Cyavoedol. The next site of business is a debate on motion number 12120, in the name of Shona Robison. On 2020 vision, the strategic forward direction of the NHS, any member who wishes to speak in the debate should press a request, speak button now and I give some guidance at the beginning of the debate that we have a bit of time in hand, so we will be a bit generous in terms of interventions and length of speeches. So I call Shona Robison to speak to me with the motion. Cabinet Secretary, around 40 minutes. Rydw i'n gweithio y cyfnodol, am fyddwn i'n gweithio'r cyfrif, rydw i'n gallu cymdeitio gyda'u pryd a fyddwn i'n Gwynedd Scotland. Rydw i'n gweithio'r Gwynedd Scotland a'r gweithio'r parnau a'r gweithio'r gweithio'r gyrsloedd yn y cwrsachau o brwyllfa'r gwasanaethau hynny. Wrth gyflawn i fyfyrdd Gwyrdd George Square ac i fyfyrdd Gwyrdd Ibolla, I have demonstrated the tireless compassion and professionalism over front-line staff, and we should be very proud of each and every one of them. The NHS has a good record, and I'm grateful to once again be able to highlight through this debate the on-going achievements of the NHS and my deep level of appreciation for the tireless efforts of NHS staff in delivering high-quality patient care. My work is universally recognised, not least by the Scottish people, with 89 per cent of inpatients rating their care and treatment positively in 2014, the highest figure since we started surveying patients. Today, the NHS treats a record number of people. Over 1 million people received inpatient treatment during the latest year, and there were over four and a half million outpatient attendances. Waiting time targets are tougher, and the NHS is performing better against those targets than was previously the case. Further improvements also continue to be secured in patient safety, with huge reductions in levels of healthcare-associated infection. Since 2007, cases of C difficile among those aged 65 and over have fallen by 81 per cent, while cases of MRSA are down 88 per cent. Good progress, but much more to be done. The Cabinet Secretary for Health and Sport rightly plays up how we are better controlling infection in hospital, but I wonder if she will recognise the challenge that medicine has, in that it's actually been some 20-plus years since there's been any new type of antibiotic discovered. One of the great challenges in the future will be antibiotic medicine resistance and how we deal with that. Scotland is not uniquely challenged in this, cabinet secretary, obviously, but it will be a problem for us, this, for others. The member is absolutely right. Yes, it is. A lot of work has been done on the prescribing practices, because we know that some of the prescribing practices of the antibiotics that we have have exacerbated the cases of C difficile. So there's been a lot of research and better awareness now of those that have, of course, very much influenced the patient safety programme, which, as I say, has been very, very successful indeed. The on-going challenges over this winter demonstrates the need for our NHS to be flexible and responsive in providing care. It tells us why integration is key to meeting the needs of individuals, carers and other family members. The issue of seven-day services mentioned in the Labour amendment is one that we are absolutely on top of. We've been working for the last year on seven-day sustainable services. The seven-days task force has done excellent work and its emerging conclusions about how we shape the workforce in the NHS and get the capacity in the right place to deliver sustainability for the future will be vital. I'm sure that members across this chamber will agree that it would be more sensible to await their conclusions so that we can make informed decisions about how best to achieve seven-day sustainable services. Yes, of course. If the cabinet secretary could tell us when the task force is going to report and perhaps also when it was due to report in terms of expectations. As I understand it, the interim report is due shortly, after which we will get the full report. What I am happy to do is to give a commitment to bring that back to Parliament once the final conclusions have been made, because I think that it is important that we are informed by the experts on these matters. Winter planning continues to play an integral role in the Scottish Government's national unscheduled care programme. The Scottish Government and NHS boards have invested a total of £50 million this winter to help offset winter pressures and ensure that services are effectively maintained and delivered. However, this winter's challenges have also brought home the need to focus on the 2020 vision's emphasis on prevention and self-management. To do that, we need to look differently at how we deliver care. NHS boards review their winter performance every year and we know that the main pressures over the 2013-14 winter period were through bed days' loss to delayed discharge and patients awaiting care in the community. That is why we are increasing our efforts in this area and, as I said before, this is a top priority for me. The NHS cannot meet these challenges alone. Health and social care integration is the most significant change for health and social care integration since 1948. It is intended to be transformational and to go beyond simple organisational redesign. Disjointed systems of health and social care are exacerbating the problems of inappropriate admission and delayed discharge from hospital where a package of care and support in the community could deliver better outcomes for them and would be more their choice. People tell us that they want to be at home with families and not in hospital. The consequences of admission to hospital are not just personal but are felt across the whole system by tying up people and resources in care that is not best suited to the individual and will often result in poorer outcomes. There is no doubt that delayed discharges impact on the wider hospital system. Beds can be unavailable to others that need them. People can wait in A&E or have their operations cancelled. Delayed discharges cost NHS many millions of pounds but, most importantly, a delay in someone's discharge is a very poor outcome for that individual. In short, it is the worst outcome at the highest cost. I will take Jenny Marra now. To follow up Malcolm Chisholm's point, can the cabinet secretary clarify and I understood that perhaps the task force was to be reporting on a bi-monthly basis? Can she clarify that? The task force will report when it has reached its conclusions. As I said to Malcolm Chisholm, the interim report is due soon. As I also said to Malcolm Chisholm, I am happy to bring the final conclusions of that task force. As politicians, it is important that we listen to the experts, particularly on issues such as seven-day services, and do not assume that we know better than them. I hope that that will be accepted by all parts of the chamber. Back to delayed discharge, evidence tells us of a functional decline that can start after 72 hours of being ready for discharge, a decline that can get rapidly worse over time. The six weeks that we inherited were always too long, the four weeks that we have now are still too long and, in the majority of cases, two weeks will be too long. That is why we have reached agreement with COSLA that we will work to discharge the vast majority of patients within 72 hours of being clinically ready for discharge. To help achieve that, I announced a further £100 million over three years this week to be invested in integrated partnerships through the NHS to help to reduce the numbers of people waiting to be discharged from hospital. That funding will be used to support health boards and local authorities to deliver good quality care and support for people at home or in a homely setting. I have agreed with COSLA that we will expect to see this new money deliver key integration outcomes in a minute that take us closer to the 2020 vision and which are best represented by indicators relating to emergency admissions for adults, re-admissions to hospital, the quality of social care services and delayed discharge. I expect that all strategic commissioning plans will be explicit in setting local objectives and respect of those key indicators and that local plans will take partnerships towards achievement of those objectives within a reasonable period of time. The Scottish Government will engage directly with partnerships reflecting the shared commitment with COSLA to improve performance against those nationally agreed outcomes, providing support and, of course, challenge to those partnerships. That signifies a genuinely new relationship between the Scottish Government and local partnerships with a shared commitment to improving performance, delivering on shared objectives and working with trust and reciprocity. I just wanted to clarify, and I noticed her remarks on the television as well, about the 72 hours, and we know that it's safe and it's clinical advice that patients are released within 72 hours. Is it the Government's target or is it the two-week target? The two-week target comes in from April. However, what we are saying is that two weeks is too long for most patients. Therefore, the integrated partnerships will have an ambition to work towards the 72-hour discharge standard, because we know that clinically, for most patients, that is what should be required. We want them to make as speedy progress towards that as they possibly can. Our current work with integrated partnerships shows a strong commitment to the shared agenda. I plan to provide another early opportunity over the next few weeks for Parliament to be updated in more detail on the progress being made by partnerships in advance of them hitting the ground running on 1 April. With an NHS budget next year increasing by £380 million to over £12 billion for the first time, this funding, I believe, perhaps should get us focusing more on what we spend that money on, rather than getting into bidding wars about delivering 1,000 more nurses in the SNP or whether 100 million more than the SNP is required, because I don't think that's what is best for planning in the NHS. We have an NHS that works hard to meet the challenges of today, one that puts patients and their families first, that delivers amazing outcomes for most patients, but we can't rest on our laurels. To do so would be to betray the values of the NHS, and we know that we have much to do to make our health and care services meet our goal for the provision of safe, person-centred and effective care. We need an approach to health in Scotland that fits with the 21st century, so we have the 2020 vision. That vision, with its emphasis on new models of care, on healthcare delivered closer to home, on prevention, remains absolutely the right one. However, what is clear to me is that, as a nation, we're not making sufficient progress quickly enough towards it, and also that we need to be clearer on how we're going to deliver that vision and the step changes that are required to get us there. I also believe that we need to raise our eyes beyond that horizon and look at what success would look like over a 10 and 15-year longer time frame. We need to move more quickly to a system with a greater focus on prevention, one that supports people better with long-term conditions, given that there's going to be 779,000 people who will be over 75 by 2037. That's a rise of 83 per cent. They need to be supported in their own homes and communities to live productive, fulfilling lives. We need a system that has more of a focus on tackling the legacy of health inequalities, all of those in a very challenging financial environment and one that requires a cross-government approach. To achieve those goals, I believe that we need to do things differently. We need an NHS that improves and evolves to meet those needs. An NHS that is bolder around the need to have more care delivered locally, with more services organised around primary care, where patients have those continuing relationships. That's going to mean enhancing primary and community care, including more resources and teams of health professionals working together in communities, ensuring that health services work effectively with the third sector and community organisations to engage with people who are at least likely to access healthcare and consequently most at risk of poor health outcomes. Health professionals being able to support patients facing wider social issues, which are having an impact on their health and wellbeing. Specialist doctors and nurses supporting people in their own homes, a care home or a hospice, as well as in hospitals. I'm being clearer about what care should be delivered locally, regionally and nationally. I'm hugely ambitious through the use of technology and through deploying the talents of our NHS staff appropriately. About how much more care we can deliver locally in homes and in communities. Without a doubt, the service that we will provide in the next 10 to 15 years will have to be different from the service that we have provided in the last 10 years. We need to work with communities to improve their health and wellbeing by harnessing their existing assets and enabling them to develop those into meaningful changes. Good relationships are vital to achieving the best possible outcomes. We want to be at the heart of every decision and we want an NHS that cares and is compassionate. We have the stronger patient voice announced by Alec Neill last summer, but I want to go further than that. I want to announce today my intention to develop a longer-term 10 to 15-year plan for the NHS that builds on but takes us beyond the 2020 vision. In doing so, I want to work with stakeholders, including patients and families, professionals and clinicians of all stripes, the Health and Sport Committee of this place and, indeed, even opposition parties. I want to try to reach as much consensus around what we want our health and social care systems to look like over those longer timeframes and the steps that we need to take to get there. This will include planning what capacity is required where and what the workforce will need to look like to deliver these new services in a different way, so the role of the professional bodies and the royal colleges will be key to informing that work. That engagement will be on-going, but I would like to have reached broad agreement, if possible, on this plan by the autumn of this year. I do not think that we will agree on every detail, but I do hope that we will be able to agree the key plans of what success will look like if we get all the things right that we are doing and we will do in the future. On that note, Presiding Officer, I hope to hear some of those ideas here this afternoon in the chamber and I move the motion in my name. I now call on Jenny Marr to speak to a move amendment number 12120, Ms Marr, around 10 minutes. I start by moving the amendment in my name. I welcome the cabinet secretary's remarks on the 2020 vision, which, as she knows, Labour has supported right from its inception. I also welcome her remarks that she has just given on the 10 to 15-year plan. We will certainly need to have a lot more detail on the scope of that plan, if it is an extension of the 2020 deadline or if it is a different thing. She is only really concentrated on it very briefly at the end of her speech, so I hope that we can come back to the chamber and hear more detail on that in the next couple of weeks. Yesterday, during the budget debate, Labour asked the Scottish Government to invest £100 million of its consequentials in a front-line fund for the NHS. I am grateful that today gives me the opportunity to talk about this a bit more and to talk about how it fits into the 2020 vision for the NHS as a whole. I hope that the cabinet secretary will forgive me. Malcolm Chisholm and I were both pressing her, but I think justifiably so on the timing for this task force. Our budget ask yesterday of £100 million for a front-line fund is based on the recommendations of our own civil servants and her own Government. They have published several position papers and plans, setting out and saying that evening diagnostics and surgery at the weekend would be a great boon to our health service-freeing capacity. I think that we are completely on the same page as the Scottish Government in this. We are really simply asking them to spend the health consequentials of £29 million, which she has yet to allocate from the November consequentials and also the general consequentials, because the health service is such a priority at the moment. I know that she will forgive me for Malcolm Chisholm and I am pressing her on the timing of this, but the Scottish Government's press release says in October 2013 that Alex Neil announced that the task force was to meet early in the new year. That would be last January a whole year ago to drive forward this, but we have not yet heard the report from that task force, so she will know why we are pressing her on a date for that. As you know, Scottish Labour has always supported the 2020 vision. We continue to do so because it is person-centred, well integrated nature as a vision that I would like to see for health and social care in Scotland. Unfortunately, especially over the past few weeks and months, it seems that that vision is travelling further and further away from the reality that patients are facing in Scotland. I do not think that there is enough tangible on-the-ground action being taken by the Scottish Government to deliver it. Perhaps it is the prerequisite of not being fully challenged until 2020 on its targets. I am slightly concerned perhaps that the plan that the cabinet secretary has just announced extends that target that is allowing the Government to take its time. I will give away in a second, but there is not enough action and progress at the moment within our NHS. I find it hard to accept that that is the case given that one of the biggest changes that I laid out in quite a lot of detail is health and social care integration, which will take place from 1 April onwards. That is going to be a catalyst for huge change in delivering the 2020 vision. I would agree that the integration health and social care is the biggest catalyst and the money that she announced is welcome, but the 2020 vision, as I am sure she will agree with me, is a lot broader than that. The current accident and emergency crisis, the persistent and continuing health inequalities that I know the cabinet secretary will agree with, that we see across Scotland every day and the tragedy of patients dying on delayed discharge lists highlight the more immediate front-line problems to be fixed before we can make any real headway into the 2020 vision. Alliance Scotland has stated this, the Royal College of Nursing has stated this and Labour has time and time again raised this as an issue in the chamber. When people's lives, health and wellbeing are at stake, it is unacceptable to have to wait a few more months for that improvement. That front-line fund would allow hospitals facing extra pressure to move to a fully functioning seven day a week operation. A front-line fund will free up beds, meaning patients get quicker, better care while decreasing pressure on staff and increase patient flow through the hospital. She knows as well as I know a critical factor in tackling delayed discharge. Looking closer at the 2020 vision, a key issue of health inequalities persists and I acknowledge the cabinet secretary touched on this in her opening remarks. How will the task force set up by the Scottish Government begin working in a more on-the-ground manner and start eradicating health inequalities? The crux of health and social care integration involves opening our arms and inviting our communities into our health service. The RCN has expressed that, given the aims of the 2020 vision, it is deeply worrying that the Audit Scotland review of reshaping care for older people found that there is little evidence of progress in moving money to community-based services and NHS boards and councils need clear plans setting out how this will happen in practice. We must also look to the tireless and committed workforce that will help us to achieve such integration. Nurses, for example, are instrumental in connecting health and social care, both in primary and in secondary care. When we see the figures from the RCN staff survey that 81 per cent of nurses have increased workloads compared to a year ago and 58 per cent feel they are under too much pressure at work, we can see how unfair additional pressure on our hard working workforce would be. The NHS's own staff survey, which the cabinet secretary announced before Christmas, reported that only 25 per cent, only a quarter of our nurses and midwives in Scotland agreed that there were enough of them to do their jobs. Vacancy rates for nursing and midwifery remain a problem across this country, standing at 3.6 per cent in September. This is a problem that could persist given the Scottish Government cuts to nursing student numbers over recent years. As we announced a couple of weeks ago, Scottish Labour will introduce a mansion tax if elected in May 2015 that will fund an additional 1,000 nurses in Scotland. This afternoon we heard again the First Minister, I think, on the issue of an understaffed NHS, but I was really led to wonder at FNQs if she and the cabinet secretary are working from different baselines or different information on this, because in today's FNQs the First Minister stated that staffing was up 6.5 per cent while the cabinet secretary said last week during a debate in this chamber that it was up 7.6 per cent and I hope that she might, or one of our ministers, might be able to clarify that in her closing remarks. As I emphasised yesterday, we will continue again to date improving the state of our NHS needs not only more resources but for them to be used as effectively as possible. In greater Glasgow and Clyde, the NHS faces costs of £167 million in backlog maintenance just to keep its buildings fit for purpose. We know, and it was raised again earlier in this chamber today, that the same health board has had to resort to using a port of cabin for A and E patients this winter. I wonder if Jenny Marra is aware that the so-called port of cabin, which is a clinical area, was actually opened 10 years ago for the first time. If it was good enough under Labour for this so-called port of cabin to be open, why is it suddenly a problem now when it was used for additional clinical capacity when required and of course will shut once the new south Glasgow hospital is open? I think that it is worrying that the SNP back ventures applaud the severe. I went through this board by board last week that the capital investment that our NHS needs just to keep the infrastructure up to base because it is not just Glasgow, as the cabinet secretary well knows. I read out the figures last week that all over the country they need capital investment to keep up to date and to keep our NHS fit for purpose. According to the Royal College of General Practitioners in NHS Highland, the large amount of spend on locum cover for rural areas shows the false economy of repeatedly underfunding general practice. The NHS in Scotland spent a record £82 million on locum doctors last year, an increase of £18 million on the previous year. I think that the cabinet secretary really needs to look at a sustainable recruitment strategy in the NHS because that kind of misspending must stop in order for her to be able to achieve the 2020 vision for Scotland. Investing in nurses through a mansion tax would help develop this long-term vision and investing in the front-line fund that we have proposed but based on the Government's own proposals would free up beds allowing hospitals to deliver better care. The most recent document reporting on the task force for seven day services on the Scottish Government website was published in March 2014. I come back to the timing of this. The document says that the timing of the task force is to be agreed, that frequency of meetings is to be agreed and that duration is to be agreed and it seems today that the publication of the report is still also to be agreed. The reality is that accident illness and emergency do not respect a nine to five working week and the cabinet secretary's civil servants have told her that in all of these papers but our hospitals are expected at the moment with this year's hiatus to get by with a skeleton staff at the weekend even since the Government recognised that this was a problem themselves. We should be aiming higher for our NHS in the 21st century. A front-line fund that the cabinet secretary has the money for and she still has 29 million in unallocated health consequentials makes sense for patients and staff. The money is there to be used. We are proposing to use the 29 million unallocated consequentials from health along with 71 million of general consequentials to be given to this fund. I know that the cabinet secretary and her colleagues in government have been accused of perhaps storing up some cash ahead of the election but I know that she will agree with me that this money should be spent when and where it can on the NHS. The budget will be finalised in early February. I think that it makes sense for the Scottish Government to heed Scottish Labour's call and implement their own plans for the seven day service that they have been working on. I endorse and support the 2020 vision but I would like it to become a reality and for that to happen the Scottish Government must take more swift and strategic action and must take it now. I begin by acknowledging the comments of others in which it has now accepted that all parties in this Parliament are committed to an NHS in Scotland in public hands and free at the point of need. While today's motion from the Government is understandably not worded exactly as I might have chosen, can I at the outset say that we will be supporting it tonight? My apologies for coming in so early but I think that it's probably quite important that the member might agree with me that it's been very revealing that UKIP have said as a matter of principle that they are prepared to privatise the national health service in England and Wales and replace it by an insurance system. Would the member just put flesh in his commitment to the national health service by saying that it should continue to be free at the point of need and continue to be controlled by the state? I'm grateful to Mr... I'm not sure that you can speak on behalf of UKIP. No, of course I would. I obviously can't respond to every barking mad tendency in the United Kingdom but I can of course confirm and underwrite the commitment that Conservatives have given. For the less said of the Labour amendment, the better. Quite why Jenny Marra should put to the sword again a proposal underwritten by a funding mechanism so discredited here only a week ago and so widely ridiculed elsewhere not leased by significant and senior figures in her own party is a mystery. Most recently Lord Mandelson, the architect of Labour's only UK election victories in the last 40 years has dismissed it out of hand. And it's extraordinary and telling that Ed Miliband's contribution to our debate is that London should step in. The same London party that this Parliament through its own votes and approach has deemed to have embarked over 13 years under Mr Blair and Mr Brown on health reforms in England which have so damaged the NHS there. Labour's solution is for Ed Miliband to act in some colonial potential capacity imposing reparations on the people of London to fund nurses in Scotland. After 16 years of devolved responsibility for health, no one other than Scottish Labour believes the responsibility for nursing in Scotland remains with the people of London. And at best, having correctly of belatedly identified the urgent need for a thousand additional nurses in Scotland, Scottish Labour make it conditional. Not in the election of a Labour administration here to where the responsibility is devolved, but in the election of a Labour government at Westminster. The prospects of which, and let me be generous here, are at least doubtful. Let us be done with this nonsense of Mr Miliband just as Britain will be done with him on May 7. Before the exigencies of the referendum campaign, the Cabinet Secretary's predecessor embarked, albeit tentatively, on a collaborative journey with the other parties to seek understanding and agreement on the future for Scotland's NHS, which takes in its stride the 2020 vision and which looks beyond. Scottish Conservatives have made clear that we will support a courageous vision, with all the difficulties that may entail if the Government is prepared to be bold and direct in its purpose. The Cabinet Secretary has convened a meeting herself with health spokesman next week, and I hope that she demonstrates the same resolve and purpose, because whatever the merits of the 2020 vision, and I think that this is the thrust of her speech today, it's clear from the testimony of so many that while it is underpinned by general agreement, it is nonetheless being hampered by an NHS which is, for want of a better description, bursting at the seams. I don't mean that as a criticism, just the capacity issues are huge. We, like Labour, accept the need for additional nurses, but I repeat our preferred and deliverable funding method here in Scotland of reintroducing prescription charges in an agreed model so that those who can afford to pay do so and in so doing pay not just for their prescriptions but for the NHS to have a thousand additional nurses, and this isn't conditional in anything other than the will of this place. However, while accepting the thrust of the Government's motion and the various achievements it identifies, I make this point, agreement between us and a publicly funded NHS free at the point of need is not a destination, it's a starting point. There is an urgent need for real creative discussion, some of it uncomfortable but no less urgent for that, on where Scotland's NHS must head and how that more distant vision is both achieved and made sustainable. I'll not rehearse the challenges again today but it's surely time for us to speak of ideas. Scottish Conservatives will not shy away from contributing to the debate. We may not have settled in views, we genuinely wish to work with others to achieve a plan that we can all support. However, strands of thinking are now emerging. We cannot sustain the current NHS board structure. The new southern general is the model for the future, but it suggests a structure with perhaps four health boards. Such centres of healthcare will still need a significant hospital structure and support, particularly given the diverse landscape of Scotland and all the challenges, particularly that posed by dementia we know that follow. This would in turn lead to a leaner pharmaceutical prescribing structure across Scotland with a more universal access to drugs for all Scots. Scottish Conservatives have talked about the responsibility of Scots to an NHS guaranteed to them by health insurance. The conundrum remains that there is ultimately no appetite to deny those who are reckless with their own health access to healthcare. What can we do to enhance individual responsibility? Perhaps when individuals reach majority, there should be a more deliberate insurance contract entered into. Perhaps on an annual basis, households, just as they receive an annual council tax statement, should receive an annual and personalised NHS statement detailing their use of services, current key healthcare information and health statistics and advice, making clear how they access the NHS and what they must themselves consider as part of a responsible approach to their own healthcare. At the heart of a sustainable future must be a rethink about primary care. It cannot be allowed to become marginalised with the public routinely seeking out A and E ahead of a GP. It needs investment. But maybe urban must follow rural and accept that small under-resourced GP practices will follow a way to be replaced with larger practices capable of staining a 24-hour model and locally, as the cabinet secretary suggested moments ago. We need to make general practice attractive to a new generation and soon as the ageing demographic of our current cohort of GPs is deeply worrying. A model based on larger well-resourced practices should be supported by an attached national and universal health visiting service. I welcomed the announcement last year for more health visitor funding. However, if our preventative agenda is to succeed, we need this universal service to reach beyond the earliest years and perhaps offer support up to the age of seven to ensure that the changes that we all want to see are entrenched in the spirit of individuals as they become self-aware. We believe that such approach will help to tackle the persistent health inequalities at source. Primary care offers the majority of healthcare but does not receive anything like the resource that this would suggest and by the arguments of some is commanding an ever-reducing share of the healthcare resource. On addictions, particularly alcohol, we have been too quiet in our deliberations since passing nearly two years ago, as yet still to be implemented MUP. However, the consequences of alcohol rebus remains a central and moral sapping demand in A&E. Again, there is a reluctance to introduce a system of fines for repeated alcohol admission but no alternative strategy has emerged. Scottish Conservatives believe that such an alternative approach is required, not one based on fines but one certainly which seeks to both reduce the reliance on A&E and one which offers a more direct rehabilitation and recovery strategy. The cabinet secretary has made quite a bit of the fact that Scotland's healthcare budget is now some £12 billion. It is a staggering sum beyond the physical comprehension of many. That is why some find it all too easy to say that the solution is more money still. Yet, when you appreciate just how much of what government spends goes towards healthcare, it may seem hard but surely an inevitable conclusion that calls just for evermore spending in itself is a fool's healthcare gold strategy. The challenges are understood. We may get lucky and some breakthroughs in science and technology may come to our rescue. Think what a fundamental breakthrough in the treatment of dementia or type 2 diabetes would represent to all our fears, plans and calculations. In truth, such breakthroughs may yet be our best hope. However, as they say, we can hope for the best but we must plan otherwise. In structure and delivery of both primary and secondary care, we need to evolve a new platform. Our preventative agenda must be dynamic, universal and sustained. Our approach to addictions has to become specialised and not to overwhelm the other mainstream services. We support the motion. That is the easy consensual bit. Last week, I urged the cabinet secretary to initiate the very discussion that she has announced this afternoon, shaping a plan that can achieve that too. Presiding Officer, it is over to the cabinet secretary. We will work with you as you do. We now move to the open debate. I remind members that we have a bit of time in hand, so we wish to take interventions. Feel free to do so, and we will try to be as generous as we can. Bob Doris, followed by Malcolm Tism. Thank you very much, Presiding Officer. Trees debate is an opportunity for the Parliament to share in the 2020 vision for Scotland's NHS. However, that vision is not owned by politicians in this place but by wider society who rightly expect so much from our NHS and, of course, by health and social care professionals on the ground who have to deliver all the aspirations and outcomes that this place wishes to see. Previously, Labour has called for a wholesale review of the NHS, a view that the SNP has consistently opposed for several reasons. I do not think that that is referred to today, particularly by the Labour Party. Those arguments are well rehearsed and I will not repeat them in this place this afternoon. However, I wonder whether our positions in reality are far apart. In practice, if we adjust the hidden secret, there might be a growing consensus emerging on healthcare in Scotland. The Scottish Government's 2020 vision strategy is evidence of a system, in my view, being kept under constant review. That is why it is being refreshed. The challenge is to ensure that we properly implement the aspirations of the 2020 vision across the NHS and, indeed, social care in a coordinated and strategic way. We all know that the NHS is complex and it is impossible to unpick waiting times at accident and emergency from acute bed numbers or from delayed discharge or, indeed, from social care provision within the community. All those matters, and many more, including not least of all the size and skills base of our health and social care workforce, are inextricably linked. That makes it, at its heart, complex, but something that we can make significant progress on. In that context, I want to look at acute bed numbers for a moment, just to illustrate an example. Before the SNP Government came to power in 2007, Labour Minister Andy Kerr said that there were good reasons to reduce acute beds. In 2011, Richard Simpson said on behalf of Labour that he welcomed the SNP dropping targets on acute beds. I could pull out other quotes that contradict that from Labour members. I am not trying to illustrate a party political point, I am trying to illustrate a different point that shall come on to. As politicians, we often focus on numbers and targets, and rightly so, the key debate on acute bed provision is not necessarily around whether we have, for instance, 15,000 acute beds, 16,000 acute beds, 17,000 acute beds. Yes, of course. I think that the member for the intervention is actually the point that I am coming on to develop further. That is why I think that we are having this debate, and we have got consensus on some of those points. Just give me the time to go and develop. The numbers that I was illustrating, Ms Grant, is that they are in themselves meaningless unless they are placed in the kind of context that you, yourself, illustrate during your intervention. We need to track whether patients being admitted to acute beds could, through preventative measures, have avoided the fact that they are in the context that you, yourself, illustrate during your intervention. We need to track whether patients being admitted to acute beds could, through preventative measures, have avoided being there in the first place, but perhaps others could have been treated in the community rather than finding themselves in acute beds either. Many patients are also being discharged more speedily than previous, and that surprises some people because they are undeniable. There has been significant progress. However, for many frail elderly people, that is simply not the case. That is why I am pleased that the Scottish Government has announced an additional £100 million over three years in partnership with COSLA and the NHS to improve social care support to tackle delayed discharge. I give a reference to the RCN briefing for today's debate, and they have made a very reasonable request. I feel that this money should be tracked to ensure that it makes a real difference to the patients that it is aimed at, that the NHS does not just soak it up like a sponge. I think that Mr Carlaw is referring to some of that in his opening remarks. Another significant area investment, in recent years, has been the huge investment in accident and emergency in itself. The rise in A&E consultants in Scotland from less than 76 full-time equivalent in 2006 to over 131 full-time equivalent in 2014. Of course, patient flow will not be the same, but it will be the same. However, to make the best use of those funds, we need to better understand the drivers of patients who are presenting at A&E through hospitals, and to understand the drivers of patients who are presenting at A&E through hospitals. On the other hand, we need to understand the drivers of patients who are presenting at A&E through hospitals, and I am pleased to see that the Government has made a significant contribution in the programme of emergency. However, to make the best use of those funds, we need to better understand the drivers of patients presenting at A&E through hospitals. Reasons for admission in the first place and make sure patients who are clinically able to leave hospital are not remaining hospital due to social care pressures that is previously mentioned. Indeed, we'd be quite keen to know how work is developing along with stakeholders such as the Oral College of Emergency Medicine and others to track some of that work to see how we are getting on with putting in not short term solutions but what the 2020 division is all about and that is long term and sustainable solutions. Having the right number of appropriately qualified care staff in people's homes and residential care establishments is also crucial. Add to that matter such as access to allied health professionals when needed or ensuring that proactive health opportunities are available around health centres, for example, not always, I have to say, GP-led and a complicated matrix of services and staff support quickly emerges. That is why a key part of the 2020 division is the workforce planning strategy. I think that integrated health and social care boards will need to do a significant job in mapping out workforce numbers across a whole range of health and social care disciplines and how they interact with each other. Doing it in isolation has not been fit for purpose in the past but integration gives us a real opportunity. Perhaps in that context we have to make sure that existing workforce and workload planning tools may have to be refreshed as well. I think that all those things have to be considered. Perhaps we could finally talk about the seven-day service. Everyone is up for that, I would say to Ms Marra. I think that those things do take a while to develop. For example, if you want to increase surgical capacity, you have to make sure that you have the doctors, the nurses, the anaesthetists and everything in place to ramp up that level of support, but not just for one year or two years but in the long term. I believe that that is what the seven-day strategy task force is seeking to do, not in a short-term solution, but in the 2020 division long-term solutions that are put in place for the benefit of the NHS and our social care services. Can I be gentle with Bob Doris by saying that there is consensus about the vision but that there is concern and disagreement about the implementation of it? I think that we have had agreement around the vision for over 10 years. We have agreed about a partnership and patient-centred approach about developing continuous integrated care in the community, about focus on prevention and anticipation and self-management, about using patient experience to improve quality, about addressing health inequalities and enhancing the safety of the patient. I think that there has been agreement about that for a long time and there has been some great implementation. I am a great fan of the patient safety programme and I am always ready to praise the work of the Scottish Government in relation to that. In fact, I think that they should sometimes publicise it a little bit more. Another aspect mentioned in the motion the early years collaborative, and I am also a great fan of that. I will take more time for results from that to realise themselves. Collaboratives being a good thing, I would remind the cabinet secretary of what I suggested last week. Why not reinstate the emergency care collaborative? Professor Derek Bell, the number one expert on emergency care in the UK, and the person who headed up emergency care collaboratives in England in Scotland, said that the situation had deteriorated in the last five years since that collaborative was disbanded. The problems are in faltering implementation in relation to developing services in the community. Jenny Marra quoted from the Audit Scotland report, so I will not repeat the quote about no progress or little evidence of progress in moving money to community-based services. The vision document itself 2020 says, and I will just quote again, focus on ensuring that people get back into their home or community environment as soon as possible. Once again, the problem of delayed discharges going in the wrong direction is highlighted because the actual implementation is against the vision. I give way now. Dr Darrys, I thank you very much for giving way and for being gentle with me, as well. I appreciate that. I also say that I appreciate the point that you are making in relation to a shift from acute spend, hospital spend and community spend. Do you think that one of the reasons for that may also be that there are a plethora of targets, including a 12-week waiting time treatment guarantee, which is sitting at 98 per cent, but there is so much of the targets that the NHS has, which are hospital-based in itself. Perhaps we have to look at targeting more outcomes that are community-based to help to drive some of that shift also. Mr Chisholm, I will give you additional time to make up your speech. The reality is that we have to develop hospital services as well. I know that, certainly, all too well in Lothian. I flagged up last week within the context of the general increasing delayed discharges, the 15 per cent of beds in NHS Lothian that are occupied by delayed discharge patients. Indeed, I expressed concern, which I should express again about the fact that Lothian, with its £70 million funding gap, received £4 million out of the £65 million last week, and I am still not entirely clear of the reasons for that. Therefore, there are concerns clearly, and I need to build up community infrastructure. However, of course, we also have the problems in emergency care, and I have already referred to Derek Bell's suggestion. However, the reality is that we need to build up capacity in both the hospitals and the community. That is why I think the Government would be unwise to dismiss so readily the two positive suggestions, the two specific suggestions involving extra resources that have been suggested by Labour in the last couple of weeks. On the seven-day working, I have read the seven-day services position paper. There may well be more than one, but I have certainly read one of them in the last few days. The flaw in the Government's position on that is that it thinks that seven-day working can be implemented without extra resources. Labour is coming to the rescue of the Scottish Government in saying that it has those proposals, and we are prepared to push you to put the available money into it. Having been a minister previously, presumably you can tell us how you have worked out on the basis of that paper, how much it will cost to implement seven-day services and come to the decision that it is £100 million. It is £100 million available. I should say before I answer that question fully that I was told that the report was to be available by December, so I am not quite sure why there has been slippage. I cannot quote five pages of the document, but the sentence that I found the most interesting of all was that there may be some actions that could be taken immediately that would result in a rapid improvement in patient care towards the end of the document. It talks about senior decision making and ward round seven days a week. It talks about emergency medicine, and I will read this one out. There is an argument that spreading elective surgery over more days to avoid the Monday, Tuesday, Wednesday congestion would help both scheduled and unscheduled care. Those are actions that can be taken immediately. That, to some extent, answers the objection that the cabinet secretary has raised about it, so I think that she should work with Labour in that particular area. Finally, Labour talks about nurses. I am very pleased that we are doing that, as the RCN has pointed out. More than one occasion, nursing numbers have risen recently, since the law of June 2012, although it is not clear why they declined so much in the preceding period when there was quite a bit of money still around in the health service. It is not enough to keep up with demand in our population ages and people living longer with multiple and often complex conditions. We simply do not have enough nurses. We have vacancies at 3.6 per cent and cuts to student numbers in recent years. We have to build up the nursing workforce. Nurses at the heart of the NHS are fulfilling so many very important roles, not just the hospital roles that people think of, but primary care services can be enhanced by the skills of nurse practitioners and specialist nurses. We all know about, for MND last week, but many other conditions, too, in mental health in the nursing at the edge initiative that I had a debate about last week. I really think that the Government should welcome Labour's proposal for 1,000 extra nurses, and even Jackson Carlaw should welcome this proposal. I know that he enjoys attacking the mansion tax, but if he actually thinks about this, what Labour's proposing is no different from what his Government or any other Government does. When there is an increase in health expenditure in England, we get our percentage share of that, so he may not like the mansion tax. The increase in services might come from BAT or income tax, but we get the share. That is what Labour is proposing. I think that he should welcome the proposal of 1,000 extra nurses, and I think that everybody in the country will. I welcome the chance to contribute to the debate. As the cabinet secretary outlined, the foundation of the Scottish Government's 2020 vision is that, by that date, just five years hence, everyone who is able to will live longer and, more importantly, healthier lives in a home or a homely setting. The challenges that we face in ageing population, higher expectations, rising medical costs, as new treatments come online and long-term health conditions, which can be successfully managed, have risen in large part because our NHS is a fantastic asset of which we should be rightly proud. The fact that we are all living longer is no bad thing. MSPs across the chamber have spoken before about the contribution that older people make to their communities in terms of social capital. Despite that, we know that there are challenges ahead. It is right that the former Health Minister, Alex Neil, last October announced a refreshing of the ambitious 2020 vision policy to meet the changing needs of the Scottish people. I noted that the briefing from the Health and Social Care Alliance welcomed today as an important development, which offers an opportunity to further engage with people who use support services and include the third sector in designing the future priorities for health and social care. It is the third sector that I want to focus on today. We know that integration is not simply about streamlining or simplifying the system for its own sake or even for those delivering care. It is not necessarily about saving money either. What it can do is improve outcomes for the person at the centre of integrated care. The vision is how to make those outcomes as possible as they can be for those people. We are not alone in that aspiration. For quite some time now, person-centred integration has been the goal of many countries across the world, especially those who value quality public services. It is a global challenge. In 2011, SPICE reported on international comparisons with regard to health and social care provision, finding that over the past 40 years across Europe and further afield, there has been a trend towards encouraging health and social care agencies to work together to improve care. They use case studies from the UK, Sweden, Italy, Canada and New Zealand, and they highlighted barriers and enablers to success. Interestingly, the report found that one of the greatest barriers to successful integration was where competition and market-orientated systems prevailed. That is why it is welcome that everyone here in this Parliament is signed up to a public system. Most importantly, the report found that the most valuable enabler of successful health and social care integration in policy terms is the effective engagement of the third sector. That should come as no surprise to many of us in this chamber. The third sector has consistently demonstrated an ability to pioneer preventative approaches that can ease a burden on traditional NHS services and help people to stay independent and healthy for longer. I was very pleased while attending the cross-party group on volunteers in the voluntary sector this week to hear a presentation from John MacDonald of Community Transport of Scotland. He was talking about the increasingly important role of community transport in getting people to health appointments, helping them to get home from hospital and keeping them socially active and well. We have all got examples of that sort of thing in our constituencies. I have the privilege of seeing it work in the south of Scotland with Anandale Community Transport and a similar project in the voluntary sector. The food train, which delivers shopping, offers befriending, library and even repair services to older people all over Scotland. It is a mark of this Government's commitment that the 2015-16 budget will see an additional £173 million to support integration. That includes the integrated care fund of £100 million to improve outcomes and build on the progress that is made with reshaping care for older people's change fund, which provided £300 million from 2011-12 to 2014-15. That reshaping care of older people's change fund, which had been a powerful lever to support the third sector, NHS local authority, housing and independence sectors, to work more effectively together and to share ownership of local change plans and delivery. Today's debate presents an opportunity to further show our appreciation for the role of the third sector as people who use support services in designing the future priorities for health and social care. It would be interesting to see how the third sector will be involved in the new boards. That is really important if we are to achieve the transformational care that we are all looking for. I welcome the opportunity to participate in the debate. We all recognise the massive challenge that we are facing. I noted in particular what the RCN said, which said that it liked the idea of the 2020 vision and the idea of planning ahead, but cautioned that short-term responses to crisis very often is meant that we are not meeting the milestones that we would want. Perhaps in unkinder times, I was known to have said that somebody would be better to fetch up at the newspaper desk rather than A&E if they wanted their health problems addressed. We saw ministers responding to crisis, getting that dealt with and, as a consequence, a headline reporting that. However, we do recognise that there is a bigger challenge there. I also note what the GPs briefing says. When they talk about the impact of cuts in primary care, the amount of pressure on GP time, we know very often that it will be the GP who listens most carefully to what somebody says, to understand the proper reason why they are coming rather than what they present with. I am sure that, across the chamber, we want to make sure that we do all that we can to protect those services. I note two briefings from the likes of Inclusion Scotland, making the case that there are other things other than simply the health budget that reflect, respond and react to our aims and present challenges in 2020. It is important, and we know that someone once said that vision without action is daydreaming. While we can please ourselves across the chamber about the vision, the challenge for us all is to make sure that we apply the rigor to spending and to planning, and to ensure that all those who understand absolutely the reality of the pressures on social care, primary care and acute care are involved fully as it develops. Only this week, I was told in my constituency that a wait for non-urgent physiotherapy has gone from three weeks to 15 weeks. That is a rational response to pressures within budgets, but if the consequences of that are that people who are waiting for their non-urgent physiotherapy become unwell and have to present a and e, that is a consequence that is much more significant. If it is a general truth that people feel distant from politics, it is certainly true that frustration arises when our debate on health is not rooted and focused in the lived experience of staff, patients and families. In every play, we shall clash about spending priorities, but that argument cannot be simply a by-product of our desire to have a fight with each other as politicians. It must be rooted in different options of how we address a shared view of desire to tackle those problems. I hope that, with goodwill, we can bring together a shared vision with some of the really hard discussions about what our priorities are across the board in terms of our spending in local government and elsewhere to make that vision happen. I trust the chamber on this occasion, which is the first time I have spoken to the chamber in a formal debate since standing down as leader will permit me to focus on a very local issue, created by our national priorities for health. I want to highlight the issue of the impact of the construction of the new south Glasgow hospital on the local community surrounding it. Highlighted again today by the First Minister, this is a massive project, one that we recognise its importance. I am grateful for the response from the cabinet secretary to the initial correspondence that I have had with her on the matter. I welcome this exciting development, which is important for the delivery of high-quality care and triggering opportunities for health-related jobs and research around drugs and medical provision within the broader community. Labour began the project and the SNP continued it, and across parties both at local and Scottish level, this project has been deemed necessary. Scottish Government funding has been critical to its potential being secured. Cross-party political support has made the development easier. The city council working to planning guidelines developed in here and across planning thinking across the country. My time and in the cabinet secretary's time has put a cap on the number of car parking places available. We all agree that in terms of the environment, car use needs to reduce, and in terms of that development, car use also needs to reduce. We agree, but the reality is that local people are living with a massive impact on them of our agreement, with no say whatsoever in that decision. We have to make sure that in our local communities, car parking displays from the hospital are now having huge consequences. New car parking schemes will have to be put in place, but the cost of that is to be borne by local people. There is no dispute that we need to manage traffic in the area, but there is a contentious argument about who should bear that cost. I have met local people, I have met the health board and I have met council officials. Everyone agrees that there is a problem. I know that the cabinet secretary recognises that too, but the solutions that have been developed are based on local people paying to fund the parking scheme. My plea to the cabinet secretary is that the project is not just for South Glasgow, it is for all of Scotland. The project will see 7,000 more staff come into the area and, understandably, the site car parking of the hospital must be protected for patients and carers. The project is an infrastructure flagship as well as a health one, costing, I think, the First Minister said this lunchtime £800 million. Everyone agrees how important it is. Will the cabinet secretary for health, along with the Deputy First Minister and Cabinet Secretary for Finance, recognise that this is a project that we centrally decided and we centrally funded but with a direct impact for local people? Will the cabinet secretary meet me so that we can think creatively about how we find a little bit of money to fund the scheme that is only required because of the development of the site? I think that if we can look at this creatively, we can support local people. In an ideal world, the measures put in place by the health board, by planning agreements by the council and council traffic management would protect my constituents. The list of solutions addressed in the cabinet secretary's letter should make a difference, but the reality is that it is not happening. The last thing that my constituents want to hear is everyone of us identifying everyone else's responsibilities. I want to accept my responsibility for the past decisions that I made and for my responsibilities now as a local member, and I want to recognise across parties that we did that. I would hope that, in summing up the cabinet secretary, she would be willing to meet me and that she would direct her officials to explore how funding might be accessed. I believe that that funding is directly linked to the infrastructure project, and relation to that project is tiny amounts of money. I know that the health board cannot sustain the funding of a parking scheme indefinitely. Neither can the council, but if we attach it to the cost of the infrastructure project itself, perhaps we can find a solution. The reality is that if we want to think big as this vision does, we need to apply our thinking to the small in the global terms, but very significant unintended consequences for individual communities suffering as a consequence of these decisions. I underline that. I make no party point on that. I think that genuinely there is a really important decision that has been made, but local communities are now suffering as a consequence of that. I would hope that we can work together to find a solution that will address those problems very intimuously, because, of course, we know and we are glad to know that that host will be up and working in a very near future. Thank you, Presiding Officer. I am delighted to follow the speech by Joanne Lamont and welcome the constructive tone of her contribution this afternoon. The first line of the Government's motion refers to ensuring that Scotland's NHS remains in public hands and free at the point of need. There is broad agreement on the importance of that point, not just in this chamber, as we have heard this afternoon, but across the whole of Scottish society. I hope that, whatever other disagreements we may have this afternoon, we can maintain that all-party agreement, that consensus, on the need for a publicly owned and publicly funded NHS. The Scottish Government has returned our NHS to its founding principle of healthcare free at the point of delivery by abolishing prescription charges. Of course, at that point, the consensus breaks down, but it is an achievement of this Government of which I am proud. We have also returned the NHS to its founding principle of healthcare free at the point of delivery by vastly increasing the number of people registered with an NHS dentist by over 1 million. The Scottish Government has invested in our NHS increasing the NHS Scotland resource budget in real terms by 4.6 per cent and pledging to protect the budget in every year of this Parliament and in each and every year of the next Parliament, a pledge reiterated by the First Minister only last week in response to a question from me. It is this Government that has expanded the health service through ensuring that there are more staff working in it than ever before. One illustration of this is the 173 per cent increase in accident and emergency consultants, which have increased from 75 in September 2006 to over 200 in September 2014. The Government has also protected our NHS from the privatisation agenda, which now characterises the NHS south of the border and is now enshrined in legislation through the 2012 act. What a contrast with the Conservative-Liberal-Democrat coalition and the damage that it inflicts south of the border. In England, the NHS has moved further away from its founding ethos, and the head of the British Medical Association, Dr Mark Porter, has said of the NHS in England that it is no longer a comprehensive service. We can see the effect on people to whom we have to say, I am sorry, that treatment is no longer available. No wonder that when Andrew Lansley left his post as health secretary in England, NHS Networks tweeted, Lansley's legacy, only Herod's maternity policy, has got a worse press. The King's Fund has described the situation facing the NHS in England as critical, and that is simply not the case in Scotland, whatever pressures there may be. Here in Scotland, there is a consensus enshrined in the Scottish Government motion that the NHS will remain in public hands. As we look towards 2020, there are a number of points that I would wish to put on record. The cabinet secretary highlighted the issue of the integration of health and social care. We need to see the policy intentions on the integration of health and social care translated into concrete action. We have had countless reports, including a Royal Commission chaired by Professor Stuart Sutherland. We have had countless reports from the Health and Sport Committee of this Parliament. We have now robust legislation, and we have clear NHS guidance. We now need to get on and make it happen, but we know that challenges remain. I wish to highlight one such challenge. The Scottish Government is committed to getting it right for every child. However, a number of children in Lothian, with a range of health conditions that require a high level of intervention and support, are being failed at the moment. They can be deemed too complex to qualify for a social care package through the local authority and yet not be considered exceptional enough in terms of their medical condition to qualify for support through the Lothian exceptional needs service. That is an area where budgets need to be pulled across health and social care boundaries so that we do indeed get it right for every child. I seek an assurance this afternoon from the cabinet secretary that she will look at the issue and, if necessary, bang heads together because the delays that have characterised certain individual cases is, frankly, unacceptable. The public also wishes to know that an NHS that is fit for purpose is utilising the clinical skills of the healthcare professionals who work within it, be they in the acute hospital sector or in primary care settings. However, the public also wishes those healthcare professionals to be able to access and use the most up-to-date healthcare technology and facilities. I wish to highlight one example, and that is of cochlear implants for profoundly deaf children, where I think that the Government's record is a good one. The Scottish Government announced in December of last year that more than £3 million will be invested in the national roll-out of a programme that will see those people with cochlear implants benefit from any changes to sound processor technology every five years. In this example, we are actually implementing what Johann Lamont talked about when she talked about the NHS being rooted in the lived experience of patients and families. I would like to pay tribute to my constituents, Catherine and Andrew Lothian, who is a two-and-a-half-year-old daughter. Of course, at that age, the half makes all the difference. Their two-and-a-half-year-old daughter, Alice, has a cochlear implant. That family brought the issue to my advice surgery. As a result of their representations, the Government has listened and has brought forward the investment to ensure that those cochlear implants are replaced every five years. That will make a real difference to Alice's life because we know that cochlear implants and profoundly deaf children, together with specialist teaching and speech and language support, can allow them to integrate into mainstream schooling. Of course, it will also have a beneficial effect in reducing the experience of social isolation for adults with hearing loss. I would like to quote something that Catherine and Andrew Lothian— I really need you to start winding up.  I wish to thank the Cabinet Secretary and her predecessor, Alex Neil, as well as the national patient organisation representing deaf children for their work in that area. The Scottish Government has a clear vision for the future of our national health service and a good record in delivering better and faster treatment for the people of Scotland. Letters unite is a Parliament to ensure that the NHS remains in public hands but also to ensure that it continues to meet the needs and aspirations of the people of Scotland now and in the years ahead. I just say that we have caught up a bit on time, so the remaining speeches are going to have to be a wee bit tighter into time. Jim Hume, followed by Dennis Robertson. I'm grateful to the members before me for making it so tight. Of course, I'm very welcome to the debate today. It's an opportunity to focus on our long-term goals for the NHS. We all value the NHS and the people who make it, founded on the principles that it should meet the needs of everyone, that it should be free at the point of delivery and that it should be based on clinical need, not the ability to pay. It remains a source of pride in which each and every one of us has a stake. The vision that we are discussing today is that, by 2020, everyone is able to live longer, healthier lives at home or in a homeless setting. Key to that is the integration of health and social care. I welcome the additional investment of the £100 million over the next three years in our NHS and, as the cabinet secretary mentioned, the 10 to 15-year plan. I hope that we will have a long-term workforce strategy within that. We will take into account nurse places but also other places such as psychologists, psychiatrists, et cetera. I think that we should have, perhaps, addressed these issues earlier. Perhaps the ball was taken off the ball during the independence campaign, but perhaps not, but anyway, so the rest is history. The 10 to 15-year plan and the £100 million could and should have been delivered earlier to avoid the kind of stories that we have heard over the last few months, any waiting times up. Delayed discharges up a lack of staff and equipment being reported by concerned nurses, cancer waiting times missed and, of course, individuals with mental health needs sometimes waiting months for treatment, while others are simply not referred to the therapies they need because of the level of demand. I welcome the additional funding and the note of the 10 to 15-year plan. I am disappointed that it has come late in the day. The crisis that we are facing now will receive funding in 2017-18—somewhat ironic, when the 2020 vision puts a focus on prevention, anticipation and supported self-management. The 2020 vision is, of course, a very good one and one that we will all support, and this year will be crucial for it with the integration of health and social care, and I hope, of course, that all the ministers will listen to the concerns being raised and ensure that the transition is as smooth as it can be. We know that we must move to a more cohesive system and that that will help to delay discharges in particular, but, as the RCN warned earlier this week, this is only one element of the pressure on beds. If we are all to live healthier, happier lives, then treatment must be readily available when a patient needs it. For the one in four of us who will suffer from mental health, the one in 10 children aged 5 to 16 who has a mental health problem, the 13 per cent of 15 to 16-year-olds who have self-harmed, the 10 per cent of new mothers who experience post-natal depression treatment simply is not always there. Heat targets for psychological treatments are being missed across the board, and the Scottish Government, in a recent debate, has said that there is parity between physical and mental illness in Scotland. I do not accept that. The Royal College of Psychiatrists stated in a study on how to achieve parity when the UK Government looked into that. That is the overarching principle, equality. Mental health care, when parity is achieved, means equal access to the most effective and safest treatment. The allocation of time, effort and resources on a basis can ensure it with need and equal status within healthcare education and practice. We know from FOI figures that I obtained that in some NHS areas, spend on mental health has fallen since 2010. We know that only 81 per cent of people were seen within the 18-week psychological therapies waiting time, while 94 per cent of patients starting cancer treatment were seen within the 62-day heat target, so incidentally both targets are being missed. Warringly, we know that two-fifths of GPs have not referred any patient to psychological therapies recently because of waiting times. The RCN has said that mental health is often the poor relation to physical health when it comes to priority and funding within the NHS. So, I do not believe that that is equality or parity. South of the border, Liberal Democrats and Government enshrined parity in law for the first time and have asked the minister to follow suit here. Unfortunately, the minister did not even mention mental health in an answer recently to me on his priorities. We need it stated clearly and unequivocably that there is equal parity. It may just be the addition of one word, but for the one in four people who suffer and have suffered or will suffer in the future for mental health, that one word means that they will have an absolute right to equal treatment. It cannot be said that there is parity when GPs are not referring people to talking therapies because of the pressures on services. We never hear of people not being referred for surgery because of pressures on other NHS services. Just a final thought from the Royal College of Psychiatrists. If we stay true to the principle of treating each person with dignity and respect in our healthcare system, then we should make no distinction between illness of the brain and illness from other body systems. I look forward to working with all parties to help to deliver the NHS for the future to 2020 and beyond and in the spirit of consensuality. I shall be supporting the Government motion today. Many thanks. I now call on Dennis Robertson to be followed by Christian Allard. About six minutes, please. No more. Presiding Officer, can I first of all declare an interest? An interest as a patient and as an interest of someone who uses the acute and primary services within our healthcare sector. I declare an interest in using the social care sector within the voluntary or third sector. It is important to acknowledge that from my own perspective but that is probably of the rest of the members in the chamber. We are all users of those services. We have just heard from Jim Hume, a fairly damning indictment of the health service at the moment in terms of mental health. I have seen vast improvements in the delivery of mental health services but not always through the national health service. I have seen that improvement through the third sector. I have seen it through different appropriate services. I am working with organisations such as SAMH, for instance. There is more to be done. I acknowledge that. However, I believe that we are certainly acknowledging and on the right path towards the improved services. Equality happens when we have changes, not just in an approach to a service and how we deliver that service but maybe in the way of our life choices too. I thank the member for taking that intervention. We are on a path and the member recognised that. Does the member agree that it is quite a long path when two-fifths of patients coming with mental health problems are not getting referred because the services are not there to treat the people from whether it is talking therapies or outwith the NHS or within the NHS? I think that there is a presumption as to why GPs do not refer. Again, that is something that GPs themselves would have to identify if they are not referring because of lack of resources, then they need to look at their care of need towards their patient. There are many good things happening within the health service. Certainly, I think that 2020 vision is certainly the way forward. When I heard that there was going to be a debate on the 2020 vision, I started to think of all the things that personally I have been involved in over many years looking towards the integration of both health and social care. I sincerely hope that the cabinet secretary can remember a visit that she made to Elgin when she opened up the resource centre for Scotland's very first fully integrated a sensory service for people who were blind, part-societed, deaf and hard of hearing in Elgin. I was very proud to be the client services manager at the time when the cabinet secretary, then a minister for health, came to open that facility. Presiding Officer, there have been many schemes and perhaps ones, and I think that this is where Malcolm Chisholm made a point, that quite often government does not blow their own trumpet as to the things that are actually going on. There are many strategies going on at the moment which are improving the life of many people within our communities. It does not necessarily mean that they are attending a hospital or a GB practice. For instance, in my own constituency, there are many organisations looking after self-help, and that is maybe healthy walking groups. Actually, GB practices are referring people to these health walking groups. Community-based services by people within their own communities coming together as a group to try and keep themselves fit, active, not just physically, but in mind too. I know that this happens all over, Presiding Officer. It happens all over Scotland, and we need to welcome that, but that in itself does not require funding or resourcing. It requires commitment by people within their community and a commitment by people within the community to look at their own specific needs and how they can address it without maybe attending either GP or acute services. Presiding Officer, I am on Monday attending a meeting looking at the eye care, and it is with Ophthalmology and Optometry Scotland. The reason that I want to mention that is because for many years, they have been developing services that have been taking patients away from the acute sector into the community. A service that has been funded by Government. Can I give Labour credit here? Labour commenced the initial part of the service, which was continued by the Scottish Government in 2007 and continued to be funded by the Scottish Government. It means that patients with certain conditions can now go to community optometry practices, taking patients away from the acute service, and community optometry can identify whether or not a patient requires to be fed into the acute service. For many patients, and this is where I acknowledge that we are all perhaps getting older, Presiding Officer, but during that ageing process, things like vision and hearing and our ability, physical abilities, do degenerate. However, it is going to the appropriate service to try and ensure that you keep as best you can in terms of your own wellbeing. That is very important. I can conclude with my good friend Dennis Robertson about the appointment of acute services and definitely that we need to change the attitude. Our attitude as patients and how we should consider health, maybe differently, our health differently and health services differently. We may be having an attitude of consumer as opposed to having an attitude of patients. That needs to be changed and we need to change the attitude. I will speak about that today because I think it is important to see that the changes are important, that these changes have to be followed and enhanced by the change of attitude of the people and ourselves. Last week we devoted a motion on Scotland Future and I was surprised that Labour had chosen to talk about the present instead. Last week, but I'm happy this week that on that debate that the Cabinet Secretary brought in front of us debating the Scottish Government 2020 vision, a strategic forward direction for the NHS, but two political parties, the three political parties of us on mine, were happy to support and to endorse the vision. This government has a vision for our nation's public services. It's protecting funding for the NHS, stopping privatisation and contributing more nurses, but it's a lot more than this and it's the reason the Scottish Government has public support. Let me repeat it. I said last week regarding nurses' numbers just to close on that point regarding the Labour amendment. The number of frontline NHS staff has increased to record levels under this government. In Glampian there were 100 more nurses in post in 2013 and of 100 new posts in 2014. With NHS Glampian funding now with 1% parity with other NHS boards around Scotland, receiving £49.1 million increase to its budget for next year, the new board is looking to recruit another 14 nurses this year and other 14 new posts that will be funded by the increase coming from this Scottish Government. I know the first minister enjoyed a visit at Nineswell Hospital in Dundee, announcing money for additional nurses, accident emergencies, is what we're talking about today of course is part of the vision and it's a great success at Nineswell Hospital and Cabinet Secretary will be one of knowing more than this, representing the city of Dundee. The change is implemented there to assess, to admit rather than to admit and to assess, have really paid off. Yes, of course, I want to. Dennis Roberts. I thank my friend and colleague Christian Allard for taking a brief intervention. Whilst Mr Allard is referring to a Government spend at the moment, would he welcome the additional spend in the Grampian Health Board for the new women's hospital, the cancer unit and certainly the primary care sectors for the new medical centres in, I think, four areas within Grampian, one within my own constituency of Blackburn? My friend Dennis Roberts was a bit too fast because I was going to come into this. Only one point I would like to make. The name of the hospital has not been decided yet and I think the board at the last meeting I was, I was not very pleased with the name of the new hospital so I would like to just call it the new hospital from now on but yes, he's totally right about the new hospital and the cancer centre. What are we talking about the multidisciplinary assessment for patients at the hospital front door is what helps to keep patients in the most appropriate and desirable environment and to reduce the total length of stay in hospital. I know Scotland Health cabinet secretary visited Aberdeen accident and emergency last week when she announced the extra funding for NHS Grampian and I know they tried to follow in the example of Ninesways Hospital. I know it's difficult because of course whole hospital has not designed the same way and you need some restructuration and it's difficult to have a patient flow which is not the same from one hospital to another one so it takes time but I think NHS Grampian board, I can concur what the cabinet secretary said at the meeting I was with in Aberdeen that the new board is quite looking forward and to copy and to improve in that way because the emergency department at Aberdeen Royal Infirmary has changed beyond recognition. I had an unfortunate opportunity to visit it last year. The reason I was dealt with with great care and great speed is that the service has been reconfigured as I said with the front door service to deal better with unscheduled care. The challenge of a new board is to improve even further and to enhance front door services and to further shape and support the patient pathway of care for unscheduled representation. As I said, I attended a lot of NHS board meetings and what's important is that this vision is really adopted by NHS Grampian, by the older board and by the new board now and that can see in different ways and like my colleague Dennis Robertson said, it's a question of infrastructure as well. £409 million was announced to help to provide state of the heart hospitals and that's throughout Scotland and of course we have the new hospital and the new cancer centre with £110 million in total which is very welcome. I know the board is particularly looking forward to the new Aberdeen maternity unit for families in Grampian but it's not only this passing officer, it's as well not only hospital but care in the community. This is the reason and I'm delighted that this government is investing in healthcare facilities across Grampian with £19 million funding for primary care projects in Ymwaka, in Balmidi, Blackburn and of course in that new town for the generation out of the outskirts of Aberdeen of Elsic which I'm sure will have the pleasure to hear about in the next future. What I would like to say in concluding presenting for the officer is that I'm delighted for the £102,000 as well that the Scottish Government has announced to provide a pilot for the site for adult social care opinion which complement perfectly the patient opinion system that we have already in hospital which are promoted in previous debate. So this is the way to provide the national health service for future generation and with a person-centred approach this is why the people of Scotland support our NHS and why this is the way that the Scottish Government has public support. Presiding Officer, I am pleased to take part in this important debate on what is surely one of our most cherished institutions of NHS. I know it's something members from across the chamber feel passionately about. We all want to see an NHS that is meeting the needs of people across Scotland. It was, after all, the Labour Party that created the NHS in 1948 as a service based on people, not profits. For me, this remains our party's proudest achievements and will continue to be our priority in years to come. I agree with many of the principles contained within the Government's 2020 vision—values of collaboration and co-operation with patients and with the voluntary sector, continued investment in the public sector rather than the private sector and increased flexibility, provisions of local services and openness and accountability to the public. Presiding Officer, there is plenty in there that we can all agree on. That is why it pains me to read some of the horror stories that have been coming out of our NHS over the past few weeks and some of which have been mentioned earlier in the debate. However, the breaking of the law by giving patients a legal right to be seen within four weeks is staggering 12,000 times since it came into force. Thousands of patients are waiting too long at the A&E and are having operations cancelled. Those stories are almost unbelievable, but sadly that is the mess that our NHS is in at the moment. The NHS is not in a mess, but it has some challenges. I wonder if Anne McTarget would acknowledge that, although absolutely all of those 12,000 patients should be treated within 12 weeks, most were treated within 16 weeks. That has got to be better than the 12,000 that waited more than a year when her party was in power in 2005-06. Anne McTarget? It was your law that has put it in place, it has broken the law 12,000 times, 12,000 people, 12,000 families that are affected by that. Behind each one of those stories, there are vulnerable patients and their families suffering, and that is why we need to take urgent action. We know that the NHS in Scotland is facing significant pressures, whilst at the same time having to make major changes to services in order to meet future needs. Audit Scotland's October 2014 report highlighted the fact that the NHS boards are finding it increasingly difficult to cope with those pressures. Demands on our NHS are increasing as a result of demographic change, particularly in the growing population of elderly and very elderly people, the number of people with long-term health conditions and people's rising expectations of healthcare. Behind the scenes, we have our dedicated NHS staff who have dedicated their careers to saving lives and caring for our vulnerable. The truth is that they are overstretched and under resourced. That is why I reiterate my colleagues' calls for an NHS front-line fund to be included in the coming budget. I will give way to Dennis Robertson. I am very grateful to the member. Does the member acknowledge that, in recognition of some of the challenges that are faced by the Government, that is why we are proceeding with the integration of health and social care to ensure that the most appropriate service and care is there for the patients and or service users? Mr Robertson, I totally agree with you that, yes, that will accommodate some of the difficulties that we are facing just now. Most of my colleagues have asked for a front-line fund for the NHS. Although I welcome the fact that the Government has committed that £100 million over the next three years to reduce delayed discharge numbers, I believe that we need additional budget to help to deal with the increasing pressures on A and D services. That front-line fund would allow hospitals facing extra pressures to move to a seven-day a week operations, meaning that hospitals would be able to deliver better care with planned surgery at the weekends and diagnostics in the evenings. It would also free up beds, meaning that patients get quicker, better care, while also decreasing pressure on the front-line NHS staff. Although junior doctors currently cover weekend and night services to a front-line fund, it could be used to ensure that under-pressure hospitals have consultants on shift, which they do not currently cover just now. Those changes would be done in conjunction with clinicians and staff to ensure that they deliver more efficient care to patients and reduce the real demands and pressures of staff and could be paid from the Barnett consequentials. That will provide real help to front-line staff, and I urge the Scottish Government to consider our proposals and its imperative that the NHS gets the support that it needs, so that Scots can get the care that they deserve. In conclusion, it is clear that our NHS faces significant challenges over the coming years. No matter which party is in power, I will always be proud of our NHS and champion its amazing staff, but, without the necessary resources, they will not be able to provide the highest quality of care that they want to provide and that our patients deserve. I now call on Graeme Dey to be followed by Stuart Stevenson. I want to focus my contribution on the strategic narrative of the 2020 vision, in which it talks about collaboration and co-operation, partnership working with, among others, the voluntary sector and increasing flexibility and provision of locally-based services. As someone representing a rural area, while supporting entirely the provision of exceptional healthcare within our main hospitals, for me the delivery of the 2020 vision must have at the heart of its intent the aim of delivering appropriately for rural communities in those communities. We are seeing tangible progress in Angus South, which I want to highlight some examples of. As the cabinet secretary knows, having visited the village approaching four years ago to meet campaigners, there has been a long-running issue in Leitham, in my constituency, over the fact that there is no direct access to GPs, with residents having to travel at the fore for our bro with frequent and even breaking for appointments. The original desire to have a satellite GP practice for a variety of reasons has not and will not be realised. However, innovative thinking, community engagement and the potential to access Government funding means that we at long last are moving to addressing the situation through a house of care arrangement, which will offer GPs from all of the practices that villagers are registered with the opportunity to provide appropriate services at a facility within Leitham. Having sat in on the initial meetings between the NHS and community representatives, I am optimistically well end up with something that fits with the 2020 vision, meets the aspiration of locals and is sustainable. I also welcome the move to enhance the services and offer it our brother infirmary, especially those around palliative care. If what is proposed comes to fruition, we are going to end up with day-patient treatments, which have until now required tiring journeys to and from nine wells being carried out within the local area. We will also see people supported in their final days in modern local facilities within Angus. However, if I may digress slightly, and I am sure that the cabinet secretary would concur that how planned changes to healthcare delivery are conveyed to the public is vital, and there is a lesson to be learned from our broth where, instead of this being a good news story around replacing antiquated not-fit-for-purpose end-of-life provision at Little Kearney hospital, with the kind of facilities that we would all want in the town, this story broke as much-loved local hospital to close. It is important that the public are made aware of all aspects of proposed healthcare changes, but misrepresentations in the media are such as this. To be fair to the media in this instance, they weren't at fault. They have the ability to shed unwarranted doubt on this Government and our NHS commitment to delivering services outwith the major conurbations. It is not only the communities of Wetham and Angus that are broader my constituency, which are benefiting from the 2020 vision-type developments. Improvements are being made through all local communities of Angus south, most notably through the work of the joint improvement team. GIT has implemented the south Angus locality medicine for the elderly model, which involves close work between GPs, hospital doctors, therapists and, importantly, social workers, to specifically cater for the healthcare and welfare of the elderly population. As a result of the integrated initiative, elderly patients experience the comfort of being cared for in their local settings, whether at home or in their local infirmaries, while gaining the reassurance of care continuity with their own health professionals in nine wells. Impressively, the model has led to a 60 per cent reduction in unscheduled admissions to hospitals, from care homes, a 40 per cent reduction in new care home admissions and a reduction in the length of stay and orthopedics by eight days. The area now uses a third less beds for those over 75, than any other part of Tayside. It has the least delayed discharges in Tayside, and it has halved the number of patients going into 24-hour care from hospital. Due to provenance worth, the roll-out of the model across Tayside, supported by the £7.86 million announced on Tuesday by the Cabinet Secretary, is, I understand, being looked at. Despite the examples that I have provided, no-one can deny of course that there is room for improvement. With the emphasis on local delivery, we must encourage partnership working, including with the voluntary sector. Therefore, I would highlight a situation that I have written to the Cabinet Secretary on, which is the threatened ending of action on hearing losses excellent Tayside here to help programme. The non-renewal of lottery funding means that the programme may only have weeks to run, unless the NHS locally steps in or alternative national funds can be accessed. Action on hearing losses train volunteers to go out into the towns across my constituency and elsewhere, servicing and adjusting hearing aids, thereby alleviating the pressure on central audiology services. If the programme closes, those central services will become swamped by demand for relatively minor work, more suitably carried out in our communities. Moreover, we will end up in the situation the direct opposite to the direction of travel for the 2020 vision in Tayside. I therefore ask the Cabinet Secretary to encourage NHS Tayside to enter into dialogue with action on hearing losses, a matter of urgency, in order that a way can be found to continue this important work. Ahead of this debate, Members received a number of briefings from assorted sources. I want to mention one, if I may, of the BMA, because I thought that it was thoughtful, well argued and in the main difficult not to agree with. The BMA is quite right in highlighting the issue of GP practice recruitment and retention and calling for action to promote general practices and attractive career choice in the remote and rural areas. They are spot on in a number of other ways, but I would have welcomed some acknowledgement of the positive practical implications of measures adopted under the JIT model for GP practices. We hear all the time about how stretched GPs are and how this impacts on their ability to interact face-to-face with patients. Last winter, NHS Tayside introduced a pilot project involving an additional doctor being deployed to three practices, two in my constituency, one in the Cabinet Secretary's, and provides support in dealing with elderly patients. The scheme was so successful, as acknowledged by NHS Tayside and the practices who admitted that its arrival had freed up GPs to engage with other patients. It has been continued and has been rolled out elsewhere. Whilst pointing out where we can and need to do better, let us please also recognise the positive steps that are already taken and being taken. Colin Stewart Stevenson, to be followed by Richard Baker. One of the great achievements of the Labour Party of the National Health Service was brought into being in 1948, but we should not forget the genesis of that achievement. It started with the Lloyd George Act of 1911 for national insurance. Indeed, to this day, the folders in which one's medical records are held are still referred to as a Lloyd George. I have heard that, actually, said an adopter surgery within the last 12 months. There are very few politicians who get their name in that way in history. We have got another one, just a few hundred metres from here. We have a Belisha Beacon. Horde Belisha was a transport minister in the 1930s. I commend to the European Health Board that perhaps the hospital yet to be named might be a Lopital Allard, thus immortalising my colleague to my left. Perhaps most important is the Highlands and Islands Medical Services Grant Act of 1913, which, for 35 years, was in essence a national health service that was centrally funded and managed free at the point of delivery for the Highlands and Islands. It, for example, put the first resident nurse on St Kilda in 1914. Scotland has led the way in which we now deliver free to people who need it health services today. So, let's hope that we can maintain the consensus that says that that's what we should do. Of course, we should also remember that William Beverage, whose report in 1942—the social insurance and allied services report—was a liberal. I will, yes. Briefly, please. Very brief, Mr Stevenson. In moving to the 21st century, Mr Stevenson, would you acknowledge that a telehealth medicine is the way for the future in a lot of our remote and rural areas? The member is absolutely right. Our geography means that we have the opportunity to innovate and the greatest benefit to deliver. It's worth remembering that the first medical air service started in 1935 in Scotland, and the first patient travelled from Islay to Glasgow on an ad hoc basis in 1933. For me, of course, there are really interesting things. Since I worked in the health service 51 years ago, where the staffing and the resources, which are so substantially less than it is now, is, of course, the 36.2 per cent increase in geriatric consultants since September 2006, up to September 2014. That, I particularly welcome, because as you can work out about, I was working as a nurse 51 years ago, that's a matter of considerable personal interest to me. And associated with that, of course, the nearly 30 per cent reduction in senior managers in the health service diverting the resources to where it's needed, which is in the front line. And I think that that's a process which has been going on for some considerable time. We've all got our hands on that, but we must make sure, as parliamentarians, that we continue to hold our ministers to account to ensure that it continues. Now things have changed. My father was a GP, single-handed, rural and urban, and as a single-handed GP he had 2,200 patients. Nowadays, it would be inconceivable that a GP could have that number of patients, because, of course, what GPs and people in the front line now do is so much greater. 50 years ago, what the GP did was very important, but it was much more about pastoral care. There was less medical intervention than we would nowadays expect. Now, we've had a lot of changes over the years. We've seen a huge focus on workplace health, we've seen a reduction in accidents in workplaces, work-related disease. We know the phrase, mad as a hatter. Well, that came from the use of mercury in the industry that made hats. People who made hats became mad from exposure to mercury. That doesn't happen anymore. The next challenge for us all is, of course, the personal responsibility that was mentioned by Jackson Carlaw. Health warning in the Herald a week ago, lack of exercise, twice as deadly as obesity. From Public Health Wales' report, higher cot death risk among families who have smokers in them, an element of personal responsibility. We get lots of messages through the media. I particularly like the independent on the 19th of April last year. A bottle of wine a day is not bad for you and abstaining is worse than drinking scientists' claims. I suspect that that is a bit over the top in terms of the claim, but the point is that we are all exposed to those messages and I think that we in public life have to take some responsibility for making sure that people get sensible messages. Let me just touch on the issue that is raised by the Labour amendment in relation to staff. Of course, the 2014 NHS staff survey shows that 26 out of 29 core questions we have seen an improvement. In particular, 90 per cent of staff said that they were happy to go the extra mile at work when required. That is an increase of three per cent since the previous survey. At the core of our health service is our staff. Let us continue to support them and congratulate them for what is a world-beating service at a world-beating price. Many thanks. Another tour de force. Richard Baker. Six minutes or thereby pleased to be followed by Richard Lyle. Last week, I took part in the debate that was brought forward by Scottish Labour on health services in Scotland because there have been such concerns over key issues of healthcare in NHS Grampian. Given the importance of those issues, it is a welcome opportunity that we have here today to return to the issue of our health services. Of course, it is right to have a long-term strategic plan for the delivery of health services in Scotland. The 2020 vision, established by the Scottish Government, is, as a number of Labour speakers have said, an approach that we can all endorse, although we cannot lose sight of the fact of the huge pressures that health services and our hard-working but under-pressure staff face today. A number of those pressures have come to the fore in recent weeks in NHS Grampian in terms of waiting times targets. Not being met, mental health services, which Dennis Robertson referred to, and a crisis in recruitment. Today, in the north, those concerns over delayed discharge have again been highlighted. I thank Mr Baker for giving way. Would Mr Baker recognise that the Government has put in additional money to deal with delayed discharge and that part of the problem in the NHS Grampian area is the fact that Aberdeen City Council has given its care services to an arms-length company that is not fulfilling the needs of the people of Aberdeen. Thus, we have increased in delayed discharge. On the second part of Mr Stewart's comments, I simply do not agree with that. On the first part, yes, I welcome any new funds that should come to NHS Grampian. As I do with investment, I tackle the problem of delayed discharge specifically in our area, but on the second part, no. Mr Stewart and I were a same briefing from NHS Grampian's leadership team when he put a similar point to them. What they said was clear that the key issue for care services in Aberdeen is to have the staff that we need in our care homes to deal with the problem of delayed discharge is once again one of recruitment. That is something that affects very much all our health services in Scotland. I think that I have dealt with a point that Mr Stewart has made. I want to make progress. I do agree entirely that we have to deal with delayed discharge. We have seen the impact that it has had on scarce NHS resources. A number of speakers have made reference to that. We have seen the impact today in the press and journal and individuals with the comments from Mr George Thomson on the unfortunate predicament of his wife Helen in Wudend hospital. Their experience vividly explains why dealing with this problem must be given such priority. It is also important to point out that, while there clearly has been a deterioration in the situation in Aberdeen regarding delayed discharge, those problems have not taken place overnight. At the core of that is a recruitment crisis to which I have already referred. That is not something that should come as a vast shock to anybody that we are dealing with these pressures. Let us look at the narrative published with the 2020 vision, which was published in 2011. The document says that, over the next 10 years, the proportion of over 75 in Scotland's population who are the highest users of NHS services would increase by over 25 per cent. That document identifies the problem that is coming to its head on. However, what we see certainly in my own area in NHS Grampian is that the response simply has not been adequate to deal with all the pressures that we have. When it comes to a scenario in the north-east, it is a problem that pertains to Scotland as a whole. It is even more acute in our part of Scotland with a demographic challenge. It is all the greater, briefly, from Mr Alard. I thank the member for taking an intervention. I just want to respond to the claim that NHS Grampian is not responding adequately. I talked at length of the reform of the front door services at Rai. The member should welcome this, and that will provide the change that we need. In NHS Grampian, it is all of not responding adequately to the situation of the Government of not responding adequately to the situation. I certainly will stand by that. I say, of course, that reform of services is an important way of tackling those issues, which we will have in the long term and amic, tag and others, referred to the importance of the integration agenda that we have between health and social care. That is something that NHS Grampian and Aberdeen City Council are working extremely hard on together to make that success, and that will help to tackle those issues that I have raised today. However, it is going to be admitted that it is taking place against a challenging backdrop in terms of resources given that our council and our health board are the poorest funded in Scotland. It is, of course, a welcome, the recent uplift in funding for NHS Grampian, but it is quite wrong to ignore the fact that some members did in the debate last week. That is the implementation of a formula agreed eight years ago by the previous Scottish Executive, which is only now introduced by ministers in this Government. This background of underfunding is a key issue when it comes to the problems, particularly of delay, discharge, which NHS Grampian and its partner agencies face. It is a key issue in terms of recruitment, and it has to be said that dealing with recruitment, as I have repeatedly said in my contribution, is at the core of the difficulties that we have in care services and care services position in Aberdeen. That is why, once again, I ask ministers to give serious consideration through the proposal of an Aberdeen waiting allowance, which they have not done in my view thus far. In 2011, many of the difficulties that were faced by our health service were predicted. They have come to pass despite that. Too often, our health services have not had the right resources to deal with those pressures. It is clear that, across the country, hard-working staff in our NHS and in our councils, too, are making tremendous efforts to make the aspirations of the 2020 vision a reality. However, those goals will only be achieved and patients will only see their benefits if ministers provide the right support in implementing what is their vision. On that, it is clear that this Government has a great deal of work to do. Richard Lyle after which I will move to the closing speeches. The 2020 vision for the NHS is a strategy that we in this chamber are familiar with, having debated it and discussed it before. I recall in the last debate the opportunity to highlight the smart care pilot that took place in North Lanarkshire and other areas in Scotland that use technology to support the delivery of integrated services in the launch of the Digital Health Institute in 2013, all of which were an opportunity to highlight the innovative approaches that we have taken to delivery of healthcare in Scotland. As I have already said, the SNP vision for the NHS is that the Scottish NHS should remain a public delivery service. Unlike that of Westminster, the condemned Government that marches the English NHS down the path of privatisation. In order to facilitate the vision for the Scottish NHS, the SNP has methods commitment to protect the NHS budget. The health resource budget for the year 2015-16 will be at a record £11.8 billion. That affects a real-terms increase, meaning that all territorial NHS boards will receive real-terms annual increases in funding. Even better than that, the Scottish Government has announced that an extra £65 million will be made available to the NHS this year. Those funds will help to alleviate some of the pressures and ensure that our NHS can continue to deliver effective and sustainable care to all patients across Scotland. That is in spite of a 10 per cent cut in the fiscal resource budget of Scotland by Westminster in 2010, meaning that the Scottish Government has increased the health resource budget by 4.6 per cent in real terms. The Government is putting their money where their mouth is. It is a pity that Westminster will not do the same. The Government has committed to increasing the revenue budget of the NHS rises in the real terms—no—for the remainder of this Parliament and for each and every year of the next Parliament, too, which the Labour Party repeatedly refused to do when this topic was debated in Parliament previously. For the year 2014-15, every one of Scotland's NHS boards are projected to break even. In contrast, Labour-run NHS Wales bodies are projecting a deficit totaling £192 million. I know that Mr Hume does not like that, but unfortunately that is the case. Moving on, however, I want to focus on those who know the NHS best—the people that live and breathe it, and the staff who work for it. I would like to share some of the facts from the NHS Scotland staff survey 2014 national report that was published in December last year, and it makes for very interesting reading. For 26 of the 29 top-level questions that all respondents were asked, the results showed an improvement in the proportion of staff giving a positive response compared to 2013 survey results. In fact, the improvement is found to be statistically significant for 25 of those 26 questions. Similarly all, but one of the 14 sub-questions showed an improvement or no change in the proportion given a positive response. For me, the spirit of the Scottish NHS was summed up in the response to one of the questions. In fact, it was one of the most positive responses in the document. The question was asked and Mr Stevenson touched on it slightly. I thought it was stealing my speech. The question was asked and 90 per cent of the respondents said that they were happy to go that extra mile at work when required. 90 per cent is thanks to all the hard-working staff that the NHS continues to do the work that it does. I would like to take the time to record my thanks for everything that it does and continue to do for us in Scotland. I am sure that members from across the chamber will agree with me, hopefully, on that. I read with interest to chief executive on NHS Scotland's annual report in which she states that there is a maintained commitment to our vision that by 2020 more people will be living longer, healthier lives at home or in a homely setting. Our focus on personal, centred, safe and effective care remains paramount. He is delighted that the health and wellbeing of the people of Scotland continues to improve. I think that the reflections of the chief executive are important and showcase the work that it has done in Scotland to put Scotland's people and their health at the centre of the healthcare delivery in our vision for 2020 in the future. It is with results like that of the NHS Scotland staff survey, the investment that this Government is making in our NHS that helps to keep the people of Scotland healthy and happy. We are working towards the 2020 vision and the action that this Government is paying the way to make that vision a reality. I turn to the Labour Party's mansion tax. In regards to the Labour Party's mansion tax, in the new statement, I know that she is Diane Abbott, who is a Labour MP commenting on the Scottish Labour spending money raised in England. She criticised Jim Murphy—in fact, she called him John Murphy—attending to buy votes with this policy. She said that John Murphy just thinks that she can buy Scottish votes with money that is expropriated from London and accused him of jumping the gun in an scrupulous way. Diane Abbott wants the money used to build houses in London, again Labour spending the same money twice. Several other London Labour MPs have also attacked Mr Murphy's mansion tax comments. Tottenham MP David Lammy said that money from London should not be siphoned off to the other regions. Tessa Jowell warned against the city simply acting as the cash cow for the rest of the UK—at least she did not call Scotland a region. Today, I support the Government's motion. I will now move the closing speeches. I call on Annette Milne up to seven minutes, please, Dr Milne. This has been a worthwhile debate, and it is a good time to take stock of progress just about halfway between the Government's announcement of its 2020 vision for the NHS in Scotland and the year by which it has hoped that goal will be achieved, with everyone able to live longer, healthier lives at home or in a homely setting. Of course, we echo the cabinet secretary's praise of our hard-working NHS staff who work under great pressure at times to look after the patients in their care. I am pleased that there is political consensus around the aspirations of the 2020 vision and cross-party commitment to a publicly-owned, funded and managed Scottish health service free at the point of need. Indeed, that overarching agreement between political parties is quite well hidden in some parts of this afternoon's debate, I have to say, but that overarching agreement is extremely important, not least because it sends out a clear signal to all stakeholders that to achieve the best outcome for patients and a sustainable system of health and social care in Scotland, there will have to be an end to silo thinking and professional barriers and a framework of co-operation between healthcare providers at all levels and local authorities and the third and independent sector to provide social care with the recipients of care and their carers at the very heart of planning their care pathway. Joan McAlpine dealt in some depth with the important contribution made by the third sector to caring for and supporting people in our communities. Of course, I agree that that will be a crucial part of a successful integrated system. Yesterday, Richard Simpson, Jackson Carlaw and I attended a very interesting seminar on the next steps for primary care in Scotland, with a broad spectrum of speakers, including GPs from affluent and deep-end practices, nurses, care sector providers and government. Although significant progress was acknowledged towards the 2020 vision, there is undoubtedly a great deal still to be done to cope with the growing demands of an ageing population with increasing levels of comorbidity and to achieve the 2020 vision of people experiencing seamless care from their earliest years right through to the end of life. There was also an acknowledgement that primary care should be the hub of an integrated system of health and social care at the heart of a network of readily available local services such as pharmacy, optometry, dentistry, physiotherapy, podiatry and other AHP provisions. That concept is already seen in many of the newly built primary care centres in Scotland, and it is very much in the users' interests. The ready availability in the centres of nurse practitioners and health visitors and the link-in to telehealth provision for house-bound people can give very necessary local support to patients in self-managing their complex and long-term health conditions and, in turn, prevent the need for hospital admission. However, to attract and retain doctors into primary care, as we have heard this afternoon, the RCGP and the BNA have rightly emphasised that its share of NHS funding has to be adequate and commensurate with the service that it provides, and that this is not yet the case. There is also a strong feeling that GP's professional contribution to patients is being undermined by an excessive administrative and bureaucratic burden, and those are issues that the Cabinet Secretary will have to address in early course if, in her pursuit of the 2020 vision for health, if general practice is again to become an attractive career option for young medical graduates. The pressures that are currently facing the NHS have been very well aired in this chamber since the start of the year, from the intractability of health inequalities to the enormous demands on GPs and A and D services. The latter, of course, exacerbated by the barriers to patient flow through the hospital system, caused by a lack of appropriate care within the community. That, of course, has occurred close to home for me as a north-east member, as has been highlighted by several other members from the area that is covered by NHS Grampian. The Government's announcement this week of a £300 million funding package to help deal with delayed discharge is, of course, welcome, and how that will be deployed is clearly very important. I note the Cabinet Secretary's indication today that it will go towards community support to allow patients to be discharged within 72 hours of being declared fit for their return to the community, which, of course, would be a major improvement. However, I was struck yesterday by a comment from Ronald Mayer of Scottish Care, who suggested that the funding should go towards community support to keep people out of hospital in the first place, on the other side of the same coin, but quite worthy of thought. Mr Mayer also made the case for initiatives such as community geriatricians and models such as hospital at home and virtual wards. The RCN has been vociferous, not least in its briefing for today's debate, about the increasing pressures on nurses, many of whom feel that they are too busy to provide the level of care that they would like. The need for more NHS nurses has been accepted certainly by us and by the Labour Party, both committed to providing a further 1,000 nurses, although we totally disagree about how they should be funded, which absolutely precludes our support for the Labour amendment today. Scottish Conservatives have also long pressed for more general practice-based health visitors, and we were very pleased when the previous health secretary heeded our calls and announced provision for another 500. Jackson Carlaw, in his opening speech, proposed developing a universal health visitor service up to the age of seven, which, of course, I support, and raised several other very radical ideas for improving health provision, which we would flag up for discussion, going well beyond 2020. We are pleased that the cabinet secretary is of the same mind, and we look forward to working with the Government's health team and others in planning for the future well beyond the next five years. Does the member also welcome the introduction of the nurse family partnerships? Yes, indeed. As we have heard in the health committee, they have been doing a particularly good job. I welcome them indeed. One particular mission from the 2020 vision has been raised by Mary Curie, and that is the lack of a mention of palliative care, an area that was acknowledged at yesterday's event as an important part of the patient pathway. The focus is rightly on keeping people well and in the community for as long as possible. With an increasingly ageing population with complex comorbidities, thought should be given to the approaching end of life, even if it may be several years away. Mary Curie pointed out that, whilst palliative care services are reasonable and increasingly available for those with malignant conditions, little provision is made for terminally ill people with non-malignant conditions. If they do access palliative care, it is usually very close to the end of life, so they want to have that included in the 2020 vision. There are many aspects of care to be addressed in achieving the 2020 vision so that only the surface can be scratched in this debate. I will conclude by commending the work of all those who have achieved so much so far and emphasising the need for partnership and co-operation between all service providers and with the people that they serve, and the need for politicians of all colours to make a concerted effort to support the achievement of the very worthy 2020 vision of health and social care in Scotland. Many thanks. Thank you, Presiding Officer. It seems that it is another day in the chamber on another health debate. If debates were to make the NHS work better than it should have been working like clockwork, unfortunately, that is not the case. It is not because of the staff who are treating patients and keeping them safe without proper support or facilities. They are working above and beyond while the Government too late realises what we have been telling them for months and years. Too late, the SNP Government starts addressing the problem, and that will not help the people who have had their operations cancelled today and the people who are today stuck in hospital because of their lack of care in the community. We very much welcome the additional fund for community care, but the 2020 vision, two and a half years ago, talked about moving care to a homely setting, and that has been a long time in coming. Audit Scotland, as Jenny Marra and Malcolm Chisholm said, said that there is no sign of the re-balancing of care. The RCN also said that there is no information to inform the debate. They say that, worryingly, delayed discharges, which are one of the problems that could be addressed if the Scottish Government were successful with its 2020 vision, has continued to increase. That is a problem for all of us. We have pleaded with the Government to fund community care, but they have done this too late. They talk about changing the bed blocking target to a two-week target from April. That is a start, but how many people could be treated in those acute care beds in that two weeks that people are waiting to be discharged into the community? Richard Baker in his speech talked about the recruitment of staff for community care, especially in Aberdeen, which we know has great difficulties because of the low wages and lack of training that is applied to community care workers. However, that is a problem throughout all our areas. We need to value the people who work in the care sector, both by paying them reasonable wages and, indeed, by giving them plenty of training, and I will give way to Kevin Stewart. I appreciate that Mrs Grant has given way there. One of the difficulties that there is in terms of recruitment is the fact that terms and conditions of some staff have been changed. Bonacord Care, the arms-length company that I talked about earlier, is one of those companies that, I believe, has changed terms and conditions, thus making recruitment much more difficult. Would you like to comment on that? I think that recruitment everywhere is more difficult for care staff because of the lack of funding. That is why I am welcoming the £100 million that the Government has put in, but we need to do something if we are actually going to have the step change that the 2020 vision lays out and, indeed, that the Government promised that it does not seem to be appearing any time soon. We also have a crisis in A and E. We see ambulances queuing up. We see people waiting on trolleys and, indeed, people's conditions deteriorating because of lack of care in the community. Over the festive period, we saw GPs closed for eight days out of an 11-day period. No wonder people have become so ill that they turn up at the door of the hospital and the hospital has no room to put them because there is inadequate care out there in the community. That is why, as is outlined by Jenny Marra, the Labour Party has proposed a front-line fund. Malcolm Chisholm said that we need to build capacity in acute and primary care. We need to deal with the pressures of A and E and cancelled operations. However, the Government dismisses that. It says that we have a seven-day task force working on that, but it has been working on that for a year. People cannot wait. Malcolm Chisholm quoted some of what the Government had already said about seven-day care. Surely, if that is the case, the Cabinet Secretary can now commit to a date on which to report about the work of the task force. However, in the interim, we have shown her how she could