 Mae'r next item of business is a debate on motion 6073, in the name of Sandish Gulhane, on addressing NHS waiting times. I'd be grateful if members who wish to speak were to press their request to speak buttons now, and I call on Sandish Gulhane to speak to and move the motion. Thank you. One year ago today, on September 22, we debated a motion on taking action on a crisis in the ambulance service and the worst accident and emergency waiting times on record. Given the reality of staffing levels on the ground, I implored the Cabinet Secretary back then that our hardworking NHS staff and indeed the Scottish people need to know what to expect as winter approached. Well, here we are again, still spiralling out of control. In the last week ending September 19, 2021, 74.4% of patients at A&E were seen within four hours. A year later last week, this had dropped to 63.5% the worst on record. Elsewhere in the system, cancer waiting times are also at their lowest on record, from 84% in June last year to 76% now. So much under the SNP government's control is going from bad to worse. Vulnerable children are unable to access mental health services with over a quarter not seen by a specialist within 18 weeks. Waiting times for routine treatments are mounting. Over 10,000 Scots have been waiting for two years for treatments and eightfold increase on last year. Hospital delayed discharge at a record high. Ambulance waiting times over two hours have increased nine fold in four years and yet the Cabinet Secretary was patting himself on the back just yesterday. We understand the pandemic has had a significant impact on the delivery of health services but the fact is that the situation has been getting worse in 2022 not better despite the pandemic receding. Many issues also predate the pandemic such as staff shortages which are the result of successive years of poor SNP workforce planning. One year on from our September 21 debate, our amazing nurses, doctors, allied healthcare professionals and paramedics remain overworked and undervalued and at breaking point. Yet one year on the same SNP minister remains in charge clinging on to his flimsy NHS recovery plan. The stats don't lie. This is a record breaking Cabinet Secretary. The SNP delivery personified. But what does the Cabinet Secretary do when faced with hard facts? He might selectively compare stats from health services elsewhere to provide what the First Minister calls context or he might pass the buck and imply that shattered front-line workers are to blame for any waiting times, seriously undermining staff morale and I'm afraid any backtracking, statements sent out later is akin to sticking a bandaid on an unwashed gaping wound. For patients who need treatment in Scotland they don't want context, they want competence but if you insist on context, how about this? Nearly 70% of nurses in Scotland feel that patient care was compromised on their last shift due to staffing levels. Yesterday evening I spoke to Norrie. Norrie's mother is 96 and has pneumonia. Norrie's mum was taken to her Ayrshire hospital A&E department last Thursday at 8 o'clock. The department was incredibly busy. Too busy. Still Norrie's mum was trialled within 90 minutes. The staff were clearly doing their very best but let's face it they can't conjure up more nurses or hospital beds and there were no spare beds. None at all. Norrie's mum spent 40 hours on a trolley in a busy corridor, cold and beside automatic doors that opened and closed every couple of minutes. Norrie's mum was frightened and crying. She was breathless and disorientated all alone because family were not allowed to be with her. On Saturday afternoon 40 hours after she first presented she was moved to the clinical assessment unit where she is now and I can say that she is beginning to feel a bit better. Can any of us imagine how we would feel if this happened to our own granny or mum? Norrie really knows about healthcare. He's been a GP for 40 years and he cannot accept that this is what awaits his patients and his family. Norrie says sadly his mum's experience is not an exception and he says it's not the fault of frontline staff who go above and beyond. Health is a devolved matter. The SNP has been in government for 15 years. The people of Scotland deserve to have dignity and respect while vulnerable. Mindful of last Thursday's First Minister's question I asked Norrie if it gave him a measure of comfort to know that Scotland's waiting times were better than elsewhere. It's response, but I can't repeat the words, so let's just say comparisons like this are meaningless and unhelpful for the people of Scotland suffering. Norrie does have a question though for the Cabinet Secretary and the First Minister. He asks if they agree that in Scotland today it is morally abhorrent for his 96-year-old mother to lie on a trolley in a cold corridor for 40 hours. Our Cabinet Secretary, I will. Would you welcome the fact that there has been an immediate improvement in waiting times since the data was published? The SNP are patting themselves on the back because of a 2.5% increase. 2.5% was the improvement in A&E waiting times That is what you want to stand up and proudly declare when it's come down from 74%. The target is 95%. My word, that is disgraceful. Our Cabinet Secretary is the fifth SNP Minister to be in charge of health, a straight line of SNP MSPs since Nicola Sturgeon held the position from May 2007. After years of SNP mismanagement, dedicated NHS staff are burning out. Workforce planning is so poor. Nursing vacancies are up 25% in a year and now stand at over 6,000. In the past year, around 15,000 workers left the NHS. The highest number in a decade and the root cause of many of the issues with A&E and routine treatment lie in the lack of flow through a hospital. The member must now conclude, thank you. There is a lack of beds in NHS Scotland. 716 fewer than at the peak in 2014-15. And urgent action is required. The NHS recovery plan is failing to have a demonstrably positive effect on waiting times. It's not working. Let's admit it and let's rewrite it ahead of this winter. Thank you and I declare an interest as a practicing NHS doctor. I move the motion in my name. I now call on Humza Yousaf to speak to and move amendment 6073.3 up to five minutes, cabinet secretary. Thank you, Presiding Officer. I move the amendment in my name and I welcome, of course, the opportunity to discuss the challenges our health service continues to face, but also speak to elements of the recovery that we are seeing across health and social care. Before getting into the detail, I thank our NHS front-line staff and our social care staff for the incredible efforts that they make day in and day out. I get to see them on more than a weekly basis in the job that I'm in and thank them personally, but for those that I don't get to see, I and the Government are eternally grateful for their efforts. Can I also say from the offset of this debate that it can only be constructive if the Opposition does not deny the reality of the context in which we operate? Looking at Sandesh Gauhani's motion in front of us, there's not a single mention of the word pandemic or the word Covid. Not a single mention, Presiding Officer, of the biggest shock our NHS has ever faced in its 74-year existence. To deny the severe impacts of the pandemic and the severe impacts it has had and continues to have in the health service is, quite frankly, to deny reality. No, I won't, if you won't mind, I'll keep going. If you were to listen to Sandesh Gauhani's opening contribution, that he referenced where we were a year ago, what he forgot to mention is, of course, there's been three waves of the pandemic since a year ago. The Omicron wave, BA2 wave and the BA45 wave, which we have just exited. So, yes, we should, of course, challenge ourselves to do better, and I accept, fully moving on to any waiting times, that the week-ending, 11 September, those statistics were simply not acceptable. I said as much, the First Minister has said as much, and that's why I'm pleased that we've seen an immediate improvement. I accept that far away from where we want to be, but an immediate improvement, which included, of course, a 20 per cent reduction in both eight-hour and 12-hour waits, respectively. And context, of course, is important. I accept that it's cold comfort for people waiting excessively for A&E treatment. But this is not a uniquely Scottish problem. Global health services right across the world are facing this challenge. It's why Scotland's A&E performance continues to be the best in the UK, not by a small margin, by quite a margin. But I accept again that more has to be done. And that's why Mr Stewart and I, Kevin, who will speak later on at the end of this debate, to close it. He and I are working hard with health and social care partnerships up and down the country to reduce those delayed discharges. If we can do that, if we can get some movement in the right direction, which I accept is not happening at the moment, if we can get some movement in the right direction, that will free up capacity within our hospital, within our acute sites, which is currently under extreme challenge. I don't accept simply creating more beds in the system as the panacea. I think that preventing people from coming to the front door of our hospitals is going to dramatically help. And that's why investment in our hospital at home, I will give way briefly to Brian Whittle. Very grateful to Cabinet Secretary for Giving Way. I've got to say that I spoke to a deep-end GP last night and he used the phrase that our health service is designed on demand and not need, and to his point, needing to prevent. Isn't it time we reset the way we looked at healthcare to prevent people's health becoming acute in the first place, which is adding to our A&E times? Cabinet Secretary, I agree with that point in its entirety that the more we could prevent admission and demand the assistance of the veterans or a hospital at home is a great example of that 45,000 bed days saved through the OPAT, where we can deliver anti-viral treatment to patients in their home or close to home with the prevention of them having to come in is a key plank to try to reduce that demand. On plan care, there has been elements of a recovery, not a full recovery, I'm not going to suggest that, because a recovery plan, of course, is over the course of the parliamentary term, but statistics published last week, which I know so far, in the Sandiskill honey and the Conservatives haven't made a comment on, shows that, for the most of our outpatient specialities, two-year waits have been eradicated, or, indeed, for over three quarters, they've been either eradicated or have fewer than 10 people waiting in those specialisms. Very, very briefly, your friend. Julian Martin. I'll try to be brief. With regard to what Brian Rittle is saying about demand, the Cabinet Secretary is worried as Dr Jennifer Armstrong from NHS Greater Glasgow and Clyde about the cost of living crisis, increasing demand on the NHS. The cost crisis, which has been created and now being worsened by the incompetent Conservative Government, is a public health crisis. People have to choose between heating and eating, that will have a direct impact on their health. Let me conclude, Presiding Officer, by saying that when it comes to our workforce, we will continue to try to expand that workforce. I'll give more detail of that next week. Of course, it is the case that NHS staffing in Scotland is higher per head than any other part of the UK. In conclusion, I will give more detail of how we are matching up against that recovery plan next week and what our winter contingency plans will be. While I absolutely accept that we still face challenges due to the effects of the pandemic, let me praise our NHS staff and social care staff for the incredible compassionate care that they provide for the people of Scotland day in and day out. Thank you. I now call on Jackie Baillie to speak to and move amendment 6073.1 up to four minutes, please. Thank you very much, Presiding Officer. It's almost 500 days since this Cabinet Secretary took office. His performance in that time has unfortunately been woeful and the consequences have been devastating for our NHS, for the hard-working staff and for patients. Our NHS is literally on life support and I fear that the SNP Government is shamefully complacent and not up to the task of fixing this. Of course, Covid exposed the weaknesses in the NHS, but we know that the problems predate the pandemic. There were already 420,000 people on waiting lists before the pandemic. That number now sits at 750,000. That's one in seven Scots. So what has the Cabinet Secretary been doing? Well, I will hand it to him. He's been a record breaker. A and E waiting times were at a record high last week. Delayed discharge also at a record high. Elective surgery at a record high. The list goes on and on, but the consequences are devastating. 7,174 excess deaths, most of them not due to Covid. Using the same estimates as the Royal College of Emergency Medicine, potentially 1,400 people lost their lives or had much worse outcomes because of delays at A and E. Under his watch, I'm struggling to find anything substantial that has got better. I accept that all this takes time and it's not to quote him a matter of weeks or indeed months, but the Cabinet Secretary has had almost, no I won't, has had almost 500 days in which to make a difference. In May 2021, when he took over, remember, pandemic restrictions were still commonplace. A and E waiting times had 86% of people treated within four hours. Now it's 63%. The number of people waiting over 12 hours has risen by a stunning 1,012%. Not 112%, 1,012% under his watch. No, I don't. I'd rather you listen to this. Waiting times for elective surgery were over 94,000. Now they are almost 140,000, a 27% increase. Bed days lost to delayed discharge was over 35,300. Now it's almost 56,000, a staggering 58% increase. A shocking 685,000 bed days have been lost since this Cabinet Secretary came to office and all of these measures are not getting better, they're getting worse. New figures published just this week show that performance against the 62-day cancer waiting times target has plummeted to the lowest point since records began. More people will die of cancer because of this. This is dangerous incompetence on the part of the SNP Government. This is years of poor workforce planning, cutting training places for nurses, years of cutting hospital beds, years of underfunding the NHS and social care that are all coming home to roost, years that the SNP have been in charge. And there have been an array of people trying to offer them advice. The RCN, the BMA, the Royal College of Emergency Medicine, the Royal College of General Practitioners, the Royal College of Physicians and Surgeons, all experts in this field, but the Cabinet Secretary is not listening. Instead, he is presiding over an exhausted and demoralised workforce. Our NHS staff really are going the extra mile to care for us. They deserve our undying gratitude, but they need more than warm words from the Cabinet Secretary. They need a recruitment policy worth its name, action to retain staff who are leaving the service early because they have had enough and decent pay for the whole workforce. Staff are the beating heart of our NHS. We need to support them if we are to recover and with a winter crisis looming there is no time to waste. When a health board is failing, they are put in special measures. The NHS cannot wait any longer. They need urgent help. If the Cabinet Secretary is incapable of delivering, then it is high time that he is put in special measures. I move the amendment in my name. Thank you. I now call on Alex Cole-Hamilton to speak to a move amendment 6073.2 up to four minutes. Thank you very much indeed, Presiding Officer. It is my pleasure to rise for my party to speak in this important debate. I thank Sandesh Kilhani for bringing it to the chamber this afternoon and I move the amendment in my name. Before I move on to the substantive portion of my remarks, I do have to reflect on the Cabinet Secretary's contribution. Had he taken my intervention, Presiding Officer, I would remind him that every time he tries to lean into the fact that the pandemic is the cause of all of this, a ferry dies, this happens all the time and he is making not just this chamber angry, the opposition party is in this chamber angry, he is making hard-working NHS staff angry as well, because he is revealing the blinkered nature of his Government's attitude to the alarm bells that they have been sounding literally for years, some of which his Government has attempted to address through legislation and through other ill-fated strategies, but he cannot keep leaning on the fact that we had a two-year pandemic when things were demonstrably worse as they are still now even before that pandemic and he needs to reflect on that. It is plain to see, Presiding Officer, that our NHS is being stretched beyond the breaking point. Patients are being abandoned in waiting rooms and doctors and nurses left exhausted. What do you mean it's nonsense? I hear from a sedentary position Government members saying that people are not being left in waiting rooms, are not being left on hospital journeys in our A&E departments. They are being abandoned by this Government. Thank you, Mr Cole-Hamilton. Sorry, I would very much like to hear contributions in this debate. I would also remind all members to speak through the chair at all times. My apologies for not speaking through the chair on this occasion, Presiding Officer, but the SNP members know exactly who has abandoned our patients. It is this Government, not our hard-working clinicians, who are crying out for help and looking to this Chamber for answers. It is estimated that one in seven Scots are now waiting lists for some kind of treatment. That is a shocking statistic. In every way you look, the situation is getting out of control and that is even before we get into the teeth of what is possibly going to be the hardest winter our NHS has ever faced. We see backbench MSPs celebrating my tiny, tiny improvements in hospital waiting times, while we have still got people waiting for hours in pain and in desperation. Over one weekend in September, just 63 patients were dealt with within those four-hour targets. The availability of child and adolescent mental health services continues to be dire as well. The need for services is illustrated starkly and tragically when a recent study tells us that a quarter of all deaths among five to 24-year-olds was from suicide. That is a shocking statistic. Just this week, we saw the worst cancer waiting times on record for the third quarter in a row with just one health board meeting this Government's target. We know that early diagnosis and treatment is vital to survival in cancer care. The Royal College of Emergency Medicine has said that waiting time delays have contributed to hundreds of avoidable deaths each year. Those people could still have been alive today. With things this bad, it's frightening to think what it might take for the Government to finally get to grips with this crisis. The stakes are incredibly high and continued failure is just simply not an option. We mustn't forget the issues at GP surgeries as well. Patients have gotten used to having to wait weeks for an appointment. Dillustrate just how bad things are. This is a case that I heard about last week. This is the story of a Ukrainian refugee who had to wait so long for a GP appointment. She was forced to travel back to Ukraine to get the medicine that she needed. How shocking is that? It's not just patients who are suffering. NHS staff are reaching breaking point. In adequate pay, poor conditions are affecting staff recruitment and retention, while there are currently over 6,000 vacancies in nursing and mobile free alone. That puts huge strain on staff already there. Presiding Officer, I want to make, with the very short time I have left, to make several, the three suggestions. Take immediate action to address NHS staff recruitment and pay. Adopt the Scottish Liberal Democrat plans for a burnout prevention strategy and carry out our proposals for more councillors in schools and a single point of contact with council waiting lists. We can't wait for this. We have been round the houses on this debate time and time again. It's time that this Government listened. Thank you. We now move to the open debate and I call Tess White to be followed by Gillian Martin. Presiding Officer, the Scottish Conservatives have said for months that people are paying the price of Humzae Yousaf's mismanagement of Scotland's NHS. Earlier this month, A&E waiting times hit their worst level on record. The figures released yesterday are only fractionally better. The sobering reality which the Vice-Chair of the Royal College of Emergency Medicine emphasised last week is that emergency department delays are associated not just with patient harm but with increased mortality. To put that into perspective, for the 3,400 patients across Scotland who spent more than eight hours in A&E, a couple of weeks ago, 40 additional lives could be lost within a single month. That's why these statistics really do matter. And let me be clear, the but stops of Bute House, NHS staff, the length and breadth of Scotland have worked tirelessly to treat their patients in recent years, often at the expense of their own well-being. Presiding Officer, in July this year, almost a year after the NHS recovery plan was unveiled, one in every 25 patients waited more than 12 hours to be seen in A&E departments across Scotland. It was the worst month since records began. What were Nicola Sturgeon and her SNP colleagues doing in July 2022? They were refreshing the case for separation with the launch of the SNP's second independence paper, a massive, massive distraction from our NHS's recovery. And hardly the sharp focus of the First Minister pointed to during FMQs last week. In August, Edinburgh Royal Infirmary's A&E department was over capacity every single day, not just by a handful of patients, but dozens of them. That has implications for the safety of patients and staff. And yet, in August, Nicola Sturgeon appeared not once, not twice, but five times at Edinburgh's fringe to hobnob with Hollywood actors and polish her PR. That tells you exactly where the First Minister's priorities lie. Presiding officer, these appalling waits occurred during the summer months, well before the pressures of winter and colder weather piled onto our NHS. And in my own region, the Medical Director for Acute Services at Aberdeen Royal Infirmary said in August that, and I quote, the system is not working because it's not fit for purpose. Ambulances are already stacking outside ARI because the hospital simply doesn't have the capacity. Pyramedics and their patients are waiting hours outside A&E, meaning that ambulances cannot be deployed elsewhere. People in the Northeast are being told to present to ARI only if their condition is life-threatening. Figures published yesterday show that for the quarter ending in June 2022, NHS Grampian failed to meet both the 62-day standard and the 31-day standard for cancer waiting times. There are long waits for MRIs, colonoscopies and access to psychological therapies. Meanwhile, Montrose Minor Injuries Unit has closed in Angus. Our Boeing community hospital has been shut because of staffing shortages. Frecom Medical Centre has closed its doors because of lack of doctors, and primary care across the Northeast is under impossible pressures. Many NHS services are being centralised by stealth, with NHS 24 acting as the gatekeeper, with lengthy waits to speak to an operator. Quite simply, Presiding Officer, if you could please note the member must conclude. I'm nearly finished. I wish Humza Yousaf would listen to what people are telling him. Humza Yousaf's NHS recovery plan has not worked. Things have gone from bad to worse. It's no wonder, really, when Audit Scotland have said there is not enough detail in the plan to determine whether ambitions can be achieved in timescales set out. The Health Secretary will be appearing before MSPs in the chamber next week to address these issues. Please listen, I'm nearly finished. At least, I sincerely hope he will address them. After months of excuses, this is an opportunity to rethink his failing recovery plan until frontline staff and the public what action he is going to take to reduce delayed discharge, increase the number of beds, improve workforce planning and focus on staff retention. Finally, Presiding Officer, you have had enough of SNP sound bites. Humza Yousaf and his colleagues need to step up and get a grip. Too much, Presiding Officer, is at stake. Thank you. Thank you. I call Gillian Martin to be followed by Carol Mocken. Presiding Officer, this is a timely debate and I am glad we're having it. The fallout from last Friday's Chancellor statement is reaching into every aspects of our life, not least in devolved areas like health. I want to have been alone in being completely stunned at some of the public comments that we're saying from the sort of respected people that normally keep their council. Not least last night, as I was preparing for today's debate, I read the words of the former Deputy Governor of the Bank of England Sir Charlie Bean. He said that quasi-quartings measures could finish the NHS. Wow! This warning should strike fear into every single one of us across England, Scotland, Northern Ireland and Wales, because we've all got our own national health services, but they're all at the mercy of decisions made by a reckless UK Government who today we know have ignored the warnings from their own officials. Presiding Officer, this is not a good week to be a Tory. It's even harder if you're a Scottish Tory in this place leading a debate in the security of the NHS in Scotland and the importance of investment in clinical and social care staff and measures to bring down waiting times and secure patient safety. Before I heard his speech, I felt sorry for Sandesh Gilhane, but he did ignore the impact his party's reckless decisions are having on the funding and the operation of a national service that I know that he does care about. The motion before us rightly asked questions about actions needed to protect patient safety, improve patient flow through hospital and make our care sector sustainable. All those areas require scrutiny, our attention and the sustaining of the highest levels of funding that the Scottish Government can manage within the grant that we have. Presiding Officer, although I really do try to temper my emotions when I talk in this chamber, I cannot hide my utter distress and, frankly, my anger at the Conservatives, who actions last week have caused immediate financial pain to our NHS already and are set to make the mental and physical health of our citizens even worse. Week after week, the Tories are on their feet telling patient stories. Miss Martin, if you just give me a second, if people want to make a contribution, they can of course stand and ask to make an intervention, but what I would prefer is if we just don't have constant comments when a member is speaking. Thank you. Week after week, the Tories are on their feet telling patient stories. We've heard one today, some of them are very distressing. But how will we make sure that every patient gets the health service they deserve and a long, healthy life? Is it by crashing the pound? Is it by giving more money to the super rich while asking the poorest whether they can heat or eat? Is it by letting inflation run wild and decimating budgets from household budgets to Government budgets? No, it is not. The Tories are demanding that we give the richest Scots in our society the same tax breaks that are been roundly condemned by the IMF and a range of financial experts and many in their party disagree with them. Tax cuts that would leave the Scottish Government with less money to fund health and social care in addition to all the other assaults on them. The rising costs of heating our care homes and hospitals, the impact of the cost of living on the mental health are a very important aspect of this and the mental health of our own staff. On the other hand, here they are in this chamber making all the demands we heard in the opening speech. A child of 10 could point out their hypocrisy, complaining about our publicly funded NHS when our mismanagement of the economy takes money away from the NHS in real terms and increases the causes of ill health in our population. I want to come back to Charlie Bean's comment. Is our NHS finished? No. Not here in Scotland it isn't because the majority in this chamber know that the way to protect the NHS in Scotland is to never have Tories anywhere near the decisions that affect it whether in here or in Westminster. Only in an independent Scotland, Tess White, can we ensure that the reckless incompetence of Liz Truss and all her far-right hedge fund, Lobby and Cow, come after her, can never get their hands on anything with respect to our NHS. I call Carol Mockham to be followed by Clare Adamson. Thank you, Presiding Officer. As we can see from the contributions so far, the nature of this debate is one that is very important to the public and is at the forefront of the public's concerns month after month, year after year. There is a reason for that. People truly value our NHS. I want to see it succeed. They understand our most valued asset as a country and that if the NHS is running well, the country is on the right track. That is why my party, and I'm sure many others here in the chamber and in our communities, just cannot understand when we are going into a winter which will undoubtedly see a significant increase in fuel poverty, malnutrition and increased concerns about spiralling mental health due to the state of the economy, why we are not here in Scotland having a serious rethink of the NHS recovery plan. The fact of the matter is this SNP Green Government has shown itself to be wholly incapable of taking responsibility for the scale of the crisis engulfing our health and social care service here in Scotland. I have added in to speak to the backbenchers as well. It is our responsibility to scrutinise what is happening here in Scotland by this Scottish Government and it's a serious point that has to be taken on board. No matter what the problem is there is always an excuse from this Government. All the while, patients and staff want solutions and a sense of on-going progress. Yes. Julian Martin. She will have heard Dr Armstrong of NHS Greater Glasgow and Clyde yesterday saying that £19 million is having to come out of our budget to pay for increased fuel costs. How can the Scottish Government possibly mitigate that? I will tell you how they can mitigate that by voting Labour at the next general election. What I have seen when visiting hospitals in my region is hardworking staff struggling to do an impossible task with 2Q staff, fewer resources and constant pressure. With that and the worst cancer waiting times on record how can we, we in this Parliament and as a people say that what we are achieving is good enough? It's time to take responsibility. Please, Government, take responsibility and, while the backbenchers put some pressure on their front benches to take responsibility because when we take responsibility we can have a serious discussion about how we help to take away the pressures on the NHS and I am one of the first in this chamber who will take on the Tories and debate what we need to do in terms of the Tory Government. In the short time that I have I would like to highlight the unacceptable length of waiting times in regard to women's health where women are being forced to wait dangerous long periods for gynaecological treatments. With DAPTA published yesterday from April to June this year highlighting only just over half of eligible referrals for cervical cancer started treatment within 62 days in the previous quarter. Now this means that nearly half of those eligible did not start cancer treatment in two months. This is a shocking statistic and is a key breach of the Government's own pledges. These are serious issues which cannot be left for so long without serious risk to life and long-term health yet it sometimes seems that because they are issues relating to women's health they are almost more likely to take a back seat. What makes me say this? Well, after repeated promises in this chamber to the contrary we still sit here approaching October with no women's health champion. Despite being told more than once in this chamber that appointment would be made in the summer so I say to the Government, to the Minister for Women's Health, to the First Minister meet your commitment to Scotland's women and get this done. Please conclude Ms Malkin. Yes, thank you. To conclude, we need solutions and we need them now. It is only when we are serious that we can actually get the necessity on the NHS to make sure that staff and patients have a better performing NHS in Scotland. Thank you, Presiding Officer. Thank you, I call Clare Adamson to be followed by Julian Mackay. Thank you very much, Presiding Officer. I stood in this chamber and said I was fed up mitigating for Tory policies in Westminster. Fed up doesn't do justice to the anger felt by myself and so many at the absolute chaos the Westminster Government has brought in. Remember the £350 million a week to Europe on the side of a bus and the let's fund the NHS instead? As Ms Martin said, Sir Charlie Bean has said that the failure to reverse the tax cuts for the wealth could result in the end of the national health service. Let's sink in. The end of the national health service. That's how far the obsession with Brexit ideology has taken us in just a few short years. On reading this Conservative motion today, you would think they were in favour of investment in public services. But a party that demands that the Scottish Government follows the Chancellor's new fiscal measures cannot credibly claim to care about our public institutions or indeed the public that they serve. Our NHS is facing unprecedented pressures caused by the global pandemic but workers in the NHS are exhausted. They continue to work on the front line in the most challenging of circumstances and they are delivering on the Government's recovery plan. They should have our support, our respect and our thanks. The Tory motion mentions hospital beds but not the fact that outpatient antimicrobial therapy services allowed patients to be seen at home, saving 45,000 hospital bed days this year alone. One example of why service restructure is working. To the fact that this was available in Regmore in 2015 and apparently has taken seven years to roll out. Clear Adamson? It's just this, it's never yes we've rolled it out, it's working, it's good. It's always why did it take so long. Why can't you just get behind the NHS as they make these improvements? Our NHS continues to outperform other UK nations. Our A&E wait times are not acceptable but there is much, much more to do to be done in getting waiting times down for key services but the NHS and the Scottish Government are addressing that. Brexit has exacerbated recruitment challenges. Is it an impact or a health and social care recruitment directly reading to increase time for hospitals for patients putting further pressure on our hospitals? Undoubtedly we need to continue investment in front-line health and social care. The Government is already acting backing this with £1 billion NHS recovery plan by £500 million urgent and unscheduled care collaborative funding £40 million in additional CAMHS revenue. This Government cannot borrow money to give away to their wealthy friends. This Government is working to a fixed budget and doing the best it can working with NHS colleagues to improve the situation going forward. I'm angry today. My staff had to intervene to get help for a young family who were left with no food over the holiday weekend. Failure in universal credit and failure of the administration and the local Labour Tory council to administer the crisis grant in a timely manner. People, children are at risk of malnutrition now and will be at risk of hypothermia as the days shorten. Health inequalities, including mental health, are exacerbated by poverty and stress. The UK Government is inflicting poverty on many, many more hard-pressed families, pensioners and those most vulnerable. And yet, they say, we're obsessed with the constitution and independence. Westminster at the moment while trashing the economy and causing the pound to cash is reviewing all retained EU law in the statute. That's clean beaches, that's product safety, that's food standards and also they seem to be obsessed with bringing back imperial measures. Well, maybe they'll understand that they don't have an ounce of credibility, an ounce of empathy or an ounce of shame in bringing this to the chamber today. I call Gillian Mackay to be followed by Christine Grahame. Thank you, Presiding Officer. It remains an extremely difficult and demanding time for our health and social care systems, which is why the legacy and impact of Covid should never be underestimated. Months of delayed appointments, cancelled procedures and the frustration worries and problems they bring cannot be fixed overnight and we shouldn't forget that the pandemic for many is not over. Covid will likely impact all manner of care this winter, which is why we need preventative action. Those eligible for vaccines must be encouraged to come forward and people need to know their rights and expectations. We must ensure that there is long-term sustainable improvement to waiting times. Tackling waiting times requires actions to both keep the population well and prevent them from having to attend in the first place and ensuring that we minimise other factors such as capacity. Normal seems very far away for our wonderful health and social care staff, who we must keep well to ensure that we minimise disruption this winter. While the rest of society has been able to take a breath, our NHS and social care staff simply haven't had the chance. For that alone, we should be endlessly grateful for their fortitude. Behind every single waiting time statistic is a team of clinicians, support staff and social care workers trying their best. We must listen to what they need, support them when they ask. Without their hard work, determination and expertise, there is no NHS. Keeping them well is not simply mitigating and protecting against Covid, but other measures and terms and conditions changes. The Cabinet Secretary for Health and Sport Jackie Baillie, Alex Cole-Hamilton and I attended a meeting earlier this year with RCN to hear from nurses. One thing that came out very clearly was a lack of flexible working patterns and the impact that this has on nurses leaving NHS employment. In many instances it resulted in nurses taking retirement only to return working in better shifts as bank cover, often in similar roles to the ones that have just left. Yesterday at health committee I was pleased to hear of work being progressed on this from Alex McMahon and I would be grateful for any update that the minister has on this in closing. While those steps are welcome we need to hear from other health professionals about what they need and address how we prevent others from being in the same positions as nurses we heard from at that meeting. We need to ensure that safe staffing legislation is implemented. For any patient impacted by cancellations we must ensure that they are kept fully informed as possible and ensure that while they wait for their operations they receive appropriate support and help to keep as well as possible, something that I raised yesterday at health committee. The cumulus of effect of the pandemic and the factors among others cannot be ignored. Presiding Officer I wanted to end with a reflection on the impact this cost of living crisis will have on our NHS and waiting times this winter. Over winter we will see the acute reality in our hospitals of the absolute mess caused by this reckless UK Government. We will see people presenting at A&E with malnutrition and conditions associated with that. We will see those with chronic illnesses and disabilities facing massive debts for running machinery that keeps them alive and facilitates their everyday lives. Yet despite all this all the UK Government is doing is handing out tax cuts to the wealthiest and lifting the cap on bankers bonuses. I am just about finished so sorry. We also know the long-term impacts of wealth inequality. There are children today who will see their health impacted by this cruel Tory regime and the decisions that they are taking now. We know the impacts that Tory policies had in our communities during the 80s and here we are again. UK Government ministers should be ashamed. Instead they are doubling down with lines in the media like if you support the poor you won't like this budget. We need to tackle waiting times, delayed discharges and other issues at the acute end as best we can. We are doing that with one hand tied behind our back with this UK Government. All the while UK Government continues implementing despicable policies that will impact families across Scotland for generations. I call Christine Grahame the final speaker in the open debate. Thank you very much. As a preliminary let me record my huge admiration for all who work in whatever capacity and care sector. Nothing brought home to me how much theirs is a vacation than their commitment during that two year long pandemic. That's where I'll start, the pandemic. Throughout the UK and the devolved health services and beyond to Europe, the pressures, the wearing of PPE, the restrictions on the usual business of our GP surgeries and hospitals was dramatically disrupted. The aftermath we now have delays in playing catch up in other areas of treatment. The board of general hospital then dividing itself into two treatment areas one for those with Covid and the other for emergency treatments. How the chief executive had to learn along with colleagues to adapt to this fast evolving global virus. Other health treatments were postponed of necessity. Access to GP services was and remains to this day limited. To this day our GP ambulance staff, our hospitals are still of necessity taking precautionary Covid protections all adding to delay. These years of course caused a backlog as I've said in treatments and of course delays for anyone. I'll listen to individual cases and have them myself as dreadful but we must put this into the extraordinary context of the pandemic. I have never known one before but apparently for the opposition it is all yesterday's news. It is not. Context is fundamental and it's not, I say to Ms Mawryn, an excuse. It is an explanation and there's a world of difference. The conservative motion doesn't mention this yet the continuing impact of the pandemic. The fact that protections are still required that staff in both health and care sector are still having to take sick leave because they contract Covid. The ambulance drivers not only require the protections but must sanitise the ambulances after each patient journey that wards have to have extra cleaning that GPs are limiting face-to-face consultations even dentistry is trying to catch up are all for the same reason. Covid is still among us and all of this is fundamental to where we are today. The root cause as of now is the necessary postponement when Covid was at its height the catching up needing to be done the continuing protections and all corroborated by the fact that in the English and Welsh NHS the positions are worse though I take no pleasure in saying that because each individual rightly is a priority for treatment wherever they live but the NHS is working through this and as in quotes normal times close quotes certain treatments certain emergencies must take priority and I say to Jackie Baillie today NHS borders confirmed that 100% of patients in the borders who are diagnosed with cancer received their treatment within the Scottish Government target of 31 days to almost 97% of eligible patients who are given an urgent suspicion of cancer referral I mean my last minute have received their treatment within the 62 target so I commend NHS borders but the motion does not even dip its toe into the waters of Brexit as a constitutional which we lost staff in health and especially the care sector so which brings me to this let's have some honesty in this debate let's have some light and less heat all Government struggled with the pandemic in both health and care sectors from early lockdown days till now and vaccines have to be delivered on a mass scale a huge demand of NHS services Covid and Brexit now compounded by reckless trust economic policies impacting on the health well-being and the safety of people in Scotland and not a whisper from the Tories about any of that I wonder why we now move to closing speeches and I call Alex Cole-Hamilton Thank you very much indeed and how to follow those intellectual gymnastics of Christine Graham who created this new thought experiment of dancing on the head of a pin by explaining to Karen Mocken that what we've heard from the Government benches all afternoon has not been excuses to all nations first it was Covid that well try explaining that to the nursing profession who begged this Parliament to pass a safe staffing bill some 10 years ago because of a problem of this Government's creation and then it was the Tory tax cuts now I find them as horrifying as the next person but they haven't even happened yet you can't use other people's mistakes to excuse away the inadequacy why are the hospitals full they can't get a bed because of the more than a thousand people who on any given night in Scotland are languishing in Scottish hospitals well enough to go home but too frail to do so without a social care package this is a crisis which is causing an interruption in flow throughout the whole of our national health service this is what the SNP should be focusing on not this ill-fated bureaucratic exercise of creating a national care service which will strip power away from the people who know how to use it best in social care and delivering it into the hands of ministers who have shown nothing but disinterest in the problems that have been told about for years upon years upon years this is a crisis of the SNP's own creation now I have no skin in the game in protecting the Conservative Government for what they're doing in terms of tax cuts but it is an insult to everybody who is currently lying on a trolley in a hospital ward in an A&E department to say this isn't on us, this is on faceless bureaucrats at Westminster of course it's on you, you've been in charge for 15 years you should start acting like it our NHS staff do an incredible job they are always here for us but Presiding Officer it is not the job of doctors and nurses to address the woeful mismanagement of this Government that's the job for ministers and they should start acting like it thank you thank you in rising to close this debate for Scottish Labour I want to genuinely recognise the outstanding work done by everyone in our NHS staff go out every single day on to the front line to look after all of us staff whom we clap for every week during the pandemic who now feel dejected, burnt out and undervalued by this SNP Government the NHS is this country's greatest institution realised by a Labour Government who rebuilt this country from the ashes of war and let me say to Gillian Martin and others I share their anger over the Tories economic policies which is why we need a Labour Government across the UK with the plan outlined by Keir Starmer this week in Liverpool to reverse the economic disaster created by the Tories and when Carol Mocken answered the cabinet secretary the cabinet secretary said that it was embarrassing I'll tell the cabinet secretary what's embarrassing that in my lifetime I have never seen the NHS in Scotland so unwell that I have never seen the people who work in it so demoralised that I have never seen people languishing on waiting lists and in any department in the current state that they are so the cabinet secretary should be embarrassed by that many of those people who work on their NHS are our friends, our family and our neighbours people who love the bones of an NHS but are totally broken because that is what 15 years of SNP mismanagement and a record of failure has done as outlined by my colleague Jackie Baillie in her opening remarks this is at the door of the cabinet secretary I would like to make some progress the cabinet secretary has been in post for almost 500 days and people say he's missing in action but he's not even missing in action, he's just missing so it's time for him to own his record he must listen and engage with what staff are telling him and his contribution he said that we should be grateful that two-year waits have been eradicated is that the sum total of his ambition for the NHS is that what he stands behind this week it was revealed that hundreds of surge beds which were made available last winter to cope with additional patient numbers are still occupied so let's reflect on the view of doctors working in our NHS as highlighted by Alex Cole-Hamilton and others John Paul Lockry, the vice president of the Royal College of Emergency Medicine in Scotland has said that the latest delays could lead to 40 deaths in the following 30 days and he said and I quote every hospital in Scotland just now wash just last week have we heard before 1200 people spent more than 12 hours waiting in emergency departments in hospitals across Scotland and it's worth hearing that again because we need to let it sink in because that is the reality in our hospitals right now and we know that part of the solution to getting people out of hospital requires well supported and well valued social care Presiding Officer, actions I'll give way to Emma Harper I really appreciate you giving way it's just on that point it's about the issues are really complicated we heard yesterday at committee from the chief executive of NHS De Fries and Galloway who said Brexit was a part of the problem for the recruitment as well so would you acknowledge that the chief executive of NHS DNG said that? Paul Lockry Of course I would acknowledge the Brexit as part of it but what we hear from the Government is excuse after excuse so if it's not the pandemic it's Brexit if it's not that it's procurement excuse excuse excuse where are the solutions Presiding Officer, actions speak louder than words and if this SNP and Green Government respected care workers they would offer them more than the derisory pay rise they were offered our care workers deserve better and that's why Scottish Labour has called consistently for care workers to receive an immediate rise to £15 an hour NHS staff are working tirelessly to provide exceptional care but they are being let down by the inaction of this Government and this Cabinet Secretary the SNP cannot shirk responsibility for the current crisis what I noticed was many SNP bankbenchers didn't even want to mention the NHS that their party is responsible for because the crisis is a result of 15 years of sustained failure by this Government a Government that's out of touch out of ideas and unwilling to take responsibility and I challenge the Cabinet Secretary to step up, show leadership to avert a coming humanitarian crisis in our hospitals this winter thank you Presiding Officer thank you I call on Kevin Stewart thank you Presiding Officer we've heard a lot today about pressures in the system the impact on people accessing health and care services and what we're doing to support improvements now for winter and for the future as the health secretary said none of this is easy in times of financial austerity but we are confident we are providing as much support as we can within our control we have higher staffing per head in Scotland compared to NHS England we have already delivered a record number of GPs working in Scotland with more per head than any other country in the UK and front line health spending 4.6% or £143 higher per head of population in Scotland than in the UK as a whole this level of commitment will help us to minimise impact on people during this difficult time and like Gillian Martin like Clare Adamson Gillian Mackay and Christine Graham I think it is crucial that we frame today's debate in terms of the cost of living crisis and the effects it will be having on the health of people across Scotland both mental and physical health we know that poverty is the single biggest driver of poor mental health and this crisis will not be affecting people equally just as during the pandemic existing inequalities are being exacerbated and, Presiding Officer there is no aspect of this crisis without implications for mental health and this is likely to be at all levels of need from rising levels of worry and anxiety to increase levels of distress to increasing demand for sign posting and community support to a likely rise in demand for specialist mental health services and we are working across Government and with key partners to look at what we can do within the limited powers of this Parliament to support people throughout this crisis probably the only folk that won't be accessing these services are the likes of the bankers whose bonus cap has been removed the ultra rich whose taxes have been cut that is the Tory way okay Brian Whittle Brian Whittle very grateful to the minister to take an intervention and I think I would like to try again and talk about the invest care law and the fact that again GP deep end last night told me that there's about 20% of people further removed from society who don't access the NHS services and they're the ones that are in the most need what are we going to do to stop that problem of demand outstripping need Minister we might reach but something that we cannot do if our budgets constantly get cut because Tories cut taxes rather than investing in our public services Doctor Doctor Gohani Doctor Gohani's motion mentioned calms waiting times as mental wellbeing minister I want to use some of my time today to focus on that is just one area where this government is taking forward significant improvement work I wholeheartedly agree that it's crucial that the right mental health help is available in the right place and at the right time and want to focus on what we need to do I know that waits for mental health services are unacceptable and we are working to ensure that we meet the standard that 90% of people start treatment within 18 weeks that's why this government has invested in calms heavily over the past year and past months and we're now beginning to see the impact of our investments they don't like this our investments in calms have shown in the latest national performance data that over 5200 children and young people began treatment last quarter that is a record and it is the highest sustained level of activity and boards are working hard those in the front line are working hard to reduce backlogs and to treat people with those who have waited longest being treated first no, I've had enough of Tories today thank you very much and we can see signs of progress there has been an 8.6% decrease in waiting times over the last 18 weeks let's look at calms staff point of order does what we have just heard from the Minister comply with the standards of respect that is expected from members in this chamber I'm sure that all members are aware of my insistence that we adhere to the code of conduct when debating issues in the chamber and I would remind members at all times to treat one another with courtesy and respect Minister I must ask you to conclude your remarks Presiding Officer maybe some of the personal remarks that were aimed at the cabinet secretary earlier fall into that regard as well because that is very personal indeed Presiding Officer we will do all that we can to protect our people from brutal Tory policies and their tanking of the economy I call on Craig Hoy to wind up the debate up to seven minutes everyone wanted to see the arrogance and complacency of the SNP Government we saw it there the storm clouds that are blooming over the horizon are bringing a winter crisis a winter crisis that this SNP Government is ill prepared for and even before they arrive our care homes are ready on life support routine operations cancelled elderly people left in hospital beds unable to be discharged cancer patients waiting too long for diagnosis and too long for treatment ambulances containing the sick and the dying queuing outside hospitals patients waiting hours and sometimes days for life saving treatment nursing and care shortages undermining patient care hardworking committed GPs in record numbers the picture is bleak and earlier this month earlier this month A&E waiting times reached their worst level on record Mr Yusof their worst level on record on your watch so this is personal because you're the minister responsible Mr Hoy through the chair please but the minister yet again sits there with his fingers crossed hoping in vain that the crisis that his Government created will be averted on this debate the urgency is now the NHS urgently needs resuscitation it needs a proper recovery plan I won't do the moment it needs a proper cancer plan it needs a proper workforce plan it needs a Government with the competence to deliver this just yesterday the minister congratulated himself on A&E waiting times but what is there to celebrate a third of people are still waiting longer than four hours to be seen in our emergency departments and any minor improvement on a record low is hardly something to be proud of the minister all too often pats himself on the back when he should be getting his finger out if the SNP wants to remind patients of its record then here it is the longest cancer waiting times ever the longest ambulance waiting times ever the longest diagnostic waiting times ever and the highest number of beds occupied due to the discharge ever but from whom's a use of all we get are empty promises and hollow words because he's an inaction man but this winter his inaction will cost lives as Tess White warned 40 additional lives could be lost within a single month as a result of A&E waiting times in my own health board area Edinburgh's royal infirmary was over capacity every hour of every day in August by an average of 80 people to extend way beyond our A&E units Cancer Research UK I will give weight this point Mr Roy has just talked about failures I wonder if he could talk about the failures size of the border because Scotland's core A&E were 9.5 percentage points better than in England is that failure Mr Roy I might remind him I stood for the Scottish Parliament to hold this Government to account so let's look at Cancer Research UK don't take my word for it let's take Cancer Research UK it warns that three quarters of patients requiring urgent cancer referral started treatment in 62 days during this quarter well below the target and the worst since the start of the pandemic I won't give weight but before the minister uses Covid as an excuse let's forget that the 62 day target has not been met since 2012 and it's not just our NHS that's in crisis and perhaps Mr Stewart might want to listen to this as a minister responsible it's social care too make no mistake the plan for a national care service in Scotland is a dangerous power grab many of the Government's failures in our NHS are made worse by the failures in social care despite saying they would eradicate delayed discharge no I won't give weight I think we've had enough from the SNP for today despite saying despite saying that they would despite despite each of the codes or are Tories allowed to say these things but SNP members not you've set an example if I can just remind the chamber if we could actually be serious for a moment please colleagues the codes of conduct is something that we must all take seriously at all times and if we are addressing one another in terms that are not either curtes or respectful then I think we do need to question that so please at all times treat one another with courtesy and respect the debate will be all the better for it Craig Hoy I can understand why Mr Stewart didn't want to hear this but he will hear this despite saying that they would eradicate delayed discharge the SNP have made it worse care at home is in crisis the workforce is demoralised and rather than fixing the current crisis they now propose a wholesale restructuring that is being arranged on the Titanic Minister this move of a national care service will waste scarce resources and it could cost lives and these aren't my conclusions these are the conclusions of key stakeholders take West Lothian IGB which says the implementation of the bill is likely to cause significant disruption and uncertainty to service delivery and staffing or the Scottish ambulance service which says there is genuine concern that this will have a negative impact on communication continuity of care duplication of effort and the ability for staff within SES to be able to communicate effectively or COSLA which warns that these plans risk repeating the cycle of successive reorganisations and come with a significant opportunity cost and disruption but that they fail to address the fundamental and deep-rooted changes needed to integrate services at the front line Minister this is a disaster waiting to happen and let's not lose sight of this SNP Government as we read in the Sunday Herald at the weekend have taken their eye off the ball because the prize of independence is in the SNP's eyes a bigger prize than fixing the crisis in our NHS this is government complacency on a scandalous scale they are failing patients across Scotland failing on A&E waiting times failing on cancer treatment targets failing on ambulance waiting times failing on routine waiting times for elective surgery failing on NHS dentistry failing on children and adolescent mental health failing on delayed discharge failing on workforce planning and when patients die this winter it will be whom's a use of who must take responsibility for the stark result of these failures because the problems we see across health and social care are problems created and problems ignored by the SNP Government a government distracted by the wrong priorities an SNP Government which sadly and to its shame cares more about dividing our nation than hearing its people Point of order, Willie Rennie Presiding Officer, it's been intimated to me that I should apologise for a discurtsy to the chair during my contribution in the ferries debate this afternoon as my conduct in this Parliament is important to me I wanted to apologise to the chair and to the whole chamber for which I do so now Thank you very much Mr Rennie Thank you We've concluded the debate on addressing NHS waiting times and we'll now move on to the next item of business which is consideration of business motion 6087 in the name of George Adam on behalf of the Parliamentary Bureau setting out a business programme and I call on George Adam to move the motion Thank you Presiding Officer, I moved Thank you Minister No member has asked to speak on the motion and the question is that motion 6087 on behalf of the Parliamentary Bureau on stage 1 extension any member who wishes to speak against the motion should press their request to speak button now and I call on George Adam to move the motion and moved Presiding Officer Thank you Minister No member has asked to speak against the motion therefore the question is that motion 6088 on behalf of the Parliamentary Bureau setting out a business programme setting out a business programme therefore the question is that motion 6088 be agreed are we all agreed the motion is therefore agreed I must advise members that we're currently experiencing a difficulty with the remote video platform and on that basis I'm minded to accept a motion without notice under rule 11.2 to move tonight's decision time to another day and I invite George Adam on behalf of the Parliamentary Bureau to move a motion to move tonight's decision time to tomorrow and moved Presiding Officer Thank you Minister the question is that tonight's decision time be moved to tomorrow are we all agreed we're not all agreed I will ask the question again for clarity are we all agreed thank you that being the case decision time is concluded and we'll move on to members business