direct correlation between diagnosis, treatment starting and survival rates, it is frankly shameful that the cabinet secretary has allowed this failure to continue, because, Presiding Officer, those are not just statistics or numbers, they are the lives of Scots being let down. Moving on to the workforce, Presiding Officer, it was Nicola Sturgeon's decision to cut training places, and today there are 3,500 nursing and midwifery vacancies in our NHS, one in three GP practices reporting a vacancy and one in six consultant posts vacant too. That is why the cabinet secretary would do well to listen to the commission that we have set up to identify ways to address the workforce crisis facing Scotland's NHS. We are hearing first-hand from staff and experts where the feelings are and what Scotland needs to deliver for staff and patients. The cabinet secretary is welcome to attend the next meeting, and we can discuss how to reverse the cuts in training places for nurses and midwives. Consider ways to attract more nurses and reduce drop-out rates, and consider the best way to clamp down on private agency spend, which is skyrocketed under this cabinet secretary and this Government to £175 million a year. We know that staff morale is a low eb too, because the staff tell us so, and that is in part due to long-term pay restraint forced upon staff by this Government. A pay cap voted for by SNP back-benchers every single one of them. A pay cap that finally looks like it will be broken due to the fantastic campaigning of staff, trade unions including unison, the RCN, GMB and Unite and colleagues on those benches. While we welcome the mention of ending the pay cap in the cabinet secretary's amendment, there is still no firm commitment that it will deliver a real-term pay increase for NHS staff, which is in part why we cannot support the Government's amendment today. Ten years in Government and no acceptance of any responsibility. What is the result of that ten years? Too few nurses, GP practices closing, consultant vacancies unfilled, cancer patients failed and services cut, and patient care being put at risk too. The report from the experts concludes and I quote again, over the past five years overall performance has declined in six of the eight key performance standards. The majority of key national performance targets were not met in 2016-17 and wider indicators of quality suggest that the NHS is beginning to struggle to maintain quality of care. They go on to quote, Scotland's health is not improving. After more than a decade in government, that is a damning verdict from the independent experts, which should mean that every single SNP MSP hangs their head in shame. On the specific issue of service reform, the First Minister said last week at First Minister's questions and I quote, When we bring forward proposals for change, we find that the impediments to that change sit on the opposition benches. What utter nonsense! The cabinet secretary has never come to this chamber in Government time, in all my time in this Parliament, to make the case for major service change that we have then opposed. I give the cabinet secretary this opportunity today. Can the cabinet secretary here and now stand up and name just one service change that has been proposed and that she supports? Stand up and name just one, that she has proposed and that she supports. Cabinet secretary, the proposals to centralise the cleff pallet service and surgery in Glasgow was proposed and I supported and approved it. Annas Arlaw. Again, not answering the question that I specifically said. No, no, no, no. I specifically said there was no vote on that. No one voted against that. What I am talking specifically about is in Government time when the cabinet secretary has ever come to this chamber and supported a proposed change and have it. I will tell you why not tell us about it. Is it the maternity unit at the Vale of Leven? Is it the maternity unit at the Inverclyde Royal hospital? Does she support those changes? Is it the closure of the kids' word at the REH? Does she support that proposal? Is it the closure of the Lightburn hospital? Does she support that proposal? Each and every single one of them, a promise that was made before the election and a service that is under threat now. And another promise, the promise to eradicate delayed discharge in 2015. We now know that the SNP Government's failure to do so has cost the NHS more than £100 million in the last year. And one of the key reasons that delayed discharge remains a problem is cuts to the budgets of local councils which provide social care. So rather than accusing the opposition of being an impediment, it is time for the cabinet secretary to start listening to the ideas from those benches. We will tell you that you can use the powers of this Parliament to stop the cuts and invest in social care instead. You can end the cuts to training places and increase the number of training places in our NHS and care sector. You can actually deliver the national guarantee for care workers, and you can ensure that all workers are given appropriate training and that no worker has to deal with the insecurity of a zero-hour contract. Silence from the SNP benches on that. Time after time, the First Minister and the cabinet secretary have been forced to come to this chamber to defend their failures. Failure after failure, day after day, patient after patient let down, staff member after staff member made to be overworked, undervalued, underresourced and underpaid. What is the reaction when staff do come forward? It is to unleash smears in television debates while actually listening to the concerns of NHS staff. Yet in the cabinet secretary amendment today before us, there is zero recognition of the failings laid at her door by Audit Scotland. Zero recognition of her responsibility. Zero recognition of the impact of 10 years of SNP mismanagement, a total and utter abdication of responsibility. Dismissing the experts who have authored damning report after damning report, refusing to take heed of the warnings issued by trade unions passing the blame and passing the buck. How many more times can the cabinet secretary come to this chamber to defend her failings and the failings of her department before the First Minister does what is best for Scotland and appoints a new cabinet secretary for health? Broken promises to staff and patients failed on NHS funding, failed on workforce planning and failed on waiting times. This cannot go on. This is not funny, cabinet secretary. This is a cabinet secretary that is out of her depth, out of ideas and out of time. Thank you, Presiding Officer. It is very disappointing that Annasawa and the Labour Party are going to vote against lifting the pay cap at tonight's vote. I think that that tells us everything that we need to know about Labour's position. Let me just reiterate that we have increased training places for nurses to 2,600—not just now—in a minute. We have increased training places for nurses to 2,600 over the course of this Parliament. We have delivered the real living wage to NHS and adult social care staff because we do what we can in leadership, Annasawa, to deliver the real living wage where we can. Perhaps others should take a leaf out of that. However, let me welcome the latest annual overview of our NHS from Audits Scotland. Of course, I accept all of its recommendations. As the health and care needs of the people of Scotland changes, it is absolutely vital that our NHS evolves to meet the challenges that this presents. Our nation has the welcome challenge of an ageing population, but we also face the consequences of often deep-rooted health inequalities, a challenge that will not be addressed by the actions of the NHS alone. Audits Scotland's report recognises that our course of action is the right one. Audits Scotland's report recognises that our course of action is the right one. It acknowledges our continued focus on safety and improvement and that the levels of patient satisfaction are at an all-time high. It also recognises that achievements are being made in reducing delayed discharge, which is something that this Government is committed to. Neil Findlay? The First Minister rightly says that we will not address health inequality by health issues alone. Does she agree with me that savaging yet again the local government budget increases health inequality, increases the gap, educational attainment gap and fails to narrow the gap between life expectancy of the poorest people and the wealthiest people? Cabinet Secretary for Health and Sport, I recognise very much the role of local government, which is why, of course, we transferred £250 million into social care in order to make sure that people get their services. Perhaps Neil Findlay should spend more time criticising the welfare reform of the United Kingdom Government, which is costing this Parliament this Government £350 million every year in order to mitigate against those. Sorry, Cabinet Secretary. Sit down a minute. I sat in and I heard Anasawa being listened to. I want to hear what the Cabinet Secretary and other speakers have to say. Those achievements that Audit Scotland recognises are a testament to the hard-working staff of our NHS and their commitment to caring for the people of Scotland. I want to thank them for that. We have been clear for some time that, for the NHS and our care services to meet the increasing demand and expectations that are placed upon them, that require a twin approach of investment and reform. The status quo is simply not an option. We have seen that, where there are performance challenges, those are best addressed by working with front-line staff. Like the rest of the UK or A&E departments have faced increased demands. In Scotland, we worked with the Royal College of Emergency Medicine and front-line staff, which started under Alec Neil. The result of that approach has been that Scotland's core A&E departments have been the best-performing in the UK for at least two and a half years. That has seen delays over four hours in A&E reduced by 10 per cent in Scotland since 2012 but increased by 180 per cent in England and 56 per cent in Wales over the same period. That is why we have welcomed representatives of NHS Wales to Scotland so that they can try and learn from our A&E experience. Building on that approach, we have established the elective access collaborative programme led by Professor Derek Bell, working with front-line staff in the academy of royal colleges to drive improvement in performance. The bill is on the additional £50 million that I announced earlier this year to improve waiting times performance. Similarly for cancer, I have formed the new expert ministerial cancer performance delivery group to drive forward the service redesign and improvement. That is backed by nearly £5 million of new investment and underpinned by our £100 million cancer strategy. The early focus on this group's work is to drive improvement against the 62-day cancer target. As while the average is six days for treatment, once a decision has been reached to treat, some patients are waiting too long and I accept that. Investment is clearly one part— Yes, certainly. Sorry, Mr Rumbles. I have to wait for me to call you. Mr Rumbles. Just a brief question to the health secretary. Is the health secretary satisfied with the level of service that patients receive in the north-east of the Grampian health board? Does she consider it a satisfactory level of service? Grampian has improvements to make, and that is why we are working with the Grampian health board, along with other boards, to make sure that on elective, for example, Mike Rumbles will be aware that they are getting their share off the £50 million, and we expect that to deliver improved performance. Investment is clearly part of the solution, and that is why we are increasing the health resource budget by £2 billion by the end of this Parliament. However, the most significant changes to our health and care system are not coming in the acute sector. I believe that there is consensus in the Parliament, and beyond that, we must not only increase resources, but also shift the balance of resources towards our community health services, not at the moment. In December 2015, Labour called for the vast majority of health-barnaut resource consequentials to be invested in social care, and so this Government has continued to invest in social care. Indeed, this year, there is almost £0.5 billion of front-line NHS investment in social care and integration. In primary care, we will increase funding to 11 per cent of the front-line NHS budget by the end of this Parliament, an increase of £500 million, £250 million of which will be in direct support of general practice, and we are also committed to shifting resources to mental health and calm services. That is why we are investing to increase the number of mental health staff in a number of key settings, such as A&E and primary care clinics, increasing to £35 million per annum to support 800 staff. That is on top of the additional £150 million over five years announced in 2016 for improvement and innovation in mental health. Work is under way with SAMH and NHS information services division to review referrals to CAMHS, and today I am happy to announce that Mr Andrew Rom has been appointed to chair the review of how our mental health legislation meets the needs of those with learning disability or autism as committed to in our mental health strategy. Ensuring that we have the workforce that we need now and into the future is why we published the first of our national workforce plan to set out the actions required nationally, regionally and locally to improve workforce planning practice and to enable better projections about the number, the shape and the nature of our future workforce. Alongside this, we are bringing forward safe staffing legislation to ensure that we have the levers in place in both the NHS and the wider care sector to have the right staff in the right place. The devotion of the staff of our health service to the ethos of the NHS is the most powerful driver of change and improvement and one of the many reasons why we believe that it is right to lift the 1 per cent pay cap and we will be working with the unions and employers to deliver this as soon as possible. I do not have time. We will also ensure that we will continue to pay at least the real living wage to all NHS staff and all adult social care staff, including for sleep-over hours. Last December, we published our health and social care delivery plan, a framework that sets out the key actions that will deliver to make this change happen. The Audit Scotland report sees the early positive signs of this work, particularly in relation to delayed discharge. Aileen Campbell is taking forward groundbreaking work on public health, building on what we have done in smoking and alcohol in the area of tackling obesity. As I said, we cannot tackle health inequalities alone. That is why we are committed to free school meals, to the baby box, to free personal care and mitigating the impact of the welfare reforms from the UK Tory Government by investing £350 million in helping the most vulnerable. That is why, in our programme for government, we declared our intention to implement Frank's law and why we support income maximisation efforts through the principles of programmes such as healthier, wealthier children, as supported by Alison Johnstone and the Greens. There is no magic bullet here, but by making significant and sustainable improvements in our services through the twin approach of investment and reform, we will ensure that our NHS continues to meet the needs of our people long into the future. I am very pleased that we have record levels of patient satisfaction in the Audit Scotland report. I am proud of Scotland's health. I am proud of Scotland's health and care services. I am proud of Scotland's health and care services. I move amendment 3. I move amendment 3. Thank you very much. I call Miles Griggs to speak to move amendment 8, 5, 3, 6, 1.17 minutes. Mr Briggs, please. Thank you, Deputy Presiding Officer. As an Edinburgh NMSP, I cannot begin by saying how shocked I was to see the cabinet secretary celebrating the closure of Edinburgh cleft lip and pallet unit. That is something that I can tell you. Families across Edinburgh and the Lodians will never forgive this Government for. No, I have not got enough time. We have heard enough already, I think. I want to start my comments today by praising those who work in our health service. It is always a pleasure to meet those who work day in, day out in our NHS. They are working, as has been heard already, in a difficult and challenging environment. I want to put on record the Scottish Conservatives' support and thanks to each and every person who works in our NHS. I cannot be the only MSP today who feels a sense of deja vu, given that it is now only a year since we debated the last shocking audit Scotland report on our NHS. It is clear, a year on, that the challenges are getting more acute. I want to focus my remarks today on two important priority areas where I believe we can help address this crisis. Firstly, general practice and then pallet of care. Given the increase in crisis facing our GP surgeries across Scotland, it is undeniable that the SNP has failed to invest in GP surgeries over the past 10 years. Figures from the Royal College of GPs show that only 7.3 per cent of the health budget in Scotland is spent on general practice. That is compared to over 9 per cent in England. Despite the SNP repeatedly saying that they are committed to shifting the balance of care—no, I have not got time—towards community, last week's audit Scotland report highlighted that it is still not clear how this is going to be funded. The auditor gave the very same warning back in 2008, and it seems that very little has changed in the intervening period. We on these benches believe that the first step required to truly shifting more care into a community setting is investing in our general practices. Last year, the First Minister announced £500 million of investment for primary care, which he said would be increasing spending on primary care services to 11 per cent of the front-line NHS budget. Scottish Conservatives called for the approach and for the additional investment in our GP surgeries and welcomed that shift in NHS spend, but it then emerged that only half of that would go directly to general practice, and there has been further confusion among SNP's own parliamentarians about exactly where that money is intended to now go. We on these benches are absolutely clear that not enough is going directly to general practice, and we are all very aware of the problems that this lack of investment is causing. One in four GP practices in Scotland is operating with a vacancy. Scotland now has a projected shortfall of 856 GPs by 2021. A GP surgery is closing every month in Scotland. One in 11 GP surgeries are not accepting new patients, and a record 52 practices have been taken over and run by health boards. As we have heard today, ministers are quick to say that Opposition parties are not bringing forward ideas and are just being critical and without being constructive. I have to say that I do not accept that premise. Last week, Scottish Conservatives launched our save our surgeries campaign to highlight all these problems and to bring forward potential solutions for general practice. We on these benches want to see more medical school places made available to Scottish students from all backgrounds and then being encouraged to stay in Scotland and work in our NHS in Scotland. It is a shocking indictment of this SNP Government's record that, today, only 50 per cent of training places in our Scottish university medical schools are being made available to Scottish domicile students. Even when ministers accept that the one key aspect of where a medical student will choose to work is often the postcode on their UCAS application form, the cabinet secretary might not like to hear that, but I think that the cabinet secretary should start listening to her predecessor, Alec Neill, who is right behind her, who has been making those exact points. We want to see patients with complex needs given longer appointments so that GPs are able to deliver a holistic care for patients across Scotland, and we want to see investment in front-line technologies to make long-term savings and a redesign of services. Just this week, the Health and Sport Committee heard directly how Scotland is not realising the potential and opportunities that health technology presents and not helping to improve people's lives and make our health service more sustainable and modernise health provision. To achieve that, we want to see general practice receive 11 per cent of the health funding budget—not 7 per cent, not 11 per cent for primary care, but 11 per cent for general practice. Just for clarity, you are saying that there shouldn't be investment in the wider multidisciplinary team to support GPs. All that money should just go to GPs. Is that what you are saying? As we say, building the team in general practice around GPs hubs, this is where we see the future. This is supporting this, but actually the crisis now, cabinet secretary, you may want to not look at it, is within general practice. People are giving up, people can't get appointments. If we don't do that, then the system will get worse as we go on. We are seeing this in this Government's record, a huge bill for locums. In short, what we want to do is save our GP surgeries. Another area in which I believe that all parties are united in this Parliament to deliver progress is in the area of palliative care. The Scottish Government in its health and social care delivery plan promised to double the provision of palliative care and end-of-life provision in the community by 2021, but there has been very little and no announcement on how this investment will be delivered. Investing in palliative care services in the community is something that is so desperately needed, as 11,000 Scots each year miss out on palliative care they need before they die. Can, I believe, reduce any emissions and unplanned hospital stays, again taking pressures off the acute health services in our country? It also allows patients nearing their life's end to receive a type and quality of care that reflects their personal choices. Can the cabinet secretary therefore, in closing this debate, provide the detail that organisations working in palliative care want over how much and where additional resources for palliative care services will indeed be invested? The Audit Scotland report is yet another indication of this Government's repeated failure to deliver the policies and the leadership required to make our NHS sustainable. It is now clear as each day, month and year passes that this Government has run out of ideas to make the reforms and changes that we need to make our NHS meet the challenges of the demographic challenges that all our communities and populations will face and to truly deliver the NHS that we all want to see. Patients and families across Scotland deserve better. Those who work day in, day out and incredibly hard in our NHS deserve better. Short Scotland deserves better than this. Deputy Presiding Officer, I move the amendment in my name. Thank you very much. Mr Breaks, I move to the open debate. It is speeches of six minutes with a little time in hand to add for interventions. I call Alex Neil, to be followed by Jackie Baillie. Mr Neil, please. Thank you very much indeed, Deputy Presiding Officer. Can I begin with something that I think we are all agreed on and which has already been referred to? That is that the single biggest contributor to ill health in Scotland is the level of poverty and inequality that we have in our society. There is no doubt at all in my mind that when you analyse the figures for mortality rates and so on over the past seven years or so, there is a very clear, direct correlation between the levels of poverty and mortality rates. The reason why I believe that we have seen a stalling of the average lifespan in the past seven years is that it is a direct result of the impact of austerity on the poorest families in Scotland, particularly those people who have suffered enormous cuts to their benefits and who rely on state benefits for their wellbeing. Let there be no doubt about that link. The health policy—no matter how good our health policy is—a health policy alone cannot solve those problems. It has to be part and parcel of a much wider programme of economic and social improvement targeted by the poorest people in our communities. I would say this particularly to Anne Sarwar. Let me draw your attention to a report done by one of the easily best research organisations in the whole country called NHS Health Scotland. It did a study two years ago to identify the most effective policy interventions to reduce health inequalities in Scotland. It estimated that the most effective single intervention was not going to be keeping that hospital open or shutting that ward or anything to do with the health service. What its research found, beyond any reasonable doubt, is that the single most important intervention that can be made in reducing health inequalities in our society is to pay everybody their living wage. The universal application, not of the Tory living wage, but of the real living wage, is the best way to reduce health inequalities in our society. On the report that Mr Neil referred to, will he also confirm that the report called for the intervention, including a rise in income tax, to tackle low levels of poverty and use taxation in a progressive way, which this Government has failed to do so far? As someone who lived through the Blair years, I do not think that I will be taking any lessons and about redistribution from a Blair right, Labour right, who supported all of those policies. Let us not descend into a party political cheap giant situation. Let us do what I always do and rise to the occasion. Having made the point about inequalities in the living wage, let me turn to the Conservatives. I do not say that in any cheap giant way, but when you talk to GPs—I know of GPs in Glasgow, for example—young GPs, very good GPs, who have applied to emigrate to Australia and have spoken to many older GPs who, in years gone by, would not have retired until they were at least 65. They are now retiring in their early 20s. Why? It is because of the tax changes to their pensions made by George Osborne and GO, which is leading to a massive reduction in the pension that they can earn over a lifetime of work. That is what GPs are telling you. At one point, when one of the most massive changes were made in the tax treatment of pensions that affected them, there was no discussion. Osborne just introduced it without looking at the consequences. Nearly every GP that you speak to when you ask them what impact has that had. First of all, they are retiring early because it is not worth their wild pension wise working beyond their mid-fifties. They retire on a Friday, collect their pension on a Monday, maybe do a couple of days locum from then on for a few more years to get some extra money. However, the health service loses the other three working days that we would have had had the Tories not made a mess of their pension fund. However, there is another effect, and there is another effect as well. When that was introduced, there was directly a 40 per cent reduction in Glasgow in the availability of hours for GPs to do out of hours. When you talk to the GPs and ask them why, what is the point of working if I go out and do out of hours, I will need to retire at 45 instead of 55 because I will not get a decent pension. The point that I am making is very important, and that is that, if we are going to successfully, and I hope that we can do it more jointly across the chamber, tackle the challenges in today's health service. It requires us to be able to influence those other policies that are having a very negative effect on things such as GP retention. Health policy is important. Of course, we have got to rise to the challenge set by the Auditor General. Of course we have, and none of us should be. None of us are complacent, but let us also recognise that, if we really want a first-class health service, we really need a living wage, a pension policy that will keep people as GPs and not force them out of service and with the consequences that that brings. I say to everybody that we will look at this on the whole, not just in terms of your own locality. Thank you very much. I call Jackie Baillie to follow by Brian Whittle. Thank you, Presiding Officer. NHS is, of course, one of our country's most valuable assets, and it is undoubtedly one of Labour's proudest achievements. However, irrespective of politics, we all hold our NHS and all the staff who work there in the highest regard. Their dedication, their service is greatly appreciated, but the doctors and nurses, in fact, all of the staff, are struggling, they are overworked, they are under resourced. Let me say as gently as I can to the cabinet secretary. Patient satisfaction is with the doctors and nurses, not with the SNP Government. Audit Scotland's most recent report on the NHS in Scotland is a damning indictment of the SNP's mismanagement of our health services. That is not the first one. We have audited Scotland's reports stretching back over the past few years, which should have served as a wake-up call for the SNP. However, here we are again, and the cabinet secretary is in denial, completely blinkered about what is going on on the ground. The report shows us a multitude of challenges from missed targets to concerns about the quality of care. Seven out of eight key performance targets missed. Patient waiting time guarantees out the window. Standards of cancer treatment declining, and that is just the tip of the iceberg. Staff are undervalued, they are under immense pressure. Agency spending on doctors and nurses is spiralling out of control. Our ambulance service is struggling. Significant health inequalities remain and health boards are being forced to make huge cuts year on year. Let me make this real for the cabinet secretary and the chamber. Let's talk about the impact that that is having. The out-of-view medical practice, a GP practice in the Vale of Leven, is so concerned about waiting times for emergency breast cancer referrals that they contacted me. An emergency referral is when the GP strongly suspects that there is evidence of breast cancer. It's not routine, it's critical that women are seen immediately. Eight weeks women are currently having to wait. Eight weeks before they get any treatment. That's eight weeks that could cost them their lives. Then there are the huge orthopedic waiting lists. There are real human consequences behind these delays. Let me introduce you to Alan Howey. He was referred for spinal surgery in June 2016. He waited over a year in pain to receive that surgery. Robert Darcy referred for knee surgery in June 2016. He waited 10 months. Bill McLaughlin referred for knee surgery on both knees in August 2016. Six months for one knee and over a year for the second. Jonathan Brown referred for knee surgery in August 2016. He waited eight months. Andrew Taylor referred in September 2016. He received an outpatient appointment with a spinal surgeon in July 2016. He needs to wait for a further year before any operation is considered. John Martin referred in September 2016 for spinal stenosis. He waited a year to see a consultant. Duncan Stewart received his orthopedic referral in October 2016. He had to wait 11 months for his operation. Alex Hutton referred for orthopedic treatment in December 2016. He was first told that he could wait until March 2017. He was then told that he would wait at least another 40 weeks. Mr Hutton has paid for private surgery because he could not wait any longer. Andrew Cordell referred for general surgery in January this year, offered his seventh appointment in August after several cancellations. That appointment was also cancelled by the NHS and he does not know when he will be seen. He had to go private because his condition is so severe. That represents a small slice of my case work on waiting times. It makes uncomfortable reading. All of the examples that I have shared with the chamber today were people who have waited and waited and waited. Shona Robison's treatment time guarantee is utterly worthless to them. They have waited so long, often experiencing chronic and worsening pain, and frankly, the cabinet secretary has failed them. What is Shona Robison going to say to all of these people and the many more in constituencies of every MSP in this chamber? An apology would be a start, but the reality is that that is no longer enough. She should vacate her office, let someone else take charge, someone who will actually put the needs of patients and staff front and centre of all that they do. Presiding Officer, dare I even suggest that we bring back Alex Neil? Let me finish by talking about the Vale of Leven hospital and the proposal to cut out of ours services, the most basic of services that should be delivered locally. Local GPs have consistently said that shutting the out-of-hours service at the Vale of Leven hospital constitutes an unacceptable clinical risk to patients, yet NHS Greater Glasgow and Clyde plough on with their proposals without consulting local residents and patients. That is despite promises from the health secretary that extensive engagement with my community would take place. Well, I have to say that the health board is ignoring the cabinet secretary, perhaps it really is time that she left the building. I declare an interest in that. I have a close family member who is a healthcare professional working in the NHS. The backdrop to this debate is the recently published audit Scotland report, which states that, I quote, the majority of key trends show that Scotland's overall health is not improving and in some areas is deteriorating. Surely this is the key measurement with which we all should be judging our NHS. It goes on to say that the average life expectancy is consistently lower than in most European countries. Healthy life expectancy has remained almost the same since 2009. Mortality rates are higher in 2015 and 2016 than they were in 2014. Drug-related deaths are up. In fact, Scotland has the highest drug death rate in the EU. A recent study by the Scottish Public Health Observatory says that comparing Scotland with other countries around the world shows that Scotland is less healthy compared to the countries with a similar socio-democratic profile. I will give way. If he also recognised a report that was done into some of the drug deaths in Scotland, which directly correlated that with the policies of the Conservative Government in the 1980s, does he think that his Government now should be following austerity policies at this point in time, given that we know that inequalities are at the root of many of the health problems that we have in this country? Brian Whittle I say that the minister has absolutely no shame given that he cut the drug-related budget. He has absolutely no shame. He could stand up in this Parliament and give us a going over a drug-related budget, but when he cut the budget, his Government cut the budget. That counts. That is how you make sure that the drug-related deaths go up. Those are not my words, Deputy Presiding Officer. Those are the words of experts on the ground. I would hope that the Scottish National Party Government, the health secretary and her team would not try and refruit them. In that case, the SNP Government and the previous Governments have to accept that it happened, and it is happening on their watch. Responses to those issues from the Government have been at best sluggish and reactionary. We have a much heralded mental health strategy in response for calls for parity between physical and mental health and an ever-increasing mental health crisis, which has had a very lukewarm response from the front-line mental health experts. Last week, we had the minister, Aileen Campbell, launching a diet on obesity consultation with the goal to make Scotland a healthier place to grow up in. Ten years in, and it has been caught unaware. They cite changes in demographics and ageing population as if overnight Scotland aged a decade. No forward planning, no vision and crucially, no heed to the consistent warnings by the profession. While we are on the subject of lame political jargon, please stop saying that we know that there is more to do. For there to be more to do, you have to have done something in the first place, and as Audit Scotland reports states, Scotland's overall health is not improving. In the time that I have left, Deputy Presiding Officer, I want to speak to the Scottish Conservative amendment pointed to in the words of the Royal College of General Practitioners, the underfunding of general practice in Scotland. I recently spent time at a GP surgeon in Kilmarmox speaking with GPs and from the practice nurse, and the picture of the paint is not a good one. They readily admit that they are in crisis, short-staffed, compounded by the fact that several partners are approaching retirement age. In the same local area, a GP practice with surgeries in Fennett, Kilmores and Crosshouse handed the practice back to the NHS. Fennett surgery is now closed for good, of the remaining two, one of the surgeries has been taken over by GPs and the other remaining under the control of the NHS trust for surgeries within a small area in crisis. Those are by no means isolated incidents. They have been replicated across the country, especially in areas outside major population centres. Continuity of care is a major concern with our GP surgeries and without it, cost will soar. Being a GP is no longer the destination of choice that once was for doctors and as the BMA state, and I quote, this is for Alex Neil, Scotland is facing significant recruitment problems and never increasing complex workload, combined with failing resources, has led fewer doctors choosing to train as a GP, while senior doctors are choosing to retire early or work abroad for a better work-life balance. I have to say, I'd rather listen to them than it would be to you, Mr Neil. This crisis cannot be fixed overnight. It takes 10 years to train a doctor. Action would have to have been taken a decade ago, which is incidentally the length of time that SNP has been in government. We need more doctors to choose general practice as their destination of choice, which requires delivering a more attractive proposition, not necessarily just in monetary terms. The RCPG states that the standard 10-minute consultation are increasingly unfit for purpose. Therefore, if we are going to give our GPs time to do the job that they want to do, we need to look at the support that they can access from the allied health professionals such as speech therapists, physiotherapists, occupational therapists, dieticians and so on. The role of the pharmacist has to be redefined. They are willing and able to show us some of the load. GPs, along with our allied health care professionals, pharmacists, nurses, healthcare visitors and midwives and many others are the healthcare professionals who will reduce the burden on our hospitals. The starting point has to be the health and wellbeing of our healthcare professionals, especially if we are going to tackle the preventable health agenda. That would be my advice as a initial gambit to Aileen Campbell for her diet and obesity consultation. Start with those who are charged with delivering the outcomes of the Government's consultation. Our nurses, midwives and doctors are reportedly unhealthier than the national average. We need to create an environment in which our healthcare professionals have the opportunity to deliver a more active, healthy lifestyle and then, in turn, they will be better equipped to advise those they care for. That is what we mean by connected and innovative thinking. If Aileen Campbell does not deal with the issue, her consultation will end up on the shelf like so many others have over the past 10 years, just gathering dust. Reactive strategy documents driven by media headlines instead of actually planning and implementation of changes, our health professionals are so desperate for. It is just not good enough. It is time that the SNP Government started listening to our healthcare workers on the front line, and, after 10 years of mismanagement, take the action that is required to support our NHS staff. Can I say just where I call Clare Hockey? I know that it is difficult not to use the term U of members but to name the member for the official report, and that is one of the protocols of Parliament. I call Clare Hockey to be followed by Jamie Halcro Johnston. I would like to refer members to my register of interests, in particular to the fact that I am a registered mental health nurse, currently holding registration with the NMC and my honorary contract with Crater Glasgow and Clyde NHS. As a mental health nurse, I know first hand of the challenges that our NHS faces and the pressures that it is currently under. But my experience of our health service puts me in a position whereby I can truly argue that it is this SNP Scottish Government that is best placed to tackle these issues going forward. The Audit Scotland report makes it perfectly clear that demand for health services continues to rise and that previous approaches of treating more people in hospital is no longer sufficient, and nor is it the treatment option that most patients want. The report highlights that the Scottish Government is already transforming the healthcare system by moving more care out of hospitals and into community settings, and it also makes clear that integration authorities are beginning to have a positive impact on the care of the people that they serve. Delayed discharge, like most of the issues that our NHS faces, is not unique to Scotland, but it is highly encouraging that the Scottish Government is taking decisive action to tackle that. For example, the Audit Scotland report points to a substantial 22 per cent reduction in delayed discharges in Aberdeen City, which it attributes directly to its health and social care partnership. At this point, I would like to commend NHS Lanarkshire's hospital at home project, which spans both North and South Lanarkshire health and social care partnerships. As an alternative to hospital, hospital at home's multidisciplinary team, which includes consultants, advanced assessment nurses, allied health professionals and community psychiatric nurses, delivers specialist and comprehensive care to frail older adults in their own homes. Research shows that most older adults would prefer to remain in their own homes so that the service not only facilitates patient choice but allows them to be cared for in a way that is safe and effectively reduces unnecessary hospital admissions. Audit Scotland's report recognises that the reforms that the Government is currently implementing in particular in the area of the integration and health of social care, which includes mental health services, will ensure that our NHS is able to deliver against the increasing demand that it faces. Presiding Officer, I have been a mental health nurse for over 30 years, and in that time, there have been many periods of transformational change. Over the years, we have seen huge changes not only in the way that we view mental illness but also in how we care for and treat people who are suffering from mental illness too. I was pleased to note that earlier this month, a report from the Mental Welfare Commission found that the number of young people with mental health problems in Scotland who are treated in non-specialist wards has fallen by more than 40 per cent. That reduction was so significant that it was acknowledged by the Conservative spokesman on mental health, Annie Wells, who tabled a motion highlighting that, and that motion was signed by 12 of her Conservative MSP colleagues. It makes a welcome change that the NHS is not being used as a political football, and that cross-party support can be found on this subject, if not others. I am grateful to the member for taking an intervention. I absolutely share the support of Conservative benches on that motion and, indeed, the results that were contained therein. However, what would the member say of the freedom of information request that the Liberal Democrats published just last year, which showed that some children are waiting up to two years in some health boards for first-line treatment from child and adolescent mental health services? If the member listens to the rest of my speech, I address some of those issues. The Mental Welfare Commission also highlighted a substantial decrease in the number of admissions of adolescents attributed in part to the expansion of the children and adolescent mental health services commonly known as CAMHS, and in particular to the services intensive home treatment teams. Because of that service, young people are able to stay at home with family, remain in contact with friends and continue to attend school, while at the same time receiving care and intensive interventions and treatment that they need from a dedicated team of mental health crisis practitioners. During such an acute episode of illness, the maintenance of emotional and social contacts with significant people is hugely beneficial to recovery, and it shows just how vital CAMHS investment has been to improving patient outcomes. Spending on mental health has increased by 42.6 per cent under the SNP, and in 2017-18, for the first time, NHS investment in mental health will exceed £1 billion. Over the past seven years, almost £20 million has been invested to increase the number of psychologists working in CAMHS, and that is later an increase of almost 60 per cent of psychologists working in the specialism. In fact, the number of professionals working in CAMHS has increased by 50 per cent in the past decade, and investment in the future of our youth, but also in our NHS staff, to whom we all owe a huge debt of thanks for the work that they do. I do not dispute that there are issues that the Scottish Government will have to work on, and as Audit Scotland report references, however, there are a lot of positives that can be taken from the report, too, but improving the nation's health in the long term requires more than acute care. Unfortunately, there is no quick fix. There is no quick fix in Northern Ireland. There is no quick fix in the NHS Tory run in England, and indeed there is no quick fix in the Welsh Labour run NHS either. However, the Scottish Government is implementing the reforms that we need here in Scotland, and we are seeing the positive changes here already. Good quality healthcare is a cornerstone to a decent society, and me and the SNP will always strive to provide that for the people of Scotland. I call Jamie Halcro Johnston to be followed by Neil Findlay. Thank you, Deputy Presiding Officer. As I drive into Kirkwall from my home in Orkney, I get a good view of the new hospital being built to serve the island. It is curved, it is sleek, it is futuristic in design. It will only have single rooms, something that I have already heard a few local folk complaining about. It is easier to have a leather when you are on a ward. You cannot please all of the people all of the time. The new hospital will be a welcome addition to the health facilities in Orkney, and it will mean that local people will be treated in modern up-to-date facilities and staff will have a workplace that meets their needs, too. A new hospital is only part of NHS provision in Orkney, and I will speak more about that later. My experience of Scotland's NHS, both personal and through family and friends, is similar to the experience of the vast majority of those who engage with our public health system. Free at the point of use, it is staffed by hardworking, compassionate and committed people who work long hours. We all come to NHS debates in this chamber from broadly the same position, seeking the best outcomes for the greatest number of patients. The NHS is a truly cross-party endeavour. We have all had a hand in its creation and maintenance, and we all share a concern for its future. That is the reason behind the scrutiny that it receives. We raise issues because we value the NHS, because we want to protect it, and because we want to ensure that, as we approach the 70th anniversary of the NHS, there will still be an NHS in Scotland another 70 years' time. Across the Highlands, we have a number of high-profile issues that have been brewing for some years, but which have come to a head in recent months. I have spoken previously about the long-wait many local cardiac patients who are forced to endure before they receive outpatient treatments or appointments. Scotland's declining performance against waiting-time targets has been particularly acute in my region's health boards, especially NHS Grampian, but with knock-on impacts on services in Orkney and in Shetland. In terms of cardiac services, this is nothing short of a crisis, and one of the health board believes will get worse before it gets better. The cabinet secretary will call some of our correspondence on this issue and revelation of an agreement to ship patients as far as Newcastle to be treated. Some have appeared to defend this position, saying that no one has taken up this option. Of course they haven't. It is simply not a realistic option for most patients with heart conditions in Shetland and in Orkney. We also know from Audit Scotland's report the enormous strain facing general practice around Scotland. Those pressures are most keenly felt in rural areas. Ask those rural communities their experiences of the last 10 years, and they will point to a decimation of local health services under this Government. For many, particularly those living in Scotland's remote and rural communities, the future risk is being one with ever-increasing distances between patients and the health services that they rely on. Take the island of Stronsy in Orkney, where the threat of a reduced service now hangs over the community after their resident medical team was suspended in May while the board undertook a review. That review has now been concluded, but I understand that there is still no date for the reinstatement of the medical team and the medical director of NHS Orkney at a public meeting on the island warned that Stronsy would likely face losing its resident team in the future and become part of a rotation system. Can the cabinet secretary give assurance to people on Stronsy that they will not lose their medical team? In Caithness, local people have taken to the streets, such is their concern over the future of hospital care in their area and the potential effects, particularly on palliative and maternity care. There is a sharp contrast between their dignified process and the mess that has been made of the review of services by the health board and Scottish Government. My colleague Edward Mountain has submitted a motion, which I support, praising the efforts of the Caithness health action team and the community, highlighting the view that palliative care for terminally ill people is best kept local. Or to residents in Caith in Murray, campaigning for a new health facility to replace the ageing and increasingly unsuitable Turner memorial hospital and Caith health centre, even the staff at the existing facilities recognise the limitations that they are forced to work under. Will the cabinet secretary give some hope to those campaigners and staff that she accepts the strength of their arguments? Will she take this matter up with NHS Grampian at the earliest opportunity? General practice and community-based care are supposed to be the heart of the Scottish Government's future planning. Yet, despite that increasing significance, Audit Scotland has pointed to an information desert and integration of health and social care that lacks the credible planning to realise the potential benefits. All of those local concerns can find root in national policy. In NHS Orkney, there is an outgoing chief executive but seemingly no planning around the future and no clearance for the board to advertise for a successor. As a small board, NHS Orkney does not have a deputy chief executive to take over. So where is the succession planning? It has led to the suggestion that the Scottish Government perhaps envidages a joint chief executive with NHS Shetland, which will be the first step towards forming a single board for the Northern Isles. Can the cabinet secretary confirm that this is not the Government's intention? Before closing, I would just like to briefly touch on some positive news that was on the media on Monday. Macmillan Cancer Research has employed a cancer nurse who will provide clear and accurate advice online to people seeking information about their diagnosis. For someone who is diagnosed with cancer or anyone who has just been informed that they have a serious life-changing illness, it can be a bewildering time to ensure that patients, particularly new patients, have clear and accurate information about their treatment process. I haven't got time— The member is in his last 30 seconds. I'm sorry, Deputy Presiding Officer. Where to access support could make a real difference in making the whole process less daunting for people living with serious diagnosis. I hope that Parliament won't mind if I take this opportunity to give my personal thanks to all the staff at Macmillan Ward in Kirkwall for their fantastic work in supporting the patients that they look after. Particularly, Eileen Cooper, who now retired, was always a reassuring face for my mother when she was receiving her treatment. Presiding Officer, we have thousands of fantastic NHS staff working hard to give the best possible care in remote and rural communities across Scotland—care that is as local as possible, if only we had a Scottish Government with the same ambitions. I call Neil Findlay to be followed by Stuart Macmillan. Thanks, Presiding Officer. I declare an interest in my wife as a clinical support worker in the NHS. My daughter is a domestic and will hopefully soon start work as an OT. The NHS does not operate in isolation. It operates within a society and communities and, along with other public services, it shapes those communities and the lives of the citizens who live in them. This year's Audit Scotland report, like last year's and the year's before's, is set against a background of massive pressures on all our public services. Indeed, it is those very public services that have, over the decades, jointly contributed to improving the health of the nation, increasing life expectancy and eradicating disease. However, that major and significant progress has now stalled an according to Audit Scotland life expectancy in Scotland. It is lower than in most European countries—indeed, it is lower than Wales, Northern Ireland and England, two point three years fewer for men, one point nine years fewer for women than in Tory England. The health budget takes up 43 per cent of Parliament's budget. Despite inflated claims about budget increases, Audit Scotland identified on page 12 of the report that revenue funding increased between 2015 and 2017 in real terms by just 1 per cent. In 2017-18, the budget falls by 0.1 per cent. The inflated claims made by the Government are simply untrue. Audit Scotland says that only happens if you take the 250 million out for social care, which, of course, Labour asked us to make sure that that was transferred to social care. If you add in that, and you are talking about the revenue increase, it is a real-terms increase in each and every year. Neil Findlay? Audit Scotland is not telling the truth on the budget. We see health boards in the Government engaged in all sorts of sleight of hand to try and balance the books. Loans are renamed brokerage, late allocations of cash occurring. Capital funding used as a temporary patch to revenue budgets to pay the day-to-day bills, reserves being used up and various other accountancy manoeuvres. On the health committee, it has been impossible to get a minister or a civil servant to admit that cuts are being made. They claim their efficiencies or savings. My understanding of savings is that you save money to spend it on something else. The £390 million that is identified are not savings, but cuts, such as the shameful cuts to the drugs and alcohol budget. That money is not being saved to spend on anything else. There is no money saved, just services cut, and the IGBs, just as they begin to do their work, are now tasked with identifying yet more cuts. All the time, we see money wasted on agency spend, heading for £200 million. Locom spend £109 million with some practices relying on them to keep the doors open, the drugs budget increasing, negligence cost up, hardly surprising as staff are buckling under pressure, emergency emissions up, procedures up, drug death rates at the highest in Europe, people waiting longer in appointments, people waiting for in-patient day-case treatment up and only one out of eight performance targets met. On sleepovers for people in social care, social care changes in introducing the living wage that we all supported. However, for some members of staff, underfunded introduction of the living wage is actually causing their wages to go down because their sleepover shifts have been cancelled. That needs to be addressed now. That is impacting on the quality of care. With patient complaints up, GP's turners workload is impacting on the quality of care that they can provide. I have to say to Alex Neil that I held a drop-in session over the summer for GPs in my area. A significant number of them came in to speak to me. Not one of them mentioned pensions. Not one. They mentioned all the other pressures that they are under, and many of them told us that they were a resignation away from their practice closing, not a single one of them mentioned pensions. However, all of that is about people. It is about people dying, people waiting for treatment, people unable to get an appointment, people waiting in social care, people stuck in hospital, people failed by this Government and, meanwhile, persistent, deep and widening inequality continues. However, it is easy to lift points from the report to beat the Government. It is up to us to provide alternatives, so let me suggest a number. I suggest that we use the powers of this Parliament to introduce progressive taxation to fund public services. I suggest that we end and reverse the disgraceful cuts to Scotland's councils. The Government does not seem to understand that you will make no impact on health inequality if you cut council budgets because education, social work, environmental services, housing and youth work all contribute to improving health statistics. You cannot improve educational attainment and narrow the gap between pupils from the poorest families and the wealthiest families when you use the attainment fund to pay the wages of janitors. That will not help in any way. Why do we continue to be at the mercy of the big drugs manufacturers who are screwing the NHS for generic drugs? The Herald reported recently that the price of just one anti-depressant rocket in 27-fold in the past four years. I believe that we should have a publicly-owned, publicly-run drugs manufacturing facility for generic drugs that could save us a fortune. On recruitment, where are the people? Where is the big continuous national recruitment process for the NHS? Where are the TV, newspaper, Facebook, Twitter, bus, cinema and billboard adverts? Where are the working schools to get people to join the NHS? Where are the big campaigns to recruit GPs, electricians, nurses and brain surgeons? I do not see them anywhere. You must conclude, Mr Findlay. The private sector is all over these campaigns. We are not. I call Stuart McMillan to be followed by Alison Johnson. I have a quick question for Anna Sarwar, who is just about to leave the chamber. If Anna Sarwar could just answer one quick question. Does she agree with all the contents of the Audit Scotland report? Okay, there is one to answer. You can't answer from a sedentary position. If you want to answer, you must get up and intervene. That would be the usual method. Mr Sarwar. I am happy to support the conclusions of Audit Scotland. If Mr McMillan wants me to be the minister, I am happy to take over from Shona Robison's convenience. Mr McMillan. I am grateful that Mr Sarwar has clarified that. Certainly, on page 5 of the report, page 5 says that the Scottish Government in partnership with NHS boards and integration authorities should, in paragraph 7 to 1 to 7 to 8, develop a capital investment strategy to ensure that NHS Scotland estate is appropriate for delivering more regional and community-based services. I just wanted to get that on the record, because of some of the scaremongering that has happened from the Labour Party in the past about health services and hospitals to close. I just thought it would be a point just to get on the record from Mr Sarwar's point of view. Just one minute, please. Mr Sarwar spoke earlier on regarding the issue of staff morale. Staff morale is crucial to deliver our services, and I agree that staff morale is vital for our services. If politicians can raise their concerns in a more responsible way, our staff, our patients and our communities might be more aware of any particular issues that are being raised. Certainly, when it takes the chair of NHS Greater Glasgow and Clyde to put out a press release, once again, having to state that the IRH and the IRH is not going to close, reports such as that undermine the valuable contribution that the hospital and its staff make and cause unnecessary worry and alarm. The hospital has a long-term future, and we will continue to play an important part in the delivery of healthcare in Greater Glasgow and Clyde. Mr Sarwar and his colleagues continually go to local newspapers and national newspapers, stating that the hospital is going to close. I think that he owes my constituents an apology, and he owes the population of Inverclyde an apology, and I will take his intervention now. Mr Sarwar. Stuart McMillan owes an apology to the NHS staff whose pay rise he voted against. Stuart McMillan owes an apology to the people of Inverclyde when he voted against or abstain, should I say, on a vote to protect maternity services at the Inverclyde Royal hospital. No-one is talking about the closure of Inverclyde Royal hospital. What we are talking about is the services within it that he should be brave enough to stand up and defend. Instead, he defends the SNP and Shona Robison, not his local constituents. He should be ashamed of himself. That is a long, long intervention and always speak through the chair, Mr McMillan. Thank you. Yes, Presiding Officer. Mr Sarwar's contribution. He is sitting there waving. That is a pretty childish Mr Sarwar. Mr Sarwar, once again comes to this chamber and attempts to talk down the population of Inverclyde and to talk down the health service in Inverclyde, and to shame on you for doing so, Mr Sarwar. I have already taken enough time, Ms Bailey. I have already taken enough, and I am sorry. I am sitting off. Our health will always be used as a political football, as we have already heard from the Labour Party today. Locally, every single election Labour claims that the IRH is going to close, and it is not going to close. If it were to be in that position— Just a minute, Mr McMillan. I cannot hear anything from the mumbling and grumbling of your not taking as an intervention, just be quiet. Thank you, Presiding Officer. If the IRH were to be in that position of closing, then NHS Greater Glasgow Clyde would not have been investing the following into the hospital. 1.2 million refurbishment in accident emergency and at the main entrance, £600,000 improvements to the outside of the hospital in the car park area. 4.3 million pounds on the new clean room for ophthalmology patients undergoing IVT. 6.5 million pounds on the replacement of Ravenskerry hospital. The issue of Ravenskerry hospital was something that happened before 2007. It was an issue that has been there for a long, long time, and it was this Scottish Government, this SNP Government, that closed the Ravenskerry hospital and replaced it with the new Otterview unit. It is also £2.5 million in the new IRH main boiler house, and the list goes on and on and on. I recommend to the Labour Party to go and do some research before they attempt to talk down the IRH at Inverclyde. There is a new £22 million to be invested in the new Greenock health centre. That will be replacing the current facility, which is requiring regular maintenance investment. Labour continually talks as if the NHS were rosy when they were in power. It certainly has some short memories. It seemed to have forgotten that, after shambles that it was, NHS Argyll and Clyde help ward, which was disbanded under a mountain of debt of over £70 million. Then there was the NHS Western Isles situation, which Audit Scotland did sterling work with, as did the Parliament's Audit Committee with its inquiry to help to sort out. Neil Findlay spoke about brokerage. The SNP Government had to put brokerage in to sort that particular health service out. Labour and this Parliament have got a record on NHS, which is not one to be proud of. I wouldn't trust them to run to the shops in my messages. Never may I run the NHS or run the country. There are challenges with the NHS. Also, some management decisions have beggar belief, and certainly this time last year, the fact that NHS Greater Glasgow and Clyde undertook a maternity review, whilst the national maternity review was actually under way, really generally does beggars belief. That was a waste of time and money, and it certainly caused unnecessary stress and anxiety from my constituents and also the maternity staff. It was a point that I raised with the chief executive, the new chief executive of all the health service of the NHS Greater Glasgow and Clyde this year. I know that you are telling me to wind up. That is just what we are all going to do. I call Alison Johnstone to be followed by Alec Cole-Hamilton. Audit Scotland's report is clear about the challenges that NHS faces. There is severe financial strain on the system, demand continues to rise, the number of people waiting for their first outpatient appointment has increased by almost 45 per cent in the last five years. Targets are not being met and the Cabinet Secretary for Health and Sport has already conceded that there is unlikely to be significant progress meeting those targets next year. The problems are urgent. My amendment was not selected today in my times brief, but I want to focus on the actions that the Green Party believe will help staff recruitment and retention and tackle health inequalities. The NHS struggles to recruit and retain staff and there are disastrous shortages in our social care sector. Last year, the Scottish Government promised to produce a comprehensive health and social care workforce plan. That has not been delivered. As Audit Scotland's report states, one plan became three plans and part one is not a detailed plan to address workforce issues but a broad framework to consider future challenges. Audit Scotland believes that the Scottish Government is likely to find it challenging to provide any more detail in the next two plans due to a lack of national data on the primary care and social care workforces. It is unacceptable that, 10 years into their management of the health service, the Scottish Government has failed to develop a robust approach to workforce planning and does not yet have the data needed to begin that work. The BMA points out that our existing workforce data is seriously lacking. Posts filled by locums are often not included in vacancy data. Proper workforce planning should address that. No one in this chamber or beyond is reassured to hear that NHS staffing is at record levels because it is quite clear that that increase in staff is not keeping pace with demand. We simply cannot go on losing the expertise of staff who have left practice. The BMA feel unnecessary hurdles stop doctors returning to work. The RCGP also call for NES to support and expand their GP returners programmes, sensible proposals that must be taken forward. If we really want to tackle problems with staff retention, we have to lift the public sector pay cap, which has eroded the value of pay. I welcome growing agreement on that. Coupled with inflation and high levels of unpaid overtime, the public sector pay cap has left staff feeling undervalued and demoralised. We know our retirement bulges on the horizon and we cannot afford to lose staff to other sectors. Low morale, as we have heard, is eroding general practice too. We are losing GPs while demand rises and the Audit Scotland report notes that their previous projections of demand on GP services may be an underestimate, so we are not prepared. GPs in the most deprived areas of Scotland need more support. They are likely to have longer patient lists and more patients with complex medical needs. Yet, last year, ISD data showed that patients in the 20 per cent most deprived areas of Scotland received less cash per patient than practices in the least deprived. GPs in remote and rural areas also face particular challenges, but we cannot allow patients in deprived areas to be under funded. I am calling for a renewed focus on health inequalities. In 2015, the First Minister told the chamber that the new GP contract was a good opportunity to revise the allocation formula to ensure that it reflects the varying needs of GP practices in different local communities. Again, in 2015, the cabinet secretary stated that we need to ensure that all the challenges that are faced by those practices operating in more deprived communities are recognised in the resources that are provided to primary care and advocated tackling health inequalities in communities through the new GP contract. Yes, there are issues with commercial confidentiality, but we need an open public conversation about the need to tackle unmet need in deprived areas, and commitments around link workers are promising, but let's embed money advice workers and practices too. The governship project proves what difference a little bit of protected time for GPs makes. There's a strong case for rolling this way of working out. The Parliament should look at tackling drug price inflation. That is an aspect of NHS spending that should be reduced without a negative impact on service delivery. I am alarmed about the impact Brexit could have on the price of generic and biosimilar medicines. I have little time left. Labour's motion speaks of mismanagement. I don't believe that every aspect of the NHS in Scotland has been managed well. I don't believe that every aspect of the NHS Scotland has been managed adequately, and my amendment, though not selected, made it clear that I and my party believe that the Government has been far too slow to address the serious challenges that NHS faces. I'm far from convinced that current proposals for safe staffing legislation will deliver genuine improvements to patient care or working conditions for staff in our hospitals or communities. The Government's amendment speaks to changes that I welcome, such as lifting the pay cap, rolling out family income maximisation services, but it is too complacent. It doesn't acknowledge systemic workforce problems or that the Government's response to demographic challenges has been overdue and inadequate, so I can't support the amendment. Labour's charge of mismanagement is broad in general. A motion advancing more specific criticism and, indeed, solutions would gain greater support, but it's wholly negative with no suggestion for improvement and I find that difficult to support. I'm not clear whether Labour supports shifting the balance of care away from the acute sector or whether we should continue to commit service delivery to hospitals. The Government supports that, but the resource shift is insufficient. I suggest that, at high time, we discussed the resources that are required to properly fund both health and social care in this country. The Nuffield Trust report, learning from the NHS in Scotland, emphasises that a polarised, hostile political context inhibits sensible discussion about the NHS. I won't support the Labour motion today, but the Government should take no comfort whatsoever in the fact that I have not supported Labour's motion in this occasion. It is a reflection of the urgent need for parties to work together on those key issues, not my satisfaction with their decision. The Deputy Presiding Officer You must close, please, Ms Johnson. The Deputy Presiding Officer Thank you, Presiding Officer. I would just like to say that, like Alex Neil, I believe that we must acknowledge that responsibility for public health doesn't lie solely with the Scottish Government's health directorate or with the NHS. Every portfolio that we look at has an impact on our national health. The Deputy Presiding Officer Thank you, Presiding Officer. An eager and ready, Mr Alex Cole-Hamilton, to be followed by Mary Todd. Mary Todd Thank you, Presiding Officer. I start by thanking the Labour Party for bringing this motion to Parliament and to assure them of our support for it tonight. While we also backed the solutions offered in the Government amendment, particularly around lifting the public sector pay cap, they do nothing to recognise the considerable failures in their administration of their health service, nor does their amendment do anything to address the crisis in waiting times, in workforce planning or in the chronic under-resourcing of mental health services in this country. As such, we cannot support such a piecemeal response. The Audit Scotland report paints a picture of incremental decision making, which has been found wholly inadequate to the scale of the challenge before it. It speaks to a crisis in our NHS and in our social care workforce and the causes behind that. I have pointed many times to the interruption of flow that exists at every level of our health service. That interruption is manifest in A and E waiting times, in the cancellation of elective surgical appointments and, most crucially, in the amount of time that our citizens must wait for life-saving treatment. It is an interruption caused in part by delayed hospital discharge, in which the absence of a night-time bed check at home, which costs just £80 a night, can result in a patient languishing in a hospital bed for a year after being declared fit to go home at a cost of more than £400 a night. That interruption persists because of the disconnect that exists between the political language deployed by the Government around prevention and health promotion and its failure to deliver both on the ground. The Government suggests that parties' opposite are bereft of solutions, but we have offered solutions and have done so plenty, but they are continually ignored and rebuffed. Where is the national fall strategy that this Parliament voted for after backing an amendment in my name in the new year? Where is the 11 per cent of NHS funding for general practice that enjoys the support of the majority of members in this chamber but has yet to be realised? Where is the new suicide prevention strategy to replace the one that expired last year? Solutions are plenty, Presiding Officer, but they are all rebuffed and ignored. It is around that last point that I wish to focus the remainder of my remarks, because, simply, in our efforts to put mental health on the same footing as physical health, we are nowhere. On any given day in Scotland, one-quarter of citizens presenting to doctors appointments will do so with an underlying mental health problem. Whilst those with a physical complaint will receive treatment and prescriptions for their problems almost immediately, those who suffer ailments of the mind will endure a waiting time that is measured in months, if not years, and that delay is costing lives, as we have seen in the 8 per cent rise in suicides last year. Two years ago, I was the first responder to a suicide of a man in the heart of Edinburgh. I watched him die, and I had an ambulance there for him 90 seconds later, when it was of no use to him whatsoever. However, I always reflected on the fact that, had he sought help for his troubles when he first started to feel unwell, he could have expected to have waited 90 days and more for first-line support and treatment. Consider also the research that was published by my party, which shows that there are children in some parts of Scotland who have to wait upwards of two years for treatment in child and adolescent mental health services. No tier 4 beds north of Dundee. Thousands of inpatient calms referrals turned away for want of staff and no consistent provision of counselling in our schools and in our colleges. I am tired of calling this a national outrage and being met with profound inaction by this Government. If you are looking for a legacy, cabinet secretary, then, above all things, let this be it. The Labour Party has been slated in this debate for not offering possible solutions in the motion, but I do not blame them for calling out the Government in this manner. The first step to solving a problem is admitting that you have one in the first place. However, week after week, in debates like this and at First Minister's questions or during topicals, we see this administration seek to turn the eyes of this Parliament south, Westminster and NHS English in the search of absolution for their dereliction of duty. I thank the Labour Party for lifting the veil, for once again laying bare the inadequacies of this Government in this area. Mark Twain once said that the only way to keep your health is to eat what you do not want, drink what you do not like and do what you would rather not. The Scottish Government, for reasons best known to itself, would rather not act on the myriad of solutions offered by members on the bench's opposite and find it manifestly difficult to swallow the strategies of others. As such, I stand and my party stand with the Labour Party tonight in their reassertion of the challenge against which this Government has been found wanting and I assure them of our support tonight. I call Marie Todd, who is followed by Richard Leonard. I remind the chamber that I am a pharmacist registered with the General Pharmaceutical Council. I welcome the Audit Scotland report. I think that it is a really helpful document and it will certainly be useful for us to reflect on the recommendations. Contrary to the sentiments expressed in the Labour motion, the Audit Scotland report is not all doom and gloom. Nobody is complacent about the challenges facing the NHS in Scotland, but the negative view perpetrated in the Labour motion really does not chime with reality. The Audit Scotland report recognises that innovative work is being done to tackle delayed discharge, to integrate health and social care and to embed realistic medicine in Scotland. The report also recognises that patient satisfaction is at an all-time high, with 90 per cent of in-patients reporting positive experiences during treatment. It highlights that patient safety indicators are continuing to improve and, no wonder, the Scottish patient safety programme has admired the world over for its approach to improvement. The reason why it works so well is because it is incredibly empowering for the staff on the ground. We know that there are some things that we do really well in Scotland, and those are highlighted in the report. Our A&E departments have outperformed the rest of the UK for two and a half years. There are all sorts of debates about targets and whether they help or hinder us in our quest to improve health, but the four-hour A&E target is useful. It is a canary in the mind target. It tells us something about the health of the whole system. It definitely tells us something about how things are going in the A&E department, the level of trolley weights, but it also tells us about the level of unscheduled care, how well are the systems in primary care working. Is it possible for people to get help in the community and avoid the need to come to hospital at all? If admission to hospital from A&E is needed, how busy is the hospital? How easy is it to find a bed? Is there a problem with delayed discharges, causing a bed shortage? Health and social care integration is essential going forward, and Scotland is leading the way on it in the UK. Meeting the A&E targets demonstrates that we are making progress, so hitting the A&E target for so consistently and for so long is a huge achievement that cannot be underestimated. That is why the Welsh Labour Government sent a team recently to learn from NHS Scotland's success to see how we hit the A&E targets, something that Wales has not done for years. That brings me to my next point. We have three health systems in Scotland, England and Wales, run by the three main parties represented in this chamber. Go compare, guys. We have heard that the Labour Government in Wales is nowhere near hitting the A&E target and hopes to learn from us, but what is happening in England where the Tories are in power? We are heading into winter. There are predictions that an already overstretched A&E departments in England could struggle to cope if they have a flu outbreak, like they have experienced in the southern hemisphere. They have cited high bed occupancy rates, caused by a lack of funding, especially in social care, and staff shortages are contributing pressures. Last December, only 79.3 per cent of patients were seen within four hours in England, compared to 92.6 per cent up here. The rate of attendance at A&E is increasing all over the UK, probably because of our ageing demographic, which is even more acute in Scotland. However, in Scotland, A&E attendance has increased by about 3.4 per cent in the last five years. In England, it has gone up 11.8 per cent, again similar for emergency admissions. In Scotland, it has increased by 3.4 per cent. In England, it has gone up 14 per cent. For safe bed occupancies, it is below 85 per cent. Last winter, in Scotland, it ran at an average of 83 per cent. In England, it is over 90 per cent on some nights, and it is over 95 per cent. It is almost impossible to make direct comparisons on delayed discharges because of the different data collection methods, but what we can say and what is indisputable is that delayed discharges are going down in Scotland and up in England. Workforce issues are a concern for all of us. Nursing vacancy rates in Scotland are 4.1 per cent. In England now, it is over 10 per cent. The number of folk applying to university nursing courses in the UK fell by a whopping 20 per cent this year, the largest fall in any UK subject, according to UCAS. Again, yet again, there are substantial differences between the UK nations. Down 4 per cent in Scotland, down 23 per cent in England, clear evidence of the difference that it makes to have a bursary and no tuition fees. Miles Briggs would not allow me to intervene on the issue of general practice, so let me touch on the issue now and remind him that we are in the process of negotiating the first ever Scottish-only GP contract. Let me remind him that that is a situation that only came about because the UK Government threatened to impose a new contract upon practices against the will of the BMA. Dr McDevitt's comment is that you would like to quote the BMA. I heard you quote the BMA, Brian Whittle, so let's listen to Dr McDevitt's quote from the BMA, the chair of the BMA Scottish GP group. He says, general practice in England is in a state of crisis. Scotland has its problems too, but it could be a lot worse. That's what we are saying, is that there are problems, nobody is denying them. The minister must come to a close, but it's significantly worse elsewhere. I call Richard Leonard to be followed by Fulton MacGregor. Deputy Presiding Officer, today's debate is a national debate of the highest importance, because last week's Audit Scotland report is a stark warning to us all, a warning that our national health service itself is sick and in need of treatment. To begin with, I want to pay tribute to all of the staff who worked so hard to keep our NHS going, day in and day out, night in and night out, still caring for and curing our sick, and that's despite the obstacles put in their way by this failing SNP government. I speak from very recent, from very personal and very close family experience of hospital care over an eight-week period, when nursing shifts were never fully staffed, so breaks were never fully taken, where resources were finite, but nursing and caring was without bound. I want to thank those staff in the Queen Elizabeth hospital, but I also want to thank all of the staff right across the NHS. They deserve so much better than they are getting today from this Government. That means that the Scottish Labour Party demands for the avoidance of doubt not just an end to the public sector pay cap and an immediate return to free and responsible collective bargaining, but it also means that we demand an end to the political choice of the economics of austerity as well. The time has passed when the Cabinet Secretary can come to this Parliament and plead that we have record levels of NHS investment when we know that every single health board across Scotland is required to make cuts, and the time has passed too when the Cabinet Secretary can get away with telling us how much worse it is in England and Wales. When the Cabinet Secretary for Finance in this Parliament simply implements the same headline taxation policy as the Tory Chancellor in Downing Street, simply implements the same public sector pay policy as the Tory Chancellor in Downing Street, simply implements the same public sector pensions policy as the Tory Chancellor in Downing Street, we know that time has passed too when the NHS pay review body conclude and I quote, the scale of efficiency savings that the NHS is required to make appear to be bigger in Scotland than other parts of the UK, with the Scottish Government telling us that health boards will be expected to make 3% efficiencies in 2017-18, and that is why last week's audit Scotland report is all the more damning, because it underlines the demands and pressures facing NHS staff in the last financial year. It makes it clear that the SNP is not building up but running down our NHS. NHS boards, according to Audit Scotland, are having to make unprecedented levels of savings, and I find it increasingly difficult to identify the level of savings needed. In fact, so many savings are being demanded by this SNP Government that, and I quote the report, there are signs that the NHS's ability to maintain quality of care is under pressure, and in GP surgeries across Scotland we know that practice lists are getting longer, leading in some areas to them being closed altogether. GP vacancies are persisting and staff morale is plumeting, but perhaps the most terrible indictment of the SNP Government in this Audit Scotland assessment is that life expectancy in Scotland remains lower than in most European countries, and that the trends are not getting better, they are getting worse. That is why we have to make tackling Scotland's shameful health inequalities a matter of national priority. In my view, why we now need dedicated health inequality impact assessments on every policy proposal from the Scottish Government and its agencies, because for too long we have allowed poverty and inequality to persist, local government budgets to be cut, our economy to stagnate on a failed model of low-pay and low investment. That cannot go on, which is why we need a living wage, strong trade union organisation and a growing economy. It is why we need progressive taxation with greater redistribution, including a new wealth tax, which is an idea whose time has come. As the Audit Scotland report clearly shows, it is time for wholesale changes in Scotland. We know that change will not come from the Tories and it is not coming from the SNP either. To the cabinet secretary this afternoon, I say, for the sake of our public services and all those people who depend on them, stop expecting health boards to make unsustainable savings, stop centralising services away from communities and stop slashing the budgets of our local councils and, for once, after 10 years in power, start to use the powers that this Parliament has got and raise the necessary funds to alleviate the crisis. If you will not do it, let me tell this Parliament that the Scottish Labour Party will. We will stand up for the NHS because it remains in the words of Anirham Bevan, a triumphant example of the superiority of collective action and public initiative. The question for this Parliament and MSPs in this chamber this afternoon is who will have the courage to join with us. I have noticed that members are starting to forget that they should always speak through the chair. I am also having to cut the time of the last three speakers. I am Fulton MacGregor, followed by Annie Wells. Speeches of five minutes, please. Thank you, Presiding Officer, and I would like to remind the chamber that I am the PLO for the Health Secretary. It beggars belief that we hear once again listening to Annas Sarwar and the Labour Party talking down the hard work of the staff in the NHS in Scotland and bringing forward a motion that is devoid of any solution or remedy. Yes, they will all say at the start of their speeches that oh, we want to thank the NHS staff and then go on to criticise the work that they are doing day in, day out. No one is claiming that our health service is perfect. SNP speakers have said that today, and the NHS in Scotland consistently outperforms that of Tory-run England or Labour-run Wales. In times of austerity imposed on us by this ruthless UK Government, we should be able to reflect proudly on that. I think that at times the other parties want it all to have the Scottish cringe, but we are doing as well as we can in those situations. Interestingly, only last week a news broadcast by ITV Wales was made, and it was filmed in my own local hospital. That is a slight misconception that it is Alex Neil's word, but the border is on mine. Before I get into the content of that broadcast, it would be remiss of me not to point out that, if Labour had had their way, there would not be any filming in the Monklands hospital, because there would not be any Monklands A&E to fill them in. Every day, thousands of people across Coatbridge and the rest of Lanarkshire have had their life saved at the Monklands, and thankfully the SNP took over the running of the NHS 10 years ago. 10 years on from that decision, we are now in a position where a business case can be prepared for the Scottish Government for a new or fully refurbished hospital, a state-of-the-art facility to take us into the new era and face up to the new health challenges. Just yesterday, not content with the plaudits of the Welsh Government and the under-4-hour waiting times, the chair of NHS Lanarkshire opened a new rapid emergency assessment care team at the hospital, providing better more patient-centred care for patients. When ITV came to Scotland to report on how the NHS under an SNP Government compares to an NHS under a Labour Government in Wales, I think that it was entirely appropriate for them to choose Monklands, one of the first signs that the SNP puts the health and wellbeing of the people of Scotland first and foremost. It turns out that it is not only ITV Wales who are looking at the Scottish NHS for pointers. The Welsh Government confirmed that it is also looking to learn lessons from Scotland that NHS Wales has sent staff on fact-finding missions. Of course, in the summer, the Nuffield Trust produced a report entitled, Learning from Scotland's NHS, when will the Labour Party come to the same table? Opposed to the Scottish Labour policy of shutting down hospitals, this Government has consistently prioritised NHS from day one. Labour wants to pick up parts of the report and miss out others, all parts of its on-going and sustained efforts to turn our treasured NHS into political football. I do not remember hearing maybe it has never happened in Annas Sarwar's left the room mentioning the privatisation agenda of the UK Government or the savage cuts to public spending putting more and more pressure on our public services. No, that would be too much. That would be him having a go at the Tory party, which is who he should be having a go at, but no, he wants to be on their side. Well, Miles Briggs on Twitter today has made sure that he is not on Labour's side, so that it is not a friendship that is reciprocated in this debate. The Government has committed additional above inflation spending in our NHS while spending in other UK countries falls. I think that those facts have been highlighted by other speakers, but it is worth noting that the budget has went up under this SNP Government. The SNP has made ambitious challenging changes to the way that the NHS is running Scotland. The on-going integration of health and social care is welcomed and necessary, and it is complex, but it is necessary to do that. I will run out of time. He is in his last minute. Patient satisfaction in Scotland is at an all-time high, as others have said, and life expectancy and survival rates for chronic conditions is up. Crucially, Presiding Officer, staffing is up, more than 12,000 additional staff since 2007. That is in no small part to the Scottish Government policy of free tuition for student nurses supported with bursaries. As I have said already, it cannot be ignored that the NHS faces massive challenges and that there is lots of work to be done. The integration of health and social care is a massive task, as I have said, and it is not only to ease the burden on hospital beds, but to ensure that everybody who is able to be out and about in their hometowns and communities is. The Labour Party should not be standing up here with those sort of motions. It should be apologetic for actively campaigning, to condemn us, to Tory Governments that we did not vote for, and therefore having serity forced upon us. It should be congratulating the Scottish Government for acknowledging challenges, but it has still been the best health service in most progressive health service in the future. That is too close now, Mr MacGregor. I call Annie Wells to be followed by Sandra White. Five minutes, please. No more than. I am pleased to have the opportunity to speak in today's debate on what is such an important issue, our NHS. On Audit Scotland report last week, it exposed the SNP's mismanagement of the NHS since it came to power more than 10 years ago. As Ruth Davidson pointed out last week, the report rightly highlights that reform is taking place, and as a party we, of course, acknowledge the challenge that the NHS crisis would present any Government. When it comes to NHS Scotland, however, it is time that the SNP-led Government took urgent action to bring our health services up to standard. Hospitals are short-staffed, workers are stressed, and the SNP Government is repeatedly failing to hit waiting-time targets, something that I will concentrate on today. Waiting-time figures have become a symbol in determining the performance of the health service. We see them used in newspaper headlines, we hear them in the chamber and, as politicians, we keep a close eye on what is happening in our respective regions and constituencies. One thing is clear—the SNP is repeatedly failing to meet the targets it itself has set. Significantly, the report highlighted that only one out of eight key waiting-time targets was met in 2016-17. Based on the most recent statistics, performance in six of the eight waiting times has declined over the past five years with one of the eight remaining static. Out-patient figures were particularly stark. Over the past 12 months, the number of people waiting more than 12 weeks for their first out-patient appointment increased 99 per cent, and the number waiting more than 12 weeks for in-patient or day-case treatment increased 132 per cent. Statistics are so bad that the health secretary was forced to already admit last weekend that waiting times will not be met by the end of next year. To highlight just one case that I have been working on in Glasgow, I have recently dealt with a constituent who, despite going on to the waiting list for an orthopedic out-patient appointment last December, will not be seeing a specialist until later this month, a weight of almost a year. In addition to the eight key waiting-time standards, further targets are being missed. Two and a half years ago, the SNP wanted to achieve zero bed blocking in our hospitals, but its lack of action resulted in some concerning figures. Audit Scotland figures revealed that bed blocking has cost the Scottish NHS over £100 million in the last year, and under the SNP, over 500,000 bed days were lost to delayed discharge from hospital of patients who were ready to leave. A ripple effect of the SNP's failure to provide adequate community care for elderly people. When it comes to operations, we know that hospitals have carried out 14,000 fewer operations in Scotland this year, amid cash, bed and staffing shortages, has left patients waiting longer for surgery. Mental health waiting times, too, are repeatedly flagging behind the 18-week target for patients to be seen upon referral. In the latest figures show that, for the last quarter, only 80.7 per cent of children and young people were seen within the timeframe. I have already had to cut my speech back. For adult psychological therapies, the figure was 72.4 per cent, nearly 18 per cent below the Scottish Government's target of 90 per cent. In my own region, Glasgow, hospitals are consistently appearing on the list for some of the worst waiting times. The SNP really talked up the Queen Elizabeth hospital as a flagship for the city, but patients are now running thin among Glasgow residents over waiting times. A and E waiting times figures showed that just 79 per cent of patients were being seen within four hours—the lowest in the whole country. The report already highlights that one in eight cancer patients nationally are not being seen within 62-day referral for urgent case treatment, but, for NHS Greater Glasgow and Clyde, the figure was even worse—nearly 3 per cent behind the national average and 4 per cent down from the same time last year. Those are inexcusable figures, and when we see the figures not being met year on year, it begs the question as to why more is not being done. To finish today, while ambitious waiting time targets maybe the glossy way of reaching out to voters, unless the Scottish Government is willing to make ambitious changes, it is highly to the know that Scotland report. Those waiting time figures will continue to be the symbol of an NHS that is failing to meet the needs of our country. The last of the contributions to the open debate. Sandra White, up to five minutes, please. Thank you very much, Presiding Officer. Can I just say, for the very first time, I will again one word that Annie Wells mentioned, her opening speech about our national health service, our health service. It is our health service, but I will not take anything from the Tories, which are actually driving people to food banks and making their health so much worse and having to go to the hospital because they can't eat and can't heat their houses, so we take no lessons from the Tories. Can I just turn to Labour? Health yet is so important, as we mentioned before, absolutely important. It was Stuart McMillan who mentioned the fact about apolitical football and a star where I can sit there and smile away. You know, this isn't a competition of who's going to be the Labour leader, but that seems to be what you want to turn it into, both of you. Absolutely, and I think it's a disgrace that something that's so important is health. When you put in a motion, when you have absolutely no ideas on it whatsoever, all you can do is negativity, nothing at all. Can I just remind everybody here in the gallery and here as well, when the Labour Party talks about more money for the health service? Can I remind everybody? Who was it? You talk about privatisation. You speak through the chair, please, Ms White. Sorry, sorry, Presiding Officer. You brought in PFI to the health service, you brought in PFI to the health service in a certain way, didn't you? You privatised the car path. Please speak through the chair and not directly to your Labour colleagues. I apologise once again, I didn't realise it to say it. I do get very angry about this particular point. We now have hospitals where people who work in the hospital, the very staff that we rely on, cannot afford to park in them. Why? Because of the PFI deals by the Labour Party, far too expensive. A PFI deal that brought in privatisation to the health service through the car path and it's too expensive for anyone who can't even buy it out. Please reflect on that, the Labour Party and anyone else who wants to listen. Privateization was leaked in to our health service by the Labour Party, by the PFI deal on the car paths. I turn now to perhaps the Audit Scotland report and the time that I've got remaining. You look at Audit Scotland report and it's very, very good. It is an area where you have to look at it. It's not all doom and gloom. When I hear what the Labour Party and the Lib Dems and the Tories have to say about it, really, you think that we were living as someone in the Labour Party said, a third world country. Well, it's not like that. We should stop scaremongering the people out there who use the health service. Let's just read some of the reports. No, I'm sorry. Let's just hear some of the reports and let's see what pages they are in. Increased funding. That's in page 12. High patient satisfaction. Already being mentioned, page 7. We've got strong culture of continuous improvement. The Newfield Trust has been mentioned as well. That's page 23. Policy direction. The report highlights that Scotland's had a consistent seed. They can't stand anything that is not negative. Rather sad, isn't it? Rather sad. They can't stand anything that's not negative. It goes on about policy direction. Scotland's had a consistent overall policy direction in health for many, many years. A broad consensus. Please listen to that. There is a broad consensus on the aim that everyone will be able to live longer. I'm glad about that. Healthier lives at home or in a homeless setting. Page 4 of the report mentions that. Building blocks for transformation being put in place. Page 27. Activity is on the way up for that. Positive image from change. There are also early signs that changes in the way services are planned and delivered are beginning to have a positive impact. Page 4. I think that that is good news. I'm not saying that everything is absolutely rosy, as you might say, but those are good positive points. I think that the public have a right to know about that instead of the scaremongering constantly going ahead. If we can turn to staff now, we talk about staff and they are very, very important. Agenda for change staff in Scotland are better paid than anywhere else in the UK. Ban five nurses in Scotland between £225 and £309 a year better off than their English counterparts. Entrepay in Scotland is £881 higher than in England. That's a good news story, surely to goodness. And 20,000 compulsory redundancies have been averted here in Scotland. That's 20,000 compulsory redundancies in the English health service. Now surely to goodness, you should be looking at the positives that are there as well as you're looking at the negatives. That's all you ever seem to look at at all. Consultant salary in Scotland can be up to £2,000 higher. And the very important one, which Annas Sarwar's conflict is on about, is the pay cap. Ending the 1 per cent pay cap. Who does that? They didn't. Thank you very much, Presiding Officer. We now move to closing speeches, and I call Donald Cameron up to six minutes, please, Mr Cameron. Thank you, Deputy Presiding Officer. I welcome the opportunity to close for the Scottish Conservatives today, although I too have an eerie sense of deja vu. This time last year, I stood up in the chamber and raised the many issues contained within Audit Scotland's 2016 report. I noted how very few targets were met, how we needed to address the growing workforce crisis, the rising stress levels that affect our staff and the fact that Audit Scotland had repeated their calls for the Government to begin the process of transferring more responsibility from acute services to the community, and what has changed since then will frankly not much. Only one of the eight performance targets were met the same as last year, a major workforce crisis, with the £171 million spent on agency staff, the same crisis that we warned about last year. Little progress has been made in shifting the balance of care the same as last year. A severe lack of clarity as to how the Scottish Government will achieve this rebalancing, again, the same as last year. In fact, not just the same criticism as last year, but the same recommendation that has been made in virtually every Audit Scotland report since Labour was in government. Let me speak about the NHS at its best. I was in Rhaig Mawr in Inverness on Friday visiting a family member who was fulsome in their praise in terms of treatment received, and I saw this for myself too. Nursing care of the highest quality, medical care of the highest quality, hospital staff who were welcoming and helpful. As I have said, it was the NHS at its best. Taking that positive experience of NHS Highland, how do you marry that with the dire picture painted by an independent auditor in this report? NHS Highland was the worst performing board in Scotland for the 12-week from referral to outpatient appointment target. Because notwithstanding the efforts of our hard-working nurses, our family doctors, the report lays bare deep systemic problems with our NHS again. Time and again, members across this chamber have warned this Government about the impending workforce crisis, as many members have alluded to. I am keen to know how he reflects on the impact of Brexit on EU nationals and the huge decrease in NMC registrations in the last financial year. How is that going to help us to staff our NHS? Donald Cameron. As I have said many times, the idea that this workforce crisis began on 24 June 2016 is ludicrous, and Clare Hocky should know that. Time and again, we have spoken of the need to implement strategy rather than simply talk about it. Time and again, we have flagged up the concerns of Audit Scotland only for it to fall on deaf ears. What do we hear from the Scottish Government? The usual mantra, at least it is not as bad as England. It was the First Minister last week, it was Marie Todd today. The SNP are in complete and total denial. People in Scotland know that this is mere deflection. They care about what happens here in Scotland, so for once will the SNP just admit that they have got it wrong on the NHS. The Scottish Government also likes to talk about patient satisfaction. I accept that it is high, but, as the BMA Scotland has said, this level of satisfaction will only get harder to maintain and that nurses and doctors have found increasing worries that the volume of work faced is compromising the quality of care that we give to our patients. Before the SNP crow about the small morsels of achievement in the Audit Scotland report, will they at least front up to the fundamental problems that exist? No, I have already taken intervention and I have limited time. Instead of talking of challenges or difficulties to overcome, will the SNP accept the sheer enormity of the problem at hand? In closing, I want to turn to some of the important remarks made by MSPs from across the chamber. Miles Briggs spoke of the huge problems that are facing general practice and spoke of our constructive suggestions, more medical school places for Scottish-based students, a 15-minute minimum appointment time for GPs. Alex Neil, I have to address his point. Of all people, Alex Neil wants to blame anyone but his own Government holding George Osborne for account for the GP crisis. It is ludicrous. It is ludicrous, not once in their briefing for this debate, to the Royal College of General Practitioners mentioned pensions. It is all about low morale, it is all about workload pressure and it is all about underfunding. Alex Cole-Hamilton spoke tellingly embodying the sheer frustration of many of us from all parties who keep making suggestions, who keep scrutinising and keep getting ignored. Jamie Halcro Johnston made an excellent point. He said, at the start of his speech, that everyone has a stake in the NHS. We are all here, we all played a part in the creation and maintenance of it. That is why scrutiny is so important. Jackie Baillie spoke movingly about the human stories behind the statistics. It is so easy when discussing a report like this to forget the human element of this crisis. Either the Scottish Government can listen to the concerns raised by all Scotland, the professional bodies and indeed those who are on the front line or they can continue to wallow in their own delusion and spend another year talking instead of taking action. The cabinet secretary should reflect and take the recommended action required to ensure that, come this time, next year, a different tale is told. A tale where our workforce does not feel burdened by diminishing support and stretched due to staff shortages. A tale where our doctors, nurses and others can deliver the excellent patient service and care that they have spent years honing. A tale where targets are met and patients are treated with in-waiting time targets. A tale where community services become empowered to diagnose and treat local residents so that hospitals can deal with more complex cases. That is the goal, but only by taking decisive and real action will that be achieved. I call Shona Robison up to seven minutes please cabinet secretary. Thank you Deputy Presiding Officer. Let me start by being very clear on this. I have never once said that everything is rosy in this Audit Scotland report, but neither is everything negative in this Audit Scotland report, as the opposition would try to portray. The truth is that it is actually a balanced and very fair report that lays out the challenges but also lays out where progress is being made. I think that Donald Cameron is probably the only opposition politician this afternoon to say anything positive about the report by accepting the Audit Scotland's reported findings on patient satisfaction. I think that that is where this debate has lacked any balance at all. Let me respond to some of the issues raised by members in this debate. Miles Briggs talked about the resources going into shifting the balance of care. We have made a very clear commitment that over the course of this Parliament £500 million will shift into community services. Over the first time, there will be more money spent in community health services than ever before. That will absolutely lead to the changes that are required in primary care and will make sure that general practice is a more attractive proposition so that we can get young doctors going into general practice. There are more medical training places than ever before. We have significantly grown the number of undergraduate medical places in Scotland. We are committed to widening access to the medical profession to all talented young people in Scotland. We have shown by the 50 places added in 2016, maintained for 2017 and specifically targeted at widening access to candidates from a wider variety of backgrounds in a second. We have also set up two pre-medical entry courses targeted at those from less-advantaged backgrounds to make sure that we can attract the best into medicine no matter where they come from. Of course, we have set up the first graduate medical school in order to boost our medical trainees here in Scotland. Miles Briggs has been accepted for taking this intervention. Can she therefore tell Parliament when the GP shortage in Scotland will be resolved? Shona Robison Will she be resolved when we get a new contract in place and a new primary care model that is more attractive to young doctors? The truth is that not enough young doctors want to go into general practice. That is why we are leading with the BMA a brand new contract that will revolutionise general practice here in Scotland. It is just a pity that Miles Briggs does not get behind those efforts. In palliative care and the resources going into him, I will write to him with an update on that. Alex Neil quite rightly pointed to the fact that tackling health inequalities cannot be done by the NHS alone. He was quite right to talk about the impact of welfare reform on the health of our nation. He was quite right to point to the very significant report from NHS Health Scotland saying that one of the single most important actions that could be taken is the delivery of the real living wage. We should all show leadership in that direction, should we not. Of course, Jackie Baillie mentioned agents very briefly. John Scott In terms of showing leadership, you will recall that I raised with you recently NHS Airshire and Arn's intention to close the chemotherapy unit at air hospital and move it to cross-house. Will you intervene in that decision, please, and make certain that chemotherapy is delivered both at air and cross-house? Shona Robison As John Scott knows, that was raised by himself at the Airshire and Arn annual review. I have been very clear with Airshire and Arn, as I would with any board, that any changes that are suggested like that has to have full consultation with the local community. The local community raised very strong concerns, as John Scott and I both heard. I have been very clear with the board about my expectations in that direction. Jackie Baillie talked about agency spend, but it did not mention funnily enough the fact that the Audit Scotland report said that there had been a reduction in agency spend over this last year. Again, a lack of balance in what is chosen to be highlighted very briefly. Shona Robison I think that the cabinet secretary would recognise that the bulk of my speech was about the people in my constituency that have not had treatment. The treatment time guarantee is out the window. They were waiting for a year. What do you say to them? Shona Robison To Jackie Baillie, we are working very hard with Derek Bell and others to make the same changes to elective care as has been made to unscheduled care, delivering huge improvements back by £50 million this year. I do not think that it is acceptable for patients to be waiting the length of time that Jackie Baillie has highlighted. I take that very seriously indeed, but what is more important is the action that has been taken to address the issues that Jackie Baillie and others have raised in this chamber this afternoon. Brian Whittle talked about the alcohol and drugs budget. Of course, what he failed to mention was the £20 million in the programme for government to boost alcohol and drugs budget. I do not have time because I have a lot of people to get through. Claire Hawke outlined the CAMHS progress being made in staffing and quality of service. Jamie Halcro Johnston raised a number of issues, and I will write to him particularly about the Stronsie issue around the health service concerns on that island. There were a number of particular issues that he raised that I do not have time to go into, but I will write to him. However, I would put on the record that the exploration of single island authorities that is going on is at the request of the councils. There is something about public services coming together on the islands, but it has to be in a way that is satisfactory to the needs of local people, and they must be fully consulted about any changes in that direction. Neil Findlay talked about what the Audit Scotland report says about money. As many people did, Richard Leonard said the same. The Audit Scotland report is categorically clear that there has been a real-terms increase in the health budget. It says it in paragraphs 10, in paragraphs 11, 12 and 13. Of course, if you include the £250 million that Labour called for us to do in passing that on to social care, then there has been a real-terms increase in each and every year. What Audit Scotland then goes on to say is that it is not just about money, it is about reform and about changing the way that things are organised and the way that services are delivered. That is exactly what this Government is getting on and doing. In terms of the recruitment efforts, Neil Findlay could not be more wrong. Huge efforts are going on to recruit in schools to open up modern apprenticeship opportunities in the health service for young people. Of all our boards, we use every opportunity, every media outlet, to recruit staff where and when they can. Alison Johnstone returned to focus on health inequalities. Can I reassure her that every opportunity has been taken in the development of the new GP contract and the new model of primary care to deliver and better reflect deprivation within that new model? Can you come to her close, please? I hope that she can take assurance from that. I am sorry that I have not been able to go back on all the other comments, but I will write to the members in response to the issues that they raised. Presiding Officer, today's debate has been a bit like Groundhog Day, another year, another Daman Audit Scotland report and 10 years of SNP mismanagement of our NHS. Last year's report on NHS was described as the worst since devolution. A year later, very little has changed. The latest report may be only a week old, but its conclusions are all too familiar. The NHS budget for 2017-18 decreased in real terms, outpatient waiting lists up 15 per cent. Audit Scotland report is absolutely clear that there has been a real terms increase each and every year, particularly if you include the £250 million for social care that Labour asked us to transfer. The member is factually incorrect. The problem for the cabinet secretary is that the dodgy double counting that it takes place from this Government when you include the £250 million in local government budgets, and the Audit Scotland report is very clear in that double counting by this Government. Maybe the cabinet secretary wants to get to her feet and tell us that the Audit Scotland are wrong when they say that outpatient waiting lists are up 15 per cent. No, inpatient waiting lists are up 12 per cent. No. The overall health of the Scottish population plagued by inequalities is described as poor. The cabinet secretary does not come to her feet to contradict that. She does not come to her feet to contradict that we have a lower life expectancy than most European countries. Drug-related deaths on the rise, the highest in Europe, are a recruitment, retention crisis across nursing, GPs, consultants and social care, increase in levels of locum spending and increase in the backlog of maintenance required on NHS buildings. Only one out of eight key performance indicators have been achieved. A spiralling downward trend from just 2 in 2015, 3 in 2014 and 4 in 2013. Yet that was entirely predicted. Audit Scotland, the BMA, the RCN and others warned seven years ago that the crisis that we faced was going to happen. Their warnings were ignored by the Government, whose slowness to respond has let down patients and staff. Even today, as Alex Cole-Hamilton said in his contribution, the SNP and its amendment has failed to take any responsibility whatsoever for the failings that are highlighted by Audit Scotland year after year after year. Auditor General said in his reports that there is consensus on the need for change and in particular the need to shift the balance of care from hospitals to the community. Despite that being the Government's policy for a decade, progress is painfully slow and in many areas we are going backwards. As anas Sarwa highlighted last week, the First Minister tried to pass the buck and blame the opposition for the lack of progress. The First Minister said in this chamber that when the Government brings forward proposals for changing NHS, the opposition opposed them because we do not want to go do the tough stuff. Of course, Nicola Sturgeon, the cabinet secretary and Richard Lyle Shelton from a sedged position cannot give us a single example of opposing that change, not one example. Let me give the chamber, the First Minister, an example of what not doing the tough stuff actually is. It is when the Government has the tax powers to make different choices to stop the cuts, to be genuinely progressive, but then they fail to use those powers and instead simply tinker around the edges. That is not doing the tough stuff, Presiding Officer, it is soft, weak government. It is also short-sighted. As anas Sarwa revealed in his opening speech, the Government's failure to tackle the problem of delayed discharge in Scotland cost the NHS over £100 million a year. Delayed discharge of course that the cabinet secretary promised to eradicate two years ago, but from cabinet secretary Shelton again from sedged position it has gone down. She promised to eradicate it two years ago and the cabinet secretary has failed to do so. From September 2016 to August 2017, over half a million bed days across Scotland were occupied by delayed discharge patients. Based on the most recent figures for 2013-14, it cost £214 for every one of those bed days, and that is a Conservative figure set to rise in December. That is a cost to the NHS of £110 million for keeping people in hospital when they are fit to leave. We know that many cannot leave hospital because after £1.5 billion of cuts to local councils since 2011, the care packages support that they need in the community simply is not there. It is on the funding of the NHS in social care that the report really exposes how utterly divorced the Scottish Government's rhetoric is from reality. Excuse me, Mr Smith. Could we have a bit of quiet in the chamber please? It is very rude when Mr Smith is trying to close this debate. Day after day we are subjected to press releases from the Government telling us that money is pouring into the NHS. As Neil Findlay highlighted in his speech, the Government is in complete denial over cuts. If I took a blade and run it across my hand and it started to bleed, and I asked the Government Minister what it was, they would say that it is an efficiency saving. The Audit Scotland report is very clear. It says that NHS boards may be unprecedented. Not you, Mr Smith. You carry on. I know that the SNP does not want to hear about the Audit Scotland report, but it is very clear. It says that NHS boards made unprecedented levels of savings in 2016-17 but failed to meet the overall planned savings targets. That is because there is a gap between the funding and income that they receive and how much it costs them to deliver services. The Government needs to start to be honest with the public to admit that health boards are being forced to make cuts to services that have nothing to do with change but everything to do with desperately trying to meet the balance books. Jackie Baillie, in her usual passionate contribution, is that the member for champion, the veil of leaving hospital, brought home to us all the human impact of those cuts on her constituents. What a contrast to Stuart McMillans ran to when he failed to say he supported the retention of maternity and children services at the Inverclyde royal hospital. Jackie Baillie also highlighted the impact on, as she rightly described, her overworked and undervalued health and social care staff. It is backed up in the Audit Scotland report that says that morale is deteriorating. Across the NHS and social care, we face recruitment and retention crisis. One in three of our GP practices reports of vacancy and we have a ticking time bomb of GPs queuing up to retire. The Royal College of GPs predicts that by 2021 Scotland will have a GP shortfall of nearly 856 just to bring coverage back to 2009 levels. Again, the Government was warned. In 2008, Audit Scotland called on the Scottish Government to collect comprehensive data on GP and GP practice staff numbers to support proper workforce planning. In 2014, the Royal College also warned that the underfunding of GPs was put in patients at risk. Those warnings were ignored. By 2015-16, the proportion of NHS spending that was allocated to GP services was at an all-time low. No Cabinet Secretary, as you have just said, the crisis facing GPs will not be solved when a new GP contract is signed. The failure of the Government to listen is not just in relation to GPs. There are over 3,500 nursing and midwifery vacancies, more than 950 of which have been vacant for three months or more, 476 consultant vacancies, 543 allied healthcare professional vacancies and 159 pharmacist vacancies. The consequence of those high-vacancy rates is an increase in the burden on existing staff, which adds to their already unsustainable workloads. Yet the Scottish Government has continued to impose a pay policy that means that someone entering a nursing today is £3,400 worse off in real terms than someone entering a nursing seven years ago. Even today, the SNP amendment does not commit to a proper pay increase for NHS staff. Let's not forget that just a few months ago, when given a chance to scrap the pay cut, each and every SNP MSP voted in this Parliament against a motion to give our NHS staff a real terms pay increase. As well as failing to back a real terms pay rise for NHS staff, the SNP amendment pays lip service to the issue of health inequalities, calling on Parliament to merely note the issue. When a boy born in a deprived community in Scotland is likely to die 30 years younger than a boy born in our most affluent areas, the Government should not be noting that, it should be thoroughly ashamed of it. More importantly, it should be prepared to tackle it. Alex Neil's contribution chose to selectively quote the 2014 Scottish Public Health Observatory report, which made clear that solutions to health inequalities cannot be tucked away in the national health service. However, it has also failed to say, as the report called for the co-interventions that redistribute income such as increasing income tax. As Richard Leonard said, it is time to make tackling health inequalities a national priority. It is time that we realise that we cannot tackle health inequalities unless we begin to tackle wealth inequalities. It is time that we had an open and frank discussion about what we want from health and social care and committed to paying for it by using progressive taxation to end the cuts to social care. It is time that we had a coherent, joined-up change programme that is built on genuine consensus with staff and the public and is driven forward by the Government. It is time that the SNP and the Cabinet Secretary for Ones took responsibility for the failings in yet another dammit audit Scotland report published on this Government's watch. When we come to vote, it is time for Parliament to stand up for our NHS, hold this Government to account and to back Labour's motion. Thank you very much. That concludes our debate on health. The next item of business is consideration of motion 7995, in the name of Clare Adamson, on behalf of the Standards Procedures and Public Appointments Committee on Lobbying, Scotland Act 2016, reporting procedures, resolution 2017. I call on Clare Adamson to speak to and move the motion. Earlier this year, Parliament approved new standing orders to prepare the way for the implementation of the Lobbying, Scotland Act 2016. Those allow the Parliament to confirm details of the operation of the act via lobbying resolutions. The committee is seeking Parliament's agreement today to a resolution that sets out the specific arrangements for the commissioner of ethical standards and public life in Scotland when the commissioner makes a report to the Parliament under the act following their investigation of a complaint. Firstly, the resolution provides that the commissioner reports are to be made in writing, which includes electronic form. Secondly, it specifies arrangements for Parliament's consideration of the commissioner's reports, including that they are to be referred to the Standards Procedures and Public Appointments Committee. Finally, the resolution sets out new procedures for the Parliament to exercise its power of censure under the act. That would involve the Parliament responding to a motion of the Standards Procedures and Public Appointments Committee to censure a person who is the subject of a commissioner's report and is found to be in breach of the act. I move motion S5M-0795 in my name on behalf of the Standards Procedures and Public Appointments Committee. Thank you very much for the question on the motion that we will put at decision time. The next item of business is consideration of business motion 8583 in the name of Joe Fitzpatrick on behalf of the Bureau, setting out a business programme. I would ask anyone who objects to SESU now, I would call on Joe Fitzpatrick to move motion 8583. Formally moved. And no one has objected. Therefore, the question is that motion 8583 be agreed. Are we all agreed? Yes. We are agreed. The next item of business is consideration of two parliamentary bureau motions. Can I ask Joe Fitzpatrick on behalf of the Bureau to move motion 8569 on approval of an SSI and motion 8570 on office of the Clarktates? Move together. Thank you very much. So we come to decision time and there are six questions today. I would remind members that if the amendment in the name of Shona Robison is agreed then the amendment in the name of Miles Briggs would fall. The first question is the amendment 8536.2 in the name of Shona Robison which seeks to amend motion 8536 in the name of Anasawa on health be agreed. Are we all agreed? Yes. We are not agreed. We will move to division and members be cast their votes now. The result of the vote on amendment 8536.2 in the name of Shona Robison is yes 58 no 59. There were no abstentions, the amendment is therefore not agreed. The next question is the amendment 8536.1 in the name of Miles Briggs which seeks to amend motion 8536 in the name of Anasawa be agreed. Are we all agreed? Yes. We are not agreed. We will move to division and members be cast their votes now. The result of the vote on amendment 8536.1 in the name of Miles Briggs is yes 29 no 88. There were no abstentions, the amendment is therefore not agreed. The next question is that motion 8536 in the name of Anasawa on health be agreed. Are we all agreed? No. We are not agreed. We will move to vote and members be cast their votes now. The result of the vote on motion 8536 in the name of Anasawa is yes 53 no 64. There were no abstentions, the motion is therefore not agreed. The next question is that motion 8569 in the name of Jofice Patrick on approval of an SSI be agreed. Are we all agreed? Yes. We are. And the final question. I have a tindall page. Sorry, not the final question. The penultimate question is that motion 775 in the name of Claire Adamson on the Lobbying Scotland Act 2016 reporting procedures resolution 2017 be agreed. Are we all agreed? Yes. Thank you. And the final question is that motion 8570 in the name of Jofice Patrick on office of the clerk be agreed. Are we all agreed? Yes. We are agreed. Thank you very much. That concludes decision time. We'll now move to members' business in the name of Claire Adamson on pancreatic cancer. We'll just take a few moments for members to change seats.