 The next item of business is a debate on motion number 2355, in the name of Shona Robison, on Scotland values its EU workforce and its contribution to health and social care. Those who wish to speak in the debate, please press the request speak buttons now. I call on Shona Robison to speak to and move the motion. 12 minutes, please, Cabinet Secretary. Thank you, Deputy Presiding Officer. I'm pleased to have the opportunity to debate this very important issue today. Every area of Scotland and more than 60 per cent of voters voted to remain in the EU. The Scottish Government's priority, therefore, is to protect Scotland's interests and ensure that the wishes of the Scottish people are respected by the UK Government in a meaningful way. We are firmly committed to ensuring that Scotland can remain in the single market, including retaining freedom of movement. Scotland values those citizens from other parts of the EU and the wider European economic area, who come here to live and work in the contribution that they make to our economy and to our society. Today I want to focus specifically on those citizens from other parts of the EEA who make such a vital contribution to our health and social care services. In doing so, I'll focus on two of the five key interests that this Government wishes to protect, our economic interests and our interests in social protection. I want to start by paying tribute to all those who work in our health and social care services, regardless of nationality. Your dedication and commitment is greatly appreciated and valued. To those European citizens from outside the UK, we want you here, we value your contribution and we'll do everything that we can to make sure that you can continue to live and work in Scotland without detriment. Scotland has a long tradition of welcoming professionals from overseas to work in our health and social care services. Free movement of Labour throughout the EEA has been hugely important in ensuring that we have the skilled workforce that we need to deliver at the services. As a member of the EU, free movement of Labour has not required us to hold information on the numbers of non-UK EEA citizens working within NHS Scotland, other health services and the social care sector. However, we have estimated that non-UK EU citizens account for approximately 3 per cent of the health and social care sector workforce in Scotland. In 2015, 3.8 per cent of the 3,113 students starting a pre-registration course in nursing and medwifery were from the EEA. That compares to 2.75 per cent in 1998, so it is a growing part of the workforce. The general medical council registered just over 1,100 EEA qualified doctors in Scotland as of December 2014 from a total of approximately 20,000. Around 1,400 of the non-UK EU citizens licensed to practice by the general medical council are currently registered in Scotland, approximately 6.8 per cent of Scotland's doctors. We are currently working with the Scottish Social Services Council and the Care Inspectorate and with employer representative bodies to identify possible approaches to improving our understanding of the numbers and contribution of non-UK EU citizens to social services in Scotland. However, estimates from the annual population survey show that in 2015, around 3.5 per cent of the workforce in the social services sector as a whole were non-UK EU citizens. However, what we do know is that non-UK EU citizens make an important contribution to our health and social care services. As a starting point, we need to remove the uncertainty for all non-UK EU citizens who are already working in our health and social care services. It is unacceptable that the UK Government has refused to give any assurances to those workers, many of whom now see Scotland as their home. Will therefore continue to press the UK Government for confirmation that those workers from other parts of the EAA will be allowed to remain here once the UK formally leaves the EU? We know that the huge challenges that our health and social care services will face in the future as demands for services grow. To enable us to meet that challenge, we need to have the workforce available to deliver those services. Our commitment to produce a national healthcare workforce plan will strengthen workforce planning and help us to train and grow the workforce that we need. However, the ever-increasing demands on our health and social care services mean that we will need to retain our ability to retain staff from inside and outside the EAA. The uncertainty surrounding the terms of the UK's withdrawal from the EU and in particular in relation to free movement of labour is already impacting on recruitment. With anecdotal evidence that it is making Scotland's health and social care services less attractive to potential recruits, Unison Scotland recently shared those concerns. Unison Scotland is concerned that, without free movement of labour, Scotland will face immense workforce planning challenges in the growing health and care sector. We are already unable to recruit and retain enough care workers to fill vacancies and the loss of EU nationals will exacerbate that, particularly in the private, residential and home care sectors. We want to retain freedom of movement for Scotland and we will continue to make that a priority in our discussions with the UK Government. Of course, we need to ensure that we can attract and train our future workforce, and that means attracting students to take up training places. Scotland's medical and dental schools are already concerned about the impact of the current uncertainty on their ability to attract the best students to their courses. We have an enviable worldwide reputation for the quality of our educational experience that we offer. However, that is a highly competitive international recruitment market and there is a real risk that we will lose many individuals if we cannot provide reassurance on tuition fees, free movement and future career opportunities. We already have non-UK EEA citizen studying and training here. They make a real contribution to our services and need to feel wanted and valued. I am pleased that we have been able to provide some reassurance to students who are already studying, those who are about to begin their studies here and those who are applying to study here from 2017-18, that they will continue to enjoy free tuition for the duration of the studies at our medical and dental schools. Unfortunately, we cannot provide assurances about their future rights to remain here to train and work and that could have an impact on their future career decisions. The setting of medical student places is based on the workforce planning needs of NHS Scotland, but let me be clear that there is no cap on university places for domiciled Scots. The Tory motion is simply inaccurate. While the Scottish Government sets the annual intake into medicine, the selection and recruitment of individual students admitted to study medicine is a matter for individual universities. As a result, the exact number of domiciled Scots students varies from year to year. The evidence suggests that Scots domiciled students are more likely to stay and work in the NHS in Scotland. For that reason, we are taking measures to increase the number of Scots domiciled students. We have increased undergraduate medical school places by 50 from this year, with those places focused on widening access criteria. The ScotGem graduate medical school will add a further 40 places from 2018 and will have a focus on general practice and rurality. Cross-border mobility and freedom of movement is essential for our health and social care services. Alongside that, we need to have registration arrangements that ensure that our health and social care professionals are fit to practice, regardless of where they come from or where they are qualified. I have recently written to Philip Dunn, the Minister of State for Health, urging him to look closely at every potential option for maintaining parity of professional qualifications going forward into negotiations. That brings me on to social protection. The EU has done much to protect and improve workers' employment rights and contribute to our vision of exemplary employer practices across health and social care. Examples of positive changes include the European working time directive, health and safety and equality and diversity legislation, as well as maternity and paternal rights. Those have helped us to deliver improved working conditions for staff, as well as protecting patient and public safety. We would see those as important protections to retain following withdrawal from the EU. We have given our commitment that we want those protections to continue. We now need the UK Government to give us the assurance that those important social and economic protections will not be removed or lessened following withdrawal. Before I close, I want to touch on three other areas in my portfolio where we have real concerns about the potential impact of EU withdrawal. First, I want to turn to medicines. Being part of the European Union provides us with an established and effective regulatory approval system, ensuring that UK patients benefit from medicines more quickly and that medicines that are researched and manufactured in the UK can be made available in the EU quickly. The UK Government must provide urgent clarity on how Britain's regulatory system and the relationship to its peers in the rest of the EU will function after Brexit. Scotland also has a long-established international reputation for excellence in health research. A vibrant research sector is vital to addressing our health challenges, to continuing improvement of our health and care services and to the development of our economy. In the parliamentary debate on the implications of the European Union referendum for higher and further education on 4 October, the Minister for Further Education, Higher Education and Science highlighted the importance and benefits of EU membership to the Scottish research sector as a whole. I echo those sentiments, which apply equally to health-related research. The research sector in Scotland has benefited greatly from EU membership. Many researchers and Scottish universities are from EU countries, and Scottish universities have secured substantial funding from the EU's Horizon 2020 research funding programme. The Scottish Government wants to ensure that Scotland can continue to play a full role in European research programmes and that researchers in Scotland will remain committed to collaborating with our European partners and to attracting the best international talent. Finally, turning to EU-wide healthcare arrangements, we recognise the considerable benefits of having access to state healthcare throughout the EEA, whether during a short-term visit, planned healthcare or as state pensioners living in other parts of the EEA. We will therefore make it clear to the UK Government that our citizens must retain their rights in this regard and that that must be treated as a priority in negotiations on withdrawal when they finally take place. Presiding Officer, returning to the central theme of today's debate, I want to finish by repeating what I have already said today and on many occasions over recent months. That is a message to those working in our health and social care services. No matter where you come from, your work is valued and we want you to stay. I move the motion in my name. I now call on Donald Cameron to speak to you and move amendment 2355.2, seven minutes. Thank you, Deputy Presiding Officer. If I may begin with a general observation, this is the first Brexit debate that I have participated in. As we all know, it is one of many. In fact, it is the 10th. We are now in double digits with more to come. Mr Russell's strained voice last week shows how these endless debates have taken their toll even on his oratorical powers. Maybe they will finally silence him. While none of us have any doubts as to the constitutional importance of events on 23 June, it is remarkable that, week after week, the Scottish Government insists that we debate motions related to Brexit rather than bring forward any legislation to improve the lives of people in Scotland. We were all elected in May into Alia to legislate, but, half a year on, I have debated not one bill in this legislature. That aside, I would like to begin my speech by putting on record my recognition of the valuable contribution that staff from across the EU make to Scotland in terms of the NHS and social care. Notwithstanding the challenges posed by Brexit, we must continue to promote Scotland as a welcoming place for Europeans to work. The UK Government has committed to retain all the EU employment protections post-Brexit through incorporating current EU law into UK law. I note that the RCN's briefing for this debate states that it is encouraged by this. However, let's not forget either that our own domestic employment law already protects workers who are employed in this country, regardless of their nationality, the law on unfair dismissal, the statutory instruments on transfer of undertakings, the array of trade union laws and, significantly, the Equality Act 2010 and the anti-discrimination legislation, which it consolidates, are all applied as domestic law weak in and weak out by employment tribunals across the land. I can assure the chamber, from her first-hand experience as an advocate, that the rights of all workers are already enforced in our tribunals applying our law. John Mason Some good laws are directives such as the working time directive, which have come from Europe, and many of us are quite concerned that, if we are left at the mercies of our Conservative Government in London, working protection may not be so great. I simply repeat the pledge that the UK Government has already made, which is to retain all the EU employment protections post-Brexit. Let us keep things in perspective. It is important to understand the numbers involved, in terms of NHS doctors in Scotland—5 per cent are EEA nationals. The current estimate that we have for the whole health and social care workforce is that EU nationals make up 3 per cent of total employees. Drilling down to the health service alone, according to the annual population survey 2015, 3 per cent of NHS workers are EU nationals, but exactly the same amount—3 per cent—are non-EU nationals. The number of EU nationals working specifically in social care, as the cabinet secretary said, is harder to estimate. Much of the data is historic, but it is at least notable that, in 2008, we were relying more on non-EU nationals in the care sector than EU nationals. Context is key, so, whilst we welcome the contribution of EU nationals, we should also put on record our appreciation of all staff wherever they are from. In preparing the speech, I gave thought to who in the SNP might best appreciate the consequences of Brexit for the NHS social care workforce and the EU nationals working within it. A wise, seasoned political veteran, someone who had maybe overseen the whole health and social care structure for a number of years, whilst in government, a former health secretary perhaps, stepped forward Alex Neil MSP. Except last week, we learnt that he voted to leave the EU. And he must have done so with some kind of understanding of the implications for EU nationals within the workforce. We learnt that he was not alone. At least six other SNP MSPs did the same, apparently. To the SNP, I say this. Before your usual moralising about Brexit begins, before you trot out the hackneyed line that this exercise in democracy was a reckless gamble, before you line up to call those passionate remain voters amongst us, born-again Brexiteers. Have a care, look around you, how many of your colleagues sitting here today are secret Brexiteers, because your supposed united front against Brexit has been well and truly shattered. Alex Neil and his loyal comrades are not just born-again Brexiteers, Deputy Presiding Officer. They were true believers on 23 June, along with approximately a third of SNP voters. More importantly, the SNP must not use Brexit as cover for the existing health and social care workforce crisis. As I have said before, the severe staffing problems that we know exist did not suddenly come into existence on 23 June. The recent Audit Scotland report lays this bear. Scotland is 890gps short of the number needed by 2021. Many staff are close to retirement, those that are left are overworked and under pressure. In social care there are huge issues with morale and an ageing workforce. The health and social care workforce in Scotland is in crisis due to nearly a decade of SNP mismanagement, so let's not hear the SNP blame Brexit for their own problems or use it as a reason not to take responsibility. There are positives. We know that Scotland already allows doctors from anywhere in the world to come and work here in shortage specialities. Our exit from the EU won't change that. Briefly, taking the health debate wider than just the workforce, there are opportunities in health which Brexit provides. In September, the health committee heard powerful evidence from Annie Gunna-Logan representing the voluntary care sector, who was asked about Brexit. She replied, When we started talking about Brexit with our membership, the issue that came up first was not the EU national workforce but whether our membership could follow different procurement laws, because people really want to be able to do that. One opportunity thus might be a reformed and easier procurement process. Let's retain a sense of proportion about other health-related issues too. The cabinet secretary talked about the European health insurance card. Switzerland, which is outside the EU and the EEA, uses that. It's not linked to EU membership. Not only that, but the UK has similar reciprocal healthcare arrangements with other non-EU countries, like Australia and New Zealand. In conclusion, the true picture of Brexit is a mixed one. Rather than one of Mr Russell's recent photographs of Westlok Tarbott showing the sun's rays illuminating a heavy highland shower, that is the image that we should bear in mind. Neither doom-laden storm clouds nor endless sunshine, darkness and light, risk and reward, challenge and opportunity, and just as it is incumbent on us not to overplay the advantages of Brexit, so it is incumbent on you not to overplay the disadvantages. We are where we are, and to quote Alex Salmond, we must play the ball as it lies. The Royal College of Nurses today calls on the Scottish Government to work together with the UK Government, and likewise today I call on the Scottish Government to engage positively with the UK Government to ensure the interests of the health and social care workforce in Scotland are protected as we exit the EU. I move the amendment in my name. I now call on Anna Sarwar to speak to and move amendment 2355.1. Mr Sarwar, around six minutes. Thank you, Deputy Presiding Officer. It is no secret that the Cabinet Secretary for Health and I have some disagreements on the management and delivery of our valued NHS, but on the issue of Brexit and the potential consequences on our health and social care sector, we are in broad agreement. I think that we can all agree that big constitutional decisions have consequences, so I would just gently say to ministers that many of the arguments that we will all make today would apply in much starker terms in a debate on independence. As I said, that is not for today. Therefore, today I want to focus on the areas where we have agreement and encourage areas where I believe that there can be constructive dialogue. I would like to start by putting on record Labour's recognition and thanks to our amazing health and social care workforce, regardless of where they come from. I want to pay tribute to their dedication and compassion as they go about their day-to-day job caring for others, directly to each and every single one of them. Thank you. There are lots of uncertain areas, but I think that they fall into three broad categories, all three mentioned by the cabinet secretary. Firstly, staffing. With an estimated 12,000 EU nationals working across the health and social care sector, it is difficult to underestimate the contribution that they make. Indeed, their role in the workforce is even more important when you consider the current extent of recruitment and retention problems already facing the sector. It is important to note that, even before Brexit, we have a workforce crisis in our NHS. That was laid bare by Audit Scotland. The reality is that, while Brexit has not caused that workforce crisis, it has the potential to only make it worse. Two and a half thousand nursing and midwifery vacancies, only a third of NHS staff believe that there is enough of them to do their jobs properly and one in four GP practices having a vacancy being just a few examples. Again, we know from the Audit Scotland report that this is having a direct impact on patient outcomes, too. Any impact on the thousands of EU workers that are currently employed in the health and social care sector is undoubtedly going to make the current situation worse. I urge the cabinet secretary and the Brexit minister to continue to press the UK Government to give an absolute commitment to existing EU nationals that are already living and working here and that their status and position is secure. However, also crucially, given the terms of our EU membership are currently still in place, employers too are given the confidence to continue to recruit staff from the EU and the potential workers are also given confidence that they have to choose to come and work here and that they will continue to have the rights to live and work here post Brexit. However, I would also go further. Given the workforce difficulties that our health and social care sector face and the importance of recruitment and retention of staff, I believe that we should be arguing for special immigration arrangements to be made for the sector that helps to protect and enhance the NHS workforce. I would also like to flag an important piece of work that needs to be done in Scotland well in advance of Brexit. That has already been touched upon by the cabinet secretary, too. While it is easy to monitor and highlight the staffing crisis in the NHS, it is much more difficult in the social care sector. In a largely privatised sector with fragmented data, getting an accurate picture of vacancy and turnover rates is difficult. Given that, I urge the minister to commit the Scottish Government to do some early work on this particular issue so that we can get an accurate and robust picture now. Moving on to regulation, in many important areas the UK Government needs to clarify whether its intention is to repeal EU regulations and replace them with UK-drafted alternatives or to continue to abide by them. Those include areas such as the working time directive, procurement and competition law, regulations of medicines and medical devices and regulations to enable common professional standards and medical education between EEA countries. It is also worth pointing out that there may also be some opportunities to address the limitations of European procurement law that has had on the health sector in particular, for example, state aid and the posted workers directive. Also, we must accept that the EU has made a mess of trade deals like T-Tip and CETA, which we should rightly reject in Scotland. However, I would express concern that Liam Fox is the individual being charged with negotiating those new deals for the UK. Thirdly, on the area of research, collaboration across the EU has enabled the UK to further its scientific research agenda through our ability to access both European research talent and important sources of funding. For example, between 2007 and 2013, the UK contributed €5.4 billion to EU research and development, but at the same time received €8.8 billion for research, development and innovative activities here in the UK. We know the leading role of many Scottish establishments, universities, individuals and companies play in research and development, and that is why we believe that the Scottish Government alongside the UK Government should therefore prioritise that issue in forthcoming negotiations. To conclude, Deputy Presiding Officer, I am sure that a clear majority of us would rather that we were not here, but we are. We must ensure that, as a collective, this Parliament and all of us are doing all that we can to minimise the consequences of Brexit, and in particular to protect our health and social care sector. Scottish Labour is committed to playing its full part. I formally move the amendment in my name. We now move to the open debate, with speeches of up to six minutes. I have Richard Lochhead, followed by Miles Briggs. I do welcome this debate because it is important to highlight that Brexit will have an impact in public services in Scotland and our quality of life, not just in economic terms but in terms of our health and wellbeing as well. As the consequences of Brexit, especially a hard Brexit, become clearer, it will remind us all that our lives are going to be affected in ways that I am sure many people did not expect such as the ability of the NHS to function properly. Of course, the NHS did feature in the referendum campaign. It is just a shame that the NHS featured in the campaign for all the wrong reasons. At the heart of the leave campaign's misleading assertions was the notorious poster, promising UK voters a spending bonanza of an extra £350 million a week on the NHS, one of the leave campaign's biggest promises, but one of the many that was abandoned soon after the vote. I note today that it has been reported that the Crown Prosecution Service south of the border may investigate if the leave campaign's assertions about the NHS led to undue influence in violated electoral law. However, thankfully, here in Scotland, we did vote to remain in the EU, and here we are today after the UK voted to leave and in the cold light of day, debating what leaving the EU actually means for families and communities the length and breadth of Scotland. There is no bigger example that affects all our lives than the NHS, a precious service that we all depend upon from cradle to grave. I expect that 38 per cent of Scots and 52 per cent of UK voters that voted to leave the EU did not decide to do so on the basis of the impact on the NHS, which of course is a pity, because today's debate is not about focusing on the benefits of Brexit for Scotland's NHS, because none of us can really think of any, but rather on the potential threat that is now posed to our NHS if Scotland has taken out of the EU against our will, particularly if we lose the freedom of movement of people in Europe. The NHS and the impact that it will have on this vital service is something that touches most people's lives. I often comment that when my two sons were born, one in Aberdeen and one in Elgin, my wife and sons were cared for by NHS staff around the world, including many EU countries. I often say that it felt like the United Nations brought my sons into the world because so many different nationalities were in the hospital theatres at those times. Indeed, I also would cost one of my own sons to Dr Gray's hospital in Elgin earlier this year after he was sent home from school because he had suffered a knock to the head at school PE, and there he was treated by a Lithuaniaan doctor and a Polish consultant. Again, I was grateful to all the staff who were there to care for my son and I was grateful that those doctors have made the decision to live and work in Scotland and in Murray. Thousands of families in Scotland each and every day are very grateful and very lucky that so many talented and hardworking doctors and nurses from the European Union have chosen to live and work in Scotland. They have chosen to pursue their careers in Scottish NHS, in their hospitals, in GP and dental surgeries, where they can apply their expertise to heal and care for our population in this country. At Brexit, it means that there may well soon be obstacles in the way that EU nationals moving to our country are working here for a period of time. It is no wonder that so many people and organisations are speaking out the dangers of Brexit and what it will mean for the NHS in the years ahead. The UK Government must heed the warning, for instance, in the Royal College of Nursing, when it said in the independent this week that the NHS would struggle to survive if there was a mass excess of staff as a result of a hard Brexit deal. That applies to Scotland as much as the rest of the UK. It is also important to recognise that EU nationals want to work in a health service to develop their careers, but it is also important that they feel welcome to come here to this country. There is no doubt in my mind that a hard Brexit will make it even more difficult to recruit medical professionals to work in more rural areas and in our smaller hospitals in this country. It is already challenging to attract staff to work in those areas out with our biggest cities and university hospitals without then going and reducing the pool of potential applicants. I have been heavily involved in a number of issues at Dr Gray's in my constituency because we have got some vacancies there that have been unfilled for some time, but some have been filled in recent times by EU nationals from Poland and elsewhere. Therefore, I, like many people, am concerned by what hard Brexit means if those desperately needed applications from the EU dry up. We have a number of vacancies at the moment. Richard Lochhead talks about the dangers of a hard Brexit. Can we infer from that that he is in favour of a soft Brexit and was he therefore one of the six? I voted to remain in the EU for reasons such as to ensure that there is no impact on the NHS as well as many other reasons. I think that what the Conservative party has to appreciate, particularly Theresa May, the UK Conservative Prime Minister, is that even the 38 per cent of Scots who voted to leave the EU did not expect a hard Brexit. They did not expect us to walk away from Europe and inflict all the damage that the Conservatives seem to be happy to inflict on our public services in this country. We have to send out a message to consultants and medical professionals and nurses throughout Europe that they are warmly welcome to apply for jobs in this country. That is why I support the Scottish Government today with the Lord Advocate announcing that it is going to intervene in the UK Government's challenge in the courts to article 50 to make sure that this Parliament has a say over the triggering of article 50, so that we can protect Scotland's interests. In the context of today's very important debate, it is important to protect Scotland's national health service as well. Miles Greggs, followed by Marie Todd. The dedication and valuable contribution that is made by all those who work in our health service and social care services, regardless of where they come from, is something that we should all acknowledge and thank them for. Although we have again heard a lot of rhetoric from the SNP today, the UK Government has been clear, whilst the UK remains in the European Union, EU nationals living in Scotland continue to have the same rights as they have now. The Prime Minister has also been very clear that the UK Government wants to protect the status of EU nationals living in the UK. The only circumstances in which that would be not possible is if British citizens' rights in other EU member states were not protected in return. I am sorry to say that we have not heard any comment on this issue from SNP ministers today and how they are supporting the work of the UK Government to protect the rights of Scots living and working across the UK, clearly a situation that is interlinked. I want to focus my comment today on the specific issue raised in the Government motion regarding the impact that leaving the EU may potentially have on those who are looking to study medicine, nursing and dentistry in Scotland. I have to say, Deputy Presiding Officer, I think that it is a bit rich of SNP ministers to express crocodile tears for the future of our NHS workforce and their concerns for those who are looking to study in Scotland when you look at the record of this Government and specifically their education policies, which, as a direct result of their funding structures in higher education, mean that Scottish universities have little flexibility when it comes to the provision of places for domiciled Scots students. The cabinet secretary has said that this is not the case today. She maybe does not read the press and journal, but Aberdeen University has been forced to admit that it is turning down students because of this SNP Government's policy. The chairman of the University of Scotland has called on the Scottish Government to increase the quota of Scots allowed to go to university. She might not want to call it a cap, but it seems to be a quota in the SNP's world. Very briefly— Cabinet Secretary, a minute. Did you? Minister. I thought you would eventually, Deputy Presiding Officer. Can I ask the member if he would tell us whether any restriction on numbers applies to any medical courses in England and Wales? Yes or no, answer will suffice. If it is, there is no such restriction, fine, but there isn't, because in actual fact what the Scottish Government does is what every Government does—it funds available places. Miles Briggs. I think that the cabinet secretary from his time or the minister—sorry, I am also promoting Mike Russell today—it is not something that I would want to do. It is quite clear that his decisions taken has mean that universities across Scotland are into funding our universities by charging international students. He knows the consequences of his decisions at the time. The fact that we are facing a crisis in the NHS workforce is because of the mismanagement of the health service by this Government, not despite it. It has been these political decisions that have had consequences, both intended and unintended, on the future planning of our NHS workforce, from the decision by the First Minister when she was health secretary to cut the number of student nurse placements to education policies pursued by this Government, which has now seen the number of Scottish domicile students decrease to a historic low of just 52 per cent. I agree with my fellow health and sport committee member Richard Lyle, who has continually questioned the reductions in Scottish medical school opportunities being offered to young Scottish domicile students. Given the fact that the number of places for Scottish students at Scottish universities is capped, a direct consequence of that is that we are increasingly seeing a limited number of places available for Scottish students to study medicine. In turn, that is clearly adding to pressures around medical recruitment. In closing the debate for the Scottish Government, I think that it would be helpful for ministers to actually say whether or not they will look at this and review the situation. Like many Scots who voted for the United Kingdom to remain in the European Union, I was disappointed with the result, but I have not got time. But as a Democrat, I respect the result of that vote. This is what democracy is all about, how we put our arguments to the people and the manner by which we live by their decisions. As we are now finding out, many SNP MSPs privately voted leave. I hope that they will now see the need to work together to make a success on the United Kingdom, leaving the EU and help to forge new relationships that work for Scotland and the UK. From the discussions that I have had with those who work in our health service and their representative bodies, they are clear that Brexit presents real challenges. However, they and we on these benches are not going to let the SNP use Brexit as an excuse for the existing challenges that our health service faces. I have listened intently to Mike Russell's weekly contributions in the chamber in each of those Brexit-themed debates. He recently accused my colleague Murdo Fraser of sounding like Pike from Dad's Army, but I have to say increasingly that Mr Russell is starting to sound increasingly like the Grinch. I do not doubt the very serious challenges facing the UK. It is for this very reason that we must come together and work together as a United Kingdom. The question increasingly people are asking themselves is when did the SNP give up on believing in the people of Scotland to face these challenges. Great countries come together to turn challenges into opportunities. The Scottish Conservative amendment calls on the Scottish Government to positively engage with the UK Government to ensure that interests of our health and social care workforce in Scotland are protected in exiting negotiations with the EU. We on these benches will be working week in, week out to make sure that that is achieved. Thank you, Mr Briggs. I call Mary Todd to be followed by Rhoda Grant. Thank you, Presiding Officer. This debate is arguably one of the most important debates that I have ever been able to contribute to. Yet, like my Conservative colleagues, I have a feeling that it is one that should not be necessary. It should not be necessary because we should be able to assume that those who treat us when we are sick are valued. We should be able to assume that those who care for the disabled and the elderly are valued. We should be able to assume that the contribution of our EU workforce to health and social care and to our society as a whole is also valued. However, the fact that we are here debating this shows the challenge that we face in defending the new Scots who have come from other parts of the EU and made our country their home. We are told that Brexit means Brexit, but what kind of Brexit are we going to have? As a pharmacist, I find myself wondering about the implications for drug development, research and access to new medicines. Will the reduced mobility of EU researchers into the UK reduce our capacity to do high-quality work? Will there be fewer opportunities to build high-level collaborations and to share knowledge? Will we still have access to EU-funded research facilities? What will happen to medicines regulation? Will our drugs still be licensed through the European Medicines Agency? Will the new clinical trials regulation set to come in in 2018? Will new drugs cost us more and come to us late because of our departure from the EU? Will UK pharma and biotech industries still have access to the European markets? It is six months on from the vote and still we have no clear idea. Six months on and the EU citizens living here still have no clear idea about their future. 6.8 per cent of the doctors who work in the UK gained their primary qualification in another country in the European economic area. 6.6 per cent of pharmacists did the same. For nurses, the number is probably similar. When we look at social care workers, the numbers are much higher, particularly in care homes, with even more people again coming from outside the EU. Some of the estimates are that nearly half of the people working in our nursing homes are not from the UK. Anecdotally, I hear that in the Highlands and Islands, the area that both myself and Donald Cameron represent, we are particularly dependent on European medical staff. The health boards have had recruitment drives in Spain and Holland trying to attract those highly qualified individuals to work in places where it has been hard to recruit homegrown doctors. In one of the highland hospitals, all of the consultants are European. In the Western Isles, only one consultant out of a total of 14 is a Scot. In Shetland, one in four doctors is European. I talk about anecdotes and I say estimate because we have so little data. Until very, very recently, it did not matter where you were born. It did not matter where you did your training. If you were registered in the UK, you could work in the NHS. We did not count the foreigners in each health board area. I want us to remain that kind of country. I feel ashamed of what we have become. I feel ashamed of the xenobobic rhetoric that I hear. I cannot believe that we now have to stand up to defend people who make such an obviously valuable contribution to our society, but that is the grim reality of the Brexit world. Unlike my colleagues, this is not an argument that I can detach myself from. Personally, as someone who worked in the NHS until this year, I have a great many friends who work from other EU countries who work in the NHS. That is a really important point in the debate for me. Those people are not strangers. They are friends, they are colleagues, sometimes they are families and they are vital members of our community. One of my childhood friends is now a midwife. She travelled the world but came back to the Highlands to work first in a hospital and now as a community midwife and to raise her family here with her Dutch husband. I spoke to her when I was preparing for this debate and she reminded me that it is not just about the health professionals, it is about the healthcare assistants, the auxiliaries, the students, the word clarkesis, the porters and many of whom are EU nationals and all of whom help our NHS to run efficiently. She told me about the Polish mums that she looks after. Nearly all of them work in care homes and it is not just the vital work that they do that we value, it is the contribution that they are making to the Highland village life. The idea that those women and, in fact, my friend and her family are being used by Theresa May as a bargaining chip in the Brexit negotiations is not just wrong, it is offensive. I know that it seems incredible that my Scottish-born friend is feeling uncertain about whether her family are welcome here, but that is how it is. Theresa May must put an end to this uncertainty and provide EU citizens with assurances that they will be allowed to live and work in the UK following Brexit. The UK Government's failure to give assurances is clearly damaging to the NHS, clearly damaging to the community that we live in, and they must end this uncertainty. Thank you very much. Paul Rhoda Grant, to be followed by Joan McAlpine, was grant please. Thank you, Presiding Officer. Sadly, the greatest lie of the referendum campaign was around investment in the NHS. The promise that leaving the EU would lead to £350 million a week investment in the NHS. Most of us knew that it was fantasy the moment it was spoken. Unfortunately, some believed it to be true. Sadly, now the term post-truth politics is recognised as a modern-day concept. It means that people believe very little of what politicians say, and that means all of us. How can we empower people to make informed decisions but allow them to be fed misinformation? It is incumbent on all of us to inform people of the facts and convince them of our arguments on the basis of those facts, explaining why we reached our opinion based on those very same facts. We also know that no politician has a crystal ball. They cannot know how things will change over the next years, but they can be honest about how changing challenges approaches. Those weekly debates show us that we are so intertwined with the EU that breaking those links is going to be difficult. There are also problems that no one foresaw that need to be faced. The remain campaign should have had more done to make people aware of those challenges. During the campaign, Nicola Sturgeon called for a positive campaign. Stop talking about the risks of leaving, she told us. Talk about the benefits of staying. Those debates are now highlighting the risks of leaving, but it is too late. We hope that EU nationals and UK nationals working abroad will be allowed to continue to live where they are. EU nationals make a huge contribution to our country and we value that and want them to stay. Neither can we make judgments about future migrants who may come and work here. Do we really want to lose their expertise as well? Our health and social care services need those skills. In NHS Highland, the board has difficulty in recruiting consultants and GPs and recently they advertised those posts in Holland. Inverness has daily flights to Shippol and, therefore, it is easily accessible to Dutch nationals to work here, be accessible to their family and friends back at home as well. The last I heard, this approach was showing some signs of success. Our amendment adds to the debate by pointing out the challenges that already exist in the health and social care service provision as highlighted by Audit Scotland. Those services will face further problems if EU nationals cannot continue to work here. We obviously hope that EU nationals will be able to remain and continue to make their home here. However, we also need to be able to recruit workers from the EU and indeed beyond. We also need that EU citizens, UK citizens living in the EU to continue to make their home there and have the same security as we would wish to give EU nationals here. We want EU legislation that protects workers' rights to be enshrined in UK law, for example the working time directive, which has only really begun protecting junior doctors from being exploited in the NHS. At the time that the directive became law, there was a degree of consternation as to how our NHS would fare without junior doctors working unbelievably long hours. We all now recognise that that system was wrong both for patient and for doctor. The NHS workforce also benefit from other social chapter rights such as equal pay, paternity leave and the like. Things that we take for granted but that will have to be enshrined in our own laws. We benefit from other aspects of working together and collaboration that go beyond workforce issues. We share knowledge of disease and how to tackle it. We share knowledge through the European Medicines Agency, which was to become a single point of entry for drug trials throughout the EU in 2018. The Kings Fund has pointed out that patients in the UK may stand to lose out on new drug trials and delay access to new and innovative treatments because of Brexit. We would also lose out in sharing this data and information at a European level and the possibility of bargaining with large pharmaceutical companies on a collective basis within the EU. Others have also talked about the European health insurance card, and our citizens more widely will be affected by that, too. They have the security of the European health insurance card when travelling in Europe, safe in the knowledge that they will get reciprocal healthcare wherever we are within Europe. That will impact many Scots travelling abroad, especially older people who maybe cannot afford to take out travel insurance and will stop them maybe going abroad on holidays. Presiding Officer, with additional funding for the NHS, promised by the Leave campaign, being at best a pipe dream, it is hard to see how health service can benefit from Brexit at all. Throws up challenges at a time when the NHS is least able to cope with them. It is important that both our Governments recognise that and do their best to support the NHS through these turbulent times, both with legislation and indeed attracting the very best people to work here. Thank you very much. I call Joan McAlpine for following Jackson Carlaw. Ms McAlpine, please. Thank you, Presiding Officer. Every picture tells a story and there is one picture, a photograph published shortly after the EU referendum vote, that tells the story of the vital contribution that EU staff contribute to saving lives in our NHS. The picture appeared on social media, and it was taken by a surgical team at a hospital. It was a kind of giant selfie. Each member of the surgical team holds up a placard. One says, Irish radiographer, German consultant anaesthetist, Spanish scrub nurse, Greek urology registrar, British Pakistani consultant urologist. That encapsulates, for many people, what the contribution of EU staff is in human terms. It was taken in a London hospital, but, as other contributions to the debate have shown, those people in their blue scrubs could be from any hospital in Scotland or across the UK. Mr Cameron implied in his opening speech that Brexit offered opportunities to non-EU doctors from overseas, but it seems to me that the rhetoric from other Conservative politicians has not just been about condemning wanting to get rid of EU medical staff, but about pulling up the drawbridge on overseas staff as a whole. During the Conservative Party conference, Theresa May gave an interview in which she said that the NHS would be made self-sufficient in doctors. She asked about reassurances for foreign-born NHS staff. There will be staff here from overseas in the interim period until a further number of British doctors are able to be trained. How insulting is that to the people who are working so hard in our NHS? I think that our First Minister put it very well when she saw that interview. She tweeted that the arrogance of the UK Government is breathtaking. There is somehow doing those doctors a favour by allowing them to save lives here. That sentiment from the First Minister was echoed by the Tory member of Parliament, Sarah Williston, a GP and chair of the UK parliamentary health committee. She was shocked, too. She said that Theresa May should unequivocally welcome our valued overseas health and care staff, because we all benefit from their skills. In the European referendum, Scotland voted unequivocally to stay in the EU, indicating a support for European membership, largely predicated, I believe, on a desire to live in an inclusive society based on respect and rights for all workers, regardless of where they are born. Like the vast majority of people in this country, I recognise and value the immense contribution of EU nationals throughout Scottish society, and not least in terms of the role of highly skilled European workers in the health and social care sector. I believe that there is a widespread recognition of the valuable role that is played by EU nationals in Scotland's social care sector specifically. In the more rural areas of Scotland, such as my region in Dumfries and Galloway and the south of Scotland, the challenges that we face in recruitment and retention of health and social care staff to serve a highly dispersed and aging population are, according to the Auditor General for Scotland, no different from the challenges that are faced across the UK more widely. EU workers are not only welcome to be part of the provision in my part of Scotland, in fact they are badly needed. In their submission to the European and External Relations Committee, which I convene, the Health and Social Care Alliance highlighted findings from a survey of its members. A significant majority of 69 per cent of those surveyed felt that Brexit would have a negative impact on health and social care in Scotland. Many respondents highlighted their concerns about the potential loss to the workforce, and one response noted that it is hard enough to find sufficient qualified staff without EU migrants will be struggling more. The British Medical Association points out that the policy of freedom of movement and the recognition of qualifications across EU states allows health and social care professionals to work in the UK in vice versa. Is this mutual exchange of skills and staffing that would allow us future standards of living by growing our population and addressing the skills gap to support an aging demographic? The Royal College of Nursing outlined in its submission to the committee Brexit could jeopardise the free movement of nursing staff from within the EU. The European Professional Qualifications Directive sets the legislative framework for the recognition of certain health professional qualifications. Without that, Scotland would potentially be unable to accept the qualifications from overseas workers wanting to work in our NHS and elsewhere. It is worth emphasising that, despite Scotland's overwhelming support for continued membership of the EU, the Conservatives Brexit gamble has already damaged our own devolved infrastructure by undermining staff working in the caring professions. The reactionary rhetoric and deep political and economic uncertainty coming from Westminster will inevitably impede our efforts to recruit and retain EU citizens to work in Scotland's care sector. That is why I urge the UK Government to guarantee residency rights and to desist from Theresa May's frankly repugnant policy of using EU nationals as Brexit bargaining chips or, as Liam Fox described them, cards to play with. Our European workers who have made lives and paid taxes here are not chips and they are not cards and they deserve at least the courtesy of a reassurance that they will be able to continue living, working in Scotland and elsewhere in the UK. In the case of NHS workers continuing to save lives. Thank you very much. Thank you, Presiding Officer. It was my privilege for most of the last nine years to, with one small interruption, to speak on health matters in this Parliament. I hope that I contributed both to a change in the substance and the tone of the Conservative approach to health. I became slightly concerned about almost the routine rhetoric of thanking staff in this chamber. It came to me that many of them were far too busy to sit and listen to our thanks. What they wanted was action from this chamber to address the very many problems that exist within the health service. Today, I have no hesitation in thanking anyone who contributes to our national health service from wherever they come and for whatever role they perform. For as long as they wish to do so, it should be the objective and policy of this Parliament that they will be able to. In those nine years, I was able to stand against three cabinet secretaries for health. I am sure that both the present front bench and Bute House will agree that the most outstanding of those three was Alec Neill, a man of real intellectual rigor and capacity. I know that he would be dismissed by his colleague in the front bench now as a born-again brexitir, but I understand that Mr Neill and six others, the seven samurai of the SNP, now cutting through the seven veils of Scotland's only vita, Nicola Sturgeon, although perhaps better described as Alec Neill and six ninjas, as some of them have the courage of anonymity at this stage in terms of how they voted. Of course, I think that we know that there could be any Tom Dick or Harry or, as we say in these parts, any Tom Dick or Gil, but I do not believe everything that I read in the newspapers and I will leave it for them to say. I will say of Mr Neill that the minute he left office, the first staff satisfaction survey that there was in the period after he ceased to be held service showed staff satisfaction and morale plummeting across almost all the indices against which they were being recorded, so I thank him for the service that he gave. I agree with Donald Cameron and Miles Briggs that workforce planning is one of the issues that is fundamentally important to the overall sustainability of our NHS, and I agree with Marie Todd that I thought that that was an excellent contribution. The place and importance of the international workforce on our NHS is fundamental. It is interesting because I see the word bargaining chips. I looked to the independence referendum when Nicola Sturgeon was asked what would happen in the event that Scotland did not have automatic membership of the European Union. She said that if Scotland was outside Europe, the 160,000 nationals from other states living in Scotland would lose the right to stay here. What did that mean? What did that mean at that point? Was she threatening, as is implicit in that quotation, that they would have to leave? I think not, but it is just as important for others to recognise that the lazy rhetoric on this, I think, is deeply unfortunate. Of course, there are a significant number of European nationals working in Great Britain, 3.3 million, 173,000 of whom live in Scotland, many of them working within the health service. I am also concerned about the 1.2 million British citizens, including 120,000 Scots, who live across the rest of Europe, 309,000 in Spain, 255,000 in Ireland, 185,000 in France and 103,000 in Germany. None of the Governments of any of those countries have given a unilateral declaration that those staff, Scots, working in health services across the rest of Europe will have some unilateral right to stay. What we need is a universal commitment from all of the states within the European Union and the United Kingdom that wherever anybody is currently working or living, they will be welcome to stay and they will be welcome to continue to work. I thank the member for giving me a way. Would you accept that one of the reasons for the uncertainty on both sides is the unnecessary delay in starting negotiations on the UK Government setting out what its position is? I think that it is important that this is one of the first issues that is addressed when those negotiations begin and I understand David Davis to have made that commitment. I agree, it has to be resolved and it has to be resolved as quickly as possible. Why do we need so many people in our health service? You only need to look—I won't rehearse some of the statistics that were evidenced by Miles Briggs a short while ago with which I agree—you only have to look at the demographics of Scotland in the next 25 years. It is estimated that the number of people living in Scotland aged 65 and over will double in the next 25 years, and the percentage of people of working age is expected to remain as it is today. If our public health services, if our public services are going to be sustainable in the future, whether we are in the European Union or out of the European Union, we are going to have to attract into Scotland in order for our infrastructure to be sustainable and succeed, foreign nationals from across the world as well as the European Union to assist us in that task. Any strategy, any agreement that fails to do that would fundamentally undermine our ability to function as a country. Mike Russell has written to Joan McAlpine a letter saying that he will be attending a joint ministerial committee this week and hoping that matters of substance will be discussed. The secretary of state, when he gave evidence to the committee, indicated that market access would be one of the issues on the table. Liam Fox and David Davis have both agreed to come to the Scottish Parliament, unlike Cabinet ministers historically, to give evidence to the committee, and this Parliament will be able to question them. It is absolutely important that we are able to conclude, just as Shona Robison did at the end of her speech, that we, too, want to thank everybody who works in our health service and contributes to our public services from across Europe. We want you to stay and we are determined that you will. I rise to offer the support of Liberal Democrats to the emerging cross-party consensus throughout most of this chamber, that the EU workforce, be they in our health service, in our social care sector or for any other profession for that matter, are welcome here and not only are they welcome, they are absolutely vital. They give us life-saving care, they will make decisions about our continuing treatment with us, they tuck us in at night, they dispense our drugs and they stand by our bedsides at our most vulnerable times throughout the health and social care sector. Already the Brexit vote, that multi-faceted act of political vandalism, has seen interest in coming to work here from EU countries literally full of a cliff edge. Many are facing that view of being a bargaining chip, that horrendous term is a disincentive to a career and a life in Scotland and that uncertainty and that reluctance to come here could not come at a worse time. In many ways we are facing a perfect storm in our workforce, both in our health sector and in our social care sector. 800, 850 fewer GPs than we require by the end of the decade, vacancies for social care nurses at 28 per cent, almost a third of them, vacant, pediatricians, midwives, nurses, physiotherapists, child psychologists—the list goes on and on. Any of my opposite numbers in the other political parties will attest to the steady stream of representations that we receive from various arms of the health sector and the social care sector to tell us that the workforce is in crisis. Yet twice in the health and sport committee last week or two weeks ago I asked the cabinet secretary, is this a crisis and twice she denied that it was so? It is clear, according to the excoriating report from Audit Scotland last week, that this Government is wholly unprepared for the staffing crisis before it. Workforce planning over five years—over five years, yes? Emma Harper. I would just like to clarify with the member, I'm a wee bit horse actually, that where in the audit report does the word crisis come up, because I've looked for it and I can't find it. Mr Cole-Hamilton. This is exactly what happened in our health committee last week. This is the SNP double thing. This is absolutely the SNP double thing. The eyes of an entire profession are looking to your Government for solutions about a demonstrable decline in our workforce across every sector in the health workforce and they are finding your Government wanting. It is time to stop arguing about terminology and look to action. Workforce planning, which was cited in the Audit Scotland report, bemoans the fact that in this country we only do workforce planning over five years, yet it takes seven years to train a GP. That workforce planning cycle led to the fact that five years ago decisions were taken by the then health secretary and now First Minister, Nicola Sturgeon, to roll up training places, to cut in midwifery training places by more than a half. We are facing a workforce planning crisis because of retirement as a result of that. Given that European citizens make up such an indispensable part of our workforce across the health sector, 6.8 per cent of GPs, as Marie Todd said in her excellent contribution, not only should we try to protect their status in this country, but we should be aggressively trying to recruit them from the countries of the origin. There is a human cost to this workforce crisis as well. The European citizens can and must form part of the solution. Last week, I spoke at length about a constituent of mine, George Ballantyne, whom I hope very much will tomorrow return home after over 150 nights in hospital following being declared fit to go home. On the three occasions, he was told that he was ready to go home and to prepare to go home. It was the social care package around him that failed through a lack of staff and availability of care that led to him remaining in hospital. That is coupled with the reality of 28 per cent of vacancies in the social care workforce. That has a material impact on our efforts to eradicate something that I share with the Cabinet Secretary our desire to eradicate delayed discharge in our society. When he does go home, he will go to Ladywell medical practice, which is in Custorfen in my constituency. That is a practice that is already on its knees through shortage of doctors. The evidence that, time and again, the European has provided us with hardworking, compassionate and dynamic individuals is a credit to the countries of origin and to the profession that they now serve. We should all of us be justifiably proud of the contribution that they make to our society and the fact that they have chosen this country in which to settle. As such, we must protect them and we must encourage more of them to come here. I am very happy to speak in this debate on how we value our fellow Europeans who work in the health and social care sector. Some issues that we can consider this afternoon are specific to this sector, but I think that there are other points that we can make that affect the broader issue of EU employees in Scotland. I think that there are a number of reasons why it is beneficial for workers to be able to move freely across borders, including, for example, one. The most obvious one is that one country, for example, is short of workers long-term, for example because of an ageing population, and we need to bring people in to supplement our workforce. That point has already been made. Secondly, needs can vary in different countries at different times. For example, a German population is expected to fall while the UK population is expected to rise, so health workers and others may be needed more in one country at one point in time and in another country later or earlier. Thirdly, we can benefit from different experiences and practices in different countries. In a whole range of different sectors, we hear of the benefit of workers coming from other countries to work in Scotland or the UK. One of the most recent groups that I spoke to was the Federation of Master Builders. Their experience has not just been that a Polish worker can fill a job, but actually bringing in a number of Polish workers into a business can change the whole ethos of that business with new ways of doing things and perhaps a better work ethic. Schools also have talked about the experience of young people coming in with a hunger for learning, both from the children and from families from other countries. There is every reason to think that the health sector is the same. Yes, we have great Scottish staff and a lot about our NHS is great, but we must not be narrow nationalists as some of the British are. We can learn to do things better and, by restricting workers from elsewhere, we are in danger of losing out on their expertise. Fourthly, linked to this, is that many health professionals want to gain experience for the benefit of their own careers by working in different countries. I have one friend who works as a GP but also does some specialising, and he has his spells in Australia, Scotland, England and has been looking at doing work in Sweden as well for some of the specific experience there. That is not so unusual these days. We live in a world where young people especially think in a very international way and are looking to work in a variety of settings for career and general life experience. Those are some of the reasons why it may be a good thing, I believe that it is a good thing, for people to be allowed to have flexibility in working across borders. However, other questions that we face today include how many non-UK EU citizens do we actually have working in health and care right now? How dependent are we on them? Can we continue if all of them or some of them are to leave? Well, the answer seems to be that we do not know. I actually think that it is worse not to know that we have a problem but not to know the extent of it than it is to know the details, the exact details of the challenges that we face. Both Unison and the RCN and their briefings for today's debate say that estimates of staff numbers from EU countries are not reliable. That uncertainty in the figures, I find very concerning. How can we really know the impact and challenge that lies ahead if we do not know clearly now how many EU folk we have? Yet there is clearly more to this than just numbers. This morning, we heard from several witnesses at the economy committee that the message that the UK is sending out is important too, whether that be to students, academic staff, construction workers or health and social care workers. That is the point that appears in the RCN briefing for today's debate when they say, "...EU staff may choose to leave the UK due to the uncertainty created before new rules are put in place." Again, it is important that EEA health and social care workers continue to feel valued as we enter this period of uncertainty. Are we saying, yes, you are very welcome here and we really want you to work, send your kids to our schools, be part of society? Or are we saying, technically, you are entitled to stay here or come here and work? Our economy and public services really need you, but we are inviting you grudgingly. We do not really want you to be here and we certainly will not be doing anything to make you feel welcome. There is a big difference between those two attitudes. That problem comes into the Conservative amendment today. It says that the UK Government has stated the intention to protect the status of all EU nationals currently in the UK. The actual words of that look reassuring, but behind it there is still the sense that they are not wanted. Others have mentioned the good moves coming out of the EU, such as the European working time directive. The hours that junior doctors have had to work, which Rhoda Grant referred to, have been absolutely scandalous. I fear very much for the direction of employment law in the UK without our European friends and colleagues keeping an eye on us. We can debate the numbers and technicalities for a long time, and I am sure that we will do so in the coming months. However, today I hope that we can all send out a real message to all those working in our NHS and beyond that we hugely value their work, whatever their nationality, and we very much hope that they will stay. Like a couple of the speakers on the other benches, I regret that we have not, as the gloom gathers outside, got the colour of Alec Neil to add to the debate as a former health secretary. He could have brought a breadth of experience and given his recent announcement that he was belatedly a Brexit supporter, he could have brought a different perspective to some of the contributions to the debate. I do not have a tremendous issue. I do not agree with what Alec Neil said, but he at least reflects the reality that 36 per cent of SNP voters voted to exit in their referendum. The reality across political parties is that we might all belong to the one political party, but there tend to be disagreements. Sometimes the SNP needs a—it would be good if this is a new period of SNP glasnos now, as we see things begin to open up. That can only help the debate. In terms of this afternoon's debate, it is right that contributions have welcomed the positive contribution of the NHS and NHS staff and of the EU staff within the NHS. After all, there are 181,000 EU nationals within Scotland, and as the motion notes, one in 20 NHS doctors are from EU countries. There is a real element of sharing. People come here who make a contribution to the Scottish economy, not just in the health service but elsewhere, but they benefit from the fantastic staff that we have in the health services. That is something to be celebrated. However, it is important that we acknowledge that the Audit Scotland report last week said that the service is stretched. The reality is that, when you are not achieving seven out of eight of your key performance indicators, there are clearly some real issues. When you see the growth in outpatients waiting from 254,000 to 275,000, that indicates issues. At board level, cuts go up to nearly £500 million. You have to question some of those in terms of what benefit they will give to the service, so that, if you close Lightburn hospital, when the service that it gives to a lot of pensioners in that area, particularly the dedicated Parkinson's service, it is detrimental to the overall service. The other aspect that should be drawn out in the debate is that people are right to compliment the NHS. Richard Lochhead, in an excellent contribution, celebrated how the NHS has been beneficial to his family and the contribution that the EU nationals made. Sometimes the Government downplays the impact of the areas of their own responsibility in relation to Brexit. I think that there are some real issues coming down the line in relation to the future Scottish budget and the health aspect of that. If you just look at, for example, yesterday's report from BDOLLP, which indicates that inflation is going to continue to be on the rise, the potential impact that that has is that it could undermine growth in the Scottish economy. At a time when we get more powers and the opportunity to raise more through taxes, that could lead to real pressures as potentially those tax revenues reduce. When the NHS budget makes up 40 per cent of the overall budget and 55 per cent of the overall budget is wages, there can be a real issue where potentially prices are rising at a rate greater than people's wages. People are right to celebrate the importance of the NHS and the contribution of EU nationals, but we must also look at the issues coming down the line in relation to the future Scottish budget and the impact that that is going to have on any NHS. If the service continues to be stretched, as the Audit Scotland report noted, and the demographics continue to grow, then there are real challenges. In general terms, people are right to voice their concerns about Brexit and their right to voice their concerns about the UK Government approach, but I think that we need a more comprehensive debate in terms of what the Government's response is and what our response is as a Parliament to the issues that confront us directly, and I hope that people bear that in mind in terms of future discussions. I thank you very much, Mr Kerrie, called for a hockey, followed by Rachel Hamilton. Thank you, Presiding Officer. Like many in this chamber, I woke on 24 June to discover that the UK as a whole had voted to leave the EU, and that Scotland had overwhelmingly voted to remain as part of the EU. The lack of a coherent plan by those who led us a merry dance towards an economic cliff edge quickly became a pamp tall, and the major players in both sides of the debate quickly exited the stage, and the questions about what happened next were met with wealth, Brexit means Brexit and a little other explanation. Perhaps the cruelest thing to happen, though, since the vote, has been the upsurge in racial attacks on our European brothers and sisters, who have made this country their home, and thankfully much less so in Scotland than in the rest of the UK, but one attack is one too many. To compound this, EU citizens have become bargaining chips in a game of brinkmanship yet to be played out between the Westminster Government and the EU. They are left with no certainty about their future here and about whether they will be welcome to continue to build their lives here, and that is just plain wrong. We face challenges in recruiting and retaining staff in our health and social care sector. At last week's health and sport committee, we heard evidence from a number of sources about recruitment and retention in the health and social care sector across Scotland. We heard that Unison Scotland alone estimates that it has 6,000 members who are EU nationals. Many of them work in the home care or care at home settings. Those workers care for our most vulnerable in our society, ensuring that our older adults can remain at home, giving respite to carers so that they can have some quality of life while they still look after a loved one, and helping families with disabled children so that those kids and their siblings can have parents who are not exhausted and drained by the circumstances that they find themselves in. Those are areas that we need to grow our workforce, not to contract the pull of work that we draw on. The current uncertainty around the status of EU nationals does not help with growing that workforce to the levels that we require. We heard evidence from professional bodies, from trade unions and from health and social care providers, and when asked about the effect that Brexit could have on its sectors, we heard warning after warning about profound concerns of the effect that this could have on our health and social care workforce. There is concern from others that it is already impacting on retention and recruitment in the health and social care workforce. There have been reports of EU citizens looking to move back home or to other EU countries. Those are highly trained health and social care professionals and they are in great demand worldwide, and there are no shortage of opportunities for them. There are also reports of a major national organisation closing its recruitment office in continental Europe following the sharp downturn in people trying to access healthcare employment in the UK. In my constituency of Rutherglen, I was recently approached by a constituent who holds a senior management post in a local care home. My constituent expressed grave concerns about the impact that the vote to leave the EU has had on a significant section of its workforce. Nationals from several EU countries are employed in various caring and support roles at this local nursing home. Not only are they worried that they may not be able to stay in this country, a place that they have called home for many years, the impact of the change in their circumstances runs much deeper. Many of my constituent's colleagues are long embedded in their local communities, with children attending nursery and schools, involved in clubs and local activities, learning and passing exams and working towards contributing to our workforce and society in future. Through no fault of their own, they are now faced with a level of uncertainty that is unfair and quite frankly cruel. Many are contemplating the prospect of having to leave Scotland and possibly uproot their families. Given that the health committee was told only last week that the health and social care sector will require to recruit up to 60,000 care workers to meet increasing demand in the future, we can ill afford to lose a significant number of the dedicated workforce already in place. I do not wish to sound like this is a one-way street, one where we are only interested in our own selfish needs to have our hospitals and our care home staffed. Yes, it is imperative that we address the challenges that the sector faces in attracting staff to meet health and social care requirements in the future. However, that will involve ensuring that those are valued and attractive roles for everyone, that there are adequate training and development opportunities for staff and that they are paid at least the Scottish living wage and that we strive to eradicate exploitative zero hours or nominal hours contracts from the sector and ensure fair and equitable terms and conditions, including sick pay, travel time and annual leave. Sadly, the health committee took evidence that indicates that, in some cases, workers' rights within the sector did not meet what we would regard as basic entitlements. Of course, many of those core rights and protections are guaranteed by EU legislation. A Brexit solution that drags us out of the single market threatens these protections and therefore coupled with the lack of reassurances on the status of EU nationals in the sector seriously undermines our ability to recruit to our requirements. EU nationals in the health and social care sector make a valuable contribution to our society. They care for us and our families, they benefit our economy and they make our society rich and diverse. Our message to EU citizens is simple. Scotland is your home, you are welcome and your contribution to our economy and society and culture is valued. We have a simple message for Theresa May and her Brexit tears. Stop undermining our public services by using your EU brothers and sisters' bargaining chips in your bungled Brexit games and give us the reassurances about their status that they deserve. Thank you very much. I call Rachel Hampton to be followed by Emma Harper and Emma Harper will be the last speaker in the open debate. Ms Hamilton, please. Like my colleagues, I too recognise and pay tribute to the fantastic work that those in the health and social work profession do and the valuable contribution that staff from Scotland, the EU and beyond make. We must continue to make the Scottish NHS a welcoming and attractive sector to work for both EU nationals and also for those born and bred here. To do that, we must acknowledge and act on the difficulties that the NHS currently faces, which I would like to set out this afternoon. There is huge excitement in East Lothian because after 10 years of waiting, East Lothian is finally starting to see the new £70 million community hospital take shape. That, of course, has been curtailed by the weight itself and the absence of an accident and emergency department. Combined with an ageing population and the Scottish Government asking for 10,000 houses to be built in East Lothian, it is crystal clear that further services and more staff will be required to meet demand. A wait-and-see approach is not good enough. East Lothian and Scotland are used to waiting for improvements to the NHS. For years, we have identified a workforce shortage, low morale in general practice and an inability to effectively cope with an ageing population with long-term health implications. Those concerns have long been apparent and we have yet to see any real solutions or effective implementation of those measures to deal with them. A new hospital is much needed, but we also require people to work there. Staff retention is growing, a growing problem in the south of Scotland. A recent Audit Scotland report published last month found that a consequence of recruitment and retention problems, plus the pressure to meet waiting times, is the rising costs of temporary staff. That was felt no more than in the borders where the largest percentage increase at 14 per cent was found or, in monetary terms, 1.8 million. The Scottish NHS spent £23.5 million on agency nursing and midwifery staff, an increase of 47 per cent compared to 2014-15. NHS borders was one of five boards that saw spending double. This level of increased spending is simply unsustainable and the evidence suggests that borders general hospital is one of those hardest to hit. This level of spending for temporary staff is also vastly more expensive than permanent staff, again detailed by Audit Scotland. The cost of agency nursing staff versus permanent staff is more than twice the cost. Action needs to be taken to regain control of the situation because the current situation is simply out of control. A constituency recently contacted me because it was impossible to make an appointment to see the GP. The struggles facing general practice have been debated in this chamber before. We have all recognised that GP's workload is far too big to manage and the morale in the profession is low. A survey commissioned by the BMA last year found that 69 per cent of GP's said that workload had a negative impact on the commitment to a career in general practice and 92 per cent of GP's said that their heavy workload has negatively impacted on the care patients received. Clearly, what is in place is not working for either patient or GP. This was only reinforced when Scottish Conservative research found Scotland is 830 GP's short of the number needed. No wonder it is difficult to make an appointment. We don't have enough cover. These issues are present now and action needs to be taken now. The number of Scottish students applying for medicine courses dropped by 11 per cent. Again, this is a clear sign that current practice is not working. When we associate that figure to Audit Scotland reports, there is a chronic shortage of staff across the board and many soon to retire. Willi Todd, please. Could the member explain how the chronic shortage of staff that she is describing is going to be improved by the Brexit situation? I thought that you might ask me this, Mary. I thought that the ways to increase staff— Could you please use full names? I thought that you might ask me this. Ways to increase staff—in a way, you are using— Can you also make sure that you don't use all the time? Sorry, on you go. I think that the member is using Brexit as an excuse for the workforce crisis. I think that if the SNP could look to ways of working with businesses and universities to bring current migration rates down to keep the brightest and best of our medical staff, also to upskill our own people and perhaps to increase the current limit on student medical places might have a positive impact. We hear much in the chamber of how best to effectively address Scotland's ageing population and the long-term health conditions associated with age. Action has been agreed in this Parliament and we all support the integration of health and social care that we see a shift from hospital care to homely community-based settings. However, there have been reports of difficulties in this regard also. Independent auditors have found NHS borders has highlighted the governance arrangements in terms of roles and responsibilities as a risk. There are visible problems that need to be resolved in the introduction of integrated health and social care and we need to ensure that those problems are addressed now before it escalates. The evidence says that there is a severe problem with the recruitment and retention here in Scotland. The evidence says that this issue is present here and now before Brexit, before the vote on 23 June. Indeed, those problems have been debated in this chamber time and time again and we have seen little action that has helped to alleviate the problem. Nowhere is recruitment and retention felt more than the Scottish borders. I have outlined the huge spending taken to fix the staff shortages. These are serious issues that must be addressed now. It does a disservice to Scotland and the Scottish NHS to blame these issues on Brexit. It does an even greater disservice to have the audacity to pretend that these recruitment and retention problems will occur due to Brexit. Emma Harper, can I say to Colin Smyth and Liam Kerr that you now have seven minutes each for this time and for your—I know that you are excited by that—winding up. Emma Harper, please. Thank you, Presiding Officer. Habensie Schmersen, T. Sinti Malle, Gadgetje Bolle, or even in Scots, are you there? Those are the basic questions that, during my career as a theatre and recovery room nurse, I taught myself to ask in several languages. If you can imagine the confusion and disorientation of coming round from anesthetic, it makes sense to try to ask a patient those simple but vital questions in the person's own language. Not only is it comforting for them, very often in that initial confusion it is the best way of obtaining important information. Those words and other relevant patient care phrases were taught to me by my friends and colleagues from across Europe and indeed further afield. It works. One of my patients, a Polish lorry driver, said that he hoped that I would be on duty when he was due to return to the operating theatre for another operation because I could speak a few words to him in his own language. We have an international workforce in our NHS and will, even in rural Dumfries and Galloway, treat plenty of patients who are not originally from Scotland. I think that looking back that it was my own experience of working as an economic migrant in the American health system that led me to be so concerned about being able to communicate effectively with people when they are at their most vulnerable. I spent 14 years working in California. I spent time at Cedarsinei Medical Centre as a transplant nurse. It would be difficult to find a more multicultural and cosmopolitan workforce. Multiculturalism leads to better, safe patient care, and this Galloway last learned a lot from medical professionals from all over the world. That experience was incredibly valuable to me. It led me to accept other cultures and people on the basis of their knowledge and skills rather than their country of origin. To the point, indeed, where I am dumb-funert that we are having this debate, I support the terms of the motion in the cabinet secretary's name wholeheartedly and without reservation. The assurances in the motion are fundamental and just shouldn't be necessary. The fact is that, however deplorable I find it, the reassurance is necessary now, and we absolutely need to say to our friends and colleagues in our NHS from other countries that their contribution is valued, appreciated and welcomed. Finlay Carson, please. I will take an intervention. Brexit is going to make any difference to the critical levels of GPs that we have in the south of Scotland, particularly in Stranraer and why the Government hasn't been able to address it up to now. I thank Finlay Carson for his intervention. When I met the chief executive officer of NHS Dumfries and Galloway last Friday, he assured me that they were doing everything they could to attract GPs to the area. There were multiple issues that needed to be dealt with. He mentioned—I am coming to the point of that—that I can hear folks shouting at me across the chamber that our radiology department could not function without the Czech Republic supplying radiologists to NHS Dumfries and Galloway. We need to value our contribution from our EU NHS workforce. It should feel at home here in Scotland. We have seen the unedified promises of lists of foreign workers and reductions in the NHS's reliance on foreign staff once we have trained more British doctors and nurses. I accept that there have been new turns on both, but I have to say, Presiding Officer, the damage done by raising the prospect of those measures shouldn't be underestimated. In Dumfries and Galloway Royal infirmary again, we have many EU nationals that work in many departments. In the operating room where I worked in, I listed 13 different countries just off the top of my head while we are sitting here listening to the start of those debates. In fact, it didn't matter previously in the slightest where those radiology department doctors came from until the Tories decided to put those issues front and centre. Presiding Officer, in an operating theatre, the patient on the table has no nationality. When you open the abdomen, the organs don't tell us which country they are from, only that person is a human being. The multiple nationalities of the surgical team allows for innovation, creativity and pooling of global knowledge so that modern surgery is safe, effective and successful every day. Unless you have been in an operating theatre, you probably won't be aware that before every procedure we take a time out, it is a pause to double check safety issues. It's a technique promoted by American neurosurgeon Dr Atil Gawande to enhance best practice. It's the moment where the whole team pauses to check absolutely everything before the scalpel touches the skin. It's one of the great strengths of our NHS that we took the time out concept and embedded it into our world leading patient safety programme. Presiding Officer, I particularly endorse the line from the motion that says, recognises the valuable contribution that health and care staff from across the EU and beyond make to Scotland. It's a great strength of Scottish society that we are prepared to accept and welcome people from across the EU. I'll offer a prescription right now even though I was not a prescribing nurse. To the politicians in Westminster and Prime Minister Theresa May and the media who have whipped up a storm against foreign workers before they continue to bash foreign workers, perhaps they might like to implement Dr Gawande's time out. Thank you very much, Ms Harper. This isn't a rebuke to Emma Harper, but just for information to new members, before you use a language other than English, even a short phrase, you have to seek the Presiding Officer's consent first. Standing order 7.1 for those who want to know that. Just for information, I didn't expect everybody to know that, but that's the point. It's for the official report. I now call Colin Smyth to wind up for Labour. I think I gave you an extra minute, seven minutes please, Mr Smyth. Thank you very much, Presiding Officer. I'd be pleased to know I intend to speak very much in English, albeit with a bit of a Dunhamer accent. For the record, I declare an interest in relation to the debate. When I was elected in May, I was employed by Parkinson's UK, although that employment ceased at the end of May. I am also a local councillor in Dumfries and Galloway. Our national health service remains our nation's most treasured possession and, unquestionably, Labour's greatest achievement. In government, we created it and we will be unflinching and defending our NHS in this chamber and across the country. However, the credit for the enduring success of our nation's most precious institution doesn't lie with the politicians. It lies with the often heroic actions of its greatest asset, our health and social care staff. Public servants who care for their loved ones, as if they were their own, should never ever stop thanking them for that. It is appropriate that, in their contributions to today's debate, so many members highlighted in the cabinet secretary's words the dedication and commitment of health and social care staff, even if, as Jackson Carlaw said, they may be a little too busy to listen to this debate. In particular, today's debate provided members with an opportunity to place on record our thanks to the EU migrants, the doctors, the nurses, the midwives, the care workers who work day in, day out, saving lives and caring for our families across Scotland and the UK. Indeed, Joe McAlpine referred to the photos circulating on social media that highlighted staff from Britain, from Ireland, from Germany, from Spain and also from Greece. As Rhoda Grant highlighted in her contribution, during the EU referendum, we were all fed the propaganda of the Brexiteers, whose big red bus told us that the NHS would receive an extra £350 million a week if we left the EU. If we barricaded ourselves in against the flood of migrants, our public services would be saved. The truth is that there is no £350 million extra per week for the NHS, and we are more likely to come across a migrant caring for us in hospital than one line in a hospital bed next to us. It is estimated that Scotland's health and social care sector employs some 12,000 EU nationals. We all know that there are parts of the sector that simply would not function without their contribution. However, today's debate has shown that the fundamental question of what will now happen to each and every one of those EU nationals working in the UK remains unanswered. Will existing staff have to leave if they do not earn enough to meet an income threshold to renew a visa in the future? What restrictions will there be on recruiting new staff? Will there already chronic staff shortages become worse without immediate access to the pool of qualified staff from other European countries? As Mary Todd said, it is nearly six months since the UK voted to leave the EU, and the answer to those questions is still we do not know. What about patient care? The financial challenges facing the NHS are already, as Audit Scotland described last week, unprecedented. The Audit Scotland report stated that NHS funding is not keeping pace with increasing demand and the needs of an ageing population. Health boards have had to make savings of £291 million in 2015-16, and that will rise to £492 million this year. As James Kelly highlighted, there is no doubt that the economic shock of the vote to leave the EU risks plunging the health and social care sector into an even deeper financial crisis than it currently faces. The economy is slowing, and tax income is lower as a result, so public sector spending could well be squeezed even further. Indeed, just today, the Institute of Fiscal Studies warned that the UK's public finances have deteriorated by £25 billion since the March budget. Although those are the immediate concerns over Brexit, members have also raised other issues in the health and social care sector that we need to start to plan for now. The cabinet secretary rightly highlighted EU standards and professional regulation and employment law, in particular the working time directive. The cabinet secretary also rightly emphasised the need to maintain and retain the reciprocal healthcare system that allows UK citizens to be treated across the EU. There are also wider public health impacts of the EU environment and food regulation, not to mention the loss of research funding and opportunities for research collaboration. As Sarwar highlighted, we should also be concerned about the approach that the current UK Government may take to trade deals. If we think that the EU made a mess of TTIP and CETA, just imagine what ministers such as Boris Johnson and Liam Fox could do. What can we do here in Scotland to best protect our NHS and social care sector? Although I mentioned earlier that even before Brexit, our NHS and social care sector faces staffing and financial challenges, it would be a remiss of this Parliament today not to at least acknowledge that, simply after two weeks of the Audit Scotland report. In her statement to Parliament last week responding to the report, the cabinet secretary said that Audit Scotland made several recommendations that the Government accepts in full. The Government amendment and the health debate later that day stated that Parliament welcomes the publication of the Audit Scotland report. Labour's reasonable amendment today simply asks that we place on record what we all know, namely that our health and social care workforce already faces significant challenges as highlighted in that Audit Scotland report. If we really do accept the Audit Scotland recommendations in full, there is no reason why we should not accept Labour's amendment today. As anas Sarwa highlighted, we know that staffing levels are already under pressure, a shortfall of 830 GPs just to return to 2009 levels, 350 consultant vacancies, 2,500 nursing and midwifery vacancies. If we are already struggling to fill posts without access to all EU nationals, recruiting the additional 65,000 health and care staff the sector will need in Scotland by 2020 will be even more challenging. That is why we really need to redouble our efforts and value on our health and social care workers for the job that they do. When I made my first speech on health in this Parliament in June, I said that as someone who was instrumental in ensuring that Dumfries and Galloway council became the first council in Scotland to gain living wage accreditation, I very much welcomed the commitment to pay the living wage in the social care sector. We need to complete that unfinished business and make sure that the living wage is extended to all care workers, including those carrying out sleepover shifts, and then build on that achievement not only with fair pay but training and adequate time to care. Indeed, I would commend Unison's ethical care standard charter as a template towards the fair and ethical employment practices that we would all like to see. It has been clear from today's debate that Brexit creates considerable threats for the health and social care sector, a sector that we know is already under considerable pressure. Deputy Presiding Officer, I would like to say at the outset what a fascinating, illuminating and novel debate we have had this afternoon, but I cannot. This is the tenth in a series of debates. My colleague Oliver Mundell closed last week lamenting that it is essentially the same debate. The Government has cut out the word environment and inserted the word justice. As members have said, it is becoming a bit like Groundhog Day. The point is as valid today as it was then. It wouldn't be so concerning if the quality of contribution from the Government seats wasn't so weak. Last week, at portfolio questions, in one of the classic sycophantic exchanges that the Scottish Government enjoys, Graham Day cued up Keith Brown, who replied, In addition to the jobs and financial benefits that we have received, we benefit massively from being a more rich and diverse country because of our membership of the European Union. Just think about that answer. It is not membership of the European Union that makes Scotland a more rich and diverse country. What Mr Brown has done there is conflate and confused two separate concepts. Membership was relationship. Hence our First Amendment today. This Government really needs to work out the difference and reflect on whether it is comfortable supporting its initial ambiguously worded motion. Does Scotland value—I'll take an intervention. Yeah, I guess at the point of Groundhog Day. When is your party going to tell us what Brexit means? I think the member for that intervention. Our party is negotiating. Our party is talking to your party about what Brexit means and I expect that to continue. Does Scotland value its EU workforce? Of course it does. When the Government set up this debate, it didn't really think anyone would disagree. Marie Todd was right. We should be able to assume and, member after member, queued up to appreciate the valuable contribution that EU nationals make to our health and social care sector, just as valuable as the UK nationals in the health and social care sector, just as valuable as the non-UK, non-EU nationals in Scotland's health and social care sector, just as Donald Cameron made clear at the outset. Just as valuable as these all are to our wider economy, industry, agriculture and construction—indeed, just yesterday, I visited a fish processor in Peterhead and they told me about the fear felt by their EU nationals due to apparent uncertainty. Despite the UK Government committing to retain all EU employment protections post Brexit and stating the intention to protect the status of all EU nationals currently in the UK. Perhaps as constituents at the fish processing factory we were more concerned because Liam Fox had described them as bargaining cards and that might have been the reason for their fear. I'm not convinced that Liam Fox ever did use that exact words and let me come on to exactly what's going on here. I thank Joan McAlpine for bringing this up, because of course Ruth Davidson said only last month, for those who have already chosen to build a life, open a business, make a contribution. I say, this is your home and you are welcome here. So why the fear? Well actually it's not surprising because on almost a weekly basis we have sat on these chairs and listened as SNP speaker after speaker decries the allegedly bigoted language of the Tory party and tries to suggest as Marie Todd did that we are xenophobic. Donald Cameron talked positively of opportunities only for Joan McAlpine to accuse the Tories of wanting to get rid of EU staff and pulling up the drawbridge for foreign-brown NHS staff, then John Mason confirming the UK Government's positive words but saying behind it they're unwanted. As Miles Briggs said, this Government refuses to acknowledge the reassurances given and such rhetoric is very dangerous indeed. I actually won't, Mr Mason, I've got a lot to get through. It's likely to rebound given that, as Jackson Carlaw pointed out, in 2014 Nicholas Sargent threatened to strip EU nationals of their right to remain in an independent Scotland unless the EU accepted Scotland as a member. Read the reports. Half of SNP supporters backed plans to make firms report foreign worker numbers. Roughly 400,000 of the more than 1 million who voted leave in Scotland voted SNP in 2015, hardly a conservative Brexit gamble, Joan McAlpine. So I say to the SNP enough of the scaremongering. The people of Scotland can see what is going on. This Government is using Brexit as a convenient shield to disguise an NHS in crisis, as James Kelly said, with seven out of eight targets missed and rocketing waiting lists. A crisis of confidence in our educational establishments, school teachers unhappy with intolerable pressure and low numbers, 150,000 college places slash universities concerned at the limited places available for Scots students. A raid on council tax plundering hardworking families and spending elsewhere, not locally. And to disguise the fact that, as yet, we have yet to have presented to this place one bill that this Government in this session wants to implement, not one. I hope that today marks the watershed after which we will see the end of the petty, ill-informed, generic language used by the SNP and that today, in accepting our amendment, a marker can be set as to how we move ahead constructively and for all the people of Scotland in a manner that does not airbrush one million lead voters from history. Let's get back to debating bills, programmes, ways to save the NHS, our education system, our local councils from the chaos that is being visited upon them by this Government. Instead of spending two hours talking about inoffensive, safe and ultimately meaningless motions presented by an executive so tired, so out of ideas, so stuck in a rut and so obsessed with separatism that governing is the last thing on their mind. Let's see some governing from this executive for all our sakes. Thank you very much Mr Kerr. I call Michael Russell to wind up for the Government Minister till five o'clock please. Thank you very much Presiding Officer. Let me start at the end with Mr Kerr's contribution. Mr Kerr quoted my speech about the closing speech from Oliver Mundell last week. I praised Oliver Mundell last week. He made a fine speech, he raised some real issues and I have to say to Mr Kerr, you are no Oliver Mundell. It is astonishing that the Tories are still resistant to debating and discussing the issues of Brexit. The Tories and Mr Kerr in particular wants to sweep under the carpet the concerns of thousands, the concerns of hundreds of thousands, the worsening prospects for the economy, the worsening prospects for trade and he asks in his speech why is he not being believed. Well let me tell him because in his speech he talked about the EU citizens in the referendum. I was active in the referendum. I heard what the no campaign in particular the Tories said during the referendum. They threatened European citizens. They told those citizens that if they voted no they would have nowhere to stay. They would be sent home. Those citizens were lied to and that is why no one will believe the Tories ever again. No one in those communities, no one in this chamber, no one in Scotland, they will not believe it. If that was not a big enough problem, at the end of Mr Kerr's contribution, he described the debate about the work of hard working NHS staff, the debate about individuals who wish to stay here and who have contributed. Now come on to some of the tributes at the moment, he described it as meaningless. No one will trust a Tory who says that it is meaningless to talk about the work of NHS staff. Meaningless, that will be remembered in this chamber for a long, long time. I have to say, Oliver Mundell would not have made that mistake. Let me start on the contributions to this debate. I was particularly impressed by three of them and I want to mention three of them. First day, my old colleague and friend Richard Lochhead, who talked about the impact of the NHS and NHS workers on his own family. That was not meaningless. Then Marie Todd talked about the impact, as she knew it, on friends and colleagues in the NHS through her own work who, when they were treated as foreigners, did not regard that as meaningless. Emma Harper talked about the good practice within the operating theatres that she had worked in, using a quote and a method from Atwell Gandhi, who is very much worth reading, and talked about the way in which people worked together, no matter where they came from. That is not a meaningless contribution to the health of citizens in this country. I want to mention Anna Sarwar's contribution, too. He will find that surprising, but he put aside for the most part the political divides to make it clear that, on this issue—and I quote his words—we need to do all that we can to minimise the consequences of the current Brexit debate on all in the NHS and all who use it. I think that he was absolutely right in so doing, and it was echoed by James Kelly and others. Richard Lochhead also pointed out that something Colin Smyth referred to. The mysterious missing £350 million—the £350 million that would, at least a proportion of it, would come to Scotland to be used in the NHS. Not a single penny is going to be seen of that money. That was, unfortunately, another lie. It was a lie that, no doubt, persuaded some people to vote to leave. It is not money that we will ever see. It is money that will not come to Scotland. It is money that could be useful in Scotland, but, unfortunately, it was not true. So, what other contributions were made? There were, I think, two distinguished Tory contributions, and I am going to embarrass both of the contributors, who were Oliver Mundell's in that sense. Jackson Carlaw was very clear in his view. Jackson Carlaw was very clear in his view. He wanted a clear message to be sent out to say to NHS staff that they were valued and he wanted them to stay. Indeed, he made the very good point that demographics require those staff to be employed within Scotland. Donald Cameron gave the same message. Perhaps he circumscribed a little by his role on the front bench, but he wanted to make sure that those staff stayed. I say to them that I know that they were both strong remainers. All they have to do in these circumstances is to say to the Prime Minister and other Tory party member that these workers are needed. They need to say that, and they need to say it often. The message, if they put that across, will surely be listened. Surely the Prime Minister listens to those two distinguished contributors. If she does, perhaps we can get an end to this endless speculation, which Mr Carlaw apparently believes is meaningless. However, for those staff, it is a matter of their entire future and, indeed, their entire future for their families as well. I wrote that before I had heard Mr Carlaw's least cogentory contribution. I am afraid that he came from Mr Briggs, who is an experienced politician. He has worked in this place for some time. Unfortunately, he was factually incorrect on two key issues. The first was the education cap. There is no cap on Scottish University places. That is quite clear. In health, as I will swear, there is workforce planning. Mr Alec Neill, who was referred to more often in this debate, said that it is getting harder and harder for Scottish applicants to win a place thanks to the strict controls imposed. Is that a cap or not? What are they referring to? The number of places was increased this year. The reality is that we are training. The number of places were increased this year. If you look at the figures—I am quite happy to quote them—f figures would suggest of the total 40,000 places in the islands that there should be 8.6 per cent of that in Scottish medical schools, which would be 3,446. There are actually 4,857 places. In actual fact, we are training a third more than we would have to train, and the reason for that is workforce planning. As I said, Alec Neill—I am sorry, I have got to make this point. The Tories do not like the idea of workforce planning, but the reality is that every year, the deans of the medical schools will sit down with the Cabinet Secretary for Health and the Cabinet Secretary for Education and will plan what goes ahead. According to Mr Briggs, I should just abandon that. Mr Briggs knows better than the deans of the medical schools. He knows how many places are required. No, Mr Briggs, you do not know how many are required. That is information that is held by universities and by the Government, and as a result, we train more than our population share. Finally, could I just correct Mr Briggs on one other point? He described me as a Grinch. I find that very sad. The more I thought about it, the more I decided to go into the role this afternoon, because the definition of a Grinch is to spoil or dampen the pleasures of others. I am delighted to spoil or dampen the pleasures of those who reject the importance of migration in Scotland. I am delighted to spoil or dampen the pleasures of those who refuse to listen to the Scottish electorate who said that they wanted to stay in Europe. I am absolutely delighted to spoil or dampen the pleasure of the born-again Brexiteers on the Tory benches. Finally, can I say that I relish the chance of spoiling or dampening the pleasure of any member at all in this chamber who thinks that the contribution of those from other parts of the EU to our health service is meaningless? I rejoice in that role. That concludes our debate on the EU workforce. The next item of business is consideration of business motion from Joe Fitzpatrick on behalf of the parliamentary bureau. I would ask any member who wishes to speak against motion S5M-2405 to say so now. I call on Joe Fitzpatrick to move motion S5M-2405. No member has asked to speak against the motion. I put the question to the chamber that we agree motion S5M-2405. We are agreed. Next item of business is consideration of parliamentary bureau motion S5M-2325 on substitution on committees. I would ask Joe Fitzpatrick to move. The question will come at decision time. There are four questions to be put today. I wish to remind members that if the amendment in the name of Donald Cameron is agreed, then the amendment in the name of Anas Sarwar falls. The first question is that amendment S5M-2355.2, in the name of Donald Cameron, which seeks to amend motion S5M-2355, in the name of Shona Robison, on Scotland values its EU workforce. Are we all agreed? We are not agreed. We will move to our vote and members will be cast their votes now. The result of the vote on amendment S5M-2355.2, in the name of Donald Cameron, is yes, 28, no, 87. There were no abstentions. The amendment is not agreed. The next question is that amendment S5M-2355.1, in the name of Anas Sarwar, is agreed. Are we all agreed? We are not agreed. We will move to our vote and members will be cast their votes now. The result of the vote on amendment S5M-2355.1, in the name of Anas Sarwar, is yes, 86, no, 29. There were no abstentions. The amendment is therefore agreed. The next question is that motion S5M-2355, in the name of Shona Robison, as amended, be agreed. Are we all agreed? We are not agreed. Parliament shall move to our vote and we will cast our votes now. The result of the vote on motion S5M-2355, in the name of Shona Robison, is yes, 87, no, 28. The motion as amended is therefore agreed. The final question is that motion S5M-2355, in the name of Jofits Patrick, on the substitution on committees, be agreed. Are we all agreed? We are all agreed. That concludes decision time. We will move to a member's business and we will take a few moments to change seats.