 Our Scottish NHS faces many challenges. I believe that it is the job of all of us in this Parliament to work to help to create a sustainable and financially secure NHS for Scotland. Recent weeks have demonstrated just the level of financial mismanagement within our NHS, which this Government has presided over. Perhaps the most obvious example of that has been the scandal in NHS Tayside, which brought this to the public's attention in the most shocking of ways, when it was revealed that NHS Tayside took more than £2 million from its charitable endowment fund. Donations made up from the public or requests in wills simply to help to cover the day-to-day running costs of that health board. The current financial situation in NHS Tayside is one that Audit Scotland over a number of years has highlighted as being high risk. According to Audit Scotland, NHS Tayside now must make more than £205 million of savings over the next five years and has overspent in areas such as workforce costs, prescribing and clinical supplies. The situation in Tayside is shocking, but it is far from on its own. Just last week, NHS Lothian, my own health board, revealed to the Parliament's health and sport committee that it too will require £31 million just to stand still at 2017 levels. NHS boards are queuing up at the Cabinet Secretary's door to beg for financial brokerage just to be able to keep delivering the health and social care services that people across Scotland rely on. It is worth reflecting that, when the SNP Government entered office in 2007, Audit Scotland noted that the Scottish NHS had a budget surplus of £50 million. Today, it is now predicted that our Scottish NHS could be overspent by more than £400 million and is struggling to find the cuts that it needs to bridge the current gaps. All that, despite receiving additional Barnett consequential funding of more than £2.45 billion from the UK Government. For every MSP in this Parliament, it must often seem that every warning light is on our NHS Scotland dashboard. NHS Scotland has failed to meet seven out of ten key waiting time targets. More than a quarter of children are waiting too long for mental health services, some up to a year. More than one in eight cancer patients are waiting more than 62 days for urgent treatment. One in four GP practices in Scotland has a vacancy. A number of GP practices have been taken over by health boards due to staff shortages. Nearly one in 10 GP surgeries in Scotland is turning away new patients. There are more than 400 vacant consultant posts and more than 2,500 vacant nursing and midwifery posts. Is staffing at NHS, do you expect Brexit to happen? Miles Briggs. It is a very interesting point, because 11 years into your Government, Brexit is the excuse, but you have been cutting the training places. The First Minister cut the places. That is where any vacancies in our Scottish NHS are because of this SNP government. No one should forget that. Care homes across Scotland, providing that care, are closing at a rate of one a month. Just yesterday, we saw the publication of figures showing delayed discharge of patients has increased by 11 per cent from February. Delayed discharge has a huge impact on people's lives when they are stuck in hospital and are not able to get home or the appropriate care package put in place. I would like to make some progress, but I will come back to you later. The cabinet secretary will be acutely aware of those cases. I have raised with her on a number of cases of my constituents here in Lothian who are stuck in hospital, sometimes for hundreds of days, unable to get a care package in place that they need. The increasing levels of delayed discharge is a significant indicator of a crisis in our health and social care services and one that is increasing in many communities. John Scott would the member agree with me that it is absolutely appalling that there have been 33,000 bed days lost in NHS Ayrshire and Arran in the last year? Can he tell me the overall number for the health service in Scotland of the number of days lost through delayed discharge? They do not like to hear the truth for some reason in this Parliament. That is exactly what we are saying, Presiding Officer. Those stories represent a shocking indictment of the Scottish National Party's Government's record in charge of our health and social care services. I want to make some progress. That is not just about numbers on a spreadsheet, it is people's lives. It is our fellow Scots, our loved ones' lives, and this cabinet secretary and the Scottish National Party Government must get a grip of this situation. That is why the Scottish Conservatives have called for specific action and for a real strengthening of this Parliament's oversight and scrutiny of our NHS finances. That is why we called in our motion for the cabinet secretary to publish the full details of the current financial position of every NHS board and integrated joint board. Information, I believe, we should all have, and for the Scottish Government to commit to monthly updates being provided to this Parliament. I welcome the email of the cabinet secretary to me just at half past 12 today to accept those very points and to outline how she will take forward enhanced reporting of our NHS finances, which will begin in June. I have other asked which I will be making beyond that, but perhaps the most concerning issue, which I think we should be also really highlighting today, is that, when we look at what is happening in our NHS, the financial crisis being faced by the 31 integrated joint boards is still yet to be revealed. I thank Miles Briggs for taking that intervention. Amongst other things, the Conservative motion talks about IGB finances and being held to account. Miles Briggs would join me in condemning the actions of Angus Council, who failed to pass on to the local IGB more than £1 million of an additional £1.56 million provided by the Scottish Government to support health and social care activities. Would he agree with me that a ruling coalition in Angus, which includes Conservative councillors, should be held to account for depriving the IGB and my constituents of much-needed funding? That is exactly the point why we are debating this today. The member needs to understand the problems that are being faced by the health and social care sector in Scotland. We all agree that the integration of health and social care is the right direction of travel to ensure that people receive the vital care that they need at the right time and place, focused on community-based and preventative care models. However, the member and the cabinet secretary need to be abundantly clear that the SMP reform is not delivering and that there are growing concerns, which the member has outlined from those who sit on the IJBs and take those decisions. I have to say that those include many SMP councillors who have even contacted me across Scotland at the role, the remit and the effectiveness and decisions. That is how much your councillors have given up on you and this Government. The integrated joint boards are now responsible for almost £8.73 billion of taxpayer spending in our health and social care services, yet the financial accountability and reporting within the IJBs is inconsistent and erratic at best. Increasingly, the budget pressures that IJBs face are directly influencing their decision-making. No, I want to make some progress. It is affecting their decision-making, decisions to cut mental health beds and services, for example. Ordered at Scotland, again, has called on the Scottish Government to make fundamental decisions about how it provides those services. I welcome the Government's acceptance that we need greater financial accountability of IJBs, but I also believe that we need to now take time to ensure that they are truly fit for purpose. This is a major reform that this Parliament passed in the last session, which we need to make sure is fit for purpose for our communities in this session. Scottish Conservatives therefore also set out our own motion and in our motion that we want to see the cabinet secretary commit to a review of the integrated joint boards. To fully understand their current financial position, yes, but also to look to how effective they have been and what future reforms of them may be needed. We cannot and we will not just stand on the sidelines and watch a crisis in our social care system build ever greater. Part of this debate I did not want to make personal. The future of our NHS and its financial sustainability, I believe, is too important for that. As I have said in recent weeks, and maybe the SNP members should start to listen, when Labour and the Liberal Democrats have called for the cabinet secretary to be sacked, I have not gone down that road. The truth is that I do not think that there is anyone on the SNP benches who could actually set up and step up to the challenge. We have had a look around you. Fergus Ewing has prided—Fergus Ewing is eating into the—Fergus Ewing has presided over the farm payments fiasco. We have seen our once world-class Scottish education system decline under Angela Constance and now John Swinney and Police Scotland. Where do we start on Michael Matheson and the problems and issues that are facing Police Scotland and the SNP's centralisation? The question is, who on the SNP benches think that they could do any better? Put your hand up if you do. Anybody? No. That tells you all. I didn't really have you in mind. We have a point of order from Christina McKelvie. I am interested to hear what the Conservatives have to say in the debate, but personal attack, personal slight on members of the chamber and bringing down the reputation of the chamber should not be what is coming from the Tories today. I quite like Mr Briggs to speak to his motion, not to impudate the reputation of people in the chamber. I thank Ms McKelvie. I am very alert to any personal attacks that take place. However, there is also some room for robust exchanges. In this case, it was within, but I would encourage all members to keep the debate to the substance and not to the personalities. Let me be absolutely clear to the cabinet secretary that mismanagement and financial chaos facing our NHS cannot continue. It is impacting on our health service and NHS staff morale. That is exactly why Scottish Conservatives are putting the SNP Government on notice over their handling of the financial crisis that is facing Scotland's health boards, and the need for action to prevent the next major financial crisis in the integrated joint boards happening. Those two critical issues that are facing our Scottish NHS have developed on the SNP's watch over the past 11 years, and now we need a Government that will get a grip of this dire situation that it has created. That is why I believe that we as a Parliament need to seek this urgent action. We must return our NHS to a secure and sustainable financial footing, and I move the motion in my name. I move amendment 1 in my name. Let me start by saying that I am immensely proud of our NHS staff, do a fantastic job, day in and day out. They often go the extra mile as witness during the severe winter weather, with heroic efforts to get to work to keep patients safe. With our world-leading patient safety programme, we have one of the safest systems in the world, with international interest in how that has been achieved. The vast majority of patients get a fantastic and timely service, and the fact that patient satisfaction levels are higher than ever would suggest that this is the case, with 90 per cent of Scottish inpatients saying that hospital care and treatment was good or excellent. I have no problem being held accountable for our NHS. That is my job. Is it a perfect system? No, it is not. Sometimes, in a system with the size and scale of the NHS, things go wrong, and I am sure that we will hear examples of that today. What is important in each of those cases is that there is an openness to reflect and learn from them, which the new duty of candor encourages. On that point about patient safety, Presiding Officer, members may be aware of news emerging of a breast screening error affecting 450,000 women in England. Jeremy Hunt has just made a statement earlier to the House of Commons. Given the significant public interest, I wanted to take the opportunity to reassure members and the public that the issue does not affect the NHS in Scotland, and patients should be reassured that there are no problems with our breast screening programme records or IT systems. As usual, all women should continue to be aware of changes to their breasts and, if they have any concerns, they should see their GP. Scottish Government officials will be working with Public Health England to identify any women affected in England who have subsequently moved to Scotland. Our NHS sometimes struggles to cope with rising demand, like every health system across the islands and beyond. Despite record high NHS staffing, up over 13,000, our performance on key targets is not where I would want it to be. Although Scotland's core A&E services are the best performing in the UK for more than three years now, 10 per cent better than they were three years ago, there are some sites that still struggle and need to improve. While we are now seeing a downward trend and delayed discharge with a reduction of 7 per cent in total bed days loss compared to the previous year, there is still much work to be done, especially in areas such as Lothian. Of course, that is why we are driving forward both investment and reform in a second. That is why we are driving forward both investment and reform of our NHS to meet the rising demand and challenges now and into the future. In 2014, the cabinet secretary stood where she is today and said that she would achieve a zero-delay discharge in our hospitals. When is that target going to be met? You are absolutely right, and I want to eradicate delayed discharge, but it is the difficult thing to do. Miles Briggs alluded to some of the challenges earlier on. Our integrated joint boards work very hard, but there is huge variation in performance there. Glasgow, for example, has almost eradicated delay, whereas areas such as Edinburgh have not, and there is a new chief officer in place who I think will do a fantastic job in that domain. I am not underestimating the scale of the problem here, and good ideas are always welcome wherever they come from across the chamber. On the subject of investment in the NHS and care services, let me turn now to address the financial issues in the motion, and let me say that I am more than happy to do so. Ensuring that there are sufficient resources in the NHS is something that I do every day. The Scottish Government's budget for 2018-19, supported by the Greens, delivered additional investment in health of more than £400 million, and takes the resource budget to £13.1 billion. In a minute, the Government remains on track to deliver its commitment to increase health resource spending by £2 billion by the end of this Parliament. It is clear that this level of investment has only been made possible without impacting on other public services through the progressive tax policies that we have implemented. Health spending is £360 million more than inflation since 2016-17. Had we not taken the budget decisions that we had, the resources that are available to our health and care services would have been considerably less. I will give a way on that point. I thank the cabinet secretary for taking the intervention. You will be aware that I have pointed out before that, over the last 10 years, NHS Grampian has been shortchanged by £165 million from her own target figures. Although that is being reduced now, will NHS Grampian ever get that money back? As I have said to the member on a number of occasions, NHS Grampian is one of the biggest gainers from the NRAC formula and again does so this year. Let me turn to the Tory motion. If the Tories are suggesting that the health and care budget is inadequate, which Miles Briggs was suggesting in his speech, they have a responsibility to set out what level of funding they would propose and how that would be funded, particularly in the light of their opposition to progressive use of taxation. Under the Tory tax plan, there would have been £500 million less available for public finances, including the NHS, so Miles Briggs does have a responsibility, and perhaps in the closing speeches from the Tories will hear about the level of resources that they think the NHS should have and where those resources will come from. Many of the areas that Miles Briggs raises in his motion today are areas that I have been engaging with the Health and Sport Committee on for some time. In response to the financial issues that I asked raised in the Tory motion, I have today written to the health committee providing information on the first round of consolidated financial reports for integration authorities, an update on NHS boards financial performance and the development of a medium-term financial framework for health and social care. I have agreed to review progress of the integration authorities and I believe that that is best done through the ministerial strategic group. I am happy to share with the health and sport committee the outputs and any further actions that arise from this with the committee. I have also set out my proposal to provide monthly information on NHS boards financial performance for 2018-19. Board's first formal reporting period for the financial year will be available in June, and we will report monthly thereafter to the health and sport committee. I hope that Miles Briggs and others agree that what has been set out as a reasonable proposal to address the concerns that are set out in the motion and provide greater transparency and accountability to this Parliament. In responding to the recommendation from the auditor general, I have committed to publish a medium-term financial framework that will take account of key programme for government commitments along with an understanding of the financial environment and approach that is required to ensure financial sustainability. The framework will be published in the coming weeks and will set out clearly the environment in which we are operating. In particular, it will set out longer-term funding needs. I am confident that the publication of the framework will be an important part in giving greater clarity to NHS boards and integration authorities as they develop their plans for the coming years, and that supports the principle that is asked for by the Greens. Of course. Miles Briggs. As I said in my speech, I welcome the fact that the Government has accepted those reforms and accepted them in our motion. Will it be able to tell the Parliament today what level of overspend does NHS Scotland stand at today? Does she have that figure? We will get the first two months of the financial plan for 2018-19 at the end of June. I am sure that Miles Briggs, as I do, wants accurate, robust information. The health financial reporting cycle has the first two months. That is how it happens every year. The first two months of the financial year are published in June. That will be made available to the Health and Sport Committee and then monthly reporting thereafter. I also ask that Miles Briggs publish his past years situations. It is important that the Parliament sees the direction of travel as well. I am very happy to provide that information, but the 17-18 position has already been made available to the Health and Sport Committee. If there is any more information that I can provide, I am very happy to do that. I want to meet the needs of the Parliament in terms of the budget scrutiny process. The Auditor General has previously called for greater financial certainty for NHS boards, but I will say at this point that a UK multi-year funding settlement has been proposed by the Prime Minister no less, along with this Government's commitment to pass on all health consequentials will go a long way to providing our health and social care partners with greater certainty of funding that they need. I will also welcome the opportunity to discuss with members the steps that we are taking at a local level in response to governance and accountability issues. I have given a detailed statement in Parliament setting out my response to the issues at NHS Tayside and the details on the investigations will be scrutinised by the Public Audit and Post Legislative Scrutiny Committee in the coming months. It will be important that all parties take stock following those reviews and that we all learn lessons from the situation in Tayside and make improvements for the future. I have also set out in my statement that we would be receiving returns from all boards by 30 April. I can, however, confirm that all boards that hold endowment funds have now responded to a letter from the DG Health and Social Care about their approach to and use of endowment funds. Those responses have been passed to Oscar to review, but I can confirm today that there was nothing in the responses that is a cause for concern and that no boards are showing retrospective use of endowment funds in order to improve their financial position as happened in Tayside. Those returns have now been passed to Oscar for external scrutiny and review. I will ensure that any recommendations from Oscar in relation to the future governance arrangements of endowment funds are fully supported. In conclusion, in my time with Scotland's health secretary, spending on health has seen the largest increase of any country in the UK and the largest increase per head on spending anywhere in the UK. I will always fight for the interests of our NHS. Reform of the NHS is equally as important as investment in it. I have set in train a huge range of actions to make the improvements that we need to see both now and into the future, including the new primary care workforce plan that was published just on Monday to sit alongside the other two workforce plans. There is much in our NHS and care services to be proud of, but I am not complacent. That is why I have set out the range of actions already under way. I have listened to calls for greater transparency around finances and have agreed to the actions today to deliver that. That is why the Government will continue its approach of meeting the challenges that we face, delivering sustained improvement and serving the people of Scotland both now and for the years and generations ahead. Thank you. I now call on Anas Sarwar to speak to you and move amendment 11984.1. Anas Sarwar. Presiding Officer, I move the amendment in my name. Another week, I am more appalling figures on the performance of the health secretary. This is not a one-off. This is the latest in a series of failures by this cabinet secretary. Now, while the Tory motion and the Government amendment focus on the financial impact, an important issue, both ignore the human consequences, the consequences for NHS staff who continue to go above and beyond and for NHS patients who are being let down by the failings of this Government. Every time there is a failure, we get the same old warm words and tired excuses from this health secretary when, year on year, her performance is declining. Declining performance on workforce, more than 3,000 nursing vacancies, one in three GP practices reporting a vacancy, with GP practices closing lists and some GP practices closing down. Hundreds of consultant vacancies and a doubling in the rate of early retirement on the health secretary's watch. Shona Robison is right to thank the staff, but her thanks is not enough. We cannot continue to overwork under resource and undervalued staff without there being human consequences. We heard last week from the BMA and the Royal College of Pediatrics such as the pressure on staff that are now real fears over patient safety. Do not forget that it was the cabinet secretary's best friend, Nicola Sturgeon, who is health secretary, cut the number of nurse and midwife training places, and we are now living with those dangerous consequences. Are NHSs in the midst of a workforce crisis for which Shona Robison must take responsibility? Failure on delayed discharge. In February 2015, Shona Robison promised, and I quote, I want to over the course of this year eradicate delayed discharge and absolutely determined to do that. But since that promise, more than 1.6 million bed days have been lost to delayed discharge, 1.6 million costing the NHS £380 million. Worse than the financial cost has been the human cost. More than 1,000 patients have died in hospital while trapped in hospital as a delayed discharge. 1,000. Another failure of this health secretary. On cancer, a national priority, in the last year more than 1,700 people suspected of having cancer had to wait longer than the expected treatment standard. Even after being referred for treatment by doctors, more than 1,200 people with cancer had to wait longer than the expected treatment standard. Shocking figures that expose the failure of this health secretary. Today, unbelievably, the health secretary sneaks out this report that shows that, rather than improving their performance, the Government's plan is to scrap the standard waiting time for cancer. Shameful behaviour from a shameless health secretary. On A&E, the report is right here, cabinet secretary. You wrote the forward. So far, no press release to go alongside it was snuck out today. On A&E, so far in 2018, more than 52,000 people waited longer than four hours. More than 7,000 waited longer than eight hours and, unbelievably, almost 2,000 waited for more than 12 hours. That is the same so far this year as the whole of 2017. Another failure of this cabinet secretary. On cancelled operations, to date in 2018, over 3,000 operations have been cancelled due to capacity or non-clinical reasons because hospitals could not cope. 3,000 operations. That is the consequence of the health secretary's workforce crisis. On the ambulance service, last week, Richard Leonard shared the terrible story of Margaret Goodman. We know that this is not an isolated case. In 2017, more than 16,000 people waited more than an hour for an emergency ambulance. 16,000 emergency patients failed by Shona Robinson. On budgets, health boards have to make over £1 billion of cuts over the next four years. In her own backyard NHS Tayside, she has to make £200 million worth of cuts over the next five years. The result is that the health secretary's own health board took money from charitable donations to support an IT system because of budget cuts imposed on them by the health secretary. So many people failed, 3,000 people failed in operations, 16,000 ambulance patients, 52,000 on A&E, 1,200 people on cancer waiting times, 1,700 people suspected of cancer, 1.6 million bed days lost on delayed discharge. She owes not just one apology, she owes thousands of apologies to patients across the country, yet no shame, no accountability and no responsibility from Shona Robinson. Because the uncomfortable truth, cabinet secretary, is that it isn't just opposition parties, NHS staff and patients that have lost confidence in you. Even SNP backbenchers are now briefing the media and calling on Shona Robinson to go. We have the bring back Alec Neill campaign, led by Alec Neill, and we even have the Jeane Freeman telling the media about how brilliant Jeane Freeman would be as the health secretary. In fact, it appears that there are only two people in the chamber who don't think that Shona Robinson should go, Nicola Sturgeon and Miles Briggs. While I understand why the Tories wouldn't want to talk about failing Government ministers resigning, who would have thought that it would be they who provided a fig leaf for the failings of Shona Robinson? I'm in my last 30 seconds, so I won't take the intervention. You can, if you wish, to this semester. I'm happy to take the intervention. Miles Briggs. I'd just like to know if the member could tell us how many times has he now called for the cabinet secretary to go. I think that at last count it was 11. Is that an effective opposition? I think that the interesting stat, Mr Briggs, is that, let's talk about the number of the health secretary's constituents who want her to go, a courier poll showing that 73 per cent of people in Dundee want the cabinet secretary to go, because Scotland's NHS needs change, change that starts right at the top of the organisation, because the First Minister has misplaced loylties. Her loyltie should be to Scotland's NHS, not to her friend. Do the right thing, First Minister, the right thing for NHS staff, the right thing for NHS patients and for the sake of Scotland's NHS, sack this failing health secretary. Mr Arthur, nobody can hear me calling the next speaker, because she's so noisy. Can I call now Alison Johnston, Ms Johnston, please? Thank you, Presiding Officer. I regret that we're called to address the financial problems facing NHS boards. In October, Audit Scotland's annual report on the NHS warned off intensifying pressures on our health service. It told us that achieving financial balances harder each year, and current approaches to making savings are unsustainable. Since then, new issues have come to light, not least the inappropriate transfer of e-health funds in NHS Tayside. Then we must turn to the matter of charity endowment funds being misused, and financial difficulties stretching way beyond Tayside. Many boards require brokerage in my own region, NHS Lothian. As we've heard, there's an indication of a £31 million gap in funding. The picture isn't uniform, but throughout Scotland there are boards struggling with delayed discharges, those who continually fail to meet CAMHS targets and ambulance, and boards where ambulance response times are not adequate. As the Royal College of Pediatrics and Child Health has highlighted, pediatricians, too, are under huge pressure. They advised that we need an additional 110 pediatric consultants over the next five years to just make sure that six children get the care that they need. All that raises the most serious questions about the oversight and governance of our health service and social care system. However, we cannot place additional pressure on health boards and IGBs to restore financial balance by making unsustainable short-term cuts to spending and services. Labour's amendment today is right to emphasise that financial pressures can be added to by a need to deliver financial efficiencies. As I think the Government's amendment also recognises, we need to address funding pressures at their root with progressive financial and fiscal planning necessary to ensure investment in Scotland's health, care and wider public services. I believe that NHS boards must be given greater ability to deliver long-term budget planning. My amendment, which was not selected for debate today, called for that. Audit Scotland has often recommended a more long-term approach to financial planning across the health service. Last year, it said that, driven by one-year funding allocations from the Scottish Government and the need to break even each year, the short-term approach makes it difficult for boards to plan and invest in longer-term policy aims—aims that we all share. I know that the Government intends to bring forward a financial framework for health and social care, but boards need more adaptability in their own right. In 2016, Audit Scotland recommended providing NHS boards with more financial flexibility, such as three-year rolling budgets, rather than annual financial targets. It also suggested reducing the pressure on boards to break even each year, stressing that even a small amount of flexibility at the financial year end can make a difference. In November, the Health and Sport Committee published its report looking ahead to the draft budget. Many witnesses stressed the need for a more sophisticated budget process. COSLA said that a short-term input-focused budget process is an inhibitor to genuine reform, and the Royal College of Nursing said that the constant annual cycle requiring budgets to break even does not allow the step change that we all seek and is desperately needed, and I urge the cabinet secretary to act on that advice. The committee's report also found that scrutiny of integration authority budgets proved very challenging, as there was, and I am quoting, little by way of information available on their financial position even at the most basic level. Given the astonishing lack of transparency, I agree that it is wholly appropriate to hold a progress review of integrated joint boards. We must afford Parliament greater opportunity to scrutinise the financial reporting, external audit and governance of the health service and social care system, and, if by amendment had been selected for debate today, it would have called directly for that additional scrutiny. As part of that review of integrated joint boards, we should be considering new ways of supporting local services that contribute so much to our health and social care system. I am confident that a review of integration authority finances and oversight of the challenges that they face will clearly indicate the need for local tax reform. Local authority budgets are under pressure, as we know, hampered by the out-of-date regressive council tax. If we are really serious about an integrated approach to health and social care, we cannot simply focus on NHS budgets every time we have a debate about strains on our health service. John Scott. What such a review is your talking about had your amendment been accepted and thank you for taking my intervention. I have included your concerns about the 494,123 days lost to the health service through bed blocking. Is she happy that her party is supporting the Government in this view? Alison Johnstone. It is absolutely essential that, if we review the issue in the round, we will see that the pressures on local authorities make it difficult for the change that we need to see delivered in social care. If local authorities were better supported, we would see more social care delivered in our communities. That would make a significantly positive impact on what is happening in our health service directly. The member is playing for better support and better finance for local government. Can she explain why she voted for the budget? Alison Johnstone. I voted for the budget precisely because I care about local government and I could not countenance sitting back, shouting from the sidelines and doing precisely nothing. Presiding Officer, as I was saying, we have to look to local authority finances too and give communities new opportunities to prioritise key services like social care. More progressive local taxation will not only benefit health and social care, but public health too. Being bold on local tax reform, as Naomi Eisenstadt recommended, will have important implications, particularly for working households at or just above the poverty line. The Government's amendment recognises that progressive financial and fiscal planning is needed to sustain our health and social care service. On recruitment challenges, I have made the point that we really need to open up access to medical training places to students from low-income backgrounds. I know that many of our universities are leading excellent work on that, but I worry that the Government is focused too narrowly on increasing application from the most deprived post-scodes in Scotland. It is not right that a student from a low-income background might miss out on widening access opportunities because they do not live in a priority postcode or they do not go on to a target school, so I would ask for a broader approach on that. I would also like to see this Parliament work together to tackle drug price inflation. I think that we must take it as a given that the cabinet secretary is accountable for NHS governance and performance. Indeed, the cabinet secretary has made it clear that she would not have it any other way. Greens will support the motion and both amendments today at decision time. I think that demands in both the opposition motion and amendment are reasonable and the Government must take action to realise that there is absolutely no room for complacency. I am grateful to the Conservative Party for bringing this motion to Parliament today. I am dismayed, however, that, given the coverage and national outrage that was met with the NHS Tayside scandal over Easter, the debate has to fall in opposition time and was not brought forward in terms of Government debating time so that this Parliament could have given it the full oversight that it deserves. Miles Briggs rightly pointed out and reminded the chamber I will give way to the cabinet secretary. Just to remind Alex Cole-Hamilton that I did come and make a statement on the issues of NHS Tayside, which gave members an opportunity to ask any questions that they wanted at that point. We are waiting for reviews. I am happy to come back to Parliament once we have those reviews. Alex Cole-Hamilton I freely accept that. I welcomed the statement at the time, but it did not give the full sum analysis that this Parliament deserves and the other health boards that these issues affect in as much. Miles Briggs reminded the chamber and it is a matter of public record that I have called for the cabinet secretary's resignation. It is not a view that I came to lightly and I take no joy in it. I have an immense amount of personal respect for the cabinet secretary, but, as Miles Briggs reminded the chamber, there are light bulbs flashing all over the dashboard of our NHS in warning of the many problems that it faces. The cabinet secretary and her Government have repeatedly ignored the will of this Parliament in things such as service redesign, particularly around the closure of local hospital wards. They have been met with a string of mis-targets highlighted by the Audit Scotland report. It is the events of Easter that were the very much straw that broke the camel's back from my party in respect of the idea that we can go this far and no further. In NHS Tayside, we saw that not only was there an element of cooking the books where £5.3 million pounds of digital health money was recycled to make those books look more healthy. We saw the revelations of charitable donations that were given to that health board for things like patient comfort and other extraneous purchases being used to plug gaps in their IT system to the point where they now have a £44.1 million shortfall. I learned that this week we are seeing a ban on GPs prescribing paracetamol as a means of making that gap. Such is the nature of the abject distress that health board is in. That was met with a response whereby the chair of that health board, Professor Connell, was managed out. He was asked to resign. I was in temperate in my response to that, Deputy Presiding Officer. I thought that that was right. It was right that somebody should take responsibility. Only then did I learn that Professor Connell had actually that the events that led to his departure had predated his tenure there. Such is the nature of this Cabinet Secretary looking for a full guy in this case. I will give way again to the Cabinet Secretary for Health and Sport. On that point, we will recognise that this predated my term in office as well, but I am taking responsibility for it. Alex Cole-Hamilton Perhaps in your closing, the Cabinet Secretary for Health and Sport's remarks at the end of the debate. Just a wee minute. I cannot hear anything. Thank you. Then perhaps the Cabinet Secretary might want to address exactly what he was not doing fast enough which led to his resignation and whether she can extend comfort to chairs of other NHS boards who might be worried that they have to take the fall for this Government irrespective of who the Cabinet Secretary was at the time. We hear, as Miles Briggs rightly points out, that NHS Lothian, my own home health board, £31 million a drift of spending of where it needs to be to keep services at 2017 levels. I am very grateful for the Labour Party for bringing their amendment today because it does widen this debate. This is not just about finance, it is absolutely about the absolute litany of missed targets within this health service. We saw the impact of poor Government policy measured out in the fact that a 23 per cent cut to ADPs, alcohol and drug partnerships in this country has led to the highest drug-related deaths in Europe—absolutely scandalous. It is at times like this that we need to turn to this Government and say that your Government and your party have been found wanting. In bed blocking, in the fact that on any given night in this country, 1,000 people will be saying in hospital beds when they are fit to go home because there is inadequate social care coverage for them to go back to. I want to pay tribute to the cabinet secretary. I want to thank her for taking up the case of William Valentine, who I raised with her in the committee yesterday. I am grateful for the correspondence that I received. William is just one of 1,000 people who, on any given day, are spending more time in hospitals than they require, and that causes an interruption and flow throughout the rest of our health service, which sees elective surgical operations cancelled, which sees four-hour waiting times in A and E, absolutely never achievable because there are no inpatient beds for those people in acute receiving units to be received into. I will, if I have time. John Mason I thank the member for giving way. Can he tell us what he is arguing for? Is he arguing for a reduced budget for the health service and more for local authorities so that they can provide more care at home? Is that what he wants? I am very grateful for the member setting me up for this point. There is no in the national performance framework, the health outcome in our national performance framework, the indicators underpinning it contain not one reference to social care. It is the landscape gap of social care in this country that is the problem. We are not paying our social care workers enough. There is not enough provision within the sector and, as a result, people are languishing in hospital when they should be in their communities. I will finish on the point about mental health, because I always come back to mental health because it is a national outrage. If your child were to fall off her bike and break her arm, you could expect her to be in plaster by the end of the day. However, if she were to come to you with anxiety or depression or eating disorders or any other kind of mental health problem, you can expect her to join one of the longest queues in our health service, and that is a national outrage. It is not just child and adolescent mental health, it is adult mental health as well. James Joplin from the Samaritans just this very morning responded to the national suicide action plan by saying—this is an astonishing assertion from the director of Samaritans in Scotland—that the Government just is not taking suicide seriously. We were waiting a year longer than we should have for that action plan, and it has been found severely wanting. The Government needs a whole-systems change approach to our health service, and unfortunately, for my party, that change now starts at the top. Thank you very much. I now move to open debate. Liz Smith, to be followed by Ash Denham. Liz Smith, please. Thank you, Deputy Presiding Officer. I think that everyone in this chamber can agree that the creation of the NHS 70 years ago was one of this country's greatest achievements, mainly because it was a universal service based on clinical need rather than on patients' income. With the passage of time, however, those needs have changed, in some cases beyond all recognition, and with them the ability of the NHS to deliver on its founding principles. Demographic changes are obviously largely the issue, but so too, ironically, is the success of the NHS. With many more people living so much longer as a result of vastly improved treatments, the challenge of delivering universal care will always be one of those most difficult confronting any Government. There are also many more people living longer, with chronic ill health, and that includes mental health. Many experts and health professionals believe that this makes the case for integrated health and social care incontrovertible. In particular, we need to find ways to ensure that older people do not overstay their time in hospital if they can be looked after at home and in their communities. It is hard to argue against that, which is why no political party is in the way of integrated service approach. The debate, however, is raging about how that integrated approach should be managed, and it is in that context that we are challenging the SNP this afternoon on its record. I want to use the example of recent issues with NHS Tayside to give substance to my argument. I have no doubt that the very serious problems that have been exposed with NHS Tayside and indeed other boards in recent weeks will have a long way to run, until the detail is uncovered about who authorised some really bad decisions, including the misuse of charitable endowment funds, something that has rightly appalled the public. Both the official inquiries and the spotlight from the media will eventually spill the beans on who knew what, when and who made the mistakes, and it is not for me to comment on that until those inquiries report. However, in the meantime, the current controversy has shown up other issues about the SNP's running of NHS boards. How can it be right that those trustees who sit on the boards are responsible for overseeing the spending of taxpayers' money and also being responsible for overseeing the spending of charitable donations given by patients and their families? Of course. I think that Liz Smith raises a very important point, one that she has raised in this chamber before. I hope that she will acknowledge that, as I have said to her before, Oscar has already signalled that he wants to work on the guidance and look at those governance issues, because I agree that that has to be fundamentally changed. I am very glad to hear that, cabinet secretary, because I think that there are very serious questions that have to be answered about that. I have to say when the reports come in, as it is not for me to comment just now, but I think that there will be serious questions about the workings of the Oscar process and about the way that the Scottish Government oversees a lot of the financial management of the NHS. Those are the issues, especially when it comes to dealing with charitable endowments. A period of four years elapsed before any real action was taken. In a letter to one of my constituents, Oscar confirmed that it did not know about the NHS Tayside scandal until 4 April. It looks as though the Scottish Government might not have been aware of the issue until around that time. That begs the question, how can four years go past? I know that it is a topic that Jenny Marra has taken up with the Audit and Communities Committee. That, cabinet secretary, is inexcusable. Liz Smith agrees with me that there are lessons to be learned for all of us, including the auditing processes, because it is important that issues like that are flagged and qualified in reports that come to the Scottish Government or any other public body. Liz Smith? Yes, I do, but I think that the Government has to understand its responsibility in that context, too. May I go on to the issue of IGBs? I do not believe that the cabinet secretary has a letter from me about that. I do not believe that the IGBs have clear lines of responsibility. There appears to be an inequity in the balance between the health and the social services expertise, and the tendering process, which allows third sector organisations to play their part in assisting with the provision of services. It is not, cabinet secretary, working well. It puts councillors in an impossible situation in some cases when they serve on an IGB and it undermines the accountability that all our constituents should expect from their local health boards. After speaking with several councillors, NHS officials and patients, it would appear that there are considerable concerns about the functioning of IGBs, which I am led to believe that the cabinet secretary has been told by members of her own party. Some very senior health officials are making the point that they find it difficult to know who has ultimate responsibility for many decisions within health and social care with the result that there is this lack of accountability. I hope that the seriousness of those concerns will be due, cabinet secretary, to authorise a full review of the IGB, as it has functioned in its first two years, to examine the issues that have been raised and to make the necessary changes that will ensure that both our health and social care services are fully equipped to deal with the extensive demands that are made upon them. As was mentioned before, the running of the health service will never ever be easy, but it would surely be given a better chance if ministers can get a grip of what is really wrong in that management process. In that respect, cabinet secretary, I really do think that it is a very urgent and pressing issue. I obviously support the motion in the name of Miles Briggs. The Scottish Government acknowledges that there is still progress to be made within the NHS. It is open about this and rightly so. The cabinet secretary has been similarly open about the situation in NHS Tayside recently, addressing it, putting in place measures to resolve it in a timely way and to support positive change moving forward. We now know that new leadership is in place, having approved the appointment of an experienced interim chair and working with NHS Scotland to appoint a new acting chief executive. An independent investigation by Grant Thornton has been commissioned, and the Scottish Government is also providing on-going support to the board through the transformation support team. The Scottish Government is also developing a medium-term financial framework to support national, regional and local financial planning for the next five years. That will, among other things, outline the broad direction for the NHS and care services to meet the changing needs of the people of Scotland, including shifting the balance of care towards community health services. However, there is a wider point to be made here about working towards, as I believe we are, the very highest standards of organisational governance in the public sector. To improve levels of things such as public engagement, transparency and decision making, and, in the case of health boards, diversity on boards and on-going training and support to members of boards so that they can carry out what is a very demanding role well. The Health and Sport Committee recently looked at governance in the NHS, and some of the board members who came in to give evidence to us expressed frustration over how difficult a role it was to fulfil effectively and that a greater level of training and support could be given to them as well as more opportunities to learn from what is working well in other board areas. I believe that they were constructive comments. Now I turn to the Conservative motion. The Conservative motion today makes mention of the financial pressures on the NHS, but it fails to make the obvious connection to the source of that pressure that there are direct result of the austerity policies enforced on the UK and Scotland by the UK Government in Westminster under the Conservative Party's misguided ideological approach. Let us never forget that austerity is a choice abandoned now by countries across Europe, I will. Liz Smith, I thank the member for taking intervention and preparation for today's speech. I look through a lot of the evidence for the Health and Sport Committee and various other health professionals. Not once was it mentioned about UK Government issues, it was mentioned about the structures and the spending issues here in Scotland. The Conservative motion explicitly makes reference to financial pressures on our public services, and that is what I am addressing here. We know that the block grant is being affected by declining amounts of money to Scotland from Westminster. I would like to know when the Conservatives in this chamber will concede the effects of their own policies on Scottish families across the country. Until we do that, we cannot have a sensible conversation about any of this. The Scottish Government has faced an 8 per cent cut to its discretionary budget over 10 years, worth £2.6 billion in real terms. The block grant from the UK Government for day-to-day spending over the next two years is projected to fall by £500 million. The Scottish Conservatives are right to draw attention to the cuts and the financial burden that it places on the Scottish Government to deliver its ambitious plans for the NHS in Scotland, but they fail to explain again how they would do anything differently in this matter. The Scottish Government has and continues to mitigate these cuts and protect and prioritise our NHS, an increase to the health portfolio resource budget this year by more than £400 million, taking it to a record high of over £13.1 billion, investing £2 billion more in health resource spending by the end of this Parliament, the highest investment commitment of any party in this chamber, increasing support for primary care by a further £500 million over this Parliament, and those commitments are enabled by an ambitious budget that prioritises our NHS and aims to create a Scotland that is fairer, more equal and more prosperous. It is a budget that both parties on either side of this chamber failed to back. The budget is an exercise in the Scottish Government using its devolved powers to protect investment in our NHS, and it is delivering that. An additional £867 million for investment in public services that otherwise would not have been available. If I remember it correctly, the Tories have made over 100 demands for increased public spending while also demanding a £500 million tax giveaway to high earners and businesses. It did not add up then, and it does not add up now. In conclusion, I would like to tell the story that I found this morning on care opinions about a patient that was in a hospital in my constituency, which is Edinburgh Royal Infirmary. My dad was in ward 106, base A, for his last few weeks. I just wanted to say how amazing all of the staff were. Not only did they look after him and gave him great treatments, they were also very friendly and understanding. They were very patient with my dad, even when he was delirious and when he was causing them a lot of work. They were all amazing people, and I could not have asked for anyone better to look after my dad in his last few days. I know that he was treated well and with great respect and care. So, for the parties in this Parliament to come to the chamber without any or many constructive suggestions for how to improve the health service is incredible. It is not the serious approach that this subject and that Scotland also deserves. Thank you. I call Edward Mountain to be followed by Stuart McMillan. Mr Mountain, please. Thank you, Presiding Officer. There has been much talk already this afternoon about NHS Tayside, but it is not just NHS Tayside because my mailbag is full of letters from constituents who are rightly scared about the future of local health provision. The time for excuses, especially in the Highlands, is definitely over. Why? Well, because we seem to lurch from one crisis to another, and enough is definitely enough. Let me be clear, closing wards, centralising services definitely comes at an expense, an expense to the care of patients. It is not the suspension in the Highlands of out-of-hours care services in Portree hospital. It is the downgrading of wards, such as the Catherness maternity unit. It is not the reduction of beds of new craigs psychiatric hospital, then it is cuts to pallative care and psychiatric care in Badknock and Straths Bay. If it is not the fact that more operations are being centralised in Rhaigmore when patients could be treated in hospitals such as the one at Gullsby, then it is the constant threat of closures that hang over the town and county hospital in Wick and the Dunbar hospital in Thurso. It does not stop there. There are cancellations of hospitals in Rhaigmore due to about just about every reason imaginable. There is failure to meet 12-week waiting time targets for cancer patients, a shortage of DPs across the Highlands, and increasing local costs. I could go on and on and on. Such shameful leadership of NHS Highlands means that patients are not receiving the standard of care that they are entitled to. No, I am afraid that I am short of time and I want to give way to the Cabinet Secretary in a minute, so let's see if she is going to ask, and if she doesn't, maybe Mr Arthur will let you in. We know at this stage that there is about £15 million of overspend in the 2017-18 in the Highlands. We also know of the maladministration of health contracts, and those issues all have the underlying theme of mismanagement and lack of leadership. If the Scottish Government truly had confidence in the management of NHS Highlands, then why did it commission John Brown to undertake a review of the corporate Governments of the Health Board? No, Cabinet Secretary, that is not the one that I am going to let you come in on. There are questions being asked, and here we go, Cabinet Secretary. Here is your moment. Let's try the simple question, Cabinet Secretary. Does the Scottish Government think that it is acceptable that NHS contracts that have been awarded have not been audited for 20 years? Would you like me to give way on that? Would you like to come in on that? I would like to come in on both of those points. Cabinet Secretary, I have to call you first. On both of those points, the member will be aware that one of those contracts dated back to 1998, and no, that is not acceptable, and NHS Highland itself has said that it is not acceptable and will act on the recommendations of Audit Scotland. On the other issue of John Brown doing the governance review, the governance review in Highland is a pilot about strengthening governance within our NHS. It started in Highland, the lessons to be learned elsewhere. Surely that is something that he would welcome. Thank you, Presiding Officer. First of all, I am delighted that Cabinet Secretary believes that handing over money for 20 years with no record of outcomes is unacceptable. As far as the John Brown review of governance is, I am going to wait to see what he says before I comment on what he has produced. Now, let's go back to that. Audit Scotland, when it came to contracts, recently condemned NHS Highland, saying that contract monitoring was inconsistent, informal and not documented, and concluded that NHS Highland couldn't demonstrate the achievement of value for money. Apparently, when it came to it, it couldn't even list the names of the patients who had undergone treatment. That's a pretty damning verdict, one that shows how far the management of NHS Highland's Audit Committee is. Now, NHS Highland has promised to fix that and to monitor their performance via its own Audit Committee. The Audit Committee that is dysfunctional will audit itself. I am struggling with that on Cabinet Secretary, I really am. Surely if there is a problem, you put it out to somebody else to find out what the true extent of the problem is and then resolve it. Real change is needed. I would like to join with Miles Briggs in calling for more parliamentary scrutiny over NHS finances. I urge the Scottish Government to publish the current financial position of all NHS boards. The public has a right to know the scale of the financial crisis, not any effecting of the NHS but NHS Highland and how that will impact on the standard of care that they can expect to receive. We already know that NHS Highland has been tasked by the Scottish Government to find £100 million of savings by 2020, but how is that going to be achievable when they have failed to achieve the savings that they needed this year and have had to seek £15 million of brokerage for next year? That means that not only will they have to find the £15 million of savings that they have failed to find this year, but they will also probably have to find the money that the Scottish Government is lending them on top of that. That means more pain for the people who are expecting services that they are not getting. The member is coming into his last few sections. Does that mean for our health service in the Highlands and Islands? It means probably closing more wards and centralising local services, which I do not believe is the answer. In times of adversity, our doctors, nurses and healthcare professionals who continue to work harder than ever before, are being let down by the management of the NHS in Highland, and I believe by the Scottish Government. It is not too late for NHS Highland and the Scottish Government to improve the financial health of our NHS, but it will take good leadership, something that we do not seem to have. I believe that it is time for change. Somebody needs to rise to the challenge of this, and I just wonder who that is going to be. I call Stuart McMillan, to be followed by Neil Findlay. Thank you very much, Presiding Officer. There are a few points that have been raised today regarding finance and challenges. The amendment that is put forward by Anna Sarwar speaks about the finances, and Alison Johnstone's comments and Erdal Mountain's comments a few moments ago touched on it as well. The issue of brokerage has been raised. The issue of brokerage is not new. That is something that has been in the NHS system for some time. Certainly, if you go back to the 2007 New York committee of this Parliament and the work that this committee undertook regarding the situation of NHS Western Isles, the issue of brokerage was something that was utilised to try to get that particular health board into a situation that was once again manageable, as compared to the mess that it was in. Miles Briggs talks about challenges. The one point that I will agree with Miles Briggs on is that there have always been challenges in the NHS, and there are challenges now, and there will always be challenges in the future. As the cabinet secretary said in her opening comments, with an organisation of the size of the NHS in Scotland, there will always be challenges that will come up from time to time. That is something that across the chamber we can all agree on. Certainly, but one point that is also extremely important is that if politicians from all sides are actually going to be fair and if they genuinely recognise the success stories as well as the challenges that the health boards and the Government accordingly face, it is an important aspect of the health journey. However, it is to actually learn the lessons of the past and also work to deliver the service so that it does not make those same mistakes going forward. I am going to touch upon some positives as well as some of the challenges. First of all, on the positives, faced with the £2.6 billion of Tory cuts over the 10 years, including the £200 million cut to day-to-day spending this coming year, the Scottish Government is using the devol powers to protect investment in our NHS. The Scottish Government is fully funding the NHS with a £400 million increase in spending for the health year. Changes to tax mean that they do not have to reduce other services to back the NHS. The budget is now £13.1 billion, and I will take your intervention. Miles Briggs has taken the intervention himself and Ash Denham have misread the chamber in the sense of the funding changes in both England and Scotland. NHS funding in Scotland is growing at half the rate of the increase in England. Had health spending under this Government kept pace, we would have seen an extra £1 billion a year in our health service. That is the facts in truth that members need to tell people in this chamber. Stuart McMillan Miles Briggs should know that every penny that has actually come to Scotland has actually went into the NHS. If Miles Briggs wants to say something otherwise, he has been disingenuous to this Parliament and disingenuous to the electorate in Scotland. There is also another element in the finance. The amounts mean that it is an uplift of 3.4 per cent in cash terms and 1.9 per cent in real terms. According to the Scottish First Commission, the changes to the draft budget announced that stage 1 of the budget bill will raise £290 million in 2018-19 to support public services and Scotland's economy. A second point was in March. March saw an unseasonal cold weather with Scotland's first-ever-read weather alert across large swath of the country, and the army provided assistance to get staff and patients to and from hospitals through deep snow. Until those 25,390 aeronautical operations took place in March 2018, compared to 23,664 in the previous month, that is a 7.3 per cent rise. I think that the chamber should be saying that it is well done to our hard-working NHS staff for their dedication and even more the fact that they fought through the snow to get into the work through the dangerous weather conditions to deliver those services. A third point, and only last week, a report to Inverclyde Council's Health and Social Care Committee highlighted Inverclyde's performance in ensuring that people spend the minimum time in hospital bed when they are ready to be discharged is among the best in Scotland. The report also marked a reduction in bed days lost—that is the number of days individuals are waiting to be discharged. The chair of the committee at Labour's Council, Robert Moran, is quoted as saying, that this is excellent news for patients, families and carers. The council, through the Inverclyde Health and Social Care partnership, have made delayed discharge a priority to ensure that older people do not spend longer than they need in hospital. Briefly, Ms Baillie, as members come to the end of his time— Of course, I am delighted to hear the member praising a Labour council, and I am sure that they will enjoy that too. I wonder whether he would comment on the fact that there are £90 million worth of repairs required at Inverclyde royal. What is he doing to progress that? Stuart McMillan I think that, as my constituents will know, I am on record of saying—and I think that anyone in this chamber would actually understand—that no building is going to last forever. There will have to be either repairs into the building or there is going to be a new hospital at some point in the future. The fact that the building was built where it is on the top of a hill is an ridiculous situation that took place at the time. A final positive point is that, with the great news of the new Greenock health centre that is going to be built, it is going to progress this year and, with the official opening of the Replacement Ravenskirk hospital, it is the orchard view that took place last year. Unfortunately, that is the positive. I do not get time for the challenges because of the interventions. I am sure that any fair-minded MSP in this chamber will recognise that every single health board has to live within their means. We only have to look back to NHS Argyll and Clyde under the shambles that was the Labour-Lib Dem Scottish Executive when it had to be disbanded. I also had to have £82.3 million put in to plug its debt. The NHS West announced shambles, which was on the committee, and Clare Baker was on the committee with the shambles that was the case. I will take absolutely no lessons whatsoever from Labour, the Lib Dems and the Tories with the mess that they have with the NHS down south. I will take no lessons from them because I know that although there are challenges and there will continue to be challenges in the NHS in Scotland, I know that there is only this SNP Government that has the NHS in Scotland at its forefront, and we are certainly to deliver for all the people of Scotland. Thank you. Just before I call Mr Finlay, can I remind members that if you intervene, you must press your request to speak button again, please? You are not listening to Ms Bailey, it is for you. I call Neil Finlay to be followed by Claire Hawke, please. Thanks, Presiding Officer, and I declare an interest in that my wife works for the NHS. I hear from her every day about the good that goes on in the health service. I have to say that the Scottish Government is very skilled at PR when it comes to the NHS in Scotland. The First Minister has often seen, along with the cabinet secretary, out and about with the cameras when there are good news stories, rightly so. He would be forgiven for thinking though that the NHS in Scotland was streaks ahead in a beacon of best practice for everyone else to follow, but sadly the reality is often very different. For every MSP in this Parliament, the NHS must be at or near the top of its post bag. We can week out at question time and in the media we see MSPs of all parties raising cases and concerns about health and social care, because any waiting times are grown. Cancer waiting times are again not being met. Last year, 16,000 people waited one hour for an emergency ambulance. Scotland has the highest level of drug deaths in Europe, three times the level of elsewhere in the UK, and 363,000 bed days in Lothian were lost last year due to delayed discharge. Before we hear any more patronising nonsense about talking down the NHS or undermining staff, let me say this, it is the staff themselves who are raising many of those issues with us. They are burnt out, shattered, under pressure and stressed like never before in their careers. They are the ones who care most of them and have invested their career in the NHS, and we have a duty to stand up for them and be their voice in this Parliament. Let me focus on how things are impacting on people on the ground. Lothian patients are having to wait 44 weeks just to see an orthopedic specialist, not for treatment, merely for a consultation. One of my constituents who works in the gym was forced off work with a leg injury and waited so long for an appointment that an employer was threatening her with the sack. She is far from alone. I have many orthopedic cases in my constituency case load. I see patients moving into new communities and unable to register at their local GB because 40 per cent of lists in Lothian are closed. I have a relative who is in St John's and is ready and wants to go home but can't because she is waiting on a package of care. That bed space could be freed up for another patient. 1.6 million bed days like this have been lost since the cabinet secretary said that she would eradicate delayed discharge. We are rapidly heading for the first anniversary of the closure of the St John's children's ward to end. Patients are out of ours. Parents are having to drive if they have a car. They are sick and injured children passed their local hospital to Edinburgh because the ward is closed at evening and weekends. The RAH, children's ward, has already closed. We all know that general practice is so critical to the wellbeing of the NHS, yet it is in crisis. According to the Royal College of GPs, there is a shortage of 856 GPs across the country. Just last night, in the village of Stonyburn in my region, a village of just 2,000 people, 300 residents turned out to a public meeting to protest with one voice about the proposal to leave the village with no GP provision. That is more than one in seven of the population. Like many other practices across the country, the local GPs are retiring and there are zero applicants to take over. Ten years ago, I am told that there would have been a dozen applicants, now none. What does that mean for local people? If you have a car, you can travel. If you do not, there is no footpath to walk, so you need to use the very poor and infrequent bus service at a cost of £4 a return, seven if you have a sick child with you. For the people in this position, healthcare is no longer going to be free at the point of need. That is an abject failure of long-term planning and general practice across Scotland by successive health secretaries. The age profile of GPs surely cannot have been a surprise to the Government. We have a system at the moment that would collapse without locum cover, which is costing around £500 a day in Lothian, £850 a day in Lanarkshire, and in Orkney, it is paying up to an eye-watering £1400 a day for locum cover to try and keep the system going. Add to that the millions-loss re-increase of agencies that charge extortionate amounts, and is it any wonder that health board finances are at a critical level? Presiding Officer, the Government's stewardship of our NHS has been dreadful. In the past, a First Minister resigned because of an issue in an office lease. Stewart Stevens resigned because it snowed. Today, we have a Cabinet Secretary overseeing the worst waiting times on record, delayed discharge increase, a crisis in general practice, wars being closed, NHS finances in such a state that are robbing the charity box to try and keep services going, and yet she retains the confidence of the First Minister. The Government likes to claim credit for good things. Now the Minister and the Government must accept responsibility for the bad. I call Clare Haughey to be followed by Annie Wells. I would like to begin by referring members to my entry in the register of interests, in that I am a registered mental health nurse, and I am currently holding an honorary contract with NHS Greater Glasgow and Clyde. As a mental health nurse who has worked in the NHS for over two decades, I am very well aware of the challenges that it is facing today. Thankfully, our population is now living longer due to advances in medical treatments and care, and therefore the pressures and demands on our NHS are growing. To meet the challenges that our health service is facing, the Scottish Government has undertaken major reforms by integrating health and social care, as well as investing record levels in our NHS, topping £13 billion this year in spite of on-going Tory austerity. Today's Conservative motion references how financial difficulties are being faced by health boards across Scotland, and that is, of course, true. However, I would go much further. Financial problems are being experienced in Northern Ireland, in Tory run England and Labour run Wales NHS. The challenges faced by the NHS Ayrshire, Tayside and Lothian are not unique to Scotland. By way of example, in England, 83 per cent of acute hospital trust were in deficit to the tune of £1.5 billion according to figures released in September last year. The Howell-Dah health board in Wales, which serves Carmarthen and Pembrokeshire, has a budget deficit of around £69 million, and the largest health board in Wales is also subject to a charity cash pro. Being a healthcare professional myself, I fully appreciate the concerns of the public and politicians regarding the spending of charitable donations in NHS Tayside. It is imperative that health boards use such money appropriately and for their intended purposes. The inquiry into the Tayside endowment fund by the OSCR is the correct step, and rightly, NHS Tayside has proactively agreed to repay the money to the endowment fund. If any expenditure in any health board across Scotland is deemed to be inappropriate, then I agree with the Scottish Government in that it must be paid back to the charitable funds from which it came. I hope that the opposition parties will join me in welcoming the requests made by the Scottish Government to the chief executive of NHS Scotland to write to every NHS board chair seeking assurance that endowment monies are being spent for the correct purposes. When the issue was brought to the attention of the cabinet secretary, she took immediate action for which the Conservative motion is calling. She has taken the decisive step to replace the NHS Tayside leadership team. She has authorised further brokerage to the health board, and the Scottish Government is continuing to work to improve governance and organisational performance across the public sector. I had hoped that today's debate would have been one of which proposals and ideas would have been forthcoming from opposition parties about how we can improve governance and the performance of our NHS, but instead it is merely sought to add to the witch-hunt against the Government. Both Labour and the Conservatives have been incredibly predictable. When a challenge faces the Government, rather than suggesting reasonable proposals and working with them, they revert to the only two things that they know. Call for the Government to spend more money and urge resignations. It is noticeable that the Scottish Conservatives— It would seem clear that Ms Hawke is not taking interventions. I will further on, Presiding Officer. It is noticeable that the Scottish Conservatives have been utterly silent on the sham of the health service that Jeremy Hunt is presiding over in England. An English NHS, which the Red Cross once described as facing a humanitarian crisis and has been rocked by junior doctor stripes. The silence has been deafening from Scottish Labour, too. The Welsh NHS is consistently among the worst performing in the UK, yet the cabinet secretary presiding over it is a favourite to become the next First Minister of that country. I will take Mr Finlay's intervention. Neil Findlay. I am a member of the Scottish Parliament responsible for my constituents here, just as is the member. I wonder whether she could tell us what comfort or what advice she could give to the 300 people who came to the public meeting last night at Stonyburn and said that they were not accepting the fact that they would no longer have a GP in their local community. I thank Mr Finlay for his intervention. You cannot always compare health systems across the world, but you cannot compare health systems across the UK, and the Scottish NHS consistently outperforms every other day on these islands. The very fact that both parties voted down the Scottish Government's budget early this year shows that they are happy to play political football with our health service. That was a budget that would have allocated more than £400 million in additional funding, yet neither voted for it. The fact remains that Labour promised less money than the Tories for the NHS at the last Holyrood election. Coupled with Tory austerity, I do not know how either party can keep a straight face when it comes to complaining about health service finances. I am resolute in my belief that our NHS is better off in SNP hands, and the proof of that lies in the woeful state of the NHS in England and Wales, where the Tories and Labour are in charge. Yes, they do not want to hear it, but they must hear it—privatisation by the back door and the front door, trust-canceling weeks of planned surgery and eye-watering waits at A&E. You would almost think that there was a plan to run down this most cherished public service. The whole-sale privatisation was seen as the only viable alternative. Today's debate comes in the same week as three positive news stories about Scotland's health service. Excuse me, Mr Dornan, you will get your turn shortly. Carry on, Ms Hawking. Part 3 of the national health and social care workforce plan was published, with £7 million investment in nurse training. I warmly welcome that. Scotland's A&E figures once again show that it will be the best in the United Kingdom, and this in the week with the Scottish Government's minimum pricing policy has finally come into force. Yes, our health service is under pressure, and yes, particular health boards have more challenges than others, and they must be addressed. We have not heard from any MSP today why the issues facing particular health boards are the direct fault of the cabinet secretary herself, and petty games like this trivialise our politics. We should let the cabinet secretary get on with her job in improving our NHS, the one that is already outperforming all the others on these islands. I remind members that they should always speak through the chair. I can have annuals followed by James Dornan. Thank you, Deputy Presiding Officer. I am pleased to have the opportunity to speak in today's debate about the severe financial problems facing NHS Scotland. Across Scotland, we are seeing daily articles on financial problems up and down the country, and rightly so, people are very worried. The Scottish Conservatives wish to see a Government that has control over health spending and one that promotes financial transparency, which is why I too echo calls made by Miles Briggs. The SNP has been in charge of the NHS in Scotland for over a decade, so it is absolutely right that we shine a light on this issue. Despite the SNP's spin on this, spending is not keeping pace with increased demand, nor is it keeping pace with increases that Scotland has seen in barnacle consequentials. Health spending in Scotland has increased by just 5 per cent between 2012-13 and 2016-17. Will Annie Wells accept that every single penny of health resource consequentials have been passed on to the health budget in Scotland and, indeed, more money in addition to that? Will Annie Wells tell us, if she thinks that more money is needed for the NHS, how much and from where? Annie Wells, maybe we actually need to look at how the money has been spent within the NHS to make sure that we are focused on the places where it is needed. In my region in Glasgow, spending is stagnated. In the Government's draft budget, the NHS Greater Glasgow and Clyde, the budget showed a real-terms cut of £22.5 million, and it is reported that NHS Greater Glasgow and Clyde was facing a funding deficit of up to £20 million. Quite clearly, the health board is under huge financial pressure, and this is only being made worse by the mismanagement of the NHS by this SNP Government. As confirmed last year's Audit Scotland report, the SNP has failed to effective a plan for the future when it comes to the workforce. One in four GP practices in Scotland has a vacancy, for example, and there are over 2,500 nursing and midwifery post line vacant. As a result of that, we have seen spending on temporary staff soar. Last year, spending on plugging staff gaps broke the £300 million mark for the first time. From 2014-15, that was an increase of more than £100 million. As a ripple effect the SNP's failure to provide adequate community care for the elderly, we have also seen increasingly high levels of bed blocking. In 2016-17, more than half a million bed days were occupied by patients who were fit to leave, the majority of which were elderly. Delayed dish charges are estimated to cost £132 million a year, and only yesterday a new figure showed a 3 per cent rise in March this year, as compared to March 2017. I would argue too that we are seeing little in terms of preventative spending, a move that would ease financial pressures in the long run. When it comes to alcohol and drugs, for example, we have seen a 22 per cent cut to ADP funding, a move that is described by the BMA as a false economy. In Glasgow, a city that has complex history with drugs and alcohol, we have seen NHS Greater Glasgow and Clyde use endowment funding for a proposed safe heroin injecting space money that could have instead been used to get people off those drugs altogether. The impact of that is, of course, huge. We can see the effect that understanding and underfunding has had on performance. Last year, the NHS only met one of its eight key waiting time targets. More than one in eight cancer patients are waiting more than six to two days for urgent drug treatment, and more than a quarter of children are waiting far too long for mental health treatment. Not at the moment, thank you. In Glasgow, I am currently dealing with a case of a young girl with spina bifidae who needs an operation that could dramatically change her life. However, she is having to wait until the end of the year due to lack of consultants. That means that, from March of last year, she is attending A and E on average twice a week. That is not on Cabinet Secretary. To finish today, I would like to echo my colleagues' calls for better control and for more transparency when it comes to NHS spending in Scotland. The SNP can no longer bury its head in the sand when it comes to public health spending. We are seeing a health service that is underfunded, understaffed and simply put under pressure. It is our hardworking front-line NHS staff right across Scotland who are suffering as a result of the inability to deliver proper investment and resources. They deserve better for the great work that they are carrying out. I am actually just concluding. They deserve better for the great work that they are carrying out each day in difficult circumstances, and I hope that this debate can finally jolt the SNP benches into action. I call James Dornan to be followed by Jackie Baillie. Thank you, Presiding Officer. I was going to start off by doing one thing, but I think I have just decided to go another direction. The party to sitting to my left, but politically to my right—party to my right, it is still to my right—called themselves a party of the union. As soon as there are any comparisons with other parts of the union that they hold so dear, that we are all so much a part of, that both of these parties and the Lib Dems work so hard to keep us together, they go up in smoke—this is not right, this is nothing to do with it. We are all working under exactly the same. The national health service might well be in Scottish control, but the budgets are dictated by what happens down in Westminster. If you want to look at what the Tories will look like if they were in control of NHS Scotland, and the only way we can do it is not by what you say, but by what you do, then we will look at what the NHS is like in England. It is an absolute shambles. The BMA itself said that the NHS in England is in complete chaos, that the health service could suffer a repeat of scenes experienced during winter 2016, and that 87.5 per cent of patients would be seen as opposed to the 90-odd per cent that is in Scotland. I have not even started them yet. We have got the ridiculous situation here where the two parties with the worst health service records, where they are in power, are trying to get rid of the best health secretary in the United Kingdom. If it was not for party politics and petty party politics, you would not be coming to this chamber and blaming demeaning it with motions such as this. Just last week we got Ruth Davidson coming and telling us that this was a party that was working in the nationalist interest and not the national interest. I would have thought that she would have been here today to tell us how that was all wrong. Of course, Labour and the Lib Dems put a stop to that when they said that she was going to be the isolated one when it came to the continuity bill. What happens is that the best way to reunite that on Holy Trinity is for you to jump in the back of a bandwagon that was started when Willie Rennie and Anas Sarwar sit down. Everyone, Mr Dornan, can we speak through the chair please? Can we cut down on some of the noise and can we remember that we should always be cut to us to fellow members in this chamber? Willie Rennie, Anas Sarwar, fighting over who could be the first to demand the sacking of the cabinet secretary, was unseemly. To the speech that he made today should be blooming, taking out of the records of the Scottish Parliament, it was nothing but scandalous. Labour Party has a record that nobody could be proud of, not even their mothers and certainly not their founders. We come to hear the day on a motion that is based on the misuse of charity funding. If we look at the Labour Party in Wales, we have a situation—I cannot even remember what it is called—that our laws, serving Betsi Cadwaladr health board in North Wales, did exactly what has been accused of here. However, that was agreed by the Welsh Government, which is run by the Labour Party. That was a system that £450,000 of charitable donations was being used for staff improvements and they are trying to say to us that we have got it wrong. The health secretary was not in when that was put in place. If she had been, it would not have been put in place the way it was. She is dealing with it in a way that she has been asked to deal with it. We still get the ridiculous situation where she is asking for her to go for something that is completely out with her. Yes, of course it will. Alex Cole-Hamilton I am very grateful to the member for giving way. If it is not the current health secretary's feet at which the blame should rest, is it the former health secretary by which I mean the First Minister of this country? James Dornan I think that the difference between you and I, Alex, is that I think that the difference between myself and Mr Cole-Hamilton is that I am not always trying to personalise it. That is about trying to solve the problem. The cabinet secretary has already taken steps to absolutely pathetic interventions from those interventions. Mr Sarwar, Mr Finlay, nothing that we would not expect from either of the two of them. All that was about was personal attacks, nothing positive, no moves towards improving the health service and refusing to take responsibility for anything that could be laid at their door. That is just another cheap political stunt by the two sides of better together. You were not in for the beginning, and you are not taking part now. My apologies, Presiding Officer. The two sides are better together, getting together to try and take one of the best cabinet secretaries in this country and the best health secretary in the United Kingdom. It is nothing but cheap politics. I think that we should just rule it out and we should all vote for the SNP amendment. I call Jackie Baillie to be followed by John Mason. Presiding Officer, I am not quite sure how I would follow that. In all seriousness, there does not appear to be a day that passes that the NHS is not in the news. Unfortunately, it is not for the enormous achievements that we know are made by NHS staff who work so hard to help us get well. Excuse me, Ms Baillie. Can we stop the conversations flying between benches, please? It is very rude, and I am sure that Ms Baillie has a lot to say. I do indeed, Presiding Officer, but it is increasingly the fact that the NHS is in the news because it is under resourced, undervalued and overworked. It is increasingly about the mis-targets, the lengthening waiting times and the lack of staff, and it is increasingly about the NHS being failed by the Scottish Government. Of course, there is a financial straight jacket that it is operating in. Audit Scotland identified a real terms cut to the health budget. The Conservatives have focused on financial accountability and transparency, and it is important to cut through the Government's spin to understand the scale of the challenge faced by health boards across Scotland. A number of speakers have already covered that. Instead, I will focus on the patient's experience of the NHS today. Let's try and see this through their eyes. I say as gently as possible that they are not impressed by the sight of the health secretary on television, as she was last night, telling everyone that things were improving. Maybe in a parallel universe, that might be the case, but not based on my constituent's experience here in the Scottish NHS. Let me tell you about their waiting times. In orthopaedics, urology, ophthalmology, A&E and cancer, their waiting times are all up. Some have been waiting more than a year, crippled with pain, now housebound as a result that they couldn't get surgery. We have the absurd situation in my area, where access to the golden jubilee, minutes down the road, is rationed or indeed denied by NHS Greater Glasgow and Clyde. There is also the waiting time to see a consultant, never mind the time to get treatment. In ophthalmology, in my area, I have constituents with cataracts being told that it will be 30 weeks before they can see a consultant, never mind actually get any treatment. For cancer patients, it is not at this stage. For cancer patients, it is heartbreaking. We all know that early detection, diagnosis and treatment increases people's chances of recovery, yet even here targets are not being met. I have raised screening for suspected breast cancer patients with the cabinet secretary before. That is where patients are referred urgently by GPs because they suspect breast cancer. Clinic appointments are meant to be under 14 days. In practice, they used to be much quicker. Now they are taking over six weeks. That could cost a woman her life. I raised this with you on 24 October 2017. You replied on 13 November to reassure me that matters had been solved and remedial action had been taken. I then wrote again, Presiding Officer, with the same problem on 11 December. The cabinet secretary replied on 23 January. There was no problem. Everything was fine. Cabinet secretary, either you were deliberately misleading or NHS greater Glasgow and Clyde was pulling your leg. I still have constituents just a month ago waiting for six weeks. I wrote again to the cabinet secretary—allow me to finish. I wrote again to NHS greater Glasgow and Clyde and the cabinet secretary on 19 March. I have not yet had a response. How many letters will it take before action is taken? I give way to the cabinet secretary. Shona Robison I can say to Jackie Baillie that I was absolutely assured that those issues had been resolved. If she is telling me that I am not, I will certainly look into it and get back to her as a matter of urgency. As I am sure that she would appreciate, of course I would. Jackie Baillie I very much welcome that commitment because I think that it is outrageous for any Government to fail women in this way and I regret that there appears to be a degree of complacency when they do not even bother to respond. How disappointed I was when I saw that today had been sneaked out, a review of cancer waiting times, not with a press release, just sneaked out and it is truly shocking. It is easy to blame the cabinet secretary, but she is not the boss. It is Nicola Sturgeon's responsibility. It is a failure of leadership by the First Minister that she keeps the cabinet secretary in place when she is struggling because Nicola Sturgeon is too scared to have a reshuffle. No, I will not give way. Presiding Officer, it is not just the Opposition saying that the Government is failing the NHS or Scotland has said it to. Perhaps even more politely than we would, the BMA representing doctors and consultants are telling us that the NHS is at breaking point. Patients are contacting their MSPs with heartbreaking stories to complain that they have been let down by a system that is not working and a Government in denial. There is no denying the Scottish Government's record. 107,000 patients waiting longer in A&E, 3,000 planned operations cancelled, 1.6 million bed days lost due to delayed discharge. I could go on and on. I know that SNP members like to deflect attention. We have heard it here today, but they cannot blame Westminster or Brexit or local government or even Wales. The Scottish Government is in charge. Health is devolved. There is no one else to blame but yourselves. Frankly, trotting out the excuse that we are doing better than elsewhere in the UK demonstrates the depressing lack of ambition. Simply accepting that, whilst we are bad, we are not the worst is not good enough for patients in Scotland. The cabinet secretary and her Government is inhabiting an alternative reality, but her sticking plaster approach to the NHS is letting down staff and patients and needs to stop now. I call John Mason to be followed by Brian Whittle. Thank you very much, Presiding Officer. First, I would like to say something positive about the wording of the motion. In comparison to some of the others that we have seen in the subject, I think that the wording is slightly better. This time, we are not overusing the word crisis, but we are using a word-like problem and challenges have also been mentioned. I think that all of us would accept that there are problems and there are challenges. Then we need to consider what is meant by the wording financial problems. I guess that there are roughly several types of financial problems, but that would include an accounting problem, something that is not recorded properly or money for one fund has been used elsewhere, or it could be the amount of money available to the health service is not being used as well or efficiently as it could be, or it could mean another financial problem, which would be that there is not enough money. If there is not enough money, then we need to consider whether that is not enough money for all that we would like to do, or is it not enough money for all that the health service potentially could do. The reality is that our health services could use almost any amount of money, they could always employ more nurses and other staff, replace older equipment, build new buildings, buy new drugs and equipment, however expensive they might be, but we will never have unlimited resources, so we will always need to choose what our priorities are. For example, should we spend less on hospitals and more on primary care? Should we spend less on physical care and more on mental health? Those are not easy choices and they should be clearly made after serious investigation and discussion between health professionals, patient representatives, managers in the health service and politicians to name but four groups. I think that we should not allocate resources. What we should not do is put a vulnerable person in the public gallery of this Parliament and demand that the cabinet secretary or the First Minister immediately provides them with the latest drug or the latest treatment, no matter how expensive that might be or how uncertain the outcomes might be. That, in my opinion, is verging an abuse of vulnerable people and is potentially damaging to the NHS as it risks upsetting the balance of how it is trying to use its resources. I am happy to take the intervention. I wonder if the member would agree with me that it is very difficult to recruit into the NHS when they are leaving faster at the other end. John Mason I mean if his argument is that it is difficult to forecast how many teachers will need in 10 years time or how many nurses or whatever, yes I would agree that it is difficult to forecast. At times in the past we have had either too many nurses or too many teachers and the complaint has been you are not giving them jobs and it may be at other times that we do not have enough of these but that is not a Scottish problem, that is a problem all over and will always suggest to be a problem for any Government. I note the demand in the motion for the— very quickly, yes. Stuart McMillan I thank John Mason for taking the intervention. Does John Mason agree with me that Brexit is actually going to hamper getting more people into the NHS as compared to the situation that we currently have? John Mason Yes, I completely agree with that. I note the demand in the motion for the immediate publication of the current financial position. I am not sure how literally that was meant to be taken or if it was just slightly poor wording but as an accountant if I could just comment that from a practical point of view I am sure that members will realise that even with modern technology it does take time to prepare financial accounts and the more accurate you want them to be with a balance sheet and valuation of stock and all those things the longer it will take to get reliable figures. I note in the cabinet secretary's letter to Lewis MacDonald that she suggests that it is the end of June for April and May figures. I absolutely support transparency and principle but I urge a little realism on timescales. On the wording of the motion 2, it uses the word accountable, which I was checking in the dictionary and it says something like, quote, required or expected to justify actions or decisions, unquote. That is certainly what is happening today. The cabinet secretary is here, is accountable, is justifying her actions and decisions. She is answering questions in the chamber, so I think that again the wording of the motion is poor when it says should be held accountable. The cabinet secretary is being held accountable. It does not mean that she is responsible for every single little decision that is made in every part of the health service and certainly it does not mean that she should resign if one or two of those decisions were wrong. Another issue that comes up through the amendments, both in Labour and the Lib Dems, is wording like financial pressures and the Lib Dems were suggesting that budgets and policies have not been sufficiently adjusted. It is again unclear to me what exactly that is meaning. If the key message is that more money should be put into health, that in itself raises further questions. Health has been one of the best protected sectors under the SNP with spending now at £13.1 billion. 43 per cent of the Scottish budget, I am sorry, I have taken two already. I cannot take another one, which is up from 38 per cent in 2008-9. In fact, when I was previously in the finance committee, some of the business organisations were saying that we were spending too much on health. If Opposition MSPs are arguing for more money for the NHS, where is it to come from? Should we raise taxes? I do not think that the Tories support that. Labour has said that they would raise a huge amount of money but could not tell us where it was coming from and nobody had checked it. Should we be cutting expenditure in some other sector in order to give more to health? What would that be, cuts to colleges, councils or what? The reality is that all of us, all organisations, all parts of the public sector have to live within our means. We have to make difficult choices. We have to prioritise the most important expenditure over what is good and what is desirable but is not a priority. Opposition politicians would have more credibility and be more respected both in here and outside if they came forward with realistic alternatives. In conclusion, I personally think that Shona Robinson does an excellent job in what is clearly one of the most difficult and challenging portfolios. I would not want her job, I congratulate her on sticking to the task, despite some of the unjustified criticism. The last of the open debate contributions is from Brian Whittle. I refer the chamber to my register of interests and I have a close family member who is a healthcare professional in the Scottish NHS session. I agree with John Mason to start by recognising that the health brief is one of the most challenging briefs in government. It is a brief where constructive dialogue and effective change can be problematic, not least of all, for the adversarial environment in politics and genders. However, what cannot be ignored is a situation that has evolved over the past decade. We are debating the financial crisis that is now enveloping the NHS—a crisis that follows the GP crisis, the pro-mental health crisis, the social hair crisis, the recruitment and retention crisis, the continuing rise in drink and drug deaths in Scotland, the obesity crisis and so on. That lack of cohesive joined-up planning is becoming all too evident. I want to use an example in Ayrshire and Arran health board. It is looking to closing the air hospital cancer unit and amalgamating it with the one across house. However, the merits are otherwise of such a move fail to take into account the lack of adequate infrastructure and public transport from outlying areas. If you happen to live in Ballantrey in South Ayrshire, it will take you over three hours and two bus changes to get to crosshouse for your cancer treatment and then you have to take the reverse journey. If you are taking the car, I wonder where exactly all those extra patients are going to park, because the car park is absolutely rammed. Patient care is clearly not the top priority here. It is most certainly a financial decision and at over £23 million in debt, how can Ayrshire and Arran be expected to deliver the four satellite treatment centres within the cancer treatment plan? Inevitable patients are the ones suffering the consequences of that poor financial planning. For me, the reality is that, barometer, we should be judging the management of the NHS by is the health and wellbeing of our nation. By just about any measurement, you care to mention that the Government is failing. Scotland is the unhealthiest nation in Europe and the unhealthiest small country in the world. We hold the top rank in too many unhealthy tables, as I have already previously stated. Perhaps more importantly, the health of our healthcare professionals continues to decline. In fact, our healthcare professionals health is below the national average, which is already very poor. As COSLA has stated in evidence to the Health and Sport Committee, healthcare professionals will sacrifice their own health to look after the health of others. It is not understating the case to say that, if the SNP does not address this issue, to give our NHS staff an environment where they have access to a decent work-life balance and that we want them to promote to others, every Scottish Government strategy is doomed to follow the litany of failures over which it has presided in the past decade. Much has been made of the recruitment into the NHS, as I asked the question to John Mason, to alleviate the chronic staff shortage created by consistent pro-workforce planning by the Government. However, looking after our healthcare professionals speaks to the retention of staff and that invaluable experience lost if they leave. It speaks to reducing the high levels of absenteeism in the healthcare profession due to stress and the unhealthy working environment that the Scottish Government makes our healthcare professionals work in. When I raised the issue of the preventable health agenda, as the member had given any thought or assessment of how Brexit and its party's budget of reducing funds to the public sector would affect the workforce in the NHS? Brian Whittle Can I thank the member for that intervention? It allows me to point out to the member that, in this chamber, the SNP has been very quick to say that there is a record amount of investment into the NHS, and yet we are in a financial crisis. We have a record number of staff vacancies within the NHS, but it is Brexit. Ten years have been in power. Ten years. The Cabinet Secretary for Health and Sport has always been enthusiastic about their desire to shift direction towards that. I do believe in that. The trouble is that we cannot judge them on that, because they cannot effectively address the agenda while continually firefighting the problems of their own making. It is not an environment for a long-term strategy that is required to support our NHS staff and put the NHS back on an even keel. The cabinet secretary must get a firm control of finance. It is not all about the money that is spent. It is also about what the money is spent on. As we have heard today from all the evidence, and the evidence that I have heard in the Health and Sport Committee on NHS governance, the spending patterns of health boards and IJBs are not being properly tracked and accounted for. Where does the responsibility lie? There are those in the chamber who have been calling for the cabinet secretary's head, and I am not going to join them. For the most part, I believe that it is a card that has become ineffectual if overplayed in the political arena, as Anas Sawa has proved. The Government's responsibility to appoint the front bench and as such, the performance of the front bench reflects the SNP. The fact that the cabinet secretary is still in place would indicate to me that the Scottish Government is not happy with the way that the NHS is being managed. I think that we should all be concerned with that. Patients may be a virtue, but, as Miles Big in motion states, if sustained and immediate action is not taken, the cabinet secretary for health and sport should be held accountable. The cabinet secretary and the SNP cannot keep pointing the finger in elsewhere. It is time to accept responsibility, take the critical action required or step aside, Deputy Presiding Officer. We now move to the closing speeches. I call on Dave Stewart for around six minutes, please. Thank you very much, Presiding Officer. I want to thank Miles Briggs and his colleagues for being this important and pressing matter to debate this afternoon. It has been a very well informed debate with passionate and very interesting contributions from across the chamber. On the consensus side, on this side of the chamber, we endorse Liz Smith's contribution about the management of joint integrated boards. Just to put that on the record, I think that she made a very excellent point, and we fully support that. This debate is not just about numbers on a spreadsheet. It is about the conditions faced by staff and patients in our hospitals and our communities. As Anna Sauer, Neil Findlay and Jackie Baillie have said in the debate, NHS staff in Scotland have been underpaid, undervalued and underresourced. It is the patients who have been feeling the pain of that in missed A and E targets, planned operations being cancelled, bed days being lost to delayed discharge, social care budgets being slashed and seven out of eight key targets being missed for two years, according to Audit Scotland. As with every member in the chamber today, I feel passionate about the NHS. It is not just another issue, it is not just another debate and it is not just another headline. Again, as with many members in the chamber today, I have family and personal connections. My brother-in-law is a mental health nurse, my neighbour is a midwife and my close friend is a senior staff nurse. As with other many members in the chamber today, I do remember the history, although I was not there at the time for signing off, on 5 July 1948, Sylvia Bekinam was admitted to hospital for a liver condition. That was a big event in her life but an even bigger event in British history. The 13-year-old was the first ever patient to be treated by the national health service. The NHS, our NHS, will be 70 years old in July. As we all know, the Labour Party created the NHS and three scored years and ten later were still defending it. Faced with an early shortage of nurses in 1948—a familiar story today—Nybevan pushed up their wages to attract recruits, a solution that I would certainly recommend to the cabinet secretary today. The 1960s saw the first British heart and liver transplant and the first kidney transplant to place in Edinburgh royal infirmary. The 1970s saw the first testue baby and CT scans, which revolutionised the way that doctors examined patients. I am proud, of course, as everyone in this room is, of what the NHS can achieve. However, I am prouder still of its hard-working front-line staff, the junior doctors, the nurses, the midwives, consultants, GPs, allied health professionals, porters and receptionists. However, despite their hard-working commitment, we face challenges that have been touched on in this debate by Alison Johnstone, Alex Cole-Hamilton, Liz Smith, Ash Denham, Edward Mountain, Annie Wells, Miles Briggs and Brian Whittle. Our ageing population, the pressures on social care, the need for robust workforce planning now and post-Brexit, and the growing mental health crisis. The nature of those public health challenges may look modern, but under the surface the root causes are the same old story. Poverty, social deprivation and inequality are significant contributors to poor health expectations, and it is the least well-off that we are most at risk. We need to reverse the inverse care law for patients who most in need of healthcare have the least access to it. Back in 1948, the NHS represented the advance of egalitarianism in our nation. There was great hope for the new future at Heraldd and a Guardian news article from the time noted, and I quote, that it is designed to offset as far as it can the inequalities that arise from the chances of life to ensure that a bad start or a stroke of bad luck, illness or accident or loss of work does not carry the heavy pelty often crippling has carried in the past. Indequality and health was the serious issue then, and it sadly remains a serious issue now. Life expectancy in the UK has stalled, and in the past 50 years the chasm between the health outcomes of the rich and the poor have widened. It is not an outrage that in the 21st century individuals' health expectations are intrinsically tied to their postcode. The theme of the debate has been about NHS financial accountability and the need for change. However, do not just take my word for it, as Professor Sahari Byrne said to the Health and Sport Committee this week, we need complex system change in the NHS. Dr Peter Benney from BNA chair said that NHS workforce was stretched to breaking point. Archdiend Scotland in a survey showed that nine out of 10 nurses say that workload has got a lot worse. NHS Lothian, in the brief to our health committee and sport committee, said that, over the last three years, NHS Lothian has not been able to present a balanced financial plan at the start of each financial year and has increasingly relied on non-recurrent resources to achieve financial balance. In closing, Presiding Officer, as Nide Bevan famously said, the NHS will last as long as those are folk left with faith to fight for it. Let us at 5 o'clock put our faith in the front-line NHS staff across Scotland. I call Shona Robison. I vote for Dave Stewart as Labour health spokesperson. I think that that was a considered and well informed contribution to the debate and a bit of a stand-out from his benches, I have to say. I want to try and come back on as many contributions as I can. Apologies if I do not manage to come back on them all. First of all, I want to come back on remarks made by Anna Sauer and Jackie Baillie about the clinical review of cancer waiting times standards. They are simply wrong. First of all, we will not scrap cancer targets. The report that they refer to is from an expert group of cancer clinicians who are looking at specific cancer pathways to ensure that they are in line with best clinical evidence and practice. The forward from the chair said in the front of the report that the retention of the cancer waiting times standards was agreed from the outset. That is looking at potentially shortening some of those pathways for certain cancer types. We will consider the recommendations from these cancer clinicians in due course, as you would expect us to do. In terms of the comments about the budget for the health service, I want to be very clear in response to those who have commented on it, that the uplift to our health budget amounts to 3.4 per cent in cash terms and 1.9 per cent in real terms, taking the budget £360 million higher than real terms only increases since 2016-17. In terms of our front-line NHS boards, that is a 2.2 per cent increase in real terms, not a reduction, but an increase in real terms. It is important to put that on the record briefly. I thank the cabinet secretary for taking this intervention. As I said earlier, if Scottish health spending had kept pace with English health spending and increases, there would have been an extra billion pounds spent on health in Scotland today. Does she not accept that point? Shona Robison What I accept is that all resource consequentials have been passed on to health in full and some more of Scottish Government funding. What I also accept is that health spending in Scotland is 7.5 per cent higher per head than in England. Those are things that should be welcomed. That equates to more than £880 million more spending on health services in Scotland compared to England, which is £880 million more. I hope that that puts to bed some of the arguments from the Tories. I turn to Alison Johnstone's remarks. I hope that she will agree that what I have done is acted on some of the concerns that she raised about the transparency of finances. I hope that she will welcome that. The point that she made about longer-term funding has been very challenging. When we get a one-year budget and the budgets are set by the UK Government, we then know what our budget is. It is quite difficult to project that over a longer period of time, but I accept that we need to try to do that. That is why the framework will be published in the next few weeks in an attempt to look at the five-year horizon of funding. I hope that Alison Johnstone will again welcome that. I also want to turn to a point that Alex Cole-Hamilton made. Alex Cole-Hamilton quoted from a daily mail article saying that Scots patients cannot get painkillers prescribed on the NHS in Tayside. NHS Tayside has said that there are no plans to stop prescribing those medicines in primary care, where they are felt to be clinically appropriate. I hope that that gives Alex Cole-Hamilton the reassurance that he requires and anybody else for that matter. I also want to say this about John Connell's resignation with the previous chair of NHS Tayside. I want to be very clear to put on record that, first of all, John Connell has no question about his probity or his contribution to public services, but what we had was a culmination of events, not a single event about the endowment fund, which absolutely predated his time in office, as it did in mind, but a culmination of events that came to the conclusion that new leadership was required in NHS Tayside. That is why I took the action that I did. I have to say that the new chair and the new chief executive in NHS Tayside are making rapid progress on a number of those issues very briefly. Jenny Marra Thank you, cabinet secretary, for giving way. She knows that we are in this chamber because initially of problems in our local health boards. News was released last night that there have been 72 drugs deaths in the city of Dundee since this time last year, a shocking doubling of the figures in the previous year. Can she take this opportunity to tell me what she is doing about the drugs crisis in Scotland and how she is going to fund services? Shona Robison What Jenny Marra will be aware of is the commission set up in Dundee to tackle that. You know that the complex reasons of the cohort of people who are involved here are very complex reasons. I met the people undertaking the commission. I hope that she is done likewise, because I think that it is important to understand what the programme of work is that they will be carrying out. If she has not, I would suggest that she does, because I think that it is important to know the work of the commission in Dundee. Can I welcome Liz Smith's tone in this debate? I think that that was another contribution that was very important. I agree with her. I think that it is time to review the IGBs and I have said that I will do that. I also agree with her about the governance issues of endowment funds. I think that what this has taught us is a number of issues. One on audit, that we need to have far better auditing of the processes so that those issues are pulled out for people to see, because with the best will in the world it is difficult for either me, as a minister or Government officials to plough through every report of every public body. We require auditing processes to highlight those issues and to red flag them. I think that that has to be a lesson learned for many organisations involved here, but I can give her this commitment that on the endowment funds governance issue, we will absolutely take action in partnership with Oscar to make those improvements that she called for. Edward Mountain raised a number of issues. I have had this exchange with Edward Mountain on a number of occasions, but it is worth me just reminding the chamber that, in the case of Caithness maternity unit, the decision there was taken due to patient safety concerns after the death of a baby. Those issues are never easy. I, as a minister, have to listen to the clinical advice that I am given from the chief medical officer and others. It would have been impossible for me not to have taken that advice. On the issue of the governance review, as I hope I said in the intervention, the governance review in NHS Highland will help us to make the changes that are required elsewhere in strengthening the governance of our NHS. Stuart McMillan, I recognise many of the successes that he talked about, the difficulties that are faced by the service across the winter period and the heroic efforts of staff to meet those. Can I say to Neil Findlay about the GP issues that he raises in his community? I know about that. That is why we have a new GP contract. That is why I published the primary care workforce plan on Monday, with nearly £7 million of additional investment in our district nursing workforce, something that I hope people would welcome. The ministers in our last few seconds. To say that Clare Haughey raised an important point here. Yes, some of our boards have brokerage arrangements that are required. Of course, we put patient care first and foremost, and that is why those brokerage arrangements are important. She was right to highlight the eye-watering £1.5 billion deficit of acute trust south of the border, which the treasury year after year bails out. I accept that brokerage arrangements are sometimes required, but it is a bit rich not to recognise that financial position south of the border while coming and criticising the position here. I would say to Annie Wells on that point that she said very clearly—I am sure that the record will confirm this—that the NHS is underfunded. If she believes that, there is an honest end on her party to come to this chamber and say how much is it underfunded by and how much are you going to propose to put into the NHS and where is it coming from? It is not good enough to say that it is underfunded, but not to come here with those answers. I hope that we might hear that in the closing speech. Presiding Officer, I hope that I will be able to say here today—I will set out the actions that I will take as health secretary. I am not complacent in any way, and I am sure that the tone of my opening statement gave that. I recognise the problems. That is why we are taking all of the action that we are, and I hope that the chamber will recognise that. I call Murdo Fraser to wind up the debate. If you take us to just before decision time, please. Thank you, Presiding Officer. The Scottish Conservatives called this debate to allow members across the chamber to raise their concerns about the NHS in Scotland. There are a broad range of concerns that we have heard from members from across the country this afternoon, whether it is Edward Mountain in the Highlands, Annie Wells in Glasgow or Brian Whittle in Ayrshire. None of that is to take away from the fact that there is much good work going on in the NHS right across the country. Indeed, I would join with the health secretary in paying tribute to all those who work in the NHS for the care that they deliver. It is important, I think, that all members recognise that. However, what we are doing in this debate today is putting the health secretary and, indeed, the Government on notice that we need real action to improve the situation across the country. We need to strengthen the oversight that the Parliament has of our NHS finances, and that starts with full publication of the current financial position of every NHS board, monthly updates of this Parliament's health and support and public audit committee and more information about integrated joint boards and their progress, and we need full transparency around budget scrutiny and local decision making. I am pleased that, with the response that we have had from the health secretary, she is accepting our motion today and she is giving guarantees to make that information available. I think that the approach that we have taken in this debate, I hope, has been constructive. What the Conservatives are not doing in this debate, as others are doing, is calling for the health secretary's resignation. That is not because we are great supporters of the health secretary, it is simply because we believe that calls like that are a distraction from the more important business of trying to sort out the problems in the NHS for the benefit of all the people that we represent. Simply appointing a new captain to the ship will not make any difference unless the ship changes direction, and it is that change of direction that we think is more important than the personalities involved. I listen with great interest to the contributions from any of the SNP members in the debate. Some of them seem to be in denial about some of the issues that people are facing right across the country. Ash Denham and Claire Hockey wanted to talk about health finances, but they did not want to take interventions from Conservative members who wanted to answer their questions, although, to be fair, Stuart McMillan did allow Miles Briggs to come in. Let me deal with the question of finances because it has come up in the debate, and it is very important. We are spending in the last year £170 million on agency staff in the NHS, which, with better workforce planning, we could substantially reduce that number. We have spent £115 million in the last year on the cost of delayed discharge with the health secretary promised that she could eliminate. As Annie Wells said earlier, if we could better use the resources that we are currently allocating to the NHS, that would make a huge difference in tackling the problems that we face. I will give way on that point. Stuart McMillan I thank Mr McMillan for taking intervention, so if Mr McMillan is backing up his colleague Annie Wells, does that mean that he also does not want additional resources into the NHS? I have just made the point, Mr McMillan, as Annie Wells said. You need to make best use of the resources that you currently have and make sure that money is not being wasted. Let me make another point about funding. This is very important, because I remind SNP members and particularly those who are drawing comparisons with the situation south of the border. We have nearly £1,500 more to spend for every man, woman and child in Scotland every year compared to the rest of the UK average, and much more than in England thanks to the Barnett formula. What do they want to do to the Barnett formula? They want to tear it up, so they will not have the benefit of that money at all. I think that the highlight of the debate for many members was the contribution from James Dornan, who at least brings some comedic value to debates such as this. Mr Dornan spent his time denouncing the Tory motion before us this afternoon, a motion that his front bench has already accepted, a motion that presumably he is going to vote for in five minutes' time, but he thought that it was worth denouncing. What is shame it is that Mr Dornan has decided to withdraw his name from the race to be his party's deputy leader? What a joy that would have been for the notion. James Dornan, thank you very much, Mr Fraser. Can I just say that I was not criticising the motion so much as criticising the rank hypocrisy that was coming from members on your benches? I think that the record will show Mr Dornan's denunciation of the motion later. However, I want to return to the issue in NHS Tayside that a number of members have referred to, because there are a whole range of serious problems within that board area alone. NHS Tayside is missing five out of eight key waiting time targets and has failed to provide data for another, meaning that they are currently only meeting one quarter of their vital targets. We had the recent well-documented episode with the misuse of endowment funds, which have had now to be repaid. What was the cabinet secretary's response? It was to sack the chair of NHS Tayside, a hugely well-respected health professional John Connell, who has been in office for just 18 months, despite the fact that the problems that had been written in NHS Tayside predated his period in office, and yet he was thrown to the wolves by the cabinet secretary. He and other senior figures treated as human shields by the health secretary made to take the blame for failures not of their making. What is most concerning about the situation in NHS Tayside is the financial position, because we now have total brokerage supplied by the Scottish Government of over £33 million, with another £12 million expected, all of which we assume the board will be asked to pay back at some point. It is impossible to see this being done without a major impact on the patient experience, and it will not be saved by simply cancelling one-off prescriptions of paracetamol. I will happily give way to the health secretary. I have already clarified the issue of the paracetamol, but that is why we have said to NHS Tayside that it does not have to repay that for a period of at least three years in order to make sure that patient care is not impacted. Surely that is something that the member would welcome. The people that I represent in areas such as Perth and Cynros want to see is the impact that that cost-cutting is going to have on a long-term or immediate-term basis on the delivery of local services. We have seen plans that the health secretary will be aware of to remove all emergency surgery from Perth Royal Infirmary and relocate that to Ninewells and to replace that with the elective surgery that is moving in the aller direction. However, what guarantees do we now have that that programme will continue? It could not be given by the management of NHS Tayside when a number of colleagues, including myself, met them just two weeks ago. What does that mean for the future of accident and emergency at Perth Royal Infirmary if cost savings are having to be made? Communities across Perth and Cynros have fought hard over recent years to retain services, and yet, once again, they potentially face risks due to financial failures on the watch of the health secretary. My colleague Liz Smith referred in the debate earlier to the question of integrated joint boards. Those were concerns that were reflected by many people. I think that there are huge issues here over a line of governance and accountability, and it is a model fast-losing public confidence and it is calling out for review and greater transparency around the decision-making process. We are not today calling for the resignation of the health secretary, although press reports are to be relieved, even some of our SNP colleagues are expecting her to be reshuffled. That in itself will not make anything better in the NHS. Instead, what we need is a new focus on sorting out the problems in Scotland's health service. That needs to start with this Parliament having a much greater sight of what exactly is happening with health service spending. We need to know that the money is being properly spent and we need to stop being in denial about the scale of some of the problems that we face. That is what staff in the NHS need to give them the reassurance that they need. It is what patients want to see and it is what our constituents expect from us. I urge Parliament to support the motion in Miles Briggs's name. Thank you very much, and that concludes our debate on NHS financial accountability. The next item of business is consideration of business motion 12.003, the name of Joe Fitzpatrick on behalf of the Parliamentary Bureau, setting out a business programme. I would ask any member who wishes to speak against the motion to say so now. I call on Joe Fitzpatrick to move the motion. Formally moved. Thank you very much. Known as asked to speak, therefore, the question is that motion 12.003 be agreed. Are we all agreed? We are agreed. The next item of business is consideration of three bureau motions. Can I ask Joe Fitzpatrick on behalf of the Bureau to move motions 12.004, 12.005 on committee meeting times and motion 12.006 on designation of a lead committee? Move together. So we turn to decision time. The first question is the amendment 11984.4, in the name of Shona Robison, which seeks to amend motion 11984, in the name of Miles Briggs, on NHS financial accountability, be agreed. Are we all agreed? We are agreed. The next question is the amendment 11984.1, in the name of Anas Sarwar, which seeks to amend the motion in the name of Miles Briggs, be agreed. Are we agreed? No. We are not agreed. We moved a division. Members may cast their votes now. The result of the vote on amendment 11984.1, in the name of Anas Sarwar, is yes, 60, no, 61. There were no abstentions. The amendment is therefore not agreed. The next question is the motion 11984, in the name of Miles Briggs, as amended, on NHS financial accountability, be agreed. Are we all agreed? Yes. We are agreed. I propose to ask a single question on 3 Parliamentary Viewer motion. Does anyone object? No. That's good. The question therefore is that motions 12004 to 12006, in the name of Joffith Patrick, be agreed. Are we all agreed? Yes. We are agreed. Thank you very much. That concludes decision time. We will now move to members' business, in the name of Mark Ruskell, on civil contingency in nuclear weapons transport. We'll just take a few moments for members and the ministers to change their seats.