Thank you very much, that concludes questions this afternoon and we now turn to the next item of business, which is a debate on motion number 15766, in the name of Jenny Marra on health. Can I invite members to wish to speak in this debate? The presser request to speak button to now, please. And I call on Jenny Marra to speak to and move the motion. Miss Marra, 14 minutes please. Thank you very much, Presiding Officer. Let me start this debate this afternoon by recognising and thanking NHS staff up and down this country for the tireless and the professional job that they do in caring for our sick and vulnerable people in communities, surgeries and hospitals the length and breadth of this country. It mae rydym yn cynnwys ar gyfer eich ddefnydd. Rydym bod mwy bach yn gwahanol rhan i'r NHS. Gynnwys rei, symud yn gyfoeddwyr ar gweithio mwy gyf wastu a fyddwch i'r diabetes. Mwyn fyddwch wedi gwneud bod nhw'n gwahanol ar gyfer ddesgrion ac yn teulu. Fyddwch gweithwyr hwn i gyrfa gyd-grinio'r llwyf yn gwyllのでist i gael mwy gydумai i'r gwestiwyr honno i gael mwy gyd-grinio. Rwy'r sydd wedi hyn yn ymdegydd oedd oedd yn gyfer mwy gyd-grinio. Ie, mae'r staff perioeth remindur ei wneud na'r gweithio'r cymraes i ni'n gwneud, rwy'n dweud y dyfodol, dechrau y ffiskol, y dyfodol yn ei ddweud i diodd, ond ei wneud i ni'n mynd i nghiwg i'r argymell bod yn gegi. Yn y bwysig ymddangosol rhaiwm, mae'r newydd mae'n minsal yn nghydol gan gydag. Mae ymddangosol yn gweithio'r ymddangosol rhaiwt yn gweithio'r ymddangosol, Ie grath yw paedd gan nhw, dyfodillad o'ch behalfio. Ond maeth i gweithio eu cyfnodalych. Diolch i gweithio'r ffaith y gwaithion sy'n falch am amser. Rwyf nos i'r darwm iawn i gyd i gyd, os ni'n eich bod yn ei wneud i gyd o gweithio, o'r rwyf neud i gyd o gyd i gyd i gyd i gyd, ryw ffynwys yn ei gyd i gyd o gyd o gyd o gyd o gyd o gyd o gyd o gyd o gyd. someone blame in absentys has a mherged among the Scottish ח olmak that only the Conservatives break from. With Nicola Sturgeon's announcement on the council tax we now all agree that if we want better public services we need to be brave enough to ask people to pay for them. Labour? Liberals? No. Jackson Carlaw. The announcement by the Scottish Government today on council tax reform is exactly the proposal that the Scottish Conservatives made last month when our tax commission reported. It doesn't pick up any of the options of the commission in which she was a part, but it echoes the very proposals that we made. If she's looking for a consensus, it certainly exists on this side. Maxine Carlaw for his intervention. I was more implying his disagreement with our proposal on income tax. If I can make a bit of progress, Labour, Liberals and now the SNP have made education a priority for any additional revenue, for right and for proper reasons. Given the challenges and problems in our health service, are we spending enough on our NHS and care services? The evidence before us would perhaps suggest not. We all share a starting point that health spending should be protected by the Scottish budget. Scottish Parliament spends one-third of the budget on our health service—a considerable sum—but we still face persistent and seemingly intransigent problems with ill health, poverty and disease in Scotland. Every MSP in this chamber, I am sure, is being told in their local area that their GP surgery is struggling to recruit doctors. List being closed to patients, health boards stepping in to run general practice and the experts telling us that the very existence of general practice is under threat. In my home city of Dundee, we have a doctor's surgery in one of the most deprived communities in Scotland, teetering on the brink of survival as the recruitment crisis strangles GP provision, threatening the very existence of that GP practice in the local area. Recruitment is a huge challenge, which health boards—and the Government—is grappling with at the moment. Posts across the country remain unfilled, many for months, with no signs of being filled in the near future, and services are having to be altered to ensure patient safety as a result. The cut in university training places for doctors from this Government is coming home to roost in our health service. It was a short-sighted decision, and I hope that mistake will not be made again. We have a huge number of doctors training in this country, leaving to go abroad, and no guarantees that the increased trend in this will follow previous years, trends in previous years gone by of doctors returning to our shores to serve the NHS. This is one of the biggest recruitment challenges, and we will need some clever thinking over the next Parliament, as we all know the effect it is having on our local services. It is now a full year since Shona Robison made the pledge to abolish delayed discharge from our hospitals within that year. Sadly, she has not been able to achieve that. According to the statistics released a couple of weeks ago, there has been a welcome improvement in A and E waiting times, but we still see more than 50 patients waiting more than eight hours at the Queen Elizabeth University hospital in Glasgow. We have seen an increase, yes. I thank the member for giving way. She talks about hospitals and local services. Does she think that we need to have a shift in health spending towards more preventative and including GP services and perhaps fewer resources going into acute and hospitals? We have had a debate in this chamber before about shift to preventative service, but the crux of this is about services being delivered locally, and that preventative approach being integrated. If John Mason will allow me to return, I was talking about the statistics released by the Scottish Government a couple of weeks ago. We have seen an increase in operations that has been cancelled for non-clinical or capacity reasons, which was addressed at health questions this afternoon. We have seen missed targets for adult starting psychological therapies, and only 70 per cent of children—this is a really important point—and young people have started mental health treatment compared to the Government's own target of 90 per cent, which is very worrying. Health boards across the country are facing millions of pounds worth of cuts or savings, with my own health board seeking to save 27 million costs over the next couple of years due to rises in agency nursing costs. I know that the Cabinet Secretary knows about that, and through primary care prescribing huge savings with the real impact yet to be felt. We can all agree that we face many challenges in our health and care service and our NHS staff are doing a fantastic job in difficult and pressing circumstances, but the pressure on staff and our NHS is only set to grow. What else will we give unless we find additional revenue and resource? Many of my colleagues from across Scotland sit waiting for decisions on services in their local areas. Big question marks fall over services in Lightburn hospital in Glasgow and St John's hospital in Livingston and many other local wards and services. The injustice of those question marks and the reason we bring this to the cabinet secretary today is that it is simply not fair that those questions persistently hang in the air, and it is certainly not fair that those question marks hang in the air until after the election in May. Honest Governments, I believe, will make decisions that are in the best interests of people and work with them to manage any change that that decision brings, but they should have the courage of their convictions and the confidence of their argument. It is not right that all of those crucial decisions are left in the balance because the Government does not want to be asked any difficult questions or face any opposition from local groups before the election in May. I expect that this afternoon's debate could be more highly charged than usual. Let me explain why I think that this will be so. When there is doubt over local services, people need their representatives to stand with them and represent their concerns. There has been a lot of discussions in early hosting meetings and in panel meetings between the four main parties about taking politics out of the health debate. Jackson Carlaw is a particularly strong proponent of this, which, if I may poke a bit of fun at him, is an interesting current position for a Conservative health spokesperson given the political hot water Jeremy Hunt finds himself in England. Johann Lamont made a similar argument not too long ago, and I think that that mostly has worked well. There is general consensus across this chamber about what needs to be done in the future—the integration of health and social care, a move away from acute, more preventative services based around primary care, expanded roles from pharmacy around primary care, increased involvement of allied health professionals and a much needed focus on preventative health policies and public health. We had a good debate in June last year, when we said that we will support government where we agree and where consensus to make progress is required, and we will hold them to account where necessary. That is our job and our democratic duty. However, where there is change proposed and especially where there is uncertainty, people in their communities need their representatives to stand with them, shoulder to shoulder, to represent them through that change or to ask questions to power on what that change is, why that change is happening and why they do not have the information they need. Especially where there is uncertainty, there is a danger that rumour and myth fill the void, and that is something that good government should do its best to avoid. It is this basic right, Presiding Officer, that brings us to the chamber today, because it has simply been abused—I do not use that word lightly in some of the instances that you will hear about from my colleagues this afternoon—decisions that have been on the cards for months and have been delayed and delayed with no good reason, which can only lead us to the conclusion that they are being delayed until the votes have been counted and the truth remains hidden until any electoral consequences safely passed. Presiding Officer, I do not think that that is a fair and honest way to run the country or our health service and the Scottish people deserve honest government. It is not just decisions on provision of local services as detailed in today's motion that have been on hold. The cancer strategy, which we have raised in this chamber several times before, is months overdue. Even the Tories in England managed to publish theirs last summer when both were due, with commendable measures on diagnosis, care and treatment, but we still wait for our cancer strategy in Scotland, not far off a year delayed. The cabinet secretary has said that the national conversation has to complete, but the cancer strategy was due for publication before she came up with the national conversation, so it is no good reason for its delay. I sincerely hope that we will see a strategy published this side of the election so that people can see it before they cast their votes. That is the crux of this, Presiding Officer, that people have the information that they need on the intention of their own Government on their local services, the most simple democratic transaction. The Scottish Government has a choice. Will they be brave enough in the future to ask the people of Scotland to pay more for quality local services, or will they be honest today that they plan to cut those local services after the election? Will the Government allow the people of Scotland to make a judgment on their record and vision for the health services, or will they try to sneak through the next few weeks without making the hard decisions and expressing their intentions only to spring them on people after their votes have been cast? I think that that would be a very unfair way to proceed, and I hope that the cabinet secretary will be able to provide us with clarity on that today. Thank you, Presiding Officer. I am very happy to take part in this debate today. It provides a timely opportunity to acknowledge the commitment and dedication of health and social care staff across the whole of Scotland to reflect on our record and performance, which I am very happy to put in front of the Scottish people in the next few weeks, and to comment on the actions that are being taken to ensure that Scotland's NHS continues to be the world-class service that it is. The budget for 2016-17 agreed by Parliament last week confirms that health spending in Scotland will rise to a record level of close to £13 billion. This Government has increased the health resource budget by 6.8 per cent in real terms between 2010-11 and 2016-17, and we will continue to provide real terms protection. As I confirmed last week in 2016-17, more than £500 million of additional funding has been allocated to Scotland's health boards with a 5.5 per cent increase in territorial boards budget levels. That funding includes investment of an additional £250 million to support the integration of health and social care and to build the capacity of community-based services. That is something that the Labour Party asked us to do in a previous debate in this place. Yes, of course. Alex Rowley's microphone, please. In my constituency in Loch Llyrysaith in Benarte, we are unable to recruit GPs. That is to say that we are not going to leave a methyl right across five. In primary care, investment and social care, if we do not have the GPs, we have a real problem. Is she not worried about that? We have time for the interventions that I can give you. Of course, that is why we are going to invest the additional £85 million over the next three years to ensure that we help primary care to develop and overcome some of the recruitment and retention problems that Alex Rowley has highlighted. The unprecedented funding that I have just mentioned is matched, of course, with a record level of NHS staffing, with over 8.9 per cent more staff now than in 2006. We have record high numbers of qualified nurses and midwives. We have, over the same period, increased the number of medical and dental consultants by 41.8 per cent, and vacancy levels are down. The Government will continue to work with the professions to support staff across the NHS in adopting improved clinical practices to deliver world-class services. Health and social care staff should also be applauded for the 18 per cent reduction in delayed discharge in December 2015, compared to the year before, and a huge improvement in performance in our A&E departments compared to last winter. Those are real achievements to be celebrated. However, there, of course, is much more to be done. We recognise the demographic changes and other risks, just a minute, and have to be prepared for those challenges. Our recently launched national clinical strategy has shown how we can adapt our services to meet those challenges and ensure that we get the best possible value for patients from the resource invested in the NHS. That ambitious strategy—a blueprint for the next 10 to 15 years—describes the rationale for patients-centred and stronger whole-system integrated primary, social and secondary care delivery across Scotland, delivered by locally responsive and increasingly multidisciplinary teams. In primary and community care, we now move forward to build capacity and provide a more broadly based mix of professionals around our GP practices and our health centres. For hospital care, we have achieved much in recent years in streamlining patient journeys. In a minute, we have achieved much in recent years in streamlining patient journeys within hospitals. However, more needs to be done and we now need to move on to ensure that once patients have undergone treatment and their condition is stable, they are discharged with appropriate support as soon as possible. Once they are home, they will be supported by strengthened primary and community care teams. The cabinet secretary is talking about resources and protecting the NHS budget. NHS Greater Glasgow and Clyde have said that they need to find over £1 million a week in savings over the next financial year. Can she confirm that? That is accurate. Cabinet secretary. NHS Greater Glasgow and Clyde's budget has increased to a level unprecedented previously, along with every other board. Along with every other board, they have to make efficiencies. They have already delivered efficiencies of 3 per cent in previous years, all of which are invested back into front-line services within those board areas. We will continue to invest the levels of unprecedented resources to the health service and we expect our boards to deliver the front-line services for that. Underpinning the clinical strategy is our long-term commitment to secure and develop local services where possible and specialised services where necessary. That will ensure that our health and social care services are responsive to the ever-changing needs of the population. Of course, the integration of health and social care is one of the most significant reforms since the establishment of the NHS. I noted with interest that Labour's motion calls on all parties to ensure the continuation of current services at a range of hospitals. I think that there is a lack of self-awareness in Labour's ranks. They should reflect on what Labour actually did for hospitals when in power and then compare that with what we have delivered. We should not forget that the very first act of Nicola Sturgeon as health secretary on 6 June 2007, when she came to Parliament and announced that we were overturning the previous Labour-led administration's decision to close the highly valued A&E departments at Monklands and Ayr hospitals. Although we have been consistent in our belief that the decisions of our predecessors to close those A&E departments were wrong, we recognise the need for a robust evidence-based to ensure that services would be sustainable and to repair the trust and confidence that have been so damaged with local communities. No, not just now. I have taken two. As such, we commissioned independent scrutiny of the options, a process established and used three times since we came into power and is still available to help inform major service change considerations. The experts of that independent scrutiny panel emphatically confirmed our position to be correct. The fact that the previous administration, notwithstanding the lack of a clear and robust evidence base, was prepared to sanction the closure of those A&E units beggars belief. What would the impact of that be? Well, since our decision to save those units, they have provided much needed emergency capacity, seeing some 830,000 attendences between them, and we have not just maintained these departments, we have invested in them and enhanced them. I was also interested to note how Labour's motion specifically calls for the retention of emergency care services at the Vale of Leven hospital. I was interested because the A&E department at the Vale closed in 2002 under the previous Labour-led administration. Indeed, it was this Government that ended a decade of damaging uncertainty by approving the vision for the Vale in 2009, thereby securing its remaining emergency services alongside the provision of local maternity services and the repatriation of a number of specialties with regards to lightburn. I have been clear, as I said, in health portfolio questions that there would need to be a material change to the position in 2011 when Nicola Sturgeon, as health secretary, ruled out the closing of the hospital based on the proposal that came to her. We have continued to invest in St John's, a list of investments that were never made under the previous Labour administration, and lots of investment in St John's. Of course, the independent review of paediatric services that has been undertaken across Lothian will report to NHS Lothian in due course. I will take Neil Findlay. The cabinet secretary has referred to the previous cabinet secretary who said that she took decisions to stop closures. She could take a decision now to stop any detriment to the children's word at St John's, but we know why she won't, because she intervened, as did her officials, to bump the words that the NHS Lothian used, to bump the review until after the election. Of course, let's be clear. There are no proposals for closure of any of these services mentioned in the motion. None of them have come to me or, indeed, have even been approved for closure by any of the local boards themselves. None of them, none of them at all, unlike the record of the previous administration. You will understand, Presiding Officer, why we feel very confident in comparing our record on safeguarding these key local services with that of the Labour Party, because actions speak louder than words. This Government has not only adopted a rigorous evidence-based approach to developing health policy. We have also been consistent in ensuring the full involvement and engagement of service users and local communities throughout. We have a coherent plan in the national clinical strategy, and, of course, the national conversation launched last August seeks public views on those ideas and asks them what their priorities are. I would contrast this Presiding Officer with the ragtag and bobtail motion written clearly on the back of a fag packet, which has more to do with trying to save the seats of a number of Labour MSPs, and has nothing to do with wanting to protect vital local services. Labour has no coherent health policy, bereft of ideas, nothing to offer at the Scottish people the paucity of their motion demonstrates that, and I am very pleased to move the amendment in my name. It occurs to me that looking at the timetable for the rest of this Parliament, that this may very well prove to be the last full general debate that we have on health. I want to make the observation that, before my time, we benefited from the experience of Sam Galbraith and in my time from the benefit of Dr Ian McKee, from Dr Richard Simpson and from Dr Nanette Milne. I think that the Parliament will be the poorer for the fact that when we meet in the next session, and I do not know the CVs of all those potential new MSPs who may be coming, but I think that it looks like we are likely to be bereft of those who have had front-line experience within the NHS as medical practitioners, and I regret that. I want to begin before I thank the staff for thanking those MSPs who have contributed to the life of this Parliament with a fundamental understanding of the service that they have had before. I joined Jenny Marra in the tribute to the staff, and I do not demure from the fact that it is worthwhile for us to do that and to start many of the debates that we have on health with that tribute. I have observed before, though, that it is very much a conceit amongst us here in this chamber that there will be health professionals all over Scotland who are currently sitting, watching the deliberations that we are currently having. Most of them are so very busy in the jobs that they are doing under such enormous pressure in the environments that they are in that I should think at times they find our thanks somewhat hollow. I mean, they are meant sincerely, but, of course, they are dependent upon us responding, I think, to what they are saying. Although Jenny Marra set up a couple of straw men, I think, there to try and disarm me, I have made perfectly clear before that this Conservative Party now has no truck with the health reforms that are taking place, which were begun by Tony Blair in 1999, continued by the coalition government and pursued by the Conservative government there. The health services of Northern Ireland, Wales, Scotland and England may be called a national health service, but in every other sense they have diverged in their own particular way. Here in Scotland we are all committed in this Parliament to a national health service in public hands free at the point of need and delivery. The debate that I have very much hoped that we can move towards is how do we create a sustainable NHS that will secure that model of healthcare into the future, which is the one that we all want to see pursued? I thought that Jenny Marra moved the motion slightly more measured tones than I feared she might, because I welcomed the fact that, after the general election, where nationally the Labour Party, I think, did use the NHS again in the hope that it would influence the outcome, it came to this chamber and said that it too wished to participate in a non-partisan approach to the development of health in Scotland. I have said to the cabinet secretary, yes, I would like to see the health taken out of politics. It is not quite the same thing as taking politics out of health, because this Parliament and all the representatives in it have a duty to pursue the day-to-day management of the health service and the critical issues that arise, even while we seek to work collectively with the government to agree that broader national consensus going forward. It does not matter what group of health professionals I meet, whether it is the BMA, whether it is the RCN, whether it is the Royal College of Emergency Medicine, whether it is allied healthcare professionals, whoever they are, are saying the same thing. We, as professionals, acknowledge the enormous challenge that is now presented to the health service in Scotland through conditions, some of which were not even in place when this Parliament first met, and which are potentially undermining our ability to maintain the kind of health service in Scotland that we want to see. So please can you, as politicians, find some way to work together to ensure that that national strategy, which secures the future of the health service, enjoys all-party support. I have also said to the cabinet secretary that that is not the same thing as the cabinet secretary announcing something and then expecting a cross-party consensus that underpins that announcement. It requires us to find a way of ensuring that all of the political parties, as well as the broader stakeholders, are participative in the work that brings about the agreement of what that strategy will be. I think that this is an excellent document, the national clinical strategy for Scotland, but in its executive summary it is candid, because it states that it is something of a higher-level review of what needs to be done and the shape of healthcare in Scotland that we need to see evolve without getting into the detail and the nitty gritty on some of what will prove to be the very difficult decisions that will have to be taken if that strategy is to be secured. Of course what we would expect is for local boards not just individually but working with each other and you'll notice that regional planning is a key part of this. We'll apply the principles of this to their local services and that's what we would expect to happen in the next phase of the strategy. I thank the cabinet secretary for this, and I'll conclude in my opening remarks by saying this. When we as a party took the view that we wanted to participate in trying to achieve a consensus we recognised that that will mean that the next Parliament will require to take some difficult decisions. Do we in this election use that potential agenda of difficult decisions as a political football or do we stand back and accept that it will require a degree of courage in the next Parliament and for government to know that it has a broader level of support? If the Government can consult with the other parties and involve us in the decisions that have to be taken then we continue to take the view that in this election health must be removed from that political debate and only a constructive approach must be the one that we follow and we commit in the election to maintaining a constructive approach on how we deliver that sustainable model of health in the next Parliament. Many thanks. We now turn to the open debate. Could I ask all members who intend to participate in the debate to press the request to speak buttons, please? I call on Bob Doris to be followed by Jackie Baillie, speeches of six minutes or so, please. Thank you very much, Presiding Officer. On Monday I visited a new £12 million health and social care centre that is nearing completion in Maryhill. The Scottish Government has invested substantially in the new centre, as it has in the NHS more generally with this year alone a record £13 billion annual budget across Scotland, representing a substantial real terms increase. Likewise, there are record numbers of staff, 9 per cent higher under this SNP Government, 11,000 overall, including two and a half thousand additional nurses and midwives. Another important achievement has been the increase in any consultants, for example, an eye-watering of 168 per cent. Are there still challenges? Of course there are, and those challenges are substantial. With a significantly growing elderly population, with increasing frailties and multimorbidities, how could it be otherwise? Surely to goodness, we can all agree on that, irrespective of who is in charge of Scotland's NHS. Indeed, when I mentioned record staffing levels in Scotland about Scotland's NHS yesterday to take a stitch of mine, he was quick to remind me of those significant pressures that are still faced by our nurses, indeed with my wife, who is also a nurse. However, that constituent was right to do so. It is reasonable to say that although the Scottish Government and Scotland's NHS is under substantial challenges, we are approaching those challenges from a position of strength. We should all be able to agree on that, rather than on the road of scaremongering and fear tactics that we have heard a little bit in opening contribution by Jenny Marra. I am pleased that the Scottish Government has stated that it is committed to maintaining and improving safe and effective local services.  I am pleased that the Scottish Government has stated in its amendment that it is committed to maintaining and improving safe and effective local services across Scotland, including in the Royal Alexander hospital, Vale of Leven hospital, Lightburn hospital and St John's hospital. That is there in black and white in the amendment before us. I hope that that hopes in its tracks any debate this afternoon, although I hear my doubts about whether the Scottish Government is going to axe those facilities. We are clearly not. That commitment has already been made and it is reiterated again today. I will resist the temptation, although my colleagues may not, to open up the debate about track records in relation to axing services that the community values. I believe that the Scottish Government's record has laid out that the Cabinet Secretary for Health is rather better than the last Scottish executive that mismanaged Scotland's NHS for a number of years. I would like to look at some of the challenges that we face in context. Yes, there have been successes along the way, so we have a real challenge in relation to the lead discharge. Of course we do. Absolutely we do, however we should recognise that in the last year alone Scottish Government funding has saw the lead discharges decrease by 18 per cent. We are still doing significantly better than we were in 2007 when the Government came to power, so much to do, but it is still real progress made. None of us should deny that irrespective of whether the fact that there is an election is coming up, or otherwise, yes. Dr Simpson. I do not deny the progress that has been made in the last year, but you must recognise, as Audit Scotland did, that in seven of the nine targets things have got worse and are deteriorating. In terms of the bed occupied days, the numbers were 20,000 in July 2011 in a month. There were 46,000 last month, so there was progress in the last year, which I welcome. Nevertheless, it is almost three times, well, twice, sorry, more than twice as bad as it was in 2011. That is not progress. Mr Doris, I can give you seven minutes. Thank you. I make the point, Dr Simpson, that we are still doing substantially better than the Labour Party when it was in management of Scotland's NHS and when the Scottish Government has identified where issues are arising that commit money and finances to investing in that, including £100 million over three years to tackle delayed discharge. That is how you manage an NHS. You keep a weather eye on it and you invest, as we are appropriate. I think that we have done a number of positive things in relation to the NHS, but I want to say a little bit about—I am cutting some of those out now because I want to say a little bit about the Vale of Leven hospital. I have to say it as a family member rather than as a MSP, particularly. My mother was cared for in the Vale of Leven hospital with a terminal illness, and it was pallid of care that she received in Lomondward. She got an exceptional service from the amazing staff that were there. Sadly, she is now passed away. I see the vital service that the Vale of Leven provides to people. That is my hometown. I represent constituents in Glasgow, but that is my hometown. The emergency facilities that are there—I do not want to end the debate during this part of the conversation about who did, what, where and when in relation to services, but the emergency services that are there are a number of my family members who really value those. I am standing here as a member of the Scottish Parliament but also as a family member saying that I am confident and committed that those services are remaining at the Vale. People will have to take that as a factual statement and not play politics on that. The staff do an amazing job in the Vale of Leven hospitals to do right across Scotland's NHS. I had a list of things that I thought would improve in Scotland's NHS quite dramatically over the years, but with elections arising, the party of government tends to list all the things that we think we have done incredibly well on. The main opposition party says all the things that we think we are weak on. When I was going to list all the things that we have done very well on, it did not just happen by accident. It was because of national clinical strategies. I am mindy that someone in the Labour Party mentions that document at some point during the debate and meaningfully engages with it. There is lots in here about unplanned admissions to hospital, whether via accident emergency units, whether it is day admissions or bed admissions, and how that is going up and up and up, and how we have to do far more. I think that one of the key things that we have to integrate into the delayed discharge question and early intervention is much more closely aligning housing policy with health and social care policy. I am delighted that health and social care integration has finally happened under this Government and there will be lots of great initiatives coming forward, but the next step has to be really weaving that together with housing policies and giving those that are moving towards the end of their lives or are becoming less independent because of their frailties and real choices in that housing journey. For many it will be staying at home for longer, for some it will be sheltered accommodation or very sheltered accommodation, for some it will be residential care, for some the last weeks of their lives such as my mother, it will be in a hospital bed, that is how it had to be, but when we weave the fabric of our policies through health and social care and Scotland's NHS, I think that we have to think more carefully about how we weave housing policy through that. It is mentioned in this document as well, the challenge for all parties after the next election is to make this a reality and my one question I would have for the Scottish Government, I think that this is a superb document, but at some point be it two years, four years, six years, we are going to have to review how NHS boards have sought to align themselves with this document and make progress and that is a challenge for us all, thank you. Thank you Mr Doris, I can give members seven minutes but not a lot more so, Jackie Baillie to be followed by Stuart McMillan. I very much welcome the opportunity to participate in this debate and let me say at the outset that the Vale of Leven hospital is my local hospital and I am going to focus on that today and I have spoken many times in this chamber about the challenging geography and the need for accessible local services so I won't lecture you again on just the difficulty in accessing services in my part of the world. I think that members will know that I will do everything in my power to protect the services there and will work with any government of whatever political stripe to do so. I am equally not afraid to challenge any government of any political stripe in so doing. My local community have petitioned this Parliament, we've held hands around the hospital, thousands have marched in the streets and believe you me we will do so again. The staff that work at the hospital are second to none. Their dedication and hard work is at the centre of the very positive experiences patients have at the Vale so I do want to thank them for all that they do but I want to acknowledge that like many staff across Scotland they're not resource to do their job properly. Now I welcomed very much the vision for the Vale at the time because it sought to provide stability and an assurance about services. I visited the Vale hospital in the company of the First Minister at that time too but you know let's be clear that despite this cuts at the Vale have continued, staff numbers have been cut, bed numbers have been cut, clinics have been cancelled, community maternity unit hours reduced, the Christie ward permanently closed and as we speak being demolished junior doctors vacancies unfilled and now ward 6 closing with the agreement of the cabinet secretary and then then we had the leaked document in January this year about NHS Greater Glasgow and Clyde's proposals to cut services. This was to make a saving of £60 million and what were they going to cut? Staff numbers, bed numbers, emergency care at the Vale, community maternity units at the Vale, perhaps in the Clyde and the RAH, the children's ward at the RAH and more besides. The cabinet secretary was very robust in telling us that NHS Greater Glasgow and Clyde didn't know their uplift for the new financial year so we want to worry. I can tell you that the cabinet secretary was wrong. They knew roughly the amount that they were due to get and guess what? Now that it's all in the public domain and everyone knows their uplift the cuts have gone up from £60 million to £69 million pounds so everything is back on the table and more and when I have asked about the Vale before because the cabinet secretary knows my interest in this both she and the First Minister have talked about the past she did it today and I recognise and welcome what they have done for the Vale in the past let me put that on the record but I want to talk about the future because that's what people in my area care about I know we're going to be kept in the dark before the election and the cuts will be rolled out after and just in case you're in any doubt about this the cabinet secretary's amendment gives the game away she deletes the part of the labour motion that talks about retaining specific services she substitutes it with warm words about hospitals and of course buildings do matter but it's what's in them that matters more and then we see the word safe before local services and I want to tease that out a little because you see I'm told I'm told that if the cuts don't go ahead then emergency and maternity services at the Vale will be deemed clinically unsafe and we as politicians simply can't argue with that it's openly talked about by senior clinical staff by health board staff by the government as well emergency care the medical assessment unit the minor injuries unit provides services for increasing numbers of local people a thousand more this year than two years ago that's their central importance to what's delivered but I also know that there are hundreds of thousands of pounds being spent on locum doctors because they can't recruit junior doctors to the Vale so will she guarantee that this will continue because this is at the heart of concerns about safety I want her to guarantee that whatever happens she will retain all current services including the maternity service which actually hasn't been mentioned in any of the commitments that the government have made to date I want that guarantee for at least the next five years and a simple yes in her reply will do fine by me and can I say to Bob Doris who demonstrated the value of the Vale of Leven hospital this isn't about playing politics this is about certainty for the local community that he grew up in and I'm sure he will share my concerns to deliver that absolutely I thank Jackie Baillie for giving way and I know she's got a track record and seeking to defend the Vale over the last few years but again I say this as a person who was brought up in the Vale and I think one or two locals in the Vale might occasionally accuse Jackie Baillie of playing politics over the Vale Jackie Baillie can I say I think the one thing that people say and it's not just a few years it's 16 years we have been having you know trouble at the Vale across successive governments I'm the first to acknowledge that but I think my local community would not deny that I am the one that's campaigned against any and all governments in protection of the Vale of Leven hospital now seasoned commentators will of course remember the care report as specialist as necessary as local as possible that was the soundbite for the future delivery of our health services and make no mistake the soundbite might be different but the national clinical strategy is actually the same we all agreed with the care report we agree with much that's in there bob doris quoted some of what was contained in the national clinical strategy and I'm happy to discuss that with him because we talk then as we do now about delivering services closer to home about shifting the balance of care about using specialist centres the same principles are in the national clinical strategy but implicit in that will be disinvestment from acute services and changes to our hospitals so please tell us now tell us before the election what services you will centralise what services you will cut and what hospitals will close we shouldn't pretend about this you really cannot you really cannot say one thing in here and one thing to health professionals and another thing entirely to communities like mine that would indeed presiding officer be beyond dishonest thank you i have been over generous with first two speakers i must now ask everyone else to keep to the seven minutes that i have allowed student mcmillan to be followed by paul martin thank you very much sir presiding officer i'm fortunate that i've not actually had to utilise health we'll sit use the excuse to sit again utilize the hospitals very often in my 43 years but i do recognise the i've got certainly a fair a number of friends and family as well as many constituents who have done and i want to put it on record my thanks to every single person who actually works within the health boards and works within our nhs they do a fabulous job and over the last 10 years there have been significant changes in Scotland's population and the needs and needs and demands placed upon our health and social care services and in 2010 in the quality strategy the Scottish government set out its strategic vision for achieving sustainable quality and the delivery of healthcare services across scotland in the face of the significant challenges of scotland's public health record of our changing demographics and also the economic environment and in 2011 the Scottish government committed to integrating health and social care to address in particular the changing needs of our growing population of people with multiple complex needs many of whom are older and certainly we've heard some aspects in the debate today regarding the regarding some some would argue legitimate questions about the future but also it's my colleague bob doris i highlighted this is kind of some of the party political nature of the health debate certainly one of the things that's been consistent over the last couple of months has been the latest attempts to spread fear over the future of local health services and i mean i certainly would argue that they're nothing short of just being a campaign tactic now Jackie Baillie a few moments ago touched upon this the NHS leaked paper now i think there's a few facts that need to be put on the record about this leaked paper fact one there are seven Labour councils on the NHS creator Glasgow and Clyde health board second we're just on a moment if that's okay secondly it is and it was an internal discussion paper thirdly it's not a definite proposal or setter of proposals or an approved plan fourthly the content hasn't been approved by the board or referred to the Scottish government and certainly none of the points in the draft discussion paper haven't put forward to the government for consideration and finally any formal proposals will need full public consultation and require government approval mr Paul Martin I'm not sure whether student knowledge has been given the correct briefing from his resource centre but just to confirm there are 27 members of the board the greater Glasgow 20 of them are appointed by the cabinet secretary for health just to confirm that for the record. Stuart McMillan i'm not denying that mr Martin but what i did say is that there are seven there are seven individuals on it from from representatives also from local authorities and also those seven are from the Labour party that mr Martin will also will be aware and all seven are Labour so the second can the second issue that i do want to touch upon it's just it's in terms of the in terms of the what was that mr bibby are you mr bibby if you wish to make interventions please stand up to do so no okay okay certainly it's just it's gonna it's gonna highlight just a couple of points me and certainly it was the Labour party who wanted to close any unit at the Inverclyde Royal hospital and it was under Labour that Inverclyde lost its consultant led matern to unit now but i do acknowledge that the NHS go to Glasgow and Clyde did however publish proposals to change the community matern to units in 2008 but these proposals were defeated by campaigners north and south of the river and also by politicians from north and south of the river and in this chamber as well we actually on one of the few occasions we've probably united to actually help defeat a set of proposals from that particular health board now Jackie Baillie touched upon the Vale of Leven and certainly history also shows that it was in 2002 and that it was under Labour that the A&E unit was closed at the Vale of Leven so it's in terms of the record of delivery certainly under Labour there certainly has been a negative a negative record in terms of in terms of actually trying to assist the populations within the west of Scotland area now certainly as an MSP since 2007 i've had a strong record of campaigning to maintain services at the Inverclyde Royal hospital my position will never ever waver from that and therefore i am delighted that that this Scottish Government is delivering for health in the Inverclyde area with the positive news for the New England Health Centre of £90 million being confirmed and also the £8 million confirmation of the continuing care hospital replacement for the Ravenskill hospital. The Scottish Government has a clear vision for the future of our NHS and will continue to take the right action to ensure that Scotland continues to have an NHS that we can be proud of today and also in the future and latest figures show that staffing in the NHS again has reached a record high with more nurses and more consultants working in Scotland's health service than ever before and there's 11,000 more staff working in our NHS and this number continues to rise and this also reflects the record levels of investment in our healthcare services with next year's NHS and social care budgets recently confirmed to be over £13 billion for the first time ever now this Scottish Government's significant investment has provided a growth in the NHS workforce to ensure people in Scotland get the high quality healthcare they deserve now i'm very much conscious that i've got to finish in six minutes signing officer up to seven but okay okay and certainly in addition this Government are building for the future with the recently announced rise of 5.6% in student nursing and midwifery intakes the fourth successive increase in as many years and the level and quality of care provided to patients has contributed to people living longer along with continued advantages in diagnosis treatment and care and this Scottish Government is also integrating health and social care and have introduced the self-directed support which is empowering people to live more independently now there are looking ahead signing officer there are various issues that will specifically impact upon the health resources available but it's a percentage volume of demand for healthcare and also the cost and also with the resulted anticipated demographic changes over the period 2030 as well as increased life expectancy and these are certainly huge challenges that the NHS does have to face but in conclusion signing officer every MSP i'm sure wants to ensure that their communities get the services that they need delivered by the appropriate range of health and social care professionals working together more effectively however it's this Scottish Government which is carrying out far reaching reforms to our health service and will continue to consult on how these can be further developed thank you very much just to be clear a generous six minutes for everyone absolute maximum of seven now call on paul martin to be followed by gil parson pysyn ofsley can i fforsley make reference to particularly bob doris his comments and latterly from shoot mcmillan in respect of the skirmongering tactics that i referred to can i just confirm on respect of the save lightbulm group it is led by jerry mccann who has no political allegiance to anyone he's a Parkinson's suffer he suffered from Parkinson's for over 20 years now and he made it clear at a public meeting that i attended in monday that his commitment is to ensuring the future of lightburn hospital and in fact he said that he was concerned that some of the emails he was receiving were individuals that were referring to the skirmongering tactics that were taking place and he said it was an insult to his intelligence that people should refer to that because what he's referring to i'll bring bob doris in in a second you'll get your chance but what he's referring to is a document that was prepared by a senior official Katrina Renfrew as i understand it at the health board in Glasgow a financial planning document which proposed at that time 60 million pounds worth of cuts but laterally 69 million pounds of cuts now that's the document that's been referred to that's the one that it's still on the table i'll give i'll give way to bob doris perhaps he could explain in more detail this document bob doris if you wish well i'm i'm delighted with the chance to give clarity to the comments that i certainly made earlier mr martin i was not making reference to any campaign or campaign group i was making reference to labour politicians though okay mr martin again he's not referring to the specific labour politician but perhaps we could hear bob doris clarify that once again but can i just also refer members to the members business debate that i led in respect of lightburn on the 28th of september 2011 just after being elected to the scottish parliament in 2011 may 2011 when the hospital was proposed for closure and i was delighted to support jerry mccann the leading campaigner of the save lightburn campaign and i did actually welcome the rejection of the health board proposal by the then cabinet secretary for health nicola studion it was one that i understand and i recall was welcomed by all parties in this chamber and i actually give credit to the cabinet secretary for health on that occasion for ensuring that that that proposal was in fact rejected and Presiding officer following this decision myself and other campaigners met along along with jerry mccann met with the then cabinet secretary for health in 2013 alec neal to discuss further investment in lightburn hospital and at that stage we were given assurances that lightburn had a future and we could look forward to a rosie future one that would be about developing that very facility the Presiding officer given this background and the political commitments that were given in this chamber and that's one of the points i'd point out to the cabinet secretary for health the bucket at the end of all of these discussions takes place at the cabinet secretary for health that's where the cabinet secretary has a role and that's where this is political because it's for the cabinet secretary that will bring her in in a second but given this background i was astounded that this financial planning document page eight of it confirms that the it says here now this is not scaremongering this is a fact this is a document that was created by Chtiw Renfrew which it says that there is a proposal that there's a closure of lightburn hospital that it should be closed now Presiding officer there's the cabinet secretary and she can come in in a second not agree with me that it's a disgrace that this parliament should be held in such contempt that the cabinet secretary for health the now the first minister takes a decision to advise the health board that she's rejecting the proposal but despite that during this parliamentary session the cabinet the the health board come back and say they're proposing it for closure will she instruct him not to propose it for closure and to withdraw it from the financial planning document? I remind Paul Martin what the chair of Greater Glasgow and Clyde has said John Brown he said none of the contents of this paper have been approved by the board or referred to the Scottish government for consideration this includes the reported closure of lightburn hospital or changes to the services provided by the Vale of Leven hospital and as i understand it as the chair he did visit lightburn hospital to reassure the staff and patients about that Presiding officer this document is a live document that's been considered by the board it includes in this document the proposal to close lightburn hospital now i question her once again why is she not instructing the health board that we've already taken a political decision she's taken it a predecessor took it that lightburn should not close it was widely consulted on why during the same parliamentary session should we be revisiting this proposal it shouldn't be included in the document in the first place never mind advisers it's not came to her once again and she should she should instruct him accordingly but of course Presiding officer i would welcome some feedback from the health board and indeed the chief executive of the health board Robert Calderwood was invited to a public meeting that was held in Monday of this week invited to by the save lightburn campaigner Jerry McCann he declined the invitation Presiding officer this is an official who has paid £190,000 a year and he can't take the time to attend a public meeting in the east end of Glasgow now i raised the point i look at mr Calderwood's hospitality register and it has a number of entries over five pages long if he can agree to around a golf with price coupon waterhouse then he can agree to attend a meeting in the east end of Glasgow to ensure and actually let's look at the health challenges that faces in the east end of Glasgow for example 30% of those who live there are more likely to die from heart disease 38% are more likely to die from lung disease and indeed when you compare the statistics of those in the east end of Glasgow that we keep being reminded by the media and many others that you're more likely to live 10 years longer if you live in bears the animal guy if you live in the east end of Glasgow then we should actually do something about these statistics and the provision of the kind of services that are provided in light burn hospital provide that very opportunity. I ask the minister, the cabinet secretary for health, to join me in this campaign along with the save light burn campaigners a very clear message hands off light burn hospital. Many thanks. Now Colin Gill-Patterson to be followed by Jim Hume. Thanks very much, Presiding Officer. It doesn't fear that long ago since I was speaking on a labour motion on health and like the others before it contains patchy research of any at all and the usual negative rhetoric that we are coming to expect from the Labour Party in Scotland. I've looked over as mentioned the motion presented today and I hope to speak to some themes related to it namely that we have a committed NHS, a safe NHS and a local NHS all delivered by a dedicated hard working staff. My constituency like many others across Scotland is blighted by many health concerns. One of the largest being smoking related illnesses. However I was pleased to read that the Scottish household survey 2014 indicated that 20 per cent of the adults in Scotland smoke which is a reduction of 3 per cent since 2011 and represents the sharpest reduction in rates of smoking since 1999. It's indicative of good progress towards the Scottish Government's target of reducing the number of adults smoking to 5 per cent or less by 2034. I was also pleased to understand that levels of smoking in the most deprived areas also fell from 40 per cent in 2010 to 34 per cent in 2014. It would be disingenuous of me not to mention the range of action that we are all aware that has been taken to tackle smoking including an increase in age restrictions on the sale of tobacco from 16 to 18 year olds. I know an overhaul of the tobacco sales and display law, the establishment of the first tobacco retail register in the UK, a range of comprehensive awareness raising campaigns and record investment in NHS smoking cessation services. I recognise my member's bill on banning smoking in cars with children present as part of Scotland's aim and goals that will help to reduce smoking in Scotland as a whole. I very much appreciate that intervention and acknowledge the work that you are doing. I think that it's good work and it should be supported. On a safe NHS, Scotland has one of the safest healthcare systems in the world with record low infection rates and internationally recognised patient safety programmes. I am pleased that healthcare improvements in Scotland—that's called HIS for short—are due to be given the powers from April 1 to close hospital wards to new admissions if there are serious concerns about patient safety. What is more fitting from my perspective is that if approved by Parliament, the secondary legislation will take forward a key recommendation from the Vale of Leven hospital inquiry. The proposed changes to the legislation will strengthen the scrutiny in our hospitals and give patients the confidence and trust in the fact that their care will continue to be among the safest in the world. Hospitals are cleaner and safer under the SNP. There have been major reductions in the number of hospital-acquired infections since 2007, with cases of sea deaf and patients aged 65 and over, reducing by 86 per cent and cases of MRSA reducing by 87 per cent—no mean achievement. Labour's motion highlights ensuring the continuation of current services. I just want to provide a couple of local examples where, under the SNP, services are not only being continued but also improved. I earlier today asked about an update from the Scottish Government regarding the new Clydebank health centre and bringing that to fruition for residents in my constituency. It was with tremendous effort in the part of many that the finance secretary who had no small part in this effort was able not only to announce a new much-needed health centre in Greenock, but as part of a combined £38 million capital investment that a new Clydebank health centre would be built, allowing the continuation of a community health service in Clydebank. A great outcome for two challenged areas. The idea that one was in prospect in the first place and the local politicians did not fight among themselves where it should be placed was something that we should all aspire to do. With a good campaign reasoned argument, we were able to provide one in each of those areas. That is good work in my view. The First Minister, just a few weeks ago, had the pleasure to visit Clydebank in my constituency and meet residents and workers across West Dunbartonshire and beyond. There we had from the First Minister a statement confirming that the veil of leaving hospital is a vital part of the local health service in West Dunbartonshire. It will make sure that it continues to be for many years to come. That includes making sure that emergency services are retained at the veil. However, members of the party opposite would have missed the First Minister's statement or did not want to accept it. As if we are too busy outside Clydebank Tau Hall, asking the SNP to put kids before local cuts, how ironic and rich coming from the Labour Party, who run West Dunbartonshire Council, which is about to see the third teacher strike in as many months. A party that pushed through the council cuts, a council cut of half a day a week education, that is right. A council cut of half a day education but was forced at an emergency. Point of order. I think that the member is misinformed, of course. He would realise that it is SNP cuts that means that West Dunbartonshire teachers are on strike. It will be well aware that that is not a point of order. Please continue, Mr Patterson. I will give you an extra 30 seconds. The Labour Council was forced at an emergency meeting of the council to reverse the dreadful decision. That came about because the roof collapsed in on them from the outcry from the public. I am looking forward to 2016, but even 2017, so that the veil of leaving hospital is not under threat and never has been under the SNP. The only time it is and was was under Labour, and it was salamisalised time after time to the situation that may have been cut. I commend the health secretary's amendment to the chamber. I want to start by thanking Jenny Marra for raising that motion in the chamber today. It has been a week while since we have had the chance to talk about changes in our NHS. Of course, I truly appreciate the hard work of the staff day in, day out, and I want to take this opportunity, like others, across the chamber to thank them for their hard work. The cabinet secretary will remember well that I have campaigned hard for community hospitals across the region and have been successful in stopping closures for some of those who were scheduled as the preferred option of some health boards. I think that we would do a disservice to all our hard work in NHS staff if we did not point out to some of the issues that make their lives more difficult at work and present some concrete plans to help to solve some of those problems. I fully agree with Jenny Marra's statement that people in communities deserve fully resourced services in their areas. Since last time, we have had the chance to discuss the progress on the NHS. There has been an increase in vacancies of nurses and midwives to the highest rate in four years and allied health professionals and pharmacy staff also. Of course, increasing pressures in winter months on the emergency services are causing thousands more to wait beyond the target treatments that are promised. Perhaps one of the most serious failings in some of the actions is the aggressive way in protecting the NHS and the reduction of funding for those who act as the gatekeepers for that health service that we all hold so daily, the GPs and, of course, our primary care services. It is perhaps appropriate to not give my words, but the words of the chair of the Royal College of GPs will be more persuasive. The words Dr Miles Mack said last month in a quote, "...general practice has been deemed to be dispensable in its current form. We have received reassurance after reassurance that further funding for general practice would be forthcoming until it reached a level appropriate to patient need. Instead, we witnessed a further reduction and an ever-increasing gap between funding for GPs and that for other areas of healthcare, patients have every right to worry." It is difficult to understand how the cabinet secretary can turn to face Scottish people and state to them that she has only added 35 GPs in the past five years or that GP training places are only, at the moment, 70 per cent filled and that increasing need is going unmet in some of the most deprived areas in Scotland. The year-on-year cuts in the GP funding since 2009 have obviously real consequences and will only get worse. The cabinet secretary continuously mentions in her amendment the importance of local services, local delivery and as much care as possible to deliver locally. Of course, we agree with that, but the track record shows that in 2014 over 100,000 patients travelled to a different health board to receive treatment, not a different hospital but an entirely different health board. Of course, that will include many people travelling to the Golden Jubilee hospital, which is a national hospital for hips, knees and other procedures. Surely he is not going to criticise that. I was going on to say that, of course, some of those are going to needed operations where the expertise is, but more than 800 patients have been told that they cannot get it because of capacity reasons. When a ship is sticking on water, it is wiser to plug the holes and polish the door handles. It appears that the focus of the Government has maybe been on polishing the surface of the NHS rather than supporting the absolute foundations that those who work to hold the NHS together. When the number of children and young people seen for psychological therapies have seen the lowest since stats began being published, we must stop and wonder what is going wrong and how we can fix it. 6,750 children are waiting for their treatment to start at the end of December. There is less than 1,300 in that quarter, but the Government still pacts itself on the number of staff employed in the past year. The gap between headcount and the second story, while time equivalent is considerable, shows that more people are not always more patient time. Of course, Mr Sheum does not tell the whole picture. He would hopefully concede that more people are being seen through child and adolescent mental health services now and has been previous to the case. There is a larger demand, and the percentage of the NHS spent on mental health services is lower than it has been for many years. We have also seen a quarter of nurses and midwives. The largest staff group in the NHS feels that there is not enough staff to do their job properly. It is a serious issue, one that we cannot be complacent on. It is a situation that risks having even less resources available for communities. It is dangerous and wise to plan closures at a time when the health services are under so much pressure and demand is on the rise. I do back the call by Jenny Marr to ensure that current services are supported appropriately. I do not know how anybody could argue against that. I would also like to remind the chamber of the principle of the Scottish Lib Dems that enable and support local and community resources to run the right services for their populations is a strategy that respects those communities and allows them to put people in the centre of planning and service delivery. However, how can they put people in the centre of planning when communities are being threatened with closures of hospitals, wards and emergency services? In conclusion, it tells communities that they should be empowered to provide more resources locally and that allowing hospitals to shut down is pulling the carpet from under their feet, counterproductive, damaging and, of course, wrong. Scottish Lib Dems will stand on the side of communities and people to make sure that no unwarrited and unnecessary hospital closures take place and will continue to stand up, of course, for the rest of the NHS and not least the right of everyone for access to the right therapy and, of course, at the right time. I thank Neil Bibby to be followed by John Mason. Thank you, Presiding Officer, for the opportunity to speak in this debate on NHS services, including those at the Royal Alexandra hospital in Paisley. The RH is a hospital when I was born as a child. I was a patient in the children's ward and my son was born at the maternity unit last year. I know from both personal experience and speaking to local families how important the services that are currently provided at the hospital are. For many people in the Paisley area, the RH is the NHS and provides the services that so many of us rely on. So, when vital services at this hospital are on the fret, I will stand up for patients, staff and the local hospital. As Paul Martin has said and as members will know, the service and financial planning for 2016, 2017 and beyond document, drawn up by officials at NHS Greater Glasgow and Clyde, was leaked in January. That showed cuts of up to £60 million that they would need to find next year. That is over £1 million a week because of underfunding from the Scottish Government. No-one can seriously suggest that the health service is being properly protected if Scotland's largest health board is considering such drastic cuts. Like many people in the Paisley area, yes, am I? So, when Labour asks for half of the resources going to health to go to social care, was that a mistake or was it not a mistake? Because you called for it, do you still support that? What we support is protecting the NHS budget. You have a strange way of definition of protecting if £1 million a week of savings are going to have to be found in the NHS Greater Glasgow and Clyde. Like many people in the Paisley area, I was shocked by the reports contents and deeply concerned that work on the proposals has been under way for some time. Proposals including closing the RAH's children's ward, making changes to maternity services and transferring additional cases from the Vale of Leven to the already overstretched RAH. Unfortunately, when it comes to the RAH's children's ward, we have been here before, back in 2011 and again last year. One mum from Paisley recently commented that closing the RAH's children's ward would be devastating and dangerous. Talking about her son, she said that if her son was having a seizure, how would she get him to the new hospital if the roads are bad? She also rightly said that Paisley is the largest town in Scotland and that people here deserve their own children's ward. Another woman told the Paisley Daily Express recently that my son was in the children's ward too and that the facilities are second to none. We take it for granted. How can they justify closing such a facility? Those are just two comments, but there will be many more right across the west of Scotland because the children's ward at the RAH does not just treat sick children from Renfrewshire, but children in other areas such as Kinverclyde and Weston-Bartonshire as well. The impact of a closure would be felt across a wide area. Another deeply concerning issue is that the health board paper stated that work is already underway on a proposal to deliver service changes to community maternity units. I have to say to the health secretary that any downgrading or closure of maternity services at Paisley's RAH would be completely unacceptable. Also deeply concerning is the proposal to transfer emergency cases from the veil of leaving to the RAH. I would share my colleague Jackie Baillie's concern about the impact that it would have in Weston-Bartonshire, but I also believe that it would have an adverse effect on the RAH, too. The health secretary was well aware that only last year she was forced to send a crisis team to the RAH A and E department as a short-term measure to tackle problems with waiting times. As we have seen in recent weeks, many people are still waiting over eight hours to be seen. It has been nonsensical and wrong to add additional pressures to the already hard-working and dedicated and overstretched staff at the RAH by adding more cases to their workload. The on-going uncertainty of the future of the RAH services is deeply disrespectful and worrying particularly for the families and NHS staff employed at the children's work. The health secretary told the Paisley del Express on 16 January that she would have the final say over any proposals. That is why I am calling on the health secretary to provide adequate funding and agree with the health board to give a long-term commitment on the future of RAH services. If Shona Robison gives that much-needed investment and cast-iron guarantee, I will be the first to welcome it, but I am not hearing it. It is time for straight answers from the Government. The Government amendment does not even mention the children's word, let alone giving a commitment to keeping it. Unlike the health secretary, I am not in a position to take decisions, but I am in a position to stand up for my constituents and campaign along with anyone concerned about the RAH. Thousands of people have already backed a petition calling for a stop to those proposals and calling for a long-term guarantee. They are also backing my call that the health secretary ensure adequate funding is provided to the health board so that those services can be maintained. Those names will be with you shortly, cabinet secretary, and it is time you listen to them. The RAH cannot become a forgotten hospital. The Government was elected on the promise of keeping health services local. It will have broken that promise to my constituents if those proposals go ahead.  As local health campaigner Jack Davidson has said, all we need is a commitment, a long-term commitment that services in Paisley will not be affected and we would be satisfied. Until then, we will continue to campaign for that commitment. I agree with Jack Davidson. John Mason is followed by Neil Findlay, who is a generous six minutes up to seven. Thank you, Presiding Officer. As we continue debating health this afternoon, I think that we have to acknowledge that health has been one of the best protected sectors in the Scottish budget over a number of years. At the finance committee we have had witnesses who have sometimes criticised this and have suggested that we could boost economic growth by cutting health and putting more into housebuilding or similar. We are certainly not in a position where we need to be in any way embarrassed by the health budget. In fact, I think that we can be very proud of the health budget that this Government and this Parliament has approved. The motion itself clearly raises a range of issues. I want to touch on some of those and also mention Lightburn hospital, which is not in my constituency but is like close by and is used by some of my constituents. However, the first theme that I wanted to touch on was that of prevention. Over the past five years, the finance committee has spent a considerable amount of time on the subject of prevention and, in particular, preventative expenditure. Are we able to shift expenditure away from reactive spending and more towards an earlier preventative approach? There are many examples of what might be done in different sectors, for example, in justice. We spend more money on younger people and hopefully save later on in prisons. In education, we spend more again on early years and hopefully have less of an attainment gap in the teenage years. In health, the question is, can we spend more in the community and less on hospitals? At a recent finance committee, I was ridiculed by colleagues when I suggested that part of me would like to close hospitals. However, the serious point would be that, if we are successful in preventative spending—let me finish this point—if we are successful in preventative spending, we should need fewer hospitals. The difficult question arises on timing. Do you close hospitals first and use money saved in the community? Or can you spend on both the hospitals and the community for a period and hopefully close hospitals later on? I was interested to read in the Herald last week a front-page article focusing on comments by the ex-Great Glasgow and Clyde NHS board chair Andrew Robertson. He was suggesting that Scotland has too many acute receiving hospitals. In fact, he suggests that there should be one hospital for 400,000 people, which would mean 12 or 13 for the whole of Scotland, in place of the present 29. At least that is a subject that we need to think about seriously. I am happy to take an intervention. Of course, I will be listening to local people before I listen to the ex-board chair of the Glasgow health board. I will ask John Mason to confirm. Do you think that Lakeburn hospital should close at any point over the next 10 years? I will come on to Lakeburn in a minute. I said that I was going to do that, but I want to deal with the theme of preventative spending, which is also mentioned in what I thought was again a very helpful briefing from the RCN for today's debate. If I can just quote a little bit from it, among other things it says, what a community is used to in terms of the services that it has close at hand may not be the service that it needs for the future. It is also worrying that the debate continues around acute services in isolation. If Scotland and her politicians are serious about moving care out to the community, then we need to see investment in prevention and a shift away from debate around single acute services. Clearly, the other side of the picture is that many people have a very warm relationship with their local hospital. Public campaigns are easily started around any potential hospital closure, and politicians of all parties tend to latch on to those campaigns, especially before an election. Would it ever be possible for politicians across the parties to agree that we want to reduce the number of hospitals long-term and that none of us would campaign to keep particular ones open? I am not sure that that could happen, but I very much doubt that it will. To move on, as I was suggested and as I said, I would on to Lightburn hospital, which lies in Carnetine, just north of my Shettleston constituency. In one sense, it is hardly a hospital at all compared with the likes of the royal or the southern, which are so huge. It is very small in comparison and has relatively few beds, and much of its valuable work is with day patients, for example Parkinson's. I receive mixed comments about it from constituents. Some feel that it is outdated, and the resources would be better invested in GP practices or in keeping people in their own homes, but others are very supportive of Lightburn, not least because it is actually in the east end. It is easier to get to than Stobhill and is basically smaller and friendlier. I have to say that I find it strange that with mental health beds at Parkhead hospital also being phased out, we potentially have the east end of Glasgow, with no major health facility other than GP practices and health centres. The south side of Glasgow has the modern Victoria ACAD and the north is Stobhill, but the east end is nothing like that. I find that a bit strange, given that our health record is so poor, and that point is made by Parkinson's in the briefing for today. Stobhill may not be on the moon, but it practice might as well be. It is very difficult to reach by public transport from our part of the city, and at a time when we want people to take more responsibility for their own health, it seems strange to move the facilities that we have further away. I find myself torn between Lightburn perhaps not being absolutely necessary in its present form, but on the other hand the bigger picture is fewer and fewer health facilities in one of the least healthy parts of our country. My question, and it is only a question at this stage, would be whether we need some kind of ACAD or other intermediate facility in the east end of Glasgow, some kind of care level between the GPs and the Royal Infirmary. In conclusion, we see health benefiting from record levels of funding, but I think that most of us agree that there needs to be a shift to more preventative spend. I urge all the parties to take a long-term view and consider if we do need or can afford all the hospitals that we have at present. I call Neil Findlay to be followed by Richard Lyle. Let me start by echoing the sentiments of others and pay tribute to the staff who work in our NHS, often going above and beyond the college duty to look after us and care for us. Let me also declare an interest in that my wife is employed as a clinical support worker at St John's hospital. My daughter, a student OT, is a weekend domestic there, too. They, like so many doctors, nurses and support staff, epitomise the care and professionalism and values of the NHS. However, those workers do not want warm or patronising words. What they want is action, because they are under pressure, like they have never been under pressure before. In Lothian, that pressure is at breaking point. Through freedom of information, I have discovered how senior management at NHS Lothian is privately unequivocal about the source of those pressures and how decisions made by Government are impacting on services, on staff and on patients. Papers that I have in my possession talk of pre-existing financial pressures, recurrent cost pressures and how the NHS faces a growing demand with reducing resources.  In July 2015, the chief executive of NHS Lothian said that the position had deteriorated significantly in recent months and that, among other things, that was caused by market failure in Edinburgh and the City of Edinburgh's council's budget deficit. Let's pause and digest that assessment by the chief executive of NHS Lothian. He clearly states that the crisis in social care is caused by the marketisation of the service, exacerbated by serious financial pressures that are currently facing councils as a consequence of Scottish Government budget decisions. It is resulting in persistent bed blocking, where space is grabbed wherever it is available, including patients being boarded in the oncology department at the western general hospital, also boarded in emergency areas and day surgery units. Let me read you this quote from NHS Lothian from July 2015. The position has deteriorated significantly in recent months, with an 80 per cent increase in delayed discharge since March 2015, resulting in the highest number of delayed discharges since when? 2007. To operate efficiently, there is a requirement to discharge 85 patients a week. The current level is 40. That is the cabinet secretary who said that she would end delayed discharge, overseeing a crisis in delayed discharge in Lothian. She shakes her head, despite the evidence from NHS Lothian. You need to wake up and smell the coffee. Do not worry, Mr Finlay. I am always awake and always taking action to address those issues. That is why, of course, we have funded an extra £2 million with Edinburgh City Council. I know that he does not want to hear positive news about Edinburgh City Council receiving £2 million additional to help to eradicate delayed discharge in the area. I can assure Mr Finlay that he is absolutely focused on doing that, and perhaps he could welcome that. If you have a little extra time, Mr Finlay. In addition to this, we see operations cancelled. This week, the performance of A&E at St John's and the ERI is the poorest in Scotland. NHS Lothian now has an overspend of £26 million, with St John's hospital having an £11 million maintenance backlog. The chief exec says that the deterioration in the delayed discharge position is having a negative impact, resulting in cancellation of elective surgery, and, in turn, that is having a knock-on effect and having to purchase private sector support to meet treatment-time guarantees, impacting on our financial position. The current position is not sustainable for any system, but even more so for one with its own capacity pressures. According to NHS Lothian, 4,500 operations have gone to the private sector and there is no infrastructure for delivering orthopedics available. In addition to this, we see only last week one in four GPs in Lothian with closed or restricted lists. After almost four years of inaction, the children's word at St John is subject to a pediatric review that puts its status as a 24-7 service under serious threat. Closed to inpatients, twice in four years, there is a huge concern about its future. 8,000 people have signed a petition calling out for it to be retained as a 24-7 unit. Public concerns are arrogantly dismissed by the health board chairman saying that he would not listen to them. NHS Lothian wanted that review to report as soon as possible because they said that any delay to it could fuel further uncertainty around the future of the world. Of course, we now know that that review was delayed until after the election, following the intervention of the cabinet secretary and her civil servants. She cannot deny that fact, but the plot thickens. Last week, I received the latest FOIs in relation to the pediatric review. The proposal to have a review, which threatens the provision at St John's, was made public in August 2015. I now have evidence that, on 23 February 2015, five months before it was announced, NHS Lothian's senior officials briefed West Lothian's two constituency MSPs, Angela Constance and Fiona Hyslop, telling them that there would be a Lothian wide review. Yet they said not a single word to their constituents. No press statement, no letters to the thousands of concerned local people, nothing but a vow of silence because it suited them politically. Where are they today for this important debate? It is my intention that they deliberately kept this information from their constituents, knowing that there would be an outcry in the communities that they are elected to represent. Those two politicians have concealed what they knew from the public that they are supposed to serve and that they have many questions to answer over that. I can assure you that those questions will be asked. Many thanks. Now, Colin Richard Lyle, do we follow by Alison Johnstone in seven minutes of the live news? Thank you, Presiding Officer, and this is where it gets interesting. As a member of the Health and Sport Committee for many years, this topic is particularly important to me. I have always supported the NHS and this SNP Government's efforts to safeguard and improve it. I personally remember Labour's plan to close Monklands hospital A and E services during their time in power. Since the SNP came to power in 2007, those plans were halted. Emergency services at the Vale of Leven hospital and St John's hospital where they have been maintained and proposals to close Lightburn hospital have been rejected. I would like to point out that under this Government, NHS staffing levels are at a record high. Additional 11,000 staff have been employed, an increase of 9 per cent, including over 2,500 thousand more nursing and midwifery staff. Number of GPs has increased by 7 per cent, and the investment in their services has as well. No, I won't. Additionally, the number of consultant vacancies has decreased. The future of NHS in Scotland looks bright, with the rise of 5.6 per cent in student nursing and midwifery intakes, the fourth successive increase in many years. I also note that the investment in NHS under this Government is also unprecedented. In this year's budget, and this year's, £500 million has been provided for health spending, given a record total investment of nearly £13 billion. A £250 million investment has also been announced to support the integration of health and social care. All territorial boards are receiving real terms increases in funding, with increasing number of patients and more complex illnesses to treat. This Government has continued to support the NHS and ensured that it can meet the demands placed on it. There has been significant investment in improvements in primary care as well, with an increase in primary care funds and a 13 per cent increase in spending on GP services. Scotland is recognised as having one of the safest healthcare systems in the world. This Government has worked tirelessly to ensure that hospitals are clean and safe as they possibly can be. In 2007, there has been a major reduction in the number of hospital-acquired infections, with cases of MRSA decreasing by 87 per cent. 100 inspections were carried out yearly by Health Care Improvement Scotland, and as of April 1, we will have the power to close hospital wards to new admissions, should there be concerns about patient safety. Social work and NHS staff now visit clients in their homes. Around 78,000 people in Scotland benefit from free personal care. Despite an increasing elderly population, the number of patients in care homes has fallen by 1,289 between 2000 and 2014. Expenditure on personal care services to older people in their homes has risen from £158 million in 2004-5 to £364 million in 2013-14. The Government passed the carers bill, ensuring that they receive all the support that they need and also announce funding for care worker training. Labour has charged the Scottish Government with failing to tackle delayed discharge. However, compared with a decade ago, the number of standard delays is down by 62 per cent. In December, delays were down by 18 per cent compared with the previous year. Delayed discharge is clearly a priority for this Government, as in 2015 it announced £100 million in funding to combat the problem. It is simply untrue that this Government has failed to reduce A&E waiting times. In fact, they have improved significantly with 94.9 per cent of people being seen within four hours or less for A&E sites across Scotland this past December. Cancer patients are also receiving faster treatment. The worst performance under the SNP Government was 91.5 per cent in the first quarter of 2014. However, this is significantly significantly better than Labour's best performance of 84.5 per cent in the quarter of 2007. By a final quarter of 2014, 94 per cent of patients were treated within the 62-day standard. Furthermore, the Government has not neglected mental health. Under the SNP funding for mental health has increased by almost 40 per cent. Since 2009, the number of clinical staff working in child and adolescent mental health services has increased by 28 per cent. No, I am sorry, I do not have time. The Government has announced more than £54 million to improve access to mental health and launch a £15 million mental health innovation fund. Public health has improved tremendously with the decreases in the number of smokers, alcohol-related hospital stays and prescription charges have also been abolished to the benefit of many low-income families. Finally, the premature mortality rate is now 19 per cent lower than it was in 2016. I am sure that everybody is enjoying all these, as the six I am. To conclude, the Scottish people are extremely happy with the NHS, the recent survey. 89 per cent of Scottish patients see overall care and treatment was good or excellent. Furthermore, there is a 21 per cent increase in public satisfaction between 2006-13 under the SNP. As I have said before and I agree with Jackson Carlaw, the Labour party needs to stop using our health service as a political football and stop talking it down. Our health service is well-funded, well-resourced and we should be proud of it. It is hard-working staff. I have no doubt that the SNP Government will continue to work to ensure that the people of Scotland receive the best healthcare possible—three of charge, thank you. I now call Alison Johnstone, after which we will move to closing speeches. A generous seven minutes, Ms Johnstone. It is universally acknowledged that the NHS and our network of social care services in every local authority is an incredible national asset. I, too, acknowledge the contribution of all those NHS staff, our GPs and our carers. They really are at the heart of this service, but funding, too, is absolutely key. Greens will set out our long-term fair and progressive tax proposals within the next two weeks. This morning, we welcomed the Government following in line with the budget proposals Greens made during this budget on vacant land, a fairer council tax and ending the council tax freeze. Of course, as colleagues have mentioned, the most cost-effective measures are those that prevent ill health in the first place. Addressing poverty and health inequality is paramount. Well-being must be at the centre of Government policy because being healthy is not simply about not being sick. The focus on a truly healthy life starts before conception by supporting the growth of community-based projects such as the pregnancy and parent centre in South Edinburgh, a welcoming, not-for-profit organisation that works with parents-to-be and their families, by supporting organisations such as the Serenians, who work with those who find themselves homeless or in a vulnerable position. We increase our national health by supporting local authorities to provide free fruit and practical food education through growing schools, for example, and by working towards free school meals for all primary pupils. I welcome the progress that is being made in some of those areas. Physical activity is key, too, and we can make it easier for our young people to be active by investing, as the Institute of Public Health directors urge, 10 per cent of the transport budget on walking and cycling. That would ease congestion and cut air pollution, too. Air pollution is causing over 2,000 deaths each year in Scotland, yet action by this Government to address this invisible killer is dangerously slow. We can encourage physical activity, too, by working with local authorities to create exciting outdoor play spaces in our schools and more affordable access to sports facilities, which are prohibitive for many. We have to address poverty and inequality if we want Scotland to be well. When more than 200,000 children live in poverty, and the Institute for Fiscal Studies advises us that that will rise by 100,000 due to on-going austerity, we have to use every means at our disposal to mitigate the impacts. I am hopeful that we will use the powers that come to this Parliament to do so, at least in part, for example by abolishing benefit sanctions. While we focus on reducing those health inequalities in Scotland, we need to focus, too, on ensuring that we work with all those who deliver healthcare, to enable them to continue to deliver the high standards of care that all in Scotland should expect. A living wage plus for carers is important. We have heard that bed blocking is costing us a fortune. Every week in Edinburgh, some 5,000 hours of social care go unmet. That has to change. A focus on primary care is essential, as 90 per cent of patient contacts are with GPs and other primary care professionals in our communities. We have to act to ensure adequate training, recruitment and, importantly, retention of GPs, as the world is very eager to recruit our well-trained medical professionals. I welcome the relationships being built across parties by the BMA, the RCGP and the RCN. Last night, I was pleased to take part in a debate on public health with cross-party colleagues and the Royal College of Pediatrics and Child Health Scotland. The manifestos of those organisations leave us in no doubt as to their experience-based and well-evidence views on how the Government and this Parliament can help to improve health outcomes in Scotland and deliver the broader national consensus that Jackson Carlaw spoke of. Engagement between clinicians, this Parliament and the public is essential and welcome. As we have heard, public meetings are taking place this month as part of a review of in-patient hospital care for children in NHS Lothian with a deadline of 18 March. The independent expert review has been undertaken by the Royal College of Pediatrics and Child Health Scotland, who has been asked to do so by NHS Lothian. All our citizens, young and old, are entitled to safe, effective and sustainable patient care. With the increasing birth rate and West Lothian's growing population, it is essential that paediatric services at St John's are protected and properly resourced. The West Lothian population is expected to increase by 25,000 within the next 19 years. That is not the time to diminish services or to centralise them or to ask people to travel to services in Edinburgh, for example. Where the national record of Scotland estimates that population growth is set to outstrip previous growth forecasts, with an expected increase of more than 28 per cent over the next 25 years, including a 27 per cent increase in children under 15. Andrew Burns, the council leader in Edinburgh, rightly notes that this growth, which is not far off a one-third increase in the population, comes with massive challenges. A future-proofed health service with facilities as local as possible is essential in dealing with this challenge. The cabinet secretary has assured Parliament that there are no proposals for closure, but nor is there a guarantee, for example, that paediatrics at St John's will not be downgraded or closed. Delay and uncertainty cause unnecessary stress for patients and staff. Staff concerns led to a downgrading off the word last summer and a reliance on expensive locums and increased overtime requirements demonstrates the need for a fully resourced plan for the future. There is understandable dismay that the people of Miss West Lothian will not find out until after the election what the future holds for them and St John's. I would ask the cabinet secretary and NHS Lothian to take every step to ensure that this report is published before the election. We have a duty to do all that we can to improve Scotland's national health, and, in order to do so, we must invest in and properly support all those who look after us, whether at home or in our hospitals. We now move to closing speeches, but before we do, I invite everyone who has taken part in this debate to return to the chamber, particularly front-bench spokesman Jackson Carlaw. I am just a bit confused during the course of the debate this afternoon. We have had extended time, and we had opposition members following opposition members. Is there a reason for that? Surely it is not because the SNP members did not take up their speaking slots this afternoon, is it? I do not believe so, Mr Finlay. I do not think that it is a point of order. The speaking order is a matter for the Presiding Officers. How members wish to use their time is a matter for them, but I will reflect on what you say and perhaps speak to you privately subsequently on this matter, if you wish. I would like to start in summing up by going right back to where the debate began with Jenny Marra's opening speech and the part of her motion that I think both the amendment agrees with as well, and that is the tribute that is paid to the NHS staff. In this national clinical strategy for Scotland, some of the decisions that will require to be taken are extremely far-reaching, and they will depend on their being the widest possible engagement of all parties' concern, not just in this chamber but within the wider NHS. There are issues for the Government that they will need to give some consideration to. I refer specifically to the NHS Scotland staff survey of 2015, which looked at employee engagement, and it measured in the survey by five standards—whether people were well informed, appropriately trained and developed, involved in decisions, treated fairly and consistently, provided with a safe environment. As far as involved in decisions was concerned, the statement then went on to say, this is including staff and organisational decision making as the potential to obtain valuable new opinions, ideas and solutions. It can also promote trust in the organisation and its sense of ownership and responsibility in respect of the changes that are made. Well, it must be a concern then that of the 29 prime questions that were then posed to NHS staff, there was a negative index change on 17 of them, there was no change on 8 and there was only an improvement on 4. Whilst the cabinet secretary said that it is vital that we learn from those findings, it is significant that of five standards, two were up and three were down, as was the overall experience of staff within the NHS in 2015. That is not an encouraging background if you are looking in the next Parliament not just to pay tribute to staff but to carry the staff with us in the difficult decisions that are required to be made. I think that I do ask the question of the cabinet secretary. Given that there is an understanding that there is a difficult series of decisions to be made if we are to secure the future of the health service in the next session, how does she envisage harnessing any non-partisan cross-party potential that there is in this chamber to the effect of arriving at a strategy upon which we can all agree? My concern at the moment is that, while there have been some perfectly productive individual discussions, they are not necessarily informed or harnessed in a way which I think allows the political parties in here to feel that they are meaningfully contributing or being included in a strategy that I think we could all unite behind. That is a potential weakness. Secondly, it is terribly important that the assessment by the staff within the NHS in 2015 is addressed and reversed because, if they do not feel that they are part of that progressive understanding of the changes that are taking place, we will see building in that a resistance and, potentially, that will exacerbate some of the fears that can be raised and have us being diverted on to conversations that are actually totally unhelpful. I do not say any of that to dismiss and I thought that there were some very powerful contributions this afternoon in respect of some of the hospitals that are mentioned in the Labour motion, particularly the Lightburn hospital and the fact that it is the only facility in the east of Scotland and all the attention and support that it received in this Parliament in 2011 and 2012. I think that there is one other thing that is not really touched on in this national clinical strategy for Scotland and it is a sense that sometimes there is a kind of ball of cotton wool that embraces the national health service, almost a little bit like a soviet style bureaucracy and we need to find a way to overcome that. Can I illustrate it thus? My mother has been in the new Queen Elizabeth hospital for the last two weeks, so I have been there more than I might have expected. It is a fabulous facility, let me say. I know that it has issues in its accident and emergency area but, beyond that, I have to say that I have been very impressed. However, I was contacted yesterday by a gentleman from the hospital who phoned me up and said that we need you to come in tomorrow, Mr Carlaw, or tonight, to complete a next-of-kin patient questionnaire. I said that it is really going to be very difficult because I am unable to get there across tonight. I said, have you a next-of-kin who can do that? I said, no, I actually don't. I said, would it be possible to complete the survey over the phone? Well, it is very unusual, but I will ask. So he went when he came back, we are in business, the highest levels have approved me asking you these questions over the phone in relation to my 85-year-old mother. Question number one, is your mother pregnant? I said, well, not to the best of our knowledge. Question number two, has your mother got gunshot wounds or any bullets lodged inside her person at the present time? I said, not so far. I only say that, not really to—I understand that these questions have to be asked of various times and places, but I am sure that it strikes a chord in the minds of most members that there is still within the NHS a cumbersome bureaucracy that sometimes seems to stand in the way of common sense given that my mother was in the hospital at the time and I thought quite obviously was not suffering from gunshot wounds. My sister did say that she should ask for a pregnancy test just to be sure, but I do think that that rather ludicrous way of illustrating the point, I hope touches a chord with people that there is sometimes a kind of layer of something that if we are going to have the health service as efficient and as effective as it can be, also needs to find some way of being addressed. It is a weakness of such a large monolithic system. Presiding Officer, I finished where I began and that is really to say that there obviously are day-to-day management issues and concerns and pressure points, staffing issues, all of which I think is perfectly legitimate for us in this chamber to tackle the Government on and to ask what their solution and issues and approach to those will be. Sometimes I worry that the Government's answer to those points is to worry more about the headline the next day than it is necessary to tackle substantively the underlying issue that the particular pressure point statistic or piece of information has revealed, and that is a weakness. However, on the general strategic approach to the future of Scotland's health service, we need to find a way of working together. If that is the Government that will lead us in the next Parliament, it will have to tell us how it intends to achieve that, rather than just by dictate, but by a genuine consensus involving all the politicians in this Parliament. I now call on cabinet secretary Shona Robison, a generous nine minutes. Can I start with Jackson Carlaw, which in his opening speech was a very constructive tone and welcomed his support for the national clinical strategy? I will make it my personal business to have a look at that questionnaire, because you make a fair point about sometimes things are asked, even though it does not make much sense to ask them, so I will have a look at that. Bob Doris gave a very moving speech and his personal testimony about the value of the services at the Vale, particularly the pilot of care provided to his mother. I think that it reminds us all of how important those services are. He also made a fair point, too, about the need to align housing policy with health and social care. That is a point well made and one that I believe has been taken on board in the new world of integration. Jackie Baillie quite rightly paid tribute to the dedication and hard work of staff. I agreed with the principles of the vision for the Vale, and that is to be welcomed. In terms of the position of junior doctors, it is important that services at the Vale and other hospitals remain a good training environment for junior doctors. I fully support that and will continue to support that. I do not believe that Jackie Baillie has, if she has read the national clinical strategy, then she perhaps needs to read it again, because it is very explicit about the key role of local hospitals. Indeed, it is very explicit about delivering healthcare as close to home, indeed in the home of people where that is possible. When it talks about specialist services, it is very clear as well that what they are talking about is, first of all, the requirement for hospitals to work together on networks to overcome some of the recruitment and retention issues that we face, but also that those specialist services that we are talking about are the ones or twice in a lifetime type of services that people are willing to travel for to receive those services. I thank the cabinet secretary for taking an intervention. I think that she would acknowledge that it is not just hospital buildings, it is about what services are in them, and that is the concern of my local community. Therefore, can I press her on whether she considers the emergency care and community maternity services delivered at the Vale of hospital just now to be clinically safe? Does she anticipate that anything will change? My fear, let me be honest with her, is that decisions are made by clinicians that we as politicians cannot challenge. My fear for those services is that unless Glasgow gets to cut them, they will be deemed clinically unsafe. The services across the NHS in Scotland are all clinically safe and we would not be providing services that are not clinically safe. That is kept under constant review and I would want that reassurance. Let me be very clear, the vision for the Vale is very clear on the services that are core to that vision. The value of emergency care at the Vale this winter was there for all to see. You only need to look at the figures of the number of people that were seen at the emergency facilities within the Vale. They have a unique set-up, as Jackie Baillie knows, around the levels of patients that can be seen in the medical assessment unit. That is quite a high level and the only transfer of patients when that is required. I have said time and time again that the value of that to the west of Scotland hospitals is very important indeed. I welcome Paul Martin's welcome for Nicola Sturgeon's decision back in 2011 to keep Lightburn hospital open. He made some very important points about health inequalities in the east end of Glasgow, which I absolutely fully agree with him on. As we have said, the difference is that Nicola Sturgeon had a proposal in front of her to close Lightburn hospital. I have no such proposal in front of me to close Lightburn hospital. Indeed, the board has been clear that no such proposals have been approved by the board, not least to come to me. I will ask the cabinet secretary to ensure that the decision taken by the then health secretary, Nicola Sturgeon, is adhered to. It was only taken a few years ago and already the health board is back saying that they want to revisit it. Tell them to think again. As I have said time and time again in this chamber, there would have to be a clear material change from the position in 2011. I do not see what that material change has been. There would have to be a material change to the position in 2011. I have said that to Paul Martin in this chamber. Gil Paterson quite rightly welcomed the investment in the health centres in Clydebank and Greenock and reiterated the First Minister's commitment to the Vale of Leven at the Clydebank town hall meeting. Jim Hume, I want to make sure that he understands, which I am sure he does, the investment that we are making in primary care services. It is an additional £85 million over the next three years in mental health, an additional £150 million over the next five years. Of course, within that, the mental health element for primary care is around £10 million because we recognise very much that we need to do more within general practice and primary care to support mental health services. Neil Bibby mentioned the RAH, and again I would pay tribute to the staff in the RAH. The A and E performance of the most recent week ending on 21 February was 92.4 per cent. It is not 95 per cent, but that is not a bad level of performance given where the RAH was last year. That hospital has dramatically improved its performance at the front door of its hospital, and that is something that I thought would be welcomed. Neil Findlay mentioned a number of issues about Llorian, and I want to just make clear that NHS Llorian's resource budget is going to increase by 6.3 per cent and above inflation increase. In addition to that, it will be a beneficiary of the accelerated movement to parity so that it will get £14 million of additional enrack funding as part of the 2016-17 settlement. In addition to that, there have been allocated resources to tackle delayed discharges and an additional allocation of resource for social care. On the delivery on delayed discharge, I can tell Neil Findlay that, as of January 2016, as of this January, there were 131 delays over three days. That compares to 255 back in October 2067, 76 delays over two weeks compared to 204 in October 2067 and 47 delayed over four weeks compared to 160 under the previous administration in 2006-07. We have more work to do, but Neil Findlay will not recognise any of the progress that has been made. On increasing capacity, as we announced last year, we plan to spend £200 million to create a network of six centres for elective surgery across Scotland. Two of those centres will be based at St John's hospital and the Edinburgh Royal Infirmary. Of course, Neil Findlay is never one for welcoming good news. I think that we have heard enough from Neil Findlay today, quite frankly. I say to Alison Johnson that I absolutely recognise some of the issues that she raised around the need for more preventive work. That is why, of course, the national clinical strategy focuses very much on the role of primary care, on the role of the community health hubs, bringing services together, not just in the statutory sector but, of course, in the voluntary third sector, as well, because they have an important contribution to make. I will finish on this point because I see that time is against me. Throughout this debate, we have heard Labour members complain about the resources to the health service. We have record resources to the health service. We have a real-terms increase at no point during the budget process that the Labour Party comes forward and asks for more money for the health service. Indeed, 50 per cent of it is supported, quite rightly in my view, to social care services. Yet again, we have an example of the Labour Party coming here and saying one thing, and then saying a completely different thing the next day or the day after that. You need to have a more coherent vision and policy for the health service, otherwise why should anybody take you seriously? Now calling Dr Richard Simpson to wind up the debate. Dr Simpson, you have until virtually five o'clock. Thank you, Deputy Presiding Officer. I begin by making what will be important in my last declaration, referring to my declaration of interest, as fellow of the two colleges and members of the BMA and a number of other medical organisations. I thank Jackson Carlaw for his kind remarks in respect of myself and on behalf of Nanette Milne, who are the two remaining medical members in the unit. Colleagues, I am going to depart from my usual summing up, in which I refer to a lot of different members and try to address the issues that they have raised. If members will indulge me, I want to look at a report card on the NHS over the last few years. Can I start with where we are in consensus? That is that we have a commitment shared by all the parties in this Parliament to the continuation of what Scottish Labour did in departing from Labour in England in asserting that we have an NHS in Scotland that is a traditional public service based on collaboration and co-operation and not on competition and opening commissioning, which includes the private sector. That is a major statement from the entire Parliament that really discriminates us from the rest of the United Kingdom. The second thing that I want to say is that there is an entire agreement across all the parties of the absolute need for health and social integration. If we do not have that, as Audit Scotland said, we will need 6,000 more acute beds, which is bad anyway, but we cannot afford it. We need the health and social integration, and that was tried under Labour. We tried with our joint futures programme, but it has now needed legislation, and hopefully the new IGBs, the integrated joint boards, will deliver that. I am also recognised many of the good things that have been done by successive Governments since the Parliament opened. The introduction of new vaccines, for example, meningitis, HPV, rotavirus, shingles vaccine, and all the public health measures that will improve the health of our community. I welcome the world-leading approach to hepatitis C because, with the new treatment, Scotland is world-leading in this. Indeed, Tayside is leading within that world-leading system. That is an enormous advance and one to be welcomed. I welcome the fact that the SNP has continued, extended and deepened the patient's safety programme. That is absolutely vital, and we need to recognise that there has been a 16 per cent or 17 per cent reduction in hospital mortality. That is extremely welcome, and the reduction in premature mortality. There are two reasons for intervening. First, I have always put my tribute to the conversation that you have made towards health in this session, in my much shorter time than you have been here. Secondly, one of the areas that you have been involved in with the health committee, on a cross-party basis, is to develop a much better system and access to new medicines. That is an example of what we can do on a cross-party basis in relation to achieving that. I will put my tribute to the role that Dr Simpson has played in relation to that. That particular aspect demonstrates what happens when the parties work together within the committee system. However, I have to say that there are many other areas—reduction in stroke, reduction in cardiovascular disease, reduction in suicides. As Gil Paterson and others have said, there are other areas of improvement that I acknowledge—reduction in smoking levels, especially in adolescence starting, reduction in alcohol consumption. However, the rest of my speech is going to be presenting the other side of the problem, because my central concern is that the SNP Government is very good about talking up the things that they do well, and that is entirely appropriate, but they fail to recognise quickly enough when things are not going right. Jackson Carlaw actually made a very good point in his summing up speech about the staff's attitudes in that survey, because that reflects where we are at. We are on a descending curve in terms of morale within the health service. If we do not recognise that, if the next Parliament does not recognise that, then we are in real trouble. Let us look at some of the things where we have not made events. We have the highest number of drug deaths of anywhere in Europe, and yet the ADP budgets are being cut by £16 million unless the health boards give them that money. That money of £16 million is within the increase that has just been announced. It is not an increase, but it is actually a cut to the ADP budgets. I can tell the cabinet secretary that my conversations already with a number of ADPs indicate that the boards are subjecting them to substantial cuts—big cuts in Edinburgh, for example, on staffing. What about obesity, which is the other big public health issue? The report card on that reads, slow progress, limited success, requires more effort. That is not me, that is the report of the obesity action plan. The level of obesity of people overweight and obese is 65 per cent in Scotland, and on children it is 68 per cent. That cannot continue. Life expectancy in Scotland will reverse if we do not tackle that problem. That is an area that I hope the next Parliament will address with great seriousness. The SNP is very good on aspirations, and we share those aspirations, but they must admit when things are not going well. They came to power attacking Labour on hidden waiting lists, introduced a highly complex new waiting time system, and were then faced with a scandal in Lothian in 2011 because of gaming. I have raised the issue of the fact that the social unavailability in Glasgow is now one in three of all patients. That means that one in three of the citizens of Glasgow were presented with an appointment saying, I cannot make it. There is something wrong with an appointment system that does that. I am not saying that there is gaming, but there is something going on with that because it is much higher than Lanarkshire, which is a fairly comparable board. The second prong of attack of the SNP coming into power in 2007 was not to cut hospital beds, and 15 per cent of those beds have gone. We can debate whether that is appropriate or not, but nevertheless that was a manifesto promise. The third prong of attack was closure of local hospitals, and much of our motion today and the debate that you have heard from colleagues on my side of the chamber, on our side of the chamber, has been about the uncertainties around the failure to make clear statements on some of these hospitals. We know that change is going to occur. Without change, we cannot survive. On the other hand, delaying reports or having prolonged reports on St John's paediatric unit is not acceptable because planning blight causes doctors not to apply for jobs there, which then makes the thing less safe and it will be closed perhaps on safety grounds. It is interesting that the Government's amendment refers to safety as part of that. Then we come to delayed discharges. Of course, the SNP members talked about the progress over the last year, and I welcomed it. I got up and welcomed it. Nevertheless, it is twice as bad as it was in terms of bed-occupied days in 2011. We have to accept what the Audit Scotland says, which is seven out of nine targets missed and the situation deteriorating, because unless we start with an honest debate, then we cannot adopt the clinical strategy and try to drive it through. I very much welcome the fact that we are talking about bed-occupied days, because, of course, if people stay in hospital over six weeks, that is a very bad thing, but on the other hand, the bed-occupied days strongly affects what is actually happening. Let us look at another promise. The preceded predecessor, Nicola Sturgeon's Cabinet Secretary, promised that every board would look at boarding out, and we would try to tackle that. Yet, 130,000 patients boarded out in the last two years, and there are two boards that are not even the capacity to report on boarding out. Now, if they do not have the capacity, how is the board in that area even beginning to look at that, that particular issue? Since 1999, we have been driven by targets, and targets have served this Parliament extremely well and served the health service and our citizens extremely well, but I have to say to colleagues that that is something that will need to be looked at and addressed, because some of the targets, I think, are now causing considerable clinical problems. Perhaps at the margin to begin with, but they are part of the reason why, as Jackson Carlaw said, staff morale is actually dropping. The particular one that I want to draw attention to is the legal requirement that everybody has their in-patient and day-case treatment dealt with within 12 weeks. Colleagues, we passed that bill in 2011. I warned at the time that I thought that was not a good law. A 100 per cent target is radically different, as Paul Gray said to the Health Committee, to a 95 per cent target. The marginal costs of that 100 per cent target to the health service are absolutely massive, because if they cannot use the golden jubilee, which is expensive for the boards, they then have to use the private sector. I have colleagues who are praising the Government for their target, because on the back of treating bunions and other small things, they are actually getting great holidays in the West Indies. Colleagues, if you give somebody a legal guarantee, then it is a legal guarantee in law. 32,000 patients have not had that legal guarantee met since it was put into practice in December 2012, and the target has not been met once since the law was passed. That is a bad target, and it needs to be looked at again. In the few minutes that I have got left, I want to refer to a couple of other things. In terms of the increase in staff in comparison to 2007, I have to say to the cabinet secretary that we have got 5 per cent more population than we had then. That is reflected, for example, in general practice. Every GP, the number of patients per head of GP has gone up by 10 per cent. Every GP is dealing with another 500 patients. That is a huge number for it to go up. It is a 10 per cent rise. It has been seen, and Jim Hume referred to it in his speech, about the GP crisis. That was not recognised for a long time. I warned about it in 2010. I said that we needed a new contract, then nothing happened. We have now got the new contract going to come in. It will not be a salvation, I have to say. The situation is that we have got 500 GPs empty. One in four practices in Edinburgh, one in four practices, there is no patient choice. They have to go to the patient allocation system to be allocated to a practice. One in four have restricted access. We have patients queuing on a Tuesday morning at 8am in the morning to be the first 30 to be accepted by a practice. That is not acceptable. It is simply not acceptable. We have a crisis, and unless we admit that and accept it, then we are not going to make advance. I will finish by mentioning two other things. One is dementia. When 50 per cent of our dementia patients with a diagnosis of dementia are admitted to hospital and it is not recorded on their notes, how can we manage dementia in hospital? That is a huge challenge for the acute sector, but it is not happening. That is a Scottish research paper based on Scotland. Finally, we have all failed to tackle health inequalities. They have actually got worse since the Parliament was founded. It is all parties, all Governments fault, and it needs to be addressed in the next election. Health is a fantastically challenging portfolio. My one regret, as I have said, that despite the fact that we share a vision on 2020, we can share a vision on the new clinical strategy that the SNP Government too often denied problems over the last seven years, waited until they were inescapable, then threw a little bit of money on it. That is no way to govern that we have to have a common purpose, a common agreement on the way forward, and if we do that, then this Parliament, which I will watch from afar with great interest, may begin to solve our problems. We have a world-leading NHS in Scotland, but unless we actually do that, we will not maintain it. Thank you, Dr Simpson. That concludes the debate on health. The